Citation? I'm finding nothing on their site more recently than August that could even be characterized as criticism, and to call that "harsh" would be wildly overstating the case.
They criticized lockdowns as the primary means to control the virus. They didn't argue against the usefulness of lockdowns in themselves. However, lockdowns have significant impact on poor people getting poorer.
WHO envoy Dr. David Nabarro:
> "We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus"
> "The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large, we’d rather not do it."
> "Lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer"
> "Just look at what’s happened to the tourism industry in the Caribbean, for example, or in the Pacific because people aren’t taking their holidays"
> "Look what’s happened to smallholder farmers all over the world. Look what’s happening to poverty levels. It seems that we may well have a doubling of world poverty by next year. We may well have at least a doubling of child malnutrition."
Well kudos to them for finally seeing reason, but I'm not willing to give them much of a break. They pushed for lockdowns full well knowing all these consequences before hand. Everyone (including myself) who mentioned a few months ago that lockdowns will make the poor poorer and will push large portions of the population into destitution were accused of being anti-science shills who cared more about property than human life. Now the chickens have come home to roost and the WHO has once again demonstrated its lack of understanding of topics beyond the realm of health. In and of itself of course, the WHO not being competent in running a society is not a bad thing -- doctors are not politicians after all -- but what is scary is how much influence they have had making societal decisions extending well beyond medicine.
I can’t take the WHO or the CDC very seriously after everything this year. One such example is when both organizations spread fallacies that masks are either not necessary/effective or only necessary in certain settings.
David Nabarro of the WHO said in an interview that lockdowns should not be the primary method of control and that lockdowns should only be used to buy time to develop better strategies to test, trace, and isolate clusters. He mentions Asian countries, Germany, and Canada as some countries that have done this pretty decently.
I don't think this is new, controversial, or a "backflip" (as some headlines have claimed). This is pretty much what the general guidance has been since March.
I can't find a source where WHO harshly criticises lockdowns. The recent statement by David Nabarro seems much more nuanced.
"We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus
...
Lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer"
"People are encouraged to adopt all precautions all the time. As Tedros of WHO says: ‘Do it All’: physical distancing, proper face-masking, hand/cough/surface hygiene, self-isolating when ill and shielding those most at risk. There should be no exceptions anywhere. This is best achieved through engaging people and trusting them rather than coercion if at all possible."
While he encourages voluntary measures rather than coercive ones, he is also clear: there should be no exceptions to mask-wearing and social distancing. That's politically hard to achieve in many countries. Hence, economic lockdowns instead.
If I told you a year ago that you'd describe a position as "overwhelming consensus", but that Ioannidis, Katz, Levitt, and Gupta had a different opinion, do you think you'd raise an eyebrow at that?
How can it be consensus when most of the top echelon of experts disagree?
It's hardly surprising that a small number of the most privileged academics have taken an anti-lockdown opinion - which is their opinion, not backed by even the simplest credible scientific model.
Business as usual is a pretty sweet deal for a professor at one of these universities. They will face absolutely minimal personal risk, and it further benefits them to get publicity by taking a contrary position.
I think this is deeply unfair to the GB signees. The issue here is not that they have a different "scientific model". They are suggesing giving a different weight to the competing costs of various approaches to covid19. I'm not sure I agree with them, but they're not disputing everybody else's science. They're saying "look, given what we know now, we think that if you rate the impact of the lockdown approach on poor people, and consider that to be a very important factor, you wouldn't see lockdowns as such a good idea".
None of that means that they are denying what lockdowns do, or the problems of a no-lockdown approach. They are saying that given a certain set of weights for each component of the consequences of a policy, we should try to avoid lockdowns.
You're free (as we all are) to disagree about the weight they choose for each consequence.
I also don't have to agree that lockdowns are essentially harder on the poor, which is concerning where it has happened but could be dealt with instead via better protections for people.
It's the same argument as 'restrictions on car-use are unfair on the poor' - an argument that you only hear from wealthy car owners.
To be honest, I was not thinking of the US or UK here, I was thinking of comments I've heard from India and Pakistan by advocates for the poorest members of those nations regarding the impact of covid19 lockdown policies.
scientists shouldnt be in the business of setting policy. they should report facts and its up to the public in a democracy and its representatives to make the policy. policy setting adds value judgements to facts.
ie science can tell us the amount of deaths or tradeoffs associated with certain choices but should never make the decision itself.
Bret Weinstein (the evolutionary biologist) has argued for a new, "brief but intense" lockdown. We know so much more about the virus now than we did back in March, we might yet be able to orchestrate a way to suffocate the virus completely.
I feel like a lot of scientists have been saying this. Maybe not as explicitly, though, which can be part of the problem. Even Fauci keeps talking about how we didn't really lock down hard enough.
It makes sense. If individuals are supposed to quarantine for two weeks when they're exposed, then if everyone quarantined for the same two weeks, it would be gone.
Obviously you can't do a true, 100%, lockdown like that, but the logic is there: the harder the lockdown, the shorter it needs to be; the looser the lockdown, the longer it'll be before this thing gets better.
> It makes sense. If individuals are supposed to quarantine for two weeks when they're exposed, then if everyone quarantined for the same two weeks, it would be gone.
Until the next airplane or ship or whatever arrives from any country in the world and has one infected person on it. Then we start all this madness again.
If you read the next sentence you would see that I was obviously not imagining such a thing was possible. I was just talking about the technical/theoretical way the logic works.
This is obviously not meant literally, if that's what you're contesting.
If your argument is that we cannot remove the vector for viral spread, while technically true, we can have a large enough suppression of spread through isolation that the virus would not have enough human infections to propagate. Animal vectors are a different story, of course, and often are the impetus for larger human infections.
It is much easier to use pharmacological means for that.
You don't fight bacterial pneumonia with good discipline and stern words, you use antibiotics. What will ultimately get out of this problem are drugs (and vaccines).
All these non pharmacological interventions are just bandaids.
I didn't say just vaccines. I said pharmacological interventions, which are more than just vaccines. No one worries about a disease if it can be treated. There are two approved drugs so far, with a third under emergency use authorization review right now. These are the way out (with an eventual vaccine afterwards).
Given the rise of "zero covid" ideas, which are unfeasible in the long run or even medium term (even with New Zealand's success, all it takes is an error... and of course, we all make mistakes), some countries are mistaking lockdowns for treatments.
OTOH, I'm not aware, at least in the EU (where I am located) of large pharmacological efforts sponsored by governments: most of the results have come, for good or bad, from the USA's Warp Speed or the UK. Yes, BNTech and CureVac are German, but they are exceptions, rather than the rule.
It isn't even proven that lockdowns can actually save lives, although the last study touching this among a whole load of other risk factors (from U of Toronto) can be now considered old (data up to early May).
Totally impossible. It will always return and resurge if there is little common immunity. There is literally no way to confine it indefinitely and any measure to seek to do so would be unreasonable and never actually work anyway for this particular disease.
That's a false dichotomy. This is obviously a balance, and someone will be upset (or sick or worse) no matter what choices are made.
I'll say this - all of the resulting pains are temporary except one. Maybe we should continue to be thoughtful of that as we battle what is a temporary struggle.
Great podcast with a Swedish Emergency Room Doctor.
According to the data they reference, Lock downs don't work and there is evidence that this virus is becoming more like the other 4 Corona Viruses in circulation.
The question isn't whether lockdowns could work or how to make them work. We know lockdowns can work because China successfully pulled one off at the beginning of this debacle and people there were largely going about their normal lives after about 6 weeks. The question is really do politicians in the US have the balls to actually prosecute a successful lockdown in the Chinese style (no leaving the house more than X times per week and only to perform essential activities, checkpoints, non-voluntary temperature checks, forced quarantines, forced mask usage, arrests for non-compliance, shutdown of every non-essential business, etc). The answer to that is a resounding no.
What China managed to learn in Wuhan within a matter of weeks was that even a tight lockdown wasn't enough. R was still hovering around 1. Most of the transmission was happening inside homes. The solution was to to implement a central quarantine. If you tested positive, you were not sent home, you were sent to a quarantine facility to get better. This reduced R to about 0.3, and they were able to eradicate the virus in Wuhan.
There have been fits and starts for this using empty hotel rooms, but nothing universal. In San Francisco, they offer hotel rooms to the homeless under the idea that they are more likely to catch the virus on the street, but they offer nothing to people who are actually confirmed to be infected. Those people go home and spread it to their family/roommates.
Even if you do dramatically reduce the spread of the virus, that doesn't do anything to solve the problem of lack of immunity. Worse yet with nobody getting exposed to the virus, it will be significantly more difficult to test a vaccine.
Overall, this strategy does not seem plausible. It would require participation of every single country in the world otherwise illegal immigrants from Mexico/Cuba/elsewhere could just re-introduce the virus.
We wouldn't even have to do that. PCR test the entire population daily, along with highly enforced quarantine for positive cases until they test negative. If we adopted this approach today, the virus would be eliminated from the U.S. population by Christmas.
It might not even need to be that intense. Dr Fauci recently said in an interview that the U.S. would be in much better shape if everyone wore a mask for 6 weeks to dramatically reduce the spread.
It was created by a Koch "economic policy think tank"[2], who regularly argues against climate change[3], the minimum wage, and social safety nets, and isn't focused on medical arguments, but rather economic well-being. It stretches credibility to suggest their primary interests are for the poor all of a sudden.
The argument is also predicated on there never being a working vaccine, and herd immunity being the primary mechanism of eventually ending the COVID-19 pandemic/lockdown[0].
> [0]Sunetra Gupta, an infectious disease epidemiologist, has been a critic of the prevailing COVID-19 pandemic lockdown strategy, arguing that the cost is too high for the poorest in society.
That's an economic argument, not a medical one.
Considering at least two vaccines are coming out of stage III trials[1] and may be widely available as early as summer 2021, I'd prefer to wait for that, rather than a scheme hatched by economically interested individuals who want to sacrifice a lot of people for essentially more wealth.
Which is where social safety nets, socialized medicine, and a stronger minimum wage come into play, but this same economic think tank as argued against all of them.
They've been on record, numerous times, arguing against benefits to the poor/poorest, and now suddenly we've meant to believe that they're looking out for the poor when it also benefits the wealthiest for the poor to sacrifice themselves?
Seems more than a little disingenuous if you look at whom we're discussing here.
Stealing from people to help the poor is very different from helping the poor by granting wider freedoms to the entire population. It's not hypocritical to support the latter but not the former.
Your argument basically boils down to: "Rich people refuse to slit their throats to give blood to the poor, therefore rich people aren't allowed to complain that lockdowns hurt the poor." It's intellectually dishonest and morally repugnant.
You might consider that economic policies effect health decisions and people's mental wellbeing, and that in making such a consideration find that they are not orthogonal issues.
> “It hinges on how many deaths we are going to tolerate before we get to a level of herd immunity where we stop transmission,” Rutherford said. “I have to come down on the side of preventing mortality.”
I must say I find this perspective difficult to understand - how can this person believe he's on the side of preventing mortality?
It appears certain at this point that there is no remaining mathematical possibility for the population-wide mortality rate in the US to end up as low as Sweden, which of course did not close primary schools or engage in any lockdown at all.
Sweden is by no means a model response - they did many things wrong. But at a minimum, it's a baseline count, no? If the USA mortality rate is higher, without even accounting for second-order mortality from the lockdowns themselves, then how can the US policy possibly be defended as anti-mortality?
Yes, that's the point - Sweden is a baseline for what happens with no lockdowns or school closures (but also few other sound counter-measures).
The US had lockdowns and fared much worse.
Taiwan had no lockdowns or school closures (but also has done some things that Sweden hasn't done, like isolate older populations) and has, so far, done better.
You can't use Sweden as a counterfactual for the US (or any other country aside from their nearest neighbours) because their culture is so different. Most people in Sweden live by themselves, it's a reasonably socially-distant culture by default, etc. Saying that it is what happens if you don't lockdown or close schools isn't comparing apples with apples.
a simplification of his argument is the end goal for all the policies is currently herd immunity. the problem with the current policy is reaches herd immunity by spreading the virus through both the vulnerable and less vulnerable population.
however, they are proposing reaching herd immunity by trying to spread the virus only through the less vulnerable population. because there is different rates of death between the two populations this should lead to less death overall.
There has been something very strange going on at Stanford since this began. Tons of really really bad stats, stuff that should destroy a person's career, even if it wasn't during a global pandemic and the bad stats resulted in the death of people.
Politics have overtaken some people's scientific sensibilities. Fortunately there are still lots of great people at Stanford, but they aren't the ones who are going on mass media.
>Politics have overtaken some people's scientific sensibilities. Fortunately there are still lots of great people at Stanford, but they aren't the ones who are going on mass media.
They've always leaned far more conservative than almost any other academic institution I can think of. Probably it's to do with the pervading influence of big business there. The Hoover Institution is one of the oldest conservative think tanks in the US.
It's weird because I had never heard that Jay Bhattacharya was super political. But early on he designed a study with unethical participant recruitment, juked and terrible stats, to push a bad pre-print for a contrarian number on the death rate that has proven to be very very very wrong. And he went out into media and pushed his bad study, at a crucial time. That the Mercury News is publishing his words is a huge black eye both for Stanford and for the Mercury News. It's clear that his COVID work is not driven by science, but rather strange political beliefs that can not be justified by data. Shameful.
> ... a contrarian number on the death rate that has proven to be very very very wrong.
What was that "very very wrong" number? I found [1] from April in which Bhattacharya estimates that the IFR is probably one tenth of the CFR of 3-4%, which would mean an IFR of 0.3-0.4%. That doesn't seem very contrarian or wrong. The CDC in May estimated 0.26% IFR [2]. The WHO just the other day [3] said that 10% of the world's population may have been infected with the virus. They also estimate ~1,000,000 deaths globally. That would imply an IFR much lower than 0.3%.
The CDC estimate was from before we had any good studies using antibody prevalence. It was too low.
The WHO estimates a fatality rate of 0.6%. If you are simply dividing deaths by (an estimate of) current cases then you will get an inaccurate number because many of the current cases will eventually die of the disease.
If CDC's mis-estimate from May can be forgiven by virtue of there not being enough good studies at the time, then why is Bhattacharya's even earlier (and more accurate) estimate being
characterized as unconscionable?
> The WHO estimates a fatality rate of 0.6%.
I don't see how that makes an estimate 0.3% to 0.4% "very very very wrong", especially considering that we haven't heard the final word on this.
> If you are simply dividing deaths by (an estimate of) current cases then you will get an inaccurate number because many of the current cases will eventually die of the disease.
I didn't do that, but if you look at the numbers you'll see that it wouldn't make a meaningful difference anyway. WHO numbers show over a million deaths since the start of the epidemic, and around 5000 deaths per day over the past month. Whether you use 0.13% or 0.14% for the implied IFR, the WHO's comments the other day are out of whack with the 0.6% fatality rate estimate.
I don't quite know what to make of the WHO estimate. I can't find further details about it. I don't think it makes sense to take this estimate and try to extract an IFR from it. They could be suggesting that the IFR of the virus is much lower than expected, but they could also be suggesting that deaths have been badly undercounted (e.g. in areas with poor health infrastructure), or that it has spread more widely among younger populations in places like Africa, where IFR would be expected to be much lower.
Bhattacharya's estimate is being criticized because, even though he was taking a contrarian view on the virus and getting results that were out of wack with other lines of evidence, he rushed out a highly flawed study (the Santa Clara seroprevalence study). This came out when we had little data about antibody prevalence, his study was one of the first ones, and it had the big name of Stanford behind it, so it was reported very widely and misled an awful lot of people about how dangerous this virus is. In his position he should have been bending over backwards to make sure he was on sure footing and not misleading the public, and instead he let this paper full of basic mistakes go to press.
> In fact, criticism of the two studies has woven a damning tapestry of Twitter threads and blog posts pointing out flaws of the studies—everything from basic math errors to alleged statistical sloppiness and sample bias
Unless I'm missing something, it's Twitter and blogs against published studies. Sounds like he's been proven wrong all right...
Damn, these are the same people who came up with that ridiculous antibody study which fueled the crackpot "widespread immunity" theory? They must have no shame to keep pushing their contrarian covid takes.
It's not all of Stanford, just one group (Jay Bhattarcharya's) that published a paper that betrayed extreme ignorance of binomial confidence intervals and modeling in general and is now the subject of this article. Why anybody would listen to this group despite after that is a good question (although, since poor understanding of statistics is rampant in the Medical field, let alone among the general population, perhaps not too surprising).
It's Battarcharya and a few others, including Ioannidis. However Stanford is completely complicit, and when I search for these people I get results like this that promote bad information and reasoning:
Rather than anything from the university that promotes the more accurate statements from the rest of the faculty.
So I would say that Stanford carries a lot of blame for letting their name be used for disinformation, and is not pushing back at all, which is a huge disgrace. If you are an alum, make some noise and refuse to make contributions until they start at least giving equal PR time to the scientifically based viewpoint.
Edit: and how could I forget Michael Levitt, who is now following in Kary Mullis' footsteps as a Nobel winning biochemist that promotes for crazy viral theories that damage public health
Well the Daily is the independent student newspaper and has little to do with official University policy. I don't know what FSI is, perhaps some department that Bhattarcharya is part of. I agree, if it was being pushed by official Stanford news sources (a search for Bhattarcharya on https://news.stanford.edu/ reveals nothing, although plenty of other COVID-related research), that that might be problematic. I agree it's not a good look for Stanford, but but if people conflate researchers from a university with a university, then that's on them.
That “conflation” is the exact same thing as the University’s reputation. If they don’t value their reputation, fine, but these bad researchers are only getting press because they are attaching the univerity’s name to their ideas. That’s not something to blame readers for. And if there are researchers at these universities that oppose them, it’s up to the university and other researchers at Stanford to stop their name being use if they disagree with its use.
Well I might be too knee-deep in academia to be a fair judge, but every university is a bunch of independent researchers of variable quality with wide latitude to pursue whatever and it seems silly to judge a university's reputation based on some individual researcher (or alumni, or whatever). I think any conflation is more the fault of media articles about the research than anything else. Yes, you write your affiliation on papers, but that does not really construe any sort of endorsement. I'm sure one can find many Stanford faculty expressing contrary viewpoints, but those are not (for whatever reason) being amplified by the media.
I can put a crazy paper on the arXiV tomorrow with my affiliation and if some media report says "The University of Chicago is claiming a perpetual motion machine" or whatever, that's the media's fault for misrepresenting the situation.
Curious, explain to me why I should listen to a random person on the Internet over a university research group? "betrayed extreme ignorance of binomial confidence intervals and modeling", lots of words but zero evidence supporting your assertions. If you have any concrete evidence to contradict their findings rather than just a blanket "extreme ignorance of binomial confidence intervals", that would be far more useful.
I think calling it "extreme ignorance of binomial confidence intervals" is incorrect and far too charitable. The authors were intentionally deceitful. Co-authors of the preprint requested that they be taken off the pre-print because they had warned that the statistics were bad. Prior the the prevalence study, they had cherry picked weird data sets and published an editorial. They are clearly trying to bend the data to their preconceived notions, in a really public way.
To see journalists pick up their work again, just because they are at a big name institution, is a huge betrayal of the public trust.
> scientific body rising up to demolish them for obviously bad work
Come on man, let's be fair: a couple of tweets and a few snarky emails hardly consist of the "scientific body demolishing them." I'm not sure if I agree with Bhattacharya's study, but it's hardly been universally repudiated. This just low-effort politicizing by Ars Technica (which has a spotty record to begin with).
Even this critical blog post[1] has all kinds of colorful discussion (mostly by academics) showing that things are simply not as cut-and-dry as we'd like them to be.
Essentially the problem with the study is that the bounds on the false positive rate of the test used was such that the data are completely consistent with all of the positives being false positives.
I am okay with qualified medical professionals having a good-faith debate about the broad physical and mental health impacts of lockdowns as it pertains to this particular virus. It is a fair discussion to have.
I am not okay with unqualified politicians making inaccurate claims about the virus, and prioritizing economic health in the absence of good governance.
I believe there are obvious risks to mental health of adults and children in being isolated from others, unable to socialize with other humans in person. I read recently too, that things like kids in school in person allow teachers and members of the community to be a safe space for children to be seen and essentially monitored for child abuse/poor living conditions. People may go to the doctor less because of fear of the disease, rather than get treatment.
It is certainly a balance - we cannot go full "save every possible life" - thus the term "flatten the curve", where the metric for success was not to have absolute minimum deaths, but to preserve the integrity of the health system to best serve all who need emergency care for any reason.
There was an article in February called "The Hammer and the Dance" that predicted a cycle of shutdowns and reopenings to balance social interaction and jobs with overriding systemic medical concerns. We are in that now.
