For anyone who is skeptical of the statistics, the response is to ask them to explain excess deaths. In America there are over 200k excess deaths; if not COVID, then why did so many more people die?
People argue that increases in death could also be attributed to suicide, deteriorating health from mental hardship of stress and quarantine, and people not seeking medical treatment they need because they are scared of covid or because they cannot afford it with so much unemployment.
I think the last one holds some water. I know of one person in my hometown who chose not to go to the hospital because he was scared of covid and ended up dying of a heart attack.
Yes, COVID has killed a _lot_ of people, but so has the response to COVID. We focused all resources on one enemy while other allies of Death stalked in the back door.
Also, in the case of Vietnam, only 14% of their population is over 55 years old, whereas 29% of the USA is over 55 (and 31% of Belgium, another hard hit country). Seeing as this disease hits people over 55 the hardest (and is barely noticed in those under 30), it is no wonder Vietnam is seeing less of an issue here.
It seems age demographics _could_ have more correlation with outcomes than any government intervention. That of course doesn't explain Vietnam entirely. Also keep in mind, Vietnam has only administered 12,000 test per 1 million people, whereas the USA has administered 492,000 per 1 million.
The bank shot demographic explanations are just more distracting BS, the obvious lesson is suppress the virus!
We need to understand better why Vietnam is seeing such positive results but saying you know why for certain is disingenuous
People want to raise doubts about the effectiveness of their suppression by implying that they have not achieved suppression but rather their younger population means they are not suffering deaths as a result. This we can say with a lot of confidence is not the case because their demographic advantages are not that great and other nations with similar demographics have not been as successful.
We do in fact need to understand their success, that is why it is so important to avoid dismissing their success with demographic excuses!
Actually let me list what I think, since you seem interested enough in my opinion to spelunk my comment history:
- COVID-19 is a dangerous infection. The degree of risk and severity is directly correlated to age.
- For those below ~30 years old, the infection is between as to much less dangerous than some strains of influenza.
- Between 30-60, the infection is appreciably more dangerous than the flu, but not severely so
- Over 60 the infection is far more dangerous than the flu, and extreme precautions are warranted
- The projections of disease modelers were incredibly off the mark early on, by orders of magnitude. The models are better today.
- The fatality rate was grossly overestimated. Early in the pandemic, we had numbers around 1-3% IFR (not CFR). This was also off by an order of magnitude. Real IFR will end up around .3-.5%. Deadly than the flu, but again with the burden on older people
- Most public health measures we are deploying were created for pandemic influenza. They do not necessarily apply in the same ways to pandemic coronaviruses.
- Masks clearly work to reduce the spread of infections. Not mandating masks is a terrible idea, and governments who have avoided it thus far will be judged harshly
- Influenza has around a 15-20% asymptomatic rate. Coronavirus has twice that. This causes huge problems for contact tracing though it is clearly not impossible
- We over-focused on surface spread and panicked people into disinfecting everything, while ignoring aerosol spread
- We over-focused on spread between strangers and in public, and downplayed the real risk, which is spread within families and those who live in close quarters
- This alone caused imbalanced risk assessments for people. Eating at a restaurant with proper distancing and ventilation IS safer than having an indoor neighborhood block party without masks.
- Lockdowns require an exit strategy that is something beyond "more lockdowns".
- Lockdowns are a great public health strategy if they are incredibly short lived and adhered to
- It was clear in March that the only way out of the pandemic was immunity, be it natural or vaccine enhanced. Lockdowns should have been thrown out the window at that time
- The goal posts were constantly moved from curve flattening to deaths to raw case counts
- Metrics for reopening should have been clear from the start and based entirely upon hospital capacity
- Ignoring the impacts of the lockdown is close-minded thinking that has and will continue to cost lives
- Essentially, we knew by April at the latest that eradication was no longer a possibility, and that we should have switched from eradication to mitigation
- Mitigation would include targeted restrictions based upon age risk
- Mitigation also requires acceptance that cases will increase and deaths will occur, but the goal is to reduce those, we can't aim for elimination. The cost is too great and the odds are too low
- Public health officials shot themselves in the foot several times throughout the pandemic
- While I understand why masks were downplayed originally, that was a terrible mistake. Saying "masks work, but we need them for our medical heroes" or some shit would have been better
- Maybe that would have made masks "cool" instead of a political signaling tool (again, I 100% support mask mandates)
- Outside spread was confused by the support of the civil rights protests in the Spring. We knew then and continue to know that outside spread is very unlikely and that the protests were safe. But at the same time we were shaming people at the beach. Both were safe, and to declare one safer than the other based upon the ontology of the events was a terrible mistake
- The media spread fear and panic before it was warranted. Constant updates on death counts outside of context was a dangerous game.
