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Comment by ashtonkem | Hacker News Reader

Building a field hospital for a pandemic and not needing it is literally dead last in my list of wasteful government expenditures to be angry about. The rationale that lead to making the hospital was incredibly clear, and that we didn’t need said hospital is a source of relief more than anything else.

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The problem is much media, and especially social media, is using things like these unused field hospitals to justify that the problem was never that bad to begin with.

Which is exactly what people said would happen if stay-home orders managed to flatten the curve.

I hate this all so much. I am honestly super depressed about how short-sighted many people I know are proving to be.

I'm with you on how depressing it is, my biggest take away from this entire thing so far is that people's ability to link cause and effect is much lower than I had previously estimated.

Have you seen any attempts to actually put cause and effect together for stay-at-home orders and number of deaths? The only attempt I've seen to quantify it found no statistical connection between the two, but high connection between population density and deaths.

Any attempt to blame fatalities solely on population density is going to run into problems the moment they look at Southeast Asia.

Please. That's not what I said.

I said that there was a measurable connection between them. Any epidemiologist will acknowledge this.

The point is that it could be seen and measured in this case. But when they attempted to find a connection between shutting down early or late (in the USA), no effect was found. The point being, the shocked horror that people already "forgot" the lessons learned last month is silly if that lesson wasn't learned and wasn't even true. The claim could do with some actual evidence.

And I'm not even saying it's not true. I'm just saying this is the only attempt I've seen to actually analyze it, and it came up the opposite way. Can you point me to anything that shows the claim is true?

https://www.wsj.com/articles/do-lockdowns-save-many-lives-is...

New York City alone is #6 on the worldwide ranking for confirmed cases in countries.

And? How does that relate to my comment?

Just a quick search on scholar shows me at least 5 studies into the impacts for a more rigorous analysis.

Plus anecdotally I'm in NYC and since the stay at home order reached full strength the 3 day rolling average of infections has been decreasing. I can only see that being attributed to two things -- mask wearing and stay at home. Mask wearing came later in our lockdown so I'm going to say stay at home has been effective especially with what I've seen the infection number for COVID, I believe that's the R0 (Rt?) number, was something like 2.5 to much higher.

I did a search but didn't find anything. Not sure exactly what to search for. Can you link to some of them?

https://arxiv.org/ftp/arxiv/papers/2004/2004.06098.pdf

https://arxiv.org/pdf/2004.14621.pdf

That's two, I think the second one is better though as it uses more recent data and from more states and they raise a point that I think speaks to why the studies are not more prevalent and that is that many stay at home orders went into effect middle to end of March so the effects would only really be seen at the end of April.

I imagine you'll see more of these popping up in the coming weeks.

>I can only see that being attributed to two things

Two more things: 1) introducing (or the halting thereof) infections to at risk populations (the whole NY nursing/retirement home fiasco, or the Italy hospitals being points of transmission, or dorm style living in Wuhan) and 2) approaching ~50% of herd immunity.

1) When did NY state stop putting exposed/infected patients into those facilities? That's going to have a outsized result in the stats, given the segment vulnerability. Same for Italy hospitals being overwhelmed without PPE.

2) Not saying it's what is at play (yet) here, but infections will naturally decrease as a greater percentage of the population gains immunity. It's what has to happen as the population approaches herd immunity. (So about 30% if herd immunity is 60%, which is plausible, given the recent estimates of 20+% of the NYC population with antibody presence.)

It's why exponential growth (for resource limited kinetics) ends up being an S curve and not a runaway exponential curve. The inflection point might not be at exactly 50% for a number of reasons, but it's good for a rough starting point.

Additionally, it will be difficult to distinguish if the stay-at-home orders are effective due to the entire population participating, or if it's tied to specific population segments. Meaning the percent of the population active vs stay-at-home isn't independent of transmission numbers. The active sub-population might be closer to herd immunity than the stay-at-home crowd.

This gets more complicated as you take into account the risk levels of particular patients.

There's potentially a lot more going on. We need some scientific causation, not just correlation.

Slow burning respiratory diseases are pretty much the nightmare scenario specifically because they are so good at tricking human risk calculations.

Compare that to diseases like Ebola, which we typically clamp down hard and fast on.

Tell me about it.

I'm now very mildly asthmatic and had pneumonia and bronchitis often as a child. I know what not breathing, and chronicly not having a strong respiratory system can be like and most people don't. I think that really factors into why people aren't taking it as seriously, going out whatever.

