
Is our fight against coronavirus worse than the disease? - hecubus
https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html
======
scout4
_The clustering of complications and death from Covid-19 among the elderly and
chronically ill, but not children (there have been only very rare deaths in
children), suggests that we could achieve the crucial goals of social
distancing — saving lives and not overwhelming our medical system — by
preferentially protecting the medically frail and those over age 60, and in
particular those over 70 and 80, from exposure._

Finally, some sanity.

The over 70 and chronically ill should be quarantined and provided with
hydroxychloroquine + azithromycin, and the rest should "social distance" those
at risk, but otherwise go about their business. That way the virus spreads
quickly among the less at risk, they suffer no or minor symptoms, and develop
herd immunity.

~~~
slowmovintarget
Except that children can spread it faster among caretakers that have contact
with the elderly. Many of those caretakers, like people my age, either have
young children (like me), or are in contact with people who have young
children.

It also turns out that certain classes of drugs can drop the otherwise
statistically less at risk squarely into the grave risk category without their
knowing it. (High BP meds, NSAIDS, others we perhaps don't yet know about).
Going for the "maybe it isn't that big of a deal" approach seems like a bad
idea to me.

~~~
hcurtiss
That has to be weighed against the impacts of cratering the economy, which we
know to be a big deal.

------
wesnerm2
There are a number of reasons why the fight is worth it. \- 88% of the people
who contract COVID-19 develop a fever. \- 20% of the people who contract
COVID-19 are hospitalized-they require oxygen. If they recover, they are left
with 20-30% decreased lung function. \- 6% are critical require ICU.

This virus has different properties from the flu. It actively destroys lung
cells. It's not clear that there is long-term immunity. Concentrated exposure
is very lethal; we have several members of a NJ family die after contracting
the illness during a dinner party. We have only a fraction of the hospital
capacity for all the coronavirus patients and this also hurts ICU patients
with other diseases.

I don't think that we want this disease to embed itself in the same way as the
flu currently does. We can't have this disease mutate each year like the flu
and cull an additional 2% of the population annually over the current annual
death rate of 0.95%. Overnight, this virus would become the leading killer--
more than all other causes combined. The number of people that will die from
this disease compares with major wars.

This is just the first of this type of pandemic. There were other viruses like
bird flu and Zika that didn't have an impact.

This also causes society to reorganize itself to lessen the impact of future
pandemics. Even without the government actions taken, the fear was already
affecting travel and other industries.

~~~
Kinnard
How did you calculate that 20%?

~~~
wesnerm2
[https://www.businessinsider.com/coronavirus-recovery-
damage-...](https://www.businessinsider.com/coronavirus-recovery-damage-lung-
function-gasping-air-hong-kong-doctors-2020-3)

------
nisten
Hmmm, I dont like the article however there is some logic here.

If you are a low risk adult, and if you have the option to infect yourself at
home, you would only have to isolate for 2-3 weeks until you have developed
immunity and are good to go back to work and help others etc...

By not letting young people get infected we're isolating them for way way
longer than they should be and this is extremely inefficient.

However, leaving ethics aside entirely, for that solution to work we would
need self-infection kits for low risk people to use at home which is quite
messed up.

------
mbostleman
The mass isolation approach fails for me on multiple levels. First, why would
you change the way 100% of the things work when all you have to do is change
the way 5% to 10% of the things work? Why not employ levels of isolation that
are proportionally aggressive to vulnerability to serious symptoms or death?
Second, I thought we decided that trying to manhandle nature because we think
we know better doesn't work? Wouldn't we be better off if we let nature take
it's course so that 90% of the population suffers mild flu systems, but gains
some level of enhanced immunity to further protect the vulnerable groups going
forward while at the same time not collapsing the economy?

------
dsjoerg
Subhead is better than headline: "There may be more targeted ways to beat the
pandemic."

Thought-provoking piece.

And if we had much more available testing, what it proposes could be a smart
way to go.

Until we have much more available testing, it's a pipe dream.

~~~
zigzaggy
Exactly. With mass testing options, we would be one solid plan away from
getting back to some semblance of normal life. A combo of taking temp and
testing those with fever, and the quarantining the sick, we could be confident
in being in public again. I know this is critical but how long will we need to
isolate if we don’t get medical intervention? Can our economy survive this
kind of shut down for more than a few weeks?

Edit to say I’m all for flattening the curve, and I’m not a denier. But there
are trade offs going on here. We aren’t rich enough to ride this out for
several months without permanent systemic damage. I think tough questions are
warranted

~~~
DanBC
> A combo of taking temp and testing those with fever,

You can have, and spread, covid-19 for several days before you develop a
temperature.

~~~
zigzaggy
Well I’m hearing most people are going to get it anyway. With tests we can
slow it down. We’re going to have to accept some risk though aren’t we? We
can’t really afford to shut the whole economy down for several months. And if
you look at Italy it doesn’t appear to working that well anyway.

At least with testing we can catch a large chunk of the asymptomatic spreaders
and get control of this thing. But in a few weeks when this fist wave passes,
we’re gonna all have to learn to mitigate risk with good hygiene and accept we
may get it. Testing is our only hope to returning to normal life before we
totally crush our economy.

------
ardit33
Eh.... no... that's what Italy tried to do, (tried to stamp out clusters,
while keeping everything the same and itdidn't work)

Right now they are having massive casualties per day, to almost (if not more)
than ww2, and there is no sign of slowing down yet.

"Italy reports 5,986 new cases of coronavirus and 627 new deaths, raising
total to 47,021 cases and 4,032 dead"

