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Comment by jlmorton | Hacker News Reader

> Containing and minimizing the effects of a pandemic is just one aspect of what we might call a civilized attitude towards human life. Conversely, not doing so is uncivilized and I might add immoral and irresponsible.

The reality is that everyone is prepared to allow others to die for their own convenience. I intentionally phrased that harshly, but it is indisputably true. In the US, 70,000 people died from the influenza season of 2018-2019. We could have sharply reduced that through quarantine measures. But no one wants to do that.

Once you accept that everyone is prepared to allow others to die preventable deaths for their own convenience, then all you are talking about is a matter of degree. It can't be immoral to believe 1 death is okay, but 2 is wrong. That's just an opinion. The only difference between believing 70,000 is okay, and 700,000 is not is a gut feeling about how much preventable death is worth it to maintain our living standards.

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It has much less to do with people dying directly from Covid and more to do with the sheer number of severe Covid cases overloading healthcare systems to the point that patients with other serious conditions can't receive medical treatment.

This occurred in Italy, New York City, etc., and is now being seen in some cities in Texas and Florida. This condition is what incentivizes societies to lock down, not just the mere occurrence of a new disease.

If a society's healthcare system can handle a severe influx of serious Covid cases, then you typically have seen that government's restrictions lift.

>This occurred in Italy, New York City, etc., and is now being seen in some cities in Texas and Florida.

Not Florida. An article from yesterday (https://www.news4jax.com/news/local/2020/06/18/florida-has-l...) ominously claims that "less than 25%" of ICU beds are available in the state, but actually read it and see that 90% occupancy rates are normal, and only a few of those in the ICU are COVID19 cases.

Texas? Let's look at Houston, where for a month it's been "we'll be running out of ICU beds in two weeks" every week.

Italian and New York hospitals were overwhelmed because a) both places put sick elderly into old age homes. b) Like elsewhere early on, doctors put everyone serious onto ventilators in a mistaken belief that they should treat patients like they do ARDS cases based on blood oxygen levels. This damaged healthy lung sacs and caused long-term dependence on mechanical respiration that doctors found almost impossible to wean patients from, and other side effects like deep vein thrombosis; Nick Cordero is a recent example. This article from three months ago (https://www.statnews.com/2020/04/08/doctors-say-ventilators-...) was completely vindicated in retrospect.

(And even NYC being overwhelmed was thankfully temporary. That's why the military hospital ship sent there was not used.)

The mean time between symptoms and death is 14 days (https://www.statnews.com/2020/04/08/doctors-say-ventilators-...). 99% of cases where people with COVID19 stay in the hospital for months is because of b), and neither a) nor b) is happening now.

56 Florida ICUs are at capacity, with a further 35 are above 90%[0]. Five days ago the largest hospital operator in Houston, TMC announced that they were at 102% [1]. There’s a little bit of flexibility there; TMC can get that down to 72% by converting every possible bed to an ICU space[2], but they are now operating above official capacity.

I agree that there’s a lot to criticize in how NYC handled their hospitals, and that in a pinch hospitals in Texas and Florida can scrounge up extra beds. But those hospitals are filling up.

0: https://www.cnn.com/2020/07/07/health/us-coronavirus-tuesday...

1: https://m.huffpost.com/us/entry/us_5efcd4b7c5b612083c5618d0?...

2: https://www.houstonchronicle.com/news/houston-texas/houston/...

>56 Florida ICUs are at capacity, with a further 35 are above 90%

There are 306 ICUs in Florida (https://bi.ahca.myflorida.com/t/ABICC/views/Public/ICUBedsHo...). As of today, 16.8% of all ICU beds are available.

As I said, a 90% ICU load is normal; hospitals routinely transfer patients elsewhere to maximize utilization across as many facilities as possible. Again, only a small portion of ICU patients are there for COVID19, and a good chunk of the remainder are people who postponed procedures during the lockdown.

Source on 90% capacity being normal? The only study I found [0] said that the ICUs studied averaged 52-87% full with a median usage of 62%.

