ryankemper

> I'm also not sure how much The_Donald was as a community.

It was very clearly a real community, as you can see evidence from the fact that they migrated to thedonald.win when Reddit made it clear that they wouldn't be treated fairly.

> So you'd be in your other community and one day they all show up and down votes and the vitriol begins... it was no mystery that this happened, it was spoken of openly in The_Donald for a time.

> Who wants to deal with that?

And yet Reddit happily ignores vote brigading and other negative externalities from any subreddit that toes their party line, so it seems bizarre to single T_D out. And as far as I know that wasn't the reason Reddit gave, rather they said something about supporting violence which in my opinion was a pretty clear "we're fishing for a made up reason that lets us boot you guys"

So, you haven't provided _any_ citations or even vague references to Wikipedia articles, rather you just called their opinion FUD and left it at that. How am I, a 3rd-party observer of this thread, supposed to extract any value from such statements?

The person you were quoting did not provide rock-solid proof that having police helps reduce violence, but they did provide a citation showing that:

> Violence against persons in poor (51%) and low-income (50%) households was more likely to be reported to police than violence against persons in mid- (43%) and high-income (45%) households

from https://www.bjs.gov/content/pub/pdf/hpnvv0812.pdf

So you could certainly argue that they are actually irrational to call the police and thus the higher rate is explained by them incorrectly thinking police would help them. But it's tricky to argue that with no data :)

Cheers

> These things are evenly distributed across society

This is an unproven assertion. You should provide evidence of it, because on its face it is a completely ludicrous claim. Rates of illicit drug activity, violent crime, etc are _not_ evenly distributed in society. Not even close.

> Exhibit B) Silicon Valley openly brags about microdosing acid to perform at work at their half million $ jobs. Overpolicing would ensnare them if overpolicing existed in that demographic and then they would be ineligible for jobs the rest of their life. If you cant be subsidized by your family then you have actual crime to consider. Guess where you will live too.

Quite simply, the reason people that microdose are not getting thrown in jail is because they're not doing the other things that would lead to them getting discovered, i.e. engaging in crime or driving a car with significant (meaning, more than a person can safely swallow to avoid arrest) quantities of lsd.

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Just incase you try to pin a belief-set on me, I oppose the war on drugs, no-knock raids, and even speeding tickets completely and would entirely abolish them if I were the BFDL.

> Since racism is systemic[1]

> [1] If you don't believe this, you're in the minority now: https://www.vox.com/2020/6/11/21286642/george-floyd-protests....

This part was a little odd. It sounds like you're saying "because this belief is widely held by people, we should treat it as true"?

I definitely am in the minority, but I find a much more logically consistent view than the modern definition of systemic racism to actually be "there are systems of authority/control/oppression, which by their nature can be exploited by racists (or other groups) to advance their ends".

In other words - and I hope this isn't too off topic of a tangent - one of the primary goals of the BLM protest seems to be "racism is leading to excess death/imprisonment for black americans, so let's try to purge any traces of racism to eliminate these excess deaths". Which to me is missing the point: practices/systems like no-knock raids, the war on drugs, civil asset forfeiture, etc give police officers an excuse to be able to violently invade someone's home (no-knock), violate 4th amendment rights (war on drugs wrt "I smelled weed in your car"), criminalize behavior that happens to be broken along racial and class lines (non-violent drug usage/possession/distribution). In other words, the problem is not that there are racist people in the system, but that we have these systems that give racist individuals the perfect excuse to achieve their nefarious ends. That's because we've built a system that justifies and encourages oppression, and we can see that without having to introduce racee.

Anyway, I'm not hear to debunk "systemic racism" since like so many of the new-speak definitions/words, as soon as you try to debunk it people claim that you're using the wrong definition. But I do think it should be noted that when it comes to looking at actual research literature on, say, likelihood of being shot by police in a given encounter broken down by race, the "systemic racism" doesn't seem to be borne out in the data. Whereas we can make incredibly important societal change without needing to introduce the idea of systemic racism, simply by addressing the actual systems of oppression we have set up that give police officers the ability to randomly pull a citizen over and harass them since at any given moment each of us is violating a nonzero number of laws.

