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Comment by AnotherGoodName | Hacker News Reader

In absolute number terms it's more deaths in total in the USA than the Spanish Flu (675k deaths total since it began), HIV (700k deaths total since it began) or any other pandemic. Population has increased so the US did lose a smaller percentage of population but on the other hand Spanish Flu didn't have a vaccine to stop it one year in. Hopefully enough of the population takes the vaccine now to stop this.

Note this also means COVID has been the number 1 cause of fatalities in total. The other top killers are heart disease and cancer. Heart disease kills ~660k a year and cancer 600k a year. We're not that much over 1 year now since the first cases in the USA. This means that COVID is absolute top cause of fatalities at the moment. For anyone that may feel the need to mention car crashes, guns or drugs those don't even rank in the top 10 of fatalities in the USA.

Something to consider if you see anyone trying to downplay this.

View on HN

>Something to consider if you see anyone trying to downplay this.

Most of the downplaying I've seen has revolved around the idea that those who died would have, "died anyway" from some other ailment or that hospitals are finding any reason they can to attribute deaths to covid.

So, while you have a great argument, I doubt you'll change any minds because those who disagree flat out reject your premise.

For the former, if someone is actually willing to listen to evidence, you can cite them numbers of average years of life lost per covid death (~15).

>you can cite them numbers of average years of life lost per covid death

That's practically inviting them to cite back the average life lost from the 1918 flu. If you're trying to counter someone who's downplaying Covid that is probably not something you should invite them to do.

That's fine though. If they point out that COVID is merely in the same order of magnitude but not objectively worse than Spanish Flu then the point that COVID should not be downplayed has been won.

I believe there are a significant amount of these people that won't actually argue that just because the Spanish flu was worse in this way that the Covid pandemic isn't a problem.

As the other poster said, if that's the argument you're resorting to, I would say you've already lost.

I've found it is helpful to count by equivalent number of deaths to something that the person has actually experienced, as it is way too easy to brush away deaths that occurred in 1918.

For instance, it's as if you took the number of years of life lost in 9/11 and multiplied it by 120.

Is the point here to argue that the Spanish Flu was worse? Yes, it was. But I think someone crying, "This is the worst pandemic in 100 years", sounds like they are pretty on the money.

^ This is my argument as well. I also translate every probability to sequential coin tosses.

And for the latter, you can cite excess mortality rates.

Good example of the asymmetry of bullshit here.

I believe the counterargument is to that what is worse, 1/15 of the population losing 15 years or the entire population losing 1 year keeping in mind that 1 year in your prime is probably worth more than 1 year in your old age. These numbers are not COVID specific, just going off your ~15.

For COVID numbers, even with 1M deaths, that would be 1/330 (US population) losing on average ~15 years vs. everyone losing almost 2 years now. It's emotionally tough to pick a policy when you are condemning one group to statistical death, but you still have to try and be objective. My personal opinion is that we'll be writing books about the "the lost generation" in 10 years about children currently in school.

Numerous problems.

1. The current death toll is with the existing lockdowns. There are good reasons to think that without (especially the early) lockdowns the death toll could have been way higher.

2. Being dead for 1 year cannot be equivalently compared to being socially distant for 1 year (not 2). Is that not obvious?

3. This is before we get into life long disability, etc. due to covid. I know someone whose parent had a covid caused stroke, essentially ending their existence as the person they were before.

Correct, all valid points. But we can assign numbers to all these things and the error bars are sufficiently large that there is ample room for debate. As for 2. is it obvious? My niece doesn't know that there are other humans like her, I would gladly take a year at the end of my life to give that gift to her. Given the current vaccination rates, many people will not see normal until 2022. For 3. it cuts both ways, how many new alcoholic parents and child abuse that ruins an entire lifetime?

> is it obvious? My niece doesn't know that there are other humans like her, I would gladly take a year at the end of my life to give that gift to her.

I'm not sure she is going to agree with you when she visits you toward the end of your life.

> For 3. it cuts both ways, how many new alcoholic parents and child abuse that ruins an entire lifetime?

It's far from obvious what the effects of COVID-19 are on child abuse. The data is hard to disaggregate because there are so many conflicting factors, but there isn't obvious reason to believe that child abuse is up during the pandemic given the data we have seen: https://www.ucsf.edu/news/2021/03/419961/child-abuse-surges-...

> I'm not sure

That sounds like it is not obvious.

> The data is hard to disaggregate because there are so many conflicting factors

Basically sums up COVID policies. The point remains, I have yet to see any clear objective policy making that even tries to estimate impact on life of all citizens. In absence of anything resembling a consideration of all age groups, I just ignore any opinion of lockdown both for and against.

Important to keep in mind about the YLL numbers I cited: most of the YLL comes from younger people who died early, even though most of the deaths are among people 70+.

So if you are going by this "differential quality of different years" argument, you have to account for the fact that most of these years actually aren't for really old people.

While I agree with the methodology in general, assuming all of us have "lost" a year in a way that is equivalent to being dead is ridiculous.

Right, but given all the debate about COVID, we still don't have a number and agree a 1-to-1 is ridiculous. Policy makers need a number to convert lost time to death time. What are they using? It seems one side is using infinite and the other side is using 1-to-1. As with everything, the answer probably is probably somewhere in between the extremes.

I don't think one side is using infinity. The issue here is that lockdowns, if done effectively, don't have to last for a full year. Look at Australia. Look at New Zealand. They managed to lock down for substantially less than a year, get the disease under control, and resume life mostly as normal. The US was not, but that also needs to be included in the tradeoff. It wasn't obvious that applying enough pressure wouldn't have prevented the uncontrolled explosion that we now have to deal with.

