Suicides on the rise amid stay-at-home order, Bay Area medical professionals say | Hacker News Reader

Suicides on the rise amid stay-at-home order, Bay Area medical professionals say

abc7news.com

83 pointsabduhl94 comments

Funnily enough, yesterday an article appeared[1] claiming the number of suicides in the Netherlands has dropped up to 20 percent. Cause as of yet unknown. Also unclear whether this effect is temporary.

One hypothesis the article states is that in normal life people's sensory inputs are overwhelmed and cause anxiety. The sudden calmness the lockdown introduced might have a positive effect. This is, however, in contrast with the paired increased loneliness.

[1] https://nos.nl/artikel/2334626-tot-20-procent-minder-zelfdod...

Similar suicide rate decline happened in Japan, decline of work stress factors (e.g. commuting, office, boss) are suspected as the cause.

https://www.theguardian.com/world/2020/may/14/japan-suicides...

I wonder what the effects of mass working from home would do for Japanese culture.

The concept of salary person sleeping at their desk until it's time to leave is a foreign concept to me. I'd have a hard time believing it if I hadn't heard about it so much.

In the US the culture is imploding, and 20% are without livelihoods, which might explain the opposite effect.

>"We all share a concern for the health of our community whether that is COVID-19, mental health, intentional violence or other issues. We continue to actively work with our Behavioral Health Center, County Health and community organizations to increase awareness of mental health issues and provide resources to anyone in need. If you are in a crisis and need help immediately, please call 211 or 800-833-2900 or text 'HOPE' to 20121 now. We are all in this together, and ask the community to please reach out to anyone who you think might be in need during this challenging time. Thank you."

Translation: we will do nothing to help you after isolating you from your support networks. Call us when you want to kill yourself.

> Call us when you want to kill yourself.

(and what we'll do is have you arrested via ambulance, throw you in jail or a medical ward like a drunk, and not much else, unless you have insurance)

One thing to note is that this article quotes one doctor and one nurse at a single hospital. They have obviously seen more suicide attempts than usual, but we must remember this is a single data point and could just be a statistical anomaly.

It would be interesting to know if this phenomenon is repeated elsewhere in California or the US, but without knowing that, we can't draw too many conclusions from this article.

We can't draw too many conclusions from the article, but a rise in the rate of suicide would not be a surprise. We know that economic uncertainty, isolation, or lack of access to support all increase deaths by suicide.

Yep, it's interesting we're absorbing costs in known areas to unknown costs in unknown areas. I'd say focus on the known, and get more skeptical about the worst case scenarios we're comparing against. As always the "compared to what" question is sometimes not even an entity in reality for comparison but a hypothetical, maybe driven by fear.

Arguably, we know even less about by how much exactly "economic uncertainty, isolation, or lack of access to support" increases suicide rates than we know about how deadly the virus is.

I don't know about uncertainty per se or on isolation but I know at least with respect to economic downturns, recessions, and slumps and all the relation has been quantified to some extent by economists or social scientists from what I understand. Not sure how much the increase goes but it's considered a measurable thing apparently and has enough history to sketch out some kind of correlation from what I understand. Known territory in otherwords.

"Quantified to some extent," yes, but not as rigorously as the effects of SARS-Cov-2. Basic epidemiological models tell us that we at least 60% or so of the population to be immune in order to reach herd immunity. Based on an infection fatality rate of 0.5% and a US population of about 328M, you multiply that out to get an order of magnitude estimate of ~1M dead, whereas during the Great Depression (probably our closest comparison point to what's going on now), as well as the recessions of 1921 and 1938, life expectancy actually increased; the only cause of death that increased was suicide [0].

There are things we don't know about this virus, such as what exactly the residual effects are on survivors, whether and for how long infection can provide immunity, what the role of vitamin D is, and many other things, but those uncertainties largely don't matter to epidemiological models at this point. We can simply run best and worst case type scenarios to get an idea what we're dealing with if we're thinking solely about the death rate. And, even if we underestimate the death rate, if there are severe and long-lasting aftereffects, that only compounds the need to do something to stop the virus.

IMO, the "knowns" surrounding economic correlations with decreased life expectancy are far, far more unknown than those surrounding a very contagious virus that kills people.

And, as I have said before, to much controversy, if a science-based, public health response to a public health crisis cripples the economy, that's a sign that our economic system is broken, not that we're overreacting to save lives, just to doom people to economic misery.

---

[0]: https://www.pnas.org/content/106/41/17290

I guess that's the thing with me and epidemiological models. I think for the bulk of Americans, maybe even people around the world, these models haven't really entered into everyday life with the ramifications of their accuracy. It's more convincing to know that economics have looked retroactively at past events and ran correlations to partly explain lived experiences. Past performance is no guarantee of future performance as the saying goes, and I"m not sure who actively tracks the next economic declines to continue to test whatever correlation models people have come up with to predict negative side effects on people's lives, but presumably they've landed roughly well enough patterns to predict something reliably, maybe not though.