0: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840149/

Let me clarify. By "normal" I meant that 90% is not an unusual or undesirable situation. To some extent, an ICU bed is not being used is going to waste; from a hospital administrator's perspective, the ideal situation is 100% utilization at all times with every excess patient smoothly being transferred elsewhere. This of course is unrealistic—you want to leave some surge capacity (thus my 90% figure) if possible—but, generally speaking, a hospital will transfer excess patients elsewhere (either within the same system, or to others in the region), and accept others' excess patients to fill up its own empty beds.

COVID19 patients are not making up a large percentage of ICU patients at the moment; see, for example, the hospital in the aforementioned article with 100 ICU beds. Yes, the 100 beds are full at that moment, but only seven are COVID19 patients; no doubt some other fraction are patients who put off procedures during the lockdown. That hospital is sending new patients it can't handle elsewhere, and will also move some existing patients elsewhere when practical/safe. This is possible because there is no overcapacity on a regional or statewide level.

Thanks for this response, its a good counterpoint with solid evidence, but the main point still stands - societies aren't merely shutting down because of a virus - it's because of a fear of healthcare systems being overwhelmed.

Not sure where you get 70,000. On average it's 16,000 - 40,000 per year, there was a really bad flu on 2017-2018, which killed about 61,000 people, but on 2018-2019 it killed 34,000[1].

Anyway, your point stands, but there are people who think covid deaths are no higher than a bad flu, and your numbers seem to mislead in that direction.

[1] https://www.cdc.gov/flu/about/burden/past-seasons.html

I am leaning towards the lock down skepticism. It's not that I think that Covid is not worse than a flu, it is worse, but there response is unparalleled. We have had a strict lockdown and lots of deaths anyway. The initial predictions about the virus turned out to be way off, it seems to be more infectious and less dangerous than we were initially told

Initially lockdown was to "flatten the curve", stop the hospitals an in particular the ICU beds from getting overwhelmed. That worked, and while it got close to breaking point here in Spain we made it through.

I noticed as new data emerged from Sweden - they hadn't spiralled out of control as many, including myself, predicted. Flatten the curve seemed to be forgotten about, and it turned into a pointless competition of who has the least cases, least excess deaths - pointless because this is far from over.

Or maybe we are past the worst of it already - the Diamond Princess cruise ship showed only 20% of the passengers infected - so maybe covid only affects 20% of the population.

You calling that a strict lockdown? When I go to a park and see tons of people there, half of them not wearing any masks. We aren't even fining people for not wearing them.

Someone here mentioned how Vietnam handled it, they reacted quickly and had steep fines (for their income) and achieved 0 deaths and now it's 80 days since last infection was reported.

There are other countries that handled it really well: Australia, New Zealand, Taiwan, South Korea, Finland.

Assuming you're talking about USA. The USA is probably an outlier since it essentially had no lockdown, no enforced mask usage, and very weakly enforced business closures. All the states had were half-assed "Stay At Home suggestions" that people pretty much ignored (and still ignore).

I wouldn't look at any state in the USA for evidence of whether lockdown works or not, because it pretty much wasn't done here.

Yes, I talked about USA, but the countries that did actual lockdown, especially early on got benefits of it.

Who had a strict lockdown? Most of the US did not and if they did, it was too short. Source: I'm a Texan.

Here is Spain was one of the strictest.

It appears they revised the estimate: https://www.cdc.gov/flu/about/burden/2017-2018.htm

> Can you explain why the estimates on this page are different from previously published and reported estimates for 2017-2018? (For example, total flu-related deaths during 2017-2018 was previously estimated to be 79,000, but the current estimate is 61,000)?

> The estimates on this page have been updated from an earlier report published in December 2018 based on more recently available information. There is a trade-off between timeliness and accuracy of the burden estimates. To provide timely burden estimates to the public, clinicians, and public health decision-makers, we use preliminary data that may lead to over- or under-estimates of the true burden. However, each season’s estimates will be finalized when data on testing practices and deaths for that season are available.

You were talking about 2018-2019 though. The 2017-2018 was an outlier and it is misleading to use it as an example of typical flu.

All preventable deaths should be prevented - this is the gold standard. In reality, of course, things don't work out that way. The analogy with a flu season is deeply misleading. The coronavirus has, in half a year, killed more people than the worst flu seasons, with extraordinary measures in place all over the world. It's completely reasonable to assume that without lockdowns we would have had millions of deaths already.

