Take the Shutdown Skeptics Seriously
theatlantic.com
theatlantic.com
The original argument was to "flatten the curve" to prevent hospitals from becoming overwhelmed. By that logic, areas where the hospitals have not been overwhelmed (which is most of the United States) should be gradually reducing restrictions, and only maintaining the restrictions necessary to prevent hospitals from becoming overwhelmed.
Lately, the prevailing argument seems to be that we need to shelter in place because virus cases will increase if we don't. That was not the original justification. Of course cases will increase! The question ought to be, will they increase to the extent that they overwhelm hospital capacity?
Most of the people quoted in the article agreed with shelter-in-place orders in the first place, and now they are being labeled as "skeptics" for sticking with the original rationale.
Every country on earth has to move the goalposts during a pandemic — this is a sign the system is still working.
The one-off $1,200 in the US is fairly unique.
> France, Germany, Denmark, Britain and others have decided to take over the payrolls of struggling companies, so that workers don’t get laid off. The hope is that by paying people to stay home, governments can slow the virus’s spread while also averting an economic depression.
> Since many European countries had similar social safety net programs already, albeit in far more limited form, the salary supports were relatively easy to expand, almost literally overnight in many places, amid widespread consensus. When they imposed their economically devastating lockdowns, countries were thus able to signal to workers that their livelihoods would remain intact and to businesses that they wouldn’t immediately implode.
Didn't the US largely do this too, via a forgivable loan to companies?
That's not to mention that many places in rural America have no capacity to deal with a pandemic - just think about the hospital in the Netflix Pandemic documentary ...
There is a real question whether we should try to squash curve or let it spread.
I would rather squashing the curve, but I don't think we as Americans have the discipline to squash it.
https://lockdownsceptics.org/code-review-of-fergusons-model/
The "Ferguson Model" is described here:
Also, the US federal government doesn't use it, they use a model from UW: https://www.vox.com/future-perfect/2020/5/2/21241261/coronav...
There's a review of the performance of the model and its updates here:
https://www.nationalreview.com/corner/coronavirus-pandemic-p...
People who live in areas with low population density don't think they need to shut down just because areas with high population density are vulnerable to this outbreak.
If you want to convince them, you'll have to show them examples where communities like their own have been hit hard by the virus.
1. It does not produce repeatable results given the same input data, due to bugs. "Averaging" the results is suggested.
2. The algorithm uses equations of unknown purpose and origin.
3. The source code is hidden from independent view.
Passing off the results of this model as "science" is risible.
Unfortunately, that's been true for 90% plus of all the science to date on this pandemic :(
Reading some of these papers and thinking of how merciless I'd be if I were their peer reviewers... then seeing people treat them as absolute truth... it's depressing as hell.
(I was one of the exceptions, and man, was that ever frustrating.)
All code is trash, but not all code is trash for all the same reasons.
I think the article author mentioned that just to show (s)he understands stochastic modelling. As can be seen from your comments and others, it's apparent some people/scientists either aren't reading the article properly at all, or have a massively wrong understanding of what Monte Carlo/stochastic modelling techniques really are.
The US is especially poorly suited to deal with a lot of people with a life-long debilitating illness from damaged lungs.
It stands to reason that a disease that outright kills 0.1-1% of the people infected also gets a fraction of people near death, which means it damages them hard enough that they almost die. This effect is entirely consistent with other diseases, for example non-covid19 pneumonia.
As of now we have not learned:
* What fraction of people develop long term effects.
* By age group.
* How do these effects compare with long term effects of other diseases, like influenza or influenza-triggered pneumonia.
* Do these effects heal over a period of time, say a few months?
I’m absolutely done with any and all media. When it mattered most (literally life and death) it was click bait, politics, and outright fakery.
There needs to obviously be a public health retrospective on this but also a policy and communication retro as well.
I want to read a book on WHAT ACTUALLY HAPPENED. I want people with subpoena power and a 500 page report. This whole thing has just been bizarre. I can’t help but feel like I’m being punked.
I've tuned out all other news pretty much, even HN is getting bizarrely disconnected from reality. see the comment wondering "has testing increased? I haven't read anything". this is getting crazy.
Notice what gets downvoted.
I don't think anyone sensible ever said "flatten the curve, and we're done!"
Flattening the curve was the first and most urgent step, to avoid the overwhelming of medical systems like what happened in northern Italy.
Quite a few countries took advantage of that time to ramp up testing. Certain ahem countries kinda squandered it.
The federal government has largely failed in the latter, you can't reopen if you can't isolate and so we've wasted lots of the time that was gained.
The second closest is Germany, with 2,755,770.
'Largely failed' doesn't seem fair.
https://www.worldometers.info/coronavirus/
We should probably also consider the number of tests in the most affected areas but I have no numbers on that.
But that was the original reasoning.
"Flattening the curve" is reducing the number of virus cases that happen. The number of cases of the virus will increase -- the number of PEOPLE with life-threatening or life-changing injuries will increase, if we don't reduce the number of people spreading the virus.
No, that is absolutely incorrect. Flattening the curve was not intended to reduce the total number of cases. It was intended to reduce the rate at which those cases occurred, i.e. to spread them out over time, so that hospitals did not get overwhelmed. It is a rate limit.
In the long run, the only way to shrink the total number of cases is a vaccine.
But extermination means no international travel, and a stronger lockdown. Which looks like it worked for NZ, but won't for the US.
Now in the first wave you only had a few starting points as there were few sick people in few clusters. Today you have sick people all around the place. If the delay of measures are delayed in the second wave as much as in the first, the second wave will be much larger and it will be far less concentrated into clusters.
