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Comment by matthewdgreen | Hacker News Reader

I guess I am on the “left”, and my view throughout this thing has been “do what the experts say we should, while maintaining a diversity of expert views.” This is also the vibe I get from most of my “left” friends. Moreover, Europe has largely followed its experts’ advice —- and with a few exceptions they’ve largely brought cases under control, so it’s not like the advice was bad.

This “pox on both houses” post, in which you try to blame both sides equally (while also ignoring the fact that only one controls the executive branch of the Federal government), does not comport with my lived reality.

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This has largely _not_ been a Federal response, this has largely been in the hands of the States, at least in regards to setting the policies. State epidemiologists are currently more "powerful" than the CDC in most states, so blaming the response on who is in majority control of the Federal government is short-sighted.

Yes, the (lack of) organized Federal response influenced the severity of the issue in the early days, but we can't lay blame at that level for what has taken place in each state since that time.

The issue isn't whether lockdowns work. Of course they do. People spread disease to one another, limit the number of people that contact each other and the disease will abate. That isn't what is worthy of debate. Rather, we should be debating if lockdowns are worth the cost, and what other methods could we use to mitigate the disease while still maintaining some amount of normalcy.

If we have that debate, it needs to be super local. Density is the driver of any pandemic with human to human transmission. NYC is the most dense city in the United States, and has a huge reliance on densely packed public transit. Dallas is incredibly sprawled and has very little transit use. They need fundamentally different responses.

It is this lack of nuance that is troubling.

This is nuts. Large portions of the response were absolutely in the hands of the Federal government, which failed catastrophically. These range from the elimination of our pandemic response team [0] to the early testing debacle, which resulted from bad tests distributed by CDC (and early failures to scale up private testing using Federal powers and expedited FDA approval) [1], to the lack of coordination between states —- typically an essential function of the Federal government —- to reticent distribution of stimulus funds that were needed to bolster an effective lockdown and support state budgets [2]. Let’s not even start with the weird Federal PPE hijackings that nobody has ever properly gotten to the bottom of. My own state governor (a Republican) had to send state police to protect imports of testing kits, so they wouldn’t be stolen by the Federal government [3].

This isn’t even close to complete, and it’s just the official response. I won’t even get into the totally catastrophic and shifting moral leadership we received from the White House, the weird stuff about opening for Easter. And ugh, the fact that close allies of WH cabinet members were deliberately funding astroturf “anti-lockdown” movements that argued for opening up even against the administration’s own recommendations [4].

Honestly, from your response I can only assume that you haven’t been reading the news since January.

[0] https://www.snopes.com/fact-check/trump-fire-pandemic-team/ [1] https://www.google.com/amp/s/www.nytimes.com/2020/03/28/us/t... [2] https://www.google.com/amp/s/www.vox.com/platform/amp/2020/4... [3] https://www.google.com/amp/s/amp.cnn.com/cnn/2020/04/30/poli... [4] https://www.google.com/amp/s/www.nytimes.com/2020/04/22/opin...

I totally agree with you, that the Federal response was pretty terrible. And I understand and am aware of the topics you provided.

However, that does not change where we are today. It would have probably helped us get to "today" a lot earlier, and it would have probably saved many, many lives which were unfortunately lost. But my argument is how we respond _today_ to new information, and how the partisanship endemic in our culture today does not allow for us to pivot in a meaningful way. If we knew what we know today 160 days ago, I doubt we would still want to lock down in the same way that we did. But unfortunately, despite now being armed with that knowledge, we are not pivoting on the plan we made back in March.

Even our knowledge of treating it has improved. The CFR is down across the board. We now know oxygen replacement therapy is better than invasive ventilators. We know that a majority of the spread is in nosocomial or in nursing homes. We know that remdisivir shows promise. We know that treating with anti-inflammatory drugs is helpful. We know better ways to prevent cytokin storms. We know better how to respond to clotting. Focusing just on the ventilator learnings, we can treat people with oxygen replacement therapy without them being in the ICU, while invasive ventilator treatment requires an ICU. This lowers the number of ICU beds needed, and thus should shift the hospital capacity discussion.

