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Comment by consumer451 | Hacker News Reader

I feel like we got lucky with COVID-19. It just wasn't that deadly. Not to be too cold about it, but it had the potential to be a good test run to see how we deal with a more fatal pandemic.

In some ways we passed the test pretty well. In others, not so much.

My question to HN is: what could we do better next time?

edit: to be clear, "we" in what could we do better = our global civilization and maybe separately in each user's country of residence.

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Who are the we here? As a civilization, we could willingly take precautions with an understanding that it's worth while to try them even if we're not 100% sure they would work (i.e. wearing masks). We could prep emergency plans for extended telework. We could do research on the best remoting learning methods so students don't lose substantial educational time (and we may even be able to apply those in beneficial ways.). We could mandate workplaces must not allow sick people to come to work instead of the hodge podge of workplace policies we have. And we could react with empathy towards the sick and the ones who could lose loved ones instead of anger.

> Who are the we here

Yes, as a civilization is what I meant. But good question. Also maybe in any HN'ers home country.

> My question to HN is: what could be do better next time?

About everything. For a start weighting in more factors like quality of life, economy, health (everything else than the pandemic at hand & including mental health) than just just a few metrics.

Second graduating the response to the dangerosity of the disease. It was clear 3 months in that only a small subset of the population was really at risk so it made no sense to punish the whole population. Young people were affected proportionally harder than older folks: best of social and love life gone, poor education for a few years, difficulty to enter the job market, while the people most at risk already lived for more than a century, have a home, often kids, etc.

Third let citizens have basic human rights. I shouldn't have to right it, but if basic human rights like movement and commerce can be removed with a finger snap (they were) we are not living in a democracy.

Four, don't push untested pharmaceutical products made by firms with proven contempt for human life on millions of people. Don't put resistants in camp (Australia) and don't censor divergent opinions like an autocracy: public debate must be this, a debate and made publicly.

Five, base policies on real science, not the reverse around where "science" is twisted to fit a narrative.

Somewhat agreed in direction, but disagree in statement. We weren't "punishing" the whole population. Nor were basic movement and commerce flat out taken from most people. There are some countries that did that, true, but I was always able to make it in to a mostly empty office to do work. And buying things was never fully impacted.

I would love to see an even handed comparison of the different responses in all countries to know if any had meaningful impact. But with how wildly different the virus acted in places, I am worried nobody will believe any analysis. At the least, we know not everyone will.

And I fully cede my understanding may be sadly behind. I remember the damage/death it was doing at the beginning in Italy and how we were all trying to not overwhelm hospitals. Then, the next few years had case counts that were off the charts, and I'm not sure what changed. Do we have a good handle on that, now?

The issue with "what could we do better" is that in a system of intelligent free actors (as opposed to some sort of sim game in which the 'creator' has control over everything) the actions that people take will change depending on the effects (for example lethality) of the virus in question.

There are personal values in play here, but very roughly, if we have a pandemic with an x% risk of death or serious debilitating injury then it's worth spending x% of our time, resources, etc trying to prevent its' spread.

Everyone is going to have a different number there, some will think we should just never give up ever, others will just think "screw it, I'll take the personal risk", but that's a good average.

We do this all of the time - people can get post viral syndromes from common colds, but we accept that this is an incredibly unlikely situation and so most people don't get into a panic when around other people.

And that's actually what we saw with coronavirus. The vast, vast majority of people at least in the first weeks of the pandemic took it seriously. After a few months a lot of people simply stopped caring because it wasn't as fatal as we feared. For whatever reason this became extremely politicised in a way that I can't quite understand.

I think people stop caring, because it is impossible to keep up a high level of vigilance for an extended period of time. Plus the risk becomes normalized.

People are not very good at evaluating risk. From an evolutionary perspective, we mainly do it by copying others. I cannot comprehend what a X% fatality rate really means on a personal safty evaluation. But seeing what other people are doing gives favorable odds. Of course, this heuristic has its pros and cons.

I’m no a COVID scold but it is behind only cancer and heart disease for leading causes of death, in the US. It certainly could have been worse, but, pardon the pun, that’s nothing to sneeze at either.

How in the world is a disease that we have a vaccine for still the 3rd leading cause of death?

Because COVID is insanely contagious. The non-specific measures we took (social distancing, masking, &c) absolutely crushed the flu, but only maintained partial control over COVID spread pre-vaccine.