So this makes any policy change risky unless the measurement latency is very short. On top of this the impact of different policies is not known. So opening slowly makes it least somewhat scientific (understanding what works and what does not)
Of course the lockdown has a lot of negatives as well. I don't think many people dispute that. So it's a real a trade-off. But one that is very hard to get right because of all the unknowns, measurement latency (covid cases and side effects), and general emerging complexity of the problem.
On top of all this, this problem hits so many areas of public and private life. It's hard to nail down messaging to meet everybody.
So bottom line is it's hard to get right, therefore easy to criticize.
"I think the same thing today as two days ago. It doesn't matter that aliens landed on earth in the meantime. That won't change my mind about aliens not existing."
Part of the point of the safer at home orders is to buy time, not only to avoid oversubscription of hospitals but also for government to ramp up testing, protocols, contact tracing, and so on. Look at South Korea for how that can work.
Unfortunately the federal government has squandered the opportunity to plan, prepare, and implement at every step along the way. At the same time, the bulk of the push to open comes not from reasoned argument, but special interests. The protesters seen at state capitols are victims of fake news, astroturfing organizers, and disinformation campaigns.
That Friedersdorf doesn’t discuss those dynamics—at all—makes me lose a lot of respect for him. It’s just lazy both-sides journalism, where a contrarian viewpoint is taken up with very little justification, examination of the facts, or assignment of responsibility to important actors. Very disappointing to read this in The Atlantic considering so much of its coverage -has- been so good.
Or, put another way: despite the prevarication, the author clearly _is_ a shutdown skeptic, of course they want shutdown skeptics to be taken seriously!
What you're asking for here is a basically a Tweet: “I mean, maybe they're not wrong.”
If you change the framing a little bit there's no reason this article couldn't have been titled "We Should Start to Think About Ending the Shutdown" or something. But if it had been titled that, most people who don't already agree would just write it off immediately. It's clear the framing was chosen to appear more reasonable and neutral in order to target those a little more open-minded or on the fence, to sneak past the out-grouping that leads people to dismiss the other side instinctively. That's not even really a criticism, given how polarized and partisan political discourse is; it's smart rhetoric.
So to answer your question directly: you can explain the argument without uncritically recapitulating it. The latter is what this essay does, which is why I think the idea that it's "someone else's argument" is a front.
For comparison, this [1] article showed up here a while ago. The authors repeatedly made clear that they disagreed with the skeptics, that they had "consensus views", that they weren't trying to Trojan horse a contrarian argument in under the guise of a call for open-mindedness and debate. That essay has flaws, and maybe it's naive, but I got the genuine sense when reading it that the authors were being forthright and earnest. I think they succeeded at making the case for the validity and worthwhileness of someone else's argument without looking like they're endorsing it.
[1] https://www.statnews.com/2020/04/27/hear-scientists-differen...
For example, a solution could be as simple as America financially supporting its citizens like other countries have done, reducing the desperation that's causing the pressure to reopen sooner than they likely know is safe. Don't make it a lesser of two evils choice in the first place.
Reminds me of something I read on here about assuming a strong man version of people's arguments instead of a straw man one. Maybe they're knowingly protesting because they believe those are the only choices they have.
Money is not nutritious when eaten.
Now, I know, that was the idea behind "critical infrastructure" - we had to keep those things running, even if we shut down everything else. But the longer we shut down, I suspect the more things we find that are critical. (Made up example: Water is critical, so water treatment is critical, so the chemicals used are critical, so the ingredients to manufacture them are critical, so certain kinds of mining are critical, so eventually mining machinery is critical.)
Neither is an empty cupboard, which a lack of money can lead to.
The shutdown skeptics/deniers willfully fail to understand that if the pandemic is allowed to rage unchecked the economy will shut down as people panic. It's telling that at the same time that want indemnity for businesses and organizations that reopen. That's why I say it's willful.
The U.S. also doesn't have to choose between individual destitution and death of the vulnerable. Some combination of financial support covered by bonds with freezing debt collection of various categories would provide significant relief.
As in all macroeconomic challenges a combination of approaches is necessary.
You might want to re-evaluate the "lockdown skeptics" arguments in that light.
Not knowing numbers is not the same as vague or unclear metrics. For example, saying "phase 3 will proceed once the hospital occupancy goes below 30%" doesn't qualify as vague in my book (numbers and such obviously made up by me). While we don't know when that happens, the metric itself is very clear and specific.
What kind of metrics does your county's lift-up plan use that are unclear just "because we don't really know enough yet"?
Every year, tens of thousands of people in the US die from influenza. But the economy is not shutdown to prevent this. We recognise that the cost of tens of millions of dollars per life saved is not worth it.
People seem to think it's morally bankrupt to put a cost on saving lives. But that is what we (as a society) do every day. Every healthcare system puts a price on each treatment. In the US the patient (or insurance) pays for it. In the UK an ethics council will determine if that is a good use of the finite money the system has.
But in order to have a proper discussion about this, we need to have some numbers. How many lives will be saved, how much will it cost? Is "lives saved" even the right metric? Any article that hand-waves away the numbers is worthless.
A thought experiment for both sides: at some point your opinion would change, for/against the lockdown. How much more or how much less deadly would COVID-19 have to be for you to change your mind?
People are going to stop reading after that because it's generally a pattern of another idiot rambling.
Don't write in that pattern if you don't want people to interpret it in that pattern.
Maybe I could compare it to car accidents - we don't ban driving because the costs would be enormous.
I hope that doesn't spawn replies about self-driving cars...
The question always comes to would you rather over react or under react to a novel pandemic?
It's also interesting that this conversation about economics isn't spreading more towards alright now that we have this lock down are there any monetary policy changes we can make to allow us to adapt to this?
Many other countries have dealt with the economic consequences of the lockdown better than the US, despite being poorer countries.
