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Comment by khazhoux | Hacker News Reader

This has me a bit confused: I look at the stats on cases and deaths per capita across various U.S. states, including California (which was very locked down, at least in theory) and Florida (which was flippant towards risks of contagion), and many states in between. The per capita cases+deaths are nearly identical across many states with very different approaches. This left me really wondering which measures were and weren't necessary. Anyone seen good studies or analysis on this?

Legitimate question, please no political commentary.

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I don’t have anything to add except that California is huge and very unevenly applied “lockdown” - there are many towns a where businesses remained open or reopened frequently, but the big cities did have large shelter in place efforts. It would be interesting to compare on the municipal level if the data was that granular.

San Francisco had some of the heaviest lockdowns in the country, yet 100 miles east in Modesto the mayor actively defied the statewide lockdowns. California is a big state.

The community I grew up in in California purposefully threw rallies and went out of their way to rebel against every single restriction. I keep this in mind when people say California's restrictions didn't work.

Edit: This was in Orange County CA, not rural. And when I say "rallies" I'm talking thousands of people, not small gatherings.

Just in case anyone thinks this was confined to rural areas it was not.

I had to go do business in LA specifically around Manhattan Beach and Inglewood, and the folks that live there were taking me to strip malls where all the businesses looked closed but we're all actually open.

They just had their windows covered. I'm talking about an MMA gym next to a hair salon next to an Ethiopian restaurant.

Yeah, the speakeasy gym thing was all across SoCal if not further. Probably given the low compliance we should have left gyms open officially.

Still, the vast majority of cases in California have been in the metropolitan areas that have also had the strongest restrictions.

Except these surrounding towns act as virus reservoirs for the large cities. That limits the effectiveness of restrictions. The “become COVID-19 carriers to own the libs” strategy kinda worked.

The vast majority of cases will basically always be in big cities because that's where the most people live. We'd need per-capita data for it to be a useful comparison.

It's out there. It's also not hard to take raw data and divide by the population size which is publicly available for all counties and cities.

SF fared a lot better than LA, which was a lot looser with restrictions...

Of course SF has a good hospital coverage, displaced a lot of poorer residents. Thus fewer people working high-risk jobs in SF actually end up counted in SF's stats.

But I don't think that SF's 62 deaths/100k (compared to e.g. 240 for LA and 232 for Miami) is solely explained by that, and that the tighter (and more adhered to) restrictions did play a role.

Without the poorly considered relaxations in Oct/Nov, despite clear indicators for a worsening situation, it'd have ended up better...

Assymptomatic carriers have been observed to carry the virus and spread it to those around them for periods that range between a few weeks up to a couple of months.

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

All it takes is a single spreader moving from outside of the metro area to negate the effect of the lockdown, specially if a considerable portion of the population is quite militant in their refusal to follow even the most basic health and safety precautions.

No SF had stronger restrictions with high adherence and had much lower per capita case and death rates. It’s hard to say how much of that is causal though (SF has temperate humid weather and a large white collar workforce that could afford to stay home that could have helped independent of lockdown).

The restrictions were almost never enforced, and only occasionally against businesses. Individuals only got arrested when they did something dumb like refusing to leave a business when refusing to wear a mask. The “lockdown” was a joke: people either chose to follow it or did not. People traveled a hundred miles or so to get haircuts in less restrictive counties of California. So it’s not really fair to compare counties when regions were crossed so often.

> Still, the vast majority of cases in California have been in the metropolitan areas that have also had the strongest restrictions.

So are the vast majority of people, and greater population density makes it harder to control the spread of communicable disease. So you’d expect, all other things being equal, not only thr vast majority of cases but the highest per capita cases to be in the metro areas.

But, actually, the highest per capita infections (both total and current) were mostly in rural, not metropolitan, counties.

>the highest per capita infections (both total and current) were mostly in rural, not metropolitan, counties.

Can you please cite your sources for this claim? I just did the math using the numbers of infections[0] and the county populations[1] and it doesn't really seem to match up with your claim at all.

There are 58 counties in California.

San Bernardino, LA, and Riverside counties are numbers 4, 5, 6 respectively for highest cases per capita and all have populations above 2.2 million.

Of the bottom 10 counties in cases per capita, only 2 have a population larger than 100k (SF, Humboldt)

[0] https://usafacts.org/visualizations/coronavirus-covid-19-spr...

[1] https://worldpopulationreview.com/us-counties/states/ca

It sounds like the restrictions didn't work at all in that community.

You can’t assert this without confirming that zero restrictions would have led to the same number or fewer deaths.

What I meant is that restrictions are ineffective if they are ignored, not that they literally had no effect.

The closing of schools in California (vs open in Florida since last fall) was a very distinct difference in both policy and actual behavior. It seems not to have had a dramatic effect on outcomes.

At least in hindsight, the closing of schools might have been a huge mistake.

Some canadian provinces are still closing down schools at the moment.

Why? Sincere question. Is there science to back it up or is it just fear of making a wrong decision?

They have vaccine shortages. The issue is the teachers, not the kids.

Are schools a major source of transmission for teachers and staff?

Yes. Workplaces with lots of contact always are.

In Nov-Feb, I was losing 40-60 employees a week to infection or quarantine. Mostly people in essential IT support positions

My sons school was open most of the year, but shutdown for a month due to teacher quarantines.

Schools are different than a business setting. Young children have less chance of getting it and less of spreading it. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp....

The population of humans in schools includes many adults.

You just contradicted the website you linked, I'm confused.

> Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have less severe illness from COVID-19 compared to adults.

Less severe response to it, not "less chance of getting it." And then just two lines later:

> Recent evidence suggests that compared to adults, children likely have similar viral loads in their nasopharynx,7 similar secondary infections rates, and can spread the virus to others

I don't know how you arrived at your opinion here.

Sincerely, I don't know. Almost all of the at risk population here has had at least a first shot. But the situation in Ontario has been pretty bad the past few weeks.

But I don't follow the science closely enough. I hope they're making the right call, because it's really hard on the kids. I'm just glad my own little guy is not of school age yet, and in fact is young enough to be mostly oblivious to the whole thing.

Conveniently skipping over the occupied ICUs. How do you not know that our medical system was overwhelmed or that the rise in cases only reversed after we shut down schools both times in the last 4 months?

Surely that wasn’t the only tightened restriction or change in behavior during the case surge, though?

There are a lot of confounding variables in these analyses. It’s going to take years to tease them apart, and we may never truly know for certain in some cases.

Perhaps, but do you lock everything down mid-spike when you know the current rate will lead to extreme triage measures within two weeks, or do you wait two weeks to act and start rejecting patients as they continue to flood in?

"the rise in cases only reversed after we shut down schools both times" implies a causal relationship, though, while ignoring the other mitigations that went into effect.

The point is not "is it wise to take precautions"; that's obvious. The point is we don't necessarily have great data on which precautions work better than others because they're largely all being put into effect at the same time.

> point is we don't necessarily have great data on which precautions work better than others

We actually do, though, and it's preventing close contact of non-household members and preventing sharing enclosed spaces with non-household members for long periods of time.

People spread the virus before they even know they're sick, and a subset of sick people either need to go to work despite being sick, or they just don't care.

Again, all those restrictions were typically implemented at the same time - distancing, capacity limits, masking, etc.

It's going to take time and years of research to tease out things like "did closing schools specifically help".

I just haven't been following the news that closely, especially for Ontario (I'm not in ON). No intent to "conveniently" hide information, though thanks for clarifying.

I don’t know why no one is saying this, but Ontario’s ICU numbers skyrocketed to 900 at the peak just a few weeks ago. We’re only down to 700 occupied beds now and normal medical procedures are still paused because of the enormous ICU load.

It wasn’t until we closed schools that the trend reversed.

People are so quick to blame fear without actually looking at the data

Is the data conclusive? I try to look at the data, but it seems like a mixed bag when it comes to school closures.

I don't know if we can conclusively say what specific action needs to be taken other than halt contact. We were on an extremely bad path, and I don't know what else could have been done since we had little vaccine supply at that time.

> It wasn’t until we closed schools that the trend reversed.

The other way to think about it is that it wasn’t until things got bad that people got cautious.

Kind of how people take homeopathic drugs when they are sickest.

Yeah because it appears to have helped reverse cases both in January and this month.

You mean cases started to drop after everyone stopped traveling for Christmas and vaccines started to hit meaningful numbers?

Who knows. The alternative was not closing schools while cases were increasing exponentially. Is that a theory we should be testing when we've already paused elective medical procedures due to the wave of COVID patients?

I said "in hindsight", meaning that we don't fault the decisions at the time. I think now is when we begin (without blame) to start evaluating what worked and what didn't.