Even more concerning than using downvote as a disagree button is flagging as a disagree button. It's happened to me many times where my good-faith comments have been flagged due to advocating a minority position (specifically, that the COVID-19 lockdown is harmful, just to give context) and I have/had to e-mail Dang to get a human to look at the flagged comments and determine if they were actually violating a guideline.

To the extent that a site like Reddit tries to police content and decide what's "hateful" content versus just mildly offensive, etc, the platform becomes less valuable to me.

These policy changes have driven me off of Reddit. Not because I was part of any quarantined "communities" but just because I see where things are going.

Reddit used to actually believe in the ideal of free speech, full stop. That stopped being true quite some time ago.

> I hope most people on HN don't agree with the train of thought that websites have no duty to their fellow man to not normalize hate speech.

I suspect that most agree with your statement, but to speak for myself, I am very skeptical of labelling something as hate speech. It starts out with banning "legitimate" hate speech ("ethnic group X is secretly controlling everything and must be purged") and quickly morphs into something like "you said all lives matter which is associated with opposition to black lives matter which over the long-run is part of a system of oppression and therefore we're going to ban you". If it's not clear, these are arbitrary examples that I just made up but I think the way Reddit is going it's quite clear that we're moving towards that.

In a way, it's much more frightening to operate on the assumption that, while there are bots, it mostly is actual humans. Simply put, a lot of the actual humans are bots (in the metaphorical sense of having incredibly un-nuanced takes and reactively responding to certain heuristic phrases that "trigger" them).

I don't have any stats on what % of twitter is bots so I'm not saying that it's not overwhelmed by bots, but we should be aware that there might be an even more chilling explanation here: that it actually _is_ humans causing the toxicity

So I totally agree that we over time will get slightly better treatment outcomes. But I think the negative effects of containment far exceed those marginally improved outcomes, therefore we still need the "game-changer" that I've been referencing in order for containment to have been worth it.

> the only thing we should be contemplating is how to eradicate the virus as soon as possible.

Do you think that eradication is actually a possibility? Or are you using it as a metaphor for "contain it super well"?

There are a number of reasons why eradication is completely infeasible. In short, COVID-19 is a highly infectious respiratory disease and it came from a zoonotic origin. We know there are animal reservoirs at this moment.

Therefore eradication is impossible. We've only ever eradicated two diseases in all of human history.

Two of the most influential models in shifting public policy have been Ferguson and the IMHE's model.

Here's Ferguson:

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

> We do not consider the ethical or economic implications of either strategy here, except to note that there is no easy policy decision to be made. Suppression, while successful to date in Chinaand South Korea, carries with it enormous social and economic costs which may themselves have significant impact on health and well-being in the short and longer-term. Mitigation will never be able to completely protect those at risk from severe disease or death and the resulting mortality may therefore still be high. Instead we focus on feasibility, with a specific focus on what the likely healthcare system impact of the two approaches would be.

(From Page 4)

Now let's shift to the IHME model. They do make passing reference to the econonic impact, same as Ferguson, but don't go any further:

http://www.healthdata.org/sites/default/files/files/Projects...

> The overall financial cost over a short period of time is likely to be enormous, particularly when juxtaposed against the substantial reductions in revenue for many hospitals due to the cancellation of elective procedures and the broader economic consequences of social distancing mandates.

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Now as I said, it's not necessarily their job to forecast the economic harm. But unfortunately we have created this notion that being pro-lockdown means "believing science" and therefore thinking that the lockdown is a bad idea is being "against science". Our politicians use these exact words, and as I said their actions show that they are not holistically evaluating the downside risk. On the contrary it appears to be a very simple game-theory type calculation where their incentive structures are leading them to make irrational decisions. COVID-19 mortality is much more "visible" than the fuzzier and longer-term mortality caused by our (IMO misguided) response to COVID-19.

