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Comment by rpiguy | Hacker News Reader

People really haven’t really woken up to the reality that contact tracking, forced testing, and eventually vaccination will NEVER happen in the US, at least not in a consistent and effective way.

A significant portion of the population won’t stand for it, and given the current make up of the Supreme Court any mandatory citizen tracking, or job based discrimination based on mandatory testing will not pass muster. Nor will forced vaccinations. We can’t get people to vaccinate against measles and whooping cough, which spread faster and kill more people (including children).

Civil liberty practically ensures that in most places tracking and vaccination will have to be optional.

Whether we like it or not we are heading toward a herd immunity strategy.

If this were killing 30% of the general population, like smallpox could, people would fall in line. But I can’t see it happening for something as comparatively mild as COVID-19.

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> A significant portion of the population won’t stand for it

Having worked as a US Census Enumerator, I can confirm this. A surprising number of Americans will call the cops or put a dog on you to avoid being asked how many bathrooms they have.

You can say this is foolish, but policy makers have to deal with what is, not what should be.

I strongly suspect that attitudes to public health will change significantly in some places as a result of the current situation and our different experiences dealing with it.

One of the things I think will probably happen is that the US public will shift to be more favourable towards a primarily public health service such as many other countries have in one form or another. Unfortunately, I expect this to happen because the shortcomings of the current system are going to be painfully exposed and result in a lot of people dying unnecessarily in the US and in the coronavirus problem taking longer to deal with than it will in most developed nations.

I also think there is a small but non-zero chance of much of the world blocking travel for people who have recently been in the US until they get their house in order. Under normal circumstances, this might sound preposterous, but clearly these are not normal circumstances. The virus doesn't care about American exceptionalism, and if the anti-science agenda that starts right at the top of the US federal government today continues, nations that do follow the science and support their healthcare professionals and ultimately get it under control to a useful level are going to be very wary of undermining that progress even if it means a big economic cost due to isolating the US that would never be seriously considered without the public health threat.

I like your optimism, but I expect things to stay divided. Polling on COVID-19 is divided almost right down the middle like everything else in America with Democrats more afraid of COVID-19 and Republicans more likely to believe it’s like a flu.

Furthermore, the heavily impacted areas are all already Democrat strongholds. Densely populated urban centers.

The only country where socialized medicine appears to be outperforming is Germany.

Right wingers will point to Italy, Spain, and the UK as failures of socialized medicine. They will point out that the healthcare systems in Democrat cities failed.

All these points have good refutations, I’m just illustrating that I think this virus will divide us further, not bring us together.

I am highly educated, top tier private university, etc., I have the profile of someone who would support mandatory testing and contact tracking, but I do not as a matter of civil liberty.

I have the profile of someone who would support mandatory testing and contact tracking, but I do not as a matter of civil liberty.

As a fellow believer in civil liberties, I understand where you are coming from here, and I am extremely wary of governments using this situation to claim "emergency" powers that they may be reluctant to give up afterwards.

But as a believer in science, I'm not sure hundreds of thousands of lives lost in the near future in my country alone is a price worth paying for my concerns about what might happen to make lives worse later.

The brutal reality is that the virus doesn't care. Fools posing in close proximity to each other with assault rifles but no protection against the virus are simply more likely to get themselves and their friends and families killed. Students who went on Spring Break and then spread the virus all across the country are more likely to get themselves and their friends and families killed. People who listen to politicians like Donald Trump and Mike Pence instead of epidemiologists are more likely... well, you get the picture.

Right wingers will point to Italy, Spain, and the UK as failures of socialized medicine. They will point out that the healthcare systems in Democrat cities failed.

I'm curious to know in what way(s) the systems in these countries are seen to have failed by those outside. With hindsight they would probably all have instituted lockdown measures sooner, but as they say, hindsight is 20/20.

The science, the actual hard number for mortality rate, is very low. It is the anecdotal evidence that is terrifying everyone (the terrible way in which it kills when it does kill, and the rate at which it spreads).

I am personally not afraid of it, I wear a mask out of courtesy and not wanting to spread it if I happen to be one of the silent carriers.

I've best seen it described by a mathametician as follows (wish I could find the link) - COVID-19 has comparable mortality to the flu, but you are 300 times more likely to contract it.

For something with such a low mortality rate I do not support mandatory contact tracking or testing. I certainly would if the number starts sharply going in the other direction.

