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Comment by whymauri | Hacker News Reader

For the love of God, why don't people understand yet that healthcare systems are not ready to be over-run by the sheer number of patients in the worst case? That the death rate of just the virus is not a good indicator of potential casualties with an over-burdened healthcare network? That even if that wasn't true, that the preventable deaths of people due to incompetent governance and leadership are still a cause for concern?

I see this sentiment, this statistic, and this comment several times, every day. And I see it debunked several times, every day. Why do people keep saying this?

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Because some people are dying to defend whatever their politician-of-choice's line of thinking is.

Please don't post shallow dismissals or flamebait here.

No one knows what's happening right now, so it's natural and inevitable that are different views. As long as people express their views thoughtfully and respectfully, that's within the site guidelines.

https://news.ycombinator.com/newsguidelines.html

Ok, sorry.

I think people are searching for answers that no one has yet, and also for leaders to gauge both sides of the impact of any response.

We must admit that a severe economic impact is also a severe health impact. That much is settled science.

So one reasonable question becomes how much damage, not just in terms of dollars, but in terms of lives, would for example a GDP of -25% cause?

The impact of the virus to the percentage of the population that requires treatment is magnified significantly by an overrun healthcare system. That is a salient point. It means that spreading out infections over a longer time will allow better treatment for hospitalized COVID patients on average and save lives.

But graphics like the famous “flatten the curve” animation [1] are unfortunately quite misleading. The “capacity” line is drawn crossing some point on the y-axis which makes the graphic look compelling. The true ICU/ventilator capacity line is perhaps 4 pixels off the y-axis on that chart. We also don’t have any x-axis units, how many months would the curve have to stretch to keep the number of cases under capacity? And there’s another factor, for as long as hospital ICUs and healthcare dollar spend is dominated by COVID cases, there are all the other healthcare needs of the country / world which are suffering.

It’s reasonable to expect a macro level analysis of the net health impact of non-pharmaceutical interventions (NPI) such as widespread and long-term suppression. I have yet to see a compelling scientific analysis on this topic.

Even the UK Imperial College report admits that there is not a clear cut moral or ethical “answer” based on the severe economic and health impacts of taking dramatic action to populations that otherwise would not be severely impacted by COVID.

The thing right now that’s confounding me is trying to comprehend how China and South Korea were able to, not flatten, but stop exponential growth, given the level of spread that we would expect to have occurred before suppressive measures were taken, based on the unmitigated R0 range. There were a lot of people traveling out of Wuhan before the lockdown [2], and yet the impact to greater China was relatively minimal, while most of China is now back to work.

Frankly it gives me hope that there’s reason to believe, particularly with warmer weather coming, that it’s easier to get R0 below 1 than we might otherwise suspect. It would be a welcome relief to be spared having to make the extremely difficult choice for or against long-term suppressive measures.

[1] - https://images.app.goo.gl/FtdN3kYowN2bSD3HA

[2] - https://www.nytimes.com/interactive/2020/03/22/world/coronav...

Maybe you should read the NYT article I sent. That is the death rate of Wuhan, where “care” meant being forcible quarantined on a stadium floor.

1.4% figure is the death rate with terrible care. Compare that to the non-corona USA death rate of of 0.8%

In other words, even with terrible care the death rate of people with corona is only twice the death rate of people without corona. That’s not very alarming to me. And hardly worth these totalitarian economy stopping measures.

That is not true. People that needed intensive care got it. They build new medical centers for a reason. Not everything China does is bad, we simply don't understand the cultural reasons for the way they sometimes act because it is different!

So we do not trust Italy either. Especially northern Italy where hospitals are on US/European level?

This completely specious position is useful for all arguments!

Gun deaths, drunk driving, terrorism, opioid deaths, suicides -- just compare them to the natural death rate and call it a day. I mean, those ones all pale compared to COVID-19, so apparently they're complete non-issues.

But I think comparisons to the natural death rate are correct in all of those cases. If someone proposed to solve the issue of drunk driving by closing all bars and banning all social gatherings, our response would be a lot closer to "come on man" than a detailed cost-benefit analysis.

The death rates aren't the only thing that enter the equation, which is obvious if you think about it for a few seconds.

Furthermore, and I can't believe I have to type this: Drunk driving isn't an airborne pathogen. You can't "catch" drunk driving after unknowingly breathing in alcohol fumes from someone in the subway, then suddenly, 10-14 days later, wake up in your car having an accident after having spread some more drunk driving to people you've been in proximity to.

Why would it be "come on man!"? Because we have the ability to ban drunk drivers from the road, which we've done. We however don't have the ability to ban the coronavirus from our lungs, but I'm sure if we did have the ability to do that, we'd just do that instead of … you know, locking everything down.

We're doing what we're doing because it's the only thing we can do. Some countries are trying other things. Some are better prepared than others and can afford to do less radical things. But what every country can pretty much (at this point) agree on is that, left completely unchecked, this will end us. Not just through the disease itself, but through the after-effects of the healthcare system collapsing.

I don't think every country can or has agreed on that. A lot of people argue that we shouldn't let the healthcare system collapse, that it's worth paying any cost no matter how large to prevent, but healthcare systems have collapsed in pandemics before and it's never been the end of the world. And to justify some of the proposals I've seen floating around, where we'll all be imprisoned at home for 3 or 6 or 18 months, "end of the world" is pretty much what you'd need to believe.

Imagine if the virus doesn't have a fatality rate that's very high in one sense, but it's high enough to overload the healthcare system so that most people who need to be hospitalized will just be left to die for a few months.

It won't end civilization, it won't be a blip in population growth, but I have a very strong reaction that "pride goeth before a fall" and you shouldn't go and assume that you and everyone you love will be lucky. It wouldn't make sense to destroy civilization or the global economy, but I don't think it's obvious that coping efforts are not worth a few trillion dollars in redistributed wealth and a lot of "nonessential" people staying at home for a while.

