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Comment by ryankemper | Hacker News Reader

If it's not obvious, I wrote this.

The intent is to be a fairly comprehensive coverage of what we know about COVID-19 and what it means for our policy. Note that the article is written from a US-based perspective although I suspect it's relevant to a broader audience.

In general, I believe that the case against lockdown has been highly stigmatized and thus many people have not been exposed to a convincing argument of why some of us feel that our response has actually made things worse.

I encourage any pull requests (see the very final section).

If you're short on time, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_endin..., which has a readability score (Flesch-Kincaid, etc) of around a middle school level and is extremely brief and to the point.

For those who have a bit more time but still not enough for the whole article, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_endin.... In particular understanding the age-stratified risk distribution, and how it differs from Influenza, is super important. Finally I'd also recommend checking out the proposal, which ironically is the shortest section: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...

Thanks for any feedback.

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I'm sorry but I can't take serious something that claims to take an impartial look at all the evidence related to the lockdown but then tries its damnedest to present all possible negatives it could without doing the same for positives. For example, there's clear evidence that the lockdown has decreased lives lost to traffic accidents but that appears nowhere here.

And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented.

Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives. Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated".

This thing is so littered with bias and lack of facts that it is not useful for any serious consideration of this. I'm sure it's great for people who already have their mind set in one direction, though.

The positive externalities is not a bad point. Where I'm having trouble is, it seems that if we wouldn't pass a law ordering people to not drive around in normal times, then it feels wrong to point to it as a positive when it's induced by people not being able to do anything.

That being said, I think it does make sense to account for positive externalities. Can you think of others that are lockdown-specific? The classic ones right now are pollution.

> Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives.

I'm not sure if that is a great example of only looking at the negatives. This is one dimension where the effects of the lockdown are basically exclusively negative as opposed to being a mixed bag. So this feels like something that absolutely _should_ be mentioned. Particularly when factoring in the irony of it increasing mortality from other non-COVID-19 infectious diseases.

> Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated".

I don't think this is at all fair either, but I must admit I chuckled a bit. It is a funny thought.

> And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented.

So, this is the biggest hole that I personally see in my argument, so I very much agree here. The trouble I ran into is, this is such an unprecedented situation that it would have felt ridiculous if I just started making up mortality predictions. So it felt like a good balance to highlight the _potential_ for increased mortality. I do think that means I likely need to soften the language around lockdown causing more mortality to accentuate the fact that it's merely _likely_ that it does.

Is there anything else you can think of? Thanks for the feedback.

> we wouldn't pass a law ordering people to not drive around in normal times,

We absolutely pass a ton of laws to make driving around safer, including restricting driving around when it's particularly dangerous (for example, when a person has had a bit to drink).

Here's more random stream of consciousness about this:

> Pareto Mitigation: An evidence-based approach

I love how this uses "evidence-based" as a dogwhistle followed by proposing an approach without providing any sort of evidence about the efficacy of the approach.

> Those who have lost their jobs tend to be those workers who are in a lower socio-economic bracket and have jobs that do not allow one to “work from home”.

This is presented without evidence. I think there's a reasonable chance this is the case, but many essential businesses/industries employ primarily lower socio-economic classes so who knows. This is just presented like you should agree with it.

It's also not clear that those that are more disadvantaged are actually worse off here. There has been a very large increase in the amount and accessibility of unemployment benefits.

There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(ツ)_/¯.

On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?

> A preventable decline in preventative care

Even the (supposedly evidence-based) proposed approach would likely lead to exactly the same decline in preventative care. This error is repeated throughout the document where there's this idea that the changes that we've seen are due to lockdown and will just go away otherwise (except, of course, for when the change is positive and, clearly, the not-quite-lockdown approach recommended would continue that positive change).

> Be wary of “hero culture”

This is maybe the strangest section. Why does this just talk about a hero culture related to real scientists? Do we think that people are more likely to think some nerdy scientist is a hero rather than our heroic manly president? This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts).

> The Soul of the Country is at Stake

OMG. I skipped this in first skim. Yeah, this makes me think I've wasted my time even thinking about this thing, this is clearly a plea to the emotions of a specific subset of the population. I'm done.

> This error is repeated throughout the document where there's this idea that the changes that we've seen are due to lockdown and will just go away otherwise

For these, it could be good to compare what has happened in countries or areas with different responses to these. I.e compare sweden vs norway.

Well, being the author I am certainly biased, but I don't think you've wasted your time :)

Thanks for the feedback. I think the dog-whistle part is quite true. I will need to circle back and add citations where I can. Particularly given that one of the thematic elements is that the lockdown is not based upon evidence.

> There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(ツ)_/¯.

I was worried about this being distracting. I think particularly bolding segments within a sentence is definitely distracting, so I will (eventually) try to clean that up.

> On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?

As far as I know it's not, but I'm not entirely sure where to go looking for weekly suicide data. I've only been able to find data over much longer intervals. This is where being an actual expert would probably help! :P

> this is clearly a plea to the emotions of a specific subset of the population

Just to bite of a piece of this before I conclude here, I personally think that a shift to censorship on such a wide scale is absolutely something to raise a bit of moral panic about. The new usage of the term "disinformation" has hit a point of Orwellian double-speak.

> This is maybe the strangest section. Why does this just talk about a hero culture related to real scientists? Do we think that people are more likely to think some nerdy scientist is a hero rather than our heroic manly president? This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts).

Sorry to bombard you with replies, but I realized I never addressed this.

