"The neutrality of the authors and Ioannidis' overall stance on the pandemic was further called into question given that the often-cited study he co-authored in April 2020 was preceded by his op-eds in March, calling the pandemic a fiasco. It was also later reported that said study was financed by JetBlue's Founder;[30] presenting a serious conflict of interest authors had failed to disclose."
Note: at the moment I wrote that it was not the current one. It already changed more than once, at the moment it's at least the third I see, and it is probably at least the third one the one wyattpeak refers to.
The title is a pretty neutral and accurate description of the article. The actual title is uninformative, and changing uninformative titles is standard practice.
There's several arguments to be made in favor of fewer restrictions. This article makes the worst ones...
- The projections were wrong
- The fatality rate is lower than feared
- Other diseases kill people too
- This isn't as bad as the Spanish Flu
- Lockdowns can harm people too
The only good argument I've heard against lockdowns is that we have mounting evidence that less onerous restrictions are sufficient to keep the transmission rate low. This article doesn't touch on that at all.
Assuming a US centric view, roughly 25% of the workforce is currently unemployed [1] (based on unemployment claims data). There is data suggesting ~37k deaths for every 1% increase in the unemployment rate [2], without considering deaths due to forced isolation (suicides and such).
Based on the above math, that puts a proposed death toll from the economic response at ~777k citizens (25% minus the preCOVID 4% unemployment rate). Current death toll from COVID specifically is ~100k citizens. So we shifted the deaths from high risk individuals to economically disadvantaged individuals.
The thesis that we overreacted ("the measures taken will cause more damage and greater loss of life than what they save") holds water. People were going to die regardless, and its easy to say we did the right thing when it's not you sitting at home waiting for a broken state unemployment system to provide you the benefits you're entitled to.
Ignoring the time periods of course, and using annual figures instead of pro-rated? The lockdown is a temporary measure until we get a handle on things.
Everybody on the internet who can divide one number by another, starts broadcasting bad math and claims to know the whole story. Its getting exhausting.
We reacted, perhaps too strongly. But we had geometric growth and high morbidity as the only knows at the time.
Now we know more. If we can get past the blame-throwing and hand-wringing, we can start monitoring and carefully restoring normal public behavior.
Economic advisers [1] [2] [3] have specifically said it will take years to recover the jobs lost over 3 months. It took 10 years from the 2008 GFC to arrive close to 3-4% unemployment. While unemployment is higher, more people will die from that economic situation. Are we going to go to Medicare For All and robust benefits systems to support citizens until those jobs come back so they don't die from lack of income and healthcare? Of course not, this is America.
But if people are on unemployment because they were laid off, then are offered their job back and refuse to come back to work... that's a different matter.
The idea that some people seem to have is that we can simply pay everybody a living wage regardless of whether they are doing any work. I think we've tried this out several times in the past.
> The Works Progress Administration (WPA; renamed in 1939 as the Work Projects Administration) was an American New Deal agency, employing millions of job-seekers (mostly unskilled men) to carry out public works projects, including the construction of public buildings and roads. It was established on May 6, 1935, by Executive Order 7034.
You assume that with no lockdown and with a strategy like Sweden, economic growth won't be stifled and you won't reach ~20% unemployment rate in the US.
And still, perhaps the complete lockdown was an overreaction if you did not aim for Virus suppression like in NZ. It depends on when the vaccine is available.
You are extrapolating linear relationship between unemployment and deaths way outside the range of historical data on which it was estimated. Surely we would see some of the ~777k deaths already. The fact that we don't suggests that the relationship does not really hold when pushed so far out.
Great. Since the whole country is not in lockdown, let's examine a region which has been highly impacted:
* Select "Excess deaths with and without COVID-19" for the dashboard
* Enter "New York City" as the location (New York state as a whole shows a similar trend)
New York state was locked down March 20th. Notice the marked increase in non-COVID-19 related deaths starting March 21st, increasing steadily into April (almost 200% higher than predicted number of deaths). The tooltips also say that this data is still incomplete, so these numbers could climb.
Now maybe it's unrelated, or maybe it's COVID-19 related that was incorrectly assigned, but you seem fairly confident that it's unrelated to the other factors the OP mentioned. I don't see how you can reach that conclusion given the data available at this time.
Look at non-COVID-19 related deaths in a location with lockdown in effect, but with few COVID-19 deaths. Those should not be people who died from COVID-19 without a test, but if lockdown drives deaths up, there should be enough of them to be visible.
If you do it in New York, chances are you would be attributing COVID-19-related but unconfirmed deaths to lockdown.
That's an arbitrary high bar to set and compare. We don't have hindsight nor the test compacity to compare it to historic pandemics. People are going to write thesis about covid19 for decades to come.
The only argument which needs to be satisfied is what restrictions should be in place.
They don't need to justify anything to reopen. The pro-lockdown crowd needs to continually justify every restriction.
So the reopen crowd is a bit up in arms right now because they keep hearing contradictory statements coming out. It's not as deadly as thought. Masks work (they didn't use to, right?). It's not transmitted as easily by surfaces as previously stated. With so many things being drawn back there is an expectation that restrictions should be drawn back as well.
That said, I get groceries twice as week and that's it, but I'm lucky to have a remote job and no real worries about my finances.
Now that he calls out the ongoing groupthink that leads to counterproductive recommendations and practices he is ... shall we say ... less than positively looked upon.
it will take ten years for us to say, I guess Ioannidis was right after all
people always say you have to think outside the box, what they don't tell you that there may be a big price to pay for that.
Ioannidis was not attacked because of his skepticism. He was attacked because of a paper with quite controversial methods, and which violated a few ethic rules:
>it will take ten years for us to say, I guess Ioannidis was right after all
Sadly I doubt that more and more. Locking down is a win-win if what you care about is not admitting a costly mistake. Its principal claim that it will save far more lives than it costs is essentially unfalsifiable to people who aren't willing to trust statistics, because lives lost to COVID are immediate and easily countable^, whereas someone dying of cancer in May 2021 because they did not get a diagnostic test in April 2020 but instead had to wait till July can just as easily be spun as being "death due to the virus" as "death due to the lockdown".
Pointy-headed epidemiologists will publish some papers a few years from now and tease out whether the lockdown made sense (or rather, where it made sense and for how long) using mortality statistics and measures like Disability Adjusted Life Years (which make impressionable people uncomfortable due to the implicit suggestion that we should weigh a lost life by how many years of life were left to live). Will politicians admit failure as a result, if the studies suggest they locked down far too aggressively and for far too long? Never gonna happen.
^ or so the media thinks, i.e. is death with COVID = death from COVID?
Actually he was accused of doing the exact same sloppy, misleading, politically/ideologically motivated "research" on the subject, of the kind that he used to criticize in his meta-studies...
Lockdowns have to be executed differently next time. It's fine to require people to work from home if they can and close schools. But you cannot decide that only food is essential and shut down everything else. That leads to a lot of problems. They key is not having many people gathering in one place. There are many ways to ensure that without shutting down everything.
Why should we even allow our government to tell us ever again what products are “essential” and what are not? Not only was that distinction pointless, but it was actively harmful.
Another example, a ban on plant nursery right at the time people should be planting their own food.
Large stores, allowed to stay open, will be gobbling up smaller, closed competitors for pennies on the dollar. Private practice hospitals will never be the same again.
> Why should we even allow our government to tell us ever again what products are “essential” and what are not?
