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Comment by CydeWeys | Hacker News Reader

Many Americans are underestimating how disruptive a mass uncontrolled pandemic is going to be to their lives. If hospitals are completely overflowing and most people who get serious symptoms die for lack of available treatment capacity, and everyone knows friends and family members who've already died form it, do you think life isn't going to be massively disrupted anyway? People will hunker down and go nowhere out of a sheer sense of self-preservation, without the government needing to tell them to.

The pandemic itself is what's causing all the disruption and economic hardship. The social distancing measures are NOT the cause -- in the absence of them we'd be doing even worse off in the long run.

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> The social distancing measures are NOT the cause -- in the absence of them we'd be doing even worse off in the long run.

I don't share your high level of certainty about that.

I don't believe an uncontrolled pandemic would have caused the amount of business closures and layoffs and mass unemployment the lockdowns have already caused. It would certainly be bad for business, and there would be some layoffs, and we would almost definitely have a recession, but many businesses that are now closed would have remained open, motivated purely by self-preservation.

Even now we see people out and about, even though the government tells them to stay home, and I don't believe that would change very much if the disease was uncontrolled. The rich can afford to stay at home, but the poor need to go to work. Self-preservation includes the desire to earn an income.

Hopefully we don't find out later on that the total amount of human suffering caused by the lockdowns outweighs the suffering caused by the disease. I think it probably won't, but we need to consider the possibility.

You aren't accounting for the massive economic costs of all these extra unnecessary deaths.

As I wrote, I believe there would be a recession either way. The question is whether the recession caused by the lockdowns will be worse than one caused by an uncontrolled pandemic.

Why do you think those unnecessary deaths would cause more economic damage than a government-mandated shutdown of almost all work that cannot be done from home?

A recession where people live is better than the exact same recession where people die. (Yes, I know, people do in fact die from purely economic reasons in a recession. That's still different from people dying being the cause of the recession, because in the second case, there's more dying. The people die from the disease, which causes the recession, and then people die from the economic consequences of the recession.)

But even in strictly economic terms: Here's a person who's 30. If they die, we lose 35 or 40 years of their work. If they have to stay home for two months, we lose two months of their work. (Yes, far more people have to stay home than would die if we all just went about our lives. But even assuming a 1% death ratio, N people x 2 months is less than N/100 x 40 years. There's also the health care costs of all the ones who are hospitalized. It's better economically to do it this way.)

People also aren't factoring in that, while the death rate may be low for young healthy people, the hospitalization rate is still quite high, and recovery time is long. And the death rate even for young people goes up substantially if the hospitals are so overwhelmed that they can't even provide oxygen and nurses for young healthy people.

Do you have solid data sources for this?

maybe you could go verify this information yourself and post back if you find something worthwhile refuting the original claim

It is a new narrative that isn't really compatible with anything else I've heard. Which is basically that asymptomatic carriers are the norm, you are contagious even without symptoms, and this kills people in the risk pool.

So, someone making a claim that it is dangerous for non risk pool people feels like something that should be easy to back up.

That's actually been the standard story for most of the time. Dangerous mostly to at-risk individuals, but requiring ventilators for a succinct percentage of people who aren't at risk.

That's the main reason that Britain changed their tactic, and the main reason most countries are worried, especially about ventilators.

That narrative isn't final- there's a lot of unknowns. As you say, we are now thinking there are more asymptomatic people than we thought, which would be huge.

Yeah, sounds like I am just further in how I read the asymptomatic narrative. My understanding is it is now the narrative that most people that get this week barely register a cold. See the story of Greta.

Such that most people are asked to distance, since they are no risk for themselves, but extreme risk for the people in the risk pool.

Is that not the fully accepted narrative now?

I don't think that is actually the case, I hope you had quite a few you first-hand accounts of people who had it and it was not 'barely a cold'. more like 4 days in bed, still very lethargic for the next 2 or 3 days. it depends on the viral load that is received. small load = milder symptoms.

I think this is why it is so dangerous for healthcare workers, they get prolonged exposure and them by the time they become ill they have a lot of virus. if you picked it up off someone on public transport, for example, then your exposure would have been maybe 10 or 15 minutes, so you get a milder case.

Is this established? Last I heard asymptomatic was the norm. And they had no explanation for why.