> The reality is that everyone is prepared to allow others to die for their own convenience.

It may be so. Those people are morally wrong however. This is a deep point that I have insisted on in other comments as well. Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.

> The only difference between believing 70,000 is okay, and 700,000 is not is a gut feeling about how much preventable death is worth it to maintain our living standards.

That is not true. Deaths caused by the regular flu are deeply regrettable and should be prevented as much as possible. If you dig into the data however, you will see that the coronavirus not only kills many more people than the flu, but it also kills people who would otherwise have many more years left to live. Diabetes, a heart condition or age > 65 yrs. shouldn't be death sentences in a modern civilized society.

> Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.

The reality is quite different. We accept a risk of death to ourselves and others in everything we do. You do it, too. Everything. You even risk death by doing nothing.

You could say "if it cost $1b to save this life, we should do it". But how many lives could be saved at $1b each before we run out of money? Then what? And what about the lives that could have been saved at $1m apiece?

If someone not willing to give up all of his assets to save someone else's life, is he uncivilized and morally wrong?

> You could say "if it cost $1b to save this life, we should do it".

This a common, yet unrealistic, hypothetical. In reality, of course, death is inevitable regardless of the economic costs. Past a certain point everybody, so far, has died. The amount of things that we can do in order to prevent any given death doesn't scale with the economic cost, past a certain (quite low) point. Spending 1B on a person won't get you 1000 times better 'medical stuff' than spending 1 million; therefore, a trade-off of e.g. one life for 1B vs 1000 lives for 1m is illusory.

In practice all societies have limited resources. My position is, however, that those limited resources, in the case of an acute health crisis, should be focused as much as possible on mitigating that crisis, without having primary concern for the economic costs.

> All preventable deaths should be prevented - this is the gold standard.

It absolutely isn't; it is complete nonsense.

Firstly, it directly conflicts with right to die; it asserts that if we can intervene in any suicide, then we should. How can stepping on the right to die be elevated to a gold standard?

Some people take risks, and those risks are fatal. Deaths in dangerous sports and other activities are easily preventable: just forcibly take away the right to engage in them. Closing off Mt. Everest to climbers will certainly prevent deaths. By your gold standard, that must be what should be done.

Preventing some deaths may even require lives to to be imperiled; someone has to be asked to risk their own life to save others.

No, no, no; live and let die is the gold standard.

People should be sometimes left to the consequences of their actions and circumstances and that includes dying. Obviously not always, and not as a rule, but sometimes. Often enough that "all preventable deaths should be prevented" is utterly preposterous.

There is no right to die in most countries in the world. Got horrible painfull and untreatable disease, but a few years left on the clock? In most places you are doomed to suffer through it. The only exception i am aware of is netherlands.

Secondly, most of your post conflates me engangering myself my choice ( i choose a dangerous sport and suffer) vs someone else endangering me (unsafe building collapses on my head).

Note that, normally, a writer can't conflate A and B, if they don't make even the slightest reference to B. That said, I've pulled off "the impossible" before.

It may be so. Those people are morally wrong however.

I'm willing to bet that you have taken many unnecessary car trips in your life. By doing so you have increased the risk to other drivers, cyclists, and pedestrians of suffering a fatal accident. Sure, it's a very small increase, but surely that outweighs your selfish desire to visit your friends or go to a movie.

Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.

It's not only acceptable, it's essential in order to make reasonable decisions.

Deaths caused by the regular flu are deeply regrettable and should be prevented as much as possible.

So, quarantines every winter?

Flu vaccine reduces risk of death. Coronavirus has no vaccine yet. I do think we take the flu too lightly. Urgent care and hospitals definitely need to be more risk averse even after this pandemic is over, and I hope we learn that lesson in this pandemic.

Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.

Casually? Sure that’s not good. But we weigh human life against cost all the time.

In the U.K. they value 1 QALY (Quality adjusted life year) at $50k. It’s very explicit.

People forget that economic activity is what pays for healthcare, welfare, etc.

You can’t ignore economics.