The epidemiologists who have been advocating for lockdown have very explicitly ignored all of those sources of mortality entirely. They have only focused on COVID-19-attributable deaths and that's it.

Now the job of the modellers is to predict COVID-19 mortality under various scenarios, and it's the job of policymakers to counterbalance those predictions against the economic realities, etc. So, it's not necessarily a problem that epidemiologists would focus on predicting just along the dimension of COVID-19 mortality.

But unfortunately our policymakers have completely disregarded that need to weigh both the positives and negatives and instead have talked about "following the science" and basically myopically parroted whatever these highly opinionated epidemiologists (Ferguson, everyone at the IMHE, etc) were saying, without mentioning the negative externalities associated with lockdown, except in passing in a way that implies that economic damage will be constrained to shareholder returns (which is completely false).

I hope you don't mind if I copy-paste a section from a piece I've already written that goes into this a bit. The TL;DR is that social isolation leads to worse outcomes, regardless of emotional loneliness. Also on the contrary, I think you are "underdoing" the social isolation point and are underestimating the extent to which this has affected everyday citizens. Keep in mind that there are some people here in the US that have literally not left their houses for the last two months except for maybe a weekly grocery store trip.

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Finally, we need to examine the effects of social isolation itself. Beyond the fact that social isolation prevents the natural exchange of microbes that occur between humans engaging in social contact, it should be noted that social isolation is directly thought to lead to increased all-cause mortality due to worsened health outcomes across pretty much every dimension that we can examine. One review (https://www.pnas.org/content/pnas/110/15/5797.full.pdf) of the impacts of social isolation and loneliness in older adults concludes that “mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08–1.48 for the top quintile of isolation), but loneliness did not (haz-ard ratio 0.92, 95% confidence interval, 0.78–1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model”.

It’s now popular to refer to what was previously called “social distancing” as “physical distancing” to note the fact physical distancing does not necessarily lead to loneliness; this is because loneliness can (perhaps) be mitigated to a limited extent by usage of social media and videoconferencing. Troublingly, we can see that it is the social isolation itself, and not the emotional feeling of loneliness, that is associated with death, and thus we can surmise, at least in older adults (but almost certainly in the broader population as well), that the widespread recommendations of social isolation (“stay at home”, “social distancing”, etc) will lead to increased all-cause mortality.

Finally, we wish to highlight that a small increase in all-cause mortality amidst the general population due to social isolation could very easily dwarf COVID-19-associated mortality, which as we have discussed is primarily constrained to a very limited subset of the population.

> You say it isn’t saving lives, so what do you think it is?

I think that they intend to save lives but that their understanding of the SARS-CoV-2 pandemic and the best way to address it is so overly simplistic that the myopic policies they are instituting are going to lead to larger mortality over the long-term. Which is the pattern we see at the broader scale as well when we examine the US' response to the pandemic.

So, like I implied above, their intentions are good, but intentions are largely worthless.

> ..because CA locked down in a timely way. How do you know hospitals wouldn't have been overrun otherwise? They were in some places (Italy). This is playing out in real time after all, and nobody has a crystal ball, especially not Elon Musk.

Well, New York is a great comparison, but let's pretend that the lockdown did avoid an overrun in California and that otherwise it would have happened.

As I indicated, given that the vast majority of these (highly important) elective surgeries are out-patient, there is not a huge need to plan ahead when it comes to suspending surgeries. On the contrary, when we do realize that we are at capacity we can suspend elective surgeries at that moment and no sooner.

BTW, the utility of elective surgeries should always be counterbalanced against the utility of extra beds for COVID-19 patients. Many of these elective surgeries are still more important than COVID-19 treatment even when we hit an overrun scenario. So it very much depends on the surgery in question, and such blanket suspensions are a very bad idea.

> Now, there are early indications that reopening is resulting in new outbreaks, like at the night clubs in South Korea.

