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Comment by christophilus | Hacker News Reader

> there are so few cases in California because of the measures that have been taken

This is probably true, but other countries haven't locked down hard and aren't seeing a big spread. Our options aren't binary. It's not as if the only choice is "Nuke everything" or "Surrender".

The US is not a very densely populated country, and density seems to have the biggest impact on the spread of this thing. We probably could do something like this:

- Dense city? Quarantine. - Moderately dense? High risk individuals quarantine, everyone else social distances, but works. - etc

Across the board, if your business is the sort that can WFH (such as software companies), then you do work from home. If not, then you're open, but with precautions. Restaurants are open, but pickup only, etc.

The point is, we've used a nuke, and it's not at all clear to me that that was the right decision.

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> other countries haven't locked down hard and aren't seeing a big spread

Let’s be precise. Some other countries haven’t locked down hard and aren’t seeing a big spread yet.

You mentioned Sweden. Here was Time a few days ago:

> A head doctor at a major hospital in Sweden says the current approach will “probably end in a historical massacre.” He says healthcare workers at his hospital who have tested positive for the virus but are asymptomatic have been advised to continue working. He asked to remain anonymous because “it is frowned upon to speak of the epidemic or to go against the official vision” but said he felt a need to speak out from an “ethical and medical point of view.”

And a good contrast is Bulgaria, which shutdown early, on March 13th or so (https://www.reuters.com/article/us-health-coronavirus-bulgar...), and which has a death rate on par with South Korea's. The neighbouring countries (Romania, Serbia, Greece) are also low but at least 2x that rate.

it all depends on circumstances. Romania had 400k workers returning from Italy in the past month. It is harder to contain.

On a per capita basis sweden isn't really more worse off than many other countries that have shutdown. It's about middle of the pack. Personal responsibility lets us have our cake and eat it too.

http://91-divoc.com/pages/covid-visualization/

By “personal responsibility” I guess you mean something like «each individual person makes their own decisions without official guidance about how their behavior might affect their neighbors – during a severe crisis when nobody has access to complete or accurate information – and we just all hold our breaths and hope none of them make bad choices».

Personally I would call this “government irresponsibility”, but I guess we’ll find how it turns out within a few more weeks.

I’m not sure “have our cake and eat it to” is a good way to describe a crisis that is killing a whole lot of people and smashing the economy (in Sweden and many other places).

> and we just all hold our breaths and hope none of them make bad choices. Personally I would call this “government irresponsibility”, but I guess we’ll find how it turns out within a few more weeks.

This approach absolutely infuriates me too, and it is the fault of "the government", but I am very curious what a more precise explanation is. Is it the current individuals in government? The ongoing culture within government? The broader culture of the country? Or maybe a mix of some of these, plus other things that I'm not able to perceive or imagine.

I bet we (humanity) could get get pretty close to the correct answer, if we made a collective and proper (easier said than done) effort to find out.

A good first step would be for you to stop supporting racist misogynistic islamophobic homophobic xenophobic narcissistic politicians who are pathological liars, science deniers, global warming deniers, and who don't believe doctors and epidemiologists, but do spread racist conspiracy theories.

Hi Don, I am always glad to hear from you (and I mean that 100% sincerely, though that may be hard for you to believe) - I think our perspectives and axioms are so incredibly divergent, that with a little effort on both our parts, a tremendous amount of learning could be achieved from proper discussion.

> A good first step would be for you to stop...

I have no hesitation whatsoever to admit that your approach may be correct, and mine incorrect, but I suspect this feeling is not mutual - is my intuition correct?

The problem (or more accurately, a problem) we have under our current form of democracy (in the US) is that we have an infinite number of variables that can be taken into consideration (and different people will select a different set for analysis), but we are only offered a single choice, with two options: Democrat or Republican.

I can respect your decision (analysis), and would be happy to devote literally hours to listening to your reasoning (I've extended such an offer in the past, as you may recall), but I suspect you don't feel the same way. Rather, it seems to me that you are determined to not like me, and accordingly, will look only at variables that support your conclusion, even if the values of those variables are absolutely incorrect (because they are based not on evidence, but rather speculation within your own mind).

In all of our conversations, you exhibit (so I perceive) extreme confidence and certainty in your beliefs, as well as an utter lack of concern (if not even realization of the very possibility) for the notion that you may not 100% correct in your beliefs - not just about me and my true beliefs, but also what is the necessary set of actions to achieve your (and my!) intended goals. If my perception is accurate, and if you are unwilling/unable to realize and rectify this situation, it seems reasonable that the consequences of this is that you will continue to have a highly flawed model of me in your mind.

I would recommend thinking of such ideas via mental experiments, such as: if one wrote software with such disregard for the importance of accurate analysis of reality, would you expect your program to function correctly? I suspect not. So why then would you expect different behavior when it comes to human and societal interactions? After all, are humans not in a sense extremely analogous to hardware that is executing software, all within a shared, interactive environment? I like to conceptualize humanity as a kind of MMORPG, not only because it's fun to look at it this way, but I think there is great utility in viewing things from a third person perspective, as it can often be helpful in achieving greater emotional separation from the situation, and therefore realize clearer thinking.

Furthermore, I speculate that if this sort of behavior is occurring at scale (across the broad population), the consequence may be that we may never be able to turn this ship around, and things will continue to get worse - ironically, bring about the very opposite of what your intended goal is!

Once again, I am putting a stake in the ground. Throwing down the gauntlet. I challenge you to engage in a proper conversation, with the goal (at least) of discovering what I really believe. I'm not asking that you agree with me, but only to face what my beliefs really are. Thus far, you[1] have been unwilling to engage in a serious, nuanced conversation, or even admit (consider?) that there could be value in such an exercise. You are free to do as you choose of course, as am I. I will continue to occasionally post comments from my perspective, and be open to proper discussion and challenges from all sides. If you choose to continue to respond with downvotes and inaccurate, hateful accusations, that is your right (although technically, it is very much counter to the HN Guidelines). And even though you may feel hate for me, and "people like me" (or so you subconsciously speculate), I will not feel hate for you, or people who hold beliefs similar to yours, because that road leads to hell.