Unfortunately, some of the things done were disruptive, and if they were also ineffective, that will lead to blame. But our mission should be honesty first, and have faith that reasonable people can accept that the best decisions were taken with the information available at the time.

Did it actually help, or was that just coincidental?

The alternative was not closing schools while cases and incoming patients were increasing exponentially. Is that a theory we should be testing when we've already paused elective medical procedures due to the already high numbers of people in the hospital?

Education is essential so yes that is a hypothesis we should be testing.

I'm not sure you understand the consequences of an overwhelmed medical system.

Regardless, school is being done online. Kids that needed laptops got them.

> Regardless, school is being done online. Kids that needed laptops got them.

Right, I forgot University of Phoenix regularly matches their in-person counterparts in terms of quality. Keep telling yourself that teachers who were never trained to do remote teaching are anywhere near the same effectiveness as before. You ever dissect something virtually? Somethings can simply not be learned through a screen. Physical education, dealing when your crush looks at you in the eye, literally anything "hands-on" like swinging a hammer at a nail, the of useful skills that can only be developed in the presence of another human are tremendous. Funnily, most of the useful things learned at school for most people are not the curriculum and it is these things that are missing.

We can have this discussion if the situation carries on through this year. I agree a lot of places have had suboptimal schooling, some better than others, but I'd rather save lives and hold off on dissecting animals for a year.

It was a huge mistake in foresight as well. Many of us were highly vocal against school closings.

Low income / essential workers & overcrowded homes are a far more significant factor that often go unmentioned when people try to compare the outcomes between state & municipal public health interventions. This was observed well before the winter surge. https://calmatters.org/projects/overcrowded-housing-californ...

How do you isolate when there's more members than actual rooms in the home & only one one restroom?

According to a study in PNAS, shelter-in-place policies in the US did not work: https://www.pnas.org/content/118/15/e2019706118

Another study in Eur J Clin Inv had similar findings comparing countries: https://onlinelibrary.wiley.com/doi/10.1111/eci.13484

COVID went wild basically everywhere. There were a few strong exceptions: China (apparently), Australia, New Zealand and some others. What these had in common was very strict police enforcement, which led to some dramatic scenes like people getting welded into their houses in China, or houses in Australia getting broken into by police on suspicion of too many people gathering.

In my _opinion_, lockdowns didn't work elsewhere because most cases are not from casual public transmission in places like stores, restaurants etc. Rather, events like kickbacks, dinner parties, and practices like in-home workers (nannies, cleaners etc) continued throughout the pandemic, or resumed shortly after the original March 2020 shockwave. While strident police enforcement of physical distancing could eliminate cases, and seemed to in a few places, the half measures used by most of the world did little-to-nothing positive while being an economic and cultural disaster.

Personally, I never caught COVID and rarely socialized during the pandemic. All the cases I heard of stemmed from the kind of thing I mention above: private dinner parties, nannies and so forth, rather than casual public transmission.

You, or any individual may have taken social distancing seriously but it's clear many or most did not, including people on both political "sides", up to and including governors, members of congress etc.

The strictness of the enforcement in China has been overstated in the media. Strict, but not that strict. Source: here during the Chinese lockdown, have compared notes with those in other cities.

Here in Japan they've never really had lockdown. Restaurants have remained open the entire time, just asked to close at 8pm. I could/can walk by them at 7pm and see them full of people talking and eating without masks. I was invited by Japanese friends the entire time (didn't go) and would see them posting pictures of their restaurant dinner gatherings on Facebook.

Further, as a comparison, Tokyo Metro has 38 million people, California has 38 million people. Tokyo Metro has ~6500 people per square mile, California has 240 per square mile. Tokyo Metro had and still has people commuting in very crowded trains every weekday. California mostly people drive cars. California closed restaurants. Tokyo Metro never closed restaurants.

Yes, Tokyo is going through a "spike" right now but compared to California it's still tiny. Compare Tokyo Metro's current "spike" (~2k people per day) with any of California's spikes at 40k per day, 20x more.

Some people will claim testing but that doesn't fit the facts either. Deaths from COVID in Tokyo Metro. California 62k death, Tokyo Metro, 2k dead. And, if you believe the attribution of death by COVID is bad then all you have to do is look at the death rate from all causes and see that Japan is doing much better than the USA

https://ourworldindata.org/grapher/excess-mortality-raw-deat...

I have no idea what Japan did right or got lucky with. Various speculations abound. Japanese don't shake hands, hug and kiss friends. Japanese may be commonly taking some medicine for unrelated things that happens to provide protection. Japanese might have more people with genetic immunity. Japanese mask compliance might be higher. Japanese aren't obese (I'm sure there's some other non-obese country they can be compared to). Japanese have a different diet (not sure what other countries have similar diets)

I recognize that even with restaurants open it's possible just the various other factors are/were enough to keep R low enough.... I really have no clue. Personally I mostly stayed locked up. I live alone. Saw less than 1 person a month in person, usually an outdoor walk with masks on.

On the other hand Japan has an older median age than most other countries. We know that age is a crucial risk factor for COVID-19 so on that basis they should have had a higher death toll, but didn't.

My guess is that the low obesity rate is the critical factor, but that remains somewhat speculative.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430889/

This is super interesting. My entirely unqualified gut reaction is that this is cultural- that Japanese people take infectious disease seriously and test+quarantine after experiencing symptoms or traveling at all, having already handled SARS outbreaks before, and many Americans are still debating whether the pandemic is real, and that behavioral difference is enough. I don’t know how to test that. But it could also just be as simple as Americans being less healthy.

What you're saying is consistent with my hypothesis. Ie that casual public transmission on subways and in restaurants is low. Rather, it's "behind closed doors", at extended private gatherings, via domestic workers and so on. Those are the only such cases I have direct knowledge of (California USA). It could be that Japanese don't gather as much, or have chosen to skip it during pandemic.

You might be right. I don't think that fits with seeing restaurants open and unmasked (since you need it off to eat and drink) but maybe the sum total of meeting in person is still much lower than "behind closed doors". The news (when I used to watch it) certainly highlighted that going to hostess club had a few spreader events like where 80% of the people in the club got COVID. I don't know how common that was, I just know it was in the news last may/june (don't watch the news much)

A lot of your observations make sense. My speculation would be:

A) Japan has a more temperate climate

B) Japan is an island and was pretty strict about locking down travel and forcing everyone entering the country to quarantine for 14 days

C) Japanese culture seems to promote very rigid adherence to rules and proper social etiquette.

People discuss the range of social <-> lockdown techniques as if they're generically effective or not, when really I think think the effectiveness of the same strategies varies vs how high the current community state of infection is, as well as a hysteresis of what level of infection you're coming from.

If you can act earlier, maintain a external boundary, and maintain a low enough level to trace then I think you can stay in a very good state with minimal inconveniences. But once the infection rate has passed a certain level, more stringent strategies are needed to get back to the same low state.

In the UK (which has pretty good test capacity) the infection rate slightly lags the lockdown restrictions as you would expect from a working policy, so I think it can be successful.

IMHO if you want to understand what an effective response looks like - don't look at North America or Europe. Think Vietnam, Australia, New Zealand, and many parts of Africa, all of which had vastly better outcomes.

Of course, I'm not an epidemiologist or public health expert, so while I have some guesses I'm not sure what exactly they did that was more effective - but there's no question that it was more effective. If I was going to look for case studies to understand what to do next time, I'd start there. If I was going to look for case studies to understand what not to do next time, well...

> Of course, I'm not an epidemiologist

and no geographer either apparently :D

What do you mean?

It doesn't account for Africa, but many of best-performing countries have been island countries (Australia, NZ, Taiwan, Iceland, etc.). Islands have some fairly obvious advantages in fighting a pandemic, and it shows in the statistics. I believe Hawaii has also done much better than other US states. I'm not sure whether that's what the comment was referring to though.

None of Thailand, Vietnam and Mongolia are islands and their handling of covid is world class compared to parts of Europe and the US.

These countries are also far poorer and in the case of Thailand especially that has been a major contributing factor, as they've been less able to afford closing their country to tourism.

Both Thailand and Vietnam have been devastated economically, and even with various levels of lockdown both country is currently experiencing the highest number of cases since the beginning of the pandemic.

Also, the vaccinated population in either country is at low single digit percentage, so no end in sight for the harsh measures. Compare that to the US or Europe where 50% of population is (partially) vaccinated and, as the result, gradually reopen.

> even with various levels of lockdown both country is currently experiencing the highest number of cases since the beginning of the pandemic.

"highest number of cases" here meaning between 1 and 2 cases per million people per day.

For context, the United States is currently at its lowest daily case count since June last year, which is slightly above 100 cases per million people per day.