To my knowledge all modern nation states have some sort of stat like that; it’s either relevant for healthcare expense planning, or disability/life insurance schemes. I believe the US rates it down to the value of each limb for the latter; and my private AD&D insurance does the same.

The response to the coronavirus has been many orders of magnitude more strict than the response to the flu. All this while be less than an order of magnitude as deadly, probably 3X-4X. This is why I think it is perfectly valid to compare it to the flu.

The collective response has been outsized to the actual risk of death, and I believe this is due to fear rather than sensible policymaking.

If it really was about reducing all cause mortality, most governments could do so much to reduce the primary causes of death, like heart disease and cancer, by banning things like cigarettes and enforcing healthier diets among the populace.

Imagine what banning sugar alone would do to the rates of obesity and type 2 diabetes in the US. But no one wants to do that.

every single person weighs economic benefit against risk to life constantly, in civilized society.

We abort 600K fetuses in the US every year. By our behavior, life is cheap.

You are just making up some arbitrary standard of "civilized society" that doesnt exist and is meaningless.

Economists have determined that people value their lives at about 100K. The govt through policy values a human life between 8 and 10 million

Right now you could spend $100 to save a life of a child in africa, yet instead you spend that money on frivolous luxuries.

> All preventable deaths should be prevented - this is the gold standard. In reality, of course, things don't work out that way.

Yes, in reality a lot of people die driving cars all around the world no matter the amount of on board safety devices and yet cars are legal everywhere. There are countless similar examples.

Preventable is what people agree or tolerate to prevent.

Children seem far more vulnerable to the flu than the coronavirus, so I don’t understand your argument.

Children get the flu vaccine.

Really? Here in Norway children would only be vaccinated against influenza if they already have other severe conditions such as diabetes, chronic heart or lung disease, etc.

Not in Sweden as far as I know.

Not in Sweden. Only elderly people and people in risk groups, like me are offered vaccination against season flue.

First, economy was never a consideration for the Swedish Corona strategi.

Secondly, the flue has quite reason, like year 2000, taken more lifes in Sweden then what Corona has taken this year. And I would be surprised if that would be exceptional to Sweden. That not even consider there are more people living in Sweden today then 20 years ago. A couple of years earlier, the death rate per 100 000 was higher then Corona this spring.

Source, Swedish statistical agency. http://SCB.se/

And yes, there are some strong indications that there was Corona in Sweden in December, in Svärdsjö, Dalecarlia. A woman that has not been outside of the region got Corona signs on X rays of her lungs. And that I guess isn't exceptional either. So, we probably hade Covid-19 a lot earlier than we has thought. Which could explain the explosion of the spread.

> Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.

Human life and economic cost are not separate things. The economy is a comprehensive (if incomplete) description human life. When we shut down the economy we cause millions to lose jobs, to lose incomes, to lose structure, to lose community, to lose activities that give their lives purpose and joy.

The economic shut down is killing people. It's also reducing quality of life and length of life. That's not to say it's not worth it. The effects of lockdown are hard to measure and no one can be sure if it's worth it or not. But this framing of economic cost vs human life as if it's just a little money is wildly inaccurate and damaging.

> It's completely reasonable to assume that without lockdowns we would have had millions of deaths already.

I agree that it's a reasonable assumption. Ivor Cummings dives into some statistics a bit more, and it isn't so clear that the lockdown had the effect, rather that it might be do to with seasonality and the way the virus spreads. I am interested if anyone has any decent criticism of the numbers he bring up in that video, as they seemed reasonable to me?

https://www.youtube.com/watch?v=-VLW0_XlWl4

> The coronavirus has, in half a year, killed more people than the worst flu seasons

That's not true. The flu seasons in 1968, 1957, 1918, and 1889 each killed over a million people worldwide, twice as many as COVID-19 in roughly the same timespan, and that out of a lower total population, and despite lockdowns and quarantines.

(Who is downvoting this simple truth? How is anyone going to discuss this issue if we can't even talk about basic facts?)

You are referring, I think, to years with pandemics that were not caused by what can be called the 'regular' flu. It's especially comical that you have included the 1918 flu pandemic among your counter-examples.

At least for Sweden, it is still true that the worst flus have killed more people than corona on a per capita basis. And we don't have to go back very far at all to find cases of this. 1993 and 2000 where particularly bad and topped corona.