I don't know how people compare two isolated islands that are multi hour flights to any other nation to the USA with a straight face. Think of the backlash at even proposing locking the Mexico border. Also, Australia and New Zealand just broke their travel bubble, I don't know if that still constitutes as a "short lockdown" if you haven't been allowed to leave your country the entire time.

> It wasn't obvious that applying enough pressure wouldn't have prevented the uncontrolled explosion that we now have to deal with.

I'm not sure exactly what you're saying here, but I think we agree. Nothing about this pandemic has been obvious.

> I don't know how people compare two isolated islands that are multi hour flights to any other nation to the USA with a straight face. Think of the backlash at even proposing locking the Mexico border.

Very little of our COVID infections have been linked to either of the geographic borders in this country. While I understand there are greater risks with those borders, it doesn't make the situation incomparable.

> Also, Australia and New Zealand just broke their travel bubble, I don't know if that still constitutes as a "short lockdown" if you haven't been allowed to leave your country the entire time.

Bars and restaurants and sports have been available the whole time. Even if there wasn't a travel ban from the country, where would people even go? Most other countries aren't allowing visitors.

I'm not sure how easy it'd be to link Covid infections to the Mexican border - they were having serious trouble even reporting accurate Covid death numbers, never mind anything more useful: https://news.sky.com/story/covid-19-mexico-underreported-cor... The Covid outbreak there was really bad and would no doubt have screwed the US if something else hadn't earlier. Though it does look like the immediate source of US infections was an unfortunately large amount of travel from a global epicenter of infections which was somehow reporting zero cases at the time. (Something went really wrong in Italy, and the English-language media has completely failed to examine what happened there - probably because their leader is a boring technocrat these days.)

> or the entire population losing 1 year

Except we didn't lose a year. A lot of us actually kind of liked the last year. Many got to work from home and discovered it was a lot less stressful than commuting into an office every day, for example. I have a feeling that some of us are going to recall the last year with a bit of nostalgia in the future.

All available data is showing that this past year has been detrimental to poor students.

Imagine trying to learn on an old phone, using a cellular internet connection in a bedroom you share with your sister.

So, while I'm glad you enjoyed your year at home -- the focus here was on the impact on students.

That isn't true. The parent comment said the "entire population" lost a year of their lives. K-12 students are about 17% of the US population, not all of it.

It hasn't been detrimental for all students. Some have thrived. https://www.slj.com/?detailStory=some-students-have-taken-to...

In my urban school district, areas with the largest concentration of poor students are the ones that most strongly support continued distance learning. Affluent + white families are the ones most opposed.

> keeping in mind that 1 year in your prime is probably worth more than 1 year in your old age.

I keep seeing statements like this, and I must disagree. My mom's retired, nearly 80, and having an absolute blast living her life. At her prime, she was the primary wage-earner, had two kids, and never had a moment to herself. Her quality of life now is much better than when she was "in her prime". She's got a bunch of friends in the same boat.

The studies that I've seen on years of life lost per COVID-19 death all appeared to suffer from co-morbidity bias, particularly around obesity and related metabolic disorders. We know those conditions seriously increase the risk of COVID-19 death.

https://www.cdc.gov/obesity/data/obesity-and-covid-19.html

And they also reduce life expectancy on their own even without COVID-19. Being obese cuts life expectancy by about 7 years.

https://pubmed.ncbi.nlm.nih.gov/12513041/

So the actual average YLL is probably a little less than 15.

I don't blame the researchers for this bias. The detailed data to correct for it generally isn't available so they're doing their best with what they have.

Then multiply it with the death rate.

I think it's kind of unlucky in some ways that Covid affected the old/unhealthy so disproportionately. I feel like we would have responded in a much more assertive and effective way had that not been the case. More people who were not in the risk groups would (ironically) have been saved, and we'd be a lot further on the road to recovery.

Not a lot of young people know a huge amount of people in the risk groups, it's easy to dismiss if it hasn't affected someone you know.

"It's only grandma."

“Good news” the variants, b117 and p2 are more likely to infect younger populations.

This seems obvious though; a lot of people assert that Covid isn't "that serious" - if it affected a larger swath of the population with more consistently negative outcomes, of course they would have taken it more seriously and responded more in line with that. I feel like that was their entire point?

OK - how about same amount of people, but more equally distributed like the Spanish Flu?

Our surprisingly-terrible reaction to COVID, due to the reasons cited in this thread, made me think of an (I think) interesting book/show plot.

What if there was an epidemic virus, that, within a year +/- a few months of contraction, killed hosts over the age of X (20, 50, 70), regardless of underlying health conditions.

It raises some interesting questions! The three I’ve come up with so far:

(1) what does a society look like, without (mature, older, very old) people? What surprising positive and negative evolutions occur?

(2) how would our current societies react to the gradual onset and eventual global expansion of such a disease?

(3) if we found a cure for the disease a few (now, shorter than previously) generations later, who would take it?

It’s kind of similar Lord of the Flies, except instead of a shipwreck, it’s a disease and it happens gradually, to preexisting societies and cultures.

Set X to 30, and make the cause of death deceptive euthanasia, and you've got the movie "Logan's Run" [1]. Make X 21 and you've got the book "Logan's Run" [2].

[1] https://en.wikipedia.org/wiki/Logan%27s_Run_(film)

[2] https://en.wikipedia.org/wiki/Logan%27s_Run

We would have reacted more assertively because that would have been a much bigger problem. We're lucky it was this way.

