This policy has outlived its usefulness, and is harming people's quality of life without a clear goal.
The initial premise of the "flatten the curve" memes was to avoid overwhelming hospitals. The shelter-in-place has not only had this effect, it's been too effective. Hospital utilization in the bay area is at around 10% when you count surge capacity that has been added [1].
Meanwhile, data is coming out to show that coronavirus has a very low fatality risk to anyone under the age of 50, and to anyone without pre-existing health conditions. A blanket shutdown does not make any sense when the vulnerable demographic has been clearly identified. How is it moral to order people to shelter in place when their risk of death is around 0.01% for 18-45 year olds.
Blanket lockdown doesn't make sense anymore. There is no risk posed to the majority of the population from covid-19. We need to switch to targeted approach, and let people get back to their lives.
Our political leaders (in California) are being fearful, afraid to take leadership and base their decisions on data.
I've seen you say similar things in a few other threads, and myself and others have said, every time: the risk to everyone is that the hospitals become overwhelmed. They are not right now because of stay-at-home orders. What you think of as failure - hospitals currently low utilization - is in fact success.
1. This doesn't appear to be a falsifiable position with respect to being overly conservative. Any action that results in the hospitals not being overwhelmed will be taken as somehow likely causing the hospitals not to be overwhelmed. It's not clear by this logic how hospital capacities are ever chosen given various uncertainties in the environment.
2. It commits a status quo bias. Only the risks of deviating from shelter in place are considered. On the one hand we have a virus with a CFR of around 0.5% with fairly well understood vulnerabilities to various parts of the population. On the other we have a completely unprecedented shutdown triggering a 2T spending package and causing record unemployment, with an unknown end goal. Is the risk of continuing down this path somehow less than the risks to the hospitals based on our knowledge of disease?
> with fairly well understood vulnerabilities to various parts of the population.
I don't think the virus is as well understood as you believe, which is why opening back up now may be premature.
Regardless, the riskiest pre-existing conditions appear to be obesity and hypertension. 57-75% of Americans are obese according to the dedicated Wikipedia page. Also bear in mind there is considerable variance among obesity rates per locale. What's the CFR in obese patients?
Edit: if you can't tell me the CFR in obese patients, you shouldn't be rushing to open everything back up. I don't know why people are silently downvoting but there is nothing incorrect or inconsistent about my comment and I'm just making a suggestion based on what little evidence exists.
Point is there will be more than enough cases to overwhelm hospitals if the virus spreads in earnest. In this respect our population is potentially more vulnerable than, say, much of Europe or parts of Asia.
I don't know why my comment is even being downvoted. There is literally nothing factually incorrect or logically inconsistent about it yet every time I post anything regarding COVID19 I get immediate downvotes.
The pandemic isn't going to stop anytime soon. Miracle cures are highly unlikely, and a safe vaccine is probably more than a year away. So I hope that anyone with obesity is taking this opportunity to lose weight at a safe and sustainable rate.
1. A lot of people are gaining weight at a prodigious rate.
2. Newly minted alcoholics are being created before our very eyes.
3. There are already a bunch of seriously bad haircuts.
And this is just among people that I know who have the luxury of sitting around the house working from home. I imagine the real life consequences for the less fortunate are significantly more serious.
> What you think of as failure - hospitals currently low utilization - is in fact success.
What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals. If this is truly a concern, and our rights our primary, then we should be building more hospitals so that we no longer have to make this Faustian bargain.
It seems impractical and short-sighted to continue these measured based upon this single metric, especially when there are so many other ways to have a lasting impact on the problem.
Aside from that, I don't personally believe it's the purpose of the government to save lives at any cost. Even the Police won't give you that guarantee.
The last rounds of major public (or notionally public) buildouts of infrastructure where profits be damned were funded by the feds, because the states and localities do not have the financial resources to add this along to whatever else they are currently funding, and even if they did you'd see a patchwork that mostly fails the truly underserved.
This is extremely unlikely due to the current administration.
> What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals
This is pretty selfish. What about all of the old and immunocompromised people that could _die_? What about the families of those people? These people deserve rights too and I’d say their right to _stay alive_ trumps your “right” to get a hair cut or whatever
Let the old and immuno-compromised shelter in place then while the rest of us build herd immunity. We don't shut down the tobacco or alcohol industry even though second hand smoke and DUIs kill orders of magnitude more innocents than covid-19 ever will. Millions of people die every year. That's never going to change - such is life. You gotta draw a line somewhere and I think the "save lives at all costs, even the cost of the nation's economy" attitude of covid-19 is too far. You'll pay for a ruined economy later in suicides and increased crime (not to mention suicides snuff out way more man-years of life than old people dying of sickness who were already nearing the end of their rope).
You don’t think that covid-19 growing largely unchecked, infecting millions of Americans and overwhelming our healthcare system won’t crash the economy and kill young people?
We have a lot to lose and betting it all on for the economy, which would likely be ruined either way, seems foolish to me.
I suppose I just don't believe that would happen. You can still practice social distancing/face masks/hand washing without shelter-in-place. I believe those three things alone would significantly slow down the spread to manageable levels. So I simply don't see a scenario where it "grows unchecked" to millions in the USA. It would hit millions eventually (like swine flu) but it would be manageable (not "unchecked"). Most of the US is geographically separated and not densely populated (except for cities like NYC), and we are only at 3M cases globally and that is with months of growth.
Lastly, even if it grew unchecked, I don't believe overwhelming the healthcare system would crash the economy. It might devastate the healthcare industry, but it wouldn't devastate all industries like prolonged, no-end-in-sight lockdowns are doing. I also don't believe it would "kill [significant amounts of] young people" because I believe the mortality rate is much lower than currently estimated.
Suicide is already killing more young people than covid-19 due to lockdown. 2 USAFA cadets committed suicide because of lockdown orders this month, yet 0 cadets have died from covid-19.
> What bothers me is ... my rights are contingent upon ...
Your rights have been an illusion the whole time. We're one organism. The individual is a useful abstraction, as is further dividing that into the cells, but these abstractions have limits.
> What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals.
What rights do you think you have here? Businesses are controlled through licensing and zoning. Outdoor spaces are regulated. Which right are you referring to?
> data suggests the vast majority of the population have taken to voluntary social distancing, which is the crux of Sweden's strategy to slow the spread of the virus.
Does it make any difference if they have "plateaued" if there are more active cases today than yesterday?
Does it make any difference that the US has not "plateaued" if the number of active cases is rising slower than in Sweden, and the death rate is lower?
It's good to have numbers, but given the wide disparity in testing rates and protocols, it's difficult to come to any significant conclusions based primarily on day-to-day case count.
Death count is at least somewhat less subject to such complications, and even there, it'd be much better to compare 7-day averages to smooth over reporting quirks.
Well, this is a truism, but it also smacks of special pleading. When readily available data contradicts a line of propaganda or groupthink, you can rationalize why it has many issues and quite possibly be right, but why are you exerting yourself to rationalize in that direction and not the opposite one? Even weak evidence against something should not enhance your confidence in that thing!
If the numbers were really meaningless, it would probably be evident in their clustering or limited range. I noticed the contrary; I didn't post a complete chart because I figured more data would probably result in diminishing returns when urging people to question their beliefs.
Russia, by the way, in the same data set, has about 7.6% more active cases than yesterday. Brazil, 8.4%. Pakistan, 4.8%. So if you hypothesized that all the increases were in the approximate range of +1% to -1%, you would be quite wrong.
Conversely, Germany's figure is down 4.8% and Switzerland is down 6.2%.
It seems as though people for whatever reason fetishize Sweden, among other nordic countries, and I'm increasingly irritated by it. Partly because it reminds me of the current US president and his judgment of different countries as "shitholes" or not. People pretend that they are clearly seeing facts in an unbiased way while doing the opposite.
No one is advocating going back to usual. Just to stop the irrational hope and actions that seem to target impossible benchmarks - you can't eradicate the disease, not a chance - instead, learn to live with it. And you do that one step at the time, not locking down further.
Exponential growth also means that 10% utilization isn't a ridiculous amount of headroom: it's <4 doublings, each of a few days, from overwhelming the system with new patients.
An R0 of 2 is towards the low end of estimates without social distancing. Zhang et al. estimate it as [2.06, 2.52] from the Diamond Princess data; Sanche et al. reported [3.8, 8.9] from data from Wuhan.
Without social distancing or contact tracing. The Bay Area's r is probably around 0.8 at this point with Santa Clara even lower (EDITED - see notes below). Some restrictions can be relaxed.
Rt of .88 according to https://rt.live I agree some restrictions could be relaxed. Hospitals were a good first step. More of the outdoors could be a good next one.