[1] https://www.who.int/news-room/fact-sheets/detail/influenza-(...
[2] https://www.statnews.com/2018/09/26/cdc-us-flu-deaths-winter...
Moreover, comparing the flu season to "just 4 months" is disingenuous. That's...roughly as long or even longer than what most people consider the flu season.
Of course, this is due to the lockdowns. I'm not trying to make the case that COVID-19 is "just a flu". we'd almost certainly be seeing much worse numbers if people weren't social distancing or whatever. And we're not finished yet.
If you count covid and flu using the same method you see far more covid deaths.
Here for covid you're using "died after testing positive for covid", and for flu you're using "died after testing positive for flu or with presumed flu". You can see these are different.
I know that different states and countries are reporting COVID deaths differently. I've seen "shutdown skeptics" claim that the reason Belgium and New York and Sweden's official numbers look so bad is because of this: supposedly they're using a methodology closer to the one you claim is being used to source the flu numbers, unlike everyone else. So I don't think my official numbers are purely what you claim they are, but probably a mix of different methodologies. Even if on balance that's producing an undercount, do we have evidence for something like an undercount by a factor of five? The former I'd be happy to accept, the latter is a bit of an extraordinary claim and calls for the evidence to match.
Neither of my sources for the flu numbers say their number was derived in the way you're suggesting - the US one in particular says that it's an estimate using a statistical model rather than a count anything like what you're saying. Did I miss something in the sources?
The coronavirus numbers are _not_ the result of multiplying the a death count, they are the death count that is muliplied to get the flu numbers.
You can find the observed flu death count for the last several years at https://www.cdc.gov/flu/about/burden/2017-2018.htm, but you have to dig a little on the page for each year - the pages are for giving "Estimated Influenza Illnesses" and describing that years model, and in the citations you can find the count of observed.
I'll come back and reply if I can make time to put together a spreadsheet with the observed counts per year with links.
[1] https://www.cdc.gov/flu/about/burden/how-cdc-estimates.htm#R... [2] https://blogs.scientificamerican.com/observations/comparing-... [3] https://aspe.hhs.gov/cdc-%E2%80%94-influenza-deaths-request-...
To count deaths you can either count only the people who had a test and were positive, or you can count deaths where the disease is listed on the death certificate as a cause or contributory factor, or you can use complex statistical modelling and look at excess all cause mortality. (positives deaths is lower than death certificates, which is lower than the statistical modelling).
Some countries further restrict the number given by testing. For example, the main number used in the UK during most of April was "was tested positive, died in hospital" -- they were not including care home deaths in that number. (They changed that in April so they now include care home deaths.)
Here's a Flu Report from the UK for the 2015-2016 season: https://assets.publishing.service.gov.uk/government/uploads/...
If you look at tables six and seven they give all cause excess mortality for the flu seasons between 2006/07 through to 2015/16 (It's a bit annoying that they've done it by flu season and not by year).
Well, mostly in just 1 month—we entered April with around 5,000 US deaths, and exited it with over 60,000. So that's about 55,000 deaths in a single month.
So I agree that there's no reason to compare COVID-19 with the flu, but your description of the vaccine doesn't appear to be that accurate.
As for very old people, yes, also true, but care givers are often immunised to decrease the risk to that population.
Second, confirmed covid deaths already exceeded estimated influenza deaths. This is covid with lockdown and not finished yet versus influenza overall.
That is without comparing how long are you sick if you get sick and without comparing possible long term consequences of disease.
I mean, by the start of it influenza comparison made sense. At this point, it does not.
That's all it takes. Such a simple thing. We can't have full re-opening while we have self-ish protesters who revel in spreading the disease and make a mockery of public health. If they'd have some personal responsibility or if stores would just take the initiative nationally to require masks for every patron, we'd be over this by fall, and subsequent waves wouldn't be so bad.
A post from someone in my hometown yesterday on facebook had a guy boycotting great clips because they made him put on a mask to step foot inside and he had to make an appointment. (State law now for all stylists/barbers/etc.). All it takes is respect of others AND the virus to stop this thing. Why can't people do this?
> “One reason is that nearly everyone there is wearing a mask,” said De Kai, an American computer scientist with joint appointments at UC Berkeley’s International Computer Science Institute and at the Hong Kong University of Science and Technology. He is also the chief architect of an in-depth study, set to be released in the coming days, that suggests that every one of us should be wearing a mask—whether surgical or homemade, scarf or bandana—like they do in Japan and other countries, mostly in East Asia. This formula applies to President Donald Trump and Vice President Mike Pence (occasional mask refuseniks) as well as every other official who routinely interacts with people in public settings. Among the findings of their research paper, which the team plans to submit to a major journal: If 80% of a closed population were to don a mask, COVID-19 infection rates would statistically drop to approximately one twelfth the number of infections—compared to a live-virus population in which no one wore masks.
I wear a mask, but I have no illusions about how unsettled the science around doing so is.
IMO the best thing we can do is look at experience from countries that managed to get the infection under control, like SK. I highly recommend these interviews with one of their leading experts, what he says makes a lot of sense:
https://www.youtube.com/watch?v=QwoNP9QWr4Y https://www.youtube.com/watch?v=gAk7aX5hksU
When he says face masks are one of the effective measures, I'd probably trust him ... The question is what exactly should be the rules.
Our country is in a lockdown for ~2 months now, and most of the time face masks were required when leaving the house. We're probably going to relax the rules a bit soon, only requiring them when closed spaced, etc. Which probably makes sense, it's pointless to wear a mask when jogging alone in the woods, or something like that (and people were not following that perfectly anyway).
My personal opinion is that face masks do help, partly because they limit how far your droplets reach, partly because it limits how frequently you touch your face. Even a simple home-made mask or scarf will help with that.
