California imposing sweeping rollback of reopening plans amid case surges | Hacker News Reader

California imposing sweeping rollback of reopening plans amid case surges

nytimes.com

73 pointslongdefeat140 comments

California shut down very hard and fast. When they reopened, nearly 100% of the population was still susceptible to the virus, so it spread like wildfire. Especially since the reopening was not exactly slow.

Compare this to the Northeast and much of Western Europe where the virus spread too quickly until lockdowns reduced the spread. Now, keeping the transmission rate low in those areas has become comparatively easy, even with wide-scale reopening.

Perhaps California could have attempted a middle ground strategy. Let the virus spread just a slight amount more than occurred during the initial lockdown in order to gradually spread immunity. The level of immunity may be nowhere near "herd immunity", but any amount of immunity in a population makes transmission of the virus more difficult.

EDIT: Part of why I make this strange argument is because CA seems to have endured a lockdown for virtually no gains. Now, the lockdowns will begin again. Perhaps allowing the virus to spread at a low and manageable rate would have conferred some benefits in terms of increased immunity in the population, thus making it easier to suppress the transmission rate moving forward.

I think we should wait to make determinations on cause until we see if that changes once the weather turns in the north and Europe and people return to heated spaces.

If this was really a matter of herd immunity, Florida wouldn’t be getting hammered right now.

Why would Florida have high levels of immunity? It was never hit hard until recently.

And I don't think this is about herd immunity, but simply about reducing the percent of the population that can infect and become infected, thus driving down the transmission rate.

Don't forget that idea is inverted for lots of the US (like Florida and Arizona). You gather indoors during the summer, in air conditioned spaces. Winter is when you're outside more often.

That is what underlies my point. Basically, I don’t think we can say that Europe or the northern US has this beat yet. It doesn’t. Once winter comes again, we get the real numbers.

What is the current sentiment on the pandemic like in California, given that they've been on lockdown for the longest? Are people getting antsy? Is there an "index" that measures sentiment across different states?

"Lockdown" is perhaps a misleading description. The restrictions on private gatherings are entirely unenforced, and everyone I know has long since started having whatever gatherings they personally feel they need.

Thinks are very different here in Seattle. No one I know is gathering with anyone indoors. You might have a couple friends over and stay outside, but indoor gatherings with multiple people are shocking insanity and just wouldn't happen.

Exactly. I wish people would stop referring to the feeble efforts the states implemented as "lockdowns". It's an absurd word to use. There were no lockdowns in the USA. There were a bunch of half-assed "Stay At Home" orders, which may as well have been called Stay At Home Suggestions because they were largely ignored. Nothing was locked. Nobody was locked in their homes. Few people, if any, were even subject to enforcement actions. Everywhere you looked during the so-called "lockdown" people were out and about, horsing around, going to parties, trying desperately to maintain business as usual, flexing their freedom just because. Every single place that the government begged people to not go, people went, saying "Nyaa Nnyaa! You can't tell me what to do!" Total eight-year-old mentality. The whole thing was a complete farce. Please, people, stop calling it a lockdown.

It might be helpful to look at Google mobility trends; I know that there was 'shutdown fatigue' almost everywhere (according to GMT).

The reason for case counts staying relatively low in those places has a lot less to do with "herd immunity" and a lot more to do with still being careful. Even though a huge number of people were infected, it was still a very small amount of the population overall, not anywhere near enough to affect the transmission rate with no restrictions.

https://www.cnbc.com/2020/07/07/herd-immunity-questioned-aft...

In MA we're not even close to entirely reopened yet, but as we continue step by step the transmission rate is ticking back up unfortunately: https://rt.live/us/MA

If you look at the numbers throughout the Northeast, you see a remarkable consistency. New cases are at a trickle, despite lots of reopening (more in some places than others) and weeks of mass protests throughout the larger cities.

I am in NYC and mask compliance here is... OK. But people are generally going out a lot, eating out a lot, shopping, etc, with very little concern. Weeks keep passing without even a tiny uptick in the rate of new cases. Clearly, there is something suppressing the transmission rate in this region. The exact same holds true for Europe.

If you haven’t left NYC, it may also be true that our perception of “going out a lot” is about equivalent to much of the nation’s “lockdown” perception.

In other parts of the country, like Florida and Arizona, it doesn’t seem like the transmission rate ever really went below 1: it just hovered around 1.

So now NY, Boston, etc are “opening up” to a roughly equivalent position that those states were in when they were under “total lockdown”: in NYC, we still don’t have indoor dining, for example, whereas Arizona still allows 50% capacity indoor dining despite nearly running out of ICU beds in most hospitals.

When you’re in the center of the epidemic, merely getting to an infection rate of 1 is not good enough. NYC got well below that. I don’t think everywhere else did, and even the places “shutting down again” may not be doing enough.

The rest of New York has been in phase three with indoor dining for a few weeks now.

That doesn't tell you whether people actually are, the way they may be in some other places. Is actual behavior at all the same in, say, NY vs FL?

I'm fatalistic about avoiding the virus in the long run, and I go out whenever I have something to do, but my food has all come from the grocery store or mail order since March. I'm still asking myself "do I need to do this" every time I consider going somewhere.

I can tell you that in Manhattan, what I see are throngs of people with and without masks, enjoying parks and food and drink all day every day, often in crowded patios. Not to mention the hundreds of protests that have occurred.

You've gotta be a bit skeptical of models like this. The source data it's drawn from looks pretty indistinguishable from a flat line; there's no reason to necessarily expect their model is precise or accurate enough to distinguish 1.04 from 0.96.

