A. As soon as a single case is detected
B. Hospitals reach a pre-determined percentage of occupancy
C. If >50% vaccinated, then no lockdown
D. No lockdown irrespective of the on ground situation
I would target preventative measures at high-risk groups. I would not implement lockdowns and I would not allow vaccination of healthy, younger age groups.
Sweden almost got it right. Their relatively higher death rate is mostly explainable by the failure early on to protect care homes.
Also I would redstribute resources from ridiculous military adventures in foreign lands to the health sector, so next time it happens the hospitals don't get swamped.
> Due to the COVID-19 pandemic, a number of non-pharmaceutical interventions colloquially known as lockdowns (encompassing stay-at-home orders, curfews, quarantines, cordons sanitaires and similar societal restrictions) have been implemented in numerous countries and territories around the world.
For example, by "lockdown", do you include things like limiting venues to 50% occupancy?
Let's say "a single case is detected" .. in someone who just entered the country and is in quarantine, and the quarantine protocols are effective.
I would do nothing different.
Let's say that single case is detected in someone who just broke the world's record for most number of kisses in 8 hours - 11,030 says https://www.guinnessworldrecords.com/world-records/68045-mos... .
Then my reaction might be a bit different.
Since the circumstances are so varied, I don't see how your question can have a reasonable answer in an HN thread.
Except for Broken_Hippo's entirely reasonable answer.
I am not a disease expert. If I'm running a country, though, I have access to the disease experts. And the appropriate response is one that is in tune with the advice from the disease experts, who would balance what is best to stop the spread of disease with what we can reasonably expect most of society to be doing.
Until then, I'm just some person in a small attic apartment meandering about on the internet and do not have the overview or access to information that would lead to an informed enough decision - especially in light of the life and death situation failure creates.
As I understand it, the PM of Sweden doesn't have the authority to do anything you describe, due to https://en.wikipedia.org/wiki/Ministerial_governance , and (in)famously "The Swedish Constitution legally protects the freedom of movement for the people, thus preventing a lockdown in peace time." quoting https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Sweden#Ec...
Are you sure your question isn't more like "if you were the dictator, what could you do?"
Also from Sweden is "Vision Zero" for road safety. https://en.wikipedia.org/wiki/Vision_Zero .
> A core principle of the vision is that "Life and health can never be exchanged for other benefits within the society" rather than the more conventional comparison between costs and benefits, where a monetary value is placed on life and health, and then that value is used to decide how much money to spend on a road network towards the benefit of decreasing risk.[2]
As a hypothetical exercise, how much monetary value do you place on human life? How do you rank economic factors over human life?
QALY (and in respectively human life) can be measured in monetary terms. It has some problems but all healthcare systems in the world do this, some openly (as in the UK), some behind the scenes. But they all do.
This is a mind experiment where we all have the luxury of hindsight. Based on current knowledge I would also do almost the same what Tegnell did but with greater emphasis on protecting the risk population, elderly and others.
Also I would cooperate with Astra Zeneca and other pharma companies to start human challenge trials immediately to speed up vaccine development.
The question posed, and refined by me, is: if you were the PM of Sweden, what would you do in the scenario presented here? Nothing? Or would you have started changing the laws/constitution so you have more power?
As the follow-up question, how much monetary value do you place on human life?
You can find online how much the UK estimates QALY to be worth for treatment purposes. That would be the starting point I would use. I wouldn't try to overturn the field by wild changes thinking that many smart people before me had made very bad policy decisions.
And to be fair: No where in the original does it say to consider only economics. Economics will come back: People's lives won't.
I would a) increase hospital capacity, b) ensure better ventilation, c) promote work from home, d) encourage people to meet more outdoors, e) start vaccine challenge studies to speed up vaccine development considerably.
In the same way lockdowns are not effective because complete compliance is not achievable for one reason or another. People will rebel and unless you are prepared to completely crush them Taliban style, it won't work.
Australia has a population of 25M people. From 29M tests, they've found 44K cases. So that's 0.17% of the population (infected). This works out to 1,700 per million. There have been 981 deaths attributed to COVID19 - that's 2.2% of confirmed cases, or 0.004% of the population. This works out to 40 per million (of the population). There are currently 603 people hospitalised due to COVID19 - that's 0.002% of the population. This works out to 20 per million.
And this is with quite limited vaccination rollout, due to a variety of factors.