But the more urgent predictions at this point come from epidemiologists. And I wonder have epidemiologists had a good track record at predicting previous outbreaks accurately, say SARS, ebola, whatever, 20th and 21st century stuff? As of today we're two orders of magnitude off from those worst case scenario of millions of deaths in the US I thought were surely coming. I guess another question is how long were these millions of deaths expected to arrive, in 12 months, 18 months?

That's a good point, how fragile or robust should an economy be expected to be to wait things out. The fact that lots of companies operate off debt probably doesn't bode well for them weathering any significant storm. Can't build a house on sand and expect it to stand as the saying goes.

> As of today we're two orders of magnitude off from those worst case scenario of millions of deaths in the US I thought were surely coming

Epidemiologists gave a range of outcomes, taking into account what they know at the time, and what measures are or could be in place.

The millions of death outcome is if no lockdown measures are put in place and people don't social distance.

For an opposite example in Japan the stay-at-home order actually reduced the number of suicides[0]. Maybe mental health treatments being so expensive in the US plays a large role in this and the quarantine is just the trigger.

[0] https://www.theguardian.com/world/2020/may/14/japan-suicides...

That, or access to said services - which usually depends on the job you have, and many Americans suddenly found themselves without one.

A blogger/psychiatrist shares some examples of how this plays out in general:

https://slatestarcodex.com/2020/04/24/employer-provided-heal...

Relevant in particular are all those examples following the pattern of "$something happened, had to switch insurance, now I can no longer see the doctor that helped me over the years, and the new one starts from scratch/does something that essentially cancels the effects of years of therapy". Now throw in the pandemic, and I can easily imagine this starting to be reflected in suicide rates.

"When I don't drink water, I feel thirst" is a not a medical problem for your doctor to fix, it is a description of how humans work.

"When I don't have social interaction, I feel despair" is the same.

The healthcare system can at best poke the parameters of these systems around the margins. It's not going to eliminate human needs.

I would like to see some numbers on that, in general people that are mentally strong are less likely to succumb to suicide when isolation hits, and would explain why other countries such as Netherlands and Japan are seeing a _decline_ of suicide rates, decades of being unable to afford mental health are probably a factor in that; I admid there is a good chance it's not as big of a factor like I imagine, and accumulated stress factors seen only in America are to blame.

It's not the same. Unlike with water and thirst, "when I don't have social interaction, I feel despair" is not true for many people, and for those for whom it is, it really depends on what they consider "social interaction" and how much they really "don't have" it.

You could do a rough ordering of quality of social interactions, lowest to highest: no interaction, text messages, IMs, phone calls, video calls, face to face meetings. Most people these days have access to at least phone calls, and my guess is that more than 50% can do video calls with most of their social circle. It's not perfect. Drinking rain water instead of a hot tea isn't ideal either - though it will sustain your life.

Point being, it was expected that limiting people's meatspace interactions will cause psychological pressure to build up, but the extent and seriousness of it is far from obvious.

True...

But I'd argue that at least 25-50% of the US population is in a 'marginal' mental health situation to begin with.

Humans do tend to try to 'patch' these holes in various ways; A big theme in Pink Floyd's 'The Wall' was filling the empty voids in your life with material/social wealth can come crashing down fast when you finally run out of gas, or those things that you're using to prop you up.

IOW, these people probably weren't in great shape before, but now that they don't have their crutches they finally crumble.

> "I mean we've seen a year's worth of suicide attempts in the last four weeks.”

Damn.

Isolation paradox: Isolating will help you be less susceptible to illness. Isolation is known to cause higher levels of loneliness, depression, fear, anxiety and weaker immune system increasing susceptibility to illness.

It's not really a paradox because it's understood. Isolation signals to your body that you are being excluded from your tribe or low on the social ladder, which means your world is now more threatening than it used to be, so you need to use more energy to be hyper-vigilant and responsive to stressors.

Social status alters immune regulation and response to infection in macaques

https://science.sciencemag.org/content/354/6315/1041.full

Really cool, thanks for the link!

As the article doesn't provide any of the actual numbers of these events, Walnut Creek has 35 confirmed coronavirus cases. The county has 1155 cases and 33 deaths.

Suicides is a rare cause of death, usually around .01%. Unless the actual totals are also mentioned, I'm always skeptical of articles attributing some huge change in the rates to some phenomenon. If my really terrible math is correct, this could he around 10 more suicides over this period, which an overworked medical staff may have played a factor in.

Suicide is not such a rare cause of death. In the U.S., suicide is the second most common form of death among young people, after accidents:

> According to the Centers for Disease Control and Prevention (CDC) WISQARS Leading Causes of Death Reports, in 2017:

> Suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 47,000 people.

> Suicide was the second leading cause of death among individuals between the ages of 10 and 34, and the fourth leading cause of death among individuals between the ages of 35 and 54.

> There were more than twice as many suicides (47,173) in the United States as there were homicides (19,510).

