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Comment by tialaramex | Hacker News Reader

High lethality is often associated with reduced transmissibility. Which makes sense - dead people certainly aren't going to cough on you.

In a Sci Fi movie maybe the virus has a long delay, you're infectious for a month with no symptoms, then drop dead in seconds. But in the real world that's less likely the more extreme it gets.

One thing that did make this virus more dangerous was that many humans became infectious significantly before they realised they had symptoms. With some viruses you get symptoms, then (sometimes as a result of the symptoms) you become infectious, making it easier for public health messages to be effective. "Stay at home if you have symptoms" is extremely effective if people aren't vectors until 12-24 hours after the symptoms are obvious, but almost useless if they're infectious a week earlier.

I'd argue that countries which think the lesson is "We developed a vaccine quickly, good job" are mistaken. The lesson was just, "Elimination strategy works" and the many countries that didn't even attempt that got lucky they weren't decimated for their incompetence.

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In many ways, this was a worst case scenario for countries without a history of fighting respiratory diseases. It’s lethal enough to rack up a significant body count, but “safe” enough for large portions of the population to disregard the risk and potentially transmit it. Oh, and it’s airborne and you’re infectious before you have symptoms.

Ironically, a disease with a much higher case fatality rate probably would’ve killed fewer Americans, since we’d be more aligned on stopping it, and it would have a greater tendency to burn itself out.

Yeah, this was something 'interesting' to learn about people's behavior. If it had been deadlier, more people would take it more seriously. It hits a "sweet spot" where it's lethal... but not quite enough to terrify everyone into staying home. So it keeps ebbing and flowing.

> Ironically, a disease with a much higher case fatality rate probably would’ve killed fewer Americans, since we’d be more aligned on stopping it

Not unless it was much higher, like 10% whole population fatality might do it but merely twice as much death wouldn't move the needle.

It's because of one of the most literal examples of survivorship bias. No living people have ever died as a result of taking some particular obviously unsafe shortcut, so they can rationalise it as OK, even though intellectually they know it's a very bad idea. Each time this unsafe shortcut kills somebody, all the living people still have no experience of dying from that shortcut because the one person who experienced the other outcome is now dead.

Close calls can help a little bit, gradually, but the effect is slow and unevenly distributed.

> it would have a greater tendency to burn itself out.

One reason I particularly point at elimination strategy (beyond the, in my opinion obviously related fact that it worked) is that zero cases has a categorically different impact than merely low numbers of cases that result from hoping a lower R-number will cause it to "burn itself out". You get to zero only one case at a time, tracking and tracing everything, getting right into the details, whereas these vague statistical approaches do not do that.

Lots of countries or regions have tried to "flatten the curve" but that's not actually a way out, it's just to buy time. Now, in this case if you bought enough time (maybe 18-24 months) you get a vaccine. But not all diseases are like that, and we could not be confident this was one.

Getting to zero is instead a (painful) permanent fix that allows you to really open up (within the country or region at zero). New Zealand's international tourist economy got a kick in the head, but its people are alive, much of everyday life is already how a lot of us in the North are hoping 2021 will be - its message this summer is "Make summer unstoppable" with small adjustments like wearing a mask on the plane, or tracking where you visited with QR code scanners - but otherwise a pretty normal vacation season, concerts, sports events and so on.

I sometimes think about this in terms of warfare. Everyone who has memories of a war survived it, and this factors into deciding whether the next war is worth it or not.

Nobody asks the people who died in the war if it was worth it.

We were mostly taught about World War I through the war poetry. They wanted our class to all memorize Wilfred Owen's poem "Dulce Et Decorum Est". I couldn't do it, got terrible marks in that class. But the Latin phrase itself sticks in your head.

Wilfred Owen did not live to see the end of that war.

It was at first astonishing to me that the same words are etched into the Arlington cemetery amphitheatre, but of course that's almost why Owen refers to them. At the time the building was constructed it would have been the thing to do - to portray death in war as a noble sacrifice.