Because, on average, the calculation for each individual does not line up with the calculation for society as a whole and people are going to make decisions that harm others.
Yes, you going to your dentist is not likely to make a difference. Everyone going to their dentist, hair dresser, etc as if it's business as usual will, and the negative impacts of your actions will not only be felt by you.
If government's role is to protect us from each other, then this is well in line with what they should be doing.
I'd agree that specifically how they've done it in the US is... not good. But I don't see the general concept as being without merit.
> Because, on average, the calculation for each individual does not line up with the calculation for society as a whole and people are going to make decisions that harm others.
Absolutely. But that's the problem with these thoughts. They're aren't wrong, but using them as a foundation for limiting a population can have an outsized negative impact worse than the thing they're trying to prevent.
In this case with hindsight we can now say it wasn't wise, as some states dramatically limited what items a person could buy, and some didn't. In some place you had "critical personnel" driving across state lines just to buy work boots.
The only reason we had to resort to indiscriminate lockdowns here in the US was that we failed to prepare for the eventuality of an epidemic back in January. Had we deployed robust testing to our major urban areas in late February or early March, we could've taken much more targeted action and avoided the broad economic repercussions that we are suffering now. So in a sense, yes, we would do the lockdowns differently in the future: we would act earlier and more intelligently, and avoid them altogether.
There are both good and bad arguments for ending the lockdown.
The better arguments tend to focus, as this one does, on the fact that a lockdown does not come without its own harmful ramifications: delaying health interventions, increases in spousal/child abuse, increase in depression/suicide, loss of income/insurance, loss of financial stability, etc. I'm not necessarily saying that these arguments are or are not persuasive, but they're looking at the right things.
The worse arguments tend to focus on the lockdowns depriving Americans of their God-given freedom to attend pool parties and political conventions, regardless of the epidemiological data.
Unfortunately, many of the people who are really motivated by the latter tend to use the former as cover. (This doesn't just pertain to COVID-19, but to a lot of controversial issues.)
Generally, when you can reasonable predict that your argument may invite some unwanted bedfellows, it's nice to toss out a disclaimer -- something like, "Now I know some people will seize on my argument to advance X, which I reject, so let's talk about the limits and bounds of what I'm arguing." That way you can make it clear that you're not willing to let your remarks be used in ways that you don't intend.
> lockdowns depriving Americans of their God-given freedom to attend pool parties and political conventions, regardless of the epidemiological data
I think your interpretation of that perspective is as shallow as saying that the Boston Tea Party was just just a bunch of people mad that tea had gotten more expensive.
The difference is motivation. Nobody profits from lockdowns in the narrow sense that Britain profited from restricting Americans rights. Lockdowns intention is to save peoples lives and allow for a less restrictive reopening later, by regaining the missed ability to do proper contact tracing.
Lockdown proponents have consistently said that it's not about reopening later as such; it's about reopening safely, and we mustn't reopen at all if it's not safe.
In my view, the two biggest factors driving lockdown resistance are 1) the pivot from 'flatten the curve' to 'lockdown until the virus is gone', and 2) the open-ended plans to ease the lockdown 'when it is safe' without defining that. It would be easier for people to endure the lockdown requirements if there were clear metrics, plans, and communication.
I live closer to this sort of thing than the HN gestalt does. There are a handful of people who are indeed just upset about their freedoms in that sense, but they are a fringe. The vast majority of people concerned about the lockdown in real life are concerned about the costs greatly exceeding the benefits, about the lockdowns being used as an excuse to grab power by power-hungry politicians, beliefs that the people advocating endless lockdowns are the ones who still have jobs and aren't experiencing the costs themselves, and disbelief at how clumsy it is to apply the same policies in your large and diverse state to counties with single-digit numbers of cases total vs thousands of cases weekly.
These are not my opinions; this is what I hear. I do not hear all that much about "muh freedoms". Dismissing all disagreement that way is not a path to understanding what is really going on out there. If you don't care about that because you're happy with your view of the world, fine, but don't whine when you get blindsided about what America really believes about things in November.
> There are a handful of people who are indeed just upset about their freedoms in that sense, but they are a fringe.
I live in a blue state, but I am seeing SO MANY PEOPLE ignoring sensible, low-effort preventive guidelines, such as social distancing and wearing masks when in close contact with others.
My best guess is that it's a mix of:
1. freedom / civil liberties / not wanting the government to tell them what to do, and
2. the shortsighted view that just because they're of an age unlikely to be hit hard by the virus, they shouldn't need to mildly inconvenience themselves to prevent the spread to more vulnerable populations.
I'm just not sure how I'm supposed to take social distancing guidelines seriously at this point. My state purports to have an order to stay at home, but as more and more businesses reopen, they've still offered no guidance on when it'll be permitted to see friends and family again. It seems increasingly clear that there's a hidden "unless you really want to" clause, and all of us who were strictly obeying the rules just got tricked.
What do you think will make people with opinions you quoted understand how the world actually works? I don't have a good answer to that. We see the same phenomenon with regards to populism in trade, immigration, etc. Sometimes people don't want to see the truth if it collides with their preconceptions. Doesn't help when leaders intentionally and constantly reinforce misinformation.
The arguments made should stand on their own, regardless of motivations. If I'm a selfish prick who wants to attend pool parties but I'm giving valid reasons for ending the lockdown, it does not follow in any way that the lockdown is justified. So, who cares what my motivations are?
The bedfellows argument can be made about both sides of the equation and we can just go ahead and consider it implied, to dispense with legaleze-like formalities and focus on what truly matters, which, to put it crudely is: will the lockdown save more people than will die as its consequence? The answer is far from obvious to me.
Suppose you are the world's best rhetorician, and can create convincing arguments to support any conclusion. To exercise this skill, each day you pick a topic, roll a die to determine what position to support, and argue for that position. These arguments are clear, concise, self-consistent, grounded in concrete observations, and emotionally persuasive. However, you could have created similarly effective arguments for another side of the debate, had the die roll gone a different way this morning.
Examining somebody's motives is a way of having a meta-debate. The quantity and quality of arguments on different sides of a topic is a function not only of the correctness of one side, but also of the time invested into coming up with those arguments. If somebody has an ulterior motive to their arguments, then they may be arguing in bad faith, attempting to persuade with arguments they know to be false, in order to gain support.
I chose my words rather deliberately here. This is not about the world's greatest logician, the person who can best determine true statements about the world. This is about the world's greatest rhetorician, the person who can best convince others of a statement, regardless of the veracity of those statements.
I agree with most of your points, but I'm a bit puzzled by this one:
> a lockdown does not come without its own harmful ramifications: delaying health interventions,
The other harms make sense, but as I understand it, the main point of a pandemic lockdown is to ensure that the healthcare system can cope.
During a pandemic, the lion's share of medical resources are dedicated to dealing with the pandemic. Making the pandemic worse by prematurely easing lockdowns will further delay health interventions.
Hospitals are currently postponing even life-saving procedures if they think their patients can survive a bit longer without them, because they don't have enough intensive care capacity in case things go wrong. That won't get better just because of a policy decision to return society to BAU.
I can have a phone consultation with my GP if I have any health concerns, and if he has concerns, arrangements can be made for an in-person consultation.
I am likely to miss my next regular dental checkup due to the pandemic, and that may mean that what could have been a filling might now be a crown. However, given the proximity of dentists to people's breathing holes, opening them up too early is likely to cause more problems than it solves.