If it creeps up to 1.1, you still don't need many rounds of infection to completely overwhelm the system. 7 rounds of infection (~a month) would result in 10.4x more total patients.
That's new cases though, isn't it? I was summing over the entire "tree" to get the total instead.
If R0=2 (each person infects two more), you have 1 case at time zero, two after the first time step, and four after the next, but the total number of cases is 1+2+4=7, not 2^2.
It's true that people are discharged from the hospital eventually (one way or another), so there's a little extra room from that, but not much.
California is somewhere near steady-state (R=1) right now, but that's not a "stable" point, in the dynamical systems sense. A small decrease below R=1 would lead to falling rates, but a small increase above R=1 can make them skyrocket.
I'm not sure if there's good data on the length of hospital stays, but an early preprint from China reported a median stay of 19 days. That's not much help here: On day 20, the intake is 60% larger than the initial cohort--and only half of them (b/c median) will be discharged.
People with more data and expertise!) have worked up full SIR and utilization models, but the general point is that exponential growth is manageable, even boring, until suddenly it suddenly isn't.
Note that is CA as a whole. LA is skewing it upward.
e.g. CA was around 1250 new cases 2nd week of April and maybe 1200 now (4% lower). With test capacity increasing, rt.live is giving 0.88, which on a 4 day serial interval implies a 33% actual reduction
Bay Area went from about 200 to about 140 now (30% lower). Factoring the reduction from testing (if same for all of CA), we're actually at a 53% reduction. That's an R of 0.81.
Santa Clara (which I admittedly originally mis-used for all Bay Area) went from 62 to 25. That's an crude R of 0.77 -- 0.7 factoring the test increases.
Various data points. This is an upper bound, more calculated for Santa Clara county.
International comparisons to lockdown level and case count changes.
Assuming serial interval of 4 and > 10x non-detection rate on March 31 and 3x now gives you this.
Knowing people were dying if the disease in early February implies very high lack of detection when SIP was in place. (Likely over 800 infections a day when Santa Clara activated SIP)
What is your evidence that hospitals in America in general, and in California, are anywhere near being overwhelmed? I've cited evidence which shows the opposite--they are very far from being overwhelmed.
I live in a county of little over 100K residents, one death occurred over the outbreak, a 91 year old person died of COVID19. Over the weeks we had a total about 65 known cases, all sent to recuperate at home, with a single patient in the hospital.
The hospital has an entire wing dedicated to COVID patients that did not actually materialize. No care is provided to other patients that might need it (unless it is an emergency). Every appointment was rescheduled months into the future.
Everyone must stay home on the account of better erring on the side of caution.
I just went to the ER last night for what turned out to be a kidney stone. The place was empty. The doctor had just learned that day that the owners had laid off 50% of the staff.
On 3/16 San Francisco and some other cities issued the shelter-in-place order, and CA had 472 patients. Two weeks later, on 3/30, CA had 6,932 patients. That's 21% average daily increase, with an existing shelter-in-place order.
With 21% daily increase, it takes 12 days to go from 10% to 100% hospital utilization. And change of policy usually takes a week or more to affect the curve. Which means, we are ~5 days away from an invisible deadline, after which hospitals will be overrun no matter what.
First, it's not clear or obvious that the 21% daily increase rate would increase indefinitely. Infection rate slows more people get infected, and new potential victims decrease.
Second, all regions saw giant, double digit growth rates at first, and then lower growth rates. Sweden is taking a more laissez faire approach, and their growth rate has dropped from over +20% d/d to +1% d/d [1]
There isn't data to support the idea that we'd have 100% utilization in the Bay Area without shelter in place.
They’re not near being overwhelmed. That’s the point of we are currently living in success. But what we know from Italy and NYC is that the margin between situation-normal and patients-are-dying-in-hallways is less than a month.
The one-size-fit-all lockdown was a reasonable first knee-jerk reaction given the situation. It isn't a tool to fight pandemic, it is just a breather to prepare the long-term sustainable tools and system - like production of tests, certified masks, etc., identifying/quarantining vulnerable population, putting contact tracing in place, adjusting various social distancing rules to be tighter/looser where it possible and makes sense, etc. - to actually fight pandemic. Yet it seems that the lockdown time has so far been almost wasted in that regard and the lockdown itself seems to be taken as the main tool to fight the pandemic (probably also coupled with the naive idea that this virus can be made to go away completely). That doesn't look good. We may get temporarily lucky - the hot and dry weather will slow down the spread until of course October/November when with such an approach we would be back to square 1.5 at best, and that if the virus doesn't mutate to become more virulent and/or deadly (the 2nd wave of the Spanish flu for example was more deadly than the first)
For example - the construction was stopped at near by site. It is a huge 3 acre site where you can easily set social distance of say 10-20ft and have the clad in PPE crew working without any risk of virus spreading.
Ease up how? I mean, what's the specific proposal? The lockdown isn't "total" anyway -- very large numbers of people are still working at full salary (including, it must be pointed out, probably more than half the readers of this very site). There's little to no low hanging fruit of safe jobs that can be reopened. Just go look at the California list of "essential" jobs and tell us what needs to be added.
Fundamentally this is just a complicated strawman. People are arguing against "lockdown" but not in favor of another option. But we were all here in late march and we know what this disease does without containment.
I'm not an expert. I'd lean towards loosening restrictions on non-essential businesses, imposing strict capacity guidelines, and adjusting the strictness of the guidelines by region at fixed intervals with a fixed lead time. Add some worker protections so people who don't feel comfortable working don't lose their jobs during when they reopen, and don't exempt them from receiving unemployment so reopening doesn't turn them into a burden for the nonessential employer.
I'm lucky right now, to be an 'essential' employee making roughly twice minimum wage, working for an employer with deep pockets. I'm not coming from a place of personal inconvenience, because my job's gotten exponentially easier since people became afraid to go out. Most of our part time staff is gone, and I'm worried that SMBs will soon start dropping like flies.
We've proven that lockdowns work, really well. now we need to find a balance in order to prevent the economy we as a society return to from being a small collection of megacorps wandering through a graveyard of small businesses and unemployment.
Shouldnt step 4 be actually first one as it has lowest risk of making anything spread? Meanwhile, kids in elementary schools are unable to keep distance from each other and opening them requires reorganization like need for more space, need have them in smaller groups etc.
1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month.
2) For better or for worse, we've conditioned people to be wary of contact with other people. A movie theater that's 10% full is still hemorrhaging money, perhaps worse than if it was closed entirely (no payroll costs/etc).
I'm not sure what the breakdown is, so this could certainly be hyperbole, but it's entirely possible that people will just feel uncomfortable doing things with groups of >10 until a vaccine is available. A restaurant with 25% of its normal business will likely still need to shut down, reduce staff, etc.
Sure, we may not have 22MM people filing for unemployment but it might still be 10MM, which is still extremely abnormally large.
All that to say, there's a real possibility that gradual re-openings don't actually accomplish anything because the root fear (i.e. catching covid-19) hasn't been resolved in the minds of many people, especially in dense urban areas.
> 1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month.
Though it could make sense to re-open them a month early, health concerns permitting. They already got a "summer break" and can make up for lost time
My kid is absolutely still participating in school, and quarantine is pretty stressful for a kid. This hasn't been just loafing around, relaxing, and playing.
> Ease up how? I mean, what's the specific proposal?
Not sure how to put this but if you're advocating for the side that wants to confine seven million people to their homes and shut down nearly all commerce you're the one that has to come up with the specific proposal.
The objection is that there doesn't seem to be any kind of numerical metric to determine the success of this shelter in place policy.
It's public policy. So what are the stated goals of that policy, and what are the criteria for determining success?
It is a serious fucking problem that people aren't even really trying to answer that question any more.
That doesn't seem right. I got tacos from down the street last night. I got paid a week ago. I bought some home office related junk from Amazon yesterday. I need to go shopping tonight.
That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all.
So I ask again: who do you want to go back to work before the virus case load drops? Be specific.
> That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all.
You're kidding right? The drop in GDP between 1929 and 1932 was about 15% or so. You're saying I'm the one being hyperbolic for calling a drop of twice that size in three months a total free fall?
I apologize I forgot about Jeff Bezos and your local taco guy. I'll try to be more optimistic, like you are doing here, by predicting an instant drop of economic activity to twice the severity of the Great Depression.
And sure I'll take your bait on specifics anyways. I think we should pick policies just restrictive enough to keep hospitalizations below system capacity and no more. There really isn't any other reasonable choice, the current policy is just delaying the inevitable for no clear reason and without any specific vision of what success looks like.
You realize that if we have the same number of cases, and deaths, but with 3-4x the economic destruction, that's a spectacular policy failure right?
> The drop in GDP between 1929 and 1932 was about 15% or so.
