Then why are we doing any lockdowns at all? If most of the young are near-safe, we should have just isolated the 60+ and kept society running as usual for the rest.
Clearly a lot of people are not willing to take the risk of contracting the virus.
Clearly a lot of people are not willing to take the risk of contracting the virus.
This seems a very difficult point for most people.
Early on, we had an exponential rise in cases and it appeared we would overwhelm hospitals. Therefore quarantine orders were issued (rather delayed imo) to offset the growth and allow hospitals to not have more cases than beds/equipment.
We had a lot less data initially and had to be proactive. The initial call was correct, and slowly easing it with monitoring is correct now.
it is totally disingenous to suggest that anyone actually proposing the "lockdown" claimed that it was about eradicating it or waiting for it to pass (both of which are widely understood to be absurd goals at this time).
And no the lockdown isn't about "lot of people are not willing to take the risk of contracting the virus", it is about keeping the pace of the tiny fraction of infections that go bad to under the capacity of the NHS / ICUs. At least that was the stated goal. It seems now that we have switched to a goal of zero infection (and not sure that it makes sense, given that I hear the WHO now refering to this virus as an "endemic disease").
This is just completely wrong. It's a useful exercise to work out how many people would need to die before herd immunity could be achieved. Use mortality numbers based on what we've learned about the virus and estimates of what percentage of the population would need to be infected to achieve herd immunity based on the behavior of any number of other viruses.
And that's assuming infection confers immunity with this virus, which we don't know yet.
As for the death rate, the rate to the non vulnerable population is immaterial. With appropriate isolation we could absolutely achieve herd immunity with minimal losses. Instead we have sent covid infected patients back in nursing homes in both the US and the UK with catastrophic results.
The numbers don't look very immaterial to me. [1] Granted there's a weird amount of variance between regions and there's a lot that isn't certain.
> If you are still questioning whether infection confers immunity, then what other strategy than herd immunity do you suggest? If we don’t develop immunity naturally, there won’t be a vaccine either. Permanent lockdown?
(Let's hope some reasonable amount of immunity is conferred! It seems likely, but I think it's useful to consider the worst case.)
I'd be happy with people doing what they ought to be doing anyway: exercising some caution and doing the obvious things to limit the spreading of the bug. I'm in a constant state of amazement at how bad we are at all of this.
In the crazy worst case where there isn't much immunity conferred by the infection, we could hopefully rely on Darwin to eventually provide us with a less dangerous version of the virus.
[1] https://en.wikipedia.org/wiki/Mortality_due_to_COVID-19#Mort...
You're looking at the numbers for the case fatality rates (CFR). The CFR is not the same as the infection fatality rates (IFR) which represent "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 ran a seroprevalence study and got the following estimates of COVID-19's IFR[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
Does the document break out IFR-S? Some news came out in recent days indicating IFR-S in the United States was around 1.3%.
I agree, 4% IFR of people over 70 is a scary number. In my opinion, governments around the world should really focus on protecting these people.
The good news is for people under 70 personal danger from the virus is close to zero.
"Does the document break out IFR-S?"
Don't know, sorry. Deciphering that table is really easy as the column names are almost the same as the English terms. And Google Translate does a really good job on the footnotes.
But reading the whole paper I'll have to leave to someone who actually reads Spanish.
I feel like I'm missing some key context that would lead a person to declare that with any sense of certainty. It's on a chart and everything! But it's not in agreement with everybody else's charts, and it's early days when it comes to the epidemiology.
(and at least in the US, our treatment capabilities are vast, but our testing regime is cartoonishly bad)
I haven't seen any other IFR estimate that included a breakdown by age group from a government or another authoritative source. Do you have anything particular in mind?
Is it a certain thing the risk for people under 70 is close to zero? Strictly speaking, no, it isn't.
It's unlikely we're going to see precise IFR numbers any time soon. But countries around the world are lifting lockdowns. Where I am, they're lifting it too. So I'll have to evaluate my personal risks without full information.
Why do I tend to rely on Spanish numbers?
- They are one of the hardest hit countries. If they had relatively few fatalities in the age group under 70, it must be reasonable to assume other countries aren't going to have significantly more.
- Don't have a link handy, but numbers published by Italian government had similar numbers of fatalities per each age group. (They didn't try to estimate IFR, though.)
- I don't think Spanish govt manipulates their numbers. But -- if anything -- they have an incentive to overestimate the IFR to justify one of the strictest lockdowns and a high number of dead.
