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Infection fatality rate of Covid-19 inferred from seroprevalence data [pdf] (who.int)
80 points by wsc981 13 days ago | hide | past | favorite | 382 comments





Here's another recent meta-study (preprint) on the same topic: Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v...

Abstract: This paper assesses the age specificity of the infection fatality rate (IFR) for COVID-19 using results from 29 seroprevalence studies as well as five countries that have engaged in comprehensive tracing of COVID-19 cases. The estimated IFR is close to zero for children and younger adults but rises exponentially with age, reaching 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. We find that differences in the age structure of the population and the age-specific prevalence of COVID-19 explain nearly 90% of the geographical variation in population IFR. Consequently, protecting vulnerable age groups could substantially reduce the incidence of mortality.

I think those results are in the same ballpark as what Ioannidis calculates. This isn't good news, really, not for middle-aged-adults anyway.

IFR(age) = 0.1 x 10^((age-82)/20)


>This isn't good news, really, not for middle-aged-adults anyway.

Or for anybody who knows middle aged and older people, especially if you spend time with them. I am honestly more concerned about killing my parents than dying myself of covid-19. This is why I skipped my mom's birthday for example, because I had pretty mild cold-like symptoms... or maybe mild covid-19.


BTW, for those substantially younger than dirt. You may be wondering why your elder elders aren’t particularly frightened by this, but folks 40 to 60 are more sensitized.

After a certain age momento mori, a reminder that you will die, start coming at you fast and furious. This is just one more. They probably care more about seeing you than this next scheduled flight to Heaven.

What unique about the shutdowns and social isolation, for the 40s-60s, are this is a momento senesci (if I have the Latin right). It’s a reminder that they will mostly likely enter a stage in life called old age, the slo-go/no-go stage of old age. A time when there will be fewer friends to visit, or the logistics become too difficult. A time when they will stay at home much more, and wouldn’t it be nice to have a comfortable home to be in. A time when that next flu won’t be so easy to shake, so maybe they skip that concert. The grim reaper isn’t knocking at the door, but rather an older, frailer version of themselves. These shutdowns and social distancing are a disconcerting trial run.

My take on things...


That older people aren't frightened by this seems like a gross generalization. Plenty of the people disturbed by the rather poor and haphazard against Covid are older people who feel personally threatened.

Everyone experiences aging but in this highly individualized culture, how one interprets the experience is also individualized - varying from welcoming to acceptance to various fitness/health measures aimed to stave it off - plus there's denial and anger.

Someone looking forward to enjoying old age might not want life to end in middle age, etc...


I think it's "memento" not "momento".

That was always a risk even before COVID-19. Regular seasonal influenza can be deadly, especially to the elderly. Patients can transmit it to others when they are asymptomatic or presymptomatic. COVID-19 has a longer incubation period and a significantly higher fatality rate but the same fundamentals still apply.

Any of us could have inadvertently killed someone by giving them the flu without even realizing it.


This is all true, but COVID hysteria has taken hold across the entire world, and HN is no exception unfortunately.

You are being reflexively down voted because people view any comparison to Influenza as illegitimate, not realizing that you are making a broader point about risk management and attribution of blame for infection as opposed to saying that SARS-2 and Influenza are literally the same viruses.

Personally I find it fascinating that I was never told it was my fault if I gave someone the flu in the course of both of us living our normal lives, but if I go to a grocery store and an elderly person does too and they get COVID-19 from me (imagine in this hypothetical there is no doubt that I gave them the virus) then somehow it’s my fault and I’m guilty of any harm that befalls then.

Incredibly dangerous precedent. I hope people see where it leads. And I hope they learn from the history of public health, such as when “public health officials” used to shut down gay bars “for the greater good”.


I can only speak for myself here, but COVID-19 has increased my awareness of the impact of flu season and I will endeavor to mitigate the risk of infecting others in the future. In the past, I hardly gave it a second thought—it never occurred to me that I could kill or harm someone by being careless (e.g. riding the metro to/from the climbing gym during flu season and indiscriminately spreading germs). Masks, giving people space, combining shopping trips, biking or driving, etc.—all are super easy ways to reduce potential harm to myself or others, so I’m more than happy to do these things as necessary going forward. There is no sense of fear or guilt, since I know I’ve done what I can reasonably do.

In that sense, I think comparing COVID-19 to the flu is helpful.


This is something I really worry about: that people are so risk averse and so invested in the COVID response that society is going to permanently become more cold, more closed off, and less human. 2020 life is no way to live long term, and I don’t even want to take a step in this direction. If I found out tomorrow that there would never be a cure or vaccine for COVID, I would just go back to living like I lived before.

People need to read history. History shows this isn't our first rodeo with a pandemic. History shows that social distancing works. History shows that society thrived after.

In fact, cities that didn't socially distance had things much worse and took longer to recover.

Humans are resilient creatures. We're not going to lose our social capabilities just because we're also evolved enough to be smart to stay safe for survival.


I disagree strongly with the notion that mitigating risk of harm to others via awareness and simple action somehow makes society less human. I live in DC, a notoriously cold and closed off city as far as social interaction goes. Mask usage (even outdoors) is close to 100% here. When I see someone wearing a mask, I’m filled with a sense of warmth and camaraderie—that person cares about me and others. Someone else may see the same scene and think, “look at all these petrified sheep”. I sort of understand, but I’d challenge those people to shift their perspective.

If kinship isn’t your thing but sober analytical thinking appeals to you, wearing a mask is a no-brainer: positive benefit with effectively zero cost (the only negative thing that can happen to you is that someone might think you’re a terrified dweeb, but they’d be wrong).


It goes far beyond masks. No hugging. No shaking hands. No singing. No bars. Masks and plexiglass for kids who are lucky enough to actually get school. Not having funerals for the dead. We can put up with these things in the short term to protect the vulnerable, and you’re right that people’s concern for others speaks well of them.

But the logic some people use to support these things veers into territory where it sounds like they would be willing to make (or demand) any sacrifice for literally any increase in safety. I worry about how that will play out long term.

But that’s just my fear. Hopefully it’s overblown (and it probably is).


>But the logic some people use to support these things veers into territory where it sounds like they would be willing to make (or demand) any sacrifice for literally any increase in safety. I worry about how that will play out long term.

Seems like you're strawmanning/shifting the goalposts, considering your initial comment says "I would just go back to living like I lived before", which would suggest you would take zero protective measures.


Yeah, I think that was an overstatement of my position and unnecessarily provocative.

I probably would mostly go back though. Overall, I’d rather accept a more dangerous world with normal human contact than continue the kind of things we’re doing now indefinitely. But I’m sure I’d be more cautious about visiting a nursing home than I was pre-Covid. I’d be a lot more likely to isolate at the first sign of a fever than I used to be. I’d wear a mask when I’m sick. But I’d probably stop avoiding gatherings, masking when I’m well etc.


I sure hope that sick people continue to wear masks once this is all over. It's basic human decency to avoid spreading germs - even the flu - to others, especially elders. This is the norm in Asia.

After COVID ends, I won't wear a mask if I'm healthy but I sure as hell will if I have a cough or fever.


Might be reasonable, but would you wear one all flu season just to make sure you don’t unwittingly infect someone while you’re asymptomatic? Might save a life.

If everybody comes out of this more careful about handwashing, I can’t argue that that’s bad. But I worry it’s going to go way past that.

I’m probably wrong though, judging by the number of people who already can’t be bothered with the one way aisles at the grocery store.


You can cough and sneeze into a mask if you want. I think it's disgusting.

More or less disgusting than coughing and sneezing all over everyone around you?

My elbow hasn't complained so far.

You just dump snot and mucus into your own elbow? What, like, onto the skin or does it just soak into the clothes you're wearing? For someone throwing around the word "disgusting" you're not exactly an exemplar.


Nope. I think sneezing into your elbow is pretty gross. You telling me it's better than your hand doesn't suddenly make it nice.

Of course it isn't nice. It's just the least bad option when other people are around.

If you know you have the flu (or COVID-19), surely you know you are likely contagious and can spread it to more vulnerable people. Yes, it is your fault and you deserve blame if you knowingly spread it to others through negligence. Stay home if you're sick.

I agree those who are symptomatic should stay home. But for COVID we go further and tell asymptomatic people to perform (flawed) transmission control measures. Where do we do that with Flu?

The point is if I don’t know I have COVID and spread it to Grandma at the grocery store, in your eyes I’ve killed Grandma. I wonder why we don’t apply that logic everywhere.


The influenza vaccine is a flawed transmission control measure and is the best we have available, same as masks. We do blame people who skip those, although it doesn't show on their faces like the absence of a mask does.

The spreadability of the flu is also much lower than that of COVID-19 (largely thanks to the vaccines), which is really why people never regarded masks as necessary for the flu.


I don't see the point. There are rules now, so not following them would indeed make it your fault if someone gets sick because of your actions that were not in accordance with the rules.

Because if I go out into the world and get infected with a disease, that’s one of the risks of living life, and we have always understood that. That’s why if you catch the flu nobody blames the man next to you at the grocery store.

For COVID we throw this out the window.

When you take the approach to its logical conclusion you end up in a very scary place.


> That’s why if you catch the flu nobody blames the man next to you at the grocery store.

I would if he wasn't sufficiently careful about it.


One of the risks of sex is venereal disease. I probably shouldn’t bother with condoms though, it’s just one of the risks of living life. Is this the same logic you are using, or am I misunderstanding you?

>Personally I find it fascinating that I was never told it was my fault if I gave someone the flu in the course of both of us living our normal lives, but if I go to a grocery store and an elderly person does too and they get COVID-19 from me (imagine in this hypothetical there is no doubt that I gave them the virus) then somehow it’s my fault and I’m guilty of any harm that befalls then.

You ignore an important factor. Those who are vulnerable to serious complications/death from influenza can and should be inoculated with the latest influenza vaccine. That significantly mitigates the risk for the vulnerable.

There is no corresponding vaccine for Sars-Cov2. As such, the similar group who are vulnerable can't mitigate the risk.

That's why I (and many others) are trying to be much more careful. I'd also add that while the IFR for those under 55 are quite low, they aren't zero.


Wear a mask and stay 6 feet away.

Thankfully the flu has an effective enough vaccine.

Effective enough for what? In some recent years seasonal influenza vaccine effectiveness was as low as 19%. That's still much better than nothing and I encourage everyone to get vaccinated, but let's be realistic about the level of protection.

https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates...


Flu is about 1/10 as deadly as coronavirus. And there’s a vaccine.

This is a debunked claim that arose from conflating IFR vs CFR. Please source your claim.

In terms of overall IFR Influenza and COVID-19 appear to be comparable. Influenza kills at least an order of magnitude more children, and for those in between roughly 35-55 they both kill about the same, and for the very elderly COVID-19 is multiple times more deadly.

The overall IFRs are very comprable except COVID-19 preferentially kills the very old. This also means when you calculate YLL (years of life lost) Influenza takes more life-years away.

I’d say at most if you take a .1% IFR of Influenza then COVID-19 is about 3x as deadly. Note however that we fundamentally classify Influenza deaths differently than with COVID-19. Almost any country considers any PCR-positive person who dies to be a COVID-19 death regardless of whether it’s a baby born with intestines outside of its body, or a young man in Orange County who died in a motorcycle accident, or George Floyd. All 3 of those examples I gave are real individuals who were PCR-positive at time of death. I know for a fact that the first two were initially labelled COVID-19 deaths, not sure about Floyd.

There’s a concept I call the pathological vs physiologixal distinction that is crucial to understand and has been totally violated with COVID—19. The short of it is that it is a mistake to confuse a virus with a disease. (This is also why the phrase “asymptomatic COVID-19” is an oxymoron; if you have no symptoms you have a virus but not a disease)

I have acne; if you culture my skin you will find the bacteria C. Acnes, which is naively believed to “cause” acne. Yet if you culture the skin of a healthy individual without acne, they also have C. Acnes. The question then is what combination of factors leads C Acnes to be pathogenic in one case (me) and not for another. The answer like most things is complicated, some combination of lipid peroxidation compromising the skin barrier, genetic skin turnover rates, etc, but most pop-sci articles will simplify it to “bacteria cause acne”.

Similarly, it is a mistake to assume that if someone dies and has a positive SARS-2 PCR test that they died of COVID. First of all due to egregiously absurd cycle thresholds, you stay PCR-positive months after infection (again, see George Floyd’s hennepin county autopsy, he “had COVID” despite having recovered from it over a month prior to his death). But more importantly even if you truly have active, replicating SARS-2 in you at time of death, you didn’t necessarily die from COVID.

I really got off on a tangent there but to wrap up, even if you take the official COVID-19 numbers - which I believe are grossly inflated - at most COVID-19 is 3x as lethal. To say it is an order of magnitude more deadly means you’re still stuck in April. It’s October now, please follow the new developments in the field. There was actually a paper released recently that traces the origins of the 10x deadly meme, debunked it and attributed its genesis to conflating CFR vs IFR. I’m on mobile travelling now without my laptop so I don’t have my megalist of research articles at my fingertips but if you search around maybe you can find it.


