Unfortunately, it doesn't go into detail where exactly these samples come from.
It's seems plausible that animal coronaviruses induce an immune response in humans that can later help against SARS-CoV-2. If so, there should be a correlation between animal contact and COVID-19 severity.
There are human beta coronavirus as well. One question nobody has answered yet is if parents with young kids are getting less ill due to cross immunization from all the colds young children bring home
I've been (perhaps naively) banking on this. We've had just about everything pass through our house in the past four years since we had our first kid. Have to imagine something in there is good for immunity.
No need to bring in animals to explain this. There are a handful of human coronaviruses - I think 4 that are not SARS-related, but I’m on mobile so will have to dig up the study later.
Besides, once a virus jumps from an animal it either becomes a human virus (capable of spreading), or somehow is a one-off virus that can jump from animal->human but not subsequently to another human. If the latter, that effect is so negligible it would not explain 20-50% of SARS-CoV-2-naive individuals having t cell reactivity.
—-
While I’m at it, just a reminder to all that SARS-2 overall is a fairly mild virus, and the level of hysteria and death-inducing counterproductive response (lockdown, suspension of elective surgeries like Newsom did for a month here in California) is completely divorced from the fundamentals of this virus.
Also a reminder that unlike flu, SARS-2 primarily kills the very old / very unhealthy, whereas flu kills the very young and the very old. Thus when you run the math on population dynamics / herd immunity, the recurring yearly deaths will be vanishingly low (unlike flu) and thus amortized across years, SARS-2 is even leas deadly than the current numbers imply.
This is because once it has passed through the population, the set of SARS-CoV-2 naive individuals becomes dominated by new entrants to the world (babies/toddlers) who essentially have 0 risk of dying from COVID (it’s basically a rounding error). Thus while SARS-CoV-2 is and will remain endemic (circulating in the population), it will barely kill anyone once the current world population is largely exposed to it.
—
Finally, a reminder that mentioning stuff like the above tends to result in censorship from social media platforms, which combined with the incredible bias of “news” organizations like CNN etc, means that those who are plugged into the matrix will never encounter real information about this threat. And surprisingly (although in retrospect it shouldn’t have been surprising to me), there are a lot of people on HN that have dranken that very kool-aid and thus will reactively downvote or even flag commenters who present their beliefs (however founded or unfounded) about the true danger of this virus versus its purported impact.
Also, since I’m already ranting, I just want to throw out that the narrative around “long-term damage” (often stated to be lifelong) is completely unfounded and contradicted by the research we already have about SARS-1, which is SARS-2’s much more deadly yet much less popular older brother.
> Thus while SARS-CoV-2 is and will remain endemic (circulating in the population), it will barely kill anyone once the current world population is largely exposed to it.
You mean once _all_ the people who could die from it, have died from it?
I anticipated this response of yours. It sounds like a great gotcha in its surface, until you realize that every fast-spreading respiratory virus works like that. It's happened with every flu pandemic, including the recent H1N1.
SARS-CoV-2 appears to be an incredible spreader and a poor killer. What that means is the cost of perpetually trying to avoid infection are very high, whereas the benefits (avoided mortality) are quite low.
Case in point, SARS-CoV-2 exhibits a fairly high degree of pre-symptomatic spread. I believe that this is almost certainly due to the findings of interferon-mediated early-course immunosuppression (read: in the early days of infection it prevents your immune system from reacting strongly, meaning that unlike many other diseases there is a period where you have enough viral load to spread it yet don't express symptoms). Also note that it does not exhibit asymptomatic spread, which would be even "worse" since pre-symptomatic spread only gives you a window of maybe days whereas asymptomatic is by definition across the whole disease course.
Now factor in the fact that many people are either completely asymptomatic or paucisymptomatic (few symptoms). For those people, which may even be the majority of cases, it's such a not-big-deal that most don't ever realize they've had it. Some will have more of an actual cold, and some will have symptoms comparable to a run-of-the-mill flu. A small fraction of those infected will go on to experience increasingly severe symptoms, probably comparable to a normal SARS-1 infection (since SARS-1 is quite nasty), culminating in the worst cases in the need for invasive ventilation at which point death is incredibly difficult to avoid. (This is obviously an area of active research but it appears that the severe form of the disease is related to a state of immune disregulation where pathological cytokine release syndrome, the tissue damage from widespread neutrophil infiltration, etc wreak havoc).
So, we have a virus that spreads incredibly well, yet is overall incredibly mild, and has very well-defined populations who are at real risk of severe outcomes. That is precisely the type of virus that is a horrible candidate for lockdown, which damages the entire society in the attempt to prevent what is perceived as a greater threat (but is actually not, in my opinion).
So, as a society we saw a papercut and chopped off our hand. Oops.
I am happy to provide sources for pre-symptomatic spread, interferon-mediated immunosuppresion, etc, but first I wanted to make sure that you were here to engage in good faith dialogue; i.e. whether I can convince you or not, you are actually willing to read (or try to read) the papers. I'm a bit scarred by numerous times (here and elsewhere) where I've invested a bunch of time into detailed posts and then quickly realized that the person on the other end was never serious about addressing the problem of SARS-2 but instead was there to toe the party line and reinforce their pre-existing conclusions.
Your definition of mild is a 'relativisation' of the problem. Since you mentioned H1N1, Covid has already surpassed its death rate in just just 3.5 months and it is on its way to cause 1.5 - 2 mil or more deaths world wide just for the first year... even with the huge restrictions all the countries are doing.
Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization. H1N1 was never this bad, and we are no near achieving any herd immunity.
"The 2009 H1N1 pandemic was estimated to be associated with 151,700 to 575,400 deaths worldwide during the first year it circulated."
The observation of widespread cross-reactive T Cell immune response does not support this claim. If 50% of the population is less susceptible, this would dramatically alter the herd immunity threshold. The binary condition "totally susceptible or totally immune" is merely a fiction used in some models, and any individual variation away from "totally susceptible" has the same effect:
If that‘s true that‘s nice – but not an argument against lockdown measures before we can be reasonably certain that‘s true, by the way.
Given that we cannot time travel and all.
Also, other countries well below 30 percent seropositivity also don’t show signs for second waves, so that‘s an indication that your explanation isn’t the only possible one.
Andrew Cuomo sent around 5,000 non-critical COVID-19 patients into nursing homes entirely because of fear that healthcare systems would be overwhelmed. The fear was unjustified: During the same time period the Javits Center, the USS Mercy, and at least four leased hotels sat practically empty:
I agree that ICU capacity, PPE inventory, and non-infected personnel were all in short supply at times and in places, but it's not such a simple conclusion as you claim. Consider that early venting seems to have been a terrible blunder, which also used up valuable ICU capacity:
> During the same time period the Javits Center, the USS Mercy, and at least four leased hotels sat practically empty.
The USNS Mercy was sent to Los Angeles, you probably mean to refer to USNS Comfort which was in New York. But both Mercy and Comfort were offered by the Feds for non-COVID-19 patients only.
Right, thanks. How about the leased hotels? The field hospital in Brooklyn? The Javits Center? Why were patients sent to NURSING HOMES before any of these?
The same question can be asked about the Comfort of course, but I guess we can shift responsibility to the Feds for that fuck-up.
But both Mercy and Comfort were offered by the Feds for non-COVID-19 patients only.
That doesn't affect the argument. The fact is that the other facilities were able to handle the total of "normal" patients as well as COVID-19 patients. The entire set of patients did not get to a size sufficient to need those boats.
New York was locally overwhelmed but it is true that they weren’t completely overwhelmed. Maybe a couple centimeters under water.
This is obviously due to the absolutely massive measures they took. They managed to put on the breaks just on time.
Italy was maybe a couple centimeters more under water but also not totally overwhelmed.
But Italy actually had to ban people from going outside (with tight exceptions) to achieve that which is nuts.
If you were testing more and catching it earlier you could get there with much milder measures (e.g. in Germany) and hospitals that came never close to being overwhelmed, as in Germany.
I don’t get you non-sequitur about people in nursing homes. How am I supposed to respond to that? Yeah, that‘s stupid? Because it is?
> Also, healthcare systems were overwhelmed nevertheless and with measures (lockdowns) in place.
This is more or less a myth. The real story is the massive scaledown in medical capacity across the country.
Locally, in New York, certain hospitals hit capacity. Other hospitals nearby did not.
Additionally, if the goal is only to avoid hospital overrun, you should concede that our current strategy is totally misguided, since we are trying to suppress spread way beyond the threshold required to prevent overrun. (Actually, I believe that we could do literally nothing to slow spread and not have a true overrun scenario, but that's a discussion for another time)
Case in point: In California our Dear Leader Gavin Newsom just plunged us right back into lockdown, including closing fitness centers (gyms), despite our hospital system being in completely fine shape.
It's all a farce. I don't use that word lightly.
As a thought experiment, imagine a world where SARS-CoV-2 jumped to humans just the same as it did, but magically we never found out about it. So, it spreads completely uninhibited. That world is a world with less unemployment, less poverty, better educated kids, less attainment disparities (lockdown, online schooling, etc ALWAYS disproportionately impacts the poor), less all-cause mortality, and in my opinion, less COVID-19 mortality over the medium-term.
Contrary to everyone saying "how can you say this is a mild virus, are you crazy?", the evidence overwhelmingly shows that it is very comparable to a bad-severe flu season at worst.
No, we would have been way better off doing nothing. That's what's so sad. Every measure we've deployed has not only been arbitrary and capricious, has not only been ineffective, but has actually made the problem worse insofar as they were effective.
I've seen people make risk appraisals with COVID-19 that are completely alien to how they evaluate risk in any other areas of their life. In the extreme case, I have friends who regularly engage in unprotected sex and do all kinds of dangerous drugs like benzodiazapenes, who are not in a COVID-19 at-risk group whatsoever, yet are petrified with fear for their personal safety (it's not that they're super selfless and just worried about infecting others, to be clear).
As a more moderate example, I've seen mothers petrified to send their kids back to school, despite the fact that their kids are at no risk from this, and despite the fact that their kids are actually at risk from Influenza, from meningitis, etc.
The real pandemic was the pandemic of mass collective delusion, accentuated by (here in the US) our tumultuous political environment in which people are willing to distort anything to the point of absurdity if they think it will win them political points.
> We don’t know whether that’s true still and what the impact exactly is.
Well, at this point you must be willfully closing your eyes. We have good evidence of pre-existing immunity in a chunk of the population. We have good bounds on our IFR, leading me to settle on a final number of around .30%. We have very clearly delineated risk factors. For many people, Influenza is more deadly, for many people they are about equivalent (for example if you are 55 with diabetes/hypertension and overweight but not obese, your risks are pretty comparable), and there are some for whom SARS-2 is way more dangerous (people 70+ with comorbidities). So even ignoring the pre-existing immunity and even without accounting for heterogenous suceptibility, when you run the numbers it quickly becomes clear that what we've done is not just unprecedented but is actually insane.
Note I haven't even brought up the constitutional/ethical implications of what we've done. I think what we've done, speaking from a US perspective, is completely unconstitutional, doubly so after the BLM protests started and were given a free pass while people were banned from church (I don't...
Thanks for all of these epic rants, they are pretty darn articulate, and full of tasty taboo claims that are much appreciated by the angry minority on this issue.
Joe Rogan and Bob Saget were talking about how "everyone" has been having COVID panic attacks and nightmares. What happened to people? How did hypochondria become a mainstream lifestyle in the safest place and time in human history?
Indeed, I've observed what I would describe as symptoms of OCD, germaphobia, and agoraphobia in a shockingly high percentage of the population.
And of my friends that were already agoraphobic and germaphobic, they've now had their lifestyles retroactively justified by this thing, so it's going to make it way worse for the people that already had it too.
(I have one friend who is a germaphobe but not where it really interferes with their life, and they adopt the correct attitude of "well I can't really control this (germaphobia, not COVID-19 to be clear) but I'm not going to pretend it's a good thing" - they've stayed much more resilient through this than one might expect)
Oh and if I can add, the number of friends of mine who have reported feeling shortness of breath as a symptom is staggering. Pretty hilarious that one of the classic COVID-19 symptoms is also a classic anxiety symptom. We've created an environment ripe for massive psychosomatic/psychogenic illness.
I mostly agree with you, but have a couple of disagreements.
and in my opinion, less COVID-19 mortality over the medium-term.
I think you're missing one factor, which is the fact that evolutionary pressures will cause the virus to become better able to transmit, but also less likely to cause fatalities. That's the normal course of such things - consider that a virus that kills its host is no longer able to transmit itself to others, so strains that don't kill the host will reproduce more effectively. And there's some evidence that this is happening with covid-19. Ignoring other factors, being able to stretch things out over time to amplify this evolutionary pressure will probably result in fewer fatalities, even with the same total number of effected. But I don't know how that balances against the other factors that you're pointing out.
We have good bounds on our IFR, leading me to settle on a final number of around .30%.
The latest scenarios published by the CDC, as of a day or two ago, puts the most likely scenario at 0.65%
Evolutionary pressure selects for survival, however the "less likely to kill" is entirely your assumption.
Case in point – the second wave of the Spanish flu was much deadlier than the first wave. And the third wave was less deadly than the second, but still more deadly than the first wave.
If the virus infects hosts efficiently, and this one does, no, it will not have evolutionary pressure to be milder.
Two Italian doctors claim they are increasingly seeing weaker and less deadly cases of COVID-19 in the country. Hamilton said it's not uncommon for a virus to become less pathogenic as time goes on. “Over time they become less dangerous or less virulent because they just want to live in you and replicate in you,” she said.
Hamilton said viruses, in general, are trying to pass on their genetic material. “In some pathogens, it’s actually better if they don’t kill you because if you’re still alive, you’re more likely to spread them around,” she said.
This is why she said some of the most successful viruses raise the fewest red flags “Things like head colds or warts,” she said.
It's like saying evolution selects for intelligence, which would be silly because no, it doesn't, even if it happened for a couple of species.
If the virus transmits efficiently, having a high enough R0, it has no pressure to evolve to something milder. SARS-Cov-1 lacked the contagious pre-symptomatic period. Note how SARS-Cov-2 keeps going strong despite the worst restrictions we've seen in our lifetime.
> I think you're missing one factor, which is the fact that evolutionary pressures will cause the virus to become better able to transmit, but also less likely to cause fatalities. That's the normal course of such things - consider that a virus that kills its host is no longer able to transmit itself to others, so strains that don't kill the host will reproduce more effectively. And there's some evidence that this is happening with covid-19.
Citation, please.
As I undetermined it, coronaviruses evolve quite slowly compared to many other viruses. In a perhaps optimistic scenario in which we have a widely available, safe, effective vaccine in early-mid 2021, there may well be no appreciable evolution of the disease before it’s mostly eradicated from the developed world.
In that scenario, the real outcomes to consider are the number of deaths and disabilities caused over the next year or so, the economic and other costs of people getting sick, and the cost (economic, social, etc) of the lockdowns and other countermeasures.
My personal belief is that countries like Taiwan and New Zealand are taking the right approach. If they continue on their current course and a vaccine shows up next year, then they will manage to keep total deaths near zero at moderate economic cost. If the entire world had pulled this off, then COVID-19 could plausibly be gone by now.
Quoting the article, and if you go there, there are numerous links to the actual studies:
Some physicians and scientists in the United States have lately also announced findings that the disease is getting weaker. One of them, Donald Yealy—the chair of emergency medicine at the University of Pittsburgh Medical Center—claims that "some patterns [of COVID-19] suggest the potency is diminished."
"The virus may be changing," he said earlier this week, adding that fewer people in the Pittsburgh area are contracting the disease, and the infections themselves appear weaker.
Maria Van Kerkhove, an epidemiologist with the World Health Organization, told media after Yealy's remarks that neither the virus's transmissibility nor its severity have diminished as Yealy claimed. Yet several other American scientists, including some at Arizona State University, announced findings in May that could bolster claims that the virus is less deadly than it once was.
The scientists at ASU said that they had detected a gene deletion in one sample from several hundred Arizona patients that potentially reduced the fitness of the disease. Notably, they claimed it was similar to a deleted sequence observed in the 2003 SARS virus that was observed near the end of that disease's epidemic—possibly signaling that COVID-19 may be bound for a similar fate.
Those conclusions were echoed by scientists in Spain this week, who proposed that COVID-19 may have adopted what the researchers call a "don't burn down the house" strategy, "reducing the severity of the infection and tissue damage without losing transmission capability." In effect, the disease could be opting to become less lethal so that it can spread more easily—a hallmark of evolutionary behavior, and also a boon for anyone who gets infected with the milder strain.
Data do appear to indicate that the virus may be losing its edge. The statistics website Worldometers, for instance, shows an unmistakably lopsided trend: Though the number of confirmed global cases has been increasing since the start of the pandemic, the number of global deaths has been trending downward since mid-April.
If that pattern holds, it may point to the conclusion that these few skeptical doctors are correct: That the coronavirus, like SARS before it, will eventually burn out in part due to its own viral mechanisms, without the need for a vaccine or for lockdown measures that have slowed the global economy.
