
A case for ending lockdown - ryankemper
https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown
======
grumple
The premise of this post is extremely flawed:

> Weeks and months later, facts on the ground show that the purported collapse
> of the healthcare system did not occur.

Yes, because we locked down population centers quickly. That's the whole
point. ICUs have still been over capacity though. Without the lockdowns, it's
obvious we'd have a lot more dead people the past month.

> Moreover, this was not due to success in seriously curtailing the spread in
> hard-hit areas like New York, but was rather due to the aforementioned
> discovery that COVID-19, while extremely deadly in certain subsets of the
> population, was not nearly as deadly overall as previously thought.

This is a lie followed by possible truth. New York and other cities were under
pretty extreme lockdowns (all non-essential businesses closed, social
distancing, but most people have been staying inside) for the past two months.
If one asserts that had no or little effect, well... HN doesn't take kindly to
what I'd like to say. Let's just say that you're delusional.

> An analysis of the flawed IMHE model is outside the scope of this article

Ah, how convenient - lying about the effect of the lockdowns and attributing
it instead to (nothing? since ICUs have clearly been over capacity while we've
cut down transmission rates) then ignoring analysis of them.

I didn't really dive into the rest of the article since I don't really like
reading words written by intellectually dishonest people.

~~~
ausbah
this is a good example of people saying the response was overblown, because
the response had its intended effect

~~~
eythian
Yeah, it's similar to (what I'll call because I don't know a real name) the
security guard paradox. If a security guard is doing their job well, then they
shouldn't really be noticed and so seem unimportant. They'll only really be
noticed if they fail in their job (or don't exist at all.)

~~~
viggity
"why do we need to pay a janitor, the bathroom is always clean"

------
ryankemper
If it's not obvious, I wrote this.

The intent is to be a fairly comprehensive coverage of what we know about
COVID-19 and what it means for our policy. Note that the article is written
from a US-based perspective although I suspect it's relevant to a broader
audience.

In general, I believe that the case against lockdown has been highly
stigmatized and thus many people have not been exposed to a convincing
argument of why some of us feel that our response has actually made things
worse.

I encourage any pull requests (see the very final section).

If you're short on time, I'd recommend at least reading
[https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...](https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#section-6-tl-
dr-simple-words-only), which has a readability score (Flesch-Kincaid, etc) of
around a middle school level and is extremely brief and to the point.

For those who have a bit more time but still not enough for the whole article,
I'd recommend at least reading
[https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...](https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#section-2-how-
serious-is-covid-19). In particular understanding the age-stratified risk
distribution, and how it differs from Influenza, is super important. Finally
I'd also recommend checking out the proposal, which ironically is the shortest
section:
[https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...](https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#section-4-pareto-
mitigation-an-evidence-based-approach)

Thanks for any feedback.

~~~
cjhopman
I'm sorry but I can't take serious something that claims to take an impartial
look at all the evidence related to the lockdown but then tries its damnedest
to present all possible negatives it could without doing the same for
positives. For example, there's clear evidence that the lockdown has decreased
lives lost to traffic accidents but that appears nowhere here.

And then when actually looking at it, it's full of pleas to emotion and claims
without any data backing them. Take "Addiction and Overdose", there's no real
data discussed (other than historical data about deaths unrelated to lockdowns
or distancing or economy). Is there no data that supports the implication (if
not outright claim) that lockdown will increase the cost or deaths from
addiction/overdose? For anyone reading this, if it feels like it's a good,
thorough examination you should absolutely discount any points like this where
there's no supporting evidence presented.

Or look at one of the following sections "General vaccination on the decline".
This is a wonderful example of the only looking at negatives. Imagine that flu
vaccination dropped 90% and that flu cases dropped 99%, this thing would
report that as a negative because, "hey, look at how many people aren't
getting vaccinated".

This thing is so littered with bias and lack of facts that it is not useful
for any serious consideration of this. I'm sure it's great for people who
already have their mind set in one direction, though.

~~~
cjhopman
> Specifically, once the proportion of recovered in the population reaches
> 1/(1-R_0), there are no longer enough vectors (infectable indviduals)
> remaining for a serious outbreak to occur. It’s worth noting that this is
> the same principle that vaccination relies upon; vaccination is just an
> artificial way to build immunity without having to undergo a full infection.

I should learn to never read anything from random people working in areas they
don't have any expertise in. This whole section is wrong.

The idea that vaccination and epidemics need the same percent of immunity is
completely 100% wrong. An active epidemic is going to infect way more people
before dying out than the simple, naive herd immunity calculation will give
you. In fact, while an r0 of 2 indicates that you get herd immunity with just
50% of the population, a typical active epidemic with the same r0 would infect
80+% before dying out.

This is clear when you think for about 1 second about it. The `1/(1-R_0)`
value gives you the point where infected people infect 1 more person, it
doesn't give the point when the infection stops spreading.

~~~
ryankemper
I'm sure you're getting weary at this point, but I really need your help
understanding what you're saying here, because to me it seems supremely
untrue.

First, `1/1-R_0`. This is exactly what Wikipedia says:
[https://en.wikipedia.org/wiki/Herd_immunity#Mechanics](https://en.wikipedia.org/wiki/Herd_immunity#Mechanics)

And it makes intuitive sense that once you infect <= 1.00 people, growth is no
longer exponential. So I don't think that point is wrong at all.

> The idea that vaccination and epidemics need the same percent of immunity is
> completely 100% wrong. An active epidemic is going to infect way more people
> before dying out than the simple, naive herd immunity calculation will give
> you. In fact, while an r0 of 2 indicates that you get herd immunity with
> just 50% of the population, a typical active epidemic with the same r0 would
> infect 80+% before dying out.

This doesn't make any sense to me. Vaccination is just an artificial way to
build immunity. So I don't understand your active epidemic point at all. Or
put another way, as the proportion of % recovered goes up, we start
approaching the eventual limit where `1/1-R_0`->1\. That is to say, in your
example we start with R_0 = 2, then as people recover that value slowly starts
decreasing until it hits 1 at the herd immunity threshold. It's not clear to
me what the discrepancy you're detecting is here.

~~~
ruarai
This is called 'overshoot'.

See here for a good explanation
[https://twitter.com/CT_Bergstrom/status/1252077930286444545](https://twitter.com/CT_Bergstrom/status/1252077930286444545)

~~~
ryankemper
Thanks. That was helpful.

So then, it does seem that if we successfully contained the virus, and then
avoided infection spread until a hypothetical future vaccine is developed,
that we could avoid the number of infections required by some amount.

Just to tie it back to the broader lockdown vs not lockdown debate, we could
probably say that a successful full containment strategy+vaccination could
decrease the net area under the curve. As far as policy is concerned I still
think the costs of locking down for that long (particularly given that the
time is unbounded) is not worth it, but that is a very valid point that I will
need to circle back and weave into the document.

~~~
wegs
Well, here's the problem: The statements your making are quantifiably
incorrect throughout the article, and by large amounts. The article sounds
authoritative, but it's not. It's the definition of Internet misinformation.

I think getting your opinion out there is important, but to be honest, the
article needs a heck of a lot more in terms of disclaimers, and much less in
terms of confident statements and grandstanding.

I've worked through the best available data. My conclusions:

1) The economic costs of ending the lock-down may be astronomical. This is
especially true with what we learn about COVID19 and lung damage (or
potentially other organ damage). If even a small fraction of the population is
on long-term disability, the costs go up super-quickly.

2) The fundamental costs of the lockdown are cheap. With reasonable economic
mitigations, the costs should be that everyone upgrades their car, computer,
or similar maybe 6-18 months later, plus an extra 1-5 percent of the GDP.

3) Most of the economic damage of the lockdown, like a cytosine storm, is
self-inflicted: bankruptcies, defaults, layoffs, etc. There are reasonable way
to manage most of those (and the rest require a very modest stimulus). We
haven't taken those steps because we're stupid.

4) If we don't put in systems to manage the economic costs, we'll be super-
vulnerable to the next pandemic.

5) This is something which will come up again, and it's also something which
is a national security issue. Engineering something like the next COVID19 as a
bioweapon is, at this point, within the scope of even poor countries (North
Korea, most countries in Africa, etc.), and there's a Moore's Law where the
resources go down super-quickly (larger organized crime organizations could
probably do this as well now). The point isn't that poor countries are more
likely to do this (they're not), but that with 200 countries in the world, the
odds that SOMEONE is likely to do this are increasingly high.

~~~
ModernMech
> 1) The economic costs of ending the lock-down may be astronomical. This is
> especially true with what we learn about COVID19 and lung damage (or
> potentially other organ damage). If even a small fraction of the population
> is on long-term disability, the costs go up super-quickly.

I have a feeling a lot of people advocating ending the lockdown are doing so
on the basis that only old and infirm people die, as if the other option is
either an asymptomatic infection or a quick recovery from something flu-like.

But I’ve witnessed some very serious infections, so this colors my perception
and pushes me toward continuing lockdowns. To your point, the disease can be
debilitating foR relatively young, healthy people. Have you ever gotten the
flu and then had to re-learn how to swallow after spending a month in the
hospital?

Yes corona is mostly deadly to older people, but even for those who do not die
there are negative health outcomes which impact their ability to work and take
care of themselves. What is the economic impact of that? Why is it not
factored into the cost/benefit analysis of opening up?

~~~
lbeltrame
> Yes corona is mostly deadly to older people, but even for those who do not
> die there are negative health outcomes which impact their ability to work
> and take care of themselves. What is the economic impact of that?

We need to know the incidence of these issues. Response needs to be completely
different in case they're the majority of cases, or if they happen in the
minority.

So far the evidence collected from what I've seen is case reports, so nothing
clear or definitive.

------
stupidcar
What about the situation in northern Italy? In the absence of a lockdown, the
healthcare system _did_ collapse, or came very close to doing so and this was
only averted when the government implemented draconian quarantine policies.

The article claims that the survival of the healthcare system in places that
implemented a lockdown has nothing to do with the lockdown, but then gives no
evidence at all to back up that assertion.