This is trivially disproven by the excess mortality figures from earlier in the year.

By the start of the Summer the UK had around 60,000 excess deaths above the five year median - which included at least one fairly severe flu season.

Later in the Summer when lockdown was still in place and/or infection rates were still very controlled, the number of excess deaths dipped slightly below the median - as you would expect it to, given that people weren't commuting and there were far fewer road accidents.

The figures also disprove the usual talking point that other deaths had increased dramatically because hospital care and chronic medical attention were hard to access. There were certainly some extra deaths, but not on the scale of COVID itself.

Unless you're going to claim that some other lethal illness was stalking the land and no one had noticed, COVID is the only remotely plausible explanation for those excess deaths.


> COVID is the only remotely plausible explanation for those excess deaths.

I personally know someone whose father likely died due to being unable to access health care in a timely fashion, as well as someone else who died of cancer after their chemotherapy was postponed. And I also know of two suicides in my extended social group in the past few months. It's tough to pin specific blame on lockdown for things like that. But it's certainly plausible that deaths like that would lead to excess deaths.

In the UK specifically the health authorities were estimating in late July that around 21,000 people had died due to lack of access to health care during lockdown: https://www.telegraph.co.uk/news/2020/07/29/lockdown-has-kil...

In the US there are a lot of concerns that dementia patients in particular are dying due to the isolation caused by lockdown measures: https://www.washingtonpost.com/health/2020/09/16/coronavirus...


> I personally know someone whose father likely died due to being unable to access health care in a timely fashion, as well as someone else who died of cancer after their chemotherapy was postponed. And I also know of two suicides in my extended social group in the past few months. It's tough to pin specific blame on lockdown for things like that. But it's certainly plausible that deaths like that would lead to excess deaths.

Sure, but we can look at when the excess deaths happened. Instead of being evenly distributed across the lockdown period, or peaking towards the end when people had longer without access to support, they came exactly when you'd expect deaths from an epidemic wave to peak before plummeting to normal levels towards the end of the lockdown period. Undoubtedly, individual deaths have resulted from lockdown, but the pattern of excess deaths matches COVID rather than lockdown being behind the aggregate increase.


...but why would excess lockdown deaths happen in a uniformly distributed way? Lockdown itself wasn't applied in a uniform fashion: hospitals figured out pretty quickly that lack of care was killing people and modified policies to mitigate that damage. My own advice to friends and family was "probably best not to go to the hospital for that" in March, and back to normal in April when I realized that the numbers weren't as bad as portrayed. Anecdotally, all of the deaths I mentioned happened close to the beginning of lockdown in their respective countries.

Again, this isn't idle speculation: genuine mainstream health authorities believe lockdown has killed significant numbers of people. This is not a controversial position.


> ...but why would excess lockdown deaths happen in a uniformly distributed way?

No, the question is why does the excess deaths distribution perfectly align with the expected and recorded COVID death spike and drop so sharply afterwards when lockdown was still in place.

It's uncontroversial that lockdown has killed and saved significant numbers of people for reasons other than COVID, but similarly it is entirely uncontroversial that the aggregate increase in excess deaths was caused by COVID. The idea that the inflection point COVID-time-to-death days after the start of lockdown is better explained by unannounced changes in policy or your personal advice to friends and family, on the other hand is about as scientifically credible as blaming 5G.


Here in New Zealand where very few people died of COVID, overall mortality dropped significantly during lockdown. This seems to have mostly been due to a lack of traffic deaths, air pollution improvements, as well as a massive reduction in non-COVID respiratory illnesses. This article actually posits a reduced number of complications from elective surgeries as a factor in the reduced death rate: https://blogs.otago.ac.nz/pubhealthexpert/2020/07/10/weekly-...:

For example, around 40% of Wellington ICU patients are typically from elective procedures and around 10% of all Wellington ICU patients die.


«I personally know someone whose father likely died due to being unable to access health care in a timely fashion, as well as someone else who died of cancer after their chemotherapy was postponed»

Without lockdowns these people would probably not have been able to access health care either, because of, well, the pandemic.


That's not correct. Sweden, which did not restrict healthcare access, and has one of the lowest ICU capacities in Europe, did not see hospital overload or healthcare rationing at any point.

Lockdowns have certainly created a death toll, that is by now mainstream consensus. The debate is about whether it's most of the excess death or only a large chunk of it.

But it's worth remembering that even then excess death numbers are low in absolute terms. A lot of people can't see that because for some reason it's standard for statistical agencies to only give a few years of data in convenient graphs on their websites, but older data is there, and it puts things in proportion. In the UK for example, which has one of the worst excess death rates in Europe, 2020 is so far a bit less deadly than 1999/2000 and the gap is widening [1]. But nothing remarkable happened in the UK in 1999/2000, nobody talks with sadness about those who were lost at the millennium. Nobody noticed anything at all. The idea that we've had some sort of terribly high or remarkable levels of excess death isn't the case: it's being noticed because people were told to expect enormous levels so started tracking the data with a microscope, and then it went up partly due to lockdowns.

In many other countries excess death is even less remarkable than that. Germany and Switzerland have seen years no different to the previous years for example. Cumulative death in Switzerland for 2020 is by now completely average, for example. There was no plague in Switzerland at any point.

[1] http://inproportion2.talkigy.com/


«did not see hospital overload or healthcare rationing at any point.»

They did ration healthcare. This was the object of multiple news articles last week: https://time.com/5899432/sweden-coronovirus-disaster/ «the country’s hospitals were implementing a triage system» The triaging was so severe that «Only 13% of the elderly residents who died with COVID-19 during the spring received hospital care» Get your facts right.

«Lockdowns have certainly created a death toll, that is by now mainstream consensus. The debate is about whether it's most of the excess death or only a large chunk of it.»

This is laughably inaccurate. On the contrary, lockdowns are largely credited for overall having averted cases and deaths. I maintain a list of peer-reviewed studies (and some preprints) on the subject, and the vast majority agree: https://twitter.com/zorinaq/status/1307723024523616257 There isn't a single peer-reviewed study that suggests lockdowns are responsible for a "large chunk" of excess deaths. You are victim of misinformation.

Your comparison to 1999/2000 flu death is invalid: there were delays in reporting deaths that caused many deaths to be reported on the week after Xmas, hence the artificially high peak of that week of 2000. If you compare monthly excess deaths (to smooth artificial peaks) you will see covid excess deaths in April 2020 surpass flu excess deaths of January 2000.

And yet, this comparison would still miss the point: covid is such a serious disease that despite (effective) lockdowns, it still managed to kill more than he most severe flu seasons of the last 20+ years. That alone should make you stop and think...

There is in fact a government report that found «in comparison with the deaths due to influenza and pneumonia occurring in the year to 31 August 2020, deaths due to COVID-19 have been higher than every year monthly data are available (1959 to 2020).» https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

Germany and Switzerland have implemented particularly effective lockdowns, hence little to no excess deaths.


The triaging was so severe that «Only 13% of the elderly residents who died with COVID-19 during the spring received hospital care»

You're seeing what you want to see. It is normal for elderly patients in nursing homes to die without being in a hospital. You're claiming that Swedish hospitals were so overloaded they turned away patients they would normally have seen, but there is no evidence of that and the paper TIME cited as support actually doesn't give any. Rather, it says:

"Swedish ICU use rates remained lower than predicted, but a large fraction of deaths occurred in non-ICU patients. This suggests that patient prognosis was considered in ICU admission, reducing healthcare load at a cost of decreased survival in patients not admitted."

The latter sentence doesn't follow logically from the first in any way. They are assuming that all COVID patients should have ended up in ICU and if they didn't, that can only be due to evil doctors turning them away at the door despite having spare beds (which Sweden always did have). That is an absurd assumption, unsupported by any direct evidence, which is why they have to rely on invalid statistical inferencing.

What happened is that PCR testing labelled a whole lot of people who were about to die anyway as "COVID deaths". COVID symptoms are so mild in virtually all cases that many patients will have simply got a little bit sick but not enough to rush them to hospital, which can at any rate be quite dangerous for the very elderly and frail, and then they died. Was it COVID that pushed them over the edge? Was it just old age? Who can really say when it gets right to the edge of a life - something has to give.

lockdowns are largely credited for overall having averted cases and deaths

By the people who recommended them in the first place. Many other people without obvious conflicts of interest have looked at this and concluded the opposite.

There isn't a single peer-reviewed study that suggests lockdowns are responsible for a "large chunk" of excess deaths. You are victim of misinformation.

The UK Government's own reports say otherwise. In fact here's an article on the BBC today: "Between March and September 2020, there were 24,387 more deaths in England than expected in private homes, and 1,644 in Wales. The large majority did not involve COVID-19."

https://www.bbc.com/news/health-54598728

Lockdowns have obviously killed people in the UK. Hospital admissions halved at the start, do you really think that would have had no impact on mortality? There is now a massive cancer backlog. The death toll of COVID is a handful of people per day in the UK, but the death toll from telling people to avoid hospitals during 2020 is going to be racking up for years, perhaps decades.

Why do lockdown supporters so often believe other people are the victims of misinformation? I've read a lot of papers coming out of epidemiology and the academic research establishments this year, many of them are atrocious. They mis-use logic and statistics every third paragraph, scientists mis-represent their own papers in press releases, their code sometimes just doesn't work. The standards in academia are incredibly low and they pump out "misinformation" at a shocking rate. If you simply believe peer reviewed studies without double checking them, you're the one being misled, not me.

Germany and Switzerland have implemented particularly effective lockdowns, hence little to no excess deaths.

I live in Switzerland. It had a rather mild lockdown, quite incomparable to many other countries thank god. It's astonishing you believe these were "particularly effective". But if you get your information from TIME, well, it's less of a surprise.


I believe what you're talking about ("...likely died due to being unable to access health care in a timely fashion" etc). is is exactly what contributes to an excess death. That's why excess deaths are important, they take into account exactly those deaths caused indirectly. (a bit unclear, but you get me I hope).

But it's quite critical to know what % of excess deaths were caused by unreported COVID-19 infections, vs lockdown. The fact is, lockdown will kill people. It's really important to figure out how many it will kill, so we can balance that against lives saved, especially with COVID-19 proving to be much less deadly than originally feared.

As an extreme example, for some poorer countries without much healthcare infrastructure, you can definitely make the case that given the inevitability of the virus spreading, in some situations the right thing to do is give up early, accept that you'll have a wave of deaths, and move on. The alternative is a slow motion disaster with about as many direct COVID deaths, and additional deaths due to lockdown. If you don't have healthcare infrastructure to begin with, overloading it doesn't change much.


You're not taking into account the denominator - the number of people getting infected.

This new virus spread far and fast, while seasonal flu is significantly more blocked off by how many people have immunity or vaccines. Number of deaths is lower for seasonal flu because the number who get infected by those known viruses is also much lower. That's why the IFR is close yet for this year more people are dying.


The numbers you cite aren’t 10x higher than median.

Observing that mortality is above median doesn’t prove that the virus is the cause of those excess deaths (e.g. we know that there were a lot of unreported heart attacks during a the same period), and it doesn‘t prove the specific claim that the IFR is 10x higher than the flu.


All of your analysis falls apart at one crucial point: all of the data we have are for Covid19 IFR given the massive lockdowns and dedicated hospital infrastructure.

If you look at regions that were ineffective in handling the spread and had their hospital capacity overwhelmed, mortality jumps through the roof - I think it was higher than 10% in Lombardia before the lockdowns. And remember that hospitals can't work at anywhere close to 100% ICU occupancy for extended periods of time, so if the high inflow persists, mortality is likely to increase much more.

The vast difference between Covid19 and influenza is anyway plain to see if you look at ICU rates, even with all the lockdowns.

So even though your analysis sounds convincing at first read, it is a very bad interpretation of the data. The reality is that Covid19 is a much worse disease than Influenza, and that drastic measures are required to keep it under control (barely).


[flagged]


It's not as simple as that.

Early on, people with low blood oxygen were put on ventilators quickly, which both took a great toll on the system, and didn't help (or even made things worse).

If you look at the graphs now (I looked at 30 countries just an hour ago), you'll see that many countries in Europe have a very visible "second wave", including Denmark, Austria, the UK, France, Spain and even Sweden - but almost no deaths; and unlike the first wave, despite more people diagnosed with SARS-COV-2, much less people need treatment, and there is no lack of beds anywhere (although there is a lot of fatigue, which is a more complicated discussion).

Given you know what to do, such as prawning, vitamin D, and more (and more importantly - what not to do - no early ventilation, for example) - then, we no longer have hospital ICUs stuffed full of people with COVID19 either.

A lot has changed since April, but when I look at arguments, some sides still hold the data from early April (assuming up to 5% IFR, and the Ferguson predictions), while some do not acknowledge that April happened and only look at the stats in Aug-Sep. Not surprisingly, such arguments aren't really converging and each side tends to assume the other side is an idiot or insane.


It's not as simple as that.

I don't know about that. Everything you say is reasonable and not at all an example of the effect I was talking about.

