Harvard, Oxford, Stanford doctors among leaders of global anti-lockdown movement

If the goal is to preserve the maximum number of human lives, lock-downs are probably reasonable (particularly since lives saved keeping the highways closed alone meets or exceeds lives saved from COVID) - this logic also would have probably kept it out of WW2, kept us from sending humans to the moon, etc.

If the goal is prevent the maximum damage to the economy possible, then lock-downs should probably be extremely brief and extremely intense.

If the goal is maximum human freedom, again, the choices are obvious.

Any discussion that doesn't first define the goals is useless with this topic.

That's not an acceptable way to engage with good-faith scientists at major institutions. It's an appeal to emotion as well as an implication of stupidity on your opponent.

I've noticed this behavior among a wide range of mainstream scientists and public health leaders too- literally mocking people who disagree with their policies. This will hurt the credibility of these scientists, especially if, in retrospect (when we have the time and luxury to study the public health response to COVID in detail), we find out that decisions led to suboptimal outcomes.

It's far better to project humility, stand by your decision, but be willing to admit when you're wrong, and adapt.

Politics have overtaken some people's scientific sensibilities. Fortunately there are still lots of great people at Stanford, but they aren't the ones who are going on mass media.

I think it's great that there is an argument about this, but it still feels disappointing that it will still clearly take a lot longer then 10 months to clarify these points to a level where no serious high level medical professional disagrees.

In the meantime, I'd also appreciate it if we could get back to a lot more talk of "flatten the curve" in our public discourse. Nobody seems to seriously doubt that at some point almost all humans will be exposed to the virus. The question is how rapidly that happens, and the concomittant impact on health care and the economy if it happens too fast.

We should stop talking about "lockdowns", and possibly never should have thought that way. The question is over restrictions, WHAT restrictions should we have, what alterations to usual way of doing things.

For instance, do you know Sweden, all along and still now, was in fact prohibiting gatherings of over 50 people, with criminal penalties for violating? Schools for children over 16 were closed. Social distancing was encouraged. Sweden didn't actually do particularly well -- although they have done BETTER than the U.S. in deaths per 100k population. But however poorly or well they did, contrary to the narrative, they in fact made major changes to social life, and in the end may have controlled social distancing BETTER than the US! (through a combination of legal restrictions and voluntary compliance, compared to the U.S. piecemeal, ever-changing, lockdown-then-nothing low-compliance environment).

So it is definitely a problem to think that our choices are a total lockdown which can reduce all risks to zero (unsustainable and not actually POSSIBLE; quotes about "which grandparents are going to die" suggest that if we do things right it will be no grandparents, which is unfortunately not true) -- and doing virtually nothing except maybe some half-hearted mask-wearing, which will result in years of ongoing massive illnesses (including possibly long-lasting chronic illness) and deaths.

In fact, we have to figure out how to do restrictions RIGHT. restrictions that are sustainable for the long-haul (becuase in fact this is going to be something we're dealing with for years, there is no deus ex machina vaccine miracle that will put things back to how they were), and that optimize for minimal infection with maximal social life. (In normal life, I have trouble explaining what I mean by 'optimizing' like this, it's nice to be talking on HN in an engineering culture that will immediately understand what i mean).

The US doesn't seem any closer to being motivated to do that though. And I"m not sure this letter actually helps,this comes across as just another allegience in the "do everything or do nothing" weird public health culture wars, which are not serving us. (For instance, "Herd immunity" is mostly not a useful thing to be thinking about here, and mentioning it just seems like signaling a 'do nothing' allegiance or implying that intentionally increasing infection rates is somehow a good thing, which it is not, unless you like years of ongoing chronic illnesses and deaths).

The anxiety attacks are pretty much: My nose is clogged, I might have covid, can I breath, oh my god, my breathing is constricted a little. Are my fingers turning blue? Can you look at my face and tell me if my face is drooping? Can I still smell things? (pulls out super strength Oregano Oil - OMG it's not as strong any more - am I losing my smell).

I'm a man. I'm 40 years old (soon 41). All my life I've been super healthy - no problems. I would never have predicted I would be this scared of something in my life.

My wife and I are planning on trying to go back to normal soon. We're going to start getting take-out food to start, still washing hands. I don't want to live the rest of my life like this, and I think now is the time to go closer to how life was before - just with some modifications. Just not as many modifications as we're under now.

If I don't change, the anxiety may kill me.

