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Comment by rwcarlsen | Hacker News Reader

Yes - but when we only hear about, think about, and look at the extremes, it becomes too easy to let our thought-processes about the situation become (even subconsciously) skewed. It's too easy to forget that the constant barrage of stories and information is actually about the extremes. It takes deliberate effort to keep the balanced view.

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For sure; that's why people reiterate the 99%+ metric. This isn't a cataclysmic virus that will wipe out life on earth, but it will tax health care systems far beyond what they're capable of handling. It will devastate economies, lock downs or not, globally.

It's far to easy to dismiss the effects if we see it "only" hurts <1% of people; which is why people feel the need to constantly reinforce the negative impacts.

Serious question, I don't have a political agenda by asking this: How will a virus that hurts <1% of people devastate economies, lockdowns or not?

Economic devastation from lockdowns is clear. Economic devastation from a virus that primarily hurts the elderly is not clear to me.

Again, I'm not making any points about the value determination of lives saved vs GDP saved, only asking how you quantify the economic impact of a virus.

> How will a virus that hurts <1% of people devastate economies, lockdowns or not?

Imagine 1% (or 0.5% or 0.2% or whatever) of planes crashed. How well do you think the airlines would fare? How many people would still fly?

1% is an insanely high number of deaths.

0.1% of London bus drivers died: https://www.ioshmagazine.com/2020/08/11/london-bus-driver-co...

If they were dying in bus crashes, people would notice.

1% is not insanely high, it's roughly how many people die each year.

Then indeed, doubling the number of people who die would be significant.

Of course, but so is the damage caused by lockdowns.

Are you suggesting that lockdowns are doubling the number of animal deaths?

anoncake writes:

> 1% is not insanely high, it's roughly how many people die each year.

So another percent on top of that is a doubling. As many people again dying from Covid-19 as die from all other causes. How is that NOT “insanely” high?

Given the average age of covid deaths, there's probably something like 80-90% overlap there. Nowhere near double.

How much does people dying disrupt our lives every year? Not at all, basically. Two times "not at all" still isn't much.

My understanding of the numbers is that < 1% of people will die. ~20% of cases require hospitalization (~10% including asymptomatic infections). It's that hospitalization number that's the worrisome. 10% of the population is way more than the hospital capacity of anywhere - in the U.S. we have about 1 bed for every 300 people, 0.3%.

Without hospitalization a fair number of the 9% that is hospitalized but won't die will instead just die. This is why you see death rates of close to 10% in areas like Lombardy or NYC where the hospital system was overloaded. And even if they don't, they're too sick to go to work. Most industries will have serious problems if 10% of employees call in sick. Then there are issues with people who have non-COVID illnesses (say car accidents) who won't be able to find beds because all the hospitals are filled with COVID patients.

When #FlattenTheCurve came out people had very legitimate criticisms that centered around them doing the math and computing that if we flattened the curve enough to avoid overwhelming the hospital system, we'd be locked down for the next 20 years. Realistically, the only solution was to lockdown, social distance, and wear masks long enough for a vaccine to come out, then vaccinate everyone who hadn't already gotten it. It looks like that'll actually be the outcome in wealthy coastal areas like the Bay Area or New England, but in the middle of the country we'll just overload the hospital system and see what happens.

The fear and media has convinced people like you that crazy things are true like a 20% hospitalization rate. But check out the cdc: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidvi... . It looks like the hospitalization rate of (cases) is hovering around 7%. That means the positive hospitalization rate of _infections_ (which would include people that never got tested and never went to a hospital, but also got covid) would be even considerably lower than that. Which would square with my experience - being acquainted with ~100 people that have had covid and knowing nobody that went to the hospital.

Like, but that's still far more than the capacity of many Western medical systems.

It doesn't matter how much you overshoot medical capacity, because as soon as you do, death rates go way, way up.

So you're saying my media is evil and trying to make me fearful using false exaggerated information, but somehow your media has no motivation besides giving you perfect accurate information. I'm an easily fooled rube while you're able to float above it and extract only the good info .

You've just cited the overriding mantra (for everyone) of our times.

"Everyone I disagree with is either acting in bad faith and trying to manipulate people or is a rube who's being manipulated. All of my opinions come exclusively from rational philosophical means achieved independently of any external media influences."

