1. This doesn't appear to be a falsifiable position with respect to being overly conservative. Any action that results in the hospitals not being overwhelmed will be taken as somehow likely causing the hospitals not to be overwhelmed. It's not clear by this logic how hospital capacities are ever chosen given various uncertainties in the environment.
2. It commits a status quo bias. Only the risks of deviating from shelter in place are considered. On the one hand we have a virus with a CFR of around 0.5% with fairly well understood vulnerabilities to various parts of the population. On the other we have a completely unprecedented shutdown triggering a 2T spending package and causing record unemployment, with an unknown end goal. Is the risk of continuing down this path somehow less than the risks to the hospitals based on our knowledge of disease?
I don't think the virus is as well understood as you believe, which is why opening back up now may be premature.
Regardless, the riskiest pre-existing conditions appear to be obesity and hypertension. 57-75% of Americans are obese according to the dedicated Wikipedia page. Also bear in mind there is considerable variance among obesity rates per locale. What's the CFR in obese patients?
Edit: if you can't tell me the CFR in obese patients, you shouldn't be rushing to open everything back up. I don't know why people are silently downvoting but there is nothing incorrect or inconsistent about my comment and I'm just making a suggestion based on what little evidence exists.
Point is there will be more than enough cases to overwhelm hospitals if the virus spreads in earnest. In this respect our population is potentially more vulnerable than, say, much of Europe or parts of Asia.
I don't know why my comment is even being downvoted. There is literally nothing factually incorrect or logically inconsistent about it yet every time I post anything regarding COVID19 I get immediate downvotes.
1. A lot of people are gaining weight at a prodigious rate.
2. Newly minted alcoholics are being created before our very eyes.
3. There are already a bunch of seriously bad haircuts.
And this is just among people that I know who have the luxury of sitting around the house working from home. I imagine the real life consequences for the less fortunate are significantly more serious.
What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals. If this is truly a concern, and our rights our primary, then we should be building more hospitals so that we no longer have to make this Faustian bargain.
It seems impractical and short-sighted to continue these measured based upon this single metric, especially when there are so many other ways to have a lasting impact on the problem.
Aside from that, I don't personally believe it's the purpose of the government to save lives at any cost. Even the Police won't give you that guarantee.
This is extremely unlikely due to the current administration.
What rights do you think you have here? Businesses are controlled through licensing and zoning. Outdoor spaces are regulated. Which right are you referring to?
Your rights have been an illusion the whole time. We're one organism. The individual is a useful abstraction, as is further dividing that into the cells, but these abstractions have limits.
Heads up: You'll also die.
This is pretty selfish. What about all of the old and immunocompromised people that could _die_? What about the families of those people? These people deserve rights too and I’d say their right to _stay alive_ trumps your “right” to get a hair cut or whatever
Lastly, even if it grew unchecked, I don't believe overwhelming the healthcare system would crash the economy. It might devastate the healthcare industry, but it wouldn't devastate all industries like prolonged, no-end-in-sight lockdowns are doing. I also don't believe it would "kill [significant amounts of] young people" because I believe the mortality rate is much lower than currently estimated.
Suicide is already killing more young people than covid-19 due to lockdown. 2 USAFA cadets committed suicide because of lockdown orders this month, yet 0 cadets have died from covid-19.
They didn't shut down daily life, and their hospitals are doing just fine. In fact, COVID cases and deaths have plateaued.
> data suggests the vast majority of the population have taken to voluntary social distancing, which is the crux of Sweden's strategy to slow the spread of the virus.
"This Japanese Island Lifted Its Coronavirus Lockdown Too Soon and Became a Warning to the World" https://time.com/5826918/hokkaido-coronavirus-lockdown/
Restrictions could start easing if you could manage an outbreak swiftly. This requires:
1) Enough tests that actually worked so you can SPOT an outbreak before it goes 3 weeks.
2) Enough resources in the medical system to handle an actual spike without collapsing
3) Enough protective equipment that won't disappear in the face of panic buying
This is the MINIMUM. Are we there yet?
Otherwise, you get Hokkaido.
Does it make any difference that the US has not "plateaued" if the number of active cases is rising slower than in Sweden, and the death rate is lower?