Right, which is precisely why the practice of indefinite containment is so flawed. Once you start doing it you can basically never stop (until you've teched up to a vaccine / game changer treatment)

Yes, but my position is that the following externalities are equally or indeed more important to be mindful of:

- worsened COVID-19 outcomes due to social isolation

- worsened COVID-19 outcomes due to fear of going to a hospital (this is a real effect)

- worsened all-cause mortality due to social isolation and a culture of widespread fear

- worsened mortality attributable to mass unemployment (note that some small portion of unemployment would have happened without lockdown but the vast majority of damage is self-inflicted and thus directly attributable to lockdown)

- worsened quality of life (the missing link that lockdown proponents tend not to address) amidst the entire population

- externalities that occur when suspending in-person education, such as the widening inequality gap between students whose parents can afford to buy them personal computers/laptops/tablets and those whose parents cannot.

- shifting to a global perspective, the impending global food shortage is predicted to make COVID-19's mortality look like a drop in the bucket

Finally, I'd like to point out that COVID-19 deaths here in the US are dominated by the extremely elderly which implies (but does not prove, of course) that our lockdown policies were ineffective at protecting the at-risk groups that we should have been focusing on the whole time

> This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd.

You're right, that was my mistake. I got a rough 20 million life-years by taking Ferguson's worst-case scenario and then applying the "COVID-19 takes average 10 years of lives" claim (which is a false claim). Thus arriving at the implied scenario that lockdown proponents say could happen but that I think is an impossible to reach number.

(For context I use Ferguson's 2.2 million as an upper bound, but that 2.2 million scenario involves an overwhelming portion of the deaths being people who were already at death's door. Thus I think 2.2 million is possible but highly unlikely due to the other factors I mentioned, whereas the 20 million life-years figure I view as basically impossible to hit because it implies that same worst-case scenario but with the wrong distribution of age)

At that point I thought to myself "wait, I forgot to account for the negative externalities". But as you indicated, that logic was wrong.

So, allow me to retroactively change my answer to just 20 million life-years period.

Thanks for pointing that out.

> It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought.

No, I understand their criteria but fundamentally disagree with the entire approach of containment, as I explained in the GP comment you replied to.

> This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years).

I don't believe that the US can use the same strategy that China, South Korea, or Taiwan has been using. They have much better control of their borders and are a much more homogenous and compliant population.

> No we didn't (collectively shit ourselves)

Agree to disagree on that one :)

> and we did not really heed the lesson that SARS-CoV-1 gave us

Agreed.

> I take it that your term "externalities" (I haven't heard it before) is referring to the side effects eg economic of our attempts to deal with it.

Exactly, see https://en.wikipedia.org/wiki/Externality#Negative. Just keep in mind that the economy is not some abstract notion, but rather is you and me and everyone else. In other words, economic damage isn't something that just hurts rich shareholders, it hurts everyone because there's less wealth.

Suspension of elective surgeries, which happened all over the country here in the US, is one of the best examples of such externalities that were caused by panic and bad policy rather than reality. For example, here in California we suspended all elective surgeries for a month. But we never were close to being overrun, and given that the vast majority of these surgeries are out-patient, there was never a need to pre-emptively cancel them. Lastly remember "elective surgery" sounds a lot like "non-essential work" but basically any pre-scheduled surgery is elective: organ transplants, hip replacements, arthroscopic labral repair (I'm waiting on that one currently), etc.

> Until you know (test, test, test again) that you have actually had the disease then I suspect you will be always looking over your shoulder.

That's why the strategy I advocate for does not rely on the availability of testing capacity, because the goal is not to practice indefinite containment.

If you've decided that you want 80% of society to behave as normal and gradually become infected and recover, then PCR testing loses a lot of its utility. It's mostly useful for clinical diagnostic reasons, to get a loose handle on spread, and finally to use as validation for other tests like serological tests.

> There are many reports of additional snags post infection eg renal problems and lung damage, not to mention the mental trauma.

These post-infection snags are quite rare, based off the evidence I've reviewed. Personally I have observed that so many advocating for lockdown make references to the supposed widespread organ failure, strokes in young people, etc, and the evidence just does not support those claims. These outcomes do happen but they are incredibly rare and given that they are logical results of inflammatory cascades (cytokine storm for example), we see the same outcomes in disease like Influenza that we are not losing our collective shit about.

