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Comment by zw123456 | Hacker News Reader

Are we sure that the economic damage of the shutdown of the world economy out weighs the heath risks of the virus. Are we in group think here? A major recession/depression means a lot of people go hungry, lose access to medical care etc. Does anyone know of studies or research that looks at the health impacts of a shutdown vs. the health risk of the virus ? Just asking questions.

I keep asking this question and I get no response from anyone. This smells like group think. Are we not able to discuss such questions ?

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I second this it seems more and more like massa hysteria. 8.000 people died on 7.7 billion people.

Its crazy to pull the handbrake on the economy. 99% of the people that died were going to be death in a year or 2 anyway.

Have you heard about that school class full of 6 years old kids in Italy that died last a week?

Didn't happen but when it happens we do not have this options anymore. Old people die and thats life.

This talk at the start of an exponential curve is exactly the problem

I wonder how many people are fitting the “how many people are tested” to the same exponential curve? If there is exponential growth in the number of tests given, it follows there would be an exponential growth in number of cases detected.

That is absolutely true, which is one of the reasons that it is surprising that the curve isn't any higher than it is.

The problem is that so many people are ill or die within a very very short window instead of being spread out as it is before the epidemic.

From a purely selfish point of view, assuming the disease will be a minor inconvenience to you because you’re young and healthy, there are other things to consider:

- what happens to your (presumably much older) parents when they get sick? Death is a very real outcome there

- what happens when you have a car crash and need intensive care but all hospital beds are full and there are also younger patients than you to treat with a better outcome? You’re triaged lower priority and may not get the care you’d normally get or survive at all

For perspective, there really aren’t that many ICU hospital beds altogether because the usual number of people who need intensive care at any given point in a city of millions is in the hundreds (maybe low thousand?) Once the exponential nature of the epidemics hits and there are thousands of people who need care right now on top of the usual load, then it’s like in Italy where some are left to die just because choices must be made and there are either healthier victims with better prognosis.

Really appreciate you posting such a rational and reasoned reply.

I think it outweighs the economic damage.

But aside from that, we need the capability to hit the pause button on the economy during similar future events. What if for example a more extreme one in the future threatened to kill 10% of the population and required a significantly longer lockdown. By having a dry-run (in comparison) now, we might be much more prepared.

The problem is not so much the health risk but the overwhelming of healthcare systems and lack of supplies. This isn't a theory, we already know the outcome of not slowing down infection rates fast enough (China, Italy, etc).

So why aren't we scrambling to build more hospitals?

Doctors and nurses is the big cap alongside equipments and rooms.

And why aren't we scrambling to get our factories making masks and other basic supplies?

That doesn't answer the question though. Ioannidis addresses the worst case scenario. Lack of supplies, also, is made much worse by closing factories and tanking economy in general, as well as e.g. cancelling blood drives (a real case from King County), none of which are caused by the virus.

it seems like this is the response from most people everywhere about until their region hits the knee of the exponential curve. this pattern played out in Italy, Spain, France, and now the US.

the Imperial College paper estimates 2 million dead in the US with no response and ~1 million dead with a limited response that doesn’t involve a full shutdown. That paper explicitly doesn’t consider the very severe economic impacts but it’s hard to imagine that deaths on that scale aren’t worse than whatever they might be.

~1 million is the current annual death rate in the US (~0.8% last I checked), and the disease kills older people much more than younger people. How many of those 2 million would have died anyway in the next couple of years? How many would have contributed to the economy over the next few years? How many of those who will die from a recession would have contributed to the economy?

These are tough questions, but I think they're worth answering so we know what we're really gaining by shutting down the economy. I know we want to save as many lives as possible, but we should also know the cost too.

Another thing to note is that the virus will overwhelm emergency rooms world wide and deprive many other patients of adequate care that will cause some unnecessary death.

So it isn't just virus deaths you have to factor in.

Those estimates are based on constantly changing data. And “exponential curve” means a lot of things. We are just now starting very limited testing in the US... what do you want to bet the number of tests given follow an exponential pattern just by nature of how they are deployed? If your test deployment is exponential your infections is gonna look exponential even if the underlying data isn’t... at least for a little while.

You can curve fit anything if you forget about the bias in your data.

> the Imperial College paper estimates 2 million dead in the US with no response and ~1 million dead with a limited response that doesn’t involve a full shutdown.

The paper points that all these estimates are based on extremely biased data.