(1) Yes, the evolutionary pressures are possible. There's also the related notion of treatments getting better over time, etc.
Basically, and you alluded to this, my position is those effects may occur to some extent, but will be massively dwarfed by the downsides of trying to slow down the timeline.
(2) As far as the CDC, I hate to be that guy but I don't trust their numbers very much. I'm just a bit suspicious of them upwardly revising their number at this point in time, especially given the statements coming out of the CDC head which seem to lack any type of nuance. In particular, they are modelling asymptomatic spread but not pre-symptomatic? Weird.
But yes, I generally give a range of .1-.7%, but settled on .30% as the best number for my purposes. It's more-or-less pulled out of my ass, although it is almost exactly the median in the big spreadsheet of IFR estimates which I now cannot find the link to (grr)
Anyway, the important thing is for my "argument", it actually doesn't matter to me if the IFR is .3% or .9%. The costs of lockdown just end up being too risky. So, feel free to ignore my mistrust of the CDC.
Note that Ferguson's classic (albeit incredibly myopic) paper models an IFR of .9% and 82% of the US population being infected, with an end result of 2.2 million. With these T-cell findings and other findings, we might see like 1/4 as many total infections, so even with the same IFR that gives us a shitty upper bound of 600k.
You are willfully blind to, or ignoring the facts right in front of you. 0.3% IFR is basically 1 million dead in the U.S. alone in the next two months from this one single cause if we go with your plan. That's just the people who die. That's assuming our system doesn't get overwhelmed (it will). We have very clear data that the U.S. healthcare system simply can't handle letting this virus burn through the population without slowing down the spread.
> Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization.
Can I get a source here? Are you basing this off of the "case hospitalization rate"? Because that number will overestimate the true hospitalization rate by a factor of 2-100x depending on where you're talking about. Same principle of looking at CFR vs IFR (although ironically CFR will start trending down, not just in the real sense as doctors get better at not overreacting with early intubation, but also in a numerical sense as states like Florida are clearly misrepresenting their case numbers which will make the denominator larger)
As one example, in the population of people who can actually still get bad outcomes but have the best outcomes - people in their 20's - the implied hospitalization rate from serology studies gives us something like 1 out of 500 young people getting hospitalized (see https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c...). So that gives us a lower bound, and a semi-decent upper bound would be the 3.4% hospitalization rate in the 60-69 age group. (They don't seem to report >69 years, which would be way worse) <--- Note that study I found a couple months ago at least, so there are probably better numbers out somewhere now, but I lost some motivation to keep doing SARS-2 research once BLM started because it became clear that it was never really about saving lives in the first place. Although that's a topic for another day)
I was not claiming that H1N1 was as bad or worse than COVID-19, to be clear.
Obviously COVID-19 is the worst pandemic we've had in over a century. But that's mostly a function of the fact that we haven't had a truly bad pandemic (the scary ones like SARS-1 fizzled out, presumably because the virus was very symptomatic and very deadly).
The point is that, we didn't lose our shit over flu pandemics which actually kill children, and actually cause more significant recurring deaths than COVID-19 will do to what I already explained about COVID-19 targetting the unhealthy/old.
If you want my argument in a nutshell:
- The most stable solution to the problem of COVID-19 is to build widespread population immunity. Also, banking on vaccines as an artificial way to get to herd immunity is a foolish strategy, because we're relying on a temporally unbounded future event, which is an awful idea.
- Lockdown not only increase all-cause mortality by making every other health condition in the world worse (both directly through social isolation and depriving exercise, as well as through suspending elective surgeries, as well as the widespread culture of fear/etc leading to people to not go to the hospital), but I actually believe that it increases COVID-19 mortality. The same factors of social isolation, stress/fear, unemployment and lost sleep are at play, but also particularly the prevention of exercise (which plays an immunoregulatory role besides the other positive effects), and even more particularly, being cooped up outside = no sunlight = no vitamin d. Vitamin D is actually a ridiculously important vitamin as far as respiratory infections go - I didn't realize how strong the effect was, I encourage you to research it. Additionally, nitric oxide, also produced by sun exposure and not provided by a vitamin d supplement, decrease blood pressure so helps cardiac events, and is even being directly studied as a COVID-19 treatment (perhaps due to immunoregulatory effects?)
- Because I don't believe in practicing containment, for the above reasons and others I don't feel like going into at this point, I believe that any attempt to artificially slow spread in the general population is counterproductive. So, insofar as universal masking works, we should not be wearing masks. Insofar as lockdowns actually work, we shouldn't be locking down. And if they don't work (and I think the evidence is not there, and thus they likely have either no effect or possibly make spread worse, particularly with masking and school closures) - well, then why are we doing them?
While I don't agree that the data supports your anti-mask, large-gatherings-are-OK preferences, I appreciate you making the strongest possible case for what has often been mocked as a "let 'er rip" response. It's helpful to see the collected data & reasoning for that idea.
In particular, even given much of your argument, I believe it's still wise for most people, and especially those with any extra risk factors, which likely include some yet-unknown among the outwardly-healthy, to avoid getting this for as long as possible. The end point – nearly everyone having an upgrade immunity to the somewhat-novel threat – is the same. But the upgrade is slower, to minimize collateral damage, and involves more conscious processes, including at some point synthesized vaccines, rather than purely natural/chaotic.
Every week brings better understanding of risks & treatments. Every week gives more opportunity for the pull of 'optimal virulence' (https://en.wikipedia.org/wiki/Optimal_virulence) to eventually select for even-milder strains. At least partially-effective vaccines for high-risk/front-line workers may arrive before the end of the year. Delays prevent overwhelming health facilities – or increasing average initial infectious loads – which each seem to risk synergistic escalations of mortality rates.
That said, it's not implausible that the right strategy for those least-at-risk – the young & very-healthy – is to mostly go about their normal day, and not worry much about getting an mild case from other mild (presymptomatic/asymptomatic) shedders. The risks are offset by the value of adding to their internal (and thus society's) immunity library against Covid-19 & related viruses.
But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
I'm happy for people to be able to choose their own risk tolerances. What I'm not happy with is mandating that I or others must go along with what I feel, (not without evidence I might add), is a state of collective delusion.
If I can wax philosophical for a bit, I remember learning in elementary school about native american rain dances, how they would dance around and thought that it would cause rain. "How foolish of them", I thought. "It's so obvious that there's no connection between dancing around and precipitation falling from the sky".
And yet, when I look around, I see us all participating in an elaborate form of pseudo-medicalized rain-dancing. Take the staggering amount of people walking around all day in nitrile gloves. Let me tell you, if I were a SARS-CoV-2 respiratory droplet, I would love those people; I get to a hitch a free ride on their gloves with my droplet completely intact, preserving the moist environment that all life (and pseudo-life since we've arbitrarily decided viruses aren't alive, which is just silly) thrives in.
Uncovered hands at least have commensal bacteria and an acid mantle (well, for those that don't wash their hands like someone with OCD) that make it harder for SARS-2 to persist. But those gloves are the perfect environment.
Why do people wear those gloves? Well, in my opinion, they associate the gloves with doctors, they associate doctors with cleanliness and a scientific version of holiness, and thus they essentially believe that the gloves act as a magic totem that ward off evil spirits - I mean, evil viruses.
Mask-wearing isn't much better. It is definitely better, and I get the "it protects you, not necessarily me" argument, but when you look at how people actually use the damn things in the real world, I think that's almost certainly false. People touch their face, their mouth, etc way more. Not to mention all the other reasons.
Which does lead to the irony: insofar as masks do work to slow spread, that's a bad thing, yet they may actually increase spread, which in my book is a "good thing"...except (a) I hate having to wear a mask, and (b) since the rest of society is not on-board, a healthy increase in cases will be met with further lockdown :(
--
Anyway, you alluded to this, but I don't think having a bunch of 20-somethings try to avoid all human contact for [1 year, infinity] makes sense. I think it's a less stable system. Just like how every year in California we have huge wildfires, which we artificially suppress, and so every year there's more and more material waiting to ignite.
Well, pandemics work the same way. When we try to keep ourselves in a state of SARS-2-virginity, we create an environment where at any moment infection can rip through us again. Look at New Zealand, which is held up by the ignorant as an example of "doing it right", and yet now they can't allow any foreign visitors without 2+ week quarantine "until the vaccine" (sigh).
The laughable thing is in the US we're not really practicing containment, and yet we also kind of are, and that leads to the total ass-backwards metric of "cases must be perpetually in decline otherwise we shut down again".
--
Okay, back to serious stuff.
> But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
See, this is my problem. The moment we stated that it was the problem of those not at risk to avoid anything that might infect an at-risk person, we went down the comple...
I have started one, and indeed wrote a post awhile back on COVID-19 specifically which I'm proud to report got censored on Facebook (I never posted it to Facebook to be clear, other people did before FB put a stop to it and globally banned my domain).
I've wanted to go back and update it, but lost motivation to do so when the BLM protests/riots started. I always cynically had thought that people didn't really care about COVID, but even I wasn't expecting such a shocking example of exactly how much of a farce this whole thing was ("we have to shut down California, look at these photos of normal beach crowds!" versus "here's 40,000 people massed together for a black trans lives matter rally, let's just pretend that we didn't claim all mass gatherings/protests were evil last week").
I did my original post using Ferguson's model as an upper bound, at the time thinking that the real numbers of the "let the disease run rampant" scenario would be much better. Well, now tying in these t-cell findings, the findings that blood type seems to impact transmission, and heterogenous susceptibility more generally, there's a lot of updating to do to make it even more clear how ridiculous the whole policy was.
I also have other research interests on things like moist wound healing that I've been considering doing a quick writeup on, since there's a lot of important info that people just aren't taught (myself included, before doing research).
Happy to send a link to you via e-mail, so that way I'm only de-anonymizing myself to individuals and not more broadly. You don't appear to have an e-mail on your profile so if you don't want to post one and care about anonymity we could also exchange GPG keys depending on how much effort you're willing to exert :P
> So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
Yes, exactly this. This is another reason I hate universal masking, because even if I think masks work when worn properly, I still have to assume that everyone is wearing them because they're mandated, but don't actually know how to use them properly.
I would much rather have it be voluntary, and then if I see someone wearing a mask, at least I know they give a little bit of a fuck. Now granted, I still wouldn't be able to (if I were trying to avoid infection) assume they knew what they were doing, but it's better than the current reality where, say, employees are forced to wear masks, and then the moment I ask them to repeat something they said because masks stifle speech, they immediately pull down their mask and tell me what they were trying to say, completely defeating the point.
I love the idea of literally signalling risk tolerance. The only thing is, that still requires ceding public space for some portion of time to the super freaked out people, which is a losing battle, so ultimately I still think we should stick with the "old" way of doing things, which is: if you're a germaphobe/agoraphobe, you stay in your damn house and watch netflix for your whole life like you did before, and everyone's "happy".
insofar as universal masking works, we should not be wearing masks.
There's another factor in here that I don't see that you've weighed. Although this is far from certain, I've seen some preliminary claims that the size of the initial viral exposure may be one of the factors that eventually determines the severity of a case. This makes intuitive sense - if you only get a small dose, your body has longer to notice the virus before it reaches a given threshold.
If this is true, then masks may still be worthwhile in order to keep a lid on the proportion of severe cases.
Yes, I've seen the notion floated but never seen much evidence one way or the other. I wish people were less afraid about voluntary self-exposure, we could perform some really enlightening trials if the ethical go-ahead was given.
(Personally, I would volunteer to be exposed to real SARS-CoV-2, but I would not volunteer to be on the receiving end of any vaccine candidates.)
Anyway, it's dubious that masks do a great job in decreasing viral load, but I think this another case where if they do the effect size wouldn't be that great.
Regardless, this really highlights how we're proposing universal measures for things that are not well researched. I like the approach Sweden has taken: if there's not strong evidence, we just don't do it. Simplifies so much.
We have a flu vaccine that millions take every year and it works. That is why we don't lose our shit over the flu.
Your most stable solution to the problem is reasonable (build widespread population immunity), but your actual solution is to try and achieve it as quickly as possible by just letting the virus spread without any measures to slow the spread. That is not reasonable.
What is your concern about uninhibited spread? Do you feel that, even given the existing seroprevalence, we could not lift all restrictions without risking overwhelming our healthcare system, which more-or-less never happened even during the peak?
which more or less actually definitely did happen. People in NYC definitely died because they didn't get a ventilator or a dialysis machine on time. Doctors and Nurses actually died trying to treat COVID patients without proper PPE because of shortages. That actually happened. Your willful blindness to these actual facts is sickening.
The money quote, which completely refutes your entire nonsense argument:
“The other day I felt defeated. The patient came in on a code. We looked at each other. The patient had to die. There was nothing we could do.” Any feelings of guilt were upended by the next patient to come through the doors when they had to tell EMS they had no ventilators. EMS said they had nowhere else to go. The patient died."
Sweden's response has been widely reported on, and even more widely mis-reported on.
Sweden chose the least amount of restrictions in the EU, and mobility analysis shows that although the Swedish people changed behaviour drastically, they did it the least of the EU countries. People were doing the most distancing in late March, same as everywhere else, and have been slowly easing up ever since.
And yet, the death rate has been going down steadily in Sweden since mid-April.
Testing has been too low for a long time, but is finally up at reasonable numbers.
And yet, the positive test rate has been cratering the past few weeks.
The Swedish public health agency have done a bunch of random samplings of antibodies to measure the immunity rate, and it always came back at much lower levels than expected. The peanut gallery was quick to crow that Sweden's "herd immunity" strategy was a complete failure, zombie apocalypse etc, but the reason people were surprised that the antibody levels were so low is because it didn't match the actual spread.
Something is pushing the death rate and case levels down in Sweden, it clearly isn't lockdown or distancing measures, and it clearly isn't sars-cov-2-specific antibodies.
There are reports out now that a lot of people seem to have immunity or resistance through T-cell response, presumably as a result of earlier coronavirus exposure.
Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower.
And all of these things together suggest that herd immunity is easier to achieve than we initially thought, and that regions that have been heavy hit, but that now see very little death and cases, might be very close to it.
> Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower.
Yes, this is a great point that often gets missed. This is the principle of vector exhaustion: by definition, those more likely to get infected will get infected first. Insofar as someone more likely to get infected is also more likely to infect others, that means that we see a non-linearity to herd immunity. Getting that first group of highly infectious people immune works wonders.
I don't think the grandparent post is correct. It's not that those who spread best are infected first. It's the ones that are most easily infected (because of their particular biology, lifestyle, etc.) who are first infected.
I believe (but honestly am not certain) that one's susceptibility to infection is independent of one's ability to spread more effectively.
Sure, I'm not saying that there is perfect overlap between the most susceptible and the most infecting individuals.
But people who travel around a lot, meet a lot of different people, are simply more likely to encounter an infected person and get infected, and in turn are more likely to unknowingly infect everyone else they meet. The same mechanisms that make someone a "super spreader" is also what makes them more likely to get infected, and to get infected early in the pandemic.
We know that for example medical personnel got infected in way higher numbers than the general population, for obvious reasons. But they're now also more immune than the general population, for the same obvious reasons. And as a result, intra-hospital spread decreases.
Yes, it's two independent measures, but with very high correlation.
Hmmm. That's a pretty good argument. The biological component is probably completely separate, but the lifestyle component, the opportunity part, overlaps significantly.
I am also highly uncertain of this. Briefly though, elderly people are more susceptible to actual infection, and I would think would be more likely to express symptoms / have higher viral load. So it depends if the marginal likelihood of more symptoms = self-isolating sooner is counterbalanced by more symptoms = spread more easily for a given encounter.
Anyway, ignoring the spreading part, the susceptibility alone does explain it to an extent, as you implied:
> It's the ones that are most easily infected (because of their particular biology, lifestyle, etc.) who are first infected.
What's the upper bound on mortality attributable to lockdown and an environment of unprecedented fear and hysteria?
Maybe start with the impending global food shortage.
And the fact that we've went backwards on poverty, went backwards on vaccines for everything that isn't SARS-2, etc.
And the fact that the physiological and psychological state lockdown puts us in, almost certainly makes us more likely to die of COVID-19 if we get it?
I don't carelessly accept the upper bound. I rationally set an upper bound and ask myself, "is this worst case something I would rather live with, rather than the worst case of the lockdown scenario?".
Then I compared the average cases.
What I found was that the worst case scenario of lockdown is worse, and the average-case scenario is worse. Only the true "best-case scenario" of "we magically get a vaccine in a month, the vaccine works for everyone without any significant repercussions and we manufacture 8 billion doses and the entire globe voluntarily accepts it" is better (although the corresponding best-case scenario of no lockdown is also similarly absurdly positive so best-case scenarios are useless anyway).
--
Tell me, what is the logic in practicing "indefinite postponement" (containment), which accrues on-going, non-linear costs (as well as the obvious linear component), and only ends when we develop a game-changer treatment or vaccine, which is a temporally-unbounded future event.