I think you might have a different idea of what "hero" means, basically all I meant is that we tend to elevate these figures (Fauci in this case) up as "heroes" and therefore act like they are infallible and thus you cannot express an opinion that contradicts them. That is what I was arguing against.

It's not about "hero" in the sense of, like, what a young child would imagine a hero is. So in the sense I'm using it, people totally do view the "nerdy scientist" (Fauci) as a hero. And I understand why they do.

> This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts)

No, it's not discrediting them, it's just saying: evaluate policies and statements on their merits, not based on simply who said them.

I hope that makes sense.

Thanks again for all your thoughtful feedback. You clearly put time into it (and a good bit of frustration, understandably :P)

> basically all I meant is that we tend to elevate these figures (Fauci in this case) up as "heroes" and therefore act like they are infallible and thus you cannot express an opinion that contradicts them. That is what I was arguing against.

What you should do is take the time and effort to educate yourself before contradicting them, (such as about basic things like how herd immunity interacts with R0 in a pandemic) and you should present caveats and disclaimers that are online with your own lack of experience, expertise and knowledge.

There might potentially valuable insights in your article, but their value is overshadowed by the way you present all your ignorance with confidence and surity.

> Specifically, once the proportion of recovered in the population reaches 1/(1-R_0), there are no longer enough vectors (infectable indviduals) remaining for a serious outbreak to occur. It’s worth noting that this is the same principle that vaccination relies upon; vaccination is just an artificial way to build immunity without having to undergo a full infection.

I should learn to never read anything from random people working in areas they don't have any expertise in. This whole section is wrong.

The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.

This is clear when you think for about 1 second about it. The `1/(1-R_0)` value gives you the point where infected people infect 1 more person, it doesn't give the point when the infection stops spreading.

I'm sure you're getting weary at this point, but I really need your help understanding what you're saying here, because to me it seems supremely untrue.

First, `1/1-R_0`. This is exactly what Wikipedia says: https://en.wikipedia.org/wiki/Herd_immunity#Mechanics

And it makes intuitive sense that once you infect <= 1.00 people, growth is no longer exponential. So I don't think that point is wrong at all.

> The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.

This doesn't make any sense to me. Vaccination is just an artificial way to build immunity. So I don't understand your active epidemic point at all. Or put another way, as the proportion of % recovered goes up, we start approaching the eventual limit where `1/1-R_0`->1. That is to say, in your example we start with R_0 = 2, then as people recover that value slowly starts decreasing until it hits 1 at the herd immunity threshold. It's not clear to me what the discrepancy you're detecting is here.

Even when the R0 reaches 1.0 those who are infected will still infect one more person (on average). Infections continue to happen after the R0 is below 1.0.

Thanks, that does make intuitive sense. I wonder for a virus like SARS-CoV-2 that has a high R_0 and thus requires maybe 80% of the population to be immune for full herd immunity, if that means that the overshoot would be pretty mild?

It would mean the overshoot would likely go close to 100%, but it is complex to model as not everyone is equally likely to be infected - basically the population is not uniform. Epidemiologist do model this, but it requires relatively complex models.

This is called 'overshoot'.

See here for a good explanation https://twitter.com/CT_Bergstrom/status/1252077930286444545

Thanks. That was helpful.

So then, it does seem that if we successfully contained the virus, and then avoided infection spread until a hypothetical future vaccine is developed, that we could avoid the number of infections required by some amount.

Just to tie it back to the broader lockdown vs not lockdown debate, we could probably say that a successful full containment strategy+vaccination could decrease the net area under the curve. As far as policy is concerned I still think the costs of locking down for that long (particularly given that the time is unbounded) is not worth it, but that is a very valid point that I will need to circle back and weave into the document.

So you are telling me, that you write an article with misstakes and think you should be the person making statements because you are able to write an article?

And you also think, that politicians are doing an economycal suicide just because they like it?

Srsly, wouldn't you assume and shouldn't you assume, that there are experts calculating and estimating that shit on every single day and trying there best to find a reasonable way out of this?

> So you are telling me, that you write an article with misstakes and think you should be the person making statements because you are able to write an article?

Yes, I am a person that makes and is currently making mistakes.

> And you also think, that politicians are doing an economycal suicide just because they like it?

I analyzed the "game theory" of this a bit here: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...

> Hanlon’s Razor is very relevant here; we think it is not reasonable to assume that they were trying to usher in a techno-totalitarian state. Rather, they were trying to prevent mortality, but their incentive structure is such that it is much worse to have done nothing and later find out that the virus was worse than we thought, than what actually happened, which is to have undertaken actions that were self-destructive and then discovered that the virus was way less deadly than we thought.

You know, i'm an expert in developing software. But i'm an expert in this because i spend years mo-fr 40h min. with time on weekends and after work.

There are plenty of people coming to me and say stuff like 'uh why does that take so long' 'i can do that quickly in an hour' etc. and at the end of the day they are wrong.

In those cases, i would just love for people to accept my expertise and let me do what i'm good at because it costs time dealing with this stuff.

And you know, all those speculations of people who are sitting down for a few hours, writing something, gathering a little bit of data left, a little bit of data right THIS IS RIDICULOUS.

You are not an economist, you are not a doctor, you are not a virologist, you are not the statistics guy. Apparently you are a SRE.

What do you think, your statement actually does? I tell you what it does, if it even does anything: It works against all the experts trying to actually do their fucking job on estimating and deciding on a daily bases about human lives.

Do you know what i decided when corona started? I will, this time, just try to be as undisruptive to the society as i can. I don't have to argue against or for it, i will trust the experts and politicians on this one.

