> Thus while SARS-CoV-2 is and will remain endemic (circulating in the population), it will barely kill anyone once the current world population is largely exposed to it.
You mean once _all_ the people who could die from it, have died from it?
You mean once _all_ the people who could die from it, have died from it?
I anticipated this response of yours. It sounds like a great gotcha in its surface, until you realize that every fast-spreading respiratory virus works like that. It's happened with every flu pandemic, including the recent H1N1.
SARS-CoV-2 appears to be an incredible spreader and a poor killer. What that means is the cost of perpetually trying to avoid infection are very high, whereas the benefits (avoided mortality) are quite low.
Case in point, SARS-CoV-2 exhibits a fairly high degree of pre-symptomatic spread. I believe that this is almost certainly due to the findings of interferon-mediated early-course immunosuppression (read: in the early days of infection it prevents your immune system from reacting strongly, meaning that unlike many other diseases there is a period where you have enough viral load to spread it yet don't express symptoms). Also note that it does not exhibit asymptomatic spread, which would be even "worse" since pre-symptomatic spread only gives you a window of maybe days whereas asymptomatic is by definition across the whole disease course.
Now factor in the fact that many people are either completely asymptomatic or paucisymptomatic (few symptoms). For those people, which may even be the majority of cases, it's such a not-big-deal that most don't ever realize they've had it. Some will have more of an actual cold, and some will have symptoms comparable to a run-of-the-mill flu. A small fraction of those infected will go on to experience increasingly severe symptoms, probably comparable to a normal SARS-1 infection (since SARS-1 is quite nasty), culminating in the worst cases in the need for invasive ventilation at which point death is incredibly difficult to avoid. (This is obviously an area of active research but it appears that the severe form of the disease is related to a state of immune disregulation where pathological cytokine release syndrome, the tissue damage from widespread neutrophil infiltration, etc wreak havoc).
So, we have a virus that spreads incredibly well, yet is overall incredibly mild, and has very well-defined populations who are at real risk of severe outcomes. That is precisely the type of virus that is a horrible candidate for lockdown, which damages the entire society in the attempt to prevent what is perceived as a greater threat (but is actually not, in my opinion).
So, as a society we saw a papercut and chopped off our hand. Oops.
I am happy to provide sources for pre-symptomatic spread, interferon-mediated immunosuppresion, etc, but first I wanted to make sure that you were here to engage in good faith dialogue; i.e. whether I can convince you or not, you are actually willing to read (or try to read) the papers. I'm a bit scarred by numerous times (here and elsewhere) where I've invested a bunch of time into detailed posts and then quickly realized that the person on the other end was never serious about addressing the problem of SARS-2 but instead was there to toe the party line and reinforce their pre-existing conclusions.
Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization. H1N1 was never this bad, and we are no near achieving any herd immunity.
"The 2009 H1N1 pandemic was estimated to be associated with 151,700 to 575,400 deaths worldwide during the first year it circulated."
Can I get a source here? Are you basing this off of the "case hospitalization rate"? Because that number will overestimate the true hospitalization rate by a factor of 2-100x depending on where you're talking about. Same principle of looking at CFR vs IFR (although ironically CFR will start trending down, not just in the real sense as doctors get better at not overreacting with early intubation, but also in a numerical sense as states like Florida are clearly misrepresenting their case numbers which will make the denominator larger)
As one example, in the population of people who can actually still get bad outcomes but have the best outcomes - people in their 20's - the implied hospitalization rate from serology studies gives us something like 1 out of 500 young people getting hospitalized (see https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c...). So that gives us a lower bound, and a semi-decent upper bound would be the 3.4% hospitalization rate in the 60-69 age group. (They don't seem to report >69 years, which would be way worse) <--- Note that study I found a couple months ago at least, so there are probably better numbers out somewhere now, but I lost some motivation to keep doing SARS-2 research once BLM started because it became clear that it was never really about saving lives in the first place. Although that's a topic for another day)
The observation of widespread cross-reactive T Cell immune response does not support this claim. If 50% of the population is less susceptible, this would dramatically alter the herd immunity threshold. The binary condition "totally susceptible or totally immune" is merely a fiction used in some models, and any individual variation away from "totally susceptible" has the same effect:
https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v...
If NYC does not see a second wave, and their seropositive numbers stay below or around 30%, this is why.
Given that we cannot time travel and all.
Also, other countries well below 30 percent seropositivity also don’t show signs for second waves, so that‘s an indication that your explanation isn’t the only possible one.
Also, healthcare systems were overwhelmed nevertheless and with measures (lockdowns) in place.
So yeah, pretty awful argument.
https://www.militarytimes.com/news/your-military/2020/04/14/...
https://nypost.com/2020/05/02/nyc-hotels-meant-for-recoverin...
https://www.amny.com/coronavirus/brooklyn-field-hospital-shu...
I agree that ICU capacity, PPE inventory, and non-infected personnel were all in short supply at times and in places, but it's not such a simple conclusion as you claim. Consider that early venting seems to have been a terrible blunder, which also used up valuable ICU capacity:
https://annalsofintensivecare.springeropen.com/articles/10.1...