You give us too much credit. Hold the size of the problem constant and spread the effects to more demographics. I guarantee there would have been a bigger response. We’re not that rational.

I didn't necessarily mean a bigger death count, just a more equally distributed one (like the Spanish flu). I think the end outcome could have been better for all demographics, and the world would be further on the road to recovery.

With Covid it was easy people to think it wasn't really a big deal, it reduced the appetite and compliance necessary to keep the pandemic contained.

"Most of the downplaying I've seen has revolved around the idea that those who died would have, "died anyway" from some other ailment or that hospitals are finding any reason they can to attribute deaths to covid."

The authors of this are doing exactly the same thing, but from the other direction:

> Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality. For the reasons presented in this section, we believe that this is likely an underestimate.

This is all simply noise. The way we'll find out the answer to this question is when someone pulls the death certificates for 2020, and actually tabulates the percentage directly caused by Covid.

It will happen, but this work isn't it.

No, because without tests, doctors didn’t uniformly attribute deaths correctly to covid, and often the official causes of death even in cases of cancer are often “pneumonia” or sepsis, or organ failure — the literal thing that killed them at the moment of death, not the cause of the symptom that overwhelmed the body.

You are making an assumption that all (or even just the majority) of excess deaths are because of this.

Moreover, we know that there are examples of the opposite: deaths where Covid was on the certificate as a contributing factor, but not the primary cause. These aren't hard to find.

An 85 year-old with congestive heart failure and late-stage cancer and Covid reflects the modal situation here. It isn't some theoretical event -- it's incredibly common.

Right, and those happen at a pretty regular rate every year. If we suddenly have 50k+ more congestive heart failure cases, or 50k less, we can tell that in the statistics.

Well, sure. It will be good to get the actual data, and then we'll know.

Right now, what we have is aggregate death counts (which we know are high), and people speculating that they're elevated because of Covid (or in this case, making models based on speculation).

The problem is that there are financial implications for a state saying they have covid deaths. From some of US covid relief packages, the more covid deaths a state had, the more money they get.

As well, you get the over-the-top cases where someone that dies of a gunshot is included in the covid death count[0].

Some states have tried to do better by breaking it down a little finer. Like Colorado provides[1] a breakdown down by confirmed vs probable. But the data here is still not great.

[0] https://www.kmov.com/news/colorado-coroner-calling-out-how-s...

[1] https://covid19.colorado.gov/data

> As well, you get the over-the-top cases where someone that dies of a gunshot is included in the covid death count[0].

? It's incredibly clear by looking at Colorado's numbers, there was no misclassification at all. Definitely mistakes have been made, but this isn't even an example of one.

Your comment is bizarre. The same case you're criticizing is from the state you go on to praise in the next sentence. These, unequivocally, have never been included in "death by covid" counts.

> financial implications for a state saying they have covid deaths

Yes, but there are also immense legal, financial, and political implications for lying about covid deaths. There is no evidence of this happening on a widespread scale.

Prior to April 2020 the diagnostic criteria for a covid death required 0 testing whatsoever. Combine that with financial incentives to record something as covid, and the lack of other income for hospitals as patients wouldn't come for minor things and elective operations were cancelled and you have a perfect storm for bad data

Not going to keep arguing about this, but there are a huge number of different ways we can confirm that our counts are roughly accurate.

There are obvious signals in total excess death counts indicating the number of deaths due to covid, we can do retrospective random testing of early classified covid deaths.

There is no evidence of some systematic conspiracy or anything of the sort. I encourage you to consider that you might be engaging in motivated reasoning.

How can you retrospectively test the people who died prior to April? How can you confirm any of the data that was generated by guesswork?

I'm fairly sure there is no tissue available to test from any of those bodies

The situation was ripe for fraud, and there is no way to prove it didn't happen en masse. Human nature suggests it did happen. The evidence of what caused those deaths is destroyed shortly after the paperwork is filled out. The whole thing is set up in such a manner that suggests inflation of the numbers, and to have no way to counter the claims as all evidence is gone

Absence of evidence is not evidence of absence.

It’s simply incentives, it doesn’t take a top-down conspiracy to have independent actors try to game a system in order to profit financially.

You do realize that 95% of COVID deaths have occured after April 2020, right?

The vast majority of deaths happened after April 2020, so even if those were all made up, it wouldn't affect the overall count much.

Is "pointing out" data considered downplaying? ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors.

From the CDC:

> Table 3 shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). The number of deaths that mention one or more of the conditions indicated is shown for all deaths involving COVID-19 and by age groups. For over 5% of these deaths, COVID-19 was the only cause mentioned on the death certificate. For deaths with conditions or causes in addition to COVID-19, on average, there were 4.0 additional conditions or causes per death...

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

Many of those 'additional causes" are things caused by COVID-19.

e.g. per that table, out of 560K deaths coded as COVID-19, 257K were also coded as "influenza or pneumonia". That's because Covid causes pneumonia.

Adding to this, pneumonia is merely inflammation of the (aveoli in the) lungs and it is almost always caused by some external factor, such as infection or illness.

> Is "pointing out" data considered downplaying? ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors.

Is this a useful metric, though? If covid is the catalyst to cause death with preexisting conditions, is not covid the actual cause of death?

Covid in these cases is an acute condition that is the direct cause of death.

Yes, it's considered downplaying to try and attribute these people's deaths to something that didn't kill them.

If the answer to the question of, "Would this person be alive were it not for COVID?" is "Yes", then COVID killed that person.