But I am seeing none of that. It is all partisan bickering over "full lockdown" or "full reopen" and both sides claiming the other is "anti-science"

I will ignore the personal attack, beyond saying that questioning someones understanding of a topic at such a basic level has no place in proper debate.

> If we knew what we know today 160 days ago, I doubt we would still want to lock down in the same way that we did.

I don't know how to respond to that - I technically agree with you, the loudest least educated voices probably wouldn't have wanted to lock down. The lack of info and the panic level probably positively contributed to saving more lives. I'm totally okay with that. I believe that knowing then what we know now, we absolutely should have done what we did, and then some. We didn't have enough testing capacity. We know that if we had locked down even earlier, we would have saved a significant number of additional lives.

It's true that part of the argument was based on hospital capacity. But the models today are still consistent with the view that the capacity in many areas would have been overwhelmed in many places had we done nothing. I think the key there is that civilians were going to "do something" and stay at home even if the government didn't tell them to, no matter what.

> But I am seeing none of that. It is all partisan bickering over "full lockdown" or "full reopen" and both sides claiming the other is "anti-science"

It's best to step away from that kind of absolutist language (none, all) - it just tends to bait people.

I think that you’re very wrong that the lack of a coordinated response by the Federal government was only an issue “in the early days”. I think the ongoing lack of Federal action (and particular economic support) has more or less trapped us into a long-term poor and fragmented state-by-state “whack-a-mole” strategy. The fact that CFR has dropped a bit does not mean there won’t be major second waves that flow back and forth between the states: we may already be seeing those in some southern and western states. It’s not too late to fix this, but we won’t.

We are arguing over two different things. I am arguing the direct response to the virus. How the lockdowns were implemented, where and for who. I agree that the federal response was bad all over, and now it is most obvious in the lack of financial assistance to both individuals and states.

Please keep in mind also, that for states that are not in (NY, NJ, CA, MI, LA) there hasn't been a _first wave_. We need to keep that in mind before we point to states like FL and GA as having a 2nd wave. Their waves were largely curtailed by the stay-home orders in place. We need to either admit we want these orders to last until there is a vaccine, or increase our threshold for acceptable case levels.

I don’t actually think we disagree that much. The problem is that we were supposed to use our early lockdowns in the “high cases” states (NY/NJ/CA) to control the epidemic and bring it down to manageable levels. At least in NY/NJ this seems to have worked. We were supposed to use our lockdowns in the “low cases” states to bring the caseload down near zero. This has not really worked that well, largely because the lockdowns were poorly implemented, and because states ended them before they had really crushed community spread to a level where testing and tracing could work.

Now there’s superficial (early) evidence that many of the low-cases states are entering a second stage of exponential growth. There may not be much room for us to simply manage the caseload at some “acceptable level” if those states really catch fire. The problem is that the only tool we have to manage this — if indeed it bears out and hospitals become overwhelmed - is another lockdown. But the lockdowns have become a political hot potato, and at least one side is dead-set against them. It seems unlikely that we’ll be able to use this tool again until things get Very Bad.

Compare this to most of continental Europe, where both high-case and low-case nations have succeeded with lockdowns, and governments are moving into a phase where careful management is likely to control the epidemic entirely going forward.

In my state we have leaders looking at data on county and zip code levels, and assigning "stages" to counties that affect how open the businesses can be, based off of how stable their numbers are looking. What's it like in yours?

That sounds like what we are doing in Wa state. It's too early to know how it will pan out.

> “do what the experts say we should, while maintaining a diversity of expert views.”

I don’t think this is an actual strategy. If there is a diversity of views, which experts do you listen to? Also, experts in which field? Epidemiologists have generally recommended very strict shutdowns, but they are not economists and are not experts on the economic ramifications. Some economists agree with strict lockdowns, others do not. So it’s not at all clear what “listen to the experts” means in this case.

We listened to the ones who were already employed to be in charge of this kind of thing, and we haven't had a case in 2 weeks, lockdown is over.