>Hospitals are currently postponing even life-saving procedures if they think their patients can survive a bit longer without them, because they don't have enough intensive care capacity in case things go wrong. That won't get better just because of a policy decision to return society to BAU.
There is very little stress on the intensive care capacity in most locations. If you are shutting down hospitals that don't have covid-19 cases because you might need capacity at some unspecified time in the future, you are doing it wrong.
> If you are shutting down hospitals that don't have covid-19 cases because you might need capacity at some unspecified time in the future, you are doing it wrong.
Disagree. Being proactive rather than reactive is how many other places have managed to have much better outcomes with this virus thusfar.
I agree that some level of proactive behavior is positive, but there is a point at which it becomes negligent.
In New York it took 3 weeks of exponential growth before hospitals were approaching max capacity. Hospitals with zero/minimal utilization should not be turning away patients. For example, if patients need a 1 or 2 day stay for cardiac or cancer procedure, you have plenty of time to ramp down admissions.
> Besides massacring nursing homes, and having the potential to infect many vulnerable patients and providers in hospitals, it painfully emerges as yet another disease of inequality
It’s very sad to me to see us destroying ourselves over covid19 without asking ourselves critically and honestly “are these steps and precautions worth it?”
I can see shelter-at-home related suicide, which disproportionately affects the young, overtaking covid19 deaths in some places. Not to mention the dramatic and permanent change to our way of life. Here’s a commonly circulating story about doctors saying they’re seeing more suicide and suicide attempts in 4 weeks than they usually see in a year[1]. When will it stop with 25% on unemployment?
How many people right now are quietly becoming alcoholics alone in their own homes?
Unfortunately the stay-at-home order has become yet another flashpoint in the modern day culture wars, with people using an opinion on it to signal tribe membership and so on. This blinds us from our duty to think critically on the steps we’re taking.
The problem is that lockdown is the much safer option to any leader. They prefer not to be accused of killing people due to not executing a lockdown. Esp given that covid-19 deaths are reported every day while lockdown related abuse/deaths/etc are not. The latter is much harder to quantify.
According to [Wikipedia](https://en.wikipedia.org/wiki/Suicide_in_the_United_States), there were 45k suicides in 2016. The suicide rate would have to near triple in order for your prediction to come about. I'm no expert in this field, but it doesn't seem plausible.
Changed my post to “some places”. Suicide has a strong and well studied correlation to unemployment, and with 25% unemployment in the US right now (with no signs of letting up) it’s going to have a profound affect for years to come.
What I find most concerning is that, even if you allow that the answer might be yes, just asking the question in the first place ends up in immediate dismissal.
Especially considering how lockdown is draconian and medieval. It's a huge cost to pay for uncertain benefits.
We're talking about ending people's livelihoods and violating their rights without definitive, positive scientific evidence that lockdown is effective.
It's pretty clear by now that it's safe to venture outside while practicing social distancing and wearing a mask - at the very least for working-age people.
It also makes sense how this has become politicized. All the elements are there too: mask-wearing and lockdown is such a juicy virtue signal. Anyone that dares to venture outside is some cretin, a murderer.
People in favor of lockdowns keep saying they're following science. But once someone dares to ask questions, so many act as if their religious feelings were insulted.
To be fair, from what I've seen on HN, the community here is quite open to reasonable discussion.
Lockdown is a draconian political mandate justified and defended on the basis of virtue. It really hasn't been a matter of science because so far it couldn't be: there's far too many unknowns and inaccuracies in the measurements we're making, they're changing all the time.
From the beginning, authorities have been scrambling to appear competent and failing catastrophically.
There are major political ramifications of lockdown and other actions of leaders. They will not readily admit failure and neither will those convinced of the virtue of these measures - it's a matter of political identity now.
Complex situations like these outbreaks are ripe with unknowns and varying degrees of ambiguity to play into. The event is so recent the data isn't great, early (and likely current data) was/is flawed, the event is still active, etc.
There are so many independent and dependent variables intertwined that drawing base conclusions on certain useful actions regarding side effects is incredibly challenging from a modeling or even data collection perspective.
As always, people jump into these gaping unknowns with predispositions and start drawing up conclusions they like fleshed out to strengthen personal agendas. Some are more articulate or exploitative of these situations than others, so their arguments are better/more widely received.
"We should lockdown because X, for all these potentially viable arguments in a blackhole of ambiguity. Oh, and BTW, the lockdown has improved my life."
Or, "we should not lockdown because Y, for all these potentially viable arguments. BTW, the lockdown has hindered my livelihood."
A lot of the data is so early we're still guessing either way. The one clear (and frankly obvious) controlled variable is that social distancing effectively limits the spread of the disease. Now as to the side effects, we're just getting largely preliminary data.
I think we should still explore these issues but we need to be clear what our agendas are and be careful linking this pandemic to strengthen our agendas.
The article assumes that the policymakers (and public) AREN'T considering the drawbacks. I disagree with that.
Many non-US countries have acted to minimize those drawbacks, so it is misleading to act as if those drawbacks are unavoidable and the lockdown is illogical.
> We know that prolonged lockdown of the entire population has delayed cancer treatments and has made people with serious disease like heart attacks avoid going to the hospital. It is leading hospital systems to furlough and lay off personnel, it is devastating mental health, it is increasing domestic violence and child abuse, and it has added at least 36.5 million new people to the ranks of the unemployed in the United States alone. Many of these people will lose health insurance, putting them at further risk of declining health and economic distress. Prolonged unemployment is estimated to lead to an extra 75,000 deaths of despair in the United States alone over the coming decade. At a global level, disruption has increased the number of people at risk of starvation to more than a billion, suspension of mass vaccination campaigns is posing a threat of resurgence of infectious diseases that kill children, modeling suggests an excess of 1.4 million deaths from tuberculosis by 2025, and a doubling of the death toll from malaria in 2020 is expected compared with 2018.
I am not an expert, but it seems to me that most of those problems would have occurred without the lockdown, due to the effects of the virus spreading unchecked.
In other words, economies were always going to take a massive hit one way or another, but with the lockdown we get some control over the form it takes.
I don't have a firm opinion on whether the lockdowns were good or bad, but: it bothers me more that no one seemed to even consider alternative options, opportunity costs, or second-and-third-order consequences.
It feels like the powers that be are playing whack-a-mole, incapable of seeing beyond the immediate problem. It doesn't bode well for a potential future (hopefully avoidable) pandemic that has far higher death rates. The Black Death, for example, is 'estimated to have killed 30% to 60% of Europe's population.'
I'd venture to say that our initial reaction to lock down early-on was prudent. The scant evidence available at the time indicated the possibility of a much worse outcome than we have now.
I think the problem is a lack of constant re-evaluation. Politics has solidified the desire of many people to make the "correct" decision and stick to it. Why can't we be comfortable with making a decision with partial information and treating it like a ship that needs occasional course-correction?
The problem is that we cannot agree with which way we should sail the ship. Our navigator showed us a map that said "there be dragons" and told us to steer far off course putting us into a perilous situation of being adrift and lost at sea. Now we cannot agree which direction looks less stormy and whether we should try to head back to land or continue to starve at sea.
Most definitely. To further the analogy...picking the heading is a democratic election. The remaining 3/4 years of an election cycle are spent undermining the choice of heading.
> It doesn't bode well for a potential future (hopefully avoidable) pandemic that has far higher death rates.
I think that if COVID19 was more deadly, we'd have a lot more agreement on implementing lockdowns, and not nearly as much politicization of the issue.