"Even with various levels of lockdown both countries have 1-2% of the case count of countries that didn't treat this seriously" isn't quite as dramatic of a statement though I guess.

(all figures using the typical 7 day rolling average and data available from Mackuba)

Yes, also South Korea is for all intents and purposes an island. It's surrounded by water, except on the North which is the most heavily militarized border in the world.

I don't think anything they said about countries/continents was incorrect was it?

In how many of the countries that did really well did the virus have the same head start that it had in the US and Europe before getting discovered?

How important is a head start though in these situations? If the response was poor in either case, the result would be poor, right?

If the US had in reality on the order of 100 cases, there could be a credible effort to get rid of all of them and reopen. You wouldn't have to lock down hardcore for as long. In Australia from what I've seen fly across Twitter, they had the luxury of periodically locking down a city when they saw a single case, to make sure it didn't escape into the population.

I agree that there could be a way for this to work in the US but it would be a long slog. South Korea seems like they could pull it off. So I'll grant you them for sure as being superior.

It started in China, a country with 1.4 billion people and 20 million pop cities and even if you 100x their official number they did better than the US or Europe. There's few excuses for our mismanagement.

That is an even less fair comparison. The Chinese government has a tremendous amount of power over the daily life of its citizens in a way that isn't replicable most other places. There were stories of China literally welding doors to apartment buildings shut and forcibly dragging people away to quarantine facilities as soon as they tested positive.

FWIW from a brief search months ago it seemed that the welding stories are hearsay. Iirc you can find reference to them in the news but it didn't sound concrete.

There were literal videos about it at the same time ( a year ago)

I recall seeing various grainy creepy videos (not just about this) supposedly of China posted on Twitter. I started to wonder who was really pushing these videos. I'd have to see a video corroborated by a reasonably trusted news source.

Eg News sources of the BBC had conflicts of interest about reporting on this ( since they have/had a division in China).

What would even be framed in the media when these were really user videos without journalists. Journalists couldn't report live, so i don't think there's something else than opinion pieces.

Yes, as I’ve said elsewhere in this thread the strictness of the Chinese lockdown has been exaggerated in the media/Western imagination.

I did some searching and it looks like you are right that there isn't anyone credible officially reporting it. However multiple credible news sources do mention welding doors shut as part of opinion pieces, including this one from Ai Weiwei[1] who presumably has more info about the situation and isn't going to simply speak on Western hearsay.

[1] - https://www.theguardian.com/commentisfree/2020/mar/08/china-...

For me "countries that did really well" is mainly places like Singapore and Taiwan and South Korea, which got the virus earlier than USA and Europe but took it seriously from the very start.

Okay, if they actually got the virus that early, then these countries are the answer to my question.

However... at least for Taiwan that doesn't feel like it adds up:

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

They've had fewer than 1700 cases, and that's including a recent massive outbreak. They peaked on March 26th 7-day average with 21 cases a day. Granted, the US took maybe a couple more weeks to ramp up to its first plateau, so maybe if it was caught here a few weeks earlier it would have made all the difference. But it feels a lot more like Taiwan just didn't have a lot of travel to and from Wuhan?

Taiwan resident here. Just wanted to include that “massive outbreak” so far means a few hundred cases nationally.

That’s bad, it might get a lot worse, and we’re all nervous — but just wanted to add the context because “massive” can mean a lot of things with orders of magnitude difference.

Yep, I only meant that relative to how you've been doing. Obviously y'all are still doing fantastic compared to others. Best of luck.

BTW is there a vaccination drive over there? That's got to calm things down somewhat right?

Rapid and strict incoming travel restrictions were a key part of "taking it seriously from the very start" with a big impact on future outcome.

There are all kinds of effective measures (e.g. contact tracing, quarantining of unconfirmed suspect cases) that work when you have 20 cases a day and don't work when you have 2000 cases a day, so going all-in while you still have just a few cases works, because by the time you have many cases, it's too late.

If you travel to Taiwan, even as a Taiwanese citizen, you must stay in an official quarantine hotel for 14 days. You are not asked to do this - you are taken to the hotel by an official quarantine taxi driver and there are records of all this. You are not allowed to leave the hotel for any reason - food is delivered to your door 3x per day, and you can ask for certain things. My sister in law did this. That is just one of over 100 strategies employed by Taiwan to reduce virus spread.

The current Vice President of Taiwan, Lai Ching-te, has a Master's degree in Public Health from Harvard. The previous VP, Chen Chien-jen, has a Master's degree in Public Health from National Taiwan University. Taiwan takes public health seriously, especially after the original SARS experience.

Nobody in Taiwan thinks the virus is a "scam" or that masks are a "tool of oppression." Even before the pandemic masks were totally common. There is complete public buy-in on masks without even having to be asked. Some of my friends work in a clinic in Taipei so I hear updates. I was also in Taiwan last year for a month. The difference in attitude between the US and Taiwan is startling. If the US had acted like Taiwan, instead of acting in a way that was indistinguishable from sabotage, we'd have a lot fewer deaths and would have avoided a recession.

Mainland Chinese citizens are not allowed to travel to Taiwan as individual tourists since July 2019. This was interpreted as an attempt to hurt tourism and so the economy at the time. May have been a factor.

Don’t forget Vietnam. One of the best responses!

The real question - how many countries did well that were at the center of the prior SARS and bird flu outbreaks of the past?

As I understand, SARS 1 and MERS are much less contagious than SARS 2.

But much more fatal. These countries had two rounds of practice in controlling a major epidemic.

I'd wait to draw any serious conclusions until after the pandemic is "over" in both countries you're comparing. It sure seems like this virus doesn't need much of a foothold to take off, and just because an island has been able to deny that so far doesn't mean they'll be able to deny the virus until they are fully vaccinated and out of the woods.

How about China itself?

I'm not sure it's fair to compare an authoritarian country to a western country that's nominally free.

What western government could pull off welding doors shut the way they did in China? Even if the government had emergency powers that "allowed" it, would they have had willing workers to do it?

>What western government could pull off welding doors shut the way they did in China?

Western governments have pulled all kinds of restrictions themselves, from curfews, closed borders, and "let's close all retail businesses" restrictions, to mandatory movement monitoring.

Heck, Italy might not have welded doors, but had the Army patrol to enforce strict lockdown, and citizens in northerns cities stay inside.

Sometimes this even meant closing them in-house with the corpses of their dead (from covid) relatives for several days. There were several such reported cases, e.g.:

https://7news.com.au/lifestyle/health-wellbeing/coronavirus-...

Announcing restrictions and enforcing them are two separate animals.

There are not enough police in most of the US to actually enforce closing businesses, let alone confining people to their homes. Especially not when half the populace sees it as a political infringement of their rights.

I'm not sure about there not being "enough police in most of the US to actually enforce closing businesses".

There's not enough police to enforce no traffic violations at all either (what would that be, a traffic cop for every street or car?). That's not how laws work, you just need to make a law/rule and collect fines from the businesses that violated it. If there wasn't the political will to do so in the states, that's another thing.

But in at least a couple of countries in the EU I know of, all businesses were closed (by government decree) except explicitly whitelisted "necessary" shopping (like groceries, drugstores, and such) for months on end.

You say that's not how laws work and then you basically say he's rihght.

You say you "just need to... collect fines". And that is the OP's point.

Without enforcement you do not get relevant levels of compliance. Just upping the fines seems easy but if your enforcement percentage is 0 (or close enough to 0 as felt by citizens) you will not get compliance.

Theres a balance if you ask me. If it costs $5000 to be caught after curfew but police go home when curfew hits too instead of patrolling the streets, you will likely have no compliance. If you get caught at least 50% of the time then $5000 probably isn't even necessary and say $1000 will be 'enough' for most people.

I believe in those instances they welded backdoors while the front door was monitored by the community enforcement people to make sure each family only sent one member to the grocery store a week, etc. It was also at the outbreak, so you would hope we would have some strong measures at the very beginning when there is highest risk and greatest benefit to the rest of the country and world from strict quarantine.

I don't know that we would have done anything similar for this one if we were ground zero, but hopefully we would have for something like aerosolized Ebola with a contagious yet symptom-free incubation time.

We did come close to doing some similar things to welding to the Grand Princess cruise ship early on.

China might be fine, or it might not be. But only a fool would trust CCP numbers.

It should be noted that this is the same CCP that until recently have been simultaneously accusing Spain and Italy and the US of being the origin of the pandemic outbreak, instead of Wuhan.

I don't think you have to trust their numbers, but could they hide extensive outbreaks like the OP is talking about (all numbers being roughly the same and measures having little observable effect)? It would be something like 4 million+ excess deaths.

There are a large number of Western people in China for business reasons, and major Western countries have diplomatic offices throughout China. The US has a Consulate General post in Wuhan itself.