I'm privileged enough, to be working from home. And staying as safe possible. I just think bad economy can ultimately take lives (not only livelihoods) of more people than COVID-19.
But one difference with the Spanish documents is they don't estimate their IFRs.
And if I'm not missing anything, doing it yourself is not trivial if possible at all. It's not enough to know that 5% (an arbitrary number, just to give an example) of a country's population developed antibodies. You'd also need to know the age structure of those 5%, which may or may not match the country's age structure.
Yes, modeling prevalence is complex but once you have the total estimated infected then finding IFR becomes trivial. Calculating SMR would be much more difficult.
Many (most?) countries do not produce reports in English but only in their native language.
When you search in the native language then it is easier to find relevant data. Especially when you catch the right keywords they use.
Here is 14th May report https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/a... that is referenced below the table.
For some reason they chose to use total from the page 3, 19.155 total by age not 27.321, total by region from page 2. I presume that they do not know the details of about 8000 diseased, but it does not matter when it is the total number.
Again while number of >= 70 year old matches the table on the page 3 - 16559, so do age groups <10 and 10-19 but other numbers do not.
The table on the page 15 contains only 263 from the age group 50-69 but the table on the 14th May report contains 2303. The IFR for this age group would be then 0.32%. Not very big but not negligible either.
Group 20-49 contains only 23 people from the 20-29 but omits 62 people from the group 30-39 and 201 people from the group 40-49. The IFR for this age group would be then 0.03%.
I don't really understand why they are using numbers from one table and not the other.
I guess, it may be related to the dates they conducted the seroprevalence study, but it's only a wild guess.
I'll try to look through the documents more carefully later, maybe there's an explanation.
Here is 14th May report https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/a... that is referenced below the table.
For some reason they chose to use total from the page 3, 19.155 total by age not 27.321, total by region from page 2. I presume that they do not know the details of about 8000 diseased, but it does not matter when it is the total number.
Again while number of >= 70 year old matches the table on the page 3 - 16559, so do age groups <10 and 10-19 but other numbers do not.
The table on the page 15 contains only 263 from the age group 50-69 but the table on the 14th May report contains 2303. The IFR for this age group would be then 0.32%. Not very big but not negligible either.
Group 20-49 contains only 23 people from the 20-29 but omits 62 people from the group 30-39 and 201 people from the group 40-49. The IFR for this age group would be then 0.03%.
There is no practical way to "isolate the sick and the elderly" when there are no supplies of PPE or testing kits for care workers. The whole point is that the sick and elderly need care, and when there's a pandemic that care requires extra measures to prevent the spread of infection.
In reality the government did the exact opposite - knowingly sending elderly people with Covid infections back to care homes, and then saying "Oh that's nothing to do with us - every move was signed off by a clinician."
And that in turn makes even less sense when you realise that tens of millions were spent on Covid-ready Nightingale Hospitals, which were opened to great fanfare - and then literally left empty, while old people were being sent to nursing homes to infect others.
Evil, or "simply" stupid and incompetent? It doesn't even matter any more A lot of people are dead for no good reason, and far more are going to die in the UK before this is over.
Unfortunately once you scare everyone into locking down you can't reverse course on a dime.
https://www.sfgate.com/news/editorspicks/article/Los-Angeles...
https://english.elpais.com/society/2020-05-14/antibody-study...
Most studies in Europe show this: 0,5 - 1.
Though I'd be cautious about being too confident in antibody study results, for now. A lot can depend on test accuracy (especially where covid is rare anyway).
This was their criticized quote:
> Globally, about 3.4% of reported COVID-19 cases have died
It was true.
One they are being scared into thinking that if they get infected they will die a horrible death and so will everyone around them. This is obviously an exaggeration because for people under 40 the vast majority will not even notice the infection. And please if you reply grasping at the straw of ‘some people are ill for long’ specify how many people and if they are seriously ill or just tired for a long time.
Second they are not in a position to set policy. The people who make the rules are even more scared and make the rules much tighter than is useful.
We know that sars-cov-2 is highly contagious - R0 values up above 2 without any action. This means that with no action, the entire population will be infected rapidly. Out of the entire population a certain percentage will have no symptoms. Another group will have mild symptoms. Another group will have severe symptoms. Another group will require hospitalization. Members of the last two groups will die.