You should be able to be fragile and still survive, that isn't an excuse to let someone die.

That's... exactly the point?

Dying with COVID does not mean you would be alive today if you hadn't contracted COVID.

That's what he is attempting to imply is a massive overcounting in the data, but additional conditions that people point out as COVID deaths also having are mostly caused by COVID-19. Oh, they died of viral pneumonia after contracting COVID-19; pretty sure they would be in a different scenario had they not caught COVID-19.

The problem is we don't know, and "both sides" don't seem willing to admit that.

What I can guarantee is that of those 95% who died with COVID, some percentage of them would have died anyway, under almost identical circumstances, except without COVID.

However, it is also true that some of those people would have lived if they hadn't contracted COVID, even though COVID was not the "direct" cause of death. For how much longer, who knows. But certainly not when they did.

In other words: the people saying we should only be counting the 5% direct deaths are wrong, and the people that say we should be counting all 100% who had COVID as deaths from COVID are... also wrong.

We can use deaths-above-replacement (among other things) to determine how many more people died than normal from all causes, and then whittle down the obviously-not-from-contracting-covid deaths from there. The submission goes into very specific detail about how they did this, and they account for many of the potential confounders related to doing this analysis.

I believe we can be much more precise than you're giving us credit for in determining if contracting COVID was the direct cause of someone's death, even with comorbidities.

To be totally honest, when I see someone say, "we can't ever be totally sure" I nearly wholly discount that opinion, because it's very cheap to proffer, almost always true, and of very little value.

It is of immense value to say this when you have people in this very thread saying we might as well count everyone who had COVID as a death from COVID.

Also one of us is confused, and I don't think it is me. From what I've gleaned from this article, the 900,000 figure is not (as you say) "determining if contracting COVID was the direct cause of someone's death", but rather trying to figure out how many people would have died if this had been a "normal" year, i.e. if we could go to a parallel universe and make COVID never exist. This is absolutely not the same thing, as such a scenario will also count deaths as a result of our response to the virus as a death "due to the virus". This is my impression as they seem to be including things like suicide (criteria "c") and people who died because people with actual COVID were taking up hospital beds (criteria "b").

"Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality."

I think this is the correct way to think about this problem, as it is likely to be an underestimate, rather than an overestimate.

In other words, counting suicides probably doesn't matter, as the number is very low. The paper says as much: "The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude."

The paper overall goes into very great detail about what was and wasn't included and why, which is vastly more rigorous than what you seem to be presenting, which is effectively throwing up your hands and saying, "we'll never know!"

Just because we don't know exactly doesn't mean we aren't able to create good estimates. We don't know how many people die of any disease. But if you have a large enough dataset, and analyze it well, you can make good determinations of the approximate scale of each factor. The paper linked in this article does that, and concludes approximately 900,000 died of COVID who would not otherwise.

Two different ideas are being conflated here.

One is the OP's idea, "deaths due to COVID". This idea is "how many people would have died if COVID had never existed". However, what a lot of people hear when you say "deaths due to COVID" is "this is the number of people that died as either a direct or indirect result of having COVID in their system". But that is not the 900,000 number being cited.

It is made even worse by the HN headline, which is "death toll from COVID", which even more strongly implies the above.

How long would you have expected them to remain alive absent COVID? Look at it as a probabilistic spectrum, not a binary choice.

Exactly! So rather than try to puzzle out this undecidable proposition for nearly a million individual deaths, let's just look at aggregate statistics. Did more people die on the whole during the pandemic than we would normally expect? Does that line up with a model that they probably died from covid?

And... that's exactly what the linked article is doing. And yeah, it turns out that all these people (on balance) would indeed still be alive had they not been sick with covid.

The linked article seems to be including suicide as a death resulting from COVID, when the increase in suicides is far more likely to be caused by our response to COVID, not having COVID.

It is definitely not only looking at whether people would have died sans covid in their system.

You think there were a half million excess suicides in the US due to our response to covid? Again, this is just nitpicking at an article that supports a (very obvious) conclusion you find politically inconvenient.

As to whether a suicide due to pandemic-induced depression "counts" as being "caused by the pandemic" or not, isn't exactly the kind of confounding effect you railed against above? Isn't the solution, again, to not demand that we micro-classify every death and simply look at the external effects we can measure?

A conclusion I find politically inconvenient? You have no idea what my politics are, please stop projecting.

To answer your question though, no, they should not be lumped together because they are not the same thing and so the mitigations would've/could've/should've been different. In other words, lumping all these things together as "caused by COVID" is the opposite of useful. For example, you do better next time with deaths due to COVID in your system (category "a") by ramping up vaccination faster/better facemask policy/earlier lockdowns/etc. You can decrease category "b" by having more hospital beds / more healthcare capacity. You can reduce the deaths in category "c" (seemingly suicides) by having lockdowns that aren't up-and-down rollercoasters / better mental healthcare / etc. All of these, though being "due to COVID" should be handled very differently so it is counterproductive to lump them all together.

Again, I think you might be projecting a bit here, because the only reason I can think of that you would want to lump them together is to push a political agenda. Not for any utilitarian reason.

Just wait till you hear about 'eggshell client' in a court of law.

You should be careful how far you go with that reasoning. If someone commits suicide due to loneliness during the lockdown does that mean covid killed that person? In an indirect way sure, covid kill him, but in my view it should not be counted as a covid death. Just taking excess deaths without differentiating these kinds of deaths is going to result in misleading statistics. It will cause people to think a person who did not have covid actually died from getting covid.