Testing a random sample of the population to get a reliable estimate of the scale of the epidemic is dirt cheap compared to the drastic measures currently being taken.

It's incomprehensible to me that this wasn't one of first steps taken.

What is the average age of death, and life-years lost compared to the severe economic impact? The article explicitly asks this question.

Because the answer is, we wont know for sure until it's over.

But you can lessen the impact on economy help with bring it back, western countries produce more than enough food to make sure nobody starves (if they want) If you leave covid 19 unchecked it will overwhelm your medical system anyway so even more people would loose access to medical care.

So the choice comes down to, hope that worst case (italy++) wont happen and carry on, or try to do something. And you cant get away with bulshit pretending that you are doing something when you are not, because people suddenly listen to scientist and doctors, when their ass is on the line.

Unsurprisingly we choose to do something.

Additionally given that in west most politicians are elected, and that most reliable voters and donors for political campaigns are from age group most affected by this virus, decision is even more obvious.

I think the economic damage will be so remarkable that nobody will go hungry. We are seeing unprecedented pro-social behavior and legislation. Social safety nets are born out of crises.

I see panic hoarding and empty grocery stores and laid off people worried about rent. And it’s been two weeks.

Forcing the government to act as our economic and political structure reveals itself inadequate in the face of a national crisis _is_ what will spur legislation. Hopefully smart forward-thinking legislation.

It has mostly hit Europe and Asia where people don't lose their medical care. And in general we don't expect them to leave their people hungry. Also there is no econonic model of millions of people dying in a few months so governments opt for the safer choices. Most governments at least.

Yeah, when I ask that question I get responses "how many people do you want to kill, because of course health comes first!" I haven't seen much of what I consider to be reasonable analysis.

I suspect this will be analyzed for years to come.

What is the value of a human life in the West?

My figure is $2 million.

Then a billion $ is 500 lives.

A trillion $ is 500,000 lives.

This is how I rate it. What is your figure on a life?

And how would you relate loss and gain of $ to buying / destroying lives?

The discussion changes when you leave the West, so start there.

I remember that the author of XKCD dug up that the EPA puts a human life around 8.4mil.

https://what-if.xkcd.com/96/

Sounds ok. I think it's less, but it's the same for this calculation.

Do people even get trained in napkin math anymore?

Wiki is very limited on the topic- https://en.wikipedia.org/wiki/Back-of-the-envelope_calculati...

Don't forget about the age of deaths here. Divide the above by life expectancy at birth, then multiply by life expectancy at death from the virus. And possibly weigh by decade, I'd probably trade another decade of my 20ies over e.g. 80ies (not that I've been there). AFAIK /the average/ age in Italy is pushing 70.

It does seem that we have blindly followed the Chinese's government's response to the outbreak without any real data. I'm guessing there may be large numbers of people who are affected who aren't really showing any symptoms other than typical cold/flu symptoms.

> without any real data

The trouble is we can only get "real data" by testing more people. If we test more people we will almost certainly discover the numbers are worse than they appear now.

All that is to say that the situation can only be worse than we already know. I'm not sure more data would lead us to isolate less at all.

You might be right that there could be large numbers of people with the virus who are doing just fine right now, but we know from nearly 200,000 cases (that's plenty) that a non-trivial portion of cases require hospitalization. That's the whole problem, right there.

So we know hospitals can be overwhelmed and a LOT of people die for it. Healthcare workers included.

We know the situation is probably worse than it looks, but we won't know how much worse for weeks yet.

So without real data, it seems to err on the side of caution is absolutely essential. This can bring countries to their knees within weeks, and it has.

What would you propose we do without real data?

>You might be right that there could be large numbers of people with the virus who are doing just fine right now, but we know from nearly 200,000 cases (that's plenty) that a non-trivial portion of cases require hospitalization. That's the whole problem, right there.

You're not applying the logic all the way through.

If a great number of people are already infected and do not require hospitalization it grossly affects the math on the potential for overwhelming our medical system.

Those infected people unnoticeable to minor symptoms have the potential to be the herd immunity we'd want from a vaccine.

> All that is to say that the situation can only be worse than we already know. I'm not sure more data would lead us to isolate less at all.

More infected people who are unnoticed because they don't show severe symptoms and require hospitalization actually makes the situation better. It would lower the hospitalization rate and alter the projections drastically in the direction of less epidemic.