~~~
katktv
I also just have to point out that Sweden, the country that didn't implement
lockdown, has 6 times higher amount of COVID-19 cases than other Scandinavian
countries when adjusted.

[https://www.nationalreview.com/corner/coronavirus-
fatality-r...](https://www.nationalreview.com/corner/coronavirus-fatality-
rate-how-sweden-compares-to-its-scandinavian-neighbors/)

~~~
dxsh
Sweden has much larger nursing homes than, for example, Norway, and most
deaths in Sweden are from nursing homes. The time integral of the curve over 1
year will tell the real story.

~~~
empath75
Most deaths in most countries are in nursing homes. Do we not care if older
people die?

~~~
jacobush
UK also shut down fairly hard and that still didn't stop the spread in nursing
homes. So lockdown does not automatically seem to stop the contagion from
coming into nursing homes.

Makes sense really. Maybe a focused effort should be made to protect nursing
homes.

~~~
pjc50
The UK shut down too late. People at the time of the Cheltenham Festival
(10-13 March) were saying it shouldn't have happened, and now:
[https://www.theguardian.com/sport/2020/apr/29/racing-
ireland...](https://www.theguardian.com/sport/2020/apr/29/racing-ireland-
chief-says-cheltenham-festival-should-probably-not-have-taken-place-horse-
racing)

------
docdeek
> Encourage at-risk groups to self quarantine, and utilize testing to protect
> them...Those with obesity and COPD

Author suggests self-quarantine for the obese instead of quarantine/lockdown
for everyone. The CDC suggests that +42% of the US adult population is obese
[0]. Are we really going to isolate or quarantine 4 out of 10 US adults and
imagine the economy can get back on track?

[0]:
[https://www.cdc.gov/obesity/data/adult.html](https://www.cdc.gov/obesity/data/adult.html)

~~~
ashtonkem
Also, advocates of re-opening vastly overestimate their ability to make that
happen. I don’t feel _safe_ going outside, so any suggestion that for the good
of the economy I should do so will be met with a string of naughty words and
continued quarantine on my part. If they want me to go back out and resume
regular economic activity, they need to focus on what’ll make that feel safe
again.

~~~
hkai
That can change very quickly once the fearmongering on the news stops reaching
you.

Here in Hong Kong, people who were obsessively sterilizing everything and were
scared to go outside 2 weeks ago are now taking off their masks and going to
the beach.

~~~
pjc50
That is not because they've stopped listening to "fearmongering", but because
the thing to fear - new infections - has receded!
[https://www.scmp.com/news/hong-
kong/society/article/3081701/...](https://www.scmp.com/news/hong-
kong/society/article/3081701/coronavirus-hong-kong-reports-no-new-cases-
covid-19-second)

By the sound of it most people are wearing masks most of the time.

(Boilerplate warning about news reliability in nonfree countries)

------
danieltillett
Ryan since you have asked for comments here are some from me.

1\. The true IFR is hard to estimate at this point, but looks to be around 1%.
This is a very difficult question to answer with the data we have and all the
limitations.

2\. There is little evidence that we can reach herd immunity levels of
infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is
too high and the immunity too short lived.

3\. The IFR has a threshold where it dramatically increases when the number of
new cases overwhelms the hospital capacity. We have seen this to a certain
extend in Wuhan, Northern Italy and NYC.

4\. As treatments improves the IFR should fall. This mean if we can shift an
infection to the future we should see less people die. Flattening the curve is
more than just avoiding overwhelming the hospital system, it is also about
shift cases to a time when we have improved treatments.

5\. Sweden has shown that it doesn’t matter if you have an official lockdowns
or not, most people will self isolate on their own. There is little extra
economic damage from imposing official lockdown policies since all the damage
is done by people avoiding infection on their own.

~~~
ryankemper
> 1\. The true IFR is hard to estimate at this point, but looks to be around
> 1%. This is a very difficult question to answer with the data we have and
> all the limitations.

An IFR of 1% seems too high. This doesn't seem to line up with data from the
Diamond Princess (~1% IFR in a population biased towards elderly). We can also
look as a lower bound at the Theodore Roosevelt (the navy ship), which had I
believe 840 positives, 4 hospitalizations, 1 death
([https://www.sandiegouniontribune.com/news/military/story/202...](https://www.sandiegouniontribune.com/news/military/story/2020-04-23/coronavirus-
testing-on-theodore-roosevelt-complete-but-crew-wont-move-back-on-board-yet)),
and this is a population heavily biased towards the young and fit thus why
it's a nice lower bound.

> 2\. There is little evidence that we can reach herd immunity levels of
> infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is
> too high and the immunity too short lived.

The unconstrained R0 doesn't mean we can't reach immunity, it just means that
almost every single person needs to get it, which _to me_ still seems
preferable to years-long lockdown.

But the more interesting point of yours is the part about short-lived
immunity. I'm going to copy-paste a portion of
[https://news.ycombinator.com/item?id=23025880](https://news.ycombinator.com/item?id=23025880)
to avoid repeating myself too much:

I think of immunity simplistically as two components:

(1) The presence of actively circulating antibodies in the bloodstream. This
is what the (oddly controversial) serology studies are measuring. It is
thought that having a significant quantity of these antibodies prevents
infection - i.e., what most people envision when they talk about immunity.

(2) Even after the antibodies have faded, there are still Memory B Cells,
which lay dormant up to decades, waiting for exposure to the characteristic
antigen (in this case, an antigen telling them that they have encountered
SARS-CoV-2), at which point they resume and rapidly scale up production of
antibodies.

The thinking here is that reinfection is likely possible after a sufficient
length of time - whether that's a couple months or a couple years isn't yet
known - but when you do get infected, your immune system will respond sooner,
more strongly, and thus you will achieve a far lower peak viral load meaning a
less serious infection with reduced transmissibility.

So in short, I'd like to see what makes you think the reinfection immunity
window is short, but regardless of the window length, we can hopefully agree
that the immunological memory cells will stick around for a while.

> 3\. The IFR has a threshold where it dramatically increases when the number
> of new cases overwhelms the hospital capacity. We have seen this to a
> certain extend in Wuhan, Northern Italy and NYC.

Agreed. My only caveat is this effect is probably not _as_ dramatic as it
initially looked, but it is definitely dramatic.

> As treatments improves the IFR should fall. This mean if we can shift an
> infection to the future we should see less people die. Flattening the curve
> is more than just avoiding overwhelming the hospital system, it is also
> about shift cases to a time when we have improved treatments.

Also agreed. I thought about paying lip service to this notion but decided to
leave it out of the first draft. Basically my assumption (and it is an
assumption) is that the treatments we discover will do a little bit but not a
lot. So probably what we've learned thus far about proning, managing oxygen
levels etc doesn't leave a ton of room for improvement without a miracle
therapeutic. I think antivirals and other treatments will help a small amount
but not nearly enough to justify postponing infection.

But yes, at this point I think we can say that in a scenario of successful
full containment+vaccine, we would have less area under curve as far as the
"overshoot" is concerned and also to a lesser extent the improvement in
treatments.

> Sweden has shown that it doesn’t matter if you have an official lockdowns or
> not, most people will self isolate on their own. There is little extra
> economic damage from imposing official lockdown policies since all the
> damage is done by people avoiding infection on their own.

I have to strongly disagree with this. In fact I view this as a strong point
in favor of "my" side: we can get the majority of the benefits of the lockdown
without actually locking down.

The magnitude of economic damage is much more than just the demand dropoff.
We've forced closures of businesses that actually would have been able to stay
open. And particularly small businesses which are not well equipped to weather
systemic shocks.

But to be clear, I absolutely agree that even without a lockdown we would see
very sizeable demand drop-off and thus there would still be some sizeable
amount of furloughing, layoffs etc.

\--

Thanks so much for the points. In particular I'd really like to hear more from
you about (2), since that is the point I disagree most with, and after that,
point (1). 3-5 I have very few objections as discussed

~~~
mdemare
> An IFR of 1% seems too high. This doesn't seem to line up with data from the
> Diamond Princess (~1% IFR in a population biased towards elderly).

The Diamond Princess has 13 deaths for 712 cases, so 1.8%.

~~~
ryankemper
That's the case fatality rate, not the infection fatality rate.

As you can see in your quote, I was talking about IFR. In general - and this
is a theme of the writeup BTW - we should be looking at IFR and not CFR. With
IFR we can reasonably extrapolate how many deaths we'll have before new
infections halt, whereas CFR is borderline impossible to use because we'd need
to know how many cases we would expect per infection. At which point, why not
just calculate the IFR anyway, right?

See
[https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v...](https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v2)

> Adjusting for delay from confirmation-to-death, we estimated case and
> infection fatality ratios (CFR, IFR) for COVID-19 on the Diamond Princess
> ship as 2.3% (0.75%-5.3%) and 1.2% (0.38-2.7%). Comparing deaths onboard
> with expected deaths based on naive CFR estimates using China data, we
> estimate IFR and CFR in China to be 0.5% (95% CI: 0.2-1.2%) and 1.1% (95%
> CI: 0.3-2.4%) respectively.

You might also want to look at
[https://www.eurosurveillance.org/content/10.2807/1560-7917.E...](https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.12.2000256)

~~~
mdemare
That article is from early March. It’s May now, no need to estimate anymore. I
agree that CFR is fairly useless. But if you test everyone, as was the case on
the Diamond Princess, IFR = CFR.

