I'm just hoping that we discover effective treatments soon, because with those we might be able to start treating this like a normal cold before any of the worst case scenarios would come to pass.
That first link isn't loading for me. Looks overwhelmed. I checked the Wayback archive, and it says it has been archived a lot of times, but it isn't working. Anybody have a working link?
About every two weeks since January, it seems there are people who say that it's too expensive to take bold action. And roughly every two weeks later it gets much more expensive, and the options become narrower. This, despite having China, and then Italy, to give us a sense of the severity, and urgency.
These are hard choices. There are no easy answers at this stage. I think there's also a large degree of cognitive dissonance at play, where people aren't really able to grasp that this is all actually happening.
Personally, I think we should have done this weeks ago. I think it's good we're doing it now, but we lost time and it's gonna cost a fortune. Rolling the dice on this virus feels reckless. That seems to be the opinion of people like Bill Gates, Taleb, Fauci, etc.
The number we need to know is the death rate in the absence of hospitalization. Because if we let it ride, and the hospitals fill up, that's the number we're looking at.
If it turns out to be only 1%, then shutting down the economy is probably a mistake. But if it's more like 10%, then without quarantine we would get an economic collapse anyway, plus a much higher death toll.
I think this somewhat gets to the gist of the issue really.
This virus is not the black death or the start of a zombie apocalypse. To a small percentage of people, getting this will be a really bad day and that percentage is higher than it is for viruses that similarly don't cause major health issues to most, but dramatically impact others.
Having said that, the aforementioned small percentage IS enough to overwhelm the existing health care system and that alone would be enough to cause many, many of the more severely effected to die when they otherwise mightn't with proper care.
So, having said all that I do, very wearily, agree largely with the lock-down measures in place. But I also think we're in a grey area between taking appropriate measures and overreacting.
I think the article gets to another real issue. Many of our esteemed political leaders are selling this more like the black death/zombie apocalypse. Granted, most people I meet aren't so good with "nuance"; but overselling government responses to the virus to get compliance will create another, perhaps even worse, set of issues. Is the real impact of illnesses necessarily jeopardizing our supply chains? No. But the messaging is telling everybody that we're on the brink of societal collapse. So everyone is hoarding and living in fear that if they get it, they're all but dead. We may well be shutting down important businesses that are important, if not essential, and we're causing greater threats because of these artificial disruptions.
I'm also worried longer term about what gets classed as this kind of emergency latter... for any number of civil liberties reasons. But I don't think the time is now to go call for a mass-protest on the steps of city hall either; though I expect that, due to this event, that day is closer than it was before the outbreak.
A 1% CFR will be catastrophic if we let it ride. Over 7 billion people worldwide. Assuming a simple 1% infection rate (extremely unlikely consider the R0 of SARS-CoV-2), that would result in over 700K dying worldwide. And that ignores the hospitalization required for non-fatal cases. Currently it looks like 18% of all infections require multi-week hospitalization. So again, with 1% infection rate, that means over 12 million hospitalizations. And that's just a 1%/1%/18% assumption.
A completely collapsed economy could trigger a society breakdown and will have deadly consequences as well, like violence (fighting over food, possesions) and bad healthcare
True. But imagine a more realistic scenario based on the CFR we've seen worldwide. Start with 7B people. Assume 50% get infected because we don't want to do a lockdown. 3.5B infections means 630M multi-week hospitalizations and 70M fatalities worldwide. And the follow-on effects will kill even more since these hospitalization rates will consume all our medical resources, so other illnesses will have higher CFRs as well.
I don't know about you, but avoiding 70m fatalities and over 600M hospitalizations is the optimal choice. Pursuing this choice would be the greatest human calamity, surpassing the destruction of WW2 in terms of lives.
Is there a way to derive infection rate from the R0 value? Because we don't even get close to 50% infection with the flu, and covid's R0 isn't like measles or anything.