When has it ever been good public policy to hinge everything upon an uncertain future event? That's just bad strategy.
To use a starcraft analogy, we're trying to sit on one base and tech up while a skilled opponent would be on 4 bases, have a strong econ and then out-tech us anyway since they, you know, actually have a sustainable, functioning economy.
There is no "impending global food shortage". It's also baseless speculation that "psychological and physical consequences of lockdown" make you more or less likely to die.
There is ample precedent, however, of doing lockdown right and basically being done with it: Asia and Europe have many countries with drastically lower infection rates than the US. And most of them are further along the way of opening back up than the US.
> What I found was that the worst case scenario of lockdown is worse, and the average-case scenario is worse.
That is assuming that prolonged lockdown continues to be our response. It clearly doesn't have to as other first-world countries cases have actually been floored.
Aside from complaining about our first run at this, we could/should probably just all wear masks and then spreading is mitigated such that new cases approach zero.
You can't just lockdown and then stop, unless you eradicate the virus entirely, which is impossible.
It only stops in the absence of lockdown when the herd immunity threshold is reached. Period.
The only question is what that threshold is. Without these findings of heterogenous susceptibility, that threshold would be 70-90% depending on your estimate of the effective reproduction number.
With these findings, that number drops to a much lower threshold. Much, much lower.
--
If I can ask you one question, what is your explanation as to how cases have floored in other first-world countries, in the absence of herd immunity, if they are not practicing lockdown?
This is just circular reasoning. Countries with lower rates of cases/deaths "did well" and countries with higher rates "did poorly." The total heterogeneity across the types and timing of responses in countries across both groups doesn't ever seem to raise any questions.
In fact, that's exactly the implication of the Nature paper that's ostensibly the reason for this thread. The more we learn about pre-existing resistance to this coronavirus, the more we can figure out whether measures taken made a difference or were simply coincident with a less-vulnerable population.
But I don’t think scientists think that previous common cold exposure actually makes you immune?
The hypothesis I heard is that this immune response due to previous common cold corona virus exposure could explain the high proportion of asymptomatic cases or cases with very mild symptoms.
Those are already priced in, so we already know about their existence, it would just be an explanation as to why they exist.
I‘m also not sure why you think that even neighboring and very similar countries are so wildly different based on wildly different levels of pre-existing immunity. That doesn’t seem very plausible. Why should, say, Germany and Italy be so different? Or Germany and France?
> But I don’t think scientists think that previous common cold exposure actually makes you immune?
That's the subject of the paper being discussed, it's worth going back and looking at it. The researchers demonstrated T-cell reactivity against it not just in blood from people who had SARS-Cov-1/2 but those who had neither. So something else is going on -- maybe one of the common cold coronaviruses, maybe some other infective but not dangerous coronavirus, maybe something else.
> I‘m also not sure why you think that even neighboring and very similar countries are so wildly different based on wildly different levels of pre-existing immunity. That doesn’t seem very plausible. Why should, say, Germany and Italy be so different? Or Germany and France?
Since we don't even know the source of this pre-existing immunity, much less how it varies between countries, it's impossible to say. But it's clear that there are many differences between what happens in countries that aren't just lockdown timing/severity. Immunity, density, demographics, climate, sheer luck, etc.
See, you haven't actually understood what I'm talking about, so no wonder you think my position/view is contradictory.
I'm not saying that as an insult BTW, just a statement of fact.
Countries stop getting new cases without lockdown measures when they approach the herd immunity threshold. So, if we look at New York, which got absolutely ravaged (relatively speaking), they don't have significant new cases anymore. Not because Cuomo is a genius - he's the opposite - but because there's almost nobody left to get infected.
So, no, while I have been citing American examples because I am quite clearly an American, what I'm saying is relevant to every country in the world. Following a course of lockdown, social distancing and universal masking is simply an exercise in lunacy. At best it has no effect, and at worse it massively increases mortality.
In short, I really don't understand the point you're making. My goal is the maximum aggregate well-being of society, thus I oppose lockdown. If my goal were a more myopic measure like "maximum lives saved" (ignoring that a life is not a life is not a life), lockdown would still be the wrong call. Now if my goal were "minimize COVID-19 mortality regardless of the cost to all-cause mortality", then lockdown may or may not be effective, I personally think that it almost certainly makes COVID-19 mortality worse in the long run full stop, but that point is more debatable. I think the first two are inarguable, though.
Please elaborate more. First you need to tell me what you think the threshold is; the findings in this paper suggest it could easily be like 15-25% as opposed to the previous figures of 70-90%.
Yes, if you take the most wildly optimistic assumption for every single variable, when literally millions of lives are on the line, it might be 15 to 25%. Still Germany, S. Korea, Taiwan, and Japan are no where near that number.
I don't have any idea what the threshold is. No one does. Based on what it tends to be with coronaviruses in general, 65% to 80% is expected. Could be way more or way less. That is why it simply isn't worth the risk of finding out. If it is 65%, then the costs of you being wrong about all this are astronomically bad. If you were 99% likely to be correct, this would be a different conversation. But you are not 99% likely to be correct.
Okay, so on mobile and I’ve already talked too much in this thread so I won’t go in-depth, but you need to read the paper that this thread is about. Your estimates of the HIT are way too high because you are not accounting for the proportion of the population that is immune to COVID-19 infection despite never having come into contact with a SARS-type virus.
Also instead of saying “based on coronaviruses in general” you should just say “based on the basic reproduction number”.
Anyway even if HIT were 65-90% my argument is the same. But the fact that you gave that 65-80% estimate means you don’t understand the math. Factor in the preexisting t cell cross reactivity. Factor in heterogenous susceptibility (risk of infection even controlling for # of exposure events/social interactions varies heavily in the population, for example old people are much more likely to get infected)
TL;DR: you need to do more background reading and update your priors. you’re operating in very stale info. I also think you’ve failed to understand my general argument outlined across this thread but I’m too tired to repeat it so I’d urge you to re-read the comments where I outline my case
There is some tantalizing evidence that maybe just maybe there might possibly be some degree of latent t cell cross reactivity. This is not actionable information, because it very well could be false.
"based on the basic reproduction number" is total nonsense. I am not basing anything on the basic reproduction number. I don't even know what you are even referring to here.
I understand the math just fine. It is you who keep doing the math wrong. You are "factoring in" 3 different variables, each of which are controversial and may not even exist at all. Then you are taking the most optimistic scenario for each one of these variables, compounding your bad math three times over.
Your argument is even more murderous if HIT is 65%. 65% of 7.5 billion people is 5 billion. IFR of 0.3% (which you admittedly completely made up) is 14 million dead? I'm on mobile but I think that's right. You want to kill 14 million people. Even though Japan, S. Korea, Singapore, Canada, Taiwan, Germany, Italy, Spain, heck arguably even NYC right now have proven that this can be controlled.
> SARS-CoV-2 appears to be an incredible spreader and a poor killer
That's only true because we've been able to treat most people who needed hospitalization. The point of the lockdowns is not to prevent deaths from SARS-CoV-2. It's to prevent the healthcare system from being overwhelmed so that moderate-to-high-severity cases go untreated thus increasing the number of deaths.
No, that's not true IMO. There's only so much hospitals can do.
Granted they can do a lot for people in the middle-ground, i.e. giving people oxygen. I don't have a number for how much death they avoid by doing that, but that's certainly where the utility lies.
When it progresses to severe enough COVID-19 that invasive ventilation is required, the battle is basically already lost; at that point something like 90% of invasively ventilated patients die. So, I'm not saying that ventilators don't work, but what I am about to say is, if we assume that without ventilators 100% of those people would die, the effect size is still so tiny that hopefully we can all agree that the whole ventilator circus was a massive distraction.
Anyway, I don't think you were trotting out the ventilator fallacy, just wanted to nip that one in the bud for any onlookers.
So back to the point: I don't know precisely how many lives are saved by those given oxygen but not invasively ventilated, I suspect it does save lives, but overwhelmingly, the reason people don't die from SARS-2 is because SARS-2 can't kill them. Again:
- Most are either asymptomatic or paucisymptomatic
- Many experience symptoms comparable to a mild cold
- Many (probably less) experience more moderate symptoms comparable to a flu
- A small fraction of those infected go on to develop increasingly severe COVID-19 eventually culminating in invasive ventilation and death.
So, all the possible utility of hospitals lies between the "moderate symptoms comparable to the flu" and "severe COVID-19 culminating in invasive ventilation". i.e. if I broke it up more granularly, we'd presumably find a category of people not bad enough to ventilate but who have very bad symptoms, and that's the faction that hospitals really help.
Anyway, hospital overrun is simply not a real concern in a place like the US. We should be more worried about the opposite - hospital scaledown.
And the reason hospital overrun isn't a concern is because COVID-19 is mild enough for most people that we don't get the hordes of people we were expecting. We do get quite a lot of people at peak, but it's manageable with some shuffling.
I'm much more concerned as well about the suspension of elective surgeries. We're going to see so many more deaths due to cardiac disease (which kills more than COVID btw), undetected cancer, etc as a result of this
> at that point something like 90% of invasively ventilated patients die.
Remember that America in general is a lot more intervention-happy than other places. It's more important to "do something", even if that something is net-negative or net-neutral. And therefore, the survivor statistics of ventilated patients in the US is absolutely atrocious.
As you can see, the survival stats are much better. 47% of the 80+ patients lives. 70% of the 60-79 group lives. 85% of the 40-59 age group lives.
But as you can also see, the number of treated patients in the 80+ group is very small. And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time.
Of course, that has been interpreted as Sweden callously sacrificing the elderly by denying them care.
But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator.
But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
> But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator.
> But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
Yes, I totally agree. Maybe didn't make that clear above, but my point was even if we pretend/assume that the ventilators are helping, the effect is small.
I think it's highly likely that invasive ventilation as applied just ended up making things worse.
> And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time.
Exactly. It's just such an American mentality. Same reason we wanted to hold up Hydroxychloroquine, Remdesevir, etc. Not saying they don't work, but that focusing on antivirals detracted from the real discussion we should have been having all along.
We're too accustomed to perfect technological solutions which let us avoid having to face the reality of our own mortality (and the mortality of our loved ones).
I’m starting to wonder is this is true. Looking at the data from the Los Angeles county dashboard and the relatively low death rate yet high infection rate seems to support this theory. Just something to think about.
Regarding the "long-term damage"... here's a post that goes into that aspect. There are sources. Saying it's unfounded shows who is pushing a "narrative".
These numbers and the permanence of the effects may be off, but hardly unfounded.
The issue I have with pushing the idea that it's a mild virus, despite loads of evidence it's far more dangerous than the seasonal flu, is that it results in less societal countermeasures.. prolonging this for all of us, and endangering those at-risk or with at-risk family members.
Keep in mind that going to the hospital can be financially ruinous.
Please wear a mask, don't throw parties, and consider your fellow members of society.
PS. quoting sources is a good way to share real information, outside of "the matrix".
The sources clearly do not support the post. Looking at the first claim of permanent disability, Veaux asserts that 90% (18 out of 20) hospitalized patients will have permanent heart damage. His source for this claim is a study showing, by his own quote, that 19% of hospitalized patients experienced cardiac damage of unspecified duration.
It seems obvious to me that he just fabricated scary numbers without regard for whether they're true.
I am happy to provide sources; as I explained elsewhere, I've had a crazily high number of encounters where I provide a bunch of sources and then get flagged or downvoted etc, which is very demoralizing so I've gotten into the habit of waiting until people bite to pull out sources.
Let me start by out-lining my beliefs about long-term damage or the other classic complications of blood clotting, stroke, or pediatric multi-inflammatory syndrome:
(1) Any time the body enters a state of pathological cytokine release syndrome, basically any runaway inflammatory cascade, a lot of really bad shit happens. Blood clotting, strokes, etc. What's important to understand is that (a) this is not at all unique to COVID, we see it with flu and any of the other dozen classes of virus that can make you sick, and (b) statistically, they happen in incredibly small numbers.
(2) Medium-term damage in the sense of your lungs taking a month or rarely, even longer, to recover absolutely can happen, we see it with SARS-1. But at the 1 year mark, for example, people's lungs look totally normal. I tend to use SARS-1 infections as a model for what severe COVID-19 (caused by SARS-2 just as a reminder) looks like. So I think SARS-1 gives us a great upper bound.
There is a narrative specifically that people who don't have bad symptoms will have hidden long term damage, that's just complete bullshit and there isn't much for me to debunk. As far as the real severe COVID-19 cases that do have some type of complication, again they might have damage for a few months, certainly not beyond the 1 year mark.
Let's talk about strokes. The "strokes in young people narrative" (which I can't resist mentioning was heavily pushed by CNN, who as you can tell I have an incredible disgust for, because until this year I truly didn't realize how far they had fallen) AFAICT stems entirely from this series of case studies:
Normally with scientific stuff, what happens is that news orgs take the study, misrepresent/oversimplify the conclusions and twist its meaning. Well, that did happen to an extent here, but actually the actual title of the article ends with "in the Young". Now, maybe there's some medical definition of young that I am not aware of, but this study does not look at young people, it looks at non-elderly people. So, in my opinion, there are a lot of scientists that are basically editorializating their own work. In other words, there is a large faction of people so incredibly concerned about COVID-19 that their bias is seeping into their scientific work. Anyway, I actually love this paper, because of the buried lede about lockdown/hysteria actually making things worse, which the authors seemingly tried to not draw attention to.
* "Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic."
* (for those concerned about stroke in the young, note the occurrence is rare in those without comorbidities. And "young" here means "not old" [youngest was 33, oldest was 49, 3/5 had serious risk factors])
My commentary: So, the first irony is that people who actually had COVID-19, and had it severely enough that they literally ended up developing strokes, were afraid to seek medical attention for quite some time, because they didn't want to catch COVID-19. My interpretation is that the media hysteria, etc has/had hit such a point, that even though they were probably feeling sick and like total garbage, they thought to themselves...
I never said that old people are worthless. I just said that, it does not make sense to fight a virus with clearly-defined risk categories by shuttering a whole society. And yes, I know the argument about "even if you won't have a bad outcome you will spread infection which will eventually kill grandma".
Overwhelmed healthcare systems are something we need an economy that's actually working to support. But note that most of what you've heard about ICU overrun is more or less a complete fabrication. Even New York, which got absolutely ravaged, had certain hospitals overflowing, yet nearby hospitals had tons of capacity. So yes, it's not ideal to have to shuffle patients around, but that's how our system is designed - we've had to do exactly that for just bad flu seasons, etc.
Anyway, ultimately, I feel that we are harming Grandma more with the lockdowns, particularly given that there is essentially no correlation between locking down and preventing death (actually the correlation is negative, and the inverse correlation, death being correlated with lockdown, supposedly does not exist although I didn't run the numbers myself to verify if that claim was true).
Finally, if you think about someone who is 80 years old and maybe has a couple health conditions, and thus a short life expectancy: What is the marginal cost to them of being locked down for a year? That might be 33% of their remaining life-time. Now, I'm not elderly so I can't speak for them, but I think many of us young-ish people have failed to think about the notion that the marginal utility of being able to live a normal life should be higher for old people. They more or less live in physical discomfort, and so the whole point of life at that age is to interact with your loved ones, sit on the patio and bask in the sun (or go to the beach), etc.
So, really we should give people the choice. If they want to self isolate and live a life bereft of human contact, more power to them. But to force it upon people who don't want it - which includes some or maybe many highly-at-risk old people with comorbidities - is wrong, in my opinion.
We (society) tried to act that haircuts, going to sports games, going to the beach, going to bars, etc were "non-essential". But when you think about it, that's literally what life is.
I get very saddened when I see 6 year olds walking around wearing masks (BTW, I always see them pull down their masks to wipe the sweat that has coated their face under the mask, which is one of many reasons why masks probably don't even work in the general public). It's extra sad when you realize that not only are kids not personally at risk, but overwhelming evidence shows - much to my personal surprise - that they don't even spread the damn thing in significant numbers.
No, everything about our response is wrong and counter-productive in my book, and it makes me sad that I can't express those views publicly without being screamed at by people who are, quite literally, brainwashed.
Fuck, the amount of people who used to show up to the office with very obvious flu symptoms a year ago, and now are screeching at people on twitter for having a maskless gathering in their backyard - is super depressing. The level of hypocrisy and more importantly, completely irrational risk appraisal, is so concerning to me. There's just no logical consistency to be found anywhere, I'm afraid.
> The level of hypocrisy and more importantly, completely irrational risk appraisal, is so concerning to me.
Well, there's a well known human bias with regards to risk assessment. We consistently overvalue new and unfamiliar risks, and undervalue known and familiar risks. This is why some people are deathly afraid of getting on an airplane, but perfectly fine driving to the airport, even though statistics dictate that the actual risk is the opposite of what they think it is.
As for corona, a huge mistake we're making is that we're looking at the death numbers for it, exclusively, myopically. We have to look at total mortality and total excess mortality, over time. A lot of things kill people all the time, and we never freak out about it. Flu seasons kill people all the time, and we never freak out about it.