I could be entirely wrong, but I just wonder whether GDP is a good measure or not for this situation. Think about childcare - it's not that children are not being cared for: in fact, they might be getting more attention from their parents or other family members. Yes, the daycare is shut down and not making money, but the work is still performed. Similar to restaurants vs. food made at home.
I wonder if the loss of non-essential businesses is as detrimental to our economy as the loss of essential businesses. During the Depression, we were losing essential businesses like farms and then on top of that we had a dust bowl. The economy feels very squishy - as in, we're able to layoff and furlough an amazing percentage and people still get the basics like food, water, and shelter, and we still have luxury goods: Apple is still releasing new iPhones even though they're made in China, we still have craft beer flowing, and we can get tacos.
Tied into this, though, is that we do have to keep money flowing not through labor, since that's illegal for a lot of folks, but start figuring out better unemployment insurance and small business aid.
Ease up by returning to normal economic activities, but with mandatory masks and gloves for most workers and consumers, while strongly encouraging social distancing.
My current belief, based on experiences reported in other countries, is that this would be enough. There's not much evidence that total physical lockdown is necessary for everyone regardless of their level of vulnerability.
I'm painfully aware, which is why I asked the question. Who would you like to see back to work, and are you certain they're not already on the list of essential positions?
If many people get very sick simultaneously, they would not only overwhelm hospitals, they would also inflict a disorderly, involuntary shutdown of large swaths of the economy, driven by fear -- instead of the orderly, voluntary shutdown we have at present, driven by government mandate.
We all want to avoid a disorderly shutdown driven by fear.
The current so-called shutdown (at least where I live) seems to be mostly voluntary. People are out and about horsing around all the time. There's no difference in traffic before and after on my street. It's pretty much being ignored by many people, and there's no visible enforcement. It seems more like a stay-at-home suggestion than an order.
Here in BC we don't have such restrictive conditions, and yet we still have very few cases. Vancouver has about 76% of the population of SF, but has half the number of cases. Restricting people to be at home has no benefit, no logic behind it, but has significant repercussions on mental health.
My understanding is that the Vancouver lockdown is largely identical to the California one, no? What is open there that isn't in CA? I know restaurants, theaters, large gatherings, etc... are all closed, which is the economic activity most of the "reopen" people are concerned about.
Edit to note: two responses "disagreeing" with me by pointing out that the BC lockdown is effectively the same thing as the California one from the perspective of economic impact. This is why I asked the question! People are being fooled into arguing with a strawman idea of "lockdown" that isn't what is actually implemented.
First, it's not a Vancouver lockdown (it's a BC thing), nor is it really a lockdown at all. Nobody is legally required to stay at home except for people who are under a specified health order. Here are the restrictions on life that are most commonly noticed:
1. Restaurants are closed except for take-out and delivery.
2. Personal services businesses are closed.
3. Large gatherings of all kinds are banned.
4. Schools are closed.
You can still go to your office if you wish to, so long as social distancing rules can be respected (staying 2m apart). This being said, the vast majority of businesses that can have their employees work remotely are doing so, simply out of a concern for their health and wellbeing. If you have to have employees in your workplace, then there are guidelines for making it as safe as possible.
There is also extensive testing. Anyone with symptoms can be tested promptly.
FWIW I'm not familiar with CA specifically, but that sounds like the same kind of lockdown we have here in NY.
Offices are voluntarily closed, as far as I can tell, not by fiat. While you're only supposed to be working at an office if you're an essential worker, the definition is somewhat loose.
No. We are allowed to drive. All workplaces are open except for places like restaurants, personal service businesses, gyms and theatres. Other businesses just have to ensure distancing.
We're allowed to drive in California too - its supposed be for "essential" travel only, but that is pretty broad. I'd estimate in the Bay Area, traffic is only down by 50% or so (though certain commute routes are more dramatically impacted).
"Everyone is required to stay home except to get food, care for a relative or friend, get necessary health care, or go to an essential job... If you need to get into a car or on public transportation to go for a walk or run, you’re going too far."
Correct. Driving somewhere doesnt increase risk, any more than walking near your home. In a large city you are probably better driving outside the city.
The lockdown restrictions are a faith based policy, not evidence based. There is no hard evidence that they will reduce total deaths over the full span of the pandemic.
That (1) driving is a pre-cursor to contact with others and (2) driving requires contact with others (gassing up, toll booths, parking attendants, snacks, LE and so on) and (3) driving could lead to accidents which might in turn lead to you ending up in the ER or requiring ambulance transport.
Walking or driving can be a precursor to contact, but as mentioned in my previous comment, if you live in a large city it is difficult to physically distance yourself when walking outside. You are probably better driving to a more remote location for exercise.
Generally there is sufficient distance from other people when gassing up, so that seems like a very low risk for a short period of time, compared to walking in a city.
You are also at risk of requiring ambulance transport if you do DIY work at home. So best just sit in a dark room because you don't want electricity workers to have to go to work, or Netflix employees to have to go into work, etc.
If you think a pandemic is the time to start major DIY projects then you really don't get it. You're not alone in that, but that doesn't make it smart or right.
If we expect a roughly fixed number of people to eventually need hospitalization, then underutilizing hospital capacity is a waste of very expensive shutdown time.
The shutdown is preventing quite a bit of sickness, disability and death from occurring during the course of the shutdown. If we could indeed maintain a shutdown forever, and if that would reduce the total amount of sickness, death, etc, then maybe it follows that an indefinite shutdown would have value to weigh against the cost. But those are some seriously questionable assumptions. What actually seems to be happening is that we are delaying people getting sick, and the value of that is not self-evident.
I am suspicious that much of the COVID-19 response is based on pretending that it is a severe pandemic flu with a comparable fatality rate. With a flu, shutting the world down until summer or until a new flu vaccine can be mass produced has clear value. But COVID-19 is not the flu.
The problem I see with that statement is that it's difficult, if not impossible to falsify.
Hospitals are nowhere near being overwhelmed, in general, which means that they have some capacity to handle an outbreak if we lift restrictions gradually. I know people who work at hospitals in places like LA, and they've reported that activity is relatively slow. (of course in part because fewer people are going to the ER for other issues)
Lives are being ruined by furthering a draconian lockdown. I know several people who have not only been laid off, but had their businesses destroyed and their dreams crushed. Someone in my neighborhood spent their life savings on starting a gourmet burgers and brews joint next to a movie theater, which would have undoubtedly succeeded in normal conditions. They're getting very few curbside orders because they opened after the pandemic started and nobody is familiar with the brand. They're almost certainly screwed, especially if some semblance of foot traffic doesn't begin coming back in the next month.
I, too, was in the early stage of starting a brick and mortar business before the lockdown. Fortunately, I hadn't opened up anywhere yet. Because my business relied on the existence of gyms, I would have been massively screwed. If there is a god, I'll thank him now for not putting me through the ordeal of owing tens of thousands of dollars to the bank. Now I'm not even going to bother opening up because there may not be any appreciable business in the next year or so, which also means people whom I would have employed have to look elsewhere and may be out of work.
Low hospital utilization seems to have become our only metric for success. I think that's crap, especially now that it's coming out that way more people have had this virus than the numbers suggested.
We can put on masks, wash our hands, and all that, but this idea that "the new normal" is to have little to no proximity with other human beings is demoralizing and wrong. Life isn't just about staying alive.
EDIT: To bring up anecdotes is not a fallacy, and I won't apologize for it.
Some ignorant boob happened to bring up NYC, and their comment to mine got flagged, but I still want to reply to that point.
You can't focus in on a particular city and then claim that, without draconian intervention, that NYC will be coming to a neighborhood near you. It's more complicated than that, and the more data we are getting, the more it's looking like we could begin to take measures to ease the restrictions in a reasonable way in parts of the world where it makes sense. But people like to point at the raw numbers rather than looking at the science or the per-capita numbers.
By using the logic of "but look at NYC!", we should keep the entire world closed until every city on the planet has no more cases, which is highly improbable and destructive.
+ CO2-increased houses make people much less clever,
+ Demotivation/decrease of testosterone makes people durably less productive, further hampering our ability maintain the little flow of goods that’s left.
We are setting up ourselves for a much more deadly future.
Exercise hasn't been banned, so unless you absolutely can not exercise without a full gym, there shouldn't be any reason to think people will be gaining weight, or having decreased testosterone. Even if you don't want to leave the house, you can still do things like Yoga, lift weights, or any number of other physical activities that need little or no equipment.
I'm not sure what the concern about CO2 is - at least in the Bay Area, we're in prime keep-the-windows-open-all-day weather. And the status quo would be working in offices or other buildings that tend to not even have openable windows, so even if the weather wasn't nice, indoor CO2 shouldn't be a concern.
