A case for ending lockdown
ryankemper.io
ryankemper.io
> Weeks and months later, facts on the ground show that the purported collapse of the healthcare system did not occur.
Yes, because we locked down population centers quickly. That's the whole point. ICUs have still been over capacity though. Without the lockdowns, it's obvious we'd have a lot more dead people the past month.
> Moreover, this was not due to success in seriously curtailing the spread in hard-hit areas like New York, but was rather due to the aforementioned discovery that COVID-19, while extremely deadly in certain subsets of the population, was not nearly as deadly overall as previously thought.
This is a lie followed by possible truth. New York and other cities were under pretty extreme lockdowns (all non-essential businesses closed, social distancing, but most people have been staying inside) for the past two months. If one asserts that had no or little effect, well... HN doesn't take kindly to what I'd like to say. Let's just say that you're delusional.
> An analysis of the flawed IMHE model is outside the scope of this article
Ah, how convenient - lying about the effect of the lockdowns and attributing it instead to (nothing? since ICUs have clearly been over capacity while we've cut down transmission rates) then ignoring analysis of them.
I didn't really dive into the rest of the article since I don't really like reading words written by intellectually dishonest people.
Basically we need to moderate both opinions which effectively work together: the "there's no problem to begin with" group feels validated by the "the world is ending" group being way off the mark
This happens with global warming too. Some people think everything's going to fall apart within the next 10 years. They're wrong. So others claim there isn't a problem, because they were wrong
I agree. Do you have any idea what approach could be taken to accomplish this though, even where dealing with a single, otherwise logical person?
I tend to try to demonstrate napkin math with pessimistic numbers to show that they're out of bound. Napkin math is particularly useful math because it allows one to play with parameters & abstracts/aggregates complicated bits. So we can also show how pessimistic things would have to be for them to be right, ie what we should be seeing now which would support their projection outside of their anecdotes or imagination
It's important to not become identified as an adversary (ie, I'm not denying a problem when I assert they should reduce their perceived risk). This means making sure to underline which facts you agree on, & verify that your values are aligned
0. https://en.wikipedia.org/wiki/Time_formatting_and_storage_bu...
For example, in New Jersey (USA), where I live, 40% of deaths are of people at extended care facilities (i.e., retirement homes). We locked down everything and everybody (i.e., no focus) and those deaths still happened; because we failed to "harden" the sites (and people) most in danger. If this is a war, that's not how you win a war. Furthermore, "flare ups" at such facilities continue to happen. That is, where is the lockdown win?
Now imagine taking 40% of the deaths off the table. Did the lockdown work? Probably. Just the same, the dynamic of the conversation changes when you look at how C19 hits - or doesn't - the general healthy population.
Finally, how many lives will be lost to the economic fall out? If the lockdown did save lives then the "side effects" of the lockdown must be considered as well.
Taking the data in aggregate and declaring lockdown a win is an oversimplification.
By the time NYC locked down, the virus had likely already been spreading unimpeded for weeks. The only possible short term solution was the population-wide lockdown, which "fixed" the issue in that it stopped the immediate disaster from becoming even worse. In nursing homes already infected, it was simply too late at that time.
The fact that the lockdown was required is evidence of a colossal failure on the part of our society. Our infrastructure should have been able to target this more precisely and we (the US) specifically squandered a huge advantage we had in that we had time to clearly see the progress of the virus overseas before it arrived, but did nothing useful with that time.
Even after all of this, few steps have been made to make the transition from "shut it all down" to a strategy that involves broad testing and targeted protection of vulnerable populations. It seems people are resigned to keeping the daily death rate steady and eventually just letting all vulnerable members of the population contract the virus and die.
Lessons to be learned? You bet. Of course.
But we took a semi-effective - again, despite the lockdown nursing homes continue to be a significant contributor to deaths - and applied it _everywhere_. Certainly, it's now reasonable to look at other options. But that's not happening.
It as if the "cure" isn't going to lead to deaths as well. That's naive.
Yet, the extended care facilities _to this day_ remain a major contributor to the death toll.
Even if you call it hindsight bias, what do you call the current refusal to step back and ask what we've learned so far? To stay the course, with a lack of data to support it? What do we call that?
Hospitals and other resources take a finite time to construct and they can only be constructed in linear time. That is to say, the number of new hospitals is not a function of the number of existing hospitals.
Now, in contrast the virus grows exponentially and is further aided by a period before symptoms appear and by asymptomatic carriers.
As such, when it overwhelms you there is very little you can do to catch in the middle of the fight up without taking draconian methods and accepting enormous number of deaths. Italy and NYC.
As such, the prudent course of action - especially for a wealthy country - is to build the additional hospitals and capacity ahead of time, even if - horror - they are never used.
A similar comparison is the ridiculous amount of military hardware that is procured and mostly never used.
Edit: spelling
At the same time the occupation is still a long slog and there are nuclear deterrants and occasional non-nuclear ones like North Korea's mass of concealed artillery aimed at Seoul.
Chances are that if current manufacturing capabilities instead of stockpiles matter both sides should probably truce because both will lose. But if they both had sense they wouldn't be at war.
WCGW. /s
"this" being the article.
The comments upon the article are a good example of someone (actually, a group of people, near unanimously [1]) saying ~"because the outcome was <x>, we know (~it is proven, or logically conclusive)[1] that the cause was <y>", which is also poor logic. This seems quite tricky for people to see though, due in part to the ~"culture war" nature of the subject I suspect (change the subject, strict logical capabilities return to normal, or so goes the theory), as well as how beliefs ("facts") are formed in the mind - I've seen this ~"if nothing happened, it proves(!) our recommended measures worked!" meme repeated so often across both social and mainstream media, and it seems to me that it has kind of become an axiomatic belief, not to be questioned, even by scientific/logical people.
If a similar assertion was made but with the subject being something other than covid-19, I suspect references to the "garlic repels vampires" fallacy would be plentiful.
You can often detect other artifacts of this thinking in online discussions. In this case, there was a lot more detail in the paragraph than the single excerpted sentence:
> Weeks and months later, facts on the ground show that the purported collapse of the healthcare system did not occur. Moreover, this was not due to success in seriously curtailing the spread in hard-hit areas like New York, but was rather due to the aforementioned discovery that COVID-19, while extremely deadly in certain subsets of the population, was not nearly as deadly overall as previously thought. An analysis of the flawed IMHE model is outside the scope of this article, but suffice to say that the model is built on extremely dubious assumptions and represents an approach of blind curve-fitting rather than a true epidemiological model, and makes bizarre assumptions that result in an unrealistic symmetricality as far as death drop-off is concerned (see this excellent analysis by “LessWrong” user Zvi) [2]. Confronted with the reality of having “succeeded” in avoiding the collapse of the healthcare system, albeit arguably not due to the lockdown policy, policymakers have not lifted the lockdown restrictions in much of the country, but on the contrary appear to have shifted the goal to a goal of total containment: staying locked down until COVID-19 has been suppressed to such an extent that it becomes feasible to perform widespread location tracking (dubbed “contact tracing”). Indeed, the current policy seems to be one of “indefinite postponement”, the key assumption being that it is feasible to avoid exposure to SARS-CoV-2 until a safe and effective vaccine is developed and delivered to the global population, and that the indefinite lockdown will not lead to excess mortality. We strongly dispute these assumptions and believe that they don’t hold up to even the slightest scrutiny.
[1] https://en.wikipedia.org/wiki/Groupthink
https://en.wikipedia.org/wiki/Herd_mentality
https://en.wikipedia.org/wiki/Group_decision-making
https://en.wikipedia.org/wiki/Belief
Interestingly, this very same behavior can typically be seen on both sides of any culture war [3] related disagreement, if(!) one is willing and able to look for, and see it that is (which is far easier said than done, because of the very neurological phenomenon that causes the disagreement in the first place). And to make it even more tricky, it is incredibly easy for the mind to spot logic errors in one's ideological opponent, but very difficult to spot in oneself. So, both sides evaluate the other as ~"soooooo stupid".
[2] https://www.lesswrong.com/posts/QuzAwSTND6N4k7yNj/seemingly-...
[3] https://en.wikipedia.org/wiki/Culture_war
As for myself, I have no stance on the matter, because epistemically, the actual(!) truth of the matter is essentially unknowable - all we can do is make educated guesses. I mostly just derive great enjoyment from observing the conversations, which illustrate the various ways that humans think, and how thinking seems to vary depending on the content of the variables involved.
Simply put, this argument is invalid. Why? Because my writeup went into the IFR. Therefore we can calculate how many deaths might occur in the "do nothing" scenario, and compare that to lockdown-induced deaths.
Also we should note that social distancing and lockdown are different things, and it _appears_ that the former is much more responsible for the slowed rate of transmission. My proposal does not involve getting rid of social distancing, although it does encourage it to be voluntary as opposed to compelled.
> Note that this classic "pro-lockdown" talking point is an unfalsifiable claim.
If you want to get down to epistemological arguments, then we should be clear: we can't know ANYTHING about the real world for certain and all no claim about the natural world is falsifiable; the only claims we can make are those that are tautological or conceptual only. The scientific method itself does not stand on anything more than sand from an epistemological perspective.
Obviously, that's a ridiculous way to think about the world and not helpful. What we CAN do is see the changes in trajectory of the virus growth rate caused by the lockdown; and extrapolate based on the data that we've seen about how it would grow without the lockdown. This is what a large number of domain experts (including data scientists with domain knowledge) have been doing, and they believe the lockdown has been necessary (and will continue to be, at least in part).
> Also we should note that social distancing and lockdown are different things, and it _appears_ that the former is much more responsible for the slowed rate of transmission.
For someone talking about the falsifiability of claims, you should take note that this is a unfalsifiable claim, and one that's intuitively ridiculous (as the lockdown causes more social distancing than would happen otherwise).
Obviously, we can't lock the entire civilization down forever, and nobody has made such an argument - there will be a gradual easing of restrictions over the coming months, but there's an expectation that we might see another wave of virus transmission in the fall.
> Obviously, we can't lock the entire civilization down forever, and nobody has made such an argument - there will be a gradual easing of restrictions over the coming months, but there's an expectation that we might see another wave of virus transmission in the fall.
So, the fear of the "second wave", in my opinion, is precisely because of practicing Containment as opposed to practicing pareto mitigation and letting the virus run its course in non-at-risk individuals. Or more accurately, since we're talking about still quaranting ~40% of the US, we would still see a small wave but it would not be nearly as significant.
In other words, the potential for the wave exists because having "protected" everybody from infection, there is now a huge differential pressure for SARS-CoV-2 to exploit. i.e. there are still plenty of vectors and thus the second wave is absolutely a concern.
Given how low prevalence in places like California is, I absolutely think we will see that wave. But again I essentially view it as a sign that we handled the situation wrong.
Given our current Containment policies, the resurgence of the wave might be met by a new wave of lockdowns. I certainly hope not, but that seems very likely. Hopefully by that point though people have mostly went back to work and thus it _might_ be politically untenable.
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I guess I'll address the unfalsifiable point really briefly (I won't do it justice) - I think the claim that social distancing did/does more than lockdown is definitely falsifiable. Maybe not perfectly so, but we can see movement data and try to correlate that with waves of infection via projecting deaths backwards in time. It's certainly fuzzy given we'd be using average time until death as a proxy, but the claim is much _more_ investigable than the infamous "lockdown worked, end of story" line.
One can pretty easily see the impact of COVID-19 there, even on countries that are not testing and therefore not reporting any cases...
Unfortunately I haven't been able to find that data for the US.
They include "deaths per day" in one of the charts. Early on I found their stats to be consistent with other trusted sources; but I've not confirmed that recently.
For countries that don't test, that number is zero. Quite the useless metric to report.
Much more meaningful would be: "(actual deaths/day) - (avg deaths/day of 2019)"
In the graphs right at the top of the page you can see several locations have more deaths than usual even if you subtract the covid19 ones. These are likely covid19 deaths that haven't been included in the stats, probably due to lack of testing.
According to that page, New York City, where almost 1 in 600 of the total population (not just of the infected) have died, is likely now tracking its stats pretty accurately.
Here's the EU version: https://www.euromomo.eu/graphs-and-maps#excess-mortality
There's some lag in these figures. The CDC will have something eventually.
Can you detect the lockdown, which took effect at 8PM on Sunday, March 22?
The New York state governor announced the statewide lockdown on March 20 (to begin two days later, as indicated above). The statewide lockdown is not causally responsible for social distancing before then.
The same is true for the announcement of closing New York City public schools, which came on March 15. If private schools closed before then, the closure of public schools later cannot "take credit" for it.
This distinction is important for causal modeling, both of the past as well as the future, if/when orders from authorities are lifted. The effectiveness of the lockdown order is measured against a world without the lockdown order, which is still a world with a lot of social distancing.
Telling people "we recommend physically distancing and wearing masks" does not qualify as lockdown. I hope that I made that clear in my writeup.
Thanks for jumping in here, I think you made the point far better than I could have.
TLDR: We're undercounting deaths due to covid-19 by ~60% nationally, and 40% in NYC.
https://www.washingtonpost.com/investigations/2020/04/27/cov...
> TLDR: We're undercounting deaths due to covid-19 by ~60% nationally, and 40% in NYC.
What it does say is this:
> “Thus I would probably add about 15% or so to the known death toll,” she wrote to two city officials. “However — no city or state will be factoring this in or reporting it, so I don’t think we should either. We should just assume that the deaths are about 15% more than we can count, but not include them in official modeling, because we will never really know.”
It does pay some lip service to the notion that some of these at-home deaths could be precisely because of the "elective" (meaning, scheduled) surgeries that we had postponed.
Interestingly per the https://www.cdc.gov/heartdisease/facts.htm, we see something like 647,000 heart disease deaths per year. So, I haven't done the napkin math, but could the 20%-odd spike of cardiac arrest events they mentioned have more to do with postponed surgeries?
I was off, Nationally were underreporting ~47%, NYC is at ~60%.
We can argue the pictures and stats in the Washington Post all day long. But either way, we're likely to be underreporting.
Also, though not directly due to the virus itself, the 'avoidable' deaths are kinda due to the pandemic and an over-response-ish factor.
This thing is going to take decades to sort out. Kinda like how people that die from digging up bombs from WW1 are counted in stats as WW1 collateral deaths, still.
