Hacker News Reader

Comment by monological | Hacker News Reader

A study was just released by Stanford University with the objective of estimating the infection fatality rate of COVID-19. The results are as follows: "In people < 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%."[0]

Is it right to shut down the entire economy with these statistics or are people overreacting? High risk individuals do have the option to get food delivered to their home, if they're afraid of contracting the virus. Shouldn't they also be able to make that decision for themselves, if they're OK with taking that risk or not?

On the other hand, we don't want hospitals filling up past their limits and putting tremendous strain on health care workers. It's definitely a tricky situation.

[0]: https://www.who.int/bulletin/online_first/BLT.20.265892.pdf

View on HN

Humans are really bad at judging risk. Here's a sample of your odds of dying from a variety of causes as a 15-45 year old, sourced from the CDC [1][2] and your paper, and assuming there are about 45 million Americans in the 15-45 year old age range:

  Drug overdose: 1 in 1000
  COVID: 1 in 2000
  Suicide: 1 in 2000 
  Car accident: 1 in 2500
  [any gun-related death]: 1 in 2500
  Homicide: 1 in 3000
  The flu: 1 in 20,000
  Struck by lighting: 1 in a million
  Terrorism: 1 in ~100 million [3]

(COVID and influenza are infection fatality rates, the rest are rates among the general population. If you live in a wealthy neighborhood and don't have guns in the house your risks from suicide, homicide, and terrorism are basically nil, while if you're in West Baltimore they're much worse.)

You be the judge from that. Personally I consider COVID worrisome enough to take sensible precautions and endure some inconveniences, but not the end of the world (well, personally. It may be the end of many societies, possibly even including the U.S). The #1 health risk that people seem to undervalue is "Don't do drugs", and the #1 most overvalued is the "War on Terrorism". It's interesting how many infringements of our civil liberties and economic life we put up with in the name of curbing terrorism, when median number of terrorist deaths in the U.S. per year is 4, and COVID is 50,000 times more likely to kill us.

[1] https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_dea...

[2] https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_inj...

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

> On the other hand, we don't want hospitals filling up past their limits and putting tremendous strain on health care workers.

This seems like it's the only thing which matters. Having a working health care system is one of the pillars of modern society?

On one extreme, I'm sure most people would agree it's not worth spending millions of dollars to add months to the lives of geriatric patients. How much collateral damage are we willing to endure to add another 9 to the probability a senior citizen doesn't die from the pandemic? It's a balancing act.

I don't pretend to know the answer, but in general I am opposed to another shutdown given how much we've progressed in handling this disease.

On a side note, I'm not a fan of how the 15% rule makes it seem like we're on the brink of being overrun - you have to keep in mind 60 to 80% of hospital beds are occupied by non-covid patients.

The IFR would be worse if medical care wasn't available because of hospitals being over-capacity and health care workers burning out (or dying themselves). Fatalities from other causes would increase too (as they're already doing due to people avoiding medical care due to fear of infection at hospitals). The absolute number of dead would also rise were the lockdowns not in place. Just how many people do we want to sacrifice to keep restaurants open?

Also, fatalities aren't the only thing we have to worry about. People who survive can have very serious complications.

Finally, why should we only look at the effects on people younger than 70?

>People who survive can have very serious complications.

This is true of several respiratory illnesses. For example there's evidence that the flu can increase the chance of a cardiovascular event for several months after recovery[0]. Is there evidence that covid has more severe long term complications than other respiratory illnesses?

>why should we only look at the effects on people younger than 70?

We shouldn't, of course. However we also shouldn't base policy off of a minority of the high risk population. Older people are also at a much higher risk of auto accidents. Instead of making the license process more difficult for everyone, several states have rules specifically for older people mandating more frequent vision tests and license renewals.

Instead of banning a low risk activity for a mostly low risk group, why don't we put resources into taking care of the high risk population(free grocery/medicine delivery, prioritized telehealth appointments, etc.) and let everyone else take care of their own risk assessment?

[0]https://academic.oup.com/eurheartj/article/29/1/96/2398118

Just a couple of days ago "the U.S. recorded over 3,100 COVID-19 deaths in a single day"[1]

I have a very hard time imagining that restaurant closings or any other lockdown measures are ever going to lead to this scale of death.