Source: https://www.nimh.nih.gov/health/statistics/suicide.shtml (see Table 1 for the statistics)

>Suicide is not such a rare cause of death. In the U.S., suicide is the second most common form of death among young people, after accidents

Death itself is rare for young people.

Nothing you've said changes that suicide accounts for about .01% of deaths. It gets discussed far more than other causes as it's preventable, but it's still rare enough that statistics can be misleading.

Note, I realized I did my math based off the deaths per 100000 number, meaning it's .01% of people commit suicide each year not .01% of deaths. It's still low enough to make statistics misleading, but I called it the wrong thing.

> Suicide is not such a rare cause of death.

Yes it is. There are about 3 million deaths in the US every year. Suicides account for 1 to 2% of all deaths. Meaning suicides are a very rare cause of death.

> Suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 47,000 people.

Tenth? And I'm guessing there is a significant drop after the first few causes of deaths. Right?

> There were more than twice as many suicides (47,173) in the United States as there were homicides (19,510).

This doesn't imply that suicides is a prevalent cause of death. It implies that homicides are even a rarer cause of death.

At what point are more people killing themselves than are getting saved by quarantine orders? No one is seriously making this calculation.

> At what point are more people killing themselves than are getting saved by quarantine orders? No one is seriously making this calculation.

>> Doctors at John Muir Medical Center in Walnut Creek say they have seen more deaths by suicide during this quarantine period than deaths from the COVID-19 virus.

Looks like some people are, and it made the news.

No one in the CDC or state health departments seem to be taking this into account. They're only optimizing for one variable: number of infected and number of covid19 deaths.

You say that as if we've known this since January or something... and as if you have inside knowledge of what those people are investigating right now. Do you? The news on this has just come out. Maybe give them a chance to react before judging?

>You say that as if we've known this since January or something

Yes, who could have possibly known about covid19 in January? [0]

>and as if you have inside knowledge of what those people are investigating right now. Do you? The news on this has just come out. Maybe give them a chance to react before judging?

It doesn't take a genius to figure out that forcing people to stay at home, to socially distance themselves from their social support network, and to quit earning a living would have a significant impact on their mental health and a dangerous impact on the mental health of those with mood disorders. Every doctor has been educated on mental illnesses. The CDC had chances to make the right choices in January. It had chances to make the right choices in February. It had chances to make the right choices in March. How long until you think we can judge the CDC?

[0] (https://www.reuters.com/article/us-health-coronavirus-testin...)

Come on dude. "Known this" in my sentence was not referring to "the existence of COVID-19" but rather "the fact that we would start seeing more suicides than disease deaths today". The right choice was shutting things down. The only question was how long it needs to keep going, which people were still trying to figure out. Now this event might give them more information that might help them figure it out. If you're reasonable you'll give them a chance to see if they'll take it into account. You know full well much of the rest of the executive didn't show remotely as much competence as the CDC about the disease itself for months despite being repeatedly warned even after the outbreak had already occurred, and now you're lashing out at the CDC for not having predicted when the first side effects would start to occur in some cities within 1 day of when you heard the news? Sheesh.

>The right choice was shutting things down . . . You know full well much of the rest of the executive didn't show remotely as much competence as the CDC about the disease itself for months despite being repeatedly warned even after the outbreak had already occurred

This is some "we have always been at war with Eastasia" doublethink. The CDC told people for a long, long time that masks were harmful and using them was stupid. The CDC shut down private and university covid19 testing in Washington.

> and now you're lashing out at the CDC for not having predicted when the first side effects would start to occur in some cities within 1 day of when you heard the news?

Ask your doctor if job loss and isolation from friends and family is a risk factor for suicide. I talked to a doctor back in early March who predicted that more people would die from suicides than from covid19.

We don't know that was the right choice at all. This is a new, untested pandemic response that hasn't been used before, essentially a planet-scale experiment with everyone's futures: https://www.nytimes.com/2020/04/22/us/politics/social-distan... It had some definite opposition from experts when it was developed, and seems to have won out for political reasons.

To clarify: I meant "the right choice" given the information, ideas, and means they had available at the time. Not "the right choice if everything was possible and known".

The CDC wasn't circulating the same facts that South Korea and Singapore were dealing with. Do you remember what Asia was doing in February? The CDC basically created this disaster. We could have shut down air traffic, told the public to use masks in February, and allowed universities and private labs to conduct testing. Instead the CDC lied.

Yes. We do know. We know very well it was the right decision; it is just difficult because China has decided to play coy and gaslight the rest of the world with their death figures, resulting in death rates having to be measured by indirect means such as number of funerary urns delivered, and terminated cell phone plans.

You do not screw around with highly communicable, severe upper respiratory diseases. Especially not while people's lungs are already being assaulted by high pollution levels.

Furthermore, Public health agencies are taking some things into account while dismissing others. CDC's guidelines for school reopening for instance demonstrate the highest level of both ignorance and wishful thinking I've ever seen in terms of keeping public education systems running. Parents don't check their kids health before sending them in on a regular basis, buses cannot get the job done running 1 kid to a seat, and there is no way you're keeping masks on kids, and a minimum distance of 6 feet separation between kids in place all day, every day in schools.