Note that I am definitely not costuming this is a no risk virus. If you are in the risk pool, this is clearly deadly. They don't know what that risk pool is, though. All evidence is that kids are nigh immune to it. Older people are likely in the risk pool. But age is looking like a proxy here.

> asymptomatic carriers are the norm

Asymptomatic people while they are infecting others doesn't mean these people will remain asymptomatic all the time. Just that at the moment they are spreading the virus they aren't having any symptoms. They can and it seems a lot of them do develop the symptoms only days later (especially once the children aren't considered).

That just means that it's hard to contain the carriers early enough to limit the growth of infection based on the symptoms. Until the antibody tests show otherwise, we can't even assume that "most will be fine" in the sense that it's not true that 20% of all infected (again, maybe excluding children) would really need the hospital.

One of the reasons 20% of all "confirmed cases" need the hospital is that the doctors can't know who of those 20% will get even worse to need the machine to be kept alive.

And no country could ever have enough doctors and machines to treat such a big part of population at once.

My question is if you are making up 20%. Especially if you consider children and younger family, it is a reasonable hypothesis that entire Italian families are getting this, not just the older members. At that point, it seems also reasonable that it could have hit many many more than they are reporting.

My hypothesis is that whatever that number is, it is not constant across regions. Something is marking it higher where it is higher. Across age ranges, even; unless Japan starts a massive upswing soon.

> My question is if you are making up 20%.

No. There are countries which do test all that could possibly be infected (e.g. if they were in contact with the person who was tested positive). Even then, those that are positive are the small percentages from all tested, but it‘s still that 20% from positives need the hospital.

I haven't been able to find hospitalization numbers. And this seems flat incompatible with the idea that asymptomatic is the norm. Which, I grant is the new narrative, not the old.

I have found reliable death numbers. Well, posted death numbers. Quite easy to find that. I haven't even seen any posted recovery time numbers. Just recovered. Do, not sure what to make of that.

I assume you could proxy "serious/critical" with "needs hospitalization". But, that number seems to be all over the place. From 4% to 10%. Still below 20%. So, where are you getting 20%?

> From 4% to 10%. Still below 20%. So, where are you getting 20%?

From the graphs of all countries that publish their data. Those that publish give you statistic of the number of tested, number of tested positive, those needed hospitalisation and the dead. The death happens with delay of up to two weeks, hospitalsation one. The doubling time of positive tested is 3 days typically. Calculate.

What is the label that says hospitalization? All I have seen are "serious". And that has not been 20%. Am I just finding junk sources?

Yes, in the countries that officially label cases as such, the "serious" ones are those needing hospitalization. Others are being told to remain at home and stay isolated. Also note that even some of those who remain at home get worse later, and some die before they can be hospitalized. The major point that you have to be aware of is that the hospitalizations and deaths come later and that the doubling time is short. Also, the doubling time of 3 days means that the country which has 1/2 of the coronavirus allocated bed capacity on 1st of April won't have enough beds starting with 4th.

Also, please try to analyze as much countries (I know about European ones) as possible. Go for the official sources, or the pages in the Wikipedia on local languages, you'll find much more reliable data, and for some countries even official "in hospital" "in intensive care" and "deaths" numbers.

> Also note that even some of those who remain at home get worse later

The most recent example Boris Johnson is in hospital since only a day:

https://www.theguardian.com/politics/live/2020/apr/06/uk-cor...

News about him being tested positive: 27 March 2020:

https://www.bbc.com/news/uk-52060791

at that moment: "the total number of UK deaths 759, with 14,543 confirmed cases."

Now: "47,806 confirmed, 4,934 dead."

That they understand that it's going to grow more: "The National Health Service freed up 30,000 beds by discharging patients who were well enough and delaying non-emergency treatment,[342] and acquired use of 20,000 beds in private sector facilities." (wikipedia)

But they still also hope that the current measures will slow down the growth.

The Nederlands publishes hospitalizations:

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...

All cases, hospitalized, deaths: 10,866 3,483 771

They test less than some countries though, but you can see the factor of hospitalizations against the deaths, and note that deaths reflect many days older (and smaller) "cases" count and hospitalizations are somewhere in between.

Haven't been back where I can post.