I think a lot of the "do not wear masks" recommendations in many countries is due to concerns that a recommendation to wear a face mask would make the shortage even worse.
What experience? You go on to recommend listening to an interview. I was hoping for data. Remember that we're discussing the suggestion in this pre-pre-preprint that we can be confident that wearing masks has a huge effect on the infection rate.
It's a combined effect that only works if it's got at least 80% compliance, preferably 100% should be required. Why take the risk of killing someone if the wearing a mask could alleviate it? Is wearing a mask such a horrible thing?
I presume that this is result of too late reaction to the outbreak but perhaps somebody knows better.
I'm guessing it's because mitigations together with an increasing immunity is lowering the reproduction under 1.
In many large cities as many as 10 or 20% are now immune and that's a huge number if the theoretical herd immunity is somewhere around 60, and the practical one is somewhere even lower.
https://www.google.com/amp/s/www.wsj.com/amp/articles/corona...
pay attention to hospitalizations. that metric is disconnected from the new cases and expanded testing relationship.
As soon as hospitals start allowing elective surgeries again hospitalizations become less of an indicator and you have to go by "suspected" or "confirmed tested" covid hospitalizations.
It'd be disconnected if you had samples that are comparable (ideally random, representative of the population), but that's not the case in most countries. When you start with very limited testing capacity, you prioritize "important" groups of people that are often at higher risk of infection (healthcare workers, older people, ...) so you can expect higher percentage of people to test positive. But as you increase the capacity / number of tests, the sample structure will change - people with lower risk of infection will get tested, so it's natural to expect the percentage positive to decrease.
If percent positive of all tests is the same as before then the infection rate is not decreasing, or increasing - its constant. That is the case in many areas although some are seeing decreases or increases. E.g. some are increasing (e.g. Maine, South Dakota), some are decreasing (e.g. NYC, NJ), some are constant (e.g. DC/MD/VA have been constantly at 20% positive for the last couple of weeks now).
Most states are looking for a decreasing rate of positive tests for two weeks especially of its the percent positive case is under 10%. Generally under 10% is considered under control or manageable by experts.
So at first tests were basically only given to people who had multiple symptoms, to be sure. Now you can get a test in my area if you're asymptomatic but working at a job that requires you to come into contact with other people.
If the percent positive of all tests is constant even as you test more people, that means that even as you test less obviously symptomatic people, the number of infected is constant, which could mean the infection rate is going up. Or not, but it's not certain that it's complex.
> Generally under 10% is considered under control or manageable by experts.
Can you cite this?
https://www.npr.org/sections/health-shots/2020/04/22/8405263...
There are several other sources out there that state that for example the WHO also recommended it as a guideline. Yes not everyone is being tested but the 10% does account to some degree of the "severity" of those being tested. If you're only able to test the most likely cases you'll get a much higher % positive.
Asking interesting questions is good. Asking commonly answered questions is...
Hospital beds, like percent positive tests, are only one metric for determining health care capacity and how close we are to having an outbreak that overwhelms the all resources needed by the health care system to properly function. Globally there is a shortage of the medication used for sedating which is used when doing intubation or another medical procedure that requires sedation. Globally there is a shortage of PPE. PPE is at an extreme shortage globally still, and without PPE you have a shortage of medical workers (who then get sick or potentially spread it to other patients who aren't covid patients) - without health care workers those hospital beds become pretty useless. A lot of the initial cases in Wuhan came from cross exposure of non covid patients to covid patients at the hospital so canceling elective surgeries And mandating PPE made sense to prevent hospitals from becoming infection hotspots.
Why is everyone so hyper focused on hospital beds? They also literally canceled all elective surgeries as part of these stay at home orders which freed up something like 70% of beds that were being used. Additionally there aren’t as many trauma victims because car accidents, tourism, etc is down.
They know severity of cases and poor outcome when contracting the disease comes from initial viral load - being in close, confined places with someone who has it for a substantial period of time increases the severity of the disease. This is true for this virus and has mountains of evidence behind it in the study of virology to be true in general with viruses. It’s increasingly important here because the virus has no treatments in terms of medications, severe cases seem to be complex and the progression of the disease from this virus is not well understood. These guidelines and requirements for wearing a mask in public and need for health care worker PPE is a large part of the effort to help people have a less severe case of the disease if and when they do get exposed.
How myopic and superficial to not think about something more than hospital beds as a metric when evaluating these shutdown policies.
From tomorrow the devolved parliaments (certainly the Scottish government) will be diverging from tonight's confused "Stay Alert" messaging as announced by Boris. For at least the next three weeks the message in Scotland is still "Stay at Home".
Look at: recorded deaths, excess deaths, hospital admissions, ICU admissions, serological studies.
Together they can give a good picture of what's happening.
Please don't look at serological studies. Many of the serological studies have frighteningly high false-postive rates that can lead to faulty assumptions that 20% or 50% of people have been infected already. This pretty much isn't true anywhere.
That's not helpful.
Once you have at least 10 or 20% immunity sero studies can be used with some confidence, and there are now a couple of tests that claim 98% or better sens/spec, so using the earlier poor ones should be avoided now.
Even New York State as a whole is surely over 5% now.
Obviously if a poor test with 85% or 90% specificity is used and you have low prevalence then you get a poor result. But if you can peg the floor of the prevalence at several percent and use an accurate test then what’s making the results useless?
But even disregarding sero studies, you can draw some conclusions of immunity from death numbers. E.g if assuming a 0.5% IFR with 1600 dead in 2100000 you would have 15% immunity (assuming everyone infected is immune of course). IFRs so high that they yield under 5% immune (basically IFR over 1.5%) aren’t consistent with observation.