The suicides exceeding virus deaths indicates the measures are working. Once we start seeing meaningful localization of the virus to the point contact tracing can take over and allow the rest of us to let down our guard, then we can talk. Suicides aren't "contagious" in the way the virus is, and if you perform due diligence on your own, there is no reason you can't maintain levels of exposure to your social network. You just have a few more questions to ask people before coming over, and to be ready to play the contact tracing game if somebody you know gets sick.

Nobody said shutting down will not have its own casualties. There was never a bloodless option on the table.

It's like a choice whether to evacuate a city that's threatened by an active volcano. The volcano may or may not erupt. It either kills everyone, or nothing happens. But announcing the evacuation is sentencing some people to death: think of all the people in emergency rooms, on life support, etc., many of whom will not survive being moved. And then you'll have "death by economics" among the evacuated, as they fail to adjust to their new reality in emergency housing, with no jobs, living among strangers not too happy about the sudden population increase in their area.

It's a tough choice, but it's a game of numbers. To a first approximation, even if lockdown is going to kill 0.01% of people one way or another, if it prevents 0.1% of people from dying, it's worth it and it's the right choice. In reality, there's uncertainty around these estimates that need to be taken into account, but the idea is the same.

(Tangent: I hate point estimates with a passion; I wish there was an easy and standardized way to express distributions in plain text.)

No, 3+ weeks ago it was obvious that we did “flatten the curve,” healthcare systems would not collapse, NYC would not need 30,000 ventilators, and that is when the stay at home orders should have been lifted. We’re not going to burrow underground until we have a vaccine, so the time is long overdue to start restoring our mental health and economic well being. Those at high risk can isolate further, but the general population has delivered what was asked of it.

> No, 3+ weeks ago it was obvious that we did “flatten the curve,” healthcare systems would not collapse, NYC would not need 30,000 ventilators, and that is when the stay at home orders should have been lifted.

That doesn't make any sense. You're basically advocating for stopping treatment as soon as progress is seen, not when the treatment is successful. It'd be like an oncologist saying:

> Good news! Your tumor is starting to respond to the chemo, and we've seen a reduction in its rate of growth, so we're going discontinue treatment.

The stay at home orders shouldn't be lifted when the curve is flattened, but when the capability is known to exist to keep it flat without the orders.

No, the CDC will be working hard to understand the rise in rates of death by suicide.

Counting death is hard, and counting suicide death in the US is particularly hard because of the regional variations in use of medical examiners and coroners and the cultural drive in some areas to say that a death by suicide was accidental.

Here's a link to a CDC page: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

> Finally, the estimates of excess deaths reported here may not be due to COVID-19, either directly or indirectly. Upward trends in other causes of death (e.g., suicide, drug overdose, heart disease) may contribute to excess deaths in some jurisdictions. Future analyses of cause-specific excess mortality may provide additional information about these patterns.

It's going to be impossible to track, but surely the financial ruin the governments have compelled people to endure is going to kill many, many thousands of people.

It's also not politically advantageous to even consider it, let alone talk about it. In a year, when nobody cares anymore, and people are killing themselves, it will never come back to haunt the policy makers that provoked it all.

If only many, many thousands of people die due to economic issues, that's still a huge win over what the virus would have done if left to run through the country at full speed.

Economic problems would've happened anyway. Global supply chains were already in disarray even before March, as China essentially lost two months of manufacturing output, container ships stopped sailing, and the whole chain was pushed into oscillations it'll take a year or more to recover from (affectionately known as the "bullwhip effect"). Airlines and hotels were done the moment the virus landed in Italy - at this point everyone with half a brain started to cancel any trip they could cancel, weeks before governments in Europe got a clue and started locking down their borders.

The only way the government could've saved restaurants, nail salons, et al. from suffering similar fate would be by suppressing all information about the virus and going to full denial mode. Otherwise, the customer base would've mostly evaporated anyway, lockdown or no lockdown, and you'd still have rolling shutdowns as place after place had to be quarantined for 2+ weeks after some employee or customer was found sick. With hotels and restaurants barely surviving on fumes, the pressure on the food supply chain would've been only little worse than it is with these places shut down.

Anyway, it's not like the governments around the world started to shut down their countries because they were bored, and wanted to stir things up. They actually dragged their feet for weeks after people following the evolution of the virus started stocking up, limiting interactions, pushing for WFH and practicing social distancing.

I immediately know two things about you:

1. You don’t live alone.

2. You have a job.

I think we’re all a little short on empathy these days.

Huh.

Point taken. Thank you for reminding me. You're correct in both guesses, and I do sometimes forget that I'm not suffering through the worst of it.

And:

3. You and your loved ones are not dealing with mental illnesses that were under control before the lockdown, but losing control during and after it.

This thing is really hard on some people.

(The above is not intended to castigate you or drag you through the mud. Just a reminder that everyone's a little different.)

