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Comment by zaroth | Hacker News Reader

I think an argument can be made the government ordered lockdowns (stay at home / shelter in place) orders were appropriate in March when we knew much less about who was most vulnerable, and did not have a well vetted treatment protocol / decision tree or any known therapeutics.

Given the tremendous public health and economic costs of lockdowns, the fear of the unknown (e.g. predicted 2% demographic wide CFR) may have justified the multi-trillion dollar cost, and an unknown number of lives lost, due to lockdowns.

Forced mandatory lockdowns today would be unethical and actually counter-productive. Given our vastly increased knowledge of the highly stratified risk profile of SARS-CoV-2, the public health case cannot be ethically made to forcibly confine the general population to their homes; separating them from their livelihoods, their community, their ordinary healthcare, and their mental and physical wellness routines.

Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance. Government programs could better support at-risk populations which are self isolating by focusing on the minority of people who are acutely at-risk.

  IFR     Age
  0.003%  0-19
  0.02%   20-49
  0.5%    50-69
  5.4%    70-79
  5.4%++  80+

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

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> I think an argument can be made the government ordered lockdowns (stay at home / shelter in place) orders were appropriate in March when we knew much less about who was most vulnerable, and did not have a well vetted treatment protocol / decision tree or any known therapeutics.

Sure. Lockdowns bought us time.

> Forced mandatory lockdowns today would be unethical and actually counter-productive. Given our vastly increased knowledge of the highly stratified risk profile of SARS-CoV-2, the public health case cannot be ethically made to forcibly confine the general population to their homes; separating them from their livelihoods, their community, their ordinary healthcare, and their mental and physical wellness routines.

I mean, partly. We know that sticking to outdoors, wearing masks, etc. helps a lot. So we should try to avoid situations such as offices with central AC, indoor restaurants, indoor gyms, etc.

That is not confining people to their homes, just using what we've learned so far to reduce infection rates in the least painful way.

"I mean, partly. We know that sticking to outdoors, wearing masks, etc. helps a lot. So we should try to avoid situations such as offices with central AC, indoor restaurants, indoor gyms, etc."

We don't "know" any of this, except in the sense that it gets repeated a lot, uncritically. The actual published data is mainly anecdotal and/or ambiguous.

Consider restaurants -- South Korea still doesn't consider them to be high-risk facilities, and they're largely open:

https://en.yna.co.kr/view/AEN20200819005400320

That case, in particular, is enlightening about the quality of the data: they blame the transmission on aerosols, but can't rule out droplet or surface contamination, either. It's a judgment call. Most of these stories are like this. The famous "Chinese restaurant" case-study that is cited all over the place to justify shutting down restaurants presents a grand total of nine infected (even though 73 "close contacts" in the restaurant were not infected), of which three may have possibly been infected at home:

https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article

Then you have studies like this, which suggest a fairly low attack rate (3.5%), even if you're sitting right next to an infected passenger on a train, for hours:

https://academic.oup.com/cid/advance-article/doi/10.1093/cid...

The authors characterize this risk as "high"...but is it, really? I mean, clearly, being in a sealed tube next to someone for hours increases the risk, but how far are we willing to go for a risk that can be characterized in fractions of a percent for face-to-face interactions that aren't measured in hours?

I feel like people don't know these numbers, and most people would be shocked if they did.

> in March when we knew much less about who was most vulnerable

If this is the falsehood we need to perpetuate in order to let guilty politicians save face and restore a semblance of sanity to our society, then so be it, but let's be unambiguously clear, this statement is incorrect.

The correct statement is: researchers knew, leaders ignored them, and media distorted them.

The WHO China joint mission released both CFR data (3.8%) [1] and IFR estimates (0.3%-1%) [2] in February, based on ~44,000 confirmed cases. They were both broken down by age and very similar to later studies based on other cases. There were no surprises after February, unless you were reading news headlines instead of actual research.

CFR as of February 11 [1]:

   CFR     Age
   0.2%  10-19
   0.2%  20-29
   0.2%  30-39
   0.4%  40-49
   1.3%  50-59
   3.6%  60-69
   8.0%  70-79
  14.8%  80+

Very similar age curve to the IFR estimates you posted.

It was already very clear in February that this disease rarely killed anyone under 60, or even 70. Leaders just didn't listen.

To use the USA because I know it best, the first big cluster of fatalities was at a nursing home in Kirkland, WA which wasn't up to code.