- Related, most locations locked down too early. Locking down prior to community spread is a waste of resources and good will.
- As said above, lockdowns needs to be applied carefully. Too soon and you blow all good will as time goes on. Too late and you may make it worse by forcing people indoors
- Locking down before community spread exists had the effect of costing states and people millions up millions of dollars with little helpful impact
- The pandemic became a political tool for the left and the right, both wielding it to the extremes. The left was virtually arguing that this was apocalyptic, the right was saying it was the flu. Both are clearly wrong, and the extremism caused public trust to tank as both arguments were easily falsifiable. Once this occurred, early in March, we lost any chance of actually combating the virus in a smart, sustainable way.
Again, anyone who was paying attention would have known that the lockdown strategy would need to extend until there is a vaccine. Nothing would materially change month to month as the lockdowns dragged on. The "just two more weeks" crowd caused a ton of fatigue in people who were earnestly wanting to help stop the pandemic. We needed leadership from the beginning explaining the tradeoffs. Explaining that lockdowns would need to continue intermittently until there was a vaccine. We needed honest leaders telling us clearly that lockdowns do not protect you forever, and once the lockdown ends you are as vulnerable as ever.
Both of those mistakes led to people, again, distrusting the public health officials. We were told we needed to lockdown to stop the spread, and we did so. And then people kept getting sick and dying. Because it was sold as a panacea to the pandemic, when that turned out to not be the case people thought, "fool me once shame on you..." and gave the good ol' middle finger to the public health officials. Again, I don't agree with this attitude but I understand it. It is frustrating to lose your job in the name of safety only to see everyone still die.
Celebrating Europe all summer long when it was so obvious to anyone who thought about it that another wave was coming was shortsighted. We spent all summer saying "if only we could be more like them!" in the United Stats, only to see them end up in the same situation as us in the Fall. Now people are saying, "so you advocated for strict Euro-style lockdowns, and they are in the same boat now.."
Today, lockdowns almost make sense. We have a clear exit strategy with a vaccine around the corner. Except, we already burned all resources and good will locking down too early.
I am not a crazy COVID denier. I am a realist who understands data and human nature.
The fact of the matter is that we have plenty of evidence from around the world that suppression is possible and practical and doesn't cost nearly as much as the economic costs of letting the virus run rampant. Pretending that demographics is important in the success of Vietnam when Japan has the worst demographics in the world next to maybe Italy is.. well.. you know the word I would be reaching for!
The arguments about "blowing goodwill" are mostly overturned by the evidence that we actually have of high compliance in very restrictive regimes. "We can't impose China-style lockdowns" is immediately undermined by the Australian lockdowns that were both politically bold (in the face of domestic political resistance from federal politicians!) and extreme but very effective and enjoyed popular support.. in the home country of the owner of the leading anti-lockdown propagandist of the world! (Not to mention Italy & France imposing lockdowns for extended periods that were never approached in scale anywhere in the US and were not a problem.)
Both-sides-ism is silly. If at this point you can't concede that the "left" (if you accept that framing) was mostly right you are not paying attention to the results. In the "blue" jurisdictions that are struggling the issues arise from popular "business-friendly" Democrats undermining health advice. One side of the US political spectrum is wildly irresponsible and the other is not, don't pretend otherwise.