That's a good point too, but honestly, the continued lockdown is getting to us too. Probably not enough to qualify for treatment, but enough to be mindful of our own mental states. But I know many others have it much worse.

I struggle to understand how those points are related to the substance of the post you're replying to. The situation OP describes is between bad & worse -- you can have empathy for people while recognizing the reality of the situation.

Are you arguing that OP's analysis of the situation is wrong because of a lack of empathy for people affected more severely by pandemic?

Awfully quick to judge eh? I agree with everything the parent comment said, and I:

1. Live alone

2. Have not worked for nearly a year now. Technically I’m on leave due to extreme burnout, so I’m even more hosed (can’t collect unemployment).

3. (see below) Have been dealing with a wicked combo of depression/anxiety/ADD/OCD for 20+ years now, but the last 3 or so have been worse. I’ve been extremely isolated for the last year—I’ve spent countless days in bed, not eating my first meal until 11pm. I was just starting to improve in February, trying to get back on my feet and out into the world. My lifelines were the climbing gym (social+exercise time) and libraries/coffee shops. Luckily I (finally) got into a therapist in January, which is still available and co-pay free.

Despite all this, I think the lockdowns were a necessary emergency response to the crisis, with one major caveat—we did (and are doing) too little, too late, and too incompetently. It was glaringly obvious back in February that we needed to start taking measured action to mitigate the spread of the virus (as other countries—Taiwan, NZ, SK, etc did). Our response was an abject failure of reason and leadership, and I hope no one ever forgets that.

So although I’m pretty thoroughly fucked, I’m adapting and surviving. In many ways, it’s comforting and galvanizing to have a common cause to rally around. My attitude is that this crisis could be a catalyst for profound personal and societal growth.

And therein lies the source of some genuine hatred that is beginning to bubble up towards people that aggressively flaunt even the most basic courtesies and precautions, like wearing any form of nose/mouth covering whatsoever when inside a building. Just yesterday I saw a couple (in their 60s) stiff arm the door greeter at WF who was handing out free mask. It was nonstop people brusquely walking headlong into me. This says nothing about the unhelpful binary thinking around open vs. closed, economy vs. health, normal life vs. totalitarianism. Society’s tool of choice for preventing and solving unfolding catastrophes seems to be to pretend they don’t exist and give up, to reflexively fracture ourselves rather than come together to solve a challenge. And I find that to be the most profoundly depressing thing of all.

"The only way the government could've saved restaurants, nail salons, et al. from suffering similar fate would be by suppressing all information about the virus and going to full denial mode. Otherwise, the customer base would've mostly evaporated"

To me it seems this claim contradicts what actually happens in places that didn't impose lockdown or lifted lockdown earlier.

To give one example, here's a video from Sweden's bars and restaurants: https://www.bbc.com/news/av/newsbeat-52618788/coronavirus-ho...

A pedestrian street in Stockholm on Apr. 1: https://www.telegraph.co.uk/content/dam/news/2020/04/01/TELE...

A market in Malmo during the pandemic Apr. 24: https://media.voltron.voanews.com/Drupal/01live-166/styles/s...

5000 gather to see a concert in Tel Aviv: https://static.timesofisrael.com/www/uploads/2020/05/coronak... (https://www.timesofisrael.com/thousands-pack-tel-aviv-concer...)

...those 5000 were today, _after_ they reached the milestone of only 18 new daily cases thanks to lock-down along other measures. The average health of swedish people is miles ahead of americans, less overweight, less diabetes, less opiod addiction, less hard drugs (cocaine, meth, etc), more average life expectancy, so yeah I'm not sure you are comparing apples-to-apples here. Also the population density in NY is 26400 vs 4800 in sweden, so you could say NY is a "special case" but when you start analyzing each situation a lot of more "special cases" not seen in sweden start to appear in the US.

"I'm not sure you are comparing apples-to-apples here."

You are right. I don't think anyone knows exactly what makes certain places suffer more than others from the virus.

I wasn't trying to compare, though. My point is people still go to restaurants, nail salons, et al. during the pandemic. So the claim about evaporating custom base doesn't seem to be grounded in reality.

Remember that video with Italian majors loosing their cool? One of them was mad at people breaking the lockdown rules to get a haircut. https://youtu.be/Uo2clI631uA?t=37

>I don't think anyone knows exactly what makes certain places suffer more than others from the virus.

Perhaps different strains of the virus explain this?

Found an article that mentioned a dominant strain infecting Europe and parts of Asia [1]. Maybe other areas have a strain that is not as dangerous?

[1] https://www.medicalnewstoday.com/articles/is-there-more-than...

The end of this year will be very bleak. By then, the stimulus checks (to businesses and individuals) will have run out, mortgage / loan deferrals will have come due, jobs will be lost and there's continued talk of a second wave of the coronavirus around then.

