San Francisco emerged from a lockdown too soon during the 1918 Spanish flu | Hacker News Reader

San Francisco emerged from a lockdown too soon during the 1918 Spanish flu

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30 pointsvinnyglennon39 comments

The spanish flu killed working age people. The case fatality rate for Italian health care workers (frequently tested so should be a good proxy for IFR) is sitting around 0,35%. When you adjust for age (those under 60) you end up with <0.1%. When you look at data based on cfr, serology, etc it all paints a picture of stratified risks based on age. The best gift my age group can give is build herd immunity.

Given most deaths in Canada are in long term care homes (up to 80% in Quebec), this gives us a clear target to improve.

It's strange that engineers are giving in to this biased and non-rational mental model, treating this situation as linear and robust.

It is non-linear and non-robust system. The main problem is that mortality rate even among young people would become much higher as soon as hospitals become overwhelmed.

So you can not make any predictive conclusions based on current stats. Please look at any of the numerous models available online which account for all factors, and you will see how badly herd immunity idea would end for all age groups.

>is that mortality rate even among young people would become much higher as soon as hospitals become overwhelmed.

I don't see how this follows. The point the parent was making is that young people don't seem to need hospital care. Why would they suddenly start dying just because 'hospitals are overwhelmed'? They still won't need them...

> Why would they suddenly start dying just because 'hospitals are overwhelmed'? They still won't need them...

Also, when hospitals are overwhelmed they stop all treatment. That young person who gets shot; has a road traffic accident; has a drug or alcohol overdose; has a problematic pregnancy and birth; has cancer -- all of these treatments become harder to provide.

Original comment is talking about deaths, there are many, many more hospitalizations.

> The point the parent was making is that young people don't seem to need hospital care.

Low risk doesn't mean no risk, and we see plenty of younger people in hospital, and in intensive care, because of covid-19.

ICNARC has a report that they update over time using data from UK intensive care units. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports

https://www.icnarc.org/DataServices/Attachments/Download/c5a...

Age at admission (years), number of people discharged alive (%), number of people died (%)

  16-39     240 (78.4)     66 (21.6)
  40-49     350 (73.2)    128 (26.8)
  50-59     568 (57.0)    429 (43.0)
  60-69     503 (41.8)    701 (58.2)
  70-79     293 (32.2)    617 (67.8)
     80+     57 (31.3)    125 (68.7)

Once admitted to ICU people aged 16-39 have a 21.6% chance of dying vs a 78.4% chance of being discharged alive.

bad use of statistics. if gp is to be believed, once in ICU you are already in the 0.x %. the question then is, are you in the 0.1 or 99.9.

The ggp made no mention at all of hospitalization rates, only fatality rates.

Not true, the point of the parent is that young people don't seem to die. For 0.1% dying, how many are going to the hospital? Let's say it's 10% (completely random number), if you increase the population then 10% completely overcrowds the hospitals, quality of care plummets and 0.1% becomes 5% (once again, completely random number).

Not taking any position nor bringing data in this debate, just pointing out the logic

But they probably have “flatten them curve” in mind, where you maintain some social distancing to reduce the speed of spread.

But some jurisdictions are so locked down that there is virtually no spread at all, leaving the population highly vulnerable to a second wave.

You seem to be focused on a scenario where we allow the virus to spread among all groups, but that was not GP's suggestion. GP's point is that we can pinpoint who is at high risk and who is not, but that was not the case for the Spanish flu. (You talk of age as if it's the only risk factor, but it's clearly not.)

Hospitals would only become overwhelmed if the virus were to spread rapidly among high risk groups. Not many low risk individuals will wind up needing hospitalization.

Lastly, it would be more constructive to the debate to link to data instead of asserting that data exist somewhere out there which support your point.

> It's strange that engineers are giving in to this biased and non-rational mental model, treating this situation as linear and robust.

It's exactly what the model giving us 2.2M deaths in the US with strict quarantine was doing. Extrapolating the cruise ship case of 1% death to 80% of the US. Parent math is actually more reasonable.

There’s lot of data from New York and elsewhere showing young people do not have nearly the same hospitalization rates as older people. Yes, we need to manage But engineers should also not find themselves governed by panic and fear.

Where can I find these models which account for all factors? I've never seen a model including e.g. long-term economic consequences.

The Spanish flu killed working age people.

When it returned the following year. It mutated to become much more dangerous to younger people.

The same year. What started as a bad flu in Kansas in the Spring of 1918 morphed into a super-killer by the Fall of the same year.[0]

[0]https://www.history.com/news/spanish-flu-second-wave-resurge...

yes - the first wave appeared to use young people as a transmission vector but didn't harm them compared to the second and third waves where they were hammered as hard as the young and old.

> The best gift my age group can give is build herd immunity.

Careful with that. There have been a number of deaths in younger age groups, statistically not as significant as those in older and at risk groups, but the risk is there.

Also reports of damage in nervous system, permanent lung damage, etc.

Statistically not as significant? Or statistically not significant?

Thanks, I updated my comment to be a little more clear that it is statistically not as significant. Didn’t realize that was ambiguous at first.

There's no current evidence that those who have been previously infected are immune.

If that was true, vaccines would be useless and lockdowns would be futile. There is no reason to believe this virus us somehow different from every other viruswe have ever seen and magically cannot be immunized against.

