Comment by bsder | Hacker News Reader

Comment by bsder | Hacker News Reader

Parent Full thread

> But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.

The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.)

The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now.

The fact that they don't is an indictment of most of the governments of most of the countries.

In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity.

Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers.

When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.

> In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits.

Do you think that's practical? This virus has a hospitalisation rate of somewhere between 10% and 20% and an ICU rate of 4-10%, and people who are hospitalised need to be in there for 2-4 weeks. If a 'gigantic wave' is even 10% of your population (which realistically it would far exceed, given how contagious the virus is) you need 10-20 free hospital beds per 1000 population of which 4-10 are ICU beds.

The United States has 800k hospital beds of which ~100k are ICU beds, for a population of 330 million (source: https://www.aha.org/statistics/fast-facts-us-hospitals) That's 2.4 hospital beds per 1000 population, of which 0.3 are ICU beds.

You're gonna need at least 10x as many additional beds as you currently have. At least. And that's for only 10% of your population getting sick.

Edit: To be clear, I'm not saying that lockdowns are pointless. I'm saying that they need to be longer and more thorough to get to the point where the virus is entirely eliminated, or they need to remain at current levels indefinitely until an effective vaccine or other treatment is available.

> This virus has a hospitalisation rate of somewhere between 10% and 20% and an ICU rate of 4-10%

Part of the reason there is even a debate is because we don't know this for sure.

I've seen a lot of discussion about a "submerged iceberg" population of asymptomatic or lightly symptomatic infections that haven't been picked up by testing, but IMO this doesn't pass the sniff test when considering populations like Australia / NZ / South Korea. Any such population should cause a steady stream of serious cases popping up that can't be traced back to known sources, along with random community testing seeing an unexpectedly high positive rate. We're seeing no such thing.

The few studies where a large population was tested and shown to be widely infected but largely asymptomatic seem to fall into one of two camps: They used immunological tests (which are now under serious suspicion don't seem reliable) or they tested a newly infected population after the first cases were found (before the majority of infections had time to manifest symptoms.) They've also been reported misleadingly (eg. the aircraft carrier case where it was reported "80% of the crew were infected but asymptomatic" when actually 80% of the crew who tested positive were asymptomatic.)

I'm also not asserting we know for sure that there is a 20-50x (or something along those lines) undercount in cases. Just that there is a huge amount of uncertainty with IFR and hospitalization rates, and none of your points really rule out that uncertainty.

Also true, and there's a chance I'm wrong and most people have already had a mild version and everything will be fine. There's enough evidence suggesting that the rates of severe complications and death are far higher than we're comfortable with, though, that I, for one, would prefer to err on the side of caution rather than run with "well, it might not kill 10% or more of the population."

The goal of lockdown in Germany is to get herd immunity in a controlled way ( over a longer period of time, without stressing our healthcare etc)

What's their estimate of the period of time required to do this?

No real estimates.

The number of hospital and ICU beds are being increased rapidly. Medical students are now allowed to work with patients until the crisis passes ( thus increasing the healthcare capacity).

After carefuly observation the plan is to slowly reduce the stringent lock down measures and increase the infection rate, while keeping the medical staff sane.

We will get the next update in the first week of may, whether the first step of "easing" worked as intended.

I'll be interested to see how it goes. Very early on (start of March) I did some calcs for Australia and basically estimated that we'd need to be in partial lockdown for something like a decade in order to not overwhelm the health system, even assuming a significant increase in hospital beds. The numbers are a little more favourable at this point though.

This is a major issue. Most of the Fair halls (like halls where CEBIT etc take place regularly) have been converted to hospitals now. Robert Koch Institute has asked all hospitals to build seperate wings for CoViD19 patients as the lung infections of those affected will also create after effects that will increase healthcare needs even after the disease is "eliminated".

What we are going to see is a new normal, even if we find a working vaccination soon.

> or they need to remain at current levels indefinitely until an effective vaccine or other treatment is available

It isn't quite so bad. Lockdowns are a continuum of measures, and you can modulate them over time. We're having to do such strict lockdowns because we were so slow in responding. Once the R is below 1 you can release measures to keep it at that threshold and modulate it over time to match your health care capacity. Merkel seems particularly well informed about this, having even explained what the curve of healthcare capacity versus R looks like for Germany.

This was a good discussion on this at the beginning of the lockdowns:

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...

Oh definitely, once the number of infectious carriers is properly under control, lockdowns can be relaxed. I just meant we can't "go back to normal" until the virus is all but eradicated and no new unexplained cases are seen for at least a couple of weeks.

If you define "back to normal" as absolutely no restrictions sure. But there's a world of difference between being locked at home and having simple restrictions like no events with more than 50 people, and lower density seating at restaurants. The plan is to find a reasonable balance that's <10% of a full lockdown in terms of restriction and ride that while measuring evolution to tweak the measures. A simple control loop.

> You're gonna need at least 10x as many additional beds as you currently have. At least. And that's for only 10% of your population getting sick.

The problem is that even if we just fill the current beds we have, we STILL don't have enough equipment for the healthcare workers.

This is a major problem.

Especially so since we can substitute therapies. For example, apparently high-flow ventilation is just as good as invasive ventilation--and maybe better. The problem is that it aerosolizes the virus, so your workers need a lot more equipment.

If you don't have enough equipment for the healthcare workers, things fall apart long before you reach available system capacity.

The point of lockdowns wasn't to stay locked until total control.

I defy you to find a specific "point" of lock down. I more or less support it but I'd still claim there's not been a proactive strategy in the US even if occasionally the US uses rhetoric. So for that reason, there's no specific "point". Maybe authorities will reach sufficient clarity that they can articulate and stick to a point but not now.

But otherwise, yeah, the entire situation is a mess, an indictment of all the state involved, etc.

The end-goal of lockdowns vary drastically by country. New Zealand just relaxed lockdown today and have declared "elimination" of all community transmission.

Most countries are seeing death rates beginning to decrease after weeks of lockdown.

I noticed the article in the WSJ about New Zealand. But I (a kiwi) haven't seen any local news indicating that the government has declared any sort of elimination. If you have seen one, could you link it? I'm currently skeptical of the WSJ article.

There were four new cases today. One confirmed by test and three presumptive cases which according to the experts probably have it. Plus there are hundreds of people in isolation/quarantine who are still sick. I wouldn't declare "elimination" just yet.

Even if new cases dwindled down to zero, that doesn't imply elimination either. There might be many asymptomatic people who are not spreading it currently because of the lockdown, but who will start spreading it once they start interacting with people outside of their bubble.

> Prime Minister Jacinda Ardern, who yesterday said the virus was "currently" eliminated, told Morning Report it was not unreasonable to use the term elimination - but that meant "zero tolerance for cases".

https://www.rnz.co.nz/news/national/415278/covid-19-new-zeal...

Reply on news.ycombinator.com