Not everyone needs to form an opinion and also state it.

And yes it might be harder for you to believe in your president right now, i do get that. But let me give you a tip: Whenever everyone would love to stop quarantaen today, i will try to avoid public spaces as long as i can, because the risk of having corona, is actually for me, a bigger problem then just staying low for a few month.

Overshoot is also a function of rates of infection. If each infection results in 0.5 new infections and 16 people are infected, that falls off to ~8, 4, 2, 1 so about doubling. On the other hand if 16,000 people are infected per day it’s still falling off at the same rate, but you get 1000x more infections before it ends.

Well, here's the problem: The statements your making are quantifiably incorrect throughout the article, and by large amounts. The article sounds authoritative, but it's not. It's the definition of Internet misinformation.

I think getting your opinion out there is important, but to be honest, the article needs a heck of a lot more in terms of disclaimers, and much less in terms of confident statements and grandstanding.

I've worked through the best available data. My conclusions:

1) The economic costs of ending the lock-down may be astronomical. This is especially true with what we learn about COVID19 and lung damage (or potentially other organ damage). If even a small fraction of the population is on long-term disability, the costs go up super-quickly.

2) The fundamental costs of the lockdown are cheap. With reasonable economic mitigations, the costs should be that everyone upgrades their car, computer, or similar maybe 6-18 months later, plus an extra 1-5 percent of the GDP.

3) Most of the economic damage of the lockdown, like a cytosine storm, is self-inflicted: bankruptcies, defaults, layoffs, etc. There are reasonable way to manage most of those (and the rest require a very modest stimulus). We haven't taken those steps because we're stupid.

4) If we don't put in systems to manage the economic costs, we'll be super-vulnerable to the next pandemic.

5) This is something which will come up again, and it's also something which is a national security issue. Engineering something like the next COVID19 as a bioweapon is, at this point, within the scope of even poor countries (North Korea, most countries in Africa, etc.), and there's a Moore's Law where the resources go down super-quickly (larger organized crime organizations could probably do this as well now). The point isn't that poor countries are more likely to do this (they're not), but that with 200 countries in the world, the odds that SOMEONE is likely to do this are increasingly high.

> 1) The economic costs of ending the lock-down may be astronomical. This is especially true with what we learn about COVID19 and lung damage (or potentially other organ damage). If even a small fraction of the population is on long-term disability, the costs go up super-quickly.

I have a feeling a lot of people advocating ending the lockdown are doing so on the basis that only old and infirm people die, as if the other option is either an asymptomatic infection or a quick recovery from something flu-like.

But I’ve witnessed some very serious infections, so this colors my perception and pushes me toward continuing lockdowns. To your point, the disease can be debilitating foR relatively young, healthy people. Have you ever gotten the flu and then had to re-learn how to swallow after spending a month in the hospital?

Yes corona is mostly deadly to older people, but even for those who do not die there are negative health outcomes which impact their ability to work and take care of themselves. What is the economic impact of that? Why is it not factored into the cost/benefit analysis of opening up?

> Yes corona is mostly deadly to older people, but even for those who do not die there are negative health outcomes which impact their ability to work and take care of themselves. What is the economic impact of that?

We need to know the incidence of these issues. Response needs to be completely different in case they're the majority of cases, or if they happen in the minority.

So far the evidence collected from what I've seen is case reports, so nothing clear or definitive.

> First, `1/1-R_0`. This is exactly what Wikipedia says: https://en.wikipedia.org/wiki/Herd_immunity#Mechanics

I have no expertise in this area, but Wikipedia does not say:

    1/(1 - R_0)

It's:

    1 - (1/R_0)

Which makes much more sense to me on a math footing. You should probably fix that in your article so it doesn't confuse other pedants like myself.

Doh! Thanks for catching that. That is a really glaring mistake on my part.

(The irony in me having said it was "exactly" what Wikipedia says is not lost on me :P)

https://gitlab.com/ryankemper/writings/-/commit/093ade629447...

No worries - it was clearly just a typo :-)

It is fun to imagine the negative herd immunity threshold implied by the erroneous form of the equation though :P

Say R0 is 2, 1/(1 - R0) means that we already hit herd immunity before SARS-CoV-2 even existed!

The frightening one for me was R0 == 1: Basically, we'd need a positive or negative infinite percentage of people to be infected depending on which direction you approach it from.

> The `1/(1-R_0)` value gives you the point where infected people infect 1 more person

Right: it's (after you correct the typo) the point where the number of active cases does not increase over time.

> I should learn to never read anything from random people working in areas they don't have any expertise in.

This is one clear lesson that can be drawn from the pandemic.

I don't think so.

Consider that many governments with professional public health departments, including those of the richest countries in the world, downplayed the unfolding disaster, completely blew it on containment as a result, and are now reduced to using _extremely_ expensive lockdown measures to try to buy time until someone can come up with a better idea.

Meanwhile, plenty of randos on the internet did the straightforward epidemiological math in January/February and correctly deduced what was coming.

I think a clearer lesson is that, sometimes, the designated professional experts will fail to outsmart a fairly simple and very well known system of differential equations.

If you find this conclusion terrifying, well, I agree.

>Consider that many governments with professional public health departments, including those of the richest countries in the world, downplayed the unfolding disaster, completely blew it on containment as a result

Governments are ultimately run on a day to day basis by politicians. Proactive measures to prevent a crisis are a much tougher action to justify, especially if they negatively affect people in a way more direct than just spending their tax dollars, than reacting to a crisis. If anything I think this crisis should teach us something about how governments make choices.