So leaders had hard data based on tens of thousands of cases showing that this disease was dangerous to the elderly, and not so dangerous to everyone else. And then the first outbreak kills a bunch of elderly people. Amazingly, they responded to this by locking down the general population, and failing to take targeted measures which would protect the elderly (not sure right now but at one point 50%+ of US Covid deaths were in nursing homes).

It's the biggest failure of leadership in our lifetimes.

[1] https://www.who.int/docs/default-source/coronaviruse/who-chi... (page 12)

[2] https://www.who.int/docs/default-source/coronaviruse/situati... (page 2)

[3] https://www.weforum.org/agenda/2020/03/coronavirus-covid19-c...

That's really fascinating. I was indeed reading headlines instead of actual research. Lesson learned.

You were hardly alone and you deserve many upvotes for this admission!

As the other commenter replied: thank you for facing this head-on! Your statement now is commendable.

Also — for anyone wanting to get accurate science reporting in the US (about COVID specifically, but I'd also say more generally), definitely check out NPR's large collection of recurring podcasts. I knew those numbers the grandparent commenter posted back in Feb, thanks to NPR's great reporting, and watching this pandemic play out has felt like dramatic irony. NPR has been on the ball with accurate science reporting for years, and it's a crying shame that their audience is dwarfed by those of cable networks.

Any specific recommendation for NPR podcasts?

no, npr has not been balanced at all. the scientists and doctors they choose for their shows have been carefully curated to amplify the dangers and fear. they mention masks incessantly, even when it's completely irrelevant ("here is carrot farmer, don majors, sowing his fields. not wearing a mask, i might add!")

they don't even pretend to be balanced any more, especially anything related to politics, and the covid response is squarely political at this point. npr no longer holds any esteem regarding science reporting or balance.

Yeah, I recall when NPR had an "expert" on All Things Considered who advised holding your breath when walking by someone on the street (this was back in March/April, when they were doing "the conversation" segments during the national lockdown).

Their science reporting on the whole has not been great, but some programs (e.g. Science Friday) are better than others.

ha, exactly, the producers agressively filter for the messaging they want from their guests, no matter the veracity or plausibility of their claims.

and agreed, science friday is better than their entire stack of daily news coverage of science-adjacent topics. marketplace, planet money, and hidden brain are pretty good for business/economics.

THANK YOU so much for this post with sources!

You're saying exactly the reason I haven't been concerned about the virus since day one. Early reports truly weren't that earth shattering when one looked at the numbers.

I truly encourage everyone reading the parent's post spread this information.

"Early reports truly weren't that earth shattering when one looked at the numbers."

I don't understand how someone can say this.

COVID has a reasonably high CFR/IFR - you see the data there.

Notably, as well, the R0 is very high, it transmits very easily.

There have been 200 000 deaths in a few short months and without aggressive suppression it would easily be in the millions.

In what world do 'millions of dead Americans and and out of control pandemic' not seem 'earth shattering' when it would be easily the worst disaster in American history (if it isn't already)?

'When one looks at the numbers', especially the totality of 'the figures' such as R0, % serious cases, lingering risk factors (and they are not new to me, these are figures I had assumed most HN readers would be somewhat familiar with) ... it's very bad.

sars-cov-19 has shattered my expectations for the ability of hn commenters to assess risk and model threats. it makes me wonder if i’m not half a psychopath for only caring about the quality of the information i have access to and the correctness of my conclusions which I then put into practice with a view towards my own personal good health going forward, as well as the health of my partner. i’m thankful every day that I don’t have kids.

"i’m thankful every day that I don’t have kids."

Wow, it's not that bad. Our clumsy leaders are 'mostly right', and whether you're in Nigeria, New York or New Zealand ... we're going to make it through this.

This pandemic, left unchecked - would kill a lot of people, but we've made a lot of changes, it's going to be ok.

It's worth considering that 'detailed information' is not something we're going to communicate to the public, that's too complicated - and - that our systems are not designed for this level of control. Truly well organized authoritarian states probably have a big advantage right now.

I’ve barely been able to keep my dog from going nuts with the quarantine + the California smoke we’ve had to deal with for months now. That and many other reasons. I don’t begrudge anyone their family decisions, but my partner and I definitely made the right one for our situation.

And Medium censored anyone trying to point this out, I remember a very extensive report back then showing what we know now and they got deleted. Twitter lit up with arm chair pathologists demanding the user be banned etc.

