
Has the Covid-19 response gone too far? - pseudolus
https://www.cbc.ca/news/health/coronavirus-covid-pandemic-response-scientists-1.5502423
======
salex89
As far as I'm concerned, no, it hasn't.

Writing from Serbia. At this point we're at around 105 confirmed ill, 0
deaths. My fiancée is an MD directly involved in trying to contain the spread.
In out of the ordinary conditions people just lose common sense. Just think
about driving in the rain. That's relatively benign, but when raining I just
can't fathom sometimes WTF I'm seeing. Imagine something like a pandemic with
yet unknown consequences and spread trend. We've seen hoarding, conflict,
disregard towards public health, panic, leisure, the works...

The current action items are: \- No going outside for anyone older than 65 \-
Curfew from 20:00 to 05:00, with a possibility to prolong it \- Closed borders
\- Airports shut down \- No transportation between cities \- Heavily limited
public gathering \- Military given law enforcement jurisdiction over civilians
\- Schools and universities shut down

And you know what, even with this measures (although I think they are late),
it's still very hard to put sense into people and grab this thing by its neck.

Disclaimer: These measures are controversial in the country, because of the
current (autocratic/oligarchic, opaque) political setup, which I am not fond
of. There is a lack of transparency in this situation, also. But would I
choose any different if asked ? Probably no.

~~~
majkinetor
Carantine has its own down sides. It may very well finish as worst solution.
Massive H1N1 vaccination decade ago also had its own problem [1] and we are
talking here about bunch of other things: effects on economy, domestic
violence, etc.

[1]: [https://www.sciencemag.org/news/2015/07/why-pandemic-flu-
sho...](https://www.sciencemag.org/news/2015/07/why-pandemic-flu-shot-caused-
narcolepsy)

------
theologic
1\. The Ioannidis article is published here. It's a quick read.

[https://www.statnews.com/2020/03/17/a-fiasco-in-the-
making-a...](https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-
the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-
data/)

2\. Quite frankly, his argument makes little to no sense to me. He throws out
numbers that are exceptionally low.

Italy or Iran seems to be obvious experiments showing that no mitigation is a
real issue. And we have alternative real world experiments. I worry that in
our attempt to make sure we have validate models, we need critical thinking,
not just "nobody knows."

Ioannidis wrote:

"If we assume that case fatality rate among individuals infected by SARS-CoV-2
is 0.3% in the general population — a mid-range guess from my Diamond Princess
analysis — and that 1% of the U.S. population gets infected (about 3.3 million
people), this would translate to about 10,000 deaths."

~~~
fmjrey
Iran's death rate must also be seen in the light of its war with Iraq that
started in 1988 and left much of the now 60+ people with poor lungs [0].

[0]
[https://en.wikipedia.org/wiki/Iran%E2%80%93Iraq_War#Iraq's_u...](https://en.wikipedia.org/wiki/Iran%E2%80%93Iraq_War#Iraq's_use_of_chemical_weapons)

------
pseudolus
Ioannidis paper: [https://www.statnews.com/2020/03/17/a-fiasco-in-the-
making-a...](https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-
the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-
data/)

Lipsitch response: [https://www.statnews.com/2020/03/18/we-know-enough-now-to-
ac...](https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-
decisively-against-covid-19/)

~~~
acqq
Also, the graphics from Italy, 5 days ago:

[https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...](https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F_ENG.png)

The x axis is a week number, the bars represent the numbers of cases and dead
per week.

And now it's worse: they already have more dead than China has, and the
increase of number of cases and dead still doesn't slow down enough, in spite
of the measures that they started to apply (the lockdown of some areas since
February 22, of the whole country since March 10).

Approximately the number of dead at the moment doubles every four days -- if
that continues for only one month more there will be a half of million who
have died, and then 4 days later, a million. That's how fast that goes.

Regarding the "we don't have data" claim: it can seem to be true only when the
US intentionally ignores the information coming from the rest of the world.
There are indeed countries that have made orders of magnitude more tests than
the US (making the number of tests performed in the US mostly irrelevant for
this discussion) and the resulting growth of numbers of cases and dead are
very steadily independent of the number of tests done, which means that the
only numbers that matter are the growth numbers, i.e. that the numbers of
cases can't be an artifact of the measurements.

There is no indication whatsoever that the growth speed can change without
applied measures.

The data is available, one just has to want to use it.

~~~
war1025
Something interesting I heard tonight, that I hope someone will look into
more, is that there were reports from Italian doctors way back in October /
November timeframe of a "strange pneumonia affecting predominately the
elderly".