> "Metrics for reopening should have been clear from the start and based entirely upon hospital capacity" I mean, sure, but that is a condemnation of your earlier positions as expressed then in real time, right? This sort of ties into your assessment of the media, it doesn't really have anything to do with your opinions about the virus or appropriate responses.
If you think the situation in "Europe" right at this moment is the same as "the US" it seems like you might be misinformed. Finland and Norway are in a much different position than France and Belgium, who are in a different position than the Czech Republic. But all of them are in a better position than Iowa, South Dakota, and North Dakota. The idea that starting a 2nd or 3rd wave from a lower base is a bad idea seems kind of deranged.
I think you think of yourself as a realist but there is lots of evidence that you have underestimated what is possible as well as the capacity of human nature to do what's right. The information is out there, just look at it.
ETA: "- Mitigation would include targeted restrictions based upon age risk" We've got mountains of evidence that letting the virus run in younger populations endangers older people, that just doesn't work.
I didn't pretend that demographics is important. Demographics _is_ important. I didn't mean to say it was the _only_ factor. My main point was to demonstrate that nobody has convincingly rejected the null hypothesis in any of these response models. My point was that I can posit a reasonable theory that there is correlation between age demographics and COVID deaths/known cases. You (rightly) pointed out a country that has terrible demographics for my theory did fine. The key here is that _both can be true_. Everyone seems to be looking for a panacea when, thus far, one simply does not exist. The lockdown approach has contradictions as well, so if you profusely reject my demographic argument, you can't strongly hold on to lockdowns. We are talking about a disease, that while a relatively "normal" coronavirus, is still novel. And we are comparing responses across nations with wildly different cultures, densities, demographics, health care systems, travel levels, living situations and access to testing. My point is that maybe it was _just_ lockdowns that helped Vietnam. And may it wasn't just the lack of lockdowns that hurt the United States. We need to consider all explanations. And for the record, I do consider lockdowns a valuable tool at times!
Regarding the good will argument. Again you pointed at one location with one culture to imply that it would be widely supported elsewhere. While culturally Australia is probably closer to the United States than any other nation, there are still very key differences. The Australia lookdowns are really interesting for that reason though, that it is culturally similar to the United States. But, and I may be wrong, the lockdowns were limited to Victoria, and were not applied blanketly across their nation. This is not in contradiction to my beliefs. I have posted in the past about the idea that my state locked down _too soon_ before there was community spread. Essentially, we locked down when things were bad in New York. A lot of the opposition to lockdowns in the United States is the blanket approach in which they are applied. Counties with zero of few cases are locked down with the same vigor as metropolitan areas where cases are exploding. People rightly wonder why they can't go to work when the outbreak is across the state. I have always thought very targeted lockdowns would be a reasonable approach.
Furthermore, your points regarding Italy and France supporting lockdowns is rather interesting as well. First, both are far more collectivist than the United States in general. This isn't good or bad, it is a different culture that approaches problems in a different way. It just so happens that viewing the whole as or more important than the individual lends itself to restrictions in the benefit of the whole. The United States traditionally indexes on the individual above the whole (argument being that each individual adds to the whole, so the effect is the same). I am not here to argue individualism vs. collectivism but I will say that the issue is more complex than "Americans don't believe in science" (this may be a straw man, I don't think you've made that argument, but I tangented myself). The other point is that as lockdowns eased, cases rose. So what does that tell us? Two things...
First, it tells us that lockdowns do suppress spread (no shit). You keep people from interacting, and diseases spread through interaction are reduced. Abstinence is also the best way to prevent HIV. It is a truism that lockdowns reduce spread. And I would never argue against that (my argument is that it isn't _just_ lockdowns). But more importantly, it tells us that lockdowns must be maintained in order to continue to reduce spread. The "anti-lockdown" argument is that the time period required to actually _prevent_ deaths (not delay) is too long. It is effectively until 60%+ of the community have received a vaccine (this is ignoring heterogeneity in mixing and travel). A two-week lockdown is absolutely pointless unless at the end of those two weeks everyone is vaccinated. A two-week lockdown just delays the spread.