[1] - https://www.adn.com/nation-world/2020/12/03/more-than-2800-a...

“Just how many people do we want to sacrifice to keep restaurants open?”

Just how many lives do we save by keeping restaurants open? Healthier food, portion control, emotional health? People sacrifice their lives to eat in restaurants...implicitly, when they drive a car to/from and risk an auto accident. It is probably small numbers against small numbers...and erring on the side of choice and economic activity is a standard US thing.

The poster didn’t propose to ignore effects on the 70+...where did you read this?

It would have been wiser had the government health communicators introduced the notion of QALY to the US public at the start of this COVID event.

https://pubmed.ncbi.nlm.nih.gov/16877455/

Anyone dealing with aging parents is painfully aware of the need to balance remaining length of patient life with quality of life, including caregivers. The rest of the US needs to grow up about this. Politicians avoid talking about this...too much like leaving Grandma on the ice floe. It’s the medical/public health professionals role to do that.

"Just how many lives do we save by keeping restaurants open?"

You tell me. How many?

"People sacrifice their lives to eat in restaurants...implicitly, when they drive a car to/from and risk an auto accident. It is probably small numbers against small numbers"

Like I said elsewhere in this thread, just the other day the US had over 3,000 COVID-19 deaths in a single day. That doesn't sound like a small number to me, and I'd be surprised if anywhere near that number of people died driving to a restaurant that day.

"The poster didn’t propose to ignore effects on the 70+...where did you read this?"

Right. They just happened to only quote the IFR rate for people < 70 years old, and not mention the IFR for people 70 and older. That sounds like they ignored them to me.

>You tell me. How many?

Based on the available evidence, I think the number is close to zero.

>Restaurants have been mandated by the state to impose certain regulations and hygiene measures. They follow the general principles of harm reduction that Monica Gandhi[0], an infectious disease expert at UCSF, goes by: masks, distancing, ventilation and hand hygiene. "There is no evidence that I can find anywhere in the world that outdoor dining with those four procedures in play increases the risk of COVID-19," she said. [1]

So there seems to be no evidence that banning outdoor dining is going to do anything positive in stopping the spread, though we know for certain it will have destructive effects on people's well being and the economy.

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

[1] https://www.houstonchronicle.com/bayarea/article/Is-outdoor-...

You didn't answer the question I asked, which was how many people's lives would be saved by keeping restaurants open.

Instead you answered a question I didn't ask: how many lives would be lost by allowing outdoor dining.

Two completely different questions.

However, if one of the requirements for making outdoor dining safe is to wear masks, I don't see how it can be made safe, since as far as I know people can't eat or drink with masks on.

Furthermore, at least in my own informal witnessing of people dining outdoors, the norm is for people to socialize at tables without masks, with only a couple of feet between them. I wouldn't call that social distancing either.

That's two strikes against outdoor dining: lack of masks and lack of social distancing.

I'd love to have asked that UCSF expert what she had to say about this.

Something else to consider is that restaurants aren't only doing poorly because they're being locked down, but even when they're open many people are choosing (very sensibly, from my perspective) to avoid them. That won't be fixed by ending lockdowns.

Anyway, I'm still waiting to hear someone tell me how many lives would be saved by allowing restaurants to open. Is it going to be anywhere near 3,000 in a single day? Somehow I very much doubt it.

I did answer the question you asked. The answer for "how many lives would be saved" and "how many lives would be lost" if outdoor dining is/isn't banned is the same; approximately zero based on the evidence. You also have to consider that even if all restaurant dining is banned, that doesn't mean people are suddenly going to stop eating together, they'll just do it elsewhere, somewhere that's probably much riskier than an outdoor patio such as a car or inside someone's house.

>I don't see how it can be made safe, since as far as I know people can't eat or drink with masks on.

Clearly the principles of harm reduction discussed in the article account for patrons eating without a mask on while they are seated at a table, but I suspect you already knew that.

>I'd love to have asked that UCSF expert what she had to say about this.