Contrast that with the fact I basically haven't left my Brooklyn apartment in 8 or 9 weeks even though my asthma and breathing issues largely subsided years ago and I would be considered less than mildly asthmatic now, I imagine other people with my profile are acting similarly.

I think it totally makes sense why you would feel that way.

I do want to mention that we know that somewhere between 25-50% of COVID-19 cases appear to be entirely asymptomatic (as opposed to pre-symptomatic). So almost half of people who get it won't even realize it, of those with symptoms, only a small fraction will go on to experience the serious respiratory issues that characterize COVID-19.

So it makes sense that you know first-hand how horrible breathing problems are. But I just wanted to be clear that, it's actually not irrational for someone to not want to stay inside for months to avoid a disease that in their specific case would almost certainly be mild. It just goes into what a person's priors are.

For sure and to be completely clear, I don't want to stay inside, I just think it's the most responsible move.

Like you said though it comes down to priors, and I'll add risk tolerance, and some pro-social behavior (I won't risk my neighbor even if it might be fine for me). I work in startups and have a few failed companies under my belt my risk tolerance in business is very high but not with health, you read that as 25-50% of cases are asymptomatic and an even smaller percent develop the very horrible symptoms, I read that as there is a 75%-50% chance I'd be symptomatic and a non 0 chance I'd be seriously ill with symptoms I'm already averse to through experience with them even though I'm otherwise young and healthy.

Edit: I'll add in, besides the above my biggest motivator for staying inside is that even if I was fine, to me its untenable to potentially spread it to someone who has a higher chance of not being fine through no fault of their own.

> we know that somewhere between 25-50% of COVID-19 cases appear to be entirely asymptomatic (as opposed to pre-symptomatic).

Which is not a big number at all, at least, not big enough to suggest that infecting more people is a solution. Considering that the chances to have symptoms and die rise exponentially with age, the estimated 25-50% are young and lucky ones. Still, it is known that even kids (unlucky, i.e. not in great proportion) do die:

https://www.thesun.co.uk/news/11576622/uk-death-toll-rises-a...

"Six-week-old baby dies of coronavirus as UK death toll hits 31,241 after 626 more killed"

France, March:

https://www.france24.com/en/20200327-16-year-old-girl-become...

"16-year-old girl becomes France’s youngest coronavirus victim"

etc.

By the way, from the older investigations about how people self-report their respiratory illnesses, it is already known that some significant percentage would not report anything and when asked claim not to have any symptoms even when they demonstrably do have them.

Even now, in the middle of coronavirus pandemics, there are people who "become used" to less oxygen in their blood, and behave as "not ill" even as their body becomes permanently damaged by the low concentration of the oxygen destroying their tissues.

So "asymptomatic" in the sense "the patient or the person filling up the questionnaire didn't feel being ill" is totally different from "the doctors didn't find any symptoms."

or, you could be angry that it became highly politicized and many media outlets absolutely overhyped the danger for clicks and political points.

if we'd been more levelheaded, we would have suggested the public should either

1) physically distance, or

2) wear a mask

in enclosed spaces and face-to-face situations.

if you're an essential worker or particularly vulnerable, you'd do both where possible. that's it. that likely would have provided all the risk reduction we needed to get the spread under control.

the message would have been simple, the effects likely as good, and we wouldn't have left a hundred million poeple on the edge of (or in) economic and psychological collapse.

but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want.

Those would’ve been excellent suggestions in January, yes. But by mid March we’d missed the opportunity to use less intense measures.

no, the virus didn't somehow get more contagious in march, it had just spread farther/deeper. the same measures would have reduced risk equally in either case. only the likelihood of need (that those measures would have non-trivially helped prevent spread) would have gone up on a per-interaction basis.

The same measures have wildly different levels of impact based on how deep the virus has gotten into the community.

> but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want

Every discussion involving advertising or app marketing here inevitably attracts tons of comments adopting a let's-be-real-here, this-is-just-how-it-is tone about the realities of the industry. And yet these same people are also experts on the news industry and know the exact opposite is true there, that "de-politicized" or "balanced" news is somehow a thing that is not only possible but stupidly trivial to produce.

I mean, I get it, I utterly despise crabbed, shoddy, stupid journalism, too. But don't pretend there's some trivial fix. It is the way it is because of a combination of economic and ultimately social pressures. It is as much a symptom as a cause.

i certainly didn't suggest the systemic fix was trivial, and that the equilibrium we've reached around news and advertising isn't cogent and compelling.

but as individuals, we each have the capacity to center ourselves emotionally, clear our heads, and think critically about the coercive messages we're being fed. we have that power, and it is effective.