Lets compare that with the US, which has had a variety of measures in place.
The US has a population of 331M people. From 511M tests, they've found 37M cases. So that's 11.18% of the population (infected). This works out to 111,800 per million. There have been 625,375 deaths attributed to COVID19 - that's 1.7% of confirmed cases, or 0.19% of the population. This works out to 1,900 per million (of the population). It's hard to find a specific number from CDC but it seems like a recent # for US current hospitalisations is 89K. So that's 0.026% of the population. This works out to 260 per million.
So. Do you want to tell me again how "Lockdowns don't work" and "Even Australia failed them now"?
Or would you prefer I collect the stats from Thailand (where I live currently) - we were doing amazingly well until last December. We made Australia's numbers, look high by comparison. Then, after some localised outbreaks, the government decided letting people roam the country unrestricted during a pandemic was fine. That was ~4 months ago. At the moment, Thailand's new cases per day, are about half of Australia's total cases over the last 18 months.
But sure. Vastly reducing travel doesn't work at all to curb the spread of a highly infectious disease.
Give me a fucking break. You can argue your "freedom" is more important - I won't agree with you, but at least your argument makes some sense from a certain view point. But right now you're just ignoring the facts and making up claims to suit your own narrative/goals.
As for your whole Afghan/Gays/HIV side show:
Last time I checked, there's no vaccine against HIV, but you also can't catch it just by being in close proximity to someone who is infected. Some places (and I thought this included the US but I don't actually know for sure) criminalise knowingly infecting someone with HIV. Would you prefer that approach?
Anyway - the point is - there literally are multiple vaccines against COVID19, and the evidence supports that the vaccinated are at much lower risk of infection, and much lower risk of hospitalisation/death in the case they do get infected. Pretty much every country on earth that is both enforcing 'lock downs' and conducting vaccinations, have said that they intend to reduce the spread via curfews/lockdowns until a sufficient number (typically 70%) of the population are vaccinated. It's not going to go away just because people are vaccinated - but the rate and prevalence of spread will reduce greatly, and the rate of hospitalisation and death will reduce greatly. That's the whole point.
Now your other point was, to "increase hospital capacity". How many hospitals/expansions that will be suitable for use both in summer and winter, do you suppose could have been built in the ~12 months from the start of the pandemic until vaccinations started rolling out? Or in the ~18 months until now?
I definitely don't support criminalizing of knowingly infecting someone with HIV. The reason why is that it will prevent people at risk to get tested before having sex (because ignorance is defence in this case). We don't want that.
Somehow all your numbers are not impressive because I don't know anyone young who has died from covid. I know they exist but most deaths I could remotely link to covid are old people who were on the death bed already. It is much better to talk about QALY instead of deaths.
I believe that lockdowns in Australia are more than just a nuisance. QALY lost in them could easily overweight any gains. But those gains are dubious. No proof that it was previous lockdowns that did anything substantial. See Japan, they did nothing comparable to Australia and yet had no serious spread either.
About vaccines – delta variant makes herd immunity impossible. 70% is not a magic number anymore. Sorry, but Australian government dropped a ball with vaccines as well. I think they could afford to be so cheeky because they banned all protests. They are now like Communist party that doesn't need to listen to critique regardless how many mistakes they make.
Main issue with hospitals is not lack of buildings. The main issue is trained personnel. You can teach enough of them in 1.5 years even from scratch. Somehow when Tegnell said covid is long term most people laughed at him. I agree with him because I studied public health, and my course project was about provision of healthcare in Afghanistan. I am not an expert in this field but at least I think I can evaluate some of the claims due to my background.
Oh the numbers aren't impressive because you don't know anyone who has died from it?
I don't know anyone who's died from HIV or Cancer but I can still recognise they're things I don't want.
> Main issue with hospitals is not lack of buildings.
No, it's the lack of beds. Guess where the beds usually go? In a fucking building.
We have plenty of unused buildings in this pandemic. Take any big hotel which could be easily refitted for hospital purposes. A couple of years ago my native country Latvia closed a lot of hospitals to reduce costs. There were even protests against those closures but the government in its infinite wisdom knows best. As far as I know, those building are still there, in many cases used for some trivial purposes.