Rt measures the "acceleration" of the infection. When you're down to a fairly flat ~150 cases per day then by definition Rt is going to be around 1. Also note that the reported daily case totals include backdated tests and when sorted by date, you'll see a steady decline and MA is pretty much flat now (see page 2 & 4 of [0]).

A state that was reporting 10 cases a day consistently would have an Rt of 1.0, if they reported 11, then the Rt would be 1.1. Similarly, VT which has an Rt of 1.07 despite only reporting 5 new cases yesterday as they are bouncing around in the single digits to low teens -- seems like it's basically noise now affecting the Rt there at this point.

It is going to be quite difficult to get it to zero in MA without closing the state borders. Logan Airport had 203,328 passengers through it in May 2020 [1], that's an average of 6777/day, at a 2% positivity rate that could be 135 cases a day right there (not including tens of thousands of people driving into the state, although our neighbors are in similar situations to MA rate-wise).

It's worth noting that MA has recently opened up testing to anyone who wants it so we're likely picking up more asymptomatic cases now. At this point contact-tracing is going to be key although they've had to lay off [2] many of the tracers due to lack of work for them.

The state continues to do well, we've had restaurants open (indoor and outdoor dining) for several weeks now, gyms have been open for a week (except Boston opened gyms yesterday) and 4th July was 10 days ago. The state tested 17K protestors [3] in June and only found a 2.5% positive rate (which was the same as the state-wide rate at the time).

We'll see, but I'm hopeful and will continue to do my part; distancing & masks in public.

[0] https://www.mass.gov/doc/covid-19-dashboard-july-13-2020/dow...

[1] http://www.massport.com/media/4100/0520-avstats-airport-traf...

[2] https://www.bostonmagazine.com/news/2020/06/29/covid-contact...

[3] https://www.masslive.com/coronavirus/2020/06/after-black-liv...

"Perhaps California could have attempted a middle ground strategy. Let the virus spread just a slight amount more than occurred during the initial lockdown in order to gradually spread immunity."

It's not even clear yet whether exposure to this virus confers immunity, nor how long such immunity would last if it does exist.

From the newest episode of This Week in Virology[1]:

Daniel Griffin: The tough thing, right, is that if you look at the "common" coronaviruses, they don't give us long-lasting immunity. Traditionally you could be reinfected multiple times in the same year. ... We've known this for the other coronaviruses, that if you get OC43 or 229e or any of the other, you don't get lifelong immunity, you can get sick again, and it's not clear that that second infection is milder than the first. My word of caution is to be careful about, you know, when we hear that 5 or 10 percent of the population is seropositive, I don't know what that means yet.

[1] - starting at about 14'34" in to episode 638: https://www.microbe.tv/twiv/twiv-638/

Though it has not been conclusively proven, literally all signs point to meanginful immunity and virtually no signs point to the opposite. Dozens of vaccines are being developed on this assumption, and there have been zero confirmed instances of reinfection of a fully recovered individual.

> all signs point to meanginful immunity and virtually no signs point to the opposite.

Here is a story from CNN via the Mercury News about 3 teachers sharing a classroom. Anecdotal, but makes me think these are signs of a lack of immunity. A positive, negative, positive test.

> A month after they caught the virus that killed their colleague, Martinez and Skillings are still struggling.

> Martinez says fatigue is lingering, she still has a cough, and she continues to take breathing treatments to relieve tightness in her chest. She recently tested negative and retested.

> Skillings says she thought she was getting better, but recently her cough returned full force. She tested a week ago and it came back positive again.

https://www.mercurynews.com/2020/07/12/three-arizona-teacher...

Right, when millions and millions of people become infected with an illness there will be a wide range of edge cases. But if reinfection within 6 months was anything other than exceptionally rare it would be obvious by now.

Now if you had a peer reviewed study to link instead of media reports, I would be very interested.

Not sure why you’re getting downvoted.

Seropositive tests have show the vast majority develop an immune response, how long that lasts we don’t know, but even if it’s only 6 months, that will reduce spread. You don’t create an epidemic plan based on edge cases.

And it’s important to note that the tests are looking for viral RNA. Viral RNA can be found even if virus are inactivated in the absence of an active infection or the shedding of active viruses.

No one yet knows whether the antibodies detected in seropositive tests actually confer protection against getting sick from this virus.

For some viruses, like, say, HIV, you can have lots of antibodies against it, but still be sick with HIV.

It is not yet clear whether SARS-CoV-2 is like HIV in this sense or if the antibodies produced by the body after infection with the virus actually confer protection against future infections.

There was a study where they tried to reinfect monkeys with the virus after they had developed a prior immune response. Even in laboratory setting, they could not reinfect the monkeys.

https://www.livescience.com/monkeys-cannot-get-reinfected-wi...

That, plus every case of supposed reinfection that has occurred so far is either inconclusive or proven to be a case of false positives. The big one was in South Korea, where the KCDC later determined that their test was picking up dead virus fragments.

It gets hard to keep pretending people can get COVID-19 over and over again. Maybe if had been documented 1000 times out of 13 million cases, but we haven't even seen anything close to that.

That’s true, but what we know about the Coronavirus class suggests it’s not like HIV (where the immune response does little to control the infection). Again, there are a lot of unknowns, but focusing on edge scenarios or edge cases just leads down rabbit holes.