Now you may be saying, "Mr. salmon30salmon, the goal is not to prevent infection but to reduce strain on hospitals" and I would respond, great! I agree! It is important, even critical, to ensure hospitals are not strained. So why is _that_ not a metric we are chasing? I get the delay, 7-12 days from being infected to being hospitalized, so by the time hospitals are full you are rightly fucked as the next 7-12 days worth of people come in. But as shitty as our models have been, they are somewhat accurate in that timeframe. I support a lockdown for localities where the local hospital is nearing capacity. That makes sense.
Which brings me to the third (maybe final? this is stream of consciousness so we will see) argument. By which metrics are you saying Iowa is worse off than any European country. Let us look at the data, the source of truth in times of madness. All of my data will be from either worldometer or the Bing Covid dashboard.
Iowa:
- There are currently 84,772 active cases (or 27,345 per M)
- Deaths per 1M population: 666
- Tests per 1M population: 359,387
- Cases per 1M population (identified): 62,970
- Positive Test Rate: 17%
- Population of Iowa: 3.1 Million
- Total Case Projection (using a 10x median from Nature[1]: 620,970 * 3.1 = 1.925 Million cases
- Death Projection for ACTIVE identified cases (84,772) (lets take the best best IFR of .6%) = 508
- IFR based on projections: (666 * 3.1) + 508 / 1.925 Million = .13%
- IFR based solely on identified cases: 1%
France:
- There are currently 1,891,592 active cases (or 29,101 per 1M)
- Deaths per 1M population: 792
- Tests per 1M population: 296,031
- Cases per 1M population (identified): 31,935
- Positive Test Rate: 10%
- Population of France: 65.3 Million
- Total Case Projection (using a 10x median from Nature[1]: 31,935 * 65.3 = 19.24 Million cases
- Death Projection for active identified cases (lets take the best best IFR of .6%) = 11,349
- IFR based on projections: (792 * 65.3) + 11,349 / 19.24 Million = .32%
- IFR based solely on identified cases: 2.4%
This was all napkin math, so it may be wrong. But between those two, who is fairing better? I would rather live in Iowa, if my only decision point was COVID risk. Iowa has tested more people (35% of their population!). Thus, more cases have been identified. So based solely on cases, Iowa is doing worse. Now it wasn't fair to apply the 10x to both France and Iowa. Iowa has probably identified more than 10% of their cases due to heavier testing. But that doesn't make it any better for France. That would increase the IFR for Iowa most likely, but not three fold to .32%. Even the identified case IFR is worse for France with 2.4% vs 1%. Even with 5x unidentified Iowa beats France with an IFR of .27%
If I were a decision maker, I would emulate Iowa (limited lockdowns if any, masks encouraged, less dense cities). But this is against my thesis, that one size does not fit all. France is more dense in her cities, has more multi-generational living etc. What works (or didn't work) for France won't work for Iowa. That is why I argue against blanket lockdowns
<3 Salmon30Salmon
A quick search seems to indicate that the authorities in Iowa are keeping exact data private. Whether to hide reality or avoid causing a panic, I can strongly say I am against keeping that data private.
And to be consistent, perhaps Des Moines should be locked down but Ottumwa not. But without the data I've not the slightest clue.
Whereas in the past I made more reckless proclamations about lockdowns and responses, I am trying to retrain my instincts for bluster and provide only what I have strong evidence or data to support.
Not for nothing, but new cases seem to have peaked in Iowa and are now trending downwards, so that is good news!
Comparing excess deaths between US and Sweden is maybe a bit more bulletproof. If — at the end of this — Sweden has fewer excess deaths than the US, then their response was in some measures more effective than ours. But there’s so much going on, we still won’t know for certain for quite a while.
Here is a chart of excess deaths: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
The problem with arguments like these, is for America at least, why does the number of people who have a fear of medical care trend so closely with number of cases?
I predict that a few months later, a popular answer will be "they were actually killed by the vaccine".
(Bookmarking this comment so that I can keep linking it when this actually happens.)