I thought this doctor explained the idea better than I could: https://medium.com/@jbgeach/eight-reasons-to-end-the-lockdow...
But I’m just winging this like everyone. I could certainly be wrong.
No, it's not time to ease up. Unlike in February, we have effectively zero buffer in many areas. A sudden increase in cases (which is what "easing up" means!) would push us right over the edge.
We ease up when the outbreak can be sustained. It can't now, and won't for several weeks, maybe two months more. Stay home.
> we have effectively zero buffer in many areas. A sudden increase in cases (which is what "easing up" means!) would push us right over the edge.
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I think that this is not the best way to think about it. We need to contrast the benefit of lockdowns (decreased transmission of the disease) with the economic costs. And just to be clear, this isn't about investment returns, the stock market, etc, it's about the very real fact that poverty, stress, and economic uncertainty all eventually lead to deaths in their own right (either indirectly due to being reluctant to seek medical care, or directly through suicide).
If you're willing to discuss further, can we see if we agree on these points?
(1) This is a highly transmissible respiratory virus, and thus eradication is impossible
(2) Given (1), the purpose of lockdowns and other measures is primarily to prevent us from exceeding our hospital capacity, at which point the number of deaths would go up dramatically
(3) The vast majority of the globe will be exposed to this. Avoiding that is not possible, so it's just a matter of when
Therefore, we should work to mitigate the _impact_ of Covid (NOT with the goal of eradicating it, which is impossible), but there is a point where the economic damage will far exceed the cost of lifting lockdown.
BTW, it's not like ending lockdown means everything goes back to normal. We would still be banning large gatherings, at least for a short length of time, and we would still be advising at-risk individuals to self-isolate (and for a country like the US, I don't have any hard numbers here but that could easily still be 30-50% of the country who's considered at risk).
Last point I want to make. Many of us here work jobs that allow us to work from home, and so we kept our jobs during this. We need to recognize that not only have tens of millions of Americans lost their jobs, but a significant chunk of those jobs will not be "coming back". Real value was destroyed. And those who lost their jobs are exactly those who are likely to be in lower socioeconomic classes and thus are much less equipped to weather events like this.
(Sorry, the above was pretty rambly, so I hope there's still some value you can get out of it :P)
You want to release lockdowns at the very moment where we are at peak outbreak size? How is that not the worst possible time to do it? The very definition of "releasing lockdown" is that the rate of spread will increase. Since the exponent now seems to be very close to zero, that means it will rapidly become higher than zero, and we will be growing exponentially again.
And we will start not from a dozen cases, but from hundreds of thousands. How does the math work on that?
Also, to pick on some of your postulates:
> (3) The vast majority of the globe will be exposed to this. Avoiding that is not possible, so it's just a matter of when
The fact that we're peaking now, way under universal infection, proves this wrong. We've beaten it, the war just isn't over. We didn't all get Ebola or HIV, which were similarly novel. The world never acquired universal herd immunity to polio either.
Some pandemics, like the 2009 H1N1 ("swine flu") outbreak, do work like that and spread effectively uncontained. And it's bad when they do. Swine flu killed a quarter million people, and COVID-19 is about an order of magnitude more dangerous. So it maybe made sense to let one spread where we want to contain the other.
Details matter, basically.
Please define "peaking". Really what you mean is that the curve of new infections is starting to flatten, but by definition, we are going to hit a new, higher peak if we lift the lockdown, because we haven't exposed enough of our population yet.
It is very important that we either agree on the 3 postulates I provided, or can convincingly explain to each other why we disagree on point (3). The vast majority of the globe will be exposed to this.
> We didn't all get Ebola or HIV, which were similarly novel. The world never acquired universal herd immunity to polio either.
Hmm. This is just incredibly wrong. It's not the "novelness" that determines whether the majority of the globe will be exposed. You have to look at how the disease is spread and how fast/easily it spreads. HIV is not a respiratory infection. So it's a total red herring. Same thing with polio. It should be really obvious that a disease where you need to be exposed to semen/blood/other fluids of someone infected (HIV), or exposed to fecal matter entering your mouth (polio), is going to behave differently than a disease that spreads via respiratory droplets (covid).
Look, the entire world agrees we cannot eradicate influenza, and we also agree that the majority of the world has some level of immunity to these diseases. Whereas with a completely novel virus, we do not have widespread immunity.