That may be true, but that isn't going to change human behavior. Encouraging people to continuing to work out at home is a good thing, but most people are demoralized. Fewer people are going to exercise because there's nothing to do, nobody to see, and not much to look forward to for the next year. I know my fitness has decreased due to demoralization. Sure, I can exercise, but it's hard to find reasons to exercise beyond mere health. Most people also want to be fit because they want to look good, but during the pandemic, looking good for whom? Toss unemployment income and "survival" junk food into the mix, and you've got a population that is probably overall less healthy.
I'm on board with keeping up the exercise, by the way. It's just that the reality is that people aren't going to come out of this more healthy because their motivation has been crushed.
>The problem I see with that statement is that it's difficult, if not impossible to falsify.
All you have to do is take a look at hospitals in NYC to know how wrong you are and right the person you responded to is.
>Someone in my neighborhood spent their life savings on starting a gourmet burgers and brews joint
Holy shit won't someone please think of the gastropubs. This is why I'll never believe this is a good faith concern for the people that really need our concern right now: no one ever says "I know a delivery driver" or "I know a busboy" or "I know a janitor" that needs help. It's always some lifestyle business owner that we should be weeping for in these outcries.
of course i would. would you like to setup a call so i can tell you to your face in real life how absolutely morally repugnant and completely facile your ideas are?
i don't care i'm not a politician. people like you get away with spouting nonsense because no one ever shames them for it (they've always gotten the benefit of the doubt about their intelligence). i'm a firm believer in shaming people for their stupidity when it affects others. you have zero stake in this mr webdev and you should at least be forced to ante up your ego. so i don't care if you're persuaded, only that next time you'll think twice about opening your mouth because you expect everyone will just politely disagree with you.
We were on an exponential growth path before. Now we’re not. It’s impossible to prove that an intervention made things not happen, but this is the predicted outcome.
I don't know about San Francsico, but, in much of the less population dense US West, the deaths from denial of so-called "non-critical" procedures are getting out of control, and hospitals and medical facilities are losing way too many employees.
People should remember that the mortality rate for COVID-19 is under 3% _with_ medical care. If it isn’t available the mortality rate goes way up to around 20%.
Wuhan hit about 17% in the early days when their hospitals were overloaded. I though that was common knowledge? I also thought it was common knowledge that about 1 in 5 symptomatic cases require medical care.
The cdc has revised their estimates down in wuhan from 17% to 12%, and hospitalization rates have also gone down as testing has improved over the last few weeks. On the flip side there is mounting evidence that many COVID-19 deaths are not being counted.
Continuing a lockdown of this severity makes no sense. San Francisco has only had 22 Covid deaths. A city the size of SF would be expected to see 5x as many cancer deaths as that in a normal month [1] and 7x as many heart disease deaths [2]. Instead, we're maintaining a policy that discourages people from seeking preventative treatment for these diseases on the basis that we don't want them contracting a less deadly disease.
The lockdown has proven to be excessive. The doomsday predictions have not come to pass, and we're entering a time of year that is known to be correlated with reduced rates of viral spread (Flu infection rates are 30x higher in the winter than the summer [3]). We need to get people back to work now. Social distancing should still be maintained where feasible but a blanket lockdown will cause way more harm than good.
> The lockdown has proven to be excessive. The doomsday predictions have not come to pass
Alternate interpretation: the lockdown worked.
I fully agree that continual lockdown without a concrete plan for what its achievable goals are, and how and when we'll reopen is excessive. Some kind of targeted, data-driven reopening in stages is the right way to be headed.
This reminds me of a quote going around a few weeks ago: "If we have done a good job, everyone will say we over-reacted."
As a counter point, NYC did _not_ do a good job and at it's peak COVID-19 killed more people than heart disease and cancer during the month of March [1].
> A city the size of SF would be expected to see 5x as many cancer deaths as that in a normal month [1] and 7x as many heart disease deaths
This comparison is irrelevant. Cancer and heart disease aren't contagious and don't spread exponentially.
Let's say there were 0 deaths from Covid-19 because there are enough beds and they got lucky enough to save everyone. Would you say that an infinite number of more people die from lightning strikes?
> The lockdown has proven to be excessive.
Because not enough people are dying? I honestly don't understand your logic.
I'm starting to see these arguments take startling similarity with the anti-vaccine arguments.
Which is that vaccines aren't necessary because people are no longer dying from said vaccinated diseases. Perhaps it's important to consider that one of the reasons why the doomsday predictions haven't came true is because places took action early.
We in fact know very little about the consequences of serious C19 infections in people under 50, and people in their 40s apparently make up a substantial cohort of ICU C19 patients. We also don't know the long-term health implications of a severe C19 case, and there's some evidence to suggest permanent lung damage is one possible outcome. And, even if we didn't know any of those things, avoiding the deaths of people over the age of 50 and the deaths of people of all ages with asthma and hypertension would still be a worthy reason to hit the brakes while we learn more.
We don’t know enough so let’s stop the economy while we find out? That is not typically how we do things, because it’s not a rational response. For example, we didn’t know whether holding a mobile phone close to our ear for extended periods of time leads to serious health issues, and there was suspicion that it does. But we didn’t prohibit it — we let people decide for themselves, and it does seem the risk was lower than suspected.
What’s happening now seems more like a knee-jerk reaction than the result of a cost-benefit analysis.
+1. This argument about not knowing long term effects of COVID-19, and hence we have to keep the economy shut down indefinitely makes no sense at all. Making masks mandatory in public, keeping people at risk at home and starting to open up the economy sounds like a more sound strategy.
Many people die in traffic accidents every day, but we don’t ban cars. Everything we do involves some risk. There needs to be a rational discussion on how much lock down is appropriate. We need to look at other countries like Sweden and Austria and learn from them. We need to look at the real costs of a depression. What we have now is “People are dying so let’s lock down everything”.
You can mitigate the risk of dying in a traffic accident unilaterally in ways you can't with a virus, and C19 is probably already killing more people than car accidents by a significant margin.
Sure you don't wear seatbelts and install airbags to mitigate the risk of COVID-19, but the point is that you can take measures to reduce the risk of contracting the virus to a socially acceptable level and not have to destroy people's livelihoods. We have after all not waited for the perfectly safe car before allowing millions of cars on the road. The lockdown in its current form seems more like waiting for the perfectly safe car.
At what cost? When do you factor in the additional deaths and other consequences from suicides, domestic violence, increased substance abuse, and so on? There are two sides to the equation.
There is dated data (from 1981) showing a 37,000 increase in deaths for each percentage-point rise in the unemployment rate. It comes from a book called “Corporate Flight: The Causes and Consequences of Economic Dislocation” by Barry Bluestone, Bennett Harrison and Lawrence Baker.
From the article citation below:
> Here’s the paragraph from Thomas’ book that applies: “According to one study [the one by Bluestone et al.] a 1 percent increase in the unemployment rate will be associated with 37,000 deaths [including 20,000 heart attacks], 920 suicides, 650 homicides, 4,000 state mental hospital admissions and 3,300 state prison admissions.”
The data is stale, for sure, but the correlation (economic downturn->increase in deaths) is arguably proven.
(I was unable to find an online version of the book to link to in Google Books or openlibrary.org; I bought the book used from Amazon, it's headed to the Internet Archive for scanning).
Then what's happening right now is a refutation of that data, right? Because we have sky-high unemployment and nothing resembling those numbers. It's almost as if unemployment in ordinary circumstances is not the same as unemployment caused by a discrete, universally-applicable crisis.
I think the "harm from unemployment will swamp harm from C19" argument will get stronger the longer lockdown lasts, but that the ~month we've had widespread lockdown orders is not close to long enough to make the argument without clear data. We have strong evidence that explosive C19 case growth kills lots of people; that's a hard data point to overcome.
If you want to be frustrated with the unbounded nature of the crisis, I think the right place to focus that anger is on testing; in Illinois, we have something like a 22% positive rate on PCR testing, suggesting we're not testing nearly enough people.
I drove passed a testing center in Aurora at the Premium Outlet Mall (I-88 & Farnsworth) twice this weekend, both Saturday and Sunday morning. They opened at 8am each day, and had reached capacity shortly after. I agree that testing efforts deserve the ire of the populace.
There's always "other consequences" you can point to for whatever policy. What about the upside that many can now work from home with flexible hours, and avoid the 996-ICU workweek.
Long term health implications have nothing to do with the lockdowns, and extending them has no impact on those theoretical boogey-men.
Lockdowns were intended to 'flatten the curve' so that hospitals aren't overwhelmed. The same number of people will get sick but over a longer period of time. Keeping the lockdowns in full effect will only ensure that those who get disproportionately sick are the ones in critical services and healthcare.