> I am not okay with unqualified politicians making inaccurate claims about the virus, and prioritizing economic health in the absence of good governance.
This sounds a bit like you are raising the qualification barrier to participate in the debate, but only if that person disagrees with you.
Luckily as educated adults we are blessed with being able to exercise our judgement to assess what is right, wrong, an honest mistake, a deliberate distortion, a kinda-bad inaccurate claim, or a dangerously-bad inaccurate claim.
Before COVID-19, I would have said that we pay for CDC, FDA, Surgeon General, epidemiologists, and virologists to be right about that stuff and they're generally trustworthy.
But then they all tried to convince Americans not to wear masks.
I didn't read their comment that way. The article isn't about doctors with years of experience advocating for lockdown, so this conversation is framed around people disagreeing with how deadly the virus is and the lockdown procedures.
I'm sure that poster, like me, also doesn't want politicians making inaccurate claims the other way about how the virus is the deadliest thing imaginable, or to prioritize saving every single life possible by orders of house arrest.
"US President Donald Trump has been lambasted by the medical community after suggesting research into whether coronavirus might be treated by injecting disinfectant into the body."
As someone who disagrees with Trump almost always, I feel like this is not a good point to harp on because most people realize he wasn't really suggesting people inject disinfectants, just musing. When conservatives see this kind of mischaracterization it just solidifies their beliefs that his critics are always wrong about him.
I am more upset about the fact he still doesn't seem to believe masks are very useful.
It is incredibly irresponsible for the President of the United States (or of any country) to speculate about obviously questionable practices like injecting disinfectant in the midst of a global pandemic and a national emergency.
And, the sad fact that we have to remind ourselves of this (you don't "muse" about injecting disinfectant!) is an indicator of just how irresponsible, destructive, and and constant the President's behavior, and it's enabling by politicians, the news media, or others in positions of influence (whose responsibility was to condemn such behavior) has been.
This is not complicated. No one who cares about their own well-being would ever want to work under a boss like that, much less let someone like that babysit their kids.
It is incredibly irresponsible for the President of the United States (or of any country) to speculate about obviously questionable practices like injecting disinfectant in the midst of a global pandemic and a national emergency.
So basically you are saying “the President of the United States did not say the totally crazy thing you said he did, rather, he said something less crazy which was both incomprehensible and totally irresponsible.”
Is that correct?
I say it this because at this point, it’s not as if we are dealing with a honest broker known for truthfulness, so, especially since everyone seemed to understand exactly what I was referring to and the “bleach” thing was a common point of mockery across media and late-night television, aren’t we kind of missing the forest for the trees?
The forest of course is a President who is utterly irresponsible and has contributed to the unnecessary deaths of over 200,000 Americans.
I absolutely apologize for and retract my incorrect description. Can we now talk about the reality of a covid-diagnosed President walking around in public without a mask?
Or does someone want to diddle and play and parse with words again?
If you are interested in rallying the base then go ahead and mock like late night comedians, but if you want to have a discussion with someone who may not be wearing the same jersey as you then you may want to be more precise.
Sure. Do you think what the President actually said - not my paraphrasing of it - was responsible and appropriate under the circumstances?
Did he demonstrate good judgement?
Also, again, I think you’re constructing an issue where none exists. Everyone in this discussion seems to have understood perfectly well what I was referring to.
I do not think what I said is really the issue here.
The issue is a number of irresponsible politicians actively and knowingly undermining public-health efforts during a pandemic.
That’s what we should be talking about.
And I find it frustrating that folks seem to want to shy away from this unpleasant truth when it’s raised.
It’s like if a truck is going to hit you and someone yells “watch out for that damned truck”, and you yell back “can’t you tell me that without cursing?”
Or if you said “you know I worry the way you said that might make it difficult for someone else to understand your message of the impending truck.”
If you keep cussing at people to get out of the way of a truck and they keep getting hit by trucks because they stop and say “did you have to use so many swear words?” maybe stop cussing.
The problem is the person driving the truck irresponsibly, not the person pointing out the impending accident.
Look. Point is. President Trump and his political enablers have proven themselves to be dangerous and irresponsible, and bear significant responsibility for the deaths of tens of thousands of americans because of the administrations terrible handling of the pandemic.
That is the truth.
I understand some people disagree. Those people are wrong.
This is ultimately about right and wrong, and irreconcilable values.
The current administration and its political enablers are pandering or outright leading the worst aspects of American society - white supremacy, exploitation of the poor and powerless, sexism, and authoritarian/fascist tendencies.
This is what I believe to be true, and while I will listen and discuss with people who may not agree with me in full, I will not equivocate about the immoral, unethical, un-American nature of the Trump Administration and what the bulk of the Republican party has become.
The great thing about a well-working democracy is when people talk with each other and select a good truck driver. (Though I’m not a fan of thinking of the President as the driver of the truck, but that’s a different issue).
Do you believe the President of the United States spoke in a responsible fashion? Do you believe his words were responsible, prudent, and appropriate to the moment?
What he actually said. He clearly gives caveats to what he's saying: he's not advocating anyone actually do anything. He's talking about further research.
"So, supposing we hit the body with a tremendous - whether it's ultraviolet or just very powerful light...and I think you said that hasn't been checked but you're going to test it....And then I said, supposing you brought the light inside of the body, which you can do either through the skin or in some other way. And I think you said you're going to test that too. Sounds interesting....And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning? ...So it'd be interesting to check that....I'm not a doctor. But I'm, like, a person that has a good you-know-what. [Pointing to his head]
Yeah, if you're fine with unqualified politicians making inaccurate claims about the virus in order to intensify lockdowns (which, frankly, has been most of the lockdown justifications) then that's pretty unfair.
The burden of proof should be on the lockdown proponents, not people trying to return to the status quo.
We're not used to sharing space with hungry wolves or big felines, in fact humans tend to exterminate them when they move into a new environment.
There's a new predator out there, invading our space and we're its lunch. there's precious little status quo to return to until we have the tools to exterminate it.
We're not used to not being apex predators. That's fact.
A new predator, to go along with all of the others. AIDS, the other things that get lumped into 'colds' or 'flus' (which are different from COVID-19 in degree, but not really in kind), Malaria, and so many more.
Except HIV isn't airborne, doesn't choke you to death within a couple weeks and the other 'cold' and 'flus' aren't nearly as deadly.
Cov2 is both everywhere and lethal, that's quite a difference in kind.
And WRT "Malaria, and so many more" we as humans and our collective organizations have been busy trying to exterminate or avoid them as much as possible. Since forever.
FWIW, I didn't read the the comment this way, and it doesn't seem like "the strongest plausible interpretation of what someone says".
From the HN guidelines: Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
I just struggle to get on board with the premise of medicalizing all of society. Can the harms from social isolation, poor quality education, economic damage, etc. really be reduced to medical factors for doctors to weigh against disease risk? I think these are inherently political decisions; or rather, politics is the process by which a society decides how to make such challenging tradeoffs.
I think a clear distinction needs to be made between normative and descriptive claims: the former, everyone has the right to make and hold their own opinion to, including both politicians and scientists; the latter, should only be entertained by policy-makers when supported by evidence-based scientific research.
For example, a politician has every right to say "I think schools should re-open immediately under X procedures," if that is what he truly feels reflects the best outcome for his constituents. Of course, it would be wrong to say this only for political posturing, corrupt influences, etc.
On the other hand, it is completely unacceptable for a politician (or anyone) to say, "Children are immune to the virus," "COVID is not a serious illness," (okay, technically that is normative but only insofar as the definition of seriousness is normative), "same as the flu," "masks cause oxygen lack," etc. Likewise, asserting these claims in an argument, "Children are immune -> we should open schools," is not right.
But, making a philosophical/policy and/or medical argument based off true, evidence-backed descriptive claims--even if the scientific community does not tend to share that normative opinion, is completely fine. So there is nothing wrong with arguing against a given measure that the majority of doctors support, so long as you aren't distorting the underlying facts.
As a practical matter, of course, this shuts down many arguments. Ex. admitting that masks pose no health risk to the wearer, cost very little, do not substantially limit any right or activity, and have at least a fair probability of public health benefit, it would be hard to argue against requiring them. But if you feel otherwise, make your case by all means. The only thing that is morally wrong is corrupting intellectual discourse by adding FUD and confusing people as to the underlying evidence and data.
This might make sense if medical experts consistently made accurate predictions, but they often seem to be wrong, and have to change their positions after the fact.
One could go as far to say that it is irresponsible to give their peripatetic claims more credence than they seem to historically deserve, especially when it's clear that there are legitimate trade-offs.
> I am not okay with unqualified politicians making inaccurate claims about the virus, and prioritizing economic health in the absence of good governance.
Who else is supposed to make these types of decisions? Doctors don't have governing experience, and they weren't elected. They can and should serve an important advisory role, but the final call should be up to our elected leaders.
If we have elected unqualified politicians, that's a separate problem. This is still a decision that's within their domain.
I sense that everyone fairly well off sort of ignores how quickly poor economic health translates into poor social and biological health. We like to act like the economy is this nice to have extra that can shut down, and everything will go on as normal, except our luxuries. But then you realize, you cant shut down ports, railroads, roads, trucking, Wal-Mart, Amazon, Target, every grocery store. And suddenly all the interconnected everything requires all the software companies to stay running. All the power companies. They all need their supplies.
>we cannot go full "save every possible life"
Where is the calculation of life lost or years lost of lifespan, because the economy wasn't there to support life.
>thus the term "flatten the curve"
I understood the context of flatten the curve to be in that we needed to buy time to prepare hospitals, manufacturing, and as a tool to prevent ICU overflow. It's now been co-opted to be used in a "until the vaccine" sort of way, which is not how it was used initially. You can see how people might have agreed with it before, but not now, and still have a consistent unchanging view (its the usage around their view that changed.) It's also very frustrating to hear rate statistics used out of context, as if the instantaneous rate is what matters, without the understanding that their denominator, time, extends into the future, and with part of the denominator in the future, the numerator is not very useful.
It's odd that you're attacking what I said when I'm kind of supporting what you're saying. That we can't sustainably lock down indefinitely until a vaccine, that we need to balance the desire to protect lives with the need to live and work.
Your statement about flatten the curve is exactly what I said.
I will say, though, I bet we disagree on this: The federal government should have minted off a few more trillion dollars to keep people home as needed without them losing their jobs or insurance. Our American political/economic system is not built to keep people healthy or economically secure, and the government should take a more active role in fixing that.
Im not sure if I agree or disagree that blindly throwing more money is the right approach, but I can say I think we did a poor job of using the information we had early on (age, weight being major factors) and using that to selectively protect the most vulnerable. Locking down elderly care to an extreme level and having the social support and food to do so, might have saved more lives-years than keeping everyone at home.
All in all, it just wasnt feasible to tell the elderly to stay home while the rest of the world continued humming. This was one way to get everybody to care.
I wasn't disagreeing with what you said about flattening the curve, I'm saying its meaning has changed in some usages, from what you described to something else.
In business, science, philosophy - the first objective is to define your goals. I find these kinds of papers and the general discussion surrounding lock-downs seem to miss this first step.
If the goal is to preserve the maximum number of human lives, lock-downs are probably reasonable (particularly since lives saved keeping the highways closed alone meets or exceeds lives saved from COVID) - this logic also would have probably kept it out of WW2, kept us from sending humans to the moon, etc.
If the goal is prevent the maximum damage to the economy possible, then lock-downs should probably be extremely brief and extremely intense.
If the goal is maximum human freedom, again, the choices are obvious.
Any discussion that doesn't first define the goals is useless with this topic.
for many individuals and for many groups of humans, goals change as the costs of a given goal become more clear. It's not always possible to state a priori what the goal is, and even after settling on one goal, new reasons (new costs) may appear to push us towards a different goal.
You compare sending humans to the moon with a pandemic. Same with WW2. Staying out of WW2 didin't guarantee you safety, quite the opposite.
There are still many unknowns about the virus impact on health so telling people they should take a chance because it might not be worse than working remotely seems a bit inresponsible.
Governments should either impose lock-downs until they find a vaccine or develop ways to "live/work" with the virus(i.e strict measures, keep the virus under control etc), though it's hard if we can't/don't even want to wear a facemask and commander in chief claims the virus is a hoax.
Lockdowns don't guarantee safety either; the virus is still out there. And the consequences of lockdowns are material, with a lot of hard-to-quantify downside risk - the black swan case could be "second great depression leading to WW3".
It's not obvious which position is the responsible one.
>>It's not obvious which position is the responsible one.
I think the responsible position would be to provide the people with a safe environment where they can work and live. Perhaps also working a bit on the inequality issue.
It's clear to me that with or without the lackdowns the worst affected are the already poor people working in the front line.
You're correct, but I meant - lives saved due to lock-down. If the lock-down meant 0 people died from COVID, then you're totally correct. Was slightly hyperbolic I suppose :)
However you're making the assumption that lives saved by the lockdown < lives lost even with the lockdown. If the lockdown had prevented all deaths from COVID, you'd be using this logic to say it was completely worthless. By this logic, the more effective the lockdown is, the more you argue how unnecessary it is.
You could argue that traffic fatalities tend to be younger victims, at least compared to COVID victims. So the number of life-years might be a better comparison. But this still doesn't resolve fundamental questions, like how much "disability" does a young person experience in lockdown? Or how much suffering does an older COVID victim experience?
The first wave of lockdowns had a clear goal: "flatten the curve" to prevent hospital capacity shortages, thereby preventing extra deaths that would be entirely attributable to resource shortages. In terms of meeting this goal, lockdown 1.0 was successful.
In the case of COVID, why can't individuals choose goals for themselves? It seems possible to allow those who want to take their chances with COVID in order to maintain personal liberties and/or economic viability to function as usual, while assisting those who want to prioritize virus avoidance (e.g. subsidized food delivery services for the elderly, a modest stipend for those who want to avoid the workplace for a while, etc.).
Is this too complicated to implement?
I would think this more nuanced approach has way more upside than going 100% one way or the other.
I think the issue is that it is a collective action problem. No one person's actions on the margin are really making much difference to society-wide spread and assuming you don't want to completely isolate yourself indefinitely, then your personal risk of contracting COVID is very sensitive to the level of infection in the society around you. In theory, we could achieve a higher average standard of living all around if we could coordinate everyone reducing their risky behavior by 30% (a number I just made up).
This is the point that I think often gets missed in the discussion around "lockdowns". I would bet that we could actually reduce the spread of COVID quite substantially without a massive change in the living standards of most people. The problem is that there is a segment of people who refuse to do anything at all to reduce the risk of transmission so we end up having to take more extreme actions to compensate.
>The problem is that there is a segment of people who refuse to do anything at all to reduce the risk of transmission so we end up having to take more extreme actions to compensate
I think you might be missing the fact that if this segment of the population does increase transmission, it can only do so by the members of that segment getting infected, and that can only happen once per person as far as we know. So over time, you would expect that group to be less and less prone to infection, and therefore less able to pass on infection to others. So the more time goes by, the weaker this argument becomes.
Strictly speaking that is of course true, but I'm not sure it is relevant over the time scales we are concerned with. If there were only a handful of such people then they would all get infected relatively quickly and stop contributing to overall spread. And that may be the case in localized outbreaks, but I see their role overall as "seeding" individual hot spots. In other words, people who disregard basic social distancing protocols may not spread COIVD until it actually becomes prevalent in their local area. And when that happens they become the super-spreaders which cause new local outbreaks to fire up.
It falls apart once you actually think about. People live in a world where we all interact together. If you want to get infected thats fine, but now you're contagious at the same unavoidable gathering places like supermarkets
> subsidized food delivery services for the elderly,
or this, now people are stuck being forced into risky scenarios because they're forced to serve the others fortunate to pay for their problems to go away
You propose this initially as "individuals choose goals for themselves" but what it requires is "government to provide options for individuals."
"Government to provide" gets you into huge trouble in large parts of the US who will decry this as socialism, etc.
And sadly, even a lot of the US that isn't so cruel and selfish, seems worse than its peer countries at executing government programs effectively...
Half the country doesn't have the imagination to imagine things could be better for everyone without being worse for them, and the other half doesn't have the imagination to hold themselves responsible for actually delivering results vs just trying.
What percentage of people who want the freedom to ignore virus precautions do you think are also willing to pay to subsidize others staying home? I'm not optimistic it would be large.
The solution you suggest would be equivalent to a permanent Red Hour, with those bent on damaging themselves and others roaming the streets at will, while those with any sense cringe helplessly indoors, starving to death. "Nuanced" is not the word I would use to describe it.
The same ones that are already paying for the current financial safety nets; it would be just a case of switching the money from those over to taking care of those at risk.
Provided the risks are understood (although I would like real data on long term covid effects before continuing) the solution would effectively bring us back to pre covid society.
> The same ones that are already paying for the current financial safety nets
Those who are currently paying for safety nets are doing so by compulsory taxes. If left up to their choice, as above poster suggests, why should anyone expect them to continue paying at the same rate?
Genuine question as i hear this argument quite often: "to maintain personal liberties". presumably infecting and/or killing other people would fall under this liberty? anyone outside their own home is considered to optimise his personal liberty and therefor ok with being killed?
if not, how do you include those who would like to maintain their personal liberties but don't want to trust others with their life in your proposed worldview (reckless behavior of others in terms of infections etc)?
Actually even more complicated than that. Say we adopt the personal liberty premise. If I am at high risk, I stay in my house and have everything delivered etc. Then my furnace breaks in a way I can't fix, and its winter. If I don't want to freeze to death, I need to get it repaired. If the repairman was willing to "take their chances", I could be forced into exposure and infection.
It really is a group activity - individuals can not take their own risk without risking the lives of others.
We accept a certain amount of risk in our lives no matter what we do. You personally had the liberty to go out and infect people who were at risk of death from colds, flu and any many others diseases before covid came along and that was never reason for a global shutdown.
Those who don't want to trust others with their lives are welcome to take the precautions that are being asked of everyone at the moment (no household mixing, complete lockdown) the only difference would be it would only be those at risk subjected to the lockdowns.
to a certain extent. hence i am not allowed to infect other people knowingly with HIV. or drive on a sidewalk. or fire guns at a school. or drive drunk. list goes on. not even sure about the flu/colds, presumably that is more a problem of proving guilt rather than liberty.
it isn't binary but a fine-tuned probability. i don't see a problem not allowing riskier than usual (i.e. increasing the probability of infection) behavior.
"In the case of COVID, why can't individuals choose goals for themselves?"
In case of driving, why can't individuals choose which side of the road to use for themselves?
"while assisting those who want to prioritize virus avoidance (e.g. subsidized food delivery services for the elderly, a modest stipend for those who want to avoid the workplace for a while, etc."
Who is going to pay for that? Those who are maintaining their personal liberties? Keep in mind that the poorer parts of the community are impacted worse by both COVID and the economy.
In a situation where a large part of the population is "taking their chances", those who "want to prioritize virus avoidance" must avoid all contact with others. That's quite a different trade off than handwashing, masks, and social distance.
> In case of driving, why can't individuals choose which side of the road to use for themselves?
It not a choice of side it's a choice of whether to use the road at all, those who agreed to use it before managed fine and those who are choosing not to use it now are perfectly free to do so.
> Who is going to pay for that?
The same people who are already paying for Furlough and all the other financial safety nets that are already in place at the moment.
> In a situation where a large part of the population is "taking their chances", those who "want to prioritize virus avoidance" must avoid all contact with others. That's quite a different trade off than handwashing, masks, and social distance.
The requirement to stop all contact is already effectively there for those at risk, and the demands aren't stopping at handwashing, masks, and social distance as those don't appear to be working; instead indefinite lockdowns, blanket bans on household mixing and abolition of major sections of peoples lives and livelihoods are being demanded.
I'm 53 and have asthma. I'm sorry my existence inconveniences you, but I believe the "isolate the at-risk and everyone else can pretend nothing is happening" is a direct attack on my liberty.
"...the demands aren't stopping at handwashing, masks, and social distance as those don't appear to be working; instead indefinite lockdowns, blanket bans on household mixing and abolition of major sections of peoples lives and livelihoods are being demanded."
Have you considered moving somewhere else? I don't know where you are, but hand-washing, mask, and social distance seem to be doing fine here, and there are no indefinite lockdowns or the other things you mention. See https://governor.alabama.gov/assets/2020/09/Safer-at-Home-Or....
I have friends and family whose businesses and livelihoods have been destroyed by this, but no it's fine we should just let them all go to the wall, what's a few evictions here and suicides there eh? I mean fuck em right, you've got yours?
If you have a look on a news site that covers areas outside the global hub that is alabama (reuters for example https://reuters.com/news/world or any other major news organisation) you will find...