The USNS Mercy was sent to Los Angeles, you probably mean to refer to USNS Comfort which was in New York. But both Mercy and Comfort were offered by the Feds for non-COVID-19 patients only.
That doesn't affect the argument. The fact is that the other facilities were able to handle the total of "normal" patients as well as COVID-19 patients. The entire set of patients did not get to a size sufficient to need those boats.
The same question can be asked about the Comfort of course, but I guess we can shift responsibility to the Feds for that fuck-up.
This is obviously due to the absolutely massive measures they took. They managed to put on the breaks just on time.
Italy was maybe a couple centimeters more under water but also not totally overwhelmed.
But Italy actually had to ban people from going outside (with tight exceptions) to achieve that which is nuts.
If you were testing more and catching it earlier you could get there with much milder measures (e.g. in Germany) and hospitals that came never close to being overwhelmed, as in Germany.
I don’t get you non-sequitur about people in nursing homes. How am I supposed to respond to that? Yeah, that‘s stupid? Because it is?
This is not self-evident. Most evidence seems to show that lockdowns didn't start till after the peak anyway.
This is more or less a myth. The real story is the massive scaledown in medical capacity across the country.
Locally, in New York, certain hospitals hit capacity. Other hospitals nearby did not.
Additionally, if the goal is only to avoid hospital overrun, you should concede that our current strategy is totally misguided, since we are trying to suppress spread way beyond the threshold required to prevent overrun. (Actually, I believe that we could do literally nothing to slow spread and not have a true overrun scenario, but that's a discussion for another time)
Case in point: In California our Dear Leader Gavin Newsom just plunged us right back into lockdown, including closing fitness centers (gyms), despite our hospital system being in completely fine shape.
It's all a farce. I don't use that word lightly.
As a thought experiment, imagine a world where SARS-CoV-2 jumped to humans just the same as it did, but magically we never found out about it. So, it spreads completely uninhibited. That world is a world with less unemployment, less poverty, better educated kids, less attainment disparities (lockdown, online schooling, etc ALWAYS disproportionately impacts the poor), less all-cause mortality, and in my opinion, less COVID-19 mortality over the medium-term.
Contrary to everyone saying "how can you say this is a mild virus, are you crazy?", the evidence overwhelmingly shows that it is very comparable to a bad-severe flu season at worst.
No, we would have been way better off doing nothing. That's what's so sad. Every measure we've deployed has not only been arbitrary and capricious, has not only been ineffective, but has actually made the problem worse insofar as they were effective.
I've seen people make risk appraisals with COVID-19 that are completely alien to how they evaluate risk in any other areas of their life. In the extreme case, I have friends who regularly engage in unprotected sex and do all kinds of dangerous drugs like benzodiazapenes, who are not in a COVID-19 at-risk group whatsoever, yet are petrified with fear for their personal safety (it's not that they're super selfless and just worried about infecting others, to be clear).
As a more moderate example, I've seen mothers petrified to send their kids back to school, despite the fact that their kids are at no risk from this, and despite the fact that their kids are actually at risk from Influenza, from meningitis, etc.
The real pandemic was the pandemic of mass collective delusion, accentuated by (here in the US) our tumultuous political environment in which people are willing to distort anything to the point of absurdity if they think it will win them political points.
> We don’t know whether that’s true still and what the impact exactly is.
Well, at this point you must be willfully closing your eyes. We have good evidence of pre-existing immunity in a chunk of the population. We have good bounds on our IFR, leading me to settle on a final number of around .30%. We have very clearly delineated risk factors. For many people, Influenza is more deadly, for many people they are about equivalent (for example if you are 55 with diabetes/hypertension and overweight but not obese, your risks are pretty comparable), and there are some for whom SARS-2 is way more dangerous (people 70+ with comorbidities). So even ignoring the pre-existing immunity and even without accounting for heterogenous suceptibility, when you run the numbers it quickly becomes clear that what we've done is not just unprecedented but is actually insane.
Note I haven't even brought up the constitutional/ethical implications of what we've done. I think what we've done, speaking from a US perspective, is completely unconstitutional, doubly so after the BLM protests started and were given a free pass while people were banned from church (I don't have a religious bone in my body and I think that's incredibly evil). Not to mention we've thrown the notion of personal responsibility out the door. It used to be that if I went out into public and got the Flu, I understand that that was a risk of being a human in the real world, and that if I wanted to avoid the flu I should have stayed sealed in a hamster ball, whether metaphorically or literally. And yet with COVID, if someone goes to the grocery store and gets COVID, suddenly it's the fault of everyone who ever refused to wear a mask, or everyone who did wear a mask but went to the grocery store just to grab one item rather than dutifully only going every 2 weeks, etc.
The reason I don't talk about ethics/constitutionality is because it doesn't convince the people I'm trying to convince (people like you). I consider it self-evident that anyone who seriously supports lockdown simply does not care about the constitution and clearly does not share my ethical framework, which I understand. Which is what's so crazy about this to me - purely from a utiltiarian perspective, any truly balanced look at the risks/rewards of lockdown would have any sane person immediately run out of the room screaming. That's how bad the deal is. Yet somehow, the risks of COVID-19 (which are quite well-defined right now btw) are perpetually unknown and we never know enough and there could always be lifelong damage, people with shards of glass in their lungs and clotted blood spilling out of every orifice, and yet nobody points out the very obvious unprecedented and unknown effects of embarking upon a massive global economic destabilization (which is forecasted to kill more from child hunger alone than COVID-19 ever could), and an unprecedented environment of fear, hysteria and panic that lost the plot back in the beginning of March.