Choosing to violate people's constitutional rights based on hypothetical long term implications is also extremely disconcerting.
That's a talking point, not an argument. In reality the state governments have broad powers, stemming back to jurisprudence from the time of the framers (cases involving these powers were heard by John Marshal), to employ police powers in the service of quarantines, and those powers were further spelled out by statute as recently as the 2000s in the wake of 9/11. None of those powers are constrained by any notion of "flattening the curve", a "flattened curve" isn't a permanent state, and there are rational goals to quarantines beyond keeping the hospitals occupied at an optimal level.
> there are rational goals to quarantines beyond keeping the hospitals occupied at an optimal level
None of the counties in the San Francisco Bay Area have been willing to outline any specific goals, nor has our Governor. If you can point me to anything more specific from the above than 'if we only save one life', I'd be shocked.
What's your point? Is there a statute you're thinking of that requires San Francisco to spell out specifically what their goals are? You said upthread that the lockdown is a violation of people's constitutional rights, but it seems clear that it isn't, at least not in our jurisprudence. You can find legal scholars debating the constitutionality of quarantine, but only in the context of hypothetical orders that haven't been issued by any state yet that would imprison people in their homes (the way China apparently did). If you don't even have the broad strokes of this right, it seems fair to ask for a citation here.
I require San Francisco to spell out what their goals are! I fundamentally reject the idea that it's our duty as citizens to shut up and do whatever London Breed thinks is best. If she's not willing to explain why these emergency restrictions are necessary and how we'll know when they aren't necessary, we shouldn't comply.
Yes, even if this isn't required by the letter of the law, it certainly does seem to be required by the spirit of US law that the people are not mere subjects to be ordered around. At least in spirit, they deserve to be informed, so that they can make an informed decision about whether they believe their representatives are behaving reasonably. And if they don't agree, they can vote them out, or exercise their free speech rights to voice their dissatisfaction.
Is there a statute somewhere that requires London Breed to spell anything out to your satisfaction? I don't know what California's emergency management laws look like; maybe you're right.
Does there have to be a statute to advocate for a rational, numerical based approach to public policy?
You're a super smart, analytical guy. You don't see any problem with imposing extremely restrictive rules on a population of millions without even a basic attempt to quantify what your desired outcome is?
Why do you want this to be a simple problem? It isn't a simple problem, not by a long shot and erring on the side of caution seems to be the right way to play this because you are at most 4 weeks away from a serious disaster if you fuck it up. The fact that SF does ok is a result of the shelter-in-place order, without it SF would look like NYC or worse.
Nobody said it was going to be simple. I'm just advocating that it not be completely and totally lacking in stated goals when it's such a severe policy intervention.
Those goals could be complex, or detailed, or multivariate, or subject to contingencies and caveats. But they can't be non-existent and they can't be secret. This is a democracy.
> The fact that SF does ok is a result of the shelter-in-place order, without it SF would look like NYC or worse.
Your sentence here is making a quantitative assessment that the result is worse than NYC, without stating the metric you're using to arrive at that assessment, or hinting at the means by which it was arrived at. It's just "worse".
That's fine for an forum comment. But it's a disaster as a government policy almost six weeks into this crisis.
What's being criticized here is the parent story, which is a press release by the actual government, and appears to make no mention of the criteria used to arrive at this drastic and staggeringly expensive policy decision, and contains nary a hint of what metrics they'll use to evaluate it, or critically, determine if the schedule should be delayed or accelerated. That's crazy.
It sounds to me as though you do not trust your leaders to have your best interests at heart.
The idea that everybody will go and pick apart the underlying data to support their favorite little theories may have something to do with the decision to keep the inputs confidential.
You get one chance every so many years to vote in a government that you trust, you're going to have to accept that.
> The same number of people will get sick but over a longer period of time.
Fewer people get sick for two reasons.
Flattening the curve reduces the amount of epidemic overshoot. People assume you reach herd immunity levels and the epidemic then dies out. Reality you overshoot herd immunity.
At some point you can reestablish contact tracing and isolation. That by itself reduces the required level of immunity and containment needed to keep the infection in check. Except for a few countries we don't have that now.
My bet at this point is within a few months. Rapid RNA tests will start being produced in large numbers. Synthetic anti-bodies for covid19 will become available. Contact tracing and isolation containment will be reestablished. Rapid RNA tests make contact tracing possible at scale. Antibody therapy increases the effectiveness of contact tracing. Basically you test everyone with symptoms. You then dose all their contacts with anti-SARS-COV2 antibodies.
What if it doesn't? What if a few months pass, and we're at the same spot we are now, except we're all a few months older and poorer?
My jurisdiction is already testing everyone with symptoms with only about half of their current testing capacity, and still has no plan to move forward.
> Meanwhile, data is coming out to show that coronavirus has a very low fatality risk to anyone under the age of 50, and to anyone without pre-existing health conditions.
34% of America is aged 50 and over[1]. Almost 40% of America is obese[2], which is a risk factor for COVID-19 complications[3].
> A blanket shutdown does not make any sense when the vulnerable demographic has been clearly identified.
When the "vulnerable demographic" is forty percent of the population, a blanket shutdown makes a lot more sense. We cannot simply consign four out of ten people to severe illness, unknown long-term complications, and/or death.
Personal responsibility must enter the equation; otherwise, you're consigning those of us who have made good decisions about our health to pay the price for those who haven't.
Why does my life, as someone who has made 'good decisions', matter more than someone's who has made 'bad decisions'. Especially when many of those 'bad decisions', like obesity, are products of socioeconomic environmental risk factors. This seems like a very privileged perspective which probably isn't very productive in managing a diverse society in times of crisis.
Solidarity must enter the equation because if you don't take care of those who are vulnerable, the economy will tank worse than it already has. People dying is expensive, and this many people dying is a lot more expensive than the cost of keeping things officially shut down.
Why is nobody focusing on Sweden's COVID numbers? Sweden didn't institute city-wide shutdown measures. Yet, there hospitals are not overwhelmed. And, their COVID case counts and death counts are plateauing.
> How is it moral to order people to shelter in place when their risk of death is 0.01% for 18-45 year olds
The data from your second source indicates that the case fatality rate in New York for 18-45 yr olds is 0.833% (14 deaths in 1705 confirmed cases). Where are you getting 0.01% from?
I don't see how the math for that works out unless literally everyone in NYC is already infected.
0.1% of the population of New York City has already died from Covid. The only way to get the CFR much lower is if virtually everyone is an asymptomatic carrier.
Food for thought - if say 70% of cases are asymptomatic or mild (and therefore they don't get tested), then NYC's CFR already drops to 0.2% for the bucket you are referring to.
In fact that's the number reported for that demographic from Wuhan data way back in January, so it wouldn't surprise anyone. It's still 20x higher than the one quoted upthread.
While I disagree with a bunch of the reasoning you use above, I agree that blanket lockdowns aren’t needed anymore.
Seattle seems to be getting out and about now, but people are being super careful and everyone’s giving each other tons of space. I don’t see why that shouldn’t apply in other places too. In a lot of ways the shelter in place guidance is a mental drain more than a real policy in my mind at this stage.
Our society includes people who are over 50 - how do ensure that YOU do not transmit coronavirus to them if you are under 50 and asymptomatic? I know a lot of people are pretty upset but it's not just about YOU. It's about everyone you come in contact with.
Just a thought, but it seems like there can be a middle ground where people belonging to certain risk groups (age, preexisting conditions, etc) are encouraged to take stronger shelter in place measures, and in exchange are granted larger amounts of financial aid to compensate.
People not belonging to risk groups can resume working, still taking extra precautions to prevent transmission. The economy can gradually reopen while also slowly building up herd immunity among the least vulnerable population. It seems unsustainable to have an indefinite blanket lockdown, but I’m very open to changing my mind on this.
I'd truly love to hear a good counterargument to this. I've argued much the same thing only to have the same opposing talking points restated verbatim.
You and the parent posters are assuming that everyone lives on their own and that younger people don't live with or take care of older people. Once things open up, employers will expect younger employees to show up. Couple that with asymptomatic transmission, how do you practice social distancing in a closed home?
The purpose of the lockdown is not to prevent everyone from getting the disease, or to hide in our homes until it magically goes away. The stated purpose of the lockdown was to 'flatten the curve'.
Don't go moving goalposts on us all now that we've flattened the curve, especially when we're talking about people's constitutional rights.
Moving the goalposts was always the idea. That's what the governor here in WA did, and said as much.
I, personally, am livid that the construction site right outside my bedroom window is now allowed to make ungodly amounts of noise for 15 hours a day and I have nowhere to go. This is insane.