~~~
ryankemper
Ah, I see. You are completely right. Thanks for pointing that out.

------
sethc2
Why was this flagged?

I don’t even necessarily agree with the author’s arguments and conclusion, and
honestly I have no clue what to think with all the information I hear that is
constantly changing from the various tribes. But when something gets flagged
simply because he advocates for ending the lockdown, I go from thinking the
lockdown is _probably_ necessary and trust the decision is made for reasons I
don’t understand, to thinking like the paranoid conspiracy theorist that this
is just a totalitarian power grab, and figure the need to suppress dissent
means that it is more likely his position is the right one. If the ideas he is
presenting are so stupid then people can decide that for themselves and don’t
need some moral busybody protecting us from thinking for ourselves by flagging
anything that states the opposite of what their tribe thinks is true.

~~~
uniqueid
This is not a great place to start...

    
    
        > I’m a software / site reliability engineer 
        > based out of Santa Barbara, California.
    

Given the stakes, we should have a preference for Coronavirus articles written
by experts. It's fine for authors to trash the WHO or to disagree with the
government, but they should have the chops if the rest of us are going to
upvote them.

I'm disappointed with the HN community. The past few weeks, most of the
medical articles to hit the front page have been written by dabblers.

~~~
dang
There have also been many articles by experts. I'd be careful about making
general conclusions based on what you remember, because most of us are far
more likely to notice and remember the things we disliked
([https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...](https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=by%3Adang%20notice%20dislike&sort=byDate&type=comment)).

More importantly, though, there may be a misunderstanding about what HN is.
It's an internet watercooler, the purpose of which is gratifying curiosity and
having curious conversation. Inevitably that involves dabbling, speculating,
and getting things wrong. That's part of what people do when they converse.
Does that have downsides, especially in a crisis? Of course it does. But I
don't think it would be a solution to try to stop the community from hammering
this out.

More here:

[https://news.ycombinator.com/item?id=22578300](https://news.ycombinator.com/item?id=22578300)

[https://news.ycombinator.com/item?id=22973700](https://news.ycombinator.com/item?id=22973700)

~~~
DanBC
> It's an internet watercooler, the purpose of which is gratifying curiosity
> and having curious conversation.

Alternatively: [https://www.youtube.com/watch?v=FzOv14fA-
BI](https://www.youtube.com/watch?v=FzOv14fA-BI)

"I don't know anything about zoology, biology, geology, geography, marine
biology, crypto zoology, evolutionary theory, evolutionary biology,
meteorology, limnology, history, hepatology, palaeontology, or archaeology,
but I think ..."

~~~
dang
That's funny, but not because other people are idiots. It's that we all do it.

------
StavrosK
For a peek into the future, Greece has just ended its lockdown and started
reopening everything, after having 0-2 deaths per day for a few days. The
number of deaths in total is around 120 after two months, last I checked.

The plan was to shut everything down, ramp up testing and ICU beds, then
reopen and carefully watch the situation. Let's see how it goes.

------
URSpider94
Nice article, I think you’ve gotten a lot right, and i think analyses like
this get down to the point where we can have a rational discussion. Here are
some counterpoints:

1\. Looking at NYC, the fatality rate is roughly 0.5%. This is based on a 20%
positive antibody sample, which is getting large enough that the false
positives aren’t overwhelming the data any longer.

2\. If we take that as a given, then if 100% of the population becomes
infected, we will have 1.5 million deaths. If we assume something more like
60%, then just one million people will die. If we lower the mortality rate to
0.3%, then maybe we are more like 750,000. I have a hard time believing it
will be much lower, considering that 0.1% of NYC’s population has already died
from covid-19

3\. Additionally, if we give up on social distancing, then those people will
die in a large wave, overwhelming our hospitals.

4\. I would love to see a plan that keeps seniors safe and lets everyone else
out. So far, that plan is not forthcoming. It’s hard to see how we keep them
safe if their family living with them and their caregivers are all infected.
So far, we’ve done a piss poor job of keeping them safe in senior living
facilities, even with a lockdown.

5\. On the comment that the same number of people will die with a flattened
curve - that’s only true if hospitals don’t get overwhelmed, which may well
still happen. Additionally, it turns out that the herd immunity point, where
transmission drops below 1, is actually a function of the base transmission
rate. We can actually reach herd immunity at a lower infection percentage if
we are socially distanced, and thus avoid some of the deaths.

Ultimately, I think we will find ways to back off the lockdown, but health
departments will be on the look-out and will be titrating the degree of
lockdown as cases rise and fall. It’s hard to see e.g. restaurants getting
back to anything close to full occupancy any time in the next year, and most
of them don’t make enough profit per table to operate half-full (or less).

EDIT: additional point to add: yes, it seems that covid deaths will be heavily
weighted to seniors. But so is mortality in general. Let’s roughly assume that
the mortality rate for covid is 0.08% for 25-35 year olds. Guess what? The
average annual mortality for 25-35 year olds is around 0.08%, so it will
roughly DOUBLE if covid sweeps through the entire population this year. Covid
could easily become the single largest killer of young adults this year.

~~~
ryankemper
Thanks. The NYC data is something I want to add in there eventually. I agree
with your assessment and reached a similar number myself. The main thing that
gives me some doubt is it seems plausible that we'll retroactively find that
the deaths directly attributable to COVID-19 were somewhat overstated, in the
sense that my understanding is a presumed COVID-19 diagnosis is accepted in
lieu of having a positive test. (Which BTW I don't necessarily disagree with
because testing was and is a bottleneck so the overstatement is almost
certainly less than the understatement would have been if being more
rigorous). We also know that there is [financial
incentive]([https://www.factcheck.org/2020/04/hospital-payments-and-
the-...](https://www.factcheck.org/2020/04/hospital-payments-and-the-
covid-19-death-count/)) to code deaths as COVID related. I'm really curious
how the influenza mortality data ends up looking for these months - the key
question being, do we see a large dropoff in Influenza deaths that might
indicate that basically any ILI is being written up as COVID-19?

The above being said, I think the new york numbers are a perfect upper bound
for something close to what a worst case scenario looks like. Although we'd
have to look at the age breakdown and obesity rates there; it's definitely
very imaginable that there might be other cities in the US with relatively
more at-risk individuals.

(BTW I didn't explain it thoroughly in the writeup but New York's data is why
I gave a really broad range of .1-.7% net IFR - and it should be clear but
this is still very napkin math-y on my part)

I'm also curious if NY serological data includes <18 year olds - if it doesn't
include children we need to account for that when extrapolating in the 100%
infection scenario.

Anyway, the above is all a really drawn out way of saying that I agree :P

> Additionally, if we give up on social distancing, then those people will die
> in a large wave, overwhelming our hospitals.

If we gave up everything, certainly. I think with mitigation targeted at the
at-risk, that's less likely.

For me "ending lockdown" doesn't mean that everyone stops wearing masks and/or
trying to maintain physical distance where possible. But I do want to avoid a
scenario where we're mandating that people wear masks outside as opposed to
just encouraging them to.

But I do agree that just because we haven't overwhelmed hospitals yet doesn't
mean that we're in the clear. I was considering saying as much in the doc but
wanted to keep the word count down for the first iteration.

However I do think that since pretty much every city has at least some low
amount of infection, and that we will have some capacity to do some clever
shuffling of ventilators, tents, etc, that hospital overrun isn't nearly as
much of a risk at this point overall.

> 4\. I would love to see a plan that keeps seniors safe and lets everyone
> else out. So far, that plan is not forthcoming. It’s hard to see how we keep
> them safe if their family living with them and their caregivers are all
> infected. So far, we’ve done a piss poor job of keeping them safe in senior
> living facilities, even with a lockdown.

Yeah, really the best thing would be voluntary exposure of people surrounding
the at-risk individuals. But I don't foresee that actually happening. I really
think nursing homes are the low-hanging fruit here, and as you indicated it
seems like we've already kind of screwed that one up in a lot of places.

But essentially, in the alternative of full containment+waiting for vaccine,
it seems to me much harder for the caregivers surrounding the extremely-at-
risk to be able to avoid getting infected and passing it on to the at-risk,
whereas in a scenario where they can get it over with then they don't have to
worry at all going forward. But that requires being able to detect that you're
sick before infecting the at-risk individual so that you can isolate while
recovering, which obviously requires really good testing capacity.

Basically, it would be great if we could selectively redirect the bulk of our
testing capacity for individuals in these situations. But there's not a very
clear way to do that, the last thing we want is having a bureaucrat decide if
you're eligible for a test or not. So perhaps the best we can do is - and this
is a theme here - encouraging those who are surrounding at-risk individuals to
get tested extremely frequently.

\--

Lastly just wanted to call out this:

> I think you’ve gotten a lot right, and i think analyses like this get down
> to the point where we can have a rational discussion.

That means a lot. I really want us as a society to get to a point where there
is broad agreement on what the facts on the ground are, so that differences in
policy come down to differences in philosophy/values rather than where it
feels like we're at now as a society, which is basically two warring factions
each with non-intersecting sets of facts ("the death rate is 5%!" versus "no
the death rate is .03!)

~~~
astigsen
> The main thing that gives me some doubt is it seems plausible that we'll
> retroactively find that the deaths directly attributable to COVID-19 were
> somewhat overstated, in the sense that my understanding is a presumed
> COVID-19 diagnosis is accepted in lieu of having a positive test.

Looking at the total number of excess deaths (for all causes, ignoring if it
is COVID-19 or not), I would say that it looks more likely that it is severely
undercounted.

You can find the graphs here: [https://www.ft.com/coronavirus-
latest](https://www.ft.com/coronavirus-latest) (look for excess mortality
rates for New York City).