What do you think is overhyped? The situation in Italy? Or the thousands of people dying a day?

This is hindsight bias. That those steps alone would be sufficient was not established in March (and could be argued even now).

it's not. i've held the same position since early march, when lockdowns started being seriously discussed.

So did the WHO. They have been excoriated by millions for supposedly saying you shouldn't wear a mask. But from the beginning they were advising that you keep your distance from others, cough into your sleeve, and wear a mask if you get sick (otherwise, save them for health care workers).

Lockdowns were invented by panicking authoritarian politicians. The ruling class showed its true nature and was all too eager to copy China's brutal boot-on-throat approach to crisis management.

The idea that politicians wanted to lockdown and trash the economy is laughable. Even now politicians are eager to open up, even though plenty of states are still in the exponential growth stage.

Considering how Google and Apple are basically mandating WFH for the rest of this year, these lockdowns aren't for them; they're for all the other people who need a way to take care of themselves without giving their bosses the finger.

in the US we still aren't even following these simple rules consistently (even in NYC where I live). I agree with your point, I blame the guy in charge of everything who's repeatedly tried to downplay the severity, causing the rest of the system to seemingly overreact to compensate for people refusing to follow the rules.

it's ok if we don't follow the rules perfectly and consistently for sufficient risk reduciton. but people absolutely flouting them is problematic, and the majority of that is likely a reaction to the overhyping in the first place.

regarding trump, luckily our governmental structures are designed to withstand such incompetence. i'm more concerned that the legislative process is torching money in the wrong places.

The models never assume full compliance. IIRC, the big one from the UK assumed 70%.

TBH, even if it was an overreaction, the effects were by and large positive, regardless of the pandemic. Work from home, less traffic, more family time, slowdown of economy, pausing of a lot of wasteful, useless activity. I really enjoyed walking around with almost no cars on the roads and listening to birds.

sure, it's great if you can afford the leisure, but 60-80% of americans can't, and it's irresponsible (at best) to ignore that.

I realize this, yet, the fact that I can afford this leisure is largely due to my personal choices of forgoing some of the luxuries these people afford.

I sympathize with those who are affected negatively by the situation, but I wish, for example, those who decide to buy a larger car would also sympathize with those who prefer clean air and less noise.

i agree that frugal living is the bee's knees (i do it myself!), but nobody likes a wagging finger over an extended hand, especially if you construct a dichotomy simply for that purpose.

If you want clean air and less noise then you should have moved to the country side where those are plentiful.

Telling people in the city, that you decided to move to, that they should be conscientious of your decidedly non-city wants, is kind of pretentious.

the effects were by and large positive, regardless of the pandemic

I generally hate the phrase "check your privilege", but in this case it fits perfectly.

It fits perfectly if by privilege you mean not pursuing a career with high intensity and instead living a frugal, simple life that is less affected by a slowdown of the global economy.

That’s only true if you pretend that service workers don’t exist.

That's the rub though. You want these to be used. The original goal we were sold is to flatten the curve, which means to use up all the base load capacity, but not exceed the base load capacity. Riding the line of base load capacity was going to be imperfect and we would see usage of these field hospitals as a signal that we are redlining our capacity and need to pull back.

The problem is that the only experts we're listening to are doctors and epidemiologists, when we should also be listening to economists. Both sets of people should be in a room together hashing out policy through an adversarial process that charts a middle ground between two bad outcomes.

Flattening the curve to well below capacity at the expense of further suffocating the economy, just means that we're completing ignoring economic externalities that is going to take years or even more than a decade to fully recover from.

You claim that we should listen to the economists but you don't seem to have any clue what the economists are actually saying and are just putting words into their mouths.

Basically every economist is acknowledging that you can't get the economy back to normal until the health crisis is under control. You can lift the ban on people going to movie theaters and restaurants if you want, but no one is actually going to do it if they don't feel safe doing so. Example: air travel is down 95+% even though there are no laws against flying places.

> Example: air travel is down 95+% even though there are no laws against flying places.

not a great example. people don't just fly for fun; they are going somewhere to do something. you're not allowed to do most of the stuff that you would travel for in the first place.

This is an event where the need for hospital capacity grows exponentially, and we can't scale up medical resources that quickly.

So off by an inch now potentially means being off by miles later on. If the doubling period wasn't lengthened enough, a hospital at 50% capacity will be in serious trouble very soon.