It's totally fine to say "hey it looks like the CFR/IFR is declining because we have better treatment methods". This is a good-faith point, backed up by some easily observable data, and something that can evolve into a discussion about how to effectively manage the disease. It's not a point that I've heard any rational person object to.

It is worth noting though – the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths. This is much better, but those numbers are increasing pretty rapidly and without careful management risks getting out of control.


"hey it looks like the CFR/IFR is declining because we have better treatment methods"

It's a claim not many are making because it's not clear it's really true.

Firstly, the bulk of the falling IFR is due to more widespread testing driving up numbers of known infections and sero-surveys indicating that even more people than that may have been infected. It's not primarily driven by better survival rates, although they did get better.

At this point it seems clear that mass ventilation was a mistake. It was actually killing people rather than saving them because it's a last-ditch resort. COVID wasn't actually deadly enough to justify this and the large scale usage was driven more by the lack of reliable information, the somewhat unusual form of presenting pneumonia in early patients, the belief that it was an extremely deadly virus and the fact that ventilators force all air coming out of the patients lungs through high quality filters, so doctors are trained that ventilation stops infected patients pumping virus into hospitals.

But doctors are smart and pretty quickly figured out that the ventilation was making things worse, that they couldn't keep the hospitals virus-free anyway, and at any rate they were about to run out of the machines so their hands were forced and they had to try something new. After that usage of ventilation went back to more normal policies, with supplemental oxygen being deemed sufficient for even quite extreme cases, because of course almost all cases need little or no hospital treatment.

Meanwhile many drugs were tried and some were hailed as drugs that could help, e.g. remdesivir or hydroxychloroquine. But later on more controlled studies done under calmer conditions concluded they actually seemed to have no effect.

Given this progress of events it's hard to argue that treatment methods actually got better, except in a very technical sense that most people wouldn't really mean. They got better in the sense that they returned to normal for this kind of virus and stopped making the situation worse. If there had been no mass panic at the start it's likely treatments would never have got so extreme to start with.

the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths

The UK has also quadrupled its testing rate since April. The numbers aren't directly comparable.

without careful management it risks getting out of control

I don't believe that's been proven at all. The analysis was done many times by now: every government intervention tried so far has no correlation with the course of the disease. That means attempts at management have failed and it has in fact been out of control the whole time, but, fortunately for us, our bodies are generally pretty good at fighting diseases except in the last years of our lives or when immunocompromised in some way, so that hasn't led to disaster.


I generally agree, though do note that vitamin D and prawning do seem to make a difference - and are practiced in many places even without local study and tracking (because the risk is negligible).

Certainly in my county, many fewer people are dying even though many more are testing positive. Many more people are getting tested, for job requirements, travel, etc. It results in more positives, naturally. In a county of more than 3 million, we have around 50 in ICU, lowest in many months. As positive tests grow. Two things (at least) might be at work: better treatment is one, the other is that there were far higher numbers of people infected than known, earlier in the year. I’m sure treatment now is better, but I would not be surprised if many more people have been exposed, and have recovered, from this virus than is assumed.

As ghoulish as it may seem, I suspect another reason behind the declining fatality rate is that the earlier waves already killed some of the most vulnerable people.

Nah, it's a statistical artefact caused by testing policies.

In March, you needed multiple symptoms to get a test, which meant that conditional on having a test, your illness was much more serious.

Because this isn't an issue right now, it looks like the mortality rates have dropped when it's more likely that we are capturing a larger proportion of mild cases.


Obviously depends on where you look for this kind of reasoning, but I don’t think it is compatible with data in general.

Sweden’s death graph totally looks like “inventory of likely-to-die people exhausted”, regardless of testing (they have not changed recommendations or actions).

Israel had no first wave in April (it had a blip, which turns out was essentially limited to ultra orthodox religious which are about 15% of the population).

In September, the official 2nd wave but really 1st wave struck the entire population - and testing capacity was already high (about 0.7% of the population tested daily). And the stats looked way too similar to other countries’ first wave.

The US is a weakly connected network of hundreds of different repositories, which makes it really hard to observe similar processes - they are not visible on aggregate.


When it comes to hospitalizations and fatality rates, people are talking past each other by only looking at part of the picture. The two main camps I see are:

1) Covid19 is far more deadly, look at all these excess deaths!

2) The IFR is low, about the same as the seasonal flu, so we really didn't need the lockdowns.

Both are half true.

Basically, we have decent herd immunity for existing viruses. Even with an identical IFR, the viruses are acting differently because we lack(ed) any real herd immunity for the new virus - so everyone was getting infected at once, which means everyone getting sick at once and risking overwhelming hospitals (this is the part people in camp 2 miss). On the flip side, because we do have decent herd immunity with existing viruses, either due to prior exposure or vaccine, seasonal flu doesn't spread nearly as far (this is the part people in camp 1 miss). A lot less people getting infected means a lot less people getting sick or dying, which explains the excess death despite the same IFR.


But IFR are not identical. That part is simply lie. It is not just taking part each other.

Seasonal flu has also much different spreading. You are spreading it for very short time and then you get clearly sick. Which makes limiting speed much easier.


Yeah, that was a bit lazy of me, but I was primarily making a point about why the two groups don't seem to be able to agree. That said the IFR does keep getting revised downwards, and last I remember it was still higher, but the same magnitude as seasonal flu.

That's not quite right either.

People in camp (2) don't miss the risk of overwhelmed hospitals. We remember that we were constantly told they were about to be overwhelmed back in April and they never were. Sweden has the lowest ICU capacity in Europe by far, yet never had overwhelmed hospitals despite very visibly turning its back on the policies supposedly required to avoid it. How can this be reconciled with there being genuine risk?

It's apparent when you look at what happened back then that there was no actual risk of anything except running out of ventilators, a problem that was in turn caused by the panic - doctors were told this was a very deadly disease so were putting people on ventilators unnecessarily, partly because ventilation ensures all the air a patient breathes out is filtered, so they thought it was a way to keep hospitals clean. Once doctors realised ventilation was doing more harm than good and the age skews of the patients started to become publicly known, they backed off the ventilator use and there was never any shortage, of either ventilators nor beds.


We don’t regularly have hospital ITUs stuffed full of people with influenza, threatening to overwhelm capacity

Who/where is we, here? Because that's absolutely not true for many countries, where seasonal flu is routinely reported by the press as creating overloaded hospitals. Here are some examples:

https://www.healio.com/news/infectious-disease/20190205/bad-...

"Bad flu seasons test US hospitals: Hospitals in the United States have implemented new policies based on last year’s severe influenza season, but infectious disease experts agree that America’s health care systems would still be seriously challenged by another bad influenza season."

https://www.independent.co.uk/news/uk/home-news/nhs-winter-p...

"NHS winter pressure: Hospitals report 99 per cent capacity over festive period as flu season looms"

https://www.dailymail.co.uk/health/article-5279685/Californi...

"Flu drives hospitals into 'war zone' conditions: Tents on the street in California, 'state of emergency' in Alabama, and Boston is using GATORADE to plug shortage of IV drips"

https://www.thelocal.fr/20170111/french-hospitals-stretched-...

"Hospitals in France at breaking point as flu epidemic spreads"

etc. Reports like this are common across the world. Partly it's that the press like reporting crisis stories and in any large medical system they can always find health workers willing to give them dramatic quotes. Partly it's that surge capacity is always inherently limited.

every single post mentioning COVID is full of these shallow armchair analyses that seem to think rejecting all prevailing wisdom is an inherent good

I've not seen anyone claim that rejecting all prevailing wisdom is inherently good. That seems like a strawman. The posts arguing about COVID aren't rejecting panic just for the sake of it, they're arguing about it because they disagree that the severity of the problem supports the consequent social policies.

HN is also full of people posting comments decrying the awful people who double check what government officials are claiming against data, facts and logic. Those are equally aggravating to those of us who don't see a problem with critical thinking: especially when the "prevailing wisdom" is a subjective assessment of who thinks what. One that's being seriously distorted by media hype and censorship, to boot. The "wisdom" many governments are listening to is sadly very far from wise.


For the US 2018-2019 flu season ( https://www.cdc.gov/flu/about/burden/2018-2019.html ):

> CDC estimates that the burden of illness during the 2018–2019 season included an estimated 35.5 million people getting sick with influenza, 16.5 million people going to a health care provider for their illness, 490,600 hospitalizations, and 34,200 deaths from influenza

Covid19 has killed ~220,000 people so far in 2020 in the US.

From the same article you quoted about the epidemic in California (from 2018, mid-January):

> This year's outbreak is on track to becoming one of the worst flu seasons in recent history due to a deadly strand that has so far killed 85 adults and 20 children nationwide as the numbers continue to climb.

Covid19 has killed ~16,000 people so far in 2020 in California.

Related to the UK 2017-18 flu season that saw hospitals stretched ( https://www.theguardian.com/society/2018/jan/18/flu-outbreak... ):

> After 35 more deaths last week, 120 people across the country have died of flu-related symptoms since early October, compared with 45 in the same period in 2016-17.

Covid19 has killed ~43,000 people in the UK so far in 2020.

For the France 2016-2017 flu epidemic ( https://www.researchgate.net/publication/321906828_Influenza... ):

> During the epidemic wave, a marked excess mortality estimate at 14,400 deaths attributable to influenza was observed.

Covid19 has killed ~34,000 people in France in 2020 so far.

Point being, perhaps it is the old news that were a bit exaggerated; either way, Covid19 is measurably worse than then any recent flu, and this is after extreme lockdown measures compared to any flu pandemic in living memory.

Note: I am fully aware that some of the lower numbers are partial numbers from about the middle of the flu season. Feel free to look up the final numbers for that season as well - they will be at worst half the Covid19 numbers.


But there are two problems here:

1. That isn't the point that was being made. Matthew McCleod argued that "we don't regularly have ICUs stuffed full of people with influenza", and that HN is full of people who reject the "prevailing wisdom" just for the sake of it. Neither is the case, and my post provides plenty of evidence to reject the belief about hospitals (which is driven by media stories not actual overload - in the UK hospitals are being reported as about to overflow although they have normal load for this time of year, i.e. the reports are misleading).

2. Your data is comparing apples and oranges. Nowhere has ever made the kind of testing effort being made for COVID. We really have no idea how many people catch or die from flu because it's not really tracked to the same level of effort. Meanwhile COVID reporting has been hopelessly inflated by a medical establishment that takes every option to increase reported numbers. People are "COVID hospitalisations" if they're admitted with a broken arm and happen to test positive even though they don't seem to be sick, they are "COVID deaths" if they get shot and test positive at time of death. They have "COVID" the disease even if no doctor ever diagnosed them based purely on fragments of RNA found in a blood sample, using a test with unknown and it seems wildly varying false positive rates, that's been ramped up well beyond the max sensitivity many PCR experts actually recommend.

Reported COVID numbers really can't be compared numerically to anything historical at this point. They are "meaningful" only when compared against each other and even then there are difficulties as countries report things differently. For instance the numbers were inflated in the UK by at least 5000 deaths because the health agency defined COVID as a terminal disease. Once you tested positive, for the rest of your life your death would be marked a COVID death regardless of how much later you died or what of. They "fixed" this by changing forever to 28 days, which is still not a valid way to measure who died of what. That's how you get the New York Times reporting a list of people who died of COVID in which the sixth person on the list was a homicide victim.

Fundamentally, if you look at excess death numbers in a lot of countries, they look like flu season. Reported IFRs have continuously fallen and even the establishment figures are now in range of a strong flu season, not anything more. That's why people keep comparing it to flu.


Influenza mortality rates are subject to exactly same problems as covid rates. The same caveats apply. And, influenza deaths are estimated - we assume that some percentage of pneumonia deaths are flu deaths without ever doing test.

You debunked nothing. All the per age IFR comparisons of flu vs covid I had seen has covid killing more people for 30 years old too.


Thanks for all your comments in this thread. I looked at your profile to try and find an email address to say this personally but I figure it's good to say this in public too. You're writing all the things I would if I had a bit more time and inclination. I know it takes a good chunk of time and courage and mindspace to go against the current like you are, but just know there are a lot of people reading comments like yours and nodding their head but just don't want to join the fray. There are also a lot of people waking up from the virus fear only to confront the way scarier danger of the agendas driving things. Your comments are helpful to them too. Anyway keep it up!

Your linked study is much better than Ionnadis' one! This one actually followed the proper protocol for a meta-analysis for one. The results here are better stratified, the data more solid (because they did their meta-analysis properly), and the justifications better.

For those not familiar with biostatistics and meta-analysis. There is a standard and well defined pathway for doing a meta-analysis. It exists for a reason. Namely that it is really easy to misinterpret the results of aggregated studies if you do it wrong. The fact that the Ionnadis' article does not follow these procedures is enough to disregard it and instead focus on understand the studies that have done proper meta-analysis.


Bt it's great news for people who want some turnover in the US Senate.

> > reaching 0.4% at age 55 > This isn't good news, really, not for middle-aged-adults anyway.

Overall mortality at age 55 is about 0.5%: https://www.statista.com/statistics/241572/death-rate-by-age...