But they are. The IFR in places like China, South Korea, and NZ that have things mostly under control at this point, the CFR is consistently above 2% (and as high as 5%), and those places are and were doing significant viral testing, so wouldn't have missed 50% or 150% of the infected. So a CFR of 2% or 1.5% isn't unreasonable (unless you're relying on sero studies as "observation").
Unless you're assuming that there's a huge swath of people (like the significant majority) of Covid-19 cases that are entirely asymptomatic (and we don't have any reason to believe this, we have upper bounds on pre-symptomatic cases at like 50% from randomized viral presence studies, and the asymptomatic numbers should be notably lower), the IFR and CFR should be reasonably close, in places that have things under control and that makes 1.5% IFR more likely than .5%.
> In the case of Stockholm there was 2.5% active infection over a month before the sero study that showed 10%.
Source for this? Sweden has 26,322 confirmed cases today. You're saying that 24000 of those were confirmed in Stockholm well over a month ago?
The same high specificity sero test that estimated 10% in the Stockholm pop., found 20% with antibodies among hospital staff in one hospital (https://lakartidningen.se/aktuellt/nyheter/2020/04/en-av-fem...)
> Unless you're assuming that there's a huge swath of people (like the significant majority) of Covid-19 cases that are entirely asymptomatic
I'm not. 50% sounds reasonable. But in Sweden, only people who are ill enough to be admitted to hospital have been tested so far (especially around the time of the earlier studies - now it's expanding to more general testing) and other than those it has been mostly hospital staff. So the missing number is all asymptomatic AND all the cases that aren't severe enough to require emergency care. And that's a significant number.
I thought there was a broad consensus now that is centering in on IFR of 0.3% in many places while others seem to have higher numbers like 0.5% or 0.8%. I haven’t seen many reports that suggest over 1%. CFR doesn’t really make any sense if you only ever confirm a fraction of the cases.
> But in Sweden, only people who are ill enough to be admitted to hospital have been tested so far (especially around the time of the earlier studies - now it's expanding to more general testing) and other than those it has been mostly hospital staff. So the missing number is all asymptomatic AND all the cases that aren't severe enough to require emergency care. And that's a significant number.
Right, but I'm not talking about sweden, I'm talking about places that were doing more significant testing.
> The same high specificity zero test found 20% with antibodies among hospital staff in one hospital
This would be unsurprising. There have been studies showing that certain at risk groups have very high prevalence (meat packers, homeless, etc.). These can't really be generalized across the broader population.
We can infer that, for example, the hospitalization rate in NYC and San Francisco and Stockholm will be similar per-case, and per fatality, and draw conclusions from there. Those conclusions don't lead to 10 or 20% of the population infected anywhere. They might lead to 5% infected in the worst hit areas (NYC, Lombardy, etc.).
Edit: I take this back partially: Stockholm apparently could reasonably be hit as hard as NYC at the moment, so it could also be at a 5% infection rate. Sweden as a whole almost certainly isn't though.
> I thought there was a broad consensus now that is centering in on IFR of 0.3% in many places while others seem to have higher numbers like 0.5% or 0.8%. I haven’t seen many reports that suggest over 1%. CFR doesn’t really make any sense if you only ever confirm a fraction of the cases.
I haven't seen this. It's certainly possible, but low estimates I'd seen were .5%, centered closer to .8 or 1%.
https://www.nejm.org/doi/full/10.1056/NEJMc2009316
Verity et al. estimated IFR around 0.6% back in March, based on stuff like the Diamond Princess, again no antibody tests:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
This is broadly consistent with the latest serology. NYC implies a bit worse if we divide excess deaths by antibody positives (though they haven't published their methodology as far as I know). Preprints from many European countries imply a bit better.
And ~0.2% of NYC is dead from coronavirus by now. So if less than 5% of the city has had it, you think IFR is >4% there? And you think NYC's announced serology data is ~15% false positives? Even though the total positive rate--which would include both true and false positives--in serology studies in most other cities (which haven't been hit nearly as hard as NYC) is far less than 15%? This makes no sense at all.
The simple explanation for Korea's high CFR is that for a disease where most countries have failed to trace ~100% of the cases, they're failing to trace about half. I think I've seen their public health authorities speculate exactly that, though I can't find the link now.
Inciting public panic is a different kind of harm from inciting public complacency, but it's harm nonetheless. I urge you to correct the misinformation you've posted above.
ETA: And really any single IFR is inherently misleading for this disease--the IFR climbs so steeply with age that it will vary greatly with population age structure, and with whether the disease disproportionately hits the most vulnerable (like when it spreads in nursing homes) or least (which should be our goal, since if we're unable to avoid herd immunity from recovered cases before a vaccine comes then that will cost the fewest deaths). But that's what was discussed above, so I stuck with it.
You're confusing NYC and NY State numbers. .1% of NYC is dead from Covid at the moment. Which leads to an IFR of 2%, an IFR which falls in line, if a bit above those expected in South Korea etc.
> Inciting public panic is a different kind of harm from inciting public complacency, but it's harm nonetheless. I urge you to correct the misinformation you've posted above.
I agree. Can you explain what about what I've said might incite a public panic? I believe all I've said is that everything I've said can be traced back to two basic assumptions:
- I think it's reasonable to believe that the IFR is among the high end of expert estimates
- Naive reading of many serology studies leads to the conclusion that something like 80% of Covid cases are completely asymptomatic. This is likely untrue and believing it leads to dangerous conclusions.
> Even though the total positive rate--which would include both true and false positives--in serology studies in most other cities (which haven't been hit nearly as hard as NYC) is far less than 15%?
Indeed, in most it is. And then there's the study that showed 60% positive serology in a city in France, and 30% positive serology in Massachusetts. So yeah a 10% or 12% false positive rate in a serology study is completely feasible, given that the French study probably had a 40% false positive rate or something equally ridiculous.