There are hundreds, if not thousands of viruses we can't be immunized against. They either mutate too quickly, rendering any antibodies we develop moot, or they kill us too quickly. We don't have a great track record in developing vaccines for viruses either.

50M people died worldwide from "Spanish" Flu, in a world much different than today, yet within a couple years the world had mostly recovered. So far we are still a long way from that number. The problem is you won't know if you are to be in the dead or gravely ill category, or the mild or perfectly fine category, irrespective of age, until it happens.

What we could have had today is the ability to identify, isolate, and thus properly quarantine those who are ill or spreading, but we did not as a society deem it valuable to invest in (outside of places like S Korea). It's a classic pay me now or pay me later situation; now we are reaping the lack of investment in the past (even before the current ineptitude).

I always thought the lack of a comprehensive nation healthcare system or at least a plan that covered everyone in some way in the US would bite us if there ever was a pandemic. We as a society decided that long term planning was not economically viable or even desirable. But we did not even do a minimum. Now we have to hope for the best.

As a nation having everyone (not just some people) healthy and when not have access to affordable healthcare is a benefit to the nation as a whole and the economy, something that the new German nation back in the late 1800's figured out. How we get there in the US in the future I don't know, I just hope we come to the same realization and do something.

This seems like fitting the facts to support a narrative. I don't see how having tax-payer funded healthcare would have helped us. There are numerous countries that do have tax-payer funded healthcare that are in the exact same situation as the US. The fact of the matter is there's nothing preventative that can be done for this virus, so wider access to healthcare should not be expected to change anything.

Very few people want to spend $40 on a fire extinguisher every few years until the moment when their kitchen is actually on fire.*

*That is, unless, history repeats itself and we lose ~1-2% of the world population[0] this Fall. That might provide sufficient motivation. [0]https://en.wikipedia.org/wiki/Spanish_flu

>spend $40 on a fire extinguisher every few years

Gosh, I hope they last longer then that!

I have a (genuine) Halon fire extinguisher hanging on the wall. According to the internets, Halon was banned in 1994!

The pressure dial on it is still in the green.

"Stored pressure ABC extinguishers are very common, and they often require internal maintenance every 6 years and hydrostatic testing every 12 years. Other types of extinguishers may vary in their internal examination and testing intervals." -https://www.cintas.com/fire-protection-services/fire-extingu...

I am starting to wonder if there is any good way for dealing with this. If you lock down preventatively, you are at risk of hurting the economy, losing a ton of jobs and looking silly if things turn out to be not as bad. If you wait, you are at risk of killing people. It seems only in hindsight there is a clear path that balances all factors. I definitely wouldn’t want to have to make decisions right now. You can pretty much only fail in one way or the other.

I think what we should learn is that we need to put much more effort into vaccines even if they are not profitable immediately but the cost of a pandemic is just so high that it’s worth being on top of things.

In a way we are lucky that this didn’t happen some decades earlier when remote work was much less of an option. When I look at my company there are definitely problems from not being able to access equipment at the office that keep accumulating but overall things are moving along pretty well. Without a 100 megabit connection I would not be able to do much.

It's a lot more than just 'looking silly'. The lockdown kills many jobs leading to people losing hope and triggering a recession worse than 2007's. That will have its death toll too.

On the other side, without a lockdown many people would have stayed home anyway. The hospitals would have been overwhelmed and there would be a general sense of panic.

It's not clear to me the economic result would be much different.

Worse, without an official lockdown there isn't any instrument available to get people back into the world once it's safe.

Does anyone have figures for the increase in deaths during the last great recession?

I'm tired of the cure cannot be worse than the disease rhetoric. Economies will recover. The dead won't.

But this situation will also lead to deaths. I already hear the mental hospitals are overflowing.

And really, if we would do everything possible to prevent deaths, we would have tackled traffic, alcohol, poverty, pollution etc. In some countries even poor healthcare overall (Trump is still fighting 'Obamacare').

It's not as black and white as this; the virus isn't the only problem in our society.

Approximately 36k deaths per year in the US are from traffic [1]. About 88k from alcohol [2]. Poverty and pollution is harder to pin down with a quick web search. According to [3], deaths-per-day from COVID-19 flattened at about 2000 deaths about three weeks ago. So in that time ~40k deaths from COVID. That’s with the curve flattened...with the curve flattened it was approximately equal to traffic deaths. If exponential growth had continued what would it be? I think deaths-per-day would doubled about 4 times. So 32k per day. Each day we’d be in the ballpark of traffic deaths. Wait a few days and it would have eclipsed alcohol-related deaths.

[1] https://en.m.wikipedia.org/wiki/Motor_vehicle_fatality_rate_...

[2] https://www.niaaa.nih.gov/publications/brochures-and-fact-sh...

[3] https://coronavirus.1point3acres.com/en

National economies will recover. Many towns and small cities will not. Medium to large cities are reasonably well diversified to weather the storm.

I came to the conclusion a while ago that the current situation is essentially a mental "trap" for people who are "big thinkers" used to being able to look at large, complex problems and come up with reasonable plans to solve them. There's just an impossible amount of variables and every choice is "wrong" in that it has unconscionable downsides. There are no "good" solutions to Covid-19 only horrific solutions at every turn.

Agreed there really are no solutions without major downsides in this. Anyone who can't synthesize pros and cons of various approaches probably shouldn't be in charge.

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