I think that the polarization we are seeing regarding lockdown policies is because COVID19 sits right in the middle of what the population at large thinks of as "very dangerous." It's not quite half-and-half, but I think it breaks down like this:
I think it's fair to say that a very large minority looks at a disease that mostly targets the elderly and infirm and thinks, "why don't we take measures to protect the vulnerable populations who aren't getting out much anyway, and let the rest of the world get on with life?" This isn't just about "making money" to these people, it's actually about living your life, and accepting what is in reality a pretty small risk for most healthy people.
One the other hand, a not-quite-supermajority believes that a disease which is 10-100 times deadlier than the typical flu when looking at raw fatality numbers is worth significant cost and effort to suppress. This would also include a significant portion of people who are themselves elderly or infirm, and they don't want to risk society neglecting to protect them if everyone else is allowed to go about their business.
It could well be that if the fatality rate really was > 3%, you would have a hyper-majority in favor of taking action, which means we would have all been in agreement about how to react, really locked down hard and eliminated it by now.
While the US debates whether we should continue our ill-conceived pandemic policies or just give up and take the hit, multiple other countries have managed to fight the virus effectively and are now opening their economies safely.
Based on their experience, what we should have been doing is:
- Lock down enough to really get the numbers down, with the understanding that it's temporary, because:
- While locked down, really beef up the test and trace infrastructure. After the numbers are reasonable, this lets you open up but find and isolate individual cases.
- Encourage/require mask wearing by anyone in public. Studies have shown that 80% mask wearing reduces the virus by over 90%.[1]
- Instead of putting money into unemployment, pay businesses to keep people on salary while they're not working. That way the jobs are still there when we open back up. European countries have done this, kept unemployment low, and in some cases spent less per GDP than the US.[2]
The earlier you start, the easier and more effective all this is. If you start early enough and already have good systems in place, you can even skip the lockdown step, aside from localized outbreaks.
It is indeed quite silly that people are thinking about policies as "quarantine for everyone" vs "let people roam the streets while coughing".
Wearing masks has zero cost in terms of GDP and unemployment. Why the heck aren't we mandating those?? Even in 1918 people were not allowed to step on a tram/metro without a mask.
Judging from people's reaction to the "end of the lockdown" here, I think Costco's leading the charge and making it OK for other businesses to require masks and enforce distancing has been, effectively, better public health policy than what we're getting out of our state government. Outside those places there's a clear "well guess the danger's over, let's all get really close and spit on each other and all touch the same stuff" attitude and pattern of behavior. It's insane—now's the time to be more cautious when out and about, than during the lockdown! Especially seeing how people are acting, it's gonna get worse before it gets better. I reckon my odds of catching it in a given store outing now are significantly higher than during the lockdown, but people aren't acting that way.
Part of what was so effective about changing american minds about smoking were the public ads that decried it.
If we want to change peoples minds about wearing a mask we need to campaign to change minds which goes all over. It's not about losing your freedom it's about being safe. I don't think legal requirements will do it. It'll just stir up the anti-government people. Whereas if we make it about looking dumb if you don't wear a mask then we'll be better off.
Also as a side benefit, making masks more acceptable in public may help us thwart facial recognition software in stores which I'm game for.
It has definitely crossed my mind more than once since this started that now is exactly the time to bust out some old-school WWII-propaganda-style slogans. Posters and everything. Shit, get WB to make some new cartoons about masks and social distancing, mimicking that style. That'd go viral like crazy.
From Neal Stephenson's Cryptonomicon, describing Britain during WWII (all emphasis mine):
"The British gas masks have a squat round fitting on the front to allow exhalation, which looks exactly like the snout of a pig, and no woman would be caught dead in such a thing if the models in the gas mask posters were not such paragons of high-caste beauty."
But maybe he invented this -- I've never seen a copy of such a poster. (Edit: I've found at last something related, just a photo, not a poster, and a "South African": (1) ) What's certain is that there were mask "issues" around 1918 in the US, at the time of another pandemics:
I don't buy the freedom argument. I can't wander around outside naked nor can I wander around with an open container of alcohol (some communities allow this - most don't and mine is in the most category) - yet few people are seriously complaining about that yet those behaviors have far less of an impact on my health than people wandering around without face masks. No, there's a belligerence at play here and there's a certain high-ranking federal officer encouraging that belligerence in part by famously refusing to wear a face mask. Face mask wearing has now become a gang sign: if you're wearing a face mask then you're one of them. That's how insane things have become in the United States and we're suffering badly as a result.
I'm not making the freedom argument. I'm suggest we sidestep the freedom argument by working to convince people it's a good idea to wear masks rather than telling them they have to wear masks.
Also, all legal requirements are backed up by some sort of punishment. A regulation put in place to wear a mask might affect different groups more than others. If you can't afford to get a mask because the supply is low, then you get fined or go to jail. I don't like regulation where I think a campaign would be much more effective.
Really people are frankly being delusional narcissistic morons who think their motivated reasoning and wanting something changes reality.
The sad thing aside from the literal thousands of needless deaths is that they could do more reengineeeing to arrange things to be safe and productive at a lower capacity (say hair dressers by appointment with masks and a clean up sequence between customers) but they largely prefer an illusion of normality even though it will just prolong the disease, measures and boost expenses.
The end game is masks, tests, and contact tracing until you have an effective vaccine. We can run an economy under those conditions, just as other countries are starting to do already.
After a couple years if a vaccine looks nowhere close, maybe that's a time to reevaluate, but right now we have several that look promising in the relatively short term.
First three things are on point, but we tried the last one. The "Paycheck Protection Program" that immediately ran out of money was our attempt to do something similar.
In a perfect world, a much larger PPP would have been more efficient and easier to manage than expanded unemployment benefits; in world we live in, that would have meant trusting an administration that prides itself on incompetence and corruption to handle what would have been the bulk of our economic response.
Yes, we implemented that poorly. But other countries have done it better, as my link points out, so it's not like it's the policy which is flawed. The shortcomings of our executive branch are basically the reason we haven't done any of these things well.
But one simple thing we could have done better is to pay the banks a fixed fee, instead of a percentage of the loan, which incentivized banks to ignore the smaller businesses.
I’ll never understand why news media thinks it makes sense to compare the entire United States to individual European countries? We are 350 million people, among 50 states, all with their own autonomous governments making their own decisions. From the European perspective, states might as well be their own countries. I think if you want to compare policies, you should drill down to that level. Not lump the whole country as one. If not that, I think we should group all the numbers from the EU collectively for a more reasonable comparison.
But that's not the point I want to make. What I was trying to get at is, why does it make sense to say "Well, why doesn't the United States just implement the policies of insert name of European country here?
Well, because the federal government, for the most part, isn't calling the shots on what individual states decide to do about the pandemic. It's up to the governors and individual state governments to decide their own course of action, for their area. In many states, the outbreak is very manageable and under control. In others, usually in states with the largest cities, the situation is much more serious. We are not all like New York City.
It it much more complicated than just lumping all the US numbers into one. I'm saying, it doesn't make sense just to look at the total US numbers, and say we are fucking up. Take the 3 most populous states in the US for example. California, Texas and Florida combined have nearly 90.5 million people. Together they account for nearly 203,000 cases total according to the CDC.
Comparatively, the United Kingdom has something like 65 million people, and a rough total of 261,000 cases according to the ECDC. Spain and Italy both individually have more than our top 3 states by population. Russia's rate per capita is higher.