I guess you could argue that the huge increase in deaths was caused by side-
effects of the lockdown, but that does not really jive with the results from
countries like Denmark, which did an early and hard lockdown, and as result
show almost no extra mortality.

------
morsch
Background: The COVID-19 pandemic is responsible for increasing deaths
globally. Most estimates have focused on numbers of deaths, with little direct
quantification of years of life lost (YLL) through COVID-19. As most people
dying with COVID-19 are older with underlying long-term conditions (LTCs),
some have speculated that YLL are low. We aim to estimate YLL attributable to
COVID-19, before and after adjustment for number/type of LTCs.

Methods: We first estimated YLL from COVID-19 using standard WHO life tables,
based on published age/sex data from COVID-19 deaths in Italy. We then used
aggregate data on number/type of LTCs to model likely combinations of LTCs
among people dying with COVID-19. From these, we used routine UK healthcare
data to estimate life expectancy based on age/sex/different combinations of
LTCs. We then calculated YLL based on age, sex and type of LTCs and
multimorbidity count.

Results: Using the standard WHO life tables, YLL per COVID-19 death was 14 for
men and 12 for women. After adjustment for number and type of LTCs, the mean
YLL was slightly lower, but remained high (13 and 11 years for men and women,
respectively). The number and type of LTCs led to wide variability in the
estimated YLL at a given age (e.g. at ≥80 years, YLL was >10 years for people
with 0 LTCs, and <3 years for people with ≥6).

Conclusions: Deaths from COVID-19 represent a substantial burden in terms of
per-person YLL, more than a decade, even after adjusting for the typical
number and type of LTCs found in people dying of COVID-19. The extent of
multimorbidity heavily influences the estimated YLL at a given age. More
comprehensive and standardised collection of data on LTCs is needed to better
understand and quantify the global burden of COVID-19 and to guide policy-
making and interventions.

[https://wellcomeopenresearch.org/articles/5-75](https://wellcomeopenresearch.org/articles/5-75)

------
wheelerwj
> I’m a software / site reliability engineer

okay, thanks.

Seriously, the list of scientist and medical organizations advising through
this period is so long, I don't know why anyone who isn't at equally
experienced tries to counter-claim their insights.

I'm not saying we shouldn't do our own research and arrive at our own
conclusion, but if you arrive at a different conclusion, you're almost
certainly the one whose incorrect. It's so likely that you're wrong, that you
must question the logic and data you used to arrive at your conclusion.

~~~
Minor49er
This attitude reminds me of the story of Mats Järlström who presented a case
about Oregon traffic lights being flawed, was written off for not being a
professional, then was proven right a year later.

Appeals to authority are never good to do blindly. If different conclusions
are reached from two parties, then the conversations must continue if they are
legitimately grounded.

~~~
josefx
> was written off for not being a professional, then was proven right a year
> later.

He was sued for using the title "engineer" while not being registered as a
professional engineer in the state. He still had an engineering degree and the
education that came with it. He was only written of since traffic light
cameras were a money maker and the times were intentionally short to keep the
money flowing. Basically he could have been Einstein himself and would have
faced the same road blocks, because the people responsible did not want to
hear the truth, their money depended on not hearing the truth.

A better comparison for this case would be the story of amateur mathematician
Goodwin in Indiana. Whose attempts to revolutionize math were ultimately
blocked by a university professor abusing his position as authority figure to
coach legislators against redefining PI. Actually it is a nice reversal:
Goodwin was a doctor first and self taught mathematician second, and he was in
direct opposition to the educated authority on math of his time. Meanwhile now
we have a computer scientist and self educated expert on virology
contradicting almost every practicing medical professional alive.

------
cy_hauser
I just hate these blogs saying this virus is akin to the the flu. Does the flu
leave bodies in trucks, apartments, and bagged on the streets? Does the flu
kill dozens of workers in meat processing plants every year. Does the flu take
more than ten years of life from the average person it kills?

Also, suicide death rates are still wildly unknown but deaths by traffic
fatalities are way down. We need to get help to people feeling suicidal.
Before the virus and now especially.

~~~
ryankemper
> I just hate these blogs saying this virus is akin to the the flu

Author here. That's a mischaracterization of what I said. But yes it is true
that overall mortality is similar to the flu. I settled on COVID-19 being 3x
as deadly, but that figure is up to debate.

The important thing to understand is the varying risk profiles. The flu kills
the very young and very old, whereas COVID-19 primarily kills the very old.

> Does the flu leave bodies in trucks, apartments, and bagged on the streets?

Yes, pandemic flu absolutely does.

> Does the flu kill dozens of workers in meat processing plants every year

Yup. Pandemic flu absolutely would.

> Does the flu take more than ten years of life from the average person it
> kills?

Could you clarify this point? I don't quite understand what you're saying. The
flu takes away more wellbeing-years per death because it kills infants and
young children whereas COVID-19 almost never does.

~~~
URSpider94
Two comments. One, saying something that is 300% larger than another is
“similar” is stretching the definition of similarity. Two, both the numerator
and the denominator matter in the death rate. In a given year, maybe 20% of
the population get the seasonal flu. We could potentially see 80+% of the
population contract covid. That’s another 4x multiplier of fatalities, but
also hospitalizations.

~~~
ryankemper
The latter point is precisely why I was careful to say "pandemic flu" when
responding to the above. But yes, the point is very valid. A novel disease
with the same IFR of an established disease will kill a lot more in the year
that it is introduced.

(BTW, something that occurred to me is that the fact that infants are largely
spared from COVID-19 is even more of a blessing than it already seems. Once
this passes through our population, new infections will be in those who are
not immune which will primarily be infants/young children, who we know thus
far have had really good outcomes relative to adults. That means the enduring
legacy of this will be much better than what we see with Influenza)

> One, saying something that is 300% larger than another is “similar” is
> stretching the definition of similarity.

I defined "ballpark" in the article as less than an order of magnitude. But, I
think this is a thought exercise that might help:

Imagine that SARS-CoV-2 doesn't exist, but we learn that this flu season is
going to be extra deadly. Instead of the ~50k of deaths last year, we know
that there will be ~150k deaths.

Would we rationally take the same extreme of measures that we have taken for
Covid? (Or, conversely, should we already have been taking these measures for
past flu seasons)?

Also I think you're very aware of this, but just for any on-lookers: don't
look at the flu comparisons as intending to minimize COVID-19; but rather
comparing to flu gives us an existing mental model that most people are
familiar with that helps us figure out what measures make sense and what
don't.

~~~
URSpider94
So, I just went and took a look. US deaths from influenza have ranged from
12,000 to a high of 61,000, with an average of more like 30,000. So, if we had
prior knowledge that we would have a season with 150,000 deaths, which would
be unlike anything we've seen since at least the 1950's and maybe longer, I
expect that the government would indeed take some evasive action. But that's
still not the right comparison. For covid-19, we were looking at somewhere
between 750,000 and 2 million deaths. In other words, 20-50 times more than a
typical flu season.

------
bronzeage
This is cherry picking hopeful data. Tests have false positives, the
serological tests detect all coronaviruses including common human CoV which
cause common cold.

The state of hospitals in Italy tell a different story. It might not be
numbers, but it is more reliable indication of what letting this go rampant
means.

~~~
tinus_hn
An argument could be made that that would lead to cherry picking hopeless
data.

~~~
disgruntledphd2
Lombardy (the region of Northern Italy where this was concentrated) has a very
very good health system.

And it still collapsed.

Don't get me wrong, lockdowns are super problematic and the economic hit is
going to be really, really bad but it's better than letting health systems
collapse.

For instance, Ireland (where I live) had 220 ICU beds before this started; we
upped that to around 500 and around 350 were filled at the highest point.

And this was with a lockdown (started March 12th, massively tightened March
26th).

Our health service would have collapsed without the measures that have been
taken, so I totally see why lockdowns have been introduced almost everywhere.

The best case scenario for this kind of event is that you react too quickly,
everything's OK and then people complain that all the measures you took
weren't necessary.

~~~
lbeltrame
> Lombardy (the region of Northern Italy where this was concentrated) has a
> very very good health system.

To be honest, it was good, but it was not as good as people hoped. Massive
errors like allowing infections to run rampant in the hospital in Alzano
Lombardo contributed a lot to the spread of the disease in the area around
Bergamo and Brescia.

ICUs were also at 80% utilization when the pandemic hit, because beds have
been slashed a lot in the past years.

------
drcongo
Never has the phrase "a little knowledge is a dangerous thing" been more apt.

------
sethc2
I appreciate the article.

I think your argument I find most dubious is the idea that we have lessened
health care capacity by sheltering at place and closing businesses. Even if we
have furloughed hospital workers, and I'm not saying that isn't a huge blow to
those people and their livelihoods, and stopped elective surgeries, and I'm
also not saying that those elective surgeries aren't things that don't matter,
I think in terms of the next 6 months, the chance that our hospitals have less
capacity to deal with serious illnesses that lead to death seem unlikely. If
anything the decrease in deaths from other things, like drunk driving, and
influenza might offset the loss in capacity from those furloughed.

I agree that if the timeframe is long enough it is very likely to ultimately
lead to more deaths from missing elective surgeries and preventative
healthcare, and I think the argument for Pareto-efficiency and only asking
those who are at risk to shelter in place isn't dismissed with this argument,
but I don't think a time frame of say 6 months to a year would lead to more
deaths in the way you state. I think you should maybe specify (or point out to
me where you state this if I missed it, i'm not a careful reader) what kind of
timeframe you believe that the combination of lack of capacity and missing out
on preventive measures would start to lead to more deaths and indicate where
you think we would reach pareto efficiency. Have we already passed the point
of pareto efficiency? Was it never good at all, and the most efficient thing
to do was no response?

I personally think you wouldn't see the effects you are talking about for
probably at least a year, and I'm hoping it doesn't last that long. I think
you might start to see an increase in deaths from other things like, overdose,
alcohol, and suicide, in a shorter timeframe than that though, and that is
something that probably should be weighed in picking the best time to end the
lockdown too.

------
daly
LIsten to a real epidemiologist:
([https://www.microbe.tv/twiv/](https://www.microbe.tv/twiv/)) episode 607.

------
Fuzzwah
> SARS-CoV-2 is a virus that can make you sick. Some people don’t feel sick at
> all, some people feel a little bit sick, and a very small group of people,
> especially old people, get very sick and might die.

Maybe mention something about the long term issues that it appears could be a
reality for even those who "don’t feel sick at all, some people feel a little
bit sick"?

Also, while the the goal of flattening the curve was focused on lowering the
impact on health care, as seen in Australia and New Zealand it can also result
in stopping nearly all local transmission.