I'm about at the point of "F BIG TECH".

[0] https://www.wsj.com/articles/controlling-the-virus-narrative...

Yes, Medium’s censorship of the numerous well evidenced and mildly worded posts analyzing COVID information was utterly disgusting. It was predicated entirely on demanding blind faith from the public that authorities were 100% correct. Obviously the WHO’s track record during COVID was anything but correct.

The post referenced in the parent comment’s WSJ article is still censored on Medium (https://medium.com/six-four-six-nine/evidence-over-hysteria-...) but can be viewed here: http://web.archive.org/web/20200321144004/https://medium.com...

This is a novel virus - meaning noone initially has natural immunity to it. This is why the infection rate needs to be slowed via lockdowns etc. Even if it was no more deadly than the regular flu (it's not - it's at least twice as bad), social distancing, masks etc would still be necessary because our medical infrastructure cannot cope with getting all the cases at once.

>This is a novel virus - meaning noone initially has natural immunity to it.

Then why do the majority of people have minimal to no symptoms?

>social distancing, masks etc would still be necessary because our medical infrastructure cannot cope with getting all the cases at once

If this is the case, why hasn't the medical infrastructure in places without such measures, such as Sweden and recently Florida, been overwhelmed?

> This is a novel virus - meaning noone initially has natural immunity to it.

This has then been proven to be an incorrect assumption, due to cross-reactivity with existing coronaviruses. While this does not prevent infection (or it is likely it does not), it may explain why some people did not experience symptoms, or very light symptoms.

> Even if it was no more deadly than the regular flu (it's not - it's at least twice as bad)

This is not a useful statement. For young people it is significantly less dangerous than a severe seasonal flu.

Is IFR the proper metric though?

The virus seems to be able to have long lasting effects in otherwise healthy people who survive, albeit I find it hard to find a legitimate study about the prevalence of this rather than popular "news".

>The virus seems to be able to have long lasting effects in otherwise healthy people who survive, albeit I find it hard to find a legitimate study about the prevalence of this rather than popular "news".

There isn't a study showing a significantly higher prevalence of adverse long-term effects compared to other respiratory viruses among healthy infectees.

This is true.

My concern around this is that if long-Covid like symptoms are common with other respiratory illnesses, then how have we been missing them for so long?

Honestly, one thing we might get out of Covid is a better understanding of some chronic illnesses that we currently don't treat well (like Chronic Fatigue Syndrome, for instance).

This is another area where the headlines are far ahead of the actual science.

So far, the "long-lasting effects" have mostly been self-reported, based on surveys of people who self-select as "long-haul covid victims". Moreover, when you look at the list of symptoms, they mostly sound like depression and/or lingering cold: headache, fatigue, cough, insomnia, etc.

There have been a handful of studies based on NMR surveys that report cardiac inflammation, but several of these have been debunked completely, and the others are of questionable methodology (i.e. using ML methods to auto-find "abnormalities" in libraries of NMR scans, and reporting everything they found).

It's not to say that there won't be people with long-term symptoms, or even that there won't be people with severe long-term symptoms -- that happens all the time, for viruses we consider innocuous. The question is: at what rate, and how much risk is there relative to all other risks?

Nobody has come close to answering that question, but it seems fairly unlikely to be of high risk, considering that we've now had 34M cases worldwide, and we're not seeing huge numbers of debilitated people overwhelming hospitals.

I dunno man, my sister had Covid in the first wave, and she has lung abnormalities that were not present before (confirmed via Xray, I believe).

They don't appear to be that major, but it's concerning that someone young and healthy (mid 30's fit but with a chronic kidney condition for 10 years) has long-term impacts from it.

I think the real concern around long-Covid stuff is that they may be chronic conditions which will present over the next 5-10 years. I agree that they're unlikely to be acute, given that hospitals haven't been overwhelemed.

Pneumonia can do very similar stuff. It is not widely known because of antibiotics usage, but even if treated it hits your lungs really hard and you can take up to a year before recovering.

A family member had the misfortune of getting one twice (at a distance of many, many years), and it took quite a while to recover.

Interesting. This is what I mean, I wasn't aware of this (and I suspect most people aren't either). Scary stuff.

Yeah, most people aren't aware of it, but that's exactly the problem with this object fixation we've been doing as a society...when all you do is look at Covid, you can easily convince yourself that Covid is unusual and terrifying.