In the UK, 75% of deaths are people aged 75 and older. I'm not sure if its the same age profile in the US but I would think yes. Even here in the Bay Area, the death rate is about 0.5% for everyone below the age of 60. If we lock down those over 60, and let everyone else live with masks and social distancing, the infection rate may skyrocket but the hospitalization and death rates will plummet. This is basically what we are seeing globally now, where the infection rate is higher than in March but death rates are much lower. Granted, there were less tests being run so that makes things hard to compare.

Also, the bigger problem is those that need to take care of their parents who are in this age group. The infectiousness is so high that if the children get sick, the parents will definitely get sick. So this is the biggest quagmire, that entire families will become isolated to protect the parents. It's not a perfect solution but better on a percentage basis for the entire country than locking down everyone, even though the risk profiles are drastically different.

For instance there is a surprising result coming from large serology studies in Spain and Italy, that outside of health workers, people who were locked down have been infected at the same rate than essential workers who were not locked down. Also the shape and timing of the Swedish infections is very similar to other european countries, suggesting the peak was due to the natural evolution of the epidemic rather than lockdowns.

I don’t think this data is compatible with lockdowns being effective, which should be a key issue given all the consequences of lockdowns.

I wrote about this in this post, which was discussed here on HN at the time: https://rssdss.design.blog/2020/03/31/all-models-are-wrong-b...

The issue is that it is very clear, at least in the US, this just is not reality. We would absolutely screw this up and kill way more people if we didn't have these training wheels on.

I am not okay with unqualified politicians making inaccurate claims about the virus, and prioritizing economic health in the absence of good governance.

I believe there are obvious risks to mental health of adults and children in being isolated from others, unable to socialize with other humans in person. I read recently too, that things like kids in school in person allow teachers and members of the community to be a safe space for children to be seen and essentially monitored for child abuse/poor living conditions. People may go to the doctor less because of fear of the disease, rather than get treatment.

It is certainly a balance - we cannot go full "save every possible life" - thus the term "flatten the curve", where the metric for success was not to have absolute minimum deaths, but to preserve the integrity of the health system to best serve all who need emergency care for any reason.

There was an article in February called "The Hammer and the Dance" that predicted a cycle of shutdowns and reopenings to balance social interaction and jobs with overriding systemic medical concerns. We are in that now.

Well, those ideals have come home for many parts of the world. Imperialism and disregard for human welfare will now serve "the economy", as we are seeing now in the United States.

I find it ethically abhorrent, but humans are humans.

Either is very concerning.

Item: This isn't the last time a nasty virus will appear and spread.

Item: The economy isn't crashing. Things are open, people can buy stuff, etc. You can buy toilet paper.

Item: For most of human history (millions of years) you would have been in a small band of maybe twelve to twenty-five people. You would have encountered other bands only rarely. Crowds are abnormal, "isolation" is highly relative.

What am I saying? I don't really know, exactly.

I am pretty sure that things are not going back to "normal" any time soon, and they may never go back.

Mass international travel is the kind of thing that just may not work with the reality of human infectious agents like viruses. If we keep flying all over the place, and encroaching on more and more places where these viruses hang out (not to mention new old viruses thawing out of melting permafrost), we are going to have more global epidemics and pandemics. This isn't Star Trek where the transporter beam magically whisks away the bad germs.

There's a reason why you're made of lots of tiny cells rather than one big bag of goo, eh?

1. Data is collected

2. Dynamics are modeled (population health, hospital capacity, economic output, etc.)

3. Problem constraints are well posed

4. Computational resources are allocated to solve for the constraints

In my mind, this would be the rational approach to solving this problem. Steps 1, 2, and 4 should be apolitical. Only step 3 is political since many people would disagree on what should be optimized. Step 3 is what people should debate. Steps 1, 2, 4 should be transparently managed by public+private working groups of experts.

Instead, the public and political discourse around lockdown and data collection are proxies for an informal debate around whether population health or economy is more important, which is not a well-posed problem, nor is it an effective way to engineer a solution.

And it’s really hard to even get agreement on what to consider in order to decide! For instance, a strict utilitarian assessment needs to consider (and opine) on the following questions:

* Does full lockdown, which it is agreed would reduce COVID deaths, increase or reduce net deaths over the same period in all cause mortality (poverty, depression, abuse, etc)?

* Does full lockdown increase or reduce net deaths over some longer period of time for all cause mortality?

Then we get to the really hard stuff, in two directions: first, cultural:

* Will full lockdown + contact tracing be implementable in the US / UK?

* If so, are the privacy and government centralization harms worth the benefit?

* If not, are the privacy, government centralization, and mortality related harms / benefits worth the tradeoff?

Second, in ‘softer’ terms:

* Will lockdown disadvantage certain members of society? (see the “K shaped recover” for lots on this.

* Are those harms short or long term, and are they worth the lifesaving that (may/will/definitely will/probably won’t) result?