How much capacity do you think there is in the healthcare system?

If the healthcare system gets overwhelmed the damage is longe term because doctors and nurses will die and it takes along time to replace them.

Doctors and nurses dying is a negligible concern IMO. Yet again - there have been a few highly publicized cases of things like this, but at scale it is just not something that happens at a non-negligible frequency. I have multiple family members in the medical field. None of them report any such issues - including my sister who is a doctor working in a covid unit in Indianapolis.

They may not die, but I'd bet a lot of them want to leave, or will have significant psychological trauma after dealing with this.

The UK NHS is recruiting at the moment, in the most visible campaign I can remember. I'm wondering if this is linked - certainly I wouldn't want to be faced with the upcoming winter in a medical role dealing with this, given what happened in March to June this year.

Yep, NYT had an article about exactly this yesterday: https://www.nytimes.com/2020/11/15/health/Covid-doctors-nurs...

I suspect that if the system gets overwhelmed, various processes will break down as they start accumulating tent cities outside the hospital and run out of equipment.

That's because the system hasn't collapsed.

Comments level getting to deep - trying to reply to a sibling. But 1% of planes crashing kills more evenly across demographics. The 1% here are almost exclusively the elderly and infirm who were contributing (directly anyway) almost nothing to the economy - and in many cases actually being a drain on the economy. Just like the parent comment - I'm not saying they aren't worth saving at economic cost, but just saying that them living also is an economic burden.

I ask this in all seriousness - do you have parents who are still alive? Do they have any chronic conditions that make them more vulnerable?

The economy is not the only thing that matters, and if children can have their grandparents for another 5-10 years, then that's massively important to them, while being irrelevant to GDP.

Full disclosure: Both my mother and my wife's parents are in the age group that is super vulnerable to Covid, and I'd like my daughter to remember them.

Not having vulnerable people close to you is not the only way you can hold my position/view. I have three grandparents who I love dearly in their 80s - one with diabetes, one with rheumatoid arthritis, and the other with lung scarring from tuberculosis. My parents are approaching 60. My wife's parents are in their 70s (both have had covid already). And I have several of my own children. My position is that, yes covid sucks. In my personal view/opinion, the danger/risk levels of covid don't warrant anything nearly so severe as what has been going on all over the world. Let people live. Don't treat them like babies that need to forced to take their medicine. We've long since crossed the liberty/safety threshold I'm comfortable with.

100% agree with your take in this comment and your others in this thread. Thanks for the nuance and perspective!

It seems you were lucky enough to not have a detrimental COVID experience with your immediate family members. I wonder how much your view would change, had you lost one or more family members. You seem to lack empathy for the 1M+ people that have lost someone (globally), and probably millions more that were potentially permanently damaged by COVID.

for what it's worth, my mom and aunt are in their 70s and will have cleared COVID this coming Thursday. When she said they both had COVID i was in tears thinking it was a death sentence given what I've read online. My mom had a fever for one day and just sniffles and body aches since. Same goes for my aunt who is also a breast cancer survivor.

I bet the experience differs a lot for different people and different cultures. My mother has diabetes and is in the vulnerable age group but from all the adults I know, she and her friends around her age are the people who were the least concerned about the virus since the beginning of the epidemics. No isolation, no masks, they just don't care and even get angry at the attempts to keep them isolated. And to be fair, I totally get it. Kind of, it is better to die standing than to live kneeling. We'll all die sooner or later.

Just because the elderly are more vulnerable it does not mean other age groups are not experiencing a higher death rate due to covid.

Per the CDC: "Overall, an estimated 299,028 excess deaths have occurred in the United States from late January through October 3, 2020, with two thirds of these attributed to COVID-19. The largest percentage increases were seen among adults aged 25–44 years and among Hispanic or Latino (Hispanic) persons."

https://www.cdc.gov/mmwr/volumes/69/wr/mm6942e2.htm

I would argue that "adults aged 25–44 years" are a pretty integral component of the economy and more of them dying than normal is not great.

The largest percentage increase may have been in that age group, but since the base rate is very low, it still amounts to few deaths overall.