It can go both ways; here in Portugal the government closed stuff like schools despite the National Public Health Council saying that was disproportionate.

When you have enough people throwing guesses around, inevitably some are bound to get it right.

What is the probability that my guess is going to be right?

I did some little thinking and modelling of my own late Feb, and reached the correct conclusions by following a simple exponential model, having very basic understanding of epidemiology, and being mindful of error bars (mostly ones created by me being a layman in the field).

On the other hand, I trusted WHO and CDC on masks around February; even posted things to HN to that extent. I now regret it and consider it a failure of not doing enough first-principles reasoning, and not digging into the feeling of confusion I had when reading the official advice.

What I got blindsided by was supply chain impacts. I read the daily updates on /r/supplychain with fascination; while I realized things are interconnected, I didn't realize just how much and in what non-obvious ways.

Bottomline, the lesson I draw from the pandemic is to trust myself a bit more, and attempt to carefully reason from first principles more often.

What did you get right in late Feb that the WHO and such were still wrong about? I feel like by that time it was already fairly clear from their communications that this was going global and heavily affect everyone.

Where WHO and others were mistaken in their communication was where they were discouraging use of facial covering. And I meant only that here. AFAIR, they were very correct about the severity of the disease. Unlike ECDC[0]; I read their reports too, and AFAIR, they were still only predicting moderate risk for Europe as late as second week of March.

[0] - https://www.ecdc.europa.eu/en

> Meanwhile, plenty of randos on the internet did the straightforward epidemiological math in January/February and correctly deduced what was coming.

Plenty of epidemiologists did the math and were talking about the situation on Twitter in January and February. I know because I was following them before China locked down. There were articles and interviews in the press from actual experts (Marc Lipsitch, Neil Ferguson, Michael Mina, Michael Osterholm) during that time.

There were science journalists (Helen Branswell, Kai Kupferschmidt) writing back then who were great at contextualizing the emerging information about the epidemic.

Dr Nancy Messonnier at the CDC warned that "Disruption to everyday life might be severe" on February 25th.

Meanwhile, randos were racking up karma across the internet with their back of the napkin bullshit.

I wish you the best. This debate has taken on all the fervor of a holy war, and putting out an contrarian position has been hugely unpopular.

One thing I'd add: employment and health insurance are tied together in the US. The lock down dramatically increased unemployment, the majority of whom will not pay expensive Cobra costs, and will soon be uninsured. The opposite of what was intended may happen: we are now less prepared to deal with an increase in demands on healthcare than we were a month ago, as uninsured people tend to avoid hospitals until they're absolutely necessary.

Thanks. That point about health insurance is great and I think I should weave that into the part that talks about furloughing medical workers.

I'll see about doing so after I take a break to eat some food. (As an aside, I'm pretty comfortable writing and can write pretty quickly but as you can imagine just getting to this first draft took a lot out of me.)

I am sorry, but you are repeatedly presenting positives aspects for opening up without presenting any of the negatives. And even these positives are very hypothetical: > Sometimes lightning does strike twice

On the other hand, you say > Remember, flattening the curve does not reduce deaths in the long-run, except insofar as it avoids overrunning hospitals, which we have already achieved.

If some countries have achieved this containment in the hospitals, not all, it is only by doing the lockdown, I can't believe you would think that opening up would not overrun the hospitals, if we open up, they will be flooded with new victims and those deaths will NOT be hypothetical.

Although you bring up many valid points, in my opinion this is where your statement fails. Opening up WILL cause new deaths.

I believe a gradual opening would be much more efficient only once the rise has already been slowed down.

The mortality rates you quote are for the case when the number of cases is low and the hospital system is working. To see what happens otherwise look at Madrid, look at the UK aiming to "protect the NHS". If you had unlimited hospital capacities your analysis would make sense, but that is the whole point(!). If you can flatten the curve, then covid is manageable, if you can't your hospital system collapses and suddenly everything not just covid is much more deadly.

Out of curiosity, to what extent do you feel we successfully flattened the curve in New York? Given that recent serology results showed between 15-20% prevalence, it does seem like it could have been significantly worse. But just to be clear we should note that we ended up having a massive excess of capacity as far as ventilators and beds were concerned (I'm guessing the real bottleneck is trained staff but am not sure)

I am unaware of a "massive excess of capacity" in NY; quite the opposite. Where do you make that conclusion from? NY, to my knowledge, has been well over capacity and has had to take severe measures. Hospitals have had more patients than they can deal with and the staff is overworked. Elective procedures have been cancelled, no visitors are allowed, doctors and nurses who ordinarily work elsewhere are working in Covid-19 units. Chicago is not doing well either. To put my chip down: yes, I do think we succeeded in flattening the curve in NY. We started the lockdown late, so we could not prevent it from getting very bad, but had we not done a lockdown, it probably would have been worse for longer.

By massive excess I was referring to vents/tents. Estimates of vents needed were far too high due to the models being relied upon (i.e. not because we surprised ourselves with how flat the curve got given the seroprevalence was not expected from policymakers as far as I can tell).

Still, I _don't_ know about how we are doing in terms of healthcare workers. That's almost certainly the bottleneck and it may be that it's still a bottleneck. I'd have to do some research to say for sure. It's very possible my statement was not correct in that light.

Meta: I'm currently constrained to using one arm since I had a not-so-fun ER visit today, so I'm not really firing on all cylinders right now. So, if you happen to look into the NY capacity matter on your end, I would love to hear your findings.