Joe Rogan and Bob Saget were talking about how "everyone" has been having COVID panic attacks and nightmares. What happened to people? How did hypochondria become a mainstream lifestyle in the safest place and time in human history?
Indeed, I've observed what I would describe as symptoms of OCD, germaphobia, and agoraphobia in a shockingly high percentage of the population.
And of my friends that were already agoraphobic and germaphobic, they've now had their lifestyles retroactively justified by this thing, so it's going to make it way worse for the people that already had it too.
(I have one friend who is a germaphobe but not where it really interferes with their life, and they adopt the correct attitude of "well I can't really control this (germaphobia, not COVID-19 to be clear) but I'm not going to pretend it's a good thing" - they've stayed much more resilient through this than one might expect)
and in my opinion, less COVID-19 mortality over the medium-term.
I think you're missing one factor, which is the fact that evolutionary pressures will cause the virus to become better able to transmit, but also less likely to cause fatalities. That's the normal course of such things - consider that a virus that kills its host is no longer able to transmit itself to others, so strains that don't kill the host will reproduce more effectively. And there's some evidence that this is happening with covid-19. Ignoring other factors, being able to stretch things out over time to amplify this evolutionary pressure will probably result in fewer fatalities, even with the same total number of effected. But I don't know how that balances against the other factors that you're pointing out.
We have good bounds on our IFR, leading me to settle on a final number of around .30%.
The latest scenarios published by the CDC, as of a day or two ago, puts the most likely scenario at 0.65%
EDIT: citation for my 2nd point: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
Basically, and you alluded to this, my position is those effects may occur to some extent, but will be massively dwarfed by the downsides of trying to slow down the timeline.
(2) As far as the CDC, I hate to be that guy but I don't trust their numbers very much. I'm just a bit suspicious of them upwardly revising their number at this point in time, especially given the statements coming out of the CDC head which seem to lack any type of nuance. In particular, they are modelling asymptomatic spread but not pre-symptomatic? Weird.
But yes, I generally give a range of .1-.7%, but settled on .30% as the best number for my purposes. It's more-or-less pulled out of my ass, although it is almost exactly the median in the big spreadsheet of IFR estimates which I now cannot find the link to (grr)
Anyway, the important thing is for my "argument", it actually doesn't matter to me if the IFR is .3% or .9%. The costs of lockdown just end up being too risky. So, feel free to ignore my mistrust of the CDC.
Note that Ferguson's classic (albeit incredibly myopic) paper models an IFR of .9% and 82% of the US population being infected, with an end result of 2.2 million. With these T-cell findings and other findings, we might see like 1/4 as many total infections, so even with the same IFR that gives us a shitty upper bound of 600k.
Case in point – the second wave of the Spanish flu was much deadlier than the first wave. And the third wave was less deadly than the second, but still more deadly than the first wave.
If the virus infects hosts efficiently, and this one does, no, it will not have evolutionary pressure to be milder.
No. For example: https://www.westernmassnews.com/news/could-covid-19-weaken-o...
Two Italian doctors claim they are increasingly seeing weaker and less deadly cases of COVID-19 in the country. Hamilton said it's not uncommon for a virus to become less pathogenic as time goes on. “Over time they become less dangerous or less virulent because they just want to live in you and replicate in you,” she said.
Hamilton said viruses, in general, are trying to pass on their genetic material. “In some pathogens, it’s actually better if they don’t kill you because if you’re still alive, you’re more likely to spread them around,” she said.
This is why she said some of the most successful viruses raise the fewest red flags “Things like head colds or warts,” she said.
It's like saying evolution selects for intelligence, which would be silly because no, it doesn't, even if it happened for a couple of species.
If the virus transmits efficiently, having a high enough R0, it has no pressure to evolve to something milder. SARS-Cov-1 lacked the contagious pre-symptomatic period. Note how SARS-Cov-2 keeps going strong despite the worst restrictions we've seen in our lifetime.
Citation, please.
As I undetermined it, coronaviruses evolve quite slowly compared to many other viruses. In a perhaps optimistic scenario in which we have a widely available, safe, effective vaccine in early-mid 2021, there may well be no appreciable evolution of the disease before it’s mostly eradicated from the developed world.
In that scenario, the real outcomes to consider are the number of deaths and disabilities caused over the next year or so, the economic and other costs of people getting sick, and the cost (economic, social, etc) of the lockdowns and other countermeasures.
My personal belief is that countries like Taiwan and New Zealand are taking the right approach. If they continue on their current course and a vaccine shows up next year, then they will manage to keep total deaths near zero at moderate economic cost. If the entire world had pulled this off, then COVID-19 could plausibly be gone by now.
https://justthenews.com/politics-policy/coronavirus/doctors-...
Quoting the article, and if you go there, there are numerous links to the actual studies:
Some physicians and scientists in the United States have lately also announced findings that the disease is getting weaker. One of them, Donald Yealy—the chair of emergency medicine at the University of Pittsburgh Medical Center—claims that "some patterns [of COVID-19] suggest the potency is diminished."