I'm Swedish, and Sweden has been mercilessly dragged through the shit in international comparisons over its handling of the virus. Sure, in isolation, covid-19 deaths in Sweden are much higher than its Scandinavian neighbours.
But if you look at total all-cause mortality, and if you look at flu seasons instead of calendar years, the 2019/20 flu season in Sweden, with all the covid-19 deaths included has resulted in Sweden still being below average total mortality compared to the last 20 flu seasons.
More people are alive, in Sweden, today, than the statistical average would predict. And this is a "disaster". How? The covid-19 dead in Sweden are overwhelmingly old people who were statistically likely to die already anyway, and them dying now from this is a "disgrace". How? No-one gave a shit about more old people dying from similar causes previous years, why does anyone suddenly give a shit now?
Yeah, the way people will tell me "look at Sweden!", meaning, "look at how awful Sweden did!" is just mind-boggling. I am insanely jealous of your guys' medical/health leadership.
I'm sure the approach of disfavoring ministerstyre bites you guys in the ass for certain types of problems, but for something like this, the fact that the ministers are not allowed to run the show is such a blessing.
(Of course, if we tried it in the US it would almost certainly fail, because even people like Fauci or the CDC head are just completely crazy...but we're not allowed to admit that)
--
Along similar lines, all the myopic IFR talk made me think about how, if we had a decade where there just happened to not be any major pandemics, a very generic common cold virus could come around with an IFR of >1% simply because there's such a high proportion of elderly people practically on death's door, who have been more or less artificially kept alive and so of course the IFR is going to look bad if it wipes them out.
> the fact that the ministers are not allowed to run the show is such a blessing.
To be fair though, there's nothing stopping government from ignoring another government agency and doing their own thing, that's what basically happened in Denmark and Norway, where their governments enacted stricter measures than their own public health agencies recommended.
The Swedish government could have done that, but it's currently a weak coalition government, which is why they adopted a more passive role.
> if we had a decade where there just happened to not be any major pandemics
In what I'm sure is a just a super coincidence, the past couple of flu seasons were extremely mild in Sweden, compared to neighbouring Denmark and Norway, which had normal flu seasons instead. I saw a twitter thread that talked about it in terms of brushfires and kindling. Dehumanizing, sure, but also pretty damn accurate:
> even people like Fauci or the CDC head are just completely crazy
I realize this is an appeal to authority, but when you say things like this, it makes it hard to take you seriously. "Completely crazy," really? Just read this guy's biography and tell me he's not qualified: https://en.wikipedia.org/wiki/Anthony_Fauci
Meanwhile, what we have on this forum is a bunch of 20-something tech kids throwing around research paper fragments that they've vacuumed up in their spare time. Gee, which of the two should I trust more?
The policies they advocate (lockdown specifically, but also universal masking) are completely crazy. The policies that the CDC head is recommending for schools are completely crazy.
The fact that Fauci has had such a long and successful and relevant career makes his failure here all the more painful. I think he’s a smart guy. But he was put in a highly stressful position, barely sleeping for months on end...I can’t fault someone in that type of situation for being unable to snap out of collective delusion. But yes, he’s still deluded.
I understand why that statement of mine causes strong reactions. Indeed I considered omitting it because I know how many people reflexively downvote the moment they see that.
But for better or worse I decided not to pull punches.
"Completely crazy" is a strong choice of words for a policy that has been independently enacted in practically every country around the world, often from the bottom up (people isolating en masse after death starts to encroach on their social circles) and sometimes very successfully (China). You say people have collectively gone mad; I say that the policy makers have access to more facts, better contextualized research, and a more holistic assessment of the situation than any armchair scientist. (Caveat: I don't know anything about the head of the CDC, so I'm only speaking for Fauci.)
To be clear, continued lockdown absolutely sucks, and we should be doing something like this instead: https://www.youtube.com/watch?v=HhRQxk9QA-o. (A brief period of lockdown, mass testing, contact tracing, supported isolation, and gradual reopening.) But hey, America.
As for masks, they're a) cheap and trivial to implement, b) have been in use for decades in countries around the world, and c) seem to prevent spread by a non-trivial amount (according to recent articles I've come across). It's downright absurd to call such a policy any kind of crazy in the middle of a pandemic.
> No need to bring in animals to explain this. There are a handful of human coronaviruses - I think 4 that are not SARS-related, but I’m on mobile so will have to dig up the study later.
Read the paper, they're making a distinction there because the zoonotic viruses are different to the endemic human ones, but closer to SARS-CoV2.
> Besides, once a virus jumps from an animal it either becomes a human virus (capable of spreading), or somehow is a one-off virus that can jump from animal->human but not subsequently to another human.
That's the point, the zoonotic viruses aren't spreading in humans, but they may well elicit an immune response.
> Read the paper, they're making a distinction there because the zoonotic viruses are different to the endemic human ones, but closer to SARS-CoV2.
To your point, the paper says this:
> Even though we cannot exclude that some SARS-CoV-2 reactive T cells might be naïve or induced by completely unrelated pathogens5, this finding suggests that other presently unknown coronaviruses, possibly of animal origin, might induce cross-reactive SARS-CoV-2 T cells in the general population.
I did miss that detail. Thanks for pointing that out. I'll need to think more on this. My gut feeling is that, if these are zoonotic viruses that are not human-transmissible, how could this phenomenon be so widespread?
EDIT: Ah, it sounds like, they detected some that could only be explained by zoonotic CoVs, whereas the majority could be explained away by exposure to human coronaviruses? (I'm planning on circling back to read the paper more closely later but need to take a break for now)
You are being downvoted because you are just plain wrong. What exactly do you think happened in Bergamo? NYC? SARS-CoV-2 is much worse than the flu. It is not overall a fairly mild virus. You don't see hospitals running out of ventilators and ICU capacity being overwhelmed every flu season. Once it passes through the entire population, we could very well see 5-10x the deaths we've seen already, or even considerably more. That's 5 MILLION people dead from a single NEW cause.
Could you give me an example of a hospital in the US that ran out of ventilators? I'll wait.
> Once it passes through the entire population, we could very well see 5-10x the deaths we've seen already, or even considerably more. That's 5 MILLION people dead from a single NEW cause.
Are you speaking globally or in the US? If you think 5 million would die in the US, your upper bound is off by an order of magnitude.
Off by an order of magnitude if we take YOUR assumed IFR, which you literally admit you "pulled out of [your] ass." Off by an order of magnitude if we ignore the clear lessons of Bergamo, that once it gets roaring the healthcare system has to make suboptimal choices. In other words, I am not off by an order of magnitude.
You want an example: watch this video https://youtu.be/bE68xVXf8Kw . A primary source that entirely refutes your ridiculous assertions.
When I said I pulled it out of my ass, I mean I examined the totality of seroprevalence surveys at the time and chose it as a sane average to work off of. So yes out of my ass, but in the sense that my argument doesn’t change if the IFR is .1% versus .7%. That’s what I meant. Unfortunately people like to myopically fixate on IFR as if the way we respond to .6% is fundamentally different from .3%. It’s not.
You’re off by an order of magnitude because your estimate is more than twice what Ferguson’s paper estimated. Ferguson modelled worst case scenario in US as .9% IFR with 82% of pop infected for 2.2 million dead. Taking that IFR and adjusting for a HIT closer to 20-25% due to the new findings is how I got the statement that you are off by an order of magnitude. You are. Again your estimate is larger than the craziest doomer epidemiologists (Ferguson).
If you respond, please make sure to address the last paragraph. And go read Ferguson if you haven’t. The paper is “wrong” but it’s a great upper bound for worst case scenario with no t cell cross reactivity and absurdly high IFR (thus why it’s a worst case).
Ventilators were not a problem and the hysterical NYT video has not proven that whatsoever.
You're being downvoted because __blockcipher__ presented a reasonable and rational argument, to which you responded with nothing but pathos, and nothing deeper than newsreel soundbites unsupported by actual science.
__bc__ might be wrong, but an hysterical retort is not the way to prove that to the rest of us. And for my money, there's at least something in his comments that's worth considering.
There is nothing reasonable or rational in bc's arguments. He is admittedly assuming an IFR out of thin air that fits his murderous agenda. He is also assuming an absurdly high likelihood that actual herd immunity begins to kick in at like 20% seroprevalence, which no one who actually has technical expertise in these matters would suggest. Once you assume an absurdly low IFR and an absurdly high latent immunity, well sure everything else just falls into place. You can layer on all the citations you want after that, but it doesn't change the fact that the entire thesis is built on a foundation of sand.
I agree with your criticism of his IFR assumption, but the way you're doing it ("his murderous agenda") is incompatible with rational debate. Stop resorting to pathos, and instead be dispassionate and back it up with facts. In this case, I actually did call him out, citing the CDC's most recent estimates of 0.65%.
> absurdly high likelihood that actual herd immunity begins to kick in at like 20% seroprevalence, which no one who actually has technical expertise in these matters would suggest.
You're the one in the wrong here, and that suggests to me that you've just latched onto popular media misunderstandings of the science - and your refusal to actually support your claims is allowing you to make these mistakes. To enlighten yourself on this topic, look at https://www.theatlantic.com/health/archive/2020/07/herd-immu...
Quoting from that:
It doesn’t make intuitive sense, Gomes admits, but “the homogenous models just don’t make curves that match the current data,” she said. Dynamic systems develop in complex and unpredictable ways, and she believes that the best we can do is continually update models based on what is happening in the real world. She can’t say why the threshold in her models is consistently at or below 20 percent, but it is. “If heterogeneity isn’t the cause,” she said, “then I’d like for someone to explain what is.”
At Stockholm University, Tom Britton, the dean of mathematics and physics, thinks that a 20 percent threshold is unlikely, but not impossible. His lab has also been building epidemiological models based on data from around the globe. He believes that variation in susceptibility and exposure to the virus clearly seems to be reducing estimates for herd immunity. Britton and his colleagues recently published their model, demonstrating the effect, in Science.
“If there is a large variability of susceptibility among humans, then herd immunity could be as low as 20 percent,” Britton told me.
I am not resorting to pathos. I am rationally pointing out that _blockcipher_'s solution is to unnecessarily kill a bunch (easily millions) of people. That is a murderous agenda. There is no exaggeration. Just facts. Your attempts to paint me as the irrational pathos-ridden one with a thesis built on a foundation of sand and paper-ed over with non-sequitor citations in this conversation are transparent.
I don't need any additional support when your own sources are telling you that it is highly unlikely that herd immunity kicks in at 20%. As an actual scientist, I can tell you that when someone says " a 20 percent threshold is unlikely, but not impossible", it means exactly what it says. Impossible is a very high bar (essentially unobtainable in biology), and when you invoke it you mean that whatever possibility there is is very very very very low.
But, he (and the paper authors!) seem to skim right over what might be the most important conclusion:
> Recognition of the nsp7 and nsp13 proteins is prominent, ~as well as the N protein~. And when they looked at that nsp7 response, it turns out that the T cells are recognizing particular protein regions that have low homology to those found in the “common cold” coronaviruses – but do have very high homology to various animal coronaviruses.
This "NP" or "nucleocapsid protein" has high homology to "common cold" human betacoronaviruses (OC43 and HKU1), so this basically means that previous exposure to these colds should confer some degree of immunity to SARS-CoV-2. The novel result that everyone seems to be dwelling on is interesting too, it raises the possibility that coronaviruses are transmitted from animals to humans more often than had been previously thought.
I remember at the start of this an infectious diseases professor commented how if you had the antibodies already against CoV you'd be fine, but if you had only half, you were at a significantly higher risk of death.
I guess the immune system can misidentify as well--I bet we haven't taxonomized everything fully yet so eventually we'll have a new name for what immunity is required.
I have no clue! I just heard this a while back on some random video three months ago from an infectious diseases professor. My knowledge of biology is very low, I really shouldn't be speculating publically, I thought it was less controversial knowledge. I've probably just phrased it badly or remembered it in too simple of a manner due to my lack of background here.
I think half is a simplification, it must mean that if you have the wrong type or quantity or some combination thereof, but again I'm guessing and not an expert or even a professional.
There's no way in which having real antibodies, but a reduced amount of them, would be worse than not having antibodies, but the following is very possible:
> It is likely that in older people the production of antibodies is slower and by the time the antibodies are developed in the titer that is sufficient to neutralize the virus, the virus changes its antigenic determinants. In this case, immuno-dominant neutralizing antibodies might start forming unstable complexes with the new form of the virus and start to infect monocytes/macrophages causing ADE. This process can trigger generalized infection of immune cells in multiple organs and cytokine storm
It's possibly by type and not mass, ie, one of each type of antibody versus various strains of COVID. I think that would make the most sense to me given the conclusion--if you don't have the right antibodies but have some you may be more susceptible to some strains and less susceptible to other strains. I will see if I get the time to find the original source.
Yeah that still doesn't make sense haha. It's not really a different strains thing. But if you read about ADE you'll see that, I don't understand it perfectly but more or less you have a partial match which seems to make the immune system turn on itself. (I butchered that but it's been a long day...)
Well it could be based on ADE--certain strains of coronavirus antibodies will help other strains replicate. In any case, I do remember quite clearly "half" but it was towards a very lay audience.
^ This should be mandatory reading for anyone. Especially people that are obsessed with the idea that all vaccine candidates are inherently safe. (Unfortunately the term "anti-vaxxer" now gets thrown around for any actual legitimate discussion of the risks of untested vaccine candidates).
I'd note that ADE literally happens in Coronaviruses, so it's extra relevant. It can even happen outside the context of a vaccine, and may play a role in the pathology of severe SARS-CoV-2 infection.
Coronavirus is a family of viruses, viruses being basically pieces of genetic material that swim around, inject their DNA into other cells, which makes the cells produce more copies of themselves until thousands of baby viruses explode out of the cell, killing it and moving on to the next cell.
COVID-19 is the condition that results from infection with SARS-CoV-2, which is a novel coronavirus that almost certainly emerged sometime in 2019. Think HIV/AIDS: HIV is the virus, AIDS is the disease, same with SARS-2 vs COVID-19.
SARS-CoV-2 while technically novel, is incredibly close related to what we now call SARS-CoV-1, which we used to just call "SARS". SARS-1 was incredibly deadly, but the pandemic fizzled out, presumably because it is quite deadly/quite symptomatic and AFAIK there isn't pre-symptomatic transmission.
SARS-CoV-2 structurally is very similar, sharing the same characteristic spike protein, and targetting the same ACE2 receptor which is expressed differentially in different tissue types. But SARS-CoV-2 is like a refined version of SARS-1, it "learned" from SARS-1's mistakes. So, it appears to be adapted to spread quite well, possibly because of cool things it does with interferon-mediated early course immunosuppression, which lets it spread for a few days before you show symptoms. It's also much less deadly than SARS-1.
Now, to craft the "optimal" pandemic virus, you want something that spreads easily, has a long incubation time, and isn't too deadly (otherwise it fizzles out by killing its hosts before they spread sufficiently). So in that sense, SARS-2 is perfectly crafted to kill a bunch of people. But please don't fall into fear-mongering, it doesn't kill nearly as many people as most have been led to believe. In my opinion it's really quite a mild virus overall, but some people can have severe COVID-19 which presents very similarly to a more run-of-the-mill SARS-1 infection (remember the original SARS is very deadly, so run-of-the-mill != no-big-deal).
REVIEW SECTION 2
We've talked about SARS-1 and SARS-2, but let me briefly butcher the immune system (I can already hear the immunologists stampeding towards me in the distance).
Your immune system's job is to distinguish self from non-self, (or more accurately, "non-self that is actually a threat" since you can have bacteria/etc that are not pathogenic/pathological). When it identifies a target, it has a lot of cool ways to kill it, but the specifics of neutrophils and antibodies, etc are out of scope.
For now, take it as given that your immune system can detect and kill pathogens.
Once it has fought off an infection, you will likely have antibodies, which are little heat-seeker-missiles that are primed to detect and neutralize the pathogen in question. (Note there's also T-Cell immunity which operates perhaps orthogonally to antibody immunity. This paper talks about T-Cell immunity).
Assuming you produced antibodies, eventually your active circulating antibodies will fade. This takes several weeks-a few months for SARS-1, and seems to hold for SARS-2, although I believe antibody prevalence is correlated with disease severity.
So eventually you have no more circulating antibodies. Contrary to what doomers will tell you, that's not a bad thing, it's inefficient to perpetually maintain antibodies. So instead your body maintains a living library of the pathogens it has previously encountered.
The rest of your comments aside, which I don't have evidence to address, "it was still really obvious to anyone with the capacity for rational thinking that containment/lockdown was a terrible idea" is just absolutely, patently untrue (if taken at face value and not just as a snipe). In fact, I'd say that most people I know with the "capacity for rational thinking" — including scientists, doctors, and amateur COVID researchers who dig through the scientific literature every day — would strongly agree with some form of lockdown.