~~~
sparrish
No, Italy's real issue is they're have the oldest population in Europe and the
highest per/capita smokers in Europe. Since Covid-19 hits that demographic
hardest (elderly with respiratory issues), they have the highest mortality
rate. The average age of those dying from this in Italy is 80.

~~~
taylodl
Don't forget the under 55 group are still consuming precious ICU resources.
No, they don't typically die, but yes they're tying up needed resources and as
such are contributing to the overall number of deaths.

------
mooreds
This discussion on HN has some great first hand accounts about the situation:
[https://news.ycombinator.com/item?id=22627636](https://news.ycombinator.com/item?id=22627636)

------
nicholsonpk
One point that stood out to me as odd is that he says family units are
clustering together and that's worse for the elderly/most at risk. He mentions
students coming home from college but aren't they the only major group coming
home that don't live there normally? If people live with their parents and
grandparents then it seems to make sense that working to keep them from
getting infected (ie - keeping K-12 students home, parents avoiding the work
place) is a better course of action than sending them into school and work. If
they've already moved away then they shouldn't be taking this time as a free
vacation to see those people anyway. I'm not sure how you would protect those
at risk people while keeping everyone else in their normal lives. Fill the
hospital beds with them and don't let in the coronavirus infected?

Edit to add: US Population 65 years and over: 16.03% (male 22,678,235/female
28,376,817) (wikipedia)

Total Staffed Beds in All U.S. Hospitals: 924,107 (aha.org)

------
thepangolino
Yes.

Current approach is a disaster.

I would have asked most at risk population to self quarantine.

Cut on red tape for usage of antivirals. (Hydroxychloroquine a proven safe one
said to work has been held back for weeks due to paperwork)

I would have even gone as far as requisitioning private companies to par for
the lack of medical supplies and drugs.

The eroding of civil liberties some EU countries is experiencing is plain
unacceptable.

------
hcurtiss
Why was this flagged?

------
yamrzou
The article asks some legitimate questions that beg for answers:

 _If we succeed in slowing the spread of coronavirus from torrent to trickle,
then when does the society-wide disruption end? When will it be safe for
healthy children and younger teachers to return to school, much less older
teachers and teachers with chronic illnesses? When will it be safe for the
work force to repopulate the workplace, given that some are in the at-risk
group for severe infection?

When would it be safe to visit loved ones in nursing homes or hospitals? When
once again might grandparents pick up their grandchildren?

There are many possible answers, but the most likely one is: We just don’t
know. We could wait until there’s an effective treatment, a vaccine or
transmission rates fall to undetectable levels. But what if those are a year
or more away? Then we suffer the full extent of societal disruption the virus
might cause for all those months. The costs, not just in money, are staggering
to contemplate._

------
ChrisClark
No. It might have been easier if countries reacted in January when it was
obviously going to infect everyone. Now it's too late for anything but a
lockdown.

~~~
CydeWeys
Yup. The surgical strike option is long past viability in the US and many
other countries. There's already way too many cases, and we don't remotely
have enough resources in the form of tests and case workers to track down
active infections and everyone that person has been in contact with.

------
Vysero
The simple fact of the matter is you can't have a significantly long lock
down, that's not possible. If the economy truly fails we all go down. You
think fighting over: toilet paper, hand sanitizer, respirators and testing
kits is crazy? Wait till people are fighting over food, water and shelter.

------
Kinnard
@dang dissenting view points are being supressed, people need access to this
type of analysis

We're killing the 10th man: [https://www.strive.com/post/the-10th-man-
rule](https://www.strive.com/post/the-10th-man-rule)

I spoke to a physician at Yale where Dr. Katz is based: he asked me to copy n
paste the text because it's behind a paywall. _facepalm_

------
onetimemanytime
I am afraid that we will sacrifice (a LOT) and the same people will die
anyway. Let's face it, maybe we'll extend their life by 7 weeks or so. Many
are alive that to millions of dollars in medical support for their last years.

But then no country will just say, "let's let our people die." However, unless
a vaccine is discovered soon enough or the virus miraculously is manageable,
people will be very uneasy.

------
danharaj
This article is almost completely rhetoric, bereft of quantitative analysis
and at odds with what the broader medical community has been saying. The New
York Times really does let any credentialed dingus post shit on their website.

~~~
yborg
The root cause of this article seems to be that it's inconvenient having my
adult kids in the house and how long must this go on.

The idea seems to be to somehow isolate at risk populations (the elderly,
mostly) and resume business as usual. As pointed out by others, it's too late
in the absence of a vaccine to do anything but try and reduce the infection
rate, unless society decides to just let the cards fall where they may and
sacrifice the old and sick.

How long it goes on would depend on the effectiveness of this strategy, and
you can tell be monitoring the infection rate. China claims that it has
essentially stopped new infections after ~3 months, so this doesn't seem like
it will be an indefinite lockdown.

------
bsder
No, because the goal is to buy _time_.

Many things that can create positive outcomes are in motion: vaccines, drugs
to lessen symptoms, testing spin up, etc.

However, all of these things need time to come to fruition.

For example, once we actually have enough tests, targeted quarantines now
work. At that point, we can start backing off the full lockdowns.

However, we're currently in an unchecked exponential growth phase. The only
thing you can do right _NOW_ , is shut down.

Given time, more options may open up. But what we need most right now is
_time_.

------
imustbeevil
I'm finding that the fight against the fight against covid is the most
unnerving.

------
ck2
Even the opening photo caption in that opinion piece is wrong.

There are plenty of 20 and 30-somethings that end up in the hospital from not
being able to breathe.

Our fight is worse because there is no testing in the USA when every other
country has mass testing. If we knew who had it, we could isolate just those
people and the country wouldn't be headed towards recession (hopefully not
depression).