Lockdowns have a tremendous cost in mental health. There's a point at which the toll is simply too high. We're not there yet, but it's not far. And waiting until "the data shows it" through elevated suicide rate is... not how I want us to play this, as a society.
Moving the goalposts could probably be a confusing bit of terminology here. OP means that the original intention was “lock down so that we don’t run out of ICU beds”, and now it is “lock down until there’s a vaccine”. The end condition is being changed every time we get close to it.
I agree that there are a lot of problems with continuing the lockdown as it currently stands. However, the phrase "now that we've flattened the curve" could be interpreted to imply the curve can't quickly become unflattened, which would be wrong.
The only thing that is going to keep the curve flat (this is kind of a mind-numbing terminology) is human behavior. Exponential growth is still a thing, and we aren't anywhere near achieving herd immunity.
(a physician friend mentioned the other day that we're not truly certain yet that COVID 19 sufferers cannot be reinfected, although that's the popular assumption. So there's also that)
Out of curiosity because I have little to no knowledge of immunology: what do you think that means if someone that already had the disease can be reinfected? Does that have any implication on the efficacy of a vaccine?
The physician I talked to was basically trying to rain on my parade when I said "hey, it will be great when there's a vaccine and we can all go back to normal." Maybe, maybe not.
I don't know that much about it, but sometimes people infected with a coronavirus can get sick again, not as ill as they were previously, but contagious. [1] COVID 19 hasn't been analyzed well enough, long enough to say for certain.
There were some scary stories early on, a month or two ago, about people becoming reinfected with full blown cases of COVID 19, but they really felt more like uncertain anecdotes. I strongly suspect the immunologists will know a lot more about this in just a few weeks. Researchers are already giving people test vaccines and sending them out into the world.
In a nasty - hypothetical - reality where people regularly get reinfected: things do not go back to normal, and we have to figure a lot of difficult social stuff out.
Unfortunately, yes. Consider the common cold: yes, it does mutate fast, but the other big barrier to producing a vaccine is that immunity to it doesn't last very long at all. So if COVID-19 immunity truly doesn't last long, that's a problem.
I doubt this is likely to be the case, though. Antibodies to SARS seemed to have long lifetimes (several years), and COVID is likely to be similar. It is certainly possible that for some people, immunity fades much faster for reasons specific to that person, and that may be what is being picked up in these reports.
It is also possible it's just shoddy lab work. There has been a ton of that going around lately, and it's not just caused by pressure from the situation. Not all scientists are equally competent....
(Disclaimer: my knowledge of immunology is likely little better than yours, but I did at least used to be a Real Scientist in a different field.)
The reason that antibodies to SARS have long lifetimes is because it is a much worse hit than COVID-19 in most cases, you can take the CFR as proof of that. Harder hit to the immune system but you survive: immunity will last longer is a good rule of thumb.
The situation is rapidly developing. Our knowledge is constantly growing and will continue to do so. Under these circumstances, I don't think moving the goalposts is avoidable. Nobody is hoping for magic: they are waiting till it's safe to go outside. Perhaps a vaccine will make that a reality in...a couple years? Regardless of what the government does, I say, prepare for a long haul.
On the one hand there is a tremendous amount of real damage being done by everyone sheltering in place. On the other hand it's not the government's orders that are the direct cause, so much as the virus itself. We are in a global pandemic. It is unprecedented. Telling everyone to go outside again is not going to magically make it happen.
Can you imagine re-opening schools right now? Summer camps? It would be sheer carnage, and those who do want to protect themselves will be less able to do so. It would just shift the pain points around, and cause a lot of deaths right away. Would that be worse than it is right now? Probably. Would it be worse than another six months of sheltering in place? Nobody knows!
I am over 50 and asthmatic - if I feel that I am in danger I am free to self-quarantine. There is no need to impinge on everyone else's freedoms to ensure my safety - I am a big boy and able to take care of my own health decisions.
You can only choose to self isolate if you have the means to give up income. Needing to come up with necessary expenses like food and utilities would be understandable, but the largest bill is rent which is a mostly product of our financial system rather than an intrinsic requirement of existence.
I could be in favor of lifting shutdown orders if there were a corresponding federal push to either halt such payments or reimburse people (federal is where the bulk of the money is distributed/printed). But without that, it's disingenuous to frame the situation as some kind of choice, when it's really the same unempathetic turning of the screws on the marginalized.
People aren't going to be able to pay their bills regardless of whether they're locked down by mandate or by choice. However, if we allow the low-risk population to continue working, they will generate tax revenue that can be used to provide for the high-risk population. From that perspective, lifting the lockdown for low-risk persons is strictly better for the high-risk population than maintaining a blanket lockdown.
The difference is that with a shutdown mandate, many people are in the same boat, which necessitates a solution. It's not uniform ("essential" and remote workers), but it's better than putting even more people in the position of having to choose their health or eventual homelessness. Especially say, to just work in nearly-empty movie theaters.
The tax revenue is a red herring. Print the money, as was quickly done for the corporate bond bailout. Or better yet, do the sustainable thing and just suspend rent payments and mortgage interest, so that the debt black hole actually unwinds a bit.
There seems to a ton of people with long term organ damage from this thing. Brushing it aside as a non event for everyone else is dangerously misinformed.
> There seems to a ton of people with long term organ damage from this thing
Are there? I've seen only a few isolated anecdotes. In any illness affecting tens of thousands, there will be a few who experience particularly severe complications. It's not useful to portray these complicated and severe outliers as being typical. Right now, the data show that the vast majority of people who contract this virus fight it off without experiencing any symptoms whatsoever and suffer no long-term damage at all, which is exactly what you'd expect from a typical virus infection.
People keep claiming that this virus has exotic and dangerous features atypical of coronaviruses and viruses in general: I've seen everything from claims of immediate reinfection to 30-day incubation periods to long-term gonad damage. None of these claims has been substantiated on the basis of anything but isolated (and frequently unsourced) anecdotes, and a very strong Bayesian prior should be that this virus works like any other and doesn't actually do these random and exotic things.
There seems to be a contingent of very online people who want to sow as much fear and anxiety over this thing as possible, even if it means presenting a warped view of the data. We should reject this endeavor.
People are irrationally terrified by COVID. There is of course a rational level of respect we should have for it, but people are TERRIFIED. That's why you are getting downvoted (and I will too probably).
Thankfully, you appear to be overwhelmingly outvoted in this "let's set up a peeing section for the swimming pool" position. Lockdown measures and the activist governors pursuing them are, for the moment, overwhelmingly popular --- the population as a whole is strongly more concerned that lockdowns will end too early, and strongly more worried that they will suffer health consequences from C19 than that they'll suffer economic consequences from lockdown.
Sadly you seem to be of the opinion that we can cower in our homes until the disease magically goes away. That's not the way this works - it doesn't just go away.
I'm really disturbed by the number of people who seem to be perfectly happy moving the goalposts for these lockdowns as long as they're politically popular. Here's a hint - freedom and constitutional rights weren't intended to be politically popular (or particularly safe) as the popular opinions don't need protection.
This isn't responsive to anything I'm saying; it merely repeats points you've made earlier more emotively.
I think you're going to find that the message board logic of "a-ha, I read a tweet that says the goal of lockdown is flattening the curve; now that curves may be flattening lockdown has to end" isn't going to get you very far in the real world.
It actually does mean something, which is that freedom is not unlimited. Your freedom of action ends at the point where it harms someone else. Classically, "your right to throw your fist ends at my face." It's the same reason (legally) you can't point a firearm at me.
What we have here is the problem that merely by breathing around someone, you can cause them harm. Unfortunately we lack the ability to determine whether or not you will, but given the contagiousness of this disease if you are infected (or become infected) it is quite likely.
I am over 50 and have immediate family members in high risk categories.
I was onboard with what was clearly a panic response by policymakers since the testing and the healthcare infrastructure was not in place. To the best of my understanding, there has been no movement from this initial panic to working through strategies that transition from massive shutdown to identifying and isolating the sick or those they have come into contact with. If we were moving forward on that front, I'd still be supportive of buying some time... I see none of that.
I see dull minded politicians and bureaucrats doing what they got away with early.
This has to stop and endless hiding in a hole waiting for some miracle vaccine or the disease to just go away of it's own accord simply is not acceptable.
Where do you get this figure? Your first link shows 14 deaths per 100,000 in that age range, or 0.014%, but that is for the entire population, not just people who have had the virus. The same data set reports 1705 cases in that age range. 14 deaths out of 1705 cases is an 0.82% fatality rate.
Of course, that 0.82% figure, reflecting only confirmed cases, is inflated. But conversely, some of those 1705 afflicted 18-45 year olds may still succumb to the virus. The true IFR in this age range in this region _might_ be closer to 0.1% than 0.82%. But 0.01% is just wrong.