Any infection that spreads easily enough (which tends to exclusively be respiratory infections since they spread the most) is impossible to eradicate, doubly so if there are natural animal reservoirs as their are with H1N1 and sars-cov-2.
> So it maybe made sense to let one spread where we want to contain the other.
We cannot contain either of these diseases. It is infeasible. This is another point we really need to agree on to be able to have a productive discussion. Tell me, is there any respected health organization that is advocating a policy of _containment_ towards covid? I am asserting that there is not.
Containment has virtually nothing to do with lethality of the disease, except insofar as a disease with a 50% mortality rate will tend to burn itself out. It's all about the transmission rate.
I agree that details matter. Which is why I think when the facts of how this virus operates are examined, it is extremely clear that we will neither contain nor eradicate the disease.
The approach you are advocating for will lead to the so-called "second wave" that will crush us, and we'll have to close our economy down again to avoid widespread infection, except (a) we won't be able to because we already damaged it too much to have that headroom, and (b) as I believe this "first wave" will show us, economic shutdown is just a bad policy across the board except in areas where we are near peak hospital capacity.
Not sure if you're interested, but my thoughts on a "second wave" are that it's an indication that a society totally mishandled the initial outbreak. We need to try to maintain a steady rate of new infections, such that we are near our capacity but not exceeding it. Now, due to how exponents work, it is really easy to mess up that balance. But we have to work towards herd immunity. (BTW, it's not something that you have to "work" towards, it's really a natural process that we can only interfere with by trying to foolishly contain rather than practicing targeted mitigation.
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> Do you have a specific policy you're trying to advocate for?
Yeah, I'll give you one to chew on. All at-risk individuals are encouraged to voluntarily self isolate, and hunker down until we have a possible vaccine. Those who are not at risk live life as normal, minus some large gatherings. While those at-risk quarantine, everyone else is developing herd immunity. BTW, it saddens me that "herd immunity" has been turned into a dirty word. It is a natural consequence of the way immunity works in a population, and so the idea that building herd immunity is "callous" or ineffective is just a total disregard of reality.
We need to build immunity in as much of the population as possible. That's the only way, and it's what we've done for every Influenza outbreak, because herd immunity isn't even something you can avoid developing without containment. But what we can do via misguided lockdowns is needlessly delay the formation of herd immunity while also destroying our economy (I am using strong language but if you look at the jobless claims, medical workers being furloughed, etc, you realize we are truly _destroying_ tremendous sources of value).
This is sort of the pareto principle. We get 80% of the benefits of a mass lockdown, with only a small increase in costs. In fact, I would go one further and say that any policies that prevent the development of herd immunity are actively causing harm since we're postponing the reconciliation into the future while damaging our economy in the present
Oh, and just to be clear, I advocate total lockdown in any areas that are nearing medical capacity. New York is the quintessential example here.
BTW, New York will be a great example of herd immunity. Their death toll is staggering right now, because massive quantities of people have been exposed. It's hard to know how many, particularly given that the death figures are a little untrustworthy, but I would assume that every death has something like 200 corresponding infections (somewhere around a .5% IFR). Give it another month, and we will see a dramatic dropoff in infection, even if we lift the lockdown, because there won't be many vectors left for covid to spread through.
Last thing I'll say is, it's very telling that you have not made any references to the economic impacts of lockdown. A rational decision requires comparing the benefits of lockdown with the costs to our economy, and by not even mentioning the latter, it seems to imply that you're not performing a rational cost/benefit analysis here, but rather are relying on very dubious reasoning.
We should probably look for mitigations that are not economically harmful and keep them in place. Mask wearing seems to be one of them. Then we can use the time that gives us to look for treatments and maybe even a vaccine.
I wonder if you are giving any consideration of the economic consequences of the virus? Those are going to happen regardless of imposed lockdowns. There's a tweet about reservations at restaurants in Seattle declining 60% prior to the lockdown. That's plenty.
BTW, New York is nowhere near herd immunity. If you assume 1000 cases per death, they would have ~1 million people that have been infected. For a virus this contagious, you want 50-60% for herd immunity, not ~12%.
Also we need real-time mass testing capabilities.
Without all of these I can pretty much guarantee that the only weapon we have is lockdowns and there will be another one come flu season, possibly through Christmas until February/March. This is mainly because we won’t be able to tell the difference between the flu and Covid-19 fast enough.