That gives the West an independent source of information about what is going on in China. China can still fudge the numbers, but those independent observations place a limit on how far China can fudge without getting caught.

I don't think thinking of these places as "islands" really makes sense. The USA could do the same for all people flying or driving in. It just has chosen not to. The US could close its boarders if it wanted to.

Just because we have two neighboring countries on north and south borders doesn't mean we couldn't lockdown people from coming in...

Literally do not get this argument.

> Just because we have two neighboring countries on north and south borders doesn't mean we couldn't lockdown people from coming in...

If there was one thing Trump was all in on, it was closing the southern border. His motivations were obviously not COVID for most of that, but the fact is he was nowhere near able to control that border (let alone close it) despite his best efforts.

Before you downvote me, I'm not saying I agree with Trump's policy on the matter, just pointing out that he did try.

> If there was one thing Trump was all in on, it was closing the southern border.

Is there any source that even suggests that the US's "southern border" played a remotely relevant role in the US's pandemic?

I mean, COVID spread like wildfire in the US throughout a timespan where the US's central government was quite militant in either denying or downplaying it's gravity. Even today we see states and cities taking militant stances in refusing to implement basic public health precautions. Why is the US's "southern border" suddenly relevant regarding covid-19?

It wasn’t relevant in the course we took. But had we locked down until there were 0 cases-like AZ or NZ—then new cases would walk across our borders.

Which states are taking militant stances against public health precautions?

The average age in many African countries is in the mid teens, and we know that age is one of the strongest risk gradients. So Africa is not at all comparable with the aging West. Australia and NZ have the huge advantage of no land borders. Everything and everyone comes through a few ports and airports, which already had the infrastructure established to tightly control and monitor everything. Meanwhile most European or North American countries can't close their sprawling land borders without starving their populations. (And the U.S. couldn't close its land borders even if it wanted to.)

> And the U.S. couldn't close its land borders even if it wanted to

Maybe not perfectly, but surely the vast majority of traffic across land borders is at managed border crossings. The US could shut those down, put the army on any unmanaged roads/routes (don’t know if this is a thing) and stop 95% or more of land border traffic?

Maybe it wouldn’t have made a difference to Covid - I don’t know about that, but I do question the impossibility claim.

The border is already closed (at least around here) to "non-essential travel". So, no crossing the border for vacationing. But "full" closure would mean blocking "essential" trade (food, oil/fuel, ...), and blocking "essential" workers that commute across the border. It could technically be done, but it'd be incredibly disruptive.

Even with full legal closure, the borders are porous enough for a border wall to have been a talking point in some previous election debates. Build a mile-tall wall out of mithril, and you'd still be left with a ton of unsecured coastline, connected by some rather convenient oceans...

>>And the U.S. couldn't close its land borders even if it wanted to.

Given that until recently the US was quite militant in refusing to act upon the outbreak, and it's a country comprised of hundreds of million of people among which about a third showed themselves to be quite defiant towards even the most trivial emergency public health policies, I don't think it's fair to refer to border control as a relevant factor in the US's death toll.

> Given that until recently the US was quite militant in refusing to act upon the outbreak

Factually untrue. The US was the first country to shut down China travel. And we got called Xenophobic for it. The mayor of Florence even held a “hug a Chinese” day in response.

https://rmx.news/article/article/fears-of-being-called-racis...

The US never shut down travel from China, it banned people not from the US from traveling from China to the US. US citizens and some other groups were still allowed to travel.

Singapore started severely restrict travel and quarantining arriving citizens a couple days before the US ban.

https://www.gov.sg/article/how-is-singapore-limiting-the-spr...

A faster travel ban for Italy and other EU countries would have done the US more good.

Factually true. Shutting down travel from China (at least for Chinese nationals, but not for Americans) after the virus was already openly spreading inside the country, and NOT shutting down travel from Europe, which was having a massive outbreak of its own, was xenophobic theater at best.

> Australia and NZ have the huge advantage of no land borders.

Australia had a major outbreak in Victoria in July last year. Victoria has a 2,550km land border with other states, including with South Australia, which peaked at 10 active cases over the same time period.

The evidence shows that strict quarantining and early lockdowns prevent spread even when there's an outbreak on the other side of a land border, and it also shows that being an island doesn't help at all if you don't do this (see also: the United Kingdom). I don't know why people constantly act like Australia and New Zealand only succeeded because they're islands when they were locking cities down at single digit case counts while the United States and India were packing stadiums full of people when they were getting tens of thousands of new infections a day.

If being an island state was really the only thing that mattered here, why is Hawaii not at Covid zero? Why is Alaska not at Covid zero?

(Despite not being an island, AK is still highly comparable to OZ.)

It’s hard to appreciate just how strict the lockdown measures in places like New Zealand and Taiwan have been. People are driven from the airport directly to a hotel, then someone comes and checks on them and they monitor the front door. Even in Hawaii, the arrival quarantine was just in whatever resort you were staying in, and was almost entirely self-imposed.

On the other side of the coin, as someone in Australia I couldn't believe it when I heard that in many other countries you can "quarantine" in a house with other people who are free to go about their day! Of course that's not going to work...

An important bit of information is Victoria indebted itself heavily to contain its outbreaks. The state is in $150B worth of debt and already increasing its taxes and fines to compensate.

It also had the largest exodus of people ever seen. About 11,000 leaving per quarter.

The fallout from businesses isn't know yet either, that'll become apparent after EOFY.

Being an island might make it easier to close borders, but the point is that closing them was likely hugely significant. I'd argue that borders remained open in many countries areas largely due to a lack of will. You could certainly close borders to most tourists and business travelers in any country that does immigration control, like Australia did. You can also close interstate land borders, like Australia did. You can even close borders to major cities, like Australia did. You don't need to close borders to food deliveries, just budget for the logistical headaches. You do have to pay the political and economic cost though. Australia was watching with both envy and horror when we started seeing stories of British people able to go on holidays to Europe again.

Of the many things we didn't bother doing, closing the Mexican border probably didn't matter a lot.

Canada did greatly restrict the border!

Holy cow; what is the birth rate to let a country have an average age in the mid-teens?!

Well Uganda has a median age of about 17 and a birth rate of about 5 children per woman.

Those places all have low population density or are literally islands, that's not comparable at all.

I am here in Vietnam (and was in California a few months ago) and the difference is day and night. Lockdown is super strict here. Everyone wears mask (even when it is only a few cases out of millions). It is a 21 day mandatory quarantine (if you get approved to get in). The results speak for itself.

Africa: Hot climate, poor testing, data likely not accurate

Australia: Island, hot climate, pretty heavy travel/quarantine restrictions

New Zealand: Island, rural with very dispersed population, heavily restricted international travel

People may argue that the UK is also an island but fared much worse. To that I would say 1) Much colder climate 2) did not heavily restrict travel like AUS and NZ did.

I've always thought the main driver of spread was probably not the political football issues like masks in public and businesses being open or closed, but what people are doing behind closed doors with family and friends. Lockdowns don't have much effect on this.

exactly. the measures were always about keeping us simultaneously busy and anxious and not about their actual effectiveness. it’s been so frustrating to see discussion after discussion about the minutiae of masking when they’re so minor to the overall picture. what mattered above all was indoor, familiar social proximity (where we’d be most likely to be exchanging spit for prolonged periods), exactly where our strong social norms dictate the least amount of vigilance.

I think the intentions were good, but it's also probably true that public health officials have been reluctant to admit when there just wasn't much they could do about the situation that would make a major difference, save for employing totalitarian enforcement measures that no one wanted.

Masks in public are not all that burdensome, so imo the mandates were reasonable regardless of the actual impact, but I wish they would have re-evaluated closing businesses a lot sooner, since that did a ton of economic damage, and the benefit there seems very questionable. I doubt the CA statistics would have been any different if they had never banned outdoor dining, for instance, or even just kept most businesses running normally but with an indoor mask requirement.

Comparing CA to TX and FL, it's also pretty hard now to argue that closing playgrounds and schools made much difference either, and that has had a severely negative impact on kids. I understand doing it in the first place when everything was unknown, but they should have been quicker to revise in response to new information.

outside of the totalitarian choices, which were entirely untenable in the US, we really had no good options to slow, much less stop, the pandemic. nearly all of it was theater.

the best mitigation would have been to get people to generally distance around familiars indoors and don a mask if you’re going to spend time in close proximity or face-to-face for a while. that would have required families to treat each other as threats rather than safeties, which is why that was not tenable. it’s so much easier to treat strangers as threats.

this best mitigation would have led us to violate a visceral belief about the world, creating significant cognitive dissonance, and that’s why we instead focused so much on ineffective measures to protect ourselves from strangers with masks and lockdowns that didn’t tackle the core infection vector through familiars. it’s really not that difficult to unravel what was happening, even at the beginning. watching us dance around this elephant in the room as if it didn’t exist has been no less than maddening.