I don't believe a binary symptomatic/asymptomatic distinction is terribly useful. I agree that most cases that are tracked eventually report symptoms, just symptoms that are mild enough they wouldn't normally have sought medical care (in normal times, because they wouldn't bother; or now, because they're afraid to go to hospital). That seems entirely consistent with the serology studies.
You originally said:
> There are basically no (larger than a single building) places that can legitimately claim 5% or higher infection rates
I believe that's very, very false--NYC's official numbers are around 4x that already, and those imply an IFR consistent with (and even higher than) estimates like Verity's. To claim even 2% IFR seems borderline-irresponsibly high to me, let alone the >4% that implied.
If you post links to the studies you mentioned, I can take a look. I believe the Massachusetts one you mention is Chelsea, which indeed found a very high rate; but subjects were approached in a public place (thus oversampling people with higher-risk behavior), in a particularly hard-hit neighborhood. So I'd guess its results are correct for the people sampled, but not representative of the overall city.
Have you studied how the specificity of antibody tests is validated, like on blood banked before the emergence of the virus? Why don't you think that validation is adequate? I agree that the correctly-calculated confidence interval for something like the Santa Clara study is near-uselessly wide, but I don't see any reason to doubt serology from harder-hit areas.
1. https://www1.nyc.gov/site/planning/planning-level/nyc-popula...
Yes, my understanding is two-fold. One, that independent verification (like https://covidtestingproject.org/) found less specificity than the manufacturer reported results. And it found that some tests had false positive rates of well over 10%, which is just completely useless. The Santa Clara study is useless with pretty much any test, but even some of the NYC numbers have error bars down to zero, depending on the serology test used.
> in a particularly hard-hit neighborhood. So I'd guess its results are correct for the people sampled, but not representative of the overall city.
I can and do also totally believe conclusions like this are possible: I'm sure that there are population subsets that have achieved near total immunity. I don't particularly doubt the conclusions of the Boston homeless study, for example, although I expect if we check back in on them, many will have reported symptoms and some will be hospitalized. But again, drawing conclusions about "we should reopen" from that kind of thing is irresponsible.
> I believe that's very, very false--NYC's official numbers are around 4x that already, and those imply an IFR consistent with (and even higher than) estimates like Verity's. To claim even 2% IFR seems borderline-irresponsibly high to me, let alone the >4% that implied.
It looks like you're correct, the data I was looking at was wrong/outdated/I can't read or something. Given that, I would agree that NYC basically has to have 5% infected, and 10% is reasonable, although 20 and 25% I'd still have doubts about (and even more doubts about them given that the data is from ~3 weeks ago). So yes, I'd agree that an IFR of 4% plus is irresponsible to suggest, and I didn't intend to do so.
NYC appears to have used an in-house IgG assay for which unfortunately no paper exists; but the Wadsworth Center seems reputable, with no obvious incentive to overstate the prevalence. To any extent they're under political pressure, that would probably go the other way (to show the success of the lockdown, and justify its continued effect). So perhaps they made a simple mistake, but their IFR ends up consistent with serology performed by other means in Europe, and with the few populations universally tested by PCR--actually on the high end, especially if we include probables or use full excess death.
The harm of the coronavirus certainly shouldn't be minimized. The harm of the continuing lockdown shouldn't be either--a generation of schoolchildren may lose months of public education, one of very few social equalizers in American society. Given the harm on both sides, I believe we should be making policy based on our best estimates of the IFR, and not either extreme of a confidence interval. That seems unquestionably <2% to me, and probably <1% based on European serology (though the NYC may be slightly higher).
Take doctors deciding who to give the respirator to seriously.
Today facts don't matter as much. But I see these things and I remember this is only about 1% (maybe couple) of population getting sick already overwhelming the system and I don't need any more convincing.
The problem at this point is that there is little evidence that shutting down is improving our defenses. The federal effort is not there. The state efforts are haphazard. Worse, while the shutdown was strong enough to destroy the economy, it was enacted unevenly and poorly enforced so that transmission outside of the NY area has barely dropped at all. Without reducing transmissions significantly, there are simply too many cases and too little infrastructure to trace, test and quarantine.
The United States will likely serve as a cautionary tale for the rest of the world for a long time to come.
It may seem like everything will blow over if the Uber Eats fairy magically manifests food in exchange for currency at the homes of Americans, but for money to function there must also be productivity.
While it is correct that nobody knows for sure how long it will take until medicine or vaccination are available, there are estimates that one can use for planning. But the article goes from "there is a level of uncertainty" to "impossible to know, let's ignore it completely".
Similarly, while the article is technically correct that the US is currently doing deficit spending, it really isn't the immutable fact that they present it as. It would be quite easy to levy taxes so that there's no deficit. Taxing the rich could finance the current level of stimulus spending for years, but the article goes from "we'll need to make adjustments to our system" to "it is impossible".
1. We depend on X 2. X is provided by free trade and the open market. 3. Quarantine hurts free trade and the open market. 4. Therefore, ongoing quarantine hurts X.
While the argument is sound, removing or reducing the quarantine (ie, solving point 3) is not the only solution. You can also change point 2, on a case by case basis, and remove the supply chain dependence on markets, money, profit, and capitalism.
Of course, someone who is "pro opening the economy" will be unable to accept this option on ideological or often self interest grounds, and thus try to reduce the option space to a simple binary, because mass death is better then the replacement of an economic paradigm from which they have benefited so.
really this whole think just shows either lack of critical thinking and foresight or that there are a lot of sociopaths that can't have any empathy.