I do agree however that it is very likely that the majority are.
> Also, though not directly due to the virus itself, the 'avoidable' deaths are kinda due to the pandemic and an over-response-ish factor.
Right, the distinction is if they would have occurred in an environment where we weren't locking down and suspending elective surgeries in places that weren't hard-hit. In a place like New York we should definitely assume that the capacity wasn't there until we have evidence otherwise though, so that would be a region where we certainly could not blame overreaction.
Thanks, I'll try to think about this more later on.
There's a few different numbers and it's important to keep them clear.
The main number that people know is "died after being tested positive with covid-19 from a covid-19 like illness". For a while this number only included people who died in hospital.
The next number (which the 40% to 60% refers to) is "died from a covid-19 related cause after testing positive, or after being suspected of being covid-19 positive". This includes all the frail people in nursing homes where tests were not carried out (they weren't being tested because it wasn't going to affect their treatment).
The 15% appears to refer to all the people who live alone at home.
> Interestingly per the https://www.cdc.gov/heartdisease/facts.htm, we see something like 647,000 heart disease deaths per year. So, I haven't done the napkin math, but could the 20%-odd spike of cardiac arrest events they mentioned have more to do with postponed surgeries?
I agree that cancelled surgeries, and also people delaying seeking help when they start to have heart problems, is really worrying and has caused some of this excess death.
If the serological surveys are correct, we know two things, it spreads rampantly even under harsh lockdowns and the IFR (infection fatality ratio) is likely <.5%.
I tend to think we should stay locked down to slow the spread if that's even still a thing given how fast it has spread in NYC. But on the bright side, NYC now has an upper bound of 4x the current cases before everyone is already infected and all hopefully immune.
The key point being that the “confirmed cases” numbers are useless due to massive overcounting, so you need to instead rely on serology.
I think the Diamond Princess is the perfect case study to use as an upper bound, since we conducted extensive testing and the population is heavily skewed towards the elderly (and therefore higher risk than general population).
See https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v...
> Adjusting for delay from confirmation-to-death, we estimated case and infection fatality ratios (CFR, IFR) for COVID-19 on the Diamond Princess ship as 2.3% (0.75%-5.3%) and 1.2% (0.38-2.7%).
While the camel's back may remain structurally intact, I'm not certain that means we can just assume it can bear an arbitrary number of additional straws.
Your argument for lockdown is unfalsifiable. Any good outcome is attributable to lockdown, and any bad outcome is because we did not lockdown soon enough. What piece of evidence could you possibly see that would convince you you were wrong?
If you want to get down to epistemological arguments, then we should be clear: we can't know ANYTHING about the real world for certain and all no claim about the natural world is falsifiable; the only claims we can make are those that are tautological or conceptual only. The scientific method itself does not stand on anything more than epistemological sand.
Obviously, that's a ridiculous way to think about the world and not helpful. What we CAN do is see the changes in trajectory of the virus growth rate caused by the lockdown; and extrapolate based on the data that we've seen about how it would grow without the lockdown. This is what a large number of domain experts (including data scientists with domain knowledge) have been doing, and they believe the lockdown has been necessary (and will continue to be, at least in part).
I believe you, but can you cite some domain experts so that we have something to work off of?
The intent is to be a fairly comprehensive coverage of what we know about COVID-19 and what it means for our policy. Note that the article is written from a US-based perspective although I suspect it's relevant to a broader audience.
In general, I believe that the case against lockdown has been highly stigmatized and thus many people have not been exposed to a convincing argument of why some of us feel that our response has actually made things worse.
I encourage any pull requests (see the very final section).
If you're short on time, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_endin..., which has a readability score (Flesch-Kincaid, etc) of around a middle school level and is extremely brief and to the point.
For those who have a bit more time but still not enough for the whole article, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_endin.... In particular understanding the age-stratified risk distribution, and how it differs from Influenza, is super important. Finally I'd also recommend checking out the proposal, which ironically is the shortest section: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...
Thanks for any feedback.
I have no affiliation with Gitlab whatsoever.
This is my personal blog that I made when I quit my previous job a couple months ago. I ended up repurposing the blog because I couldn't figure out how to get a table of contents working on a generic markdown file (i.e. I originally was just going to link to plain markdown in my git repo), but I was able to quickly figure out how to get it working with hugo. I used Netlify / Hugo via Gitlab to do so, so the Gitlab logo just happened to be part of the default theme. I'll look into removing it for clarity later.
> Once you get sick, you can’t get sick again for a long time. Eventually you might be able to get sick again, but it will not be very bad. When enough people have gotten sick and then gotten better, the sickness can’t spread any more.
(Incidentally, at one point you leave out the 'z' from "hospitalization".)
1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
(Personally, while I think voicing unpopular opinions is definitely a role we need in society, it seems to me that dismissing widely accepted opinions as due just to "talking heads on the media" puts disputants in an adversarial position that makes it more likely for people to hunker down in their existing opinions, and less likely for anyone's mind to change. Your refutation would have been more, not less, convincing to me if it had just pointed to the Lancet article.)
No worries; I also missed that you're not the original author. COVID + policy is a perfect storm of temper-stoking conversational topics.
From WHO a few days ago: https://www.who.int/news-room/commentaries/detail/immunity-p...
I considered going for a deeper debunking but held off for the initial draft. I might circle back if people feel it's valuable. Let me take a quick stab though:
When we talk about immunity we need to realize the term is used imprecisely by laypeople (btw I'm totally a layman if it's not already clear).
I think of it simplistically as two components:
(1) The presence of actively circulating antibodies in the bloodstream. This is what the (oddly controversial) serology studies are measuring. It is thought that having a significant quantity of these antibodies prevents infection - i.e., what most people envision when they talk about immunity.
(2) Even after the antibodies have faded, there are still Memory B Cells, which lay dormant up to decades, waiting for exposure to the characteristic antigen (in this case, an antigen telling them that they have encountered SARS-CoV-2), at which point they resume and rapidly scale up production of antibodies.
The thinking here is that reinfection is likely possible after a sufficient length of time - whether that's a couple months or a couple years isn't yet known - but when you do get infected, your immune system will respond sooner, more strongly, and thus you will achieve a far lower peak viral load meaning a less serious infection with reduced transmisibility.
This is a robust mechanism that we see across tons of disease, including common cold coronaviruses. In my completely uncredentialed opinion, this effect is so common and well-supported that we should essentially assume it happens until we really have proof that it doesn't. I know that might sound backwards, but it really is such an enduring mechanism.
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Here's another argument you might prefer. We know that at least hundreds of thousands of people have successfully recovered from COVID-19. Loosely, we can divide the immune system into the "non-specific" and the "adaptive" subsystems. Given that we have seen extensive recovery from this illness and that those who have recovered have detectable levels of antibodies, and furthermore that there is a case of a women who could not manufacture antibodies due to a rare auto-immune disorder who failed to recover, it stands to reason that the same mechanism that provides medium-term immunity is the mechanism responsible for recovery.
That is to say, that it's very farfetched to think that people are recovering purely from non-specific immune responses and that the detectable presence of circulating antibodies is just a red herring. But I suppose you could try arguing that if you wished.
Specifically this part:
> People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice.
So, first of all, I think the concern is on its face totally unwarranted because people likely do have immunity to reinfection for several months, but regardless the presence of the immunological memory (provided they avoid getting infected with Measles which causes immunological amnesia) means that the second infection will be really not very bad and unlikely to transmit easily.
But more importantly:
Our public health organizations (and the media) have adopted the following belief: It is worth it to either mislead the public or to outright lie in order to achieve compliance. If it's not clear from the article, I find such a position detestable, not only on ideological grounds but also because functionally it causes people to endanger their health by engaging in superstition.
This is my theory on why we've seen so many articles from previously-respectable organizations like CNN that seem to focus on the narrative that young people are dropping like flies from this. Why? Because they believe that if young people are not scared shitless for their personal health, that they will not comply with the lockdown measures.
So, the WHO is really not trying to hide their motivation here.
Now the irony is I oppose immunity passports on ideological grounds, at least when used _within_ a society. As far as being used as a literal passport, that's fine by me. If the rest of the world wants to practice containment, it's welcome to do so, but I think from an evidence-based perspective, containment seems like an incredibly dangerous proposition.
This whole thing has really shaken my understanding of people.
In Italy it's pretty evident from the communication from the government, the experts (which released a "disaster story" of possible 150,000 ICU cases in a month, a number so high that should have been at least explained) and the media (including tabloids).
Since Germany has started reopening, media here (but, according to what I read - but please correct me if need be - not the case with the major German papers) started saying that "infections are accelerating elsewhere! See? Our model of lockdown is the only one that works!"
It might be true, but it should be grounded in facts and not in misrepresentation of them.
P.S.: Since you mentioned a critique of the widely-used model for this epidemic, do you have any more links to dig further? I simply do not know enough and I want to inform myself more.
The most important point of criticism is this section: https://www.lesswrong.com/posts/QuzAwSTND6N4k7yNj/seemingly-...
I don't mean this is as a criticism, but it struck me as some dissonance as I was reading.
I've also heard that there might be criticism to other models like the Imperial College one, but so far I've never found anything with some substance.
The IMHE model, after re-estimating, _was_ too optimistic. My argument does not hinge on the IMHE model being too pessimistic; but rather simply that the IMHE model is basically useless and thus we shouldn't base policy on it.
I expect us to have well over 100,000 COVID-19 deaths - indeed probably 3x that but I admit I haven't sat down and done the age-bracket-weighted mortality napkin math. (Basically, take each age group's IFR and multiply by that age group's population in the US, after multiplying by some constant <1 which represnts the sum of herd immunity threshold plus overshoot)
So basically, I think that COVID-19 mortality is going to be way worse than the model predicts, but given the way I view the cost of lockdown, etc, I still think the approach I am proposing is superior to locking down.
Does that make sense?
Some models (not published) from our expert panel in Italy are instead, in my ignorant view, very pessimistic (they say they elaborated 90 of them). The lockdown will be "eased" (quotes, for most people it's the same as before) on May 4th and one of the predictions said we'd get 150K ICU cases (as I wrote in the parent post). This looks very hyperbolic, at least on paper, because there are many measures still in place, so it's not the same as "no social distancing, no protection, everyone free".
In this case they keep mentioning uncertainty and the argument is that otherwise the public may behave in a way they don’t want. Whatever your opinion on the arguments, that’s not science and it is also poor politics because sooner or later they’ll lose credibility and really that’s all they have.
New tests for neutralizing antibodies like proposed by some groups[1] will make sure the antibodies not only are there, but that they actually work.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
Remember the other famous WHO announcement at the beginning of this outbreak: “No evidence of human-to-human transmission”
Also, the WHO said shit like this: https://nypost.com/2020/03/20/who-haunted-by-old-tweet-sayin...
Typo fixed! I think I've found at least 15 typos total now. Oops...
One thing I'd add: employment and health insurance are tied together in the US. The lock down dramatically increased unemployment, the majority of whom will not pay expensive Cobra costs, and will soon be uninsured. The opposite of what was intended may happen: we are now less prepared to deal with an increase in demands on healthcare than we were a month ago, as uninsured people tend to avoid hospitals until they're absolutely necessary.
I'll see about doing so after I take a break to eat some food. (As an aside, I'm pretty comfortable writing and can write pretty quickly but as you can imagine just getting to this first draft took a lot out of me.)
Who is "we"? I understand your use of "we" to speak from the perspective of us as a society through most of the article, but this makes it sound like there's more than one author.
I chose to use "we" both because it fits with the semi-formal tone better, but more importantly because I want to give others a chance to open PRs if they choose to do so, so I was basically future-proofing for a possible scenario where I wasn't the only contributor.
https://academia.stackexchange.com/questions/2945/choice-of-...
With all the misinformation going around I resorted to mainly listen to scientists in the relevant fields directly (if you speak German, the NDR podcast with Prof. Drosten is really nice in my opinion). Therefore I think it really helpful if research institutions and researchers themselves who are in that field (!) are vocal (but reserved and competent) about studies and thoughts. For instance, today the four big research institutions in Germany (Max Planck, Helmholtz, Leibnitz, Frauenhofer) published a joint message in favor of social distancing and contact restrictions: https://www.nytimes.com/reuters/2020/04/29/world/europe/29re...
Edit: I only found the German press release so far: https://www.mpg.de/14759871/corona-stellungnahme
I'm just a dude that likes to read research papers. As an aside, there is totally an archetype of the software engineer that thinks they're equipped to dive into unrelated fields, and I definitely match that trope. I will say in my defense though, that I try to build simple mental models and take them to their logical conclusion, which is a quality that I see in people I admire, and conversely a quality that I find lacking in people that I feel don't have a lot of insight.
Many might disagree but I am a very strong believer that arguments should be evaluated on their merits, rather than credentials. Indeed having credentials makes it that much easier to fall prey to cognitive distortions.
IMO this should be a disclaimer in bold right at the very top of the article.
This doesn't really pass the sniff test. You wrote 7500 words on this topic, but felt that including "I have zero experience in any relevant fields" would be overly verbose? Are you sure there wasn't another reason?
arguments should be evaluated on their merits, rather than credentials
It's not about credentials, it's about relevant knowledge and experience, without which it can be very difficult to actually properly evaluate the merits.
https://gitlab.com/ryankemper/writings/-/commit /05b4b616c5e0017b0f80682533399c8696d897b5
When you lack the expertise to do that effectively, you should listen to the experts (ideally those that demonstrate that they are evaluating ideas based on their merits).
The trick is determine which questions you have the expertise to evaluate for yourself and which you are better of relying on experts to evaluate.
Unfortunately, this is an area where a large number of non-experts vastly overestimate the difficulty of the material vs their own level of knowledge. This leads to the increasing proliferation of misinformation and misleading analysis like yours.
Credentials are not the only way to acquire or demonstrate expertise. You say you are a "dude that likes to read research papers", how many epidemiological research papers have you read? How much time have you spent discussing those papers with epidemiological experts? Did you reach out to any of those experts to have them take a first pass as fixing any mistakes you made before you decided to post it publicly
Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.
You are being irresponsible.
Ideas need to be evaluated on their merits in all cases, especially in times of controversy.
Which is why it is important that people with the expertise evaluate those ideas on their merits.