In general, COVID-19's IFR by age is pretty close to overall mortality. So even in unrestricted spread, limited by only herd immunity, at worst direct deaths from it would less than double your chances of dying in a year.


> less than double your chances of dying in a year.

The way this is phrased makes it sound like it's not a big deal. Doubling every individual's chance of dying within an entire generation is not something we should say lightly. Imagine if the base fatality rate was 50% rather than .5%.


Maybe I’m crazy, but I view doubling a chance of dying in a year, and then returning to normal mortality for the next year, as far preferable to mass business closures, suspension of civil liberties, pulling kids out of school without evidence, mandating everyone wear masks, etc.

I guess I never realized how risk averse people apparently are. I imagine these same people never drive a car since those things are deathtraps by comparisons.


I was quite amused early on when people were talking about how brave truck drivers were for risking a COVID-19 infection. The per-year-worked fatal injury rate for truck drivers(1) is 0.024%. Meanwhile, a COVID-19 infection for the 20-49 age group has just a 0.02% fatality rate. Logging is even worse, at 0.14%/year-worked.

More than just risk adverse, I think a lot of people don't understand how risky life in general is.

edit: ...and I'll point out, those truck drivers may still have been brave! If you mistakenly think the risk is higher than it actually is, you're still brave for taking it on.

1) https://www.trucks.com/2017/12/26/trucking-deadliest-jobs/


[A]n English person aged 55–64 years who gets infected with SARS-CoV-2 faces a fatality risk that is more than 200 times higher than the annual risk of dying in a fatal car accident.

Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v...


I glanced at the study and the fatality rates they use are absurdly high. They estimate .7% IFR for that age range which is way too high.

Anyway, my point was simply that if we took the same attitude towards risk that you all do with COVID and applied that elsewhere, we’d all be rolling around in hermetically sealed hamster balls until we died of boredom.


How convenient.

The study linked in the OP estimates a median .27% IFR across all populations.

The following numbers are from several month old seroprevalence studies so take them with a grain of salt but:

https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...

Pegs the 50-59 age range around the median IFR. Whereas the >70 mortality is where things really start falling off of a cliff.

BTW my point was never “your chance of dying in a car crash is >= COVID”...although that statement would be very true for <40 age populations. My point was more broadly that people have a risk aversion to COVID that is unmatched by their attitudes towards risk in all other areas of life.


> BTW my point was never “your chance of dying in a car crash is >= COVID”...although that statement would be very true for <40 age populations. My point was more broadly that people have a risk aversion to COVID that is unmatched by their attitudes towards risk in all other areas of life.

Which was based on your observation of driving VS Covid19 mortality, or at least it appeared to be from the comment.

People have a very natural risk aversion for a new disease that is extremely likely to kill their parents or grandparents, that has unknown long-term effects, that has no known treatment, and that risks becoming endemic if not contained soon (and that has already killed more people than malaria).


You fundamentally misunderstand SARS-2 if you think it “risks becoming endemic”. It already is endemic and it would be regardless of whatever measures we took. It’s a zoonotic virus that is great at spreading. It is functionally impossible to eradicate.

...and it may have animal reservoirs: https://www.sciencemag.org/news/2020/08/covid-19-hits-us-min...

"The Dutch government reported multiple cases of transmission from mink to farm staff"

If it can happen in a farm, there's a reasonable chance it can happen in the wild too. Cats also seem to be able to get it: https://www.webmd.com/lung/news/20200911/covid-19-may-strike...

Animal reservoirs make the flu pretty much impossible to eradicate.


The US has a mortality rate from car accidents per capita of 0.01%/year(1). The CDC's best guess infection fatality rate estimate(2) for the 20-49 age group is 0.02%/infection.

With a conservative herd immunity threshold of 50%, that'd put an uncontrolled COVID-19 pandemic and random car accidents about equal for that age group. For the 50-69 age group, the CDC estimates a 0.5% IFR, so COVID-19 would be 25x higher mortality than random car crashes.

1) https://en.wikipedia.org/wiki/List_of_countries_by_traffic-r... 2) https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...


a) IFR is in fact higher according to that research, and b) US roads are far more dangerous than UK roads.

> IFR is in fact higher according to that research,

By "that research" you mean https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v... right?

Because it actually gives a slightly lower IFR than the CDC at age 55 (0.4% vs 0.5%), not higher. So I'm not sure what you mean.

> US roads are far more dangerous than UK roads.

Yes, according to the WHO(1) the US has a 3.6x higher mortality rate from car accidents than the UK, which gets us to 90x higher for the age group I quoted.

Anyway, I didn't want to contradict that figure. Just give perspective.

1)https://www.who.int/violence_injury_prevention/road_safety_s...


Why are you assuming that you would return to normality for the next year? If this becomes endemic, the mortality rate doubles forever, especially since there doesn't seem to be long-lasting immunity to this virus.

Double 0.5% is 1%. Where'd you get 50%?

I believe the parent was making a rhetorical point: if your base fatality rate were 50%, then doubling it would mean you’d be guaranteed to die. Therefore, saying something “only” doubles your risk of death can understate the impact of what that doubling means in practice.

It's pretty simple: at my age randomly dying isn't something I'm concerned about at all. So doubling those chances is still not something I'm concerned about.

It's certainly not an existential threat to society.


For comparison, from what I've read the typical annual influenza fatality rate is around 0.1% (don't know what the under-70 rate would be). So, this puts covid-19 solidly in the uncanny valley of viral mortality rates; not low enough to be "just like a flu", not high enough to justify shutting down the world. No wonder opinions on it are so divided.

Daily reminder: new respitory diseases come and go, nobody usually cares.

What makes Covid different and what caused the shutdowns was when Lombardy alone had 450 deaths a day. No regular influenza could do that.

It's not as if we decided out of thin air the virus was dangerous.


We flattened the curve... we bought time... most of us took active measures. It's helped. We have evidence it works.

Yet, people, who i assume are smart people, say that we're overreacting and we're causing societal harm and taking away their freedoms.

I can only laugh and cringe...

History shows that those cities that took active measures in every prior epidemic survived better and recovered better and thrived after.

This isn't our first pandemic, wont' be our last. Where we failed is we were woefully unprepared, our administration convinced people it's not that bad but here we are months later, deaths are still pushing upwards of 1,000 americans a day and people are saying its no worse than the flu.

There is no evidence to support this argument unless you're trying to deceive people.

You don't even need to know statistics. Take the worst flue year where we had 48k deaths that year. Covid is 5x worse that and we still haven't even made it through an entire year.

Take our best flue year - 1986-87 - where only 2,868 or so died. We'll be 100x times worse than that year with COVID alone and we're just NOW entering the common flu season.

The basic math doesn't support some of these studies that seem to use statistics for political gain rather than simple math for communicating the obvious differences.

And lets not forget - the death toll is only under control because we are taking active measures.


> It's not as if we decided out of thin air the virus was dangerous.

But this is kind of exactly what we did. Go look at a yearly all-cause mortality chart going back the last 110 years. You’ll see this year is a noticeable but not so great uptick (of which many of the deaths will be overdoses, suicides, lack of medical treatment for preventable diseases etc btw). Whereas say the 1918 Flu pandemic was much more deadly in absolute and relative terms both.

Remember we’re talking about a disease that for many is so mild that they never realize they have it. For others like the very elderly it can be very bad, with a 5% chance of dying if infected, but it’s no surprise that surveys that ask people to estimate COVID-19 mortality show that on average people overestimate the fatality by between 10-100x.

SARS-2 is real, but the real virus really is in our minds. I hope one day you will come to see things my way too.

I also hope more commenters here will go mode out what happens when you perform universal rather than targeted mitigation measures: universal ends up with more mortality by slowing down infections in those who are not at risk, which delays hers immunity for almost no benefit.


In the worst flu seasons we have 50k people die. In the easiest flu seasons we have 3k people die.

So if you take the worst flu season - which we count as a year - we're almost 5x that with covid and its not even a full year yet...

If you take the best flu year, we're pushing 100x that.

Where are we over estimating anything when we break it down into simple terms?

Which btw, these current death rates are with active measures in place. If we didn't have these measures then the trends set early on would be off the charts by now.


> Which btw, these current death rates are with active measures in place. If we didn't have these measures then the trends set early on would be off the charts by now.

Sweden contradicts this.

> So if you take the worst flu season - which we count as a year - we're almost 5x that with covid and its not even a full year yet...

The way we count COVID deaths is fundamentally different from how we count Flu deaths.

It's much better to look at total deaths and compare to previous years. You'll see we've experienced an uptick this year but not one that is nearly as massive as you would predict based off the hysteria


Sweden doesn't contradict anything. Search for the news right now and you will see their cases are increasing and they're dealing with trying to control it.

Really, the only hysteria there is, is from people like you projecting it.

Wearing a mask and socially distancing is rational.


> Search for the news right now and you will see their cases are increasing and they're dealing with trying to control it.

This applies to all of Europe though. Places like France, Germany, Belgium, and Italy are all seeing skyrocketing daily cases.

From what I remember, it’s not that Sweden didn’t encourage mask wearing or social distancing, it just didn’t make anything mandatory, and it didn’t enforce any lockdowns. It hasn’t particularly saved their economy from any damage, although it didn’t seem to cause them to have rates of infection or deaths to get much worse than the average in Europe, and their hospitals didn’t get overwhelmed.

If anything, it seems to demonstrate that the idea that avoiding lockdowns will save the economy isn’t realistic, and the economy, but lockdowns aren’t going to help much either.

At this point it seems like all anyone can do is wear a mask, do what you can to socially distance while living a relatively normal life, and wait for either a vaccine or the pandemic to pass its course.


I'm not a big fan of the word hysteria (literally "condition of having a uterus"), but that said, the two are not mutually exclusive. Wearing a mask is rational, and there are also people acting irrationally out of fear (remember how hard it was to get toilet paper?).

That's not happening anymore. Time to be adults, instead of terrified children, and find alternatives to lockdowns and mask-shaming with the occasional assault, and arrests from local governments.

>and find alternatives to lockdowns and mask-shaming with the occasional assault

assault for wearing masks, or failing to wear masks? I'm only aware of the former.


"No regular influenza could do that."

Sure it could. The whole point of the IFR calculation is that it gives you an average perspective on how fatal a disease is, relative to other diseases. It's not an absolute maximum fatality rate, for every circumstance.

Put a strain of "normal" flu in a vulnerable population with no pre-existing immunity, and it would do a lot of damage. But if you don't count all the other people who had it without symptoms, then you get a misleading picture.

Also, of course, you have to realize that the population of "Lombardy" (~10M) is a bit larger than the population of New York City (~8M), where we see 100-300 deaths per day as a baseline mortality rate:

https://www.baruch.cuny.edu/nycdata/population-geography/pop...


450 deaths a day was not the total, those were only those from confirmed COVID patients. Excess mortality was more like 650.

Citation required (I've looked, and all I can find are annual mortality rates per capita, which are higher, certainly, but not double the rate for a year). Even if you're right, a doubling of baseline mortality per day is certainly something plausible for influenza in specific scenarios.

Italy as a whole is now seeing new cases per day roughly twice that observed in the spring, and yet deaths are up a tiny fraction of what you would expect from the Lombardy example. So it's not clear that Lombardy represents a typical outcome, even for Italy:

http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h...

Point being, again, it's difficult to draw conclusions from data points that are on the extremes of the distribution. The IFR is a measurement of average behavior.


Source: https://www.corriere.it/dataroom-milena-gabanelli/covid-risc... (in Italian). 45000 excess people are estimated to have died in about 60 days, for an average of 750 per day so I was even remembering fewer than the actual value.

Testing was awful in the spring, serological surveys were made in June and estimated that only 15% roughly of the cases were caught and other surveys estimated even lower percentages (as low as 6%). The territorial distribution is also much more even this time, so it is easier to cope for the healthcare system.

My point is that any a priori estimate of the IFR falls apart if the healthcare system fails and the purpose of lockdown is to avoid that. You don't lock down because it's the only way to keep the IFR down; you lock down when you realize that tracing is failing to capture and/or isolate many cases, and therefore lockdown is the only remaining way to keep the IFR down.


OK, first, I need to say this: that news article has a number of false claims. Most notably, it claims that the fatality rate (# deceased / # infected) is 1-3%. Regardless of your opinions on the paper being discussed here, no credible source believes that the IFR for this virus is over 1%. That information is simply wrong.

That said, the claim for 45,000 excess deaths in March and April appears to come from this:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

With this table having the details:

https://www.thelancet.com/cms/10.1016/S0140-6736(20)31865-1/...

The 45,000 number in that table is for all of Italy, whereas Lombardy specifically had excess mortality of 25,212 in March and April, with another ~700 in May. So that's 420 excess deaths a day in March/April, over a baseline of 275 (16,480 deaths in Lombardy, on average, for March and April of 2015-2019). This is nowhere near the 650 excess deaths per day you claimed in the GGP comment, but is a factor of about 2.5x over baseline.

