Because it tells a very interesting story how many lives we're willing to accept to be lost in normal circumstances.
Cars, air pollution, avoidable infections, ... - there's a lot of harm society could avoid and doesn't.
And the people who benefit are the ones in power, whereas the ones who suffer are the ones without power.
So the trade offs are largely not accepted because they are acceptable to society at large, but because the people who have the power to make the decisions are insulated from it.
In the US wealth is a decent proxy for power, so this claim can actually easily be quantified.
Simply draw maps correlating the wealth of a neighborhood with the adverse effect being discussed. Whether it’s air pollution levels, or it’s deaths due to car accidents, or mercury in water, or lead in walls, it will invariably be the case the problem correlated strongly with the wealth of the area.
Inspiration did come from The Narrow Corridor[1], which has a good history of the building of state capacity in Europe, and how it affected trade. In particular, cost falls, which is one way “attacked and/or killed by bandits” could be proxied. Another thing that drives down cost is reducing the number of tolls along the road, as discussed in this paper:
https://mason.gmu.edu/~mkoyama2/About_files/StateCapacitySur...
So again, while I don’t think that it’s a stretch to assume traders who had to cross dangerous territories accounted for the dangers, I don’t have a direct source. :-)
[1] https://www.penguinrandomhouse.com/books/555400/the-narrow-c...
I'm still waiting to see what has happened to the number of deaths caused by heart attack, stroke, etc. that aren't COVID related. I'm betting those causes of death have dropped by about the same amount of COVID deaths.
A theory in that article is that it's likely to due to undiagnosed CORVID deaths from effects it can have on the entire respiratory system.
Elective in this case doesn’t mean cosmetic, it means an appointment was booked at a certain time. The procedures are still necessary.
Hospitals are in fact mostly empty. It’s just the COVID units which were overwhelmed, and even there, most EDs across the US were never overwhelmed, and none of them across the country are currently overwhelmed.
If your hospital is empty, it’s because of the actions you took. Stop doing those actions, and your neighborhood will soon look like mine soon.
This thing of going to come in so many waves because humans seem to be incapable of not just learning from the past, but also the present.
What actions do you mean? Move out from downtown to suburbs?
Without significant efforts to lower the R value (Aka the actions I alluded to; facial covering, social distancing, track and trace) - it’s only a matter of when, not if.
Minus a wonderful medical breakthrough, come find me next winter and let’s see how sure you are with such a quip.
Oh, and by then, a great expense to life, the cities will likely have reached herd immunity, but I won’t quip back, as it would be in bad taste.
I am hopeful that they will find that they are already well into the prevalence range of herd immunity. If so, that will put them, to use a turn of the phrase, ahead of the curve. It would also mean that they didn't really flatten anything at all, and they could suspend their shutdown immediately.
If they are only at low single digit prevalence, that would be truly very bad news indeed.
If they're somewhere in the middle, say, 25-35% prevalence, then they could get through it with one more surge, or draw it out indefinitely. In that case it will be interesting to see which path they choose.
[1]: https://www.washingtonpost.com/outlook/2020/04/16/coronaviru...
Those are probably largely people that probably did just as much activity somewhere other than their home neighborhood (physical-but-nonessential labor, gym, athletic hobbies that rely on now-closed businesses, etc.)
Also, heart disease and type-2 diabetes are years in the making, and a month of moderate exercise and better eating won't make up for it overnight. Not to mention added stress.
When people go back to work, they will have less time at their hands. They will have to adjust to commuting again, taking kids to/from school again, being somewhere at time again.
All of that will cut into their exercise time. All the people who are exercising out of boredom now will stop exercising out of being tired of doing lot of things again.
I personally had a month long series of treatments scheduled that got cancelled, and now I have no idea when I'll be able to get that treatment. Better than dying from the virus, though.
Making a rough guess of two months of shutdown, we've lost 1/6 of our annual non-emergency medical capacity for 2020. It'd be impossible to put a number on the cost in lives that means, but I think we can probably say with certainty that there are a non-insignificant number of people who will die or experience permanent medical issues because diagnosis and/or treatment was delayed.
Perhaps I've missed it, but I'm honestly shocked this isn't priority number one for a partial reopening in regions with low infection rates.
This was plainly brought into view for me with a dental procedure I had to cancel/reschedule. It's deemed non-essential, but is necessary to prevent me from losing an entire tooth or two. If it's not done reasonably soon it's only a matter of time before it turns into an emergency dental procedure.
But sudden drop in total number of deaths from 52,992 down to 35,863 in the last week - looks suspicious.
