Comment by XorNot | Hacker News Reader

Comment by XorNot | Hacker News Reader

The graph this blog draws doesn't work that way. The whole point of not overloading the medical system - and definitely not getting it at 100% capacity, is that once you're at capacity, it's not just COVID-19 treatment which stops (which means, all those people who would otherwise survive die) - it's all treatment.

Get appendicitis? Routine surgery, can be done in a few hours. And will definitely kill you without treatment. Break a bone? Car crash? Treating you in emergency now might involve kicking someone else off respiratory support.

The cost of overburdening the healthcare system is not some calculation of a nuisance amount of citizen death over a time period - it's a whole bunch of people who otherwise live full and productive lives, instead stop existing.

What happens when you go above that dotted line is not the continuation of a predictable trend, it is a chaotic bifurcation in behavior which does not have predictable secondary effects. The COVID-19 case load follows that shape. The deaths and long-term health problems do not.

> Treating you in emergency now might involve kicking someone else off respiratory support.

This has been my standard reply to the "It's just a flu" concept for some time now.

Aside from all this, it's incredible how difficult it is for people to think about this using all the info available (long onset of symptoms, asymptomatic spread, high % of hospitalizations / intensive care, etc) plus thinking in the long term.

I know the generalized idea is no face masks if you don't have symptoms, but if we all used them it might have a good effect on curving the spread.

Unfortunately, western cultures associate face mask with sickness, and are frowned upon.

I think we're out of N95 masks in the U.S. and we have to wait a month or so to get them from China.

3M is retooling their US factories. They should be producing by now.

There also is a factory in Georgia that makes them. They probably are working three shifts.

Good luck getting them off China.

Wash your hands frequently, sneeze in your armpit, use disposable tissues, don't touch your face, don't shake hands, don't go to large meetings. This is the standing advice in the Netherlands.

Those are basic precautions that depend only on the availability of soap. Face masks need to be worn properly to work, and in cultures where people don't wear them normally this is an issue. Only medical staff really has a valid use for face masks now, also because of limited availability.

>Face masks need to be worn properly to work, and in cultures where people don't wear them normally this is an issue.

But clearly this is not insurmountable.

> I know the generalized idea is no face masks if you don't have symptoms, but if we all used them it might have a good effect on curving the spread.

There was never enough for everybody. So second best option is, known infected + healthcare. Health professionals work under heavy viral load, which is positively correlated with your chance of getting sick and having a bad outcome. Which means in an overloaded healthcare system without adequate amounts of PPE (like Italy now), doctors will be dying, even if they were young and otherwise healthy. And dying doctors drops the system capacity too.

(Capacity of most healthcare systems seems to be limited by the amount of beds and ventilators available, but these you can always make - and China is indeed making them full-steam, to help the rest of the world. You can't make new doctors that quickly, and there isn't much of them either.)

> but if we all used them it might have a good effect on curving the spread.

They aren't very effective and people who use them tend to touch their face a lot more. Not a good idea - unless you are infected.

It's people didn't think it was as serious then they wouldn't be overloading the hospitals. Most people can probably stay home.

Sorry! It's the opposite for me. What is incredible is having access to Google and 4 days worth of reading material, people(non-experts) want to weigh in on everything from geopolitics, to how to run healthcare institutions, or what the federal bank should do.

If you are an expert in anything watching this play out everyday has become a gigantic nuisance and a distraction. Not because it matters what the herd is debating but because of the effect it has on leaders, decision makers etc. It piles pressure on them to waste time/resources/energy reacting to the herd.

Even with the info explosion the educated herd is as dumb as it has ever been, probably dumber, for the simple fact there is always more info than whatever you hear on the news or can read up in 2 weeks.

As if the educated herd made a diff to the election of Trump or Brexit. Some people argue the response is evolving with each crisis. I haven't seen any evidence of that.

One chilling comment, among many, from the doctors in Italy, posted here a couple of days ago were that stroke victims were not being treated in any way. Basically they were on their own. A condition that was at least manageable, with intensive therapy, was now left untreated and the suffers had severe disability as the only outcome, if they survived.

Sounds like you don't disagree with his underlying argument, just that the cost is a function of both time and height of the curve.

I took his point to be simply that flattening the curve does itself have significant associated costs. That a maximally flattened curve is not necessarily the best approach.

For people who rely on public transport to get to work and who can't work remotely, I think they would argue that the cost / day of flattening efforts itself also begins to rise significantly. That is, the first week or two are less impactful than subsequent consecutive weeks. And that cost is borne widely. That increasing cost may or may not balance out the failure to have the cost axis take into account the height of the curve.

Flattening the curve depends entirely on the kind of measures taken, and the curve also depends on how is the epidemic spreading. Measures taken depend on their effectiveness, feasibility and side effects given a certain situation. It's very hard to argue the economic effects based just on the curve of cases.

However, this guy (who, by the way, is just a developer who has given "a few days of thought" to this issue) does not seem to know anything about this issue but still proposes a conspiranoic theory that HN entertains way too much.

There’s a whole range of costs associated with various preventative measures which could be taken in the face of any risky activity. Some of these things (like encouraging good hygiene) are obviously worth doing, others like canceling all public schools much less so.

And it’s not just an abstract “economic” cost on the X-axis, ultimately it also comes back down to quality of life and even a cost in lives. Actual people losing their businesses, losing their houses, etc.

I can’t help but think of Asimov and Three Laws. Taken to its extreme, robots interpret the law of “not allowing humans to come to harm” in a way that they ultimately enslave humanity.

First, I think the nCFR is fundamentally and significantly overstating the risk to the general population because orders or magnitude more people already have it than have been tested positive. Second, I think the treatment for COVID is pretty basic. With a concerted effort to deploy temporary facilities across the US we could add sufficient ventilator beds for a quick peak in cases and save trillions of dollars in economic damages.

Thank you for putting it so succinctly!

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