Owen's point is that there's nothing noble about choking to death in a fog of gas, of so many dying so far from home, war is not noble or patriotic, it's horrible.

> It's because of one of the most literal examples of survivorship bias. No living people have ever died as a result of taking some particular obviously unsafe shortcut

People take something far more seriously if someone they know, especially a family member, friend, immediate colleague, etc, dies of it, compared to if the only deaths they know are stranger deaths reported in the media. So I don’t think it is true that people will ignore something unless they personally die from it, if your spouse or child or parent or best friend or boss dies from it you will take it very seriously.

I don't personally know anyone who has died from COVID. As far as I know, I don't know anyone who knows anyone who has died of it either. Probably the majority of people are in the same boat as I am. Not saying I don't take it seriously, but I'm sure I'd take it even more seriously if someone I knew died from it.

(A work colleague got sick with it, had to go to spend some time in hospital due to breathing difficulties, but has since recovered – that obviously raises the psychological impact of it for me a bit, but they live in another country, if they lived in the same country, even same metro area, as me, the psychological impact for me would be greater.)

"High lethality is often associated with reduced transmissibility. Which makes sense - dead people certainly aren't going to cough on you."

The worst case I can think of is an ubiquitous animal vector (rats? mice?) that only gets a mild form of the disease but can spread it, while people fall dead all around.

Like with the plague. This is why it stuck around for centuries while causing high death rates. Without the animal transmission it would have been much more contained.

Obviously, it was made worse by people blaming cats and killing their best defense.

>> High lethality is often associated with reduced transmissibility.

I think the scariest combo would be long incubation time + transmissibility while asymptomatic + high lethality when symptoms appear. This type of virus would spread far and wide before it’s detected, and would also be very deadly.

I mean HIV is this type of virus. It's not airborne though.

The nasty part of coronavirus is that while you are most contagious in the first 24 hours of symptoms presenting, you are also meaningfully contagious for about 48 hours prior to symptoms appearing.

Interesting, have any links to this?

Sure.

Here’s one link: https://medical.mit.edu/covid-19-updates/2020/07/how-long-sy...

Contact tracing protocol is built around this, so I’m sure other references exist as well.

It makes me wonder how the world would cope today with a Bubonic Plague or Spanish Flu, those two I reckon would probably be more similar to your hypothetical Sci-Fi disease.

Bubonic Plague is still around, quite deadly if untreated, antibiotics work if given quickly enough (and are used as a preventative measure for contact persons). Large outbreaks are rare.

There's a sci-fi example of this in the TV show Counterpart. Kind of surreal watching it and then becoming a part of a real life pandemic.

What does "non-hypothetical sci-fi" mean? Surely all sci-fi is hypothetical, in that "fi" stands for "fiction"?

Sorry, I misread the comment upthread. I meant to say the show is an instance of an actual sci-fi show that covers the topic.

I suppose that "hypothetical sci-fi" could be sci-fi that could be written but has never been

On the Spanish Flu specifically, the evidence indicates most people who died were killed by secondary bacterial infection, not the virus itself[1]. This was the result of a combination of poor hygienic conditions and lack of antibiotics. Considering that, I think what we are witnessing with SARS-CoV-2 is about what the Spanish Flu would look like today.

[1] https://academic.oup.com/jid/article/196/11/1717/886065

Bacterial pneumonia has a 30% death rate these days.

I've been wondering - would it be possible that something like HIV comes along, only airborne? This would be a nightmare scenario obviously, but is it possible?

Definitely possible, but I (not an expert) think unlikely. Viruses still have to contend with physics and limited resources.

For example, by “something like hiv” do you mean something that acts very slowly, but eventually kills you? That indicates a low viral reproduction rate - which means you’re spreading far fewer virus particles than something like covid, thus a low transmission rate, even if airborn.

