Comment by adrinavarro | Hacker News Reader

Comment by adrinavarro | Hacker News Reader

> "it is nonsensical to compare covid to other major pandemics […] Covid will never even come close to those numbers. And yet many countries have shut down their entire economies"

> "That makes covid a mere blip in terms of its effect on mortality."

This sounds wrong to me for several reasons. First of all, it's silly assuming that other countries are shutting down their economies without a very good reason for doing so. As I understood it, the "good reason" for doing so was that the infection & death rate was growing so fast, that it was putting hospitals & morgues way beyond their capacity. At the same time, the situation was keeping non-COVID, hospital-worthy visits out of the healthcare system, thus creating a massive public health problem.

(Let's not forget the improvised hospitals, improvised morgues, etc. These were very real.)

It'd be interesting knowing why somehow the COVID cases 'vanished' from this doctor's hospital. But instead of looking into why this happened, this doctor is just saying "turns out that the problem went away, so in the end it was good that we didn't bother too much about it".

And the thing is - we're not through it yet. Thankfully the death rate seems not being as bad as we thought it could be, but this could very well be down to current measures such as isolating elder people, testing at-risk populations, higher awareness levels, and the fact that the average infection age is now much lower than it was in March. So, now, healthcare systems are not collapsing.

There's a myriad of variables that likely affect the virus spread and outcome. For example, the age and characteristics of the populations where the virus is spreading, how population is distributed around the territory (and its density), how frequently this population "comes together" (social behavior - ever seen a swede profusely hugging and kissing?, public transportation, remote working…), and so on.

And when it comes to the healthcare system capacity debate: Sweden frequently put elder, infected people straight in palliative care (http://archive.is/VC5vb), bypassing hospitals. Other countries did admit elder people into hospitals, thus putting more strain into the healthcare system, which later on prompted a lockdown to prevent said system from collapsing.

> First of all, it's silly assuming that other countries are shutting down their economies without a very good reason for doing so.

I certainly wouldn't want to assume that governments only ever do the correct thing, or the thing that is in my best interests, so I think it's reasonable to ask questions.

> As I understood it, the "good reason" for doing so was that the infection & death rate was growing so fast, that it was putting hospitals & morgues way beyond their capacity. At the same time, the situation was keeping non-COVID, hospital-worthy visits out of the healthcare system, thus creating a massive public health problem.

The UK enlisted the army to build enormous field hospitals and staffed them with doctors and nurses from other hospitals. Most of them closed after seeing only a few patients, since all other hospitals were operating far below capacity. Emergency rooms were ghost towns. Meanwhile, all elective surgery was cancelled, reducing the quality of life for thousands of people while doctors stood around waiting for the promised influx that never happened.

It seems to me that the response in the West has been largely reactionary, driven by fear and public opinion, and disconnected from any real analysis of what genuinely works and what the long-term plan is -- with the possible exception of Sweden, who despite all the "they don't care" rhetoric you see in other comments, not only put a lot of analytical care into their approach, but discussed that analysis openly.

Maybe it was based on seeing what happened in other countries, ie. Spain and Italy? I can say for sure that the impact in the health care system here in Spain was very significant.

It's hard to disentangle cause and effect though. Countries that were very hard hit also had the most extreme government reactions to it. This can compromise the efficiency of the healthcare system, for example, I've read that in Spain at the peak of the epidemic many nurses and doctors were self-isolating because they'd tested positive, so there was a huge loss of healthcare capacity. Then later on it was discovered that a lot of positive tests are asymptomatic and asymptomatic people don't transmit the disease, so this just hurt healthcare capacity for no reason.

Many countries had problems with care home workers abandoning their jobs, for example to return to their home countries before borders closed. There are some quite horrific stories of the terrible conditions created in care homes in some of the places with excess death spikes.

The imagery of ice-rink morgues etc had a similar effect. There was no real demand surge for morgue space, but undertakers were refusing to work until they were supplied with ample PPE because they thought they would be infected by the bodies with a killer virus. Same story in Bergamo. So then a sudden shortfall in PPE was converted into a shortfall in funeral capacity, even though at that point there was no sudden tsunami of bodies. This then led to more panic especially amongst health system workers.

It's very hard to disentangle what really went on here.

> "Then later on it was discovered that a lot of positive tests are asymptomatic and asymptomatic people don't transmit the disease, so this just hurt healthcare capacity for no reason"

I think it makes sense to isolate anyone who tests PCR positive for coronavirus, right?

Also, is it 100% sure that asymptomatic people will not transmit the disease? What if they are just pre-symptomatic? Where do you establish the cut-off?

No. Why would it? Given how mild almost all infections are, and that doctors/nurses can routinely save lives from much more serious conditions, it's a strange cost/benefit analysis that assumes it's better to lose huge chunks of healthcare capacity than for some people to get COVID.

Asymptomatic is being used as a different classification than pre-symptomatic in the literature. Asymptomatic means you never develop symptoms. Pre-symptomatic means you haven't yet but will. Pre-symptomatic phase is not long though. Typically just 1-3 days, I think, from the latest literature.

Given the tiny window of time that exists when people are infectious and might not know it, and given the very low likelyhood of a PCR test being done in exactly that time, and given that PCR testing has a lot of problems (e.g. triggers even if your body has destroyed the virus), and given that nurses and doctors are pretty important, I can't see it being useful to actively test in hospitals. It's everywhere by now anyway.

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