For whatever it's worth, here's a paper that makes a claim of a much lower excess mortality figure of 5740 for Bergamo, and 3703 in Lombardy in the first four months of 2020, using better-controlled models for mortality in the regions:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520169/

I think it's somewhat pointless to debate the exact number of people dying every day, because we'll never know, and in any case, the virus was clearly quite deadly in that place at that time. However, both of these sources note that excess mortality spiked in March and April, and by May, had returned to below normal levels. So whatever happened in Lombardy, it was a statistical anomaly, and we should be careful extrapolating from it.

Did the virus cause significant excess mortality in Lombardy in March and April? Yes. Could the flu cause similar levels of excess mortality in a naive population? It can, and it has. The 1958 pandemic killed about 116,000 people in the US, which is well above the 12,000-60,000 people we see per year in modern times, and worse on a population-adjusted basis:

https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemi...

https://en.wikipedia.org/wiki/United_States_influenza_statis...

People like to make comparisons to the 1918 pandemic, but if anything, Covid-19 appears to be on par with the 1958 pandemic in terms of overall severity.


(1) A COVID-19 infection can have long-term effects even in young people.

(2) We all have seen the images of hospitals overwhelmed with COVID-19 patients, not having enough breathers, etc. For some reason this doesn't happen with the typical annual influenza ...

If you reduce everything to statistics about mortality rates, you are missing very important parts of the picture.


> We all have seen the images of hospitals overwhelmed with COVID-19 patients, not having enough breathers, etc. For some reason this doesn't happen with the typical annual influenza

Are you sure about that? it's probably not the same extent as what has happened with covid-19, but some hospitals do get overwhelmed during flu season.

A quick google search pre-2019 returns a lot of results, for instance:

https://time.com/5107984/hospitals-handling-burden-flu-patie...


It happened, but it is not even close to what COVID does. During influenza season, the hospital I work at sometimes cancel elective procedures if it's a particularly bad year for influenza. Luckily influenza season has an end date. With COVID, we hardly even had any capacity left for oncology, the last thing we might cancel. Luckily the lockdown effects happened just in time before we had to take drastic measures there. This was not just a local problem, as patients here are centrally spread over all hospitals in the country.

That's the real problem with the disease, not only the fatality rate and long-term effects, but how quickly and severely it can bring a hospital system and all associated healthcare to its knees.


(1) Is generic and not entirely true. Long term effects are indeed present but only in those genetically predisposed. Doesn't apply to the majority.

(2) Actually we didn't. My wife works in a small city hospital. They only have 4 beds with respirators and almost never had more than 2-3 people at a time there. The city is being locked down the second time because we have 5 infected in 20k. We also had in the region of 20 (real) COVID deaths since March. All over 80.

There is no complete picture as all hospitals and clinics have a financial incentive to declare COVID deaths as opposed to anything else. Some do keep internal unofficial stats but even those are rare.


> (2) Actually we didn't. My wife works in a small city hospital.

"It didn't happen to me so it must not be happening anywhere else"


If I were to use the "It didn't happen to me so it must not be happening anywhere else" logic I would say something sily like: - "We tested positive(including at blood tests for the exact strain) and none of us had any simptoms so nobody is dead or even sick. It's all a lie."

It's about as valid an argument as appealing to the pictures of "overwhelmed hospitals". Yes, we've all seen those pictures. We've also seen pictures of empty emergency care units that were created in anticipation of a wave of illnesses that didn't materialize.

In general, we can say that in the overwhelming majority of cases, hospitals did not get overwhelmed with COVID patients like some of the models predicted. That may change as we move into the second winter season, but it's not a foregone conclusion.


Two things: first, you don't need every hospital to be overwhelmed for it to constitute an issue.

Second, every successful preemptive measure is by definition an overreaction. Perhaps you don't see more overwhelmed hospitals precisely because lockdowns are effectively preventing that.


> Two things: first, you don't need every hospital to be overwhelmed for it to constitute an issue.

Of course, but you need a significant amount of hospitals to be overwhelmed to cause significant excess death. Remember, we're trying to minimize excess death of all causes, not just COVID-19.

> Second, every successful preemptive measure is by definition an overreaction. Perhaps you don't see more overwhelmed hospitals precisely because lockdowns are effectively preventing that.

Sure, but that insight doesn't really help. Maybe that's true, maybe it isn't. Given that neither Brazil nor Sweden had a lockdown and given that neither of their healthcare systems collapsed as some models predicted, my guess would be that a lockdown isn't necessary to prevent such a collapse.


Excess death in places where hospitals were overwhelmed (Lombardy, NYC, Madrid) was so many standard deviations above normal values that I am not even sure how we can be having this discussion.

Sweden could be a special case, but Brazil literally had 0.1% of its population wiped out. In Manaus there were five time as many excess deaths as confirmed COVID deaths. If that's not healthcare collapsing I don't know what it is.


> Excess death in places where hospitals were overwhelmed (Lombardy, NYC, Madrid) was so many standard deviations above normal values that I am not even sure how we can be having this discussion.

Sure, you may have very high excess death in a few areas, but unless you think people from New York are somehow more important than everyone else, all excess deaths must be weighted equally. Remember, we're trying to optimize for all-cause mortality across the entire country.

> Sweden could be a special case, but Brazil literally had 0.1% of its population wiped out.

Every year, Brazil loses 0.65% of its population to all-cause mortality. COVID-Mortality in Brazil may be high, but it is pretty much on par with Chile, which has had a severe lockdown.

> In Manaus there were five time as many excess deaths as confirmed COVID deaths. If that's not healthcare collapsing I don't know what it is.

Yes, for a brief period, hospitals in certain cities did indeed get overwhelmed. That's very visible.

What isn't visible is people that would suffer and die in the next years because their livelihoods were destroyed because of a lockdown of questionable efficacy.

In Chile, you have starving protestors clashing with the police. In Brazil, approval for Bolsonaro is at the highest since his presidency started. Put two and two together.


2 is obviously a real concern, where the cases spiked the hospitals ran into serious trouble - and they will spike if left unchecked.

Also, consider that they have to mostly shut down the rest of the hospital due to staffing issues - but also the highly infectious nature of COVID.

Left unchecked, every hospital will hit their limits quickly. That'a a distinguishing characteristic of this one.

Edit: here is what the curve looks like without suppression measures in place. In NYC they came essentially to capacity very quickly. Imagine if that curve had of kept going, it would have been very bad.

It's the same R0 everywhere, the 'effective R' will come down to the difference being the age and relative health of the population, and of course other suppressive measures being taken.

[1] https://forward.ny.gov/daily-hospitalization-summary-region [2] https://www1.nyc.gov/site/doh/covid/covid-19-data.page


> (1) A COVID-19 infection can have long-term effects even in young people.

What is the rate of this?



That's interesting, thanks. First study I've seen with more than a handful of participants, doing something other than self-reporting of symptoms.

That said, it's notable that:

* They don't have a control group (makes it impossible to know what the baseline rate of these symptoms is in the population).

* They don't measure the various criteria for "organ impairment" before the participants caught covid (makes it impossible to know if the people who were found to be abnormal were abnormal before catching the virus -- there are a fair number of smokers and obese people in this sample, so this isn't an idle concern).

* They find a fairly strong association with hospitalization (i.e. the people who are sickest, end up having the most lingering symptoms).

* The people who were sickest tended to have the most pre-existing risk factors for the same outcomes being measured by the study (i.e. there's a hidden correlate).

Because of these limitations, you can't really draw any broad conclusions from this study. In general, I'd say that it shows that older / obese / unhealthy people are more likely to have both severe Covid, as well as concomitant symptoms of severe Covid.


There are beginning to be data on this available around well defined, young, and ultra healthy groups such as athletic leagues. Look within a given league at these long term effects / organ damage / health problems among those who recovered to rule out a lot of the self-selection or other variables.

To some of your other points, the high end leagues are quite well medically documented, and the individuals are quite healthy.

That said, it also appears for some individuals, initial “long term” damage (ongoing heart or liver problems three months after recovery) may be less or gone some six months in.

Seems answers are as yet by and large unresolved. In situations where one does not yet know the actual risk, one may prefer an abundance of caution over unknown “calculated” risk given the long tail of possible effects.


"There are beginning to be data on this available around well defined, young, and ultra healthy groups such as athletic leagues. Look within a given league at these long term effects / organ damage / health problems among those who recovered to rule out a lot of the self-selection or other variables."

I'm aware of one publication, which showed 4 athletes with heart-inflammation markers in a sample of 26 athletes:

https://jamanetwork.com/journals/jamacardiology/fullarticle/...

If there are others you're aware of, I'm interested in the links.


BTW I’m on mobile so didn’t re read that study but when I read the myocarditis study a month ago it turned out that the base rate of myocarditis was really no different than the COVID-19 rate and thus the whole scare was more or leas unfounded.

For studyi these supposed long-term effects I like to look at SARS-1 studies since we’ve had almost two decades. What we find is a few months of raidological ling abnormalities that heal, and mild cognitive deficits that linger for up to a year before disappearing completely. SARS-1 is miles worse than SARS-2 so the idea that young asymptomatic COVID-19 cases will end up with long term health problems is just completely farcical.

Unfortunately reading these studies requires a very critical lens. You showed that in your above comments but, for example, the person alleging these unproven and speculative long term impacts appears not to take that critical approach.


"I’m on mobile so didn’t re read that study but when I read the myocarditis study a month ago it turned out that the base rate of myocarditis was really no different than the COVID-19 rate and thus the whole scare was more or leas unfounded."

Generally agreed. There have been a few papers on this, and most of them were...flawed. To say the least.

This paper is the latest to suggest lurking heart problems in young healthy people, and while the sample is quite small and the observed metrics are questionable, I haven't seen anyone seriously attack the methodology. But in general, I'm skeptical of the claim as well, and I wouldn't suggest that this paper is definitive evidence of anything.

"Unfortunately reading these studies requires a very critical lens. You showed that in your above comments but, for example, the person alleging these unproven and speculative long term impacts appears not to take that critical approach."

100% agreed. It's been a general problem with all of these Covid-related pre-prints. Terrible, flawed studies get picked up by the media and credulously reported. By the time the flaws are found by serious researchers, the media is on to the next headline, never taking time to correct the record.


We don’t know yet, which is a reason to be cautious.

Feel free to be cautious for any reason you want. But don't expect it of others if you can't provide evidence there is reason to be cautious.

We've got plenty of concrete evidence COVID infections can result in long-lasting chronic symptoms. That's sufficient reason to be cautious until we know the rate.

We actually don’t have this evidence. If anything we have strong evidence of the opposite.

SARS-2 radiological abnormalities resolve in months and this is for hospitalized cases which are by definition more severe than your usual cases.

There is really no evidence of what you claim.

We’re now 7 months into the major part of this pandemic and people are still stuck citing the fears we all had in April.


https://www.nature.com/articles/d41586-020-02598-6

> Evidence from people infected with other coronaviruses suggests that the damage will linger for some. A study published in February recorded long-term lung harm from SARS, which is caused by SARS-CoV-1. Between 2003 and 2018, Peixun Zhang at Peking University People’s Hospital in Beijing and his colleagues tracked the health of 71 people who had been hospitalized with SARS. Even after 15 years, 4.6% still had visible lesions on their lungs, and 38% had reduced diffusion capacity, meaning that their lungs were poor at transferring oxygen into the blood and removing carbon dioxide from it.


Thank you for this post and all the others. Where can I find the evidence you mention?

Sorry for the delay.

https://pastebin.com/GeCpFhih

very haphazard but at least will give you pointers to most of the studies


I have a dump of research papers I can send to you. Currently traveling so might take till tomorrow morning

Considering that there has been tens of millions of people with a covid infection, where are these people with chronic symptoms?

https://www.nature.com/articles/d41586-020-02598-6

> Symptoms might take a long time to fade; a study posted on the preprint server medRxiv in August followed up on people who had been hospitalized, and found that even a month after being discharged, more than 70% were reporting shortness of breath and 13.5% were still using oxygen at home.

> One study of 143 people with COVID-19 discharged from a hospital in Rome found that 53% had reported fatigue and 43% had shortness of breath an average of 2 months after their symptoms started. A study of patients in China showed that 25% had abnormal lung function after 3 months, and that 16% were still fatigued.


After 1 month, 70% report shortness of breath. After 2 months, 43% and after 3 months, we're down to 25%. People are clearly recovering.

People have died of the common cold. Edge cases happen.

(1) So can the flu but we move along hunkey dorie.

[flagged]


1) long covid is still being studied, obviously, but there are many cases of it - https://bgr.com/2020/08/21/coronavirus-symptoms-long-covid-s...

It’s a disease that attacks your organs, there’s going to be damage.


I don't think anybody's denying it exists. What hasn't been shown is if long-term consequences are more prevalant with covid than with other viral lung infections.

Studies on long-term consequences of a virus that has been around for <1 year?

People are claiming "long covid" for a virus that's been around for <1 year, so presumably the prevalence of this "long covid" could be studied?

Studies and reviews are taking place. The NIHR one suggests prevalence of symptoms lasting over a month in the 10-20% range.[1]

As with any other early stage research relying heavily on self reported symptoms, the prevalence figures are not well established and the mechanisms causing it not yet understood, but they don't look like flu.