> not to mention the mental trauma.

I believe the mental trauma caused by the wide-spread panic and fear-mongering is vastly worse than the mental trauma of recovering from COVID-19.

25-50% of people that get COVID-19 are entirely asymptomatic or are paucisymptomatic.

For many, it's like getting the flu.

And for some - significant numbers, but not as many as we're led to believe - it is a horrendous disease that results in invasive ventilation followed by likely death.

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Not quite mental trauma, but fear of going to the hospital has led to people who actually have COVID-19 to avoid getting treatment because they don't realize they have COVID-19 (yet are experiencing serious adverse conditions):

From https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...:

"Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic."

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Now onto real mental trauma:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...

* "Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population."

* "Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend.

And my favorite, a case study of COVID-19 related paranoid delusions in a schizophrenic:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162758/

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Sorry for the massive wall of text.

Let's back up a bit to talk about the two strategies.

(1) Containment lets you indefinitely avoid COVID-19-induced mortality in the short-medium term, at the expense of ongoing, mounting costs to wellbeing and the economy. These costs are certainly non-linear, for example businesses can generally only survive a given number of days/weeks based off their capital expenditure and thus it's not quite as simple as a linear relation. But for our purposes, it's easiest to think of the wellbeing and economic cost as being in direct proportion to how long we spend in containment.

The postponement of mortality only becomes the true avoidance of mortality when we get a "game-changer": a vaccine or a highly effective treatment that seriously improves outcomes.

Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment.

(2) My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. These groups are encouraged to shelter at home and are supported in doing so.

Bans on freedom of movement, transaction, etc are lifted. Non-at-risk individuals are encouraged to return to work. Given that we inflicted psychological harm on millions of individuals, we also would probably want a policy where someone is allowed to not work, but they must formally quit their job in order to be allowed to collect unemployment for up to a year (we likely also need to adjust unemployment because it's just way too high relative to wage earners right now). What we need to avoid is a case where someone "chooses" (in scare quotes because we have done true psychological damage to people) not to work for a year but their company can't let them go, since otherwise the company cannot replace them with a working employee.

So in short, we let people do what they want, we strongly encourage the at-risk to shelter at home and put out appropriate public health messaging in proportion to the real risk (which means overall WAY less fearmongering since we're so out of whack currently).

The uncertainty benefit is something we should implicitly factor in as well. The ultimate end state of my proposal is much more "known" than with containment (because we have no bound on containment worst-case scenario but we can use Ferguson to get a decent bound for mitigation). We're not sure how much mortality we will see, but with a 0.9% IFR and 82% of the population being infected we get about 2.2 million deaths per Ferguson (https://www.imperial.ac.uk/media/imperial-college/medicine/s...). I think that's a great upper bound to use.

BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO.

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The last thing I want to say is that I actually think in terms of wellbeing-years or quality-adjusted-life-years, and not just "lives". My belief is that the life of a healthy 12 year old is several times more valuable than the life of an 80 year old with heart disease, to use an example.

So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.

> Let's take this concrete example. Say there is some worker in this factory. They don't want to go to work. They don't feel safe. Now they are torn between two authorities. What happens if they do show up? What happens if they don't show up? Will they be seen as "not a teamplayer"? Will their career stall out compared to their yes-men colleges? Maybe even get fired without any cause given. Half a year later so as not to make it obvious?

Yes, I think pretty much exactly that would happen. (I'm not super up-to-date on the CARES act or other legal measures that they might be able to take, or if unemployment pays out to people who "quit" their jobs currently, so there's a small chance that those are options)

However my conclusion is that's an example of why forcibly shutting down businesses was a terrible idea in the first place and never should have been done.

But yes I totally agree, our governmental systems are not set up to handle these questions.

I must confess that when the "flatten the curve" meme started spreading around and the initial 4-5% case fatality rate and 20% hospitalization rate numbers were being given, that I actually believed in flattening the curve and thus initially supported the lockdown. I should have known at the time that the goalposts were going to be moved. In retrospect it's incredibly obvious.