[1] Actually, this is a bit harsh in that it could easily be interpreted as an assertion that you are unique in this regard. Rather, quite the opposite is true - it is my perception that I haven't encountered a single comment that has indicated a willingness to properly consider my fairly unique perspective. To be clear, this is not an assertion that all people on HN are in some way guilty of wrongdoing, but only that I have not encountered anyone "doing the right thing", for my definition of "the right thing" (dealing with this subset of reality honestly and ethically).

https://en.wikipedia.org/wiki/Sealioning

As predicted.

Let me know when you muster up courage proportional to your ego, and maybe we can have a discussion that consists of something more than insults and evasive tactics.

> On a per capita basis sweden isn't really more worse off than many other countries that have shutdown.

This is so untrue.

Norway and Denmark had initially many more cases then Sweden but since their curves flattened.

As of yesterday

Norway - 26 deaths / milion

Sweden - 102 deaths / million

Denmark - 52 deaths / milion

U.K. 166 deaths per million with a full lockdown in place

"with a very late full lockdown in place". It actually proves that locking down early works and things get out of control extremely fast

It doesn't prove anything about lockdowns given that the UK has plenty of healthcare capacity and in fact like elsewhere its hospitals are nearly empty right now. If fewer British people survive in their hospitals all it may show is those hospitals aren't very good, but it wouldn't be due to being "too late" as that would require deaths due to overload.

If you look at the huge drop in cardiac ER admissions it's clear that people are dying because they are having heart attacks and not going to hospital when they should. There's actually a severe problem with hospital underload right now. Governments, supposedly following the science, have built emergency field hospitals and shut down other medical work to protect hospitals that are now nearly empty. This was not predicted by anyone pushing lockdowns and is a grotesque mis-prediction with deadly consequences.

Nobody will talk about it at the moment, but I suspect when all this is studied in years to come the UK will be seen to have done worse partly because its population over-reacted to government extortions to "stay home, save the NHS". People are going to die just because they aren't going to hospitals they've been told they need to "protect" as some sort of moral mission. The NHS is often called a national religion, which isn't quite right - it's a religion to some and unfortunately those people aggressively attack anyone who points out what an institutional failure it is. It's easily believable that people will be avoiding hospitals in the UK in greater numbers than elsewhere right now.

We need to watch out for a lot of retroactive nonsense in the coming months. People will claim epidemiologists predicted all this (they didn't), that the lack of lockdown explains differing death rates (already disproven completely by the case of Sweden). Cold logic is all that will clear the fog.

UK was the country that first wanted to isolate the elderly and get young people infected and immune. The current case count is a reflection of that rather than the lockdown which came afterwards.

False. Sweden has had no lockdown at all and has had less fatalities per capita.

You may want to pick a less terrible example. UK went into lockdown very late, tried to insist on some bullshit herd immunity theory, very nearly lost even its PM, and is now paying the price in blood.

That's extremely overdramatic.

But there is also "Beglium - 359 deaths / million" which had early lockdowns. They started their lockdown one day before Denmark. By cherry picking countries one can chose a story to tell. I think it is too early to say if Sweden's strategy was stupid or not.

I guess Denmark and Norway as both Nordic countries with similiar wealth and culture are as similar to Sweden as possible.

one can argue that Sweden has a larger immigrant population than those countries. Majority of deaths in Sweden are from immigrant populations. They are blamed for not following the social distancing rules that most Swedens follow day to day. Also they are poorer, live in larger families in small houses etc. and it is harder for them to follow the rules.

One can also argue that the virus doesn't care about your ethnicity, and just because it's hit some particular community hard first doesn't mean it's not going to spread through the rest of your society too absent serious measures being taken. In the US, focusing on the "others" who had the virus, in our case the Chinese, while not taking effective measures early enough to stop the disease, was a huge mistake. It was a distraction, an excuse for racism and not doing more. This is not just a disease of poor immigrants. It's coming for everyone.

https://www.nytimes.com/2020/04/07/us/coronavirus-race.html

That doesn't remotely change the fact that non-black people are still dying in droves, and you can't attempt to minimize this pandemic as saying "Well it's mostly black people dying, so if you're not black don't worry", which is the analogy to the post about the poor foreign immigrants dying from it in greater numbers in Sweden.

Don't just drop a link, let's hear your real argument here.

I'm not making an argument. I'm just providing a reference to counter the claim made. I have no dog in this fight other than I like to see references and evidence. Hence why I only dropped a link. You don't need to pick fights with everyone, you know?

How much of that is related to a higher percentage of black people doing more dangerous jobs (one with increased contact with the public)

Of the three people they mention in the article, two take buses.

There's not even an attempt to control. Are black judges living in Westchester statistically more likely than white judges living in Westchester to suffer more from the disease?

Belgiums population density is much much higher

Belgium counts deaths not in hospitals much more accurately. Really, looking at worldometer numbers and comparing between countries makes no sense whatsoever, yet everyone (including media) does it anyway.

Know what else Belgium has? A flattened growth rate. Sweden’s on alone a bad track.

Belgium has people concentrated in a few centers, is a travel hub in the middle of Europe and has a high density of EU employees. With that they imported cases from pretty much everywhere at an early stage.

I'd say it's too early to tell. The consequences can lag for up to three weeks, no?

Yeah not really worse off, just worse off than all their neighbors?

They have roughly an order of magnitude more deaths per million than Finland does (11.6 vs 99). We're somewhat locked down in Finland.

On the other hand, Sweden also took measures, they just weren't as extreme. The virus spread in Europe mainly through travel and large groups of people. Sweden has neither (also because no neighboring country would allow travel). They didn't impose a lock down but it's not like nothing happened in Sweden.