> when we should also be listening to economists

Maybe we can listen to economists coming out of this too then; On things like

- Healthcare attached to employment

- UBI

- Sick Leave

- Servers wages

- Gig Economy

- Taxation and Austerity

We would have been better off economically if we had listened to much of the general consensus before.

Curious what you think we should listen to economists on for those things.

For most of the things you specifically mentioned, there's not much consensus today.

They're not mutually exclusive. It could be (is likely) that the problem never was as bad to begin with and that it was lessened by flattening the curve. Even ERs have been seeing only 40-50% of normal patient numbers and have been cutting staff and shifts. You don't see that except for the fact that experts assumed and/or modeled very very wrong. And that the population has been scared to the unhealthy extent such that they think the virus risk is worse than not seeking treatment for heart attacks and strokes.

There's much we have yet to learn about this thing. We might not figure it out satisfactorily for years. Remember zika?

And it's certainly less severe among those infected than was predicted (at least per capita infections, if not overall). As long as people/ officials/ experts deny that, (or exclusively credit flattening the curve, or fail to admit how wrong they were, where appropriate) don't expect the public to take fear-based guidance from the same sources as credible.

>> It could be (is likely) that the problem never was as bad to begin with

As of today the USA has 75,000+ dead and counting. That is pretty fucking bad.

I agree that it's pretty bad. You're sort of making my point, though. People forcing the issue to be binned into either a "bad" or "not bad".

No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago. Yet very few seem willing to admit that, because (I'm guessing) they think it might mean losing some amount of fear based leverage or control. Or don't want to give people false confidence to disregard rules. Or whatever the motivation.

And the public in general is perceptive of that, especially the ones less inclined to blindly trust government.

When the original concern was overcrowding hospitals, and the new risk is ERs closing or laying off staff from under-use, the nature and magnitude of the healthcare infrastructure risk has completely changed.

Which means either:

1) we were wrong and it isn't as bad as we thought, or

2) that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good. And that's strictly looking at healthcare, before even taking into account economic considerations beyond the hospitals being able to stay open.

>> No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago.

It's a lot less bad than it was estimated 3 months ago because most states understood the severity of the situation and hunkered down as much as they could.

>> that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good

Our "deaths per day" number averages 2000. I don't know how this can be remotely perceived as some sort of massive success other than relative to the original estimates that were based on doing nothing.

Stopping people from getting the virus was, unfortunately, not the goal. American epidemiologists don't and didn't believe that's something we can achieve in the short term.

Yes- I was speaking specifically to the goal of not overwhelming the healthcare system.

Unfortunately, right now we're saving it from gluttony only to have it starve.

3) We were wrong about the kinds of people who were going to catch this (e.g. poor folks, people of color, people in nursing homes, prisoners, people who work jobs they can't freely leave in meatpacking plants), who while they'll fill up a coffin just the same as anybody...

...are also all groups less likely to go to a hospital / ER even in GOOD times, and even when they do, tend to be treated like crap (e.g. assumed to be "drug-seeking", have their pain dismissed, often end up overlooked in triage, etc.)

This is the same old haves vs. have-nots story we've been telling, taken to a while new level -- if you're wealthy enough to be able to work from home, you've likely just been hunkering down and wondering what all the fuss is about.

It's not about fear-based leverage, it's about one group of people refusing to admit they're too insulated from the rest of society to see that the lower rungs that keep everything running are getting massacred.

> No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago. Yet very few seem willing to admit that, because (I'm guessing) they think it might mean losing some amount of fear based leverage or control. Or don't want to give people false confidence to disregard rules. Or whatever the motivation.

“3 months ago” was February 8 so not sure what you think was being said at that point.

1.75-2 months ago, when social distancing measures actually began and the whole #FlattenTheCurve started, the White House announced that they had a model that with all the #FlattenTheCurve measures in place, they expected between 100,000 and 200,000 to die of the virus by August 1st. https://apnews.com/6ed70e9db88b80439a087fdad8238009

So far 75,000 have died, with two and a half months to go and over a 1,000 dying every day still. It seems like the original prediction of over 100K by august 1st with full preventative measures is well on the way to being hit.

What are you talking about when you say it’s less bad than what we were told 3 months ago? What do you think you were told?

Not deaths. Healthcare system & infrastructure capacity vs demand. The whole point of "flattening the curve."

Predictions were being made before the first confirmed cases in the US, but we were still in containment mode vs suppression.

