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Comment by newacct583 | Hacker News Reader

That's a somewhat cynical take, and I don't think any public policymakers would agree with your framing. What you're saying amounts to "We don't need more ventilators because all those people are probably going to die anyway and it won't save many lives."

A better reason is because we beat the outbreak. A few areas like Milan/Madrid/Brussels went past their health care capacity and could have used more hardware. But they're all past peak now, and everywhere else (almost -- there are a few worrisome spots in the US still growing, and the developing world is still a big question mark due to lack of testing) managed to reach peak without hitting their limit.

That's good news. We won. It's certainly not a problem that some of the efforts turned out not to be needed. It's like a war effort: everyone had a part to play, we needed to be conservative with our risk analysis and try different things.

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You've completely misunderstood his argument.

It's widely accepted and known that fatality rates once you're put on a ventilator (due to Coronavirus) is ridiculously high compared to when you're put on a ventilator for other illnesses (something like 80% vs 20%). It suggests that ventilators might not be the right solution to what's happening to these people. So some doctors have been questioning the wisdom of continuing to use ventilators, and some doctors have been looking to alternative solutions that might have more success and better outcomes. One idea that was floated was CPAP (though I don't know what happened to that).

Nobody here is saying "ah, ventilators aren't working, fuck it, let everybody die". That's offensive to everybody here and a bad faith argument that isn't constructive in any way.

Prone positioning seems to be helping a lot

https://www.cnn.com/2020/04/14/health/coronavirus-prone-posi...

The 80% number is from New York. It's not borne out by other regional data. And again, if ventilators don't help someone needs to explain why the death rate in Milan shot through the roof when they ran out of ventilators. We just don't know yet.

As for offense: I apologize again. But the "ventilators don't work" take is getting too much traction among people who do make that argument, and IMHO it needs to be shut down. It's not good science. Not yet. Let the doctors do their work.

I'm not sure it's accurate to say we "beat the outbreak". First, it's a common opinion among experts that a second wave will emerge. If we declare victory and don't prepare, there's no reason it can't be much worse.

Second, at least in the US, it appears things are slowly gaining steam in more rural areas where healthcare is much more thin on the ground. At the same time, there's a push to reopen things, especially in states the skew more towards rural. It might not end up amounting to much, or it could be a disaster in the making, but it's not quite time to say "we won".

So... I agree with all that. It's not over. I just don't think enough attention is paid to just how outrageously bad things looked in late March. At the growth rates we were seeing, we'd have blown right through health care capacity and we'd have been looking at hundreds of thousands of US deaths by the second week of April. And it didn't happen. The growth stopped cold, because the lockdowns worked.

That's good news, and needs to be celebrated, so that we can continue the work. Instead, people on the left think "It's still serious!" and refuse to celebrate what we've achieved. And people on the right, not invited to the party, are being led to believe that the lockdowns somehow weren't the victory they actually were.

And that's bad. We won the war. The battles aren't over, but we know we can beat this.

I don't think you should make an analysis of our progress political. It does a disservice to "people on the right" if you think their opinions on the matter are somehow driven by left-leaning messaging. Such messaging has generally not, on other issues these past few years, done much to move right-leaning opinions. As such, if we're seeing people on the right are affirming opinions that you just "left", it should be much more thoughtfully considered as a legitimate, honest opinion, not one driven primarily by left/right messaging.

I agree that political generalizations often do a disservice to people on both sides, who often have their views caricaturized. When you say don't "make... political" do you agree that the cultural trends exist and are worthy of discussion in a conversation about handling the disease?

I think those are relevant topics of conversation. However, in the context of this discussion thread and the claim of "we won" over the virus, there wasn't previously a "left/right" framing of the issue. Adding it only after we were a few layers deep into the thread was unnecessary to the discussion of whether or not we had achieved victory over the virus.

It's problematic because it also didn't seem an accurate characterization of of opinion trends, which shouldn't have mattered one way or another in the conversation.