> Somehow halting the production of luxury cars for a few more weeks, with the explicit intent of trying to save lives, doesn't seem like an injustice to me.

Forgive the cliche, but the road to hell is paved with good intentions.

"Trying to save lives" is the new "think of the children". It's the same mentality that gives us legislation like the EARN IT act.

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The question we should ask is, (1) has the government provided a reasonable justification for placing such limits on commerce, freedom of movement, etc. And (2), is the strategy we're pursuing, from a public health perspective, the right one?

My answer to both (1) and (2) is "hell no". The rules our government has ruled out are arbitrary and capricious and are largely based on superstition. Case in point: closures of public parks and beaches.

Arguing (2) is out of the scope of this comment but suffice to say that my belief is the negative externalities introduced by our COVID-19 response are far, far worse than COVID-19 itself.

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FWIW, I am not a fan of Musk in general. I am inherently suspicious of people that are trying to save humanity. As we have seen with Musk - for example, how Tesla factory workers are treated in the pre-COVID-19 era - because he is working tirelessly to save humanity, he is willing to sacrifice actual humans to achieve his goals. Because after all, in the scheme of things, if you're talking about fighting existential threats like climate change or being stuck on one planet, what's the cost of even 100,000 human-lives' worth of wellbeing in comparison? It's not even close.

But when it comes to COVID-19, I absolutely think Musk is right. Yes he has made some absolute asinine comments/predictions but his general points about suspension of civil liberties, and statements that COVID-19 is not nearly as lethal as we were told...all of that is totally true in my book.

> When the term exponential heaves into view then we should quite rightly shit ourselves and do as we are told.

And yet we didn't collectively shit ourselves to nearly the same extent for any of the other novel viruses that have popped up in the last couple decades and spread exponentially.

Exponential spread is the default state of things. It's only when a virus becomes widespread in a population that the exponential spread ceases, as you indicated in your reference to R.

To use a contrived example: Imagine a new virus SARS-CoV-1337 with an R of 250 and an infection fatality rate of .00000001%. Would it warrant the response we've made to SARS-CoV-2? Clearly not.

Therefore we need to look at the actual outcomes associated with the virus, and then counterbalance those against the externalities introduced by suppressing spread. Implicitly everyone in favor of lockdown is assuming that the mortality avoided by hunkering down until a theoretical game-changer (vaccine, highly effective antiviral, monoclonal antibodies etc) is available at scale, is a bigger benefit than the negatives incurred by trying to prevent spread (lockdown/containment).

My personal opinion is that the externalities of our current approach (I'm speaking from a US-based perspective) far exceed the cost of COVID-19 itself.

I really think that the word "billionaire" needs to stop being used as a bad word.

Billionaires are citizens too. They are bound (imperfectly) by laws. Therefore they too encounter situations where practicing civil disobedience makes sense.

The burden of proof is on the person claiming the widespread organ failure. I can't provide a study saying it doesn't happen because there's not studies saying it does happen for those studies to debunk :)

But, here's one group of case reports that is commonly held up as evidence of the supposed strokes in young people / widespread organ failure / etc:

"Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young" - https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...

EDIT: Oh, or were you referring to sources around the impacts of systemic inflammation? I can certainly provide those if you're interested.

To be clear, I've been talking about NY because it's the classic example of hospital overrun. So talking about prevalence in the rest of the country is irrelevant.

> And the efficacy of the antibody tests has proven problematic.

This statement is too vague to be of use. You should probably try to debunk specific serology studies rather than making hand-wavey dismissals..

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(BTW I didn't respond to your other comment because it was in very bad faith as far as the "sacrificing at the altar of herd immunity" comment goes)

> The risk of COVID to me is low. The risk to society of me going about my daily business as if nothing has happened is high. There are social adjustments that do little to reduce my risk, but decrease overall risk, and unsurprisingly, people who don't understand, or don't care about the difference between the two, push back on them.