The China travel ban, for example, was implemented by Feb 1st, from quick glance. (Edit: made Jan 31 & took effect Feb 2)

We were worried about overwhelming the healthcare system. But it's dying from lack of patients.

Of course it's less bad, we did something about it.

It's like the Y2k bug. There were forecasts of doom, so we did something about it, so then there was no doom. That doesn't mean the original alarm bells weren't justified.

Framing the situation as we were right or wrong is weird though. No one has a time machine to go and come back with the truth, as if someone knew exactly how this would play out but was keeping it a secret.

It was a total mystery 3 months ago. We're only barely starting to tease it apart now. Given that, the conservative option, the choice that kills the fewest people, is what we did.

We could have avoided overshooting if we'd known 3 months ago what we know now. The problem is we didn't have knowledge from the future. 3 months ago it was clear this would have an extreme impact, economically.

What would you have done differently, given what we didn't know back then? (Also keeping in mind we still don't know all that much about this disease.)

> There were forecasts of doom, so we did something about it, so then there was no doom. That doesn't mean the original alarm bells weren't justified.

The field hospitals were built at roughly the same time the lockdowns started. You seem to be saying the decision to build them should be made independently of doing anything else.

But I generally agree with your sentiment about hindsight and acting conservatively. Though that includes knowing what the conservative option even is. Do we also burn money and spray disinfectant on the streets? Are we manufacturing a recession for nothing?

I don't entirely blame the media. Some of this is over-pessimism on public health officials.

For instance in the Bay Area, the SIP's argument was justified primarily from hospital capacity (https://www.sccgov.org/sites/covid19/Pages/order-health-offi...). It wasn't (as has since become) suppress the transmission rate until a test, trace, isolate system can be restored. [1]

Even on April 7, Santa Clara (https://www.mercurynews.com/2020/04/07/coronavirus-santa-cla...) was still projecting 2500-12000 cases by May 1. The higher end of that was highly unlikely even then (that would require cases growing faster than Seattle had been pre-SIP). In retrospect, even the best case scenario was also too pessimistic - at current rates Santa Clara won't hit 2500 until after May 21 -- double the time the "best case" had estimated.

Compare the communication to say Germany or New Zealand, where clear numbers, confidence metrics, range of possibilities, and objectives are outlined.

[1] Which actually has already happened. I'm not exactly sure what the goal is at this point - we have metrics but it's a bit unclear what they are based on (esp. the hard to reach testing numbers).

I always emphasize to my family that we shut down the whole country, the outbreak was relatively well contained to a few areas, and it has still almost certainly already killed more than 100,000 people and may well kill over 200,000.

Given our extreme response, the high death toll should be more shocking to people.

And we're not even close to the end of this. If the IFR holds up at what we're seeing, we already have another 50K deaths that will happen in the next few weeks.

Then the math gets really ugly. If herd immunity requires north of 60% to have been infected, that means 197M Americans. Of those 197M, roughly 5% will require hospitalization, and 1% will die. That equates to 10M hospitalizations and 1.9M deaths. Even being generous and lowering the IFR to .1%, means 190K deaths. Now this make be spread out over the next 7 months, but the butcher's bill will be paid. Hopefully we'll get a vaccine by then, or some therapeutic drugs, but I'm not optimistic.

Yea it’s like buying a fire extinguisher and then being mad that you never had to use it

I think people are more upset with the fact that they are unemployed and their states are locked down. The initial request from my governor was "2 weeks to flatten the curve". After two months, and hearing we never reached near capacity, and our local emergency hospital is also winding down, why are we still closed? Now we're told it could until June

Because the metrics for “we don’t need this emergency hospital” and “the epidemic is beginning to burn out” are different.

But the whole point of the lockdowns was to "flatten the curve" meaning to prevent the hospitals from becoming overwhelmed. That's been done.

The risk of a second wave is still known, and cases are still rising in quite a few states.

And the risk seems fairly small if you look at the numbers. But then you're some sort of conspiracy nut. In Philadelphia, half of the cases are in nursing homes, and more than half are of people older than 60 years of age. There is risk to opening the country, but telling old people to stay home seems more sane than keeping people from being able to make ends meet

At least 0.16% of NYC is dead from COVID-19, and that number will rise as both the disease continues and we go back and discover cases we missed. If those numbers hold nationwide, you’re talking about half a million people dying or more.

I personally wouldn’t want to argue for putting half a million in an early grave for the sake of opening up.