But my opinion that it wasn't an accurate characterization should not have been an issue in this thread at all: The introduction of politics derailed the discussion from one about progress against the virus to political rather than factual motivation for our opinions. Had the thread started out differently I wouldn't see that as much of a problem, though I think the introduction of political ideology into conversation on HN is often counter productive in general.

Thank you for clarifying, and so thoroughly as well. I suspected that this was the case. I was just curious because the line I referenced could have a range of interpretations. Thanks.

> just how outrageously bad things looked in late March.

I agree things looked terrible then. I think a big part of the conversation now is "how much was lockdown, and how much was bad projections?"

Given what we knew at the time, it was the right choice. Now we need to decide how to move forward.

> I think a big part of the conversation now is "how much was lockdown, and how much was bad projections?"

With all due respect: That's not a conversation among any serious academics. It's a conversation happening among political actors in political contexts (c.f. Tucker Carlson floating this two nights ago).

It's just not correct. And as you phrase it, it doesn't even make sense. "Projections" don't cause a change in R0. If you want to argue that this happened for some other reason than lockdowns you need to have a reason. And there are none that make sense.

(I mean, maybe it's herd immunity. In that case, why did the infection curves in different US states at very different death counts all bend the same way at roughly the same time after lockdown? Maybe it's weather: likewise, also the fact that the early China outbreak with similar behavior happened in the middle of winter. Maybe it's a mutant strain: nope, no particular evidence for specific ones having different behavior.)

If you want to have a conversation, you need to come to the table with a working theory. Social isolation has been known for centuries to work exactly the way it has here. It's a very attractive hypothesis, and is going to be difficult to disprove.

Yes, lockdown absolutely works.

Yes, things are terrible in New York City.

The question, maybe not debated among "academics" but debated among others, is whether spread rates ever would have gotten as bad in suburban and rural areas as they did in densely populated cities.

Models that used the same variables for NYC with population density of 30k people / sq mile as for rural states with tens or hundreds of people per square mile are just not realistic.

The virus is a serious threat. It's good that we took the actions we did. That is in the past. The question now is how we move forward. Part of that is gaining a better understanding of how bad the conditions on the ground actually are. All indications are that we can relax restrictions to some extent and still not overwhelm the hospital system. Indications also point that our current restrictions are absolutely catastrophic for the economy.

So we have to find the balance.

FWIW: the fastest growing US states right now are Nebraska, Iowa and Kansas (though Illinois is also up there, and no doubt dominated by the Chicago metro area).

The idea that rural areas don't see rapid growth isn't really well-founded. What happened was that large international cities experienced their outbreaks earlier. Nebraska may be small still, but at their current growth rate they'll match New York's all time high new infection rate (per capita) in just two weeks.

Go browse the charts at https://91-divoc.com/pages/covid-visualization/ and note how similar all these curves look. No one is special. Everyone grows rapidly without lockdown. Everyone levels off with it.

Only a few states have actually seen a peak and a significant reduction in new infections (c.f. Vermont, Montana, Hawaii). Those are the ones that might consider opening up right now. Everyone else just isn't safe yet.

I am in Iowa. I am aware of our situation here. It is highly localized to several meat processing plants. Bigger cities are seeing larger numbers.

I live less than an hour away from the capital, Des Moines. We have ~30 confirmed cases total in my county. My mom lives near the northern border. They have 2 confirmed cases total.

We never went to strict "shelter in place". Today the majority of the state is relaxing restrictions and restaurants can allow limited dine-in options if they wish.

Maybe it will go terrible. Maybe it won't. We will see.

> Maybe it will go terrible. Maybe it won't. We will see.

Would you have recommended that strategy to Lombardy in February?

I mean, you're citing current absolute statistics at a time when your infection count is growing rapidly. Your per capita new infection rate now is the same as New York's was on March 22. You understand that's not the right way to think about an epidemic, right? If you aren't flat then you're in the process of growing exponentially, and that doesn't just fix itself.

> Would you have recommended that strategy to Lombardy in February?

It seems you are willfully misinterpreting me. As you will see above, I said:

> The virus is a serious threat. It's good that we took the actions we did.

Things were much less known then. Now we have better ground truth and are less likely to be blindsided. I stand by my state's actions and decisions to date.

