I read that the paper cited does not include the effects of isolating cases and contact tracing to suppress new infections.
Added: Waiting period will result in asymptomatic people showing symptoms and they can then be tested and isolated. That is why the stay-at-home practice is useful during the incubation period. If the actual number of cases in CA is not too large and within family infections can be controlled, then part of everyday life can resume in about 1 month.
Actually, I'm sure it is not.
Honestly, with the governor this morning toying with "about 18 months", we are agreeing to give up more than 1% of our life just to reduce the risk of the 1% chance of death.
If you do order the military to enforce it, you are likely to end up with a civil war. Some people will eventually resist, and then either the army starts firing on Americans or they let people go on with their lives.
On a more personal note, the mental health cost of perfect social isolation is already getting to me, and frankly, I don't think I would survive more than a bare couple of months, even if the magic goods fairy delivered me every essential item I could ever want in infinite quantity.
Let's cook up a fantasy scenario where we have unlimited resources and can treat as many patients as needed. Let's also optimistically pretend that only 1% of cases need ICU treatment. Take 1% of 327M and you get 3.2M ICU beds required. Now let's say that at the peak, half the population is sick (likely given the unmitigated exponential explosion scenario), meaning we need 1.6M ICU beds at the peak. We have roughly 100k ICU beds in the country, 1/16th what we need. The cost of those beds would be trillions of dollars. Of course we can't magically materialize ICU beds, so hundreds of thousands will die. I'd choose 6-12 months of the GFC over that _any day_.
Do you not believe these basic facts or just don't have empathy for other people who are at risk?
2: 12 months of not actually living is already giving up about 1.3% of the life of our whole population, and that's not counting the health problems caused by poverty or the mental health cost of eternal social isolation.
3:. There is no believable model where 100% of the population gets the illness. Even the absurdly pessimistic models end up at 60-70%
4: the models that assume nearly everyone gets sick require that there are already many, many, many undetected cases, which makes severity and mortality much lower than is being otherwise imagined
5:. This will sound callous, but 99% of fatal cases involve folks with other serious chronic illness, and at least 80% (good numbers are hard to find) are past retirement age. Though these people add.much value and happiness to our world, they aren't going to produce much more economic productivity. This doesn't mean they don't matter, but we were having a discussion on economics
Why do people think that waiting 2 weeks or 2 months will solve it? Only way that works is if enough people have it and now have immunity, which helps prevent spread when quarantine is over.
We are going to have a worse economic impact from mass quarantine than the 200 thousand people (mostly over 60) that would have died.
Who said it will solve it? It will flatten the curve as it already has in other countries, hopefully avoiding a catastrophic overload of the healthcare system.
Hence their conclusion is that we'll have to basically do this on and off, flattening the curve just enough that we can let it rebound for a while without overwhelming the system, until vaccine is available. Which they estimate as 18 months, out of which 12 will be on lockdown - however you space it out.
So yeah, the economic impact will be massive. But it doesn't have to translate to people dying, if we focus on preventing that. One person could feed themselves and others with the fruits of their labor since the agricultural revolution. It's a question of distribution, not of availability.
Essentially: either this disease overwhelms us, in which case most people you know will have had it and multiple people you know will have died, or (statistically) no one you know will have gotten sick and the whole thing will look like a nothingburger.
But it wasn't. It was a disease that would have killed tens of millions if unchecked, we just got it under control. At least, that's what we hope.
In this particular case here in this topic: there's a voting (but seemingly not commenting) population that just really wants COVID-19 to be a flop. I'd be tempted to say that's a political position, but in fact politicians have largely unified on this (finally). Maybe it's a counterculture or conspiracy thing.
I mean in the last week, multiple legit stories have been flagged off the home page about Coronavirus. Go back and look at the comments on the story that hit the frontpage about Trump trying to buy exclusive rights to a vaccine... A story that was ultimately confirmed as true. But yet it was flagged off the frontpage by Trump supporters that denounced it as "fake news" of course, as if he doesn't regularly do things that would be unbelievable without video/audio evidence.
Meanwhile, any comment, like yours, that mention the BLEAK REALITY THAT THIS IS GOING TO LAST MORE THAN 3 WEEKS is getting downvoted. Systematically. As if downvoting you changes basic fucking maths.
Frankly, I think it's massive cases of denial. I think people are just starting to get an image of how bad this is going to be and how fucked our social structure is about to be. Especially if this drags on for many months (like those of us paying attention understand is likely).