Again, this is all presuming we agree to be utilitarian about this, (which I am not particularly inclined to be personally).

And, crucially, the answers to these questions is going to vary based on how much control a given government has right now, how much trust citizens have in their governments, how good the social safety net is, how protected / enforceable the borders surrounding the lockdown are — it’s impossible to get a global answer here.

I don't understand why the Western civilization fails so profoundly at this task - even when we have good examples showing that it can be done. But it is a subject for another discussion (also why the antigen tests have been used so far in such a limited fashion? https://medium.com/@zby/it-is-9-months-now-why-we-have-no-ma...) - for now we need a plan that would be adjusted to the individualism of the Western world. I believe that it needs to be more bottom up, we should give people more power to self organize and devise new arrangements. For that we need one crucial technology - rapid at home tests (like those proposed at: https://www.rapidtests.org/, though I am a bigger pessimist at using them in grand top down schemes).

In the spring there were ideas about building 'safe bubbles' - by limiting contacts to a few, who would also limit their contacts. This can work much better than it seems - because most of the contacts that can bring us the virus, the long and close contacts, come from our stable social network. These are the people with whom we can negotiate rules and procedures. There were examples of this being done - but the only successful cases were of whole teams who totally isolated themselves. Now with rapid tests this can work for less strict isolation measures - as any intrusions of the virus inside the bubble could be quickly detected.

For instance, a question: what do we do of people without preexisting conditions that recover very badly from the infection:

https://www.theguardian.com/world/2020/oct/09/brain-fog-the-...

Honestly Im not sure I'm trust anyone who has the money to be placing full page ads in papers to be looking out for me.

Oh what do you know....after googling it it turns out this person is associated with The Federalist.

So if we were all careful, herd immunity would be delayed. And if the careless are out and about, the vulnerable become especially vulnerable in public, and anyone who might come in contact with someone vulnerable, and anyone who didn't know they were vulnerable. And we'd all suffer from the prolonged effects of the disease which may include breathing issues and even mental health issues.

If herd immunity truly was viable it should be made policy and the answer would be to deliberately infect everyone deemed "safe" and get it over with. Yet the argument is "for mental health" or "for the economy" and never "because it's the right path".

No one is 100% "safe" and deliberate infection is unethical even in a medical academic context. Until these two facts change, herd immunity is out of the picture, and so should be these doctors. I'd be interested to know if these doctors were ever infected and if not willing to infect themselves. Otherwise, they're putting themselves in a special class as non-participating beneficiaries only.

It feels like we've been unable to visit anybody for about 7 months now.

It's hard enough to keep your sanity in check, the major problem is everyone else that has been locked up with you are also having wild mood swings.

Some body needs to make a documentary about this experiment going on down here.

I had the ability to visit and see my grandma in hospice before her death because visitor restrictions were lifted.

The US can allow a quarter of a million people to die alone surrounded by faceless health workers in PPE, but I'm happy to be in a country which doesn't because we went for eradication. And we have much, much less money per capita or social spending than the US - but we still managed to pull it off with the help of our government, military and existing healthcare workers.

I'm gonna stop you right there, because it's looking less and less likely that there will be such a thing. https://www.theguardian.com/world/2020/oct/06/flurry-of-coro...

"As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity."

Have we established that herd immunity is possible?

https://www.nature.com/articles/s41577-020-00451-5

https://www.nature.com/articles/d41586-020-02400-7

I cannot currently find the link on the (at least) one confirmed case of re-infection.

"Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home.* When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.*"

I would like to see this "comprehensive and detailed list of measures" before I make up my mind, but the suggestion for retired people does not sound exceptionally feasible. (There are over 50,000,000 people over the age of 65.)

Also:

> More than 100 medical and health experts at Stanford signed a letter condemning their colleague’s “falsehoods and misrepresentations,” saying they “undermine public-health authorities and the credible science that guides effective public health policy.” (source: https://www.buzzfeednews.com/article/stephaniemlee/herd-immu...)

Sweden is a bit of an outlier. They're a socialist country (by 2020 standards) that screwed up for non-economic reasons. They just got it wrong.

What most people who are middle-class or higher don't understand is hustle. People fetishize that word in Silicon Valley, but hustle is the principle of needing money to live and doing whatever it takes to get it. It isn't pretty, but it's how the other half lives. These people don't have savings because their wages are too low, so when they have an unexpected expense, it fucks them up. Hustle is: Pawning possessions. Odd jobs. Short cons. Gig labor. Petty crime. Panhandling. Whatever it takes, in truth. These people aren't morally worse than us middle-class salarymen and -women. They just have shittier options.