The economic impact isn't coming from people dying, its from the measures being used to prevent people from dying. It seems like the economy operates on such a knife edge a little push has serious repercussions. We shut down restaurants because they're a prime locus for spreading. Now those employees are out of a job. The restaurant closes or can't pay its rent, now the owner of the building has knock-on effects.

Even without mandated lockdown, the effect is the same. If I have a 1% chance of dying/long term effects, and I can reduce it if I don't go to restaurants, I won't go to restaurants.

Agreed. Even with significantly reduced capacity it doesn’t seem restaurants around here are turning people away.

Demand has dropped off. Whether there are government restrictions or not, people have overwhelmingly decided it’s not worth the risk.

For the vast majority of people, that chance is significantly lower.

For dying, yes, for long term effects, it's not so clear. And I would also count "I infected my parents and they died" as long term effects.

There is no evidence for long-term effects, only anecdotes.

I'm sure many New Yorkers whose parents died will disagree.

They don't use your private definition of "long-term damage".

And you know that because you have asked them all?

I will neither use your personal terminology nor play games like this. Good day.

>The economic impact isn't coming from people dying, its from the measures being used to prevent people from dying

I would say the economic impact is from the fact there is a pandemic. Even Sweden, which tried to avoid lockdowns, still saw an economic impact because people will avoid going out during a pandemic.

The fact that businesses are forced to close, or in the other case, that people would have been forced to work during a pandemic for fear of being homeless is a public policy failure.

The economy is impacted by people not spending as they were pre covid due to the desire to both avoid contracting the virus in locations they would have previously frequented as well as people saving more in fear of a weakening economy.

My savings rate has increased significantly since Covid as I am barely eating out at all due to the risk of contracting Covid via restaurants as well as worrying that the economy could get much worse and wanting to be prepared. I am just an average person so I would assume that there are many hundreds of thousands of people doing the same as me, thus the economy contracts.

My state is essentially not shut down at all, so very little impact is due to government regulations and almost all of it is due to personal spending choices. The less restrictions in place, the more the virus spreads and the less money I spend.

The economy is highly dependent on people spending and many people dont want to spend right now.

The less restrictions in place, the faster the pandemic and all its effects are over.

how so? Is there proof getting covid grants lifetime immunity? If not, how does that effect the plan if we assume that everyone gets covid at least once a year? Every year you now have a chance of dying from Covid, and overall life expectancy is chopped globally. Are you ok with 250k deaths a year from covid every year going forward? Why would people spend more if the virus just keeps going? Again, my state has no restrictions in place that I am aware of and no one is spending and businesses are closing. That does not seem like a great plan.

I think a better plan is to keep the virus under control, prevent needless deaths and then get vaccinated, especially now when we are so close to a vaccine release. Why risk the lives of tens of thousands of people when we can just all wear a mask and get vaccinated?

> Is there proof getting covid grants lifetime immunity?

No, and there never will be since medicine is not mathematics. But nor is there any reason to believe our immune systems can't deal with this virus like they deal with any other virus.

> Are you ok with 250k deaths a year from covid every year going forward?

250k/7.8 billions = 0.003%. Yes, I'm fine with that.

> Why risk the lives of tens of thousands of people when we can just all wear a mask and get vaccinated?

That's a hypothetical question considering we don't have a vaccine yet and masks are hardly the only restrictions.

Also many of those people who didn't die will have anywhere from mild effects to serious impairments for the rest of their lives.

A huge amount of people who survive will deal with increased depression, anxiety, etc.

Even though its easy and callous to write off the lives of millions of (easily preventable) deaths with a hand-wave, there are going to be serious and long-term effects for those who didn't die and for their families, jobs, etc...

I personally know many people who are suffering from severe pandemic-related anxiety and depression who have not contracted the disease.

The current discourse and societal response to the disease seems likely to have as big or larger of a mental health effect than the immediate consequences of the disease itself.

The lack of a proper societal response to the disease, and what that reveals about the fragile state of our civilization is what's responsible for severe pandemic-related anxiety.

There's truth to this, but I don't think it's the whole picture. It's certainly possible to be concerned about the state of civilization without "doomscrolling" or checking covid death numbers each morning. These behaviors are consequences of the media landscape more than of the disease itself.