I am immediately suspicious of "everyone has gone mad except me" arguments, and I'd posit that "worldwide hysteria" just isn't a thing that happens without good reason.
Worldwide mania is just an extension of that. Since I believe that literally social media / the internet / other aspects of modern technology have allowed the propagation of mind-viruses to a degree never seen before, I truly believe that it is simply a state of mass collective delusion.
> "it was still really obvious to anyone with the capacity for rational thinking that containment/lockdown was a terrible idea" is just absolutely, patently untrue (if taken at face value and not just as a snipe).
Okay, you are right and I let my frustration be visible there, I agree that it is not a fair characterization. More accurately, I feel that people who came down on the pro-lockdown side have the capacity for rational thinking and yet were/are not using that capacity insofar as COVID-19 is concerned.
> I am immediately suspicious of "everyone has gone mad except me" arguments
You should know that I am too. I spent quite some time trying to figure out what obvious thing I was missing.
Well, I think enough evidence is in at this point, if you're willing to look at it. The truth is that otherwise intelligent and knowledgeable people can very easily fall into states of delusion. It's no secret that as humans we are endowed with an incredible set of cognitive distortions, that presumably had adaptive value at one point, but now hamper efforts towards rationality.
If you've ever taken the time to synthesize a body of research into a coherent whole - not necessarily writing an actual paper etc, but just trying to iterate and construct a really good mental model - then you know what an enormous amount of careful thought, effort, and intelligence it requires. It's simply not easy to do, thus I think that the majority of doctors really just regurgitate the things they learned in med school, the majority of scientists do their version of that, the majority of software engineers just make whatever hacky change they need to get their feature out without thinking about the whole system (often because the system is crushingly complex, etc).
So when I look at what our "leaders" and public health officials have done, I see a total failure to take that mentality, a total failure to see what was really there in front of them. And I don't necessarily blame them; it's well known that an environment of sleep deprivation and stress cripples the capacity for cognitive flexibility.
Anyway, to conclude, you are right that my characterization was unfair. I do stand by the notion that they behaved irrationally, but not because of some fundamental lack of ability to be rational, but simply because truly being rational takes an incredible amount of careful attention. (And obviously, none of us, myself included, are truly rational, but what I mean is, are you near that asymptote or are you off in the woods somewhere ranting about how it's too unsafe to open up our schools, etc)
> IFR takes into account both symptomatic and asymptomatic cases and may therefore be a more directly measurable parameter for disease severity for COVID-19.
> Spreading the idea that shutting down was unwise is incredibly irresponsible.
Nonsense. I would argue that spreading the idea that shutting down was a good thing is and was incredibly irresponsible, but the difference is I don't believe in suppressing other peoples' ideas. But pro-lockdowners seem to love it. For the same reason they like the lockdown: it's a mentality that stems from a love of compulsion and control, and a sharp anxiety about living a full life.
> I'll let you do the math on how many are estimated to die without mitigation.
I don't advocate against mitigation (nursing homes, etc), but I advocate against containment full-stop.
Anyway, I have done the math. In fact, I've done the math with an IFR of .9% and assuming 82% of the population got infected (see Ferguson's paper).
2.2 million deaths. That's what the worst case scenario was.
And on balance, it was worth it.
What do I think the actual number is? Well, I'd use a new upper bound of maybe 600,000 - which BTW is around the number of cardiac deaths per year in the US. Amortized across 5 years, it becomes even less shocking.
These are upper bounds, btw. I think the actual number could be lower, but I don't bank on it. Unfortunately, given the way we classify deaths, it will be very difficult to find out what the "real" death toll was looking back.
You'd effectively have millions of additional deaths from lack of hospital capacity, more than doubling the yearly death rate. And additionally you'd have millions of more people with debilitating complications from all causes.
That's absolute insanity. You're devaluing life. Stop it. It's frankly scary to think you're out there.
Huh? No it wouldn't. Read my other comments in the thread, the point is that after it works its way through the population, the set of SARS-CoV-2-naive individuals becomes dominated by new entrants to the world (babies/toddlers), who don't die from COVID-19.
So over a period of 5 years, the average yearly death will be this year's deaths / 5. That doesn't hold in the same way for the Flu since it does kill babies.
> You'd effectively have millions of additional deaths from lack of hospital capacity
This is just false. I can't really debunk it because you didn't make an actual argument, so let's leave it at that.
> And additionally you'd have millions of more people with debilitating complications from all causes.
Huh? Are you saying complications from COVID-19 itself, or are you saying non-covid reasons which would get neglected due to lack of medical care?
> That's absolute insanity. You're devaluing life. Stop it. It's frankly scary to think you're out there.
No, I actually value life, which is why I understand how precious it is, and what a cruel thing it is to do to subject an entire planet to a regime of isolation and fear. As I've said elsewhere in this thread, I also believe that lockdown leads to more mortality than doing nothing, so even if you don't care about wellbeing and just want to myopically look at lives saved, I'm arguing that lockdown is worse on both counts.
123 comments
[ 3.7 ms ] story [ 205 ms ] threadIt's seems plausible that animal coronaviruses induce an immune response in humans that can later help against SARS-CoV-2. If so, there should be a correlation between animal contact and COVID-19 severity.
Besides, once a virus jumps from an animal it either becomes a human virus (capable of spreading), or somehow is a one-off virus that can jump from animal->human but not subsequently to another human. If the latter, that effect is so negligible it would not explain 20-50% of SARS-CoV-2-naive individuals having t cell reactivity.
—-
While I’m at it, just a reminder to all that SARS-2 overall is a fairly mild virus, and the level of hysteria and death-inducing counterproductive response (lockdown, suspension of elective surgeries like Newsom did for a month here in California) is completely divorced from the fundamentals of this virus.
Also a reminder that unlike flu, SARS-2 primarily kills the very old / very unhealthy, whereas flu kills the very young and the very old. Thus when you run the math on population dynamics / herd immunity, the recurring yearly deaths will be vanishingly low (unlike flu) and thus amortized across years, SARS-2 is even leas deadly than the current numbers imply.
This is because once it has passed through the population, the set of SARS-CoV-2 naive individuals becomes dominated by new entrants to the world (babies/toddlers) who essentially have 0 risk of dying from COVID (it’s basically a rounding error). Thus while SARS-CoV-2 is and will remain endemic (circulating in the population), it will barely kill anyone once the current world population is largely exposed to it.
—
Finally, a reminder that mentioning stuff like the above tends to result in censorship from social media platforms, which combined with the incredible bias of “news” organizations like CNN etc, means that those who are plugged into the matrix will never encounter real information about this threat. And surprisingly (although in retrospect it shouldn’t have been surprising to me), there are a lot of people on HN that have dranken that very kool-aid and thus will reactively downvote or even flag commenters who present their beliefs (however founded or unfounded) about the true danger of this virus versus its purported impact.
Also, since I’m already ranting, I just want to throw out that the narrative around “long-term damage” (often stated to be lifelong) is completely unfounded and contradicted by the research we already have about SARS-1, which is SARS-2’s much more deadly yet much less popular older brother.
You mean once _all_ the people who could die from it, have died from it?
I anticipated this response of yours. It sounds like a great gotcha in its surface, until you realize that every fast-spreading respiratory virus works like that. It's happened with every flu pandemic, including the recent H1N1.
SARS-CoV-2 appears to be an incredible spreader and a poor killer. What that means is the cost of perpetually trying to avoid infection are very high, whereas the benefits (avoided mortality) are quite low.
Case in point, SARS-CoV-2 exhibits a fairly high degree of pre-symptomatic spread. I believe that this is almost certainly due to the findings of interferon-mediated early-course immunosuppression (read: in the early days of infection it prevents your immune system from reacting strongly, meaning that unlike many other diseases there is a period where you have enough viral load to spread it yet don't express symptoms). Also note that it does not exhibit asymptomatic spread, which would be even "worse" since pre-symptomatic spread only gives you a window of maybe days whereas asymptomatic is by definition across the whole disease course.
Now factor in the fact that many people are either completely asymptomatic or paucisymptomatic (few symptoms). For those people, which may even be the majority of cases, it's such a not-big-deal that most don't ever realize they've had it. Some will have more of an actual cold, and some will have symptoms comparable to a run-of-the-mill flu. A small fraction of those infected will go on to experience increasingly severe symptoms, probably comparable to a normal SARS-1 infection (since SARS-1 is quite nasty), culminating in the worst cases in the need for invasive ventilation at which point death is incredibly difficult to avoid. (This is obviously an area of active research but it appears that the severe form of the disease is related to a state of immune disregulation where pathological cytokine release syndrome, the tissue damage from widespread neutrophil infiltration, etc wreak havoc).
So, we have a virus that spreads incredibly well, yet is overall incredibly mild, and has very well-defined populations who are at real risk of severe outcomes. That is precisely the type of virus that is a horrible candidate for lockdown, which damages the entire society in the attempt to prevent what is perceived as a greater threat (but is actually not, in my opinion).
So, as a society we saw a papercut and chopped off our hand. Oops.
I am happy to provide sources for pre-symptomatic spread, interferon-mediated immunosuppresion, etc, but first I wanted to make sure that you were here to engage in good faith dialogue; i.e. whether I can convince you or not, you are actually willing to read (or try to read) the papers. I'm a bit scarred by numerous times (here and elsewhere) where I've invested a bunch of time into detailed posts and then quickly realized that the person on the other end was never serious about addressing the problem of SARS-2 but instead was there to toe the party line and reinforce their pre-existing conclusions.
Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization. H1N1 was never this bad, and we are no near achieving any herd immunity.
"The 2009 H1N1 pandemic was estimated to be associated with 151,700 to 575,400 deaths worldwide during the first year it circulated."
The observation of widespread cross-reactive T Cell immune response does not support this claim. If 50% of the population is less susceptible, this would dramatically alter the herd immunity threshold. The binary condition "totally susceptible or totally immune" is merely a fiction used in some models, and any individual variation away from "totally susceptible" has the same effect:
https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v...
If NYC does not see a second wave, and their seropositive numbers stay below or around 30%, this is why.
Given that we cannot time travel and all.
Also, other countries well below 30 percent seropositivity also don’t show signs for second waves, so that‘s an indication that your explanation isn’t the only possible one.
Also, healthcare systems were overwhelmed nevertheless and with measures (lockdowns) in place.
So yeah, pretty awful argument.
https://www.militarytimes.com/news/your-military/2020/04/14/...
https://nypost.com/2020/05/02/nyc-hotels-meant-for-recoverin...
https://www.amny.com/coronavirus/brooklyn-field-hospital-shu...
I agree that ICU capacity, PPE inventory, and non-infected personnel were all in short supply at times and in places, but it's not such a simple conclusion as you claim. Consider that early venting seems to have been a terrible blunder, which also used up valuable ICU capacity:
https://annalsofintensivecare.springeropen.com/articles/10.1...
The USNS Mercy was sent to Los Angeles, you probably mean to refer to USNS Comfort which was in New York. But both Mercy and Comfort were offered by the Feds for non-COVID-19 patients only.
The same question can be asked about the Comfort of course, but I guess we can shift responsibility to the Feds for that fuck-up.
That doesn't affect the argument. The fact is that the other facilities were able to handle the total of "normal" patients as well as COVID-19 patients. The entire set of patients did not get to a size sufficient to need those boats.
This is obviously due to the absolutely massive measures they took. They managed to put on the breaks just on time.
Italy was maybe a couple centimeters more under water but also not totally overwhelmed.
But Italy actually had to ban people from going outside (with tight exceptions) to achieve that which is nuts.
If you were testing more and catching it earlier you could get there with much milder measures (e.g. in Germany) and hospitals that came never close to being overwhelmed, as in Germany.
I don’t get you non-sequitur about people in nursing homes. How am I supposed to respond to that? Yeah, that‘s stupid? Because it is?
This is not self-evident. Most evidence seems to show that lockdowns didn't start till after the peak anyway.
This is more or less a myth. The real story is the massive scaledown in medical capacity across the country.
Locally, in New York, certain hospitals hit capacity. Other hospitals nearby did not.
Additionally, if the goal is only to avoid hospital overrun, you should concede that our current strategy is totally misguided, since we are trying to suppress spread way beyond the threshold required to prevent overrun. (Actually, I believe that we could do literally nothing to slow spread and not have a true overrun scenario, but that's a discussion for another time)
Case in point: In California our Dear Leader Gavin Newsom just plunged us right back into lockdown, including closing fitness centers (gyms), despite our hospital system being in completely fine shape.
It's all a farce. I don't use that word lightly.
As a thought experiment, imagine a world where SARS-CoV-2 jumped to humans just the same as it did, but magically we never found out about it. So, it spreads completely uninhibited. That world is a world with less unemployment, less poverty, better educated kids, less attainment disparities (lockdown, online schooling, etc ALWAYS disproportionately impacts the poor), less all-cause mortality, and in my opinion, less COVID-19 mortality over the medium-term.
Contrary to everyone saying "how can you say this is a mild virus, are you crazy?", the evidence overwhelmingly shows that it is very comparable to a bad-severe flu season at worst.
No, we would have been way better off doing nothing. That's what's so sad. Every measure we've deployed has not only been arbitrary and capricious, has not only been ineffective, but has actually made the problem worse insofar as they were effective.
I've seen people make risk appraisals with COVID-19 that are completely alien to how they evaluate risk in any other areas of their life. In the extreme case, I have friends who regularly engage in unprotected sex and do all kinds of dangerous drugs like benzodiazapenes, who are not in a COVID-19 at-risk group whatsoever, yet are petrified with fear for their personal safety (it's not that they're super selfless and just worried about infecting others, to be clear).
As a more moderate example, I've seen mothers petrified to send their kids back to school, despite the fact that their kids are at no risk from this, and despite the fact that their kids are actually at risk from Influenza, from meningitis, etc.
The real pandemic was the pandemic of mass collective delusion, accentuated by (here in the US) our tumultuous political environment in which people are willing to distort anything to the point of absurdity if they think it will win them political points.
> We don’t know whether that’s true still and what the impact exactly is.
Well, at this point you must be willfully closing your eyes. We have good evidence of pre-existing immunity in a chunk of the population. We have good bounds on our IFR, leading me to settle on a final number of around .30%. We have very clearly delineated risk factors. For many people, Influenza is more deadly, for many people they are about equivalent (for example if you are 55 with diabetes/hypertension and overweight but not obese, your risks are pretty comparable), and there are some for whom SARS-2 is way more dangerous (people 70+ with comorbidities). So even ignoring the pre-existing immunity and even without accounting for heterogenous suceptibility, when you run the numbers it quickly becomes clear that what we've done is not just unprecedented but is actually insane.
Note I haven't even brought up the constitutional/ethical implications of what we've done. I think what we've done, speaking from a US perspective, is completely unconstitutional, doubly so after the BLM protests started and were given a free pass while people were banned from church (I don't...
Joe Rogan and Bob Saget were talking about how "everyone" has been having COVID panic attacks and nightmares. What happened to people? How did hypochondria become a mainstream lifestyle in the safest place and time in human history?
Indeed, I've observed what I would describe as symptoms of OCD, germaphobia, and agoraphobia in a shockingly high percentage of the population.
And of my friends that were already agoraphobic and germaphobic, they've now had their lifestyles retroactively justified by this thing, so it's going to make it way worse for the people that already had it too.
(I have one friend who is a germaphobe but not where it really interferes with their life, and they adopt the correct attitude of "well I can't really control this (germaphobia, not COVID-19 to be clear) but I'm not going to pretend it's a good thing" - they've stayed much more resilient through this than one might expect)
and in my opinion, less COVID-19 mortality over the medium-term.
I think you're missing one factor, which is the fact that evolutionary pressures will cause the virus to become better able to transmit, but also less likely to cause fatalities. That's the normal course of such things - consider that a virus that kills its host is no longer able to transmit itself to others, so strains that don't kill the host will reproduce more effectively. And there's some evidence that this is happening with covid-19. Ignoring other factors, being able to stretch things out over time to amplify this evolutionary pressure will probably result in fewer fatalities, even with the same total number of effected. But I don't know how that balances against the other factors that you're pointing out.
We have good bounds on our IFR, leading me to settle on a final number of around .30%.
The latest scenarios published by the CDC, as of a day or two ago, puts the most likely scenario at 0.65%
EDIT: citation for my 2nd point: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
Case in point – the second wave of the Spanish flu was much deadlier than the first wave. And the third wave was less deadly than the second, but still more deadly than the first wave.
If the virus infects hosts efficiently, and this one does, no, it will not have evolutionary pressure to be milder.
No. For example: https://www.westernmassnews.com/news/could-covid-19-weaken-o...
Two Italian doctors claim they are increasingly seeing weaker and less deadly cases of COVID-19 in the country. Hamilton said it's not uncommon for a virus to become less pathogenic as time goes on. “Over time they become less dangerous or less virulent because they just want to live in you and replicate in you,” she said.
Hamilton said viruses, in general, are trying to pass on their genetic material. “In some pathogens, it’s actually better if they don’t kill you because if you’re still alive, you’re more likely to spread them around,” she said.