I personally still have a wheeze (slight, but it's there) from a cold I had years ago. If someone asked me to self-report it as part of a "long-haul rhinovirus" study I might, but nobody ever looks for that.

I can confirm this.

I got a really hard pneumonia few years ago. It took several days in hospital to find an antiobiotic which actually worked, and I was in pretty bad shape in ER when it finally started to work.

It took 10 weeks to recover back to work, and over a year before lungs were back to normal, confirmed by x-ray.

Pneumonia can be deadly, even for healthy young adult.

But CFR isn't the only decision input: CFR is only relevant when you can easily isolate some groups harder than others, or else unchecked spread in e.g. the low-CFR age group of children will inevitably reach the elderly as well. E.g. people who work in elderly care can be parents as well, making the infection chain required from lowest to highest CFR age groups very short.

BTW, back in February many then-current spread models where extremely optimistic in hindsight (e.g. aerosol spread was virtually ruled out "because if aerosol was a factor, spread would be much faster than observed", they simply didn't know about other spread-slowing factors), we now know that non-blanket spread control is actually harder.

Don't agree at all - your own data disproves your argument.

"It was already very clear in February that this disease rarely killed anyone under 60,"

CFR 0.5% for 40-49

You do realize that 40 is not that old? And that 0.5% CFR is really quite high?

Are you maybe one of those '22 and feeling indestructible' people? How could someone possibly talk about 0.4 CFR and greater CFR for an age-diverse population and not realize how extremely dangerous that is?

And it's 'quite serious' for probably 8-14% of those - and that they may get life-long consequences?

And the CFR jumps quite high when there is a lack of medical facilities?

And the R0/transmissibility is really quite high, not like some 'rare disorder' - it's something that without suppression almost all of us will contract. The 'young and partied' are now becoming walking Death Adders, it's a 'systematic issue' and not very helpful to point out that 'some are less likely to die' just as they are the 'root cause of spread'.

Even if was just to 'protect the elderly' a the shut down was easily warranted.

There are 200 000 deaths from COVID more than US Combat Deaths in Iraq, Vietnam, Korean wars combined - in just a few months.

This is the most devastating and deadly thing to happen to America in at least a century, the lock-down was reasonable, there were probably even other measures we should have been taking.

Social distancing on an interpersonal social level is 'economically inexpensive' for god sakes, we're more resilient than to have to be able to 'party' every week or few.

We have to be smart about this but all things considered we have no choice.

What we 'could have done differently' was probably a) react sooner b) move more aggressively in elderly care c) wore masks and d) had a plan for this ready beforehand instead of making it up as we go along.

Edit: Please do the calculation given: 1) your stated CFR rates 2) the 'herd immunity threshold' of 60-80% of population infected 3) an aggressive R0 meaning that this would happen quite quickly 4) adjustment to CFR given overflowing hospitals and lack of available staff - and the numbers are excessively bad, at very least millions dead, which is a monumental risk.

Look, terabytes of back-and-forth in internet comments has happened over this. The calculation you are asking to do is not a realistic scenario. The pandemic is gonna come out to be on the order of one year’s worth of smoking. People have been dying totally preventable deaths due to cigarettes at that rate your entire life.

"The calculation you are asking to do is not a realistic scenario."

Yes - with the original lock down, with extensive social distancing measures - the 'end result' will be in the same order of magnitude as 'smoking' (actually much more) - but without suppressive measures it would be apocalyptic.

It's entirely plausible to estimate: it's in the order of millions of dead in a short period. It would probably be the 'worst disaster in US history by a long shot'. Probably worse than all wars in including Civil War and WW1 + WW2 combined.

FYI The UK and Sweden were estimating 60-80% of the population infected in order to get 'herd immunity' - so given the IFR/CFRs stated above ... that's millions of Americans dead, and just as many with lingering effects.

some emergencies in life call for one to gather up the courage and valor to storm normandy beach, believing death to be very likely imminent. this emergency calls for patience and stoicism. life is a numbers game. I almost died a few hours ago on my way to the mountain view costco for some fruit, sausages and croissants. a vehicle ran a red light and passed between my car and the car i was following through the intersection. I need my car to enable my lifestyle, but I wear my seatbelt, not that a seatbelt would’ve saved me tonight. I’m 40 years old, and covid may well take me if i’m so statistically unlucky, but I’ll wear my mask, avoid air conditioned crowded indoor spaces and social gatherings IRL. I hate this pandemic for stealing a year or three of my life, but I will continue to try to manage my risks, recognize what threats I can, and look for enjoyment and fulfillment in the areas of life that are available to me in the present. I look forward to resuming my normal patterns of life, whenever appropriate.