I am unsure what the NYC capacity is right now, but I know in some parts of the city, patients literally died in hallways before even getting a proper room. I also personally know a nurse in a hospital in Westchester county (just north of the city), and they had to make impromptu Covid-19 ICUs out of various parts of the hospital, and that turns doctors and nurses who ordinarily did other things (such as surgeries) into ICU doctors and nurses.

NYC built more hospital capacity as a response to the dire situation in their hospitals. That some of that extra built capacity is unused is not evidence of overreaction. I also find it odd to separate out the availability of doctors and nurses from the physical beds when our primary question here is whether the hospitals are strained; a bed is of no use with doctors and nurses to help the patient.

I'm honestly curious: have you not read the news papers articles talking to doctors and nurses who have personally witnessed the over capacity hospitals in NYC and Chicago?

Do you think that your experience of looking for a job in the middle of the lockdown might have introduced subconscious bias into your argument?

No, not at all. I quit my job of my own volition, and have several years of living expenses in liquid financial assets. Most people are not that lucky.

Additionally, the two companies that I had narrowed the search down to did not freeze hiring. Pretty lucky, since tons of companies did, although I constrained my search to remote jobs only so that's probably why.

I accepted a job offer and start soon, actually.

That being said, I do think that the general experience of being jobless during this has made me more sympathetic of those that truly lost their jobs than I otherwise would have. Which is not to say that I wouldn't have been sympathetic, I absolutely would have, but the fact that I had to deal with COBRA and other fun artifacts definitely made things a bit more tangible for me.

Excellent point/question.

I found a typo: "incredible stess" --> "incredible stress".

This is well written. Thank you. It's wrong that this post is currently flagged.

Thank you. https://gitlab.com/ryankemper/writings/-/commit/ca2771bbe1df...

We turned off the flags. I haven't read the article, but it seems thoughtful enough, and the thread substantive enough, to count as on topic here.

Thanks, will definitely read it, but on a first glance I couldn't see any information on your background or experience in the field of epidemiology or a related science. It would definitely help to put your thoughts into context and if you have a background in this field it would give your collection of thoughts more weight.

With all the misinformation going around I resorted to mainly listen to scientists in the relevant fields directly (if you speak German, the NDR podcast with Prof. Drosten is really nice in my opinion). Therefore I think it really helpful if research institutions and researchers themselves who are in that field (!) are vocal (but reserved and competent) about studies and thoughts. For instance, today the four big research institutions in Germany (Max Planck, Helmholtz, Leibnitz, Frauenhofer) published a joint message in favor of social distancing and contact restrictions: https://www.nytimes.com/reuters/2020/04/29/world/europe/29re...

Edit: I only found the German press release so far: https://www.mpg.de/14759871/corona-stellungnahme

I have no directly relevant credentials whatsoever and don't claim to. (I actually considered saying as such in the writeup but it's already so verbose that I felt it wasn't worth it).

I'm just a dude that likes to read research papers. As an aside, there is totally an archetype of the software engineer that thinks they're equipped to dive into unrelated fields, and I definitely match that trope. I will say in my defense though, that I try to build simple mental models and take them to their logical conclusion, which is a quality that I see in people I admire, and conversely a quality that I find lacking in people that I feel don't have a lot of insight.

Many might disagree but I am a very strong believer that arguments should be evaluated on their merits, rather than credentials. Indeed having credentials makes it that much easier to fall prey to cognitive distortions.

> I have no directly relevant credentials whatsoever and don't claim to.

IMO this should be a disclaimer in bold right at the very top of the article.

Done.

https://gitlab.com/ryankemper/writings/-/commit/05b4b616c5e0...

Thanks, it’s a good commitment to representing your argument clearly and does you credit.

I have no directly relevant credentials whatsoever and don't claim to. (I actually considered saying as such in the writeup but it's already so verbose that I felt it wasn't worth it).

This doesn't really pass the sniff test. You wrote 7500 words on this topic, but felt that including "I have zero experience in any relevant fields" would be overly verbose? Are you sure there wasn't another reason?

arguments should be evaluated on their merits, rather than credentials

It's not about credentials, it's about relevant knowledge and experience, without which it can be very difficult to actually properly evaluate the merits.

> This doesn't really pass the sniff test. You wrote 7500 words on this topic, but felt that including "I have zero experience in any relevant fields" would be overly verbose? Are you sure there wasn't another reason?

https://gitlab.com/ryankemper/writings/-/commit /05b4b616c5e0017b0f80682533399c8696d897b5

When have some expertise, you should absolutely evaluate ideas on their merits.

When you lack the expertise to do that effectively, you should listen to the experts (ideally those that demonstrate that they are evaluating ideas based on their merits).

The trick is determine which questions you have the expertise to evaluate for yourself and which you are better of relying on experts to evaluate.

Unfortunately, this is an area where a large number of non-experts vastly overestimate the difficulty of the material vs their own level of knowledge. This leads to the increasing proliferation of misinformation and misleading analysis like yours.

Credentials are not the only way to acquire or demonstrate expertise. You say you are a "dude that likes to read research papers", how many epidemiological research papers have you read? How much time have you spent discussing those papers with epidemiological experts? Did you reach out to any of those experts to have them take a first pass as fixing any mistakes you made before you decided to post it publicly

Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.

You are being irresponsible.

Absolutely wrong. Analysis done by informed laymen is essential in breaking intellectual logjams in established fields. These situations happen over and over again in history. It's increasingly looking like we have one of these logjams in public health right now.

Ideas need to be evaluated on their merits in all cases, especially in times of controversy.

> Analysis done by informed laymen is essential in breaking intellectual logjams in established fields.

