Comment by BadInformatics | Hacker News Reader

Comment by BadInformatics | Hacker News Reader

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This analysis presumes that hospital emergency and critical care capacity is flexible (it's not), that we can expect medical professionals to keep on performing at 100% in the face of overwhelming stress (they will not), and that Canada would somehow succeed at what Italy did not back in the first half of 2020 by doing even less mitigation. An argument in favour of no mitigation would have to demonstrate:

1. covid-related mortality and morbidity would not make up for any drop in other excess deaths

2. short-term stops on all non-critical care would, on balance, result in a significant drop in excess deaths over longer-term stops on a smaller percentage of non-critical care

3. hospital systems and their staff would still be intact after such a large wave. This may sound crazy, but while we're trading anecdotes you may be surprised at how many ICU nurses considered quitting because of how hard the latest surge hit. These are the people who dictate how many "ICU beds" we have, not the physical beds themselves!

4. that we can make any kind of meaningful analytical statement on covid mortality vs excess mortality for a specific age group given the lack of reporting data on both. In particular, data from coroner's offices on covid deaths has a huge lag time at present. Looking at case counts only is a poor proxy given you have to model infection -> death/recovery/discharge lag times, geographical variations and healthcare capacity as well. The HMD link merely provides total counts and proportions with no additional commentary. You can find more specific discussions on the subject [1], but they don't cover demographic breakdowns over time and necessarily maintain a high degree of uncertainty.

I don't think it's controversial to say governmental policy here has been sub-optimal at best. But to say that one extreme approach or the other is what we ought to have done based on woefully incomplete data is a stretch too.

[1] https://health-infobase.canada.ca/covid-19/epidemiological-s...

> This analysis presumes that hospital emergency and critical care capacity is flexible (it's not), that we can expect medical professionals to keep on performing at 100% in the face of overwhelming stress

No I'm not. Remember, what I said was: "So in many circumstances the hospitals would be overloaded for less total time and thus lead to less non-covid excess deaths."

Let's assume hospitals are severely overloaded, and are simply unable to treat COVID patients. The pedantic meaning of what I said will certainly be true: non-covid excess deaths will be less.

But the steel-manned version - less excess deaths in total - could still be true if lockdown drags on sufficiently long, and COVID-19 is sufficiently mild, and/or the marginal benefit of hospital care on survival is low enough.

> hospital systems and their staff would still be intact after such a large wave. This may sound crazy, but while we're trading anecdotes you may be surprised at how many ICU nurses considered quitting because of how hard the latest surge hit. These are the people who dictate how many "ICU beds" we have, not the physical beds themselves!

I'm well aware. Frankly, I suspect that problem is made worse by a long, dragged out, pandemic. People can often handle a short period of extreme stress better than they can handle a much longer period of high stress.

> Let's assume hospitals are severely overloaded, and are simply unable to treat COVID patients. The pedantic meaning of what I said will certainly be true: non-covid excess deaths will be less.

Even the pedantic interpretation does not necessarily hold. Though healthcare resources for life-threatening conditions are not strictly zero-sum, many of them would effectively be once covid overwhelms existing ICU and ED capacity. There are plenty of examples of personnel being pulled from e.g. cancer care or cardiology teams to help in covid wards. This directly translates to increased wait times for patients in those categories, much like would happen if people were putting off getting checked out themselves.

Moveover, hospitals and healthcare systems to not just "bounce back" after being severely overloaded. Staffing is already strained, and unless you ban clinicians from taking leave you would see cascading reductions in capacity after a couple months of being overloaded. This is to say nothing of the equipment shortages we had in the early days of the pandemic. Ultimately, patients who would require care for non-covid reasons would still suffer because of a massive backlog. Determining whether this backlog would be larger or more/less harmful when amortized compared to what we have now requires health economics analysis that I am certainly not qualified to perform.

> Frankly, I suspect that problem is made worse by a long, dragged out, pandemic. People can often handle a short period of extreme stress better than they can handle a much longer period of high stress.

This feels right to me too, though I've not the literature to verify it. However, it's an equally valid argument for strict short-term lockdowns a la New Zealand, Australia, Vietnam, Taiwan, etc. That is to say, it does not follow that not mitigating is the only reasonable strategy to prevent a dragged out pandemic.

A better (if grim) post-hoc analysis of Canada would be to compare the Atlantic provinces (less densely populated, strictly enforced interventions), the other smaller provinces (less densely populated, few interventions until recently) and the large provinces (densely populated, moderate but very poorly enforced interventions). My guess is that all three approaches will not be found to be equally effective.

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