1. It is pointless moving elsewhere as the virus and the response is worldwide (that 7 months of this hasn't brought this to your attention is...of note.)
2. The measures are being viewed as insufficient and and we are facing curfews and all of the things that I mentioned ARE happening.
IMO even with those goals stated it is not clear what course of actions should be taken. Because they could be all linked together, a crumble economy might kill more people you are trying to save [1].
> If the goal is maximum human freedom, again, the choices are obvious.
Really, do explain please. First I'd like to know what you mean by freedom. I assume you're also considering that a) the dead have no freedom, and b) those incapacitated in some/many ways (economic, physical etc.) are definitely going to have less freedom in the long term.I think it is anything but obvious how to maximize freedom in general, let alone with respect to a pandemic.
Freedom is having a choice. Between, say, having fun in overcrowded bar till 3am or staying in your apartment alone, ordering delivery and watching netflix. Quite simple.
I never said it simple. Choosing between driving dodge ram or prius also affects others, because pollution. All I said that freedom is having mutiple choices.
But that's my point, freedom defined as "more choice" is not simple because more choice for you may mean less choice for me. You can't just separate out the consequences.
This statement might be applicable to so many things in today's tumultuous world (e.g. politics). Goals are just not defined anywhere. Maybe this is the reason we argue so much. Some people want guns, others want to ban them. The reason we can't get to a consensus is that we likely all have different goals.
Exactly. That is why we have politicians - they are (or could be) our representatives to propose compromises that try to consider everybody's goals. Scientific or technical inputs should be inputs to these proposals, to identify causal effects, but they should never be directly dictating the political choices that get made. Technocracy doesn't work, precisely because the technician focuses most on their area of expertise, and not on how it interacts with our society. We need strong politicians to navigate compromises.
This is a very good point, but sadly in reality it seems these goals are purposely hidden or obscured for subjective gain or unpopluar ideological reasons.
Initially the pandemic response was about "not overwhelming the hospitals", but it seems some politicians disagree on the fundamental direction. I'd just be happy if my government had a clear policy on their goal. Do they want to reduce infections or do they want to prevent overwhelming emergency services?
Obviously my knowledge on facts is very limitted, I simply don't have time for that, but the news still report lots of capacity in hospitals.
Well there are three possibilities
1) Reduce Infections: You try to get infections down to zero.
2) Ignore Infections: Usually used for common cold. People even go to work with it.
3) Limit Infections: You dynamically scale meassures to stay at a defined limit. In this case a number derived from hospital capacity.
I think this is an excellent point, and goes to some of my frustration as to how I think the "goal posts" have been moved. I completely agree with the "flatten the curve" mindset of preventing our heath systems from being overwhelmed. But we've been far under that where I live for months now, and it seems like the view from the left (which I usually tend to agree with) is now that we should prevent any transmission and essentially be in our current state of lockdown (which, granted, where I live isn't super strict, but still very few people are going into the office and nobody I know is meeting in groups) until there is a vaccine.
I don't know what you mean by "lockdown" since masks, hand washing, and social distance is not really what I'd consider a "lockdown", but...
What happens when you say, "flatting the curve worked!" and relax all the recommendations and requirements? The infection numbers go exponential again, right?
Yes about three weeks ago. If that was going to cause exponential growth then we should have seen a sustained rise in cases by now, but it hasn't happened.
Reality is rarely that clear-cut. E.g., imagine an airplane.
If the goal is maximum range, we should get rid of first-class seats, life vests, and all sort of useless amenities. (Do we really need four lavatories?)
If the goal is maximum comfort, we should get rid of all economy seats. No more affordable plane tickets.
If the goal is maximum speed, we should retire our fleet and re-introduce supersonic flights. Those suckers living under a frequent flight path can use earplugs.
If the goal is maximum safety...
What I'm saying is: every time we say "our goal is X", it implies an additional condition "assuming other things stay reasonable." Of course, something like COVID is not within anyone's living memory, so it's hard to build a consensus on what's reasonable - but we can't just short-circuit it by saying "Just say what you want and stick to it!"
The reaction to COVID is not within anyone's living memory. COVID-like events definitely are.
2009 Swine Flu, predicted to be hugely deadly, WHO changed the definition of pandemic so they could declare it one. Ended up being a non-event (nb: numbers are not comparable as there was no mass testing programme like today).
In many countries excess deaths are no different to previous years. For instance in Switzerland cumulative death in 2020 is by now the same as long term expectation. Fewer people died at the start of the year than average, then it went above average during COVID, then it came back to the long term average slowly over the summer. COVID is nothing more than a seasonal flu, here. In Germany it's not even that. Excess death for 2020 is smooth and flat, compared to 2018 where it saw bigger spikes. Also Swine-Flu like.
Even in the UK, which has largely shut down its health care system and imposed draconian lockdowns, excess deaths matched 1999/2000 which were not notable years. Nobody noticed any unusual levels of death back then.
This is why there have been so many people criticising lockdowns so strongly, for such a long time, and now people are paying attention because SCIENTISTS! but you could look at the government sourced data in perspective back in April or May, to understand that the reaction was not proportionate to the threat.
Yeah that's the goal, and you do need a tight lockdown to reach it, but only for a short time (4-8 weeks) if everyone commits to it. That's really not too big a sacrifice to ask to kill an epidemic.
It's also clearly direly needed practice for the next, worst epidemic. We got lucky with COVID-19, it's on the mild side of the scale.
In a worse case scenario, say Ebola mutates to an airborne strain, the countries and cities that essentially used COVID-19 as a practice run to develop the procedures and social knowledge to quickly shut down an epidemic, will be looking smart.
We've known for decades that pandemics are coming, as the world becomes more physically connected. We've written tons of books and made tons of movies about it. Every zombie movie of the past 20yrs is about a viral outbreak.
So it's insane that so many Western countries are behaving like idiot children in the face of this entirely predictable and predicted problem.
A small number of infected people leads to about the same R as a larger number. It's things like contact tracing and masks and limiting large groups that reduce R without having a lockdown.
(I'm talking about R when a small to moderate number of people are infected; the slope of the R vs number infected curve will vary due to many factors)
Fairly severe, but it worked for Australia. Victoria got well defined goals for metro and regional areas. Now regional Vic is more or less open. Metro is close to threshold but lagging with just under 10 cases a day.
If the goal is prevent the maximum damage to the economy possible, then lock-downs should probably be extremely brief
I respectfully disagree. For a while I've been thinking that's more or less a classic false choice -- this argument that those in the "saving lives" camp are somehow refusing to care about the powerful value in our economy.
But I think you save the economy by beating the virus. People won't walk into a crowded and poorly ventilated restaurant until the virus is gone. Anything that prolongs the virus's presence in our country will drag down the economy. I feel like some of the "pro-economy" people aren't sufficiently recognizing that.
Sweden tried to save the economy, but ended up with a similar hit to the economy as other European countries, at a higher cost of lives.
Hopefully their second wave has less impact, with more people immune now, but it proves your point. We need to have a basic trust before we spent any money (excluding basic needs of course)
> In business, science, philosophy - the first objective is to define your goals.
How many times have you seen someone actually write out their utility function? Or agree on a single number on which the results of an A/B test will be based, regardless of other metrics? Defining your goals is an admirable objective, but it's not commonly done to the degree you're proposing.
All else equal, we want to preserve the maximum number of human lives, prevent the maximum damage to the economy possible, and provide maximum human freedom. Quantitatively defining the tradeoffs there is basically impossible.
What's much more common is proposing a few options, and listing out how each options affects the metrics you care about, then deciding an option.
Said more explicitly, it's easier subjectively to pick a point on a rigorously found pareto frontier than to subjectively define a utility function to be rigorously optimized.
I don't understand why the goals need to be 'maximum' anything. By it's nature, maximizing for something means something else needs to be completely minimized.
Life, society and the world doesn't work like that, regardless of whether there's an extreme event going on.
Any goals should include balance and shouldn't just be trying to maximizing one variable.
Even using something I personally can't stand as an example, models. In a model, maximizing a variable rarely leads to any desirable outcome and models tend to be a poor reflection of reality as is.
Reality is far more complex, having a goal be to maximize for one specific variable means your minimizing other variables that are in many cases complete unknowns.
Instead of working towards measured goals designed to minimize overall negative impacts, the reaction has been to maximize for saving as many lives as possible at the expense of all else.
The problem is, there's no way to even really be sure what we've done is maximizing the amount of lives saved, but at the same time we've ignored very real negative impacts in this blind rush towards maximizing saving as many lives as possible.
And to be honest, from what i've seen on the news, heard people saying, read on comments here...this seems to be the primary motivation behind this goal(or thinking like this)
>“Whose grandmother and grandfather and family members are you willing to sacrifice for this stupid idea?” asked Santa Clara County Executive Jeff Smith, whose administration in March led the Bay Area in imposing the first U.S. lockdown in the pandemic and has since been criticized since for its slow pace of reopening.
This is a logical fallacy intended to appeal to emotion. Wide sweeping policy decisions affecting the health and well being of most of society should never be based on emotional appeal.
The goal is to put weights on all these objectives, sum them up and maximize the sum. Normally the weights are done in $, for example one extra healthy life year is $50k. It's the concept of QALY. Does it take more than $50k of damage to the economy to save a life? If 200k old people died with average 20 years to live, the cost is $200bn. Thankfully with exponential pandemics the actions are pretty obvious, I.e. killing 200k people makes sense, 1m doesn't and 10k would be too expensive economically.
It is deeply frustrating to me that there doesn't even seem to be agreement on basic facts about sars-cov-2/covid19 yet. Death rate? They're still arguing. Risk of serious complications by age group or complications? Still arguing. Negative impacts of social distancing/lockdown measures? Still arguing.
I think it's great that there is an argument about this, but it still feels disappointing that it will still clearly take a lot longer then 10 months to clarify these points to a level where no serious high level medical professional disagrees.
In the meantime, I'd also appreciate it if we could get back to a lot more talk of "flatten the curve" in our public discourse. Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus. The question is how rapidly that happens, and the concomittant impact on health care and the economy if it happens too fast.
I agree with your sentiment. It really shows that COVID-19 has been politicised so much that people can't debate on the topic anymore in good faith, because nobody wants to admit that they might have been wrong. Especially people like Donald Trump make a scientific debate extremely difficult, because he has been undermining the virus from the beginning and even if science was to find that the virus was less dangerous than initially thought many scientists, especially those who had public exposure, wouldn't want to support/admit an idea which could play into Trump's favour. The whole thing is just a bloody mess.
> Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus.
Unfortunately there are many people who really believe we can eliminate the virus through strict measures. Just read many responses here on Hacker News and you'll find plenty of those people.
This rings true. As soon as it was politicized neither side will budge an inch. And scientific progress requires people being able to admit they were wrong in the face of new evidence. Egos should not be wrapped up in how many feet at which social distancing is effective and how effective masks are and when lockdowns should be enforced or let up. Its really unfortunate and, in my opinion, goes to show the two party system is bad for democracy, science, progress, etc. We need more polictical parties and ranked choice voting, and less blind following of one's parties ideals/agenda/candidates.
Asked if his administration was worried about a coronavirus pandemic, Trump says, “No, we’re not at all. And we have it totally under control. It’s one person coming in from China.”
The World Health Organization declares the coronavirus a “public health emergency of international concern.” • At an event in Michigan, Trump says, “We’re working very strongly with China on the coronavirus—that’s a new thing that a lot of people are talking about….We think it’s going to have a very good ending for it. So that I can assure you.”
Now, I will grant you that he established the task force on Jan 29th, but against that I will note that the "China travel ban" did not prevent Americans who had been in Wuhan and other affected areas from returning to the US. I would also add the person chosen to head the task force at the start, secretary of HHS, Alex Azar, on August 23rd (after all we know now) explained things this way:
> Alex M. Azar II, the secretary of health and human services, defended members of President Trump’s family on Friday for refusing to wear masks at the recent presidential debate despite a requirement that the audience do so. The first family and the president are “in a different situation than the rest of us,” Mr. Azar said, because they are in a protective bubble."
I think it's fair to say that Trump's actions along with his then-private conversations with Woodward, can be reasonably (if incompletely) summarized by saying that he has tried to downplay the virus from the start.
And that's the problem with... let's say politics generally, but Trump especially. Two of Trump's biggest winning issues have been travel bans and China. Taking the opportunity to combine them was such a political no-brainer that he didn't need to believe in the virus to do it. Over and over again, when Trump has succeeded politically by saying things that are transparently untrue, we have been told that we'll never understand him politically if we are hung up on facts, because we need to "take him seriously, but not literally." I think that advice applies very neatly to this case. His travel ban was seriously meant as a gesture of resistance against a serious threat of disease from China, but the threat was not literally the coronavirus, as his subsequent rhetoric showed. Having a travel ban against foreigners arriving from China felt good and safe for his supporters regardless of the literal medical danger posed by a literal virus. "Seriously, but not literally" means that Trump could support a covid travel ban without believing that covid was a real threat. As usual, his target audience understood instantly, while the rest of us once again took months to figure out that Trump might not even have a literal opinion.
I've been reading about this virus daily since February and my impression has been the opposite. It's a very boring virus which has offered very few surprises. We knew since February that it is a flu-like respiratory disease with high rates of hospitalization and death, especially among the old. The initial estimates for fatality rate were about 4% and that has now been narrowed to 1% based on better testing and treatment. Social distancing and masks are effective at controlling the spread. All of this has been known since February/March, most of it is spelled out here: https://www.who.int/docs/default-source/coronaviruse/who-chi...
At the same time, there has been an endless parade of contrarians trying to make the whole thing into a big mystery and muddy the waters for some reason. There was the theory that the virus was spreading much earlier than expected. There was the theory that most cases were asymptomatic and that immunity had already been reached. The theory that lockdowns are not effective. The theory that there were different strains with highly different behavior. Some vague theory about t-cell immunity.
None of these contrarian theories have been supported by any real evidence, but there is a large appetite for them and people will seize on any puzzling number to try to rethink the whole picture of the virus.
This doesn't align with my tracking of virus facts.
1) the death rate is still unclear because very few localities have done sufficient and/or the right kind of testing to answer this in a definitive way.
2) initial estimates about hospitalization across age cohorts seem to have turned out to be fairly far off. Tracking the stats for my own state (New Mexico; admittedly a fairly small population), we sometimes have almost flat hospitalization rates across age cohorts.
That report was dated 16-24 February 2020. It was authoritative at the time of writing (hard not to be given the limited breakouts outside of Wuhan at that time), and the reporting on the physical structure and mechanisms of the virus have remained largely unchanged AFAIK.
But the epidemiological aspects of covid19 have, I think, changed quite a bit since that report. The report doesn't in fact coe down strongly in favor of masks:
"The relative importance of non-pharmaceutical control measures including masks, hand hygiene, and social distancing require further research to quantify their impact."
and in the section titled "Knowledge Gaps" includes "Effectiveness of the public health control measures and their socio-economic impact ... * Wearing mask in general public", along with most "lockdown" type policies.
1) I'm not a researcher and I can't claim to have a comprehensive view of the evidence, but I think there have been enough high-quality studies based on seroprevalence to give a good estimate. This one https://www.medrxiv.org/content/10.1101/2020.08.06.20169722v... found an IFR of 0.83% in spain, or 1.07% if counting excess deaths. This one https://www.medrxiv.org/content/10.1101/2020.06.27.20141689v... found an estimate of 1.39% in NYC. The WHO has estimated 0.6%. These studies are based on representative antibody surveys with good statistical power, they should be accurate. There are factors like demographics and comorbidities that can push the number much higher or lower in a given community, but the range does not seem that wide to me.
2) I haven't been tracking hospitalization data very closely, you may be right that this has changed ... I've seen little discussion of it.
I agree that mask use in particular was controversial for a rather long time, with bodies like the CDC seemingly dragging their feet on recommending the use of masks. Still, I think that it's been a pretty settled question since April (CDC recommended masks from April 3 https://www.livescience.com/cdc-recommends-face-masks-corona...).
I would agree with you that it does look as if the overall IFR is in the range of 0.8-1.6%, and that the Spanish study was well conducted. But it is also horrifying that a pandemic that has killed more than 1M people worldwide still has so few similar studies to help answer these questions.
2. I don't want to make strong claims about this, but I do think it has moved quite a bit.
3. Yes, mask utility seems really well established now and has been for "many" months.
I still wish we would hear more public speakers using the numbers from 1. above combined with "flattening the curve" to make it clear what we're trying to do. 1% of the US is a million people. That could still be the outcome, but at the very least, we'd like that not happen all in the same month!
If you look at the responses to that editorial, they note that the 11% positivity of igA tests, cited as suggestive of a high level of undetected infection, is actually the false positive rate of the test, among other embarrassing errors.
The first citation on your linked editorial is Ioannidis, which is the same Stanford researcher in the OP article here, and the same group responsible for the utterly flawed Santa Clara study. It seems like it's literally this one group, and a few other weirdos and contrarians, singlehandedly raising spurious doubts about the science, and then being amplified beyond all reason.
The cited Ioannidis study also sucks, he takes a number of seroprevalence studies, including some very flawed or underpowered ones, and then takes the unweighted median for some reason? More details here, including an illustration of how the high-quality, randomly-selected samples do not vary so much https://twitter.com/GidMK/status/1283232023402868737
You're missing a big part of the picture. It is well established that some patients infected with SARS-CoV-2 either never produce detectible levels of antibodies, or have them fade away quickly. In order to measure actual infection numbers we need to look beyond antibody seroprevalence, and factor in CD4+ and CD8+ T cell assays as well.
90% of PCR-positive subjects in the ENE-COVID test, for example, did also have a positive antibody test. So actual infection numbers might be ~10% higher than the raw numbers from the antibody tests (and I believe that this is factored into the results reported by such studies). It doesn't change our big-picture understanding of the disease.
I think the death rate in particular has been the victim of politics. Each side has in interest in presenting it as higher or lower, particularly relative to the flu. The true value is unknowable as it requires perfect test data. And the available data (case fatality rate) is rejected by the "it's just the flu" camp, because they say the true denominator is much higher.
But honestly, who cares about the actual number? The flu death rate is subject to the same problems. Nobody gets tested for asymptomatic flu. We're should be comparing the CFR for flu to the CFR for COVID, and this shouldn't be an argument.... But it is.
Indeed, which is why I consider excess mortality numbers to be the most useful numbers on death rate that we have, although I have still not found an excellent breakdown on what they show (notably by age cohort).
But excess mortality can be changed by behavior. That's part of the point of lockdowns. You can't know the hypothetical death rate given no lockdown measures.
Trouble is it isn't a fixed number. It depends who the people are, what treatment is available and so on. It's come down over time for various reasons. These things aren't as simple as they might be.
"The most compassionate approach that balances the risks and benefits of reaching herd immunity is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk"
This flies in the face of rationality. You don't just get sick for a day and gain herd immunity. You are sick and contagious for weeks, you then infect other people whom go out and infect other people. Do these doctors seriously believe people at risk can just isolate themselves from the world? Most don't even realize they're at risk.
If you want to put that risk of infection and death onto people then say it, but don't try to sugar coat it like this is a good idea that will protect everyone. If anything it's necessary to keep markets afloat and various economies from failing.
It would seem you are perhaps not giving them credit for their "better protecting those who are at highest risk" statement. Without knowing the specifics of their plan, perhaps it would cost less to simply give all high risks populations a stipend and highly controlled housing and months of prepackaged food supplies / shelf stable foods than to continue to keep large sectors of the economy closed.
In essence, "here are all the essentials for life, please sequester. if you cannot sequester and require assistance, contact _____".
These calls for a certain sort of action are very hard to parse properly and assess, even if we could all agree on an assessment mechanism (itself also almost impossible). I’m personally skeptical of these minority-report PhD calls to action because I think they prescribe a direction rather than raising the actual things to be considered by local jurisdictions to make a good decision.
And it’s really hard to even get agreement on what to consider in order to decide! For instance, a strict utilitarian assessment needs to consider (and opine) on the following questions:
* Does full lockdown, which it is agreed would reduce COVID deaths, increase or reduce net deaths over the same period in all cause mortality (poverty, depression, abuse, etc)?
* Does full lockdown increase or reduce net deaths over some longer period of time for all cause mortality?
Then we get to the really hard stuff, in two directions: first, cultural:
* Will full lockdown + contact tracing be implementable in the US / UK?
* If so, are the privacy and government centralization harms worth the benefit?
* If not, are the privacy, government centralization, and mortality related harms / benefits worth the tradeoff?
Second, in ‘softer’ terms:
* Will lockdown disadvantage certain members of society? (see the “K shaped recover” for lots on this.
* Are those harms short or long term, and are they worth the lifesaving that (may/will/definitely will/probably won’t) result?