HN has just generally been particularly insufferable the last week and a half, but at least the really obnoxious deniers have mostly ... stopped.
https://news.ycombinator.com/item?id=22256458
https://news.ycombinator.com/item?id=20438487
https://news.ycombinator.com/item?id=15032682
https://news.ycombinator.com/item?id=15307915
https://news.ycombinator.com/item?id=21588105
https://news.ycombinator.com/item?id=21325122
https://news.ycombinator.com/item?id=15546533
https://news.ycombinator.com/user?id=BetterThanSlave
https://news.ycombinator.com/item?id=16397133
https://news.ycombinator.com/item?id=19912334
https://news.ycombinator.com/item?id=20742578
https://news.ycombinator.com/item?id=21803541
https://news.ycombinator.com/item?id=21907232
(sorry...hard to stop)
People also chronically overinterpret whatever they see on HN that they don't like—again, myriads of comments make the opposite generalization to yours. Randomness plus cognitive bias equals narrative.
As for voting patterns, I'm not sure I agree. For example, it's not true that downvotes used to be reserved for something factually incorrect. The voting mechanisms are subject to the same psychology as they always were.
Your comments often argue in edgy ways that are not exactly in keeping with the spirit of this site. From my perspective that's more likely why they're getting downvotes. I took a quick look and your comments that I saw which were upvoted don't seem to have this quality. Usually, when people complain about downvotes, there's something in their comments that they're not aware of, but which is apparent to readers. Of course there are also downvotes simply because of disagreement, but all comments get those, and they usually get fixed by corrective upvotes if there's nothing else in the comment that has a downvoteable quality.
IMO, this thing is a trap for politicians. A true lose lose for them.
[0] less so for some.
The people ordering lockdowns only have limited tools in their arsenal.
Why is it impossible that we're headed for an economic catastrophe until a vaccine is out? I can totally see it happening - something where we will have to ration out our basic supplies even. <-- already happening wrt some stuff.
That would just be the cost of saving a few million lives.
The hope is that it will work everywhere like it seems to have in Hubei and Korea -- near-zero new case counts and a regime of continued care, a few extra regulations, and pervasive testing. And it might work. But if it doesn't, yeah: we should turtle, accept the economic catastrophe, and wait for a vaccine. Would anyone sane argue otherwise?
a. no need to be rude and b.
The same reason sane people drive automobiles which kill 40,000 people in this country a year[0]: the alternative can be worse.
How many people do you figure are going to get rolled back into poverty at 15% world GDP loss?
[0]Less this year I suppose.
A whole lot, but they'll get back to parity (on average) in about 6 years, assuming a 2.5% GDP growth. How many dead people do you think will come back to life after six years, in comparison?
I don't want to be glib, but I genuinely don't think you've thought this through. I just can't see a moral argument for allowing a 10M+ death count at the kind of economic impact we're talking about right now.
Then try thinking through the impact of what could become the biggest economic disruption since the great depression or the great leap forward. Those went well for people. 80 trillion GDP, down to 68, back to 80 in 6 years is a 36 trillion dollar loss in the next six years alone. That's 3.6 million per victim and to be frank, most people aren't worth 3.6 million dollars.
Look, this is a reasonable thing to disagree about but you aren't engaging in good faith.
edit: math
Besides, it's better to contain it 'too much' because then you can loosen restrictions a bit and still have managable number of cases, than not contain it enough and have run away process you won't be able contain even with most severe measures you are able to enforce.
The super-spreaders here are most likely people who are doing one or more of:
* are ignoring medical advice
* have contact with many people
* are asymptomatic or incubating
* don't follow best hygiene practices
> Currently there is no evidence to support transmission of COVID-19 associated with food. Before preparing or eating food it is important to always wash your hands with soap and water for 20 seconds for general food safety.
But, given that:
1. Takeout food comes in a container which we know can transport the disease, and
2. My local pizza joint has a hard enough time getting a good health department score as it is
I am going to be cooking at home for a while until I have a better idea about how this is going to play out in my own community.
https://www.nbcnews.com/news/us-news/ny-gov-cuomo-says-no-ne...
Look at the graph.[1] Those are actuals, not predictions. This gets 10x bigger each week. The US is 12 days behind Italy. US at 10,000 now. 100,000 next week. 1 million in two weeks. The lockdown may slow that down. Probably not enough.
[1] https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06...
I mean sure, if you held up the same R0, yes, that math works out, but people aren't trees. They'll voluntarily socially distance, dropping R0 significantly.
https://joindiaspora.com/posts/73d4e930421d0138028e002590d8e...