Do you mean “attacks the immune system”? How does it get airborn, if it’s in the relatively few immune cells in the lungs? I suspect if you inhaled an aerosol of hiv particles you might catch it, but it doesn’t have a way of getting in the air.

Again, not an expert/wild speculation, but I think the risk of something fast acting, highly transmissible, and highly lethal, is more of a concern than a slow-acting lethal virus.

>Elimination strategy works

If the strategy is 'everybody stay at home' then it work in the same way shot gun works in eliminating cancer. It works but the cure is worse than the disease.

It’s normal here in NZ and with the exception of borders, restrictions were removed a fair while ago. The economy is considerably better off than most expected too.

https://i.stuff.co.nz/business/123696832/gdp-jump-of-14-per-...

Didn't nz had strict lockdown?

Also from the article:

However, Stats NZ national accounts manager Paul Pascoe said the effects of Covid-19 on different industries had varied “and for some industries these may persist for some time”.

The rebound was not enough to make up for the lost activity during the lockdown period, with GDP in the 12 months ended on September 30 down 2.2 per cent on the prior year.

> Didn't nz had strict lockdown?

Yes, and more than one. Community transmission was eliminated several times.

The point is to compare the strategy to others.

The entire country only locked down once, starting March, reducing to milder conditions in April and totally ending (going to "Alert Level 1" which isn't the same as before COVID but it's pretty much normality in everyday life) on June 9th. But Auckland (their biggest city), locked back down after another cluster of unknown origin was detected, perhaps related to an import business, for several weeks from August, and the rest of the country was at "Alert Level 2" in that period until the first week of October.

Subsequent small outbreaks have not triggered a lockdown because their government remained confident it understood the scope of the infection although one leak got close, they asked people not to travel into central Auckland for a day or two at one point and sealed off a residential building while they tested everybody who lives there.

They anticipate continuing to have occasional small outbreaks detected, e.g. a border worker gets infected, infects a family member before a test spots it - and their plans assume they will either quickly achieve confidence they've contained the outbreak or they'll lock a region or if necessary the entire country back down to eliminate.

For example at a press conference the press basically wanted to know if the government was imagining people should prepare to pay for an extra week's accommodation on vacation in case they can't return home (obviously unaffordable to many families) but the government seemed to be more thinking about if you've left a week's cat food and instructions for a neighbour, do you have a way to tell them they need to feed your cat for an extra week? So, personal anxieties rather than population scale ones, the government can pick up a hotel bill but it can't bring your pets back to life.

I am certain GDP has been nobody’s primary concern in NZ during this time, but -2.2 % is not bad considering how international NZ’s economy is. For comparison, UK is at -9.6 for the same period US -2.9 with a far higher human cost.

There are many who argue against lockdowns, but I haven’t yet seen an argument for that approach with an example of how it could look (for death toll and the economy). Has any country managed both those things without a lockdown? A hand waving “that approach could never work in X country because it’s so different there” seems the standard response to any strategy that has been proven to work.

Sweeden is one example, the death toll is still manageable and the life is pretty much still normal.

Not a country: florida, it is one of the state in the usa that has the least covid related restriction. They are doing very well. Went there myself to visit recently.

Its not hard to see why lockdown is not worth it. According to cdc, covid has very very low ifr :

0-19 years: 0.00003

20-49 years: 0.0002

50-69 years: 0.005

70+ years: 0.054

It gets real dark real fast. The Post link suggests that their approach has worked, as long as you value a human life at no more than $1.1m. They are approaching 8k deaths and their approach is suggested to have added 5k to that.