The implication was that coronavirus has been in widespread circulation for
longer than people realize, which they theorized was part of why Italy has
been unable to contain it.

Normally I'd just dismiss that as rumor, but it was on NPR, and I feel like
they normally at least try to filter out the complete nonsense.

~~~
acqq
Look at the graph from my parent message again -- that info that you cite
(coronavirus being active in November) would completely not match what we
already know. We know extremely good how fast it spreads and how fast people
start to die:

[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_c...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_cruise_ships#Diamond_Princess)

"On 20 January 2020, an 80-year-old passenger from Hong Kong, China, embarked
in Yokohama, and disembarked in Hong Kong on 25 January. On 1 February, six
days after leaving the ship, he visited a Hong Kong hospital, where he tested
positive for SARS-CoV-2.[47][48]"

"On 4 February, the authorities announced positive test results for SARS-CoV-2
for ten people on board, the cancellation of the cruise, and that the ship was
entering quarantine."

"Two passengers died on 20 February[78] and a third on 23 February, all three
Japanese citizens in their 80s.[79] A fourth passenger, an elderly Japanese
man, was reported on 25 February to have died.[80] The fifth fatality, a
British national in his 70s, died on 28 February.[81] A 78-year-old Australian
national, who was evacuated from the ship, died on 1 March in Australia,
making him the sixth.[82] A Hong Kong national from the ship died on 6 March,
making him the seventh coronavirus-related death from the ship.[83]"

With the doubling time of 4 days, if the first case had been dying in November
and nothing had been done to prevent the spread now there would be million of
dead in Italy now.

------
rich_sasha
One thing that did occur to me: if it is mostly the elderly and vulnerable who
get affected, why don't we concentrate the isolation efforts on them, and
allow the rest of the society to live semi-normally.

It's not that I can't be asked to sit at home. Rather:

\- There is a huge economical toll from locking up everyone. And it's
economies that pay for hospitals

\- While everything else is shut, what diseases, damage etc. is done
elsewhere? How many people will die because their lesser-priority illnesses
get forgotten?

\- Would we not be better placed, as societies, to help vulnerable people, if
we remained productive?

\- Do we get best of both worlds of "herd immunity" and protecting those
likely to die?

As a healthy young person I'm fully committed to protecting the vulnerable, I
just wonder if the above is better than an all-out lockdown.

[EDIT: formatting]

~~~
singularity2001
It effects middle-age people as well, it’s just that when mortality rate rises
from 0.01 (flu) to 0.3% in this specific age group it looks much better than
for the elderly with over 10% mortality. 0.3% is still catastrophic and even
those who don’t die can have severe long-term effects (see Netherlands cases)

~~~
rich_sasha
I see, thanks. Makes sense!

------
swat535
Can someone with a better knowledge explain to me what's going on here?

The number of infection is not relevant, shouldn't the number of severe cases
requiring hospitalization be the metric to care about the most?

It looks like this number is drastically lower.

------
logjammin
While I'm not defending the entirety of Ioannidis's argument (he makes a
couple of mistakes; e.g. we know social distancing has some effect), it's
important to point out what his central argument actually is, and how it's
different from how the CBC article that purports to describe it. He doesn't
assert that the policy response has gone too far; instead, he asserts that in
the absence of good data on the pandemic, it's difficult to know whether the
policy response is too much or not enough. In my view, on this point he's
exactly right.

From the actual Stat article:

"At a time when everyone needs better information, from disease modelers and
governments to people quarantined or just social distancing, we lack reliable
evidence on how many people have been infected with SARS-CoV-2 or who continue
to become infected. Better information is needed to guide decisions and
actions of monumental significance and to monitor their impact."

On "we lack reliable evidence": his point is that we don't have what we need,
namely an accurate denominator in calculations of morbidity and mortality. "We
don’t know if we are failing to capture infections by a factor of three or
300." He's not wrong! In epidemiology, accurately estimating, say, case
fatality rates is notoriously difficult - especially in the middle (or the
beginning!) of an epidemic. Given the issues we're all familiar with
surrounding the lack of testing, this should come as no surprise.

On "better information is needed": I don't think it's that far off-base to say
that in the absence of (what asserts is) good data, it's impossible to
calibrate policy responses to 2019-nCov so that you're saving as many lives as
possible while doing as little damage to the rest of society (e.g. economy) as
possible at the same time. This suggestion is eminently reasonable: "The most
valuable piece of information for answering [questions about how many people
will die of the coronavirus] would be to know the current prevalence of the
infection in a random sample of a population and to repeat this exercise at
regular time intervals to estimate the incidence of new infections.".

Ioannidis (a physician and an epidemiologist) has made a career out of
shedding light on science's mistakes and blind spots, and rightly so. I think
the controversy surrounding this piece is overblown: the "fiasco" he's talking
about is not a policy response fiasco, but an "evidence fiasco" \- without
knowing (or, in the US, even attempting to know) the true prevalence and
incidence of coronavirus, it's impossible to say how well we're responding.

 __* Edit / addendum:

Counterpoints to Ioannidis to the effect of "well this is all moot anyway,
when faced with high uncertainty about a really scary thing, you act as
cautiously as possible regardless of the quality of your data" have a lot of
merit. If you're a policymaker right now and you see what's happening in
Italian ERs, hell yes you implement social distancing on a mass scale, maybe
full lockdown / shelter in place, etc.

But these two sets of tools aren't mutually exclusive; we have a lot of smart
and capable people, plus a lot of money, to sic on each. We can allow
policymakers to react strongly and cautiously right now to maybe save lives,
_while also_ setting up the sorts of basic epidemiological studies Ioannidis
calls for: repeated random samples of a representative chunk of a population
(e.g. the US population) with the ability to test everyone for corona
(preferably using multiple different tests) in order to accurately estimate
the denominator.