> wasn't much they could do about the situation that would make a major difference, save for employing totalitarian enforcement measures that no one wanted.

Are you insane? There are tons of countries that are not totalitarian, with big land borders, that have done far better than the US. There are countries (SK, Japan) with tiny numbers of cases.

There are obviously thousands of things that could have been differently and or better.

One key area I think the US did really badly on was messaging - basically, having Trump drawing the whole thing into his orbit made everybody feel like it's just business as usual. It's hard to take something really seriously when the nation's highest elected official talking nonsense about it on Twitter, so obviously people don't follow rules. Public health messaging is really easy to get right, and the nations that have done really badly (Britain, the USA, Brazil) all had heads of state who did the worst possible kind of messaging.

I agree about Trump and federal messaging being terrible, but CA’s messaging was strong from the beginning. Empirically, it doesn’t appear to have made a significant difference compared to other states.

Are you insane? There are tons of countries that are not totalitarian, with big land borders, that have done far better than the US .... There are obviously thousands of things that could have been differently and or better.

The latter part doesn't follow logically from the first. It can be that performance is essentially random, or determined by geographical factors, or by the pre-existing health of the population, and so on. The assumption that governments can control respiratory viruses like SARS-CoV-2 is at the heart of all of this but needs very strong evidential support, given how strong the evidence against this belief is by now.

If you look at the data then there are no obvious explanations for why some countries did better than others. It's far from insane to observe this. There are a lot of plausible sounding explanations but they all fall apart due to exceptions, e.g. Japan did very little for a long time and yet has hardly been affected. In fact Asia in general has not been strongly affected (Taiwan is another example) despite a wide variety of response severities, which raises the question of whether Australia/New Zealand's relatively good performance is due to location rather than behaviour. Meanwhile Latin America was very hard hit despite some truly totalitarian responses by the authorities.

Your own explanation is especially weak because it appears to be based on a cartoon New York Times interpretation of what happened outside the USA. The British government's messaging was the polar opposite of Trump's. The PM appeared next to two chief scientists every single day, and the government was basically replaced by SAGE, the scientific advisory board. The SAGE scientists took total control of the messaging including designing large scale ad campaigns specifically designed by behavioral psychologists to provoke as much fear as possible in the population. The UK also has by far the highest vaccine uptake in the world. The whole thing had a singular focus, the messaging was very well organized to an extent that evokes people's worst fears of competent totalitarianism and so the idea that the UK was somehow doing the same things as Trump just has no basis in reality.

Yet, in the end, it didn't seem to matter. Sweden has had lower excess deaths despite consistent year-long messaging of chill, relax, it's no big deal. Hence, politics can be pretty conclusively eliminated as the source of any differences.

"I was at a hospital the other night where I think there were a few, there were actually a few coronavirus patients, and I shook hands with everybody, you'll be pleased to know, and I continue to shake hands," - Boris Johnson

Anybody who thinks the UK represents competent totalitarianism needs to really think about where they are getting their news from. The UK's response was objectively worse than similar countries, in that more people died per capita, and this was because of two late lockdowns, both late because top politicians ignored scientific advice.

The success of the vaccine rollout is arguably the result of the government's procurement efforts, but also deserving of credit are the UK population (overwhelmingly non-skeptical), and the NHS, which allows for a highly organized and centralized rollout.

it’s ironic that you use the phrase “overwhelmingly non-skeptical” to negate a totalitarian supposition, when totalitarianism, or more narrowly authoritarianism, requires, and in fact subjugates their populace to being (via propaganda), a docile and unquestioning public. “skeptical yet willing” would be more deserving of credit than “obliviously following”. the public should absolutely question and challenge ‘experts’ (i take issue with this framing itself but that’s a discussion for another time), because not only are experts often wrong but not doing so sets a dangerous sociopolitical precedent.

Firstly, I don't think skepticism is the inverse of docility, or even necessarily aligned with being questioning. Skepticism is traditionally characterized by an attack on the methods of knowledge-production, and as such, can engender docility and make questioning incoherent.

Vaccine skepticism isn't based on a question or challenge towards experts - questions or challenges exist within a specific framework, a specific body of knowledge. Rather, it is based on a challenge to the value and nature of expertise itself. As such, it's absolutely compatible with docility, totalitarianism, and antipathy towards questioning. In fact, since experts are experts by virtue of their existence within a specific body of knowledge, they are always by their very nature open to questions and challenges. Attacking the idea of expertise can as such be a way of attacking these areas of open questioning and challenge.

A good example of this is how authoritarian governments are typically hostile to academic institutions.

skepticism is an “attack” on certainty, particularly unjustified uncertainty, for which blindly trusting (esp. only government-sanctioned) experts plainly qualifies. only by shedding our false veils of certainty do we inch ever closer to seeing the world as it truly is.

there are a plethora of open questions in vaccine science and epidemiological policy that naturally allow for skepticism. it’s not only political or partisan. you can strip away the political and still be left with plenty valid skepticism.

and yes, skepticism challenges the notion of expertise itself. it suggests humility is undervalued, that an ‘expert’ knows so little against the backdrop of the world’s knowledge (much less the world itself), especially when the ego becomes intertwined with the ideological. experts over time trend toward surety rather than openness and inquiry, especially as stature rises in a field. it’s so common that the out-of-touch know-it-all is a storytelling caricature.

while it’s not always a valid line of attack, questioning the basis of “expertise” can certainly unveil erroneous assumptions, poor methodology/data, and faulty reasoning. the raison d'être of skepticism is to push knowledge forward, not hold it back, and this sort of challenge is just as valid as any other in this regard.

finally, authoritarian governments are hostile toward academic institutions due to concerns over its power and legitimacy as embodied by... skepticism (of the state and its propaganda).

No it wasn't. I will keep repeating this fact on HN until my fingers fall off - lockdowns do not work. They. Do. Not. Work. The data is in and the data is unambiguous, lockdowns have no effect at all. The UK having worse outcomes than some other regions that had far less strict measures should be enough to kill this idea off completely, yet you cite that very fact even though it clearly disproves the notion that lockdown timing had anything to do with the UK's results.

As for your cited quote, would you like me to cite the thousands of other things government leaders have said over the course of the year that support my point? Yes, the PM is a naturally optimistic guy. None of the people around him are, and they've all been ramping the fear factor to 11 continuously, and in particular they controlled the public messaging not the PM. With the result that there is now a serious problem in the UK with people who are afraid to leave their own homes.

... The UK lockdown was very strict, but it was also very late. Lockdowns work fine, they just don't work when you call them after everybody already has it.

Strictness and timeliness are unrelated characteristics.

Being afraid to leave your home has, for large parts of the last year, been very reasonable behaviour. The coronavirus has already killed 5 times more people than the blitz. Being an at-risk person in the middle of one of the UK waves was about as dangerous as regularly riding a motorcycle without a helmet.

They don't work regardless of when deployed. The idea the UK was late is doing the rounds inside the UK establishment but it's wrong. If they worked places that stopped doing lockdowns would have seen huge surges and higher death rates than places that kept them, but that didn't happen and there are by now many such examples. Lockdowns don't work because (a) COVID doesn't seem to care about them and (b) COVID is nowhere near deadly enough to justify them, as demonstrated by the counter-example states and countries that rejected them and saw far less than the predicted mortality.

> The idea the UK was late is doing the rounds inside the UK establishment but it's wrong.

You seem frankly a bit divorced from reality. If you go to a chart of the daily incidence rate before either the first or the second wave, then mark on it when the lockdowns occurred, it's clearly visible that they occurred too late.

I had to discourage my at-risk mother from going to a choral Christmas concert last year, at a time when they were clocking 40,000 new cases every day and that number was doubling every few days. That chart is etched into my brain because of how worried I was, and at the time, conservative ministers were still going on TV and talking about a five day christmas.

If you go to the deaths graph, you can see that as a result of this awful mistake, tens of thousands of people died. This is plainly visible in the statistics. Whatever political axe you have to grind is frankly irrelevant, and to be honest, facetious.

You seem to be trying to identify causation from a single graph. That's not how data analysis needs to be done. You have to compare different datasets that vary in the control variable. In the case of Europe the UK vs Sweden is a good comparison because they are similar in most ways that should affect viral propagation except for lockdowns. Sweden has seen significantly better death rates than the UK, despite the theory saying they should have done much worse, meaning the theory is wrong. Because the theory is wrong you can't derive anything by looking at UK curves in isolation and comparing them to a theoretical counterfactual.

You can also look at the different performance of US states (none) despite very different measures.