Don't let Donald Trump and the huge numbers out of New York City/ New Jersey fool you. Most areas of the country have the pandemic under control, and very importantly, hospitals are not at risk of being overrun. Weather that remains to be the case as we loosen restrictions going forward will be interesting to monitor though.
The lock-down has never been about saving lives. It's about preventing the chaos that would occur if we did nothing and let the health care system crash.
People in charge get this, sure saving lives is nice, but it's about maintaining the order of things.
You really think if this went out of control people would not pull a gun in a hospital to get their relative help? Or groups of people would not be targeted, even more than they are now, as scapegoats?
Even now it's acknowledged that many more are going to get it, many more will die, but at least things will not spiral out of control and we will be able to manage the hospitalization rates.
let's not get sidelined on the same minutiae over and over again. lockdowns could have, and should have, been replaced with 2 simple rules:
1. either physically distance or wear a mask around groups of strangers, particularly inside.
2. if you get sick, self-quarantine (and go see a doctor).
that would have been 99.9% of the reduction in transmission risk for 0.1% of the cost of lockdown, with a bonus of providing time for medical workers and epidemiologists to provide care, mitigations, and develop containment strategies (like tracing).
the reasons we haven't boil down to news-fueled panic/anxiety crossed with political calculation, with a bonus of shifting the losses to the disadvantaged.
Exactly this. These are facts that have never changed and were known from day one:
1. Because the virus is spread mainly through droplets, the risk goes down if you keep your distance from other people.
2. Because the virus is spread mainly through droplets, the risk goes down even more if everyone (especially those with symptoms) wears a mask.
Since day one, since before the disease had even left China, the WHO was clear on all these points, the CDC followed shortly after, with one partial exception, which was the mask recommendation. (On masks, the WHO said from day one that anyone who was potentially infected should wear a mask; they initially advised against population-wide mask wearing due to supply.)
Masks and distancing could have and should have been rolled out the day the first COVID-19 case washed up on American shores. Both could have been enforced through stiff penalties on noncompliant businesses (no masks, no distancing, you get shut down for 30 days). They were already in use in South Korea which did a great job of getting the disease under control.
The Korean strategy worked better than the American strategy. Less death, less economic damage. Why did America screw up so badly? Pure hubris and incompetence on the part of Americans, starting with American leaders on both sides of the aisle. The war on COVID-19 was being waged and it was being beaten on the other side of the world, but myopic Americans were too preoccupied with themselves to watch and learn. It's as simple as that. Poor leadership, panic and nationwide myopia.
I don't know if I necessarily buy some of this articles arguments. It mentions the effects of stay at home, such as increases in deaths of despair. Wouldn't that also have gone up because many of those might've been caregivers or breadwinners of a family? And for the domestic abuse (which imo is the worst), a lot of those victims were already undergoing mental abuse since that's largely a precursor to physical and these reports already should've been happening because imo mental abuse is equal to physical, it's just that people are less likely to report this behavior. It just has such long lasting effects. I can't back up either of those claims, so maybe I'm being dumb, but those two takes seem a bit strange. The stats on cancer or heart related treatment seems to be backed up though, so I can't comment on that.
The real issue with all of this is that the Trump administration is incompetent and American government in general is reactionary and only promotes policies that are selfish. Its been known for years that people have no safety net, just put on NPR and like once a week this comes up, and it's always been known that small businesses really aren't racking in the cash to stay afloat for a long time without money. The government just needs to step up and support people, with health care for all, with long term financial assistance, and they need to increase taxes to do this. They are sort of doing it now with checks, but that's going to go away once the pandemic is over and everybody who is not in tech or generally upper middle class will go back to being on edge because one disaster will eff to their lives.
You also can't blame this on epidimiologists. They provide their assessment and policy makers have to weigh those options with all the other ones and come up with a strategy. That'd be like be like blaming the person who came up with the hail marry when it is a coach's decision to use it every play.
> If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.
his own estimate is
> reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.
Though he doesn't come out and say it, it's clearly framed as a reasonable estimate of the ultimate death count: 'This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average. The media coverage would have been less than for an NBA game between the two most indifferent teams.'
None of that commentary makes sense except under the assumption that the author thinks the U.S. death total will be 10,000ish, and would have been unnoticeable without the availability of PCR testing.
This is the kind of political goggles that i referred to, which twist every kind of argument. It's pure bad faith argumentation not worthy of follow up.
(which the groupthink here unfortunately encourages)
It's probably too late to be noticed, but I feel compelled to say that I think you are wrong here. I've read enough of Ioannidis' work (and that of other statisticians) to know that this is just an example of how the math would work out if those assumptions were true. Later in the piece, he uses the different numbers of 60% infection with a 1% death rate. Neither is a projection, or a claim that the assumptions are true.
His actual belief, which he states several times in the piece is that we don't yet know how many people are going to be infected or what the death rate is, and that our priority should be gathering more information: "The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have."
Different people have different styles of argument. From what you say, presumably if you used the example that Ioannidis did, this would imply that you believed this estimate was correct. Others have different styles, and you should not assume that they are making an assumption just because they happen to use numbers for an example.
No mention of A/B testing on randomized regions. When you lack data make some. The problem with policies are people. They don't behave the way the policy expected. I'm not saying all out extreme A/B but finding the right pparameter values in parallel rather in multiple-week series'.
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[ 3.1 ms ] story [ 184 ms ] threadAlso, independently of that, per Wikipedia
https://en.wikipedia.org/wiki/John_Ioannidis
"The neutrality of the authors and Ioannidis' overall stance on the pandemic was further called into question given that the often-cited study he co-authored in April 2020 was preceded by his op-eds in March, calling the pandemic a fiasco. It was also later reported that said study was financed by JetBlue's Founder;[30] presenting a serious conflict of interest authors had failed to disclose."
30) https://www.buzzfeednews.com/article/stephaniemlee/stanford-...
-----
Edit: RE title:
Note: at the moment I wrote that it was not the current one. It already changed more than once, at the moment it's at least the third I see, and it is probably at least the third one the one wyattpeak refers to.
- The projections were wrong
- The fatality rate is lower than feared
- Other diseases kill people too
- This isn't as bad as the Spanish Flu
- Lockdowns can harm people too
The only good argument I've heard against lockdowns is that we have mounting evidence that less onerous restrictions are sufficient to keep the transmission rate low. This article doesn't touch on that at all.
the measures taken will cause more damage and greater loss of life than what they save
And as we all well know, a diseases' damage can grow geometrically. That's the whole issue. Which can also be 'conveniently forgot'
Based on the above math, that puts a proposed death toll from the economic response at ~777k citizens (25% minus the preCOVID 4% unemployment rate). Current death toll from COVID specifically is ~100k citizens. So we shifted the deaths from high risk individuals to economically disadvantaged individuals.
The thesis that we overreacted ("the measures taken will cause more damage and greater loss of life than what they save") holds water. People were going to die regardless, and its easy to say we did the right thing when it's not you sitting at home waiting for a broken state unemployment system to provide you the benefits you're entitled to.
[1] https://news.ycombinator.com/item?id=23271769
[2] https://nypost.com/2020/04/20/explaining-the-link-between-un...
Everybody on the internet who can divide one number by another, starts broadcasting bad math and claims to know the whole story. Its getting exhausting.
We reacted, perhaps too strongly. But we had geometric growth and high morbidity as the only knows at the time.
Now we know more. If we can get past the blame-throwing and hand-wringing, we can start monitoring and carefully restoring normal public behavior.