Which is why it is important that people with the expertise evaluate those ideas on their merits.

What doesn't help is when less informed laymen think they can accurately judge the validity of ideas put forward by slightly more informed laymen.

What active hurts is when those less informed laymen start spreading their half-balked ideas and trying to impact policy without making an effort to get their ideas validated by people with the experience to find the simple, obvious errors they are making.

> without making an effort to get their ideas validated by people

Me posting this is literally me doing that, so your visible irritation is very oddly placed.

HN is a platform dominated by laymen in this field. Posting this article here is an attempt to publish and widen distribution. It is not an attempt to reach out to people with expertise prior to publishing.

> Credentials are not the only way to acquire or demonstrate expertise. You say you are a "dude that likes to read research papers", how many epidemiological research papers have you read? How much time have you spent discussing those papers with epidemiological experts? Did you reach out to any of those experts to have them take a first pass as fixing any mistakes you made before you decided to post it publicly

> Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.

This is not a fair characterization; I was very clear that this represented my "first draft" and that I was looking for feedback specifically to have people poke holes in it.

Fortunately, a lot of people did have substantive contributions that pointed out errors or places where the arguments were weak, as opposed to merely engaging in sanctimonious gatekeeping as you are doing.

> This is not a fair characterization; I was very clear that this represented my "first draft" and that I was looking for feedback specifically to have people poke holes in it.

Where was this made clear? The closest I can see is at the very end where you call it a living document and will accept pull requests that match the "style and intentions of this document" which to me sounds like you are only interested in meeting pull requests that strength your argument to further your intended narrative.

I appreciate your adding a disclaimer about your lack of relevant experience, but even it says nothing about this being a "first draft" that you expect to have holes poked in.

So I fully stand behind my characterization and I find your use of the term "sanctimonious gatekeeping" to far less of a "fair characterization".

Okay, I half concede your point. I expressed the desire to have holes poked in my top-level comment contextualizing HN submission / thread comments itself, but did not make clear reference to it in the document itself. So the external dependency means that you are by-and-large correct.

The part I don't concede is this notion:

> Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.

In that, it strays far too close to the dangerous notion of "advocating for ending the lockdown, however flawed, is killing people". Which is a notion I cannot and probably never will be able to get behind.

> In that, it strays far too close to the dangerous notion of "advocating for ending the lockdown, however flawed, is killing people".

I have no problem with advocating to end the lockdown. We need to do it as soon as practicable. You ar correct in supposing that a lockdown that lasts longer than necessary ends lives. I think there are some good steps we can take towards that, such as reopening underutilized hospitals in areas where that utilization has plateued.

You are doing more than that, you are trying to summarize everything we know about covid. In an environment with so much misinformation about covid floating around that is demonstrably dangerous, it behooves is to be extra care to not feed into that cycle.

> Indeed having credentials makes it that much easier to fall prey to cognitive distortions

And having no credentials makes it even easier to make blatantly wrong assessments, to read the data incorrectly, to completely misunderstand terms of art, to accidentally believe that because you are smart, you can evaluate another field easily with some hard thinking.

Having no credentials means you are likely to not know what you don't know, and so gloss over an entire section of a field when making conclusions. It means not having worked with similar data before to help build a "sniff test" for when something in your work doesn't look right.

The difference between no credentials and credentials in assessing a complex topic and communicating that to a broad audience is as a vast as the difference between the seasonal flu and coronavirus.

I'm a bit confused by the Gitlab logo on your site. Do you work for Gitlab? Is Gitlab endorsing your article?

Oof, good observation and I should definitely clarify here.

I have no affiliation with Gitlab whatsoever.

This is my personal blog that I made when I quit my previous job a couple months ago. I ended up repurposing the blog because I couldn't figure out how to get a table of contents working on a generic markdown file (i.e. I originally was just going to link to plain markdown in my git repo), but I was able to quickly figure out how to get it working with hugo. I used Netlify / Hugo via Gitlab to do so, so the Gitlab logo just happened to be part of the default theme. I'll look into removing it for clarity later.

Circling back: https://gitlab.com/ryankemper/nfhugo/-/commit/1a8ead81ff65d7...

> This is a living document and we encourage contributions in the form of pull requests.

Who is "we"? I understand your use of "we" to speak from the perspective of us as a society through most of the article, but this makes it sound like there's more than one author.

s/we/I

I chose to use "we" both because it fits with the semi-formal tone better, but more importantly because I want to give others a chance to open PRs if they choose to do so, so I was basically future-proofing for a possible scenario where I wasn't the only contributor.

FWIW, I will probably circle back here and switch to "I", since I think it's probably worth it to avoid confusion.

I may submit a PR then it would become "we".

Thanks. I'm going to leave it as is. As another commentator has mentioned, use of the singular "we" is very common in academic writing anyway, not that I'm saying that this blog post of mine is "real" scientific research or anything

This is fairly common for many styles of writing even when it's clearly just one author. Considering he's open to pull requests it makes even more sense.

https://academia.stackexchange.com/questions/2945/choice-of-...

Having, as you suggested, skipped just to the TL;DR, this bit jumped out at me as something that we very much don't know is true, and that it's dangerous to assume is true without proof:

> Once you get sick, you can’t get sick again for a long time. Eventually you might be able to get sick again, but it will not be very bad. When enough people have gotten sick and then gotten better, the sickness can’t spread any more.

(Incidentally, at one point you leave out the 'z' from "hospitalization".)