~~~
ryankemper
> Maybe mention something about the long term issues that it appears could be
> a reality for even those who "don’t feel sick at all, some people feel a
> little bit sick"?

Have you seen any scientific literature alleging this possibility in those who
are not seriously ill? Not to sound like the WHO, but I have not personally
come across any evidence that this is at all true. And indeed it seems highly
non-credible.

> Also, while the the goal of flattening the curve was focused on lowering the
> impact on health care, as seen in Australia and New Zealand it can also
> result in stopping nearly all local transmission.

This is true, but now they can't let anyone into their country until the whole
island has been vaccinated. That could get very tricky.

Well, I suppose they could do what Taiwan and other countries have done and
aggressively test&quarantine all entrants. That's certainly possible.

~~~
URSpider94
The popular press has summarized an article from NEJM discussing five strokes
in relatively young patients with either asymptomatic or mild covid cases.
Yes, it’s anecdotal.
[https://www.google.com/amp/s/www.forbes.com/sites/robertglat...](https://www.google.com/amp/s/www.forbes.com/sites/robertglatter/2020/04/27/why-
is-covid-19-coronavirus-causing-strokes-in-young-and-middle-aged-people/amp/)

------
kaolti
Going back to the basics on this one.

Has any government presented a cost benefit analysis of all the available
options to address this situation?

Like most things in life this isn't black and white, so where is the analysis
of the pros and cons, worst case projections, etc of not doing anything /
going into lockdown / other alternatives.

I for one have not seen it.

Shouldn't such an analysis be the basis of any decisions we make? It follows
therefore that it needs to be first of all DONE, then publicly presented and
argued from all angles before a decision is made.

But, no. A decision has been made and presented to us. We can rest assured,
they say, the science CLEARLY shows that this is the right decision. Then - at
least in the UK - later they admitted that the economic impact and the
following consequences have not yet been looked into.

The arguments should not be about lockdown or not. It is fair and everyone
duty to scrutinise government decisions, not because they should have done the
exact opposite, but simply because they haven't presented a robust case for
what they're doing.

Let's not forget, it is their ONLY job to represent us - a job all of us are
paying for -, and do things that are in our best interest, yet they fail to
properly justify decisions.

Anyone who without question agrees to locking down the economy might want to
consider that bailouts, stimulus packages, unemployment benefits, and anything
else the government does is paid for with our money.

Add to this the borderline misleading way covid deaths are classified and a
dozen other similar issues and you have yourself a very interesting situation
which should be raising questions in everyone.

~~~
lkrubner
" _Shouldn 't such an analysis be the basis of any decisions we make?_"

No. We can decided to make decisions based purely on the morality of the
decision. Given a death rate somewhere between 1% and 3% the question becomes
whether we will accept that many deaths, without taking action. There is no
need for a cost/benefit analysis, as we can decide the issue entirely on a
moral basis.

~~~
logicchains
You can't know the morality of the action without modelling all the
consequences. Morality is a complex thing, and certainly cannot be determined
by just a single number (number of deaths from the virus avoided).

------
dmode
It seems like everyone is an expert on infectious disease these days. From
site reliability engineers to electric car manufacturers.

------
ryanwaggoner
If you're going to write a 7500 word article on why most experts are wrong
about a subject, you should probably start by providing the reader with some
reason to care about what you have to say. Writing with this authoritative
tone and no disclaimer as to your lack of expertise and knowledge in any
relevant field is dangerously irresponsible.

Further, insisting that every reader fully read your treatise and evaluate the
claims and arguments "on the merits" is unrealistic, unfair, and fails to
acknowledge that virtually all of them also lack the expertise to be able to
do so.

------
quezzle
This should be flagged.

Why is a software engineer qualified to present this?

Just misinformation spoken with a tone of authority.

~~~
throwaway0a5e
>This should be flagged.

>Why is a software engineer qualified to present this?

The opinions of software engineers about subject outside their area of
expertise is the bulk of the commentary on this site. I don't think it's
realistic to expect a community to enforce a restriction on submissions when
such a restriction would hit so close to home. That would require a level of
cognitive dissonance that even HN is probably not capable of.

I agree with you that people should STFU about things they are not experts in,
or at the very least not present their opinions on such things with some veil
of authority.

~~~
quezzle
One of the big issues in the pandemic is the spread of misinformation.

I don’t think media channels ... and I’m including HN here ... should be
giving a megaphone to random opinions. Now it the time for experts voices to
be amplified, not random people with an opinion.

I notice in the comments dang supports this post which is a surprise.

~~~
dntbnmpls
> One of the big issues in the pandemic is the spread of misinformation.

Along with censorship and blind worship of authority.

> Now it the time for experts voices to be amplified, not random people with
> an opinion.

Which experts? The experts you agree with or are politically aligned with? Or
all experts?

> I notice in the comments dang supports this post which is a surprise.

An even greater surprise is the attempt to censor people who are giving their
honest and fair opinion and assessment - which is not misinformation.

The experts have spoken and people have the right to discuss and offer their
opinions. Using your logic, hacker news shouldn't exist because only the
"experts" should be allowed a voice.

------
sgt101
Well section 2 presents two cherry picked studies that are off the consensus
for IFR (0.4%) and so have been latched onto by those who want them to be true
and want everyone else to believe them. And then goes on to demonstrate a
novel example of simpsons paradox with an italian study. Just junk. Bin it.

------
rexgallorum2
There is a fundamental problem with claims that the infection fatality rate
(fatality rate for all infections, including undetected infections) is
ridiculously low.

New York City has seen over 18,000 deaths directly attributed to Covid-19. The
actual number may be higher, but probably isn't lower. How many actual
(including undetected) cases would there have to be in NYC to produce the
given number of deaths at any given IFR? Figures at the low end suggest a
number of cases far in excess of the total population, so they are naturally
impossible. The real IFR is somewhere between the lowest plausible number
based on the total population and the implausibly high case fatality rate
(based on detected/confirmed cases).

Anyone want to do some math on that?

------
dmode
Oh boy, I just wasted my time reading this, and I really wish the headline
would have flagged that this is written by a "site reliability engineer" and
not an epidemiologist with credentials. Feel like there would be a revolution
in HN if this was the other way around - an epidemiologist writing about site
reliability engineering after reading a few articles for 2 weeks. Should we
not exercise restraint, thoughtfulness and humility instead of writing
commentary and articles in areas where we have rudimentary understanding ? It
is really an insult to experts in this area who have studied viruses for
decades, have considered a variety of factors, have conducted academic
studies, and have build complex models, all to be outdone by a "site
reliability engineer".

As for the article itself, it is so full of misinformation,
oversimplification, and hyperbole, where should I even begin.

1) Claiming absolute authority on fatality rate as 3x of influenza, when
global experts have yet to agree on a number
[[https://www.nytimes.com/2020/04/17/us/coronavirus-death-
rate...](https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate.html)]

2) Then basing the article on an absolute fatality rate, when the fact remains
that fatality rate depends on a number of different scenarios include health,
immunity, age, hospitalization, ICU beds, and may be even weather etc. [2] To
lump all of that into a single number simply hides the cost of COVID. Just in
Michigan alone, 35% of COVID deaths are within the black community. Not having
a grasp on how this impacts along racial and economic lines demonstrate a very
rudimentary understanding of public policy. Ask yourself, if the fatality rate
is 1% on average, but 10% for black people, will you still call for opening
the economy [2] [https://fivethirtyeight.com/features/why-its-so-freaking-
har...](https://fivethirtyeight.com/features/why-its-so-freaking-hard-to-make-
a-good-covid-19-model/)

3) Repeated references to comparison with influenza, but not mention of the
massive R0 differences between the two [3]. Influenza has a R0 of 1.3, while
COVID is estimated to have an Ro of 5.5. And this matters, because now COVID
is not only more fatal, but is also spreads faster. Both the denominator and
numerator are deadlier for COVID, which is a compounding factor that the
article doesn't discuss at all. if 20% of US population get impacted, we will
have a death toll of 600K at 1% fatality rate. That will be 10x than that of
the worst strain of influenza. [3]
[https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article](https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article)

4) There are a lot of reference to negative externalities of lockdown [without
much data to back-up], but no mention of the positive ones. Such as plummeting
car fatality rates, plummeting crime rates, and plummeting pollution [4] [4]
[https://www.nationalgeographic.com/science/2020/04/pollution...](https://www.nationalgeographic.com/science/2020/04/pollution-
made-the-pandemic-worse-but-lockdowns-clean-the-sky/)

5) A strange out of context reference to social isolation and related deaths.
The linked article and current situation are very different. People are
isolating from others, but they are very much spending more quality time with
their loved ones. I don't see any data on spike in depression during this
period, and anecdotal evidence suggests that people are refreshing their
relationship with their loved ones.