But at least we saved some lives /s
[1] https://www.marketplace.org/2020/05/08/how-many-jobs-will-co...
[2] https://bfi.uchicago.edu/working-paper/covid-19-is-also-a-re...
[3] https://www.politico.com/newsletters/politico-nightly-corona...
But if people are on unemployment because they were laid off, then are offered their job back and refuse to come back to work... that's a different matter.
The idea that some people seem to have is that we can simply pay everybody a living wage regardless of whether they are doing any work. I think we've tried this out several times in the past.
My local library was built by the WPA.
> The Works Progress Administration (WPA; renamed in 1939 as the Work Projects Administration) was an American New Deal agency, employing millions of job-seekers (mostly unskilled men) to carry out public works projects, including the construction of public buildings and roads. It was established on May 6, 1935, by Executive Order 7034.
https://en.wikipedia.org/wiki/Works_Progress_Administration
We could fix a lot of our infrastructure and unemployment problems through something like that.
And still, perhaps the complete lockdown was an overreaction if you did not aim for Virus suppression like in NZ. It depends on when the vaccine is available.
Where are you getting this data to conclude we haven't seen a such a spike?
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
* Select "Excess deaths with and without COVID-19" for the dashboard
* Enter "New York City" as the location (New York state as a whole shows a similar trend)
New York state was locked down March 20th. Notice the marked increase in non-COVID-19 related deaths starting March 21st, increasing steadily into April (almost 200% higher than predicted number of deaths). The tooltips also say that this data is still incomplete, so these numbers could climb.
Now maybe it's unrelated, or maybe it's COVID-19 related that was incorrectly assigned, but you seem fairly confident that it's unrelated to the other factors the OP mentioned. I don't see how you can reach that conclusion given the data available at this time.
If you do it in New York, chances are you would be attributing COVID-19-related but unconfirmed deaths to lockdown.
That's an arbitrary high bar to set and compare. We don't have hindsight nor the test compacity to compare it to historic pandemics. People are going to write thesis about covid19 for decades to come.
+ some of the projections were correct
- The fatality rate is lower than feared
+ higher in some countries
- Other diseases kill people too
+ like smallpox and ebola
- This isn't as bad as the Spanish Flu
+ it's only just started
- Lockdowns can harm people too
+ less than killing and permanently injuring people
False. That is one of the effects of lockdown. We need to try compare the level, but people are being injured and dying because of the lockdown.
Are you referring to Ioannidis? If not, can you link to them?
https://news.ycombinator.com/item?id=23115056
The only argument which needs to be satisfied is what restrictions should be in place.
They don't need to justify anything to reopen. The pro-lockdown crowd needs to continually justify every restriction.
So the reopen crowd is a bit up in arms right now because they keep hearing contradictory statements coming out. It's not as deadly as thought. Masks work (they didn't use to, right?). It's not transmitted as easily by surfaces as previously stated. With so many things being drawn back there is an expectation that restrictions should be drawn back as well.
That said, I get groceries twice as week and that's it, but I'm lucky to have a remote job and no real worries about my finances.
Why Most Published Research Findings Are False John P. A. Ioannidis
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
Now that he calls out the ongoing groupthink that leads to counterproductive recommendations and practices he is ... shall we say ... less than positively looked upon.
it will take ten years for us to say, I guess Ioannidis was right after all
people always say you have to think outside the box, what they don't tell you that there may be a big price to pay for that.
https://www.buzzfeednews.com/article/stephaniemlee/stanford-...
Sadly I doubt that more and more. Locking down is a win-win if what you care about is not admitting a costly mistake. Its principal claim that it will save far more lives than it costs is essentially unfalsifiable to people who aren't willing to trust statistics, because lives lost to COVID are immediate and easily countable^, whereas someone dying of cancer in May 2021 because they did not get a diagnostic test in April 2020 but instead had to wait till July can just as easily be spun as being "death due to the virus" as "death due to the lockdown".
Pointy-headed epidemiologists will publish some papers a few years from now and tease out whether the lockdown made sense (or rather, where it made sense and for how long) using mortality statistics and measures like Disability Adjusted Life Years (which make impressionable people uncomfortable due to the implicit suggestion that we should weigh a lost life by how many years of life were left to live). Will politicians admit failure as a result, if the studies suggest they locked down far too aggressively and for far too long? Never gonna happen.
^ or so the media thinks, i.e. is death with COVID = death from COVID?
https://www.mercurynews.com/2020/04/20/feud-over-stanford-co...
Quite the irony given his expertise.
See: https://abc7news.com/health/suicides-on-the-rise-amid-stay-a...
Another example, a ban on plant nursery right at the time people should be planting their own food.
Large stores, allowed to stay open, will be gobbling up smaller, closed competitors for pennies on the dollar. Private practice hospitals will never be the same again.
https://www.forbes.com/sites/nicksibilla/2020/04/27/michigan...
Because, on average, the calculation for each individual does not line up with the calculation for society as a whole and people are going to make decisions that harm others.
Yes, you going to your dentist is not likely to make a difference. Everyone going to their dentist, hair dresser, etc as if it's business as usual will, and the negative impacts of your actions will not only be felt by you.
If government's role is to protect us from each other, then this is well in line with what they should be doing.
I'd agree that specifically how they've done it in the US is... not good. But I don't see the general concept as being without merit.
Absolutely. But that's the problem with these thoughts. They're aren't wrong, but using them as a foundation for limiting a population can have an outsized negative impact worse than the thing they're trying to prevent.
In this case with hindsight we can now say it wasn't wise, as some states dramatically limited what items a person could buy, and some didn't. In some place you had "critical personnel" driving across state lines just to buy work boots.
The better arguments tend to focus, as this one does, on the fact that a lockdown does not come without its own harmful ramifications: delaying health interventions, increases in spousal/child abuse, increase in depression/suicide, loss of income/insurance, loss of financial stability, etc. I'm not necessarily saying that these arguments are or are not persuasive, but they're looking at the right things.
The worse arguments tend to focus on the lockdowns depriving Americans of their God-given freedom to attend pool parties and political conventions, regardless of the epidemiological data.
Unfortunately, many of the people who are really motivated by the latter tend to use the former as cover. (This doesn't just pertain to COVID-19, but to a lot of controversial issues.)
Generally, when you can reasonable predict that your argument may invite some unwanted bedfellows, it's nice to toss out a disclaimer -- something like, "Now I know some people will seize on my argument to advance X, which I reject, so let's talk about the limits and bounds of what I'm arguing." That way you can make it clear that you're not willing to let your remarks be used in ways that you don't intend.
I think your interpretation of that perspective is as shallow as saying that the Boston Tea Party was just just a bunch of people mad that tea had gotten more expensive.
These are not my opinions; this is what I hear. I do not hear all that much about "muh freedoms". Dismissing all disagreement that way is not a path to understanding what is really going on out there. If you don't care about that because you're happy with your view of the world, fine, but don't whine when you get blindsided about what America really believes about things in November.
I live in a blue state, but I am seeing SO MANY PEOPLE ignoring sensible, low-effort preventive guidelines, such as social distancing and wearing masks when in close contact with others.
My best guess is that it's a mix of:
1. freedom / civil liberties / not wanting the government to tell them what to do, and
2. the shortsighted view that just because they're of an age unlikely to be hit hard by the virus, they shouldn't need to mildly inconvenience themselves to prevent the spread to more vulnerable populations.
