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Comment by beardyw | Hacker News Reader

Years ago I used to work in this area and you should not underestimate what a difficult thing "cause of death" is. At the time we mostly worked with the initial condition which led to death. But in-between that and death could be quite a few other conditions. There are relatively few ultimate conditions. Trying to apply more than one just confuses the stats/people. But our approach had one case of "flat feet" as a real cause of death! You can't win.

That makes excess deaths valuable in the case of COVID.

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That complexity was pretty ruthlessly exploited here in the US by groups that wanted to downplay the issue and end mitigation efforts. Endless takes on "well actually they didn't die of COVID they already had $co-morbidity-x or $co-morbidity-y and that's what REALLY killed them".

The point is valid. The risks of COVID-19 to people who did not have serious co-morbidities was continuously overstated. This led to measurable misunderstandings among normal people as to the actual risk.

https://catalyst.independent.org/2021/03/24/americans-misinf...

> This led to measurable misunderstandings among normal people as to the actual risk.

You say "normal people" as if not having co-morbidities is more common. But large swathes of the population are old, obese, have asthma or some other co-morbidity.

Apparently despite those large swaths, the actual rate of hospitalization (at least as of September of 2021) is dramatically lower than most people expect.

Why do you think that is?

> 71.6% of adults aged 20 and over are overweight, including obesity. Nearly 40% of American adults aged 20 and over are obese.

You're making my point. The data is from the US.

Somehow, despite high rates of that specific comorbidity, the data shows Americans are hospitalized at dramatically lower rates than Americans estimate.

The post I replied to said:

> That complexity was pretty ruthlessly exploited here in the US by groups that wanted to downplay the issue [...]

Apparently it was not exploited too ruthlessly if surveys show people were still grossly overestimating COVID-19 severity in the population.

Does this result in better COVID-19 policies being made? Who is responsible for this disconnect between reality and what is perceived? How can we fix it?

Or does it even need fixing? Perhaps we'd save more lives if everyone were convinced half of COVID-19 cases were fatal.

Likewise, certain US groups who pointed to total deaths not only ignored comorbidities but also that the average age of death for a Covid victim is past the average age of life expectancy.

They then and still are trying to push vaccines on cohorts that absolutely do not need them (see numerous EU countries who are not doing this).

On top of that, they managed to convince many US citizens that vaccines prevented transmission as part of their efforts to force vaccines on everyone. Go check some past HN threads for a wild ride!

Bonus points are awarded for obesity being a major risk factor that we’ve done 0 to address post Covid despite the absolutely massive benefits we’d see from it - Id wager far outstripping masking or vaccinating. Externalities for thee but not for me, I guess.

> Likewise, certain US groups who pointed to total deaths not only ignored comorbidities but also that the average age of death for a Covid victim is past the average age of life expectancy.

Did they ignore them, or were they just not devaluing the lives of the sick and elderly? If 10,000,000 people are dead that would otherwise be living, standing up and saying "but they were old or fat!" has a kind of asshole sting to it, no?

> They then and still are trying to push vaccines on cohorts that absolutely do not need them (see numerous EU countries who are not doing this).

Vaccines aren't just for the people that get them. They are for the people around them as well. I'm a perfectly healthy 35 year old, but I visit my 90 year old grandfather often, and live in a community with many elderly. If the vaccine makes me less likely to transmit, that's good for everyone, whether or not it matters much to me in isolation.

> On top of that, they managed to convince many US citizens that vaccines prevented transmission as part of their efforts to force vaccines on everyone.

They do tho. Maybe not 100%, but to a degree they certainly do.

> Bonus points are awarded for obesity being a major risk factor that we’ve done 0 to address post Covid despite the absolutely massive benefits we’d see from it - Id wager far outstripping masking or vaccinating. Externalities for thee but not for me, I guess.

Not even sure what you're saying here.

That's what always struck me. Sure the majority are old but they're still dying from COVID not from something else, also there's a significant number that aren't old and if we do nothing because the most at risk portion are already old we're going to lose a lot that aren't. We spend massive amounts of money keeping the elderly alive every day because we recognize that time is important and precious for these people and their families so we don't just dump them at 85 because "well you've outlived most of your cohort already anyways".