"Provoked" is not the right word. Policy makers reacted as slowly as possible, and in quite obtuse ways. The main benefit of the shutdowns was to allow for a few weeks where we could catch our breath from being caught woefully unprepared - proper equipment for healthcare workers, enough N95 masks and hand sanitizer for everybody, new procedures at businesses, etc. Instead politicians continued to do very little or even worked against positive action (just like the month before the shutdowns), and so the news cycle ran its course. Now people are bored of the stalemate, and have devolved into political camps arguing for/against stupid plan A xor stupid plan B. What we really needed and still need is competent leadership with competent public health and competent economic response, especially at the federal level.

It is the same conflation as "the lockdown hurts the economy"/"an out of control pandemic hurts the economy"

Maybe being told to stay indoors spikes hopelessness, or it could be that living in a country with an out of control pandemic with no end in sight spikes hopelessness.

There's a lot of factors that make the world a stressful, bleak looking place besides stay at home orders.

We have other pandemics that we could probably test this hypothesis with, but I suspect that it would be more accurate to say that how we see this particular pandemic is what causes both the massive economic damage and the feelings of hopelessness, suicides, etc. Businesses are losing customers not because the government imposed a lockdown, but because people think they can stop the pandemic and avoid death by staying away. Though there's probably not going to be much enthusiasm from the media towards exploring this idea, since it puts the economic damage etc squarely on their heads.

> Businesses are losing customers not because the government imposed a lockdown, but because people think they can stop the pandemic and avoid death by staying away. Though there's probably not going to be much enthusiasm from the media towards exploring this idea, since it puts the economic damage etc squarely on their heads.

Perhaps let's first explore the question whether they were right. Epidemiology 101 seems to say they absolutely were. The less people interact in close quarters, the less a sickness spread.

I have a feeling we're forgetting here that there's an actual virus on the loose. The pandemic isn't a media construct, it's not a mass hysteria. So I think we should also entertain the option that a virus spreading fast through our communities is also responsible for some of the economic damage.

Maybe we overreacted just a little bit. Some of these people might’ve just needed a friend.

I'd like to remind people that the pandemic does not significantly increase the risk of death for healthy people under 50. It makes little sense to force young people to stay at home and get fired when the healthy are at little risk of dying and such a lockdown will not completely eliminate a pandemic.

I thought that by now we wouldn't have to go over this every time.

- This coronavirus spreads asymptomatically, which means people under 50 mingling with each other are deadly threats to people over 50. In particular, to their parents, grandparents, aunts, and neighbors.

- The chance of dying is low for young people, the chance of suffering serious damage to lungs and other internal organs that takes months to recover is a bit higher (some of it may be permanent, but that's yet to be determined).

- The chance of dying for everyone goes up several times if the medical system gets DDoSed by COVID patients.

EDIT:

> It makes little sense to force young people to stay at home and get fired

One of the most important effects of the lockdown being done top-down by governments is that employers can no longer fire people who wanted to protect themselves, their families and their communities from getting sick. Leaving this choice entirely to individuals is in practice equivalent to forcing them to choose between staying safe and having a job.

> people under 50 mingling with each other are deadly threats to people over 50

This is why those at risk of death should self-isolate.

>the chance of suffering serious damage to lungs and other internal organs that takes months to recover is a bit higher

Do you know where I can find the statistics for the risk of permanent lung scarring by age, or something approximating this? This is something I hadn't considered but would like to explore more.

>The chance of dying for everyone goes up several times if the medical system gets DDoSed by COVID patients

It's almost entirely getting DDoSed by old people.

>employers can no longer fire people who wanted to protect themselves

Employers are firing everyone. We're hitting some of the highest unemployment levels in American history. This is a moot point.

This is incorrect. The infection fatality rate for COVID-19 is about 0.2% (1 in 500, or 200 per 100,000) for ages 20-40. [1] The baseline death rate for ages 25-29 is about 100 per 100,000. [2] Getting COVID-19 puts you at roughly triple the chance of death from all other causes combined. It's about 5x the risk of unintentional injury, 12x the risk of suicide, 16x the rate of homicide, 20x the risk of cancer, and 200x the risk from HIV or diabetes.

[1] https://ourworldindata.org/mortality-risk-covid#case-fatalit...

[2] https://www.cdc.gov/nchs/data/dvs/LCWK1_2015.pdf p. 4

Your comment says "The infection fatality rate for COVID-19 is about 0.2%" but you reference "Case fatality rate of COVID-19 by age" as the source.

The infection fatality rate and the case fatality rate are two very, very different concepts.

"The IFR differs from the CFR in that it aims to estimate the fatality rate in all those with infection: the detected disease (cases) and those with an undetected disease (asymptomatic and not tested group)... The IFR will always be lower than the CFR..." [1]

Spanish government's estimates of COVID-19's IFR are[2]:

For the age group under 50, the estimated IFR is about 0.003%

For the age group 50 - 69 yo, it's 0.04%

And for those over 70, it's 4.1%

[1] https://en.wikipedia.org/wiki/Case_fatality_rate#Terminology

[2] https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/a... Look for the table on page 15

As if there are no households with members above and below 50?