I don't know about "insanely contagious".

In my small company we are cca 25 people and we have very cramped quarters. However, it has been more than once that some colleagues have had covid but nobody else was infected, despite being in meetings with the sick guys.

You can get lucky, but not this lucky with something that's really contagious.

I have had a hard time squaring how contagious it is by external evidence, with how non contagious it is within family units. I finally started seeing families where it would hit everyone in the family, but there are tons of examples of it not spreading to everyone. Which is practically unheard of for this style of virus. This is particularly pronounced when it comes to kid sicknesses. For the most part, you can just ask if other kids are getting sick to know if your is about to. Covid? We literally carpooled with families and did not catch it from them. Just, how?

This is a touch naive, though. How is heart disease so high on the list? After all, we are "convinced" it is poor diet and exercise.

There is some irony that it may be much of the really poor aspect of our diets came from health programs of the last century that were grossly miss targeted. Of course, the frustration there is it was not some nefarious push by folks. We just got it wrong.

Back to covid, I share the incredulity in how the deaths are driven largely by unvaccinated numbers. Even crazier when you see stories like https://www.npr.org/2022/01/12/1072411820/law-enforcement-de..., where the very groups that are seeing rises in deaths pushing back against vaccines. Truly mind numbing.

This is harder to catch a cancer or heart disease from someone else, vaccinated or not.

Its probably not and OP is misquoting.

It is absolutely true. COVID isn't the army-crippling societal disaster it was in 2020, but it's still a really really nasty virus.

https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Stupidity is a human condition that is more dangerous than cancer.

Entirely depends on how deadly it is but we F'd up big time by blowing all our social capital on the last one.

A year in, it had between 1.5 and 3.5 percent mortality rate, the first few months it was up to 15 percent in some areas and segments of the population [1]. Even today at 0.1-1 percent fatality rate [1], the odds are horrible for something so easy to contract. NB the statistic does not differentiate by vaccination status.

Yet, despite those odds, an enormous segment of the population of the US failed to all sorts of cognitive biases, and is convinced, contrary to all evidence [2], that it's better to get covid than a vaccine. This indicates to me that the US has failed as a society to respond well to such a preventable disease.

Denmark ( where I lived during Covid ) handled it much better and is a similarly capitalistic society, but with a different attitude towards institutions, and the issue was not politicized. The general population listened to the CDC-equivalent institution. The government offered free testing, (rapid+the more expensive ones), and was proactive with respect to vaccination. The government coordinated a very successful booster vaccination campaign in early January of 2022, effectively ending the covid era.

[1] https://ourworldindata.org/mortality-risk-covid

[2] https://ourworldindata.org/grapher/united-states-rates-of-co...

The death rate is so hard to really interpret. It is stupid skewed by age in ways that so many other things aren't. Even for non-vaccinated people, you have to get into the 30s before you see that number jump above .1 after the initial wave.

And the initial wave being so high just screams that we weren't counting the accurate number, as we didn't know how widespread infections were. As we learned that more and more infections were effectively asymptomatic, early numbers on what was happening are hard to take at face value.

None of which is to downplay it. Lots of people died. I hope we can find actionable things to help for any future outbreaks.

> As we learned that more and more infections were effectively asymptomatic, early numbers on what was happening are hard to take at face value.

According to [1], it's 40.5% of the confirmed population. It's indeed a high rate, but those cases are also taken into consideration wrt to mortality rate as far as I am aware. It also highlights just how transmissible this virus is, allowing it to eventually infect the vulnerable population.

We also learned that covid was a component in a very large portion of excess deaths. Yes, somebody may have died of cancer, but covid was also present. It's possible that the patient sans covid would not have died.

Plus, there is the inverse, long covid and its symptoms lingering and weakening the population making it susceptible to subsequent diseases.

The problem however, in all of this, is that any trust to certain institutions in the US is now gone, which will only cause more harm.

[1] https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

> In this meta-analysis of the percentage of asymptomatic SARS-CoV-2 infections among populations tested for and with confirmed COVID-19, the pooled percentage of asymptomatic infections was 0.25% among the tested population and 40.50% among the confirmed population.

The charts did not seem to get updated based on backfilling of how many people were infected. Or does that just not reflect on how I read the charts?