That’s a popular point with the talking heads on the media but I’d encourage you to read up on it. Best estimates look like 1-4 years of immunity [1]

1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

I hadn't seen the Lancet article—I was getting my latest information from the Quanta article also on the front page (https://www.quantamagazine.org/what-can-other-coronaviruses-... I guess it's a matter of language and personal preference, but "this global pandemic will be in abeyance for a year or so" doesn't match my informal understanding of "a long time". I also believe, as sibling postpawl (https://news.ycombinator.com/item?id=23025675) points out, that there is still at least a divergence of opinions here, and that it is dangerous to get it wrong.

(Personally, while I think voicing unpopular opinions is definitely a role we need in society, it seems to me that dismissing widely accepted opinions as due just to "talking heads on the media" puts disputants in an adversarial position that makes it more likely for people to hunker down in their existing opinions, and less likely for anyone's mind to change. Your refutation would have been more, not less, convincing to me if it had just pointed to the Lancet article.)

You make a good point. Sorry about my reply. I’m so used to getting downvoted these days I’m trying out different writing styles. (Maybe this one is a fail)

> Sorry about my reply. I’m so used to getting downvoted these days I’m trying out different writing styles. (Maybe this one is a fail)

No worries; I also missed that you're not the original author. COVID + policy is a perfect storm of temper-stoking conversational topics.

“There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”

From WHO a few days ago: https://www.who.int/news-room/commentaries/detail/immunity-p...

This statement was the source of widespread criticism and I in fact criticized it myself in the writeup.

I considered going for a deeper debunking but held off for the initial draft. I might circle back if people feel it's valuable. Let me take a quick stab though:

When we talk about immunity we need to realize the term is used imprecisely by laypeople (btw I'm totally a layman if it's not already clear).

I think of it simplistically as two components:

(1) The presence of actively circulating antibodies in the bloodstream. This is what the (oddly controversial) serology studies are measuring. It is thought that having a significant quantity of these antibodies prevents infection - i.e., what most people envision when they talk about immunity.

(2) Even after the antibodies have faded, there are still Memory B Cells, which lay dormant up to decades, waiting for exposure to the characteristic antigen (in this case, an antigen telling them that they have encountered SARS-CoV-2), at which point they resume and rapidly scale up production of antibodies.

The thinking here is that reinfection is likely possible after a sufficient length of time - whether that's a couple months or a couple years isn't yet known - but when you do get infected, your immune system will respond sooner, more strongly, and thus you will achieve a far lower peak viral load meaning a less serious infection with reduced transmisibility.

This is a robust mechanism that we see across tons of disease, including common cold coronaviruses. In my completely uncredentialed opinion, this effect is so common and well-supported that we should essentially assume it happens until we really have proof that it doesn't. I know that might sound backwards, but it really is such an enduring mechanism.

Here's another argument you might prefer. We know that at least hundreds of thousands of people have successfully recovered from COVID-19. Loosely, we can divide the immune system into the "non-specific" and the "adaptive" subsystems. Given that we have seen extensive recovery from this illness and that those who have recovered have detectable levels of antibodies, and furthermore that there is a case of a women who could not manufacture antibodies due to a rare auto-immune disorder who failed to recover, it stands to reason that the same mechanism that provides medium-term immunity is the mechanism responsible for recovery.

That is to say, that it's very farfetched to think that people are recovering purely from non-specific immune responses and that the detectable presence of circulating antibodies is just a red herring. But I suppose you could try arguing that if you wished.

Great write up. It’s so strange the WHO would release a statement like that.

Very strange. If you haven't seen it, they did say why they did it here: https://www.who.int/news-room/commentaries/detail/immunity-p...

Specifically this part:

> People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice.

So, first of all, I think the concern is on its face totally unwarranted because people likely do have immunity to reinfection for several months, but regardless the presence of the immunological memory (provided they avoid getting infected with Measles which causes immunological amnesia) means that the second infection will be really not very bad and unlikely to transmit easily.

But more importantly:

Our public health organizations (and the media) have adopted the following belief: It is worth it to either mislead the public or to outright lie in order to achieve compliance. If it's not clear from the article, I find such a position detestable, not only on ideological grounds but also because functionally it causes people to endanger their health by engaging in superstition.

This is my theory on why we've seen so many articles from previously-respectable organizations like CNN that seem to focus on the narrative that young people are dropping like flies from this. Why? Because they believe that if young people are not scared shitless for their personal health, that they will not comply with the lockdown measures.

So, the WHO is really not trying to hide their motivation here.

Now the irony is I oppose immunity passports on ideological grounds, at least when used _within_ a society. As far as being used as a literal passport, that's fine by me. If the rest of the world wants to practice containment, it's welcome to do so, but I think from an evidence-based perspective, containment seems like an incredibly dangerous proposition.

Yeah that makes total sense. I can’t believe how few people buy the media’s stuff so easily. I have relatives forwarding me the corana causes strokes in young people articles. Normally intelligent people.

This whole thing has really shaken my understanding of people.

> Our public health organizations (and the media) have adopted the following belief: It is worth it to either mislead the public or to outright lie in order to achieve compliance. If it's not clear from the article, I find such a position detestable, not only on ideological grounds but also because functionally it causes people to endanger their health by engaging in superstition.

In Italy it's pretty evident from the communication from the government, the experts (which released a "disaster story" of possible 150,000 ICU cases in a month, a number so high that should have been at least explained) and the media (including tabloids).

Since Germany has started reopening, media here (but, according to what I read - but please correct me if need be - not the case with the major German papers) started saying that "infections are accelerating elsewhere! See? Our model of lockdown is the only one that works!"