The time lag is a valid way of deriving this number. In places that do a lot of testing, the number does look lower than 20%. Especially considering most only test those that go to the hospital.

https://www.worldometers.info/coronavirus/coronavirus-age-se...

people from all age ranges are dying, it is higher rate the older you are but 0.2% is still a lot of young people(10-39years old)

This is one where the nature of this virus not sending most young people to the hospital throws off that stat, heavily.

So, if they are right and most cases don't go to the hospital, then this is high. If they are wrong, and most cases do go to the hospital, then they have basically no idea how it spreads so quickly. At least, their stories are going to need massive revisions.

And again, I'm not claiming anyone wants this. Nor that I know all. Age just feels suspiciously like a proxy for whatever is upping someone's risk.

There is also the massive economic costs of everyone who gets sick. With uncontrolled pandemic, something like 5-10% of people would be out sick, 20% of those in the hospital. Plus, all the people who are caring for the sick or quarantined.

Essential businesses which are in person would be more vulnerable. There is a significant risk that health care, manufacturing, transportation, or grocery stores would need to shut down because too many workers are out sick and the rest are afraid to come to work.

> With uncontrolled pandemic, something like 5-10% of people would be out sick, 20% of those in the hospital.

It doesn't look that that estimate is nearly right. It is true that there are always people reported as "tested positive having no symptoms at the moment" but that is different from "tested positive and never developed the symptoms" due to the point where we are in the exponential curve. In short, the numbers could be significantly worse in an uncontrolled pandemic.

Now if it's only e.g. every second person that can be infected and completely remained asymptotic all the time, in an uncontrolled outbreak you'd have a moment where e.g. 10% of all population is so sick to need the hospital. And no system could sustain that. The reason for the huge hospital need is not "to give them a nice bed" but that they could be exactly those who will eventually need the machine to be kept alive.

That is likely true but if this runs it’s course naturally we will see an enormous peak and then just as rapid a drop as we reach herd immunity in a couple months

The true choice here is between a lot of deaths and a couple months of staying at home and fewer deaths but years of staying at home.

> That is likely true but if this runs it’s course naturally we will see an enormous peak and then just as rapid a drop

And millions of preventable deaths, just in the US alone. You're underestimating the psychological and economic impacts that would have.

In reality we wouldn't experience such a sharp peak because people aren't stupid; many will start self-quarantining anyway as the pandemic rips through the nation. The economic disruption isn't a choice we're making; it's going to happen one way or the other with this pandemic. Don't think people are going to continue merrily going out in society when it's a guaranteed ticket to a terrible disease.

I would like to hear an estimate of how badly this would effect demand. If a million people who spend a thousand dollars a month die then isnt that 12 billion shaved off spending over that next year? Im sure its more complicated due to ecnomic rent relations and other things I don't even know about but isnt this by itself a disaster?

The actuarial value of the typical human life is roughly in the neighborhood of 5-10 million dollars. It wouldn't just be spending shaved off in one year, it'd be every year after that too, and then there'd be all the knock-on effects of more government required assistance for dependents that can no longer be supported properly, lots of foreclosures, a reduction in childbirth and size of the next generation ...

And by the way, your math is off by a factor of one thousand.

From a purely economic standpoint, most of those deaths are not significantly reducing GDP.

As others have said, with a virus more contagious than influenza, the only real choice is for lots of people to get it. I'm all for a partial quarantine of the old and at-risk that lasts for a year, but it just isn't possible to shut down the whole world for that long. People don't understand how interconnected the global supply chain is. If this goes on, it will start with some simple things like your favorite deodorant brand and snacks disappearing from store shelves. Hopefully, people notice and pull back restrictions before it gets worse.

OK, so my wife and I are both over 70, and she's immunocompromised. Even so, personal issues aside, I agree that a global shut-down for a year or more would be hugely, even unimaginably, disruptive. And I also agree that health impacts for those not at high risk would be relatively minor.

However, once Covid-19 was circulating freely in the general population, isolation for old and otherwise at-risk populations would arguably be less effective. So we'd need more effective isolation for them.

I don't know what that might look like. Upon reflection, I don't believe that relocation-based isolation would be acceptable, and it probably also wouldn't be safe.

I've been trying to imagine how my wife and I might avoid infection for a year or more. We're lucky, I suppose, because we live in a well-organized community. And there are teams of younger people who do most of the shopping.