"The virus may be changing," he said earlier this week, adding that fewer people in the Pittsburgh area are contracting the disease, and the infections themselves appear weaker.
Maria Van Kerkhove, an epidemiologist with the World Health Organization, told media after Yealy's remarks that neither the virus's transmissibility nor its severity have diminished as Yealy claimed. Yet several other American scientists, including some at Arizona State University, announced findings in May that could bolster claims that the virus is less deadly than it once was.
The scientists at ASU said that they had detected a gene deletion in one sample from several hundred Arizona patients that potentially reduced the fitness of the disease. Notably, they claimed it was similar to a deleted sequence observed in the 2003 SARS virus that was observed near the end of that disease's epidemic—possibly signaling that COVID-19 may be bound for a similar fate.
Those conclusions were echoed by scientists in Spain this week, who proposed that COVID-19 may have adopted what the researchers call a "don't burn down the house" strategy, "reducing the severity of the infection and tissue damage without losing transmission capability." In effect, the disease could be opting to become less lethal so that it can spread more easily—a hallmark of evolutionary behavior, and also a boon for anyone who gets infected with the milder strain.
Data do appear to indicate that the virus may be losing its edge. The statistics website Worldometers, for instance, shows an unmistakably lopsided trend: Though the number of confirmed global cases has been increasing since the start of the pandemic, the number of global deaths has been trending downward since mid-April.
If that pattern holds, it may point to the conclusion that these few skeptical doctors are correct: That the coronavirus, like SARS before it, will eventually burn out in part due to its own viral mechanisms, without the need for a vaccine or for lockdown measures that have slowed the global economy.
I was not claiming that H1N1 was as bad or worse than COVID-19, to be clear.
Obviously COVID-19 is the worst pandemic we've had in over a century. But that's mostly a function of the fact that we haven't had a truly bad pandemic (the scary ones like SARS-1 fizzled out, presumably because the virus was very symptomatic and very deadly).
The point is that, we didn't lose our shit over flu pandemics which actually kill children, and actually cause more significant recurring deaths than COVID-19 will do to what I already explained about COVID-19 targetting the unhealthy/old.
If you want my argument in a nutshell:
- The most stable solution to the problem of COVID-19 is to build widespread population immunity. Also, banking on vaccines as an artificial way to get to herd immunity is a foolish strategy, because we're relying on a temporally unbounded future event, which is an awful idea.
- Lockdown not only increase all-cause mortality by making every other health condition in the world worse (both directly through social isolation and depriving exercise, as well as through suspending elective surgeries, as well as the widespread culture of fear/etc leading to people to not go to the hospital), but I actually believe that it increases COVID-19 mortality. The same factors of social isolation, stress/fear, unemployment and lost sleep are at play, but also particularly the prevention of exercise (which plays an immunoregulatory role besides the other positive effects), and even more particularly, being cooped up outside = no sunlight = no vitamin d. Vitamin D is actually a ridiculously important vitamin as far as respiratory infections go - I didn't realize how strong the effect was, I encourage you to research it. Additionally, nitric oxide, also produced by sun exposure and not provided by a vitamin d supplement, decrease blood pressure so helps cardiac events, and is even being directly studied as a COVID-19 treatment (perhaps due to immunoregulatory effects?)
- Because I don't believe in practicing containment, for the above reasons and others I don't feel like going into at this point, I believe that any attempt to artificially slow spread in the general population is counterproductive. So, insofar as universal masking works, we should not be wearing masks. Insofar as lockdowns actually work, we shouldn't be locking down. And if they don't work (and I think the evidence is not there, and thus they likely have either no effect or possibly make spread worse, particularly with masking and school closures) - well, then why are we doing them?
There's another factor in here that I don't see that you've weighed. Although this is far from certain, I've seen some preliminary claims that the size of the initial viral exposure may be one of the factors that eventually determines the severity of a case. This makes intuitive sense - if you only get a small dose, your body has longer to notice the virus before it reaches a given threshold.
If this is true, then masks may still be worthwhile in order to keep a lid on the proportion of severe cases.
(Personally, I would volunteer to be exposed to real SARS-CoV-2, but I would not volunteer to be on the receiving end of any vaccine candidates.)
Anyway, it's dubious that masks do a great job in decreasing viral load, but I think this another case where if they do the effect size wouldn't be that great.
Regardless, this really highlights how we're proposing universal measures for things that are not well researched. I like the approach Sweden has taken: if there's not strong evidence, we just don't do it. Simplifies so much.
Your most stable solution to the problem is reasonable (build widespread population immunity), but your actual solution is to try and achieve it as quickly as possible by just letting the virus spread without any measures to slow the spread. That is not reasonable.
literally one second of googling: Proof: https://www.buzzfeednews.com/article/kadiagoba/ventilator-sh...
The money quote, which completely refutes your entire nonsense argument: “The other day I felt defeated. The patient came in on a code. We looked at each other. The patient had to die. There was nothing we could do.” Any feelings of guilt were upended by the next patient to come through the doors when they had to tell EMS they had no ventilators. EMS said they had nowhere else to go. The patient died."