[1]https://www.bmj.com/content/371/bmj.m3981, https://evidence.nihr.ac.uk/wp-content/uploads/2020/10/Livin...


Symptoms over a month and “long term issues” are not the same thing. Severe COVID-19 can cause radiological abnormalities persisting for 3 months, but these heal.

Long COVID is unproven and anecdotal and seems to be more likely to be psychosomatic in most but not all cases.


You can check how much people get better in a few months and extrapolate.

Exactly.

Or if it's even caused by Covid and not some underlying pre-existing pathology that ANY disease could trigger.


There's complications in ..every..single...disease.

People have died of papercut complications..

What if 'long covid' is some underlying pre-existing pathology that ANY disease could trigger.

So the question becomes are these statistically likely complications and is this directly from the covid virus.

The media is feeding you fear about 'long covid' and 'covid toes' and 'covid reinfection' and all of the other sensationalized things about Covid that people eat up like Jerry Springer.

Covid-19 and all of it's viral siblings are all solidly respiratory viruses.

Anything else you hear is speculative fear based over hyped statistically unlikely complications with unproven conclusions.

This whole pandemic is fed off of people who are just fundamentally bad at statistics and interpret every reported sensationalized account as an likely possibility and trust that the news media is unbiased, agenda less, and faithful to the truth.

Also...bgr.com is a news outlet not a science source. They make money off of fear. Do you well to look at data and think for yourself.


(1) is totally unproven speculation. We can’t even prove this happens for SARS-1 which per case is far more severe than SARS-2, its less deadly yet more infectious brother.

(2) absolutely does happen in bad flu seasons, and by the way most of those images are misleading or taken from prior years. Seriously. Even in say, New York, you’d have hospital A overflowing yet hospital B 10 miles away was at 30% capacity remaining. At least in the US a true overrun scenario never happened yet most don’t realize this.

You have to understand the role that mass collective delusion has played in our misguided response. And the media’s selective reporting doesn’t help.


> its less deadly yet more infectious brother.

Nitpicking here, Sars-1 is, as I understand, more infectious but also more obvious. So you don't have asymptomatic spread and other things. This ultimately comes down to exactly what you mean by "infectious" though.

> is totally unproven speculation.

At this point we have more known Covid-19 long haulers in the US than there are Sars-1 infections globally. Comparisons to SARS-1 don't much matter.

> absolutely does happen in bad flu seasons

Indeed it does, most people weren't aware of this, and covid-19 making people more aware of the danger of the flu isn't a bad thing. Get vaccinated!

> you’d have hospital A overflowing yet hospital B 10 miles away was at 30% capacity remaining.

There was a period of time when NYC was globally short on ventilators and ICU beds. Raw hospital beds were never a real concern.

Also worth remembering that NYC would have run out of hospital beds entirely if they didn't implement strict lockdown measures. The NYC (or really NY) stay at home order went into effect on March 20, and daily cases peaked plateaued 1.5 weeks later.


Thanks joshua.

By infectious I meant the basic reproduction number, but I believe SARS-2 is also more infectious (in the sense if likelihood of infection per exposure event) given its incredibly high binding affinities. It seems to be unusually good at infecting humans in a way SARS-1 wasn’t. Not sure if that’s due to furin cleavage or what. I’m a bit rusty on the mechanics there so open to dissenting opinions.

Also I don’t believe SARS-2 exhibits asymptomatic spread; that seems to be largely a myth. It does undeniably exhibit PRE-SYMPTOMATIC spread however. My hunch is that the early course interferon mediated immunosuppression explains that phenomenon.

IMO the true asymptomatics (never showing symptoms) are asymptomatic largely because of T-cell cross reactivity which theoretically will reduce or entirely prevent spread. Thus why we really don’t have good evidence of asymptomatic spread but we have a wealth of evidence on pre-symptomatic.

> Also worth remembering that NYC would have run out of hospital beds entirely if they didn't implement strict lockdown measures. The NYC (or really NY) stay at home order went into effect on March 20, and daily cases peaked plateaued 1.5 weeks later.

There is absolutely no way for you to prove this nor for me to disprove it, which tells you about its explanatory value. I personally find it much more likely that the dropoff in cases is purely explainable by timing; NY was already rounding the bend when it enforced its (IMO pseudoscientific and deleterious) measures.

Basically everywhere in the globe, including Sweden, showed a large uptick for some time followed by a peak and wind-down. That’s just the pattern infectious diseases show. To immediately attribute it to human intervention when SARS-2 landed on our shores months earlier than originally thought just seems like hubris to me. In any case the statement is not falsifiable so I won’t focus on it any further.

> There was a period of time when NYC was globally short on ventilators and ICU beds.

New York as a whole was a huge proponent of early invasive ventilation which probably ended up killing people unnecessarily. NY’s implied IFR was something like .7%, a number so bad it is unmatched by anywhere else in the US. My guess is not good pre-existing Vitamin D3 levels exacerbated by being directed to stay inside, combined with stress, fear, lack of exercise and lost sleep attributable to lockdown + general hysteria, and finally the aforementioned iatrogenic harm caused by excessive ventilation.

In retrospect it seemed the ventilator panic was only marginally more rational than the toilet paper panic.

I should note that, if we assume every use of a ventilator prevented a certain death, ventilators still had only a marginal effect since something like 90% of those ventilated died, and it’s only those with incredibly severe COVID-19 who end up ventilated (well, ironically except NY which seemed to ventilate “early and often”, so the cases were still severe but not incredibly severe)

> At this point we have more known Covid-19 long haulers in the US than there are Sars-1 infections globally. Comparisons to SARS-1 don't much matter.

I have a lot of trouble believing in a bunch of anecsotsl cases of people on Twittwr with very obvious political leanings, given that most long haulers I have seen are in popupations with next to no risk or SARS-2. It’s much more likely to be that the 20-something year olds are either inducing psychosomatic symptoms, or exaggerating their actual symptoms, or coincidentally got Epstein-Barr virus or similar at the same time.

I would expect bad COVID cases to have lingering effects for a few months, sure. But not “long-term” - although maybe we have different definitions there. Fatigue 1 month after successful resolution of infection doesn’t really say anything to me. But to give you something more tangible, I don’t believe anyone who’s in their 20s and otherwise healthy is really experiencing this mysterious syndrome, with a few very rare exceptions of course. You have to keep in mind the incredible psychoemotional environment we are living in currently.


Just a note to thank you for your extraordinary contributions to this thread. You’re dead on the money. If I had more time on a Saturday, I would be writing many of the same things.

> It does undeniably exhibit PRE-SYMPTOMATIC spread however.

Yes, I mostly agree with this characterization.

> There is absolutely no way for you to prove this nor for me to disprove it, which tells you about its explanatory value. I personally find it much more likely that the dropoff in cases is purely explainable by timing; NY was already rounding the bend when it enforced its (IMO pseudoscientific and deleterious) measures.

There are multiple studies that support my assertion (that lockdowns reduce R0 and without them cases continue growing at near-exponential rates). Thanks to a wide variety of government policies, we have reasonable sample sizes. See for example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268966/ (longitudinal) and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293850/ (correlational). So yes, I'd argue your assertion here is wrong and there's strong evidence to state that.

> Basically everywhere in the globe, including Sweden, showed a large uptick for some time followed by a peak and wind-down.

This is a misconception. While not as extreme as other places, Sweden did implement social distancing measures. And you're actually incorrect about the shape of sweden's case count graph. It went up, paused, went up again a month later, and then went down some.

You can argue all kinds of things about herd immunity and whatnot, but that's not well supported. From the evidence we have the only conclusion you can make is that lockdowns do work in reducing spread, and they keep spread low later. That's the only conclusion based in evidence. Anything else is based on conjecture about things unseen.

> My guess is not good pre-existing Vitamin D3 levels exacerbated by being directed to stay inside, combined with stress, fear, lack of exercise and lost sleep attributable to lockdown + general hysteria, and finally the aforementioned iatrogenic harm caused by excessive ventilation.

Like this. This is not supported by any evidence. It was possible to go outside, it was possible to exercise. Stress and fear would be raised independent of lockdown measures. You're being just as hysterical about stay at home orderers as you accuse lawmakers of being about covid.

> I have a lot of trouble believing in a bunch of anecsotsl cases of people on Twittwr with very obvious political leanings, given that most long haulers I have seen are in popupations with next to no risk or SARS-2. It’s much more likely to be that the 20-something year olds are either inducing psychosomatic symptoms, or exaggerating their actual symptoms, or coincidentally got Epstein-Barr virus or similar at the same time.

I generally agree that long haulers are probably at least somewhat exaggerated, but we have indisputable evidence that serious, but non-fatal cases cause long lasting side effects in many (most!) severe patients (https://www.nature.com/articles/d41586-020-02598-6). If that eventually wears off, that's good, but until we understand these things further, we should be cautious. A disease with a .4% IFR is very different than one with a .4% IFR and a 2% or 5% chance of leaving you with lifelong severe breathing problems, and there's a reasonable chance that Covid-19 is the second and not the first.


3 deaths per 1000 infections is a pretty strong motivation to prevent infections, it doesn't need to be a contest between doing nothing and shutting down the world, strategies for reducing transmission can be independently evaluated.

And when you add in fewer older people getting infected when there are fewer infections in general, well, there you go.


Why 3 in 1,000 and what’s the threshold you’d accept and why?

The initial headline of the article stated that the infection fatality rate for people under 70 is 0.3%.

'threshold you'd accept' isn't a response to my comment, which expressly rejects the idea that there are only 2 options. Some mitigations are only justified by very high levels of risk. Others are justified by much lower levels of risk.


Extreme poverty is expected increased by 150 million people world wide bc of Covid.

I'd wager there's a lot of people whose kids are running around a shantytown shoeless who would disagree with your levels of risk.


I don't understand what part of my comment you are responding to.

The flu also affects older people more. If you compare flu IFR to COVID by the same age group, covid is more dangerous across all age groups.

(I did the math myself using CDC estimates for both the flu and covid and assuming a 50% asymptomatic rate for the flu.)


Covid-19 is perfectly evolutionarily adapted to fit into this gap. Its divisive ability has practically been evolutionarily selected for.

That's wonderful, the virus is literally political.

What you need to look is not fatality rate, but total fatalities caused by the disease. Flu kills 60000 a year max in US, Covid kills 5x that number. And it is unclear what will be a fatality rate for younger people whose organs are damaged by previous infection.

Actually you need to look at both. IFR shows you how dangerous the disease is once you contract it. The yearly fatality rates shows how much risk you have from the disease in a given year. Covid is much more contagious than flu - so there is bigger risk that you will contract it eventually, but once contracted it might be not much worse.

We still don't have comparable stats on that - even for flu the stats are really all over the place: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809029 """ There is very substantial heterogeneity in published estimates of case fatality risk for H1N1pdm09, ranging from <1 to >10,000 per 100,000 infections (Figure 3). Large differences were associated with the choice of case definition (denominator). Because influenza virus infections are typically mild and self-limiting, and a substantial proportion of infections are subclinical and do not require medical attention, it is challenging to enumerate all symptomatic cases or infections.2, 45 In 2009, some of the earliest available information on fatality risk was provided by estimates based primarily on confirmed cases. However, because most H1N1pdm09 infections were not laboratory-confirmed, the estimates based on confirmed cases were up to 500 times higher than those based on symptomatic cases or infections (Figure 3). The consequent uncertainty about the case fatality risk and hence about the severity of H1N1pdm09 was problematic for risk assessment and risk communication during the period when many decisions about control and mitigation measures were being made. """


Your math doesn’t add up.

Clarify please.

Well, the 2017 flu was a little over 60,000, but it was close to 60k, so we could say that, but the 1968 and 1957 flus were worse than that. Covid-19 isn't to 300,000 (5x 60k) yet, but I suppose it could get there. However, the idea of organs damaged, resulting in future fatalities, is not just "unclear". We could speculate the same about almost any virus, or for that matter any vaccine. Until time has passed, we won't know, but at this point neither northern Italy nor any other region that had early waves of Covid-19 have reported any such problem in even 1% of cases (not even 0.01% of cases, that I'm aware of).

If a vaccine is tested on 10,000 people, and appears safe, we call it good enough, without waiting for several years to check on the possibility of long-term affects. It's not like vaccines have never had problems, but at some point you need to go by what you actually know and have seen, and the same logic applies to viruses (or any other risk). We haven't in fact seen anything that suggests a widespread problem in people who recover from covid-19, and given past results with SARS, MERS, and the four other coronaviruses which cause "colds", we don't have much reason to expect it. Could it happen in some significant percentage? Sure. The same is true of any virus, or for that matter any vaccine. But we don't gain anything from speculating on that.


> Until time has passed, we won't know, but at this point neither northern Italy nor any other region that had early waves of Covid-19 have reported any such problem in even 1% of cases

Did they actually do any monitoring and reporting? There is aplenty of people around with long Covid, I know personally one guy, who was actually diagnosed with myocarditis he never had before.