Keeping all the elderly together in shared living spaces didn't work to their advantage by the way.

maybe let's focus less on the lockdown as the cause of this, and more on the awful social security and mental health services. lockdown/quarantine doesn't suddenly turn normal people suicidal, it just escalates already existing economic hardships or mental problems.

also, should be obvious, but we cannot know how many more people would've died if there was no lockdown, so comparing numbers as they are today is really dumb.

Japan, like the Netherlands, was not "locked down"

Do you happen to live there? I do.

Lots of shops closed, WFH for large parts of the population. Schools of all sorts closed, sports club closed, severe limits to groups of people. No hairdressing, no driving-school, I could go on.

edit: I am talking about NL

Are you being arrested and criminally charged in Japan for being outside?

Japan is not locked down. California is locked down.

Why was this downvoted? It is true that there is difference between "it is illegal to go outside" and "a lot changed, but you still can go for walk or sport".

It is not illegal to go outside in California either. Walking, running, bicycling, etc. are encouraged.

None of those things are "encouraged." There are non-stop radio spots telling people to stay home. You've got cheeky stuff like Randy Newman singing lyrics like "get away from me" to the frankly dystopian line from George Takei saying, "Stay in splendid isolation."

The are otherwise normal people that are still terrified. Anecdotally, I know people who have had the thing and still won't participate in society because they are convinced that they could die. We've really done a good job of disturbing people, and we're going to see weird fallout from it.

"get away from me" and "Stay in splendid isolation" don't exclude sport or going outside.

A lot of those terrified people did indeed die; exactly 1 every 4000 people (in the US), plus a lot more will die in the following months, not to mention the ones that "recover" but thanks to permanent damage to their lungs and other organs will die in the next few years due complications from it, so please let's not talk like those fears are unfounded.

1 in 4000 is not a lot, as deadly pandemics go.

I'm not aware of numbers on permanent lung damage. Too much of the news seems to be fear-mongering anecdotes when we could really use all the objective facts we can get.

Permanent damage will only be calculated months or years from now, because x-rays and every other machine to investigate that has a slightly more important job right now, so any decision will probably have to be taken before we get the "objective facts" you want.

You can call it fear mongering or whatever you want but the statistics show 1.3% death rate of infected in the us[0], meaning approx. 1 every 100 people with the virus is dying, and the white house estimates a max of 240.000 deaths before this ends[1], you could still say 1 every 2000 is not a lot, and then you may realize how important any number of deaths is its completely subjective based on your own perceived value of human lives, maybe even 3999 deaths every 4000 is not much for some people because logically speaking the surviving people can repopulate the planet, and maybe in such case we should be really worried about not injecting any fear mongering into that 1 person that will survive.

[0] https://www.google.com/amp/s/medicalxpress.com/news/2020-05-...

[1] https://www.washingtonpost.com/world/2020/03/31/coronavirus-...

The news is full of scary anecdotes, because that gets clicks. People are rightfully starved for information, the data is fuzzy, incomplete, and complicated, the situation is unusual, has evolved, became politicized unfortunately, etc.

I'd like to think you and I could agree in general to a broad set of known facts, and certain ranges of predictions, a set of possible outcomes, etc. But I think we'd still disagree on how to proceed! That's the part I'm curious to talk about. I don't mean to be argumentative with any of this or quibble over details, just trying to share my line of thinking, and curious about yours.

I can agree with the predicted 240k deaths in the U.S. you quoted, I guess that would be about 1 in 1375 people in a country of 330 million. I end up comparing those odds to the 863 of every 100k people how in any given year [1], which is 1 in 115, or almost 12 in 1375. These numbers vary by age, but the averages serve as decent enough discussion points when we talk about a large population in aggregate, which is how I look at this.

I'd feel differently if it were easier/possible to save those 1 in 1375 people who will die from covid, but it's not. The lockdowns were successful keeping hospitals from being overwhelmed (something I supported), but there is zero indication that we can stop this with lockdowns, quarantines, or contact tracing at this point. There are too many infected people. The odds are that there will not be a vaccine for many years, either.

Experts say that the most likely outcomes are that this virus decreases in severity to become another variant of the common cold, or comes up occasionally making for something like a bad flu year [3]

I feel bad for the tens of millions of folks in the U.S. negatively impacted by the lockdowns, especially without evidence supporting that lockdowns will make a long term difference if hospitals are not overwhelmed. I'm afraid the economic price to pay is going to be terrible for so many people, so many lives turned upside down, that the economy is going to get a lot worse before it gets better. Look what happened after the 2008 recession, the protests, the ascendency of right wing national politicians, civil wars in the middle east, etc. This looks like it could be worse. I feel horrible about the added debt being passed to the younger generation for this stuff, why should they pay with a lower standard of living because collectively we can't save for a rainy day?

At this point it seems best to me to support hospitals and what we know works, including helping the vulnerable self-isolate. I don't think it's justified to force unwilling people into lockdowns unless hospitals are becoming overwhelmed.