In particular, even given much of your argument, I believe it's still wise for most people, and especially those with any extra risk factors, which likely include some yet-unknown among the outwardly-healthy, to avoid getting this for as long as possible. The end point – nearly everyone having an upgrade immunity to the somewhat-novel threat – is the same. But the upgrade is slower, to minimize collateral damage, and involves more conscious processes, including at some point synthesized vaccines, rather than purely natural/chaotic.
Every week brings better understanding of risks & treatments. Every week gives more opportunity for the pull of 'optimal virulence' (https://en.wikipedia.org/wiki/Optimal_virulence) to eventually select for even-milder strains. At least partially-effective vaccines for high-risk/front-line workers may arrive before the end of the year. Delays prevent overwhelming health facilities – or increasing average initial infectious loads – which each seem to risk synergistic escalations of mortality rates.
That said, it's not implausible that the right strategy for those least-at-risk – the young & very-healthy – is to mostly go about their normal day, and not worry much about getting an mild case from other mild (presymptomatic/asymptomatic) shedders. The risks are offset by the value of adding to their internal (and thus society's) immunity library against Covid-19 & related viruses.
But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
> So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
Yes, exactly this. This is another reason I hate universal masking, because even if I think masks work when worn properly, I still have to assume that everyone is wearing them because they're mandated, but don't actually know how to use them properly.
I would much rather have it be voluntary, and then if I see someone wearing a mask, at least I know they give a little bit of a fuck. Now granted, I still wouldn't be able to (if I were trying to avoid infection) assume they knew what they were doing, but it's better than the current reality where, say, employees are forced to wear masks, and then the moment I ask them to repeat something they said because masks stifle speech, they immediately pull down their mask and tell me what they were trying to say, completely defeating the point.
I love the idea of literally signalling risk tolerance. The only thing is, that still requires ceding public space for some portion of time to the super freaked out people, which is a losing battle, so ultimately I still think we should stick with the "old" way of doing things, which is: if you're a germaphobe/agoraphobe, you stay in your damn house and watch netflix for your whole life like you did before, and everyone's "happy".
If I can wax philosophical for a bit, I remember learning in elementary school about native american rain dances, how they would dance around and thought that it would cause rain. "How foolish of them", I thought. "It's so obvious that there's no connection between dancing around and precipitation falling from the sky".
And yet, when I look around, I see us all participating in an elaborate form of pseudo-medicalized rain-dancing. Take the staggering amount of people walking around all day in nitrile gloves. Let me tell you, if I were a SARS-CoV-2 respiratory droplet, I would love those people; I get to a hitch a free ride on their gloves with my droplet completely intact, preserving the moist environment that all life (and pseudo-life since we've arbitrarily decided viruses aren't alive, which is just silly) thrives in.
Uncovered hands at least have commensal bacteria and an acid mantle (well, for those that don't wash their hands like someone with OCD) that make it harder for SARS-2 to persist. But those gloves are the perfect environment.
Why do people wear those gloves? Well, in my opinion, they associate the gloves with doctors, they associate doctors with cleanliness and a scientific version of holiness, and thus they essentially believe that the gloves act as a magic totem that ward off evil spirits - I mean, evil viruses.
Mask-wearing isn't much better. It is definitely better, and I get the "it protects you, not necessarily me" argument, but when you look at how people actually use the damn things in the real world, I think that's almost certainly false. People touch their face, their mouth, etc way more. Not to mention all the other reasons.
Which does lead to the irony: insofar as masks do work to slow spread, that's a bad thing, yet they may actually increase spread, which in my book is a "good thing"...except (a) I hate having to wear a mask, and (b) since the rest of society is not on-board, a healthy increase in cases will be met with further lockdown :(
--
Anyway, you alluded to this, but I don't think having a bunch of 20-somethings try to avoid all human contact for [1 year, infinity] makes sense. I think it's a less stable system. Just like how every year in California we have huge wildfires, which we artificially suppress, and so every year there's more and more material waiting to ignite.
Well, pandemics work the same way. When we try to keep ourselves in a state of SARS-2-virginity, we create an environment where at any moment infection can rip through us again. Look at New Zealand, which is held up by the ignorant as an example of "doing it right", and yet now they can't allow any foreign visitors without 2+ week quarantine "until the vaccine" (sigh).
The laughable thing is in the US we're not really practicing containment, and yet we also kind of are, and that leads to the total ass-backwards metric of "cases must be perpetually in decline otherwise we shut down again".
--
Okay, back to serious stuff.
> But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
See, this is my problem. The moment we stated that it was the problem of those not at risk to avoid anything that might infect an at-risk person, we went down the completely wrong path. When you exrapolate it to its logical conclusion, I think you can see how ridiculous the notion is. I'd note that it's a mentality we never took for the flu, etc (ignoring examples like the 1918 pandemic, etc).
If I'm am immunocompromised individual, it's my job to isoalte myself if that's what my risk tolerance leads me to do. It's not my job to screech at the rest of society for living their lives like human beings. It just doesn't make any sense.