Again, this is all presuming we agree to be utilitarian about this, (which I am not particularly inclined to be personally).
And, crucially, the answers to these questions is going to vary based on how much control a given government has right now, how much trust citizens have in their governments, how good the social safety net is, how protected / enforceable the borders surrounding the lockdown are — it’s impossible to get a global answer here.
There are constitutional questions as well. The US Constitution has no clauses which allow for its suspension in an emergency. Executive branches have some ability for short periods of time. There are some instances & cases (like the Japanese internment camps in the US during WW2) that are interesting to consider in context with this.
Yeah exactly. I think it’s interesting to compare and contrast the two countries that have done best with this: China and New Zealand. China is high control and high trust (mostly) and well controlled border , New Zealand is like mid to low control but very high trust, and it has a perfectly defined and controlled border.
US is (broadly) low control, low trust, net importer with large land borders and neighboring countries by sea, so it’s a much harder problem even if you had consistent messaging and planning from the top.
my business partners in china report day to day life is basically mask free, and when there is a reported outbreak there is massive testing and contact tracing.
Youtubers in china show that same story in street footage; so on balance yes, I think it’s generally accurate.
It's a huge mistake to think the choices are "lockdown" or nothing.
We should stop talking about "lockdowns", and possibly never should have thought that way. The question is over restrictions, WHAT restrictions should we have, what alterations to usual way of doing things.
For instance, do you know Sweden, all along and still now, was in fact prohibiting gatherings of over 50 people, with criminal penalties for violating? Schools for children over 16 were closed. Social distancing was encouraged. Sweden didn't actually do particularly well -- although they have done BETTER than the U.S. in deaths per 100k population. But however poorly or well they did, contrary to the narrative, they in fact made major changes to social life, and in the end may have controlled social distancing BETTER than the US! (through a combination of legal restrictions and voluntary compliance, compared to the U.S. piecemeal, ever-changing, lockdown-then-nothing low-compliance environment).
So it is definitely a problem to think that our choices are a total lockdown which can reduce all risks to zero (unsustainable and not actually POSSIBLE; quotes about "which grandparents are going to die" suggest that if we do things right it will be no grandparents, which is unfortunately not true) -- and doing virtually nothing except maybe some half-hearted mask-wearing, which will result in years of ongoing massive illnesses (including possibly long-lasting chronic illness) and deaths.
In fact, we have to figure out how to do restrictions RIGHT. restrictions that are sustainable for the long-haul (becuase in fact this is going to be something we're dealing with for years, there is no deus ex machina vaccine miracle that will put things back to how they were), and that optimize for minimal infection with maximal social life. (In normal life, I have trouble explaining what I mean by 'optimizing' like this, it's nice to be talking on HN in an engineering culture that will immediately understand what i mean).
The US doesn't seem any closer to being motivated to do that though. And I"m not sure this letter actually helps,this comes across as just another allegience in the "do everything or do nothing" weird public health culture wars, which are not serving us. (For instance, "Herd immunity" is mostly not a useful thing to be thinking about here, and mentioning it just seems like signaling a 'do nothing' allegiance or implying that intentionally increasing infection rates is somehow a good thing, which it is not, unless you like years of ongoing chronic illnesses and deaths).
Thank you! Everyone I see saying "But what about Sweden" really means "let's do nothing". They skate over everything else that Sweden does - unemployment insurance, universal healthcare, and better compliance with the restrictions they do have.
>It's a huge mistake to think the choices are "lockdown" or nothing.
Completely agree. Lockdowns and "shelter-in-place" orders were a reasonable response in March when we had no idea what we were dealing with and had to preserve the integrity of the hospital system. But they were never going to be sustainable for more than a few weeks.
The next step, closing "non-essential" business and limiting gatherings, is a logical progression, and is something that can be tweaked and tightened/loosened as the data indicate.
Then we have masks, social distancing, and frequent hygiene. This should continue indefinitely, at least until a vaccine has been widely distributed. I'm shocked by the opposition to this.
> “...closing ‘non-essential’ business and limiting gatherings, is a logical progression...”
you’re advocating lockdown. we only need to curtail (not completely shut down) socializing-oriented businesses like bars/clubs, not ‘non-essential’ businesses. we should advocate for, rather than try to coerce, limiting large private indoor gatherings and being responsible when gathering.
> “Then we have masks, social distancing, and frequent hygiene...”
only social distancing is needed, but you can’t mandate these things in any case. only social pressure works on the level of groups and communities. masks and over-cleaning are effective only on the (in some cases very slim) margins. don’t breath into each other’s faces and we’ve done the majority of what is effective, rather than ritualized compliance signals.
Again, even the mythical Sweden bans gatherings of more than 50 people, with criminal penalties for non-compliance.
Do you consider that a "lockdown"?
To me, "lockdown" -- a word I had previously heard mostly in reference to prisons -- means absolute cancellation of all social life, the word implies an absolute and universalism. That is not possible on an indefinite ongoing basis.
But we absolutely need restrictions. I'm not ready to say right now exactly what those restrictions should be -- they need to be based on science that we haven't done enough of, and they probably need to change as we learn more about things and as we observe how different restrictions (as well as different accomodations like improved ventilation) effect spread (which may be different from one society to another). We have barely yet begun to take seriously the need to seriously figure out what to do, instead of arguing about "lockdown" vs "do nothing".
To my reading, you are still engaged in that odd dichotomous debate, advocating the "do pretty much nothing" approach, absoultely confident (based on what science?) that this is sufficient.
> "To my reading, you are still engaged in that odd dichotomous debate..."
it's uncharitable to project. you're also trying to coerce my position into "do nothing", which is not only uncharitable but incorrect. "do only things that have meaningful, not mollifying, effect" is more correct.
> "But we absolutely need restrictions."
that's cart before horse, an overly confident a priori assertion, rather than an empirically-backed deduction, like much of the discussion around "the science".
> "...they need to be based on science..."
science will expand our body of knowledge in time, but science is not unassailable (science doesn't create truth, only reflects incomplete shades of it back to us), and an unrealistic faith in science to settle decision-making under uncertainty today simply doesn't help. it just plays into media partisanship, as an unwarranted appeal to authority to coerce others' behaviors (i.e., an application of power) irrationally. in 20-50 years, science might tell us what the best course of action might have been, but it won't settle the debate in this moment.
but luckily we already have plenty of information to make informed decisions, even if much of that information is imperfect. and note that it's not the complicity rituals we've bought into from our "leadership".
for instance, it was clear as early as february that the elderly were at much heightened risk. we should have locked down elderly care facilities and bubbled them, employing a tiny fraction of the $2T in economic aid spent already (in the US) rather than largely wasting it on further enriching the already wealthy. that would have reduced fatalities by on the order of ~60%. a meaningful effort, rather than safety theater.
it was clear around march that those with co-morbidities were also at heightened risk. that's harder, but getting that information out to the public changed the behavior of those at risk without the need for lockdowns for everyone. people are capable of making informed decisions with trustworthy information. it's (partisan and media-fueled) propaganda that's made it difficult to tease out what's reliable and trustworthy, cornering us into largely ineffective, performative mitigations (i just heard a woman on npr proclaim "i don't just wash for 20 seconds, i wash for 30 seconds!" as if that makes any difference to anything other than her own self-righteous ego and npr's editorialized virtue signaling).
it was clear that the trajectory of the virus was more flu than black death, deadly to less than 1% rather than 30-60%, despite the hyperbolic rhetoric around "exponential" growth (actually sigmoidal/logistic). if it had it been a new black plague, it would have been quite obvious early on, and people's behavior would have swiftly adapted out of self-preservation without requiring martial law.
it's clear that a few simple mitigations (distancing, avoiding large gatherings) can keep the infection rate largely under control, which is about the best we can do without destroying entire societies, governments, and economies (which we seem wont to do anyway).
life is an endless series of cost-benefit tradeoffs. we accept risk and death every day, not attempting to save every single life at all costs. if we did, we'd spend every excess dollar beyond water, food, shelter, and clothing on potentially preventable causes of mortality like cardiovascular disease, cancer, and respiratory disease[0], but we don't. it's irrational to act differently for a novel virus that isn't very deadly, all things considered.
lies told by the "left" are no better than the lies told by the "right". and the whole left-right dichotomy is a misdirection perpetrated by both to blinder our thinking in ways that benefit only the entrenched powers. in other words, break free and stop parroting phrases like ...
if I'm a priori suggesting that we surely need some restrictions although I can't commit now to exactly what we'll need for the course of the pandemic -- then you are a priori suggesting that we don't, right?
But we're not going to resolve this here.
I am curious about one thing specifically though, my one question you didn't respond to. The person you were responding to said we didn't need lockdown, but we did need some restrictions to nonsesential businesses.
But you replied that closing down nonsessential businesses was in fact "lockdown".
If that's lockdown, do you think Sweden's restrictions of gatherings over 50 people (with criminal penalties for violating) is also "lockdown"? If so, contrary to popular conception, it would turn out that Sweden actually engaged in "lockdown" all along after all, I guess? And do you think even Sweden basically over-reacted?
> "...then you are a priori suggesting that we don't, right?"
no, because it was based on incorporating the wealth of (imperfect) information that we already have. your statement started with "But we absolutely need restrictions" and then essentially said "not enough data", which makes that statement an a priori presumption. it could be that no restrictions are worth it, but your statement already ruled that out without rationale. mine didn't rule out restrictions, but rather advocated limited and targeted (high bang-for-buck) measures.
as for the rest, a semantic argument over "lockdown" seems unlikely to be fruitful, for an overly-curt phrasing on my part (as in, losing essential nuance for the sake of expedience). i'd generally agree that an indoor social gathering of sufficient density can raise transmission risk, but an arbitrary cutoff is not so useful. 50 people in a house is different from 50 people in a performance hall. incidentally, that's why distancing is a better general rule of thumb, because it concerns density directly (masks, for instance, don't).
and it's not about overreaction but rather precision and efficacy. once you institute a law with stiff penalties, you're raising the spectre of use of force against the populace, which, in a democratic society, should be reserved for the most extraordinary of circumstances, like existentially-threatening insurrections (e.g., civil war, plotting against a governor, etc.), not, relatively-speaking, small parties (or low-risk businesses for that matter). when provided reliable information and not overwhelmed by distortionary narratives, people will generally make reasonable estimations of risk relative to their idiosyncratic risk tolerances, and act accordingly.
all the rest is rhetoric trying to ramp up tensions and fears so that power can be coalesced and exerted. we just don't need to feed that beast in this case (or in most cases, 9/11 being another prominent example).
I think this is the first time i've seen someone say that Sweden's approach involved unnecessary restrictions, but it's an opinion. Maybe lots of people think this I just haven't been talking to them.
We agree that "limited and targeted (high bang-for-buck) measures" are called for, I guess we just disagree on what sorts of things they plausibly should be? I'm not sure why you are making this into a disagreement on 'a priori' or whatever.
The thing with a 50-person limit is it is easy to understand and easy to comply with. A limit about number of people per cubic meter... the harder it is to know if you are doing it or not, the lower compliance there will be, whether voluntary or with penalties. It makes sense to approximate for comprehensibility -- since it's based on imperfect data in the first place, we certainly don't know the exact risk level of various densities or types of gatherings, only guesses based on imperfect data. (It would be really good to be investing in trying to get better guesses.) It's already an approximation no matter what. That doesn't mean it won't be effective at limiting infection, it is not damned by being an approximation, whether expressed in terms of people per cubic foot or no gatherings over 50 people.
Telling people "hey, just a as a rule of thumb you should 'distance', to whatever degree you think appropriate, but it's up to you" will, I am pretty confident, have very little effect on anyone's behavior. At least not in the U.S. Maybe in Sweden.
it's not a disagreement so much as an (perhaps pointed) observation. a priori matters because it's often used to erroneously present beliefs as truths while eliding critical assumptions, for instance, saying "I am pretty confident [distancing recommendations will] have very little effect on anyone's behavior" without providing any further rationale.
it's also erroneous to take objections about that particular restriction as blanket evidence for believing sweden is being heavy-handed overall. that's dichotomous thinking, setting up a false dichotomy and then shoving the opposing position into (what you believe is) the unfavorable corner (for the second time).
the point was that that particular restriction was misguided, not its goal of containing the highest likelihood transmission vector, the large private social gathering. the excuse of being easy to understand is exactly how we get bad legislation with numerous unintended consequences that just beg for more (poor) legislation to patch the ever-incresing follow-on consequences, rather than doing the harder work of being as precise and efficacious as possible the first time (and every other time).
these are not only erroneous but also ineffective approaches to argumentation. you don't get better rationale, better positions, and better policy from employing such tactics. and yes, we do just disagree on what the best measures are, but that's also the important bit.
> We should stop talking about "lockdowns", and possibly never should have thought that way. The question is over restrictions, WHAT restrictions should we have, what alterations to usual way of doing things.
Agreed, but there needs to be a discussion about what an acceptable amount of cases is as well. Because the strategy seems to be eradication, which is ridiculous. As soon as any restrictions are eased there is much hand wringing the second case counts go above some very low but arbitrary level.
Why wouldn't herd immunity be an acceptable condition for the part of the population that aren't at risk to develop a severe condition? The balance is protecting those at risk all the while allowing those that aren't to continue working as normal.
EDIT: I'm sorry, I misread. You're not against the idea, it just doesn't inform us as to how to balance our policies.
"Paulette Altmaier, a former Cisco Systems vice president and philanthropist who criticized Santa Clara County’s slow reopening in a full-page newspaper ad in May, found it refreshing."
Honestly Im not sure I'm trust anyone who has the money to be placing full page ads in papers to be looking out for me.
Oh what do you know....after googling it it turns out this person is associated with The Federalist.
In the UK, 75% of deaths are people aged 75 and older. I'm not sure if its the same age profile in the US but I would think yes. Even here in the Bay Area, the death rate is about 0.5% for everyone below the age of 60. If we lock down those over 60, and let everyone else live with masks and social distancing, the infection rate may skyrocket but the hospitalization and death rates will plummet. This is basically what we are seeing globally now, where the infection rate is higher than in March but death rates are much lower. Granted, there were less tests being run so that makes things hard to compare.
Also, the bigger problem is those that need to take care of their parents who are in this age group. The infectiousness is so high that if the children get sick, the parents will definitely get sick. So this is the biggest quagmire, that entire families will become isolated to protect the parents. It's not a perfect solution but better on a percentage basis for the entire country than locking down everyone, even though the risk profiles are drastically different.
How do nursing homes continue to operate in this scenario?
I hear a lot of people talking about this kind of shield the vulnerable approach, but no-one who can answer the question of how nursing homes work in this condition.
Thus far? Nursing homes have operated as 'places people go to die'. COVID has just made those deaths a little faster.
In all seriousness, taking any amount of effort to protect nursing homes would be better than what we have right now. Like, "stop sending COVID patients to nursing homes" levels of effort. (Thanks, NY and MI - plus others I'm sure)
My dad was in a nursing home for a few years, he died just before Covid. I don't dispute the point in general, but it really really matters to the families of these people what happens in nursing homes.
Consider: nursing homes have many staff. Most of them are young and badly-paid. In any let it rip scenario, many of these will have Covid, and will bring it into the home.
OK, so let's test everyone. Even ignoring the fact that testing is not 100% accurate and takes time (do you test all staff and have them wait for the results), you'll get loads of staff infected, and who do you replace them with?
It appears in Sweden that a major carrier of Covid into nursing homes was agency staff (short-term people brought in to cover staff gaps). How do you stop this from happening again?
Full disclosure: my mother, father-in-law and mother-in-law are all over 70 with a consequent higher risk level, so this is not abstract to me as I'd like them to survive long enough so that my newborn daughter remembers them.
No one has answered this? Come now. It's not hard to solve.
Nursing homes remain closed to visitors. Staff and residents only. Staff are tested daily for covid. Nursing home residents do not leave the nursing home. Staff and residents wear contact tracing bracelets and residents stay distant from one another.
You do the best you can. The common cold can be deadly for people in nursing homes. We cannot drop the risk to zero.
This isn’t rocket science. You quarantine, test frequently, keep skeleton crews, contact trace, etc.
Like I said, it isn’t going to be perfect. It can’t be perfect. You do the best you can. You don’t shut down the entire US economy because nursing homes aren’t bulletproof.
With daily testing, constant PPE for staff, contact tracing, and other preventive measures it will be fine. It won’t be perfect but it will be fine. It will likely be better than typical.
The NBA quarantine works because it's for a multi-billion dollar industry and aimed to protect fewer than 500 players. Over a million people are in nursing homes, and more than another million work in them.
I am not sure why you think it's more realistic to lock down three million people totally than have most people take moderate precautions. Remember, this is in a proposed scenario in which the average grocery shopper will have a high likelihood of being infected, without masks or any social distancing measures being taken.
The White House tried the "frequent rapid testing" strategy, and that didn't seem to do a very good job of protecting the staff there. Again, this was in the current situation in which we have a relatively low prevalence of contagion, with social distancing measures and masks in the outside environment.
My mom is in a memory ward. The access to visitors is extremely limited. At one point we could only visit through a window to wave hello. Now, visitors are allowed in certain areas. But it's not foolproof and I'm sure if there's an outbreak there will be a lot of casualties unfortunately.
They don’t and we are seeing increasing cases in them in Europe. Only manager change is better procedures hopefully that might reduce spread internally.
I agree in general, but I think that the problem is that a lot of people refuse to wear masks or exercise even a modicum of social distancing. I think we already have all the tools we need to control COVID to a level where most people can live a relatively normal life but there is a minority of people who refuse to accept that this is a serious problem at all and refuse to take any action, no matter how trivial, to deal with it.
I don't understand why people are still taking Sunetra Gupta seriously, Oxford or not. She predicted that half the UK population may have already had COVID-19, back in March. Even as late as May, the true figure was less than 7%.
We don't actually know the true figure of how many people have been infected with SARS-CoV-2. The antibody assays used in most population studies miss many of the mild cases. This is naturally difficult to quantify.
You can infer it from models though. If you know the R number, fatality rate, and death rates you can fit it all to a model and estimate how many people have been infected. Not as simple as that, but my point is that testing people isn't the only method, so imperfect tests don't mean that we definitely don't know the answer.
This is the best one I've seen for the UK - they just updated it today and estimate that 9-15% of people in England have been infected.
No you can't infer the infection rate from models. That's circular logic. You have to accurately measure the infection rate first before you can calculate the fatality rate. All of the existing tests have a fairly high false negative rate. So we can only calculate the lower bound on infections; the upper bound remains unknown.
1) This declaration was made at a conference on economics. That makes the motivations seem like they are economic in nature, not driven by medical motivations.
2) It isn't clear to me that these doctors are experts on coronavirus. Only one is mentioned as currently practicing. As I understand it, death isn't the only negative consequence associated with coronavirus. Their declaration seems to ignore this and only seems to be based on a meta-analysis of death rates.
3) We do not currently have a lockdown. We have some restrictions in place. Their declaration is not just against lockdowns, it's against gathering restrictions, masks, etc.
"The project was sponsored by the American Institute for Economic Research, which is a libertarian think tank funded by billionaire Charles Koch's conservative Koch Foundation"
https://en.wikipedia.org/wiki/Great_Barrington_Declaration
The Koch brothers are known for financing climate change deniers.
For the as long as I've been alive, the human collective has destroyed natural areas, polluted, and harmed human populations that were unable to defend themselves, all in the interest of serving "the economy".
Well, those ideals have come home for many parts of the world. Imperialism and disregard for human welfare will now serve "the economy", as we are seeing now in the United States.
I find it ethically abhorrent, but humans are humans.
"The American Institute for Economic Research (AIER), at whose meeting the declaration was launched, has been described as a libertarian thinktank that has received funding from the Koch Foundation and has previously supported climate change denial.[8][7]"
No one is denying the negative effects (economic, educational, mental) of such serious lockdowns. It seems that this group is making a claim that if we just take extra caution with the elderly and those with pre-existing conditions, the rest of us can get back to relatively normal. I think this claim is reasonable and I would normally agree.
The issue is that it is very clear, at least in the US, this just is not reality. We would absolutely screw this up and kill way more people if we didn't have these training wheels on.
> We would absolutely screw this up and kill way more people if we didn't have these training wheels on.
Who is this "we" you speak of? Do you include yourself in this group of people that need training wheels? Or do you think you yourself are perfectly capable of doing it right but those other deplorables are not?
I don't need training wheels, and I don't expect any adult citizen of a free country to need them either. I think the majority of people have far more common sense and desire not to hurt others than they are being given credit for. Unfortunately, the media focuses on the outliers that don't have those qualities and makes everyone think everyone else is like that. That is doing our society a serious disservice.