I work in the healthcare space, and a physician recommended this review recently published in JAMA.[1]. He felt it was probably the best summary of all the data that’s out there (>29,000 papers on Covid).

I found this particularly relevant - Although viral nucleic acid can be detectable in throat swabs for up to 6 weeks after the onset of illness, several studies suggest that viral cultures are generally negative for SARS-CoV-2 8 days after symptom onset.

[1] https://jamanetwork.com/journals/jama/fullarticle/2768391

> No one yet knows whether the antibodies detected in seropositive tests actually confer protection against getting sick from this virus.

We do know when we do detailed antibody assays on people who are seropositive, that most have developed neutralizing antibodies

It seems you're moving the goalposts though. Your initial statement was that there were zero confirmed cases of reinfected individuals. The commentator gave you an example of such a case (and I can give you an another with the thoughts of a doctor [1]), then you moved back and said 'if it was anything more than exceptionally rare'.

At the very least can you maintain your argument? More dangerously could be the situation in which those that are asymptomatic initially end up with shorter duration immunity than those that have symptoms. Which would toss out a lot of our understanding of how severe the virus could end up being out the door.

[1] https://www.vox.com/2020/7/12/21321653/getting-covid-19-twic...

The positive, negative, positive cases are almost certainly testing artifacts rather than reinfections though - they all seem to involve someone who was infected testing positive after a relatively short time period, and researchers in countries like South Korea have found that the patients don't seem to have any viable virus or be able to infect others when they test positive for the second time: https://uk.reuters.com/article/us-health-coronavirus-southko...

As far as I know, their original claim is still true: there are zero confirmed reinfections with Covid-19.

I maintain that there is no peer-reviewed research proving that an individual can become infected after recovering from COVID-19. There are only scattered media reports.

However, I am not claiming it is strictly impossible. That has not been proven either. But at this point, we could only assume it is extremely rare, at least within a 5-6 month window.

People like to act like this is the end of the world. It's easy to blame media here, as media is taking a handful of cases out of millions and making sweeping (end of the world) claims.

I agree, I think there is likely meaningful immunity. But, it is very much up in the air on how long that immunity will last.

SARS immunity lasts a few years (1-3 years I believe). On the other hand, several extant coronaviruses contribute to the common cold, and my understanding is that immunity for these is only a few months or less. This is partly why one can catch a cold multiple times in a year.

It's also worth remembering that the common cold has many different sources, and only some of those are coronaviruses.

This comment has not aged well at all with several study preprints released in the last 12h indicating rapid loss of immunity and secondary infections

Do you have a source?

My comment has held true for 5 months and I have not seen or heard anything to convince me otherwise. Link? Or just more random media reports?

The immune system remembers. Some people's better than others. It'll all be OK.

The effectiveness of a middle ground strategy is pure conjecture. Canada shut down fast and hard - like California - and is not seeing cases spike. Perhaps because we re-opened slowly and people are still generally cautious - wearing masks in public and maintaining social distance. Or perhaps because we have not been getting wildly mixed messages from local/provincial/national leaders about the severity of the situation or what to do about it.

My understanding is that Canada is currently at the stage of reopening that California is rolling back to, where gyms, indoor restaurants, and movie theaters are closed.

Yup, that's the case in Ontario. Mask wearing is also now mandatory indoors. I guess the question is why did California rush to re-open fully?

The governor's been clear that's part of the intended strategy; counties will be allowed to rush forwards as long as infection rates remain low, and then pull back if infections rise. He's consistently warned that some rollbacks should be expected.

The problem with this strategy is that it's been incredibly confusing; I'm getting whiplash from all the back-and-forth. The news reporting has been bad, as well, not clearly distinguishing between statewide and per-county (or for counties on the "watch list", which changes daily).

My friends who are in the service industry have to figure out from day-to-day what they're going to be doing. This is just a giant mess.

Yeah, I think that's fair. I've been plugged in enough that I don't feel the whiplash much, but I can't imagine how confusing it would be to understand what's happening from just scrolling through headlines in the morning.

...and just this evening Santa Clara county (most of the valley) announced they're shutting down gyms and salons on Wednesday, because they expect the state will shut us down anyway. Craziness.

I'm glad our state is doing something, it's just so unpredictable.

It's also hard to rollback quickly when you've got a 2-week lag between when you steer the ship and when it starts to turn. I can't see how anything other than a gated approach over significant time can be preferable, unless the motivation is political (spoiler: it is).

It is, but... should it not be? Politics is the process by which people decide what society should look like.

I was happy when the state released clear metrics for what would allow a county to move onto Phase 2.5 and Phase 3 of the reopening.

Initially one of the key metrics is that the county have 0 deaths and no more than 10 new coronavirus cases per 100k residents over a 2 week period.

Then the number became 25 cases per 100k residents.

Then it became 100 cases per 100k residents.

Then my county was permitted to mostly reopen with 300+ new cases per 100k residents, in conjunction with a few hundred deaths per week. To me it's clear that we've strayed from the original emphasis on "science based" metrics.

Which county might that be? Only Los Angeles has more than a few hundred death due to COVID total.

In Santa Clara county still about 20 times as many people die every day due to unrelated causes than due to COVID. That makes it hard to justify the economic damage, which is devastating to those who lost their job and are waiting for unemployment benefits for months now.

Yup, LA. I think we're currently ~50 deaths and 2500 new confirmed cases per day

> I guess the question is why did California rush to re-open fully?