I have been exercising caution and following the recommended guidelines. I will continue to. I would guess most people here will as well.

We can't be in lockdown forever. The prudent thing to do, in my opinion, is to loosen restrictions slowly, being fully aware that we may have to tighten them again.

> I stand by my state's actions and decisions to date.

Your state's decisions and policies are producing rapid outbreak growth, though. Why do you expect that growth to change if the policies don't?

Going back to the link above, I see that Iowa's new infection rate (I'm looking at the 7-day average because per-day numbers are jumpy) has grown by a factor of 3.78 in the past 14 days. That's a daily growth rate of 10%, or a doubling period of a tiny bit over one week. At this rate, you will reach the same per capita rate that New York experienced at its absolute peak (April 9th) in just 13 days.

So... what's going to change in two weeks? Your curve isn't bending, your policies aren't changing. What's going to save you?

Here's what won't save you: locking down once things "get bad". Go back to the same site and see how long it takes from a lockdown until a state reaches peak. It's 10-20 days.

I mean, maybe I'm wrong. Maybe there really is some as-yet uncharacterized effect separate from lockdowns that steps in at the last minute just before states reach capacity to halt the outbreak. I just don't think Iowa should be betting on that, and I'm very scared about what we're going to see in the north central plains states in the comming month.

Consider us your control group then.

Why can't Wuhan or Milan or New York have been the control group? We've already run the experiment. We know how this works. Iowa doesn't look any different. It just doesn't. Iowa simply got started late.

You... genuinely don't think this is going to happen, do you? Even with the numbers above, you just figure something's going to change and you won't need to do anything?

> you won't need to do anything?

You seem to be going out of your way to misunderstand what I am saying.

Iowa is highly locked down. We simply have not been ordered to "shelter in place".

Most of these restrictions remain in effect. The twenty counties that are experiencing outbreak growth remain completely locked down. The plan is to re-evalute and dynamically change restrictions as time goes on.

The official Coronavirus info page for Iowa is at [1].

Every county that has had restrictions lifted has experienced multiple weeks of declining case growth. Supposing they see an uptick in cases, measures will be re-instated.

It makes no sense to lock down rural counties that have seen zero or next to zero cases. Doing so will not ease the case load in the metros a hundred miles away.

[1] https://coronavirus.iowa.gov/

I think it's difficult to argue that it was "bad projections" instead of lockdowns that have made things better than projected. Because if it is wasn't the lockdown that helped, why has the virus behavior been so different in NY & NJ, but we didn't see outbreaks on the scale of NYC in other metro areas that had the benefit of seeing what was happening in those hotspots and acted accordingly? If the lockdown wasn't helping things, I would expect other densely populated areas to have had similar outbreaks. If the lockdown wasn't a significant determining factor, then we shouldn't be seeing hotspots in areas around the meat processing plants where the lockdown might as well not exist for the portion of the population that worked at the plant, and their families.

The models probably weren't perfect, but I don't think they were wrong in their general trends, even if the magnitude of those trends would have been slightly different in reality.

In any case, we'll know more in 2-3 weeks if things start to tick back upwards in areas that ease restrictions. Though even then, my concern is that the effect of lifting restrictions will occur too slowly and subtly, and so by the time we know there's a problem it will already be too late to easily contain.

I said nothing even approximately like "all those people are probably going to die anyway" and that is not, in fact, what I think! It is offensive that you would make up something like that and claim that is what I said.

What a growing number of doctors are saying is that ventilators often turn out to do more harm than good in treating COVID, ventilators have been used too soon and too often in treating COVID, and ventilators have probably resulted in excess deaths over alternative treatments.

I apologize if I offended you. That certainly seemed like what you were saying. The take is not new, and has been circulating among the "open up" community for a while.

As far as whether ventilators have "probably resulted in excess deaths"... that's just not justified by any science yet. We don't know. There's some suspicion in that direction, based mostly on New York ICU fatality rates (which are quite high despite otherwise good numbers through the rest of the process). But there's equally good evidence from e.g. Milan, which experienced very high death rates due presumptively to lack of treatment hardware.

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