I think this is a lot like finishing your full 7 day medication treatment, even though you feel fine on day 3.
That said, I don't know when and how the right way to wind down is, and I don't think anyone else does either. I'm glad we're doing this in a decentralized way over 50 states, so many different strategies can be tried.
I would also add that we who can WFH with full wages do well to remember millions of already less well off people have been left without income and life structure, and they're not just complaining because they're spoiled children!
When you take a 7 day course of antibiotics, you are reducing your bacterial load to a level at which it is highly unlikely to bounce back from zero and, critically, the chance that it bounces back and selects for resistant strains is comfortably low.
No one seriously expects any length of shutdown in the US to reduce the case count enough to eliminate COVID-19. Worse, even if we reduce the case count to an unnoticeably low number, we’ve made essentially no progress
toward a suppression strategy that will detect and control new cases to avoid another shutdown.
I was more saying that you probably need to wait longer than it seems you should. In part because we're dealing with exponential growth.
> Worse, even if we reduce the case count to an unnoticeably low number, we’ve made essentially no progress toward a suppression strategy that will detect and control new cases to avoid another shutdown.
Another reason to postpone everyone getting infected is that the longer that waits, the better treatments we'll have for the sick.
Funny that this is exactly the same narrative as here in the UK. Initially it was about flattening the curve for healthcare capacity, now we are in some weird holding pattern where the goal is becoming increasingly vague.
The second link is death per 100,000 people (not death of confirmed cases), that, for 18-45, is 14.21 per 100,000 (0.014%). There are confirmed cases of 1705.26 per 100,000 for 18-45. Thus, the death for 18-45 over confirmed cases is 0.83%, much higher than flu for 18-49, which is 0.02%: https://www.cdc.gov/flu/about/burden/2018-2019.html. Noted that the new antibody tests showed much higher cases than the confirmed cases. But the 0.01% number you cited is wrong. Please fix.
The "very low fatality risk" thing only applies to people who can get proper treatment for the disease. If healthcare resources get overwhelmed, the fatality risk will get a lot higher, for the younger population also.
> The initial premise of the "flatten the curve" memes was to avoid overwhelming hospitals.
I don't think it was a 'meme' - if you're thinking it was just something on Facebook or something like that. It was and still is a government goal informing their policy.
Setting aside Dawkins, and looking beyond image macros, it seems to me that the meaning of 'meme', in it's common usage, can encompass the meanings of "message", "claim", "idea" and more. It's not necessarily dismissive, and can sometimes emphasize the simplicity of structure or frequency of use.
What's different now vs before the lockdown started regarding flattening the curve? R0 is a little under 1 right now, but what will it be when most things reopen?
The goal of the lockdown is to keep R0 under 1 until we have measures in place to permanently mitigate the spread [1]. This means lots of testing and contact tracing, which is not even possible right now with case numbers being as big as they are.
Reopening right now would just get us back to #flattenthecurve in a matter of 4 weeks.
> There is no risk posed to the majority of the population from covid-19
There is risk to everybody, it's just lower for some. There's enough evidence of permanent damage inflicted on organs and other gnarly details that I (34M) will be absolutely careful not to get this disease. [2]
Multiple counties have already confirmed they are contact tracing every case. The Bay Area has a lower per capita daily case rate than Germany who is opening schools. This should be manageable.
Now we should be slightly reopening and targeting an Rt near 1, and driving towards population-based immunity.
We had looser controls from mid-March to the beginning of April. They were evidently effective. Why do we need to stay in a regime of stricter controls-- mayhaps we can loosen a little from ehre and see what happens?
Plenty of jurisdictions have less restrictive orders than the SF Bay Area, and are showing declining case counts.
In New Zealand, South Korea and Australia coronaplague is on the way out thanks to testing and contact tracing. Why can't the US muster the political will to do the same?
We are already seeing the damage because a number of meatpacking plants had to go off-line when a substantial part of their workforce was ill and could not report to work, yet many citizens advocate for even lighter restrictions. Nothing of this makes any sense.
>In New Zealand, South Korea and Australia coronaplague is on the way out thanks to testing and contact tracing. Why can't the US muster the political will to do the same?
When it comes to complete elimination, you leave out the most important ingredient: all three countries have fantastic border control, thanks to geography in two cases, and an extremist neighbor in the third.
Compared to some Western European countries, the US are looking pitiful. Italy went from 5000 cases/day in early April to 2000 now and Germany from 7000 cases/day to 1500 now. The US continues with 25000 new cases every day and no downward trajectory in sight. This is community transmission, not imported cases.
This is in no way relevant to my point. You brought up three countries that have nearly eliminated the virus from their land, while overlooking the single most important prerequisite in all three cases.
Edit: In other words, we can strive to reduce community transmission, but achieving the specific results found in the three you mentioned would also require a radical change in how we handle our borders.
No it wouldn't. You ignored his point entirely, which is that even if we did manage to further lock down our borders, it does nothing to stop community transmissions. Those countries you listed weren't able to control the virus through strong border control, they did so through strong controls over community transmission.
Which should've been obvious, considering the initial transmissions in South Korea came from a cult.
>You ignored his point entirely, which is that even if we did manage to further lock down our borders, it does nothing to stop community transmissions.
Your statement on the relationship between border control and non-border community transmission is obvious and irrelevant to my statement. Why are you belaboring the obvious?
>Those countries you listed weren't able to control the virus through strong border control
The topic of the comment I responded to was the rapid near elimination of the virus from a country. This was done in the context of fantastically strong border control, which [during this time frame] is a prerequisite to achieving that goal. Now you have changed the topic to "controlling" the virus, which is a relatively vague term and concept.
> The shelter-in-place has not only had this effect, it's been too effective. Hospital utilization in the bay area is at around 10% when you count surge capacity that has been added [1].
This matters if the end game is herd immunity, but not if the end game is to wait out a vaccine, or a sophisticated testing infrastructure. Unfortunately, I don’t think we know what the end game is going to look like now.
I've been wondering for a while what the end game is.
There seems to only be 3 options:
1: Lockdown forever.
2: Everyone becomes immune.
3: Vaccine.
1 is unrealistic. 3 will take a year. 2 the lockdown is too effective - we need at least some people to get infected, and hospitals to be utilized at a manageable rate.
Is there a 4th option I did not think of? Because I can't figure out how they are going to end this.
I guess reopen a state, let people get infected, then close again? Basically a poorly done version of 2?
The idea is not just to keep the curve low initially and then abandon all measures, but to figure out how to keep the curve consistently low over time until a vaccine or highly effective treatment is discovered.
Basically, when you're in free fall and the parachute slows you down comfortably, don't take that as the cue to cut your chute.
Also you may have overlooked adequate testing availability and contact tracing.
And even if contact-tracing is lagging, an abundant supply of testing can at least help to ensure that symptomless or incubating-but-not-showing-symptoms-yet infections can be identified early to prevent wildfire-type spread.
My guess would be that with more tests and resources available, start with a stuttered type approach, open for 2-3 weeks, then lockdown for 2-3 weeks while we wait for new infections to manifest symptoms and for infected to quarantine until they're not infectious.
That could serve as a baseline for what to watch for during reopening, to gauge risk as to whether to repeat with some alteration in timing.
> Is there a 4th option I did not think of? Because I can't figure out how they are going to end this.
Some flavor of mandatory mask/glove/bunny suit wearing and social distancing (e.g. mandatory table-to-table distance at restaurants) would keep the curve flat while allowing a majority of day-to-day life to resume.
Lockdown until you can get back to containment (drive infection numbers so low that you have the resources to trace/test contacts and send possible infections into quarantine).
"Everyone becomes immune" will take longer than vaccine if you don't want to overload your hospitals, and bets on long-term immunity which we don't know yet.
This sounds like a false tricotomy (see what I did there?). Taiwan has effectively contained the outbreak with fewer than 500 cumulative cases for their very dense population of 23m. Unfortunately we can't go back and act swiftly in the beginning like they did, so we'll never approach that level of success, but we can take some lessons from what they continue to do.
I was there in January and February and had my temperature taken routinely to enter populous shopping areas, tourist-packed areas, transit, etc. Mask usage was mandatory in some cases, like buses. They ensured they had sufficient inventory of masks, and even published it so that you could look up which pharmacy to go to. There were lines down the block outside of them, but they also had a reliable ration available for anyone who would wait.
State-side, I haven't had my temperature checked once. Even when I reentered the US, there wasn't so much as a thermal camera to walk in front of (that I could see, anyway). This was the procedure upon entering both Taiwan and transiting through Japan all the way back in January when cases in Taiwan were in the single digits. I can't even find a single mask here.