For anyone calling for the reopening of cities, even something like try it out and see (maybe this is better on this site, filled with engineers who don't just test stuff out live and see what happens) are you willing to die for this cause? Or are you willing to let a loved one die for this cause?
So far only .03% of the population of Sweden has died from Covid-19. (3.2k/10.2M). Pretty negligible. Does that really justify the consequences of shutting down the world economy?
Most of those people were going to be dying soon anyway. Like my grandma, she was 93.
I think we are experiencing the modern equivalent of China's disastrous "Great Leap Forward". But instead of being caused by terrified bureaucrats listening to a tyrant, this time it's from terrified politicians listening to the bleeding-heart media. The same folks that are always whining about something have now brought about the "Great Leap Backward".
One could say the world is now suffering under the tyranny of the media. Or rather, suffering the tyranny of the meek.
[0]: https://www.theguardian.com/world/commentisfree/2020/apr/21/...
Brazil normally has 3800 deaths per day [0] so, as Bolsonaro says, so what. Some of the sick and elderly dying a few months earlier does not warrant removing the livelihoods of everyone else.
>Let's see where they are in a week or two (it'll be with 3x these death numbers and likely entering a lockdown de facto due to popular support for it).
Popular support is a function of media manipulation. And we know what types gravitate to that kind of work.
[0]:https://worldpopulationreview.com/countries/brazil-populatio...
I have no clue what you're getting at, fwiw.
As for the meat of your comment, exponential growth hits like a truck. 1/3 of Brazil's confirmed Covid-19 cases were confirmed last week. In general that means the death rate, which lags infection rate by a week or so, is based on 100K infected, not 150K. So this time next week we'll see 1000 per day. The week after, 1500 per day, actually probably more as hospitals get overwhelmed.
> Some of the sick and elderly dying a few months earlier does not warrant removing the livelihoods of everyone else.
And what of the hundred plus people under thirty and the 1000 plus people under 60 who have died from covid-19 in Brazil so far? And the 100 plus people under thirty and the 1000 plus additional people under 60 who will die from covid-19 in Brazil in the next week?
>I have no clue what you're getting at, fwiw.
Basically the kind of people that on any given day (it switches to a new subject every few weeks) are whining(/bullying) about feminism, gay rights, misogyny, bullying, #metoo, etc etc are now causing the collapse of the world economy.
>As for the meat of your comment, exponential growth hits like a truck.
They say that but hasn't happened. And it's not like the virus is going disappear everywhere before the lockdowns need to be let up so there really is no point in having them in the first place. People just need to soldier on.
>And what of the hundred plus people under thirty and the 1000 plus people under 60 who have died from covid-19 in Brazil so far? And the 100 plus people under thirty and the 1000 plus additional people under 60 who will die from covid-19 in Brazil in the next week?
As shown in the previous link, 1 person net is added to the population of Brazil every 21 seconds. That's the real emergency.
It's happening right before your eyes: To repeat myself, 1/3 of Brazil's confirmed Covid-19 cases were confirmed last week. That's exponential growth. If that trend continues, and without intervention it will, a week from now, Brazil will be over 200K confirmed cases. A week later, well over 350K.
For comparison, Brazil is about where Italy was on March 20th. They had instituted a nationwide lockdown on March 9th, and still had peak deaths (at around 900/daily) a week later on the 27th and 28th. For brazil at this point, that's basically unavoidable.
So just checking, at what point do you believe a lockdown is reasonable? When covid causes more deaths than every other cause of death combined? Because that's just a month away.
> As shown in the previous link, 1 person net is added to the population of Brazil every 21 seconds. That's the real emergency.
I see no reason to consider this an emergency. If anything, we can expect the birth rate to begin decreasing as Brazil stabilizes. Of course that won't happen if a virus sweeps through and kills a bunch of people.
> Basically the kind of people that on any given day (it switches to a new subject every few weeks) are whining(/bullying) about feminism, gay rights, misogyny, bullying, #metoo, etc etc are now causing the collapse of the world economy.
I'm sorry you feel this way. I wish you happiness and peace in these hard times.
I think lockdowns of the entire population does more harm than good. I say protect the vulnerable and let the rest self-isolate if they feel the risk is warranted.
After all this ain't the Black Death plague, it's a bad cold that has a zero effect on most that get it.
Basically we've reverted to centralized control of the economy so it's failing like communism.
>>1 person net is added to the population of Brazil every 21 seconds. That's the real emergency.
>I see no reason to consider this an emergency.
It's an ecological emergency, take a look at the Amazon.
>I'm sorry you feel this way. I wish you happiness and peace in these hard times.
Yeah you're real smug working for Google aren't ya. Tell that to all the business owners, unemployed workers, and starving masses.
If you feel the need to lash out at someone, I'm a better target than those facing more hardship. But yes, while I'm fortunate, I know many people who aren't in as stable a situation, most of them however recognize the necessity of that hardship.
It's an unfortunate situation yes, but the alternatives aren't better.
> After all this ain't the Black Death plague, it's a bad cold that has a zero effect on most that get it.
You're right, it's more like the Spanish flu, which killed 3% of the world's population at the time, or 180 million people today. That's not a sacrifice we should be willing to make.
> Basically we've reverted to centralized control of the economy so it's failing like communism.
No. This is comically incorrect. In some sense there is more centralized economic control sure, but well first of all that isn't communism, but second of all, that centralized control is succeeding at its goal, which is to reduce the death toll of the virus. You may not share the same value system, but that's Ok with most people, who don't value profit over lives. Granted this would be easier to bear for everyone if the US had a stronger social support system.
> It's an ecological emergency, take a look at the Amazon.
I don't see how deforestation in the amazon, which usually has to do with comsumerism in places like the US, has anything to do with the population of Brazil.