> We haven't in fact seen anything that suggests a widespread problem in people who recover from covid-19, and given past results with SARS, MERS,

Actually lots and lots SARS survivors did develop long-term problems. Besides, experiments on animals show, both SARS-1 and MERS caused very severe Antigen-dependent enhancement, which made the attempt to produce a vaccine futile. Not many viruses are capable of doing this, mostly flavivuruses and betacoronaviruses.


> Flu kills 60000 a year max in US

These numbers are patently false. If this was even remotely true pretty much every family would know someone who has died from the flu at some point.

The flu numbers are statistical evaluations based on no actual death counts. The real numbers of deaths from the flu are very likely much, much smaller.


It's usually less than that (but still in the tens of thousands). But 2017-18 was estimated at >60,000. https://www.cdc.gov/flu/about/burden/index.html#:~:text=Whil....

You are of course welcome to ignore the CDC. You have a lot of company these days.


I dunno, CDC says that.

Your logic is actually backwards. Flu is extrapolated but it’s extrapolated fairly. Whereas for COVID-19 we perform mass testing and label every PCR-positive death a COVID death. I hope it’s self evident why that approach will massively inflate COVID deaths but if you would like I can break it down in detail for you.

That’s why you look at excess mortality to see what’s actually happening and see how covid is being undercounted. You can’t hide the bodies:

https://www.economist.com/graphic-detail/2020/07/15/tracking...

You can look at past graphs here for a number of European countries to see how countries like Norway and Finland compare to e.g. the U.K. and Sweden. This helps dispel any myths about lockdowns themselves causing significant excess mortality: https://www.euromomo.eu/graphs-and-maps/


0.1% for flu is of symptomatic infections. I think covid would get another near ~2X multiplier under the same measure.

Currently, CFR for covid is 4%, so 40x multiplier.

I'm talking about flu IFR not CFR though, even it is usually cited only of symptomatic infections and not counting fully asymptomatics.

I guess not so many people get flu? I don't regularly get vaccinated, and I only had 1 flu-like disease in the last decade.

Covid is way more virulent. If 10x more people get it, it doesn't need to be more deadly in terms of IFR to be a concern.


> If 10x more people get it, it doesn't need to be more deadly in terms of IFR to be a concern.

Sure, but what sort of concern? A "shut down everything, COVID-cases are rising!" sort of concern?


Apple and oranges. That flu fatality rate is without social distancing.

No, IFR is the infection fatality rate. It's the number of fatalities divided by the number of infections. If you reduce the infection rate, the proportion of those infections that results in death will not change. This of course doesn't apply if healthcare systems are overwhelmed, but that's not what we're talking about here.

For flu the commonly cited IFRs out there are restricted to symptomatic people (though still lower than flu CFR, this inflates it relative to seropositivity IFR estimates on covid).

We don't test for who has flu.

That does not affect the IFR, it just make it harder to measure.

You don't know the number of people who die who were infected if you didn't test them. I think your argument is only valid when the death rate is the same amongst tested and untested people.

I don't know how, but epidemiologists are able to estimate it.

> We don't test for who has flu.

What? Of course we do. Influenza rapid tests are among the most common diagnostics during flu season. Epidemiologists rely on these tests as well as serological surveillance to derive IFR estimates for the various flu bugs, just as they do for covid.

But it doesn't matter. Your assertion was that flu and covid IFR's are "apples to oranges" because we're taking measures to reduce covid infections. This is nonsense on the simplest logical level. Reducing the infection rate doesn't reduce the danger to the individuals who do get infected, as long as the standard of care remains stable.


They're referring to testing people who aren't sick. I don't know how much it's done in studies in order to get asymptomatic estimates, but we definitely don't try to test everyone who was only exposed, like we are with SARS-CoV-2.

Social distancing reduces the number of infections - but it does not change the course disease once a patient is infected. So out of the infected (for IFR or out of the reported case for CFR) there should be the same fraction of fatalities with and without social distancing. Fatality rate is that fraction.

And 40% of the population getting a influenza vaccine yearly.

As others say, this is way too much to say "meh", but I do think it needs a rethink of the lockdown strategies.

Lockdowns kill people; people with cancer, people who need surgeries, people who lose income to support themselves. Clearly, so does Covid, and we need to balance it.

Can we do better, as societies, if we aggressively protecting old and vulnerable people, and let fitter people continue with their lives? This can avoid the economic collapse of lockdowns, bring about some degree of herd immunity, and yes, trading some lives saved by lockdown for lives saved by "normality".

Suppose 70% of the society is under 50, and has a IFR of 0.1%. Take UK (65mn people), and suppose everyone in that group gets it. That would lead to 45k fatalities (very close to what was already experienced), plus herd immunity, and lack of economic collapse. It's clearly not so simple, but it's start.

I'm in no position to question the research, but I spoke once to a professor of respiratory diseases at UCL, who quoted that mild Covid cases often do not register in antibody testing (for reasons unclear), so I wonder if even the 0.3% is an overestimate.


This is more or less what Texas has decided to do. I’m in California, but my entire family is there, and many of my younger family members are going about their lives relatively normally.

At least one of my cousins caught it and their whole young family (parents 30’s, kids <10) were fine. My 90+ year old grandparents are obviously being kept very isolated. Their kids (my parents’ generation - 60’s) are being careful, but not cancelling their entire 2020.

Everybody hated on Texas because of the Lt. Governor’s over the top declaration of sacrificing grandparents for the economy, but there are definitely aspects of their approach that I prefer to what’s happened in California.


Florida went even further and removed all state level lockdown orders on September 25. So far it's too early to tell what effect that will have on the death rate. Case numbers are roughly flat.

https://www.worldometers.info/coronavirus/usa/florida/

I'm not advocating for other states to follow Florida's approach. But it serves as a natural experiment. Depending on what happens to their daily death rate over the next couple weeks that will tell us a lot about the effectiveness (or lack thereof) of lockdowns.


>Depending on what happens to their daily death rate over the next couple weeks that will tell us a lot about the effectiveness (or lack thereof) of lockdowns.

It's already been more than a couple weeks since September 25th; how many more "couple weeks" do we need until we can draw a conclusion?


For patients who are going to die, that typically happens about three weeks after initial infection. After the lockdown orders will lifted it still takes a while for businesses to reopen and for people to change their behavior. There are delays in state level data reporting.

So I would say that if we don't see a sustained rise in death rates in about three more weeks from today then that would confirm the "null hypothesis" of lockdowns being ineffective. Or if they have a major spike in deaths then that would indicate that lockdowns are effective.


Well, you'd need a couple weeks before you expect to seeing measurable impact on cases/hospitalizations and another couple weeks before it starts really showing up in deaths. The daily data is noisy to start with so it's hard to eyeball trends, but it looks like cases have started to trend up recently and deaths are still mostly flat, which is about what you'd expect at this point in time if the lockdown that was lifted was having a significant effect on limiting COVID impacts.

> Depending on what happens to their daily death rate over the next couple weeks that will tell us a lot about the effectiveness (or lack thereof) of lockdowns.

Less than you might think, because we know the value of lockdowns for an contagious respiratory disease varies based on conditions, including the current infection and immunity rates on the local population, for which we have inadequate surveillance pretty much everywhere. It also varies by the degree of enforcement, which is also inadequately measured but probably was lowest in the same places that are inclined to remove lockdowns entirely. So we're missing lots of data necessary to interpret both the local meaning and the meaning for other places of any numbers that come of a one-jurisdiction top-level policy change.


'Lockdown' is only one artifact of net social distancing.

People's individual decisions to distance probably are the most important factors - in soft-lockdowns, some people might not have trouble having parties, hanging out with friends etc. but depending on the culture, directives by government, the level of 'fear' from the daily results ... people may adjust their behaviour.

I wish there was much more study on exactly what social distancing means in material reality, not just 'policy'.


You have no idea how it would affect you or your family members until it does. This person lost 8 family members. https://www.cnn.com/2020/10/14/us/phoenix-arizona-aguirre-fa...

"Then, despite all precautions against the virus, a family member got sick. Then another and another and another. Now, seven months after the shutdown, seven people in Ricardo Aguirre's extended family and his father, Jesús, 67, have died of Covid-19 complications."

Two observations: First, this happened despite all precautions. Secondly, extended families can be hundreds of people, including many elderly. Lastly, in a large-enough population you will inevitably find clusters that are more affected by some illness than the average person. That's why you need to observe solid data, not a media spectacle, to come to rational conclusions.


> First, this happened despite all precautions

... in this family.


The sad reality is that broad, indiscriminate lockdowns are the only real tool available to some "world powers". We know we can manage the covid pandemic with ubiquitous testing and targeted temporary lockdowns. But there is no testing capacity.

Which means ... it's not really possible to rethink the lockdown strategies. Given a choice between a thing that directly kills people, and something that more people die from in indirect ways, people are always going to default to preventing the direct deaths.


One of the more... interesting things about Covid-19 is that the countries everyone thinks are stuck with indiscriminate lockdown as their only tool due to lack of testing capacity actually have the most testing capacity, and the one everyone points to as a mass testing success story has about an order of magnitude less in per capita terms and is likely severely limited in their ability to actually detect cases as a result. It's the result of cached facts from like 6 months ago that have never been refeshed because the media have carefully avoided drawing attention to the new information in order to preserve their narrative, whilst using language that leads people to think it's still true.

Do you have details? A quick glance here shows low positive test rates in the countries that seem to be doing the best. Low positive test rates seem like adequate testing.

https://ourworldindata.org/coronavirus-testing


Low positive rates are an indicator that a country is having to do more testing to locate their cases than a country with a similar amount of cases, but higher positive rates. Nothing more, nothing less. At best, it indicates that the country has a relatively low infection rate (which is why countries that are doing better have low positive test rates), at worst it's because they're testing the wrong people.

Think about it this way. Currently, countries like the US or much of Europe tend to offer testing to anyone with mild potential symptoms that are caused by many common diseases. If they ever reach the point where Covid-19 cases make up such a substantial proportion of people with those generic symptoms as to affect the number of tests required, the country is in really deep, Lombardy-level trouble. The idea that the level of testing required depends on the size of the outbreak is nonsense created to continue the narrative that Western countries like the UK and US are still failing on testing and that's why we have so many cases well past the point it should've been put to bed. It made sense as a metric of testing aggressiveness in February when everyone was looking for cases linked to travel from China, since it tended to indicate how wide a net countries were casting when doing this, and a little bit back in March and April when many countries were only testing people with serious and obvious symptoms. Not so much these days.

(Note also that South Korea doesn't routinely offer testing to people with mild symptoms. Anyone can get tested if they pay out of pocket for it, but it's discouraged and at a tenth of the testing capacity of most Western nations I don't think they could handle many people demanding it. Which means they can't reliably detect cases not linked to ones they already know about, and of course those unlinked cases grow exponentially... Makes meaningful comparison of case figures and test positivity figures hard.)


I understand that low infection rates don't follow testing. But low infections rates _also_ means there are adequate tests for infections. What I was after was any kind detail about these countries being test constrained. Links, etc. Anything like that?

> The idea that the level of testing required depends on the size of the outbreak is nonsense created to continue the narrative that Western countries like the UK and US are still failing on testing and that's why we have so many cases well past the point it should've been put to bed. It made sense as a metric of testing aggressiveness in February when everyone was looking for cases linked to travel from China, since it tended to indicate how wide a net countries were casting when doing this, and a little bit back in March and April when many countries were only testing people with serious and obvious symptoms. Not so much these days.


It feels to me in some cases there is a bit of a point of principle here: "look, we're inflicting so much pain on everyone, just to make sure you're safe".

If an evil alien race came and threatened to kill everyone unless we isolate everyone over 45, I'm sure humanity could do it.

If we can't be smart about fighting the pandemic, that's a super sad statement about humanity's ingenuity.


We could do age-based lockdowns. Stores near me have ~2 hour periods in the day where you can only shop if you're 65+, I don't see why they can't make that the only time 65+ people are allowed to enter.

It's not even clear that lockdowns prevent deaths. A recent peer-reviewed study found lockdowns aren't associated with a statistically significant decrease in the number of deaths; what matters is social distancing: https://www.jpost.com/israel-news/social-distancing-more-imp...

There's plenty of evidence of long-term damage even in young and barely symptomatic cases - it's not a binary "dead/not dead" outcome.

What if the virus causes substantial disease burden years to decades down the road? We can't know, and should take every precaution to prevent its spread.


> What if the virus causes substantial disease burden years to decades down the road? We can't know, and should take every precaution to prevent its spread.

This is the precautionary principle selectively applied, and it’s what’s so wrong with the “lockdown” debate.

What if lockdowns cause substantial health problems years to decades down the road? We can’t know that either. Acting like Covid is the only thing whose aftereffects might be worse than we can tell right now is ignorance.


This is a very important point. We don't know enough about long term effects yet.

In the same vein, we do not even know if herd immunity really is a thing here, and what thing it would be. E.g. the guy from Hong Kong who got reinfected (first time severe symptoms, second time no symptoms) was probably infectious the second time again. Herd immunity only works if the people who are immune are not infections and therefore cannot (re-(infect each other and more importantly the vulnerable population.