And if we talk about health care in Afghanistan (which I studied closely) then they managed to provide basic care (vaccinations, antibiotics, diabetic medicines) for about $10 per person per year (thanks to the donations from IMF, World Bank and WHO which most internet commentators detest). Yes, the basic emergency care really costs so little if we are forced to cut out all bullshit and reduce our standards a little but still keep most of the gains in child and adult mortality. Since the Taliban has returned, it is possible that they will lose this funding and highly probable that all the gains will be lost in the next few years. But those we don't care about because muh they deserve it for being so stupid to be born there or something...
Does this mean there is a balance in favor of not imposing lockdowns; who knows? No one knows if a CB analysis is absent. The latter should include effect of vaccination and the ameliorative effects of an ever-widening range of medicines which have been shown in many peer-reviewed clinical studies to save lives and reduce the severity of the disease. But governments set their face against this. One wonders why.
Finally it should be noted that Covid-19 is not smallpox (lethality about 30%). Huge numbers of people who have competent immune function remain either asymptomatic or totally immune to the virus (lethality 0.007% - 5.4% or more depending on age and co-morbidity).
Quoting https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110323/ :
> In the first few months of the viral pandemic, there were scattered media reports of individual instances of suicide ostensibly related to the effect of COVID-19 and several articles published in scientific journals that principally relied on such media reports ...
> Analyses of actual suicide rates during the COVIDE-19 pandemic based on national and regional/local health statistics from across the world, however, provide a different picture. A majority of such comprehensive data-based studies report a modest reduction in total suicide rates whereas the remainder report no significant net increase in suicide rates during the first year of the COVID-19 pandemic
Quoting https://www.bbc.com/news/55949640 : "The only reliable recent data available on suicides in England - from the University of Manchester - has found that rates have not risen during lockdown."
Quoting https://blogs.bmj.com/bmj/2021/03/10/louis-appleby-what-has-... : "Now we have reports from several countries, based on national or state-level suicide data. They come from Australia, New Zealand, the USA, Canada, Peru, Norway and Sweden—high income countries in most cases—and they carry a consistent message. Suicide rates have not risen."
Suicide is relative very rare. Even antidepresant drug trials find it very difficult to establish if they increase suicidality because of rarity. There are some antidepresants that are thought to increase suicides in children and still can be prescribed because of some improvement in the quality of life.
Lockdowns however where mostly bad except in some cases. I think that some young people who spend a lot of time playing games were happy. Incidentally they are also the ones who are most active online.
But even if it has no effect, the harm of lockdowns can be in other ways. The drug overdose deaths and increased alcoholism for example seems to be true. Any suicides can still follow after several years.
There is no evidence that there are consequent suicides. Nor that they are ignored.
You write "not yet" .... a hand-wavy statement which instantly adds FUD any topic.
It could be that lockdowns cause people to suddenly die 3 years years later. I could make up lots of "it could be" scenarios. Unsupported claims, with evidence contrary to the claim, should not be used to make policy decisions.
And this is a hypothetical about making a policy decision.
Yes, let's also reduce premature deaths due to obesity, smoking and alcohol use. You write that like you think it's farcical, but many people advocate for exactly that.
One problem is that many companies make lot of companies make a lot of money pushing sugary foods, tobacco, and alcohol.
That money affords political power preventing stricter laws.
John Oliver, for example, did a segment on Last Week Tonight about how tobacco companies prevent change, in https://en.wikipedia.org/wiki/Tobacco_(Last_Week_Tonight) , with examples of how, for example, PMI sued Uruguay at the WTO to prevent including obligatory health warnings on tobacco boxes.
There was no Big Iron Lung opposing the polio vaccine.
People smoke, drink alcohol and eat junk food would never accept the level of restrictions we had with lockdowns. One thing is to put a warning on a box, a different things is to actually prohibit buying that box and smoking with a high penalty.
And vaccines are much more effective and considerably less intrusive than any NPIs. The problem is that people so much overemphasised their effect and actively resisted vaccine challenge studies (with volunteers deliberately wanting to get infected) to speed up vaccine trials. The whole world could have been vaccinated by now and delta variant booster be ready by now.
Quoting https://en.wikipedia.org/wiki/COVID-19_lockdowns :
> Research and case studies have shown that lockdowns are effective at reducing the spread of COVID-19, therefore flattening the curve.[4] The World Health Organization's recommendation on curfews and lockdowns is that they should be short-term measures to reorganize, regroup, rebalance resources, and protect health workers who are exhausted. To achieve a balance between restrictions and normal life, the WHO recommends a response to the pandemic that consists of strict personal hygiene, effective contact tracing, and isolating when ill.