[1] http://www.cdc.gov/nchs/fastats/deaths.htm [2] http://www.cdc.gov/nchs/data/dvs/MortFinal2007_Worktable23r.... [3] https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor...

So many falsehoods and dubious claims in your comments for someone claiming to be basing his opinion on facts: China already injected 100 people with a vaccine under a trial[0], Oxford will soon inject 10000, both said it will take months to know if the vaccine truly worked as intended but is nothing like your claim of "years".

> "[is not] possible to save those 1 in 1375 people who will die from covid"

You know which day of the week surgeries are most successful? Monday, can you guess why that is? Is because surgeons are most relaxed after a weekend and are fully rested and ready to fully focus on the procedure at hand, that should give you a small glimpse to the giant difference between treating 100 people one week and treating 1 person per week in the course of 100 weeks; in simpler words: The less people are in the hospital the more likely the ones there will receive plentiful care and monitoring, understanding that isn't rocket science.

[0] https://www.livescience.com/coronavirus-vaccine-adenovirus-c...

[1] https://www.euronews.com/2020/05/22/coronavirus-more-than-10...

What specified falsehoods and dubious claims did you find in my comment?

They oxford trails may fail because they can't find enough infected people, our of 10k volunteers they are worried they might not have 50 infected people, less than 20 and the trial is a failure [1]. The numbers show that this is disappearing, at least this wave.

>The less people are in the hospital the more likely the ones there will receive plentiful care and monitoring, understanding that isn't rocket science.

Are you justifying leaving 40 million Americans unemployed, their lives up in the air, based on the supposed marginal differences between Monday and non-Monday surgeries? Don't you worry about the damage the lockdowns are causing? Do we burden younger generations with more debt and a lower future standard of living when the hospitals are not overcrowded?

I stated my line of thinking, why I went from being scared of the virus in March to being more scared of the damage from the lockdowns by the end of April.

What is your line of thinking? Do you worry about the damage the lockdowns are causing? Do you think the lockdowns are working to eliminate the virus? When do you think is a good time to stop the lockdowns? Do you think it's fair to lockdown people who don't feel the way you do?

I'm genuinely curious about why you think the way you do.

[1] https://www.bloomberg.com/news/articles/2020-05-24/oxford-un...

Thank you.

In case anyone's looking for a specific link:

"It’s okay to go outside to go for a walk, to exercise, and participate in healthy activities as long as you maintain a safe physical distance of six feet and gather only with members of your household. Below is a list of some outdoor recreational activities: Athletics, Badminton (singles), ..."

https://covid19.ca.gov/stay-home-except-for-essential-needs/...

We detached this subthread from https://news.ycombinator.com/item?id=23269796.

Note that the Netherlands was not "locked down." Only certain places of business have been suspended, like brothels. People go about their lives as normal.

I don't know if you live in the Netherlands, but stating "only certain businesses like brothels have been suspended" is a massive understatement of the impact of the "intelligent lockdown" as it is called.

Bars, gyms, schools have been closed for two months now. Only a few restaurants offer take-out and more offer delivery. Dining in is not possible. Work-from-home is default for everyone I know. Nursing homes have only just been allowing visitors again.

It is true that the Netherlands was not locked down, but people definitely are not going normal about their lives.

> It is true that the Netherlands was not locked down, but people definitely are not going normal about their lives.

True, it's even better than normal.

Let's not pretend that the extent of California's reaction to the coronavirus is even comparable to that of Netherlands, Japan, etc..

> True, it's even better than normal.

That's definitely not true.

> Let's not pretend that the extent of California's reaction to the coronavirus is even comparable to that of Netherlands, Japan

You are right, it's not. But that wasn't the point. But pretending that California is the only one suffering and taking measures while the Netherlands or Japan are not is also out of touch with reality.

To the extent that it's relevant to the article in the OP, it could sure be better than normal for a lot of people. Working from home where previously it was not available, minimum wage being paid for people forced to stay home. It's basically a forced vacation. I'm sure some business owners are unhappy, but frankly I find reduced suicide rate predictable.

Can you give an example of something that’s hugely different? Reading https://www.theguardian.com/world/2020/mar/16/california-cor... and https://news.ycombinator.com/item?id=23269838, I don’t see huge ones.

I would think the main difference in effect on suicide rates (if any) is in the system of government benefits. It’s less stressful to lose your job in the Netherlands than in the USA.

I think it also is telling that the governor of one of the richest parts of one of the richest countries in the world deemed it necessary to say “garbage collection will continue.”

We detached this subthread from https://news.ycombinator.com/item?id=23269780.

This doesn't fit with what would be expected.

So we need numbers.

The suicides are not expected during lockdown/isolation. It should reduce suicides.

They are expected to be economic when people start realising they have lost their jobs and their business have failed and their lives ruined with no way out.

This would be more expected at reopen and everyone else is rebuilding, life is very comparative.

And why the hell are they asking doctors and not coroners?

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