6) Section 4 presents a half baked plan of "opening" up without broader
discussion of trade-offs and implications. For example, opening up but
encouraging "at-risks" group to self quarantine. This is not how US workplaces
work. Let's stay I am a at-risk worker with chronic lung disease, but I also
work at a factory floor and my health insurance is through my employer. How am
I supposed to self-quarantine when my employer will simply ask me to show up
and if I don't I will lose my job and insurance ? And there won't be any
government dollars to support

7) There is no discussion on how we can support the re-opening without ability
to test people at scale. How will you know that the server at a restaurant or
your gym instructor is not infected without massive upgrades to testing
infrastructure ?

These are some basic observations from the article. I can keep going as every
paragraph in this article has some questionable conclusions. I also feel the
"soul of the nation" feels very hyperbolic.

~~~
lbeltrame
> I really wish the headline would have flagged that this is written by a
> "site reliability engineer" and not an epidemiologist with credentials.

(Note: not the author). I think any article like this can attract (and even
deserve, depending on what's presented) criticism. But I absolutely dislike
the "lack of credentials" as an opening argument.

It's much better to tear away the points you don't dislike, IMO, without
mentioning credentials. It's obvious that being in the field can give you much
better understanding of the issues, but not being in it does not mean one will
not try to reason over the data (even if wrongly).

I'm a biologist (well...half biologist, half computational biologist, and
something else thrown in the mix). Does that mean I can not criticize
(hypothetically) something on epidemiology because I don't have credentials,
or, conversely, not try to figure out something in the data (even if my
reasoning is totally wrong) because I don't have the required credentials?

I understand the above is a little too black-and-white, but I mean, let's
encourage debate, even strong disagreements like your post, without going over
what the author is doing in the first place.

P.S.: (not a jab at you, but a thought that emerged while writing this reply)
I believe there are a lot of models floating on SARS-CoV-2, but I feel we also
need loads of basic, bench level experiments to understand it better.

~~~
whatisthiseven
I don't get it. Imagine an HN where random people who never did any software
started flooding HN with articles about how the software people are lying to
us all and just making big bucks. Software is easy, here is how to make great
software. And every single one of them was just random near-garbage pulled
from a couple minutes reading slides from Agile experts and the occasional
wiki article about "software abstraction".

It would be downvoted so fast for being so wrong, and no one would engage with
it for being so terribly wrong because disproving all the points is exhausting
and not worth the time. Yet, you would think it OK on HN.

Maybe you downvote some of the wrong ones, but others get lots of comments,
and soon all these wrong posts just get more attention and comments as people
are arguing over half-made points in a blog post by a sales guy that "has a
few software friends".

The long-term changes to HN would eventually push away people that care.

But we don't live in that world, maybe not yet. So instead we allow people who
get so many basic facts wrong about an epidemic to post on HN, and @dang
explained elsewhere why this makes sense (and I agree from a moderating
standpoint to keep this content up) and I agree with it.

But we really only allow this content because it isn't the bulk of content on
HN. If the bulk of content on HN resembled the above, I don't think we would
like the community HN becomes.

Quite ironically, this is highly related to the virus itself. The virus isn't
a problem on its own. It is a problem because it infects hundreds of millions
of people very quickly, and we have poor means for slowing or stopping it at
all.

Very much like misinformation.

------
jonahbenton
Others have said it already. This piece is so deeply flawed as to be grotesque
and macabre, its intellectual self-justification (including a use of Pareto
that completely misunderstands the reason we use the term Pareto) blind to
actual facts. We are as yet in most cases not at the banality of evil stage
specifically with COVID but good lord it is work like this that makes it easy
to see in real time how we get there.

------
mchusma
Thank you for the time and effort in the write up as well as your engagement,
it is what we need.

2 points: while I sort of get your "order of magnitude lik a flu" point I
think it undermines your argument because you get lumped in with crazies. In
your comments you also seem to conflate pandemic flu with seasonal flu, so I
would suggest using "seasonal flu" if that is what you mean to avoid
confusion. I think there are compelling arguments for ending the lockdown
while still believing it is 10x worse than the flu. I don't like conflating
the points myself, and rather prefer to just look at the actual IFR/R0
numbers.

I don't know if this warrants a section, but I will say that I believe that
the issue you discuss in this article is the lockdown, which is a political
discussion. You have a lot of people on here asking for your credentials, or
asking if you are an epidemiologist or virologist. While scientists can help
inform us as a society on things like the IFR and R0, at the end of the day
the core item under discussion here is a societal choice. In the US as a
society appear to make a decision that infectious disease deaths up to about
70,000 people annually (a bad seasonal flu) do not warrant any official
lockdown measures. The question of the threshold for various political
responses is in fact a political question, not a question for virologists,
therefore is the domain of all citizens. The author is as much an expert on
this particular question as really anyone else.

There has been a troubling severe censorship going on across platforms,
including YouTube which would presumably not allow you to post this as a
speech as it contradicts WHO guidelines, and our own "Hacker news" which
ironically celebrates the culture of people building things of their own
merit, not tied to past credentials, yet for a while has flagged this open and
reasonable attempt to understand a political question.

~~~
mchusma
One other quick note on my point above about case for lockdown. I am sure
there are a ton of unknowns on the actual costs of the lockdown, but a back of
the envelope suggest maybe 2 weeks of GDP seem directionally correct for the
US, or about $1T. Assuming a QALY value of $100k. If you assume the official
lockdown saved even 500k lives (only considering official lockdown, not other
measures like voluntary social distancing, etc). If you assume the QALY for
the group that died is 6 (I read this estimate somewhere but don't have
source, seems to make ballpark sense because deaths are weighted towards
elderly with comorbitities).

Then you have a value of 100k _500k_ 6=$300B vs about $1T cost.

You can play around with these variables, for example if you feel in the US
our value for a QALY should be 2x Canada and 4x UK, then use $200k. If you
feel that the majority of the viral suppression was from masks, distancing,
and other voluntary efforts, then you might reduce the lives saved by the
lockdown estimate down to 100k.

Again, I dislike "like the flu" arguments, because I think we can just debate
the actual merits of a policy. In this case, using almost any assumptions, the
lockdown doesn't make sense versus other health measures we could be spending
money on.

------
atian
Is anyone else having trouble reading this writing? I've gone through it
multiple times but I really cannot extract any point being made other than
eager aside references.

The title is not fitting at all for the content.

------
laufj
The immunity section ignores the fact that the virus could mutate, and thus
reinfect people immune to the previous form

------
nraynaud
does that mean that China was right to try to ignore the issue for a few days
at the beginning?

------
MisterTea
"I’m a software / site reliability engineer based out of Santa Barbara,
California."

From someone living in NYC: fuck off. You have no business telling anyone
anything regarding health and safety.

------
Ajunne
It's been a long time, but I see we've returned to "I'm not an epidemiologist
or virologist but a software engineer, and I'm writing a blog post because I
know things better".

------
anonymouswacker
I especially liked the comparison of a cytokine storm to the governments'
response to the virus.

As soon as I read that the antibodies tests were showing that approx. 1/4 of
NYC most likely already had the virus, and did a little basic math with the
latest data on death rates, I realized that the lockdowns no longer make sense
in NYC.

I guess that means I am now in the same bandwagon as Musk, Trump, and all the
other supposed idiots or deniers that think this virus is not as deadly as it
first appeared.

Back to work.

------
jillesvangurp
I think this is summarizing what a lot of people with a working brain probably
already are thinking privately.

In general, I think there are too many arm chair scientists with opinions
right now and this is not helping. Part of the reason is that we're all
sitting at home mildly bored and frustrated with the sudden restrictions on
our life.

My general attitude is that I understand people are afraid and considering I
don't like scaring people, I'm open to adapting to their needs right now and
am trying to be mindful. So, doing the right thing for me is not blaming
people for being irrational and trying to adapt to their emotional needs.

However, I am very worried about the self inflicted economic pain and misery
and how that is going to affect me personally as well as people I care about.
E.g. my parents are retired and already had their pension devalued a few times
in the last decade. Stuff like this is likely to cause more cuts. They are
well off regardless but there are many pensioners who get to ride out their
remaining years/decades with a significant cut in income and no chance to fix
that. Stuff like this happens when we trigger a global recession/depression
out of fear.

Another thing that I observe happening is that lockdown policies and the
resulting bureaucracy, constantly changing rules, etc. are by and large coming
from people who are interpreting what they are hearing from others. A few
weeks ago when everything was extremely scary this was understandable. But
we're past that now.

Most of what they hear is either without much scientific basis/merit, severely
watered down/dumbed down pseudo scientific babble, or worse flat out wrong
information.

Also these decision makers have agendas that go beyond trying to do the right
thing. E.g. a lot of politicians have enormous egos and are under a lot of
pressure to be seen doing something. Add populism to the mix or overzealous
anti vaxers, and you have a perfect storm of mass hysteria and a lot of
completely pointless policy. Add lawyers to the mix, and you get a lot of ass
coverage on top. Bureaucrats when faced with demands raining down from the
top, oblige by coming up with lots of rules and demands for more budget.
Politicians oblige, and you get more of the same.

So, a scientist might say something like "Sure, whatever, go wear a non
medical mask if it makes you feel good. It might even help though I'm not
aware of any studies to that effect. But go knock yourself out. "

In the hands of bureaucrats that turns into the police issueing crippling
fines for small businesses tolerating customers without masks in their shops.
This is actually happening in Germany. In France people have to print a form
stating their intentions when leaving their house and the police is very busy
enforcing that. In Sweden, restaurants are open as normal and the government
seems to have shown some restraint with imposing measures. France got hit
really hard early on but is now improving. Germany and Sweden are largely fine
already. Germany has enjoyed a widely published low death rate despite being
quite late with locking down. The point is, they are doing widely different
things (including doing nothing) with more or less similar outcomes. It's
fine. The world is not ending.

IMHO we are well prepared in case this virus comes back. We'll detect it
earlier, act more decisively and hopelessly less stupidly. So, lift the
restrictions and allow people to self restrain and decisively act locally
based on testing/incidents/common sense.

------
sadalienvulcan
In the "Debunking the claim that it’s “just the economy”" section of the
original post [0], the author is arguing that "economic damage leads to lives
lost". But the kind of economic damage this causes doesn't have to. The reason
it does is a result of the policy decisions our governments make.

The author references a study from LSE [1a], saying:

> Their analysis focuses on the UK, but they conclude that maintaining
> lockdown in the UK beyond June 1 will lead to a net reduction in wellbeing-
> years.

The referenced paper weighs up the benefits of lifting the lockdown at a
particular point in time vs the costs of extending it. They do this using a
metric called wellbeing-years. They list the possible positive and negative
outcomes of lifting the lockdown then convert these into wellbeing-years.
These are used to calculate the total value of lifting the lockdown at the
start of May, June, July and September. They summarise these findings in Table
4 of the paper [1b]. It shows that there will be negative total value to
maintaining the lockdown beyond 1st June, as the original post says.

Table 4 suggests the highest cost of lockdown is reduced incomes and the
reduction in wellbeing it brings [1b]. But surely the UK government could
increase their income support so that there is no loss in wellbeing? This
would change the balance of the cost-benefit analysis considerably (and maybe
saving lives is worth the money).

So how much would this cost then? In Appendix 2 [1c], they calculate that
£750,000 of lost income is worth 7.5 wellbeing-years (one year of a persons
life at the average wellbeing of 7.5/10). This implies that a single
wellbeing-year is worth £100,000 of lost income. Looking at Table 4, lifting
the lockdown in September instead of May would cause reductions in income
equivalent to (48+66+86+103) _10,000 = 303,000 wellbeing-years. That
represents £100,000_ 303,000 = £30.3 billion in lost income we'd need to make
up.

Luckily, the 6 wealthiest people in the UK are worth a combined £39.4 billion
[2]. Repatriating that wealth and distributing it as income relief would
completely remove the negative impact of lost income. Doing so would tip the
balance in favour of extending lockdown to 1st September. This is important
because lifting the lockdown in September rather than May would result in
145,000 fewer COVID-19 deaths [1d].

Using that papers analysis to justify ending the UKs lockdown early is akin to
saying: I value preserving the private wealth of 6 people over the lives of
145,000 others.

[0]:
[https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...](https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#debunking-
the-claim-that-it-s-just-the-economy) [1a]:
[http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf](http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf)
[1b]: Results, Table 4,
[http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page...](http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page=10)
[1c]: Appendix 2, "The monetary value of Life-Years",
[http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page...](http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page=17)
[1d]: Section 3.6, "COVID-19 Deaths",
[http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page...](http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page=8)
[2]: [https://www.theguardian.com/news/2019/dec/03/uk-six-
richest-...](https://www.theguardian.com/news/2019/dec/03/uk-six-
richest-\[2\]): [https://www.theguardian.com/news/2019/dec/03/uk-six-
richest-...](https://www.theguardian.com/news/2019/dec/03/uk-six-richest-
people-control-as-much-wealth-as-poorest-13m-studypeople-control-as-much-
wealth-as-poorest-13m-study)

------
chente
Everyone is an epidemiologist in a pandemic.