But for most people, there's no structure for anything like that. Except for those who belong to churches, I guess. And maybe it could develop via social media.

The question we have to ask, is as an at-risk person, do you have a higher chance of contracting the disease over the course of its activity if you are quarantined for two months but most people aren't, or if everyone is quarantined for a year?

I.e. if during quarantine you need to interact with people once per week to get groceries, etc., and there is only a partial quarantine, many people will be carriers, so each time you go out you have a 5% chance of contracting the virus. Your chance of contracting it during this time is 1 - 0.95^9 ~= 37%.

In the full quarantine, fewer people are carriers at a given time, but the virus will be in circulation longer. So let's say there is a 1% chance of getting it every time you go out. Your chance of contracting it during this time is 1 - 0.99^52 ~= 40%.

This is a simplified model that doesn't account for the way the percentage changes over time, but it makes a valid point.

So the odds of each at-risk person contracting the disease may not be much higher (or possibly even lower) in a partial quarantine, even though more people overall are getting it and over a smaller time period (pressuring hospitals). The advantage being that the world continues to function during this time.

If it behaves like other coronaviruses, there's a pretty good chance that it'll be circulating indefinitely. So at long as at-risk people haven't been infected, they'll need to isolate indefinitely.

As I see it, quarantines can only flatten the infection curve, so that healthcare resources don't get maxed out. And realistically, I doubt that any quarantine could be enforced long enough, and so remain effective long enough, to prevent eventual infection. The only hope is that, when they do get infected, adequate medical care will be available.

There's no such thing as a "full quarantine" for everyone. It's totally impossible.

"it will start with some simple things like your favorite deodorant brand and snacks disappearing from store shelves"

Something tells me that those will come back on the store shelves, no more and no less but for their market potential (in a restored size market, of course) ...or people will just pick another candidate for their favorite product. I prefer to enjoy the ride to that postcoronavirus world and be glad to live these interesting times in general.

What impact? First, the worst case estimate with soft distancing from the Imperial College paper everyone is quoting is 1M in the US. Even if it isn't an overestimate (their models have tons of assumptions and past pandemic estimates for death rates/etc were usually overblown), 3M people die in the US every year iirc, and given the demographics there'd be a large overlap. It's significant, but not worth messing up the lives of 100s of millions in the USA alone for years, and knock-on effects potentially for decades.

> The true choice here is between a lot of deaths and a couple months of staying at home and fewer deaths but years of staying at home.

Where did the years part come from?

However long it takes to make a vaccine and distribute it widely

Hate to break it to you, but hospitals are going to be overrun either way. 70-year-olds outnumber ICU beds 1,000 to one in many counties, some counties have no ICUs, some counties have no hospitals! [1]

Because hospitals will be overwhelmed by a factor of 10 or so, social-distancing to slow things down by 50% is not going to change that.

The numbers paint a pretty clear picture, for those who bother to look at them.

1. https://khn.org/news/as-coronavirus-spreads-widely-millions-...

> but hospitals are going to be overrun either way

Only if COVID patients are prioritised.

What's the point of assigning an ICU bed to a 79yo with two potential comorbidities who will be dead within the week regardless of how much treatment is given? Compared to a 30yo who has been in a car crash and has a chance of survival.

I already have friends and family members who have died of various causes. We haven't destroyed civilization over it.

How many of those friends and family members died of causes that could be prevented through temporary social distancing? And how many years was that spread over, vs the single month we'd be looking at here with an uncontrolled coronavirus pandemic?

You're underestimating how bad things can get.

Everyone I know who has died could have been at least temporarily saved by extreme, civilization-destroying efforts.

“Temporary social distancing” is much less benign than you make it sound. More like “intentionally creating an economic depression of unknown severity”.

Life went on mostly as normal after the Spanish flu, by the way, which is the closest thing we can compare this to.

Are you not aware that, during the Spanish flu, entire cities were shut down for months, exactly like what's happening now? And that without these actions the effects of it would have been much worse? You bringing this up is exactly proving the opposite of the point you're trying to make.

Enforced social distancing is nothing NEW. It's as old as pandemics themselves.

Medical science barely existed at that time.