The only answer I can come up with for this is a larger team of specialists in the relevant areas combined with a small number of generalists to coordinate between the experts and synthesize the findings.

obviously you listen to the epidemiologist, not the economist. The economist is an expert on the economy and not on pandemics, and therefore will always give advice that is aimed at keeping up the economy and not saving people and preventing the spread of the virus. Its baffling to me that you think an economist has any kind of valid input on this matter. At best an economist could advise you on how to keep the economy afloat under the restrictions the epidemiologists has advised.

We could easily eliminate a greater share of premature deaths if the government sent soldiers to force Americans to exercise at the point of a bayonet. Probably more than will die in this pandemic (~650,000 deaths due to heart disease each year). Does that mean this is a wise course of action? Of course not. The negative consequences in terms of reduction of civil liberties vastly outweighs the medical benefit. The same logic needs to be applied here.

The epidemiologist isn't trained in thinking about the persisting scar on opportunity left by lockdowns. A response to a pandemic that solely cares about limiting lives lost due to the virus stands to inflict massive harm as people lose their jobs and social unrest triggered by the suspension of civil liberties.

Medical professionals are experts in medicine. Not in making holistic decisions about the course of society. They absolutely should have a prominent spot in sharing information with the leaders of society, but their advice needs to be weighed against the costs of carrying out that advice.

Economic problems come with a cost on human life. There are numerous studies and paper that show how bad being poor and unhappy are for a person's health. Why WOULDN'T we consider the economic ramifications?

Maybe we would, but it isn't like there is consensus on economist side. And it isn't like not having a lockdown is good for the economy , because that has clear economical consequences too:

https://www.nytimes.com/2020/04/14/opinion/coronavirus-reope...

>> At best an economist could advise you on how to keep the economy afloat under the restrictions the epidemiologists has advised.

> Why WOULDN'T we consider the economic ramifications?

He's not saying that. He's talking about who should be giving the marching orders. Let me put it another way: in a war, the generals decide what equipment the military needs and the economists figure out how to produce it. You don't have the economists saying: the economy is good at making buses, it makes sense to us to weld extra armor to them rather than to design a tank from scratch, so go fight the war in armored buses.

But before you go to war, the leaders listen to a diversity of opinions. Could diplomacy work? Could sanctions? What about an alliance prior to war? Could we use covert methods? The problem here is that we waged war without having that discussion. We went straight to the Generals (in our case, epidemiologists) without getting the opinion of the diplomats, allies, covert ops (economists, labor groups, civil rights groups) etc.

> But before you go to war, the leaders listen to a diversity of opinions. Could diplomacy work? Could sanctions? What about an alliance prior to war? Could we use covert methods? The problem here is that we waged war without having that discussion. We went straight to the Generals (in our case, epidemiologists) without getting the opinion of the diplomats, allies, covert ops (economists, labor groups, civil rights groups) etc.

You're leaning a bit too hard on the analogy: you can't negotiate with a virus. The pandemic is more akin to an attack by an irrationally implacable enemy with a couple months advance warning of the threat at the border. In the analogy, the policy options are: resist, Y/N? If Y, then how effectively?

When a country is attacked, does its leadership typically first consult with its economists to determine if resistance is cost effective vs. just letting the enemy take territory or kill citizens with little opposition? Usually the generals evaluate what they can achieve, and if success unachievable, then alternatives are considered. Surrender is always an option, but it's usually towards the bottom of the list.

> When a country is attacked, does its leadership typically first consult with its economists to determine if resistance is cost effective vs. just letting the enemy take territory or kill citizens with little opposition?

Yes, countries very often let the enemy take territory or kill citizens because resistance wouldn't be cost effective. All countries of course try to project the image that they wouldn't, that their territory and the lives of their citizens are priceless. But border skirmishes happen all the time and the vast majority of them don't lead to war.

People's lives and livelihoods are strongly coupled to the economy though. Heavy economic damages result in skyrocketing suicides and homelessness. It's not like shutting down the economy only hurts "gluttonous corporations" and "greedy capitalists"

in a world where losing a job can be just as disastrous to one's health as disease, you really don't think their opinions are valid whatsoever? not everyone has large savings or the ability to work from home.

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