I think the person above meant:

>"Would this person be alive were it not [for contracting] for COVID?"

Alive when? Right now? By that logic the Spanish Flu has retroactively become quite harmless. The important question is, how much earlier did someone die because of Covid. 2 weeks of life just aren't worth as much as 50 years.

The relevant question is whether the person would have died anyway, without covid. If not, that's a covid death.

Put another way, people in perfect health shouldn't be the only ones whose covid deaths are counted.

Yes, because many of those comorbidities are conditions that people could otherwise live with for decades... and furthermore, at least a couple of those comorbidities listed in that table are caused by COVID-19: pneumonia and respiratory failure.

If an obese person is in a car accident and immediately dies, we say that they died due to the more immediate health event: the car accident. -- even though we know that obese people are more susceptible to death in car accidents.

Those other factors like pnuemonia, arrythmia, organ damage, sepsis, etc. are mostly caused by COVID-19.

This is like saying that 0% of people who have contracted HIV have ever died of HIV, they died of other diseases. Well, sure, but what allowed those other diseases to be contracted?

I think where that 5% figure is used incorrectly: if you look at the other factors, they seem to not be "someone had a stroke, caught covid, and died", they're stuff like "Someone had Covid, developed pneumonia and died".

The top "other factors" are (in order): Pneumonia, "everything else", respiratory failure, high blood pressure, diabetes, cardiac arrest, heart disease, acute respiratory distress syndrome, etc.

It's pretty clear to say that far more than 5% died of Covid induced complications, not that they died of "natural" causes and also tested Covid positive. Saying the 5% number is almost certainly abuse of statistics, especially given the notable uptick in mortality in the US.

> Is "pointing out" data considered downplaying?

I'd consider it playing devil's advocate, depending on the scenario. The problem is, these days I often see a lot of bad faith arguments being passed off as "just playing devil's advocate".

You can be obese and diabetic and still live to be 80+ years old. My grandma is both, and will be turning 81 this year.

But if someone who is only 30, but obese and diabetic dies to COVID, it's a pretty damn bad faith argument to try to claim that COVID was not the cause of death.

At the end of the day, the question is, how many more deaths happened due to COVID than there would be otherwise. For that answer, we can look at excess mortality (which the article uses), which shows more deaths than the official COVID death tally.

https://ourworldindata.org/excess-mortality-covid

Thank you, somebody with some sense

> ~5% of deaths had "covid only" while the remaining 95% had other factors with the average having 4 other factors

Well, I don't even know where to find this kind of data, but your hypothesis could be tested by comparing the number of deaths in 2020 against the number of deaths in 2019, broken down by cause of death.

If that was the case, you wouldn't expect abnormal excess deaths, though.

The "well they had comorbidities" argument does rather miss that after middle age that's true of pretty much everyone.

Or to take me as an example: I have asthma. That probably counts as a comorbidity, so if I die of covid, should that count as a covid death or not? I'm 42, I can reasonably expect another 42 years of life. Most chronic illnesses don't kill you.

> I have asthma. That probably counts as a comorbidity, so if I die of covid, should that count as a covid death or not?

I've actually seen some people with Asthma may have possibly survived because of certain Asthma medications that may do something to block covid, I can't remember the study, but if you're on that specific med, maybe that helped?

I'm > 400 lbs (690 in 2012), I'm 41, I survived having it. Except for long-covid which was a bitch.

That's one reason to look at excess mortality. The number of people who would have "died anyway" this year would be pretty similar to the number who died last year.

We'll have to wait 20+yr for the controversy to simmer down but I bet when you run the numbers using a metric like YPLL (which is the typical metric used for these sorts of comparisons) the difference between Covid and other big pandemic outbreaks over history is going to be more minor.

Very back of hand numbers, but, assuming this article is true (haven't looked into it)

900,000 death * 15 yll/death [0] = 13.5 million YLL

~63 million YLL for Spanish Flu and 0.5 million YLL for typical flu season [1]

[0]: https://www.nature.com/articles/s41598-021-83040-3

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843747/

Flu seasons before vaccines were much worse than now though, it was like having covid every single year. The Spanish flu was about an order of magnitude worse than the normal flu seasons which is why it was so devastating.

> 900,000 death * 15 yll/death [0] = 13.5 million YLL

Right, so an average American lost 0.03 years of their life due to covid. I guess some thinks everything they did last year to save that 0.02 or so years was worth it. Basically you save a week by social distancing and locking down for a year.

This is the number of years lost with social distancing.

You could make this same argument about anything that causes large amounts of deaths.

Places that didn't do social distancing didn't lose much more, there is no evidence that social distancing saved more than I estimated here. My estimate was even very generous in your favour since I estimated death without social distancing to be the worst in the world. But we could estimate to be roughly the death rate in Florida, in which case most of the social distancing did basically nothing.

I think that's a risky assumption. It's plausible that even in no-social-distance areas, the most vulnerable people socially distanced anyway.

Right, and that was enough. Forcing kids and people under 60 to stay home and social distance didn't seem to be necessary to avoid disaster. But California still did it for over a year, that is the price you paid. How many years of life did it save in California compared to letting people distance as they themselves deem necessary? Not that many.

Social distancing was never as much about saving people directly as about allowing the healthcare system to handle the mess.

In computer terms, it's about launching processes in a controlled manner vs let them run freely and make the system paginate.

You don't let critical systems paginate.

Right, I agree with that. But it was only valid for the first few weeks. The healthcare systems weren't critically overrun anywhere in the world. Yes, from time to time not every patient they wanted to put on a ventilator got one, but ventilators doesn't dramatically improve the odds of survival so it wasn't a big deal anyway.