Hustle is a force that governments can't really control (unless they go hard core, like China) because these people are usually quite good at evading authorities. Hustle keeps afloat the people the system has failed. It keeps them from dying. It also, in a pandemic, spreads disease. It's why compliance has been so atrocious in the US and UK and Peru.

Do you need to "lock down" sufficient to get R below 1? Unless you want a humanitarian catastrophe, the answer is yes. Unfortunately, if your economic system runs on the "don't work, don't eat" model, you are going to see so much hustle (noncompliance, to use a more distant bourgeois word) that even your most ardent efforts are likely to have only moderate results. That doesn't mean they aren't working, and it doesn't mean you don't need them. It's still better to have R at 1.1 than at 2.5. But the fact is that an economic system like US-style extreme capitalism isn't built to handle anything out-of-context like a pandemic.

"The project was sponsored by the American Institute for Economic Research, which is a libertarian think tank funded by billionaire Charles Koch's conservative Koch Foundation" https://en.wikipedia.org/wiki/Great_Barrington_Declaration

The Koch brothers are known for financing climate change deniers.

It seems clear to me this is not the time to relax precautionary measures.

https://en.m.wikipedia.org/wiki/Great_Barrington_Declaration

The argument is also predicated on there never being a working vaccine, and herd immunity being the primary mechanism of eventually ending the COVID-19 pandemic/lockdown[0].

> [0]Sunetra Gupta, an infectious disease epidemiologist, has been a critic of the prevailing COVID-19 pandemic lockdown strategy, arguing that the cost is too high for the poorest in society.

That's an economic argument, not a medical one.

Considering at least two vaccines are coming out of stage III trials[1] and may be widely available as early as summer 2021, I'd prefer to wait for that, rather than a scheme hatched by economically interested individuals who want to sacrifice a lot of people for essentially more wealth.

[0] https://en.wikipedia.org/wiki/Great_Barrington_Declaration

[1] https://en.wikipedia.org/wiki/COVID-19_vaccine#Vaccine_candi...

[2] https://en.wikipedia.org/wiki/American_Institute_for_Economi...

[3] https://en.wikipedia.org/wiki/American_Institute_for_Economi...

https://www.independent.co.uk/news/uk/home-news/coronavirus-...

This flies in the face of rationality. You don't just get sick for a day and gain herd immunity. You are sick and contagious for weeks, you then infect other people whom go out and infect other people. Do these doctors seriously believe people at risk can just isolate themselves from the world? Most don't even realize they're at risk.

If you want to put that risk of infection and death onto people then say it, but don't try to sugar coat it like this is a good idea that will protect everyone. If anything it's necessary to keep markets afloat and various economies from failing.

1) This declaration was made at a conference on economics. That makes the motivations seem like they are economic in nature, not driven by medical motivations.

2) It isn't clear to me that these doctors are experts on coronavirus. Only one is mentioned as currently practicing. As I understand it, death isn't the only negative consequence associated with coronavirus. Their declaration seems to ignore this and only seems to be based on a meta-analysis of death rates.

3) We do not currently have a lockdown. We have some restrictions in place. Their declaration is not just against lockdowns, it's against gathering restrictions, masks, etc.

First of all, its principal authors are legitimate medical specialists, who happen to hold a contrarian opinion. This is fine. Science doesn't work without discussions and clashes of contradicting point of view.

However, the declaration is written in very political, not scientific language. The mention of "herd immunity" doesn't give it any good points, too. Regardless of what anybody might think, most epidemiologists are quite aware that full lockdown is a nuclear option, that will be tried only after all other means have failed. We hate lockdowns just like everybody else. As the nuclear option, it works, but all of us are currently busy trying to figure out anything, really anything, that could bring the reproduction rate below 1 without resorting to a full lockdown. We work long days and weekends for that. So it is quite unfair to blame researchers and politicians for this. Nobody wants it.

And just in case — no, you wouldn't want to leave the virus with the reproduction rate > 1 unchecked. With that, sooner or later (but in quite a short time, several months top) medical systems everywhere will be catastrophically overloaded. Then, all the hell breaks loose.

I must say I find this perspective difficult to understand - how can this person believe he's on the side of preventing mortality?

It appears certain at this point that there is no remaining mathematical possibility for the population-wide mortality rate in the US to end up as low as Sweden, which of course did not close primary schools or engage in any lockdown at all.

Sweden is by no means a model response - they did many things wrong. But at a minimum, it's a baseline count, no? If the USA mortality rate is higher, without even accounting for second-order mortality from the lockdowns themselves, then how can the US policy possibly be defended as anti-mortality?