“ Assume that the differential Swedish approach dampens the GDP fall this year by 1 percentage point. This represents a gain of approximately $5.6 billion. Also suppose that the approach has caused 5,000 extra deaths — a reasonable guess from comparisons with other Nordic countries. How could one estimate that loss of life in economic terms? The value of a statistical life, used by the Swedish Transport Administration in its cost-benefit analyses of investment in traffic security, is approximately $4.6 million. Using this number, the economic cost of lost lives would be as high as $22.9 billion — clearly outweighing the benefits from the smaller GDP fall. One might argue that the value of lost lives should be set much lower, as the vast majority of deaths have been among elderly people, with fewer years left to enjoy life: 89 percent of the dead in Sweden have been above 70 years of age, and 67 percent above 80. One reaches the break-even point in my calculation if one lowers the value of an average life lost to $1.12 million. For the Swedish approach to be “profitable,” the average life lost must be valued lower than that.”

https://www.washingtonpost.com/outlook/2020/10/20/sweden-eco...

https://covid19.who.int/region/euro/country/se

How is 1 in 200 people between the ages of 50 and 70 "very very low"?

In the US, it would be hundreds of thousands of deaths in just that age group.

And 1 in 20 people over 70 obviously isn't low.

Low or high can be very subjective, at least I consider it very very low.

I wouldn't ask my parent/grand parent to isolate, if they don't want it.

>And 1 in 20 people over 70 obviously isn't low

People in over 70 has already high chance of death regardless of covid or not. So given that they are infected with covid, 1 in 20 chance is not high.

So given that they are infected with covid

That this is not some uncontrollable inevitability is the whole point. Places that were proactive have less economic harm and far less death and illness. I suppose people aren't going to change, so the ship has sailed for much of the world, but it wasn't inevitable for vast numbers of people to get infected.

As far as 1/200 being subjectively low, if something had a 1/200 chance in killing you, would you do it 5 times a day? We can answer probably not of course, because you probably wouldn't do it once a week (or you wouldn't be).

> As far as 1/200 being subjectively low, if something had a 1/200 chance in killing you, would you do it 5 times a day?

It would probably be considerably more fun to self isolate while taking up drinking, smoking, motor biking without a helmet and a variety of other risky activities. At least those are interesting, and they are probably less risky.

The point is, even without any precaution, they might never be infected in the first place, so probably death from covid for this specific age group is : probability of getting infected * 1/200. So even less than 1/200.

If I'm in this age group, obviously I would happily take this chance, if the alternative is lockdown/restriction.

> the death toll is still manageable and the life is pretty much still normal.

It's probably worth noting that this statement is currently contentious both inside and outside Sweden.

I’m not sure about Sweden. This week their king was on TV saying ‘we have failed’. Nearly 8,000 dead. This is not normal.

That is his opinion, which I disagree. I myself would not consider it 'failed'. Sweeden total death this year is not significantly different compared to previous year.

What are you taking about? Sweden reported that this November was the deadliest in the last 100 years since the Spanish flu in 1918. Compared to Norway, Sweden has 20x more deaths from covid (Sweden 8000 vs Norway 400 deaths) and Sweden has only 2x population (10M vs 5M). And Norway has a better GDP than Sweden despite stricter lockdown policies.

Number of death for 2020 are not significantly different than previous year:

https://www.statista.com/statistics/525353/sweden-number-of-...

yes it said the dec 2020 data is only up to dec 11 but its unlikely that the number its going to be substantially increase with half month to go.

another stats:

death per million for 2020 is not much different compared to five year average:

https://legionsletters.com/mortality#SWEDEN-MORTALITY

Searching about I see data like yours and ones like those I include below, which show an excess. Why these differ, I don’t understand.

In your link, if you assume the death rate for the remainder of the year will remain static and calculate the end of year total (it’s roughly adding 5%) you get a number that looks like it spikes, but not hugely.

The below show a clear excess and a long tail after the spike in deaths.

https://www.efta.int/Publications/news/COVID-19-Excess-Morta...

https://www.nature.com/articles/s41591-020-1112-0

https://academic.oup.com/eurpub/advance-article/doi/10.1093/...

A conspiracy theorist acquaintance of my sisters sent her data in our country that was wrong, same argument - look COVID-19 isn't killing anybody, it's a plot, blah bah. The raw data (weekly mortality) is published by government on a weekly basis and I just explained to my sister how to download it into Calc or Excel or whatever and see for herself.