So why did California continue with their measures for a year? They still did among the worst in the world so those measures seems to have had little to no effect at all.

> But it was only valid for the first few weeks. The healthcare systems weren't critically overrun anywhere in the world.

We live in a different planet? I live across the border with North Italy, and it was only 2 weeks what it took for the situation to go from "oops, looks like there's a problem" to "let's mobilize doctors out of retirement and potentially kill them to save people". There have been different levels of restrictions since. Same in France, Spain, Germany, pretty much anywhere in Europe.

> Yes, from time to time not every patient they wanted to put on a ventilator got one, but ventilators doesn't dramatically improve the odds of survival so it wasn't a big deal anyway.

Ventilators were abused at the beginning out of ignorance about the disease, but they're still the best last-resort treatment for critical cases. In my region, during the second wave, most deaths happened to people waiting for a ventilator, or during transfer from oxygen to a ventilator, and those on ventilators generally survived.

That said, now there's a more defined and effective protocol before reaching a ventilator that requires hospitalization nonetheless, and makes you require one if not followed.

> So why did California continue with their measures for a year? They still did among the worst in the world so those measures seems to have had little to no effect at all.

California had terrible numbers despite the fact that measures worked. It's been studied ad nauseam and social restrictions is the among most effective measures to be taken in every study, with a solid interval of confidence. One of my favourite studies is [0] because it shows that some things were done right (lockdowns, closing schools, remote work) but some had little to no effect (surface disinfection).

[0] https://www.nature.com/articles/s41562-020-01009-0

> You could make this same argument about anything that causes large amounts of deaths.

The cumulative time wasted by humanity each day by putting seatbelts on or by stopping for red lights.

Is very small compared to the lives saved by those measures. Traffic safety laws saves about 20k young people per year in USA. Assume each had 40 years left to live, that is 0.8 million years, or about 0.002 years per person per year. That is about half a day of life saved per year per person, meaning 12 hours. Putting on a seatbelt takes a few seconds and you do it a few times per day, say 20 seconds per day. Add that up over a year and you get 100 minutes or about 2 hours spent seatbelting to save 12 hours of life.

Traffic lights takes more time, but they also allows for more dense traffic so I don't think that removing them would help at all. I doubt San Francisco traffic would get any better if you removed most traffic lights, likely it would get worse in all the chaos, so unless you prove to me that they actually hurt commute time rather than help I put those savings on the seatbelts.

> Is very small compared to the lives saved by those measures

Don’t get me wrong, I wear a seatbelt and stop at lights.

I was just agreeing with the parent comment. There seems a fairly strong vein that wanted no lockdown and for us to just accept any resulting carnage. I’m not part of that group.

You appear to be making the assumption that disease spread would not be different had lockdown not happened. The question isn't cost of lockdown vs cost of disease with lockdown, it's cost of lockdown vs cost of disease without lockdown. Without a lockdown, April and May would probably have had 10x (at least) more cases, and way more than 10x more deaths because hospitals wouldn't have had the space to hold everyone who was sick.

No country in the world is even close to an order of magnitude worse than USA regardless of what they did, so it isn't a reasonable estimate. Worst case is less than about 2x USA's numbers, I used that as an estimate of how many lives you saved with your measures.

India?

Does India have 20k dead per million?

Also, during the influenza of 1918 there wasn’t widespread availability of oxygen. If we were still at that level of technology there would be significantly higher mortality. You can see a bit of this play out in India where people are dying who shouldn’t be.

> Something to consider if you see anyone trying to downplay this.

I admit I'm the morbid one in the group, memento mori and all. But I think the real stat we should track is years of lost life expectancy. That's the only statistic that makes sense when doing cross disease examinations. Not speaking specifically about covid, but more generally, something which primarily kills young people is much bigger deal than something which primarily kills old people.

I wonder if that measure should be used for criminal justice as well. As well as showing that killing an old person is less harmful, it also excludes babies. Both these groups seem to have lives that are worth less even to themselves and so it's (however distasteful) not as bad if they die. We already do that with abortion by valuing an unborn baby's life less.

Many places already has laws around infanticide which is much lower than manslaughter. Canada for example sentences mothers to at most 5 years with no minimum for killing their baby.

YLL is a horrifying metric because it values someone who is 20 over someone who is 60. The only argument I can see for its "usefulness" as a statistic is if you want to imply that the old are less useful than the young. This kind of statement about the bare utility of a human life is the same statement that underlies a lot of how we have treated the disabled or those on welfare in the past. And it only makes sense if you think about a human life in terms of its economic usefulness as some sort of cog in the economic machine that wears out and can be discarded safely after age 67.

Not necessarily. In my persona value system I would much rather live 20 more years when I'm 20 over living those same years once I'm 60.

It makes sense if we consider the possibility of novel life experiences to be an important value of how we live life. If you've made it to 60 (a not uncommon life expectancy), you've had a chance to travel, have children, live through many different life occasions, etc. If you're 20, you've barely had two years as a legal adult where you could make something of your life. It has little to do with economic productivity.

Someone who is 20 should be valued more than someone who is 60. Case in point, the deaths of the ~100,000 centenarians are going to be way less impactful than a disaster that wipes out the entire town of San Antonio.

Here is a choice for you:

1. You get killed at 20.

2. You get killed at 60.

Which option would you choose?

see my comment here for a different angle than just pure utility: https://news.ycombinator.com/item?id=27080048

> YLL is a horrifying metric because it values someone who is 20 over someone who is 60.