Exponential growth boggles the mind.
Script source: https://pastebin.com/raw/j89ZUdVq
The 25M number doesn't seem realistic because every country that has had a COVID-19 outbreak has freaked out trying to control it, and either succeeded via very expensive means or (in most cases) hasn't had the outbreak grow far enough to know whether or not they've failed.
My interpretation is overreaction should be what's done to mitigate the pandemic for the foreseeable future. Right now, almost every country is playing catch-up.
Would the US democracy survive it? I don't think so.
Second order effects would be huge though and you'd still take all sorts of economic and social hits.
I don't see why democracy would die. Spanish flu was far worse.
"Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined.In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1-1.2 million in the US.
... We therefore conclude that epidemic suppression is the only viable strategy at the current time.
"
ONE MILLION DEAD AMERICANS.
You shit your pants after 3000 died at 9/11.
"Fortunately it appears the parameters used in that model were too negative. The experience in China is the most critical data we have. They did their “shut down” and were able to reduce the number of cases. They are testing widely so they see rebounds immediately and so far there have not been a lot. They avoided widespread infection. The Imperial model does not match this experience. Models are only as good as the assumptions put into them. People are working on models that match what we are seeing more closely and they will become a key tool. A group called Institute for Disease Modeling that I fund is one of the groups working with others on this."
So we're all discussing this, and if you've read the report you already know more than most people, and we know that the truth is in the middle.
But what we should really think about as clever individuals is that whatever is going to happen this year, and however long the lockdowns are going to be: it has to happen in order.
> panic: sudden uncontrollable fear or anxiety, often causing wildly unthinking behavior.
When fear runs wild and uncontrolled, it can paralyze us into inaction, or worse yet, motivate us unthinkingly towards action that may end more lives than even inaction would. Or to put it another way - panic is a great way to waste a bunch of perfectly good fear.
Fear should be properly harnessed, controlled, and guided through proper thinking and wisdom - then we can maximize our chances of it motivating us to take those extreme, life saving actions you alude to.
Stress - as caused by fear - can shorten your lifespan and reduce it's quality as well. When possible, one should guide ones fears towards reasonable risks you can do something about - where the costs might be worth it - and away from the irrational or unactionable - where they are not.
I suspect the governors of some rural states are likely to issue weaker social distancing orders, minimizing the economic impact but still benefiting from national economic relief legislation the same as states more severely effected.
There would certainly be a lawsuit claiming that it's unconstitutional. It might even win... eventually. You know, back when SCOTUS is in proper session, and it's all kinda moot.
We know for a fact there were some early suppression of the outbreak, so it wouldn't be too much to speculate that they're under-reporting new cases and/or over-reporting recoveries.
Even if so, there's the problem that totalitarian, high-control societies like China have tools to deal with these kinds of problems that other societies do not.. to put it lightly.
- HK, SG, KR, and JP have similar trends.
- No "patriotic virus" -- infecting Chinese only after leaving China.
- Limited spread / impacts outside Hubei.
- Lifting quarantine.
Testing numbers are all but certainly low, but given shitshows elsewhere (IT, US, PH, DE, ES, likely IN and others), due to logistics and limitations. Comprehensive population antibody testing should be interesting.
But what China's data can tell, is that there is a strategy out there to contain the virus, if implemented. And it takes about 2 months of total lockdown. It is probably the most effective containment in human history, but with a cost.
So the exact number of China's data isn't going to be meaningful to others, but the actions taken have implications and we should follow.
31 questions and answers about COVID-19
The numbers that matter are local numbers surrounding you. No leader will tell you that cause they want obedience.
This is an exogenous event, which will kill a lot of people in short time, on top of the usual circumstances. A natural disaster. A war.
3000 Americans died, a Trillion USD was spent on two wars, civil liberties were irrevocably destroyed (DHS, etc).
The USA never suffered casualties of 1+mil ever. Ask the old Europeans how that feels.
Proportionately speaking, that estimate is on par with the amount of American deaths per total population during WW2 and something like 1/7 the American deaths per total population during the civil war.
You think if they had the choice they would have rather sat at home watching netflix?
For one thing, it should be easy to prevent the latter whereas it's far from clear whether there's much we can do about the former.
Being dead is absolutely comparable with being dead though, no matter what lead there. It's the absence of a person that matters, to the people who miss them, not what people removed from that think about it in the abstract.