Oh yea I absolutely need these training wheels. I am fully aware that if all of the restaurants, bars, or other activities that I love going to were open and operating that I probably wouldn't be able to resist going "just this once".
The issue is not people's common sense or desire to not hurt others. The nature of this issue doesn't lend itself to being stopped just through common sense - you can transmit this disease for days without realizing it. Common sense says don't play with fire. It doesn't say maybe you shouldn't go see grandma after the pumpkin patch for 7 days.
Well, I don't, so please don't say "we" need them.
> The nature of this issue doesn't lend itself to being stopped just through common sense
Maybe I should have said "common sense and discipline". Apparently you are aware that you shouldn't do certain things, but you don't have the discipline to not do them.
This is going to sound harsh, but discipline is part of being an adult just as much as common sense is. If it is really true (I'm not sure it is, but let's assume it is here for the sake of argument) that most people in the US are more like you than like me, unable to exercise the required discipline in a situation like this, then that is a very, very bad thing for the US, because you can't have a free society if its citizens lack the discipline to do what they know is the right thing to do. And that puts all of us at the mercy of whatever the idiots in positions of power want to do to us in the name of "protecting our safety". I don't want to live in that kind of country. Do you? Think carefully.
I'm not sure if you're being somewhat ironic but your hypothetical scenario is of course today's reality, where large parts of the US have put someone in power primarily in the name of 'protecting their safety / way of life / jobs' (i.e. making themselves great again).
It's hardly, then, a stretch to postulate that many would lack the discipline to do the Right Thing without stricter measures incentivising them
I'm not. But the kind of "protecting safety" I am talking about is narrower than what you appear to be assuming.
> large parts of the US have put someone in power primarily in the name of 'protecting their safety / way of life / jobs' (i.e. making themselves great again)
I'm not talking in general terms about things the government does that affect people's safety, way of life, jobs, etc. (At least, I'm not talking about such general things in this particular discussion.) I'm talking about a specific thing that many people appear to want the government to do: dictate what individual people can and cannot do, at a very detailed level, in the name of "protecting safety", instead of allowing individual people to use their common sense and discipline, which is what is supposed to happen in a free country.
Lockdowns in response to COVID-19 are just one example of this thing; the US is full of nanny-state laws that micromanage people's lives in all kinds of ways in the name of "protecting safety". (Actually, as P. J. O'Rourke pointed out many years ago, "nanny state" is much too charitable a term, as "nanny" implies at least some amount of actual empathy and compassion; a better name would be "Nurse Ratched state".) All of those laws have as an underlying assumption that people in the US do not have the common sense and discipline to act in their own best interests. That assumption is incompatible with a free society. If the assumption is actually true for a majority of people in the US, then it is a very, very bad thing for the US, since the benefits that everyone wants will also go away if the US is no longer capable of being a free society.
For example, as the events of 2020 have starkly shown, many people in the US are harassed, or worse, by cops and other government officials for no good reason. But the only reason the cops and other government officials even have the ability to harass people that way in the first place is all those nanny state laws: any cop that wants to mess with a citizen is going to be able to find some law that citizen is violating. Giving the government the power to micromanage people's lives, whether it's in the name of "protecting safety" or anything else, is giving government officials the power to mess with citizens, and that power will inevitably be abused. The only way to avoid the abuse is to not give the government that much power in the first place. And that means that every adult citizen needs to take responsibility for having the common sense and discipline to do the right thing without having to be micromanaged into it.
I think it's pretty clear that we live in that kind of country. Not just based on the parties during spring break or when beaches opened back up in Florida.
There are laws making payday loan companies post their APR (usually around 1000%) in bold face on their websites. Everyone in this industry will tell you to never get a payday loan, but it's a multi billion dollar industry that preys on people who lack discipline and common sense.
What will ultimately hurt the establishment (by which I mean mainstream scientists and public health leaders) is this attitude: """“Whose grandmother and grandfather and family members are you willing to sacrifice for this stupid idea?” asked Santa Clara County Executive Jeff Smith, """
That's not an acceptable way to engage with good-faith scientists at major institutions. It's an appeal to emotion as well as an implication of stupidity on your opponent.
I've noticed this behavior among a wide range of mainstream scientists and public health leaders too- literally mocking people who disagree with their policies. This will hurt the credibility of these scientists, especially if, in retrospect (when we have the time and luxury to study the public health response to COVID in detail), we find out that decisions led to suboptimal outcomes.
It's far better to project humility, stand by your decision, but be willing to admit when you're wrong, and adapt.
They're not good-faith scientists. Bhattacharya is a co-author of the widely debunked Stanford seroprevalence study. Kulldorff doesn't believe in child-to-adult transmission. I think this is an appropriate response.
I do agree their scientific positions are tenuous, but having worked in a few scientific fields where the mainstream ultimately was proved completely and totally wrong (RNA can be an enzyme, the ribosome is an RNA machine) I've learned that even scientists who appear to be "not good faith" may be as ethical and as intelligent as the people they were disagreeing with.
I wouldn't classify Bhattacharya in the same bin as Peter Deusberg (well known virologist who insisteted that HIV transmission did not cause AIDS).
I am surprised there isn’t a discussion on the effectiveness of lockdowns.
For instance there is a surprising result coming from large serology studies in Spain and Italy, that outside of health workers, people who were locked down have been infected at the same rate than essential workers who were not locked down. Also the shape and timing of the Swedish infections is very similar to other european countries, suggesting the peak was due to the natural evolution of the epidemic rather than lockdowns.
I don’t think this data is compatible with lockdowns being effective, which should be a key issue given all the consequences of lockdowns.
The serology studies in Italy are unfortunately underpowered because of a dumb decision: any person positive with IgG (which appear after or very close to the end of the infectious period) would have to quarantine then wait for a double negative PCR test. Thanks to this, only half of the expected people participated.
Well, lockdowns definitely worked, as there was significant decrease in the number of cases afterwards. Yes, it was a brute force solution that nobody liked. Yes, epidemiologists and politicians still retain it as the last possible resort. But rest assured everything else will be tried before that. Nobody likes lockdowns. We medical researchers had to stay home like everybody else, and we didn't like that a bit.
Travel restrictions and mass gathering bans (as well as school holidays) were contributing to the situation, too. Even Sweden had some measures in place, as well as fully closed borders and mass gathering bans. This will be a next step in the current situation for most other countries.
But the question isn't whether soft measures have an impact. It is whether a hard lockdown, closing shops and restaurants, forcing people to stay home, works. If the same result is achieved without those a hard lockdown, we should stop considering it a useful option.
Maybe I'm misunderstanding you, but Sweden has never had "fully closed borders". They have been closed for countries outside of the EU, but that was only to conform with the rest of the union. No borders were closed for public health reasons.
> I don’t think this data is compatible with lockdowns being effective, which should be a key issue
In many countries, it never even had to go that far. In the United States, for instance, the Constitution prevents executives from taking the kinds of actions they took towards locking down the general public.
The reason we have laws is because sometimes the objective realities around us are not the most important consideration. If it is illegal to threaten people who simply wish to leave their own homes with fines, violence, or punishment - it is illegal whether there's a pandemic in progress or not.
I've had 2 panic attacks (literally couldn't move my fingers and arms thought I was dying - went to the ER for this), and probably 20 mild to severe anxiety attacks since April. Before Covid, I have never experienced anxiety or panic, in my life, ever.
The anxiety attacks are pretty much: My nose is clogged, I might have covid, can I breath, oh my god, my breathing is constricted a little. Are my fingers turning blue? Can you look at my face and tell me if my face is drooping? Can I still smell things? (pulls out super strength Oregano Oil - OMG it's not as strong any more - am I losing my smell).
I'm a man. I'm 40 years old (soon 41). All my life I've been super healthy - no problems. I would never have predicted I would be this scared of something in my life.
My wife and I are planning on trying to go back to normal soon. We're going to start getting take-out food to start, still washing hands. I don't want to live the rest of my life like this, and I think now is the time to go closer to how life was before - just with some modifications. Just not as many modifications as we're under now.
A few things might help you deal with the anxiety:
* There seems to be basically no fomite risk, at least in a home setting
* A small number of specific spaces are especially prone to spread. The japanese warn of the three c’s: closed spaces, crowds, close contact. So like don’t go to a bar, but do go to a library where everybody has masks. Or do do go a park where everything is ventilated
* Lots of cases may be asymptomatic. But if you get an asymptomatic infection, who cares? People aren’t reporting their smell is a bit diminished. They’re reporting it is temporarily gone. It’ll be pretty bloody obvious.
To be frank, it sounds like you have inaccurately weighed up symptoms and transmission methods. This has led to a lot of behaviours in the physical world which reinforce your anxiety, but give you a reinforced inaccurate view of the state of the world.
I’ve read lots of covid papers. Have not heard of drooping face as a common sign.
I live in a completely locked down area with a surging virus count. And I’m pretty cautious....about a small set of activities which are highly risky. I’m not however worried in general, as the transmission vectors seem pretty known and there’s a whole swath of things I can do that are basically zero risk.
To give an analogy, it’s like you’re worried about a frame crushing car crash while driving in a school zone. Or fiddling with your seatbelt tightness and worried it may not be optimal for safety, when the main determinants of car safety are actually personal alertness, time of day, etc. But if you adopted a whole bunch of wrong behaviours while driving a car it would absolutely reinforce anxiety!
To some extent anxiety is an irrational process. But I do think it has some basis in the physical world and by really going over what risks are and what risks aren’t you can tame it and reason with it somewhat. Good luck!
> To give an analogy, it’s like you’re worried about a frame crushing car crash while driving in a school zone. Or fiddling with your seatbelt tightness and worried it may not be optimal for safety, when the main determinants of car safety are actually personal alertness, time of day, etc. But if you adopted a whole bunch of wrong behaviours while driving a car it would absolutely reinforce anxiety!
> To some extent anxiety is an irrational process. But I do think it has some basis in the physical world and by really going over what risks are and what risks aren’t you can tame it and reason with it somewhat. Good luck!
As an aside, I chose to move to a dense urban region in large part because I suffer from car anxiety. In particular, I get really anxious that the moment I stop feeling anxious my alertness will drop and I'll be in a terrible collision. Although full on panic attacks are pretty rare from this.
(I have actually almost nerd sniped[0] myself by being really deep in thought about complexity theory while on mental autopilot back from my internship and making a left turn without realizing how close oncoming traffic was)
I’m glad I’ve dealt with anxiety for most of my life before all this happened.
It’s interesting to see the general population deal with high anxiety for the first time.
I think the only way to live healthily with anxiety, outside of medicine, is to develop metacognition about your emotions and thoughts.
Recognize that life is inherently risky and you have little control over it outside of your reactions.
The hardest test is dealing with somatic symptoms and navigating the catastrophic thinking. It’s the ultimate challenge to talk yourself down when you’re convinced you’re having a heart attack or unable to breath.
Covid is a risk but for most people not a significant threat.
I'm not sure what point you're trying to make. Your anxiety attacks aren't caused by the covid virus, you realize that, right? It's a psychosomatic problem, yeah? In your head.
My point is that "the lockdown" isn't causing anxiety disorders.
Why can my 81-year old mother walk her dog with only a mask on, while you get a sniffle and wind up in the ER?
You're malfunctioning one way by having an irrational reaction to quarantine, and a second way by attributing that abreaction to the quarantine and not to your personal history.
You need a psychologist not a meal from a restaurant, eh?
I probably sound unsympathetic, and I apologize for that. Panic attacks are a serious problem, and I do sympathize with you. My own anxiety revolves around my mom dying in agony with her lungs filling with fluid...
Please maintain quarantine and treat your personal psychological issues with a beer or a joint or some breathing exercises or meditation or a nice nap or perhaps a bath. You know, something with a low risk of propagating a deadly virus to innocent people that have never done you any harm, eh what?
> My point is that "the lockdown" isn't causing anxiety disorders.
It absolutely is- doctors, scientists have been warning about it from the beginning, including ones who strongly supported lockdown. Trivializing it as "your personal psychological issues"- yes that's very unsympathetic. And it also betrays ignorance, you can't just treat mental health issues with a beer.
You have to realize that virus-causes-death and lockdown-causes-anxiety attacks are two different kinds of "cause". I mean, on some level they're both just cells malfunctioning, eh? But these two orders of causality are not the same.
> you can't just treat mental health issues with a beer.
First of all, yes you jolly well can.
Second, the cure for anxiety attacks may not be beer but it surely is not "break quarantine". That just transfers the anxiety onto the vulnerable. It's a B.S. argument founded in myopic selfishness.
She's brave enough to risk walking her dog. She should stay home, and she's curtailed a lot of other activities she used to participate in (like hanging out at the local cafe), but she personally draws the line at walking the dog. It's a calculated risk. Our neighbor is sparsely populated, the streets are wide and there are lawns, people are good about walking in the street to pass her, we live near the ocean so there's a constant breeze blowing in fresh clean air, and so on.
This guy is letting his mind play tricks on him and then using that to argue that quarantine isn't important to prevent the spread of the global pandemic that is still killing people.
The other responses are quite good, but let me add a few things on coping with panic attacks.
They get more tolerable over time. Remember that actual health problems almost always develop over time. Even COVID takes days to kill you. At 40, you have a low likelihood of sudden cardiac death. It can happen, of course, but as long as you work out and eat well, you're doing what you can. So, if you feel like hell for 5 minutes, with distinct waves, it's probably a panic attack.
The tingling symptoms you get are probably the result of hyperventilating. Slowing down your breathing can help. To an extent, though, these things just have to be ridden out.
Cold water helps a lot. Go to the sink and splash water on your face. Optimal temperature seems to be 20 C (68 F). That'll help lower your heart rate. Slow your breathing to match.
Also, as someone with panic attacks, I know that during the first ones, I feared the shame and embarrassment that would accrue to sudden collapse at a young age (I was 24). Thing is, no one's going to think it's your fault. If you have a random-ass heart attack at 24 (or 40), it's not something you did and you shouldn't feel bad about yourself. You can still die-- life is inherently risky-- but no one's going to think bad of you for being unlucky, and you shouldn't think bad of yourself (in that extremely low-probability counterfactual) either.
Death: either there's an afterlife or there isn't. If there is one, it'll be interesting to see what's on the other side of this whole thing. If there's no afterlife, you won't exist to be disappointed. Either way, not worth dread. People die, but no one is dead. If those who have left us still exist, they probably see themselves as more alive than they were when down here; and if they don't exist, then it is not accurate to say they are dead so much as they just aren't.
Plenty of Buddhists meditate on their own death. It helps to process the inevitable; to dedicate 10 or 20 minutes once in a while to the acknowledgement of mortality. Don't do this during a panic attack because you can't really "meditate" while in one.
Music often helps. Smells can help, as long as you don't develop that meta-level anxiety.
There's also no shame in seeking therapy and medication. You said 20 attacks since April-- that's about 1 per week. If that's all you have, taking a benzo, typically at a low starting dose, as-needed, isn't going to make you an addict. You don't want to be taking those things every day though.
Finally, panic attacks do end. They are the ultimate troll, and they can throw all sorts of weird-ass symptoms (including phantom smells) but they don't last forever. Each wave, in my experience, is about 90 seconds (90 horrible seconds). Awareness, crescendo, semi-relief, return to merely moderate anxiety. The interval of vulnerability (in which these waves are prominent in my mind) is 15–60 minutes, 90 minutes on the outside.
As I get older, the attacks themselves get a lot milder. That said, the physical recovery is more of an issue. Even a mild attack leaves me feeling like I overdid it at the gym. But I'll take that over the all-out psychic horror I experienced in many of my first ~50 panic attacks.
Good luck! I'm sorry to hear that you're going through this.
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[ 20.1 ms ] story [ 5343 ms ] threadNotably, Navarro is explicit in that article about it not being an argument for the let-it-run-wild "herd immunity" approach.
WHO envoy Dr. David Nabarro:
> "We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus"
> "The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large, we’d rather not do it."
> "Lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer"
> "Just look at what’s happened to the tourism industry in the Caribbean, for example, or in the Pacific because people aren’t taking their holidays"
> "Look what’s happened to smallholder farmers all over the world. Look what’s happening to poverty levels. It seems that we may well have a doubling of world poverty by next year. We may well have at least a doubling of child malnutrition."
Everyone, including the WHO, too.
Read the WHO's "COVID-19 Strategy Update" from mid-April. It's pretty clear about the cost of lockdown-esque restrictions.
https://www.who.int/docs/default-source/coronaviruse/covid-s..., especially page 9.
I don't think this is new, controversial, or a "backflip" (as some headlines have claimed). This is pretty much what the general guidance has been since March.
"We in the World Health Organization do not advocate lockdowns as the primary means of control of this virus ... Lockdowns just have one consequence that you must never, ever belittle, and that is making poor people an awful lot poorer"
In his first point, he notes:
"People are encouraged to adopt all precautions all the time. As Tedros of WHO says: ‘Do it All’: physical distancing, proper face-masking, hand/cough/surface hygiene, self-isolating when ill and shielding those most at risk. There should be no exceptions anywhere. This is best achieved through engaging people and trusting them rather than coercion if at all possible."
While he encourages voluntary measures rather than coercive ones, he is also clear: there should be no exceptions to mask-wearing and social distancing. That's politically hard to achieve in many countries. Hence, economic lockdowns instead.
How can it be consensus when most of the top echelon of experts disagree?
The point is: there isn't consensus. There is debate.
Business as usual is a pretty sweet deal for a professor at one of these universities. They will face absolutely minimal personal risk, and it further benefits them to get publicity by taking a contrary position.
None of that means that they are denying what lockdowns do, or the problems of a no-lockdown approach. They are saying that given a certain set of weights for each component of the consequences of a policy, we should try to avoid lockdowns.
You're free (as we all are) to disagree about the weight they choose for each consequence.
It's the same argument as 'restrictions on car-use are unfair on the poor' - an argument that you only hear from wealthy car owners.
How do the poorest people in India impact the decision of whether or not to lockdown the US?
ie science can tell us the amount of deaths or tradeoffs associated with certain choices but should never make the decision itself.
It makes sense. If individuals are supposed to quarantine for two weeks when they're exposed, then if everyone quarantined for the same two weeks, it would be gone.
Obviously you can't do a true, 100%, lockdown like that, but the logic is there: the harder the lockdown, the shorter it needs to be; the looser the lockdown, the longer it'll be before this thing gets better.
If you're willing to ration food and other resources, a lot of options open up. Nobody wants to rip the bandaid off, though, so we're stuck in limbo.
The rest of us schmoes, yes.
In $8,000 per month hotel rooms, of course![1]
[1] https://www.sfchronicle.com/bayarea/article/S-F-s-hotels-for...
Until the next airplane or ship or whatever arrives from any country in the world and has one infected person on it. Then we start all this madness again.
The cure cannot be worse than the disease.
Literally impossible
If your argument is that we cannot remove the vector for viral spread, while technically true, we can have a large enough suppression of spread through isolation that the virus would not have enough human infections to propagate. Animal vectors are a different story, of course, and often are the impetus for larger human infections.
All these non pharmacological interventions are just bandaids.
You compared lockdowns to a bandaid, and I agree. We need bandaids sometimes until we get proper treatment.
OTOH, I'm not aware, at least in the EU (where I am located) of large pharmacological efforts sponsored by governments: most of the results have come, for good or bad, from the USA's Warp Speed or the UK. Yes, BNTech and CureVac are German, but they are exceptions, rather than the rule.
It isn't even proven that lockdowns can actually save lives, although the last study touching this among a whole load of other risk factors (from U of Toronto) can be now considered old (data up to early May).
It has been 8 months. That ship has sailed
I'll say this - all of the resulting pains are temporary except one. Maybe we should continue to be thoughtful of that as we battle what is a temporary struggle.
It's a dire situation with no good solution. Ascribing grand malice diminishes that. It's reductionist.
Lockdown will not frustrate the virus regarding any long term objective.
For what? People who side on curtailing a public health crisis do not want the economy to collapse.
To claim a lockdown is ineffective is to deny the transmissivity of airborne viruses.
Good thing I didn't claim that then
According to the data they reference, Lock downs don't work and there is evidence that this virus is becoming more like the other 4 Corona Viruses in circulation.
https://www.youtube.com/watch?v=w6IeN6sgJ3g
Exactly. Authoritarianism works really well during a pandemic. But it isn't the American "way," so we're stuck with coronavirus.
There have been fits and starts for this using empty hotel rooms, but nothing universal. In San Francisco, they offer hotel rooms to the homeless under the idea that they are more likely to catch the virus on the street, but they offer nothing to people who are actually confirmed to be infected. Those people go home and spread it to their family/roommates.
Overall, this strategy does not seem plausible. It would require participation of every single country in the world otherwise illegal immigrants from Mexico/Cuba/elsewhere could just re-introduce the virus.