It’s not just leaders, but constituents as well who propped up the overly heavy-handed/authoritarian response to COVID. Even pointing out just the flaws inherent to relying on skewed CFRs from limited testing would result in friends/colleagues viciously attacking me for not being “compassionate” or speaking out of turn for not being a public health expert.

Some of this behavior I observed may have been due to our proximity to Kirkland (the early nursing home breakout), but there was an element of mob mentality, a perfect storm of ignorance + fear + reliance on authority, that I was shocked and dismayed to experience. After a short while, I just stopped discussing COVID with anyone because of the utter inability of people to calmly discuss complex issues and engage in a joint truth seeking mission.

Unfortunately even with all we know now, I don’t think people have revisited how COVID should be managed or how the risks should be perceived, in part due to politicization of the issue and in part due to anchoring bias. Our leaders are supposed to lead the masses through such events without such flaws, but for all the claims from leaders about “listening to science” and “looking at data”, they’ve simply failed us as you pointed out.

I seriously doubt this CFR holds with an overwhelmed health care system. Since then effective treatments have been discovered and saved the lives of many who would have died if gotten sick earlier. Now we are most likely just 2-3 months away from a vaccine and big preventable outbreaks seem stupid.

The end result of your argument is standing by while somewhere between 1-2M Americans die, between 2-4x as many as died due to the Spanish Flu.

It is true that if you multiply the age-specific IFR by the age-specific US population then you get a number which is ~2 million. That assumes infecting 100% of the US population, which is impossible. A naive worst case scenario is more like 1 million US deaths.

If you could protect just everyone who is 80 years and older (that's 4% of the total population) then that naive 1 million number falls by about half to 500k.

If you could somehow reach herd immunity by only exposing the least vulnerable of the overall population, you would get there with less than 30,000 deaths.

Even those numbers are assuming there is zero latent immunity, which we now know is not true.

The argument is not to "stand by". The argument is we need to be much smarter, because the interventions are not free, in dollars or in lives (US Federal deficit is looking to hit $4 trillion this year, versus 2019's $1 trillion) and the interventions are also not effective as we've already seen over 200,000 deaths.

> Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance

you forgot to include "provided they can afford to".

True, but re-introducing lockdown doesn't help anyone afford anything. More like the opposite.

I think "doesn't help anyone" is a bit of a stretch, since many tech workers actually did quite well during the lockdown, since they were forced to spend less due to a lack of options.

I'm in Ontario so what is being discussed does have an affect on me and I really don't know if a lockdown is the answer. What I do know is our Premier (Doug Ford) is a fuck up. We should be much more prepared by now and this lock-down talk is him panicking because we have no way better way to manage outbreaks.

If they can't afford to self-isolate on their own, they also can't afford to self-isolate under government orders. Locking everyone else down doesn't help those who are at risk afford isolation, it actually makes it much more difficult because the government has less money to work with to support those who are at risk.

What you (Edit: not _you_ in particular, but what a country does by making self-isolation opt-in) are doing here is shifting the blame of who is responsible.

If the government says that you must stay home for public health, then it is reasonable to expect that the government assists in covering costs associated with that.

As soon as the government says "You can go to work if you feel it best, the choice is up to you" a non-trivial amount of people are going to be forced to go back to work, whether they feel like they should or not. Because "you're allowed to, staying home was your choice", these people will not be compensated for making the public-safety choice.

I don't know about you, but I wouldn't want to be in a situation where the person who is making my lunch (or stocking grocery shelves, etc) should have stayed home, knows they should have stayed home, but couldn't afford to stay home because "it's not mandatory".

Then the government should compensate those who are staying at home because they are at risk. If the choice is between locking everyone down and compensating everyone, and just compensating those who are at risk the second option is obviously cheaper.

And regardless, I think the vast majority of those who are at risk were not working before the pandemic, so do not really need to be compensated. More than 60% of people who have died so far in Ontario are in long term care facilities. Over 85% of people who have died in Ontario are in their 70's or older (so likely retired). So the number of at-risk people we are talking about here is actually pretty small.

In which case, locking just them down would accomplish nothing, since they are already “locked down.”

Then the government should compensate those who are staying at home because they are at risk.