+-------------+--------------+-----------+--------+-------+
| Country, | Active Cases | Yesterday | Chg | % chg |
+-------------+--------------+-----------+--------+-------+
| Sweden | 15,647 | 15,441 | 206 | 1.33% |
+-------------+--------------+-----------+--------+-------+
| Belgium | 28,602 | 28,255 | 347 | 1.23% |
+-------------+--------------+-----------+--------+-------+
| Oman | 1,675 | 1,655 | 20 | 1.21% |
+-------------+--------------+-----------+--------+-------+
| Georgia | 335 | 331 | 4 | 1.21% |
+-------------+--------------+-----------+--------+-------+
| Ecuador | 21,020 | 20,777 | 243 | 1.17% |
+-------------+--------------+-----------+--------+-------+
| Netherlands | 33,477 | 33,120 | 357 | 1.08% |
+-------------+--------------+-----------+--------+-------+
| World | 1,928,133 | 1,908,936 | 19,197 | 1.01% |
+-------------+--------------+-----------+--------+-------+
| Latvia | 538 | 533 | 5 | 0.94% |
+-------------+--------------+-----------+--------+-------+
| Greece | 1,821 | 1,806 | 15 | 0.83% |
+-------------+--------------+-----------+--------+-------+
| Poland | 8,874 | 8,817 | 57 | 0.65% |
+-------------+--------------+-----------+--------+-------+
| Iraq | 473 | 470 | 3 | 0.64% |
+-------------+--------------+-----------+--------+-------+
| Cyprus | 659 | 655 | 4 | 0.61% |
+-------------+--------------+-----------+--------+-------+
| Lebanon | 541 | 538 | 3 | 0.56% |
+-------------+--------------+-----------+--------+-------+
| Portugal | 21,742 | 21,632 | 110 | 0.51% |
+-------------+--------------+-----------+--------+-------+
| Slovenia | 1,098 | 1,093 | 5 | 0.46% |
+-------------+--------------+-----------+--------+-------+
| Lithuania | 934 | 930 | 4 | 0.43% |
+-------------+--------------+-----------+--------+-------+
| Norway | 7,317 | 7,294 | 23 | 0.32% |
+-------------+--------------+-----------+--------+-------+
| Kuwait | 2,254 | 2,249 | 5 | 0.22% |
+-------------+--------------+-----------+--------+-------+
| Estonia | 1,364 | 1,361 | 3 | 0.22% |
+-------------+--------------+-----------+--------+-------+
| USA | 813,655 | 812,966 | 689 | 0.08% |
+-------------+--------------+-----------+--------+-------+
| Japan | 11,260 | 11,260 | 0 | 0.00% |
+-------------+--------------+-----------+--------+-------+Death count is at least somewhat less subject to such complications, and even there, it'd be much better to compare 7-day averages to smooth over reporting quirks.
If the numbers were really meaningless, it would probably be evident in their clustering or limited range. I noticed the contrary; I didn't post a complete chart because I figured more data would probably result in diminishing returns when urging people to question their beliefs.
Russia, by the way, in the same data set, has about 7.6% more active cases than yesterday. Brazil, 8.4%. Pakistan, 4.8%. So if you hypothesized that all the increases were in the approximate range of +1% to -1%, you would be quite wrong.
Conversely, Germany's figure is down 4.8% and Switzerland is down 6.2%.
It seems as though people for whatever reason fetishize Sweden, among other nordic countries, and I'm increasingly irritated by it. Partly because it reminds me of the current US president and his judgment of different countries as "shitholes" or not. People pretend that they are clearly seeing facts in an unbiased way while doing the opposite.
The Sweden angle has been pushed hard in conservative media circles. You’re seeing a reflection of that here.
An R0 of 2 is towards the low end of estimates without social distancing. Zhang et al. estimate it as [2.06, 2.52] from the Diamond Princess data; Sanche et al. reported [3.8, 8.9] from data from Wuhan.
Could you tell me where are you getting this magic number ballpark estimate from? (somewhere concrete, not just your gut and imagination)
International comparisons to lockdown level and case count changes.
Assuming serial interval of 4 and > 10x non-detection rate on March 31 and 3x now gives you this.