Because states have a higher cost of borrowing than the feds and usually also have constitutional balanced operating budget mandates, they tend to rely on federal aid to deal with major extended emergencies. With the feds not providing substantial state aid in this crisis, there’s significant financial pressure for economic reopening.

Canada did not act in unison, it was very province-by-province. Ontario locked down quite hard, whereas British Columbia only required shutdowns of service businesses, and suggested everyone stay in.

My mistake. I guess I'm specifically speaking of Ontario.

Outside of Ontario & Quebec on really Vancouver and Calgary have had any notable cases. The infection rate country-wide is minor compared to California and almost all deaths are clustered in retirement and extended care facilities. Most importantly the health care system was never even close to overwhelmed. It's been a very different story than major US hotspots.

You paint an incredibly unfair picture with your comment.

British Columbia shutdown hard and fast, controlled the disease well, and has daily case numbers in the single digits.

Ontario fucked everything up, had massive spread in their care homes, and still has hundreds of cases a day.

It was all middle ground strategy from day one. The national lockdown was timed to the nyc wave and that was a probably a mistake depending on how you view the purpose of the lockdown. If it was to flatten the curve, outside of nyc, we did too much too soon and are now reaping the effects of “precaution fatigue.” It’s a marathon rather than a sprint, but each region, has its own race to run on it’s own timeline, it’s own demographic and medical infrastructure factors.

Or maybe it's just that the places where it spreads are indoor dining and bars, and people just won't stop overanalyzing it.

> The national lockdown was timed to the nyc wave

There was no “national lockdown”. The California lockdown was timed based on the Bay Area and Los Angeles surges.

> ... but any amount of immunity in a population makes transmission of the virus more difficult.

That may be true from a pure logical/mathematical point of view, but that doesn't mean it makes a practical difference.

Herd immunity is something that happens when a very large percentage of the population is immune. For mumps (which has a very high R0), you need about 92% immunity level for it to be effective.

For COVID-19, it is currently estimated to be around 60+%. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151357/)

We are nowhere near these kind of immunity levels right now, and it's impossible to get to that level without vaccine unless you're willing to accept that a huge amount of people will die or get seriously ill.

Any suggestion that herd immunity is relevant in today's environment is plain wrong.

But we knew it since March. Any reason to not believe Angela Merkel who says continuously it's just beginning and will last years? Now we even know there's probably no long term immunity. Antibodies to other coronaviruses last around 12 months, so COVID-19 case might be similar.

I did not suggest herd immunity has occurred. You seem to be confusing the idea of herd immunity with the similar idea that any immunity in a population will reduce the transmission rate by some amount.

You’re saying that maybe CA should have done some middle ground closure since that might have help a little more with increasing immunity.

My point is that the goal of increasing immunity is pointless unless it can be raised to a very high percentage and without taking massive casualties.

Without a vaccine, that’s simply not possible for COVID-19.

And thus that suggestion doesn’t make a lot of I sense.

The benefit of a slight higher but still very low level of immunity is so small that there’s no point.

The point of raising immunity is to (speculatively) make it easier to keep the transmission rate low. So other measures become less necessary. Maybe we could open schools, for example. This seems to be what has happened in the places that have been hit hardest. But obviously partial immunity in the population is only one factor impacting the transmission rate. There's masks and lack of indoor gatherings, etc. Though I hear in France, which was hit very hard, they're not even bothering with masks any longer.

Yes.

But increased immunity is only useful if it reduces transmission rates substantially, measurably.

And that requires a very high immunity rate.

It’s pointless to pursue an increase in immunity when the transmission rate only reduces by some negligible amount that’s in the noise.

In how many ways do I have to restate the same concept?

In Sweden none of the studies have shown immunity levels anywhere near that high, but ICU cases and deaths are trending down sharply, despite people getting tired of social distancing (BLM protests, high school graduation parties, midsummer parties all happened with no corresponding spikes) and having started traveling for vacation.

This is a strange virus, there is something else going on causing lower levels of immunity to have a stronger impact on cases than the naive math would suggest.

This is the same thing that happened in India. Precious lockdown token was used up too early, now they can't go back to lockdown again even thought its speading like wildfire.

I'm not a virologist, but it seems like even in NYC the antibody test was "only" ~20% positive. ~30% if you drill down to certain subgruops: https://www.6sqft.com/new-york-covid-antibody-test-prelimina...

I think it would mean, even in NYC, its current "herd immunity" would reduce the so-called R value by only 20%. That doesn't sound enough to explain the difference between NY and CA.

There have been multiple publications in the last month suggesting that a substantial fraction (i.e. 40% or more) of the population could have some level of cell-mediated immunity to the virus.

https://www.sciencemag.org/news/2020/05/t-cells-found-covid-...

https://www.biorxiv.org/content/10.1101/2020.06.29.174888v1

On top of that, the threshold where growth slows is substantially lower than the “herd immunity threshold” that is naïvely calculated from R0. The flu almost never infects more than 10-15% of the population, despite an R0 of around 1.8, and a corresponding “herd immunity” threshold in the 50% range. A recent Science paper suggested a more reasonable herd immunity threshold of 43% for Sars-CoV2.

https://science.sciencemag.org/content/early/2020/06/22/scie...

Between the two, it’s not inconceivable that NYC has reached the point where virus transmission is substantially self-limited. It’s not even a remote possibility - it’s likely.

If you look at the subgroup of most socially connected people most likely to come into lots of contact with other people, they probably hit really high numbers. And then those "hub" people being immune could have an outsized effect on reducing further spread. I have no idea of he numbers though and if it is playing a large role.