I hope you're not looking at case numbers, because Sweden is so far behind on testing compared to most of europe.

Look at the rate of growth for deaths per day (filtering out weekends because obviously swedes refuse to die on weekends)

Most places are seeing a plateau in number of daily deaths while Sweden is still growing exponentially

I'm looking at deaths per capita. It can still be manipulated but it's the hardest to manipulate.

Look at the trend... 15% of their deaths happened in the past 24 hours

It's very hard to compare the US with Sweden. In Sweden people are able to stay at home without losing much income due to a strong welfare state - which has also been made event stronger due to the virus. In the I assume that a lot of people would be economically forced to disregard "personal responsibility".

The good thing is we’ll see in the end. Lots of predictions. It’s almost as if you can’t be criticized for being too cautious. Sure, but the good will won’t last forever.

The US accepts 22k deaths a year without blinking due to flu. That’s just the flu. What’s the magic number we’re willing to accept? 50k? 100? There has to be a percentage of the population we are willing to accept as casualty because we already do, just unstated.

The lockdown will ultimately spread misery far and wide if left unchecked. Massive rise in poverty, violence, drug abuse, depression, crime, suicide, homelessness, prostitution, etc.

People need to be more clear on what they’re willing to accept. Right now there is no real discussion on “what next”. Lots of obsessing over the current body count though.

> accepts 22k deaths a year without blinking

The US spends a lot of effort trying to convince people to get flu shots, take antivirals if they get sick, and stay away from vulnerable populations while contagious; hospitals prepare extensively for increased use during flu season (and medical workers are vaccinated, making flu much less personally risky for them), widely distribute easy-to-administer flu tests, treat people and keep them alive as best they can, etc. Estimated flu death numbers are also not comparable to current reported Covid death numbers, because they include a ton of guesswork, since many of the people who die while infected with flu officially succumb to some other condition (according to death certificates).

We don’t go into total economic lockdown for 2 months per year, because it would be impossible to enforce and extremely expensive, but we sure did during the last comparable pandemic, the 1918 flu.

Currently (and this will hopefully change as medical knowledge improves), Covid seems to be more than 10x more deadly than seasonal flu for most demographic groups. In an unchecked Covid epidemic (with hospitals overwhelmed) it appears that on the order of 1% of the population dies. (This has happened in some towns in Italy, where a very high percentage of the population was likely infected.)

> lockdown will ultimately spread misery

Having 1% of the entire population die within a matter of months is going to cause an extremely severe economic shock with or without official actions.

Let’s not talk abstractly. How many deaths within your family and circle of friends are you willing to accept?

The logic still applies. Obviously, I hope for zero deaths. But I also don’t forbid them from driving, despite the high number of deaths for that mode of travel. I don’t tell them to quarantine themselves every flu season.

Anyway, I’m not sure we’ve overreacted. I’m just saying it’s possible and it’s pretty amazing how it’s hard to have a conversation about it. People treat the topic like there’s only one answer and anyone who dissents is a murderer.

The risks of driving and seasonal flu are fairly well understood. And there are mitigation’s in place: seatbelts, traffic laws, theraflu, flu shots, etc.

I’m not calling you a murderer. I’m asking you to put a hard number in the risk you are willing to absorb.

Mine is 0.

> Mine is 0.

To be perfectly fair, the current lockdown _IS_ going to kill people that would've survived otherwise. People that now won't go into emergency rooms out of fear of contracting Covid19, poor people whose source of income is completely dried out. And longer term, this is going to cost massive amounts of money, a fraction of which would of course be used to prolong someone's life in some way, eventually. I think the question raised in this thread is simply one of "what's the trade-off". It's very clear that there are costs to this lockdown, and at least to me it's also very clear that that some of those costs are human lives. However, we can't estimate those costs. We do have a guess of the rough fatality rate of covid19, and we do have models that will tell us how many people will die if we don't go into lockdown. But we don't have the same luxury for estimating the amount of people hurt and dead because of it that could otherwise be saved. We can quantify the monetary loss, but not how much of that loss would've otherwise gone towards saving lives. I think the question of "what are the human costs of this lockdown" is a fair one to ask. Don't get me wrong, I too think the lockdown makes sense and overall does save lifes. But the lockdown is not without risk, and even more importantly: I have not seen any estimate of the risk. Is it lower than 0.5-5% of the population? I think so, but both of us haven't done the math, so you talking down to people who ask about it is wrong.

> To be perfectly fair, the current lockdown _IS_ going to kill people that would've survived otherwise. People that now won't go into emergency rooms out of fear of contracting Covid19

You've got the blame all wrong here. These people that are dying who would've survived otherwise are directly being killed by the pandemic, not by the lockdown. If the pandemic were completely uncontained then the hospital system would be way more overwhelmed and you'd be much more likely to die of other causes for lack of healthcare. The lockdown is saving lives by helping to preserve healthcare resources so that if you have some other need like a heart attack there might still be a doctor free.

It's not like, if the lockdown weren't happening, then there wouldn't be a pandemic. What would happen is that the pandemic would be way way worse.

Good question. How many deaths within your family and circle of friends are you willing to accept from political instability resulting from lockdowns?

Zero. And so far there have been zero, but I know of people who've actually died from COVID-19.

We are very, very far from political instability still. Let's not be alarmist.

Of course. It's not like a global recession in the midst of widespread political polarization has ever caused problems before.

> The US accepts 22k deaths a year without blinking due to flu. That’s just the flu. What’s the magic number we’re willing to accept? 50k? 100? There has to be a percentage of the population we are willing to accept as casualty because we already do, just unstated.

Unfortunately the worst case death numbers for an uncontrolled pandemic crack into the millions in the US alone. That is, frankly, more deaths than anyone with a sound conscience is willing to accept.