~~~
DougN7
I want to know how social distancing can work in the long run. Obviously it
slows the spread, but until 60-70% of the population is exposed (200+ million
in the US), we won’t have herd immunity. That means we’ll still be fighting
exponential growth.

So how long will it take to expose 200 million people? At 10 million a month
(horrific!) it will still take two years. No country can afford to spend $1
trillion every quarter to prop up the economy. I’m afraid social distancing
merely delays the awful inevitable.

~~~
ericb
If the recent study that 90% of people can be virus free after 6 days of
hydroxy choloroquine and azithromycin holds up, it seems like we could get
through things much quicker than all that.

~~~
blaser-waffle
choloroquine is not a trivial drug. large amounts of it can have ugly side
effects and can be quite toxic. exposing everyone to the virus and then
slamming them with choloroquine is not a viable option.

~~~
ericb
Agreed, but most of the side effects go away once you stop treatment, or only
occur with long term use.

------
majkinetor
I suspect that certain pharma drugs given to elder people for cardiovascular
and diabetes diseases may be in part responsible for current state. The
similar thing was probably partly in effect a century ago with aspirin and
Spanish flue.

~~~
orwin
Anti-inflammatory medication is responsible for some of the death, and NSAID
are often taken by people with diabetes (joint pain and stuff like that).

Still, uncontrolled glycemy + covid19 will likely put you to ICU, NSAID or
not. If you have diabetes and controlled glycemy, (+ you're young and did not
consumme NSAID), you're likely to come out OK.

~~~
majkinetor
You are puting it mild. Those people are often on bunch of drugs concurently:
ACE inhibitors, NSAIDs, anti-inflamatories. Many of those drugs deplete
essential nutrients such as Zinc, vitamin C etc. Maybe that is the dominannt
reason why older folks have such incidence. I wonder what are the stats for
old & healthy (rare thing indeed, but not unheard of).

------
blauditore
What concerns me the most is that many people fail to take a balanced stance.
It seems I only hear extreme opinions, but perhaps this has to do with the
fact that those with moderate views are not as loud and involved.

~~~
loopz
I prefer informed stance, like from pandemic health experts.

------
dang
A thread on Ioannidis' article from 2 days ago:
[https://news.ycombinator.com/item?id=22612591](https://news.ycombinator.com/item?id=22612591)

------
happytoexplain
"Dares to ask" is such an awful, dishonest phrase. It's begging to
derail/mischaracterize the conversation.

------
zozbot234
I'm fed up with this "it's just a cold" meme. If COVID-19 is "just a cold" or
"just a flu", why are ICU's in places like Italy and elsewhere so overwhelmed
with severe pneumonia cases?

~~~
th2020032010
Throw away for the following reasons: this isn’t a point of view I share but I
do know that the emotions will take over on this answer, I like my karma but I
also don’t want this to be available under my original name here for future
out of context quotations.

Maybe the reason is that a large number of the people who are dying today are
already on borrowed time. Consider this as an option, just for a moment. The
medical advancements in the last 100 years increased the survival chances of
many who would not be here already, if not said advancements. Natural
selection exists for a reason. We, as a species, are actively working against
natural selection, definitely on the medical front.

Thus what we are maybe witnessing today is a natural selection in action.