Maybe, but it's wishful thinking, never going to happen. Think of the outcry against the $600 unemployment supplement where some people received more than they were making previously, not to mention arguments that it incentivized staying unemployed.

Do you think governments have some kind of magical money well? Every cent they spend has to be paid by someone and if no one is earning how are they going to pay taxes?

Besides obviously if everyone is in lockdown, how are you going to buy food in a closed store with empty shelves? Do you think the government can just write a law and bread appears? People actually have to do a lot of work to make it.

> If they can't afford to self-isolate on their own, they also can't afford to self-isolate under government orders.

Well this is true now, now that CERB is over. But before, those that were eligible, received 2000 a month from the government.

> government has less money to work with to support those who are at risk

There are now talks about a serious wealth tax on the rich to help fund future covid efforts that will allow those that can't afford to self isolate, to be able to.

You’re absolutely right. Unemployment benefits should absolutely be available to anyone who can’t do their job as a consequence of choosing to shelter-in-place.

Countries can much better afford to offer unemployment benefits to the “at-risk sheltering” population than they can to offer the same benefits across their entire working population. Most working age people are not at high risk.

Provided you’re not paying people more to not work than they would earn working, you can let the market decide.

As if the tooth fairy is going to pay if there’s a general lockdown. Either the government forces employers to keep paying their workers so they all get fired or the businesses go under, or they allow them to curtail wages. The government can’t afford to pick up the tab.

Yeah let’s sacrifice our old for the economy! Also only deaths count, fuck weak people with long term effects of COVID-19

More like, let's sacrifice the young in poor countries to protect the elderly in rich countries: https://www.reuters.com/article/us-health-coronavirus-childr...

The current solution is to sacrifice the jobs, opportunities, mental health, education, and futures of the young, where the young is anyone not retired. Why should new graduates lose their offers and join a massively setback economy with 40 mil unemployed, millions of families lose labor income, pupils lose a year of education while forcing their parents into a difficult situation of trying to work while their children are home alone all day, businesses shutter and many shutdown, all compounded with the mental health effects of vast isolation, loss of social events, and outings - because the elderly, relatively rich retiree can't stay home for a few months instead while we make a vaccine and slide checks under their door?

In the same breath: "Yeah let's sacrifice out old for the economy!", you simultaneously encourage the current situation: sacrificing the current and future prospects of the entire rest of the population for no other reason than you believe the old can't quarantine without taking everyone else with them? The economy isn't just some GDP numbers and the DOW - that crap helps the hefty 401(k)s of the retirees anyway, it's people's jobs, savings, ability to afford food, rent, and vacations, and so on.

Of all possible responses to the GP, I think yours is the dumbest and least helpful. You've combined two strawmen, a false choice, and the least charitable interpretation of the GP into a single brain-dead one-liner.

The "economy" you speak of is not merely investment income for wealthy people, or whatever other expendable construct you made for yourself. It is our livelihoods. It's how we feed our children, provide shelter, education, security, and hope for the future. A destroyed economy destroys lives, and carries as many or even more risks to our physical and mental health as does the virus itself.

I'm someone who cares about people. The choice is not simply between the elderly and the economy, and we have enough tools and resources such that we don't have to sacrifice any group for any other. But if your strawman + false-choice were our reality, your priorities are fucked up. If, theoretically, you'd be willing to sacrifice the health and wellbeing of the vast majority of the worlds population to whom this virus is no more a threat than a severe seasonal flu, to preserve the few reamining years or months of life for the "elderly" (whatever that means to you), I would honestly feel justified in calling you heartless and irrational.

USA has had a 7 day average of around 40000 new cases a day for the month of september, and around an average of 750 deaths a day (more actually but for sake of argument.) That's a 2% CFR.

Intuitively, Id think the infection rate is underreported relative to the death rate.

More than likely but it's probably not an order of magnitude difference.

If 90% of cases are unsymptomatic or have minimal symptoms we'd expect an order of magnitude underreporting of cases, assuming people were only tested when they go to the doctor/hospital.

If 90% of cases are unsymptomatic and not showing up in the cases, then 75 million people in the US will have already had covid, and you're also getting 400 thousand new cases a day.

Sorry, but that's nonsense.

For some states the population infection rates are 20-30%, so it's not an unreasonable number (https://www.bmj.com/content/370/bmj.m3563/rr-5)

It is. All states would have to be in that range.