Also, we have vaccines for the flu that significantly decrease your chance from dying of it. I get the vaccine every year. There's a big difference between being completely at the whim of a disease and being able to take proactive measures against it to help protect yourself. The only proactive measure that works against COVID-19 (which is much deadlier than the flu mind you) right now is social distancing, so it's not surprising to see so many people using the only effective measure that currently exists. Don't underestimate people's desire to not suffer a debilitating illness that leaves them unable to breathe for a week before killing them. Social distancing would be happening regardless of the official stay at home orders.

> Lots of obsessing over the current body count though.

I mean ... yeah. These are our friends, our family, our neighbors. Each one of them was a real person who is dying unnecessarily, and more deaths like them could be spared through better social distancing. This isn't "obsessing", it's a very real concern. You'd care more if it were people you knew dying. I've already had people in my extended contacts die of it (I live here in NYC), and it's rough. Hell, I already got it, and fortunately recovered. Let me tell you, spending days unable to catch your breath even just from walking is terrifying. You'd understand more if this was affecting you more personally. It's not just some abstract discussion about numbers.

Stockholm (the worst hit part of Sweden) has about half the deaths per capita of the state New York (26 deaths per 100k vs 56 deaths per 100k) despite Sweden having laxer restrictions. And Stockholm is generally more densely populated.

So while I too am a bit skeptical of the Swedish policies it is doing pretty average on a global scale. Worse than some countries with harsh lockdown but also better than some countries with harsh lockdowns. It is too early to say for sure if the Swedish policy was stupid or not.

In Swedish news the currently most popular theory for why we have more deaths per capita than our Scandinavian neighbors is not necessarily our lax lockdown (though it may have made things worse) but lack of supplies and poor routines in old people's homes. This is of course speculation.

Is it really the best comparison to use Stockholm vs. New York state instead of Stockholm vs New York city? A city-city comparison seems more logical, no? In the latter comparison, we have NYC 2x as dense as Stockholm with a much larger population.

I don't know the particularities of Sweden, so maybe it makes more sense as you have outlined it. My apologies if that's the case!

Most of the cases in New York are concentrated in and around NYC, which is an international travel hub with 3 very busy international airports in the area. I don't think there are many places in the world which are going to have had the same number of asymptomatic and symptomatic carriers pass through. So on that basis I don't think it's a good benchmark for most other cities or countries to use.

I wonder if it's better to compare Swedens overall per-capita infection rates with other states in the US where there is a lockdown but whose capitals/major cities are more secondary cities from the perspective of international travel. Let's try North Carolina (picked for being closest in population to SE and also being not a top airport hub or travel destination compared to its neighbors) though it does have significant business and educational centers, it's probably a fair comparison to Sweden wrt population density.

NC total population: 10.5 million NC confirmed cases: 7,285

SE total population: 10.2 million SE confirmed cases: 11,445

So anyway, there are other states and countries that are doing better and worse than Sweden, but I don't think that Sweden is in any way demonstrating that it is doing better by trying to ignore the problem and possibly to blame the lack of strict enough sanitation ("lack of supplies and poor routines"), it's just coming later than to higher-volume travel centers like WA, NYC, the UK, France, Italy, etc.

In any case, the idea of doing better or worse will, in the end, be measured in per capita deaths at the end of this disaster, and we haven't gotten there yet. I truly hope that Sweden finds its way through with as few deaths as possible, but I don't think that's what they've done.

You've gotta compare deaths, not confirmed cases, because cases are being so severely under-tested right now (especially in Sweden, which has a nearly 10% case fatality rate, indicating that they're probably only catching 1 case out of every 50, or more). Deaths are the most reliable statistic we have right now because they're the least likely to be under-reported (though they still suffer from that). Once this is all over and we can do population studies based on widespread blood antibody testing then we'll have better stats, but that's years out.

So, comparing the deaths per 10M population, Sweden is currently at 1,014, whereas North Carolina is at 114. So Sweden is suffering roughly one order of magnitude worse from the pandemic than North Carolina is at the moment. And keep in mind that North Carolina went into a shelter in place order over two weeks ago while Sweden hasn't yet, so there's a loooot more pending cases in Sweden's pipeline than NC's.

Without air traffic and closed borders, a country that's not that affected could get through it with few measures. Not sure if many countries are still at that stage but it's no coincidence that international travel hubs got affected worst.

> Stockholm (the worst hit part of Sweden) has about half the deaths per capita of the state New York (26 deaths per 100k vs 56 deaths per 100k) despite Sweden having laxer restrictions.

So far. It's way too early into this unfolding disaster to be making pronouncements like this while the figures are still increasing exponentially. NYC has had shelter-in-place for several weeks now while Stockholm has not. If you'd done this analysis a week ago, and then two weeks ago, you'd see Stockholm looking progressively better and better in comparison to NYC the more you go back in time. In other words, they're catching up, because here in NY we're sheltering in place and it's working, and in Sweden they aren't (yet) and thus their spread is higher.

> And Stockholm is generally more densely populated.

Not in comparison to NYC it's not, which is the fair comparison for Stockholm because Stockholm is a city whereas all of New York is a much much larger state that amounts to 1/3rd of the land area of the entirety of Sweden. NYC's density is 10,715/km2 vs Stockholm's 4,200/km2.

Anders Tegnell - author of Swedish strategy says that the measures are working and deaths are concentrated in Somali, Iraqi and Syria - born population.

https://www.expressen.se/nyheter/coronaviruset/folkhalsomynd...

https://www.aftonbladet.se/nyheter/a/2Gx0Ev/fodda-i-somalia-...

Country of birth Number of cases Over-representation

Somalia 283 7

Turkiet 150 5,1

Irak 242 2,9

Finland 188 2,3

Eritrea 55 2,1

Syrien 197 1,8

Iran 83 1,8

Forna Jugoslavien 60 1,6

So pehaps this is what's been planned after all. Remember that Swedish eugenics laws lapsed only in 1976.

https://www.economist.com/europe/1997/08/28/here-of-all-plac...