~~~
nostromo
The article is more about policy than epidemiology.

~~~
ohlookabird
The former should however follow recommendations of the latter I think. If you
agree, then policy isn't independent of epidemiology.

~~~
ryankemper
I agree (I think). Personally I believe the two are related. Epidemiology must
inform the policy. And similarly we can only understand epidemiology if we
understand the basic building blocks of immunity.

That, in fact, is why I have an initial section that's just about these
deceptively simple concepts that we all need to understand. I wish our leaders
had actually metaphorically sat the American people down and explained the
basics. The average person really does not know what a virus is, or how
diseases are transmitted.

So, I actually entirely agree with the position that this is something that
relates to epidemiology. Where I differ is that I don't believe in
gatekeeping, I think if someone has taken the effort to synthesize research
into a policy proposal, however poorly, it seems at least worth debating the
ideas on their merits. The experts who know more than me (and they do, at
least some of them) should be able to convince a rational/reasonable person
that their position is the correct one without resorting to credential-waving.

\--

BTW I do read quite a lot of research papers, but I don't naturally have much
interest in epidemiology. Just to give you an idea, I usually end up reading
papers about stuff like: moist wound healing, and the role of red light
therapy in fibroblast differentiation, and more broadly the role of
electromagnetism in wound healing and neuronal galvanotropism. Weird stuff
like that that's connected by invisible threads.

So, why did I read a bunch of epidemiology/COVID-related research papers?
Well, the state of discourse here in the US, and also globally, has hit such a
level of insanity that I decided that I needed to figure out what the facts
were. (I'm not saying I have "figured out the facts" perfectly, or even at
all, just that I am trying to) Honestly, it might sound ridiculous, but the
turning point for me was reading that Venice Skate park was filled in with
sand to prevent people from skating there. That is what informed my intuition
that we are collectively being driven by superstition, and therefore what
motivated me to read a bunch of research papers and reach my own conclusion
about what's going on.

My ultimate conclusion? Well, the writeup is pretty clear on that one.

------
mistersquid
> Remember, flattening the curve does not reduce deaths in the long-run,
> except insofar as it avoids overrunning hospitals, which we have already
> achieved. Flattening the curve is not beneficial for its own sake; indeed,
> it worsens the economic damage, and thus it should only be practiced unti we
> know that we won’t overwhelm hospitals. The area under the curve remains the
> same. We strongly belief that a rational examination of the evidence will
> show that practicing containment “until the vaccine” (which will take years
> and is not guaranteed to be possible, although we personally believe that we
> eventually will have an effective vaccine) is a foolish policy that will
> lead to far more mortality than simply “biting the bullet”.

The problem with the analysis and exhortation to end the lockdown is contained
in the above.

Flattening the curve is a way of maintaining hospital capacity and is an
ongoing effort. Saying "we have already achieved" it is nonsensical.

What does make sense is maintaining hospital capacity and following a
reopening protocol along the lines of:

1\. Reopen sections of economy, relaxing stay-at-home for some workers.

2\. Monitor for outbreaks.

3\. Test and contact tracing.

4\. In case of new outbreaks: quarantine and strengthen stay-at-home.

5\. Repeat 1-4.

And continuing this until

\- Advent of treatments for COVID-19

\- Advent of vaccine for SARS-CoV-2

\- Herd immunity has been achieved.

The essay linked in the OP refutes the simple argument that lockdown must be
maintained by presenting an overwhelming number of details about COVID-19, its
lethality, elective vaccination, secular superstition, and all other manner of
irrelevant topics.

The reason for the lockdown is to maintain healthcare capacity in the face of
a virus that is highly contagious.

A workable and moral framework for ending lockdown looks something like what
I've outlined above.

The OP provides no suggestions on how lockdown might end, other than gathering
an enormous amount of tangential evidence to prove "The Case for Ending
Lockdown".

~~~
ryankemper
I'm not going to dive into your full post, but suffice to say that you are
advocating a policy of capital-c Containment. Your implicit assumption is that
we can avoid infection sufficiently long enough such that the future utility
of vaccines and as-of-yet-undiscovered treatments outweighs the cost.

My position is that the cost of lockdown massively outweighs the cost of
COVID-19 itself, and furthermore I am suspicious of the belief that we can
effectively contain it without boarding people in their houses.

> The reason for the lockdown is to maintain healthcare capacity in the face
> of a virus that is highly contagious.

And yet the lockdown has, overall, scaled _down_ our healthcare capacity
amidst the most serious pandemic in a century. Why is that? I can already
foresee an argument of "oh well, the lockdown is fine, we just need to pass
government regulations that pays hospitals to maintain this extra capacity".
And my argument to that is, beyond a general distrust of government
incompetence, paying somebody to sit around will not maintain their skills in
the same way as paying them to actually perform the preventative care that we
hired them for in the first place.

> The OP provides no suggestions on how lockdown might end

But I literally provided a proposal. The proposal is to have at-risk members
of population - and yes, we can identify who is at risk really quite easily
with the data we now have - quarantine as we've all been doing. Meanwhile, the
rest of society is no longer forbidden from transacting and producing value.

Again, if you look at the fatality rate data, you will see that if we can just
protect everyone over 60 - and especially everyone over 70 - we will mitigate
probably 80% of the deaths. Unfortunately, even _with_ the lockdown, we have
utterly failed to do so thus far in many parts of the country.

In particular, I strongly oppose the moral panic around people going to the
beach, public parks, etc. Unlike our politicians, I strongly believe that
these activities can be done safely and that there is insufficient evidence to
show that they were ever a serious transmission vector in the first place.

~~~
mistersquid
I appreciate your thoughtful reply. I am not arguing for containment but for
graduated exposure while maintaining health care capacity.

While it is true that some health care providers are experiencing a decline in
demand due to, for example, people no longer seeking medical attention for
(e.g.) coronary problems and other non-respiratory ailments, this is not the
health care capacity that matters with regard to coronavirus infections.

Non-coronavirus medical problems are important, but the widespread increase
YOY in mortality across the entire United States is evidence that such medical
demand is eclipsed by the demand for treatment related to coronavirus
infections. [0]

Second, and I mean this with all due respect, your suggestion "to have at-risk
members of population […] quarantine as we've all been doing. Meanwhile, the
rest of society is no longer forbidden from transacting and producing value"
is not so much a proposal as a flight of fantasy.

