Comment by mistersquid | Hacker News Reader

Comment by mistersquid | Hacker News Reader

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I appreciate your thoughtful reply. I am not arguing for containment but for graduated exposure while maintaining health care capacity.

While it is true that some health care providers are experiencing a decline in demand due to, for example, people no longer seeking medical attention for (e.g.) coronary problems and other non-respiratory ailments, this is not the health care capacity that matters with regard to coronavirus infections.

Non-coronavirus medical problems are important, but the widespread increase YOY in mortality across the entire United States is evidence that such medical demand is eclipsed by the demand for treatment related to coronavirus infections. [0]

Second, and I mean this with all due respect, your suggestion "to have at-risk members of population […] quarantine as we've all been doing. Meanwhile, the rest of society is no longer forbidden from transacting and producing value" is not so much a proposal as a flight of fantasy.

The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.

Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%. [1] While the number of infections required to overwhelm hospital capacity is hard to pin down (i.e. forecast), ProPublica 17 Mar 2020 page offers a few different projections. [2] One of those projections forecasts that if 40% of US adults are infected over 12 months, hospitals across the country would experience demand at 100% to 200%+ current capacity.

Those less-vulnerable members of the population who "only" need hospitalization at a rate between 2.5% and 7.4% would be left without medical recourse and would die at a much higher rate than what you are imagining.

[0] https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...

[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

[2] https://projects.propublica.org/graphics/covid-hospitals

> While it is true that some health care providers are experiencing a decline in demand due to, for example, people no longer seeking medical attention for (e.g.) coronary problems and other non-respiratory ailments, this is not the health care capacity that matters with regard to coronavirus infections.

Right, but in this case it's leading to workers getting furloughed. So that is a direct lowering of capacity, although I suppose one could argue that those workers will be called back when shit hits the fan. But if that's the case...why not have them doing important preventative care in the meantime, since we know our hospitals are not overwhelmed yet? Basically anything that doesn't require people being in hospital beds for days since that would take away resources for future COVID-19 victims.

> Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%.

This appears to be a hospitalization rate that is not accounting for all the hidden infections, which is why that number is so high. That's why the serological studies are so important. Otherwise, we need to estimate how many "cases" there will be (meaning, "serious cases" essentially), which is a lot more difficult than finding the true IFR / hospitalization rate and then multiplying by age-stratified population size. In particular, the CDC numbers are very at odds with the hospitalization rate of some of the serological studies I cited in my article. And it's not just a factor of 2x, it seems to be a massive difference. For example they show a 2.5% hospitalization rate for ages 18-49 whereas the number I've been using shows a .8% hospitalization rate for ages 40-49 at the high end, and then a .2% hospitalization rate for ages 20-29 at the low end.

I will need some time to dig into https://projects.propublica.org/graphics/covid-hospitals, but I'm having trouble finding where they give their estimated hospitalization rates. I did note that the article has the following quote:

> “You will have people on gurneys in hallways," Cuomo said at a press conference on Monday, later adding that New York would need up to 110,000 total hospital beds, around twice the number it currently has. “That is what is going to happen now if we do nothing."

And we know now that this was absolutely not the case. Recall that New York ended up not really needing the USS Comfort, and we now know that at least 15% of the population has been infected per the serology studies. So the fact that that prediction was wrong makes it feel like other predictions using the same model will be very wrong. I'll see if I can find the paper that the Harvard team published.

And then this quote seems to imply they're operating off of the bogus 20% hospitalization rate that I mentioned in the article:

> According to the Harvard scenario where 40% of adults in the country contract the disease, about half a million people in the San Francisco region may get infected, with more than 100,000 residents requiring hospitalization.

Anyway, moving on:

> The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.

It's not clear to me why this is the case. Those essential workers who are vulnerable would be quarantined (whereas right now I believe they are not quarantined which is a problem). So, the 70 year old working as a bank teller would stay at home, collect unemployment (I wish we had a better system of unemployment but that's another matter), and the bank would presumably try to fill the role with someone else who is available to work in the meantime.

--

Thanks for the discussion.

Yes, the same to you: thank you for engaging with me and thinking carefully about what the data--poor though they may be--might mean.

I'm more reconciled to the idea of "ending lockdown", and would characterize my position as one of guarded reluctance, especially until such a time that medical and public infrastructure can provide widespread testing.

That said, I think the value of our discussion is more intellectual than practical given the data are secondhand, the data are unreliable, we are not medical experts, even medical experts disagree, and much remains unknown and unknowable about how the coronavirus epidemic will mitigate or exacerbate in response to human behavior.

That said, perhaps you might find the current Federal guidelines for reopening economies interesting if not heartening. [0] I found two things especially interesting: 1) the articulation of criteria for assessing whether, 2) the outline of a phased approach to reopening.

[0] https://www.whitehouse.gov/openingamerica/

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