What doesn't help is when less informed laymen think they can accurately judge the validity of ideas put forward by slightly more informed laymen.
What active hurts is when those less informed laymen start spreading their half-balked ideas and trying to impact policy without making an effort to get their ideas validated by people with the experience to find the simple, obvious errors they are making.
Me posting this is literally me doing that, so your visible irritation is very oddly placed.
> Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.
This is not a fair characterization; I was very clear that this represented my "first draft" and that I was looking for feedback specifically to have people poke holes in it.
Fortunately, a lot of people did have substantive contributions that pointed out errors or places where the arguments were weak, as opposed to merely engaging in sanctimonious gatekeeping as you are doing.
Where was this made clear? The closest I can see is at the very end where you call it a living document and will accept pull requests that match the "style and intentions of this document" which to me sounds like you are only interested in meeting pull requests that strength your argument to further your intended narrative.
I appreciate your adding a disclaimer about your lack of relevant experience, but even it says nothing about this being a "first draft" that you expect to have holes poked in.
So I fully stand behind my characterization and I find your use of the term "sanctimonious gatekeeping" to far less of a "fair characterization".
The part I don't concede is this notion:
> Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.
In that, it strays far too close to the dangerous notion of "advocating for ending the lockdown, however flawed, is killing people". Which is a notion I cannot and probably never will be able to get behind.
I have no problem with advocating to end the lockdown. We need to do it as soon as practicable. You ar correct in supposing that a lockdown that lasts longer than necessary ends lives. I think there are some good steps we can take towards that, such as reopening underutilized hospitals in areas where that utilization has plateued.
You are doing more than that, you are trying to summarize everything we know about covid. In an environment with so much misinformation about covid floating around that is demonstrably dangerous, it behooves is to be extra care to not feed into that cycle.
And having no credentials makes it even easier to make blatantly wrong assessments, to read the data incorrectly, to completely misunderstand terms of art, to accidentally believe that because you are smart, you can evaluate another field easily with some hard thinking.
Having no credentials means you are likely to not know what you don't know, and so gloss over an entire section of a field when making conclusions. It means not having worked with similar data before to help build a "sniff test" for when something in your work doesn't look right.
The difference between no credentials and credentials in assessing a complex topic and communicating that to a broad audience is as a vast as the difference between the seasonal flu and coronavirus.
This is well written. Thank you. It's wrong that this post is currently flagged.
And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented.
Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives. Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated".
This thing is so littered with bias and lack of facts that it is not useful for any serious consideration of this. I'm sure it's great for people who already have their mind set in one direction, though.
That being said, I think it does make sense to account for positive externalities. Can you think of others that are lockdown-specific? The classic ones right now are pollution.
> Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives.
I'm not sure if that is a great example of only looking at the negatives. This is one dimension where the effects of the lockdown are basically exclusively negative as opposed to being a mixed bag. So this feels like something that absolutely _should_ be mentioned. Particularly when factoring in the irony of it increasing mortality from other non-COVID-19 infectious diseases.
> Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated".
I don't think this is at all fair either, but I must admit I chuckled a bit. It is a funny thought.
> And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented.
So, this is the biggest hole that I personally see in my argument, so I very much agree here. The trouble I ran into is, this is such an unprecedented situation that it would have felt ridiculous if I just started making up mortality predictions. So it felt like a good balance to highlight the _potential_ for increased mortality. I do think that means I likely need to soften the language around lockdown causing more mortality to accentuate the fact that it's merely _likely_ that it does.
--
Is there anything else you can think of? Thanks for the feedback.
We absolutely pass a ton of laws to make driving around safer, including restricting driving around when it's particularly dangerous (for example, when a person has had a bit to drink).
> Pareto Mitigation: An evidence-based approach
I love how this uses "evidence-based" as a dogwhistle followed by proposing an approach without providing any sort of evidence about the efficacy of the approach.
> Those who have lost their jobs tend to be those workers who are in a lower socio-economic bracket and have jobs that do not allow one to “work from home”.
This is presented without evidence. I think there's a reasonable chance this is the case, but many essential businesses/industries employ primarily lower socio-economic classes so who knows. This is just presented like you should agree with it.
It's also not clear that those that are more disadvantaged are actually worse off here. There has been a very large increase in the amount and accessibility of unemployment benefits.
There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(ツ)_/¯.
On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?
> A preventable decline in preventative care
Even the (supposedly evidence-based) proposed approach would likely lead to exactly the same decline in preventative care. This error is repeated throughout the document where there's this idea that the changes that we've seen are due to lockdown and will just go away otherwise (except, of course, for when the change is positive and, clearly, the not-quite-lockdown approach recommended would continue that positive change).
> Be wary of “hero culture”
This is maybe the strangest section. Why does this just talk about a hero culture related to real scientists? Do we think that people are more likely to think some nerdy scientist is a hero rather than our heroic manly president? This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts).
> The Soul of the Country is at Stake
OMG. I skipped this in first skim. Yeah, this makes me think I've wasted my time even thinking about this thing, this is clearly a plea to the emotions of a specific subset of the population. I'm done.
For these, it could be good to compare what has happened in countries or areas with different responses to these. I.e compare sweden vs norway.
Thanks for the feedback. I think the dog-whistle part is quite true. I will need to circle back and add citations where I can. Particularly given that one of the thematic elements is that the lockdown is not based upon evidence.
> There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(ツ)_/¯.
I was worried about this being distracting. I think particularly bolding segments within a sentence is definitely distracting, so I will (eventually) try to clean that up.
> On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?
As far as I know it's not, but I'm not entirely sure where to go looking for weekly suicide data. I've only been able to find data over much longer intervals. This is where being an actual expert would probably help! :P
> this is clearly a plea to the emotions of a specific subset of the population
Just to bite of a piece of this before I conclude here, I personally think that a shift to censorship on such a wide scale is absolutely something to raise a bit of moral panic about. The new usage of the term "disinformation" has hit a point of Orwellian double-speak.
Sorry to bombard you with replies, but I realized I never addressed this.
I think you might have a different idea of what "hero" means, basically all I meant is that we tend to elevate these figures (Fauci in this case) up as "heroes" and therefore act like they are infallible and thus you cannot express an opinion that contradicts them. That is what I was arguing against.
It's not about "hero" in the sense of, like, what a young child would imagine a hero is. So in the sense I'm using it, people totally do view the "nerdy scientist" (Fauci) as a hero. And I understand why they do.
> This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts)
No, it's not discrediting them, it's just saying: evaluate policies and statements on their merits, not based on simply who said them.
I hope that makes sense.
Thanks again for all your thoughtful feedback. You clearly put time into it (and a good bit of frustration, understandably :P)
What you should do is take the time and effort to educate yourself before contradicting them, (such as about basic things like how herd immunity interacts with R0 in a pandemic) and you should present caveats and disclaimers that are online with your own lack of experience, expertise and knowledge.
There might potentially valuable insights in your article, but their value is overshadowed by the way you present all your ignorance with confidence and surity.
I should learn to never read anything from random people working in areas they don't have any expertise in. This whole section is wrong.
The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.
This is clear when you think for about 1 second about it. The `1/(1-R_0)` value gives you the point where infected people infect 1 more person, it doesn't give the point when the infection stops spreading.
First, `1/1-R_0`. This is exactly what Wikipedia says: https://en.wikipedia.org/wiki/Herd_immunity#Mechanics
And it makes intuitive sense that once you infect <= 1.00 people, growth is no longer exponential. So I don't think that point is wrong at all.
> The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.
This doesn't make any sense to me. Vaccination is just an artificial way to build immunity. So I don't understand your active epidemic point at all. Or put another way, as the proportion of % recovered goes up, we start approaching the eventual limit where `1/1-R_0`->1. That is to say, in your example we start with R_0 = 2, then as people recover that value slowly starts decreasing until it hits 1 at the herd immunity threshold. It's not clear to me what the discrepancy you're detecting is here.
See here for a good explanation https://twitter.com/CT_Bergstrom/status/1252077930286444545
So then, it does seem that if we successfully contained the virus, and then avoided infection spread until a hypothetical future vaccine is developed, that we could avoid the number of infections required by some amount.
Just to tie it back to the broader lockdown vs not lockdown debate, we could probably say that a successful full containment strategy+vaccination could decrease the net area under the curve. As far as policy is concerned I still think the costs of locking down for that long (particularly given that the time is unbounded) is not worth it, but that is a very valid point that I will need to circle back and weave into the document.
And you also think, that politicians are doing an economycal suicide just because they like it?
Srsly, wouldn't you assume and shouldn't you assume, that there are experts calculating and estimating that shit on every single day and trying there best to find a reasonable way out of this?
Yes, I am a person that makes and is currently making mistakes.
> And you also think, that politicians are doing an economycal suicide just because they like it?
I analyzed the "game theory" of this a bit here: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...
> Hanlon’s Razor is very relevant here; we think it is not reasonable to assume that they were trying to usher in a techno-totalitarian state. Rather, they were trying to prevent mortality, but their incentive structure is such that it is much worse to have done nothing and later find out that the virus was worse than we thought, than what actually happened, which is to have undertaken actions that were self-destructive and then discovered that the virus was way less deadly than we thought.
There are plenty of people coming to me and say stuff like 'uh why does that take so long' 'i can do that quickly in an hour' etc. and at the end of the day they are wrong.
In those cases, i would just love for people to accept my expertise and let me do what i'm good at because it costs time dealing with this stuff.
And you know, all those speculations of people who are sitting down for a few hours, writing something, gathering a little bit of data left, a little bit of data right THIS IS RIDICULOUS.
You are not an economist, you are not a doctor, you are not a virologist, you are not the statistics guy. Apparently you are a SRE.
What do you think, your statement actually does? I tell you what it does, if it even does anything: It works against all the experts trying to actually do their fucking job on estimating and deciding on a daily bases about human lives.
Do you know what i decided when corona started? I will, this time, just try to be as undisruptive to the society as i can. I don't have to argue against or for it, i will trust the experts and politicians on this one.
Not everyone needs to form an opinion and also state it.
And yes it might be harder for you to believe in your president right now, i do get that. But let me give you a tip: Whenever everyone would love to stop quarantaen today, i will try to avoid public spaces as long as i can, because the risk of having corona, is actually for me, a bigger problem then just staying low for a few month.
I think getting your opinion out there is important, but to be honest, the article needs a heck of a lot more in terms of disclaimers, and much less in terms of confident statements and grandstanding.
I've worked through the best available data. My conclusions:
1) The economic costs of ending the lock-down may be astronomical. This is especially true with what we learn about COVID19 and lung damage (or potentially other organ damage). If even a small fraction of the population is on long-term disability, the costs go up super-quickly.
2) The fundamental costs of the lockdown are cheap. With reasonable economic mitigations, the costs should be that everyone upgrades their car, computer, or similar maybe 6-18 months later, plus an extra 1-5 percent of the GDP.
3) Most of the economic damage of the lockdown, like a cytosine storm, is self-inflicted: bankruptcies, defaults, layoffs, etc. There are reasonable way to manage most of those (and the rest require a very modest stimulus). We haven't taken those steps because we're stupid.
4) If we don't put in systems to manage the economic costs, we'll be super-vulnerable to the next pandemic.
5) This is something which will come up again, and it's also something which is a national security issue. Engineering something like the next COVID19 as a bioweapon is, at this point, within the scope of even poor countries (North Korea, most countries in Africa, etc.), and there's a Moore's Law where the resources go down super-quickly (larger organized crime organizations could probably do this as well now). The point isn't that poor countries are more likely to do this (they're not), but that with 200 countries in the world, the odds that SOMEONE is likely to do this are increasingly high.
I have a feeling a lot of people advocating ending the lockdown are doing so on the basis that only old and infirm people die, as if the other option is either an asymptomatic infection or a quick recovery from something flu-like.
But I’ve witnessed some very serious infections, so this colors my perception and pushes me toward continuing lockdowns. To your point, the disease can be debilitating foR relatively young, healthy people. Have you ever gotten the flu and then had to re-learn how to swallow after spending a month in the hospital?
Yes corona is mostly deadly to older people, but even for those who do not die there are negative health outcomes which impact their ability to work and take care of themselves. What is the economic impact of that? Why is it not factored into the cost/benefit analysis of opening up?
We need to know the incidence of these issues. Response needs to be completely different in case they're the majority of cases, or if they happen in the minority.
So far the evidence collected from what I've seen is case reports, so nothing clear or definitive.
I have no expertise in this area, but Wikipedia does not say:
1/(1 - R_0)
1 - (1/R_0)
(The irony in me having said it was "exactly" what Wikipedia says is not lost on me :P)
https://gitlab.com/ryankemper/writings/-/commit/093ade629447...
Say R0 is 2, 1/(1 - R0) means that we already hit herd immunity before SARS-CoV-2 even existed!
Right: it's (after you correct the typo) the point where the number of active cases does not increase over time.
This is one clear lesson that can be drawn from the pandemic.
Consider that many governments with professional public health departments, including those of the richest countries in the world, downplayed the unfolding disaster, completely blew it on containment as a result, and are now reduced to using _extremely_ expensive lockdown measures to try to buy time until someone can come up with a better idea.
Meanwhile, plenty of randos on the internet did the straightforward epidemiological math in January/February and correctly deduced what was coming.
I think a clearer lesson is that, sometimes, the designated professional experts will fail to outsmart a fairly simple and very well known system of differential equations.
If you find this conclusion terrifying, well, I agree.
Governments are ultimately run on a day to day basis by politicians. Proactive measures to prevent a crisis are a much tougher action to justify, especially if they negatively affect people in a way more direct than just spending their tax dollars, than reacting to a crisis. If anything I think this crisis should teach us something about how governments make choices.
I did some little thinking and modelling of my own late Feb, and reached the correct conclusions by following a simple exponential model, having very basic understanding of epidemiology, and being mindful of error bars (mostly ones created by me being a layman in the field).
On the other hand, I trusted WHO and CDC on masks around February; even posted things to HN to that extent. I now regret it and consider it a failure of not doing enough first-principles reasoning, and not digging into the feeling of confusion I had when reading the official advice.
What I got blindsided by was supply chain impacts. I read the daily updates on /r/supplychain with fascination; while I realized things are interconnected, I didn't realize just how much and in what non-obvious ways.