Not sure I follow
The first Figure in this article (Dutch) shows the number of deaths from any cause.
https://nos.nl/artikel/2330786-oversterfte-door-corona-blijf...
During the Corona outbreak, almost double the amount of people are dying compared to the same time last year.
There are fears it will increase domestic abuse.
[0] https://www.businessinsider.com/chart-us-weekly-coronavirus-...
About 35k people die from car crashes in the U.S. each year (or at least they did). That has always served as my personal benchmark for risks: if I'm more likely to die in a car crash, I don't worry about it.
I worry about Covid-19.
Lifetime risk is a better way of comparing the two because (a) both of them represent lifetime risks and (b) COVID is front-loaded, spreading furiously through the population so your daily risk today is higher than your daily risk of a dying in a car crash, but your lifetime risk remains much lower.
It's also worth calling out the flu has killed 2X as many people as COVID has to date this flu season. A bad flu season in the US kills about 60K people each year.
[1] https://www.iii.org/fact-statistic/facts-statistics-mortalit...
> It's also worth calling out the flu has killed 2X as many people as COVID has to date this flu season. A bad flu season in the US kills about 60K people each year.
So far. The flu season started before the covid season so that's a bit of an apples and oranges as you are comparing different time scales. The bigger issue though is its unknown how big covid could get if it balloons. Like its mostly on par with flu now, but its not over yet and that's with the taking of extreme messures to prevent transmission (which we dont do to prevent flu). Measuring potential risk in terms of what's happened so far when we haven't even seen what a complete season of covid look like, feels premature. Jumping off a bridge also looks safe if you base your predictions on the lack of all the bad things that happened before you hit the ground.
You'd need to be a lot more specific. Which state are you referring to? Most US states are safer on Covid mortality than Germany. California + Texas + Florida (the three largest by population) combined have the same population as Germany with half the per capita death rate.
It would be like combining Italy, Spain and Greece and pretending they're all seeing the same situation.
Germany has a per 100k mortality rate of 5 for Covid.
Texas has a per 100k mortality rate of 1.5. California is 2.7. Florida is 3.6.
Germany has 89m people with 4,538 deaths. Texas has 29m people with a mere 453 deaths.
California + Texas + Florida = 89m people, with 2,290 deaths.
More large states? Ohio is 3.9. Virginia is 3. Arizona is 2.4. North Carolina is 1.5.
So as you can see, most of the US in fact doesn't look like New York, New Jersey, Michigan. Just like most of Europe doesn't look like Spain.
More countries in Europe for comparison (per 100k rate):
Belgium 47, Spain 44, Italy 38, France 29, Britain 23, Netherlands 21, Switzerland 16, Sweden 15, Ireland 11.6, Portugal 6.7, Denmark 6, Austria 5, Norway 3, Finland 1.6.
The three largest US states combined have a rate of 2.5.
Lower, if your population is young and healthy. Much lower, if you miraculously stop community spread until medication is available.
Higher, if the disease spreads too fast and hospitals are overloaded, or if your population is old or unhealthy.
I'm 55 so I'm pretty sure my risk is higher than that. Also, the covid risk is highly front-loaded. If I'm gong to die from covid, I'm likely to do so now whereas if I'm going to die in a car crash that might happen now or it might happen later. I don't really care about dying per se. Sooner or later it's going to happen. What I care about is dying sooner and more painfully than I have to. Drowning on my own bodily fluids doesn't sound like a pleasant way to go.
Additionally, I believe the 1% chance of dying in a car crash is over the course of a lifetime. A 55 year old has likely lived well over half their life and has also aged past a significant chunk of the riskiest time to be in a car (likely 16-30).
I personally believe that given the R0 and the large number of asymptomatic cases, there's no putting this genie back in the bag, and I agree with prominent epidemiologists that we're all going to get it one way or the other -- because nobody's going to stay inside the 18 months it'll take to develop a widespread vaccine. That's why I support Sweden's model. [1] So I just rounded up to 100% and projected out.
> Additionally, I believe the 1% chance of dying in a car crash is over the course of a lifetime. A 55 year old has likely lived well over half their life and has also aged past a significant chunk of the riskiest time to be in a car (likely 16-30).
Good point! I wonder if it's a bimodal distribution. I assume older folks can't get out of the way fast enough as pedestrians and are more likely to get into accidents when driving.
[1] https://thehill.com/changing-america/well-being/prevention-c...
I mean they’ve had 15000 recorded cases (of course since they’re letting the disease roam free without a general population testing regimen that’s going to be a minuscule fraction of the denominator which they expect to reach 7 million ish) and 1500 deaths. Crude CFR is 10%.