~~~
ironmagma
Natural selection is not something you want a lot of in a human society. We
thrive by protecting our weak, it is what allows us to have a diverse
population that can focus on becoming smarter instead of stronger. This is why
we have nurturing parents and loving relationships instead of the models
adopted by other species.

~~~
th2020032010
Yes, I agree. But it seems nature thinks different.

~~~
loopz
So let's provide the virus all the hosts, so it can mutate in every kind of
way?

~~~
StavrosK
Let's just stop all medicine, apparently, since all it does is "prolong the
life of the weak". What infuriating drivel.

~~~
loopz
It says something about what drives many people today unfortunately.

------
lmilcin
I think people should have right to their opinions but voicing some is
sometimes just plainly dangerous.

Yes, we know it works. China has allowed the disease to spread, yet they have
instantly turned it around by introducing extreme measures. Just watch this
very informative piece:
[https://www.youtube.com/watch?v=mCa0JXEwDEk](https://www.youtube.com/watch?v=mCa0JXEwDEk)

If you are not convinced extreme measures are worth it, just take a look at
Italy which still can't get a grip on its population the way Chinese
authorities were able to (being authoritative state has some advantages
sometimes).

The plague has barely started and they already ran out of space to keep
bodies.

If you are of another opinion (that it has barely started) the current
statistics show that only half of percent of population is diagnosed
([https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/))
and if you look at logarithmic graph it barely shows any signs of slowdown.

We know there are some asymptomatic cases but only at most 3-4 per one
requiring hospitalization which means at most 2-3 percent of population is
actually ill. So yes, it just barely started.

South Korea is good example where early, aggressive hunting of cases before
they spread brings good results, there was an article on HN recently.

For this reason I think educating people that this is serious matter and we
should all refrain from doing things that can spread the disease, if not for
our own health then for public safety, is everybody's responsibility now.

This does not mean we have to panic. We just need to understand what is and
what is not reasonable prevention. Think about this: if everybody stayed home
for two weeks this would mostly be over.

I understand we can't all stay home. Not everybody has a job that allows it.
But a lot of people can and the ones that have to move around can do a lot of
sane things to make it much harder for disease to spread.

~~~
dilyevsky
It’s not two weeks. If you want to completely eradicate it you need at least
three weeks _after_ number of new cases flatlined completely then clamp
_extra_ hard on any remaining pockets

~~~
lmilcin
That's why I wrote "it will be _mostly_ over". In two weeks most cases would
resolve either way (sorry for being so insensitive..)

And yes, you made an excellent point. The point of not moving around is not
just prevent spreading the virus but it also lets authorities to clamp down
and focus on remaining pockets, which is just as important.

------
jvanderbot
Don't say this. I want the world to learn that mass white-collar work-from-
home is not debilitating.

~~~
creato
I hate to break it to you, but this event as a whole is almost certainly going
to be debilitating. WFH advocates will be lucky as hell if this event isn't
used to say "WFH doesn't work" for decades.

Personally, I'm WFHing now and I don't like it. Many things are more of a pain
in the ass to get done despite me having access to top quality tools to do
them with, and many day to day things are much harder and slower to do (quick
chats with coworkers about work tasks).

~~~
jvanderbot
We're certainly facing economic ruin. But it is caused by shelter-in-place and
mandatory closings. Those businesses set up for, supported by, and easily
pivoting to employees who work from home will suffer less damage than those
that require (by policy or nature of work), on-site staff. This is why I'm
hopeful that WFH will be seen as a net positive, because it is a distributed
system more difficult to knock out.

WFH will not stave off economic ruin from COVID-19. But it may save many
businesses from closing.

------
hnburnsy
From the UK...

'As of 9am on 19 March 2020, 64,621 people have been tested in the UK, of
which 61,352 were confirmed negative and 3,269 were confirmed positive. As of
1pm 144 patients in the UK who tested positive for coronavirus (COVID-19) have
died.'

So that 5% positive and 0.2% death rate of those tested. Seems likely that
they would only be testing the worst cases.