From some of the charts and numbers I've seen, about 10 million people in the world die from infectious diseases in an average year. If everyone got COVID-19 and 1% died, that would be something like 70 million. Plus who know how many would die from other causes that could not be treated due to the epidemic. So, what is worth doing to save 70 million people? I don't even know if I want to attempt to answer that, but if you're saying we're going too far, then you should have an answer.

But whatever, I'll attempt to answer myself. In the US, my impression is that liability for a death in civil court, could be on the order of a million dollars, as that's the order of magnitude of what an average person makes in a lifetime. Multiply a million times 70 million and you get $70 trillion. So that puts bailouts and stuff that cost a couple trillion in perspective. Maybe it is in fact coldly rational to try to prevent the virus from spreading?

Imagine that last year, someone proposed that you and 99 other random people should hole up in your rooms for 3 months. You can't see anyone in person, nobody can visit you, you can only leave to get groceries or go for a walk alone. In return, one person gets cured of lung cancer. Do you take that deal?

Of course you don't, it's not even close. That's an absurd degree of sacrifice to make in return for 1/100th of a life. But it's the same degree of sacrifice we would be making in a 3 month lockdown.

Well, it's a bit contrived, but look at the math with our numbers. 1/100th of a life is worth maybe (at least) $100,000 in present day US society. $100K/3 = $33.3K/month. That's $400K per year. I imagine that I'm creating less value doing what I'm doing now, and probably so are you. So, yes, it seems like a logical person would choose to sacrifice for that. Not everybody should, and currently, indeed some people are going about their jobs more normally. But overall, it makes perfect sense for most according to reasonable estimated costs vs benefits.

You've been using a lot of really contrived scenarios that don't faithfully represent reality.

Here's the reality: We're trying to stop a pandemic of a highly contagious disease that can overload most countries' healthcare systems and has the potential to kill millions.

Also, putting aside how contrived your example is: yes I fucking would take that deal. 3 months of inconvenience in return for someone's life being saved? You know people fight cancer for years, right?

That’s not a terrible argument. But people are more upset about murder drunk driving, terrorism, opiod, and suicide than dying of disease because it’s human caused.

It would make most sense to compare CoVID19 to deaths caused by disease per year in the USA, as that is apples to apples. I don’t have those numbers off hand.

Edit: https://ourworldindata.org/causes-of-death

The overall rate is roughly the same as the death rate from disease.

As I said in a previous comment, this is your fallacy:

1. "New thing X puts us at risk of losing Y lives every day."

2. "We lose Y lives to car accidents every day".

3. "Ergo, X is harmless!"

Except you now have 2Y lives lost every day.

Thats not a fallacy. Thats exactly my point. It's not worth decimating human rights over 1 year of 2x the human death rate. If it were 4x, 5x sure, but 2x is not worthy of banning nearly all physical human interaction for many months or more.

I don't like being locked down at home any more than you do. But right now, my freedom to go out impedes on my neighbour's freedom not to get sick.

COVID-19 has spread father than you think. It is also more damaging than you think. I'm hopeful the lockdowns won't be too long, and countries will gradually open up rather than all-at-once.

I strongly suspect you do. Nearly 100% of the people I've seen argue in favor of indefinite lockdowns are white collar internet natives, capable of getting a reasonable amount of personal and professional satisfaction through a monitor. If you know anyone who works with their hands for a living, or whose primary social activity is having a beer with the bros, you understand why it's not as simple as just "it'll end when it ends".

I don't know where you see me arguing in favour of indefinite lockdowns, and quite frankly, screw your shitty judgemental attitude.

Not only am I low risk, but I've already had the virus and passed it nearly asymptomatically. I'm likely immune. This shit doesn't benefit me in any way.

And while I may indeed, like most people on this site, make a living online; I've stopped working nearly entirely and have been donating my time to work on COVID-19 projects.

In the mean time, I can't see my girlfriend, can't hang out with my local friends (sorry, "bros"), can't do my usual sports, and I still have to support the people in my life who have it much harder than me because they can't work.

So no, I'm not in favour of indefinite lockdowns, but I'm also not in favour of ignoring the problem until it goes away on its own.

When I say "indefinite", I just mean that you don't seem to have a standard for how long the lockdown can be at maximum. The lockdown in my area, for instance, were imposed with no expiration date or even a clear explanation of when it'd start be lifted. (Which is why I'm very frustrated with people who seem to be siding with that kind of vague policy.)

Maybe I'm mistaken and you're not on board with that. Is there some definite period of lockdown you're in favor of, where after that period we accept we've done what we can?

I'm not the right person to ask. I'm not an expert. What I know is that I don't want to stay stuck in my house for the next few months, but I also want life to be normal when I do get out, and not turned into a "nobody can shake hands or kiss" movie.

I'm also not in favour of vague policies but can you really blame politicians in this case? It's easy to make predictions but nobody really knows what things will be like three weeks from now. What's the point of saying things will return to normal in three weeks if it's not grounded in anything?

My concern is that politicians don't seem to be acknowledging fundamental limits on how long a lockdown can last. One governor in my country suggested eight months was a possibility! That obviously couldn't actually happen - but the government could do a lot of damage fighting against reality to try and make it happen. Even for a 2 to 3 month lockdown, there are critically important questions like "why will anyone accept our country's money if we're not producing goods and services" and "what will we do about the fact that all small businesses are bankrupt at that point", and I don't see answers to them.

> If it were 4x, 5x sure, but 2x is not worthy

That seems like a normative judgement, there's no way everybody you talk to would agree with the exact place you drew the line.

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