But that is corona with social distancing and very widespread working from home, so it isn't really an apples to apples comparison.

What is "regular" flu? There are many strains in circulation, including those that caused past pandemics. We have vaccines and acquired immunity, so it's been some time since the last truly deadly flu epidemic, but the flu should not be dismissed so lightly.

And why wouldn't I include 1918 in a list of flu pandemics that killed over a million people?

There are many strains of corona virus as well, most of them cause a simple cold. We are not comparing COVID-19 to a common cold.

Right, I compared COVID-19 to the worst strains of the flu, not to the common cold. I found that the worst strains of the flu killed more people.

But even that simple statement of fact is suppressed, even here on HN, because this issue is so heavily politicized.

Is it? I see it acknowledged, and often paired with the observation that the worst flus have not been mitigated by extreme social distancing as we have now.

Before vaccines the flu killed over a million people worldwide every single year.

Coronavirus deaths aren't preventable.

Youre are going to have the same number of deaths sooner or later as long as the hospitals aren't overwhelmed.

Corona isn't going anywhere.

Let's look at British Columbia, Canada where we have managed to stabilize at ~10 cases a day. How long before we get the same number of deaths with our population of 5 million people. Hmm, 5 million divided by 10 divided by 365 is 1369 years. Even if we consider 10 cases for every one detected case that's ~137 years! Longer than a human life span. Ignoring things like improved treatment options, vaccines, and other things that are going to change in our understanding.

So I think this proves the argument wrong.

If you consider the other costs you're avoiding, long term issues for sick people, the cost of treating all these people in hospital, the potential for people to get sick with this multiple times (we don't know if you get any immunity by getting sick) then it's even clearer.

Your argument boils down to: keep society shut down forever, problem solved.

They have only stabilized at that level if you are willing to permanently keep things the way they are. Are you comfortable with the restrictions currently in place being permanent?

Hopefully a vaccine is discovered.

I think we can keep things where they are. The current restrictions aren't great but they are sustainable:

- Virtually no travel in and out of the country (goods still flow though).

- No gatherings > 50 people.

- Keep 2m away from others (except for "bubbles").

- Wash your hands.

- Masks in certain situations (not mandatory for most).

- Various limitations in place as to how businesses operate, e.g. distance between tables in restaurants, physical barriers, cleaning, one way aisles in stores etc etc.

Since I'm not the type or age who goes partying out in crowded bars or to packed concerts that stuff doesn't really bother me personally. Sure, it's no fun, but the alternative seems like a lot less fun. In my (global) company we all switched to wfh when this started and I'm fine with that.

Wow. All I can say is that you have very different priorities than most others. Most are ok with those changes temporarily. Almost nobody is willing to make that sacrifice permanently.

Permanently != until there's a vaccine or effective treatment.

There's lot of room for optimization/improvements. Travel might be ok to locations that have this under control, for example. We might find better solutions for keeping the transmission low. We could decide to clamp down harder and eradicate the virus locally so that we can trade off local restrictions vs. travel restrictions.

It's just between all the bad options here this seems to be the least bad. 2 years of the disease raging through the community until (maybe) there's herd immunity sounds so much worse. I'm pretty sure the Americans who think this is the way to go will change their minds come this fall assuming the current trend continues. Maybe I'm wrong... Let's catch up in December ;)

Well, I’m not sure what I think, honestly, but I just wanted to point out that a vaccine is not a sure bet, just like herd immunity is not a sure bet.

> Youre are going to have the same number of deaths sooner or later as long as the hospitals aren't overwhelmed.

Even assuming there's never a vaccine or effective cure, this is not true: temporarily reducing the R number (lockdowns, distancing, masks) reduces the overshoot in the total number of people who get the disease (some proportion of which will die). It's the difference between scenario 0 and scenario 1 in the excellent https://ncase.me/covid-19/ playable models.

What you just said, and the link you just linked, say two completely different things. You should watch that link again.

Quoting the site: "This reduces total cases! Even if you don't get R < 1, reducing R still saves lives, by reducing the 'overshoot' above herd immunity. Lots of folks think "Flatten The Curve" spreads out cases without reducing the total. This is impossible in any Epidemiology 101 model. But because the news reported "80%+ will be infected" as inevitable, folks thought total cases will be the same no matter what. Sigh."