When I see data like this but see estimates in the news of 1-2 million deaths
in the US it makes me shake my head.

~~~
greedo
Your numbers are far off. The death rate (CFR) isn't based on the number of
people tested, but of people infected. That's currently at 4.4% for the UK.
The UK has roughly 68M citizens. If 5% get infected, that's 3.4m cases. Of
those, (assuming the current CFR), 150K will die. Additionally, over 600K will
require hospitalization for around 2 weeks. The NHS has been stripped of
funding for decades, and is in no condition to handle that load.

~~~
hnburnsy
Not my numbers, but why do you and I guess others think 5% will get infected
when only 4.4% of the worst cases are testing positive? Wouldn't sampling the
random population result in a significantly lower positive rate?

~~~
zzleeper
"worst cases are testing positive" ?????

Most tests are on healthy people that were close to positive. If the R0 is as
high as they say (2-4) then most people (60+%) will get it.

~~~
hnburnsy
Testing Criteria in UK...

\----------------

2.1 Patients who meet the following criteria (inpatient definition)

requiring admission to hospital (a hospital practitioner has decided that
admission to hospital is required with an expectation that the patient will
need to stay at least one night) and

have either clinical or radiological evidence of pneumonia or

acute respiratory distress syndrome or

influenza like illness (fever ≥37.8°C and at least one of the following
respiratory symptoms, which must be of acute onset: persistent cough (with or
without sputum), hoarseness, nasal discharge or congestion, shortness of
breath, sore throat, wheezing, sneezing

[https://www.gov.uk/government/publications/wuhan-novel-
coron...](https://www.gov.uk/government/publications/wuhan-novel-coronavirus-
initial-investigation-of-possible-cases/investigation-and-initial-clinical-
management-of-possible-cases-of-wuhan-novel-coronavirus-wn-cov-infection#inp)

~~~
acqq
> Testing Criteria in UK...

And? The specific testing methodology doesn't prove that the speed of new
people getting sick and die will change anytime soon without establishing very
strong measures, which is the only information that you need to know.

Calculate yourself the speed in any country, not just the UK. See the numbers
6 days ago, see the numbers 3 days ago, see the numbers now. How many days is
the doubling time? Three days. What does it mean? The factor of 2 ^ 10 in 30
days: one thousand TIMES more cases needing hospital in four weeks.

Some numbers now show (with big measures introduced!) 4 days. That reduces the
factor to around 200 TIMES more cases needing hospital in four weeks.

There aren't that many hospitals in the world.

Nobody can conclude from the available data that it doesn't spread that fast,
as it's consistent across many countries and different amount of testing, it
can be concluded just that the virus still didn't spread across all the places
it could, and that it's an interest of everybody to stop that spread.

------
scotty79
> "... Tell people to stay at their homes, get depressed, commit suicide,
> domestic violence. Who knows? Child abuse, children losing their education,
> ..."

This is so funny. It kind of reminds me warnings about anticipated dangers of
early trains:

Critics of early steam-spewing locomotives, for example, thought “that women’s
bodies were not designed to go at 50 miles an hour,” and worried that “[female
passengers’] uteruses would fly out of [their] bodies as they were accelerated
to that speed”—which, for the record, they did and will not.

[https://www.mentalfloss.com/article/67806/early-trains-
were-...](https://www.mentalfloss.com/article/67806/early-trains-were-thought-
make-womens-uteruses-fly-out)

~~~
ggggtez
So you are saying that you know for certain that keeping children home from
school... _cannot_ deprive them of an education? And keeping billions of
people home, unable to socialize for months, with no end in sight... won't
increase depression and anxiety? I'd like to know how you came to those
conclusions...

Frankly, the discussion about trains has nothing to do with anything, and
should be disregarded. "Once upon a time someone was wrong about something,
therefore this person is wrong about an unrelated thing" is silly.

~~~
scotty79
I'm pretty sure kids will be fine despite spending more time with their
parents. Vast differences in educational requirements of different countries
assure me that possibly whole years of primary education are worth nothing.
Besides, main concerns when it comes to closing schools clearly showed that
schools are not so much places of education but most importantly storage pens
for children so they don't bother their adults.

People who seek knowledge have internet.

And keeping billions at home to socialize just with people who live with them
and with people who they can call and connect through internet won't increase
on average depression and anxiety any more than going out currently does.

I came to this conclusion by living at home as vast number of people do.

His statements reminded me of the train scare because people had wild theories
because they didn't know any better.

This guy should have lived at home and should know it's not some hostile
environment you are barely able to spend a night in but must escape every
morning or you'll surely go insane. Home for most people is the most cozy
place in the world and it's filled with their most favorite people, pets and
items.