I can't say for sure what will be pointed out specifically about socialized medicine in the UK, France, and Italy, but our numbers for the United States outside of NYC appear to be much better than those countries and I suspect that is where the right wing will come out and say our private system outperformed the public systems (i.e., cherry picking the countries with the highest mortalities for comparison with the US).

They will point out that Italy had to triage beds and favored treating younger patients with higher chances of survival, allowing some older patients to die. It was the rational thing to do, but also unimaginable here in the US where you would be sued to high heaven.

Can't you imagine the situation in Italy turned into a campaign add in Florida? "The Democrats want a health care system that lets seniors die" or some such with some pictures of overwhelmed Italian hospitals and a sad looking old man not being treated, but coughing and wheezing.

I never said these were good arguments, I just know that they will say it, I've been following politics for a very long time.

The only crises that bring both parties together are ones that hit everyone. Technically a virus hits everyone (does not discriminate as you say), but in fact it does discriminate. It spreads faster where population is denser and where there is mass transit.

So just like everything in the US, this crisis is divided between urban and fly over. The urban people are literally worried for their lives, and the fly over people are worried about their jobs. This is a super broad generalization, but I am trying to make the point that the virus is not affecting all people the same way and it happens to be right down party lines.

As far as I'm aware, no-one actually knows the true mortality rate yet, nor things like which demographics are more or less severely affected other than in a few clearly distinct cases.

Most of the US seems to be a bit behind Europe in where it is on the curve, so it also seems premature to compare statistics.

Until we know when and how different places have implemented lockdown conditions, track-and-trace programmes and other responses, possibly in several stages over an extended period, and how successful each place has been at limiting total excess deaths caused by the virus and at avoiding unwanted side effects from those responses, it will be difficult to draw any reliable conclusions.

That seems to be a big part of the problem we face: the data we have so far is still well short of what we'd like to know in order to accurately assess the threat and decide on a proportionate response. Consequently, everyone is basing policy largely on educated guesswork and hoping to avoid any catastrophic escalation happening too fast to react, with some increasing awareness that the more severe responses will probably have serious consequences of their own if maintained for more than a very short period and we don't necessarily fully understand those either.

We have excellent data now, which has caused all numbers to be revised down week after week from a ridiculous 3.4 million dead to 70K by July (the Flu killed 80K in the 2018-2019 season). There is enough data for me to decide it is not worth giving up any privacy or civil liberties for while numbers are going down. If the numbers start to go the other way, then I will reconsider. We should adapt to information as we receive it.

Of course it will be tenuous and disingenuous for any political ad to make statements about the success or failure of containment strategies. I was only pointing out what we will be said, and what people will believe, not what was rational. Irrationality is not a roadblock in politics, lol.

We have excellent data now? Please share the sources, because over here the lack of solid data seems to be the biggest obstacle to better policy making. We have official figures for COVID-19 deaths that only cover some cases and don't line up with the excess above seasonal rates. We have no idea how many people have already had it without major symptoms and estimates vary by an order of magnitude. We do not know the long term implications for those who have recovered in terms of immunity. Media sources are trying to work out fatality rates naively by dividing deaths so far by confirmed cases so far, ignoring the multi-week lag, so they are comparing incompatible figures and producing figures that may be very optimistic. Who is doing better than this right now?

As a Brit, I am very sceptical of that. In the UK this crisis is painfully exposing the deep structural flaws of the NHS. The UK is now at the bottom of the world leaderboard for testing, because its 100% centralised and government run healthcare system has totally failed at scaling up capacity. One reason - it's actually refused and ignored testing capacity in the private sector.

e.g. here's a firm saying they could run lots of tests but the government hasn't returned their calls

https://www.telegraph.co.uk/news/2020/04/15/british-company-...

Here's another analysis that mentions private sector companies being baffled by lack of swabs being sent to them:

https://reaction.life/why-is-the-uk-so-slow-at-increasing-te...

Places like Germany have an apparently much lower death rate because they're testing far more aggressively. Why is that possible, well, because there's no ideological problem with involving the private sector in healthcare like there is in Britain. It's really hard to fail more severely than the UK has done. It's uniquely terrible at handling this crisis, and that's the fault of its unique healthcare system. Nobody rational in America will look at this performance and say, yep, that's what we need.

nations that do follow the science and support their healthcare professionals and ultimately get it under control to a useful level are going to be very wary of undermining that progress

So far the data says the epidemic is basically following the same path everywhere, regardless of what governments do. There appears to be no correlation between how governments reacted and outcomes, so no, nowhere is going to be blocking travel to the US because of coronavirus.