This is why she said some of the most successful viruses raise the fewest red flags “Things like head colds or warts,” she said.
It's like saying evolution selects for intelligence, which would be silly because no, it doesn't, even if it happened for a couple of species.
If the virus transmits efficiently, having a high enough R0, it has no pressure to evolve to something milder. SARS-Cov-1 lacked the contagious pre-symptomatic period. Note how SARS-Cov-2 keeps going strong despite the worst restrictions we've seen in our lifetime.
Citation, please.
As I undetermined it, coronaviruses evolve quite slowly compared to many other viruses. In a perhaps optimistic scenario in which we have a widely available, safe, effective vaccine in early-mid 2021, there may well be no appreciable evolution of the disease before it’s mostly eradicated from the developed world.
In that scenario, the real outcomes to consider are the number of deaths and disabilities caused over the next year or so, the economic and other costs of people getting sick, and the cost (economic, social, etc) of the lockdowns and other countermeasures.
My personal belief is that countries like Taiwan and New Zealand are taking the right approach. If they continue on their current course and a vaccine shows up next year, then they will manage to keep total deaths near zero at moderate economic cost. If the entire world had pulled this off, then COVID-19 could plausibly be gone by now.
https://justthenews.com/politics-policy/coronavirus/doctors-...
Quoting the article, and if you go there, there are numerous links to the actual studies:
Some physicians and scientists in the United States have lately also announced findings that the disease is getting weaker. One of them, Donald Yealy—the chair of emergency medicine at the University of Pittsburgh Medical Center—claims that "some patterns [of COVID-19] suggest the potency is diminished."
"The virus may be changing," he said earlier this week, adding that fewer people in the Pittsburgh area are contracting the disease, and the infections themselves appear weaker.
Maria Van Kerkhove, an epidemiologist with the World Health Organization, told media after Yealy's remarks that neither the virus's transmissibility nor its severity have diminished as Yealy claimed. Yet several other American scientists, including some at Arizona State University, announced findings in May that could bolster claims that the virus is less deadly than it once was.
The scientists at ASU said that they had detected a gene deletion in one sample from several hundred Arizona patients that potentially reduced the fitness of the disease. Notably, they claimed it was similar to a deleted sequence observed in the 2003 SARS virus that was observed near the end of that disease's epidemic—possibly signaling that COVID-19 may be bound for a similar fate.
Those conclusions were echoed by scientists in Spain this week, who proposed that COVID-19 may have adopted what the researchers call a "don't burn down the house" strategy, "reducing the severity of the infection and tissue damage without losing transmission capability." In effect, the disease could be opting to become less lethal so that it can spread more easily—a hallmark of evolutionary behavior, and also a boon for anyone who gets infected with the milder strain.
Data do appear to indicate that the virus may be losing its edge. The statistics website Worldometers, for instance, shows an unmistakably lopsided trend: Though the number of confirmed global cases has been increasing since the start of the pandemic, the number of global deaths has been trending downward since mid-April.
If that pattern holds, it may point to the conclusion that these few skeptical doctors are correct: That the coronavirus, like SARS before it, will eventually burn out in part due to its own viral mechanisms, without the need for a vaccine or for lockdown measures that have slowed the global economy.
Basically, and you alluded to this, my position is those effects may occur to some extent, but will be massively dwarfed by the downsides of trying to slow down the timeline.
(2) As far as the CDC, I hate to be that guy but I don't trust their numbers very much. I'm just a bit suspicious of them upwardly revising their number at this point in time, especially given the statements coming out of the CDC head which seem to lack any type of nuance. In particular, they are modelling asymptomatic spread but not pre-symptomatic? Weird.
But yes, I generally give a range of .1-.7%, but settled on .30% as the best number for my purposes. It's more-or-less pulled out of my ass, although it is almost exactly the median in the big spreadsheet of IFR estimates which I now cannot find the link to (grr)
Anyway, the important thing is for my "argument", it actually doesn't matter to me if the IFR is .3% or .9%. The costs of lockdown just end up being too risky. So, feel free to ignore my mistrust of the CDC.
Note that Ferguson's classic (albeit incredibly myopic) paper models an IFR of .9% and 82% of the US population being infected, with an end result of 2.2 million. With these T-cell findings and other findings, we might see like 1/4 as many total infections, so even with the same IFR that gives us a shitty upper bound of 600k.
Can I get a source here? Are you basing this off of the "case hospitalization rate"? Because that number will overestimate the true hospitalization rate by a factor of 2-100x depending on where you're talking about. Same principle of looking at CFR vs IFR (although ironically CFR will start trending down, not just in the real sense as doctors get better at not overreacting with early intubation, but also in a numerical sense as states like Florida are clearly misrepresenting their case numbers which will make the denominator larger)
As one example, in the population of people who can actually still get bad outcomes but have the best outcomes - people in their 20's - the implied hospitalization rate from serology studies gives us something like 1 out of 500 young people getting hospitalized (see https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c...). So that gives us a lower bound, and a semi-decent upper bound would be the 3.4% hospitalization rate in the 60-69 age group. (They don't seem to report >69 years, which would be way worse) <--- Note that study I found a couple months ago at least, so there are probably better numbers out somewhere now, but I lost some motivation to keep doing SARS-2 research once BLM started because it became clear that it was never really about saving lives in the first place. Although that's a topic for another day)
I was not claiming that H1N1 was as bad or worse than COVID-19, to be clear.
Obviously COVID-19 is the worst pandemic we've had in over a century. But that's mostly a function of the fact that we haven't had a truly bad pandemic (the scary ones like SARS-1 fizzled out, presumably because the virus was very symptomatic and very deadly).
The point is that, we didn't lose our shit over flu pandemics which actually kill children, and actually cause more significant recurring deaths than COVID-19 will do to what I already explained about COVID-19 targetting the unhealthy/old.
If you want my argument in a nutshell:
- The most stable solution to the problem of COVID-19 is to build widespread population immunity. Also, banking on vaccines as an artificial way to get to herd immunity is a foolish strategy, because we're relying on a temporally unbounded future event, which is an awful idea.
- Lockdown not only increase all-cause mortality by making every other health condition in the world worse (both directly through social isolation and depriving exercise, as well as through suspending elective surgeries, as well as the widespread culture of fear/etc leading to people to not go to the hospital), but I actually believe that it increases COVID-19 mortality. The same factors of social isolation, stress/fear, unemployment and lost sleep are at play, but also particularly the prevention of exercise (which plays an immunoregulatory role besides the other positive effects), and even more particularly, being cooped up outside = no sunlight = no vitamin d. Vitamin D is actually a ridiculously important vitamin as far as respiratory infections go - I didn't realize how strong the effect was, I encourage you to research it. Additionally, nitric oxide, also produced by sun exposure and not provided by a vitamin d supplement, decrease blood pressure so helps cardiac events, and is even being directly studied as a COVID-19 treatment (perhaps due to immunoregulatory effects?)
- Because I don't believe in practicing containment, for the above reasons and others I don't feel like going into at this point, I believe that any attempt to artificially slow spread in the general population is counterproductive. So, insofar as universal masking works, we should not be wearing masks. Insofar as lockdowns actually work, we shouldn't be locking down. And if they don't work (and I think the evidence is not there, and thus they likely have either no effect or possibly make spread worse, particularly with masking and school closures) - well, then why are we doing them?
In particular, even given much of your argument, I believe it's still wise for most people, and especially those with any extra risk factors, which likely include some yet-unknown among the outwardly-healthy, to avoid getting this for as long as possible. The end point – nearly everyone having an upgrade immunity to the somewhat-novel threat – is the same. But the upgrade is slower, to minimize collateral damage, and involves more conscious processes, including at some point synthesized vaccines, rather than purely natural/chaotic.
Every week brings better understanding of risks & treatments. Every week gives more opportunity for the pull of 'optimal virulence' (https://en.wikipedia.org/wiki/Optimal_virulence) to eventually select for even-milder strains. At least partially-effective vaccines for high-risk/front-line workers may arrive before the end of the year. Delays prevent overwhelming health facilities – or increasing average initial infectious loads – which each seem to risk synergistic escalations of mortality rates.
That said, it's not implausible that the right strategy for those least-at-risk – the young & very-healthy – is to mostly go about their normal day, and not worry much about getting an mild case from other mild (presymptomatic/asymptomatic) shedders. The risks are offset by the value of adding to their internal (and thus society's) immunity library against Covid-19 & related viruses.
But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
If I can wax philosophical for a bit, I remember learning in elementary school about native american rain dances, how they would dance around and thought that it would cause rain. "How foolish of them", I thought. "It's so obvious that there's no connection between dancing around and precipitation falling from the sky".
And yet, when I look around, I see us all participating in an elaborate form of pseudo-medicalized rain-dancing. Take the staggering amount of people walking around all day in nitrile gloves. Let me tell you, if I were a SARS-CoV-2 respiratory droplet, I would love those people; I get to a hitch a free ride on their gloves with my droplet completely intact, preserving the moist environment that all life (and pseudo-life since we've arbitrarily decided viruses aren't alive, which is just silly) thrives in.
Uncovered hands at least have commensal bacteria and an acid mantle (well, for those that don't wash their hands like someone with OCD) that make it harder for SARS-2 to persist. But those gloves are the perfect environment.
Why do people wear those gloves? Well, in my opinion, they associate the gloves with doctors, they associate doctors with cleanliness and a scientific version of holiness, and thus they essentially believe that the gloves act as a magic totem that ward off evil spirits - I mean, evil viruses.
Mask-wearing isn't much better. It is definitely better, and I get the "it protects you, not necessarily me" argument, but when you look at how people actually use the damn things in the real world, I think that's almost certainly false. People touch their face, their mouth, etc way more. Not to mention all the other reasons.
Which does lead to the irony: insofar as masks do work to slow spread, that's a bad thing, yet they may actually increase spread, which in my book is a "good thing"...except (a) I hate having to wear a mask, and (b) since the rest of society is not on-board, a healthy increase in cases will be met with further lockdown :(
--
Anyway, you alluded to this, but I don't think having a bunch of 20-somethings try to avoid all human contact for [1 year, infinity] makes sense. I think it's a less stable system. Just like how every year in California we have huge wildfires, which we artificially suppress, and so every year there's more and more material waiting to ignite.
Well, pandemics work the same way. When we try to keep ourselves in a state of SARS-2-virginity, we create an environment where at any moment infection can rip through us again. Look at New Zealand, which is held up by the ignorant as an example of "doing it right", and yet now they can't allow any foreign visitors without 2+ week quarantine "until the vaccine" (sigh).
The laughable thing is in the US we're not really practicing containment, and yet we also kind of are, and that leads to the total ass-backwards metric of "cases must be perpetually in decline otherwise we shut down again".
--
Okay, back to serious stuff.
> But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
See, this is my problem. The moment we stated that it was the problem of those not at risk to avoid anything that might infect an at-risk person, we went down the comple...
I've wanted to go back and update it, but lost motivation to do so when the BLM protests/riots started. I always cynically had thought that people didn't really care about COVID, but even I wasn't expecting such a shocking example of exactly how much of a farce this whole thing was ("we have to shut down California, look at these photos of normal beach crowds!" versus "here's 40,000 people massed together for a black trans lives matter rally, let's just pretend that we didn't claim all mass gatherings/protests were evil last week").
I did my original post using Ferguson's model as an upper bound, at the time thinking that the real numbers of the "let the disease run rampant" scenario would be much better. Well, now tying in these t-cell findings, the findings that blood type seems to impact transmission, and heterogenous susceptibility more generally, there's a lot of updating to do to make it even more clear how ridiculous the whole policy was.
I also have other research interests on things like moist wound healing that I've been considering doing a quick writeup on, since there's a lot of important info that people just aren't taught (myself included, before doing research).
Happy to send a link to you via e-mail, so that way I'm only de-anonymizing myself to individuals and not more broadly. You don't appear to have an e-mail on your profile so if you don't want to post one and care about anonymity we could also exchange GPG keys depending on how much effort you're willing to exert :P
> So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
Yes, exactly this. This is another reason I hate universal masking, because even if I think masks work when worn properly, I still have to assume that everyone is wearing them because they're mandated, but don't actually know how to use them properly.
I would much rather have it be voluntary, and then if I see someone wearing a mask, at least I know they give a little bit of a fuck. Now granted, I still wouldn't be able to (if I were trying to avoid infection) assume they knew what they were doing, but it's better than the current reality where, say, employees are forced to wear masks, and then the moment I ask them to repeat something they said because masks stifle speech, they immediately pull down their mask and tell me what they were trying to say, completely defeating the point.
I love the idea of literally signalling risk tolerance. The only thing is, that still requires ceding public space for some portion of time to the super freaked out people, which is a losing battle, so ultimately I still think we should stick with the "old" way of doing things, which is: if you're a germaphobe/agoraphobe, you stay in your damn house and watch netflix for your whole life like you did before, and everyone's "happy".
There's another factor in here that I don't see that you've weighed. Although this is far from certain, I've seen some preliminary claims that the size of the initial viral exposure may be one of the factors that eventually determines the severity of a case. This makes intuitive sense - if you only get a small dose, your body has longer to notice the virus before it reaches a given threshold.
If this is true, then masks may still be worthwhile in order to keep a lid on the proportion of severe cases.
(Personally, I would volunteer to be exposed to real SARS-CoV-2, but I would not volunteer to be on the receiving end of any vaccine candidates.)
Anyway, it's dubious that masks do a great job in decreasing viral load, but I think this another case where if they do the effect size wouldn't be that great.
Regardless, this really highlights how we're proposing universal measures for things that are not well researched. I like the approach Sweden has taken: if there's not strong evidence, we just don't do it. Simplifies so much.
Your most stable solution to the problem is reasonable (build widespread population immunity), but your actual solution is to try and achieve it as quickly as possible by just letting the virus spread without any measures to slow the spread. That is not reasonable.
literally one second of googling: Proof: https://www.buzzfeednews.com/article/kadiagoba/ventilator-sh...
The money quote, which completely refutes your entire nonsense argument: “The other day I felt defeated. The patient came in on a code. We looked at each other. The patient had to die. There was nothing we could do.” Any feelings of guilt were upended by the next patient to come through the doors when they had to tell EMS they had no ventilators. EMS said they had nowhere else to go. The patient died."
I wouldn't be so sure about that, actually.
Sweden's response has been widely reported on, and even more widely mis-reported on.
Sweden chose the least amount of restrictions in the EU, and mobility analysis shows that although the Swedish people changed behaviour drastically, they did it the least of the EU countries. People were doing the most distancing in late March, same as everywhere else, and have been slowly easing up ever since.
And yet, the death rate has been going down steadily in Sweden since mid-April.
Testing has been too low for a long time, but is finally up at reasonable numbers.
And yet, the positive test rate has been cratering the past few weeks.
The Swedish public health agency have done a bunch of random samplings of antibodies to measure the immunity rate, and it always came back at much lower levels than expected. The peanut gallery was quick to crow that Sweden's "herd immunity" strategy was a complete failure, zombie apocalypse etc, but the reason people were surprised that the antibody levels were so low is because it didn't match the actual spread.
Something is pushing the death rate and case levels down in Sweden, it clearly isn't lockdown or distancing measures, and it clearly isn't sars-cov-2-specific antibodies.
There are reports out now that a lot of people seem to have immunity or resistance through T-cell response, presumably as a result of earlier coronavirus exposure.
Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower.
And all of these things together suggest that herd immunity is easier to achieve than we initially thought, and that regions that have been heavy hit, but that now see very little death and cases, might be very close to it.
Yes, this is a great point that often gets missed. This is the principle of vector exhaustion: by definition, those more likely to get infected will get infected first. Insofar as someone more likely to get infected is also more likely to infect others, that means that we see a non-linearity to herd immunity. Getting that first group of highly infectious people immune works wonders.
I believe (but honestly am not certain) that one's susceptibility to infection is independent of one's ability to spread more effectively.
But people who travel around a lot, meet a lot of different people, are simply more likely to encounter an infected person and get infected, and in turn are more likely to unknowingly infect everyone else they meet. The same mechanisms that make someone a "super spreader" is also what makes them more likely to get infected, and to get infected early in the pandemic.
We know that for example medical personnel got infected in way higher numbers than the general population, for obvious reasons. But they're now also more immune than the general population, for the same obvious reasons. And as a result, intra-hospital spread decreases.
Yes, it's two independent measures, but with very high correlation.
Anyway, ignoring the spreading part, the susceptibility alone does explain it to an extent, as you implied:
> It's the ones that are most easily infected (because of their particular biology, lifestyle, etc.) who are first infected.
Ok...
There's an upper bound on the number of deaths, that's good. It's bad to carelessly accept having to hit that upper bound.
Maybe start with the impending global food shortage.
And the fact that we've went backwards on poverty, went backwards on vaccines for everything that isn't SARS-2, etc.
And the fact that the physiological and psychological state lockdown puts us in, almost certainly makes us more likely to die of COVID-19 if we get it?