That is simply not true and just speculation - especially for a disease that has been around for less than a year. Most of the studies that reported things like heart damage and other kind of side effects were retracted, but the retraction never made it in the press and social media, just the initial poorly ran studies that got hundreds of thousands of shares. One of the so called long COVID studies was done through people recruited through Facebook groups and Reddit communities, all of them having self reported symptoms, but none having actual positive tests.

I don't agree that it would necessarily tax health care systems "beyond what they're capable of handling" (for my definitions of those words). I also disagree that economies would be devastated if we had avoided all lockdown and economy-affecting mitigations. But I understand that reasonable people could disagree with me on both those issues and that is fine.

Durinng their peak earlier this year, Italian doctors were choosing who lives and who dies in the normal course of triage. That's the definition that matters to public health policy.

To me, beyond what it is capable of handling - means that the system gets damaged - not the people that it is treating. What you described is what I would call "beyond it's peaking capacity for treating patients". Not a general "beyond capacity to handle". Imagine driving a car. Not being able to fit all your friends in the car is different than the car frame being crushed because too many people climbed onto it. I'm saying that the former is what we have/will experience - not the latter.

Tbh that sounds like a ridiculous standard. Our hospitals are fine as long as they haven't been hit in a nuclear first strike and are still standing?

This feels a bit tortured. COVID has, is, or is threatening to overload our healthcare system as evidenced by:

1) Severely reduced in-take of new patients of patients due to lack of beds available (and longer COVID recovery time)

2) Reduced ability to effectively care for other patients due to limited beds and transmissibility of the disease, and workforce reductions as healthcare workers get sick (this is not a hypothetical, this is happening in the hospital my wife and brother work at).

3) Forcing healthcare works to perform their jobs without subsequent PPE for their own protection, increasing their own health risks and creating serious issues for mental well-being when working in this environment day-in and day-out.

The healthcare system is designed to treat patients. Believing the system is not exceeding what it can handle because somehow "the system itself" is not damaged (which I'm not even sure what you mean by that) but dismissing patient care and outcomes is like evaluating a vehicle's crash rating, but not evaluating the damage to the vehicle occupants.

That is not true on two fronts. First, doctors were not choosing who lives and who dies. They were deciding who would have the higher chance of survival if they were treated. There is no certainty that a) the selected treatment group would survive or b) the unselected would have survived but for the triage.

Secondly, that is exactly what triage is! People die, doctors are trained to decide of a group of people which are dying, who has the better chance of not dying.

I think this is missing the mark. Italian doctors were choosing who would get an ICU bed and who would not. There were more patients needing ICU beds than the beds available. Not giving an ICU bed to someone in need meant basically a death sentence. That is not the normal state of affairs, as far I can understand.

Well again, not _really_. We were also ventilating people who didn't need it. You don't need an ICU bed if you aren't vented. Furthermore, the mortality rate of being on an ventilator is non-negligible.

I would be interested in seeing if there is data to say whether being put in the ICU actually _increased_ risk of death. Of course this would be hard to prove as only the most sick went to the ICU etc.

This fake story should die already.

(from another post) >To me, beyond what it is capable of handling - means that the system gets damaged - not the people that it is treating

I think your definition of "what they are capable of handling" (for some reason I can't reply to your other clarification of this definition) isn't one that many people would think is a good one. It may be technically correct in some domain, but this isn't it. Healthcare systems are there to provide healthcare for people, and if they can't do that (as in this situation) then they are incapable of handling it. In addition (in the UK at least, can't speak for anywhere else), this has led to not only ICU capacity being exceeded, but also routine healthcare being diminished - either because of people being unable to visit a hospital, or unwilling to do so.

I think the 99%+ metric is reassuring. However the 1% will have a massive cost to our healthcare system, we are in extremistan as Nassim Taleb likes to say. For example, in normal times 10% of the US population represent 64-66% of the health care costs (https://youtu.be/2qhrPa7paAU).

The thing is, it's more likely to be skewed in the wrong direction, the direction that it is safer than you think. So actually its important to understand how bad it is for those who get it. We have consistently had >1k deaths per day in the US and then many others with longterm issues.

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