Knowing people were dying if the disease in early February implies very high lack of detection when SIP was in place. (Likely over 800 infections a day when Santa Clara activated SIP)
Edit: More detailed explanation above.
e.g. CA was around 1250 new cases 2nd week of April and maybe 1200 now (4% lower). With test capacity increasing, rt.live is giving 0.88, which on a 4 day serial interval implies a 33% actual reduction
Bay Area went from about 200 to about 140 now (30% lower). Factoring the reduction from testing (if same for all of CA), we're actually at a 53% reduction. That's an R of 0.81.
Santa Clara (which I admittedly originally mis-used for all Bay Area) went from 62 to 25. That's an crude R of 0.77 -- 0.7 factoring the test increases.
If it creeps up to 1.1, you still don't need many rounds of infection to completely overwhelm the system. 7 rounds of infection (~a month) would result in 10.4x more total patients.
If R0=2 (each person infects two more), you have 1 case at time zero, two after the first time step, and four after the next, but the total number of cases is 1+2+4=7, not 2^2.
It's true that people are discharged from the hospital eventually (one way or another), so there's a little extra room from that, but not much.
No, you need to account for that. We're at steady-state to decreasing hospitalization already (that is at r=1, increase = decrease).
I'm not sure if there's good data on the length of hospital stays, but an early preprint from China reported a median stay of 19 days. That's not much help here: On day 20, the intake is 60% larger than the initial cohort--and only half of them (b/c median) will be discharged.
People with more data and expertise!) have worked up full SIR and utilization models, but the general point is that exponential growth is manageable, even boring, until suddenly it suddenly isn't.
The hospital has an entire wing dedicated to COVID patients that did not actually materialize. No care is provided to other patients that might need it (unless it is an emergency). Every appointment was rescheduled months into the future.
Everyone must stay home on the account of better erring on the side of caution.
With 21% daily increase, it takes 12 days to go from 10% to 100% hospital utilization. And change of policy usually takes a week or more to affect the curve. Which means, we are ~5 days away from an invisible deadline, after which hospitals will be overrun no matter what.
That's not nearly far enough for my liking.
Second, all regions saw giant, double digit growth rates at first, and then lower growth rates. Sweden is taking a more laissez faire approach, and their growth rate has dropped from over +20% d/d to +1% d/d [1]
There isn't data to support the idea that we'd have 100% utilization in the Bay Area without shelter in place.
[1] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...
That's what I read the parent to be implying.
Fundamentally this is just a complicated strawman. People are arguing against "lockdown" but not in favor of another option. But we were all here in late march and we know what this disease does without containment.
Ease up can mean a lot of things between what we have now and no lockdown whatsoever.
What level of easing depends on the goal and the data showing what level of control is being achieved.
Not sure how to put this but if you're advocating for the side that wants to confine seven million people to their homes and shut down nearly all commerce you're the one that has to come up with the specific proposal.
The objection is that there doesn't seem to be any kind of numerical metric to determine the success of this shelter in place policy.
It's public policy. So what are the stated goals of that policy, and what are the criteria for determining success?
It is a serious fucking problem that people aren't even really trying to answer that question any more.
That doesn't seem right. I got tacos from down the street last night. I got paid a week ago. I bought some home office related junk from Amazon yesterday. I need to go shopping tonight.
That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all.
So I ask again: who do you want to go back to work before the virus case load drops? Be specific.
You're kidding right? The drop in GDP between 1929 and 1932 was about 15% or so. You're saying I'm the one being hyperbolic for calling a drop of twice that size in three months a total free fall?
I apologize I forgot about Jeff Bezos and your local taco guy. I'll try to be more optimistic, like you are doing here, by predicting an instant drop of economic activity to twice the severity of the Great Depression.
And sure I'll take your bait on specifics anyways. I think we should pick policies just restrictive enough to keep hospitalizations below system capacity and no more. There really isn't any other reasonable choice, the current policy is just delaying the inevitable for no clear reason and without any specific vision of what success looks like.
You realize that if we have the same number of cases, and deaths, but with 3-4x the economic destruction, that's a spectacular policy failure right?
I could be entirely wrong, but I just wonder whether GDP is a good measure or not for this situation. Think about childcare - it's not that children are not being cared for: in fact, they might be getting more attention from their parents or other family members. Yes, the daycare is shut down and not making money, but the work is still performed. Similar to restaurants vs. food made at home.