Containment only works when the entire country is on board. (And by the way, even if that were the case I still think it's a terrible idea, but let's ignore that for now). So, we should have immediately realized that if we wanted to preserve even a shred of freedom and our Western values, containment never should have been an option. In fact, Sweden said as much: their health leader (I forget the name) outright said that they don't have the ability/right to do the type of lockdown that China did. And yet somehow, the rest of us have looked at China and unthinkingly swallowed their recommendations to enact authoritarian policies. And we've actually praised them ("we" meaning basically anyone on the left or in the center) for their response!
> The risks are offset by the value of adding to their internal (and thus society's) immunity library against Covid-19 & related viruses.
Exactly. It's just a more stable system that way. And as someone who isn't at-risk, it's way easier for me to get exposed and isolate for 2-3 weeks than it is to have to be perpetually on-guard for an indefinite time period (at least a year).
The last point I want to make, is that anyone who's ever done work that required sterile conditions (such as culturing fungi), or handled substances active in the microgram range, knows how incredibly difficult it is to avoid breaking sterile protocol. Pathogens live absolutely everywhere, and so you have to exert enormous cognitive effort and skill to basically visualize every possible source of infection and to diligently watch what you're doing with your body, where your breath is going, etc. I mentioned substances active in the microgram range - I've inadvertently dosed myself, presumably by absent-mindedly touching my lips - so I have a very good mental model of what it takes to guarantee a lack of infection. You have to watch your every move, avoid touching any mucuos membrane, wash your hands constantly, etc. It's simply just not possible for your average person, and not possible for a trained professional to do for more than a period of several hours. And yes, we don't literally need perfect sterility to avoid spreading SARS-CoV-2, but it gives a great illustration of the kind of mentality that you need to adopt.
Sorry for the meandering and rambling nature of all my posts today, I drank way too much metaphorical coffee. Thanks for actually engaging in discussion, it's these interactions that make the effort worth it, since as you can see I'm already getting downvoted quite significantly - although encouragingly, thus far I have not had a single comment flag, whereas it used to be literally every comment of mine that went against the grain (in a respectful manner) got flagged and I'd have to e-mail dang every damn time.
I've wanted to go back and update it, but lost motivation to do so when the BLM protests/riots started. I always cynically had thought that people didn't really care about COVID, but even I wasn't expecting such a shocking example of exactly how much of a farce this whole thing was ("we have to shut down California, look at these photos of normal beach crowds!" versus "here's 40,000 people massed together for a black trans lives matter rally, let's just pretend that we didn't claim all mass gatherings/protests were evil last week").
I did my original post using Ferguson's model as an upper bound, at the time thinking that the real numbers of the "let the disease run rampant" scenario would be much better. Well, now tying in these t-cell findings, the findings that blood type seems to impact transmission, and heterogenous susceptibility more generally, there's a lot of updating to do to make it even more clear how ridiculous the whole policy was.
I also have other research interests on things like moist wound healing that I've been considering doing a quick writeup on, since there's a lot of important info that people just aren't taught (myself included, before doing research).
Happy to send a link to you via e-mail, so that way I'm only de-anonymizing myself to individuals and not more broadly. You don't appear to have an e-mail on your profile so if you don't want to post one and care about anonymity we could also exchange GPG keys depending on how much effort you're willing to exert :P
I wouldn't be so sure about that, actually.
Sweden's response has been widely reported on, and even more widely mis-reported on.
Sweden chose the least amount of restrictions in the EU, and mobility analysis shows that although the Swedish people changed behaviour drastically, they did it the least of the EU countries. People were doing the most distancing in late March, same as everywhere else, and have been slowly easing up ever since.
And yet, the death rate has been going down steadily in Sweden since mid-April.
Testing has been too low for a long time, but is finally up at reasonable numbers.
And yet, the positive test rate has been cratering the past few weeks.
The Swedish public health agency have done a bunch of random samplings of antibodies to measure the immunity rate, and it always came back at much lower levels than expected. The peanut gallery was quick to crow that Sweden's "herd immunity" strategy was a complete failure, zombie apocalypse etc, but the reason people were surprised that the antibody levels were so low is because it didn't match the actual spread.
Something is pushing the death rate and case levels down in Sweden, it clearly isn't lockdown or distancing measures, and it clearly isn't sars-cov-2-specific antibodies.
There are reports out now that a lot of people seem to have immunity or resistance through T-cell response, presumably as a result of earlier coronavirus exposure.
Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower.
And all of these things together suggest that herd immunity is easier to achieve than we initially thought, and that regions that have been heavy hit, but that now see very little death and cases, might be very close to it.
Yes, this is a great point that often gets missed. This is the principle of vector exhaustion: by definition, those more likely to get infected will get infected first. Insofar as someone more likely to get infected is also more likely to infect others, that means that we see a non-linearity to herd immunity. Getting that first group of highly infectious people immune works wonders.
I believe (but honestly am not certain) that one's susceptibility to infection is independent of one's ability to spread more effectively.
But people who travel around a lot, meet a lot of different people, are simply more likely to encounter an infected person and get infected, and in turn are more likely to unknowingly infect everyone else they meet. The same mechanisms that make someone a "super spreader" is also what makes them more likely to get infected, and to get infected early in the pandemic.
We know that for example medical personnel got infected in way higher numbers than the general population, for obvious reasons. But they're now also more immune than the general population, for the same obvious reasons. And as a result, intra-hospital spread decreases.