Not to my father, who is in his late 60s and the most at-risk member of the family, and who has been more opposed to the lockdowns than any of us.

His calculation is that at some point - for the good of the family, long-term - the economic damage and delayed social development of his grandchildren outweigh his personal safety.

I have encountered very few older people who don't also think this way.

The only argument I can see for its "usefulness" as a statistic is if you want to imply that the old are less useful than the young.

It's not about "usefulness", it's that saving the life of a young person produces a larger benefit in terms of expected future years of life. Take the extreme case: if a building is on fire and you can only rescue one person, would you be indifferent between saving the life of a 10 year old child versus a 90 year old with terminal cancer?

If you're going to get super utilitarian about it, strict years of life lost is not the best measure. As nearly all of human history proved out, very young children, especially infants, are particularly easy to replace. It's losing people in the prime years that really hurts a society, why for instance the US Civil War and the two World Wars were so terrible, where huge regions lost a majority of 20-40 year old men. Although again, if we're being very utilitarian, men are a lot less valuable than women, which is at least one reason we've usually sent men to war. Childbearing doesn't scale nearly as easily as child seeding.

interestingly i take it more from an intergenerational contract that at some point it's the duty of the old to senesce and optimize for the good of subsequent generations.

As I understand it this intergenerational contract used to be quite strong as people would see that previous generations invested in them and as a pay it forward sort of mechanism, they would in turn pay it forward to generations that proceed them .

I suppose there was some "take care of me when I'm old" in the intergenerational contract too, but I understood that as secondary to the propagation aspect...

I agree that we should be tracking years of lost life expectancy. I also believe in attempting a quality adjustment; we get better public policy from counting Quality Adjusted Life Years (QALY) lost.

I think that the main obstacle to this approach is that people instinctively think cross-sectionally rather than longitudinally. When you say "kills young people" and "kills old people", listeners focus on 2021. A young person is somebody born in 2000 and an old person is somebody-else, born in 1940. That is cross-sectional thinking, with 2021 as the date of the cross section.

But the real issue is that we nearly all live to grow old and get to experience both sides of the issue. Someone born in 2000 is likely to live until 2080. They will probably see a different respiratory virus going round then; it may even be what kills them.

So what would you personally prefer? The pro-lockdown approach trades losing a year out of your twenties to lock downs, in return for some action (perhaps ineffective, perhaps unnecessary) to ensure that you survive the plague of 2080 and get to live a few years longer.

The anti-lockdown approach makes the opposite trade-off. It is not really young versus old; it is now versus later.

I'm getting old and rather dreading later. I would prefer that society prioritize letting the young get on with their lives, education, dating, etc. and if I lose some poor quality care-home years, well, I've seen my grandparents and parents get old and frail, and I'd rather not dwell on the details of what I'm dreading.

If young people want to argue for the anti-lockdown trade-off, if they claim that in general young people shouldn't be locked down in the hope of protecting the elderly and they will accept their fate gracefully when they get old, well, I would think them wise beyond their years.

Remember that life expectancy went from 60 -> 80 over the last century.

80% of the deaths have been from folks aged 65+. So, it is arguable that the Spanish flu would have killed a lot more if the average lifespan was higher.

It's an interesting point. Spanish Flu hit younger people, so having more older people might not have affected the numbers much. On the other hand, maybe having so many old people with covid affected which variant traveled around.

It affected younger people more:

https://en.wikipedia.org/wiki/Spanish_flu#Patterns_of_fatali...

> The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old.

> Something to consider if you see anyone trying to downplay this.

It's invalid reasoning to use this study to "upplay" the pandemic.

It includes deaths due to depressions and delayed medical interventions, which you could argue isn't the result of COVID directly, but the result of lockdowns.

So when people use this study to claim "see, this many lives were lost, we were right to institute lockdowns" - that's circular reasoning, part of the reason so many lives were lost is because of lockdowns.

Number saved due to lockdown

Number died due to lock down

Personally I lost access to badly needed medical care due to lockdown. Was quite scary.

Eventually got Covid. Sucked but nothing compared to what else I’ve been through. So initially was dismissive.

However definitely some lasting changes to my clotting levels.

I have to be perfect with blood thinners these days, we’re before covid I could fudge with them.

"Personally I lost access to badly needed medical care due to lockdown. Was quite scary."

My nearly 70 year old mother is in the same boat. She recently dealt with breast cancer treatments (a rare form) and thankfully was given the all clear before covid. She still needed to do follow up visits, more testing etc. but due to covid was told to stay away. Even though she was more comfortable with the risk of getting covid vs. ensuring her cancer is in remission they wouldn't see her.

If there had been no mitigation efforts the death toll would have skyrocketed as our healthcare systems collapsed.

I doubt that. People would naturally follow social distancing protocols (out of fear for their own lives). They would still hang out, but less and more in the open, and still go to the doctor, but less and only for the necessary issues. Literally the only place where "healthcare systems collapsed" (in the West) was Italy, which was caught completely unprepared.

There's a sensible middle ground between life-as-normal and enforced lockdowns.

We only know what happened with radical mitigation efforts. What happened was, ICUs repeatedly got near capacity and occasionally exceeded it in the US. What would happen without those radical mitigation efforts? ICUs would have had even more people with life-threatening illnesses and healthcare would have been rationed, resulting in more deaths.