I don't think you're a conspiracy nut, and you're right that the risk is fairly small right now in places where there have been few confirmed cases. But an exponential growth rate means the risk not small for very long. Covid-19 is the leading cause of death in the US right now. That we don't have the ability to test people before they go back to work is a huge problem. We can't even catch when someone has a fever.

> In Philadelphia, half of the cases are in nursing homes, and more than half are of people older than 60 years of age

That has little to do with the infection rate and a lot to do with who gets tested. In nursing homes people are getting monitored all day. There are many countries that are far more dense than the US that are currently open, because they test everywhere and prevent people effected from being out.

They are still rising in a few states that have locked down.

I have to wonder, what do the people pushing to re-open expect will happen in those states?

"It'll disappear, just like a miracle."

The risk of the second wave is precisely the indication that our indefinite containment strategy was fundamentally flawed. We didn't actually avoid mortality in a permanent sense, we just postponed it. Which is why many on the side that you are advocating for are beginning to express the notion that we need to be on guard for the next _months-years_. Not just the next _weeks_.

As briefly as possible: Containment only has real utility if we can develop a game-changer that drastically alters COVID-19 outcomes, and that we don't have to wait so long for it that lockdown-induced mortality eclipses the time-adjusted benefit. It's a risky strategy that requires waiting for an uncertain, temporally-unbounded event, which in turn means that the "indefinite postponement" strategy incurs unbounded cost. We simply don't know enough to make definitive predictions about upper bounds on time-to-discover-incredible-treatment.

Whereas in a no-lockdown, natural herd immunity strategy, we are experiencing a fairly well-bounded spike in short-medium term mortality. I've been using Ferguson's 2.2 million figure for the US which is based off 82% population infection with an IFR of 0.9%, with the population equally susceptible at the physical level (behavioral differences are modelled, I believe). That's an excellent upper bound, it's certainly not the mortality we should _expect_. So we have a much tighter certainty, we will experience somewhere between 200,000-2.2 million deaths due to COVID-19.

When weighed against the alternative, which again is to incur unbounded risk from lockdown-associated mortality, the correct path becomes quite clear in my opinion. A very marginal increase in all-cause mortality in the whole population could very easily offset the spike in COVID-19 mortality which is constrained to fairly limited subsets of the population overall.

We have to start thinking about how, long term, we are going to start managing the 7th and 8th wave as well.

"The epidemic is beginning to burn out" is also very different from "everything can go back to normal now". We saw how quickly this can get out of hand if left unchecked last month. If people rush to get back to normal and pretend that things are fine, it's just going to happen again.

It’s depressing that people have already forgotten the lessons from last month.

Anxiety over an inability to procure resources due to economic uncertainty for the future and lack of income is also an epidemic.

It's depressing that people think 25% of the workforce can be out of work for an indeterminate period of time without massive, potentially society-ending effects.

No one thinks that.

I think that.

Specifically, I think that first world societies can afford to give 25% of the workforce a paid sabbatical without ceasing to exist. And I find it depressing that there are people who think this is a shock that rich societies cannot absorb.

Sure, it'll be painful. Taxes will have to go up afterwards, the retirement age might have to rise. But it's possible.

I can only assume you mean without drastic changes to our current economic system, because otherwise in this modern age of automation that seems entirely possible.

> massive, potentially society-ending effects.

"Society" ending or "Socialism only for the rich" ending?

That's not the result of having "forgotten". It's the dual squeeze of pitiful government response for workers (a single $1200 check vs. near full-benefits in Europe) combined with a hysterical "we gotta open up" corporate funded protest campaign from the extreme right.

Don't forget the gaslighting "100k people dead is doing a good job" BS.

People are being hoodwinked while they're scared shitless.

> Don't forget the gaslighting "100k people dead is doing a good job" BS.

It always looked bad and looks worse the closer 100k becomes. It can’t be too long before some measures will say it has been exceeded. Then what will the claim be?

Goalposts can be moved - in fact, hasn't that happened before? Next claim will be 150k, then 300k. It will never be enough to actually do anything until/unless Prince Prospero or his castle gets sick.

Stumbled on the below - just denying covid is the cause of death is another angle. https://www.nytimes.com/2020/05/09/us/politics/coronavirus-d...

I do truly believe that almost any reasonable person will look at the death rate and realize that the US has fucked up the response in a big huge way. The conspiracy people saying that the death rates are a lie are not that many. This is one where the silent majority does realize whats going on and how bad the administration is fucking it up.

