Hacker News Reader

Comment by tptacek | Hacker News Reader

We in fact know very little about the consequences of serious C19 infections in people under 50, and people in their 40s apparently make up a substantial cohort of ICU C19 patients. We also don't know the long-term health implications of a severe C19 case, and there's some evidence to suggest permanent lung damage is one possible outcome. And, even if we didn't know any of those things, avoiding the deaths of people over the age of 50 and the deaths of people of all ages with asthma and hypertension would still be a worthy reason to hit the brakes while we learn more.

View on HN

We don’t know enough so let’s stop the economy while we find out? That is not typically how we do things, because it’s not a rational response. For example, we didn’t know whether holding a mobile phone close to our ear for extended periods of time leads to serious health issues, and there was suspicion that it does. But we didn’t prohibit it — we let people decide for themselves, and it does seem the risk was lower than suspected.

What’s happening now seems more like a knee-jerk reaction than the result of a cost-benefit analysis.

+1. This argument about not knowing long term effects of COVID-19, and hence we have to keep the economy shut down indefinitely makes no sense at all. Making masks mandatory in public, keeping people at risk at home and starting to open up the economy sounds like a more sound strategy.

People are not showing up in the ER unable to breathe because they know someone who holds their Cellphone to their ear.

Covid-19 is not a theoretical threat.

Many people die in traffic accidents every day, but we don’t ban cars. Everything we do involves some risk. There needs to be a rational discussion on how much lock down is appropriate. We need to look at other countries like Sweden and Austria and learn from them. We need to look at the real costs of a depression. What we have now is “People are dying so let’s lock down everything”.

You can mitigate the risk of dying in a traffic accident unilaterally in ways you can't with a virus, and C19 is probably already killing more people than car accidents by a significant margin.

Sure you don't wear seatbelts and install airbags to mitigate the risk of COVID-19, but the point is that you can take measures to reduce the risk of contracting the virus to a socially acceptable level and not have to destroy people's livelihoods. We have after all not waited for the perfectly safe car before allowing millions of cars on the road. The lockdown in its current form seems more like waiting for the perfectly safe car.

I think the most important thing we're waiting for is adequate testing levels.

Like most things it’s a spectrum. Rationally if something posses a non trivial risk, we should try to mitigate it until we can quantify the risk.

If some single digit percentage of cell phone users end up in the ICU I would certainly hope we ban the use of them until we can understand it better.

At what cost? When do you factor in the additional deaths and other consequences from suicides, domestic violence, increased substance abuse, and so on? There are two sides to the equation.

Perhaps when the data starts showing it.

There is dated data (from 1981) showing a 37,000 increase in deaths for each percentage-point rise in the unemployment rate. It comes from a book called “Corporate Flight: The Causes and Consequences of Economic Dislocation” by Barry Bluestone, Bennett Harrison and Lawrence Baker.

From the article citation below:

> Here’s the paragraph from Thomas’ book that applies: “According to one study [the one by Bluestone et al.] a 1 percent increase in the unemployment rate will be associated with 37,000 deaths [including 20,000 heart attacks], 920 suicides, 650 homicides, 4,000 state mental hospital admissions and 3,300 state prison admissions.”

The data is stale, for sure, but the correlation (economic downturn->increase in deaths) is arguably proven.

https://nypost.com/2020/04/20/explaining-the-link-between-un...

(I was unable to find an online version of the book to link to in Google Books or openlibrary.org; I bought the book used from Amazon, it's headed to the Internet Archive for scanning).

Then what's happening right now is a refutation of that data, right? Because we have sky-high unemployment and nothing resembling those numbers. It's almost as if unemployment in ordinary circumstances is not the same as unemployment caused by a discrete, universally-applicable crisis.

This study suggests that the resulting rise in deaths isn't immediate. That it isn't measurable now does not mean it isn't coming.

>1 %-point rise in the unemployment rate raises the risk of dying next year by 6%.

https://www.sciencedirect.com/science/article/abs/pii/S02779...

I will not dispute that you could be right. We'll only know for sure looking back from the future (lagging indicators and such).

I think the "harm from unemployment will swamp harm from C19" argument will get stronger the longer lockdown lasts, but that the ~month we've had widespread lockdown orders is not close to long enough to make the argument without clear data. We have strong evidence that explosive C19 case growth kills lots of people; that's a hard data point to overcome.

If you want to be frustrated with the unbounded nature of the crisis, I think the right place to focus that anger is on testing; in Illinois, we have something like a 22% positive rate on PCR testing, suggesting we're not testing nearly enough people.

I drove passed a testing center in Aurora at the Premium Outlet Mall (I-88 & Farnsworth) twice this weekend, both Saturday and Sunday morning. They opened at 8am each day, and had reached capacity shortly after. I agree that testing efforts deserve the ire of the populace.

There's always "other consequences" you can point to for whatever policy. What about the upside that many can now work from home with flexible hours, and avoid the 996-ICU workweek.

And those consequences matter. You can't handwave them away and pretend they don't exist.

Don't forget that you work in a fairly unique field. Many, many occupations cannot work from home.

Long term health implications have nothing to do with the lockdowns, and extending them has no impact on those theoretical boogey-men.