And know that...how? Because "correlation = causation" is a legitimate scientific hypothesis now? Any legitimate scientific study has things like control groups to verify that the studied action wouldn't have happened otherwise, something I learned if high school biology in the first week. Your statement has none of that. And, any time you do look at places with NPIs vs non NPIs (Jutland in Denmark, or compare FL and TX vs Ny and CA, you see that your assumption is completely invalid.

If hospitals are full, not all people who need care can get care. It's not a complicated concept. ICUs in many parts of the country hit capacity during the pandemic, and that was with radical efforts to limit the spread of the virus.

Ventilators weren't as needed as originally thought. USA even killed a lot of patients by being over eager putting them into ventilators. If you put a healthy person in a ventilator there are a few percent chance of giving them pneumonia which typically kills them. When you blast air into their lungs it is really easy to accidentally blast bacteria all over them as well.

The articles about "we now know better how to treat patients" was mostly this, don't put them on ventilators unless it gets super critical, most patients got better without one. Also I haven't seen data on this but I strongly suspect the main reason USA lost so many young people to covid compared to other countries is that USA is way more eager to put people on treatment like ventilators, basically blasting bacteria into the lungs of young otherwise mostly healthy people killing them. Those young lives would have been saved if they weren't diagnosed in the first place.

> When you blast air into their lungs it is really easy to accidentally blast bacteria all over them as well

You might consider yourself lucky if they blast air into your lungs. Italian healthcare was using pure oxygen, which, used at prolonged periods of time basically burns your lungs. Some government officials recently admitted that this caused a lot of "COVID" deaths.

There are tons of places where you can directly observe the effects of lockdown measures.

You say that, and they said it (only 90s kids will remember "fifteen days to slow the spread") but as of right now, it's a truism. Maybe the lockdown worked to ease the stress on the medical system. Maybe only the first 15 days of lockdown did that, or 30. I highly doubt that the entire year of lockdowns saved the medical system, and I would be willing to bet the effectiveness of the lockdowns in preventing a collapse of the medical system ended within the first 3 months. So suppose that's true, 3/4ths of the lockdown and all the mental health and depression related deaths associated with it were unnecessary. I don't know when the lockdowns stopped being effective in protecting the medical system, but I know it wasn't this morning. Some amount of those deaths are attributed to lockdowns that were unnecessary.

Also, you can't quantify the hypothetical death toll in that scenario in any real numbers, to say "would have skyrocketed" is unfounded. I could understand "would've been higher" that sounds reasonable.

I'm not trying to downplay it, I believe the official CDC counts, but some additional considerations are: Is the high total death count related directly to our response(or lack thereof), or to our higher population of people pre-disposed/vulnerable to this virus? For the past few months the focus has been on people ignoring lockdowns, ignoring bans on gatherings, vaccine hesitance etc. but it seems that, based on the co-morbidities, we were an already largely unhealthy population to begin with.

We shouldn't downplay the progress we've made while we're at it. 100 million vaccinations is quite an accomplishment. If we're going to beat ourselves up for having the top total deaths(while not being in the top 20 per capita), we should pat ourselves on the back for that one. Getting 100 million people to do anything is hard.

It was #3 in 2020 even though widespread testing only started in March. Seriously frightening stuff. Imagine if we went from zero heart disease or zero cancer deaths to present numbers in the span of one year...

https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm

Heart disease and cancer aren't even singular diseases.

Hell, even the Flu is a combination of diseases: TypeA, TypeC, etc. etc. Even Flu-TypeA is a combination of different diseases: H3N2 (Bird Flu) and H1N1 (Swine Flu) are both Flu-TypeA.

For a singular disease + minor mutations (COVID19 vs B.1.1.7 vs P.1 extremely similar and covered by the same vaccine) to cause such a death count is pretty remarkable.

I had no idea about HIV deaths, I would have guessed it would be 2x-3x COVID deaths. I don't think that means "HIV had a smaller impact than I thought", I think that means COVID is bigger than I thought. We get desensitized to the numbers. Thanks for the perspective.

HIV is a lot harder to spread than airborne viruses. But, imagine how much worse it would have been if it was airborne.

To be fair, I feel it's been naturally downplayed already. It's really not shocking anybody anymore. There's a weird fuzzy average life that emerged where most people are just waiting for the thing to go away and the casualties have become numbers.

To add to this, looking strictly at deaths, neglects the long term affects and people with severe but none-fatal cases. Not to mention the capacity issues associated with Covid.

"cAsE fAtAliTy rAtE iS oNlY 1%" is a horrible metric to base any policy off of.

It's also greater than all of US military combat deaths for every war combined i.e. Civil War, WW1/2, Korea, Vietnam etc.. And think of how much concern (legitimately so) we have for them.

US Civil War death toll is estimated between 620,000 and 750,000, which is higher than the official Covid toll so far. It was also much more highly concentrated in a small number of states in a country that was far less populated.

That's not 'combat deaths' though, that's 'total deaths'.

In those wars, a huge number of people died from things other than direct combat.

Here are the numbers [1]

[1] https://en.wikipedia.org/wiki/United_States_military_casualt...

Most of the people trying to downplay covid aren't interested in logic and reasoning, though.

Both HIV and the Spanish Flu killed young people with most of their lives ahead of them. All early loss of life is tragic, but the number of deaths alone isn't the only measure.

If you calculate the loss of lifespan, HIV would blow Covid out of the water, because the median age at death would mean ~40 or 50 years of life lost. Covid's median age at death is so high, it's often above a country's life expectancy.

It's also worth noting the US population has more than tripled since 1918 and grown by a third since 1990.

This isn't meant to downplay Covid's impact, but to make a more nuanced comparison with past pandemics.

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