That's selection bias, though. You don't see the vast majority of people barely going out.
The bedfellows argument can be made about both sides of the equation and we can just go ahead and consider it implied, to dispense with legaleze-like formalities and focus on what truly matters, which, to put it crudely is: will the lockdown save more people than will die as its consequence? The answer is far from obvious to me.
Examining somebody's motives is a way of having a meta-debate. The quantity and quality of arguments on different sides of a topic is a function not only of the correctness of one side, but also of the time invested into coming up with those arguments. If somebody has an ulterior motive to their arguments, then they may be arguing in bad faith, attempting to persuade with arguments they know to be false, in order to gain support.
> a lockdown does not come without its own harmful ramifications: delaying health interventions,
The other harms make sense, but as I understand it, the main point of a pandemic lockdown is to ensure that the healthcare system can cope.
During a pandemic, the lion's share of medical resources are dedicated to dealing with the pandemic. Making the pandemic worse by prematurely easing lockdowns will further delay health interventions.
Hospitals are currently postponing even life-saving procedures if they think their patients can survive a bit longer without them, because they don't have enough intensive care capacity in case things go wrong. That won't get better just because of a policy decision to return society to BAU.
I can have a phone consultation with my GP if I have any health concerns, and if he has concerns, arrangements can be made for an in-person consultation.
I am likely to miss my next regular dental checkup due to the pandemic, and that may mean that what could have been a filling might now be a crown. However, given the proximity of dentists to people's breathing holes, opening them up too early is likely to cause more problems than it solves.
There is very little stress on the intensive care capacity in most locations. If you are shutting down hospitals that don't have covid-19 cases because you might need capacity at some unspecified time in the future, you are doing it wrong.
Disagree. Being proactive rather than reactive is how many other places have managed to have much better outcomes with this virus thusfar.
In New York it took 3 weeks of exponential growth before hospitals were approaching max capacity. Hospitals with zero/minimal utilization should not be turning away patients. For example, if patients need a 1 or 2 day stay for cardiac or cancer procedure, you have plenty of time to ramp down admissions.
I can see shelter-at-home related suicide, which disproportionately affects the young, overtaking covid19 deaths in some places. Not to mention the dramatic and permanent change to our way of life. Here’s a commonly circulating story about doctors saying they’re seeing more suicide and suicide attempts in 4 weeks than they usually see in a year[1]. When will it stop with 25% on unemployment?
How many people right now are quietly becoming alcoholics alone in their own homes?
Unfortunately the stay-at-home order has become yet another flashpoint in the modern day culture wars, with people using an opinion on it to signal tribe membership and so on. This blinds us from our duty to think critically on the steps we’re taking.
https://abc7news.com/suicide-covid-19-coronavirus-rates-duri...
What I find most concerning is that, even if you allow that the answer might be yes, just asking the question in the first place ends up in immediate dismissal.
We're talking about ending people's livelihoods and violating their rights without definitive, positive scientific evidence that lockdown is effective.
It's pretty clear by now that it's safe to venture outside while practicing social distancing and wearing a mask - at the very least for working-age people.
It also makes sense how this has become politicized. All the elements are there too: mask-wearing and lockdown is such a juicy virtue signal. Anyone that dares to venture outside is some cretin, a murderer.
People in favor of lockdowns keep saying they're following science. But once someone dares to ask questions, so many act as if their religious feelings were insulted.
To be fair, from what I've seen on HN, the community here is quite open to reasonable discussion.
From the beginning, authorities have been scrambling to appear competent and failing catastrophically.
There are major political ramifications of lockdown and other actions of leaders. They will not readily admit failure and neither will those convinced of the virtue of these measures - it's a matter of political identity now.
There are so many independent and dependent variables intertwined that drawing base conclusions on certain useful actions regarding side effects is incredibly challenging from a modeling or even data collection perspective.
As always, people jump into these gaping unknowns with predispositions and start drawing up conclusions they like fleshed out to strengthen personal agendas. Some are more articulate or exploitative of these situations than others, so their arguments are better/more widely received.
"We should lockdown because X, for all these potentially viable arguments in a blackhole of ambiguity. Oh, and BTW, the lockdown has improved my life."
Or, "we should not lockdown because Y, for all these potentially viable arguments. BTW, the lockdown has hindered my livelihood."
A lot of the data is so early we're still guessing either way. The one clear (and frankly obvious) controlled variable is that social distancing effectively limits the spread of the disease. Now as to the side effects, we're just getting largely preliminary data.
I think we should still explore these issues but we need to be clear what our agendas are and be careful linking this pandemic to strengthen our agendas.
Many non-US countries have acted to minimize those drawbacks, so it is misleading to act as if those drawbacks are unavoidable and the lockdown is illogical.
I am not an expert, but it seems to me that most of those problems would have occurred without the lockdown, due to the effects of the virus spreading unchecked.
In other words, economies were always going to take a massive hit one way or another, but with the lockdown we get some control over the form it takes.
It feels like the powers that be are playing whack-a-mole, incapable of seeing beyond the immediate problem. It doesn't bode well for a potential future (hopefully avoidable) pandemic that has far higher death rates. The Black Death, for example, is 'estimated to have killed 30% to 60% of Europe's population.'
I think the problem is a lack of constant re-evaluation. Politics has solidified the desire of many people to make the "correct" decision and stick to it. Why can't we be comfortable with making a decision with partial information and treating it like a ship that needs occasional course-correction?
I think that if COVID19 was more deadly, we'd have a lot more agreement on implementing lockdowns, and not nearly as much politicization of the issue.
I think that the polarization we are seeing regarding lockdown policies is because COVID19 sits right in the middle of what the population at large thinks of as "very dangerous." It's not quite half-and-half, but I think it breaks down like this:
I think it's fair to say that a very large minority looks at a disease that mostly targets the elderly and infirm and thinks, "why don't we take measures to protect the vulnerable populations who aren't getting out much anyway, and let the rest of the world get on with life?" This isn't just about "making money" to these people, it's actually about living your life, and accepting what is in reality a pretty small risk for most healthy people.
One the other hand, a not-quite-supermajority believes that a disease which is 10-100 times deadlier than the typical flu when looking at raw fatality numbers is worth significant cost and effort to suppress. This would also include a significant portion of people who are themselves elderly or infirm, and they don't want to risk society neglecting to protect them if everyone else is allowed to go about their business.
It could well be that if the fatality rate really was > 3%, you would have a hyper-majority in favor of taking action, which means we would have all been in agreement about how to react, really locked down hard and eliminated it by now.
Based on their experience, what we should have been doing is:
- Lock down enough to really get the numbers down, with the understanding that it's temporary, because:
- While locked down, really beef up the test and trace infrastructure. After the numbers are reasonable, this lets you open up but find and isolate individual cases.
- Encourage/require mask wearing by anyone in public. Studies have shown that 80% mask wearing reduces the virus by over 90%.[1]
- Instead of putting money into unemployment, pay businesses to keep people on salary while they're not working. That way the jobs are still there when we open back up. European countries have done this, kept unemployment low, and in some cases spent less per GDP than the US.[2]
The earlier you start, the easier and more effective all this is. If you start early enough and already have good systems in place, you can even skip the lockdown step, aside from localized outbreaks.
[1] https://www.vanityfair.com/news/2020/05/masks-covid-19-infec...
[2] https://www.nytimes.com/2020/05/23/opinion/sunday/coronaviru...