That chart is etched into my brain because of how worried I was

In other words you were terrified and forced that fear on your family, based on a mis-understanding of how to use data to draw scientific conclusions. And now you're accusing anyone who points out the truth to you of political axe grinding, although it's you who just threw in a random mention of "conservative ministers" implying their politics is responsible for lots of deaths. That's a political talking point!

> what people are doing behind closed doors with family and friends. Lockdowns don't have much effect on this.

At least here in the UK, lockdown meant not seeing friends or family (unless you lived with them). Was that not the case in the US? Of course if people flout the rules then they won't have any effect.

It varied from state to state. I live in Maryland, and there was maybe a 2 week period last spring where you weren't allowed to drive anywhere except to get groceries and medicine, or if you were an essential employee for a business that was allowed to stay open. Outside of that two week period, the only travel restriction I know of was a mandatory quarantine period for people traveling in from other states.

Ah, for comparison we had a 6-week period of similar restrictions last spring. Followed by another 4-week period in September, and a 3 month period at the start of this year.

Outside of those times there were restrictions on meeting indoors (at times max 6 people, at other no meeting indoors at all) pretty much continuously since last April.

I remember a period last spring and early summer when parties and gatherings were getting "busted", but I don't think the enforcement of restrictions on private gatherings has been meaningful for the majority of the pandemic.

I think most of the US had much less strict "lockdowns". I think the most restrictive it ever got in my area was that gatherings of 10 or more people were not allowed, and to actually get it enforced, you probably had to go way over 10.

Also, in the USA there were a lot of things that were on paper "not allowed" but it didn't matter because it wasn't enforced at all. Mask wearing, social distancing, stay-at-home orders, did people actually get cited for violating? I know, at the height of the pandemic, I could easily drive out of my region, eat at a restaurant indoors, gather somewhere unmasked, and there was zero chance I'd be fined. Even for things like mass-gatherings, usually it was just the business owner who got fined, and the 1,000 people caught gathering got off scott free.

There was a study released not long ago that came to that same conclusion regarding schools. It found that most students who were infected didn't catch it at school, but from family members and friends after hours.

This is from earlier: https://www.cebm.net/covid-19/excess-mortality-across-countr... Interestingly Sweden that got famous for defying lockdowns saw an uptick of 1.5% excess mortality per 100K people compared to 12.9% for the US that was relatively more locked down. I'm not sure what to make of it, but it sure is an interesting data point.

I would not typify the US as "mostly locked down"

Indeed, and Sweden also had the benefit of the lockdowns in the rest of Europe. I don't think you can compare Sweden to the entirety of the US. A single state maybe.

Would you typify the US as more Locked Down than Sweden? Because their numbers are better. If their approach was worse why are their numbers not worse?

I've heard it suggested that there was a lot of voluntary distancing and othet measures taken in sweden. It wouldn't suprise me if there was more actual distancing in "not locked down" sweden than in "locked down" US. But perhaps the protests etc I've seen on TV wetrre exagerated?

Fewer travellers in and out of Sweden.

Simple. US has obesity as a significant comorbidity factor.

> the US that was mostly locked

the US was not mostly locked down, and indeed made noncompliance with safety measures a major partisan identity issue for the faction controlling the federal executive, the upper federal legislative house, most state governments, and much of law enforcement even in the other states. It mostly had modest, inconsistent, uncoordinated, and largely unenforced restrictions. A few jurisdictions did at least nominal lockdowns for fairly brief periods (California did twice, though virtually every county sheriff had publicly announced that they either would not enforce orders at all or would do so only by education around compliance by the time of the second one near the end of 2020.)

Fixed mostly to relatively. That wasn't my main point really. I thought the data points were interesting.

Sweden's early success with their 'herd immunity' experiment was short lived.

They failed to actually achieve 'herd immunity' and did not avoid the eventual virus death toll:

https://www.news.com.au/world/coronavirus/global/sweden-cris...

By comparison Finland, it's neighbor took a much stricter approach and never reached the same level of death.

Finland: 931 deaths at 168 per million with a 1.0% death rate.

https://epidemic-stats.com/coronavirus/finland

Sweden: 14275 deaths at 1406 per million with a 1.4% death rate.

https://epidemic-stats.com/coronavirus/sweden

Can we then talk about the economic disruption felt by each respectively compared to the 0.4% difference in death rate? I don’t have insights into either county.

Here are the Gross Domestic Product (GDP) figures for these two countries:

Sweden: https://tradingeconomics.com/sweden/gdp-growth-annual

Finland: https://tradingeconomics.com/finland/gdp-growth-annual

Looking at those charts they show very similar economic outcomes for the two countries.

Of the last 4 COVID effected quarters Finland won two and Sweden won two.

And Sweden actually felt the highest quarterly contraction at -7.7% compare to the -6.1% for Finland.

That 0.4% difference in death rate is measuring survivability as it records the chance of dying from the virus.

That 0.4% difference suggests Finland's health system was better than Sweden's at handling the virus, as your chances of dying were much less.

When it comes to actual deaths Finland was doing over 830% better (i.e. 168 per million compared to 1406 per million) than Sweden.

Edit: Fixed my bad math. My 90% better figure was out by a factor close to 100.

The more cases you have, the more overwhelm your testing system is. The difference in death rate is most probably due to the fact that Finland was testing more positive cases (relatively) to Sweden.

Note it death rate of infected, if you have less infected the death rate should be unaffected as long as you have enough resources to treat everyone equally well.

That data is either wrong or severely outdated. The Economist website [1] has Sweden's excess deaths per 100k at 102 (not 13). While better than the US -- which was also not really locked down as other commenters state -- it is 5x worse than neighboring Finland, and infinitely worse than neighboring Norway and Denmark (which had negative excess deaths during the pandemic).

[1] https://www.economist.com/graphic-detail/coronavirus-excess-...

It seemed like a lot of the states that did well despite opening early were southern states where it isn't really winter when it's winter.

Also I've heard the claim that (to be as apolitical as I can here) in Florida they secured the elderly population more quickly and carefully than in New York. You may want to look into that claim.

I'd say "Florida secured their elderly population more quickly and carefully than in New York" misses the fact that New York ACTIVELY put its elderly in harms way by requiring nursing homes take patients.

If New York ONLY ignored the problem that'd be one thing... but they actively made decisions that led to a large number of deaths - and more importantly those decisions were AGAINST the CDC guidelines.

Heh, well there you go. I wanted to avoid that point to avoid politics (per the OP's request), but yes. Also I think I heard NY wasn't the only state that did this.

NJ also did this

Michigan too. all with disastrous results.

Well, truth be told, I didn't bring up the politics of it.. just the simple truth.

WHY they made the decisions is a rabbit hole... but the facts are simple.

>If New York ONLY ignored the problem that'd be one thing

So where would recovered nursing home residents go? Keep staying in the hospital which would mean active covid patients would die in the streets? Or the streets?

I think this is a fair question. I don't think it was anybody's intention to deliberately kill people. Even assuming the worst about people's nature, it's just not great for political careers. I imagine there was a reason for the decision however ill considered.

Orange Man Bad seems to be the only justification for not using the hospital ship and temporary hospitals the feds sent.

Pretty shitty. That people are willing to gaslight around it over politics is shittier still.

In hindsight to one of the many unused field hospitals? But at the time we didn’t know how effective the mitigations were going to be and fully expected the field hospitals to be full

Not to mention the USS Comfort was banned from accepting any Covid patient.

From experience in another state, they go first to the hospital, secondly back into nursing home but into isolated quarantined floors with specially trained fully covered ppe'd staff until several times testing negative, then into warm floor, then back to normal resident floor.

Not as I believe initially was case in NY from hospital directly into regular resident floor.

They also sent non eldery COVID infected patients to nursing homes.

https://www.wxyz.com/news/region/detroit/20-year-old-beating...

And Cuomo has the balls to write a book patting himself on the back for doing such a good job? Utterly disgusting!

This has nothing to do with "recovered NHs (nursing home) patients"... this has to do with housing COVID patients in NHs.

This ain't "grandma went to the hospital and got sent back to the nursing home" and it was never about that.

Hospitals were over stressed so they sent sick people to nursing homes.

https://apnews.com/article/new-york-andrew-cuomo-us-news-cor...

"More than 9,000 recovering coronavirus patients in New York state were released from hospitals into nursing homes early in the pandemic under a controversial directive that was scrapped amid criticism it accelerated outbreaks, according to new records obtained by The Associated Press."

Notice: Not "9000 NH patients sent back from the hospital". 9000 individuals NOT nursing home patients sent to NHs

New York, AGAINST CDC guidelines, forced NHs to house sick people that weren't prepared to handle them - and THOUSANDS of old people died because they then got sick from the influx of COVID patients.