The argument is also predicated on there never being a working vaccine, and herd immunity being the primary mechanism of eventually ending the COVID-19 pandemic/lockdown[0].
> [0]Sunetra Gupta, an infectious disease epidemiologist, has been a critic of the prevailing COVID-19 pandemic lockdown strategy, arguing that the cost is too high for the poorest in society.
That's an economic argument, not a medical one.
Considering at least two vaccines are coming out of stage III trials[1] and may be widely available as early as summer 2021, I'd prefer to wait for that, rather than a scheme hatched by economically interested individuals who want to sacrifice a lot of people for essentially more wealth.
[0] https://en.wikipedia.org/wiki/Great_Barrington_Declaration
[1] https://en.wikipedia.org/wiki/COVID-19_vaccine#Vaccine_candi...
[2] https://en.wikipedia.org/wiki/American_Institute_for_Economi...
[3] https://en.wikipedia.org/wiki/American_Institute_for_Economi...
They've been on record, numerous times, arguing against benefits to the poor/poorest, and now suddenly we've meant to believe that they're looking out for the poor when it also benefits the wealthiest for the poor to sacrifice themselves?
Seems more than a little disingenuous if you look at whom we're discussing here.
Your argument basically boils down to: "Rich people refuse to slit their throats to give blood to the poor, therefore rich people aren't allowed to complain that lockdowns hurt the poor." It's intellectually dishonest and morally repugnant.
They don't actually care about the poor.
I must say I find this perspective difficult to understand - how can this person believe he's on the side of preventing mortality?
It appears certain at this point that there is no remaining mathematical possibility for the population-wide mortality rate in the US to end up as low as Sweden, which of course did not close primary schools or engage in any lockdown at all.
Sweden is by no means a model response - they did many things wrong. But at a minimum, it's a baseline count, no? If the USA mortality rate is higher, without even accounting for second-order mortality from the lockdowns themselves, then how can the US policy possibly be defended as anti-mortality?
As low as only a thousand times higher than Taiwan?
The US had lockdowns and fared much worse.
Taiwan had no lockdowns or school closures (but also has done some things that Sweden hasn't done, like isolate older populations) and has, so far, done better.
however, they are proposing reaching herd immunity by trying to spread the virus only through the less vulnerable population. because there is different rates of death between the two populations this should lead to less death overall.
There hasn't really been a coherent US policy, though, has there? The administration has been unable to get behind a reality-based response.
https://www.nejm.org/doi/full/10.1056/NEJMe2029812?source=ne...
Politics have overtaken some people's scientific sensibilities. Fortunately there are still lots of great people at Stanford, but they aren't the ones who are going on mass media.
They've always leaned far more conservative than almost any other academic institution I can think of. Probably it's to do with the pervading influence of big business there. The Hoover Institution is one of the oldest conservative think tanks in the US.
What was that "very very wrong" number? I found [1] from April in which Bhattacharya estimates that the IFR is probably one tenth of the CFR of 3-4%, which would mean an IFR of 0.3-0.4%. That doesn't seem very contrarian or wrong. The CDC in May estimated 0.26% IFR [2]. The WHO just the other day [3] said that 10% of the world's population may have been infected with the virus. They also estimate ~1,000,000 deaths globally. That would imply an IFR much lower than 0.3%.
[1] https://padailypost.com/2020/04/06/stanford-experts-say-covi...
[2] https://www.usatoday.com/story/news/factcheck/2020/06/05/fac...
[3] https://apnews.com/article/virus-outbreak-archive-united-nat...
[4] https://www.who.int/docs/default-source/coronaviruse/situati...
The WHO estimates a fatality rate of 0.6%. If you are simply dividing deaths by (an estimate of) current cases then you will get an inaccurate number because many of the current cases will eventually die of the disease.
> The WHO estimates a fatality rate of 0.6%.
I don't see how that makes an estimate 0.3% to 0.4% "very very very wrong", especially considering that we haven't heard the final word on this.
> If you are simply dividing deaths by (an estimate of) current cases then you will get an inaccurate number because many of the current cases will eventually die of the disease.
I didn't do that, but if you look at the numbers you'll see that it wouldn't make a meaningful difference anyway. WHO numbers show over a million deaths since the start of the epidemic, and around 5000 deaths per day over the past month. Whether you use 0.13% or 0.14% for the implied IFR, the WHO's comments the other day are out of whack with the 0.6% fatality rate estimate.
Bhattacharya's estimate is being criticized because, even though he was taking a contrarian view on the virus and getting results that were out of wack with other lines of evidence, he rushed out a highly flawed study (the Santa Clara seroprevalence study). This came out when we had little data about antibody prevalence, his study was one of the first ones, and it had the big name of Stanford behind it, so it was reported very widely and misled an awful lot of people about how dangerous this virus is. In his position he should have been bending over backwards to make sure he was on sure footing and not misleading the public, and instead he let this paper full of basic mistakes go to press.
I'm not sure if you are accusing the Stanford doctors in the article of bad stats or those arguing against the doctors in the article.
https://arstechnica.com/science/2020/04/experts-demolish-stu...
Unless I'm missing something, it's Twitter and blogs against published studies. Sounds like he's been proven wrong all right...
(disclaimer: Stanford '09)
https://fsi.stanford.edu/news/coronavirus-deadly-they-say
Rather than anything from the university that promotes the more accurate statements from the rest of the faculty.
So I would say that Stanford carries a lot of blame for letting their name be used for disinformation, and is not pushing back at all, which is a huge disgrace. If you are an alum, make some noise and refuse to make contributions until they start at least giving equal PR time to the scientifically based viewpoint.
Edit: and how could I forget Michael Levitt, who is now following in Kary Mullis' footsteps as a Nobel winning biochemist that promotes for crazy viral theories that damage public health
https://www.stanforddaily.com/2020/05/04/qa-nobel-laureate-s...
I can put a crazy paper on the arXiV tomorrow with my affiliation and if some media report says "The University of Chicago is claiming a perpetual motion machine" or whatever, that's the media's fault for misrepresenting the situation.
https://arstechnica.com/science/2020/04/experts-demolish-stu...
I think calling it "extreme ignorance of binomial confidence intervals" is incorrect and far too charitable. The authors were intentionally deceitful. Co-authors of the preprint requested that they be taken off the pre-print because they had warned that the statistics were bad. Prior the the prevalence study, they had cherry picked weird data sets and published an editorial. They are clearly trying to bend the data to their preconceived notions, in a really public way.
To see journalists pick up their work again, just because they are at a big name institution, is a huge betrayal of the public trust.
Come on man, let's be fair: a couple of tweets and a few snarky emails hardly consist of the "scientific body demolishing them." I'm not sure if I agree with Bhattacharya's study, but it's hardly been universally repudiated. This just low-effort politicizing by Ars Technica (which has a spotty record to begin with).
Even this critical blog post[1] has all kinds of colorful discussion (mostly by academics) showing that things are simply not as cut-and-dry as we'd like them to be.
[1] https://statmodeling.stat.columbia.edu/2020/04/19/fatal-flaw...
Essentially the problem with the study is that the bounds on the false positive rate of the test used was such that the data are completely consistent with all of the positives being false positives.
I am not okay with unqualified politicians making inaccurate claims about the virus, and prioritizing economic health in the absence of good governance.
I believe there are obvious risks to mental health of adults and children in being isolated from others, unable to socialize with other humans in person. I read recently too, that things like kids in school in person allow teachers and members of the community to be a safe space for children to be seen and essentially monitored for child abuse/poor living conditions. People may go to the doctor less because of fear of the disease, rather than get treatment.
It is certainly a balance - we cannot go full "save every possible life" - thus the term "flatten the curve", where the metric for success was not to have absolute minimum deaths, but to preserve the integrity of the health system to best serve all who need emergency care for any reason.
There was an article in February called "The Hammer and the Dance" that predicted a cycle of shutdowns and reopenings to balance social interaction and jobs with overriding systemic medical concerns. We are in that now.
This sounds a bit like you are raising the qualification barrier to participate in the debate, but only if that person disagrees with you.
But then they all tried to convince Americans not to wear masks.
I'm sure that poster, like me, also doesn't want politicians making inaccurate claims the other way about how the virus is the deadliest thing imaginable, or to prioritize saving every single life possible by orders of house arrest.
There's an entire group of politicians in the U.S. irresponsibly discouraging basic use of masks.
That is what the parent poster is talking about.
What is difficult to understand about this?
"US President Donald Trump has been lambasted by the medical community after suggesting research into whether coronavirus might be treated by injecting disinfectant into the body."
https://www.bbc.com/news/world-us-canada-52407177
I am more upset about the fact he still doesn't seem to believe masks are very useful.
And, the sad fact that we have to remind ourselves of this (you don't "muse" about injecting disinfectant!) is an indicator of just how irresponsible, destructive, and and constant the President's behavior, and it's enabling by politicians, the news media, or others in positions of influence (whose responsibility was to condemn such behavior) has been.
This is not complicated. No one who cares about their own well-being would ever want to work under a boss like that, much less let someone like that babysit their kids.
Trump was blathering there and had no idea what he was talking about, but he nowhere says “people should try injecting bleach”
Is that correct?
I say it this because at this point, it’s not as if we are dealing with a honest broker known for truthfulness, so, especially since everyone seemed to understand exactly what I was referring to and the “bleach” thing was a common point of mockery across media and late-night television, aren’t we kind of missing the forest for the trees?
The forest of course is a President who is utterly irresponsible and has contributed to the unnecessary deaths of over 200,000 Americans.
I absolutely apologize for and retract my incorrect description. Can we now talk about the reality of a covid-diagnosed President walking around in public without a mask?
Or does someone want to diddle and play and parse with words again?
Did he demonstrate good judgement?
Also, again, I think you’re constructing an issue where none exists. Everyone in this discussion seems to have understood perfectly well what I was referring to.
I do not think what I said is really the issue here.
The issue is a number of irresponsible politicians actively and knowingly undermining public-health efforts during a pandemic.
That’s what we should be talking about.
And I find it frustrating that folks seem to want to shy away from this unpleasant truth when it’s raised.
It’s like if a truck is going to hit you and someone yells “watch out for that damned truck”, and you yell back “can’t you tell me that without cursing?”
Or if you said “you know I worry the way you said that might make it difficult for someone else to understand your message of the impending truck.”
While the truck is hurtling towards you.
Focus on the truck.
Look. Point is. President Trump and his political enablers have proven themselves to be dangerous and irresponsible, and bear significant responsibility for the deaths of tens of thousands of americans because of the administrations terrible handling of the pandemic.
That is the truth.
I understand some people disagree. Those people are wrong.
This is ultimately about right and wrong, and irreconcilable values.
The current administration and its political enablers are pandering or outright leading the worst aspects of American society - white supremacy, exploitation of the poor and powerless, sexism, and authoritarian/fascist tendencies.
This is what I believe to be true, and while I will listen and discuss with people who may not agree with me in full, I will not equivocate about the immoral, unethical, un-American nature of the Trump Administration and what the bulk of the Republican party has become.
Do you believe the President of the United States spoke in a responsible fashion? Do you believe his words were responsible, prudent, and appropriate to the moment?
"So, supposing we hit the body with a tremendous - whether it's ultraviolet or just very powerful light...and I think you said that hasn't been checked but you're going to test it....And then I said, supposing you brought the light inside of the body, which you can do either through the skin or in some other way. And I think you said you're going to test that too. Sounds interesting....And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning? ...So it'd be interesting to check that....I'm not a doctor. But I'm, like, a person that has a good you-know-what. [Pointing to his head]
https://www.wsj.com/articles/an-experimental-ultraviolet-lig...
That’s what matters.
The burden of proof should be on the lockdown proponents, not people trying to return to the status quo.
There's a new predator out there, invading our space and we're its lunch. there's precious little status quo to return to until we have the tools to exterminate it.
We're not used to not being apex predators. That's fact.
Cov2 is both everywhere and lethal, that's quite a difference in kind.
And WRT "Malaria, and so many more" we as humans and our collective organizations have been busy trying to exterminate or avoid them as much as possible. Since forever.
From the HN guidelines: Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
This is begging the question, though.
For example, a politician has every right to say "I think schools should re-open immediately under X procedures," if that is what he truly feels reflects the best outcome for his constituents. Of course, it would be wrong to say this only for political posturing, corrupt influences, etc.
On the other hand, it is completely unacceptable for a politician (or anyone) to say, "Children are immune to the virus," "COVID is not a serious illness," (okay, technically that is normative but only insofar as the definition of seriousness is normative), "same as the flu," "masks cause oxygen lack," etc. Likewise, asserting these claims in an argument, "Children are immune -> we should open schools," is not right.
But, making a philosophical/policy and/or medical argument based off true, evidence-backed descriptive claims--even if the scientific community does not tend to share that normative opinion, is completely fine. So there is nothing wrong with arguing against a given measure that the majority of doctors support, so long as you aren't distorting the underlying facts.
As a practical matter, of course, this shuts down many arguments. Ex. admitting that masks pose no health risk to the wearer, cost very little, do not substantially limit any right or activity, and have at least a fair probability of public health benefit, it would be hard to argue against requiring them. But if you feel otherwise, make your case by all means. The only thing that is morally wrong is corrupting intellectual discourse by adding FUD and confusing people as to the underlying evidence and data.
One could go as far to say that it is irresponsible to give their peripatetic claims more credence than they seem to historically deserve, especially when it's clear that there are legitimate trade-offs.
Who else is supposed to make these types of decisions? Doctors don't have governing experience, and they weren't elected. They can and should serve an important advisory role, but the final call should be up to our elected leaders.
If we have elected unqualified politicians, that's a separate problem. This is still a decision that's within their domain.
I sense that everyone fairly well off sort of ignores how quickly poor economic health translates into poor social and biological health. We like to act like the economy is this nice to have extra that can shut down, and everything will go on as normal, except our luxuries. But then you realize, you cant shut down ports, railroads, roads, trucking, Wal-Mart, Amazon, Target, every grocery store. And suddenly all the interconnected everything requires all the software companies to stay running. All the power companies. They all need their supplies.
>we cannot go full "save every possible life"
Where is the calculation of life lost or years lost of lifespan, because the economy wasn't there to support life.
>thus the term "flatten the curve"
I understood the context of flatten the curve to be in that we needed to buy time to prepare hospitals, manufacturing, and as a tool to prevent ICU overflow. It's now been co-opted to be used in a "until the vaccine" sort of way, which is not how it was used initially. You can see how people might have agreed with it before, but not now, and still have a consistent unchanging view (its the usage around their view that changed.) It's also very frustrating to hear rate statistics used out of context, as if the instantaneous rate is what matters, without the understanding that their denominator, time, extends into the future, and with part of the denominator in the future, the numerator is not very useful.
Your statement about flatten the curve is exactly what I said.
I will say, though, I bet we disagree on this: The federal government should have minted off a few more trillion dollars to keep people home as needed without them losing their jobs or insurance. Our American political/economic system is not built to keep people healthy or economically secure, and the government should take a more active role in fixing that.
All in all, it just wasnt feasible to tell the elderly to stay home while the rest of the world continued humming. This was one way to get everybody to care.
I wasn't disagreeing with what you said about flattening the curve, I'm saying its meaning has changed in some usages, from what you described to something else.
If the goal is to preserve the maximum number of human lives, lock-downs are probably reasonable (particularly since lives saved keeping the highways closed alone meets or exceeds lives saved from COVID) - this logic also would have probably kept it out of WW2, kept us from sending humans to the moon, etc.
If the goal is prevent the maximum damage to the economy possible, then lock-downs should probably be extremely brief and extremely intense.
If the goal is maximum human freedom, again, the choices are obvious.
Any discussion that doesn't first define the goals is useless with this topic.
Except ..
for many individuals and for many groups of humans, goals change as the costs of a given goal become more clear. It's not always possible to state a priori what the goal is, and even after settling on one goal, new reasons (new costs) may appear to push us towards a different goal.
There are still many unknowns about the virus impact on health so telling people they should take a chance because it might not be worse than working remotely seems a bit inresponsible.
Governments should either impose lock-downs until they find a vaccine or develop ways to "live/work" with the virus(i.e strict measures, keep the virus under control etc), though it's hard if we can't/don't even want to wear a facemask and commander in chief claims the virus is a hoax.
It's not obvious which position is the responsible one.
I think the responsible position would be to provide the people with a safe environment where they can work and live. Perhaps also working a bit on the inequality issue.
It's clear to me that with or without the lackdowns the worst affected are the already poor people working in the front line.
There are plenty of stories in the UK of people having their cancer treatments postponed due to lockdown, and their cancer now being terminal.
Where are you getting that figure? Wikipedia lists 40k US deaths from all traffic-related causes in 2018 (https://en.wikipedia.org/wiki/List_of_countries_by_traffic-r...), but 200k+ from 8 months of COVID?
https://en.wikipedia.org/wiki/Disability-adjusted_life_year
Is this too complicated to implement?
I would think this more nuanced approach has way more upside than going 100% one way or the other.
This is the point that I think often gets missed in the discussion around "lockdowns". I would bet that we could actually reduce the spread of COVID quite substantially without a massive change in the living standards of most people. The problem is that there is a segment of people who refuse to do anything at all to reduce the risk of transmission so we end up having to take more extreme actions to compensate.
I think you might be missing the fact that if this segment of the population does increase transmission, it can only do so by the members of that segment getting infected, and that can only happen once per person as far as we know. So over time, you would expect that group to be less and less prone to infection, and therefore less able to pass on infection to others. So the more time goes by, the weaker this argument becomes.
> subsidized food delivery services for the elderly,
or this, now people are stuck being forced into risky scenarios because they're forced to serve the others fortunate to pay for their problems to go away
"Government to provide" gets you into huge trouble in large parts of the US who will decry this as socialism, etc.
And sadly, even a lot of the US that isn't so cruel and selfish, seems worse than its peer countries at executing government programs effectively...
Half the country doesn't have the imagination to imagine things could be better for everyone without being worse for them, and the other half doesn't have the imagination to hold themselves responsible for actually delivering results vs just trying.
The solution you suggest would be equivalent to a permanent Red Hour, with those bent on damaging themselves and others roaming the streets at will, while those with any sense cringe helplessly indoors, starving to death. "Nuanced" is not the word I would use to describe it.
Provided the risks are understood (although I would like real data on long term covid effects before continuing) the solution would effectively bring us back to pre covid society.
Those who are currently paying for safety nets are doing so by compulsory taxes. If left up to their choice, as above poster suggests, why should anyone expect them to continue paying at the same rate?
[0]: https://en.wikipedia.org/wiki/Red_Hour_Productions
if not, how do you include those who would like to maintain their personal liberties but don't want to trust others with their life in your proposed worldview (reckless behavior of others in terms of infections etc)?
It really is a group activity - individuals can not take their own risk without risking the lives of others.
Those who don't want to trust others with their lives are welcome to take the precautions that are being asked of everyone at the moment (no household mixing, complete lockdown) the only difference would be it would only be those at risk subjected to the lockdowns.
it isn't binary but a fine-tuned probability. i don't see a problem not allowing riskier than usual (i.e. increasing the probability of infection) behavior.
In case of driving, why can't individuals choose which side of the road to use for themselves?
"while assisting those who want to prioritize virus avoidance (e.g. subsidized food delivery services for the elderly, a modest stipend for those who want to avoid the workplace for a while, etc."
Who is going to pay for that? Those who are maintaining their personal liberties? Keep in mind that the poorer parts of the community are impacted worse by both COVID and the economy.
In a situation where a large part of the population is "taking their chances", those who "want to prioritize virus avoidance" must avoid all contact with others. That's quite a different trade off than handwashing, masks, and social distance.
It not a choice of side it's a choice of whether to use the road at all, those who agreed to use it before managed fine and those who are choosing not to use it now are perfectly free to do so.
> Who is going to pay for that?
The same people who are already paying for Furlough and all the other financial safety nets that are already in place at the moment.
> In a situation where a large part of the population is "taking their chances", those who "want to prioritize virus avoidance" must avoid all contact with others. That's quite a different trade off than handwashing, masks, and social distance.
The requirement to stop all contact is already effectively there for those at risk, and the demands aren't stopping at handwashing, masks, and social distance as those don't appear to be working; instead indefinite lockdowns, blanket bans on household mixing and abolition of major sections of peoples lives and livelihoods are being demanded.
"...the demands aren't stopping at handwashing, masks, and social distance as those don't appear to be working; instead indefinite lockdowns, blanket bans on household mixing and abolition of major sections of peoples lives and livelihoods are being demanded."