I don't carelessly accept the upper bound. I rationally set an upper bound and ask myself, "is this worst case something I would rather live with, rather than the worst case of the lockdown scenario?".
Then I compared the average cases.
What I found was that the worst case scenario of lockdown is worse, and the average-case scenario is worse. Only the true "best-case scenario" of "we magically get a vaccine in a month, the vaccine works for everyone without any significant repercussions and we manufacture 8 billion doses and the entire globe voluntarily accepts it" is better (although the corresponding best-case scenario of no lockdown is also similarly absurdly positive so best-case scenarios are useless anyway).
--
Tell me, what is the logic in practicing "indefinite postponement" (containment), which accrues on-going, non-linear costs (as well as the obvious linear component), and only ends when we develop a game-changer treatment or vaccine, which is a temporally-unbounded future event.
When has it ever been good public policy to hinge everything upon an uncertain future event? That's just bad strategy.
To use a starcraft analogy, we're trying to sit on one base and tech up while a skilled opponent would be on 4 bases, have a strong econ and then out-tech us anyway since they, you know, actually have a sustainable, functioning economy.
There is ample precedent, however, of doing lockdown right and basically being done with it: Asia and Europe have many countries with drastically lower infection rates than the US. And most of them are further along the way of opening back up than the US.
That is assuming that prolonged lockdown continues to be our response. It clearly doesn't have to as other first-world countries cases have actually been floored.
Aside from complaining about our first run at this, we could/should probably just all wear masks and then spreading is mitigated such that new cases approach zero.
It only stops in the absence of lockdown when the herd immunity threshold is reached. Period.
The only question is what that threshold is. Without these findings of heterogenous susceptibility, that threshold would be 70-90% depending on your estimate of the effective reproduction number.
With these findings, that number drops to a much lower threshold. Much, much lower.
--
If I can ask you one question, what is your explanation as to how cases have floored in other first-world countries, in the absence of herd immunity, if they are not practicing lockdown?
Others are doing much better. There are hardly any new cases in, say, Germany, with by now extremely minimal measures and no lockdown.
Your epic texts seem to come from a weird parallel world.
In fact, that's exactly the implication of the Nature paper that's ostensibly the reason for this thread. The more we learn about pre-existing resistance to this coronavirus, the more we can figure out whether measures taken made a difference or were simply coincident with a less-vulnerable population.
The hypothesis I heard is that this immune response due to previous common cold corona virus exposure could explain the high proportion of asymptomatic cases or cases with very mild symptoms.
Those are already priced in, so we already know about their existence, it would just be an explanation as to why they exist.
I‘m also not sure why you think that even neighboring and very similar countries are so wildly different based on wildly different levels of pre-existing immunity. That doesn’t seem very plausible. Why should, say, Germany and Italy be so different? Or Germany and France?
That's the subject of the paper being discussed, it's worth going back and looking at it. The researchers demonstrated T-cell reactivity against it not just in blood from people who had SARS-Cov-1/2 but those who had neither. So something else is going on -- maybe one of the common cold coronaviruses, maybe some other infective but not dangerous coronavirus, maybe something else.
> I‘m also not sure why you think that even neighboring and very similar countries are so wildly different based on wildly different levels of pre-existing immunity. That doesn’t seem very plausible. Why should, say, Germany and Italy be so different? Or Germany and France?
Since we don't even know the source of this pre-existing immunity, much less how it varies between countries, it's impossible to say. But it's clear that there are many differences between what happens in countries that aren't just lockdown timing/severity. Immunity, density, demographics, climate, sheer luck, etc.
I'm not saying that as an insult BTW, just a statement of fact.
Countries stop getting new cases without lockdown measures when they approach the herd immunity threshold. So, if we look at New York, which got absolutely ravaged (relatively speaking), they don't have significant new cases anymore. Not because Cuomo is a genius - he's the opposite - but because there's almost nobody left to get infected.
So, no, while I have been citing American examples because I am quite clearly an American, what I'm saying is relevant to every country in the world. Following a course of lockdown, social distancing and universal masking is simply an exercise in lunacy. At best it has no effect, and at worse it massively increases mortality.
In short, I really don't understand the point you're making. My goal is the maximum aggregate well-being of society, thus I oppose lockdown. If my goal were a more myopic measure like "maximum lives saved" (ignoring that a life is not a life is not a life), lockdown would still be the wrong call. Now if my goal were "minimize COVID-19 mortality regardless of the cost to all-cause mortality", then lockdown may or may not be effective, I personally think that it almost certainly makes COVID-19 mortality worse in the long run full stop, but that point is more debatable. I think the first two are inarguable, though.
Yes, if you take the most wildly optimistic assumption for every single variable, when literally millions of lives are on the line, it might be 15 to 25%. Still Germany, S. Korea, Taiwan, and Japan are no where near that number.
Also instead of saying “based on coronaviruses in general” you should just say “based on the basic reproduction number”.
Anyway even if HIT were 65-90% my argument is the same. But the fact that you gave that 65-80% estimate means you don’t understand the math. Factor in the preexisting t cell cross reactivity. Factor in heterogenous susceptibility (risk of infection even controlling for # of exposure events/social interactions varies heavily in the population, for example old people are much more likely to get infected)
TL;DR: you need to do more background reading and update your priors. you’re operating in very stale info. I also think you’ve failed to understand my general argument outlined across this thread but I’m too tired to repeat it so I’d urge you to re-read the comments where I outline my case
There is some tantalizing evidence that maybe just maybe there might possibly be some degree of latent t cell cross reactivity. This is not actionable information, because it very well could be false.
"based on the basic reproduction number" is total nonsense. I am not basing anything on the basic reproduction number. I don't even know what you are even referring to here.
I understand the math just fine. It is you who keep doing the math wrong. You are "factoring in" 3 different variables, each of which are controversial and may not even exist at all. Then you are taking the most optimistic scenario for each one of these variables, compounding your bad math three times over.
Your argument is even more murderous if HIT is 65%. 65% of 7.5 billion people is 5 billion. IFR of 0.3% (which you admittedly completely made up) is 14 million dead? I'm on mobile but I think that's right. You want to kill 14 million people. Even though Japan, S. Korea, Singapore, Canada, Taiwan, Germany, Italy, Spain, heck arguably even NYC right now have proven that this can be controlled.
That's only true because we've been able to treat most people who needed hospitalization. The point of the lockdowns is not to prevent deaths from SARS-CoV-2. It's to prevent the healthcare system from being overwhelmed so that moderate-to-high-severity cases go untreated thus increasing the number of deaths.
Granted they can do a lot for people in the middle-ground, i.e. giving people oxygen. I don't have a number for how much death they avoid by doing that, but that's certainly where the utility lies.
When it progresses to severe enough COVID-19 that invasive ventilation is required, the battle is basically already lost; at that point something like 90% of invasively ventilated patients die. So, I'm not saying that ventilators don't work, but what I am about to say is, if we assume that without ventilators 100% of those people would die, the effect size is still so tiny that hopefully we can all agree that the whole ventilator circus was a massive distraction.
Anyway, I don't think you were trotting out the ventilator fallacy, just wanted to nip that one in the bud for any onlookers.
So back to the point: I don't know precisely how many lives are saved by those given oxygen but not invasively ventilated, I suspect it does save lives, but overwhelmingly, the reason people don't die from SARS-2 is because SARS-2 can't kill them. Again:
- Most are either asymptomatic or paucisymptomatic - Many experience symptoms comparable to a mild cold - Many (probably less) experience more moderate symptoms comparable to a flu - A small fraction of those infected go on to develop increasingly severe COVID-19 eventually culminating in invasive ventilation and death.
So, all the possible utility of hospitals lies between the "moderate symptoms comparable to the flu" and "severe COVID-19 culminating in invasive ventilation". i.e. if I broke it up more granularly, we'd presumably find a category of people not bad enough to ventilate but who have very bad symptoms, and that's the faction that hospitals really help.
Anyway, hospital overrun is simply not a real concern in a place like the US. We should be more worried about the opposite - hospital scaledown.
And the reason hospital overrun isn't a concern is because COVID-19 is mild enough for most people that we don't get the hordes of people we were expecting. We do get quite a lot of people at peak, but it's manageable with some shuffling.
I'm much more concerned as well about the suspension of elective surgeries. We're going to see so many more deaths due to cardiac disease (which kills more than COVID btw), undetected cancer, etc as a result of this
Remember that America in general is a lot more intervention-happy than other places. It's more important to "do something", even if that something is net-negative or net-neutral. And therefore, the survivor statistics of ventilated patients in the US is absolutely atrocious.
Halfway down this page there's a diagram of survival rates of patients in ICU in Sweden by age group: https://www.svt.se/datajournalistik/corona-i-intensivvarden/
As you can see, the survival stats are much better. 47% of the 80+ patients lives. 70% of the 60-79 group lives. 85% of the 40-59 age group lives.
But as you can also see, the number of treated patients in the 80+ group is very small. And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time.
Of course, that has been interpreted as Sweden callously sacrificing the elderly by denying them care.
But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator.
But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
> But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
Yes, I totally agree. Maybe didn't make that clear above, but my point was even if we pretend/assume that the ventilators are helping, the effect is small.
I think it's highly likely that invasive ventilation as applied just ended up making things worse.
> And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time.
Exactly. It's just such an American mentality. Same reason we wanted to hold up Hydroxychloroquine, Remdesevir, etc. Not saying they don't work, but that focusing on antivirals detracted from the real discussion we should have been having all along.
We're too accustomed to perfect technological solutions which let us avoid having to face the reality of our own mortality (and the mortality of our loved ones).
https://www.quora.com/How-can-a-disease-with-1-mortality-shu...
These numbers and the permanence of the effects may be off, but hardly unfounded.
The issue I have with pushing the idea that it's a mild virus, despite loads of evidence it's far more dangerous than the seasonal flu, is that it results in less societal countermeasures.. prolonging this for all of us, and endangering those at-risk or with at-risk family members.
Keep in mind that going to the hospital can be financially ruinous.
Please wear a mask, don't throw parties, and consider your fellow members of society.
PS. quoting sources is a good way to share real information, outside of "the matrix".
It seems obvious to me that he just fabricated scary numbers without regard for whether they're true.
Let me start by out-lining my beliefs about long-term damage or the other classic complications of blood clotting, stroke, or pediatric multi-inflammatory syndrome:
(1) Any time the body enters a state of pathological cytokine release syndrome, basically any runaway inflammatory cascade, a lot of really bad shit happens. Blood clotting, strokes, etc. What's important to understand is that (a) this is not at all unique to COVID, we see it with flu and any of the other dozen classes of virus that can make you sick, and (b) statistically, they happen in incredibly small numbers.
(2) Medium-term damage in the sense of your lungs taking a month or rarely, even longer, to recover absolutely can happen, we see it with SARS-1. But at the 1 year mark, for example, people's lungs look totally normal. I tend to use SARS-1 infections as a model for what severe COVID-19 (caused by SARS-2 just as a reminder) looks like. So I think SARS-1 gives us a great upper bound.
There is a narrative specifically that people who don't have bad symptoms will have hidden long term damage, that's just complete bullshit and there isn't much for me to debunk. As far as the real severe COVID-19 cases that do have some type of complication, again they might have damage for a few months, certainly not beyond the 1 year mark.
Let's talk about strokes. The "strokes in young people narrative" (which I can't resist mentioning was heavily pushed by CNN, who as you can tell I have an incredible disgust for, because until this year I truly didn't realize how far they had fallen) AFAICT stems entirely from this series of case studies:
["Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young"](https://www.nejm.org/doi/full/10.1056/NEJMc2009787) - April 28, 2020
Normally with scientific stuff, what happens is that news orgs take the study, misrepresent/oversimplify the conclusions and twist its meaning. Well, that did happen to an extent here, but actually the actual title of the article ends with "in the Young". Now, maybe there's some medical definition of young that I am not aware of, but this study does not look at young people, it looks at non-elderly people. So, in my opinion, there are a lot of scientists that are basically editorializating their own work. In other words, there is a large faction of people so incredibly concerned about COVID-19 that their bias is seeping into their scientific work. Anyway, I actually love this paper, because of the buried lede about lockdown/hysteria actually making things worse, which the authors seemingly tried to not draw attention to.
* "Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic."
* (for those concerned about stroke in the young, note the occurrence is rare in those without comorbidities. And "young" here means "not old" [youngest was 33, oldest was 49, 3/5 had serious risk factors])
My commentary: So, the first irony is that people who actually had COVID-19, and had it severely enough that they literally ended up developing strokes, were afraid to seek medical attention for quite some time, because they didn't want to catch COVID-19. My interpretation is that the media hysteria, etc has/had hit such a point, that even though they were probably feeling sick and like total garbage, they thought to themselves...
As do I. It's been a day at work, I'll see if I can dig into this soon.
In the meantime, thanks for the thoughtful response.
Also, people don’t suddenly become worthless once they turn 80. They can still die prematurely, even if only, say, five years early instead of fifty.
Overwhelmed healthcare systems are something we need an economy that's actually working to support. But note that most of what you've heard about ICU overrun is more or less a complete fabrication. Even New York, which got absolutely ravaged, had certain hospitals overflowing, yet nearby hospitals had tons of capacity. So yes, it's not ideal to have to shuffle patients around, but that's how our system is designed - we've had to do exactly that for just bad flu seasons, etc.
Anyway, ultimately, I feel that we are harming Grandma more with the lockdowns, particularly given that there is essentially no correlation between locking down and preventing death (actually the correlation is negative, and the inverse correlation, death being correlated with lockdown, supposedly does not exist although I didn't run the numbers myself to verify if that claim was true).
Finally, if you think about someone who is 80 years old and maybe has a couple health conditions, and thus a short life expectancy: What is the marginal cost to them of being locked down for a year? That might be 33% of their remaining life-time. Now, I'm not elderly so I can't speak for them, but I think many of us young-ish people have failed to think about the notion that the marginal utility of being able to live a normal life should be higher for old people. They more or less live in physical discomfort, and so the whole point of life at that age is to interact with your loved ones, sit on the patio and bask in the sun (or go to the beach), etc.
So, really we should give people the choice. If they want to self isolate and live a life bereft of human contact, more power to them. But to force it upon people who don't want it - which includes some or maybe many highly-at-risk old people with comorbidities - is wrong, in my opinion.
We (society) tried to act that haircuts, going to sports games, going to the beach, going to bars, etc were "non-essential". But when you think about it, that's literally what life is.
I get very saddened when I see 6 year olds walking around wearing masks (BTW, I always see them pull down their masks to wipe the sweat that has coated their face under the mask, which is one of many reasons why masks probably don't even work in the general public). It's extra sad when you realize that not only are kids not personally at risk, but overwhelming evidence shows - much to my personal surprise - that they don't even spread the damn thing in significant numbers.
No, everything about our response is wrong and counter-productive in my book, and it makes me sad that I can't express those views publicly without being screamed at by people who are, quite literally, brainwashed.
Fuck, the amount of people who used to show up to the office with very obvious flu symptoms a year ago, and now are screeching at people on twitter for having a maskless gathering in their backyard - is super depressing. The level of hypocrisy and more importantly, completely irrational risk appraisal, is so concerning to me. There's just no logical consistency to be found anywhere, I'm afraid.
Well, there's a well known human bias with regards to risk assessment. We consistently overvalue new and unfamiliar risks, and undervalue known and familiar risks. This is why some people are deathly afraid of getting on an airplane, but perfectly fine driving to the airport, even though statistics dictate that the actual risk is the opposite of what they think it is.
As for corona, a huge mistake we're making is that we're looking at the death numbers for it, exclusively, myopically. We have to look at total mortality and total excess mortality, over time. A lot of things kill people all the time, and we never freak out about it. Flu seasons kill people all the time, and we never freak out about it.
I'm Swedish, and Sweden has been mercilessly dragged through the shit in international comparisons over its handling of the virus. Sure, in isolation, covid-19 deaths in Sweden are much higher than its Scandinavian neighbours.
But if you look at total all-cause mortality, and if you look at flu seasons instead of calendar years, the 2019/20 flu season in Sweden, with all the covid-19 deaths included has resulted in Sweden still being below average total mortality compared to the last 20 flu seasons.
More people are alive, in Sweden, today, than the statistical average would predict. And this is a "disaster". How? The covid-19 dead in Sweden are overwhelmingly old people who were statistically likely to die already anyway, and them dying now from this is a "disgrace". How? No-one gave a shit about more old people dying from similar causes previous years, why does anyone suddenly give a shit now?
Maddening and irrational. I am so tired.
I'm sure the approach of disfavoring ministerstyre bites you guys in the ass for certain types of problems, but for something like this, the fact that the ministers are not allowed to run the show is such a blessing.
(Of course, if we tried it in the US it would almost certainly fail, because even people like Fauci or the CDC head are just completely crazy...but we're not allowed to admit that)
--
Along similar lines, all the myopic IFR talk made me think about how, if we had a decade where there just happened to not be any major pandemics, a very generic common cold virus could come around with an IFR of >1% simply because there's such a high proportion of elderly people practically on death's door, who have been more or less artificially kept alive and so of course the IFR is going to look bad if it wipes them out.