There's no way to derive infection rate at all, unfortunately. Even for pandemics in the past, where we can go back and look at all the epidemological data, estimates of infection rates tend to vary by at least 10 percentage points.
> Because if we let it ride, and the hospitals fill up, that's the number we're looking at.
Actually, we're looking at a bigger number in that case, because people without the disease but still in need of a hospital/ICU.bed are going to die who otherwise would have survived.
A reasonable proxy for that I suggest is the ICU rate from Diamond Princess -- assume all ICU-severity cases die, and all normal hospitalization cases survive, under a tent in the hospital parking lot. About 4x DP fatality rate.
I believe that at this point, any quarantine or 'shelter in place' order must be voluntary. We stand to lose too much by giving up fundamental rights, and it is questionable what we would gain from...what, arresting the vanishingly small number of people who are still blasé about the measures?
Like the article notes, our goal is now to slow the virus, not stop it. Normalizing heavy-handed authoritarian measures will only breed future despotism.
Must not be voluntary. Humans are erratic and generally selfish.
> now to slow the virus, not stop it
Stopping it is ideal and when the plague is leathal enough, the only option. It is not draconian to institute measures that are effective. They will be instituted eventually (eg if a plagie was ebola with a 60% mortality and 2wk incubation), regardless of what philosophy you subscribe to.
If you have a complete mandatory lockdown that works to stop the spread, it's highly likely that there will be a resurgence of infections as soon as the lockdown is lifted.
Italy has said that if you knowingly break quarantine without a good reason you could be charged later with murder. That seems like a much more effective approach than making arrests, from the standpoint of both deterrence and practicality.
Not invulnerable, just not eager to give up their way of live and sanity for a stupid flu like sickness which they might or might not get. They are much more likely to die in a traffic accident when leaving the bar intoxicated, than from CORVID-19.
I believe your first statistic is based on where you get the disease or not. The second is just based on the number of car accidents per year. I don't think we really know what the odds are you will be infected
The first assumes that increasing vents, ECMOs, and hospital beds is all that's needed. You'd still need trained staff to man them. Staff that is extremely vulnerable to this disease. Also, if you don't shut things down, you'll overwhelm the system, even if you were able to double the number of beds...
Do those things cost trillions of dollars? I don't think so. Each country could probably commit a couple hundred million to this and be better off than a complete shutdown.
In a world with perfect planning, yes it would have made more sense for us to expand our healthcare so that we could withstand something like this. But we didn't. We made our bed, and we have to use what we have in hand.
We can't create enough bed space, vents, ECMOs, in the next 6 months. We can't train enough doctors, nurses, etc in 6 months. So we play the hand we're dealt, and choose a mitigation strategy that doesn't result in 70M worldwide fatalities (6M in the US).
It usually takes a doctor between 7-10 years to get licensed. Sure you can change requirements, but do you want someone just out of med school working in ICU without adequate supervision, making complex assessments and treatments? The pipeline for both nurses and doctors is just severely constrained.
But what if those medical resources aren't available yet? What if we need to wait weeks or months for them, no matter how much money we have to spend? If the entire world needs these things all at once, there is going to be a shortage (and there is). That's a death sentence for a lot of people, an overwhelmed medical system, and perhaps a runaway burden on the health system that no amount of dollars can catch up with.
I think that's a large part of why we're shutting down. If this thing got away from us (we can't possibly know yet), a lack of isolation would mean every place that didn't isolate would essentially have an Italy situation on their hands. That's an insane risk to take.
The disease spreads exponentially, not linearly. Bed increases (and staff, buildings, ventilators...) would have to also be exponential to meet it head-on.