It's easy to be misled by the nature of exponential growth. In most people's vocabularies these days, the term seems to mean just "very fast", but correctly understood, it's more specific and more complex than that.

Exponential growth, in this context, means that the rate of new infections is proportional to the number of existing infections. This cuts both ways: when the number of existing infections is large, the rate of growth is also large -- which is why exponential growth is so dangerous -- but when the existing number is small, the growth rate is also small. If you look at a graph of an exponential curve, there's a long relatively flat region to the left, before the knee in the curve is hit and the thing takes off.

The point is, even though we here in CA started the lockdown relatively early, we've never gotten the case numbers down to a manageable level. I'm not sure why not. Although a lot of us have taken the virus seriously from the beginning, maybe there are still too many who don't. The sad truth is that a lot of people won't believe it until it affects someone they know -- and while it's well under control, that tends not to happen. So it looks like a bad outbreak in a region creates "mental herd immunity", where almost everyone cooperates with the lockdown; places that haven't had such an outbreak don't take it as seriously.

> The point is, even though we here in CA started the lockdown relatively early, we've never gotten the case numbers down to a manageable level. I'm not sure why not.

Because we started reopening just as the curve was flattening, without bending the numbers down much.

The visual “knee” is purely a result of your chosen scale; there is no scale-independent mathematical definition.

Put it on a log/log chart, and it’s a straight line; no part of the growth is qualitatively different than any other.

I'm well aware of that -- except that an exponential is a straight line on a semi-log chart. But to people hearing the numbers, who aren't familiar with the phenomenon of exponential growth, a linear scale, despite being somewhat arbitrary, better captures the psychological impact. Consider an idealized example: we start with one case, and a doubling time of three days. It takes the whole first month to get to about 1000 cases. Even though you and I know that that's an extremely aggressive growth rate, 1000 cases still doesn't sound like a lot to many people, when they compare it to the population of the US (or annual numbers of deaths from various other causes, like swimming pool accidents -- a comparison I've actually heard made). In the next month, though, it would get to 1M cases, which is a much larger fraction of the population and is correspondingly likelier to get people's attention.

Sweeden didn't lock down at all: https://youtu.be/z34ILhFs-xs?t=182

There is little evidence the lockdowns did a damn thing.

Resuming the lockdown, particularly in such a sudden fashion, is just blow after blow.

Such small benefit for such enormous cost.

I am not convinced this could get through the legislature. I'm also confused how "emergency powers" can last for Governor's to have almost unlimited power for 4 months now.

As someone with weak lungs and a weak immune system, how about we not deliberately let the virus spread, mmmkay? That would be really super. How about, instead, we actually implement a Stay At Home order with teeth and enforcement, and actually try to wait this out until a vaccine becomes available. Unlike what we did which was an overtly unenforced Stay At Home Suggestion that people predictably ignored..

> Part of why I make this strange argument is because CA seems to have endured a lockdown for virtually no gains.

California never implemented a lockdown. The people staying home did so voluntarily, but the rest were out horsing around as usual doing whatever non-essential tasks they could find among what businesses they could find that were also defying the "order". Putting everyone else at risk who had to step out to do actual essentials like limited grocery shopping.

The only question now is, which state will win the race to be the first to reinstitute stay-at-home orders?

My guess is that no states will do that.

Even as the number of cases goes up, deaths (the more important number) keeps coming down.

https://i.imgur.com/LMVNbBD.png

We keep hearing about how this trend will reverse soon, ("two weeks from now"), but that hasn't happened yet.

It seems pretty clear now that even our low estimates of fatality were too high and that many people had Covid-19 in March/April/May and were never tested/counted.

> deaths (the more important number)

One of the more interesting things I've been reading is that we shouldn't think about this as a total binary. There are reports that survivors exhibit have long-term effects, such as neurological issues [1] and lung damage.

So yes, it's good that fewer people are dying! But that doesn't mean everything is simply great now.

[1]: https://www.bbc.com/future/article/20200622-the-long-term-ef...

My guess is that the deaths probably would maintain roughly the same rate for the true number of infected, which is a number we do not know because of asymptomatic cases. That numbers of people testing positive is going up doesn’t mean that the overall rate is going up given we do not know the true infected rate, but number of deaths provides a reasonable proxy for that.

We understand the disease a bit better, and have better treatments (eg dexamethasone) than we had in March, so I'd expect the true fatality to go down somewhat. (read carefully, this is not in contradiction with the CDC raising their estimate of the IFR). Better treatments are of no use if hospitals are overwhelmed, unfortunately.

The percentage of tests with a positive result has increased, which indicates an increase in the true number of cases.

https://coronavirus.jhu.edu/testing/individual-states

Deaths may look stable/going down, but that's potentially difficult to understand given regional reporting. I think deaths are naturally down as the "first wave" hit many long term care facilities with a much higher death rate than the rest of the population.

Check out the SF data: comparing "All California" to Bay Area shows that we're rising in cases and deaths in california as a whole, but flat/declining in northern california.

This phenomenon, I believe, is happening all over the place.

https://projects.sfchronicle.com/2020/coronavirus-map/

> We keep hearing about how this trend will reverse soon, ("two weeks from now"), but that hasn't happened yet.

It happened a week ago. It's easier to see when you look at a moving average.

https://imgur.com/a/xGLRjGa

https://www.worldometers.info/coronavirus/country/us/

https://ourworldindata.org/grapher/covid-daily-deaths-trajec...

Yes, there's a blip at the end of the chart.