As for "follow the science", that phrase is being used mostly to mean "listen to epidemiologists". But their models are all being disproven in real time, over and over again. Nobody is going to have any respect that so-called science when this is over. It simply is incapable of making accurate predictions. It's no more a science than economics is.

There are some serious questions to be answered about the UK's response. However, those concerns mostly seem to originate with the political leadership (or, arguably, the lack of it) rather than the NHS itself.

It has never been the case that the NHS was the only provider of healthcare facilities in the UK or that it did everything "in house". We have biotech firms and medical equipment providers and direct clinical healthcare services in our private sector, too, and the NHS works with many of them routinely. Some of the big questions seem to be about why the government and NHS aren't making use of the capabilities those organisations might be able to provide in this particular situation.

I'm not sure the data we have so far does support your claim that everywhere is on the same path regardless of government response. Indeed, your own example of Germany suggests otherwise. There are also the (relative) success stories in Asia where they appear to have managed to avoid imposing the heavy restrictions we've seen in Europe without letting the virus get out of control. The widespread use of testing and the willingness to engage in population-scale track-and-trace programmes seem to be recurring themes in the places with better outcomes so far.

It looks like the thinking from governments in the UK and other locked down European nations is rapidly evolving to these heavy lockdowns being unsustainable for more than a few weeks, but possibly being a useful bridge to a time when we can adopt a track-and-trace strategy with a manageable number of cases. This brings us back to the same questions yet again about testing and engagement by the UK leadership with other facilities that might be available.

The body you intend to complain about is not "the" NHS, but the government Department for Health and Social Care.

> The UK is now at the bottom of the world leaderboard for testing, because its 100% centralised and government run healthcare system has totally failed at scaling up capacity.

The NHS had capacity. The DH&SC decided that testing wasn't worthwhile. (I disagree with them, but they were saying that covid-19 is so contagious and testing doesn't affect the treatment someone gets so there's no point testing them, and when they made that decision we didn't have reliable antibody testing).

> One reason - it's actually refused and ignored testing capacity in the private sector.

That's not a decision for "the NHS" to make.

Testing the population for Covid-19 would be Public Health England, not the NHS. PHE has a central arm, but is mostly split out to local authorities.

But PHE can't make that decision if the minister has said not to test.

> because its 100% centralised and government run healthcare system

That's not at all how the NHS works in England. It's mostly not centralised. Most commissioning is done locally by Clinical Commissioning Groups. They buy services from NHS providers who, again, are mostly local organisations. There's some central commissioning, but that tends to be very specialised services. ("inpatient mental health treatment for deaf adults", for example.)

Ministers have been saying test for a long time now.

But if you want to play civil servant lawyer and argue "any failing part of the British healthcare system isn't really the NHS", go for it. From the international perspective nobody cares. Public Health England is the Department of Health is the NHS is the government. How the government divides up responsibility between variously branded bureaucracies doesn't alter the overall outcomes, nor the reasons for them. The UK centralised all CV testing in a bureaucracy that was quickly overwhelmed, didn't scale up, didn't involve the private sector and didn't react quickly to need. Privately run healthcare systems managed all these things.

Here's a politician saying it's the fragmentation, not lumbering centralisation, that has caused problems for the English response to Covid-19. https://twitter.com/Debbie_abrahams/status/12528814744595374...

Newsnight have a good point when they say the Lansley reforms caused problems.

> Nor will forced vaccinations

I'm not even close to an anti-vaxxer, and a lot of that is because existing vaccines have been around for a long time and we know a lot about their safety. The US government forcing vaccines that were rushed to market scares me. This is the government that did the Tuskegee experiment.

> This is the government that did the Tuskegee experiment.

This is not even closed to comparable. So far off that I begin to suspect everything else you said.

The Tuskegee experiments were a limited horrible experiment undertaken by the US government fully aware of the fact that they were performing horrific experiments on the people in the study specifically to see how bad things would get.

The vaccines being rushed through trial are sourced from multiple labs in multiple countries with the hope they will help the entire population. The primarily role the US government plays is to ease the rules and to provide some funding. They are not pushing a particular vaccine, type of vaccine, the trial groups, or any of the other details.

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