Anyone can go look and see that south korea, a far more urbanized state is open for business right now.

"examine this discrepancy" vs. "it's fake news" - for some the latter just makes more sense.

Active disinformation campaigns work.

Saying SK is open while we're not leads to "let's open America" for that mindset.

They'll have that mindset regardless of the reasoning for it. We'll just all have to watch as they show up on the news going "I never believed this could happen to me!".

Not all countries in Europe are going full benefits. Mine has given peanuts to all those people who cannot work at all due to the lockdown (and only a tiny fraction got the money). Or worse, it has offered them loans.

> Don't forget the gaslighting "100k people dead is doing a good job" BS.

Now do the per capita numbers and see that we’re actually doing better on a deaths/million basis than several European countries.

Just to be clear, the epidemic only "burns out" when somewhere between 50-90% of the population has immunity. Almost certainly closer to 80%+ unless we discover that a significant portion of the population is resistant to infection due to genetic differences or possible cross-immunity with other milder human CoVs.

By suppressing the transmission of this virus, we have failed to build immunity in most of the population. As a result any serious lifting of suppression measures will lead to moderate-severe outbreaks.

On balance, I believe that the most effective method is to resume life as normal, and focus on encouraging the at-risk to shelter, along with providing them appropriate government support. Whereas the approach we've taken has destroyed our economy in a very real sense, which will increase mortality even in the absence of a global food crisis.

The suspension of elective surgeries on a broad basis was very clearly a mistake, but unfortunately it's the type of mistake that no-one will admit was a mistake.

We postponed absolutely important surgeries as a result of this, even in areas like, for example, my county in Central California, which has very low prevalence of COVID-19. Here in California we "only" suspended elective surgeries for a month and now have a backlog that we're still working through.

So, just to say it explicitly: the fear that "things will never be normal again" is unfounded, at least in those who are operating off a mental model wherein COVID-19 is 10x as deadly as we previously thought.

The fact that we chose a strategy of indefinite postponement was our mistake. Because now people are beginning to realize that if we "go back to normal" then "the lockdown was for nothing". I consider this to just be a sunk cost fallacy, I believe quite frankly that ultimately the lockdown "was for nothing" (that is to say that, at the time it may have been justified based off the projected numbers, but with what we know now we should know that we only shot ourselves in the foot).

TL;DR: I believe that we need to resume normal operation of society, and make strong efforts to protect the at-risk. Trying to indefinitely postpone exposure to COVID-19 is a loosing battle. We've adopted a strategy of indefinite containment/postponement that relies on hunkering down and waiting for a _temporally unbounded event_. Given that lockdown-associated damage increases the longer containment is maintained, we are trading off a linear component of damage for a speculated future improvement in outcomes due to vaccines/a game-changer treatment. That to me is eminently foolish.

Most decision-making heuristics don't just try to blindly increase expected value (decrease expected loss) but also factor in uncertainy. In general it's acceptable to trade off a little EV for a lot more uncertainty. (Unfortunately in the case of the lockdown, I believe we incurred -EV along with far more uncertainty, for a net loss across all dimensions)

> I believe that we need to resume normal operation of society, and make strong efforts to protect the at-risk.

Nearly half the population is at-risk (age, comorbidities, obesity).

Describe how you expect 100M at risk Americans to shelter, while the remaining 229M party like it's 1999? For example, I work with a team of 9; two have diabetes and are overweight, one has hypertension, one has heart issues. One has a mother with cancer he takes care of. I have two children who in your scenario would be going to school and bring home SARS-CoV-2 for dinner. My wife also works in public service, and prior to the shutdown, interacted with hundreds of people per day. So I'm sure my coworkers will be thrilled that you're willing to sacrifice them up on the alter of herd immunity.

It's not an epidemic any longer and hasn't been for a while. It's a full blown global pandemic headed towards being endemic long term.

All three are very different scenarios that require different strategies and where we should have very different expectations for what is and is not achievable.

People are praising countries like New Zealand, but what's their endgame? Be in a situation where their citizens can't even safely travel from their country until global herd immunity is achieved because every vacation or business trip is a chance to end up being sick far from home?

This isn't going away just like the seasonal flu and common cold are not ever going to go away.

> People are praising countries like New Zealand, but what's their endgame? Be in a situation where their citizens can't even safely travel from their country until global herd immunity is achieved because every vacation or business trip is a chance to end up being sick far from home?

Yes. And I’ll have this over every alternative I’ve seen so far. I’m in New Zealand.