Have you considered moving somewhere else? I don't know where you are, but hand-washing, mask, and social distance seem to be doing fine here, and there are no indefinite lockdowns or the other things you mention. See https://governor.alabama.gov/assets/2020/09/Safer-at-Home-Or....
If you have a look on a news site that covers areas outside the global hub that is alabama (reuters for example https://reuters.com/news/world or any other major news organisation) you will find...
1. It is pointless moving elsewhere as the virus and the response is worldwide (that 7 months of this hasn't brought this to your attention is...of note.)
2. The measures are being viewed as insufficient and and we are facing curfews and all of the things that I mentioned ARE happening.
A right balance needs to be found.
[1] https://www.hsph.harvard.edu/news/press-releases/economic-do...
Really, do explain please. First I'd like to know what you mean by freedom. I assume you're also considering that a) the dead have no freedom, and b) those incapacitated in some/many ways (economic, physical etc.) are definitely going to have less freedom in the long term.I think it is anything but obvious how to maximize freedom in general, let alone with respect to a pandemic.
Initially the pandemic response was about "not overwhelming the hospitals", but it seems some politicians disagree on the fundamental direction. I'd just be happy if my government had a clear policy on their goal. Do they want to reduce infections or do they want to prevent overwhelming emergency services?
Obviously my knowledge on facts is very limitted, I simply don't have time for that, but the news still report lots of capacity in hospitals.
How do those two policies differ?
Well, I mean, there's the obvious: don't treat people with COVID. But that seems sub-optimal.
What happens when you say, "flatting the curve worked!" and relax all the recommendations and requirements? The infection numbers go exponential again, right?
https://www.npr.org/sections/coronavirus-live-updates/2020/0...
The infection numbers didn't go exponential.
https://www.worldometers.info/coronavirus/usa/florida/
If the goal is maximum range, we should get rid of first-class seats, life vests, and all sort of useless amenities. (Do we really need four lavatories?)
If the goal is maximum comfort, we should get rid of all economy seats. No more affordable plane tickets.
If the goal is maximum speed, we should retire our fleet and re-introduce supersonic flights. Those suckers living under a frequent flight path can use earplugs.
If the goal is maximum safety...
What I'm saying is: every time we say "our goal is X", it implies an additional condition "assuming other things stay reasonable." Of course, something like COVID is not within anyone's living memory, so it's hard to build a consensus on what's reasonable - but we can't just short-circuit it by saying "Just say what you want and stick to it!"
You've just described politics.
2009 Swine Flu, predicted to be hugely deadly, WHO changed the definition of pandemic so they could declare it one. Ended up being a non-event (nb: numbers are not comparable as there was no mass testing programme like today).
In many countries excess deaths are no different to previous years. For instance in Switzerland cumulative death in 2020 is by now the same as long term expectation. Fewer people died at the start of the year than average, then it went above average during COVID, then it came back to the long term average slowly over the summer. COVID is nothing more than a seasonal flu, here. In Germany it's not even that. Excess death for 2020 is smooth and flat, compared to 2018 where it saw bigger spikes. Also Swine-Flu like.
Even in the UK, which has largely shut down its health care system and imposed draconian lockdowns, excess deaths matched 1999/2000 which were not notable years. Nobody noticed any unusual levels of death back then.
This is why there have been so many people criticising lockdowns so strongly, for such a long time, and now people are paying attention because SCIENTISTS! but you could look at the government sourced data in perspective back in April or May, to understand that the reaction was not proportionate to the threat.
But I guess to reach that, you still need a pretty severe lockdown.
It's also clearly direly needed practice for the next, worst epidemic. We got lucky with COVID-19, it's on the mild side of the scale.
In a worse case scenario, say Ebola mutates to an airborne strain, the countries and cities that essentially used COVID-19 as a practice run to develop the procedures and social knowledge to quickly shut down an epidemic, will be looking smart.
We've known for decades that pandemics are coming, as the world becomes more physically connected. We've written tons of books and made tons of movies about it. Every zombie movie of the past 20yrs is about a viral outbreak.
So it's insane that so many Western countries are behaving like idiot children in the face of this entirely predictable and predicted problem.
(I'm talking about R when a small to moderate number of people are infected; the slope of the R vs number infected curve will vary due to many factors)
I respectfully disagree. For a while I've been thinking that's more or less a classic false choice -- this argument that those in the "saving lives" camp are somehow refusing to care about the powerful value in our economy.
But I think you save the economy by beating the virus. People won't walk into a crowded and poorly ventilated restaurant until the virus is gone. Anything that prolongs the virus's presence in our country will drag down the economy. I feel like some of the "pro-economy" people aren't sufficiently recognizing that.
How many times have you seen someone actually write out their utility function? Or agree on a single number on which the results of an A/B test will be based, regardless of other metrics? Defining your goals is an admirable objective, but it's not commonly done to the degree you're proposing.
All else equal, we want to preserve the maximum number of human lives, prevent the maximum damage to the economy possible, and provide maximum human freedom. Quantitatively defining the tradeoffs there is basically impossible.
What's much more common is proposing a few options, and listing out how each options affects the metrics you care about, then deciding an option.
Said more explicitly, it's easier subjectively to pick a point on a rigorously found pareto frontier than to subjectively define a utility function to be rigorously optimized.
Life, society and the world doesn't work like that, regardless of whether there's an extreme event going on.
Any goals should include balance and shouldn't just be trying to maximizing one variable.
Even using something I personally can't stand as an example, models. In a model, maximizing a variable rarely leads to any desirable outcome and models tend to be a poor reflection of reality as is.
Reality is far more complex, having a goal be to maximize for one specific variable means your minimizing other variables that are in many cases complete unknowns.
Instead of working towards measured goals designed to minimize overall negative impacts, the reaction has been to maximize for saving as many lives as possible at the expense of all else.
The problem is, there's no way to even really be sure what we've done is maximizing the amount of lives saved, but at the same time we've ignored very real negative impacts in this blind rush towards maximizing saving as many lives as possible.
And to be honest, from what i've seen on the news, heard people saying, read on comments here...this seems to be the primary motivation behind this goal(or thinking like this)
>“Whose grandmother and grandfather and family members are you willing to sacrifice for this stupid idea?” asked Santa Clara County Executive Jeff Smith, whose administration in March led the Bay Area in imposing the first U.S. lockdown in the pandemic and has since been criticized since for its slow pace of reopening.
This is a logical fallacy intended to appeal to emotion. Wide sweeping policy decisions affecting the health and well being of most of society should never be based on emotional appeal.
I think it's great that there is an argument about this, but it still feels disappointing that it will still clearly take a lot longer then 10 months to clarify these points to a level where no serious high level medical professional disagrees.
In the meantime, I'd also appreciate it if we could get back to a lot more talk of "flatten the curve" in our public discourse. Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus. The question is how rapidly that happens, and the concomittant impact on health care and the economy if it happens too fast.
> Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus.
Unfortunately there are many people who really believe we can eliminate the virus through strict measures. Just read many responses here on Hacker News and you'll find plenty of those people.
No, he wasn't. Where did you get that idea? https://www.nytimes.com/2020/01/31/business/china-travel-cor...
Asked if his administration was worried about a coronavirus pandemic, Trump says, “No, we’re not at all. And we have it totally under control. It’s one person coming in from China.”
https://www.cnbc.com/2020/01/22/trump-on-coronavirus-from-ch...
January 30th:
The World Health Organization declares the coronavirus a “public health emergency of international concern.” • At an event in Michigan, Trump says, “We’re working very strongly with China on the coronavirus—that’s a new thing that a lot of people are talking about….We think it’s going to have a very good ending for it. So that I can assure you.”
https://www.whitehouse.gov/briefings-statements/remarks-pres...
Now, I will grant you that he established the task force on Jan 29th, but against that I will note that the "China travel ban" did not prevent Americans who had been in Wuhan and other affected areas from returning to the US. I would also add the person chosen to head the task force at the start, secretary of HHS, Alex Azar, on August 23rd (after all we know now) explained things this way:
> Alex M. Azar II, the secretary of health and human services, defended members of President Trump’s family on Friday for refusing to wear masks at the recent presidential debate despite a requirement that the audience do so. The first family and the president are “in a different situation than the rest of us,” Mr. Azar said, because they are in a protective bubble."
https://www.nytimes.com/live/2020/10/02/world/covid-19-coron...
I think it's fair to say that Trump's actions along with his then-private conversations with Woodward, can be reasonably (if incompletely) summarized by saying that he has tried to downplay the virus from the start.
At the same time, there has been an endless parade of contrarians trying to make the whole thing into a big mystery and muddy the waters for some reason. There was the theory that the virus was spreading much earlier than expected. There was the theory that most cases were asymptomatic and that immunity had already been reached. The theory that lockdowns are not effective. The theory that there were different strains with highly different behavior. Some vague theory about t-cell immunity.
None of these contrarian theories have been supported by any real evidence, but there is a large appetite for them and people will seize on any puzzling number to try to rethink the whole picture of the virus.
1) the death rate is still unclear because very few localities have done sufficient and/or the right kind of testing to answer this in a definitive way.
2) initial estimates about hospitalization across age cohorts seem to have turned out to be fairly far off. Tracking the stats for my own state (New Mexico; admittedly a fairly small population), we sometimes have almost flat hospitalization rates across age cohorts.
That report was dated 16-24 February 2020. It was authoritative at the time of writing (hard not to be given the limited breakouts outside of Wuhan at that time), and the reporting on the physical structure and mechanisms of the virus have remained largely unchanged AFAIK.
But the epidemiological aspects of covid19 have, I think, changed quite a bit since that report. The report doesn't in fact coe down strongly in favor of masks:
"The relative importance of non-pharmaceutical control measures including masks, hand hygiene, and social distancing require further research to quantify their impact."
and in the section titled "Knowledge Gaps" includes "Effectiveness of the public health control measures and their socio-economic impact ... * Wearing mask in general public", along with most "lockdown" type policies.
2) I haven't been tracking hospitalization data very closely, you may be right that this has changed ... I've seen little discussion of it.
I agree that mask use in particular was controversial for a rather long time, with bodies like the CDC seemingly dragging their feet on recommending the use of masks. Still, I think that it's been a pretty settled question since April (CDC recommended masks from April 3 https://www.livescience.com/cdc-recommends-face-masks-corona...).
2. I don't want to make strong claims about this, but I do think it has moved quite a bit.
3. Yes, mask utility seems really well established now and has been for "many" months.
I still wish we would hear more public speakers using the numbers from 1. above combined with "flattening the curve" to make it clear what we're trying to do. 1% of the US is a million people. That could still be the outcome, but at the very least, we'd like that not happen all in the same month!
https://www.bmj.com/content/370/bmj.m3364
So the actual IFR is probably lower than the numbers you cited.
The first citation on your linked editorial is Ioannidis, which is the same Stanford researcher in the OP article here, and the same group responsible for the utterly flawed Santa Clara study. It seems like it's literally this one group, and a few other weirdos and contrarians, singlehandedly raising spurious doubts about the science, and then being amplified beyond all reason.
The cited Ioannidis study also sucks, he takes a number of seroprevalence studies, including some very flawed or underpowered ones, and then takes the unweighted median for some reason? More details here, including an illustration of how the high-quality, randomly-selected samples do not vary so much https://twitter.com/GidMK/status/1283232023402868737
https://doi.org/10.1016/j.cell.2020.08.017
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C24&q=mem...
But honestly, who cares about the actual number? The flu death rate is subject to the same problems. Nobody gets tested for asymptomatic flu. We're should be comparing the CFR for flu to the CFR for COVID, and this shouldn't be an argument.... But it is.
Trouble is it isn't a fixed number. It depends who the people are, what treatment is available and so on. It's come down over time for various reasons. These things aren't as simple as they might be.
This flies in the face of rationality. You don't just get sick for a day and gain herd immunity. You are sick and contagious for weeks, you then infect other people whom go out and infect other people. Do these doctors seriously believe people at risk can just isolate themselves from the world? Most don't even realize they're at risk.
If you want to put that risk of infection and death onto people then say it, but don't try to sugar coat it like this is a good idea that will protect everyone. If anything it's necessary to keep markets afloat and various economies from failing.
In essence, "here are all the essentials for life, please sequester. if you cannot sequester and require assistance, contact _____".
And it’s really hard to even get agreement on what to consider in order to decide! For instance, a strict utilitarian assessment needs to consider (and opine) on the following questions:
* Does full lockdown, which it is agreed would reduce COVID deaths, increase or reduce net deaths over the same period in all cause mortality (poverty, depression, abuse, etc)?
* Does full lockdown increase or reduce net deaths over some longer period of time for all cause mortality?
Then we get to the really hard stuff, in two directions: first, cultural:
* Will full lockdown + contact tracing be implementable in the US / UK?
* If so, are the privacy and government centralization harms worth the benefit?
* If not, are the privacy, government centralization, and mortality related harms / benefits worth the tradeoff?
Second, in ‘softer’ terms:
* Will lockdown disadvantage certain members of society? (see the “K shaped recover” for lots on this.
* Are those harms short or long term, and are they worth the lifesaving that (may/will/definitely will/probably won’t) result?
Again, this is all presuming we agree to be utilitarian about this, (which I am not particularly inclined to be personally).
And, crucially, the answers to these questions is going to vary based on how much control a given government has right now, how much trust citizens have in their governments, how good the social safety net is, how protected / enforceable the borders surrounding the lockdown are — it’s impossible to get a global answer here.
US is (broadly) low control, low trust, net importer with large land borders and neighboring countries by sea, so it’s a much harder problem even if you had consistent messaging and planning from the top.
Youtubers in china show that same story in street footage; so on balance yes, I think it’s generally accurate.
We should stop talking about "lockdowns", and possibly never should have thought that way. The question is over restrictions, WHAT restrictions should we have, what alterations to usual way of doing things.
For instance, do you know Sweden, all along and still now, was in fact prohibiting gatherings of over 50 people, with criminal penalties for violating? Schools for children over 16 were closed. Social distancing was encouraged. Sweden didn't actually do particularly well -- although they have done BETTER than the U.S. in deaths per 100k population. But however poorly or well they did, contrary to the narrative, they in fact made major changes to social life, and in the end may have controlled social distancing BETTER than the US! (through a combination of legal restrictions and voluntary compliance, compared to the U.S. piecemeal, ever-changing, lockdown-then-nothing low-compliance environment).
So it is definitely a problem to think that our choices are a total lockdown which can reduce all risks to zero (unsustainable and not actually POSSIBLE; quotes about "which grandparents are going to die" suggest that if we do things right it will be no grandparents, which is unfortunately not true) -- and doing virtually nothing except maybe some half-hearted mask-wearing, which will result in years of ongoing massive illnesses (including possibly long-lasting chronic illness) and deaths.
In fact, we have to figure out how to do restrictions RIGHT. restrictions that are sustainable for the long-haul (becuase in fact this is going to be something we're dealing with for years, there is no deus ex machina vaccine miracle that will put things back to how they were), and that optimize for minimal infection with maximal social life. (In normal life, I have trouble explaining what I mean by 'optimizing' like this, it's nice to be talking on HN in an engineering culture that will immediately understand what i mean).
The US doesn't seem any closer to being motivated to do that though. And I"m not sure this letter actually helps,this comes across as just another allegience in the "do everything or do nothing" weird public health culture wars, which are not serving us. (For instance, "Herd immunity" is mostly not a useful thing to be thinking about here, and mentioning it just seems like signaling a 'do nothing' allegiance or implying that intentionally increasing infection rates is somehow a good thing, which it is not, unless you like years of ongoing chronic illnesses and deaths).
Completely agree. Lockdowns and "shelter-in-place" orders were a reasonable response in March when we had no idea what we were dealing with and had to preserve the integrity of the hospital system. But they were never going to be sustainable for more than a few weeks.
The next step, closing "non-essential" business and limiting gatherings, is a logical progression, and is something that can be tweaked and tightened/loosened as the data indicate.
Then we have masks, social distancing, and frequent hygiene. This should continue indefinitely, at least until a vaccine has been widely distributed. I'm shocked by the opposition to this.
you’re advocating lockdown. we only need to curtail (not completely shut down) socializing-oriented businesses like bars/clubs, not ‘non-essential’ businesses. we should advocate for, rather than try to coerce, limiting large private indoor gatherings and being responsible when gathering.
> “Then we have masks, social distancing, and frequent hygiene...”
only social distancing is needed, but you can’t mandate these things in any case. only social pressure works on the level of groups and communities. masks and over-cleaning are effective only on the (in some cases very slim) margins. don’t breath into each other’s faces and we’ve done the majority of what is effective, rather than ritualized compliance signals.
Do you consider that a "lockdown"?
To me, "lockdown" -- a word I had previously heard mostly in reference to prisons -- means absolute cancellation of all social life, the word implies an absolute and universalism. That is not possible on an indefinite ongoing basis.
But we absolutely need restrictions. I'm not ready to say right now exactly what those restrictions should be -- they need to be based on science that we haven't done enough of, and they probably need to change as we learn more about things and as we observe how different restrictions (as well as different accomodations like improved ventilation) effect spread (which may be different from one society to another). We have barely yet begun to take seriously the need to seriously figure out what to do, instead of arguing about "lockdown" vs "do nothing".
To my reading, you are still engaged in that odd dichotomous debate, advocating the "do pretty much nothing" approach, absoultely confident (based on what science?) that this is sufficient.
it's uncharitable to project. you're also trying to coerce my position into "do nothing", which is not only uncharitable but incorrect. "do only things that have meaningful, not mollifying, effect" is more correct.
> "But we absolutely need restrictions."
that's cart before horse, an overly confident a priori assertion, rather than an empirically-backed deduction, like much of the discussion around "the science".
> "...they need to be based on science..."
science will expand our body of knowledge in time, but science is not unassailable (science doesn't create truth, only reflects incomplete shades of it back to us), and an unrealistic faith in science to settle decision-making under uncertainty today simply doesn't help. it just plays into media partisanship, as an unwarranted appeal to authority to coerce others' behaviors (i.e., an application of power) irrationally. in 20-50 years, science might tell us what the best course of action might have been, but it won't settle the debate in this moment.
but luckily we already have plenty of information to make informed decisions, even if much of that information is imperfect. and note that it's not the complicity rituals we've bought into from our "leadership".
for instance, it was clear as early as february that the elderly were at much heightened risk. we should have locked down elderly care facilities and bubbled them, employing a tiny fraction of the $2T in economic aid spent already (in the US) rather than largely wasting it on further enriching the already wealthy. that would have reduced fatalities by on the order of ~60%. a meaningful effort, rather than safety theater.
it was clear around march that those with co-morbidities were also at heightened risk. that's harder, but getting that information out to the public changed the behavior of those at risk without the need for lockdowns for everyone. people are capable of making informed decisions with trustworthy information. it's (partisan and media-fueled) propaganda that's made it difficult to tease out what's reliable and trustworthy, cornering us into largely ineffective, performative mitigations (i just heard a woman on npr proclaim "i don't just wash for 20 seconds, i wash for 30 seconds!" as if that makes any difference to anything other than her own self-righteous ego and npr's editorialized virtue signaling).
it was clear that the trajectory of the virus was more flu than black death, deadly to less than 1% rather than 30-60%, despite the hyperbolic rhetoric around "exponential" growth (actually sigmoidal/logistic). if it had it been a new black plague, it would have been quite obvious early on, and people's behavior would have swiftly adapted out of self-preservation without requiring martial law.
it's clear that a few simple mitigations (distancing, avoiding large gatherings) can keep the infection rate largely under control, which is about the best we can do without destroying entire societies, governments, and economies (which we seem wont to do anyway).
life is an endless series of cost-benefit tradeoffs. we accept risk and death every day, not attempting to save every single life at all costs. if we did, we'd spend every excess dollar beyond water, food, shelter, and clothing on potentially preventable causes of mortality like cardiovascular disease, cancer, and respiratory disease[0], but we don't. it's irrational to act differently for a novel virus that isn't very deadly, all things considered.
lies told by the "left" are no better than the lies told by the "right". and the whole left-right dichotomy is a misdirection perpetrated by both to blinder our thinking in ways that benefit only the entrenched powers. in other words, break free and stop parroting phrases like ...
But we're not going to resolve this here.
I am curious about one thing specifically though, my one question you didn't respond to. The person you were responding to said we didn't need lockdown, but we did need some restrictions to nonsesential businesses.
But you replied that closing down nonsessential businesses was in fact "lockdown".