I wonder if the loss of non-essential businesses is as detrimental to our economy as the loss of essential businesses. During the Depression, we were losing essential businesses like farms and then on top of that we had a dust bowl. The economy feels very squishy - as in, we're able to layoff and furlough an amazing percentage and people still get the basics like food, water, and shelter, and we still have luxury goods: Apple is still releasing new iPhones even though they're made in China, we still have craft beer flowing, and we can get tacos.
Tied into this, though, is that we do have to keep money flowing not through labor, since that's illegal for a lot of folks, but start figuring out better unemployment insurance and small business aid.
My current belief, based on experiences reported in other countries, is that this would be enough. There's not much evidence that total physical lockdown is necessary for everyone regardless of their level of vulnerability.
Not a doctor, not medical advice, etc.
step 1) re-open elementary schools
step 2) re-open middle schools
step 3) re-open high schools & colleges
step 4) re-open all small businesses that do not result in gatherings of more than 2 people in one place, then 5, then 10, then 20, then 50
I'm not saying that's the right approach but there is certainly middle ground between current shutdowns and a total re-opening of society.
1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month.
2) For better or for worse, we've conditioned people to be wary of contact with other people. A movie theater that's 10% full is still hemorrhaging money, perhaps worse than if it was closed entirely (no payroll costs/etc).
I'm not sure what the breakdown is, so this could certainly be hyperbole, but it's entirely possible that people will just feel uncomfortable doing things with groups of >10 until a vaccine is available. A restaurant with 25% of its normal business will likely still need to shut down, reduce staff, etc.
Sure, we may not have 22MM people filing for unemployment but it might still be 10MM, which is still extremely abnormally large.
All that to say, there's a real possibility that gradual re-openings don't actually accomplish anything because the root fear (i.e. catching covid-19) hasn't been resolved in the minds of many people, especially in dense urban areas.
Though it could make sense to re-open them a month early, health concerns permitting. They already got a "summer break" and can make up for lost time
My kid is absolutely still participating in school, and quarantine is pretty stressful for a kid. This hasn't been just loafing around, relaxing, and playing.
I'm lucky right now, to be an 'essential' employee making roughly twice minimum wage, working for an employer with deep pockets. I'm not coming from a place of personal inconvenience, because my job's gotten exponentially easier since people became afraid to go out. Most of our part time staff is gone, and I'm worried that SMBs will soon start dropping like flies.
We've proven that lockdowns work, really well. now we need to find a balance in order to prevent the economy we as a society return to from being a small collection of megacorps wandering through a graveyard of small businesses and unemployment.
For example - the construction was stopped at near by site. It is a huge 3 acre site where you can easily set social distance of say 10-20ft and have the clad in PPE crew working without any risk of virus spreading.
We all want to avoid a disorderly shutdown driven by fear.
Generally there is sufficient distance from other people when gassing up, so that seems like a very low risk for a short period of time, compared to walking in a city.
You are also at risk of requiring ambulance transport if you do DIY work at home. So best just sit in a dark room because you don't want electricity workers to have to go to work, or Netflix employees to have to go into work, etc.
If you think a pandemic is the time to start major DIY projects then you really don't get it. You're not alone in that, but that doesn't make it smart or right.
Edit to note: two responses "disagreeing" with me by pointing out that the BC lockdown is effectively the same thing as the California one from the perspective of economic impact. This is why I asked the question! People are being fooled into arguing with a strawman idea of "lockdown" that isn't what is actually implemented.
https://sf.gov/stay-home-except-essential-needs
"Everyone is required to stay home except to get food, care for a relative or friend, get necessary health care, or go to an essential job... If you need to get into a car or on public transportation to go for a walk or run, you’re going too far."
1. Restaurants are closed except for take-out and delivery. 2. Personal services businesses are closed. 3. Large gatherings of all kinds are banned. 4. Schools are closed.
You can still go to your office if you wish to, so long as social distancing rules can be respected (staying 2m apart). This being said, the vast majority of businesses that can have their employees work remotely are doing so, simply out of a concern for their health and wellbeing. If you have to have employees in your workplace, then there are guidelines for making it as safe as possible.
There is also extensive testing. Anyone with symptoms can be tested promptly.