To be fair though, there's nothing stopping government from ignoring another government agency and doing their own thing, that's what basically happened in Denmark and Norway, where their governments enacted stricter measures than their own public health agencies recommended.
The Swedish government could have done that, but it's currently a weak coalition government, which is why they adopted a more passive role.
> if we had a decade where there just happened to not be any major pandemics
In what I'm sure is a just a super coincidence, the past couple of flu seasons were extremely mild in Sweden, compared to neighbouring Denmark and Norway, which had normal flu seasons instead. I saw a twitter thread that talked about it in terms of brushfires and kindling. Dehumanizing, sure, but also pretty damn accurate:
https://mobile.twitter.com/boriquagato/status/12776325020692...
I realize this is an appeal to authority, but when you say things like this, it makes it hard to take you seriously. "Completely crazy," really? Just read this guy's biography and tell me he's not qualified: https://en.wikipedia.org/wiki/Anthony_Fauci
Meanwhile, what we have on this forum is a bunch of 20-something tech kids throwing around research paper fragments that they've vacuumed up in their spare time. Gee, which of the two should I trust more?
The fact that Fauci has had such a long and successful and relevant career makes his failure here all the more painful. I think he’s a smart guy. But he was put in a highly stressful position, barely sleeping for months on end...I can’t fault someone in that type of situation for being unable to snap out of collective delusion. But yes, he’s still deluded.
I understand why that statement of mine causes strong reactions. Indeed I considered omitting it because I know how many people reflexively downvote the moment they see that.
But for better or worse I decided not to pull punches.
To be clear, continued lockdown absolutely sucks, and we should be doing something like this instead: https://www.youtube.com/watch?v=HhRQxk9QA-o. (A brief period of lockdown, mass testing, contact tracing, supported isolation, and gradual reopening.) But hey, America.
As for masks, they're a) cheap and trivial to implement, b) have been in use for decades in countries around the world, and c) seem to prevent spread by a non-trivial amount (according to recent articles I've come across). It's downright absurd to call such a policy any kind of crazy in the middle of a pandemic.
Read the paper, they're making a distinction there because the zoonotic viruses are different to the endemic human ones, but closer to SARS-CoV2.
> Besides, once a virus jumps from an animal it either becomes a human virus (capable of spreading), or somehow is a one-off virus that can jump from animal->human but not subsequently to another human.
That's the point, the zoonotic viruses aren't spreading in humans, but they may well elicit an immune response.
To your point, the paper says this:
> Even though we cannot exclude that some SARS-CoV-2 reactive T cells might be naïve or induced by completely unrelated pathogens5, this finding suggests that other presently unknown coronaviruses, possibly of animal origin, might induce cross-reactive SARS-CoV-2 T cells in the general population.
I did miss that detail. Thanks for pointing that out. I'll need to think more on this. My gut feeling is that, if these are zoonotic viruses that are not human-transmissible, how could this phenomenon be so widespread?
EDIT: Ah, it sounds like, they detected some that could only be explained by zoonotic CoVs, whereas the majority could be explained away by exposure to human coronaviruses? (I'm planning on circling back to read the paper more closely later but need to take a break for now)
> Once it passes through the entire population, we could very well see 5-10x the deaths we've seen already, or even considerably more. That's 5 MILLION people dead from a single NEW cause.
Are you speaking globally or in the US? If you think 5 million would die in the US, your upper bound is off by an order of magnitude.
You want an example: watch this video https://youtu.be/bE68xVXf8Kw . A primary source that entirely refutes your ridiculous assertions.
You’re off by an order of magnitude because your estimate is more than twice what Ferguson’s paper estimated. Ferguson modelled worst case scenario in US as .9% IFR with 82% of pop infected for 2.2 million dead. Taking that IFR and adjusting for a HIT closer to 20-25% due to the new findings is how I got the statement that you are off by an order of magnitude. You are. Again your estimate is larger than the craziest doomer epidemiologists (Ferguson).
If you respond, please make sure to address the last paragraph. And go read Ferguson if you haven’t. The paper is “wrong” but it’s a great upper bound for worst case scenario with no t cell cross reactivity and absurdly high IFR (thus why it’s a worst case).
Ventilators were not a problem and the hysterical NYT video has not proven that whatsoever.
Ferguson is the craziest doomer epidemiologist at estimating 0.9% IFR. Even though IFR in Bergamo was like 20%. Facts. Can you recognize them?
Pulling IFR from spotty seroprevalence studies is a fine way of showing that you literally have no idea what you are writing about.
__bc__ might be wrong, but an hysterical retort is not the way to prove that to the rest of us. And for my money, there's at least something in his comments that's worth considering.
> absurdly high likelihood that actual herd immunity begins to kick in at like 20% seroprevalence, which no one who actually has technical expertise in these matters would suggest.
You're the one in the wrong here, and that suggests to me that you've just latched onto popular media misunderstandings of the science - and your refusal to actually support your claims is allowing you to make these mistakes. To enlighten yourself on this topic, look at https://www.theatlantic.com/health/archive/2020/07/herd-immu...
Quoting from that:
It doesn’t make intuitive sense, Gomes admits, but “the homogenous models just don’t make curves that match the current data,” she said. Dynamic systems develop in complex and unpredictable ways, and she believes that the best we can do is continually update models based on what is happening in the real world. She can’t say why the threshold in her models is consistently at or below 20 percent, but it is. “If heterogeneity isn’t the cause,” she said, “then I’d like for someone to explain what is.”
At Stockholm University, Tom Britton, the dean of mathematics and physics, thinks that a 20 percent threshold is unlikely, but not impossible. His lab has also been building epidemiological models based on data from around the globe. He believes that variation in susceptibility and exposure to the virus clearly seems to be reducing estimates for herd immunity. Britton and his colleagues recently published their model, demonstrating the effect, in Science.
“If there is a large variability of susceptibility among humans, then herd immunity could be as low as 20 percent,” Britton told me.
I don't need any additional support when your own sources are telling you that it is highly unlikely that herd immunity kicks in at 20%. As an actual scientist, I can tell you that when someone says " a 20 percent threshold is unlikely, but not impossible", it means exactly what it says. Impossible is a very high bar (essentially unobtainable in biology), and when you invoke it you mean that whatever possibility there is is very very very very low.
https://blogs.sciencemag.org/pipeline/archives/2020/07/15/ne...
would anybody mind providing a summary of conclusions for the general audience here?
But, he (and the paper authors!) seem to skim right over what might be the most important conclusion:
> Recognition of the nsp7 and nsp13 proteins is prominent, ~as well as the N protein~. And when they looked at that nsp7 response, it turns out that the T cells are recognizing particular protein regions that have low homology to those found in the “common cold” coronaviruses – but do have very high homology to various animal coronaviruses.
This "NP" or "nucleocapsid protein" has high homology to "common cold" human betacoronaviruses (OC43 and HKU1), so this basically means that previous exposure to these colds should confer some degree of immunity to SARS-CoV-2. The novel result that everyone seems to be dwelling on is interesting too, it raises the possibility that coronaviruses are transmitted from animals to humans more often than had been previously thought.
I guess the immune system can misidentify as well--I bet we haven't taxonomized everything fully yet so eventually we'll have a new name for what immunity is required.
What do you mean by half?
I think half is a simplification, it must mean that if you have the wrong type or quantity or some combination thereof, but again I'm guessing and not an expert or even a professional.
There's no way in which having real antibodies, but a reduced amount of them, would be worse than not having antibodies, but the following is very possible:
> It is likely that in older people the production of antibodies is slower and by the time the antibodies are developed in the titer that is sufficient to neutralize the virus, the virus changes its antigenic determinants. In this case, immuno-dominant neutralizing antibodies might start forming unstable complexes with the new form of the virus and start to infect monocytes/macrophages causing ADE. This process can trigger generalized infection of immune cells in multiple organs and cytokine storm
But, related, and maybe what the professor was talking about:
https://en.wikipedia.org/wiki/Antibody-dependent_enhancement
^ This should be mandatory reading for anyone. Especially people that are obsessed with the idea that all vaccine candidates are inherently safe. (Unfortunately the term "anti-vaxxer" now gets thrown around for any actual legitimate discussion of the risks of untested vaccine candidates).
I'd note that ADE literally happens in Coronaviruses, so it's extra relevant. It can even happen outside the context of a vaccine, and may play a role in the pathology of severe SARS-CoV-2 infection.
https://www.nature.com/articles/s41586-020-2550-z_reference....
Before the actual paper, some review.
REVIEW SECTION 1
Coronavirus is a family of viruses, viruses being basically pieces of genetic material that swim around, inject their DNA into other cells, which makes the cells produce more copies of themselves until thousands of baby viruses explode out of the cell, killing it and moving on to the next cell.
COVID-19 is the condition that results from infection with SARS-CoV-2, which is a novel coronavirus that almost certainly emerged sometime in 2019. Think HIV/AIDS: HIV is the virus, AIDS is the disease, same with SARS-2 vs COVID-19.
SARS-CoV-2 while technically novel, is incredibly close related to what we now call SARS-CoV-1, which we used to just call "SARS". SARS-1 was incredibly deadly, but the pandemic fizzled out, presumably because it is quite deadly/quite symptomatic and AFAIK there isn't pre-symptomatic transmission.
SARS-CoV-2 structurally is very similar, sharing the same characteristic spike protein, and targetting the same ACE2 receptor which is expressed differentially in different tissue types. But SARS-CoV-2 is like a refined version of SARS-1, it "learned" from SARS-1's mistakes. So, it appears to be adapted to spread quite well, possibly because of cool things it does with interferon-mediated early course immunosuppression, which lets it spread for a few days before you show symptoms. It's also much less deadly than SARS-1.
Now, to craft the "optimal" pandemic virus, you want something that spreads easily, has a long incubation time, and isn't too deadly (otherwise it fizzles out by killing its hosts before they spread sufficiently). So in that sense, SARS-2 is perfectly crafted to kill a bunch of people. But please don't fall into fear-mongering, it doesn't kill nearly as many people as most have been led to believe. In my opinion it's really quite a mild virus overall, but some people can have severe COVID-19 which presents very similarly to a more run-of-the-mill SARS-1 infection (remember the original SARS is very deadly, so run-of-the-mill != no-big-deal).
REVIEW SECTION 2
We've talked about SARS-1 and SARS-2, but let me briefly butcher the immune system (I can already hear the immunologists stampeding towards me in the distance).
Your immune system's job is to distinguish self from non-self, (or more accurately, "non-self that is actually a threat" since you can have bacteria/etc that are not pathogenic/pathological). When it identifies a target, it has a lot of cool ways to kill it, but the specifics of neutrophils and antibodies, etc are out of scope.
For now, take it as given that your immune system can detect and kill pathogens.
Once it has fought off an infection, you will likely have antibodies, which are little heat-seeker-missiles that are primed to detect and neutralize the pathogen in question. (Note there's also T-Cell immunity which operates perhaps orthogonally to antibody immunity. This paper talks about T-Cell immunity).
Assuming you produced antibodies, eventually your active circulating antibodies will fade. This takes several weeks-a few months for SARS-1, and seems to hold for SARS-2, although I believe antibody prevalence is correlated with disease severity.
So eventually you have no more circulating antibodies. Contrary to what doomers will tell you, that's not a bad thing, it's inefficient to perpetually maintain antibodies. So instead your body maintains a living library of the pathogens it has previously encountered.
I'd encourage anyone to read about https://en.wikipedia.org/wiki/...
I have none.
I am immediately suspicious of "everyone has gone mad except me" arguments, and I'd posit that "worldwide hysteria" just isn't a thing that happens without good reason.
Well, we have well-understood cases of more localized hysteria, like https://en.wikipedia.org/wiki/Tulip_mania.
Worldwide mania is just an extension of that. Since I believe that literally social media / the internet / other aspects of modern technology have allowed the propagation of mind-viruses to a degree never seen before, I truly believe that it is simply a state of mass collective delusion.
> "it was still really obvious to anyone with the capacity for rational thinking that containment/lockdown was a terrible idea" is just absolutely, patently untrue (if taken at face value and not just as a snipe).
Okay, you are right and I let my frustration be visible there, I agree that it is not a fair characterization. More accurately, I feel that people who came down on the pro-lockdown side have the capacity for rational thinking and yet were/are not using that capacity insofar as COVID-19 is concerned.
> I am immediately suspicious of "everyone has gone mad except me" arguments
You should know that I am too. I spent quite some time trying to figure out what obvious thing I was missing.
Well, I think enough evidence is in at this point, if you're willing to look at it. The truth is that otherwise intelligent and knowledgeable people can very easily fall into states of delusion. It's no secret that as humans we are endowed with an incredible set of cognitive distortions, that presumably had adaptive value at one point, but now hamper efforts towards rationality.
If you've ever taken the time to synthesize a body of research into a coherent whole - not necessarily writing an actual paper etc, but just trying to iterate and construct a really good mental model - then you know what an enormous amount of careful thought, effort, and intelligence it requires. It's simply not easy to do, thus I think that the majority of doctors really just regurgitate the things they learned in med school, the majority of scientists do their version of that, the majority of software engineers just make whatever hacky change they need to get their feature out without thinking about the whole system (often because the system is crushingly complex, etc).
So when I look at what our "leaders" and public health officials have done, I see a total failure to take that mentality, a total failure to see what was really there in front of them. And I don't necessarily blame them; it's well known that an environment of sleep deprivation and stress cripples the capacity for cognitive flexibility.
Anyway, to conclude, you are right that my characterization was unfair. I do stand by the notion that they behaved irrationally, but not because of some fundamental lack of ability to be rational, but simply because truly being rational takes an incredible amount of careful attention. (And obviously, none of us, myself included, are truly rational, but what I mean is, are you near that asymptote or are you off in the woods somewhere ranting about how it's too unsafe to open up our schools, etc)
> IFR takes into account both symptomatic and asymptomatic cases and may therefore be a more directly measurable parameter for disease severity for COVID-19.
The latest CDC estimates an IFR of 0.65%
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
I'll let you do the math on how many are estimated to die without mitigation.
And for a lot of those who don't succumb to COVID-19, here are the extra-pulmonary effects:
https://www.nature.com/articles/s41591-020-0968-3/figures/2
Spreading the idea that shutting down was unwise is incredibly irresponsible.
Nonsense. I would argue that spreading the idea that shutting down was a good thing is and was incredibly irresponsible, but the difference is I don't believe in suppressing other peoples' ideas. But pro-lockdowners seem to love it. For the same reason they like the lockdown: it's a mentality that stems from a love of compulsion and control, and a sharp anxiety about living a full life.
> I'll let you do the math on how many are estimated to die without mitigation.
I don't advocate against mitigation (nursing homes, etc), but I advocate against containment full-stop.
Anyway, I have done the math. In fact, I've done the math with an IFR of .9% and assuming 82% of the population got infected (see Ferguson's paper).
2.2 million deaths. That's what the worst case scenario was.
And on balance, it was worth it.
What do I think the actual number is? Well, I'd use a new upper bound of maybe 600,000 - which BTW is around the number of cardiac deaths per year in the US. Amortized across 5 years, it becomes even less shocking.
These are upper bounds, btw. I think the actual number could be lower, but I don't bank on it. Unfortunately, given the way we classify deaths, it will be very difficult to find out what the "real" death toll was looking back.
You'd effectively have millions of additional deaths from lack of hospital capacity, more than doubling the yearly death rate. And additionally you'd have millions of more people with debilitating complications from all causes.
That's absolute insanity. You're devaluing life. Stop it. It's frankly scary to think you're out there.
Huh? No it wouldn't. Read my other comments in the thread, the point is that after it works its way through the population, the set of SARS-CoV-2-naive individuals becomes dominated by new entrants to the world (babies/toddlers), who don't die from COVID-19.
So over a period of 5 years, the average yearly death will be this year's deaths / 5. That doesn't hold in the same way for the Flu since it does kill babies.
> You'd effectively have millions of additional deaths from lack of hospital capacity
This is just false. I can't really debunk it because you didn't make an actual argument, so let's leave it at that.
> And additionally you'd have millions of more people with debilitating complications from all causes.
Huh? Are you saying complications from COVID-19 itself, or are you saying non-covid reasons which would get neglected due to lack of medical care?
> That's absolute insanity. You're devaluing life. Stop it. It's frankly scary to think you're out there.
No, I actually value life, which is why I understand how precious it is, and what a cruel thing it is to do to subject an entire planet to a regime of isolation and fear. As I've said elsewhere in this thread, I also believe that lockdown leads to more mortality than doing nothing, so even if you don't care about wellbeing and just want to myopically look at lives saved, I'm arguing that lockdown is worse on both counts.
That is, if we hadn't shut down, we'd have exponentially more infections right now.
There are deleterious effects to shutting down. But your theory that shutting down has lead to more deaths is absurd.