But it's not stopping the spread. A friend's office in Västerås just had a case and only now went wfh, while that friend already wfh but still drops off and picks his kids up from school and is getting symptoms now.

The comment about the deaths being primarily in particular communities sounds like the opposite of working, though. Can you provide context regarding why it's working if people in some communities are dying?

* Edit: thanks for clarifying. I didn't realize that your comment about measures working as intended was hinting at a eugenics motives of the policymakers when I first read it, but do now.

Well the real reason there is no lockdown in Sweden is that the owners of the country said No to lockdown. The rest is just unique Swedish doublespeak.

https://www.ft.com/content/3b8ec9fe-6eb8-11ea-89df-41bea0557...

> An estimate from The Economist finds that the value of Swedish billionaires’ fortunes is equivalent to a quarter of the country’s annual gdp. Only in tax havens such as Cyprus or Monaco, or captured economies such as Russia or Georgia, are plutocrats more dominant

https://www.economist.com/briefing/2019/11/28/in-sweden-bill...

Perhaps. Or perhaps cultural behavioral norms, or even just lack of understanding due to language barriers is to blame. Strategic, covert genocide seems fairly unlikely to me, but then I'm relying purely on personal heuristics, which in turn rely upon my limited knowledge of Sweden.

Maybe it's just concentrated on poorer parts of the population? Generally poorer people tend to live closer together and can't afford staying home when they're sick. Immigrants tend to be poorer in most countries, including Sweden. I'm not sure how it helps to name place of birth for infected, finding out the actual factors determining the spread would be more helpful.

Keeping with the spirit of precision:

- that doctor is making a prediction about the future, based (in part) on evidence that you and I are unable to verify

- there has been no shortage of incorrect opinions and predictions from those who are genuine experts throughout this crisis

Please note that I am not disagreeing with you. Rather, I am adding benign supplementary information.

I keep hearing these stories about how Sweden's approach will end in disaster, but their new case rate is ~500 per day with >10,000 existing cases. A 5% growth rate of new cases strongly implies that they are already past the peak.

What am I missing that would imply things are about to get vastly worse there?

(I do see some other specific mistakes there that lead to a higher death rate, but I don't see the concern about things suddenly getting worse in the future)

Existing cases counts are at worst fantasist, at best state and policy dependent. You can't compare case counts between countries.

Then what you're missing is that sweden case counting method report very low numbers (either that or their mortality rate is absurdly high, which seems more unlikely).

Hmm.

One of the traits of this virus that makes it so different from past potential epidemics is that it's able to spread rapidly through a population for up to two weeks before it starts becoming "visible" (symptoms start to arrive in large enough numbers to become alarming). At the tail end of those two weeks, the infection may have spread enough to become very difficult to control.

So, if we took some kind of middle road, and then two weeks later the virus exploded, would that change how you felt about the approach?

I'm still treating this question honestly, btw. I completely agree that it would be nice if such severe measures were unnecessary and the damage to people's livelihoods could start getting addressed. But, the problem that policy-makers are dealing with is that this isn't an infection that responds well to a "wait and see" approach; by the time you start to "see" and react, you could be in deep trouble.

It's also an open question for me. I'm wondering though if, even with the limited data we have now, there are examples of countries that took a similar approach and had their two-weeks-later 'explosion' (or possibly three, is what I've heard).

People want to make things complicated and not take anything at face value, but if you look at global cases on a log scale, you see how they started exponential, flattened out, and then once there was a foothold outside china, went exponential again, and now is flattening again.

Wouldn't it be logical to assume this will repeat as soon as people decide it's under control again? How can you go back to normal, before everyone has caught it, and expect the rate not to go back to exponential?

Another complication and I'm sure the task force is wrestling with this. If you undo the restrictions you're never going to be able to put them back in place and have the adherence you did the first time. I just don't believe the people will accept being on lock-down for weeks, then getting a taste of getting back to work and then being asked to go back on lock-down. I also didn't believe people in the US would follow the lock-down rules anywhere near to the degree they have so :shrug: who knows?

Ooof, I hope you're wrong about this, and that people would enjoy more having sporadic periods of freedom rather than months straight of lockdown, but I can't say that for sure. You may be right.

> - Dense city? Quarantine. - Moderately dense? High risk individuals quarantine, everyone else social distances, but works. - etc. Across the board, if your business is the sort that can WFH (such as software companies), then you do work from home. If not, then you're open, but with precautions. Restaurants are open, but pickup only, etc.

How is this _that_ much different from what's being done now?

Michigan has banned selling seeds.

Governors are forcing businesses closed or no seating allowed.

Those guidelines are good ones to maintain for perpetuity. Would decrease the thousands of flu deaths we see each year too but today's situation is closer to a nationwide lockdown than a PSA about washing hands

Well for example there's lots of non-essential business that can operate while enforcing social distancing. Closing bars and restaurants makes sense. But closing stores were you walk in and walk out does not make sense. Banning fishing doesn't make sense. Very broad strokes have been used to lock stuff down.

And at least in Michigan, they're not taking the time to open up low risk businesses now - instead they're filling in even more of the gaps that allowed life to continue. No golf courses, even without any staff contact. No landscaping. No landscaping supplies. No motorboats or jet skis. No travel between two residences you own.

But at least you can still buy lottery tickets!

Some of these can be explained at least. Landscaping is very non-essential, and it's hard to maintain social distancing while doing it because the way the crews operate is it's a bunch of guys riding together in one truck between each job sites (it's not a caravan of different vehicles, one per vehicle).

Additionally, my mom has been complaining about the landscapers where she lives and is angry that they're still allowed, because they flagrantly violate social distancing and get near her when she's trying to go on walks around her neighborhood.

Things are getting so bad in Detroit that bodies are piling up in unrefrigerated rooms in hospitals. Now's not really the time to be questioning if they're being too strict with the social distancing; at this point they really just do need everyone staying home, period, and not coming into contact with anyone. Motorboats and jet skis sure as hell aren't essential, and might tempt people into congregating with people they shouldn't be congregating with (boating is typically a social endeavor for example).

