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Comment by Abishek_Muthian | Hacker News Reader

China's Red Cross supposedly advised Italy yesterday that 'total economic shutdown'[1] is the only way to contain the COVID-19 situation in the country now.

It all comes to what part of the curve the country is now, the choice being total lockdown incl. economic shutdown vs aggressive testing.

Considering US lapsed on aggressive measures in the beginning and that proper test kits are just being flown in from Italy[2]; total economic shutdown seems to be the only option left.

P.S. There are still high-risk countries which hasn't gone into lockdown neither doing aggressive testing as of now, claiming the number of cases are low although the day-to-day delta is increasing exponentially.

[1]Italy correspondent of Aljazeera gave this information multiple times on live, couldn't find static link to it as of writing.

[2]https://www.msn.com/en-us/news/us/air-force-flew-500000-coro...

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> total economic shutdown seems to be the only option left

That's quite the overreaction.

Italy found that among fatalities the median age is over 80 (older than the average lifespan of an Italian man).

99% of fatalities were among people with a prior illness. About 50% of the deaths were people suffering from at least three other illnesses.

https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho...

To put it another way: most of the folks dying from COVID-19 were already dying. This disease is the straw that broke the camel's back.

Should we just give up on them? No! But instead of quarantining everyone, and sending us back to the stone age, we should work to quarantine these folks while the rest of us return to normalcy and build up our antibodies and herd immunity.

> 99% of fatalities were among people with a prior illness. About 50% of the deaths were people suffering from at least three other illnesses.

So far... wait until you get the number of critical cases above the number of ICU beds and you'll see 18 year olds dying from this

You won't, because we triage patients.

Triage isn’t a cure

No, but it's something every software developer understands is necessary in every system every day.

Ventilators are first come first serve. Once someone is on a ventilator it’s not like you can unhook them for a younger patient.

And there are always ventilators becoming available and patients getting triaged for their order in line (if there is a line).

Not any more:

"With demand outpacing supply of beds and respirators, medical workers are told to prioritize younger patients."

"The principle of "first come, first served" has been abandoned, said Mario Riccio, an anesthesiologist who works at a hospital in Cremona."

- https://www.politico.eu/article/coronavirus-italy-doctors-to...

Based on what? According to the Bloomberg article -

”As of March 17, 17 people under 50 had died from the disease. All of Italy’s victims under 40 have been males with serious existing medical conditions.”

They reached maxed capacity of beds or ventilators right? We read stories of doctors having to make life & death decisions. Where are the dead 18 year olds?

Spreading info like that on a hunch, or an exaggeration, is counterproductive if not damaging.

> They reached maxed capacity of beds or ventilators right?

They just started to reach max capacity, and not in every region, every hospital at the same time...

Fair enough, I should have said, ”In some areas”. A little snippet from the CDC I have posted a bunch that I found useful -

”Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic.”

So, we know not all the hospitals are experiencing the same levels at the same time. A big reason I wish we were more precisely targeting shutdowns and quarantines.

It doesn’t make sense to throw these blanket executive orders over entire states. As we can see from the slides, the economic consequence are dire. Why not target the cities entering acceleration only?

In the meantime, start building drive thru testing. Distribute thermometers. Practice social distancing & aggressive sanitation, but not destroy out national security in the process.

But this part,

”All of Italy’s victims under 40 have been males with serious existing medical conditions”

Sure it’s early, but even in Italy, in one of the worst places in the world for the virus right now, that information should be very illuminating to us I think.

> Why not target the cities entering acceleration only?

Because the long incubation period and the lack of sufficient testing makes it impossible to know which cities are infected early on.

And, to put more bluntly, because we have two models to look at and choose from: the Chinese one, with harsh containment measures that were very effective (if you believe their numbers) and the Italian one, with moderate containment measures and a lack of sense of urgency from the populace, which resulted in a downward spiral with more deaths than China despite having only ~58% the number of cases.

> I should have said, ”In some areas”.

And no, you shouldn't have said that, you should just wait another week.