Bottomline, the lesson I draw from the pandemic is to trust myself a bit more, and attempt to carefully reason from first principles more often.
--
Plenty of epidemiologists did the math and were talking about the situation on Twitter in January and February. I know because I was following them before China locked down. There were articles and interviews in the press from actual experts (Marc Lipsitch, Neil Ferguson, Michael Mina, Michael Osterholm) during that time.
There were science journalists (Helen Branswell, Kai Kupferschmidt) writing back then who were great at contextualizing the emerging information about the epidemic.
Dr Nancy Messonnier at the CDC warned that "Disruption to everyday life might be severe" on February 25th.
Meanwhile, randos were racking up karma across the internet with their back of the napkin bullshit.
Additionally, the two companies that I had narrowed the search down to did not freeze hiring. Pretty lucky, since tons of companies did, although I constrained my search to remote jobs only so that's probably why.
I accepted a job offer and start soon, actually.
That being said, I do think that the general experience of being jobless during this has made me more sympathetic of those that truly lost their jobs than I otherwise would have. Which is not to say that I wouldn't have been sympathetic, I absolutely would have, but the fact that I had to deal with COBRA and other fun artifacts definitely made things a bit more tangible for me.
Excellent point/question.
Still, I _don't_ know about how we are doing in terms of healthcare workers. That's almost certainly the bottleneck and it may be that it's still a bottleneck. I'd have to do some research to say for sure. It's very possible my statement was not correct in that light.
Meta: I'm currently constrained to using one arm since I had a not-so-fun ER visit today, so I'm not really firing on all cylinders right now. So, if you happen to look into the NY capacity matter on your end, I would love to hear your findings.
NYC built more hospital capacity as a response to the dire situation in their hospitals. That some of that extra built capacity is unused is not evidence of overreaction. I also find it odd to separate out the availability of doctors and nurses from the physical beds when our primary question here is whether the hospitals are strained; a bed is of no use with doctors and nurses to help the patient.
I'm honestly curious: have you not read the news papers articles talking to doctors and nurses who have personally witnessed the over capacity hospitals in NYC and Chicago?
On the other hand, you say > Remember, flattening the curve does not reduce deaths in the long-run, except insofar as it avoids overrunning hospitals, which we have already achieved.
If some countries have achieved this containment in the hospitals, not all, it is only by doing the lockdown, I can't believe you would think that opening up would not overrun the hospitals, if we open up, they will be flooded with new victims and those deaths will NOT be hypothetical.
Although you bring up many valid points, in my opinion this is where your statement fails. Opening up WILL cause new deaths.
I believe a gradual opening would be much more efficient only once the rise has already been slowed down.
- I think the part about the freedoms is unnecessary because I feel the vast majority of the pro-lockdown people do not share your enthusiasm for freedom and public discourse. While your main argument may shift their opinion, the part about liberty may cause them to stop reading and discard your other arguments.
- I think some claims would sound more persuasive if there were more links to research. For example, the claim about 0.1-0.7% mortality. There's a study about China (0.66% mortality) and a bunch of others that could support your point. You could also add mortality stats for influenza in the US from the CDC website (I think it's 0.13% on average).
- The TLDR sounds bitter and childish, in my opinion.
Overall a great summary and I'll share that with others.
> Other countries do not even have the concept of freedom of speech/assembly embedded into their founding documents.
as it was clear that the author hadn't done any research on this - many countries explicitly or implictly have these in their founding documents.
In short, the important distinction is not that it's embedded into the founding documents, but that we do not place the limitations on free speech that other countries do.
i.e. places like UK, germany, france - while they may have the phrase "free speech" in their documents, the limitations put on it are extreme enough that they're basically referring to a totally different concept.
So, it would be more accurate to say that other countries do not share our concept of free speech, in that ours has _very_ few limits put on it.
I think this part goes way too far presuming intent, really hurts your case without a qualifier.
> Those advocating a policy of containment, and with it, totalitarian-style lockdown, are not doing so based upon scientific evidence, but rather upon superstition and tribalism.
And to be so critical of "omission", the TLDR says nothing of air-to-air transmission while eating, like in a restaurant.
The article claims that the survival of the healthcare system in places that implemented a lockdown has nothing to do with the lockdown, but then gives no evidence at all to back up that assertion.
https://www.nationalreview.com/corner/coronavirus-fatality-r...
That's the whole point of YPLL and other age adjusted metric that the scientist and academics who study disease, pollution, etc. use.
Makes sense really. Maybe a focused effort should be made to protect nursing homes.
COVID-19 is bad, but if you exclude the nursing homes from the stats it doesnt justify the lockdown damage. Is there a realistic plan to isolate big nursing homes somewhere?
Besides, the circumstances of the deaths are vastly different: deaths at retirement homes vs deaths in general population. Indeed, merely locking down Swedish retirement homes would have made your pro-lockdown argument meaningless.
Comparisons with eg Sweden at this point have always seemed strange to me because the whole point of a herd immunity approach is to increase exposure initially, which will necessarily involve deaths being less spread out. The real question is, after a year, what's the total excess mortality including non-COVID cases due to delayed treatments due to lockdown etc. (which are never included in the models, which focus on one disease, and would take time to manifest) ?
I'm not opposed to shelter in place but the endgame logic has always been unclear, and as such, classist. The right way to do it, for example, is to pay people to stay home.
https://translate.google.com/translate?sl=it&tl=en&u=https%3...
As an addition, not all the measures were correct to "fight" the pandemic in Northern Italy, where I am located. Glaring errors were made in putting patients within nursing homes, with "guarantees" of separation. Well, these guarantees did not hold, and death counts flared up there. To be fair, this also happened in all nursing homes in the country.
Also some regions were more efficient than others, some even started implementing contact tracing in absence of a position from the government (still not clear as of today).
I believe that a more directed lockdown (or avoiding errors like in Alzano Lombardo, near Bergamo, where basically a hospital turned into an "infection center") would've worked miles better than the current situation, where regions with almost no new infections are locked up as much as those with significant counts.
Author suggests self-quarantine for the obese instead of quarantine/lockdown for everyone. The CDC suggests that +42% of the US adult population is obese [0]. Are we really going to isolate or quarantine 4 out of 10 US adults and imagine the economy can get back on track?
It's a good start. Also "encourage" is different from "enforce".
They can't compel a vulnerable WFH person to rejoin an open plan sardine office, nor can they fire them for not rejoining without attracting attention for discrimination. I know a tech worker who used to wheel an oxygen tank to the office: I imagine that person is more than a little concerned right now.
It also implies that a partly WFH workforce cannot be sidelined: once one person is remote the whole culture needs to be organized around remote process.
Depends on your labour laws, and facilities more than on the market IMHO.
Better than everyone pulling their hair out at home. Plus, why not have people choose themselves whether they're healthy enough to take chances and go out to work?
Because people who chose to take that risk will still go back to their homes and infect people who'd rather not, or can't afford to.
Because people go to work sick otherwise they can't put food on the table, especially in a country where not going to work massively means losing your job in a country without a sensible, humane healthcare system.
Three reasons immediately spring to mind:
1. It's a very well established fact that C19 can transmitted by asymptomatic people. "Healthy enough" does not mean "safe"
2. Ignoring that fact, I know can personally name several people who would absolutely go to work sick.
3. I've have several employers who would say "Do totally have a choice...come in or you're fired and I'll find someone else who will do it". This includes a very vivid memory of a manager telling one employee that she doesn't not have a valid excuse to miss her shift while she was still weeping because her grandmother had died.
(3) is still a valid concern. Government policy could help, but it'd be weird (and provoke a major public backlash, no doubt) if us fat people got a stipend for being fat.
People who aren't virus-free shouldn't be in the general public. That's kinda the point.
If I bought the assumption that getting COVID19 was relatively safe for me, I'd gladly swap jobs to keep someone else safe, especially if it meant moving up in the world. An at-risk individual could do my job, and I'd take their in-person job.
While I think there are better mechanisms, free markets could take care of swapping people around. If you're self-quarantining, and you have a better job than I do, I'll take your job. My job is now vacant for you. That's far from ideal -- you've just taken a pay cut -- but it's far better than mass unemployment.
What we'd need from there would be much cheaper than the successive stimuli (e.g. support for at-risk low-income individuals: like a stimulus check, bigger, but only to people who need it).
Now, to be willing to do this, I'd need to believe COVID19 is relatively safe for me (e.g. <1% odds of death _or significant long-term complications_). That's an assumption I don't buy. By looking at IFR/CFR numbers, we've ignored the much bigger question: how many people end up with permanent lung damage or other organ damage. Until we have a clear answer, I'm in lock-down mode unless I'm forced out.
Note that a company giving a bad reference because you refuse the terms is likely to lose a lawsuit (in the US) since courts will find it reasonable for someone to refuse to come into work given the experts advice at this time. Thus the company will probably just confirm your dates of employment and refuse to say anything more about your performance while working there.
How often do these kinds of lawsuits happen anyway? I'm imagining that engaging in one is also a career-limiting move in itself, but maybe the situation is better?
> Fortunately at will employment works both ways
This pandemic is really turning the world upside down; things that were favoring one group of people suddenly turn around and favor the previously exploited one...
> courts will find it reasonable for someone to refuse to come into work given the experts advice at this time
One of the things I've noticed during this crisis is how big a responsibility rests on the shoulders of government and NGOs alike. I could describe the behavior of most of the market in February and March as a large responsibility deflection game. So many companies knew what should be done, and were ready to do it, but were openly waiting until relevant governments started issuing emergency rulings that gave them no other choice. For instance, late March I was still getting messages from a travel agency that boiled down to, "we understand that you think it's bad out there, and safety of everyone is paramount, but the government's foreign affairs bureau did not issue a ban on travel to Italy, so all is fine and everyone's going to Rome as scheduled". And yes, there was no travel ban issued; it was only "highly discouraged" for ~2 weeks before the country went into lockdown.
If they want to survive, adjust they must.
Whichever model we take (lockdown, soft lockdown, no lockdown, or something else entirely), our goal should be to structure economic supports to allow for that restructuring as quick, painless, and job-loss-free as possible. If we don't do that, things will play out exactly as you describe, with a painful adjustment period. If we do that, they can play out better.
But play out they will. Businesses can't force people to stay. If the cost for me to pick an in-person job over an at-home one is $10,000, I'll quit my remote one as soon as I get a job offer $10,000 above my current salary. Businesses can't force me to stay. And vice-versa the other way. That's a free market. And the increased unemployment benefits right now provide some buffer to make those changes.
Here in Hong Kong, people who were obsessively sterilizing everything and were scared to go outside 2 weeks ago are now taking off their masks and going to the beach.
By the sound of it most people are wearing masks most of the time.
(Boilerplate warning about news reliability in nonfree countries)
Why? So long as you're not close to other people there's no risk in being outside.
I of course actually do go outside, but only to my patio, not to go back to my old gym or coffee shops.
Recreation wise, I've seen lockdowns rolled out in WA. Whatever they didn't close immediately became extremely overcrowded; they even closed city parks for one weekend (2 weeks into stay at home order and with parking lots already closed), because they became insanely crowded, I run in a park nearby (Green Lake) and I've never seen it like that.
Basically, I'm sorry but you are probably privileged, self-righteous or prone to media fear-mongering; I suspect all 3. For the majority of the population, only the 3rd will have some effect, and that less than you'd think.
But you’re missing the point. Sending back my barista to Starbucks isn’t going to help said barista if I am unwilling to go to said coffee shop and spend money. The economy cannot start back up again until people start spending money again; my barista won’t spend money until they’re financially secure, and I won’t spend money on my barista until I feel that doing so won’t endanger my health.
Keep in mind that restaurant bookings were down 50% by mid March according to OpenTable. This is before most states had stay at home orders in place. A non-trivial portion of the economic collapse has been caused by entirely voluntary behavior, which is very hard to reverse.
I do however agree on recreation; governments should find a way to open up public spaces while preserving distance. I personally suspect that opening parks but constraining parking might do the trick, but I’m sure there are some weird caveats to that.
Also, I suspect that the utility of economic activity at this level is kinda like utility of money, i.e. logarithmic - going from 0% to 50% is much more significant, especially for individuals, than going from 50% to 100%.
On the latter, this is only true for individuals. Businesses have more variable expenses. If there isn’t enough economic activity to cover the cost of at least staff and electricity, businesses will rationally decide to lay-off or furlough workers to slow down their burn rate. Thus going from 0 to 50 might make literally no difference, depending on the underlying costs. This is particularly problematic for restaurants, with famously thin margins during the best of times.
What are they going to do about it, conscript people to go work at Smithfield or Tyson until they fall over with coronaplague, too? You can't just issue edicts, you have to suppress transmission.
Of course we can eventually re-open, we have to re-open eventually; we’ll starve if we don’t. But we have to actually make decisions and come up with strategies that’ll make it possible for us to re-open first. If we pretend that we can just reopen the economy without doing that first, people will get sicker and the economy won’t get better.
For what it's worth, this is the same CDC that suggests that the level of obesity that increases COVID risk is BMI 40+ [0], which is more like 6-7% of the US population.
[0] https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precaut...
Still an enormous number of people but far lower than 40ish percent.
I should have made it clear but I wasn't attempting to construct an exhaustive list of risk factors, but more give an example of what that might look like
1. The true IFR is hard to estimate at this point, but looks to be around 1%. This is a very difficult question to answer with the data we have and all the limitations.
2. There is little evidence that we can reach herd immunity levels of infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is too high and the immunity too short lived.
3. The IFR has a threshold where it dramatically increases when the number of new cases overwhelms the hospital capacity. We have seen this to a certain extend in Wuhan, Northern Italy and NYC.
4. As treatments improves the IFR should fall. This mean if we can shift an infection to the future we should see less people die. Flattening the curve is more than just avoiding overwhelming the hospital system, it is also about shift cases to a time when we have improved treatments.
5. Sweden has shown that it doesn’t matter if you have an official lockdowns or not, most people will self isolate on their own. There is little extra economic damage from imposing official lockdown policies since all the damage is done by people avoiding infection on their own.
You should open a PR incorporating your reasoning into the document. Be respectful but make it better. I'd hope the best ideas would win out but then again the author has the authority to merge or not.
To the author maybe you should give one other person you respect whose opinion differs from yours the ability to merge PRS as well. Maybe...
