Comment by HarryHirsch | Hacker News Reader

Comment by HarryHirsch | Hacker News Reader

To cope with pandemic, and eventually, endemic SARS-CoV-2 and to respond to future public health threats requires deploying real-time information systems, a public health implementation workforce, flexible health systems, trust in government and public health institutions, and belief in the value of collective action for public good.

I agree with all that. Now - can we have paid sick leave and workers rights, so that someone who is COVID-positive can stay home and cure their infection instead of having themselves drag back to work after five days?

The paper suggests data infrastructure. How about quarantine infrastructure? How about lower housing prices and better salaries so that only one parent has to work and schools don't have to be in session at a time of high COVID incidence?

We can't even have access to proper testing - everyone remembers Jen Psaki pulling a smirk when a reporter asked why the government can't send tests to every citizen. Now we are promised a website where you can order two tests per adult. And real soon you can even get reimbursed for tests that you bought yourself, if you could get any.

Sorry, trust in government is lost. Maybe it can be rebuilt, but it'll take two generations, by which time everyone who is susceptible to COVID has died of it and humanity has evolved to coexist with the virus.

We are screwed.

One of the more bizarre aspects of this whole ordeal, to me at least, is that at this point in the pandemic the government in the US is still only talking about vaccines, masking, and social distancing. Why? Are there not therapeutics out there (there are) that limit severity and reduce duration? Half of my friends have gone from a feeling of relief once they got their booster to a feeling of abject terror when they realized you can still get Omicron despite being boosted. Trying to pretend that we're going to vaccinate our way out of this is nuts, it's just whak-a-mole. Why are treatments for once you get it - and we're all going to get it - not a thing?

I don't really want a national strategy written by "the experts" for life with Covid. Everyone remember when all of the restrictions that we endured because of 9/11 were "temporary" while we addressed the "emergency" of Islamic terrorism? 20 years later and I still have to take my shoes off at the airport, and get occasionally gently caressed by a low level federal employee to get on an airplane.

With that in mind ...

>How about quarantine infrastructure?

Yeah no thanks, man.

You need to take therapeutics early enough to make any difference, ideally as soon as you test positive. By the time you reach inflammatory stage and are admitted to hospital it's too late. But the way we are doing right now, the testing infrastructure is completely overwhelmed. Tried buying a kit recently? Around here they are all sold out!

We need quarantine. Here's what I don't get: when AIDS came, everyone got used to condoms very quickly, and all the gay sex clubs closed down. Why can't we change our attitude today as the homosexuals did back then?

I mean, I suppose I agree with you that the government and our elites' management of it and the pandemic has been gawd awful, and particularly awful over the last ~6-9 months. What I don't understand about your point is that you're on the one hand saying "they can't even mass produce tests via the Defense Production Act and put them in the mail" and then on the other saying "government managed quarantine is a good idea".

Perhaps because contracting HIV meant near-certain death after a long drawn out decline, and Omicron looks to be less deadly than the flu for a vaccinated elderly person?

Magic Johnson is still in good health after > 20 years, due to very effective antivirals. Nowadays HIV is a chronic condition, manageable with medication, not a death sentence, but people haven't gone back to fucking like rabid badgers.

>due to very effective antivirals

Magic Johnson is still in good health because he was unimaginably rich when he got it. Others who got HIV at the time he did died of AIDS.

I'm not sure what your point is.

What I'm saying is that today life expectancy of a 21 year old who is HIV-positive is only 9 years less than of a seronegative individual. If you are diagnosed now as a young person you can expect 30 or 40 years of decent health, it's a very manageable condition, but people haven't gone back to full-on crazy. Outcomes like Magic Johnson are the rule nowadays.

Which just proves the point that HIV and AIDS are in no way comparable to COVID.

I'm still lost.

That’s today. The prognosis when the behavior change you’re referring to happened was much different.

When AIDS first came some politicians and public health zealots seriously proposed forcibly quarantining HIV carriers. That was actually a fairly mainstream position back in the 1980s, not something from the lunatic fringe. Fortunately we came to our collective senses and never imposed quarantines on any major scale.

https://www.nejm.org/doi/full/10.1056/nejmp1413425

The AIDS fatality rate at the time was virtually 100% (effective anti-viral medications weren't available yet). By contrast the CDC estimated the COVID-19 fatality rate at 0.6% since the start of the pandemic, and rapidly falling now due to vaccines and other improved treatments. A difference in fatality rate of over 2 orders of magnitude between the two diseases surely calls for dramatically different policy responses.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

One valuable lesson we did learn from the AIDS pandemic is that shaming people for making unhealthy choices is not an effective public health measure. It's better to focus on education and harm reduction.

> Trying to pretend that we're going to vaccinate our way out of this is nuts, it's just whak-a-mole.

I had to explain this recently, people still believe "Vaccine is freedom" and "Vaccine is the solution", because "people are less likely to end up in hospital". Maybe that's true, but hospitals are still full, new cases are still as high as ever, vaccine effect is getting weaker in short time and variants are coming up.