Here is a fresh preprint from University of Padova showing that weak quarantines have no significant effect:

Quantifying undetected COVID-19 cases and effects of containment measures in Italy

https://www.researchgate.net/publication/339915690_Quantifyi...

Current situation in Geneva, Switzerland - 2 critical male patients, one 27, one 29, no prior comorbidities at all. Not sure they will make it. Wife is a doctor and just checked this in their information system.

The idea that relatively young (most of folks here) will be just fine is not true. With overwhelmed healthcare, most criticals will simply die. Once doctors will get sick (and they will), it will make everything, I mean literally any disease and injury much more dangerous. Sure, most will survive, hopefully without any permanent lungs/kidneys/testes damage (was this confirmed or just a rumor?).

Maybe as humanity we've grown weak and can't tolerate medieval mortality rates anymore, but this is who we are right now. There is no easy solution to this. There is unavoidable harsh economic impact coming. Nobody has clue which option will be at the end better than others.

Accept it, and try to find ways to help fellow human beings instead. We are in this all together, rich and poor, left and right alike.

>Current situation in Geneva, Switzerland - 2 critical male patients, one 27, one 29, no prior comorbidities at all. Not sure they will make it. Wife is a doctor and just checked this in their information system.

I don't know about the law in Switzerland but unless you are lying that is something she could be fired for in many countries.

For checking overall status without going into details? All doctors within given hospital have this kind of access here. 'Many countries' sounds rather like very few for this case, aren't you thinking US specifically?

It is as tough in Sweden, doctors and nurses have of course access to patient files but every access is logged and if someone is caught accessing files about a patient they are not working with they will be reprimanded or fired.

The last thing hospitals want to do right now is to fire doctors.

I mean sure, but I was just saying that countries outside US takes unauthorized access to personal medical data incredibly serious.

Two examples doesn't change the stats. There were 0.8% of deaths in Italy that did not have any prior comorbidities. Picking two of those examples does not increase the 0.8%.

I don't think any one is under some kind of delusion that some young people will die. The only question is what percentage and what changing those numbers will cost. Picking specific examples of bad outcomes and pretending the risk is as high as older people isn't doing anyone any favors.

I wish I could upvote this about 50 more times.

It's not just old people though. Infants. Immunocompromised individuals. People with asthma. People undergoing chemotherapy.

The narrative that this disease only affects the economically unproductive is dangerous at best, and inhumane at worst.

Honestly, what do you think is going to happen to these people if the economy totally shuts down? it's going to be easy to have a chronic & serious health condition? The same?

My feeling is that I'd rather be chronically sick in a good economy than in a depression. What happens when medicine becomes unavailable due to supply chains being cut off?

The ultimate purpose of the shutdown is to not overwhelm healthcare providers, so people who need treatment actually receive it rather than die waiting in an overcrowded ER. So yes, they would fare better in a shutdown with lessened spread of the virus and fewer people putting strain on healthcare.

Why didn't you respond to the actual point? What do you think is going to happen to people with chronic health conditions in a depression, or when supply chains stop functioning? What happens when (random example) e.g. anti-HIV medicine shipments can't be made and we start to get new mutations in those diseases?

Do you just assume we'll treat chronic health issues as a priority in a depression? I'd like to think we do as well, but the point is that things may well just stop working.

People with chronic health conditions outside of the coronavirus aren't going to get much care in a crammed ER run on triage and therefore serving acute cases rather than chronic if we don't attempt to limit the spread. The staff shortage is worse than any supply shortage. In a healthy economy free of pandemic, CA is short on doctors and nurses.

> what do you think is going to happen to these people if the economy totally shuts down?

I expect the economic impacts to be rough either way. We don’t have a choice for “no economic impact” anymore. Either we do it in a coordinated and somewhat controlled manner now while we still have a handle on cases vs illness, or the impacts hit, roll, and peak along with the cases of illness while well/well-ish people try to improvise individual responses which probably have similar econ impacts but may not be as effective.

Or did we think that thousands on thousands falling ill at once wasn’t going to hurt economically?

