L.A. was uniquely vulnerable to this Covid catastrophe. Here is what went wrong | Hacker News Reader

L.A. was uniquely vulnerable to this Covid catastrophe. Here is what went wrong

latimes.com

15 pointscmurf16 comments

Way back when all this started and the paper came out from the Imperial College, counseling social distancing and other non-pharmaceutical interventions, the idea was to make a priority of not overwhelming the hospitals. The thinking was that there was no reasonable way of stopping this, so the goal was to ensure as best as possible that no one died because they couldn't receive the supportive care they needed: meaning, because there was no ICU bed available for them.

The lockdown mechanism was meant to be periodic and short-lived. We lockdown if we see hospitals are going to be overrun. Then, we open back up again. We don't sacrifice our economy — and our sanity — by keeping things shutdown long-term. We swallow hard and realize that people are going to die. We protect the vulnerable by encouraging them to take extra precautions.

But what have we done instead? According to the article, we failed to take into account both the very real phenomenon of lockdown fatigue, and the phenomenon of simply kicking the can down the road: namely, avoiding more cases in the summer (via lockdowns) to then have them pile up in the winter.

So, here we are in L.A. and elsewhere. Now, despite the draconian lockdowns and damage to the economy and people's sanity and general well-being, the hospitals are overwhelmed. Ambulances are circling, looking for an empty bed, while their patient-passengers gasp for air.

The moral here is that politicians (and much of the populace) panicked and turned into obsessive-compulsives, convinced that if they only did that "one more thing," they could make everything right. And now we see how ridiculous that turned out to be.

How do you come out this end and think “we did too much”? We have definitive proof that we actually did too little. Look at S. Korea, New Zealand, Thailand, etc.. More contact tracing, stricter targeted lockdowns, paying people to stay home. The problem is that we didn’t do enough, instead we took half measures and took all the damage with barely any of the benefit.

The idea that death was inevitable is wrong. There are plenty of nations and extremely dense cities with very low death numbers. Sure, Americans are higher risk because they are more obese (or so we think) but our death counts were avoidable.

In the United States, our death count is skewed by a handful of cities, some of which represent some of the top destinations in the world. New York City gets 65 million visitors a year. Los Angeles get something like 50 million. All of South Korea — never mind Seoul — gets just under 18 million. And let's not even talk about New Zealand. Other than the hobbits, who's going there.

In the United States our numbers are skewed by places like NYC and LA. The rest of the country is doing much, much better, overall. Moreover, we're a free country. Yes, I realize that, on paper, South Korea, Thailand, New Zealand are also. But the kind of contact tracing and other measures that has gone on in some of these countries is simply unacceptable here, and rightly so.

I stand by what I've said. We are destroying this country in an effort to "save lives." Your suggestion is what? More destruction?

If you read the original paper from the Imperial College, you'll note that death estimates in the United States were from 200 thousand (if we followed their recommendations) to 2.2 million (if we did nothing). Remember, these were estimates. But you will see that we are close to the low end in actual numbers. So, when you say that the idea of death being inevitable is simply wrong, what exactly are you basing that on? Can you answer that? Where do you come up with your assertion?

You are spreading misinformation. First, the vast vast majority of transmission in the united states was not from visitors, but from community spread, even in highly visited cities like NYC.

The 2 million number from the imperial paper everyone likes to quote is explicitly

> In the (unlikely) absence of any control measures or spontaneous changes in individual behaviour

Where specifically voluntary quarantine (50% compliance) and case isolation (70% compliance), and closure of schools are exanples of interventions discussed. In what world do the current death totals (340k in the United states) disprove the idea that interventions saved lives, and more effectively managed interventions would have saved more lives (as they did in other countries).

I am not spreading "misinformation." That term is the new slander. I am referring to initial infections, not pretending that tourism has been going full swing since March. You cannot compare New Zealand to New York City. I don't even think you can compare Seoul — and I accounted for the difference in interventions, regarding Seoul. But you conveniently leave that out.

As for your "everyone likes to quote," I in fact said: "you'll note that death estimates in the United States were from 200 thousand (if we followed their recommendations) to 2.2 million (if we did nothing)." Are you pretending now that I am misrepresenting the paper? You are simply repeating what I've written, and pretending to be contributing something new to the conversation.

If you are referring to the initial infections then you are just as misleading. Again, we don't need to speculate about how much the coronavirus was initially spread to different cities based on their tourist populations, we can just look at the facts of how much initial spread there was to each location/

On February 24th, there were 14 cases diagnosed in the United States, and 39 people who were infected and repatriated to the United States[1]. In comparison, at the same time there were 564 cases in South Korea[2].

The difference between 350k deaths (so far) and 200k deaths (total) is a lot, and is perfectly consistent with the paper's findings that if you perform some interventions but not all of them, hundreds of thousands of people will die unnecessarily.