We are being cautious right now. That, by definition, means we're likely overreacting.

I was wondering if there’s an efficient way to screen a large population with low prevalence with limited tests. I’m thinking of the 1000 prisoner wine riddle with one drop of poison if that rings a bell

I thought that, but then how do you explain situations like Italy? Such a tremendous number of people are suffering.

> The trouble is we can only get "real data" by testing more people.

We get "real data" by properly testing, not necessarily by testing more people.

Currently we are mainly testing people arriving with symptoms.

This results in underestimate of the number of infected and an overestimate of mortality and morbidity rates.

“It won’t happen here.”

“It could happen here, but it’s not a big concern.”

“It’s happening here, and it’s a big concern, but we don’t have reliable data so let’s do nothing.”

“We have reliable data now, but it’s too late to do anything.”

Are you quoting people from an actual conversation, or setting up a straw man to justify draconian actions based on limited data?

While data is limited, the basic premise of viral spread and quarantine is nothing new or ineffective. There is no doubt there is exponential growth, and limiting that would be effective sooner than later health and economy wise.

Is the growth of testing also exponential? Cause if it is, than it follows the confirmed infected will also look exponential even if the underlying actual growth number is totally different.

You can make anything fit an exponential curve if you try hard enough.

There is no data as far as the latter is concerned. The current data (Fed actions, pronouncements of 18mo shutdowns, recession worse than 2008, etc.) is to the contrary. What, really, is the economic impact of virus deaths after exponential growth quickly bumps into population size and lots of mostly non-working people die? Nobody even tries to answer this.

Are you suggesting the four stage strategy?

https://www.youtube.com/watch?v=nSXIetP5iak

That is incorrect. The US, UK, and others were taking a mitigation strategy until the last couple of days; the change wasn't driven by delayed blind copying of China, but by this analysis, which was shared with governments as a WIP before being published:

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

There may be legitimate criticism of the broad policy approach, but “blindly following China” isn't one of them.

How many people dying is acceptable to you?

Do you mean as a result of the virus, or as a result of losing their livelihood and being plunged into poverty?

I'm afraid that on the long term, the social unrest and the economic consequences will far outweigh the damage done by the virus. There is no plan on how long you can shut down whole countries. Europe, for example is not like China, you are just locking down everything, you don't have any other regions to support you. Sure, some people can work from home now, but by having the economy run at minimum level, work will go down, there will be no more projects even for IT people. How many people are losing their jobs already, what will happen if we need to quarantine ourselves for another 6 months to flatten the curve, if jobs are cut after just 2 weeks? I might have enough saved to be able to live not working for a couple of years, but I don't think that will help me if the entire social order is collapsing.

> I'm afraid that on the long term, the social unrest and the economic consequences will far outweigh the damage done by the virus.

I'm french. I have italian friends. I don't care about the economy. It will be back up. As long as there are humans they will need goods.

> there will be no more projects even for IT people.

Sure. But let's put it in balance for France:

- less work for IT people

- 350K deaths

I vote for number one. I can't believe I'm reading that on this forum, where people are supposed to be educated. This is insane.

"I don't care about economy" I didn't know I'd ever say this, hate these words, but this is privilege talking.

Look at life expectancy chart for Russia in the 90ies. This was mere economic mismanagement, and it's far worse than the worst case virus scenario. In some countries, unemployment and economic mismanagement leads to civil wars, revolutions and dictatorships.

Sure, techies in democratic/democratic-socialist first world countries will be probably fine in bad economy, if my experience in the great recession is any indication. A chance to buy cheaper stocks, too! However, even in a mild recession hundreds of millions (at least) will suffer. I'd choose 350k deaths.

EDIT: Come think of it, if you could completely mitigate one historical event in Europe, would you go for Spanish flu (millions of deaths!) or Great Depression (mere economy, of no consequence)?

Of course the spanish flu. The most deadly event in recorder history. Killed more than the two great wars.

Life is the most important thing.

"The most deadly event in recorder history" apparently you are not very familiar with recorded history. Incidentally, Great Depression allowed a certain populist guy to come to power in a European country and to unleash an event that was several times more deadly. I guess he didn't do enough damage to your country in particular, eh?

I has ravaged my country. However the bad situation of germany at that is to be blamed on the French for being too soft on this country after first world war. They should have been kept under control.

Also, the spanish flu has killed between 50M - 100M according to the most recent estimations.

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