I lost my father through a completely stupid accident, made possible through carelessness on his behalf I think. If he had been murdered by someone, I would have felt a lot of hate, and that would have sucked and damaged me no doubt -- but the grief of missing someone is still the same, and I'd say the difference between murder and an accident are both tiny pebbles compared to a person being gone. Even if he had died to save 1000 million people, I would miss him exactly the same.
If a serial killer murders your father, we're going to react differently than if your father dies of a heart attack.
What matters, to me, is that I can no longer speak to a person. How that came about is very, very minor compared to that. Even knowing that we all will die some day does not change the simple, banal, them-shaped gap someone leaves. That gap is what remains, what created it does not. I'm just speaking for myself, but that I do.
How and why people die is no doubt very important when it comes to very removed people using tragedies, which was very much the case with 9/11. For them it's the other way around: the gap never really mattered and is soon utterly forgotten, while that evil deed none of us most forget remains as long as it's useful. I remember families of victims speaking out against war after 9/11, and mostly being ignored by a nation angry on their behalf. The dead were exploited more than honored, if you ask me.
We don't actually know that will happen with the virus, it could become like the flu and continue killing every year. We hope natural immunity will last but that is far from a given, it may only last months or years. A vaccine is also not a given, it's older brother SARS doesn't have one.
5 billion hosts gives an awful lot of room for mutations to occur, this thing is still in a new environment it's not adapted to.
Then there's the lasting health effects, it's possible it causes permanent lung damage and we have no idea if it leaves any landmines behind like chickenpox does.
If so we're pretty thoroughly fucked. We aren't going to manage to wipe out this virus by shutting down the developed worlds economy's because the rest of the world (especially warzones and the like) isn't capable of doing the same. We can't keep the economy shut down forever to prevent spread in the developed world and not all starve to death.
I'd argue that the best response should that turn out to be true is to pour more resources into medical research until we do find a vaccine... which rather requires having functional stable economies instead of us all going bankrupt because we shut them down.
the short term plan alone will flatten the curve too much, if successful, and we simply dont have confirmations about whether we build immunity or the virus dies out, so without those features the short term plan being the long term plan or a recurring plan (even if we build immunity but we flattened too much, then clusters reemerge). But in conjunction with the medium term plan and most people not being reinfected its the best solution
long term plan either way is a vaccine, effective treatment
edit: can you engineers please tell me and the world what some of you disagree with about this information? this isn't the place to write a dissertation on every edge case necessary to explain whats going on, and the lack of that dissertation doesn't undermine the point or utility of what is written
Nothing I said refutes the soon-ness of information coming from all around the world, its still not here though.
What is up with this obsession with testing? We need to lower R0 and scale up medical infrastructure. Elimination at this point is a fantasy.
To be clear, testing is important. But to suggest that it should be the priority over isolation and distancing seems misguided.
[1]: https://twitter.com/mattyglesias/status/1240740763752902670
No at-home test exists yet, and we surely aren't producing 300 million tests daily yet, but this should be the target.
Tests are good. We need containment now if we want them to be useful.
Partially because of the idea that South Korea tested its way to safety. While its true that heavy testing was a key part of their containment plan, it also relied on a lot of investigative work, etc. It's also too late in the US since we already had uncontrolled and undetected community spread.
Partially because the US government screwed up the testing capacity. So people are overly valuing testing because its an easy way to assign blame. People love an oversimplified cause to a disaster because it makes life seem less random.
Antibodies are what we need to be testing for. 10 minutes from blood to result. Works on formerly infected and currently infected.
You need tests to backtrack and force isolate the sick. This waiting it out shit won’t cut it
> You need tests to backtrack and force isolate the sick. This waiting it out shit won’t cut it
You can only test and isolate if you first institute quarantine measures. Even after instituting quarantine measures, we still will unlikely be able to prevent an eventual resurgence of the disease.
From everything I've read, there's no path out of this that doesn't involve either:
a. shelter & scaling up critical care
b. at least a million people in the US dead
Ofc you lock down then test everyone who comes in the hospital and then everyone who they came in contact with recursively until you stop finding any positives. Then you lock em all up for three weeks
Edit: and i dont mean self quarantine. I mean like the chinese did it
I agree that it is a pipe dream to suggest that we could scale up critical beds such that hospitals will not be overburdened. But I disagree that there is nothing to be done.
If we've bought time so that rather than 5 critical cases/bed we have 3, that is a huge improvement and still means potentially hundreds of thousands saved.
I am also skeptical that the primary or only shortage is labor.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
They seem to have picked the green line and not the orange line. Hopefully they’re planning for intermittent social distancing, or have some other medium term plan.