> I say protect the vulnerable and let the rest self-isolate if they feel the risk is warranted.
I read this as you saying you want some of the most vulnerable populations among us to sacrifice their safety and quality of life for the rest of us, while you yourself are unwilling to do the same for them. Is that correct?
People have to start speaking up against the overly politically-correct or we end up in situations like the current lock-down.
>It's an unfortunate situation yes, but the alternatives aren't better.
You can look at Sweden and see that is not true. Only .03% of population has died. That is 3% of 1%. [0]
It's not as if deadly flu's and other nasty diseases that people have to avoid naturally are not going around all the time anyway.
>You're right, it's more like the Spanish flu, which killed 3% of the world's population at the time, or 180 million people today. That's not a sacrifice we should be willing to make.
It's not killing 3% of the population. More like 3% of 1%.
~60M people die every year worldwide. Coronavirus barely moves the needle.
>I don't see how deforestation in the amazon, which usually has to do with consumerism in places like the US, has anything to do with the population of Brazil.
I live in the Amazon. Humans are like a plague of locusts, cutting down all trees and killing everything that moves. Deforestation is mainly from the poor doing slash and burn. And from people just trying to earn a living (the wrong way), more and more of them every day. (FWIW I'm here showing a better way. ie reforestation)
>So you want some of the most vulnerable populations among us to sacrifice their safety and quality of life for the rest of us? But you're unwilling to do the same for them? That feels rather selfish to me.
No I said protect the vulnerable and let the rest self-isolate if they feel the risk is warranted. As in, don't bring the virus into old folks homes.
You talk as if you think the common cold disappears after people hide in their houses for awhile.
And as if the world can go on shut down indefinitely.
Going on 8 wks of shut down here and it's a joke. Idiots copying the stupid.
[0]: https://www.worldometers.info/coronavirus/country/sweden/
The capitol of sweden is being hit as hard as NYC. And that's despite many social distancing measures in place. The idea that sweden isn't being impacted negatively is wishful thinking.
> It's not as if deadly flu's and other nasty diseases that people have to avoid naturally are not going around all the time anyway.
The resignation that shit's bad, so we should let it get worse is fatalistic and untenable.
> And as if the world can go on shut down indefinitely.
Indeed it can't, no one is proposing that.
No actually in both cases it's a miniscule percentage of the overall population. People should be looking at percentages, because absolute values just cause lockdown hysteria.
>The resignation that shit's bad, so we should let it get worse is fatalistic and untenable.
It's not resignation, it's indignation at the over-reaction to this practically common virus.
>> And as if the world can go on shut down indefinitely.
>Indeed it can't, no one is proposing that.
So the whole exercise is pointless because the virus is going to do it's rounds anyway.
Yes, .2% of NYC residents are dead from Covid. Another % or so will likely have lifelong consequences. And that's with social distancing. Without, we'd be looking at 1% and 5-10%. And many of that 5-10% are young.
Looking solely at deaths doesn't tell the whole story.
> So the whole exercise is pointless because the virus is going to do it's rounds anyway.
Sure sounds like resignation to me. But no, the measures being taken now allow us to understand more about the virus and ways to prevent it. We're seeing lockdowns end and lighten, replaced by more lighweight measures like mask requirements and contact tracing.
We could have had this happen weeks ago and have been done at a fraction of the cost, but the US response was delayed due to the same kind of head burying as is happening in Brazil now.
> Sure sounds like resignation to me.
No it's just reality. I've had a dengue a few times. Some die. People are working to fix it. We don't shut down everything for it.
You've resigned to the collateral damage caused from the economic shut down. I have not. Maybe if you had your own business you'd have a different opinion on the matter.
I'm not, I absolutely believe the economic shutdown could be handled much better. I believe that a certain party doesn't want to actually respond appropriately, because it would violate the narrative they push about government incompetence. I wish they valued lives more than they do, unfortunately they feel that sacrificing either those to economic plight or disease is worth the value of the idea that government is incompetent.
Either that or they are incompetent. Either way they should be removed.
> 0.2% dead and everyone loses their minds.
May I remind you of 9/11. Covid so far has been a 9/11 in NYC every week for 3 straight weeks. So yeah, declaring war seems par for the course.
Hardly. Those are the two countries that have resisted shutdown of their economies and are showing negligible percentage of deaths.
And the World Food Programme has stated that the coronovirus shutdown is putting ~265 million at risk of famine and "as our Executive Director told the UN Security Council on Tuesday, we could be looking at 300,000 people dying every day for three months" [0]
>Brazil is early into this and seeing a high rate of transmission (R0 2.8). We really don't know enough in this country's case what the end result will be in terms of mortality.
Yeah. Perhaps it will bump up from .005% of their population dying to .03%. Mostly the already sick and elderly.
[0]:https://www.dw.com/en/world-food-program-act-now-to-prevent-...
The irony here is that these sentences are correct, but the author comes to exactly the wrong conclusion from them. There is no battle between a pro-human and pro-economy camp, because if we just threw the doors open and let the virus rage out of control, everyone would end up staying home out of fear anyway and there'd be no difference, in terms of economic damange, from a state-mandated shutdowns now. Note that there is nothing preventing you from flying right now, but the planes are still empty. Or how the government is ordering meat processing plants to reopen but they are still running way below capacity because workers are just staying home so they don't get sick.
It is not a choice between economic damage and lives lost, it's a choice between an orderly lockdown now and a chaotic de facto lockdown later, except the latter has a lot more people dying - the economic damage is inevitable either way.
Do not take shutdown skeptics seriously, they don't deserve it.
FWIW I do live in a country which is in lockdown for ~2m now, and I do think it was the right thing to do. But it's not really feasible to stay in indefinite lockdown - not just because of economy, but because of impact on public health etc.