It might be true, but it should be grounded in facts and not in misrepresentation of them.

P.S.: Since you mentioned a critique of the widely-used model for this epidemic, do you have any more links to dig further? I simply do not know enough and I want to inform myself more.

https://www.lesswrong.com/posts/QuzAwSTND6N4k7yNj/seemingly-... is the critique (it's in the article but easy to miss)

The most important point of criticism is this section: https://www.lesswrong.com/posts/QuzAwSTND6N4k7yNj/seemingly-...

I've read it, but (perhaps I'm wrong, I'm a biologist turned to computational biology so not expert on epidemiological models ;) didn't the author (and similar Stats News post) argue that it is too optimistic, IOW the opposite that you were arguing in the post?

I don't mean this is as a criticism, but it struck me as some dissonance as I was reading.

I've also heard that there might be criticism to other models like the Imperial College one, but so far I've never found anything with some substance.

Good question. I should have proactively addressed that:

The IMHE model, after re-estimating, _was_ too optimistic. My argument does not hinge on the IMHE model being too pessimistic; but rather simply that the IMHE model is basically useless and thus we shouldn't base policy on it.

I expect us to have well over 100,000 COVID-19 deaths - indeed probably 3x that but I admit I haven't sat down and done the age-bracket-weighted mortality napkin math. (Basically, take each age group's IFR and multiply by that age group's population in the US, after multiplying by some constant <1 which represnts the sum of herd immunity threshold plus overshoot)

So basically, I think that COVID-19 mortality is going to be way worse than the model predicts, but given the way I view the cost of lockdown, etc, I still think the approach I am proposing is superior to locking down.

Does that make sense?

Yes, I understand your point now. Thanks a lot for clarifying.

Answering above for the same reason of the nesting limit.

Some models (not published) from our expert panel in Italy are instead, in my ignorant view, very pessimistic (they say they elaborated 90 of them). The lockdown will be "eased" (quotes, for most people it's the same as before) on May 4th and one of the predictions said we'd get 150K ICU cases (as I wrote in the parent post). This looks very hyperbolic, at least on paper, because there are many measures still in place, so it's not the same as "no social distancing, no protection, everyone free".

It’s not that strange, that’s what happens when you forget if you are a scientist or a politician. If you try to be both at the same time the result is you’ll misrepresent your scientific data to make it fit your political goals.

In this case they keep mentioning uncertainty and the argument is that otherwise the public may behave in a way they don’t want. Whatever your opinion on the arguments, that’s not science and it is also poor politics because sooner or later they’ll lose credibility and really that’s all they have.

> it stands to reason that the same mechanism that provides medium-term immunity is the mechanism responsible for recovery.

New tests for neutralizing antibodies like proposed by some groups[1] will make sure the antibodies not only are there, but that they actually work.

[1] https://www.researchsquare.com/article/rs-24574/v1

Hmm. I’d be curious to get your take on the lancet link. Are they just referencing different sources or does one have newer information?

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

The WHO also retracted their statement later.

https://mobile.twitter.com/who/status/1254160937805926405

Conversely, is there any evidence in the other direction, ie that those who have recovered have NO protection?

Remember the other famous WHO announcement at the beginning of this outbreak: “No evidence of human-to-human transmission”

And there's been studies out of Korea since that have shown that patients do indeed receive antibodies that provide immunity as well as showing that many recovered patients produce false negatives due to deactivated viruses still in their system. One of which was at the top of HN yesterday.

Also, the WHO said shit like this: https://nypost.com/2020/03/20/who-haunted-by-old-tweet-sayin...

https://gitlab.com/ryankemper/writings/-/commit/9071eebf0964...

Typo fixed! I think I've found at least 15 typos total now. Oops...

I see a lot of good points here. Thanks for creating this.

I think your argument is well-written (aside from s/effects/affects/ in effects an extremely limited..) but just not convincing.

I think this part goes way too far presuming intent, really hurts your case without a qualifier.

> Those advocating a policy of containment, and with it, totalitarian-style lockdown, are not doing so based upon scientific evidence, but rather upon superstition and tribalism.

And to be so critical of "omission", the TLDR says nothing of air-to-air transmission while eating, like in a restaurant.

I've read the whole thing and I have these comments:

- I think the part about the freedoms is unnecessary because I feel the vast majority of the pro-lockdown people do not share your enthusiasm for freedom and public discourse. While your main argument may shift their opinion, the part about liberty may cause them to stop reading and discard your other arguments.

- I think some claims would sound more persuasive if there were more links to research. For example, the claim about 0.1-0.7% mortality. There's a study about China (0.66% mortality) and a bunch of others that could support your point. You could also add mortality stats for influenza in the US from the CDC website (I think it's 0.13% on average).

- The TLDR sounds bitter and childish, in my opinion.

Overall a great summary and I'll share that with others.

I laughed at this:

> Other countries do not even have the concept of freedom of speech/assembly embedded into their founding documents.

as it was clear that the author hadn't done any research on this - many countries explicitly or implictly have these in their founding documents.

Yes, the statement as I wrote it was imprecise enough to be false. I am going to circle back and fix it.

In short, the important distinction is not that it's embedded into the founding documents, but that we do not place the limitations on free speech that other countries do.

i.e. places like UK, germany, france - while they may have the phrase "free speech" in their documents, the limitations put on it are extreme enough that they're basically referring to a totally different concept.

So, it would be more accurate to say that other countries do not share our concept of free speech, in that ours has _very_ few limits put on it.

Circling back:

https://gitlab.com/ryankemper/writings/-/commit/6daa56a4a05f...

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