You have some seriously confused notion of what happened in New York (and, I think, similar happened in Texas - I may be wrong on that).

To the big floaty hospital ship the Orange Man sent to NY harbor? That would be a good start. They also converted Javits Center into an emergency hospital that was barely utilized too.

And on top of that, the actively hid deaths of nursing home residents that happened in hospitals to further downplay the impact of COVID to the nursing homes.

If you only watch the main stream media it's no wonder you haven't heard any of this :p

What is more likely is that the name of the interventions had very little correlation with the features that actually matter. Just because 2 places declare a "lockdown", it doesn't mean that they are doing any similar policy.

You would likely need to look at county by county data. Austin TX is probably closer to Albany NY behaviorally, than it is to Kent County TX. Schoharie County NY is probably closer to your average TX county. America isn't red state vs blue state, it's rural vs urban.

Nursing homes had the biggest outbreaks. Perhaps only prolonged exposure in confined spaces between elderly people was the only pathway that mattered. In some ways I think of it like a fire spreading. There will be spots that burn easily and quickly. But once they burn out, the fire has nowhere else to go that burns as well.

I suspect there’ll be decades worth of study of this. Hopefully it’ll help the next time.

I'm an infectious disease epidemiologist, and there absolutely will be decades spend unravelling this.

To address the parent question - one thing to keep in mind is that states are extremely heterogeneous, and "Did or did not lock down/mask mandate/etc." isn't actually a binary variable, but a very difficult to measure continuous response of both policy and compliance.

Where I live, the restrictions have explicitly been tuned so as to not overwhelm hospital facilities. Minimizing deaths was not a stated goal. They measured new cases and how many hospital bed were available, then adjusted restrictions accordingly per County. So for example, you might see no indoor dining in one County, but indoor dining allowed at 25% capacity the next County over. They seem to have done a pretty good job given the stated goal.

I think the flaw in this premise is believing that the regulations promulgated at the state level had any real impact on the public response. It's not the "lockdown" that keeps people at home, it's the disease. In some states they did not order restaurants to close, but that doesn't imply that attendance at restaurants in those places was normal.

Schools in Florida have been open since last fall. That's a pretty huge difference, with little difference in pandemic deaths.

Some of the States with the strictest measures were the ones that got hit hard early before much was known about the virus (NJ, NY, CA) so their death tolls could be expected to be higher. Additionally many States that were more relaxed also are more rural so one would expect some differences from that too. Hoping there will be a retrospective on all of this.

At least one study was done in Florida comparing counties that had mask mandates vs those that did not. The general conclusion matches your observation, mask mandates did not appear to have a material effect on any covid related metrics (infections, hospitalizations, deaths, ect.)

This is a bit nuanced because lots of people wore masks without a mandate, but it is also true that many people are pretty anti mask and definitely won't wear one if not forced to.

From my perspective it is pretty clear that masks did not have a large enough protective effect to show up in aggregate data.

As far as lockdowns go, they work until you end them, at which point you have just delayed the inevitable.

If you want to look at the data yourself, I would highly recommend the following site run by a prof at University of Illinois (use the population normalized graphs): http://91-divoc.com/pages/covid-visualization/

Having a hard time finding the primary study I mentioned but I have provided links with some (population normalized) data below.

Florida counties (scroll down to second graph near the bottom for the start of the discussion): https://rationalground.com/after-nine-months-we-still-know-m...

Various graphs showing infection rate pre and post mask mandate: https://rationalground.com/mask-charts/

More mask graphs, mostly US states: https://rationalground.com/post-thanksgiving-mask-charts-sti...

As far as lockdowns go, they work until you end them, at which point you have just delayed the inevitable.

Where in the data can you see this? Lockdowns don't appear to work. If they did, then places that didn't use them or cancelled them very early would have had drastically higher numbers than other places that kept them and the curves would be clearly moved around. But that isn't visible in the data.

That said, I'm glad you posted those links and agree with you on the lack of effectiveness of mask mandates. I've been posting links like those and various other studies for the past year because it was clear within weeks that these measures weren't having any impact. Sometimes those posts got upvoted but mostly, down down down. Very interesting that the top comment on this thread is one pointing out that lockdowns and mask mandates don't work: it used to be quite the taboo to point that out in this forum. And just recently there were the threads about the WIV, where again, many posts that a year ago would have been sitting at -4 and near-unreadably gray were sitting near the top. It's good to see that some rationality is returning to these discussions, because the data is public and easy to browse. It's not hard to flip through a bunch of countries and observe that you can't figure out when lockdowns/mask mandates started/ended with any reliability by looking at the data, even though affecting the data is the only justification for those measures' existence.

I think there is some evidence that lockdowns at least offered partial mitigation, but my memory is fuzzy on that. They certainly didn't stop transmission but they may have blunted the rate a bit.

I also looked into the mask literature when the pandemic first started and agree there is no evidence to support their effectiveness (unless they are N95s). Even the meta-analysis published by the WHO stated there was no evidence for their effectiveness but tentatively recommend their use as the cost of mask usage was low.

I will add that most of the studies had healthcare workers wearing masks, and did not test the combination of both parties wearing masks. It is entirely possible that everyone wearing masks + distancing + limited contact duration may be "effective". In this case it's less about being actually protected (N95) and more about lowering the probability of transmission events, which our common leaky/crappy masks may be able to accomplish under the aforementioned conditions.

I doubt(/hope) no one believes that if I take a healthy and infected person, give them both surgical masks, and lock them in a small room together for a few hours, that the masks will prevent the healthy person from contracting covid.

I think there is some evidence that lockdowns at least offered partial mitigation, but my memory is fuzzy on that.

If you remember, please do post so I can take a look. Because, the evidence I've seen is all completely unambiguous and resolves the question completely in favour of "lockdowns do not work and have no effect". And actually there are now many simple examples of that, of places where restrictions were not applied, or were applied much less strictly, or were lifted, and no differences were observed in outcomes (e.g. Sweden, Florida, Texas, South Dakota, Belarus, Japan etc).

It is entirely possible that everyone wearing masks + distancing + limited contact duration may be "effective".

If that were the case then sudden behavioural changes caused by mask mandates should reliably cause graphs to drop or obviously inflect to a lower growth rate. That should happen everywhere mask mandates come in and are well enforced (which they are, this has been measured). But we don't see that. Of course you can cherry pick a few graphs where there seem to be such inflections, but when you look at lots of them it becomes clear there's no correlation with anything.

I see people wearing masks outside all the time, as well as in empty cars. Health 'experts' say nothing about any of this. So, I'm pretty sure lots of people do believe that unfortunately :(

You would need to look at everything from ages to whether the lockdowns where enforced to how people lived (high or low density) to how deaths were counted. It would be an interesting study.

"We found that states with higher income inequality experienced a higher number of deaths due to COVID-19."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313247/

Count of covid cases and deaths has been highly politicized and manipulated in Florida to the point of firing people for reporting them.

Not sure how possible it is to get accurate info in this environment.

That’s why overall excess deaths are a better measure. You really can’t game them.

I think it’s still hard because deaths for almost everything else go down when people aren’t out getting in car crashes, picking the regular flu, etc etc.

Automotive fatalities were actually up substantially in 2020.

There should still be a difference between open vs close then since they open approach would still have people going out driving and getting the flu.

Also, locking down everyone (and its economic consequences) probably had / will have an effect on number of suicides (not sure if negative - I can't stand it, I'll kill myself - or positive - I can't stand it but life will be better after covid)

Surprisingly not:

"Widespread assumptions that suicide rates would increase during the pandemic are not supported by the growing amount of evidence coming out of Canadian provinces and other jurisdictions around the world, say experts who study the topic."

https://www.cbc.ca/news/canada/calgary/suicides-alberta-bc-s...

Not really. Excess deaths certainly are not entirely caused by the virus, so you still need to try to subdivide them somehow, which is once again a ripe opportunity for "gaming" / creative statistics.

But if you assume the main thing special about this year was the virus and strategies aimed at mitigating it, you can still compare overall outcomes between jurisdictions. If tight lockdowns decrease COVID deaths but increase other deaths enough to compensate then they didn’t achieve anything. It would be valuable to know the exact breakdown but you don’t have to.

Right, but my point is that it's hard to separate those things if your idea is just "excess deaths tell us the cost". So if lockdowns slow COVID but increase suicides... ¯\_(ツ)_/¯

I know it’s easy to be a bit cynical once we take an abstract view.

Please let’s remember it is not a simple lever.

Let’s remember the overflowing ICUs and morgues and the very very limited menu of possible immediate actions - all this amongst unprecedented scrutiny, politicization and division.

We’re human. We’re doing the best we can. Lockdowns do flatten the curve.