Lockdowns were intended to 'flatten the curve' so that hospitals aren't overwhelmed. The same number of people will get sick but over a longer period of time. Keeping the lockdowns in full effect will only ensure that those who get disproportionately sick are the ones in critical services and healthcare.

Choosing to violate people's constitutional rights based on hypothetical long term implications is also extremely disconcerting.

That's a talking point, not an argument. In reality the state governments have broad powers, stemming back to jurisprudence from the time of the framers (cases involving these powers were heard by John Marshal), to employ police powers in the service of quarantines, and those powers were further spelled out by statute as recently as the 2000s in the wake of 9/11. None of those powers are constrained by any notion of "flattening the curve", a "flattened curve" isn't a permanent state, and there are rational goals to quarantines beyond keeping the hospitals occupied at an optimal level.

> there are rational goals to quarantines beyond keeping the hospitals occupied at an optimal level

None of the counties in the San Francisco Bay Area have been willing to outline any specific goals, nor has our Governor. If you can point me to anything more specific from the above than 'if we only save one life', I'd be shocked.

What's your point? Is there a statute you're thinking of that requires San Francisco to spell out specifically what their goals are? You said upthread that the lockdown is a violation of people's constitutional rights, but it seems clear that it isn't, at least not in our jurisprudence. You can find legal scholars debating the constitutionality of quarantine, but only in the context of hypothetical orders that haven't been issued by any state yet that would imprison people in their homes (the way China apparently did). If you don't even have the broad strokes of this right, it seems fair to ask for a citation here.

I require San Francisco to spell out what their goals are! I fundamentally reject the idea that it's our duty as citizens to shut up and do whatever London Breed thinks is best. If she's not willing to explain why these emergency restrictions are necessary and how we'll know when they aren't necessary, we shouldn't comply.

Yes, even if this isn't required by the letter of the law, it certainly does seem to be required by the spirit of US law that the people are not mere subjects to be ordered around. At least in spirit, they deserve to be informed, so that they can make an informed decision about whether they believe their representatives are behaving reasonably. And if they don't agree, they can vote them out, or exercise their free speech rights to voice their dissatisfaction.

Is there a statute somewhere that requires London Breed to spell anything out to your satisfaction? I don't know what California's emergency management laws look like; maybe you're right.

Does there have to be a statute to advocate for a rational, numerical based approach to public policy?

You're a super smart, analytical guy. You don't see any problem with imposing extremely restrictive rules on a population of millions without even a basic attempt to quantify what your desired outcome is?

Why do you want this to be a simple problem? It isn't a simple problem, not by a long shot and erring on the side of caution seems to be the right way to play this because you are at most 4 weeks away from a serious disaster if you fuck it up. The fact that SF does ok is a result of the shelter-in-place order, without it SF would look like NYC or worse.

Nobody said it was going to be simple. I'm just advocating that it not be completely and totally lacking in stated goals when it's such a severe policy intervention.

Those goals could be complex, or detailed, or multivariate, or subject to contingencies and caveats. But they can't be non-existent and they can't be secret. This is a democracy.

> The fact that SF does ok is a result of the shelter-in-place order, without it SF would look like NYC or worse.

Your sentence here is making a quantitative assessment that the result is worse than NYC, without stating the metric you're using to arrive at that assessment, or hinting at the means by which it was arrived at. It's just "worse".

That's fine for an forum comment. But it's a disaster as a government policy almost six weeks into this crisis.

What's being criticized here is the parent story, which is a press release by the actual government, and appears to make no mention of the criteria used to arrive at this drastic and staggeringly expensive policy decision, and contains nary a hint of what metrics they'll use to evaluate it, or critically, determine if the schedule should be delayed or accelerated. That's crazy.

It sounds to me as though you do not trust your leaders to have your best interests at heart.

The idea that everybody will go and pick apart the underlying data to support their favorite little theories may have something to do with the decision to keep the inputs confidential.

You get one chance every so many years to vote in a government that you trust, you're going to have to accept that.

We do not, in fact, have to accept that. That's the value of having a limited government - if they misbehave, you can often just tell them no.

> The same number of people will get sick but over a longer period of time.

Fewer people get sick for two reasons.

Flattening the curve reduces the amount of epidemic overshoot. People assume you reach herd immunity levels and the epidemic then dies out. Reality you overshoot herd immunity.

At some point you can reestablish contact tracing and isolation. That by itself reduces the required level of immunity and containment needed to keep the infection in check. Except for a few countries we don't have that now.

My bet at this point is within a few months. Rapid RNA tests will start being produced in large numbers. Synthetic anti-bodies for covid19 will become available. Contact tracing and isolation containment will be reestablished. Rapid RNA tests make contact tracing possible at scale. Antibody therapy increases the effectiveness of contact tracing. Basically you test everyone with symptoms. You then dose all their contacts with anti-SARS-COV2 antibodies.

Not the end of the world.

> My bet at this point is within a few months.

What if it doesn't? What if a few months pass, and we're at the same spot we are now, except we're all a few months older and poorer?

My jurisdiction is already testing everyone with symptoms with only about half of their current testing capacity, and still has no plan to move forward.

Then we revisit.

Which I'd be fine with if governments were explicit about that timeline .

And there's the strokes.

https://www.washingtonpost.com/health/2020/04/24/strokes-cor...

Reply on news.ycombinator.com