The idea of cordoning off the vulnerable when those who are most vulnerable
are essential workers in groceries, transit, delivery not to mention the non-
essential service workers, hospitality staff, janitors, teachers, etc. What
you are proposing can have no basis in reality.

Finally, those less-vulnerable members of the population you are imagining
actually end up hospitalized at a rate between 2.5% and 7.4%. [1] While the
number of infections required to overwhelm hospital capacity is hard to pin
down (i.e. forecast), ProPublica 17 Mar 2020 page offers a few different
projections. [2] One of those projections forecasts that if 40% of US adults
are infected over 12 months, hospitals across the country would experience
demand at 100% to 200%+ current capacity.

Those less-vulnerable members of the population who "only" need
hospitalization at a rate between 2.5% and 7.4% would be left without medical
recourse and would die at a much higher rate than what you are imagining.

[0]
[https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...](https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-
death-toll-total.html)

[1]
[https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm](https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm)

[2] [https://projects.propublica.org/graphics/covid-
hospitals](https://projects.propublica.org/graphics/covid-hospitals)

~~~
ryankemper
> While it is true that some health care providers are experiencing a decline
> in demand due to, for example, people no longer seeking medical attention
> for (e.g.) coronary problems and other non-respiratory ailments, this is not
> the health care capacity that matters with regard to coronavirus infections.

Right, but in this case it's leading to workers getting furloughed. So that is
a direct lowering of capacity, although I suppose one could argue that those
workers will be called back when shit hits the fan. But if that's the
case...why not have them doing important preventative care in the meantime,
since we know our hospitals are not overwhelmed yet? Basically anything that
doesn't require people being in hospital beds for days since that would take
away resources for future COVID-19 victims.

> Finally, those less-vulnerable members of the population you are imagining
> actually end up hospitalized at a rate between 2.5% and 7.4%.

This appears to be a hospitalization rate that is not accounting for all the
hidden infections, which is why that number is so high. That's why the
serological studies are so important. Otherwise, we need to estimate how many
"cases" there will be (meaning, "serious cases" essentially), which is a lot
more difficult than finding the true IFR / hospitalization rate and then
multiplying by age-stratified population size. In particular, the CDC numbers
are very at odds with the hospitalization rate of some of the serological
studies I cited in my article. And it's not just a factor of 2x, it seems to
be a massive difference. For example they show a 2.5% hospitalization rate for
ages 18-49 whereas the number I've been using shows a .8% hospitalization rate
for ages 40-49 at the high end, and then a .2% hospitalization rate for ages
20-29 at the low end.

I will need some time to dig into
[https://projects.propublica.org/graphics/covid-
hospitals](https://projects.propublica.org/graphics/covid-hospitals), but I'm
having trouble finding where they give their estimated hospitalization rates.
I did note that the article has the following quote:

> “You will have people on gurneys in hallways," Cuomo said at a press
> conference on Monday, later adding that New York would need up to 110,000
> total hospital beds, around twice the number it currently has. “That is what
> is going to happen now if we do nothing."

And we know now that this was absolutely not the case. Recall that New York
ended up not really needing the USS Comfort, and we now know that at least 15%
of the population has been infected per the serology studies. So the fact that
that prediction was wrong makes it feel like other predictions using the same
model will be very wrong. I'll see if I can find the paper that the Harvard
team published.

And then this quote seems to imply they're operating off of the bogus 20%
hospitalization rate that I mentioned in the article:

> According to the Harvard scenario where 40% of adults in the country
> contract the disease, about half a million people in the San Francisco
> region may get infected, with more than 100,000 residents requiring
> hospitalization.

Anyway, moving on:

> The idea of cordoning off the vulnerable when those who are most vulnerable
> are essential workers in groceries, transit, delivery not to mention the
> non-essential service workers, hospitality staff, janitors, teachers, etc.
> What you are proposing can have no basis in reality.

It's not clear to me why this is the case. Those essential workers who are
vulnerable would be quarantined (whereas right now I believe they are not
quarantined which is a problem). So, the 70 year old working as a bank teller
would stay at home, collect unemployment (I wish we had a better system of
unemployment but that's another matter), and the bank would presumably try to
fill the role with someone else who is available to work in the meantime.

\--

Thanks for the discussion.

~~~
mistersquid
Yes, the same to you: thank you for engaging with me and thinking carefully
about what the data--poor though they may be--might mean.

I'm more reconciled to the idea of "ending lockdown", and would characterize
my position as one of guarded reluctance, especially until such a time that
medical and public infrastructure can provide widespread testing.

That said, I think the value of our discussion is more intellectual than
practical given the data are secondhand, the data are unreliable, we are not
medical experts, even medical experts disagree, and much remains unknown and
unknowable about how the coronavirus epidemic will mitigate or exacerbate in
response to human behavior.

That said, perhaps you might find the current Federal guidelines for reopening
economies interesting if not heartening. [0] I found two things especially
interesting: 1) the articulation of criteria for assessing whether, 2) the
outline of a phased approach to reopening.

[0]
[https://www.whitehouse.gov/openingamerica/](https://www.whitehouse.gov/openingamerica/)

------
tonetheman
I feel like this is misguided. At least he did not tell everyone to drink
bleach or inject light into your body.

------
dangus
> About me

> I’m a software / site reliability engineer based out of Santa Barbara,
> California.

People need to stop chiming in on subjects on which they are not experts.

Ryan, as a site reliability engineer, I know you’re annoyed annoyed when
people on the street talk to you about your job and misinterpret just about
everything about how technology works.

I had a potential customer of my employer express interest (based on me
wearing corporate swag in a public place), ask some questions that became
semi-technical, then go on to completely equate being hosted on a cloud
service as not having any privacy or security measures or control over our
data, completely misinterpreting my answers.

This is what you’re doing to doctors and epidemiologists, and whatever other
people do scientific research on viruses. And now your personal blog post has
spread its influence far enough to be seen by hundreds if not thousands of
people who will latch on to your non-expert opinions.

~~~
ryankemper
As you can tell, I read everyone's feedback.

I don't share your views on this matter. I think, particularly given that
public policy is relevant to all of us, that it does make sense for even a
layperson to engage in the conversation. This is not _merely_ a scientific
issue. Rather, we need to don our scientist caps to try to figure out what is
likely to happen under different scenarios from an epidemiological standpoint,
and then we need to think like economists when analyzing the economic impacts
of proposed policies, etc. It's very much an intersectional discipline.

While I am very transparently trying to shift peoples' opinions, I am also
inviting them to try to shift my opinion.

Rather than sink 200 hours into this in order to make it picture-perfect, I
wrote a first draft that I feel covers some important points, and shared it to
get feedback. As you have seen, some parts were completely wrong, some parts
were completely right, and a lot of parts were/are in between.

By doing so, I've exposed myself to viewpoints that I would not have otherwise
heard, and vice versa.

We all get frustrated when people make statements that expose an ignorance on
a subject that we are well versed in. But how we choose to respond to it is
very telling. So personally, if someone makes a ridiculous statement about my
field, _but their statement was made in good faith and they are seeking
feedback_ , I will absolutely take the time to try to tell them where I think
they got it wrong. Even if I think they got, well, _everything_ wrong.

~~~
dangus
I do believe that you believe your article was written in good faith...

You said you didn’t sink 200 hours into this project, and that is my exact
criticism. The people working on covid-19 mitigation in hospital systems,
labs, pharmaceuticals, and within the CDC and state health agencies actually
do this for a living and have spent well over 200 hours per-capita figuring
this stuff out. I mean, heck, that’s only about a month’s worth of full time
work. That’s how little expertise you’re bringing to the table here: basically
less time than a summer internship.

~~~
ryankemper
What role do you feel private citizens should take in discussing public
policy?

I agree that my projections won't be as accurate as, say, the top modellers'.
(BTW, I'm working on the next iteration of this article that will tie in
Ferguson's model which is IMO very high-quality and what I will use to better
characterize the containment case, since I agree with the criticism that I
need to do a better job characterizing the "other side" so to speak)

Where I disagree is the incredible notion that only "scientists" or
epidemiologists are equipped to propose/discuss policy. That seems very
backwards to me. We need experts, scientific, economic, etc, in order to help
us make predictions about the ramifications of various public health
interventions. But when it comes to an ultimate decision on policy, that
requires knowing what our _values_ are (i.e. what we're optimizing for).

I don't see many epidemiologists trying to forecast the economic cost of
lockdown, or trying to debate the ethical merits of these extreme measures,
nor the constitutionality therein. They're not fully equipped to do so.
Neither am I, as we've already said. But each of us as private citizens needs
to look at the data and the projections, and then look at our personal values,
in order to determine what we feel is best.

Or to put another way, what I would call "the cult of expertise" has a
bootstrapping problem. Let's say I accept that I should follow whatever the
experts say without question. The hard problem of expertise is, how am I, a
non-expert, supposed to evaluate who is an expert? Or which of the experts
specifically I should trust?

When we decide someone is an expert we are making a value judgement based off
of our own heuristics, biases, preconceptions, etc. There's no getting around
that.

To be clear, I am not "arguing against" the concept of experts. Or claiming
that I know more than them, etc. All I'm saying is, it's not enough to just
say "let the experts handle it", because the problem of "who is the expert?"
is intractible. So instead, we make the best effort that we can.

\--

Finally, I want to say that, as I've said elsewhere, if my argument is truly
so riddled with flaws and holes - and this thread has pointed out a _lot_ of
flaws, which I am currently trying to address - then it should not be very
hard to show why my conclusions are incorrect. It really shouldn't require
having to resort to credential-waving, etc.

Thanks for engaging. I truly appreciate it.