[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6908e1.htm [2] https://en.wikipedia.org/wiki/COVID-19_pandemic_in_South_Kor...

The numbers are not skewed by NYC and LA because most other big cities and states have similar or worse numbers per capita. They got got hit harder early on, and LA is recently experience a surge in cases due to citizens not following guidelines, but overall they don't lead significantly in any categories.

> In the United States, our death count is skewed by a handful of cities, some of which represent some of the top destinations in the world. New York City gets 65 million visitors a year. Los Angeles get something like 50 million. All of South Korea — never mind Seoul — gets just under 18 million. And let's not even talk about New Zealand. Other than the hobbits, who's going there.

Ridiculous and unfounded claim. Global travel has basically been shut down since the pandemic started, people aren’t going to New York for vacation right now.. The continued spread is not from mass tourism, but from our own failures.

> In the United States our numbers are skewed by places like NYC and LA. The rest of the country is doing much, much better, overall.

Sure, overall the dense cities suffer the most and rural places are doing better relative to US average. However, extremely dense cities in other countries (Taipei, Hong Kong, Seoul) have handled it order of magnitude better. So your point here is moot, even in NYC and LA were the only focal points they are still way worse than the global average.

> Moreover, we're a free country. Yes, I realize that, on paper, South Korea, Thailand, New Zealand are also. But the kind of contact tracing and other measures that has gone on in some of these countries is simply unacceptable here, and rightly so.

Contact tracing is your bounds for freedom? There are plenty of ways in which most people in the US are not free. Saying that we're much freer than other countries who are "free on paper" seems like American exceptionalism at it's finest.

> I stand by what I've said. We are destroying this country in an effort to "save lives." Your suggestion is what? More destruction?

You can beat this virus without destroying everything, it's simple really you just pay people to stay home. You put the economy on ice, beat the virus hard and fast and then open again. This is what New Zealand did and it worked. Doing half measures will only prolong the hurt and make the damage worse. If we had taken this more seriously and done better contact tracing and lock-downs earlier we wouldn't have a binary choice of "destroy your economy or let hundreds of thousands of people die".

The problem is that now in the US it's too late, so all we're left with are terrible options.

> So, when you say that the idea of death being inevitable is simply wrong, what exactly are you basing that on? Can you answer that? Where do you come up with your assertion?

We have empirical evidence that death is avoidable:

South Korea COVID deaths: <1000 Vietnam COVID deaths: <50 NZ COVID deaths: <50 Taiwan COVID deaths: <25 Hong Kong COVID deaths: <150

If you don't let the virus spread, people don't die. Simple as that.

We're the richest nation in the history of the world (and supposedly the greatest) and we've let >300,000 people die of this virus, how's that for American exceptionalism.

To reinforce the point, NZ is 2nd "most obese" in the OECD after the USA. Australia and Canada are similar.

The US should really be compared to Canada - the most similar and closest country. Death rate 36 per 100k vs 91 in the USA , according to Wikipedia.

Oh look American exceptionalism has degraded into making excuses for why our situations are uniquely worse than any other place on Earth.

Give me a break.

Reasons given: colder, drier weather, false sense of confidence, people started to let their guard down, huge manufacturing sector, combination of poverty and density. I am not convinced LA was uniquely vulnerable given these reasons.

Unique? No, but it does point to the folly of trying to impose one size fits all solutions. What would work best in Los Angeles is not what would work best in Boomer, West Virginia or Atlanta, Idaho. How people live and interact are different in these places but instead of acknowledging that, we've had dictates come down from high above which demonize those who understand their communities better than someone living hundreds or thousands of miles away in very different conditions.

No one is asking for one size fits all. Just a uniform set of guidelines that leaders form using public health, scientific and economic experts and that is then promoted as the right thing to do. This nonsense of having an expert stand at the podium and say we need to be wearing masks and then the president standing up and saying he's not going to wear one and it's not a big deal has been very, very destructive.

Regardless of the initial mistakes of not promoting mask usage, once we knew that masks could help significantly, all our top leadership should have been on board and encouraging use through example and word. They were not and that alone has likely contributed to many thousands of unnecessary deaths.

For a stark reminder of the inequalities in Covid impact, there’s a nice map here detailing Los Angeles rates by subregion:

https://products.xtown.la/coronavirus

For non-LA natives, the west side (near the coast) is considerably more affluent than the rest, and sees much lower rates. Even places like Palms and Brentwood which are packed with apartments seem to be doing alright relative to the rest.

Big part of Latino culture is visiting each other, hugging, living in multi-generational dwelling. We've seen this in El Paso, same story in LA.

Too many people living in too small of housing units. I see it near my house. Then many of these people lost their jobs due to the lockdowns, leaving them home. Lots of people were still having parties here too, you can hear them all the time.

Reply on news.ycombinator.com