This is not a fair characterization. Rather, it could be said that the externalities of suspension of elective surgeries, widespread business closures, widespread social isolation and unprecedented fear (which is certainly disproportionate to the risk, _even in those with comorbidities_), are all factors that those who are parroting the "Stay home!" party line are neglecting.

I don't think it's fair to say that those who argue against the path we've taken are doing so because of their purely personal risk factors. When highly interconnected systems - like the global supply chain - unravel, it's very hard to predict the full ramifications there. It might be good to start with the impact of these lockdowns on the global food supply and the estimates of 100+ million extra cases of starvation. (I generally try to focus on other factors because quite frankly, to flip your rhetorical technique around, I think that many in favor of these lockdowns don't really care too much about how lockdowns impact conditions in third-world countries and thus I largely try to talk about the direct first-world impact).

I don't think those in favor of lockdown are trying to do harm, their intentions are good. But the poor understanding of key concepts such as _what an economy actually is_ is leading to a number of irrational statements being made: for example, the argument that re-opening business is "trading human lives for money". The actual reality is much more nuanced.

While on the contrary, perhaps it's just been in my online interactions, but arguing against lockdown/indefinite containment is consistently characterized as either motivated by self-interest or due to the perceived personal risk being low. In essence, the "you clearly don't care about old peoples' lives" argument.

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I've been doing a pseudo-experiment where I've been asking acquaintances of mine what they think the overall infection fatality rate of COVID-19 is, and also what they think their personal risk is. Everyone I've talked to has overestimated the mortality risk both to others and to themselves by an order of magnitude. For example, many have told me that they think the infection fatality rate is 2.2% overall, or 4-5%, etc.

In one case a largely healthy young 20-something estimated their personal risk of death at 2%. That's multiple orders of magnitude off.

This pseudo-experiment of mine proves nothing, but it's an interesting insight into what people think. (Many of my social groups are very transparently "liberal"-leaning and disproportionate panic in the US is split on party lines so that's not very surprising).

> but it turns out that COVID causes multiple organ failure, treating which needs a wider range of facilities, and can progress very quickly from respiratory symptoms to that, so they aren't actually much use.

Just to be clear, COVID-19 contributes to organ failure in very limited cases from a statistical sense. So this is absolutely something that is happening, but just wanted to be clear that we are not seeing hordes of people keeling over from strokes, organ failure, etc.

It's known that the complications that come into play when the body has entered a cytokine-storm type state are very far-reaching. For the same reason that inflammation is a critical part of the healing process, systemic inflammation can cause incredible damage to organs and other physiological systems.

The risk of the second wave is precisely the indication that our indefinite containment strategy was fundamentally flawed. We didn't actually avoid mortality in a permanent sense, we just postponed it. Which is why many on the side that you are advocating for are beginning to express the notion that we need to be on guard for the next _months-years_. Not just the next _weeks_.

As briefly as possible: Containment only has real utility if we can develop a game-changer that drastically alters COVID-19 outcomes, and that we don't have to wait so long for it that lockdown-induced mortality eclipses the time-adjusted benefit. It's a risky strategy that requires waiting for an uncertain, temporally-unbounded event, which in turn means that the "indefinite postponement" strategy incurs unbounded cost. We simply don't know enough to make definitive predictions about upper bounds on time-to-discover-incredible-treatment.

Whereas in a no-lockdown, natural herd immunity strategy, we are experiencing a fairly well-bounded spike in short-medium term mortality. I've been using Ferguson's 2.2 million figure for the US which is based off 82% population infection with an IFR of 0.9%, with the population equally susceptible at the physical level (behavioral differences are modelled, I believe). That's an excellent upper bound, it's certainly not the mortality we should _expect_. So we have a much tighter certainty, we will experience somewhere between 200,000-2.2 million deaths due to COVID-19.

When weighed against the alternative, which again is to incur unbounded risk from lockdown-associated mortality, the correct path becomes quite clear in my opinion. A very marginal increase in all-cause mortality in the whole population could very easily offset the spike in COVID-19 mortality which is constrained to fairly limited subsets of the population overall.