I'd say that landscaping is at least a field that has the possibility of operating while social distancing.

As for bodies piling up in Detroit... While that's true, additional restrictions added today won't have any impact there. Either the previous restrictions were sufficient, in which case Detroit should be peaking soon, or they weren't sufficient and there'll be several times that number of bodies before these restrictions start to have an effect.

My personal view is that low-risk activities should be allowed whenever possible to maximize the time period that people will willingly endure these restrictions. It looks like this won't be a sprint but a marathon, and people's willingness to comply is extremely relevant there.

I am in Tokyo and it's been going on longer here than many places.

Gradually increasing pressure has been the approach. It feels to me like you're right. I am willing to accept more pressure, though already burdened. It's because there's been time to adjust.

You're missing the point, which is that if you think the situation is bad now, just wait how bad it'll be in two weeks if we don't act even more stringently now. Letting up on the restrictions now would be exactly the wrong thing to do when the healthcare system is already bursting at the seams; it'd make things much much worse in the weeks to come.

The very earliest that it makes sense to even start considering reducing the restrictions is once the healthcare system is back to operating at under its maximum capacity. And you have to ease things back slowly, ready to clamp back down if necessary if the healthcare system seems ready to be overwhelmed again.

My reading is that either restrictions were sufficient before, or the new ones won't be enough either. And the more onerous the restrictions, the less likely it is that people will be willing to follow the important ones in the future.

It doesn't logically follow that just because mild restrictions weren't sufficient, that stricter restrictions won't be. China used very strict restrictions and they stopped the spread of the disease hard.

Every incremental improvement you can do to decrease the R_0 will have its effect. Progressively stricter social distancing measures as required absolutely will work, so long as they are being obeyed anyway.

> so long as they are being obeyed anyway.

And that's MY point. How long will people be willing to obey the current restrictions? How long would they be willing to obey even stricter ones, or more lenient ones?

I don't think obedience can be assumed forever. Even China had to weld people inside their apartment buildings. And I don't know if that would be practical here.

The talking point the anti-governor folks are repeating is that landscaping companies can’t even deliver mulch to your driveway. Which, sure, I guess that’s overly draconian but in the grand scheme of things I can’t bring myself to be angry about it.

There's inevitably the potential for person-to-person contact in business anyway, yes, even running a mulch yard, delivering mulch, getting a receipt signed on delivery, etc. It's not unreasonable at all to shut down all non-essential businesses until our healthcare system starts operating under its maximum capacity again, and to define "essential" strictly.

Given that we're in the early stages of the worst pandemic to hit the world in over a century, like you, I too can't bring myself to be angry about landscaping being shuttered, or jet skis, or whatever other silly unnecessary things people are complaining about. If even one more person dies because a landscaping company opened back up a month earlier, then it wasn't worth it. And that's easily a possibility we're looking at here.

What you're not thinking of is that restrictions such as this also cost lives. Suicides will be up and there will be much more economic stress afterwards.

> it's hard to maintain social distancing while doing it because the way the crews operate

I have no idea how to quantify it, but social distancing at a grocery store, surrounded by an ever-rotating group of people, seems much more risky than a work-crew, which is composed of the same 6 people all day.

The work crews are hanging out all day every day, whereas you do your grocery shopping once a week maximum, for less than an hour, and everyone wears a mask to reduce the chance of spreading anything.

On the work crew, if one person gets it, basically everyone else on the crew is guaranteed to get it too. In the grocery store, a single visit, especially with proper precautions taken, is unlikely to spread it.

But the grocery store workers are there all the time, and interacting with a wide variety of people. Sure, the chance per person is lower - but overall?

And the spread on a work crew is limited - there's only 6 people there. But that grocery store worker? Can you define super spreading event?

Seriously, how is allowing kayaking/sailing but banning motor boats, even when alone, anything but taking advantage of the crisis to push through an environmental agenda?

People wonder why others are afraid to give the government more power, this is one of the best examples of why.

It could depend on the store.

Over here in The Netherlands, most supermarkets have, to various degrees, implemented measures to protect workers (plexiglass, timed restocking, etc.) and measures to encourage social distancing (reminders and lines on the floors, a maximum number of customers via a set number of carts and having an employee wipe down the carts and handing them out manually at the entrance, old-people-hour in the morning, etc.).

The psychology behind this is fascinating. It's not just the measures that help, but the fact that simply being handed a cart after passing through the turnstile puts me (and I suspect everyone else) in 'awareness' mode. I've noticed that I myself generally pay more attention to not hover around employees, and take a detour via a quiet aisle whenever I can.

This stands in contrast to all the non-supermarket stores I occasionally visit. aisles are narrower, they don't have a designated entrance-employee, and at best there's some A4 glued somewhere asking me to pay by card if I can. Not only is it more difficult to practice 'social distancing', I don't notice a similar change in 'mindset' and have caught myself more than once leaning over an employee or passing close by other shoppers. And interestingly, both myself and said shopper seemed to notice this less (in the supermarket I've noticed many more older customers wait intentionally for me to pass at an appropriate distance).

And that's not even considering weird situations like our local HEMA (a very popular convenience store) implementing a bunch of measures, but then if you want to go and pay for your stuff you have to pick up an unclean scanner gun for the self-checkout, essentially undoing any measures they implemented. Out of curiosity I stuck around to see if these 'guns' are cleaned. They're not.

I guess my point is that stores are trying to implement sensible measures but so far it's mostly been supermarkets that seem to do a decent job (even if there's quite a bit of variation between stores from even the same company). I imagine it's much easier for these chain-stores to both get expert advice /and/ implement measures nation-wide. For those who have serious concerns it's a good reason to avoid 'mom and pop' stores though.

I guess what I’d like is for the gov to provide methods that would allow business to remain open if they complied with certain measures. They shouldn’t need their own expert, the gov should be able to provide measures.