How can you say the economic impacts will be of similar magnitude when looking at the age distribution in severe cases & death here? How do hospitals being overwhelmed have the same magnitude of effect as a literal shutdown of a country? Or, indeed, the shutdown of multiple?

To me it seems likely the difference between a recession (guaranteed) and a real, extremely serious depression which will be fully capable of exacting its own toll on lives.

First, while I fully expect that the worst effects will hit the advertised danger demographics the hardest, at wide enough infection coverage there are going to be poster children for folks who didn't fit that profile[0]. Not just a few.

Second, I expect that the illness impacts will hit even broader, both in sheer numbers and crossing demographic expectations, resulting in people directly absent from work and consumption for weeks at a time.

Those are the first order effects. The second order effects on psychology among a large number of folks having loved ones dying and acquaintances suffering are going to produce some behavior changes. Some of them would be similar to those we're seeing with lockdown, but as I said, improvised rather than coordinated, probably combining some degree of the same impacts but with less of the benefits.

The recession might be milder if we trade a higher death toll. Might.

But the financial markets sure didn't think we were going to escape one even before US civil measures started ratcheting up.

[0] https://medium.com/@juliael84791135/this-isnt-a-normal-flu-i...

"these people" are dying in mass and overwhelming the medical system and even the crematoriums. And they deserve to have quality of life and die with dignity and proper care.

I'd rather a strong, comprehensive public health response than trying to economic recovery ourselves out of this problem. IMHO, the economy is a distraction to numb us from the tsunami of ICU patients and deaths to come.

The economy is not sacred, and is cyclical, and needs a good purge and rebalancing every 8 years or so. Recessions reallocate capital to be used more efficiently. After 2008 they were politicized as something to be avoided at all costs.

The part of the economy that is responsible for electricity, clean running water, food and emergency services absolutely is sacred. The rest of it can maybe be put on hold for a few months; but it will be very painful for many, many people.

What isn't sacred are the people who own all that. They are as disposable as are any other parts of the economic machine. Replacing them is probably a good idea.

So what’s your proposed solution? Let’s get back to work, let the fire burn and who dies, dies?

It’s a solution ( it wouldn’t work the way you think, but it’s an option), but at least admit it clearly and live with it.

I'm sure that accusing someone with righteous indignation here feels edifying, but it indicates to me that people are perfectly okay with trading on lives - future ones. At least admit it clearly and live with it.

I think the interesting question (that we don't know yet) is how much of these actions are political because they want to show themselves strong and the public demand some kind of action. And how many of these actions are needed to flatten the curve, prepare the healthcare system and to work on cures/vaccines? For example shutting down schools have a huge effect on society but does it have a similar huge effect on the spread of disease?

How long can you just shut down industries, keep kids out of school and will it make a significant dent in the total mortality? It could be that a couple of weeks of social distancing will be enough but can it be months and what are the comparable effects.

I know it is more dangerous than the normal flu and I will not downplay that but take Italy (that yes, would be worse of without shutdowns) you have 4k deaths so far; mostly old people while a couple of seasons ago they had 24k deaths attributed to a bad flu season.

The social distancing and shutting down society needs to work reasonably fast otherwise I wonder if it is worth it, at least in countries where you already have widespread disease.

Let's assume for a moment that governments did nothing.

Obviously, the illness itself was always going to cause an economic blow by killing and sickening people.

And then there would be damage from behavioral changes. People were pulling kids out of schools, canceling events, and avoiding travel without being ordered to do so.

It doesn't seem like the "good economy" you suggest was ever an option.

Honestly, what do you think is going to happen to these people if the economy totally shuts down? it's going to be easy to have a chronic & serious health condition?

https://www.statista.com/statistics/505995/adults-with-hyper...

The state with the lowest incidence of hypertension still has roughly 1 in 4 adults with hypertension. West Virginia is at the top with more than 1 in 2 adults. What do you think happens to them when they develop COVID-19? Hypertension is at the top of the list of co-morbidities that worsen outcomes. Medication to treat hypertension is often extremely inexpensive even without insurance ($10-$20/mo at the low end) and thus hypertension is often easy and inexpensive to manage.