One of the recurring things with conspiracy theorists is that they aren't in the least interested in fact checking. They're engaged in a search only for reassurance that they're correct, if you give conflicting data they keep searching but if any source will agree with them it must be right.

You probably shouldn't add only 5% based on the remaining days. Deaths stats are frequently preliminary for weeks or even a few months as reporting itself may be delayed (in particular right now if you're quarantined and a sick person passes peacefully regardless of cause what's the point of breaking quarantine to do paperwork more quickly? They aren't any more or less dead if you do the December 1st death paperwork on December 15th)

We'll see what the number end up, covid has spread since the beginning of this year, highly unlikely that in next 2 weeks suddenly the death jump significantly.

Also keep in mind that the excess death may or may not be due to covid alone.

> highly unlikely that in next 2 weeks suddenly the death jump significantly.

Is it? Cases have been spiking but deaths are going in the other direction or are flat lining. There is usually an increase in deaths about a month after covid cases go up.

Even conservative modelling predicts a lot more deaths (+50%) and less conservative models see a doubling or more.

https://www.worldometers.info/coronavirus/country/sweden/

https://covid19.healthdata.org/sweden?view=total-deaths&tab=...

Just last night on the news they announced we were actually out of recession. The bounce back has been pretty good. Tourism is still fairly impacted. Most everything else feels pretty normal.

The lockdowns were worth it IMO. Especially now we see it ravaging the rest of the world becoming more and more severe. That just feels totally foreign to me since we only experienced a very mild outbreak initially, followed by a tiny one a bit later on.

NZ is a good place to be.

I disagree but I still respect your choice, at very least you acknowledge that in the end lockdown or not lockdown is subjective preference.

Can you explain your preference for no-lockdown? NZ is covid free, the economy is rebounding fast and we have had very few deaths and (relative to others) short lockdowns. Unemployment is considerably less than expected. Christmas is shaping up to be normal.

The results in NZ are only subjective if you pull some elaborate contortions, NZ has done well.

Few months lockdown is not short at all. Even then they still not allowing international visitor.

My preference is simply based on cost/benefit analysis.

I'm not opposed of covid free at all, as long as whatever method you choose doesn't cause problem that outweight the risk.

Here is some example that is not a lockdown:

Increasing health care capacity

Developing better treatment

Use more accurate test

Sweeden, florida has done very well too without lockdown. Although there is still possibility that their politician succumb to pressure and enact lockdown in the future.

Downside of lockdown: unemployment, bankruptcy, mental health issue, delayed treatment of other illness, kids can't attend in person school, etc.

You can say that all of these is not big deal. I still respect you while I disagree with you, after all its subjective preference.

>elaborate contortions

Please don't use these words just because we have different value.

You give Florida as an example. If we scaled up New Zealand's population to Florida's their total COVID-19 fatalities would be about 100. But Florida's policy approach has killed over 20 thousand people already, and shows no sign of stopping.

You list as a downside of New Zealand's approach unemployment. Scaled up, New Zealand would have about 600k unemployed people. But Florida actually has 650k. So that seems like instead of avoid unemployment, an economy devastated by pandemic but unwilling to lockdown has shrunk anyway.

So so far your cost is twenty thousand extra friends and relatives dead, and your "benefit" is fifty thousand extra unemployed.

Did you actually perform a cost/benefit analysis? I don't think you did.

>But Florida's policy approach has killed over 20 thousand people already, and shows no sign of stopping.

Keep in mind that the 20000 death number is highly inflated because it include death with covid not just due to covid. People who happen to be covid positive during the death is included in the number.

Most importantly with the current death number, i didn't say florida government handling it perfectly but I much much rather to live in this place if I have choice.

If you think its a horrible way to live then only thing i can say: to each their own.