Herd immunity has never happened without a vaccine.

https://en.wikipedia.org/wiki/Herd_immunity

> Herd immunity was first recognized as a naturally occurring phenomenon in the 1930s when A. W. Hedrich published research on the epidemiology of measles in Baltimore, and took notice that after many children had become immune to measles, the number of new infections temporarily decreased, including among susceptible children.

(To be clear, though, I don't think the herd immunity strategy is a good one for COVID-19.)


The concept makes no sense. As soon as a carrier hits a group that does not have widespread immunities, you will get a disease cluster.

Not only do you have to have a huge portion of the population exposed to the disease, you need to maintain that proportion indefinitely AND will still deal with occasional flair ups among vulnerable communities.

That's not what most people think when they hear the word "immunity".


I guess I should have said 'Successful herd immunity'. The sentence after what you quoted is:

"Mass vaccination to induce herd immunity has since become common and proved successful in preventing the spread of many infectious diseases."


While I agree, we must always consider the impact of lockdown. This is what is missing to me in the current strategies. For example, how do the rare, and very significant, long-term health issues compare to the fairly prevalent mental health issues caused by lockdown, unemployment etc?

I'm in no position to make that call, maybe lockdown is still the right answer. But we absolutely must do this analysis seriously, publicise the results and debate it widely.


For example? I haven't seen a single paper showing such long-term consequences in healthy people are significantly more likely than from other viral infections. We'd especially expect to be seeing a large number of such cases in Sweden, should it be common, given they had no lockdown and a large number of infections.

It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious.

This is like saying "COVID isn't worse than the flu" - even if it was true, having another flu-sized disease burden would already be bad, so it's a bit of a weird goalpost.

That being said, there's a lot of literature describing post-covid symptomes and hypothesized mechanisms of action, like [1]. The virus has been around for less than a year, so a quantitative comparison with something we have studied for decades makes no sense.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/


That depends on what you mean by "little immunity". Many people appear to have some immunity based on prior exposure to similar coronaviruses. That won't prevent infection but tends to reduce disease severity.

https://www.jci.org/articles/view/143380


That "some immunity" is clearly insufficient, because people who actually got infected with Covid itself and then again with Covid, in many if not most cases have more severe symptoms. In fact, the scarce evidence suggests Covid might be a subject to Antibody Enhancement; that would mean that every next infection will get worse and worse. In any case, Coronaviruses have long be known to cause very short term immunity. Even more importantly, constant reinfection may debilitate the organism so much, that even a healthy person will eventually fall into the risk group.

That is unscientific fear mongering. As with any virus there will be some outliers. But in general there is no evidence of widespread antibody enhancement. Reinfections are rare, and most reinfected cases have minor symptoms.

https://www.jimmunol.org/content/early/2020/09/03/jimmunol.2...


> That is unscientific fear mongering.

Please be careful with your words. What I said is clearly scientific, because it can be falsified.

> most reinfected cases have minor symptoms.

This is clearly not true. See https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

The article you linked is extremely old, July 17, when there was no reinfections known.

Besides, it is already known, that MERS and SARS both cause Antibody enhancement in animals, with paradoxical results - lower viral load, but severe damage

https://en.wikipedia.org/wiki/Antibody-dependent_enhancement...


>It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious.

But it does make it highly inconsistent to adopt policies so extremely destructive to economic and mental health when the same wasn't done for other viruses with similar long-term effects.


We have a chance at eradicating COVID-19, unlike other viruses that have been endemic for decades.

How would we eradicate a virus that has animal hosts? If the prevailing origin hypothesis is correct then the virus is presumably still circulating among horseshoe bats.

SARS-1 has been eradicated in humans;its precursor still probably is circulating among bats.

Of course you haven't seen papers describing long-term effects, simply because the virus hasn't been around long enough for any long-term conclusions.

Therefore there are no studies saying there are NO long term effects either.

There are clues that long term effects/permanent effects even in mild cases may exist. E.g. some six scuba divers with mild symptoms/asymptomatic progression were checked afterwards (Innsbruck, Austria) and had what looked like permanent lung damage. Then again, the sample size here is far too small and the cohort far to "exotic" to draw any conclusions yet.


> Of course you haven't seen papers describing long-term effects, simply because the virus hasn't been around long enough for any long-term conclusions.

So you'd support locking down based on something for which we don't have any evidence yet?


We have seen evidence that the virus kills. That alone warrants action. In the beginning, the general lockdowns were fine, simply because we didn't know enough yet to come up with better solutions, and frankly didn't really have the time to rectify this before taking any action. Now whether or not to lockdown and what to lockdown can be applied more fine-grained. Of course, everything is still in flux, and some decisions will turn out to be wrong later. The entire response is trial-by-error, for lack of alternatives

In regards to potential long term effects, those should be a concern as well when making decisions, yes. Not the only concern of course, but not something to be ignored either.


>That alone warrants action.

In only warrants action if we're sure the negative consequences of the action won't be greater than the negative consequences of the viral deaths.


Interesting.

On one hand we have clear and ample evidence that the virus kills, and even more so when the health system of a country gets overloaded.

On the other hand we have a bunch of hypotheses arguing that lockdowns kill, etc, but no clear evidence for that yet. E.g. suicide rates are up on some locales like Japan and the UK, but down in others like Germany. (I am not disputing theses hypotheses as false, btw, as there is ample evidence that in order situations of e.g. economic turndown or e.g. isolation severe adverse effects occurred/occur; tho it remains to be seen what damage there actually will be)

Given how you seem all about the evidence, this should give you pause.

I agree that the effects of measures have to be weighted against the good of measures - namely "curve flattening". However, I still do think that the initial lockdowns were warranted as a short term measure, and that future, more fine-grained (hotspot) lockdowns are warranted.

Then there are other measures, such as facemasks... some people dispute the effectiveness... But really, that's a no-brainer now; even if it turns out the masks are not effective at all, the worst that came out of it really is mild discomfort wearing them (exceptions for medical conditions of course apply) - and some morons shouting at each other for either wearing a mask or not wearing a mask.


It appears however, that the whole strategy of "learning of living with Covid" might turn out to be unrealistic, we'll be forced to go for virus eradication route. NZ and TW, and partially CN did it, and they are doing very good.

I wouldn't know about China, because frankly, the data they release is fishy. NZ and TW do better, but mostly because of travel restrictions (and people do not like to travel anyway right now for the most part) and because they are islands. Doing the same for the big islands of "Eurasia" and "America" and Africa seems less feasible.

The "solution" will be vaccines combined with some adjustments on how people live for the foreseeable future. Until the next pandemic comes along.


I am not quite sure I buy "it is an island argument". There is very little political will I am sure, but virus doe not care about the politics. If winter death toll will be very high, it might trigger very drastic shifts in the policies. Vaccines might turn out to be not efficient enough as well.

I haven't seen any evidence, but there was a paper published recently that said that the lung damage dealt by covid is usually healed in ~3 months.

You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people?

> and lack of economic collapse

In your model you’re calling for a strong lockdown of 30% of the population. How is that not going to have a powerful negative impact on the economy?

Also, as a practical matter, I doubt society will accept a strategy that minimizes the impact of covid-19 on one group of people at the expense of another group of people when the other group of people are politically powerful (and, not incidentally, a great number of various types of leaders are part of the other group).


> You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people?

> In your model you’re calling for a strong lockdown of 30% of the population

Why ask a question and then assume an answer?

Precautionary measures for the elderly can be food delivery, direct financial support, free N95 masks, free healthcare, priority vaccination, etc.


Food delivery and direct financial support don’t protect people from getting covid by themselves. They would help people isolate... so you’re still talking about locking people down to protect them.

Free N95 masks would help to the extent it increases the number of people wearing them. But that’s hardly aggressive. Aggressive would be mandating that old/vulnerable people wear masks (which is another form of lockdown).

Free healthcare would help with the financial situation of those that get the virus and survive, which isn’t exactly the goal.

Priority vaccination... well, there is no safe and effective vaccine. Maybe that will be a good path six months from now. But if we had one, the goal would be to vaccinate everyone. Priority would be nice, but would ultimately only shorten the months-long window for infection (vs those without priority) by a matter of weeks. So that would be helpful, but not a game changer.


> Lockdowns kill people

Agreed. But what causes lockdowns? An uncontrolled pandemic. What does uncontrolled pandemic also cause? Collapse of healthcare infrastructure, which is a civil emergency that also results in countless deaths.

Lockdowns, as implemented in places like the US, are a reactive measure because of a system-wide failure to adopt and maintain proactive measures needed to control things. You don’t arrive at “herd immunity” without them, but mass deaths, both from the disease and being unable to receive other routine or emergency healthcare.


I'm not demonizing lockdowns. They have a use, for sure, and they save lives. I just mean, they have their own downsides too, and we should use new data to evaluate how we implement them.

It is now clear societies cannot really afford full, long-term, unconditional lockdowns. We have to pick and choose what we do, stratifying by age/health conditions seems a good way about it to me.


Nowhere outside of places New Zealand and Taiwan has had long-term, unconditional lockdowns, and nowhere in the US has reached anywhere near this level of restrictions. I live in a state that ostensibly had “extreme” lockdowns and whole cities and communities decided themselves exempt from the orders with zero consequences.

It’s also impossible to stratify people on the basis of health in the US because not everyone is cognizant of their health status or risk factors, certainly the government has no insight into these beyond the crudest levels. Age also doesn’t really work because the lack of social safety nets mean older workers have to remain employed or rely on younger cohorts in order to survive.


UK put everyone who cannot work due to Covid on 80% of their salary (sort of). So surely it could do that to a smaller cohort too.

That US cannot do it is no reason to not consider it.


Oh, certainly. Apologies for my US-centric framing. I hope the rest of the world follows South Korea, Taiwan, Vietnam’s example and not our’s. South Korea has only had limited, regional lockdowns and never closed their borders. If everyone followed their examples, lockdowns would likely be unnecessary to begin with.

The UK did this once. It's probably not going to happen again, certainly not on such generous terms, and one lockdown was not enough to stop Covid - just to delay it until right on top of the winter flu season.

Depends on the social security network, doesn't it?

It does. This is part of what I mean: if say 70% of the country can go about its business as normal, this frees a lot of resources for the state to help the remaining 30%. Stable-ish economies can foot the bill for this as well.

Simply caching away the unfit is not what I meant.


Me neither. In Europe we are lucky enough that most countries can maintain social networks for quite a while despite having mass unemployment and the like. But this only buys time. Hopefully enough.

Antibody tests do miss many cases, especially those with mild or no symptoms. Some patients are able to fight off the infection before antibodies are produced, or antibody production fades away quickly.

https://www.bmj.com/content/370/bmj.m3364


This same comment posted 3 or 4 months ago would have been downvoted into oblivion. Now it's the top comment on this article. It's good to see peoples' perspective is becoming more reasonable on this issue.

It was! I just refuse to optimise my posting for karma...

Only two states have continued preventing elective surgeries, one state (Texas) that was overwhelmed stopped but has since re-allowed them.

Around 60,000 cancer patients will be under-treated due to corona virus. The current estimates are that 10,000 people will die due to missed treatment. Just for the "fun" of it, lets assume all of them died due to under-treatment, that is still 1/4th the death toll of the virus itself.

If the goal is fewer deaths, why don't we encourage more treatment AND continue practicing social distancing? We can have both in this case.

I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid...


In Poland, cancer prevention literally got obliterated this year. That's thousands people whose cancers could be found early and treated, but won't be.

That's not to mention any other long-term disease.

Just the GDP drop, and the ensuing under-financing of healthcare etc, I think may well easily kill more people than Covid.


>I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid...

Are you sure? The economic fallout of lockdowns is pushing millions of people in poorer countries into poverty, and causing thousands of children to starve: https://www.france24.com/en/20200728-coronavirus-linked-hung...


> that is still 1/4th the death toll of the virus itself.

That is the wrong comparison. We all die.

One better comparison could be expected years of life. The number I read was that Covid causes an expected decrease of 10 years in lifetime. What was the expected decrease in lifetime for those cancer patients because they missed out on treatment? I know you are only calculating a ballpark figure, but I suspect your ballpark is too inaccurate to be useful.

A sibling comment mentions quality-of-life-adjusted years.


In medicine, people like to talk about quality-of-life-adjusted years. Why? Because there's no point in making somebody live more years that are subjectively bad (e.g due to treatment side-effects), rather than less years that are subjectively good. When it comes to policy-making that affects us all, it's time to extend that to the collective level.

We need to ask ourselves, how much suffering can younger generations be expected to endure to make the older generations live statistically a bit longer? Remember, the average COVID death is in their eighties, which is already beyond life expectancy.


>Because there's no point in making somebody live more years that are subjectively bad (e.g due to treatment side-effects), rather than less years that are subjectively good.

This also applies to locking down the elderly, as lockdowns cause more loneliness, which increases the risk of mental deterioration: https://medicalxpress.com/news/2020-07-highlights-loneliness....


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