How many folks working at pharma companies do you think have hypertension? What happens to the supply chain when people are incapacitated?

Even if a minority of the population will need hospitalization (hell, even if the minority is small enough to avoid overwhelming hospitals)... how many do you think will work through a SARS-CoV-2 infection?

The gravity with which I treat this pandemic is in large part based on government action. China quarantined nearly 100 million people. Iran is building mass graves. The uber-pro-business trump crony that serves as the secretary of the treasure took one look at the GOP plan and essentially said "double it, and make it cash with no means testing."

The folks arguing for immediately disruptive action aren't ignoring the economic consequences, they've decided that the economic consequences of doing nothing will be worse.

WHO director specifically mentioned in his briefing yesterday that 'Young people are not invincible and that data from many countries show number of cases below age <50 getting admitted to hospitals make up a significant proportion of patients'.[1]

It's not just fatalities, hospitalisation i.e. exhausting healthcare facilities is the primary concern with COVID-19.

There is no guarantee that young people wouldn't make up high mortality list in a poor country with high younger population, rich countries should get their acts together to stop that from happening in vulnerable countries.

[1]https://youtu.be/6BOKgSCPD4E?t=32

Not to mention complications. Little is known yet, but there are indications that some surviving patients get permanent lung damage. Especially when intensive care is not available. Imagine having 30 million 40-year-olds who will be short of breath for the rest of their lives.

There is no need to imagine, we have the forecasts from the Imperial College report:

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

There are 40 million 40-somethings in the USA, you're proposing that 100% of them will have lung damage.

Let's imagine that 80% of the population is infected, that 80% of cases are symptomatic, and that 80% of the 4.90% of hospitalised cases (this 4.90 is direct from the report) get damaged lungs. This is one million 40-somethings, not the entire population.

1 million sounds like a lot, but its only 2.5% of the population at that age range, and assume worst-case.

You know what causes reduced lung functionality in adults? Asthma, driven by air pollution from vehicles and coal power plants. 7.7% of adults have Asthma. Where is the war-scale drive to eliminate fossil-fueled vehicles and power generation?

So true, I can't understand why climate change hasn't been given the same considerations in the past :(

> Where is the war-scale drive to eliminate fossil-fueled vehicles and power generation?

Might as well just shut the economy down to eliminate that.

> You know what causes reduced lung functionality in adults?

Vaping. I see most of the young adults doing this. Its probably why they're having the higher hospitalization rates with coronavirus. They already have lung damage.

Yes, thank you. So many people are confused about this just being about the # of people dying from covid. The entire health system gets knocked down and all the other preventable diseases that killed us before are no longer prevented.

We haven’t built herd immunity to the flu despite millennia of trying.

This thing has evolved three strains with only a couple hundred thousand cases. A couple billion turns it into a shit show.

Stop spreading this. Median hospitalization age is 65. 40% of patients on icu are under 50. With the rates of hospitalization in 30-39 year olds no country would have enough icu beds even for them

Gonna need to see some actual data. Median hospitalization age of 65 and then 40% of patients in the ICU being under 50 already doesn't even make any sense.

Maybe a moot question/point, but do we take into account patients in ICU that are unrelated to COVID? E.g. traffic accidents, workplace accidents, heart attacks, etc. I am not trying to spoil the discussion, and I do understand that medical services try to save all lives irrespective of age. So someone who's 80 and is down with COVID and someone who is 25 and fell from his Kawasaki doing 200km/h will each occupy a unit in ICU. That would skew the data.

(my bad, it's not easy to go through the slides on a phone)

Edit: by "skew" I imply mix the two categories COVID Vs "all other causes" and will give false average if we are trying to focus only on the COVID cases.

Sure it does. 40% under 50 years old means 60% are 50+ years old. The median is by definition the 50th percentile; aka, at least 50 years old and likely somewhat older, since more than half of all cases are in people who are 50+ years old. Median age being 65 aligns pretty well with that, given that 65 is somewhat above 50.