We also don't know the degree or duration of immunity previous infection provides; we have both analytical reasons to expect and early expiremental evidence that prior infection provides some immunity in the near term, but one quote I've seen is that the level of information we have isn't enough to give us confidence beyond that it probably usually provides some degree of immunity for some period between 6 months and 60 years after infection, without knowing either the degree of protection or where in that range the usual duration falls.
Absolutely.
> I wonder if you are giving any consideration of the economic consequences of the virus? Those are going to happen regardless of imposed lockdowns. There's a tweet about reservations at restaurants in Seattle declining 60% prior to the lockdown. That's plenty.
Yes, I have given consideration to that, and I think your point is an important one. Basically, I draw a distinction between unavoidable economic impact due to covid itself (your example with restaurant reservations) versus self-inflicted economic damage (forcing closures rather than letting businesses decide for themselves, discouraging elective surgery in areas without a huge outbreak which has led to incredible job loss/furloughs in the medical sector)
> BTW, New York is nowhere near herd immunity. If you assume 1000 cases per death, they would have ~1 million people that have been infected. For a virus this contagious, you want 50-60% for herd immunity, not ~12%.
Right, hitting the "herd immunity" threshold is great, but the important point is that any marginal increase in recovered cases leads to reduced transmission, even if it does not lead to containment the way "full" herd immunity does.
Per your point, if we stick with that 1000:1 estimate (which honestly I think is within an order of magnitude of the true number), that implies we're only 2, maybe 3 "doublings" away from herd immunity in New York. (Let me know if you see an issue with that logic).
By comparison, in my home state of California, we currently have 1000 deaths which we would expand to 1 million cases using that same 1000:1 ratio, whereas our population is about 40 million, so we have an implied 2.5% herd immunity
That was going to be the policy of the UK government, until (apparently) modelling based on data from Wuhan showed that it would lead to ~250,000 deaths in the UK.
Yes, because debt is the only thing that causes stress.
Being cooped in a tiny apartment away from friends and family can be very difficult for those with severe depression and anxiety. In some cases it will and has lead to suicide.
> than force everyone back into the mix and risk a new outbreak
Just because a lockdown is lifted doesn't mean anyone is forced back into leaving home.
The problem with the lockdown is it forces the same solution on to every individual. Individuals have different needs, risk factors, priorities, and appetite for risk. People should be able to these make decisions for themselves.
Yes it is, without proper economic support. It's go back to work or risk poverty. It's not a fair choice if people can't safely stay home without going broke.
> The problem with the lockdown is it forces the same solution on to every individual. Individuals have different needs, risk factors, priorities, and appetite for risk. People should be able to these make decisions for themselves.
That's framing this as an individual choice when it's a societal issue. If people can do whatever they want, it's just the tragedy of the commons. People will do what's good for them instead of what's good for public health. In this kind of scenario, individualism often just translates to selfishness.
Life's not fair bucko.
I do not agree on any single one of your numbered points.
1) "eradication is not possible" just does not follow from "this is a highly transmissible respiratory virus". "Eradication will be difficult" follows; but several countries have shown us that "eradication is entirely possible if proper measures are taken"
2) The purpose of lockdowns is to eradicate the virus. https://medium.com/@joschabach/flattening-the-curve-is-a-dea...
3) See 1.
So my position is that eradication is possible, and - given the possibility of multiple waves if the virus becomes endemic (large virus population --> increased chances of dangerous mutations) - it is vital that we give it a really good try.
The discussion should re-focus on how we go about eradicating the virus, while minimizing the damage to the economy. This article outlines an appropriate path forward: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...
I know in Florida we had to furlough a lot of medical staff because they didn’t get as many cases as expected and elective procedures are banned.
I dislike citing news articles, I'd prefer to cite real research, but here's a crappy source: https://www.usatoday.com/story/news/health/2020/04/02/corona...
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When I first started hearing about the Coronavirus and figuring out the situation, my initial reaction was that we need to foster herd immunity, and avoiding exposure is near-impossible over the long run therefore we should just "get it over with" - not going out of our way to get infected but also not hiding.
Then as we heard about Italy, France, etc, my view shifted, and I viewed the lockdown as a necessary evil.
I've now swung back the other way. Time will tell, but I really think that subsequent research we'll show that we took a huge problem - a covid pandemic - and turned it into two huge problems - a pandemic along with significant swaths of our economy getting destroyed.