They weren't idiots. They understood that the flu spread from person to person, and that shutting gatherings of people would curtail the spread.

This happened. It's part of history. You can't argue against it. There are thousands of contemporaneous newspaper articles about all the measures that were taken to curtail the spread of the Spanish influenza.

My point being that we have significantly better data to inform us on exactly how to reduce the transmission rate, we have constantly-improving testing methods, we have the ability to research medicines than can help, we have the ability to research a vaccine. Not only is the not the Spanish flu, it is happening in a profoundly different context. The comparison is superficial.

Define normal in this context. The effects of the 1918 flu pandemic really were region dependent, because some regions were more strict than others (in terms of social distancing, curfews, etc.) and those regions that were more relaxed were affected more heavily (the classic American example is Philadelphia vs St. Louis). We see some evidence of this happening now in places taking stricter measures globally, although the data is too early to say anything conclusive.

> intentionally creating an economic depression of unknown severity

Okay, assuming it's a strict trade-off between 1) no social distancing, economic disruption happening at some point in time in the future, and significantly higher death rates; or, 2) social distancing, economic disruption now, and lower death rates, which is better? This is the reality of the situation -- there will be economic disruption no matter what, and so if we don't attempt to quantity the disruption, the two differences here are social distancing and number of deaths.

Social distancing will save at most 1million lives (mostly 60-is 70 year olds, who had 10 years left anyways) in America.

6 months of quarantine in the US would cost 2 millions lifetimes of going outside. Full lifetimes, that is, not 10-year-lifetimes.

This is aside from all the economic damage. The cure is worse than the disease.

It's not remotely equivalent to compare a year spent dead to a year spent indoors. You need to put a large multiplier on that.

Saying Americans is possibly too broad because from the looks of it, there really are some attempts to walk a different route. The same is with some nations.

Let’s see, for example, if the Texas more relaxed approach performs better than California. The nuances between approaches may blossom into a wider difference. It’s not obvious that Americans are all sailing in the same boat.

The societal cost of covid19 vs social distancing depends on the time scale. Three to six months? Covid19 is almost certainly worse. Nine to twelve months? Fifteen months? Two years? Strict social distancing will be much much worse at those time scales. People will starve and segments of the logistical network necessary to sustain the medical industry will be in danger of collapsing. Not to mention the enormous strain on governments and services caring for tens if not hundreds of millions of people.

Lucky for us, South Korea has shown that this thing is beatable, even without a vaccine. Exhaustive testing, contact tracing, and enhanced hygiene measure are a great follow up for social distancing (though I have no idea what's going to happen in southeast Asia or Africa). But larger countries will require more supplies and time to manage the virus. The question I haven't heard the answer to yet is how long can the shutdown last before it effects our ability to treat covid19 and provide for basic necessities? I'd rather not we not figure that one out the hard way. We need to be looking for active solutions and this article provides some good ideas.

Disruption from Spanish Flu was short-lived, and yes the damage caused is from the lockdown, not the pandemic. In the worst-affected areas (except maybe on small city level), the deaths are still a blip. If there was no media circus around it, everybody would still be mostly unaware; any kind of reaction would just be starting now with some areas having issues in hospitals, and even then judging by how people ignored the lockdown in Seattle when it was partial, it wouldn't be as bad as now. Then, by CA govt's own admission in the worst case they'd be near herd immunity (iirc they listed 56% infected) in 8 weeks. That includes the times where the deaths are still a blip compared to flu, and hospitals are not overwhelmed. So let's say 5 weeks of panic. And then that's it.

Hospitals are not overflowing. We have 6,100 hospitals,989,000 hospital beds available. And my best friend is a Registered Nurse (California) and says they are not even close to capacity. She also stated what is presented on the news is 100% a lie.

Okay. I also have a friend. He is 35yo and has COVID and his blood oxygen saturation is at 80%. The UCLA hospitals refuse to admit him. They’re already over capacity.

No hospital in the US is currently turning away patients who have acute hypoxemia. If your friend's blood oxygen is actually 80% then he is at immediate risk of death. Call an ambulance right now.

That is because CA went "stay at home" first and was able to avert the disaster that is NYC. Open everything and we are fucked.

In 2018 CA hospitals actually were over capacity for the flu. They aren't now as much as the covid obsessed want them to be.

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