An IFR of 1% seems too high. This doesn't seem to line up with data from the Diamond Princess (~1% IFR in a population biased towards elderly). We can also look as a lower bound at the Theodore Roosevelt (the navy ship), which had I believe 840 positives, 4 hospitalizations, 1 death (https://www.sandiegouniontribune.com/news/military/story/202...), and this is a population heavily biased towards the young and fit thus why it's a nice lower bound.
> 2. There is little evidence that we can reach herd immunity levels of infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is too high and the immunity too short lived.
The unconstrained R0 doesn't mean we can't reach immunity, it just means that almost every single person needs to get it, which to me still seems preferable to years-long lockdown.
But the more interesting point of yours is the part about short-lived immunity. I'm going to copy-paste a portion of https://news.ycombinator.com/item?id=23025880 to avoid repeating myself too much:
I think of immunity simplistically as two components:
(1) The presence of actively circulating antibodies in the bloodstream. This is what the (oddly controversial) serology studies are measuring. It is thought that having a significant quantity of these antibodies prevents infection - i.e., what most people envision when they talk about immunity.
(2) Even after the antibodies have faded, there are still Memory B Cells, which lay dormant up to decades, waiting for exposure to the characteristic antigen (in this case, an antigen telling them that they have encountered SARS-CoV-2), at which point they resume and rapidly scale up production of antibodies.
The thinking here is that reinfection is likely possible after a sufficient length of time - whether that's a couple months or a couple years isn't yet known - but when you do get infected, your immune system will respond sooner, more strongly, and thus you will achieve a far lower peak viral load meaning a less serious infection with reduced transmissibility.
So in short, I'd like to see what makes you think the reinfection immunity window is short, but regardless of the window length, we can hopefully agree that the immunological memory cells will stick around for a while.
> 3. The IFR has a threshold where it dramatically increases when the number of new cases overwhelms the hospital capacity. We have seen this to a certain extend in Wuhan, Northern Italy and NYC.
Agreed. My only caveat is this effect is probably not _as_ dramatic as it initially looked, but it is definitely dramatic.
> As treatments improves the IFR should fall. This mean if we can shift an infection to the future we should see less people die. Flattening the curve is more than just avoiding overwhelming the hospital system, it is also about shift cases to a time when we have improved treatments.
Also agreed. I thought about paying lip service to this notion but decided to leave it out of the first draft. Basically my assumption (and it is an assumption) is that the treatments we discover will do a little bit but not a lot. So probably what we've learned thus far about proning, managing oxygen levels etc doesn't leave a ton of room for improvement without a miracle therapeutic. I think antivirals and other treatments will help a small amount but not nearly enough to justify postponing infection.
But yes, at this point I think we can say that in a scenario of successful full containment+vaccine, we would have less area under curve as far as the "overshoot" is concerned and also to a lesser extent the improvement in treatments.
> Sweden has shown that it doesn’t matter if you have an official lockdowns or not, most people will self isolate on their own. There is little extra economic damage from imposing official lockdown policies since all the damage is done by people avoiding infection on their own.
I have to strongly disagree with this. In fact I view this as a strong point in favor of "my" side: we can get the majority of the benefits of the lockdown without actually locking down.
The magnitude of economic damage is much more than just the demand dropoff. We've forced closures of businesses that actually would have been able to stay open. And particularly small businesses which are not well equipped to weather systemic shocks.
But to be clear, I absolutely agree that even without a lockdown we would see very sizeable demand drop-off and thus there would still be some sizeable amount of furloughing, layoffs etc.
--
Thanks so much for the points. In particular I'd really like to hear more from you about (2), since that is the point I disagree most with, and after that, point (1). 3-5 I have very few objections as discussed
The Diamond Princess has 13 deaths for 712 cases, so 1.8%.
As you can see in your quote, I was talking about IFR. In general - and this is a theme of the writeup BTW - we should be looking at IFR and not CFR. With IFR we can reasonably extrapolate how many deaths we'll have before new infections halt, whereas CFR is borderline impossible to use because we'd need to know how many cases we would expect per infection. At which point, why not just calculate the IFR anyway, right?
See https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v...
> Adjusting for delay from confirmation-to-death, we estimated case and infection fatality ratios (CFR, IFR) for COVID-19 on the Diamond Princess ship as 2.3% (0.75%-5.3%) and 1.2% (0.38-2.7%). Comparing deaths onboard with expected deaths based on naive CFR estimates using China data, we estimate IFR and CFR in China to be 0.5% (95% CI: 0.2-1.2%) and 1.1% (95% CI: 0.3-2.4%) respectively.
You might also want to look at https://www.eurosurveillance.org/content/10.2807/1560-7917.E...
Even if the IFR turned out to be 0.5% in the end (I hope it is) this is still a lot of dead people.
2. Coronavirus are rather unusual for pathogens in that our immunity to them fades very quickly (less than a year on average) and you can get reinfected again. The question is if SARS-CoV-2 the same. We only have limited data so far, but if you have a look at figure 3 of this pre-print paper [0] you will see the antibody response has faded significantly 60 days post infection.
3. I think it was pretty dramatic in Wuhan, Northern Italy and NYC, but I guess this is one of personal opinion. What is certain is if the number of cases had doubled the system there would have broken down completely.
4. We seem to be in agreement.
5. The reports coming out of Sweden suggest that the economic damage there is just as bad as those countries that went into an official lockdown [1,2]. All Sweden seems to have accomplished is the killing of a large number of elderly Swedes.
Most people are not idiots and they won’t put themselves at risk of getting COVID-19 if they have a choice, but there are enough idiots that won’t self isolate to cause problems. If the economic difference of going into lockdown is the same as not, then why not help idiots not be idiots.
0. https://www.medrxiv.org/content/10.1101/2020.04.15.20066407v...
1. https://www.cnbc.com/2020/04/30/coronavirus-sweden-economy-t...
2. https://www.thelocal.se/20200428/swedens-central-bank-leaves...
I don’t even necessarily agree with the author’s arguments and conclusion, and honestly I have no clue what to think with all the information I hear that is constantly changing from the various tribes. But when something gets flagged simply because he advocates for ending the lockdown, I go from thinking the lockdown is probably necessary and trust the decision is made for reasons I don’t understand, to thinking like the paranoid conspiracy theorist that this is just a totalitarian power grab, and figure the need to suppress dissent means that it is more likely his position is the right one. If the ideas he is presenting are so stupid then people can decide that for themselves and don’t need some moral busybody protecting us from thinking for ourselves by flagging anything that states the opposite of what their tribe thinks is true.
I was thinking of sharing on Facebook but I'd probably get banned, even if i still feel we should probably keep the lockdown for a little bit longer, because apparently the moral authorities have decided it is off limits to suggest we should end the lockdown or even discuss whether we should.
> I’m a software / site reliability engineer
> based out of Santa Barbara, California.
I'm disappointed with the HN community. The past few weeks, most of the medical articles to hit the front page have been written by dabblers.
Honestly, that shouldn't be surprising. AFAICT, the only way in which the HN community exceeds some random subreddit is in thinking highly of itself.
HN itself combined with hckrnews.com provides an okay enough ui and mix of random interesting articles that makes it still beat out reddit for me.
https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
> The HN community doesn't think anything. It's a collection of millions of people.
You could say the same thing about r/The_Donald. And it would be true there, too. But communities, including HN, do often tend to have particular inclinations and behavior as a group, even if there are many individual members who diverge.
And I'd rather see people seriously discuss the groupthink of those communities rather than just dismiss it due to the fact that it isn't completely universal.
> I'd rather see people seriously discuss the groupthink of those communities
It's difficult to discuss that seriously because there's so little objective basis for the claims people make about it. Perceptions vary wildly, and the claims tend to be grand and dramatic. If you hear enough of them, it becomes unmistakeable that they're not really about HN; for one thing, they're so contradictory.
I'm looking for people to poke holes. And so far I've just heard a lot of, well, that.
Which I agree with, I am not an expert, and have not (I hope) pretended to be one.
> Do you see any substantive issues with the content
(For what it's worth, I agree that it doesn't make sense to participate in a discussion like this without at least having done some background reading)
More importantly, though, there may be a misunderstanding about what HN is. It's an internet watercooler, the purpose of which is gratifying curiosity and having curious conversation. Inevitably that involves dabbling, speculating, and getting things wrong. That's part of what people do when they converse. Does that have downsides, especially in a crisis? Of course it does. But I don't think it would be a solution to try to stop the community from hammering this out.
More here:
Alternatively: https://www.youtube.com/watch?v=FzOv14fA-BI
"I don't know anything about zoology, biology, geology, geography, marine biology, crypto zoology, evolutionary theory, evolutionary biology, meteorology, limnology, history, hepatology, palaeontology, or archaeology, but I think ..."
Basically, users flagged it. I think the explanation Dang gave me in his e-mail reply is almost certainly correct, and it doesn't contain anything sensitive so I'll just share it here:
> All I can tell you, though, is that users flagged it. We don't know why they flag things, and can only guess. My guess in this case is that it's a combination of some users having covid-story-fatigue, and other users disagreeing with the view in the article. As you know, this question has become politicized and is getting more polarizing as we go forward.
The plan was to shut everything down, ramp up testing and ICU beds, then reopen and carefully watch the situation. Let's see how it goes.
1. Looking at NYC, the fatality rate is roughly 0.5%. This is based on a 20% positive antibody sample, which is getting large enough that the false positives aren’t overwhelming the data any longer.
2. If we take that as a given, then if 100% of the population becomes infected, we will have 1.5 million deaths. If we assume something more like 60%, then just one million people will die. If we lower the mortality rate to 0.3%, then maybe we are more like 750,000. I have a hard time believing it will be much lower, considering that 0.1% of NYC’s population has already died from covid-19
3. Additionally, if we give up on social distancing, then those people will die in a large wave, overwhelming our hospitals.
4. I would love to see a plan that keeps seniors safe and lets everyone else out. So far, that plan is not forthcoming. It’s hard to see how we keep them safe if their family living with them and their caregivers are all infected. So far, we’ve done a piss poor job of keeping them safe in senior living facilities, even with a lockdown.
5. On the comment that the same number of people will die with a flattened curve - that’s only true if hospitals don’t get overwhelmed, which may well still happen. Additionally, it turns out that the herd immunity point, where transmission drops below 1, is actually a function of the base transmission rate. We can actually reach herd immunity at a lower infection percentage if we are socially distanced, and thus avoid some of the deaths.
Ultimately, I think we will find ways to back off the lockdown, but health departments will be on the look-out and will be titrating the degree of lockdown as cases rise and fall. It’s hard to see e.g. restaurants getting back to anything close to full occupancy any time in the next year, and most of them don’t make enough profit per table to operate half-full (or less).
EDIT: additional point to add: yes, it seems that covid deaths will be heavily weighted to seniors. But so is mortality in general. Let’s roughly assume that the mortality rate for covid is 0.08% for 25-35 year olds. Guess what? The average annual mortality for 25-35 year olds is around 0.08%, so it will roughly DOUBLE if covid sweeps through the entire population this year. Covid could easily become the single largest killer of young adults this year.
The above being said, I think the new york numbers are a perfect upper bound for something close to what a worst case scenario looks like. Although we'd have to look at the age breakdown and obesity rates there; it's definitely very imaginable that there might be other cities in the US with relatively more at-risk individuals.
(BTW I didn't explain it thoroughly in the writeup but New York's data is why I gave a really broad range of .1-.7% net IFR - and it should be clear but this is still very napkin math-y on my part)
I'm also curious if NY serological data includes <18 year olds - if it doesn't include children we need to account for that when extrapolating in the 100% infection scenario.
Anyway, the above is all a really drawn out way of saying that I agree :P
> Additionally, if we give up on social distancing, then those people will die in a large wave, overwhelming our hospitals.
If we gave up everything, certainly. I think with mitigation targeted at the at-risk, that's less likely.
For me "ending lockdown" doesn't mean that everyone stops wearing masks and/or trying to maintain physical distance where possible. But I do want to avoid a scenario where we're mandating that people wear masks outside as opposed to just encouraging them to.
But I do agree that just because we haven't overwhelmed hospitals yet doesn't mean that we're in the clear. I was considering saying as much in the doc but wanted to keep the word count down for the first iteration.
However I do think that since pretty much every city has at least some low amount of infection, and that we will have some capacity to do some clever shuffling of ventilators, tents, etc, that hospital overrun isn't nearly as much of a risk at this point overall.
> 4. I would love to see a plan that keeps seniors safe and lets everyone else out. So far, that plan is not forthcoming. It’s hard to see how we keep them safe if their family living with them and their caregivers are all infected. So far, we’ve done a piss poor job of keeping them safe in senior living facilities, even with a lockdown.
Yeah, really the best thing would be voluntary exposure of people surrounding the at-risk individuals. But I don't foresee that actually happening. I really think nursing homes are the low-hanging fruit here, and as you indicated it seems like we've already kind of screwed that one up in a lot of places.
But essentially, in the alternative of full containment+waiting for vaccine, it seems to me much harder for the caregivers surrounding the extremely-at-risk to be able to avoid getting infected and passing it on to the at-risk, whereas in a scenario where they can get it over with then they don't have to worry at all going forward. But that requires being able to detect that you're sick before infecting the at-risk individual so that you can isolate while recovering, which obviously requires really good testing capacity.
Basically, it would be great if we could selectively redirect the bulk of our testing capacity for individuals in these situations. But there's not a very clear way to do that, the last thing we want is having a bureaucrat decide if you're eligible for a test or not. So perhaps the best we can do is - and this is a theme here - encouraging those who are surrounding at-risk individuals to get tested extremely frequently.
--
Lastly just wanted to call out this:
> I think you’ve gotten a lot right, and i think analyses like this get down to the point where we can have a rational discussion.
That means a lot. I really want us as a society to get to a point where there is broad agreement on what the facts on the ground are, so that differences in policy come down to differences in philosophy/values rather than where it feels like we're at now as a society, which is basically two warring factions each with non-intersecting sets of facts ("the death rate is 5%!" versus "no the death rate is .03!)
Looking at the total number of excess deaths (for all causes, ignoring if it is COVID-19 or not), I would say that it looks more likely that it is severely undercounted.
You can find the graphs here: https://www.ft.com/coronavirus-latest (look for excess mortality rates for New York City).