Agreed! I'm kind of expecting that something like that will happen over here eventually.

I agree... they closed access to waterways here because they were seeing some boats too close together. That makes a lot of sense if you don't think about it, and clearly should not have happened.

> density seems to have the biggest impact on the spread of this thing

Pick two random people Jo and Chris. If Jo wants to pass a letter from hand to hand via intermediary carriers so it gets to Chris, what’s the shortest time for it to get to Chris?

Ways to slow down the letter passing are to prevent long distance connections (close airports), slow down connections (only go to supermarket once a week), remove connections (close pubs).

To avoid any carriers passing a letter to you, you want to avoid: highly connected social people; gatherings of connected people; reduce number of meetings.

Density is one aspect, but perhaps not the most important.

> This is probably true, but other countries haven't locked down hard and aren't seeing a big spread.

Which countries might that be? If you're referring to South Korea, they're ahead of the game enough on testing for this to be workable (unlike us). If you're referring to anyone else, they're simply not at that point yet in the curve, but will arrive there.

Various European countries. Sweden comes to mind.

Sweden has more deaths per capita from coronavirus than the US, has an exponentially increasing death rate (i.e. they haven't turned the corner yet), and a very high case fatality rate of 9.4% indicating that they're severely under-testing. This is not what a successful disease prevention strategy looks like.

Sweden's deaths per capita is neck and neck with the United States and following approximately the same trajectory with no lockdown. It's neither appreciably better nor appreciably worse.

http://91-divoc.com/pages/covid-visualization/

The US, like the UK, did a terrible job early on when containment was most critical. Several states are in lockdown now but arguably, the reason for our awful current new cases/death rate is due to the resistance to taking action in February when it first hit. There are also many places in the US that are not in lockdown. From another comment: “Approximately 44 of 50 states have lower per capita death rates than Sweden.“ The US cannot be compared directly to Sweden because it doesn’t have a single policy like Sweden. It’s also worth noting that Sweden has taken some lockdown measures ie your comment about “no lockdown” isn’t accurate. Finally, it’s early days and time will tell. The UK changed their policy because there is no credible evidence that herd immunity is effective. I believe Sweden will as well once the disease spirals out of control. And hopefully less people will die as a result. Unfortunately, there will also be the insufferable few that claim we could have survived without being cautious because you can’t prove that those measures were responsible for saving lives. Don’t be that person.

> the reason for our awful current new cases/death rate is due to the resistance to taking action in February when it first hit.

The reason is actually NYC, specifically Cuomo and DiBlasio passing the buck back and forth and doing nothing. If you remove just NYC, the rest of the country is for the most part doing a lot better than Europe.

It's even worse than that, de Blasio was basically in denial and wasn't doing anything, even through mid-March when cases were exponentially skyrocketing here. It took all the heads of his public health department threatening to resign for him to actually start doing things, and the idiot even went to his gym on the last day that gyms were even open.

Both he and Cuomo took way too late to act, and now we're all suffering for it. Cuomo has since at least gotten better, but de Blasio has been terrible throughout.

Sweden has by far the highest number of cases/deaths with respect to neighboring countries. Finland has 1/10th of the number of deaths per capita [0]. They are also faring much worse than Denmark and Norway (in terms of both cases and deaths) where much stricter measures are enforced.

[0] https://www.forbes.com/sites/davidnikel/2020/04/14/sweden-22...

Why limited to neighboring countries though?

The fact is Sweden has no full quarantine and they have less infection rates and less fatalities per capita than many countries with full quarantine.

It's clear that full quarantine may not be effective.

You have to compare states with comparable population density, cultural norms and roughly comparable initial cases. Climate plays a huge role in how much people engage in potential infection prone activities. E.g. like being outside in parks, beaches.

Uk is on full quarantine. There are no cultural norms because there's no culture there at the moment.

It should have less than Sweden if quarantine is effective.

The question is: how many infections happened before the quarantine was established? In UK the quarantine was started way to late. That the UK has in common with Italy, Spain and France. But in all these countries, a massive infection rate has been drastically reduced by the quarantine.

In Sweden, there seem to have been only very few initial cases and the virus seems to be slow to spread there - it probably helps that Sweden is over 80% larger than the UK and has only 1/6 of the population. Also, at this time of the year it is much colder than the UK, less reason to be outside in big groups.

If you check the infection graphs, in the UK the quarantine finally seems to have an impact on the infection numbers, which stopped growing a while ago. Sweden still seems to have growing infection numbers.

It's still SPREADING at a more rapid rate in U.K. than Sweden on full quarantine.

Full quarantine is effective, almost tautologically so. If the virus is still increasing exponentially then whatever quarantine measures you do have in place simply aren't full enough yet. At the extreme end of a full quarantine, imagine everyone is prohibited from leaving their homes for any reason, and once a week someone in a fully sealed bunny suit comes by to drop off food for the week. That's a pretty darn full quarantine, and you better believe it'd be effective.

Fortunately, we don't need to go to such extreme measures to get the replication rate below 1, but my point is, that extreme measures absolutely do work. The virus isn't magic; it needs to spread through relatively close personal contact. If you eliminate personal contact and sharing of spaces entirely, it cannot spread at all.

Sure it's effective.

But is it more effective than simple washing hands and social distancing?

I think Sweden is proving that it's not.

Additionally short of what you're proposing...full total lockdown...the virus isn't going anywhere...it will be in society when we emerge from quarantine immunologically naeive ready for another wave of Corona.

Japan fits. Some cities are more restricted, but even here personal freedom remains. The emphasis is for people to choose to do the right thing.

> The US is not a very densely populated country, and density seems to have the biggest impact on the spread of this thing.

You might be right, and I hope you are. But at least 'intuitively' my experience is that the more insular a community is, the more exposed those /within/ that community are because of frequent interaction.

So, basically, a big city is not very insular, but people spread the virus via public transit and whatnot.