But the headline is clearly that deaths have fallen ~70% even as total (reported) cases has continued to grow exponentially.

The US wide totals are muddling the picture substantially. Deaths have continued to shrink substantially in previously severely affected states like NY or NJ.

The other big issue of course is lag. If you look at daily positive tests, current hospitalizations and newly reported deaths in one graph the lag becomes more visible.

Here I e.g. just used a log y axis to show all three in one plot: https://anarazel.de/t/2020-07-13/all_in_one.png

which imo makes that more visible.

That seems to me to be obfuscating the factors that everyone knows. Cases are growing exponentially in some states, while deaths fell tremendously in the states that previously had the most cases. California and Florida didn't have deaths fall 70%; they had deaths more or less plateau, while the age of the infected shifted younger, and now the increase in cases is getting to the point where it more than compensates for the lower death rate.

3 weeks ago there was a blip at the end of the cases chart just like this one. You don't need to be a super genius to understand that the growth rate in deaths is roughly going to lag the growth rate in cases by about the amount of time it takes someone to die, which is about 3 weeks.

3 weeks from today we will have about 2200 deaths per day, based on the 7 day moving average.

3 weeks from today we’ll likely be at around 1000 deaths per day, not 2200. https://covid19-projections.com/us

The case fatality rate for the virus is going down due to increased testing (identifying more cases) and better treatment (Remdesivir, dexamethasone, and better medical knowledge in general).

So it won’t be as bad as a naive extrapolation might make things look. Still bad though.

C19pro is the best model out there, but it only uses deaths as its input. That's good because cases are a noisier measurement, but it's bad because of the lag effect I just described. It will take time to correct if there is a large transient in R.

All else being equal, if the case count triples, the death count is going to triple. Now in this case there are two things that aren't equal. #1 is that the cases are more biased towards younger people, and #2 is that positivity has increased. I expect that these two factors will roughly cancel each other out and the death count will be about 2200. Would you care to place a wager on the over/under at 1600?

> deaths (the more important number)

Is it though?

> For every one person who dies:

> 19 more require hospitalization.

> 18 of those will have permanent heart damage for the rest of their lives.

> 10 will have permanent lung damage.

> 3 will have strokes.

> 2 will have neurological damage that leads to chronic weakness and loss of coordination.

> 2 will have neurological damage that leads to loss of cognitive function.

* https://www.quora.com/How-can-a-disease-with-1-mortality-shu...

This is the point that so many people miss.

We’re also 1/3 of the way to WWII deaths in the US.

>18 of those will have permanent heart damage for the rest of their lives.

Adding critical context: Nearly half of americans are obese and/or have heart disease, and ~650,000 are killed by it each year.

How much lower would all those numbers be if americans simply exercised and ate healthy on a regular basis?

How does this pass the sniff test (or am I misinterpreting it?).

Assume 1% fatality rate for infections (it’s actually lower), you’re saying somewhere 19% to 60% (depending on overlap of those categories) have permanent damage?

That’s clearly not what we’re seeing.

> How does this pass the sniff test (or am I misinterpreting it?).

Article links to sources. Interpret as you will.

Just a counter-'claim' against the GP that all we have to worry about is the fatality rate.

As hospitals fill up, even with a low mortality rate, it means all sorts of other procedures are delayed or cancelled.

You're misinterpreting it. It says that for every 1 fatality there are 19 covid patients that have longlasting complications. It doesn't state though how many mild, uncomplicated cases there will be for every 1 hospitalized, i.e. what the denominator is. For example, if there are 1000 cases for every hospitalized case, then 19/1000 isn't that high.

I’m still confused. We know the fatality rate is ~1% (0.6% as per CDC’s latest).

So for every death there are 99 other cases. There is no way that 19 of those have permanent disabilities. That would means several million Americans are seriously disabled by the virus.

The Quora link cites sources if you doubt the math.

They are funky. The source of the “19% had heart damage” is 19% of those hospitalized.

We know that approximately 10-20% of all cases are hospitalized. So that 19% is actually 2-4% (19% of 10-20%).

> Even as the number of cases goes up, deaths (the more important number) keeps coming down. > We keep hearing about how this trend will reverse soon, ("two weeks from now"), but that hasn't happened yet.

Your graph shows an increase over the last week. A rolling average shows that more clearly:

https://covidtracking.com/data/charts/us-daily-deaths

If you look at the currently worse off regions / states you can see the rise in deaths more clearly. E.g. in the south and west there's a pretty clearly recognizable rise:

https://covidtracking.com/data/charts/regional-deaths

Here's a link to per-region stats: https://covidtracking.com/data/charts/all-metrics-per-state and some example states with pretty clear trends:

AZ: https://public.tableau.com/shared/6GDK353C7?:display_count=y...

CA: https://public.tableau.com/shared/GKK6SFGNR?:display_count=y...

FL: https://public.tableau.com/shared/P2SSPXC3Y?:display_count=y...

TX: https://public.tableau.com/shared/M8KY224BR?:display_count=y...

> deaths (the more important number) keeps coming down.

Deaths are important, obviously, but they are also a severely lagging indicator.

Edit: Formatting

The linked NYT article says that deaths are up 28% over the last two weeks.

... after dropping 80% from the peak

The places that had the drop in deaths aren't the places that are having the exponential increase in cases now.

It makes no sense to say that deaths have plummeted in NY, as cases have too, and therefore Arizona or Florida doesn't have to worry about deaths increasing as cases skyrocket.

