Questioning the Clampdown | Hacker News Reader

Questioning the Clampdown

wsj.com

46 pointssbuttgereit62 comments

The last 24 hours have seen some dueling arguments, from respected sources, regarding how to model this.

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.

There is a summary of the imperial paper on Twitter

https://twitter.com/jeremycyoung/status/1239976309456916482

Not a very pleasant reading if people are hoping on a quick fix.

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 I checked the Wayback archive, and it says it has been archived a lot of times, but it isn't working.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?

the first link is a pdf. try checking your downloads folder?

I know it’s a PDF. I got it eventually. Did you check archive.org for the url? As of yesterday it was simply broken.

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.

Very well written.

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.

Don't forget we have massive campaigns to immunise against flu.

We don't really have an accurate infection rate from the flu since we don't test for it. Most of the flu data is collected via surveys...

1% of 7 billion is 70 million, so its 100 times worse than you thought.

That was the percentage of infections I was spitballing. 1% of that (a really low CFR) would be 700K fatalities.

> 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.

> death rate in the absence of hospitalization

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.

You need to include number of infections, because 1% of a very large number will overwhelm healthcare systems.

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.

There's nothing voluntary when your boss is saying, "Well, I'll be at work - look forward to seeing you there".

> must be voluntary

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.

Have you seen photos of large groups still hitting the bars? Lots of people think they're invulnerable.

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.

Please don't dismiss this illness. Your stated facts are not correct. One is 50 times more likely to die from CORVID-19 than a car crash.

The latest CORVID-19 fatality rates for those aged 15 to 44 is 0.5% [1].

The odds of dying in a car crash in one year are 0.01% [2]

[1] https://www.statnews.com/2020/03/16/lower-coronavirus-death-...

[2] https://injuryfacts.nsc.org/all-injuries/preventable-death-o... - assumed 78 year lifespan

Not to be picky, but those stats may be different for people that get intoxicated on a regular basis. Much like OP suggests.

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

It's COVID-19, not CORVID-19. And like your accuracy in spelling the disease, your facts are also poor and unsubstantiated.

Future despotism agrees.

Here's what it comes down to then; Which option is cheaper:

1. Spend money to temporarily increase hospital beds and ventilator capacity, but keep everything else running normally, or;

2. Shutdown everything to slow the spread so that we don't need to increase bed and ventilator capacity.

I'm tempted to say that adding bed and ventilator capacity is cheaper. I don't think that option costs trillions of dollars, like option 2 does.

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).

Why 6 months? How much money does it take to do it in 1 month? Is that amount of money less than trillions of dollars?

It's not a cost issue. It's supply & capacity issue. You cannot create instant supply immediately, even with a trillion dollars.

Lower requirements by having virus treatment staff with rapid specialized training

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.

Cremona, Italy - not a single patient survived ventilation/ecmo to date https://www.youtube.com/watch?v=rfkbv_WQtn0

It's not either/or, it's essential to do both shutdowns with enforced social distancing and build capacity, the first to buy time for the second.

The disease spreads exponentially, not linearly. Bed increases (and staff, buildings, ventilators...) would have to also be exponential to meet it head-on.

https://archive.md/KMBQc

In the final analysis, it will be said that Trump sacrificed his crown jewel, the American economy, to save lives.

I think better of him for it.

[flagged]

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.

There isn't consensus on whether "ok, boomer" is a slur vs a protest or criticism. It seems inappropriate to me to ban accounts for using that phrase.

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.

[1] https://www.cdc.gov/H1N1flu/estimates/April_February_13.htm

[2] http://www.protezionecivile.gov.it/media-communication/press...

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.

Not even H1N1 - annually about 500K people die of the flu and we don't even consider panic.

I just googled that H1N1 had a fatality rate of 0.02% . Current estimates are that covid is 50x more deadly.

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