> Did they ignore them, or were they just not devaluing the lives of the sick and elderly?

Not devaluing the lives of the elderly is implicitly devaluing the lives of the not elderly. This is a trade off that was given almost no consideration in the greater (US) discussion.

> They do tho. Maybe not 100%, but to a degree they certainly do.

The degree is extremely important here. Without a certain level of transmission prevented this benefit becomes nonexistent. See grandpa enough times and he’ll catch it. That you don’t know the degree but still felt safe seeing him is very concerning and you were likely mislead.

> Not even sure what you're saying here.

Choosing to focus on masks and vaccines while ignoring obesity removes are principled arguments for the former. The latter has benefits both against future pandemics of all kinds as well as broad public health benefits. Thus, anyone not raising hell about how fat America is while advocating for forced vaccination and mask wearing is playing politics and not really interested in public health outcomes.

Like you, people claimed forced vaccinations were justified by externalities - but the same logic was not applied to forced weight loss.

As if forcing weight loss could have happened fast enough to be useful.

The benefits apply to more than just Covid and if maintained for the rest of a persons life. It’s a higher up front linear cost with an exponentially higher payout.

How do you even force weight lost?

> Not devaluing the lives of the elderly is implicitly devaluing the lives of the not elderly. This is a trade off that was given almost no consideration in the greater (US) discussion.

It did though. We are going back to normal for the most part, despite the continuing risk to the elderly. Early lockdown was for everyone since very little was known about the disease.

> Choosing to focus on masks and vaccines while ignoring obesity removes are principled arguments for the former.

It's an obvious matter of practicality. Masks are easy and fast and will, statistically, do more good than a country wide weight loss drive. Would it be better long term if the country was fit? Yeah, for far more reasons than COVID. That's not practical though, as evidenced by the governments pre-existing desire and failure to make that happen.

> Like you, people claimed forced vaccinations were justified by externalities - but the same logic was not applied to forced weight loss.

Which is completely consistent with the state of the world pre-covid?

Along similar lines, the legal system ends up dealing with this as well. Because a crime is often defined both in terms of actions taken (e.g. "Person X stabbed person Y".) and in terms of outcomes (e.g. "Person Y died."), the legal system needs to connect the cause and the outcome. So, if X is a surgeon, and stabbing was part of an unsuccessful surgery trying to save Y's life, that wouldn't be murder.

* X stabs Y, and Y immediately dies. Simplest case, X is responsible for Y's death.

* X stabs Y as part of a surgery. Y was predicted to have 2 months to live, but instead dies on the operating table. X did not murder Y, even though they were the cause of Y's death occurring on that specific day, rather than 2 months later.

* X stabs Y as part of a mugging, and Y immediately dies. Coincidentally, Y was predicted to have 2 months to live, but instead dies in the mugging. X did murder Y, even though it was the same difference in total lifespan as the previous example than 2 months later, because the intent matters.

* X stabs Y as part of a mugging, but it only requires some light stitches. While Y is driving to the emergency room, they are killed in a car accident. X would be liable for causing injury, but wouldn't be liable for the death, because it was an unrelated coincidence.

* X stabs Y, and Y later dies of blood loss at the hospital after refusing treatment for religious reasons. The defense argues that this should be counted as manslaughter instead of murder, because Y's refusal of treatment breaks the chain of causality between the action and the eventual outcome. The judge disagrees, as "defendants must take their victims as they find them."

These are all hypotheticals based on my layman's understanding of the law, except for the last one, which occurred in the case of a Jehovah's Witness who refused blood transfusions for religious reasons [0]. This became more of a ramble than I intended, but I definitely agree that causation is tricky, and "cause" could be any of "action with a causal link", "immediately preceding cause", or "deviation from a just world that initiated a causal chain", and would lead to vastly different statistics depending on the definition.

[0] https://www.bailii.org/ew/cases/EWCA/Crim/1975/3.html

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