This looks correct. Here's the data https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm?s_cid=mm... Scroll down for TABLE. Hospitalization, intensive care unit (ICU) admission, and case–fatality percentages for reported COVID–19 cases, by age group —United States, February 12–March 16, 2020

Parent was referring to fatality rates and you instead presented hospitalization rates, why do you want them to stop spreading fatality rate information?

When hospitals are full, the fatality rate will approach the current hospitalization rate.

You will get tarred and feathered for your comment but you are correct.

Here is why you'll get tarred and feathered, because right now the media is covering the health costs of the virus extensively, but it's not covering the economic costs, which are already unfolding now in the form of businesses dropping vendors and announcing layoffs because their anticipated revenue until further notice is zero.

I've seen so many bros on my feeds who puffed out their chests a month or two ago and said, this virus is not a big deal. Then there were cases in their state and the media was reporting the deluge of new cases in the US and they said oh I was wrong, we need to be on total lockdown, and they're hiding in their apartments.

What will happen next is the jobless claims will come in, which we can clearly predict based on current business activity, and they will break records. I saw one estimate of around 1.5 million jobless claims this week, which is a record. I guess the bros will start squawking about the economic damage in 2-3 weeks once the media has covered this widely and people they know are out of work.

Small businesses (and some large ones too) typically don't have large cash reserves like Google. They also don't know whether this will last for one month or six. So they are in the process today of shutting down and telling everyone to go home without pay, they have to do this until they know what the long-term outlook is.

Nothing changes, most people are sheep, they parrot whatever's in their feed, they are poor at prognostication and self-examination, their attention is occupied by whatever narrative is being shouted most loudly. Nothing you can do.

I noticed yesterday for the first time that there is starting to be some discussion about the damage caused by the lockdowns. Before that I was amazed that no one was interested in even discussing it. So there seems to be a trend of people waking up to it. Thanks for your brave comment. Bros are slow ;)

Take a pause for 2-4 weeks and reevaluate. Everyone has a 6 month buffer right..? :)

Quarantine doesn't send anyone to the stone age. The economic shock will be devastating. But there is no long-term, sustained growth without occasional pruning.

Also...

You make the error of assuming that (A) high blood pressure, diabetes, and heart disease mean that a person is "already dying," and (B) people who survive don't become debilitatingly sick.

Some of this economic damage is also the result of toppling imbalances that have been artificially propped up since before 2008.

The virus is just a convenient excuse; a crisis would have hit at the first sign of trouble.

> The virus is just a convenient excuse; a crisis would have hit at the first sign of trouble.

Sure, the market was seeming to be overheated and due for a correction.

Without the virus, maybe it's 2008.

With the virus, it's starting to feel like 1929 again.

Huge numbers of people are unemployed right now that wouldn't be in a normal recession.

Wait till the unemployment numbers come out.

> Italy found that among fatalities the median age is over 80 (older than the average lifespan of an Italian man).

> 99% of fatalities were among people with a prior illness. About 50% of the deaths were people suffering from at least three other illnesses.

This is true, but what about the overcrowded hospitals this causes? People who weren't gonna die will now die. And what do we do about the doctors and nurses who are pleading with everyone to act?

Perhaps something along the lines of strict contact tracing could have been done, but now it seems like it's out of hand.

Death rate is still pretty high for young people, too 0.5 - 1%. I wouldn’t take that risk.

> Italy found that among fatalities the median age is over 80 (older than the average lifespan of an Italian man).

Selection bias. They're so overwhelmed they're using age as a primary factor to triage patients. Clearly, if you put your medical resources towards saving the younger patients, the younger people are going to have a better survival rate. Lack of a ventilator, when you have a severe lung disease, is a massive risk factor at any age.

> 99% of fatalities were among people with a prior illness. About 50% of the deaths were people suffering from at least three other illnesses.

Again, if you look at the oldest people, you're probably going to find more diseases there. This could easily be just another consequence of age-based triage.

I dislike this hyperbole. I still have electricity, running water, heating. Where is this stone age? Where is my cave?

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