People only say that since California is actually under reporting more than Florida.

Do you have a reliable source that the covid deaths in FL were manipulated downward?

This one seems a good place to start:

https://www.sun-sentinel.com/coronavirus/fl-ne-ss-prem-covid...

Even if true, that doesn't suggest that the overall numbers are artificially low. That represents a reporting time gap, the deaths were still presumably counted correctly.

I think we need something much stronger before we enter into evidence such a powerful allegation.

EDIT: http://www.healthdata.org/special-analysis/estimation-excess... seems to suggest California covid deaths were underreported to a greater degree than Florida. That would be even stronger evidence that Florida had better outcomes compared with the disruption.

Only Rebekah Jones, who left her last three jobs with criminal charges, has claimed that. None of her claims have ever been substantiated by a single legit source.

Only followers of fringe left wing Twitter believe any of that.

Somewhat related, on the opposite point. Elon Musk among others said the counting of deaths was manipulated upwards, with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already. I think there is a desire to overcount which must not be glossed over either.

>I think there is a desire to overcount which must not be glossed over either

So there was overcounting, but somehow excess mortality in 2020-2021 is higher than in normal years? How?

>with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already

A high percentage of people in the US have "serious health conditions" like diabetes, obesity, high blood pressure etc. If Covid accelerated their deaths then it should be counted as a covid death because they would likely be otherwise alive now. If you want to get pedantic there's a measure called QALY(quality adjusted life years).

Musk said there would be zero cases in the US by April 2020 among other dumb predictions, so I don't think he's the best person to go to for Covid related information since his domain is technology and not epidemiology. https://www.forbes.com/sites/joewalsh/2021/03/13/elon-musks-...

> So there was overcounting, but somehow excess mortality in 2020-2021 is higher than in normal years? How?

People dying of heart attacks because they didn’t seek timely care because of fear of going to the hospital. Medical screenings postponed. Undetected cancers. Suicides. There is a direct correlation between unemployment rates and disease. My annual physical, due in July 2020 was cancelled. How many other people’s were as well? Also one also should note increases in deaths of despair. That’s a real thing.

Excess deaths can’t be called “covid,” without proof that they were. How would else know Covid was the cause and not the flu? Are we just assuming excess deaths were Covid? The uncomfortable truth is that lockdown proponents don’t want to admit that their policies may have caused more damage than the disease from which they were claiming to protect us.

I don’t know the answer. My point is that excess deaths aren’t necessarily Covid deaths. That’s an assumption, not a fact.

>Medical screenings postponed. Undetected cancers

Most of these will show up at a later time. And some of them were caused by hospital overcrowding, doctors trying to save themselves etc. not lockdown.

>Suicides.

Suicides are down.

>My annual physical, due in July 2020 was cancelled. How many other people’s were as well?

How many people die within a year due to something that's caught in a physical? I'd say barely any. If you're counting them then you should also count the lives saved by reduced pollution due to the lockdowns.

>Also one also should note increases in deaths of despair. That’s a real thing.

Suicides are down.

>Excess deaths can’t be called “covid,” without proof that they were. How would else know Covid was the cause and not the flu?

Because flu deaths are included in normal rate of deaths. If you're saying there are multiple times the number flu deaths than during a normal year with no measures to contain it, and it doesn't show up on the yearly disease surveillance, then you're arguing in bad faith.

>The uncomfortable truth is that lockdown proponents don’t want to admit that their policies may have caused more damage than the disease from which they were claiming to protect us.

The uncomfortable truth that pro-covid(and anti-vax people) don't want to admit is that their attitude of calling covid just a flu or something less harmful has caused death, disease, hospital overcrowding, increased number of lockdowns due to increased cases/deaths, and damage from the lockdowns. Compare the economies of countries that strict lockdowns but were able to open up sooner like Australia, New Zealand, China etc.

Do you think people will keep participating in the economy and crowded events etc. at the same rate if there are scenes like this at hospitals? https://www.youtube.com/watch?v=D0Y1YakG60s

Now that things are opening back up, if there is hospital overcrowding and more covid deaths and cases due to the pro-covid and anti-vaccine people, then who is to blame for the economic damage and death from ensuing lockdowns?

I’ve been wondering recently... should I appoint ELon Musk as an authority on everything or not?

The jury’s still out in my case.

The firing of that official — there is a lot more to that story.

https://tallahasseereports.com/2020/05/20/rebekah-jones-firi...

Please stop spreading misinformation. Rebekah Jones was not fired for reporting data manipulation. She is simply a liar. All of her key claims have been debunked.

Please stop spreading misinformation. Rebekah Jones wasn't a data scientist and was never asked to falsify any numbers. She is simply a liar.

https://www.nationalreview.com/2021/05/rebekah-jones-the-cov...

Claiming that on the back of an opinion piece in a partisan publication which seems not at all interested in neutral fact finding but revels in partisanship and plays this up as a political issue does not bolster your argument's credibility. Indeed it weakens it. I say that as a non-American who doesn't have a horse in the race.

Which facts in that article are incorrect?

No state had an optimal viral mitigation strategy. The optimal strategy being impractical or even impossible.

Densely populated places that would have acted flippantly would have been much worse.

Densely populated places with mixed unit housing had hurt themselves with the strategy they chose.

So basically California and New York could just barely keep numbers as close to Florida numbers by locking down hard. The methods California and New York chose could have been even more optimized, but not possible for a US government to do.

One aspect is that IIRC California got a much earlier spread than Florida, so any measures taken in Florida to reduce the spread (including by people on their own initiative) effectively happened at an earlier stage.

To really understand it you’d need to look at cultural, geographic, climate, demographic, etc differences that apply to transmission rates. I’d be curious to see it though, and a similar one for other illnesses.

https://twitter.com/IAmTheActualET/status/139036896599463117...

There is literally no such thing as a red state or a blue state, so not surprising it doesn't map to anything.

It's almost perfectly urban vs. rural. Urban areas in "red" states are generally blue, and vice versa. "Blue states" are just those with mostly urban populations.

It became more extreme during the Trump era with many historically red suburbs around cities turning blue and some rural areas turning more red.

People are lumping the numbers together for the entire pandemic.

During the first wave New York and New Jersey got hit really hard. Basically, it was too late to do anything.

I’ve asked myself this question. I have no hard data to back this up, but wonder If it’s related to outside time and vitamin D absorption, which seems to have an affect on covid. Ex: did NYC have a tougher time than Florida as a result of this, and even with all the protocols in NYC, they could do only as well as Florida with no rules.

NYC has a combined sewer system [0] [1] that overflows when it rains more than .... ~1/10 of an inch per hour (iirc). The fecal-> aerosol transmission route is certainly very important: https://news.ycombinator.com/item?id=27156256

"Who do you share a bathroom with" is very important for tracking transmission. In NYC, everyone shares a bathroom.

[0] https://www1.nyc.gov/site/dep/water/combined-sewer-overflows...

[1] https://www.riverkeeper.org/campaigns/stop-polluters/sewage-...

Either you lock people downs and those would reject it will go out nonetheless. Or you don't and people who are at risk will lock themselves down.

There's no particular benefit to one or the other so states do what match their current constituents. And that's exactly what you'd expect in a democracy.

Assessing mandatory stay‐at‐home and business closure effects on the spread of COVID‐19 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484

California was an early hotspot for the virus, and had a huge amount of cases early on when treatments weren’t great. There was also a big surge over the holidays.

The places hit hardest were very dense cities... viruses spread very well in big cities, regardless of mitigation steps.

I agree. These numbers and methodology are highly suspect to me, particularly given the large self granted estimate range. Obviously lots of room for error. Not very useful analysis imo.

I don't want to be a conspiracy theorist here, but Florida has seemed like a pretty untrustworthy source of info on their covid numbers. There is even an ongoing battle with a data scientist who was fired, according to her, for refusing to fake the covid numbers. Just at a glance, Florida's reported covid numbers seem to be so anomalous compared to the rest of the country, even though when you think of Florida you think of groups at high risk from covid. I can't say they're actually lying about their numbers, but it's enough of an outlier to reasonably remove it from the data set.

Please stop spreading misinformation. Rebekah Jones was never asked to falsify any numbers. She is simply a liar.

https://www.nationalreview.com/2021/05/rebekah-jones-the-cov...

The information that a former Florida state data science employee was fired and alleges it’s because she refused to falsify data is not misinformation. She may be lying, it the information I stated was 100% true. Also, don’t come at people with far right propaganda networks as your source of knowledge.

Population density is the reason.

Many of the people behaving poorly in Florida weren't Florida residents

I think you should population density as a variable.

You could be less restrictive in a rural area, while the same policies would have been very harmful in cities.

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