"Flatten the curve" != "wait until the epidemic burns out"

The fact that the rhetoric started with one and ended with the other makes the whole process feel dishonest.

We literally have to talk about goals as they come up. It's not that complicated. It makes no sense to keep saying "flatten the curve" as a goal once we achieve that goal, and it makes no sense to say "wait for it to burn out" during a period of skyrocketing growth.

Once we get over the exponential growth, we then have to wait for it to drop. Otherwise we'd just go right back to exponential growth.

All you people acting like "oh, the curve flattened, now we can go back to normal" are the kind of people that caused three massive spikes in the 1918 flu.

We're very likely to have a second spike that is way worse than the first because of this attitude.

Literally noone is saying "go back to normal". If the goal was to get it to burn out, the initial statement should have been "we need to isolate until it burns out".

That was not the initial sell to the public.

Well look at Wuhan, Europe, etc. Had people in the US taken the lockdown seriously, we would have ended with an Rt below 1.0 (ideally WAY below 1) so we would be more than ready to reopen now. Instead, people keep doing crap and getting infected, and here we are stuck at home for two months.

It’s more like experts telling you that models predict you’ll need 50 fire extinguishers to put out a kitchen fire, you express skepticism, and you’re branded a science-denying lunatic.

"The rationale was incredibly clear"

If you trust the same kind of "Scientific Modeling" that create Hurricane Path Predictions. Notorious for being hysterically wrong.

Then sure... that's wonderfully "clear"...

If, instead, you look at "models" and "projections" as junk science that's easy to prove wrong by simply looking at any model and how horribly wrong it's been in the past?

Like... the COVID models have been horribly wrong so far...

Then no... it's not "incredibly clear"

Which models on COVID are you referring to that are horribly wrong?

Also curious why you think the US was so badly effected compared to say south korea or thailand?

Do you think it would be safe for everyone to go back to relative normal? What would your prediction of the effect be? What data would you trust to validate that prediction?

I'm asking out of genuine curiosity how someone who I'm assuming is well meaning can get to this position. I'm happy enough to be convinced if your prediction turns out correct as there will be plenty of different states that are going to do a variety of strategies.

"Which models" the ones projecting 2.2 million deaths... the ones based on 4% fatality rates.

"do you think it would be safe" With the data thats coming out? Yes. Absolutely. COVID is turning out to only be a little more dangerous than the Flu and "lockdowns" are not slowing or stopping the spread of the virus.

"How can someone get to this position"

Honestly... January WHO was saying COVID didn't pass person to person and models were predicting 2.2 million dead in the US alone.

I'm not making a prediction... I'm casting aspersions on the "predictions" that have been used to feed opinions like "do you think it would be safe?" as if we are all going to die - 99.5% of those who get it survive. Worse than the flu but not worth shutting everything down (which hasn't stopped it at all - look at New York).

Personally I know we can protect those who need extra protections (Old, ill, etc) without unproven shutdowns based on faulty models fed with bad data.

Why do I feel this way? Because I know that hurricane predictions are "Scientific models" and are wrong just like "market predictions" and all other forms of prediction based models based on past data.

Wanted to say thanks for the honest answers. The models you describe weren’t the ones that I saw - maybe in the worst case with like a 2% death rate?

I'm opinionated and if I can get something to change my mind I try to keep an open mind.

But I've seen higher death rates in public threads as a common theme.

https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate...

"In Italy, the death rate stands at about 13 percent, and in the United States, around 4.3 percent, according to the latest figures on known cases and deaths. Even in South Korea, where widespread testing helped contain the outbreak, 2 percent of people who tested positive for the virus have died, recent data shows."

Granted... those death rates are "known" cases which gets cut when you add no/low symptoms to the "unknown infected".

We are still gathering data and the numbers vary greatly depending on country and testing methods.

Which is my biggest point... it goes from 4%+ down to .5% or lower depending on how you spin the numbers.

Hard to take "projections" seriously with THAT much unknown data.

edit: For the 2.2 million dead projection:

https://www.factcheck.org/2020/03/trump-and-the-coronavirus-...

"The CDC modeled four scenarios and estimated that 200,000 to 1.7 million U.S. residents could die, the Times reported."

"Think of the number: 2.2 — potentially 2.2 million people if we did nothing. If we didn’t do the distancing, if we didn’t do all of the things that we’re doing." -Trump

More stupid media trying to cause outrage when a month prior the outrage was there's not enough medical resources.

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