Yes, it's two independent measures, but with very high correlation.
Anyway, ignoring the spreading part, the susceptibility alone does explain it to an extent, as you implied:
> It's the ones that are most easily infected (because of their particular biology, lifestyle, etc.) who are first infected.
Ok...
There's an upper bound on the number of deaths, that's good. It's bad to carelessly accept having to hit that upper bound.
Maybe start with the impending global food shortage.
And the fact that we've went backwards on poverty, went backwards on vaccines for everything that isn't SARS-2, etc.
And the fact that the physiological and psychological state lockdown puts us in, almost certainly makes us more likely to die of COVID-19 if we get it?
I don't carelessly accept the upper bound. I rationally set an upper bound and ask myself, "is this worst case something I would rather live with, rather than the worst case of the lockdown scenario?".
Then I compared the average cases.
What I found was that the worst case scenario of lockdown is worse, and the average-case scenario is worse. Only the true "best-case scenario" of "we magically get a vaccine in a month, the vaccine works for everyone without any significant repercussions and we manufacture 8 billion doses and the entire globe voluntarily accepts it" is better (although the corresponding best-case scenario of no lockdown is also similarly absurdly positive so best-case scenarios are useless anyway).
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Tell me, what is the logic in practicing "indefinite postponement" (containment), which accrues on-going, non-linear costs (as well as the obvious linear component), and only ends when we develop a game-changer treatment or vaccine, which is a temporally-unbounded future event.
When has it ever been good public policy to hinge everything upon an uncertain future event? That's just bad strategy.
To use a starcraft analogy, we're trying to sit on one base and tech up while a skilled opponent would be on 4 bases, have a strong econ and then out-tech us anyway since they, you know, actually have a sustainable, functioning economy.
There is ample precedent, however, of doing lockdown right and basically being done with it: Asia and Europe have many countries with drastically lower infection rates than the US. And most of them are further along the way of opening back up than the US.
That is assuming that prolonged lockdown continues to be our response. It clearly doesn't have to as other first-world countries cases have actually been floored.
Aside from complaining about our first run at this, we could/should probably just all wear masks and then spreading is mitigated such that new cases approach zero.
It only stops in the absence of lockdown when the herd immunity threshold is reached. Period.
The only question is what that threshold is. Without these findings of heterogenous susceptibility, that threshold would be 70-90% depending on your estimate of the effective reproduction number.
With these findings, that number drops to a much lower threshold. Much, much lower.
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If I can ask you one question, what is your explanation as to how cases have floored in other first-world countries, in the absence of herd immunity, if they are not practicing lockdown?
Others are doing much better. There are hardly any new cases in, say, Germany, with by now extremely minimal measures and no lockdown.
Your epic texts seem to come from a weird parallel world.
In fact, that's exactly the implication of the Nature paper that's ostensibly the reason for this thread. The more we learn about pre-existing resistance to this coronavirus, the more we can figure out whether measures taken made a difference or were simply coincident with a less-vulnerable population.
The hypothesis I heard is that this immune response due to previous common cold corona virus exposure could explain the high proportion of asymptomatic cases or cases with very mild symptoms.
Those are already priced in, so we already know about their existence, it would just be an explanation as to why they exist.
I‘m also not sure why you think that even neighboring and very similar countries are so wildly different based on wildly different levels of pre-existing immunity. That doesn’t seem very plausible. Why should, say, Germany and Italy be so different? Or Germany and France?
That's the subject of the paper being discussed, it's worth going back and looking at it. The researchers demonstrated T-cell reactivity against it not just in blood from people who had SARS-Cov-1/2 but those who had neither. So something else is going on -- maybe one of the common cold coronaviruses, maybe some other infective but not dangerous coronavirus, maybe something else.
> I‘m also not sure why you think that even neighboring and very similar countries are so wildly different based on wildly different levels of pre-existing immunity. That doesn’t seem very plausible. Why should, say, Germany and Italy be so different? Or Germany and France?
Since we don't even know the source of this pre-existing immunity, much less how it varies between countries, it's impossible to say. But it's clear that there are many differences between what happens in countries that aren't just lockdown timing/severity. Immunity, density, demographics, climate, sheer luck, etc.
I'm not saying that as an insult BTW, just a statement of fact.
Countries stop getting new cases without lockdown measures when they approach the herd immunity threshold. So, if we look at New York, which got absolutely ravaged (relatively speaking), they don't have significant new cases anymore. Not because Cuomo is a genius - he's the opposite - but because there's almost nobody left to get infected.
So, no, while I have been citing American examples because I am quite clearly an American, what I'm saying is relevant to every country in the world. Following a course of lockdown, social distancing and universal masking is simply an exercise in lunacy. At best it has no effect, and at worse it massively increases mortality.
In short, I really don't understand the point you're making. My goal is the maximum aggregate well-being of society, thus I oppose lockdown. If my goal were a more myopic measure like "maximum lives saved" (ignoring that a life is not a life is not a life), lockdown would still be the wrong call. Now if my goal were "minimize COVID-19 mortality regardless of the cost to all-cause mortality", then lockdown may or may not be effective, I personally think that it almost certainly makes COVID-19 mortality worse in the long run full stop, but that point is more debatable. I think the first two are inarguable, though.