I still get people that are 100% convinced young people were somehow not getting it during the initial waves. Which frankly is non-sensical. Knowing that kids can get it, there is no explanation I have seen that could somehow magically have kept it out of every school that hadn't closed yet in the first year.

And testing is still... interesting. With many I know that test positive only doing so weeks after any symptoms, such that I was even told that 'loss of smell' is no longer a defining symptom? Schools have flat given up on either testing or requiring negative before the kids are allowed back. Ours at least encourage and support masking during the return period.

I don't think it is trust in the institutions, necessarily. Though, that certainly isn't helping. I think it is lack of certainty period. In large because we just don't have anyone with a 100% handle on the situation.

Please stop spreading misinformation. The population level infection fatality rate for SARS-CoV-2 was never as high as 1.5% at any stage of the pandemic.

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

https://doi.org/10.1016/j.envres.2022.114655

Sure, fair enough I used the reported cases to deaths, for that rate which is what the world in data listed. In contrast the CDC claims that it is now a 0.6% rate.

This however, reinforces my point, even with an exaggerated deathrate we failed to properly contain the disease and take things seriously.

In open societies outside of a few islands there was never any real possibility of containing the virus after it left Wuhan. And what does "take things seriously" even mean? The notion that regular people should restrict their lifestyles and submit to mandates indefinitely over a virus with a >99% survival rate was always stupid.

> The notion that regular people should restrict their lifestyles and submit to mandates indefinitely over a virus with a >99% survival rate was always stupid.

We didnt know that at the time. The statistics at the time showed a very different story.

You can compare the handling of the situation across countries and regions with similar socioeconomic conditions and observe that certain states performed significantly worse than counterparts outside.

I didn’t speak about indefinite mandates either and mentioned Denmark repeatedly, for a good reason.

In Denmark we didn’t have vaccine or mask mandates, and opened well before most countries in January of 2022 while sustaining far fewer deaths compared to say Sweden.

Correction, you had the option of wearing a mask or being vaccinated, depending on the kind of establishment. For metro masks were required. In other spaces, masks were required when moving around, but not when sitting.

I think trying to control human behavior better might be futile but something we could improve would be the supply chain issues.

And for added benefit that would also apply to other potential disasters.

Like imagine the impact if the Port of Los Angeles couldn't operate for X period due to an awful earthquake.

Perhaps I am mistaken, but most of the supply chain issues seem to have been caused by the reopening more than the pandemic. The economy cannot be shutdown and re-opened on a dime. I think it was a big mistake to think it could be.

It may be counter intuitive, but in some ways the opposite may be true. Viruses that are more deadly, are much less likely to cause massive pandemics like we experienced with Covid. When a virus is so virulent that it kills its host quickly and consistently, it dies off faster as the host doesn't have as much time to pass the virus to another host.

But it could easily have killed children disproportionally and not the elderly, without changing much in its spread.

This is almost backward, from my understanding. If it was much more deadly, it wouldn't have spread.

I'm sure there is an inflection point on the "deadly" nature versus the "spreads" factor.

That said, I fully endorse your closing question. I'm not at all sure what we learned. Other than folks get heavily invested in their narratives and don't back down. Pretty much ever. (Though, I think we already knew that?)

Evidence shows that there is a negative correlation between transmission and virulence, where the more virulent a virus is the less it spreads. I believe this is at least partially due to the fact that if it kills the host, it can't spread as far as if the host lives and keeps spreading. However, I believe that correlation is over the long run, and that there is plenty of evidence towards diseases that both spread easily and are deadly in the short run (smallpox, cholera, etc). Selection pressures seem to push viruses to be less deadly over time, but that's just it: over time.

Cholera is an interesting example of this because it relied on the fecal transmission route, where it would easily spread through tainted water. It didn't matter all that much if the hosts died, as long as it got into the water supply.

> This is almost backward, from my understanding. If it was much more deadly, it wouldn't have spread.

You should read up on smallpox. 30% death rate and extremely transmissible.

Ah, I assumed "much more" to be higher than that. So, apologies on missing the magnitudes we are duscussing.

Would a virus with a lethality of, say, 10% really have its infectiousness damaged that badly by 1 in 10 sufferers dying? I appreciate that once you get up to a more substantial fraction, people die before they can spread the disease... but "too deadly to spread" is a much higher number than "deadly-enough to literally decimate its carriers".