>and shows no sign of stopping

as more and more the virus spread, more people develop natural immunity

as times go the treatment method improve

and then there is vaccine coming

>But Florida actually has 650k.

Keep in mind that unemployment number is not all solely caused by lockdown

But for sure some unemployment is caused by lockdown due to simple logic: if you don't allow business to open due to lockdown, the worker wouldn't have job.

My simple cost-benefit analysis:

The risk/cost of covid :

less than 1% death rate and mostly skewed to older population

The lockdown risk/cost:

Some unemployment, some bankruptcy, some mental health issue, some delayed treatment of other illness, kids can't attend in person school, etc

At least for me The lockdown risk/cost is much more than the risk/cost of covid

>So so far your cost is twenty thousand extra friends and relatives dead, and your "benefit" is fifty thousand extra unemployed.

More accurate example would be: 1 people I know dead due to covid, benefit : life continue as normal for the rest of people. Pretty damn worth it to me.

> Keep in mind that the 20000 death number is highly inflated because it include death with covid not just due to covid.

Although 20 thousand people's cause of death is listed as COVID-19, about 27 thousand excess deaths occurred already in Florida, and that'll probably be closer to 30 thousand by New Year.

So, rather than 20 thousand being "highly inflated" as you propose it's likely a considerable undercount.

> But for sure some unemployment is caused by lockdown due to simple logic: if you don't allow business to open due to lockdown, the worker wouldn't have job.

Unemployment is being caused largely by the economic slowdown, and by significantly reduced footfall, driven by inability to control a pandemic.

Of course in New Zealand that's largely restricted to just one sector: International tourism, whereas in Florida their whole economy is constantly being kicked in the head by the policies you admire and will be for months to come.

>27 thousand excess deaths occurred already in Florida

Are the excess death is solely caused by covid ?

>Unemployment is being caused largely by the economic slowdown, and by significantly reduced footfall, driven by inability to control a pandemic.

I'm not saying I agree with all Florida government policies. The unemployment issue exist even without pandemic, but here I'm specifically taking about the unemployment that is caused by lockdown.

if you don't allow business to open, then some extra unemployment bound to happen. Assuming the lockdown do work, Is it worth it for a virus that have less than 1% death rate ? for me its very very not worth it. Furthermore unemployment is just one of the many of problem caused by lockdown.

> Are the excess death is solely caused by covid ?

Not all of them, I'm sure plenty of people in Florida committed suicide out of despair, drank themselves to death and so on as a result of the pandemic virus as well. It would be easy to become hopeless somewhere with tens of thousands of needless deaths while idiots cheer it on from a safe distance.

> if you don't allow business to open, then some extra unemployment bound to happen

If all your businesses are "open" but potential customers sensibly choose to reduce their exposure by staying away, unemploymentment sky-rockets anyway, as it has in Florida. Then you'd need substantial government action to prevent the worst effects of that, and of course that was never likely under Trump whereas Ardern's government in New Zealand immediately began programmes to try to prevent employers going bankrupt during Level 3 and to protect individuals from the economic impact, as well as pursuing elimination strategy for the virus itself.

As a result New Zealand was able to largely re-open and is already well into its economic recovery - aside from international tourism. They're having a pretty good summer.

Your problem is that you started with a belief you wanted to justify and then you've embarrassed yourself by pretending you've proceeded rationally when actually you were just making excuses. Just admit to people how it is, you're a selfish asshole who doesn't want to obey restrictions that keep other people safe. Just say it, if it makes you feel bad that is, after all, your problem.

At the of the day how it is received is down to the individual. Our family is healthy and we've all kept our jobs and none of us are suffering any form of hardship. Lockdown was temporary.

Some people have lost businesses, jobs or careers and they're going to be less happy about that.

From my day to day perspective my life is very normal. I remember the level of background anxiety grew rapidly the more it spread into the community in the initial outbreak. The second and third waves around the world look increasingly terrifying.

I'm calm. Im at peace. That suits me perfectly.

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