As I pointed out elsewhere here, "lockdown" is a broad term.
Do not change the goalposts. You wondered why we don't implement method to reduce deaths due to obesity, alcohol use, and tobacco.
I gave you one a very clear reason.
I most assuredly did not say that prohibiting the sales of tobacco, with a high penalty, was the only way to reduce those deaths.
And I pointed to tobacco companies specifically fighting putting warnings on a box.
But lockdowns in this strict sense was the most stupid idea ever. Outdoor events had very little effect on covid spread anyway.
If covid was a short term problem, it would make some sense. But it wasn't. The research is inconclusive at best. The studies are not on the level of pharmaceutical interventions. Remember how long it took to prove that ivermectin is not effective? Nothing with the same level of rigor has been done with lockdowns.
I stand by my assertion that we don't implement prohibitions at the same level with smoking, drug use and junk food as we did with lockdowns. The reason for leaving home is to meet other people or visit places. If you close an indoor pub or a restaurant that's a measure but not really a lockdown as people could still order food or wine and eat and drink outside. So, in this sense lockdowns are equal to blanket alcohol prohibition. Even if it worked to some extent in 1920s in the US, people voted to stop it. It wasn't a recommendation to stay at home like a warning on tobacco box, it was an order with high penalties. And I think in Australia it is still like that. They have added exercise for valid reason. But what if I don't want to exercise but only walk around and enjoy nature or a beach?
Why do you say the research is inconclusive?
The Wikipedia link showing support for lockdowns as you describe is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881715/ . Some quotes:
> Lockdowns are found to be the most significant NPIs in terms of variations to the Rt
> The results, which where published in July, paint quite a grim picture which unfortunately has been later confirmed: measures in place after the strict lockdown is lifted are not enough to avoid the overwhelming of the healthcare system.
> Early implementation of lockdowns has been found associated with large reduction of incidence.
> The results confirm the effectiveness of lockdowns and travel bans.
> Furthermore they suggest that partial lockdowns might be as effective as full lockdowns if implemented earlier.
Or, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325386/ where Itay's red zone is closest to a full lockdown:
> the red zone policy was by far the most successful in reducing the rate of growth of new cases, hospitalizations in regular wards and ICUs.
> the red zone is an instrument that makes it possible to rapidly bring down cases and the speed of transmission of the virus and consequently both hospitalizations and deaths (being very correlated). However, it implies severe social and economic consequences due to forced economic activity suspensions and restrictions on the freedom of movement. Therefore, this choice can be considered as a tool of last resort in cases of dramatic spread of the epidemic or when the local health system is close to the collapse.
> There is a vast literature on the effects of nonpharmaceutical interventions (NPIs) of various measures on the speed of spread of COVID-19 ... Many studies have proven the effectiveness of these measures in reducing the spread of severe acute forms of COVID-19
You write "we don't implement prohibitions at the same level with smoking, drug use and junk food".
I'll again point out the guideline that lockdowns are meant as "short-term measures to reorganize, regroup, rebalance resources, and protect health workers who are exhausted."
With evidence that it works - experience in enacting a cordon sanitaire for smallpox, Ebola, and SARS outbreaks: https://en.wikipedia.org/wiki/Cordon_sanitaire_(medicine)
What sort of evidence is there that a short term intervention will help reduce deaths due to smoking, drug use and junk food?
Do you know what is a metastudy? And that the biggest metastudy about ivermectin actually tended to support that it is slightly effective? So, how do we know that ivermectin is actually non-effective? Because those positive studies have big limitations that make the results very suspect.
It takes a lot of time to read through every study, its methodology, limitations etc. I have had not time for that but others have done and those reviews have very big error bars about their effectiveness and overall evidence is not very convincing.
Medicine is a field which is very complicated and as in stock market, past experience with similar things do not guarantee future results with different diseases. Researchers needed more than 50 years to realize that stomach ulcer is caused by bacteria. Before that they believed that no bacteria could live in such acidic environment. So, don't bring an examples about different diseases. It does work like that in medicine.
But now everybody on the internet is an expert and reads one study, selectively quotes something without even understanding full implications and thinks that they have proven everything. No, that's not a game I am playing here.