The argument to flatten the curve, beyond preventing exceeding hospital capacity, which is absolutely a critical goal, was also that those of us who are not at serious risk could spread to those who _are_ at risk, and therefore everyone needs to act in lockstep. Well, if you take a systems-level view, absolutely the best thing a non-at-risk person can do is get exposed to covid, fully quarantine themselves, and then return to daily life. Having a huge swath of the population with immunity is the best way to protect our at risk population. (In a perfect world, we could culture sars-cov-2 and voluntarily expose ourselves - basically a vaccine except you're exposing yourself to the real deal and not a virus rendered inert)
Also, back on the "exceeding hospital capacity" point, it is precisely those at-risk who are filling up hospitals and needing intubation or ventilation. So we can have a huge portion of the population who is not at risk still living their lives (with some adjustments), and the effect on hospitalizations would really not be that bad as a result.
I'll be closely following Sweden's data over the next months. I'm very curious how their strategy pans out.
The problem with this kind of "systems-level view" is that individual humans are not cogs in a system. What you propose here is asking every non-at-risk person to take an unknown, but possibly as high as a percent or two, risk of dying. I doubt many people will take you up on that. I certainly won't.
I think the best you're going to get along these lines is to find out, once widespread antibody testing is available, how many people have already been exposed to the virus without knowing it. If that number of people turns out to be large enough, it will be a lot easier to get things back to something approaching normal.
This is a complete farce. 1-2% of dying in not-at-risk individuals? We know that the diamond princess, the cruise where we tested everybody, had around a 1% mortality rate, and that was with a bunch of at-risk individuals (the elderly, in this case). That basically gives us an upper bound IFR, and other data coming out from places like Germany is putting us closer to .2-.6% IFR.
But yes, if someone has extreme anxiety that they are going to die from covid, even despite evidence to the contrary, they should absolutely stay at home. No one should be forced to go outside, but unfortunately in many parts of the world people are being forbidden from going outside practically at all.
The important thing here is the individual needs to be empowered to make an informed decision based off their personal risk tolerance. If someone decides that the unknowns are too overwhelming and they want to remain at home until a hypothetical future vaccine is hypothetically released, that's totally fine. But critically, I don't want to be living in a society that is forcing me to stay inside for reasons that are not based on evidence-based public health policy. And unfortunately so much of what we've seen (e.g. closing public parks, banning jogging, disallowing drive-thru church meetings until the decision was overturned) is not grounded in sane policy, but instead in panic-driven reactionism.
This seems like a highly disproportionate response.
> other data coming out from places like Germany is putting us closer to .2-.6% IFR.
Which is not that different from 1% if you're talking about people deliberately exposing themselves to the virus. If I'm not going to do that at 1%, I'm not going to do it at .2% either. So the term "complete farce" seems way over the top. To me, if you seriously think a significant number of people are going to be willing to deliberately infect themselves and take a .2% risk of dying, or even a considerably lower risk than that, that seems like a farce.
> The important thing here is the individual needs to be empowered to make an informed decision based off their personal risk tolerance.
I'm generally in favor of the idea that people should be given the best available information and then should make their own decisions. In this particular case, I just think you are way, way off as far as your apparent estimate of the average person's risk tolerance when it comes to deliberately infecting themselves with a virus.
Also, if we're going to talk about evidence-based public policy, we need to look at the evidence regarding how well people make decisions when they are empowered to do so. I think the evidence of the last couple of months shows that many people are very bad at that; a lot of public places continued to be crowded with people well after the point where there was plenty of public information telling everyone that close contact with other people in crowded places would spread this virus.
Further, our current public policy regime holds public officials responsible when things go bad, regardless of whether it was actually their fault. That creates a huge incentive for public officials to impose restrictions on people, whether or not they actually make a difference. If we really want to be empowered to make our own choices, we need to stop expecting our public officials to automatically protect us from bad things happening, and take the responsibility for protecting ourselves.
Where is this number coming from?
(Also, .007% is 7 per 100,000.)
Those numbers came from https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c..., but given it's in dutch it's probably easier to use this table that a redditor compiled:
https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...
My bad on not including the source originally; I was on mobile and couldn't track it down (and therefore probably should have just not commented)
https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d
It's also not the case that reducing government mandated restrictions will just snap the economy back. Plenty of people are going to avoid sitting in restaurants and the like, regardless of what the government says.
And hopefully businesses will keep lots of people working from home, so that we can limit the spread as much as possible while working towards better treatments and a vaccine.
Yes. And that's a good argument in favour of gradually lifting government restrictions: the private sector will do some of its own lockdown as necessary.