What I said: "temporarily reducing the R number (lockdowns, distancing, masks) reduces the overshoot in the total number of people who get the disease (some proportion of which will die)."

How are these "completely different"?

The R value is only reduced while extreme measures are active.

It will go back to its normal r value one society returns to normal.

There's no avoiding society returning to normal as people need jobs to pay rent and buy food.

The R is reduced while any effective measures are active. The playable sim for Scenario 1 has them active while there's blue shading over the graph, deactivating them once herd immunity is reached in that sim. In that case, compared to scenario 0 (do nothing), fewer people have been exposed so fewer people die. So it is not true to say, as you did, that "Youre are going to have the same number of deaths sooner or later as long as the hospitals aren't overwhelmed."

> There's no avoiding society returning to normal as people need jobs to pay rent and buy food.

You've moved the goalposts, but even so, the later sims suggest other things that can be done with less invasive measures like test and trace, wearing masks and social distancing. These don't prevent people doing jobs. They do decrease the number of people who die.

They are preventable, vaccine on the horizon.

SARS is a coronavirus and there's never been a vaccine for it.

How do you know there's a vaccine on the horizon?

>All preventable deaths should be prevented

What's a preventable death? Everybody dies eventually, there's no such thing as a preventable death. There's delaying death, but everyone dies. Period.

I feel that in this thread people are quite stubborn about interpreting things literally, or misinterpreting them all together.

I will give it my best shot at clarifying:

Preventable refers to what a given society can be expected to manage given its limited resources and given other moral constraints, such as not impinging on people's freedoms unnecessarily. A number of the terms I have used have vague meanings that can't be clarified (not by me at least) within the scope of an HN comment. A good faith interpretation of my statement would be that a society should hold saving lives as its highest priority, as long as this does not cause catastrophic costs or dystopian levels of population control. Some temporary economic costs and some temporary restrictions on certain freedoms should be accepted, I think.

>> All preventable deaths should be prevented

> in this thread people are quite stubborn about interpreting things literally, or misinterpreting them all together.

My complaint is a bit different. I'd say "preventable deaths should be prevented" and people will interpret that as if it said "all". I reply that if I meant "all" I would have said "all".

Your case is a bit different, because you said "all" but did not mean "all".

> I feel that in this thread people are quite stubborn about interpreting things literally, or misinterpreting them all together.

That's my impression about the Internet as a whole these days...

This seems needlessly pedantic.

But not every man truly lives.

Yes, fortunately most people agree that stopping covid lies on the unacceptable side of the line.

So let's expand on that a bit then.

Cancer is a rather big problem. It taxes society quite a bit, costs a lot of money and in general inconveniences quite a lot of people that need to support or help cancer patients.

Would you agree then that perhaps it's a better idea to let cancer patients die rather than try and find cures or reduce the chances of dying? Why or why not? If you had cancer but of the curable kind, would you accept the state killing you because it inconveniences others?

My point is not that society should take no effort to reduce preventable deaths. Society should do whatever we collectively want to do.

Rather, my point was that it's hypocritical to argue that anyone that does not want to continue major disruptions is either immoral, uncivilized, or an absolute monster.

Everyone attaches some value X to human life, and some value Z to normal functioning. Not everyone values these things the same. But everyone certainly has a value, and almost everyone is okay with allowing many tens of thousands annually to die a preventable death in order to avoid disruptions to life. That being true, let's stop the moralizing arguments, and focus instead on why coronavirus is worse than other illnesses, and why it's worth it to continue our efforts to disrupt it.

In other words, my argument is really about language and rhetoric, not the coronavirus itself.

I think your argument is nonsense and pedantic to be completely honest.

For example, being against the treatment of the Uighurs in China would be an example of moralizing if we took your argument to the extreme. The government in China simply places lesser value on their lives and since we all attach different values to human lives it's hypocritical to criticize their treatment.

You're avoiding the actual argument at hand in favor of nitpicking the rhetoric. Basically, tone policing. And I don't think tone arguments solve anything over than diversion.

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