A small, rural town is insular, but the locals interact much more than the city-folk. All it would take is one infected out-of-towner to trigger rapid spread locally.

I wouldn't be surprised if the problem that, for now, seems to be contained to liberal metropolises, will find their way into all sorts of rural communities because just one person passed it on. I hope I'm wrong.

I think you are correct. Georgia's heat map approach to graphically displaying infections based upon per capita case rates really highlights this, IMO: https://dph.georgia.gov/covid-19-daily-status-report

Sweden is one of the few countries that didn’t lock down. I’m Danish, and we locked down hard and are now on the process of reopening where as Sweden has 4-5 times the amount of deaths we do per capita, despite being a much, much larger geographical area and they’re closing down more and more as we are opening.

The political fallout the Swedish government will face over having so much more dead than Denmark and Norway is likely going to destroy their current government and lead to a further increase of their right-wing populist party.

So yeah, there are countries that didn’t close down hard, but they look royally fucked because of it. I think the only country where the government failed where the current administration is gaining popularity is the US. For some reason.

it seems to me it's not only density but mobility too. The US is a very mobile place, people can move around very easily. I think you have to consider that along with density when looking at how fast a virus can spread.

I hope a side effect of the virus spread is proving wfh feasible to many skeptics. Working from home goes a long way to reducing pollution and increasing productivity and morale. It's definitely not one size fits all and doesn't work for all personalities and jobs but it should be used where it can work. At a min, it keeps people off the roads/tracks.

> The US is not a very densely populated country, and density seems to have the biggest impact on the spread of this thing.

The US has the highest number of confirmed coronavirus cases of any nation. The US is seeing about 2,000 confirmed coronavirus deaths a day at the moment:

https://coronavirus.jhu.edu/map.html

Contrast the US results with Australia's or South Korea's results. Australia and South Korea are doing much better.

> The US has the highest number of confirmed coronavirus cases of any nation.

Your statement isn't very useful. It's the per capita death rate that matters the most of any metric. It's non-sense to compare the US to countries with 5% or 20% of the population using absolute numbers.

In terms of density, it's the NYC region that overwhelmingly accounts for the problem in the US. NY + NJ = majority of US deaths. The NYC region is the most dense on population in the US, which dramatically magnified its outbreak.

Approximately 44 of 50 states have lower per capita death rates than Sweden. Most US states are doing extraordinarily well in fact.

Half of US states are seeing no serious outbreak at all.

Arizona has 7.3 million people and only 131 deaths.

Belgium has 11.4 million people and 4,000 deaths. Sweden is considered a relatively good outcome in Europe so far, they have 10 million people and 1,000 deaths. Texas has three times the population of Sweden with 1/3 the deaths.

Some more examples:

Utah 19. Oregon 55. Arkansas 30. Washington DC 67. Delaware 41. Hawaii 9. Idaho 33. Iowa 49. Kansas 69. Maine 20. Minnesota 79. Nebraska 18. New Hampshire 23. New Mexico 31. North Dakota 9. South Dakota 6. Montana 7. Vermont 29. West Virginia 9. Wyoming 1. Puerto Rico 45.

Lower population density helps a lot in most cases. However San Francisco is also one of the most dense cities in the US and only has ~15 deaths or so. That's thanks largely to climate, which impedes transmission heavily. The same reason the entire San Diego County only has 53 deaths.

> It's the per capita death rate that matters the most of any metric.

The US has the 15th highest per capita death rate. It's on track to go up in that ranking:

https://www.worldometers.info/coronavirus/#countries

And Sweden is higher in the per capita death rate and on track to go up much higher in that ranking.

Yes. Contrast Sweden and the US to Australia and South Korea. Australia and South Korea are doing much better. The Australian and South Korean response has been competent.

Australia has a mandatory stay-at-home order, and they issued it earlier in their outbreak than we did in theirs. That explains why they're doing so well.

In South Korea they all gravitated to masks very early, and they developed enough testing capacity early on to allow contact tracing to remain viable (so far).

Australia is outside of the Covid Belt of temperatures that is ideal for SARS-CoV-2 transmission.

Australia is spared for the same reason most of Latin America, most of Africa and hotter climates in Asia have been.

Nigeria, Egypt, Mexico, Argentina, Colombia, Indonesia, Vietnam and Thailand don't have such low death rates because they've been running testing at the rate of Germany and doing tracing & lockdown & testing & quarantine as well as South Korea. It's the hotter climates. It's hot in Melbourne, Perth and Sydney during the Winter in the Northern Hemisphere, ie during the outbreak so far. Melbourne has been shielded for the same reason Lagos Nigeria has been.

Australia's measures are without question further helping to limit cases. Having a warmer climate during the outbreak time while simultaneously implementing aggressive measures, is the ideal double whammy to get a good outcome. The climate makes it dramatically easier.

> Nigeria, Egypt, Mexico, Argentina, Colombia, Indonesia, Vietnam and Thailand

Indonesia is only testing at the rate of 116 tests per million people. You only find what you measure. When the rate of testing is that low you can't make any claims about the true coronavirus death rate in Indonesia:

https://www.worldometers.info/coronavirus/#countries

And it hasn't helped that the Indonesian government has been deliberately withholding coronavirus information from the country:

https://www.thejakartapost.com/news/2020/03/13/we-dont-want-...

There is no such thing as "Covid belt of temperatures". Please provide reliable sources. This is just your pet hypothesis.

I used to think per capita means more but in this case does the absolute growth rate have anything to do with total population?

I read it's not due to climate I read it's because there was already a Coronavirus in the area and they have built a herd immunity.

> Sweden is considered a relatively good outcome in Europe so far

I don't think that's true. Germany or Austria might be good outcomes. Sweden had few measures in place but their death rate is far higher than most neighbours.

Thank you I've been saying this for a while but have been being crucified by the flat curver movement who takes no accountability in proving that their method is working with hard data.

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