We need something else. More early treatment, limit mass spreader events.

> Are there not therapeutics out there (there are) that limit severity and reduce duration?

Yes, but they are super expensive and limited right now.

> Trying to pretend that we're going to vaccinate our way out of this is nuts, it's just whak-a-mole. Why are treatments for once you get it - and we're all going to get it - not a thing?

Trying to pretend that we have the resources to treat this once someone gets a severe case (both in terms of medicine and hospitals beds) is nuts.

If COVID is going to become endemic (and it looks like it will), then Omicron is actually a good representation of what that looks like: not as horrible as previous strains, but a lot more contagious and less vulnerable to vaccines...just like the flu that goes around every year now. But until we can establish that this is just another flu, we should be careful and do what we can (get vaccinated, boosted, wear masks, cancel that mosh pit session). And once it is just determined to be like the flu, does this mean flu season will be twice as sucky as one can get hit by the flu and then COVID every year? Ugh, even that end would not be ideal, better get vaccinated yearly for both COVID and the flu now, and health insurance premiums are definitely going up (more than they are currently going up, anyways).

>Yes, but they are super expensive and limited right now.

Okay. Make them not super expensive and limited. It's not like the Fed is going to stop printing money any time soon.

>Trying to pretend that we have the resources to treat this once someone gets a severe case (both in terms of medicine and hospitals beds) is nuts.

Why? Both of those things (medicine and hospitals) are limited by money and physical infrastructure right now. We're 2 years into this pandemic, and I think it's time for a dose of reality that should covid become endemic we'll need more of those. It's like we just said "get vaxxed and the pandemic ends" over and over and enough people actually believed that and in the meantime we did nothing to solve production issues or build more hospital beds.

They are hard to make, so currently the "expensive" part simply corresponds to the amount of effort and material needed to make them, see https://www.knoxnews.com/story/news/2021/10/04/monoclonal-an...

> Both of those things (medicine and hospitals) are limited by money and physical infrastructure right now.

We are spending stupid amounts of money on healthcare right now. I wouldn't be surprised if a lot of our inflation problems build up from the amount of resources we are redirecting into healthcare.

> It's like we just said "get vaxxed and the pandemic ends" over and over and enough people actually believed that and in the meantime we did nothing to solve production issues or build more hospital beds.

We underestimated how many people would not want to get vaxxed, and how many don't want to wear face masks, how many idiot governors don't want to take responsibility for their states. But ya, if this gets endemic, we will live on, but we will also pay the price for that.

> we will also pay the price for that.

You won't, you'll be vaccinated and wearing a mask.

It doesn’t matter, the costs are socially distributed even if just through insurance premiums.

Vaccines and masks don't prevent all the other health ailments that might require medical attention (and someone can still get a breakthrough case, even though it is less likely, and in that case less likely to need intervention).

We all pay the price when treatment is delayed or denied because the hospital is overflowing with COVID patients. Or because all our medical staff have quit because society feels they should bear unlimited amounts of trauma.

> >How about quarantine infrastructure?

> Yeah no thanks, man.

It’s going to be fascinating to see how New Zealand fares with Omicron and future variants. Quarantine has served us well (it was setup in hotels).

100% agree, but while it need not be said that New Zealand is not the United States ... New Zealand is not the United States.

> One of the more bizarre aspects of this whole ordeal, to me at least, is that at this point in the pandemic the government in the US is still only talking about vaccines, masking, and social distancing.

This is simply false.

> Why? Are there not therapeutics out there (there are) that limit severity and reduce duration?

Yes (those there's evidence that existing monoclonal antibody treatments are ineffective, or at least significantly less effective, against Omicron), and the government has been talking about them regularly, and pretty much nonstop recently, even (for the newest ones) before they were submitted for approval.

https://www.whitehouse.gov/briefing-room/statements-releases...

https://www.whitehouse.gov/briefing-room/statements-releases...

https://www.whitehouse.gov/briefing-room/statements-releases...

https://www.whitehouse.gov/briefing-room/statements-releases...

https://www.whitehouse.gov/briefing-room/press-briefings/202...

https://www.whitehouse.gov/briefing-room/press-briefings/202...

https://www.whitehouse.gov/briefing-room/press-briefings/202...

I mean my government got out a novel vaccine in a year and distributed 3 to four doses to those who have wanted it. I'm impressed. Ask any other entity in the world to accomplish that...

The US, UK and Germany all did this,I believe? With Cuba not far behind (theirs was approved July 2019).

They are all impressive entities and I have high levels of trust for all of them in comparison to all the other institutions of the world and my own lone abilities.

I don't know how a strategy that involves "change the majority of people's minds about government" and "change the heavily entrenched 11 trillion dollar health care industry" is a realistic one.

what about someone whose kids are sick with covid? make sure that is included.

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