The point of current public policy (at least from the POV of the people smart enough to understand and propose it) has been to decrease R0 so that it takes much longer for the entire population to become infected (which will almost certainly happen anyway unless an effective vaccine appears quickly). Why would we want to do that? Because if the entire population is rapidly infected, the numbers requiring hospitalization would vastly exceed the resources of our medical system. That means that:
1. Some of those who might have survived COVID-19 had they received effective hospital care will die. 2. People with other treatements requiring hospital care will find it difficult or impossible to receive it, leading to more deaths from non-COVID-19 causes.
None of this has anything to do with "if they get infected they will die a horrible death and so will everyone around them" - that's nothing but a silly strawman painted by people who, for some reason, want to downplay the risk of allowing a virus with R0 > 2 to plough through a population.
Everywhere you see governments building up these huge emergency hospitals and then tearing them down again without them being used.
If your story were true they’d keep the hospitals and loosen restrictions to maximize use, saving the economy while keeping a safe margin.
> allowing a virus with R0 > 2 to plough through a population
Sounds so scary but
> the entire population to become infected (which will almost certainly happen anyway)
Is the same thing, but put in a not scary manner.
These people making the rules are not as smart as you think they are. When the rules were made there was a lot of uncertainty and a lot of pressure to take action. Logically some of the rules work and some don’t. Truly smart people would just say ‘oh well we will remove the rules that don’t work’. Instead what you see is clinging to ineffective rules, defending them with poor excuses as doing otherwise means admitting you were wrong.
In the US, look at mr. Cuomo and his indefensible failure of sending infected old people to nursing homes. It’s clearly the worst thing to do and look at his reaction now that the results are in! He just says he didn’t know even though his signature is on the page ordering it. How smart is that.
> allowing a virus with R0 > 2 to plough through a population
puts a very concrete time estimate on it. We know that the SARS-CoV-2 replicates every 4 days on average, so this scenario has a doubling of cases every 4 days. Starting from a single infected person, the US would become completely infected in roughly 120 days, i.e. they would roughly be done by this point or early next month, with all the consequences that entails. In contrast,
> the entire population to become infected (which will almost certainly happen anyway)
does not imply any specific timeline. It could happen in 30 days, it could happen in 30 weeks, it could happen in 30 years.
Handwaving nonsense. You said that, not people advocating for serious and sensible public policy re: COVID-19.
> "Sounds so scary ..."
Have you actually listened to the people who had COVID-19 and recovered from more than mild symptoms? If there was an army or a terrorist group about to invade the US and kill 100k people, mostly at random, I suspect you'd consider that fairly "scary", as would most other people.
> "Is the same thing..."
As noted by another sibling comment, no it's not the same thing at all.
> "... there was a lot of uncertainty ..."
There is still a lot of uncertainty. We don't really know what works and what doesn't work. What you characterize as "clinging to ineffective rules" I would characterize as "trying to be cautious in the face of massive uncertainty".
I would never defend all of Cuomo's actions as NY Governor. He made a number of extremely serious errors, even though his demeanour in his later press briefings was exemplary.
Yet there are the unnamed but great
> people advocating for serious and sensible public policy re: COVID-19.
According to you these people have no idea what they are doing. Indeed if you believe that, the only way to go is to keep doing nothing out of caution.
And it is not like under 60s are all that safe. In the US 25% of deaths are under 65.
More or less infeasible than throwing millions of people out of work and forbidding everyone from seeing their friends and families?
And it is not like under 60s are all that safe. In the US 25% of deaths are under 65.
85% of the US population is under 65. So 15% of the population has 75% of the deaths, meaning a randomly selected person over 65 is 17 times more likely to have died than a random person under 65.
For politicians it was just easier to lock us all in because such measures are more accepted by the public if everyone has to give up and not just a few. On the other hand, the lockdown for all created so much noise that we didn't focus enough on those at risk and easing their lockdown in some way. Even Sweden got it wrong by banning visits to elderly homes only by late March.
Besides the lockdown for elderly (and a growing list of others at risk) I wish they'd broken up elderly and care homes where-ever possible. If just half the residents moved to a younger relative for a year (and pay the relative for their work, obviously) the homes might not be those death traps they are.
Here in Austria the government worked a lot with Angst. It went so far that the younger were more afraid of the virus than the elderly. I had to spend days to persuade a 35-yr-old that she doesn't have to be afraid and from her initial "I don't want this virus" position she moved to "I already had it" six weeks after...
Young people in their 20's and 30's are dying too, just at a lower percentage.
Many young people who survive COVID-19 end up with permanent lung damage and other on-going issues.
A New York Times staffer who's 33-years old ran 3 miles and walked 10 more the day before she came down with COVID-19 on April 17.