> We keep hearing about how this trend will reverse soon, ("two weeks from now"), but that hasn't happened yet.

It hasn't?

https://www.cnbc.com/2020/07/10/coronavirus-deaths-tick-up-i...

You're mixing those states together with New York, for which cases and deaths are strongly positively correlated:

https://www.nytimes.com/interactive/2020/us/new-york-coronav...

>We keep hearing about how this trend will reverse soon, ("two weeks from now"), but that hasn't happened yet.

Deaths are down if you look at the US as a whole.

However, if you look at the state level its not always the same picture.

Florida's death toll is up from a 7-day rolling average of 51 in April (the peak of its first wave) to 71 as of yesterday.

I can't edit my comment now, but I also just noticed that the CDC recently revised the IFR upwards from 0.26% to 0.65% (https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...), apparently as of a few days ago. Our death rate estimates were too low, if anything.

Nostromo has been consistently spreading misinformation about the pandemic on HN since it started. When are they going to be banned?

Having a wide and healthy discussion on this site does not require that we entertain people advocating mass death.

The constant refrain that this isn’t a big deal seems belied somewhat by the five hundred thousand dead people.

You guess, keep hearing, seems pretty clear.

Thanks doctor.

Maybe next you can educate us on why the data you linked literally contradicts everything you said. The trend in deaths is increasing.

I'm very grateful for the rollbacks.

I was against Newsome but how he's handled this pandemic is better than both Dems/Repubs. I understand he felt he was too 'heavy-handed' in the beginning but it was the correct decision. But...he's trying to appease the 'center' by allowing counties freedom to make decisions. Regardless, he's doing the right thing and I'm glad I moved here a few years ago.

In conclusion, I hope Gavin tries to get a real deal on masks (buy them for Californians and give them away at steep discounts) and mandate masks THROUGH THE LEGISLATURE or fear of automatic fines. Japan is doing great and they work indoors but the key is they all wear masks. We need a robust mask policy, asap.

P.S. Since I can't reply to the [dead] comment below, let me do that here. The reason why Gavin should do it through the Legislature is for permission and buy-in. It only needs to be temporary but in the same action, one could reduce the price of compliance by leveraging the size of the California govt, heck he could even get businesses involved too, make a really large purchase. This isn't about fines, it's about preventing the spread of covid19.

Closes all non-critical offices, which for HN, should be big news. How is everyone's company deciding whether it's "critical" or not?

This doesn't sound like I want to go the herd immunity route: https://twitter.com/DaniOliver/status/1279155358666305541

These are the affected counties:

https://twitter.com/GavinNewsom/status/1282780070323515393

Notably, San Francisco isn’t included. Probably because SF hasn’t opened up as much as other counties on this list.

Neither had Contra Costa, yet here we are.

It's not just those counties. There are new statewide restrictions:

https://twitter.com/GavinNewsom/status/1282752861835649024

The counties you listed have additional new restrictions.

https://mobile.twitter.com/GavinNewsom/status/12827536569834...

I dont understand for the life of me why the state cant get tough on masks and distancing with the rule of law. All they do is put out suggestions and guildelines. Until they flex the guidlines with some muscle it's just theatre

Because it's unconstitutional and masks don't even work unless they are N95 which are fitted. Neither for the wearer, nor for the people around them.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181938/

https://www.cdc.gov/eid/article/26/5/19-0994_article

> Disposable medical masks (also known as surgical masks) are loose-fitting devices that were designed to be worn by medical personnel to protect accidental contamination of patient wounds, and to protect the wearer against splashes or sprays of bodily fluids (36). There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure. Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza.

> We did not consider the use of respirators in the community. Respirators are tight-fitting masks that can protect the wearer from fine particles (37) and should provide better protection against influenza virus exposures when properly worn because of higher filtration efficiency. However, respirators, such as N95 and P2 masks, work best when they are fit-tested, and these masks will be in limited supply during the next pandemic. These specialist devices should be reserved for use in healthcare settings or in special subpopulations such as immunocompromised persons in the community, first responders, and those performing other critical community functions, as supplies permit.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/

> Penetration of cloth masks by particles was almost 97% and medical masks 44%. This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.

https://www.osha.gov/Publications/OSHA3767.pdf

> The purpose of a facemask, when worn by a patient suspected or confirmed with an illness such as influenza or tuberculosis, is to reduce the amount of large infectious particles released as the patient talks, sneezes, or coughs; this limits their concentration in the room air and reduces the infection risk to others who are present.

> However, facemasks by design do not seal tightly to the wearer’s face. Therefore, they allow unfiltered air to easily flow around the sides of the facemask into the breathing zone and respiratory tract of the wearer. In addition, the materials used for facemasks are not regulated for their ability to filter particles and are known to vary greatly between models. This makes it possible for small particles to pass through or around the facemask and be inhaled by the wearer. This is why they are not considered respiratory protection— facemasks do NOT provide the wearer with a reliable level of protection from inhaling smaller particles, including those emitted into the room air by a patient who is exhaling or coughing, or generated during certain medical procedures.

Also eyes are an entry point too:

https://www.biorxiv.org/content/10.1101/2020.05.09.086165v1....

> Conclusions: Together, these results indicate that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus. This highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease.

EDIT: Why is everyone downvoting me? I literally shared multiple studies which state "There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure."

>I literally shared multiple studies which state "There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure."

It's the first half that I would take issue with, and I don't see anything you quoted as convincingly supporting it.