Also instead of saying “based on coronaviruses in general” you should just say “based on the basic reproduction number”.
Anyway even if HIT were 65-90% my argument is the same. But the fact that you gave that 65-80% estimate means you don’t understand the math. Factor in the preexisting t cell cross reactivity. Factor in heterogenous susceptibility (risk of infection even controlling for # of exposure events/social interactions varies heavily in the population, for example old people are much more likely to get infected)
TL;DR: you need to do more background reading and update your priors. you’re operating in very stale info. I also think you’ve failed to understand my general argument outlined across this thread but I’m too tired to repeat it so I’d urge you to re-read the comments where I outline my case
There is some tantalizing evidence that maybe just maybe there might possibly be some degree of latent t cell cross reactivity. This is not actionable information, because it very well could be false.
"based on the basic reproduction number" is total nonsense. I am not basing anything on the basic reproduction number. I don't even know what you are even referring to here.
I understand the math just fine. It is you who keep doing the math wrong. You are "factoring in" 3 different variables, each of which are controversial and may not even exist at all. Then you are taking the most optimistic scenario for each one of these variables, compounding your bad math three times over.
Your argument is even more murderous if HIT is 65%. 65% of 7.5 billion people is 5 billion. IFR of 0.3% (which you admittedly completely made up) is 14 million dead? I'm on mobile but I think that's right. You want to kill 14 million people. Even though Japan, S. Korea, Singapore, Canada, Taiwan, Germany, Italy, Spain, heck arguably even NYC right now have proven that this can be controlled.
Yes, if you take the most wildly optimistic assumption for every single variable, when literally millions of lives are on the line, it might be 15 to 25%. Still Germany, S. Korea, Taiwan, and Japan are no where near that number.
That's only true because we've been able to treat most people who needed hospitalization. The point of the lockdowns is not to prevent deaths from SARS-CoV-2. It's to prevent the healthcare system from being overwhelmed so that moderate-to-high-severity cases go untreated thus increasing the number of deaths.
Granted they can do a lot for people in the middle-ground, i.e. giving people oxygen. I don't have a number for how much death they avoid by doing that, but that's certainly where the utility lies.
When it progresses to severe enough COVID-19 that invasive ventilation is required, the battle is basically already lost; at that point something like 90% of invasively ventilated patients die. So, I'm not saying that ventilators don't work, but what I am about to say is, if we assume that without ventilators 100% of those people would die, the effect size is still so tiny that hopefully we can all agree that the whole ventilator circus was a massive distraction.
Anyway, I don't think you were trotting out the ventilator fallacy, just wanted to nip that one in the bud for any onlookers.
So back to the point: I don't know precisely how many lives are saved by those given oxygen but not invasively ventilated, I suspect it does save lives, but overwhelmingly, the reason people don't die from SARS-2 is because SARS-2 can't kill them. Again:
- Most are either asymptomatic or paucisymptomatic - Many experience symptoms comparable to a mild cold - Many (probably less) experience more moderate symptoms comparable to a flu - A small fraction of those infected go on to develop increasingly severe COVID-19 eventually culminating in invasive ventilation and death.
So, all the possible utility of hospitals lies between the "moderate symptoms comparable to the flu" and "severe COVID-19 culminating in invasive ventilation". i.e. if I broke it up more granularly, we'd presumably find a category of people not bad enough to ventilate but who have very bad symptoms, and that's the faction that hospitals really help.
Anyway, hospital overrun is simply not a real concern in a place like the US. We should be more worried about the opposite - hospital scaledown.
And the reason hospital overrun isn't a concern is because COVID-19 is mild enough for most people that we don't get the hordes of people we were expecting. We do get quite a lot of people at peak, but it's manageable with some shuffling.
I'm much more concerned as well about the suspension of elective surgeries. We're going to see so many more deaths due to cardiac disease (which kills more than COVID btw), undetected cancer, etc as a result of this
Remember that America in general is a lot more intervention-happy than other places. It's more important to "do something", even if that something is net-negative or net-neutral. And therefore, the survivor statistics of ventilated patients in the US is absolutely atrocious.
Halfway down this page there's a diagram of survival rates of patients in ICU in Sweden by age group: https://www.svt.se/datajournalistik/corona-i-intensivvarden/
As you can see, the survival stats are much better. 47% of the 80+ patients lives. 70% of the 60-79 group lives. 85% of the 40-59 age group lives.
But as you can also see, the number of treated patients in the 80+ group is very small. And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time.
Of course, that has been interpreted as Sweden callously sacrificing the elderly by denying them care.
But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator.
But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
> But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
Yes, I totally agree. Maybe didn't make that clear above, but my point was even if we pretend/assume that the ventilators are helping, the effect is small.
I think it's highly likely that invasive ventilation as applied just ended up making things worse.
> And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time.
Exactly. It's just such an American mentality. Same reason we wanted to hold up Hydroxychloroquine, Remdesevir, etc. Not saying they don't work, but that focusing on antivirals detracted from the real discussion we should have been having all along.
We're too accustomed to perfect technological solutions which let us avoid having to face the reality of our own mortality (and the mortality of our loved ones).