And now this: "I am one of the lucky ones. I never needed a ventilator. I survived. But 27 days later, I still have lingering pneumonia. I use two inhalers, twice a day. I can’t walk more than a few blocks without stopping."—https://www.nytimes.com/2020/05/14/opinion/coronavirus-young...
Far lower. It may be still undesirable, but if we want to talk about risk, there is no absence of risk for anyone, yet the risk changes a lot depending on age and comorbidities. This matters if one wants to take the risk or not, given that it will never be zero.
> Many young people who survive COVID-19 end up with permanent lung damage and other on-going issues.
Some of these issues apply to any type of pneumonia. It takes a year or so to fully recover if you had a bad one. And to evaluate "permanent" damage, we need more time. It would be better to say "we don't know yet if the damage is permanent or not".
TBH, I have yet to hear a decent argument against this, given the following thoughts:
1. Development of a vaccine will take a minimum of 12 months, more like 18.
2. It is not feasible, either for democracy or our economy, to stay locked in/sheltered at home for this long.
3. Thus, the main concern should be to "flatten the curve": keep the infection rate low enough so that, even though people still get infected, hospital systems don't get overwhelmed. I think it's important to note that the only places yet that have had overwhelmed (or close to it) hospital systems had extreme density (Wuhan, NYC), often coupled with lots of mixing of young and old (Northern Italy).
4. A corollary to number 3 is that as long as hospital systems aren't overwhelmed, or close to it, that you shouldn't lock down further. The belief is that the majority of society becoming infected within 12/18 months is inevitable, so extreme lockdowns will do little beyond push deaths out a bit.
5. Do everything you can to protect the highly vulnerable (old, immuno-compromised) as they appear to be at exponential greater risk.
I mean, as the US starts to open up, it is quite clear the virus has not been contained, so for better or for worse the above is the approach we are taking as well.
Herd immunity only happens when a critical mass of the population - >70% at a minimum - is given immunity by a vaccine.
This creates a population with a low enough R to guarantee that outbreaks die out, even if some people aren't vaccinated.
Even then it still doesn't guarantee personal immunity, because people in small clusters can still become infected. But instead of a national health emergency which threatens to overwhelm primary care, you get small localised individual/cluster outbreaks which are very much easier to handle.
I think you've got a selection bias there. Those illnesses are household names because they are/were so prevalent. But what of the illnesses that never became prevalent enough to become household names because populations developed immunity fast enough to suppress the spread?
I can't think of any.
We are deeply embarrassed about Sweden.
Supposedly, Singapore and South Korea were proof that this could work anyway, but it seems to have failed in both places - Singapore had to give up and lock down after cases exploded, whilst South Korea also had a whole bunch of spread that completely escaped contact tracing and nowhere near enough testing to pick it back up again, but somehow managed to reverse it through stricter social distancing measures well short of a full lockdown for reasons no-one has explained. I'd be very interested to see what serology studies have to say about South Korea's actual infection rate.
It is hard to imagine SK's infection rate is anything other than very small, given their extremely low death rate (264 for a pop of ~50MM) - to insinuate otherwise is, well, questionable.
Sadly a different dimension has crept into what should be a reasoned public health emergency response. I'm not sure from where, or why, or indeed who - but we should be vigilant, the cost is terrible.
2017 flu had 60k deaths, despite likely undercounting.
As Nietzsche once put it: “insanity is rare in individuals, but common in the herd”
you could be severely sick with some other disease then get COVID19 in addition, what killed you?
I think 10 years from now we will look back at this time as the time where everything was counted as COVID19
https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm
These data are subject to being modified after the fact.
This still makes sense if the lockdown has lowered other causes of death like car crashes.
https://www.iii.org/fact-statistic/facts-statistics-mortalit...
I don't mean to say that Covid is not a problem -- of course it is. But the response is not correct given the magnitude and nature of the problem.
To me it seems like massive government investment in protecting at risk populations is the answer.
A non-trivial proportion of those become seriously ill for months. It's possible they're going be left with permanent health problems.
I know of one music app developer in his forties with no health issues who spent more than a month on a ventilator. He recovered - barely - but it's going to be a while before he's back to working full-time.
Nonsense about flu statistics is just ignorable whataboutery. Covid is a very nasty illness, and until a vaccine is developed it has potential to do huge direct damage.
Without lockdowns it would have spread like wildfire and a lot of people would have been off work at the same time. Some food supply chains in the US are already struggling.
Imagine what would have happened with only ten times more casualties.