Just to be clear, the epidemic only "burns out" when somewhere between 50-90% of the population has immunity. Almost certainly closer to 80%+ unless we discover that a significant portion of the population is resistant to infection due to genetic differences or possible cross-immunity with other milder human CoVs.

By suppressing the transmission of this virus, we have failed to build immunity in most of the population. As a result any serious lifting of suppression measures will lead to moderate-severe outbreaks.

On balance, I believe that the most effective method is to resume life as normal, and focus on encouraging the at-risk to shelter, along with providing them appropriate government support. Whereas the approach we've taken has destroyed our economy in a very real sense, which will increase mortality even in the absence of a global food crisis.

The suspension of elective surgeries on a broad basis was very clearly a mistake, but unfortunately it's the type of mistake that no-one will admit was a mistake.

We postponed absolutely important surgeries as a result of this, even in areas like, for example, my county in Central California, which has very low prevalence of COVID-19. Here in California we "only" suspended elective surgeries for a month and now have a backlog that we're still working through.

So, just to say it explicitly: the fear that "things will never be normal again" is unfounded, at least in those who are operating off a mental model wherein COVID-19 is 10x as deadly as we previously thought.

The fact that we chose a strategy of indefinite postponement was our mistake. Because now people are beginning to realize that if we "go back to normal" then "the lockdown was for nothing". I consider this to just be a sunk cost fallacy, I believe quite frankly that ultimately the lockdown "was for nothing" (that is to say that, at the time it may have been justified based off the projected numbers, but with what we know now we should know that we only shot ourselves in the foot).

TL;DR: I believe that we need to resume normal operation of society, and make strong efforts to protect the at-risk. Trying to indefinitely postpone exposure to COVID-19 is a loosing battle. We've adopted a strategy of indefinite containment/postponement that relies on hunkering down and waiting for a _temporally unbounded event_. Given that lockdown-associated damage increases the longer containment is maintained, we are trading off a linear component of damage for a speculated future improvement in outcomes due to vaccines/a game-changer treatment. That to me is eminently foolish.

Most decision-making heuristics don't just try to blindly increase expected value (decrease expected loss) but also factor in uncertainy. In general it's acceptable to trade off a little EV for a lot more uncertainty. (Unfortunately in the case of the lockdown, I believe we incurred -EV along with far more uncertainty, for a net loss across all dimensions)

I think it totally makes sense why you would feel that way.

I do want to mention that we know that somewhere between 25-50% of COVID-19 cases appear to be entirely asymptomatic (as opposed to pre-symptomatic). So almost half of people who get it won't even realize it, of those with symptoms, only a small fraction will go on to experience the serious respiratory issues that characterize COVID-19.

So it makes sense that you know first-hand how horrible breathing problems are. But I just wanted to be clear that, it's actually not irrational for someone to not want to stay inside for months to avoid a disease that in their specific case would almost certainly be mild. It just goes into what a person's priors are.

And yet, a large part of the reason we weren't overrun is because our initial estimates of hospital beds and ventilators needed were far too high on a per-infected-person basis.

So yes, we definitely cut down transmission, but it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation; other clinical outcomes result in either the individual dying quite quickly (imagine a nursing home patient with multiple comorbidities), or in the patient recovering in 1-2 weeks. But there's that uncanny valley of people healthy enough to not immediately die but in bad enough shape that they need these aggressive interventions.

This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally. It also makes it easier to centralize the resources where you do need it. For example it's much more feasible for government programs to handle food delivery, grocery delivery, and all these other logistical concerns when you only need to provide it for 10-40% of the country as opposed to 80% of it.

Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago, which does mean that there was room for another doubling or too before transmission started naturally slowing down to a noticeable extent. So we absolutely could have had a lot more patient volume, but again the # of hospitalizations/invasive ventilation cases is much more related to the # of vulnerable people infected as opposed to the number overall.

(The classic argument here is that by fighting transmission in all members of the population, that the at-risk are better protected. For a number of reasons I think such an approach is misguided but I won't go into the full argument against that here)