In the early summer, the CDC published a study estimating that the confirmed cases were 6-24 times lower than the actual cases. With testing continuing to ramp up, I suspect the gap has narrowed, but some significant multiple is still likely the case here and an order of magnitude is not outside the realm of possibility.

That's not how CFR works. CFR is fatalities from known cases. If you're thinking about infection rate, you need to look at IFR, not CFR. If you want to compare one disease to another, you need to compare CFR to CFR, and IFR to IFR.

Back then, we were told that the lockdown was a temporary measure to avoid overloading the hospital infrastructure. We needed to allow time for hospitals to add beds, respirators, etc. “Flattening the curve”. Then the goalposts were moved. What is desperately needed is an honest, open discussion of costs and benefits. Its true also that there were some very scary predictions based on early models that turned out to be flawed. We do know quite a bit more now, but we don’t seem to be applying it.

The goal posts were not changed. Once the curve was flattend, the lockdowns were lifted, and measures relaxed.

While we did manage to flatten the curve in spring, growth is back on an exponential curve in Canada, which means the threat of overwhelming the health infrastructure is still looming. A sweeping lockdown may not be the best answer, but measures needs to be taken to slow the growth.

Exponential growth is no joke. Hospitals are more prepared, but exponential growth means that even if you double the hospital capacity, they will still be outmatched rapidly if nothing is done to slow down the spreading.

"The goal posts were not changed. Once the curve was flattend, the lockdowns were lifted, and measures relaxed."

I think you should tell that to the residents of New York City, who only today got back the privilege of eating indoors (and only at 25% capacity). The governor wouldn't have granted that, had he not been sued (twice). The case count has been flat since June:

https://www1.nyc.gov/site/doh/covid/covid-19-data.page

I think it's probably worth comparing NY to Madrid, for a counter-example of what could have happened if lockdown had been ended earlier.

There's a really good FT article on this here: https://www.ft.com/content/b9653470-8779-4037-86ad-96edfcd6f...

Overall, Madrid opened much quicker and is now in the grip of another outbreak.

If you count cases by specimen date (when they were taken) and not by reporting date (when the results were known), the picture is a little different: while high, cases seem (too early to be sure) to have plateaued around the end of August.

See https://www.cebm.net/covid-19/spains-outbreak-updated-on-reg... for some discussion (two weeks old though, so beware).

Hmmm, interesting. Its very difficult to make comparisons with wave 1 though, as we presumably had the same number of asymptomatics, but with the much lower levels of testing, we didn't find any of them.

The third wave will probably be a lot easier to model (god, I wish I was joking on that).

I find this talk of first/second wave misleading. This is not the flu for mortality, and it is not an influenza virus. It spreads differently.

Some people at my institution in fact have argued that you should not use flu-derived models, but instead model the spread and the outbreaks in similar ways to SARS and MERS, which rather than big "waves", had a series of spaced outbreaks. At an internal seminar they showed that at least their models for the Bergamo area seemed to be consistent with the actual data.

I'm talking about Canada, where the first wave has been quenched.

The U.S. is a very different picture, in many states the first wave never really went away.

> Anyone can always choose to self-isolate based on their own personal risk factors

Nobody can self-isolate 100%. The strong may only need supplies, but others will also need care or medical assistance. This puts an upper limit on individual isolation. The good news is that isolation compounds: reaching 99% in isolation, in an environment of zero general isolation is much less valuable than reaching 95% in an environment where everybody else does as well.

I’m in my 30’s and am not worried about dying. I’m worried about my health insurance annual out of pocket max.

Lifelong damage to the lungs and other organs should come into the equation before jumping to conclusions, it could be within an acceptable range for you but so far the data for that is pretty much non-existent so you can't know for sure.

How can you state anything about lifelong damage for a virus that's existed for only eight months?

We have studied tissue damage for a lot longer than Covid-19 has been around and in many cases presumably know which kinds will eventually heal and which kinds won't.

"Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance."

The problem with this statement is that COVID is not a 'personal' issue. It's a systematic issue. Your disease affects everyone.

To put in a different kind of 'Liberty / Responsibility' context - how about we allow anyone who contracts COVID to sue the person they got it from for damages!

Then how many people are going to go out, and how careful they are going to be?

While we may not need 'shelter in place' for <70 populations, we are inevitably going to face social distancing etc..

We need to 'get smart'.

...

And 0.5% IFR already at the age of 50 is scary.

In this 'new era' there are a lot of people over 50 probably nearing 40% of the population or something like that.

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