Agreed, I was assuming too high of a value being discussed.

> If it was much more deadly, it wouldn't have spread.

That depends fairly heavily on how much more, and how long before symptoms and death you're infectious. Measles, for example, is insidious in part because it's infectious days before the rash appears.

Erm, the article is about influenza. It hit a pretty good sweet spot of deadly and contagious a little over a hundred years ago.

Sorta. Comparisons to any disease/outbreak from before antibiotics are doomed to use for comparisons.

They are not useless, to be sure. But they will be very dirty in the stats.

Wut? Influenza is viral.

Not wrong, but it is credibly cited as a reason for high fatality. Mostly from onset of bacterial pneumonia, I think.

Though I cede it may as well be wishful thinking on why we have never seen one like it, since.

I feel like that the things that didn't go that well would have gone better if the bodies really had stated to pile up. Maybe I'm too optimistic.

Well, bodies did literally start to pile up in morgues and hospitals and still some groups of people managed to convince themselves that it was fake or made up.

Bodies piling up in morgues is one thing but bodies piling up in houses because there's no more room in the morgues and no one going around to collect them is quite another.

That also happened. I remember seeing the reports from some south american nations (don't remember exactly which one) of people who had dead relatives in their houses and no one could go and fetch them.

That may have been a sensationalized media story. I think that regularly happens in normal times as well, due to lack of services.

It was not a sensationalized media story. It was something that happened and that wasn't normal.

https://www.nbcnews.com/news/latino/don-t-leave-him-here-ecu... https://elpais.com/sociedad/2020-04-01/el-coronavirus-desbor...

It got to the point that the COVID task force coordinator had to issue an apology: https://twitter.com/EcuadorTV/status/1245492946675347460?s=2...

I think your comment really proves my point. Even when there's overwhelming evidence of how bad it really was, there's always someone who will downplay it or even deny it.

Did people downplay the severity in Ecuador, or did the piles of bodies make people take it seriously? Where I'm from (Northern Europe) the bodies were definitely not piling up. It's even hard to show that any excess mortality over the period. If the people of Ecuador didn't take covid serious after that horrible situation, I guess I can forget about westerns rallying against a more deadly pandemic.

There's no need to be so disagreeable about this: GP's only point is that it could have been much worse from a lethality perspective.

I'm just pointing out that when the evidence of bodies piling up emerged, people denied it, so I assume that will still happen even if bodies pile up even more.

If that did happen, I think it could have been a civilization ending event. There are some viruses with 50% fatality rate. That would have been non-deniable, pushing people to wearing full hazmat suits for daily activity. It is hard to see how any renormalization could have happened.

Sure, we could do better. We could stop wasting effort on ineffective measures such as school closures and mask mandates.

https://nypost.com/2023/02/27/10-myths-told-by-covid-experts...

> it had the potential to be a good test run to see how we deal with a more fatal pandemic.

Wasn't the AIDS pandemic already a good test run? It appears AIDS killed twice as many people in the African region in the year 2021 alone than COVID-19 has all told. Particularly with respect to the Americas, I expect AIDS would have proven to be far more deadly if it weren't for our effective proactive measures. That we seemed to be running around like chickens with our heads cut off when COVID-19 came around, even after the lessons learned from the previous major pandemic not that many years earlier, suggests that we simply don't learn (or tells that pandemics can be different enough that the lessons aren't transferrable).

Do better? I'm expecting we'll do significantly worse next time.

My worry is that the public's willingness to take a pandemic seriously has been burned out by COVID-19, so our response to a far more lethal bird-flu pandemic will be weaker than our COVID-19 response was (and it was legitimately impressive how everybody pulled together for like a few weeks back in March 2020).

Stop all non essential air travel much faster. Hard to flatten the curve if an asymptomatic infectious virus has no geographical limits.

Take our 72 hour mRNA solution to the virus and put it in an intranasal vaccine that is property dosed to provide sterilizing immunity.

Nasal vaccines hold promise but we still don't have one approved for COVID-19.

https://www.nbcnews.com/health/health-news/nasal-covid-vacci...

Yeah I know which is crazy. mRNA is way riskier and newer tech than intranasal is.

how society reacts to a pandemic is not independent of how lethal the disease is.

Human challenge vaccine trials.

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