I guess you could argue that the huge increase in deaths was caused by side-effects of the lockdown, but that does not really jive with the results from countries like Denmark, which did an early and hard lockdown, and as result show almost no extra mortality.
Methods: We first estimated YLL from COVID-19 using standard WHO life tables, based on published age/sex data from COVID-19 deaths in Italy. We then used aggregate data on number/type of LTCs to model likely combinations of LTCs among people dying with COVID-19. From these, we used routine UK healthcare data to estimate life expectancy based on age/sex/different combinations of LTCs. We then calculated YLL based on age, sex and type of LTCs and multimorbidity count.
Results: Using the standard WHO life tables, YLL per COVID-19 death was 14 for men and 12 for women. After adjustment for number and type of LTCs, the mean YLL was slightly lower, but remained high (13 and 11 years for men and women, respectively). The number and type of LTCs led to wide variability in the estimated YLL at a given age (e.g. at ≥80 years, YLL was >10 years for people with 0 LTCs, and <3 years for people with ≥6).
Conclusions: Deaths from COVID-19 represent a substantial burden in terms of per-person YLL, more than a decade, even after adjusting for the typical number and type of LTCs found in people dying of COVID-19. The extent of multimorbidity heavily influences the estimated YLL at a given age. More comprehensive and standardised collection of data on LTCs is needed to better understand and quantify the global burden of COVID-19 and to guide policy-making and interventions.
okay, thanks.
Seriously, the list of scientist and medical organizations advising through this period is so long, I don't know why anyone who isn't at equally experienced tries to counter-claim their insights.
I'm not saying we shouldn't do our own research and arrive at our own conclusion, but if you arrive at a different conclusion, you're almost certainly the one whose incorrect. It's so likely that you're wrong, that you must question the logic and data you used to arrive at your conclusion.
Scientists and organizations are made up of people, and thus they can make errors like everyone else. Our expert panel yesterday in Italy pulled out catastrophic scenarios (150K people requiring ICU) that were heavily criticized, not only by "regular" commentators but also scientists.
I don't mean that experts can't be trusted. quite the opposite. They play an important role in advising for a proper public policy to manage the current epidemic, but with such a large number of unknowns, mistakes can and will happen. And when they occur, they must be pointed out regardless of where they come from.
It would be interesting on HN if we developed a habit of interrogating everyone for their credentials and shouting them down immediately if they're just another software engineer.
It didn’t sound like an interrogation, it sounded more like a brick wall of “this conversation is over.”
There are definitely diplomatic ways to say this to people or change the subject.
When people ask me, I usually say “I have no idea, we’re all stuck on this ride until the end”.
That would be horrible but anyone who is a specialist in a field knows how consistently wrong the HN hivemind is on any subject outside the realm of software. This place is perhaps the biggest community of people who overestimate their knowledge on any subject when in reality they have little knowledge/expertise in said subject.
Ironic, because many people here seem to believe not taking ourselves too seriously will lead to this forum degenerating into another Reddit.
HN is a rich source of ironic behavior indeed.
For example, I also don't have medical education, yet I am entitled to analyze information and insist that homeopathy, Chinese medicine and chlorine necklaces absolutely do not help against the virus, unlike the educated medical professionals who disagree with me.
Whether the author is a health official who has authority to do something is irrelevant to the substance of their opinion.
Discussing the experience and expertise that someone has in a subject when they’re making policy prescriptions is absolutely in bounds. While it sounds high minded to say that we should argue everything on the merits alone, the brutal reality is that this results in the experts (who are few) being shouted out by the amateurs (who are many).
Expertise matters; this isn’t debate club. If you’re going to start making extraordinary claims in a field you just started studying last month, you must provide extraordinary proof. Not having expertise in an area doesn’t make you a bad person, it just means that maybe we don’t have to listen to your take.
Perhaps by gaining a degree and employment in the area of health and medicine?
A software reliability engineer citing LessWrong and reddit to argue epidemiologists fundamentally misunderstand how to do epidemiology is much closer to the instinctive contrarianism of the average defender of homeopathy....
Appeals to authority are never good to do blindly. If different conclusions are reached from two parties, then the conversations must continue if they are legitimately grounded.
He was sued for using the title "engineer" while not being registered as a professional engineer in the state. He still had an engineering degree and the education that came with it. He was only written of since traffic light cameras were a money maker and the times were intentionally short to keep the money flowing. Basically he could have been Einstein himself and would have faced the same road blocks, because the people responsible did not want to hear the truth, their money depended on not hearing the truth.
A better comparison for this case would be the story of amateur mathematician Goodwin in Indiana. Whose attempts to revolutionize math were ultimately blocked by a university professor abusing his position as authority figure to coach legislators against redefining PI. Actually it is a nice reversal: Goodwin was a doctor first and self taught mathematician second, and he was in direct opposition to the educated authority on math of his time. Meanwhile now we have a computer scientist and self educated expert on virology contradicting almost every practicing medical professional alive.
The first and most important is "who is the expert". Out of all epidemiologists and government bodies saying different things, who should we listen to?
Secondly, people have other expertises that may be relevant. Experiments have demonstrated that getting people with a lot of different perspectives together can produce better decisions. I recognize that I'm not an expert in respiratory diseases. But I'm pretty good with mathematics, including graph theory and statistics and differential equations. Someone else may know a lot about how supply chains or small businesses are affected by various policies. Or they may be experts in the psychological effects of various levels of isolation.
I also want to mention shouldn't necessarily underestimate the armchair analyst. It's possible to learn a lot on your own. This ties in with the first point I made above, about who is the expert. Evaluating people based on credentials is one way. It's easy and low effort. Taking into account conflicts of interests and track records will improve your evaluation quality a lot. And for most people it's probably not worth their time to evaluate how credible an armchair analyst is.
Many of us activist bloggers got our start by asking "stupid questions" and then digging deeper when the answers didn't make sense.
Some times we just need motivated laypersons to explain what the experts are trying to say.
Other times we need to point out the emperor is naked.
And so forth.
The average scientist or medical organisation has no more economic knowledge than a layman. The costs of the lockdown are primarily economic. We couldn't possibly make the best decisions by listening to people who are only in a position to identify the benefits of the lockdown (medical) and not the costs (economic). In that regard, some random blogger is just as qualified to assess the economic costs as some random doctor or epidemiologist.
After all, you were able to recognise both parameters?
Not to mention the fact the core competency of an epidemiologist is statistical analysis and predicting human behaviour with mathematical models at a high level of abstraction, so it's not like the interdisciplinary understanding is a stretch for them
Public policy wrt Covid basically occurs at the intersection of epidemiology and economics. The epidemiologists can help tell you what will happen under different scenarios, and the economists can tell you what will happen economically speaking in those same scenarios.
We're basically balancing the economic impact directly attributable to sick days and to COVID-19 deaths, with the impact of the shutdown itself.
As you already know, my conclusion is that the latter is far more severe. But that balancing act is of course precisely what all the debate is about.
There's no hole in my view because I believe that experts are right more often than not, but I also believe that they can get things wrong, or fail to see the ramifications of certain policies.
Thus why so much of the discussion seems to be optimizing for a single variable - COVID-19 deaths - while ignoring plenty of other dimensions that we care about (deaths from all causes in the long run, quality of life, etc).
In particular quality of life is absolutely missing from the analysis in many who claim that the lockdown is justified.
OTOH, someone well versed in economy but not in epidemiology or medicine would fail to understand some of the health implications of the current epidemic.
It's not a problem per se, but that's where the discussion on public policy comes in, weighing all the opinions from the stakeholders, then making a decision (right or wrong, but taking responsiblity for it).
That's why I'm wary of statements like "we will reopen when the scientists say so": it's a deflection of responsibility (they don't carry the burden, rightly so, for their decision, but politics does), and for the politics, a serious step back from its duties.
It now occurs to me that the experts (epidemiologists?) have already done this, which would be a pretty good starting point. If so, why aren't we now debating their plans?
I want someone, anyone to state thresholds and benchmarks. Tell us the parameters and values. Then we can have a constructive debate.
Declining infection and death rate for X days.
Permissible level of activities to keep R < 1.
Supply chain activity levels to keep people fed, production of essential goods.
Given the complete lack of a plan at the federal level, we can forgive the Ryan Kempers of the world for trying to make some sense of this craziness.
Also, it just now occurs to me the newly formed regional compacts most certainly are doing the same. I'll look to see my jurisdiction is publishing.
1. Examples: https://www.vox.com/2020/4/10/21215494/coronavirus-plans-soc...
Very quick response, because I will go back and read all the linked plans more thoroughly.
I want more of Center for American Progress's "Step #6: Targeted, gradual lifting of restrictions", done more concretely.
https://www.americanprogress.org/issues/healthcare/news/2020...
Apologies, because I'm way more arm wavy than pedantic, so always struggle to explain myself:
I expect:
Concrete targets with concrete numbers, to be revised as necessary. Repeating from above "Downward trend for X days."
Explicit preconditions and assumptions. Like "3 day supply surplus of PPE, with excess mfg capacity to allow ramp up." and "Sufficient testing (per capita) with X hours turnaround with < X false negatives."
Automatic actions, consequences when targets & thresholds are reached. Like "Restore social isolation if trends are flat or increasing for X days."
Initially, best guess for targets and thresholds are just fine, then iterate as we mature.
PS- CAP omitted temperature screenings, which I currently think must be part of the overall strategy.
And scroll down to the section on hero worship to see where the author anticipated and addressed your objection.
Also, suicide death rates are still wildly unknown but deaths by traffic fatalities are way down. We need to get help to people feeling suicidal. Before the virus and now especially.
Author here. That's a mischaracterization of what I said. But yes it is true that overall mortality is similar to the flu. I settled on COVID-19 being 3x as deadly, but that figure is up to debate.
The important thing to understand is the varying risk profiles. The flu kills the very young and very old, whereas COVID-19 primarily kills the very old.
> Does the flu leave bodies in trucks, apartments, and bagged on the streets?
Yes, pandemic flu absolutely does.
> Does the flu kill dozens of workers in meat processing plants every year
Yup. Pandemic flu absolutely would.
> Does the flu take more than ten years of life from the average person it kills?
Could you clarify this point? I don't quite understand what you're saying. The flu takes away more wellbeing-years per death because it kills infants and young children whereas COVID-19 almost never does.
(BTW, something that occurred to me is that the fact that infants are largely spared from COVID-19 is even more of a blessing than it already seems. Once this passes through our population, new infections will be in those who are not immune which will primarily be infants/young children, who we know thus far have had really good outcomes relative to adults. That means the enduring legacy of this will be much better than what we see with Influenza)
> One, saying something that is 300% larger than another is “similar” is stretching the definition of similarity.
I defined "ballpark" in the article as less than an order of magnitude. But, I think this is a thought exercise that might help:
Imagine that SARS-CoV-2 doesn't exist, but we learn that this flu season is going to be extra deadly. Instead of the ~50k of deaths last year, we know that there will be ~150k deaths.
Would we rationally take the same extreme of measures that we have taken for Covid? (Or, conversely, should we already have been taking these measures for past flu seasons)?
Also I think you're very aware of this, but just for any on-lookers: don't look at the flu comparisons as intending to minimize COVID-19; but rather comparing to flu gives us an existing mental model that most people are familiar with that helps us figure out what measures make sense and what don't.
Mortality rate for the "regular flu" are well under the mortality rate for ALL age groups except the under 20 folks. (https://duckduckgo.com/?t=ffab&q=seasonal+flu+death+rate+by+...)
The regular flu does NOT kill significantly more young people than COVID-19. The number of young people killed by either is almost a statistical outlier when comparing against overall deaths.
> Could you clarify this point?
COVID-19 deaths take away far more wellbeing-years per death than the regular flu. (https://wellcomeopenresearch.org/articles/5-75/v1)
The state of hospitals in Italy tell a different story. It might not be numbers, but it is more reliable indication of what letting this go rampant means.
And it still collapsed.
Don't get me wrong, lockdowns are super problematic and the economic hit is going to be really, really bad but it's better than letting health systems collapse.
For instance, Ireland (where I live) had 220 ICU beds before this started; we upped that to around 500 and around 350 were filled at the highest point.
And this was with a lockdown (started March 12th, massively tightened March 26th).
Our health service would have collapsed without the measures that have been taken, so I totally see why lockdowns have been introduced almost everywhere.
The best case scenario for this kind of event is that you react too quickly, everything's OK and then people complain that all the measures you took weren't necessary.
To be honest, it was good, but it was not as good as people hoped. Massive errors like allowing infections to run rampant in the hospital in Alzano Lombardo contributed a lot to the spread of the disease in the area around Bergamo and Brescia.
ICUs were also at 80% utilization when the pandemic hit, because beds have been slashed a lot in the past years.
I think your argument I find most dubious is the idea that we have lessened health care capacity by sheltering at place and closing businesses. Even if we have furloughed hospital workers, and I'm not saying that isn't a huge blow to those people and their livelihoods, and stopped elective surgeries, and I'm also not saying that those elective surgeries aren't things that don't matter, I think in terms of the next 6 months, the chance that our hospitals have less capacity to deal with serious illnesses that lead to death seem unlikely. If anything the decrease in deaths from other things, like drunk driving, and influenza might offset the loss in capacity from those furloughed.
I agree that if the timeframe is long enough it is very likely to ultimately lead to more deaths from missing elective surgeries and preventative healthcare, and I think the argument for Pareto-efficiency and only asking those who are at risk to shelter in place isn't dismissed with this argument, but I don't think a time frame of say 6 months to a year would lead to more deaths in the way you state. I think you should maybe specify (or point out to me where you state this if I missed it, i'm not a careful reader) what kind of timeframe you believe that the combination of lack of capacity and missing out on preventive measures would start to lead to more deaths and indicate where you think we would reach pareto efficiency. Have we already passed the point of pareto efficiency? Was it never good at all, and the most efficient thing to do was no response?
I personally think you wouldn't see the effects you are talking about for probably at least a year, and I'm hoping it doesn't last that long. I think you might start to see an increase in deaths from other things like, overdose, alcohol, and suicide, in a shorter timeframe than that though, and that is something that probably should be weighed in picking the best time to end the lockdown too.
Maybe mention something about the long term issues that it appears could be a reality for even those who "don’t feel sick at all, some people feel a little bit sick"?
Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission.
Have you seen any scientific literature alleging this possibility in those who are not seriously ill? Not to sound like the WHO, but I have not personally come across any evidence that this is at all true. And indeed it seems highly non-credible.
> Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission.
This is true, but now they can't let anyone into their country until the whole island has been vaccinated. That could get very tricky.
Well, I suppose they could do what Taiwan and other countries have done and aggressively test&quarantine all entrants. That's certainly possible.
That said, most evidence I've read is fairly anecdotal, or made up mainly by case reports. Has anyone compiled so far (this is a honest question, I don't know) the incidence (this is what matters) of different issues post-recovery?
Has any government presented a cost benefit analysis of all the available options to address this situation?
Like most things in life this isn't black and white, so where is the analysis of the pros and cons, worst case projections, etc of not doing anything / going into lockdown / other alternatives.
I for one have not seen it.
Shouldn't such an analysis be the basis of any decisions we make? It follows therefore that it needs to be first of all DONE, then publicly presented and argued from all angles before a decision is made.
But, no. A decision has been made and presented to us. We can rest assured, they say, the science CLEARLY shows that this is the right decision. Then - at least in the UK - later they admitted that the economic impact and the following consequences have not yet been looked into.
The arguments should not be about lockdown or not. It is fair and everyone duty to scrutinise government decisions, not because they should have done the exact opposite, but simply because they haven't presented a robust case for what they're doing.
Let's not forget, it is their ONLY job to represent us - a job all of us are paying for -, and do things that are in our best interest, yet they fail to properly justify decisions.
Anyone who without question agrees to locking down the economy might want to consider that bailouts, stimulus packages, unemployment benefits, and anything else the government does is paid for with our money.
Add to this the borderline misleading way covid deaths are classified and a dozen other similar issues and you have yourself a very interesting situation which should be raising questions in everyone.
No. We can decided to make decisions based purely on the morality of the decision. Given a death rate somewhere between 1% and 3% the question becomes whether we will accept that many deaths, without taking action. There is no need for a cost/benefit analysis, as we can decide the issue entirely on a moral basis.
Further, insisting that every reader fully read your treatise and evaluate the claims and arguments "on the merits" is unrealistic, unfair, and fails to acknowledge that virtually all of them also lack the expertise to be able to do so.
Why is a software engineer qualified to present this?
Just misinformation spoken with a tone of authority.
>Why is a software engineer qualified to present this?
The opinions of software engineers about subject outside their area of expertise is the bulk of the commentary on this site. I don't think it's realistic to expect a community to enforce a restriction on submissions when such a restriction would hit so close to home. That would require a level of cognitive dissonance that even HN is probably not capable of.
I agree with you that people should STFU about things they are not experts in, or at the very least not present their opinions on such things with some veil of authority.
I don’t think media channels ... and I’m including HN here ... should be giving a megaphone to random opinions. Now it the time for experts voices to be amplified, not random people with an opinion.
I notice in the comments dang supports this post which is a surprise.
Along with censorship and blind worship of authority.
> Now it the time for experts voices to be amplified, not random people with an opinion.
Which experts? The experts you agree with or are politically aligned with? Or all experts?
> I notice in the comments dang supports this post which is a surprise.
An even greater surprise is the attempt to censor people who are giving their honest and fair opinion and assessment - which is not misinformation.
The experts have spoken and people have the right to discuss and offer their opinions. Using your logic, hacker news shouldn't exist because only the "experts" should be allowed a voice.
New York City has seen over 18,000 deaths directly attributed to Covid-19. The actual number may be higher, but probably isn't lower. How many actual (including undetected) cases would there have to be in NYC to produce the given number of deaths at any given IFR? Figures at the low end suggest a number of cases far in excess of the total population, so they are naturally impossible. The real IFR is somewhere between the lowest plausible number based on the total population and the implausibly high case fatality rate (based on detected/confirmed cases).
Anyone want to do some math on that?
As for the article itself, it is so full of misinformation, oversimplification, and hyperbole, where should I even begin.
1) Claiming absolute authority on fatality rate as 3x of influenza, when global experts have yet to agree on a number [https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate...]
2) Then basing the article on an absolute fatality rate, when the fact remains that fatality rate depends on a number of different scenarios include health, immunity, age, hospitalization, ICU beds, and may be even weather etc. [2] To lump all of that into a single number simply hides the cost of COVID. Just in Michigan alone, 35% of COVID deaths are within the black community. Not having a grasp on how this impacts along racial and economic lines demonstrate a very rudimentary understanding of public policy. Ask yourself, if the fatality rate is 1% on average, but 10% for black people, will you still call for opening the economy [2] https://fivethirtyeight.com/features/why-its-so-freaking-har...
3) Repeated references to comparison with influenza, but not mention of the massive R0 differences between the two [3]. Influenza has a R0 of 1.3, while COVID is estimated to have an Ro of 5.5. And this matters, because now COVID is not only more fatal, but is also spreads faster. Both the denominator and numerator are deadlier for COVID, which is a compounding factor that the article doesn't discuss at all. if 20% of US population get impacted, we will have a death toll of 600K at 1% fatality rate. That will be 10x than that of the worst strain of influenza. [3] https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
4) There are a lot of reference to negative externalities of lockdown [without much data to back-up], but no mention of the positive ones. Such as plummeting car fatality rates, plummeting crime rates, and plummeting pollution [4] [4] https://www.nationalgeographic.com/science/2020/04/pollution...
5) A strange out of context reference to social isolation and related deaths. The linked article and current situation are very different. People are isolating from others, but they are very much spending more quality time with their loved ones. I don't see any data on spike in depression during this period, and anecdotal evidence suggests that people are refreshing their relationship with their loved ones.
6) Section 4 presents a half baked plan of "opening" up without broader discussion of trade-offs and implications. For example, opening up but encouraging "at-risks" group to self quarantine. This is not how US workplaces work. Let's stay I am a at-risk worker with chronic lung disease, but I also work at a factory floor and my health insurance is through my employer. How am I supposed to self-quarantine when my employer will simply ask me to show up and if I don't I will lose my job and insurance ? And there won't be any government dollars to support
7) There is no discussion on how we can support the re-opening without ability to test people at scale. How will you know that the server at a restaurant or your gym instructor is not infected without massive upgrades to testing infrastructure ?
These are some basic observations from the article. I can keep going as every paragraph in this article has some questionable conclusions. I also feel the "soul of the nation" feels very hyperbolic.
(Note: not the author). I think any article like this can attract (and even deserve, depending on what's presented) criticism. But I absolutely dislike the "lack of credentials" as an opening argument.
It's much better to tear away the points you don't dislike, IMO, without mentioning credentials. It's obvious that being in the field can give you much better understanding of the issues, but not being in it does not mean one will not try to reason over the data (even if wrongly).
I'm a biologist (well...half biologist, half computational biologist, and something else thrown in the mix). Does that mean I can not criticize (hypothetically) something on epidemiology because I don't have credentials, or, conversely, not try to figure out something in the data (even if my reasoning is totally wrong) because I don't have the required credentials?
I understand the above is a little too black-and-white, but I mean, let's encourage debate, even strong disagreements like your post, without going over what the author is doing in the first place.
P.S.: (not a jab at you, but a thought that emerged while writing this reply) I believe there are a lot of models floating on SARS-CoV-2, but I feel we also need loads of basic, bench level experiments to understand it better.
It would be downvoted so fast for being so wrong, and no one would engage with it for being so terribly wrong because disproving all the points is exhausting and not worth the time. Yet, you would think it OK on HN.
Maybe you downvote some of the wrong ones, but others get lots of comments, and soon all these wrong posts just get more attention and comments as people are arguing over half-made points in a blog post by a sales guy that "has a few software friends".
The long-term changes to HN would eventually push away people that care.
But we don't live in that world, maybe not yet. So instead we allow people who get so many basic facts wrong about an epidemic to post on HN, and @dang explained elsewhere why this makes sense (and I agree from a moderating standpoint to keep this content up) and I agree with it.
But we really only allow this content because it isn't the bulk of content on HN. If the bulk of content on HN resembled the above, I don't think we would like the community HN becomes.
Quite ironically, this is highly related to the virus itself. The virus isn't a problem on its own. It is a problem because it infects hundreds of millions of people very quickly, and we have poor means for slowing or stopping it at all.
Very much like misinformation.
2 points: while I sort of get your "order of magnitude lik a flu" point I think it undermines your argument because you get lumped in with crazies. In your comments you also seem to conflate pandemic flu with seasonal flu, so I would suggest using "seasonal flu" if that is what you mean to avoid confusion. I think there are compelling arguments for ending the lockdown while still believing it is 10x worse than the flu. I don't like conflating the points myself, and rather prefer to just look at the actual IFR/R0 numbers.
I don't know if this warrants a section, but I will say that I believe that the issue you discuss in this article is the lockdown, which is a political discussion. You have a lot of people on here asking for your credentials, or asking if you are an epidemiologist or virologist. While scientists can help inform us as a society on things like the IFR and R0, at the end of the day the core item under discussion here is a societal choice. In the US as a society appear to make a decision that infectious disease deaths up to about 70,000 people annually (a bad seasonal flu) do not warrant any official lockdown measures. The question of the threshold for various political responses is in fact a political question, not a question for virologists, therefore is the domain of all citizens. The author is as much an expert on this particular question as really anyone else.
There has been a troubling severe censorship going on across platforms, including YouTube which would presumably not allow you to post this as a speech as it contradicts WHO guidelines, and our own "Hacker news" which ironically celebrates the culture of people building things of their own merit, not tied to past credentials, yet for a while has flagged this open and reasonable attempt to understand a political question.
Then you have a value of 100k500k6=$300B vs about $1T cost.
You can play around with these variables, for example if you feel in the US our value for a QALY should be 2x Canada and 4x UK, then use $200k. If you feel that the majority of the viral suppression was from masks, distancing, and other voluntary efforts, then you might reduce the lives saved by the lockdown estimate down to 100k.
Again, I dislike "like the flu" arguments, because I think we can just debate the actual merits of a policy. In this case, using almost any assumptions, the lockdown doesn't make sense versus other health measures we could be spending money on.
The title is not fitting at all for the content.
From someone living in NYC: fuck off. You have no business telling anyone anything regarding health and safety.
As soon as I read that the antibodies tests were showing that approx. 1/4 of NYC most likely already had the virus, and did a little basic math with the latest data on death rates, I realized that the lockdowns no longer make sense in NYC.
I guess that means I am now in the same bandwagon as Musk, Trump, and all the other supposed idiots or deniers that think this virus is not as deadly as it first appeared.
Back to work.
In general, I think there are too many arm chair scientists with opinions right now and this is not helping. Part of the reason is that we're all sitting at home mildly bored and frustrated with the sudden restrictions on our life.
My general attitude is that I understand people are afraid and considering I don't like scaring people, I'm open to adapting to their needs right now and am trying to be mindful. So, doing the right thing for me is not blaming people for being irrational and trying to adapt to their emotional needs.
However, I am very worried about the self inflicted economic pain and misery and how that is going to affect me personally as well as people I care about. E.g. my parents are retired and already had their pension devalued a few times in the last decade. Stuff like this is likely to cause more cuts. They are well off regardless but there are many pensioners who get to ride out their remaining years/decades with a significant cut in income and no chance to fix that. Stuff like this happens when we trigger a global recession/depression out of fear.
Another thing that I observe happening is that lockdown policies and the resulting bureaucracy, constantly changing rules, etc. are by and large coming from people who are interpreting what they are hearing from others. A few weeks ago when everything was extremely scary this was understandable. But we're past that now.
Most of what they hear is either without much scientific basis/merit, severely watered down/dumbed down pseudo scientific babble, or worse flat out wrong information.
Also these decision makers have agendas that go beyond trying to do the right thing. E.g. a lot of politicians have enormous egos and are under a lot of pressure to be seen doing something. Add populism to the mix or overzealous anti vaxers, and you have a perfect storm of mass hysteria and a lot of completely pointless policy. Add lawyers to the mix, and you get a lot of ass coverage on top. Bureaucrats when faced with demands raining down from the top, oblige by coming up with lots of rules and demands for more budget. Politicians oblige, and you get more of the same.
So, a scientist might say something like "Sure, whatever, go wear a non medical mask if it makes you feel good. It might even help though I'm not aware of any studies to that effect. But go knock yourself out. "
In the hands of bureaucrats that turns into the police issueing crippling fines for small businesses tolerating customers without masks in their shops. This is actually happening in Germany. In France people have to print a form stating their intentions when leaving their house and the police is very busy enforcing that. In Sweden, restaurants are open as normal and the government seems to have shown some restraint with imposing measures. France got hit really hard early on but is now improving. Germany and Sweden are largely fine already. Germany has enjoyed a widely published low death rate despite being quite late with locking down. The point is, they are doing widely different things (including doing nothing) with more or less similar outcomes. It's fine. The world is not ending.
IMHO we are well prepared in case this virus comes back. We'll detect it earlier, act more decisively and hopelessly less stupidly. So, lift the restrictions and allow people to self restrain and decisively act locally based on testing/incidents/common sense.
The author references a study from LSE [1a], saying:
> Their analysis focuses on the UK, but they conclude that maintaining lockdown in the UK beyond June 1 will lead to a net reduction in wellbeing-years.
The referenced paper weighs up the benefits of lifting the lockdown at a particular point in time vs the costs of extending it. They do this using a metric called wellbeing-years. They list the possible positive and negative outcomes of lifting the lockdown then convert these into wellbeing-years. These are used to calculate the total value of lifting the lockdown at the start of May, June, July and September. They summarise these findings in Table 4 of the paper [1b]. It shows that there will be negative total value to maintaining the lockdown beyond 1st June, as the original post says.
Table 4 suggests the highest cost of lockdown is reduced incomes and the reduction in wellbeing it brings [1b]. But surely the UK government could increase their income support so that there is no loss in wellbeing? This would change the balance of the cost-benefit analysis considerably (and maybe saving lives is worth the money).
So how much would this cost then? In Appendix 2 [1c], they calculate that £750,000 of lost income is worth 7.5 wellbeing-years (one year of a persons life at the average wellbeing of 7.5/10). This implies that a single wellbeing-year is worth £100,000 of lost income. Looking at Table 4, lifting the lockdown in September instead of May would cause reductions in income equivalent to (48+66+86+103)10,000 = 303,000 wellbeing-years. That represents £100,000 303,000 = £30.3 billion in lost income we'd need to make up.