Most of my friends--who aren't in tech, but are still better off than many--are now without jobs; soon they will not be able to afford food; if you are living paycheck to paycheck, you are already pretty screwed right now... like, I am seeing people begging for jobs on Facebook right now, so they can eat. If you are incapable of even having the discussion about whether 2% of people dying is better or worse than 25% of people going hungry for months, how can you make any claims about suffering? Our economy is unjust and unfair, but likening the existence of all of these jobs with some abstract number is "dangerously stupid" and kind of indicates you don't actually care at all about "human suffering". :/
This is really the crux of the matter. Discussions right now seem to be one-sided -- dominated by immediate epidemiological models of human harm -- but it may well be that the long term effects of massive prolonged unemployment ultimately cause more human harm, possibly even more deaths (due to depression, substance abuse and other illnesses of despair, secondary effects of crime, secondary effects of homelessness, possibly starvation/malnutrition in some parts of the world, etc.).
I don't know what the answer is, but I hope that policymakers are weighing the big picture here and considering econometric models as well as immediate medical ones.
This disease is overwhelming hospitals. If hospitals are overwhelmed then patients with any disease or trauma have higher mortality and morbidity. The mortality rate of COVID19 is not the problem, the problem is the hospitalisation rate.
I think it's healthy to question the efforts taken to deal with the virus. I'm not arguing for or against the quarantines, but I do think people need to be aware of the tradeoffs being made.
To save the maximum number of lives will require shutting down a substantial portion of the economy for 18 months until a vaccine is ready for distribution. This could save more than 2 million additional lives by recent estimates. There will also be substantial damage, and not just in terms of returns for shareholders. Livelihoods, retirement savings, and marriages will be destroyed. Lives will be taken by depression and unhealthy habits developed. This is going to be a very tough burden to bear.
If we assume his parents were in their twenties when they had him, they are in the 80+ bracket, with 14% mortality.
As to what we are getting from this shutdown? Does “a major boost to Medicare For All and maybe even basic income to substitute for the fact that the minimum wage has not budged since 2009” count as a thing we get? Probably not, he got his already.
You can't post personal attacks to HN, nor generational slurs, nor flamebait in general. We ban accounts that do these things.
If you'd please review https://news.ycombinator.com/newsguidelines.html and use HN in its intended spirit, including right now when stress, fear, and anger are at higher than usual levels, we'd be grateful.
We don't ban accounts only for using that phrase. If someone just said "ok boomer", I'd either not reply or do a "please don't" (https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...). In practice, though, accounts that do that kind of thing tend also to do other things. Combining it with personal attack is already an escalation.
In any case, it is generational flamebait, which is off topic on HN regardless of generation.
Anyone concerned with individual rights should be concerned at the government responses. H1N1 caused 10K+ deaths and infected tens of millions in the US, and we had nothing even remotely approximating this response.
This is not to say that we shouldn't be concerned and diligent in our efforts at containment, but that we should also be concerned and diligent about our liberty. Right now I see a lot of emphasis on the former and almost none on the latter, and anyone who voices concerns is labeled a crackpot or worse.
The 10K+ deaths is over the entire course of H1N1/09. The US had ~4K deaths from 2009-04 to 2009-10 [1]. Italy has had 3K deaths in just 2020-03 [2]. You can't directly compare the early state of COVID-19 to the end state of H1N1/09.
I think emphasis on the former is appropriate because the current measures are reasonably limited to the traditional scope of government disaster relief. Anti-gouging provisions, retooling factories to more socially useful goods, weeks-long shelter in place orders: all of these things regularly happen in response to disasters, although typically not simultaneously everywhere.
I see some people talking about "oh, you know, we'll just have to ban social gatherings until 2021". If that happens - if the official conversation in a few weeks is about extending emergency measures rather than safe strategies for reopening bars - I expect people will get a lot more concerned and diligent.
This one (pdf) has been highly influential to US and UK governments and is pretty sobering and alarming: https://www.imperial.ac.uk/media/imperial-college/medicine/s...
This one is way on the other end: https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a...
I'm just hoping that we discover effective treatments soon, because with those we might be able to start treating this like a normal cold before any of the worst case scenarios would come to pass.