Especially your last question. My statement was that we don't forcefully take away cigarettes from smokers. I don't know if that would be effective or not but that was never for consideration. We don't do first of all because we value people's freedom to choose and we don't think that it is ever appropriate to force people like that.
Where are these studies? I linked to multiple papers, themselves containing links to other papers, all stating that lockdowns are effective.
Put up or shut up.
Otherwise you're one of the people you're complaining about.
I personally read https://astralcodexten.substack.com/p/lockdown-effectiveness...
You wrote: "everybody on the internet is an expert and reads one study, selectively quotes something without even understanding full implications and thinks that they have proven everything"
You didn't even point to a study.
Were the red zones in Italy effective? That's the closest Italy had to the specific type of lockdown you mention. And I pointed to a study which argued that it was indeed effective.
I asked you a question do you know what a metastudy is? You didn't answer, so I suppose the answer is no. You are not qualified to even read the studies and understand what they really say.
As far as I read from the study you quoted, there was no clear data that showed that the red zones in Italy were effective. Italy had one of the worst results overall. Arguing that lockdowns there were effective is like a mockery of science.
Quoting from it:
> In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency.
If you honestly believe "higher" is a meaningful point, then "peer-reviewed review in the scientific literature" is "higher" than someone's review in a personal newsletter.
You cannot possibly believe that newsletter summary you pointed to contains "practically all meaningful available evidence". Quoting the same review paper I linked to:
> searchers in PudMed for restrictions AND COVID, lockdown AND COVID, (control measures) AND COVID and (social distancing) AND COVID return more than 2000, 2900, 3000 and 8000 results respectively. Furthermore, any systematic review should play with synonymous and similar words. This monumental work, which would end up with well more than fifteen thousand papers is left for the future and it would benefit from a large collaboration.
If your statement is true then either Astral Codex Ten managed to read and review 10K+ papers on the topic, or you somehow know that most of those papers are not meaningful.
As for "no clear data" about Italy's red zones, what is unclear about these quotes from that Italy paper?:
> the red zone policy was by far the most successful in reducing the rate of growth of new cases, hospitalizations in regular wards and ICUs.
> the red zone is an instrument that makes it possible to rapidly bring down cases and the speed of transmission of the virus and consequently both hospitalizations and deaths (being very correlated). However, it implies severe social and economic consequences due to forced economic activity suspensions and restrictions on the freedom of movement. Therefore, this choice can be considered as a tool of last resort in cases of dramatic spread of the epidemic or when the local health system is close to the collapse.
> The package of measures contained in the red policy well responds to the need of quickly reducing the speed of transmission of COVID-19 and consequent hospitalizations.
That sounds pretty clear to me, and you haven't highlighted the faults, nor identified where I've mis-understood things, beyond making seemingly unsupported statements of fact.
I'll be clear as well. Stay-at-home orders for, say, New York might have been useless while the red zone orders for Italy were useful.
But your argument appears to be that no lockdowns for COVID were useful, while I can point to at least one case where it was successful.
Regarding "metastudy", the term "meta-analysis" is far more frequently used. A quick HN search shows I'm aware of that concept, yes. https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
I ignored that question as it appeared a meaningless ad hominem, especially as you weren't actually pointing to any meta-analysis to back your claims, nor demonstrating that you are qualified to read the primary literature and able to understand what they really say.
Literature review is not higher that meta-analysis. It quotes one study but how reliable it is?
What about ivermectin? A lot of studies find it effective. That's not the final conclusion however.
If you want to play the FUD game, I'll again remind you that the sole citation you've provided is to a non-peer reviewed review in a personal newsletter.
You still haven't explained how you can interpret a paper with statement like:
> The package of measures contained in the red policy well responds to the need of quickly reducing the speed of transmission of COVID-19 and consequent hospitalizations"
as having "no clear data that showed that the red zones in Italy were effective".
Based on this exchange so far, I have precisely zero faith that you can wade through the misinformation on ivermectin - https://en.wikipedia.org/wiki/COVID-19_misinformation#Iverme... - or understand the relevant research literature - https://en.wikipedia.org/wiki/COVID-19_drug_repurposing_rese... .
To quote you - "everybody on the internet is an expert and reads one study, selectively quotes something without even understanding full implications and thinks that they have proven everything. No, that's not a game I am playing here."