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Comment by jaywalk | Hacker News Reader

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

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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

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.

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.

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."

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

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.

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