Garden variety masks are not suitable for healthcare professionals; that's why N95 masks are reserved for them. But the ordinary masks are vital to reduce the odds of transmission where the proportions of infected to not-infected are inverted.

It's fundamentally different whether you have one (potentially) infected person surrounded by non-infected people, or one (presumably) non-infected person surrounded by infected people. The latter needs an N95 and maybe more, and the former needs anything as long as it deflects exhalations a little.

As I mentioned to the other person, the first study I cited states:

> There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure.

The later study also states non-N95 masks allow 97%. So basically useless.

I don't see the statement that there is "limited evidence" for something as providing information. Is there "unlimited evidence" for anything?

The studies you cite focus on the use of masks to protect the wearer of the mask. The purpose of masks is not to protect the wearer of the mask but to protect others.

In simple hand-waving terms the mask diffuses the wearer's exhalation reducing the velocity of the air stream and its contained particles, thereby reducing the distance the particles can travel and increasing the odds that the particles drop out of the airstream and onto a surface before they encounter another person.

The diffusive effects of masks does not provide a 100% barrier but given that Covid-19 appears to be predominantly transmitted via airborne particles rather than surface contact, mask wearing can still have a large impact on transmission without being directly protective of the wearer.

No, the first study I cited states:

And the later study states non-N95 masks allow 97%.

The Xiao, et al study you refer to is a historical literature review of transmission of prior non-Covid-19 viruses.

It is unclear if the historical studies involved social distancing or close proximity (critical to current understanding of Covid-19 mask efficacy) and it is concerning that the paper reports "most studies were underpowered because of sample size and some studies also reported suboptimal adherence in the face mask group."

More importantly, Covid-19 appears to have different transmission characteristics than other influenza style viruses, making literature reviews such as the one you cite less predictive of Covid-19 behaviors than would often have been the case with other viruses.

The paper is interesting but it's definitely not supported by their data to say the paper shows masks worn by infected individuals are ineffective at reducing the spread of Covid-19 in a social distance context.

[edit: updated with additional detail from the cited paper]

Enforcement is the state forcing its will on you eliminating the individual’s ability to evaluate risk. Eric Garner is dead because of government rule flexing you suggest.

The government should buy ads showing the efficacy of face masks and use the ad council to pretty it up.

If you have politically connected individuals flouting the rules, people will salami tactics their way to not wearing the masks.

*edit: thanks for the word correction suggestion.

FYI it's "flouting".

> Enforcement is the state forcing its will on you eliminating the individual’s ability to evaluate risk.

Except that the primary benefit of masks wrt covid is to significantly reduce the likelihood of the wearer to spread covid (by reducing how much spit escapes ones mouth). So the decision to wear/not wear is not directly about the decider's risk, it's about societal risk.

That's a myth which keeps getting repeated. I posted multiple studies which debunk it:

https://news.ycombinator.com/item?id=23825646

They don't debunk anything.

The last study you quote says "this highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease.". Another is a meta-study of very few low quality studies. The osha guidelines are essentially just explaining that respirators are important in some settings, which nobody serious doubts. Another just determines that respirators are more effective than cloth masks. Doh.

Just quoting a bunch of half related studies doesn't make a fact.

How is it half related? The first study I cited states:

I cited multiple studies. No idea where your "bunch of half related studies" is coming from. Your comment comes off as condescending.

Journal of the American Medical Association has a more recent publication on this question with current results from Covid-19 data as opposed to earlier viruses[0]. Their conclusion is the same as the consensus conclusion here on HN, that masks can play a significant role in preventing the spread of Covid-19.

[0] https://jamanetwork.com/journals/jama/fullarticle/2768532

Why doesn't the state also mandate exercise, diet, and sleep?

Because lack of those generally doesn't harm others.

And, you can be charged with things caused by lack of sleep--reckless driving, for instance.

However, there is a difference between fining someone for lack of compliance and jailing someone for lack of compliance. Jailing someone in the middle of a pandemic is stupid.

This is such a silly response. Did you have the same compelling argument when mandatory seatbelt laws went into effect?

What's silly, precisely? Seat belts are cool, so no, you're wrong.

Homemade masks (as opposed to N95) and handkerchiefs are only marginally effective against reducing transmission. Having a strong immune system is a scientifically proven way to reduce your health risk significantly.

What is silly is all the people who are content to do the absolute bare minimum, easiest possible thing to attempt to protect people's health: merely putting a piece of cloth on their face; while at the same time neglecting to put in the work to improve their overall health, and thus their risk to others of spreading the virus.

States have existing laws about controlling diseases.

      https://www.ncsl.org/research/health/state-quarantine-and-isolation-statutes.aspx

If you want to advocate for additional science based health laws, go ahead.

Can you really imagine the police confronting and/or arresting someone for not wearing a mask only to take them to jail to contract the virus?

They're called fines. This is a total strawman.

What happens when people don't pay the fines? I am under the impression that a warrant for arrest would be issued by a Judge. At which point, I imagine you'd go to jail when apprehended.

While in jail, my understanding is that there is an increased likelihood of contracting COVID due to lack of social distancing and ability to more easily follow recommend guidelines to prevent infection.

Still seeing scarecrows?

What? I was implying punitive measures in general, but the logic on COVID in jail seems to be a bad one. If you can't be in public and respect the spread of the virus, at what point do we take you out of circulation until the danger has passed?

The same argument can be made about violence. If you commit violence against another human you go to prison, but violence rates are significantly higer in prison, so are you implying we dont send them there?