Offices are voluntarily closed, as far as I can tell, not by fiat. While you're only supposed to be working at an office if you're an essential worker, the definition is somewhat loose.
The shutdown is preventing quite a bit of sickness, disability and death from occurring during the course of the shutdown. If we could indeed maintain a shutdown forever, and if that would reduce the total amount of sickness, death, etc, then maybe it follows that an indefinite shutdown would have value to weigh against the cost. But those are some seriously questionable assumptions. What actually seems to be happening is that we are delaying people getting sick, and the value of that is not self-evident.
I am suspicious that much of the COVID-19 response is based on pretending that it is a severe pandemic flu with a comparable fatality rate. With a flu, shutting the world down until summer or until a new flu vaccine can be mass produced has clear value. But COVID-19 is not the flu.
Hospitals are nowhere near being overwhelmed, in general, which means that they have some capacity to handle an outbreak if we lift restrictions gradually. I know people who work at hospitals in places like LA, and they've reported that activity is relatively slow. (of course in part because fewer people are going to the ER for other issues)
Lives are being ruined by furthering a draconian lockdown. I know several people who have not only been laid off, but had their businesses destroyed and their dreams crushed. Someone in my neighborhood spent their life savings on starting a gourmet burgers and brews joint next to a movie theater, which would have undoubtedly succeeded in normal conditions. They're getting very few curbside orders because they opened after the pandemic started and nobody is familiar with the brand. They're almost certainly screwed, especially if some semblance of foot traffic doesn't begin coming back in the next month.
I, too, was in the early stage of starting a brick and mortar business before the lockdown. Fortunately, I hadn't opened up anywhere yet. Because my business relied on the existence of gyms, I would have been massively screwed. If there is a god, I'll thank him now for not putting me through the ordeal of owing tens of thousands of dollars to the bank. Now I'm not even going to bother opening up because there may not be any appreciable business in the next year or so, which also means people whom I would have employed have to look elsewhere and may be out of work.
Low hospital utilization seems to have become our only metric for success. I think that's crap, especially now that it's coming out that way more people have had this virus than the numbers suggested.
We can put on masks, wash our hands, and all that, but this idea that "the new normal" is to have little to no proximity with other human beings is demoralizing and wrong. Life isn't just about staying alive.
EDIT: To bring up anecdotes is not a fallacy, and I won't apologize for it.
Some ignorant boob happened to bring up NYC, and their comment to mine got flagged, but I still want to reply to that point.
You can't focus in on a particular city and then claim that, without draconian intervention, that NYC will be coming to a neighborhood near you. It's more complicated than that, and the more data we are getting, the more it's looking like we could begin to take measures to ease the restrictions in a reasonable way in parts of the world where it makes sense. But people like to point at the raw numbers rather than looking at the science or the per-capita numbers.
By using the logic of "but look at NYC!", we should keep the entire world closed until every city on the planet has no more cases, which is highly improbable and destructive.
All you have to do is take a look at hospitals in NYC to know how wrong you are and right the person you responded to is.
>Someone in my neighborhood spent their life savings on starting a gourmet burgers and brews joint
Holy shit won't someone please think of the gastropubs. This is why I'll never believe this is a good faith concern for the people that really need our concern right now: no one ever says "I know a delivery driver" or "I know a busboy" or "I know a janitor" that needs help. It's always some lifestyle business owner that we should be weeping for in these outcries.
+ Home violence,
+ CO2-increased houses make people much less clever,
+ Demotivation/decrease of testosterone makes people durably less productive, further hampering our ability maintain the little flow of goods that’s left.
We are setting up ourselves for a much more deadly future.
I'm not sure what the concern about CO2 is - at least in the Bay Area, we're in prime keep-the-windows-open-all-day weather. And the status quo would be working in offices or other buildings that tend to not even have openable windows, so even if the weather wasn't nice, indoor CO2 shouldn't be a concern.
I'm on board with keeping up the exercise, by the way. It's just that the reality is that people aren't going to come out of this more healthy because their motivation has been crushed.
Can you produce evidence of this? What of the evidence that indicates SIP orders have had no effect, or potentially were detrimental?
https://www.wsj.com/articles/lockdowns-wont-stop-the-spread-...
[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm
[2] https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article
[3] https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...