Comment by mlyle | Hacker News Reader

Comment by mlyle | Hacker News Reader

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Hey, I'm in broad agreement with you, but, a nit ...

> Here’s how you can tell people’s philosophical positions: if they talk about fear of a “second wave” they are Containers, since that implies the initial “wave” will not infect the majority; ie the virus is successfully contained.

Here in the SF Bay Area we pretty effectively blunted the first wave with public health controls, which meant health care was not stressed much. Despite the Stanford serosurvey saying that we have 3% with a history of infection, the real number is probably more like 1%. Daily case counts are decreasing, so the initial "wave' did not infect the majority.

It's not enough to decrease Rt noticeably at all. We need to figure out how to loosen up controls in a way that provides economic benefits, keeps a nice constantish burn towards herd immunity, but with enough safety margin to prevent catastrophe that New York got too close to.

Instead, our public health seems to be further tightening instead of experimenting with small measures to relax the controls. There's a loud contingent advocating what would effectively be permanent controls.

So, that's definitely a good point to raise. I agree and should have been more clear. I think there should not be a second wave because I think we need to resume more or less normal society and let people naturally get exposed (since voluntary self exposure will not ever be tenable in the US I fear).

But given the way that California aggressively locked down early into this, I agree that we have been sloping down and thus there is guaranteed to be subsequent waves.

Basically, the waves are real but are arbitrary and are caused by our own misguided interventions.

> We need to figure out how to loosen up controls in a way that provides economic benefits, keeps a nice constantish burn towards herd immunity, but with enough safety margin to prevent catastrophe that New York got too close to.

100% agreed. Now the argument I do somewhat agree with is that it's very hard to get that balance right when dealing with exponential transmission. Which is why on balance I'm leaning much more towards "we'll cross that bridge when we get there" (because the alternative is that we have to stay permanently locked down).

Also the portion of the population I am advocating should be allowed to return to work is precisely the portion of the population that produces very low hospitalization rates.

I strongly believe that anyone who has been reading CNN the last few weeks would be _shocked_ to learn that we get 1 hospitalization for every 500 20-29 year olds infected (and again, these numbers are not fully settled but they're at least in the right order of magnitude IMO)

> There's a loud contingent advocating what would effectively be permanent controls.

Yup, this is what has me really scared. The widespread belief being that it is actually plausible to avoid ever getting infected and therefore any infections that follow a softening of lockdown introduce deaths that never would have occurred in the hypothetical alternate universe.

--

So, thanks for raising that point, I fully agree. The TL;DR is that implicit in "we need to watch out for the second wave" is the notion that "we need to fight these waves and halt their spread" which I strongly disagree with.

EDIT: And just to be clear, if we "re-open" we'll still all be wearing masks and keeping arbitrary distance between each other so it's not like we're all running around exchanging bodily fluids willy nilly. But I really do think that the shutdown has been, in some part, effective in curtailing spread, and thus naturally I would expect a higher infection rate following a re-opening.

EDIT 2: Removed the part about the political leanings of those advocating for long-term lockdown because it's going to set off people's defense mechanisms and potentially cause them to draw the wrong impression of what I'm saying

In San Diego people under 30 are close to 20% of total confirmed and over 5% of hospitalized cases. About 7% of confirmed are hospitalized for this age group. Our positive test ratio is under 7%. Tests are constrained by policy but not dramatically so. https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs...

Another data point is the US military. I believe they test much more widely due to their living conditions. So far the cfr is about 0.4%.

> In San Diego people under 30 are close to 20% of total confirmed and over 5% of hospitalized cases.

People under 30 are over half the population in San Diego, so you've just said there's 1/10th as many of them in the hospital as we'd expect if the total risk were equal.

The serology data tells us that an even greater portion of cases in the young are missed-- they are probably actually half the number of infections in San Diego, but a much smaller proportion of hospitalized cases.

The current data implies something close to what he said: about a 1 in 500 to 1 in 1000 chance of hospitalization for people under age 35.

Young people interact with more individuals, and engage in more behavior that exchanges microbes such as unprotected sex, protected sex, sharing pipes/vapes, sharing utensils, etc.

We should expect that the proportion of people with Covid should be heavily biased towards the young for that reason, as it is for any disease that does not have a biased transmission.

Most indications I've seen is that the young are not harmed much by covid, but can still get infected just as easily, thus why we see:

"X% of hospitalizations are young people" as opposed to the statement that people actually interpret it as: "X% of young people infected with covid are hospitalized".

Does that make sense?

For any test that is not given randomly or universally, there is a selection bias. A test given based on severity of symptoms bias heavily against patients with light symptoms, presumably younger people. But to get from 7% (hospitalized to confirmed) to 1 in 500 is a factor of 35. BTW the city of Canton (Guangzhou) just tested all their high school seniors in preparation for school reopenning and found zero positive case so far. And they did find cases among other groups.

I don't think anyone enjoys lockdown. At a minimum we need sufficient testing, sufficient ppes, sufficient surge capacity and training for standard supportive care. We are still quite a ways from that. Even if death is unavoidable people deserve to have reasonably good care.

> But to get from 7% (hospitalized to confirmed) to 1 in 500 is a factor of 35.

This is broadly in the range implied by a number of measures across the entire population. 20x for randomized population sampling (Iceland), 20-80x from serology studies, etc.

In this analysis, https://www.medrxiv.org/content/10.1101/2020.04.18.20070821v... 35x is actually the exact factor that cases are estimated to be under-reported by in California. :P

> I don't think anyone enjoys lockdown. At a minimum we need sufficient testing, sufficient ppes, sufficient surge capacity and training for standard supportive care.

Here in the SF Bay Area, ICU usage peaked 3 weeks ago, and controls have been tightening. We're well below seasonal norms for ICU usage at this point. Surely the original controls that caused the original trend down in disease would be good enough now, and could even be loosened slightly further to have more parity with other jurisdictions that are successful.

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