Luckily, the 6 wealthiest people in the UK are worth a combined £39.4 billion [2]. Repatriating that wealth and distributing it as income relief would completely remove the negative impact of lost income. Doing so would tip the balance in favour of extending lockdown to 1st September. This is important because lifting the lockdown in September rather than May would result in 145,000 fewer COVID-19 deaths [1d].
Using that papers analysis to justify ending the UKs lockdown early is akin to saying: I value preserving the private wealth of 6 people over the lives of 145,000 others.
[0]: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin... [1a]: http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf [1b]: Results, Table 4, http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page... [1c]: Appendix 2, "The monetary value of Life-Years", http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page... [1d]: Section 3.6, "COVID-19 Deaths", http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page... [2]: https://www.theguardian.com/news/2019/dec/03/uk-six-richest-...: https://www.theguardian.com/news/2019/dec/03/uk-six-richest-...
That, in fact, is why I have an initial section that's just about these deceptively simple concepts that we all need to understand. I wish our leaders had actually metaphorically sat the American people down and explained the basics. The average person really does not know what a virus is, or how diseases are transmitted.
So, I actually entirely agree with the position that this is something that relates to epidemiology. Where I differ is that I don't believe in gatekeeping, I think if someone has taken the effort to synthesize research into a policy proposal, however poorly, it seems at least worth debating the ideas on their merits. The experts who know more than me (and they do, at least some of them) should be able to convince a rational/reasonable person that their position is the correct one without resorting to credential-waving.
--
BTW I do read quite a lot of research papers, but I don't naturally have much interest in epidemiology. Just to give you an idea, I usually end up reading papers about stuff like: moist wound healing, and the role of red light therapy in fibroblast differentiation, and more broadly the role of electromagnetism in wound healing and neuronal galvanotropism. Weird stuff like that that's connected by invisible threads.
So, why did I read a bunch of epidemiology/COVID-related research papers? Well, the state of discourse here in the US, and also globally, has hit such a level of insanity that I decided that I needed to figure out what the facts were. (I'm not saying I have "figured out the facts" perfectly, or even at all, just that I am trying to) Honestly, it might sound ridiculous, but the turning point for me was reading that Venice Skate park was filled in with sand to prevent people from skating there. That is what informed my intuition that we are collectively being driven by superstition, and therefore what motivated me to read a bunch of research papers and reach my own conclusion about what's going on.
My ultimate conclusion? Well, the writeup is pretty clear on that one.
So...do you have any feedback about the content here?
It seems to me these are big questions that necessitate a healthy debate considering all the pros and cons of lockdown measures. There's a lot of moving parts and dimensions: time, which activities should be resumed or kept closed, who should observe what protective measures, travel restrictions, etc. We need people, experts from various fields AND layfolk, to have a real dialog about them. "Lockdown until vaccine unless proven otherwise" is simply not going to work.
Perhaps I haven't found these kind of voices because there is not actually a decent argument to be made. Maybe I've just missed them. Maybe epidemiologists aren't, by and large, disposed to think about economic impact, long term health implications of living in lockdown, or other second order effects. Or quite likely they are scared shitless to make anything resembling a pro-opening argument because their field is ridden with groupthink orthodoxy at the moment. Much like we see from whichever (IMO) bad actors were flagging this post.
Germany is having this discussion and Czech republic too. In both cases, epidemiologist recommend slight release of rules (not a big one, but still lowering lockdown).
The problem with the analysis and exhortation to end the lockdown is contained in the above.
Flattening the curve is a way of maintaining hospital capacity and is an ongoing effort. Saying "we have already achieved" it is nonsensical.
What does make sense is maintaining hospital capacity and following a reopening protocol along the lines of:
1. Reopen sections of economy, relaxing stay-at-home for some workers.
2. Monitor for outbreaks.
3. Test and contact tracing.
4. In case of new outbreaks: quarantine and strengthen stay-at-home.
5. Repeat 1-4.
And continuing this until
- Advent of treatments for COVID-19
- Advent of vaccine for SARS-CoV-2
- Herd immunity has been achieved.
The essay linked in the OP refutes the simple argument that lockdown must be maintained by presenting an overwhelming number of details about COVID-19, its lethality, elective vaccination, secular superstition, and all other manner of irrelevant topics.
The reason for the lockdown is to maintain healthcare capacity in the face of a virus that is highly contagious.
A workable and moral framework for ending lockdown looks something like what I've outlined above.
The OP provides no suggestions on how lockdown might end, other than gathering an enormous amount of tangential evidence to prove "The Case for Ending Lockdown".
My position is that the cost of lockdown massively outweighs the cost of COVID-19 itself, and furthermore I am suspicious of the belief that we can effectively contain it without boarding people in their houses.
> The reason for the lockdown is to maintain healthcare capacity in the face of a virus that is highly contagious.
And yet the lockdown has, overall, scaled _down_ our healthcare capacity amidst the most serious pandemic in a century. Why is that? I can already foresee an argument of "oh well, the lockdown is fine, we just need to pass government regulations that pays hospitals to maintain this extra capacity". And my argument to that is, beyond a general distrust of government incompetence, paying somebody to sit around will not maintain their skills in the same way as paying them to actually perform the preventative care that we hired them for in the first place.
> The OP provides no suggestions on how lockdown might end
But I literally provided a proposal. The proposal is to have at-risk members of population - and yes, we can identify who is at risk really quite easily with the data we now have - quarantine as we've all been doing. Meanwhile, the rest of society is no longer forbidden from transacting and producing value.
Again, if you look at the fatality rate data, you will see that if we can just protect everyone over 60 - and especially everyone over 70 - we will mitigate probably 80% of the deaths. Unfortunately, even _with_ the lockdown, we have utterly failed to do so thus far in many parts of the country.
In particular, I strongly oppose the moral panic around people going to the beach, public parks, etc. Unlike our politicians, I strongly believe that these activities can be done safely and that there is insufficient evidence to show that they were ever a serious transmission vector in the first place.
While it is true that some health care providers are experiencing a decline in demand due to, for example, people no longer seeking medical attention for (e.g.) coronary problems and other non-respiratory ailments, this is not the health care capacity that matters with regard to coronavirus infections.
Non-coronavirus medical problems are important, but the widespread increase YOY in mortality across the entire United States is evidence that such medical demand is eclipsed by the demand for treatment related to coronavirus infections. [0]
Second, and I mean this with all due respect, your suggestion "to have at-risk members of population […] quarantine as we've all been doing. Meanwhile, the rest of society is no longer forbidden from transacting and producing value" is not so much a proposal as a flight of fantasy.
The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.
Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%. [1] While the number of infections required to overwhelm hospital capacity is hard to pin down (i.e. forecast), ProPublica 17 Mar 2020 page offers a few different projections. [2] One of those projections forecasts that if 40% of US adults are infected over 12 months, hospitals across the country would experience demand at 100% to 200%+ current capacity.
Those less-vulnerable members of the population who "only" need hospitalization at a rate between 2.5% and 7.4% would be left without medical recourse and would die at a much higher rate than what you are imagining.
[0] https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...
[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm
[2] https://projects.propublica.org/graphics/covid-hospitals
Right, but in this case it's leading to workers getting furloughed. So that is a direct lowering of capacity, although I suppose one could argue that those workers will be called back when shit hits the fan. But if that's the case...why not have them doing important preventative care in the meantime, since we know our hospitals are not overwhelmed yet? Basically anything that doesn't require people being in hospital beds for days since that would take away resources for future COVID-19 victims.
> Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%.
This appears to be a hospitalization rate that is not accounting for all the hidden infections, which is why that number is so high. That's why the serological studies are so important. Otherwise, we need to estimate how many "cases" there will be (meaning, "serious cases" essentially), which is a lot more difficult than finding the true IFR / hospitalization rate and then multiplying by age-stratified population size. In particular, the CDC numbers are very at odds with the hospitalization rate of some of the serological studies I cited in my article. And it's not just a factor of 2x, it seems to be a massive difference. For example they show a 2.5% hospitalization rate for ages 18-49 whereas the number I've been using shows a .8% hospitalization rate for ages 40-49 at the high end, and then a .2% hospitalization rate for ages 20-29 at the low end.
I will need some time to dig into https://projects.propublica.org/graphics/covid-hospitals, but I'm having trouble finding where they give their estimated hospitalization rates. I did note that the article has the following quote:
> “You will have people on gurneys in hallways," Cuomo said at a press conference on Monday, later adding that New York would need up to 110,000 total hospital beds, around twice the number it currently has. “That is what is going to happen now if we do nothing."
And we know now that this was absolutely not the case. Recall that New York ended up not really needing the USS Comfort, and we now know that at least 15% of the population has been infected per the serology studies. So the fact that that prediction was wrong makes it feel like other predictions using the same model will be very wrong. I'll see if I can find the paper that the Harvard team published.
And then this quote seems to imply they're operating off of the bogus 20% hospitalization rate that I mentioned in the article:
> According to the Harvard scenario where 40% of adults in the country contract the disease, about half a million people in the San Francisco region may get infected, with more than 100,000 residents requiring hospitalization.
Anyway, moving on:
> The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.
It's not clear to me why this is the case. Those essential workers who are vulnerable would be quarantined (whereas right now I believe they are not quarantined which is a problem). So, the 70 year old working as a bank teller would stay at home, collect unemployment (I wish we had a better system of unemployment but that's another matter), and the bank would presumably try to fill the role with someone else who is available to work in the meantime.
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Thanks for the discussion.
I'm more reconciled to the idea of "ending lockdown", and would characterize my position as one of guarded reluctance, especially until such a time that medical and public infrastructure can provide widespread testing.
That said, I think the value of our discussion is more intellectual than practical given the data are secondhand, the data are unreliable, we are not medical experts, even medical experts disagree, and much remains unknown and unknowable about how the coronavirus epidemic will mitigate or exacerbate in response to human behavior.
That said, perhaps you might find the current Federal guidelines for reopening economies interesting if not heartening. [0] I found two things especially interesting: 1) the articulation of criteria for assessing whether, 2) the outline of a phased approach to reopening.
> I’m a software / site reliability engineer based out of Santa Barbara, California.
People need to stop chiming in on subjects on which they are not experts.
Ryan, as a site reliability engineer, I know you’re annoyed annoyed when people on the street talk to you about your job and misinterpret just about everything about how technology works.
I had a potential customer of my employer express interest (based on me wearing corporate swag in a public place), ask some questions that became semi-technical, then go on to completely equate being hosted on a cloud service as not having any privacy or security measures or control over our data, completely misinterpreting my answers.
This is what you’re doing to doctors and epidemiologists, and whatever other people do scientific research on viruses. And now your personal blog post has spread its influence far enough to be seen by hundreds if not thousands of people who will latch on to your non-expert opinions.
I don't share your views on this matter. I think, particularly given that public policy is relevant to all of us, that it does make sense for even a layperson to engage in the conversation. This is not merely a scientific issue. Rather, we need to don our scientist caps to try to figure out what is likely to happen under different scenarios from an epidemiological standpoint, and then we need to think like economists when analyzing the economic impacts of proposed policies, etc. It's very much an intersectional discipline.
While I am very transparently trying to shift peoples' opinions, I am also inviting them to try to shift my opinion.
Rather than sink 200 hours into this in order to make it picture-perfect, I wrote a first draft that I feel covers some important points, and shared it to get feedback. As you have seen, some parts were completely wrong, some parts were completely right, and a lot of parts were/are in between.
By doing so, I've exposed myself to viewpoints that I would not have otherwise heard, and vice versa.
We all get frustrated when people make statements that expose an ignorance on a subject that we are well versed in. But how we choose to respond to it is very telling. So personally, if someone makes a ridiculous statement about my field, but their statement was made in good faith and they are seeking feedback, I will absolutely take the time to try to tell them where I think they got it wrong. Even if I think they got, well, everything wrong.
You said you didn’t sink 200 hours into this project, and that is my exact criticism. The people working on covid-19 mitigation in hospital systems, labs, pharmaceuticals, and within the CDC and state health agencies actually do this for a living and have spent well over 200 hours per-capita figuring this stuff out. I mean, heck, that’s only about a month’s worth of full time work. That’s how little expertise you’re bringing to the table here: basically less time than a summer internship.
I agree that my projections won't be as accurate as, say, the top modellers'. (BTW, I'm working on the next iteration of this article that will tie in Ferguson's model which is IMO very high-quality and what I will use to better characterize the containment case, since I agree with the criticism that I need to do a better job characterizing the "other side" so to speak)
Where I disagree is the incredible notion that only "scientists" or epidemiologists are equipped to propose/discuss policy. That seems very backwards to me. We need experts, scientific, economic, etc, in order to help us make predictions about the ramifications of various public health interventions. But when it comes to an ultimate decision on policy, that requires knowing what our _values_ are (i.e. what we're optimizing for).
I don't see many epidemiologists trying to forecast the economic cost of lockdown, or trying to debate the ethical merits of these extreme measures, nor the constitutionality therein. They're not fully equipped to do so. Neither am I, as we've already said. But each of us as private citizens needs to look at the data and the projections, and then look at our personal values, in order to determine what we feel is best.
Or to put another way, what I would call "the cult of expertise" has a bootstrapping problem. Let's say I accept that I should follow whatever the experts say without question. The hard problem of expertise is, how am I, a non-expert, supposed to evaluate who is an expert? Or which of the experts specifically I should trust?
When we decide someone is an expert we are making a value judgement based off of our own heuristics, biases, preconceptions, etc. There's no getting around that.
To be clear, I am not "arguing against" the concept of experts. Or claiming that I know more than them, etc. All I'm saying is, it's not enough to just say "let the experts handle it", because the problem of "who is the expert?" is intractible. So instead, we make the best effort that we can.
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Finally, I want to say that, as I've said elsewhere, if my argument is truly so riddled with flaws and holes - and this thread has pointed out a _lot_ of flaws, which I am currently trying to address - then it should not be very hard to show why my conclusions are incorrect. It really shouldn't require having to resort to credential-waving, etc.
Thanks for engaging. I truly appreciate it.