I'd love to hear what she would have to say as well. Though seeing as she has a long career studying infectious diseases and has studied covid extensively over the past year, I'm inclined to think she has a good understanding of the risks involved in certain activities, certainly beyond the anecdotal evidence of commenters on HN.

>I'm still waiting to hear someone tell me how many lives would be saved by allowing restaurants to open. Is it going to be anywhere near 3,000 in a single day? Somehow I very much doubt it.

I'm not sure why you're waiting for this answer. The number of deaths in a day(3000) is unrelated to restaurants allowing outdoor dining, so why are you comparing them? Closing restaurants will not bring that number down, based on the science we have available, but if you have evidence that suggests otherwise feel free to share.

You're here to save lives. Great. Do you want to start by banning all alcohol consumption, ban unprotected sex, or by making private vehicle ownership illegal?

Banning abortion saves lives too. Also motorcycles.

> ...but even when they're open many people are choosing (very sensibly, from my perspective) to avoid them

We should just open them then if nobody is going to go to them. In one breath you say we need to restrict them and in the other breath you say nobody will go. "I don't like to go there any more, it's too crowded" -- Yogi Berra

Another amazing feat of physics - like masks. When Covid cases go up it's because people aren't wearing masks. When the CDC and other international organizations record near-zero flu deaths for the year 2020 it's due to mask usage.

Somehow both things are happening at the same time.

"You're here to save lives. Great. Do you want to start by banning all alcohol consumption, ban unprotected sex, or by making private vehicle ownership illegal? Banning abortion saves lives too. Also motorcycles."

Except for banning abortion, none of those things has a chance of actually being made illegal any time soon, so no use talking about any of them. And I don't think getting in to an argument about abortion in this thread would be productive.

Let's see what else you've got...

"We should just open them then if nobody is going to go to them. In one breath you say we need to restrict them and in the other breath you say nobody will go."

Except some highly inconsiderate, ignorant, and/or stupid people are still going. It's those we have to worry about. So I'd vote to keep them closed.

"Another amazing feat of physics - like masks. When Covid cases go up it's because people aren't wearing masks. When the CDC and other international organizations record near-zero flu deaths for the year 2020 it's due to mask usage."

You know, it could be both? Because the flu might not be as contagious, and there are other measures being used as well, like increased hand washing, which might be more effective for preventing the flu than preventing COVID-19. And even if all the measures are equally effective, there just might not be as much flu going around this year. Anyway, the fact that flu deaths are also going down, probably due to some of the lockdown, mask, and distancing measures is is even more reason to continue them.

If you look at the plots of the data sources from the meta-survey of literature that is [0] you'll notice the IFR positively correlated with high population and infrastructure. These places get a better idea of the actual IFR and are diluted out by places that falsify data (China) and aren't capable of taking real population level data (smaller and undeveloped countries).

The first part of the paper is justifying this choice as to not dilute out the measurements from the small regions. I guess if you hang a lampshade on it like that it almost makes sense this paper was approved. But it's easily misinterpreted.

Actions could have been taken, and the cost of those actions could be much lower. It's because we keep comparing those numbers that we forget what really matters. The only reason economy matter is because people matter.

Even if those restaurants would be having a difficult time, or even close their businesses. I don't think those people work there would just die. Unlike those "high-risk individuals" you just so causality decide don't matter.

It is ridiculous.

1. Isolating just those above 70 is both cruel and impossible. The old and vulnerable need significant amounts of care.

2. 0.05% of hundreds of millions is still a lot of people. (And the number is far higher than that because it's impossible to isolate the >70)

3. the entire economy isn't shut down, far from it. At this point, it's on the order of a 5% hit. The pain is unevenly spread. A competent government would spread the burden.

4. If you were immuno-compromised, would you want your food delivered by the people traveling through multiple busy dining rooms?

5. Vaccines are just weeks away for the vulnerable, and mass vaccination a few months. The virus is spreading quickly, so just a little bit more isolation for a little bit longer will save hundreds of thousands of lives. Saving hundreds of thousands of lives might not be worth it if we had to shut down for years, but if shutting down for a couple months can save that many, it seems much more reasonable.

6. Your 0.05% figure assumes that hospitals and staff aren't overwhelmed. The figure increases dramatically when they are.

Reply on news.ycombinator.com