Wearing masks has zero cost in terms of GDP and unemployment. Why the heck aren't we mandating those?? Even in 1918 people were not allowed to step on a tram/metro without a mask.
If we want to change peoples minds about wearing a mask we need to campaign to change minds which goes all over. It's not about losing your freedom it's about being safe. I don't think legal requirements will do it. It'll just stir up the anti-government people. Whereas if we make it about looking dumb if you don't wear a mask then we'll be better off.
Also as a side benefit, making masks more acceptable in public may help us thwart facial recognition software in stores which I'm game for.
"The British gas masks have a squat round fitting on the front to allow exhalation, which looks exactly like the snout of a pig, and no woman would be caught dead in such a thing if the models in the gas mask posters were not such paragons of high-caste beauty."
But maybe he invented this -- I've never seen a copy of such a poster. (Edit: I've found at last something related, just a photo, not a poster, and a "South African": (1) ) What's certain is that there were mask "issues" around 1918 in the US, at the time of another pandemics:
https://www.history.com/news/1918-spanish-flu-mask-wearing-r...
1) https://www.alamy.com/a-female-of-the-south-african-air-forc...
Also, all legal requirements are backed up by some sort of punishment. A regulation put in place to wear a mask might affect different groups more than others. If you can't afford to get a mask because the supply is low, then you get fined or go to jail. I don't like regulation where I think a campaign would be much more effective.
The sad thing aside from the literal thousands of needless deaths is that they could do more reengineeeing to arrange things to be safe and productive at a lower capacity (say hair dressers by appointment with masks and a clean up sequence between customers) but they largely prefer an illusion of normality even though it will just prolong the disease, measures and boost expenses.
Last time I ran the numbers, they said we’d be in the current holding pattern for 27 years.
Here is how you can run the math:
1) Divide deaths per day by 0.005, or use an epidemiologist’s estimate of new cases per day.
2) Look up the world’s population.
3) Divide the two, and multiply by 0.8 (which is a good estimate of the necessary herd immunity fraction). Convert from days to years.
While you’re at it, look how long flu vaccines last until the virus evolves immunity, then look at how often coronavirus changes relative to the flu.
Edit: I agree with the bits about having the government pay salaries directly, and that early action can effectively stop pandemics before they start.
After a couple years if a vaccine looks nowhere close, maybe that's a time to reevaluate, but right now we have several that look promising in the relatively short term.
In a perfect world, a much larger PPP would have been more efficient and easier to manage than expanded unemployment benefits; in world we live in, that would have meant trusting an administration that prides itself on incompetence and corruption to handle what would have been the bulk of our economic response.
But one simple thing we could have done better is to pay the banks a fixed fee, instead of a percentage of the loan, which incentivized banks to ignore the smaller businesses.
But that's not the point I want to make. What I was trying to get at is, why does it make sense to say "Well, why doesn't the United States just implement the policies of insert name of European country here?
Well, because the federal government, for the most part, isn't calling the shots on what individual states decide to do about the pandemic. It's up to the governors and individual state governments to decide their own course of action, for their area. In many states, the outbreak is very manageable and under control. In others, usually in states with the largest cities, the situation is much more serious. We are not all like New York City.
It it much more complicated than just lumping all the US numbers into one. I'm saying, it doesn't make sense just to look at the total US numbers, and say we are fucking up. Take the 3 most populous states in the US for example. California, Texas and Florida combined have nearly 90.5 million people. Together they account for nearly 203,000 cases total according to the CDC.
Comparatively, the United Kingdom has something like 65 million people, and a rough total of 261,000 cases according to the ECDC. Spain and Italy both individually have more than our top 3 states by population. Russia's rate per capita is higher.
Don't let Donald Trump and the huge numbers out of New York City/ New Jersey fool you. Most areas of the country have the pandemic under control, and very importantly, hospitals are not at risk of being overrun. Weather that remains to be the case as we loosen restrictions going forward will be interesting to monitor though.
People in charge get this, sure saving lives is nice, but it's about maintaining the order of things.
You really think if this went out of control people would not pull a gun in a hospital to get their relative help? Or groups of people would not be targeted, even more than they are now, as scapegoats?
Even now it's acknowledged that many more are going to get it, many more will die, but at least things will not spiral out of control and we will be able to manage the hospitalization rates.
1. either physically distance or wear a mask around groups of strangers, particularly inside.
2. if you get sick, self-quarantine (and go see a doctor).
that would have been 99.9% of the reduction in transmission risk for 0.1% of the cost of lockdown, with a bonus of providing time for medical workers and epidemiologists to provide care, mitigations, and develop containment strategies (like tracing).
the reasons we haven't boil down to news-fueled panic/anxiety crossed with political calculation, with a bonus of shifting the losses to the disadvantaged.
1. Because the virus is spread mainly through droplets, the risk goes down if you keep your distance from other people.
2. Because the virus is spread mainly through droplets, the risk goes down even more if everyone (especially those with symptoms) wears a mask.
Since day one, since before the disease had even left China, the WHO was clear on all these points, the CDC followed shortly after, with one partial exception, which was the mask recommendation. (On masks, the WHO said from day one that anyone who was potentially infected should wear a mask; they initially advised against population-wide mask wearing due to supply.)
Masks and distancing could have and should have been rolled out the day the first COVID-19 case washed up on American shores. Both could have been enforced through stiff penalties on noncompliant businesses (no masks, no distancing, you get shut down for 30 days). They were already in use in South Korea which did a great job of getting the disease under control.
The Korean strategy worked better than the American strategy. Less death, less economic damage. Why did America screw up so badly? Pure hubris and incompetence on the part of Americans, starting with American leaders on both sides of the aisle. The war on COVID-19 was being waged and it was being beaten on the other side of the world, but myopic Americans were too preoccupied with themselves to watch and learn. It's as simple as that. Poor leadership, panic and nationwide myopia.
The real issue with all of this is that the Trump administration is incompetent and American government in general is reactionary and only promotes policies that are selfish. Its been known for years that people have no safety net, just put on NPR and like once a week this comes up, and it's always been known that small businesses really aren't racking in the cash to stay afloat for a long time without money. The government just needs to step up and support people, with health care for all, with long term financial assistance, and they need to increase taxes to do this. They are sort of doing it now with checks, but that's going to go away once the pandemic is over and everybody who is not in tech or generally upper middle class will go back to being on edge because one disaster will eff to their lives.
You also can't blame this on epidimiologists. They provide their assessment and policy makers have to weigh those options with all the other ones and come up with a strategy. That'd be like be like blaming the person who came up with the hail marry when it is a coach's decision to use it every play.
I'm not sure what you mean by this. Two months ago he estimated[1] that the total death count in the U.S. would be 10,000, and we're already 10x that.
[1]: https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a...
> If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.
his own estimate is
> reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.
The Gamgelt study for example estimates IFR at 0.28%. he has recently published a meta review of those studies https://www.medrxiv.org/content/10.1101/2020.05.13.20101253v...
None of that commentary makes sense except under the assumption that the author thinks the U.S. death total will be 10,000ish, and would have been unnoticeable without the availability of PCR testing.
(which the groupthink here unfortunately encourages)
His actual belief, which he states several times in the piece is that we don't yet know how many people are going to be infected or what the death rate is, and that our priority should be gathering more information: "The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have."
Different people have different styles of argument. From what you say, presumably if you used the example that Ioannidis did, this would imply that you believed this estimate was correct. Others have different styles, and you should not assume that they are making an assumption just because they happen to use numbers for an example.