People were sensible and conscientious there. People voluntarily cut back their social behaviors, but they haven't enacted a hard shut down. It seems to me that we just haven't implemented any common sense behaviors and expect Trump/the governor/Fauci/whoever to come up with some genius plan to solve the crisis for us.
To anyone reading the comment above, it is extremely poor advice and should not be followed.
Stay at home and shelter in place orders are not solely for the purpose of protecting ones-self from contracting the virus. They also serve to limit the spread from unsuspecting carriers. You can carry and spread the virus unknowingly and this will result in susceptible people contracting it and dying.
The only way we know that shelter in place orders worked is if they feel like an overreaction after this is all over with.
We're all scared and desperately seeking answers and relief. We all want this to be over as soon as possible.
But we must put the public health above all else. This is not the time for egocentric defiance of the recommendations from our leaders.
> The only way we know that shelter in place orders worked is if they feel like an overreaction after this is all over with.
That's the only way to know? You think it's reasonable to take away the civil liberties of seven million people indefinitely without at least trying to come up with a better performance metric than that?
You have literally no interest in setting up any kind of plan to assess how the policy is working?
The only people losing civil liberties are the people that die after contracting the virus because we failed to social distance for the necessary amount of time.
The "performance metric" you're looking for is the number of tests we conduct. Unless we're testing hundreds of thousands every day, we have no choice but to continue to shelter in place or stay at home. We are not even close to the amount of testing we need to know who does and doesn't have the virus.
When you have enough tests, you know who has the virus and who doesn't. All those infected (and all the people they've contacted) can quarantine or seek the care they need, and those who aren't infected can all go get haircuts.
So the shelter in place order should be in effect until we have conducted approximately seven million tests, after which we will institute a voluntary program where people who test positive are asked to quarantine and seek care?
I think you're right, we do need a plan, but we need trained epidemiologists and other public health figures to define that plan. Many features of disease spread are counterintuitive and we need people with training to help us, the public, understand the problem and reasonable solutions. When people like Michael Osterholm tell me that it is possible one or two million people will die in the United States, I believe him and I'm willing to go along with the plan. That said, I would like to see more clear definition of where the risk lies, how we can take small chances that have a low chance of going catastrophically wrong, and how we can responsibly try to revert to some kind of normality.
I mean, it's not like this crisis started an hour ago. What's their plan? Like can someone write it down and post in on a government website?
We're all commenting on what appears to be an official government press release that is announcing an entire month of some of the most serious restrictions on the public ever put in place, that does not appear to even try to take any kind of quantitative approach to explaining why that policy was put in to place, and how its effectiveness is being assessed.
Broad, destructive public policy not tied to success metrics is fucking insane and I think the strong negative reactions to it are completely warranted.
Once you commit to some success metric, you're going to be stuck with it even it proves to be a bad metric. Let's say we all agree the "2 weeks with decreasing number of deaths" is a good target. Then we go back to work, and we discover that going back triggers a rapid spread and kills a bunch of people and starts to overwhelm hospitals. Now we need a new metric.
This is a novel scientific problem. Caution and study are warranted. People's lives are at stake.
People's lives are always at stake. That's how public policy works. Like 100% of the time. Try painting lines on the highway or administering a school lunch program without putting people's lives at stake.
The only thing novel here is completely abandoning the concept of public policy goals. There's nothing scientific about setting your public policy without any metrics at all. This is kind of the opposite of a scientific approach.
I'm not suggesting having no metrics, I'm talking about hard targets. Acknowledging that there are things we don't know about the problem and that we're not overcommitting to a course of action based on some specific target is reasonable.
At the same time, to your point, I would like to see clear explanations of "these are the aspects of the disease we are trying to understand (virality, mortality, etc)," these are the constraints on our healthcare system, these are the economic effects, here are the tradeoffs we're trying to make. All of that stuff is good, but it's a complex problem and assuming that we know enough at this point to set a clear numerical goal seems wrong to me. Describing general parameters for our data gathering and decision-making is good, though, and I agree that I'd like to see more of it.
I think that the government agency in charge of the shutdown should be able to answer each of three basic questions with clarity and some kind of numerical response:
1) What are you hoping this policy will accomplish?
2) What sequence of events, if any, would cause you to accelerate your timetable for easing restrictions?
3) What sequence of events, if any, would cause you to delay your timetable for easing restrictions?
I mean those should be the raw basic cost of even having this conversation. I am used to seeing magical thinking and emotional political arguments in many places but I am surprised to see such hostility to a basic quantitative approach on HN of all places.
Your questions are all reasonable. I'm not personally opposed to quantitative decision-making, but I'm also painfully aware of the limitations of quantitative methods, especially when applied under pressure. I would argue that a blind faith in mathematics is just as wrongheaded as the magical thinking you're describing.
To give a clear example of why I'm skeptical, look at the use of quantitative methods to conduct governance in the banking industry. It's not that we shouldn't have used numerical methods, it's just that they ended up being woefully insufficient because of how they were applied. There's no reason we couldn't make the same mistake here in a premature bid for some kind of certainty.
Yeah but this is like setting monetary policy without using interest rates or something. Or coming up with a government spending program and not even trying to do a quick analysis of how much it will cost. It's fucking insane.
Public policy requires metrics and stated goals, and requires that they not be secret. Without those it's not democracy.
We're half-aligned. The decision-making process and the data used to inform it should be public, but I don't think we should be saying at this point "when we see these targets hit we will remove these measures." I think our knowledge is still too incomplete to set that target intelligently.
Nearly uniform testing levels among the states sufficient to indicate that we're getting a real sample of the population, and not the biased sick sample we're getting with PCR testing, would be a start. If you want to be angry about something, be angry that we can't get our act together to get this data collected.
It's going to be a lot easier to win arguments about lockdown when we're confident in our testing data. Right now, nobody is.
You start doing it when you can gather enough information, fast enough to prevent new spikes from happening. The number of "known cases" becomes very low, and then ideally one can react fast enough when new clusters start forming.
When someone comes up with a sane, sensible and actionable plan.
Waiting it out for a vaccine. Even/odd days. Provisioning of masks for everybody. Enough toilet paper to ensure basic sanitation. Enough COVID tests to effectively gauge progress or regress. Rationing. Put all unemployed Americans on the military payroll and make them take turns delivering supplies.
We could look at what any other country who has made even nominal progress with this epidemic have done, pick any single step at random and it would be one made in the right direction.
Instead we've all been told to stay home just long enough to lose our jobs, file some papers and (maybe) receive a paltry stipend, we don't even have the testing infrastructure to know how bad this really is (confirmed cases aren't increasing if the supply of tests isn't keeping up with demand!), and that isn't stopping our syphilitic warlock from telling everybody to take anti-parasitics, drink Lysol and get back out there before it affects his re-election campaign.
There is no leadership. There is no plan. There's a reason this isn't getting better, but letting nature take its course is not the solution.
I understand you feel my characterization is unfair. But the focus on our own personal interaction with the virus without acknowledging how ignoring shelter at home orders can spread the virus to others, is selfish and egocentric.
I do not believe there is room for an alternative viewpoint to that.
> The only way we know that shelter in place orders worked is if they feel like an overreaction after this is all over with.
That makes no sense whatsoever. Millions of children are not vaccinated because of the lockdown. Will the mayor take responsibility for his share of deaths that will occur? Will there be a counter for that, that ticks up every day? And for all the pain and suffering of those that can't afford gratuitous shutdowns?
> it's not about money in my opinion and is about deaths
Are you aware of the fact that people die every day to e.g. deliver groceries to your store, harvest plants, build houses etc pp? Do we shut down all activity that will lead to somebody somewhere losing their life?
This policy has outlived its usefulness, and is harming people's quality of life without a clear goal.
The initial premise of the "flatten the curve" memes was to avoid overwhelming hospitals. The shelter-in-place has not only had this effect, it's been too effective. Hospital utilization in the bay area is at around 10% when you count surge capacity that has been added [1].
Meanwhile, data is coming out to show that coronavirus has a very low fatality risk to anyone under the age of 50, and to anyone without pre-existing health conditions. A blanket shutdown does not make any sense when the vulnerable demographic has been clearly identified. How is it moral to order people to shelter in place when their risk of death is around 0.01% for 18-45 year olds.
Blanket lockdown doesn't make sense anymore. There is no risk posed to the majority of the population from covid-19. We need to switch to targeted approach, and let people get back to their lives.
Our political leaders (in California) are being fearful, afraid to take leadership and base their decisions on data.
[1] https://www.smchealth.org/post/san-mateo-county-covid-19-dat...
[2] https://www1.nyc.gov/site/doh/covid/covid-19-data.page#downl... and https://www.6sqft.com/new-york-covid-antibody-test-prelimina...