If that's lockdown, do you think Sweden's restrictions of gatherings over 50 people (with criminal penalties for violating) is also "lockdown"? If so, contrary to popular conception, it would turn out that Sweden actually engaged in "lockdown" all along after all, I guess? And do you think even Sweden basically over-reacted?
no, because it was based on incorporating the wealth of (imperfect) information that we already have. your statement started with "But we absolutely need restrictions" and then essentially said "not enough data", which makes that statement an a priori presumption. it could be that no restrictions are worth it, but your statement already ruled that out without rationale. mine didn't rule out restrictions, but rather advocated limited and targeted (high bang-for-buck) measures.
as for the rest, a semantic argument over "lockdown" seems unlikely to be fruitful, for an overly-curt phrasing on my part (as in, losing essential nuance for the sake of expedience). i'd generally agree that an indoor social gathering of sufficient density can raise transmission risk, but an arbitrary cutoff is not so useful. 50 people in a house is different from 50 people in a performance hall. incidentally, that's why distancing is a better general rule of thumb, because it concerns density directly (masks, for instance, don't).
and it's not about overreaction but rather precision and efficacy. once you institute a law with stiff penalties, you're raising the spectre of use of force against the populace, which, in a democratic society, should be reserved for the most extraordinary of circumstances, like existentially-threatening insurrections (e.g., civil war, plotting against a governor, etc.), not, relatively-speaking, small parties (or low-risk businesses for that matter). when provided reliable information and not overwhelmed by distortionary narratives, people will generally make reasonable estimations of risk relative to their idiosyncratic risk tolerances, and act accordingly.
all the rest is rhetoric trying to ramp up tensions and fears so that power can be coalesced and exerted. we just don't need to feed that beast in this case (or in most cases, 9/11 being another prominent example).
We agree that "limited and targeted (high bang-for-buck) measures" are called for, I guess we just disagree on what sorts of things they plausibly should be? I'm not sure why you are making this into a disagreement on 'a priori' or whatever.
The thing with a 50-person limit is it is easy to understand and easy to comply with. A limit about number of people per cubic meter... the harder it is to know if you are doing it or not, the lower compliance there will be, whether voluntary or with penalties. It makes sense to approximate for comprehensibility -- since it's based on imperfect data in the first place, we certainly don't know the exact risk level of various densities or types of gatherings, only guesses based on imperfect data. (It would be really good to be investing in trying to get better guesses.) It's already an approximation no matter what. That doesn't mean it won't be effective at limiting infection, it is not damned by being an approximation, whether expressed in terms of people per cubic foot or no gatherings over 50 people.
Telling people "hey, just a as a rule of thumb you should 'distance', to whatever degree you think appropriate, but it's up to you" will, I am pretty confident, have very little effect on anyone's behavior. At least not in the U.S. Maybe in Sweden.
it's also erroneous to take objections about that particular restriction as blanket evidence for believing sweden is being heavy-handed overall. that's dichotomous thinking, setting up a false dichotomy and then shoving the opposing position into (what you believe is) the unfavorable corner (for the second time).
the point was that that particular restriction was misguided, not its goal of containing the highest likelihood transmission vector, the large private social gathering. the excuse of being easy to understand is exactly how we get bad legislation with numerous unintended consequences that just beg for more (poor) legislation to patch the ever-incresing follow-on consequences, rather than doing the harder work of being as precise and efficacious as possible the first time (and every other time).
these are not only erroneous but also ineffective approaches to argumentation. you don't get better rationale, better positions, and better policy from employing such tactics. and yes, we do just disagree on what the best measures are, but that's also the important bit.
Agreed, but there needs to be a discussion about what an acceptable amount of cases is as well. Because the strategy seems to be eradication, which is ridiculous. As soon as any restrictions are eased there is much hand wringing the second case counts go above some very low but arbitrary level.
EDIT: I'm sorry, I misread. You're not against the idea, it just doesn't inform us as to how to balance our policies.
Honestly Im not sure I'm trust anyone who has the money to be placing full page ads in papers to be looking out for me.
Oh what do you know....after googling it it turns out this person is associated with The Federalist.
In the UK, 75% of deaths are people aged 75 and older. I'm not sure if its the same age profile in the US but I would think yes. Even here in the Bay Area, the death rate is about 0.5% for everyone below the age of 60. If we lock down those over 60, and let everyone else live with masks and social distancing, the infection rate may skyrocket but the hospitalization and death rates will plummet. This is basically what we are seeing globally now, where the infection rate is higher than in March but death rates are much lower. Granted, there were less tests being run so that makes things hard to compare.
Also, the bigger problem is those that need to take care of their parents who are in this age group. The infectiousness is so high that if the children get sick, the parents will definitely get sick. So this is the biggest quagmire, that entire families will become isolated to protect the parents. It's not a perfect solution but better on a percentage basis for the entire country than locking down everyone, even though the risk profiles are drastically different.
I hear a lot of people talking about this kind of shield the vulnerable approach, but no-one who can answer the question of how nursing homes work in this condition.
In all seriousness, taking any amount of effort to protect nursing homes would be better than what we have right now. Like, "stop sending COVID patients to nursing homes" levels of effort. (Thanks, NY and MI - plus others I'm sure)
Consider: nursing homes have many staff. Most of them are young and badly-paid. In any let it rip scenario, many of these will have Covid, and will bring it into the home.
OK, so let's test everyone. Even ignoring the fact that testing is not 100% accurate and takes time (do you test all staff and have them wait for the results), you'll get loads of staff infected, and who do you replace them with?
It appears in Sweden that a major carrier of Covid into nursing homes was agency staff (short-term people brought in to cover staff gaps). How do you stop this from happening again?
Full disclosure: my mother, father-in-law and mother-in-law are all over 70 with a consequent higher risk level, so this is not abstract to me as I'd like them to survive long enough so that my newborn daughter remembers them.
Nursing homes remain closed to visitors. Staff and residents only. Staff are tested daily for covid. Nursing home residents do not leave the nursing home. Staff and residents wear contact tracing bracelets and residents stay distant from one another.
You do the best you can. The common cold can be deadly for people in nursing homes. We cannot drop the risk to zero.
Daily testing doesn't help much if you end up disqualifying most of your staff.
Like I said, it isn’t going to be perfect. It can’t be perfect. You do the best you can. You don’t shut down the entire US economy because nursing homes aren’t bulletproof.
With daily testing, constant PPE for staff, contact tracing, and other preventive measures it will be fine. It won’t be perfect but it will be fine. It will likely be better than typical.
I am not sure why you think it's more realistic to lock down three million people totally than have most people take moderate precautions. Remember, this is in a proposed scenario in which the average grocery shopper will have a high likelihood of being infected, without masks or any social distancing measures being taken.
The White House tried the "frequent rapid testing" strategy, and that didn't seem to do a very good job of protecting the staff there. Again, this was in the current situation in which we have a relatively low prevalence of contagion, with social distancing measures and masks in the outside environment.
>I am not sure why you think it's more realistic to lock down three million people totally than have most people take moderate precautions.
Realistic? How about legal, likely, or plausible. The March lockdowns aren’t happening again, not on a wide scale. People will riot.
I wrote about this in this post, which was discussed here on HN at the time: https://rssdss.design.blog/2020/03/31/all-models-are-wrong-b...
https://www.bmj.com/content/370/bmj.m3364
This is the best one I've seen for the UK - they just updated it today and estimate that 9-15% of people in England have been infected.
https://joshuablake.github.io/public-RTM-reports/iframe.html
1) This declaration was made at a conference on economics. That makes the motivations seem like they are economic in nature, not driven by medical motivations.
2) It isn't clear to me that these doctors are experts on coronavirus. Only one is mentioned as currently practicing. As I understand it, death isn't the only negative consequence associated with coronavirus. Their declaration seems to ignore this and only seems to be based on a meta-analysis of death rates.
3) We do not currently have a lockdown. We have some restrictions in place. Their declaration is not just against lockdowns, it's against gathering restrictions, masks, etc.
"The project was sponsored by the American Institute for Economic Research, which is a libertarian think tank funded by billionaire Charles Koch's conservative Koch Foundation" https://en.wikipedia.org/wiki/Great_Barrington_Declaration
The Koch brothers are known for financing climate change deniers.
Well, those ideals have come home for many parts of the world. Imperialism and disregard for human welfare will now serve "the economy", as we are seeing now in the United States.
I find it ethically abhorrent, but humans are humans.
https://en.m.wikipedia.org/wiki/Great_Barrington_Declaration
The issue is that it is very clear, at least in the US, this just is not reality. We would absolutely screw this up and kill way more people if we didn't have these training wheels on.
Who is this "we" you speak of? Do you include yourself in this group of people that need training wheels? Or do you think you yourself are perfectly capable of doing it right but those other deplorables are not?
I don't need training wheels, and I don't expect any adult citizen of a free country to need them either. I think the majority of people have far more common sense and desire not to hurt others than they are being given credit for. Unfortunately, the media focuses on the outliers that don't have those qualities and makes everyone think everyone else is like that. That is doing our society a serious disservice.
The issue is not people's common sense or desire to not hurt others. The nature of this issue doesn't lend itself to being stopped just through common sense - you can transmit this disease for days without realizing it. Common sense says don't play with fire. It doesn't say maybe you shouldn't go see grandma after the pumpkin patch for 7 days.
Well, I don't, so please don't say "we" need them.
> The nature of this issue doesn't lend itself to being stopped just through common sense
Maybe I should have said "common sense and discipline". Apparently you are aware that you shouldn't do certain things, but you don't have the discipline to not do them.
This is going to sound harsh, but discipline is part of being an adult just as much as common sense is. If it is really true (I'm not sure it is, but let's assume it is here for the sake of argument) that most people in the US are more like you than like me, unable to exercise the required discipline in a situation like this, then that is a very, very bad thing for the US, because you can't have a free society if its citizens lack the discipline to do what they know is the right thing to do. And that puts all of us at the mercy of whatever the idiots in positions of power want to do to us in the name of "protecting our safety". I don't want to live in that kind of country. Do you? Think carefully.
It's hardly, then, a stretch to postulate that many would lack the discipline to do the Right Thing without stricter measures incentivising them
I'm not. But the kind of "protecting safety" I am talking about is narrower than what you appear to be assuming.
> large parts of the US have put someone in power primarily in the name of 'protecting their safety / way of life / jobs' (i.e. making themselves great again)
I'm not talking in general terms about things the government does that affect people's safety, way of life, jobs, etc. (At least, I'm not talking about such general things in this particular discussion.) I'm talking about a specific thing that many people appear to want the government to do: dictate what individual people can and cannot do, at a very detailed level, in the name of "protecting safety", instead of allowing individual people to use their common sense and discipline, which is what is supposed to happen in a free country.
Lockdowns in response to COVID-19 are just one example of this thing; the US is full of nanny-state laws that micromanage people's lives in all kinds of ways in the name of "protecting safety". (Actually, as P. J. O'Rourke pointed out many years ago, "nanny state" is much too charitable a term, as "nanny" implies at least some amount of actual empathy and compassion; a better name would be "Nurse Ratched state".) All of those laws have as an underlying assumption that people in the US do not have the common sense and discipline to act in their own best interests. That assumption is incompatible with a free society. If the assumption is actually true for a majority of people in the US, then it is a very, very bad thing for the US, since the benefits that everyone wants will also go away if the US is no longer capable of being a free society.
For example, as the events of 2020 have starkly shown, many people in the US are harassed, or worse, by cops and other government officials for no good reason. But the only reason the cops and other government officials even have the ability to harass people that way in the first place is all those nanny state laws: any cop that wants to mess with a citizen is going to be able to find some law that citizen is violating. Giving the government the power to micromanage people's lives, whether it's in the name of "protecting safety" or anything else, is giving government officials the power to mess with citizens, and that power will inevitably be abused. The only way to avoid the abuse is to not give the government that much power in the first place. And that means that every adult citizen needs to take responsibility for having the common sense and discipline to do the right thing without having to be micromanaged into it.
There are laws making payday loan companies post their APR (usually around 1000%) in bold face on their websites. Everyone in this industry will tell you to never get a payday loan, but it's a multi billion dollar industry that preys on people who lack discipline and common sense.
That's not an acceptable way to engage with good-faith scientists at major institutions. It's an appeal to emotion as well as an implication of stupidity on your opponent.
I've noticed this behavior among a wide range of mainstream scientists and public health leaders too- literally mocking people who disagree with their policies. This will hurt the credibility of these scientists, especially if, in retrospect (when we have the time and luxury to study the public health response to COVID in detail), we find out that decisions led to suboptimal outcomes.
It's far better to project humility, stand by your decision, but be willing to admit when you're wrong, and adapt.
I wouldn't classify Bhattacharya in the same bin as Peter Deusberg (well known virologist who insisteted that HIV transmission did not cause AIDS).
For instance there is a surprising result coming from large serology studies in Spain and Italy, that outside of health workers, people who were locked down have been infected at the same rate than essential workers who were not locked down. Also the shape and timing of the Swedish infections is very similar to other european countries, suggesting the peak was due to the natural evolution of the epidemic rather than lockdowns.
I don’t think this data is compatible with lockdowns being effective, which should be a key issue given all the consequences of lockdowns.
You can’t just say I used anti-shark spray after I was bit; since I didn’t get bit again it must have worked.
In many countries, it never even had to go that far. In the United States, for instance, the Constitution prevents executives from taking the kinds of actions they took towards locking down the general public.
The reason we have laws is because sometimes the objective realities around us are not the most important consideration. If it is illegal to threaten people who simply wish to leave their own homes with fines, violence, or punishment - it is illegal whether there's a pandemic in progress or not.
The anxiety attacks are pretty much: My nose is clogged, I might have covid, can I breath, oh my god, my breathing is constricted a little. Are my fingers turning blue? Can you look at my face and tell me if my face is drooping? Can I still smell things? (pulls out super strength Oregano Oil - OMG it's not as strong any more - am I losing my smell).
I'm a man. I'm 40 years old (soon 41). All my life I've been super healthy - no problems. I would never have predicted I would be this scared of something in my life.
My wife and I are planning on trying to go back to normal soon. We're going to start getting take-out food to start, still washing hands. I don't want to live the rest of my life like this, and I think now is the time to go closer to how life was before - just with some modifications. Just not as many modifications as we're under now.
If I don't change, the anxiety may kill me.
* There seems to be basically no fomite risk, at least in a home setting
* A small number of specific spaces are especially prone to spread. The japanese warn of the three c’s: closed spaces, crowds, close contact. So like don’t go to a bar, but do go to a library where everybody has masks. Or do do go a park where everything is ventilated
* Lots of cases may be asymptomatic. But if you get an asymptomatic infection, who cares? People aren’t reporting their smell is a bit diminished. They’re reporting it is temporarily gone. It’ll be pretty bloody obvious.
To be frank, it sounds like you have inaccurately weighed up symptoms and transmission methods. This has led to a lot of behaviours in the physical world which reinforce your anxiety, but give you a reinforced inaccurate view of the state of the world.
I’ve read lots of covid papers. Have not heard of drooping face as a common sign.
I live in a completely locked down area with a surging virus count. And I’m pretty cautious....about a small set of activities which are highly risky. I’m not however worried in general, as the transmission vectors seem pretty known and there’s a whole swath of things I can do that are basically zero risk.
To give an analogy, it’s like you’re worried about a frame crushing car crash while driving in a school zone. Or fiddling with your seatbelt tightness and worried it may not be optimal for safety, when the main determinants of car safety are actually personal alertness, time of day, etc. But if you adopted a whole bunch of wrong behaviours while driving a car it would absolutely reinforce anxiety!
To some extent anxiety is an irrational process. But I do think it has some basis in the physical world and by really going over what risks are and what risks aren’t you can tame it and reason with it somewhat. Good luck!
> To some extent anxiety is an irrational process. But I do think it has some basis in the physical world and by really going over what risks are and what risks aren’t you can tame it and reason with it somewhat. Good luck!
As an aside, I chose to move to a dense urban region in large part because I suffer from car anxiety. In particular, I get really anxious that the moment I stop feeling anxious my alertness will drop and I'll be in a terrible collision. Although full on panic attacks are pretty rare from this.
(I have actually almost nerd sniped[0] myself by being really deep in thought about complexity theory while on mental autopilot back from my internship and making a left turn without realizing how close oncoming traffic was)
[0] https://xkcd.com/356/
It’s interesting to see the general population deal with high anxiety for the first time.
I think the only way to live healthily with anxiety, outside of medicine, is to develop metacognition about your emotions and thoughts.
Recognize that life is inherently risky and you have little control over it outside of your reactions.
The hardest test is dealing with somatic symptoms and navigating the catastrophic thinking. It’s the ultimate challenge to talk yourself down when you’re convinced you’re having a heart attack or unable to breath.
Covid is a risk but for most people not a significant threat.
Why can my 81-year old mother walk her dog with only a mask on, while you get a sniffle and wind up in the ER?
You're malfunctioning one way by having an irrational reaction to quarantine, and a second way by attributing that abreaction to the quarantine and not to your personal history.
You need a psychologist not a meal from a restaurant, eh?
I probably sound unsympathetic, and I apologize for that. Panic attacks are a serious problem, and I do sympathize with you. My own anxiety revolves around my mom dying in agony with her lungs filling with fluid...
Please maintain quarantine and treat your personal psychological issues with a beer or a joint or some breathing exercises or meditation or a nice nap or perhaps a bath. You know, something with a low risk of propagating a deadly virus to innocent people that have never done you any harm, eh what?
It absolutely is- doctors, scientists have been warning about it from the beginning, including ones who strongly supported lockdown. Trivializing it as "your personal psychological issues"- yes that's very unsympathetic. And it also betrays ignorance, you can't just treat mental health issues with a beer.
You have to realize that virus-causes-death and lockdown-causes-anxiety attacks are two different kinds of "cause". I mean, on some level they're both just cells malfunctioning, eh? But these two orders of causality are not the same.
> you can't just treat mental health issues with a beer.
First of all, yes you jolly well can.
Second, the cure for anxiety attacks may not be beer but it surely is not "break quarantine". That just transfers the anxiety onto the vulnerable. It's a B.S. argument founded in myopic selfishness.
Serious disconnect here with the pro lockdown side
This guy is letting his mind play tricks on him and then using that to argue that quarantine isn't important to prevent the spread of the global pandemic that is still killing people.
They get more tolerable over time. Remember that actual health problems almost always develop over time. Even COVID takes days to kill you. At 40, you have a low likelihood of sudden cardiac death. It can happen, of course, but as long as you work out and eat well, you're doing what you can. So, if you feel like hell for 5 minutes, with distinct waves, it's probably a panic attack.
The tingling symptoms you get are probably the result of hyperventilating. Slowing down your breathing can help. To an extent, though, these things just have to be ridden out.
Cold water helps a lot. Go to the sink and splash water on your face. Optimal temperature seems to be 20 C (68 F). That'll help lower your heart rate. Slow your breathing to match.
Also, as someone with panic attacks, I know that during the first ones, I feared the shame and embarrassment that would accrue to sudden collapse at a young age (I was 24). Thing is, no one's going to think it's your fault. If you have a random-ass heart attack at 24 (or 40), it's not something you did and you shouldn't feel bad about yourself. You can still die-- life is inherently risky-- but no one's going to think bad of you for being unlucky, and you shouldn't think bad of yourself (in that extremely low-probability counterfactual) either.
Death: either there's an afterlife or there isn't. If there is one, it'll be interesting to see what's on the other side of this whole thing. If there's no afterlife, you won't exist to be disappointed. Either way, not worth dread. People die, but no one is dead. If those who have left us still exist, they probably see themselves as more alive than they were when down here; and if they don't exist, then it is not accurate to say they are dead so much as they just aren't.
Plenty of Buddhists meditate on their own death. It helps to process the inevitable; to dedicate 10 or 20 minutes once in a while to the acknowledgement of mortality. Don't do this during a panic attack because you can't really "meditate" while in one.
Music often helps. Smells can help, as long as you don't develop that meta-level anxiety.
There's also no shame in seeking therapy and medication. You said 20 attacks since April-- that's about 1 per week. If that's all you have, taking a benzo, typically at a low starting dose, as-needed, isn't going to make you an addict. You don't want to be taking those things every day though.
Finally, panic attacks do end. They are the ultimate troll, and they can throw all sorts of weird-ass symptoms (including phantom smells) but they don't last forever. Each wave, in my experience, is about 90 seconds (90 horrible seconds). Awareness, crescendo, semi-relief, return to merely moderate anxiety. The interval of vulnerability (in which these waves are prominent in my mind) is 15–60 minutes, 90 minutes on the outside.
As I get older, the attacks themselves get a lot milder. That said, the physical recovery is more of an issue. Even a mild attack leaves me feeling like I overdid it at the gym. But I'll take that over the all-out psychic horror I experienced in many of my first ~50 panic attacks.
Good luck! I'm sorry to hear that you're going through this.
For instance, a question: what do we do of people without preexisting conditions that recover very badly from the infection:
https://www.theguardian.com/world/2020/oct/09/brain-fog-the-...