Bloomberg and the government as of 10 hours ago claim their strategy of “ignoring” a disease that’s just not that fatal is working great, and that unlike the rest of the world they’ll never have to deal with it again as they’re en route to developing herd immunity. [2]
IMO it’s becoming more and more clear that we collectively lost our minds in panic over something that’s just not that bad. The Swedish model is one to replicate.
[1] https://aatishb.com/covidtrends/
[2] https://www.google.com/amp/s/www.bloomberg.com/amp/news/arti...
Your just cherry picking numbers and extrapolating to fit your conclusions. Their CFR is 10% now. 10%. That's extraordinary. You can't dismiss their current stats and then say they don't have a genpop testing regimen as a means of supporting your claims.
And even if you get "lucky" with a crude CFR of 1%, that's disastrous. If just 50% become infected, that's 50K deaths, not 500. And another 250-500K hospitalizations with long lasting effects.
(2) Let's use our noodle for a sec greedo.
They haven't been attempting to control the spread of COVID, and you're telling me they only have 15,000 cases out of a population of 10,000,000 when the R0 is between 2 and 3? Do you genuinely believe that it's not a lack of proper testing? When Gangelt had a seropositive rate of 15% and Santa Clara has 2-5% previously infected?
That would make the denominator not 15,000 but 200,000-1,500,000 or 0.75% to 0.1% which is again in line with IFR estimates we've been seeing lately. Worse than the flu, certainly, but not devastating.
Frankly, that's probably a conservative denominator.
Second as I explained in a peer post, trying to establish the infection fatality rate of the disease based on its case fatality rate is like trying to figure out how risky skydiving is by setting your denominator at "whoever shows up in hospital with skydiving injuries" and the numerator at "whoever survives" -- it's peak adverse selection bias. Can you imagine the government of Sweden telling the population that 1 in 10 of them will die and them being okay with this plan? haha.
Studies are pinning the infection fatality rate at between 0.25% and 1%, and more often than not in the lower quartile of that band -- and almost all of those deaths are the old and sick who should be isolated and protected.
Further, because so many people don't have symptoms and it's so contagious, and the vaccine is at least 12-18 months away, we are all going to get it. Well 70% of us anyways. Sweden is front-loading this burden. Basically none of the numbers are directly comparable, as the minute the US re-opens it'll be playing whack-a-mole with city/state level shutdowns as China is.
Sweden will not.
Further, we have been seeing anywhere from 30-80% of cases are asymptomatic or result in mild flulike symptoms and therefore not accounted for in case fatality rates. Indeed the Gangelt study put the overall infection fatality rate at 0.37% when Germany's case fatality rate is around 2%. It wouldn't surprise me at all if your risk was about 7X lower than the stated 1.3%, as low as 0.25%
I also wouldn't be so quick to assume car crashes are a pleasant way to go.
[1] https://www.worldometers.info/coronavirus/coronavirus-age-se...
Most of the passengers on the Diamond Princes cruise ship were 65+ years old.
Only 0.23% of the passengers died after Covid-19 outbreak.
No, it hasn't.
> A bad flu season in the US kills about 60K people each year.
You're not counting covid-19 deaths and flu deaths using the same methods so you can't compare yet. The method you're using for flu is inclusive and will tend to overcount. The method you're using for covid-19 deaths excludes some deaths and we know it's undercounting covid-19 deaths.
When we get the figures for care home and nursing home deaths included we'll see large increases in covid-19 deaths.
It is dishonest to point to a severe flu season and talk about "flu killing 60k people per year". The range is 12k to 61k. https://www.cdc.gov/flu/about/burden/index.html
Yes, it has. Citation needed, because I provided data and you didn't.
> You're not counting covid-19 deaths and flu deaths using the same methods so you can't compare yet. The method you're using for flu is inclusive and will tend to overcount. The method you're using for covid-19 deaths excludes some deaths and we know it's undercounting covid-19 deaths.
[citation needed]
> When we get the figures for care home and nursing home deaths included we'll see large increases in covid-19 deaths.
That's a totally dishonest way of approaching this when we know for a fact people under 50 have basically no risk from COVID and that folks who are over 70 have easily two orders of magnitude higher risk. In Italy, 99.2% of people who died were age 80.5 and had an average of 3 underlying diseases.
Age 30-39 they had 5 deaths, under 30, 0 deaths at the time this article was written [1] as compared to 852 deaths aged 80-89.
You and I both know the young aren't affected meaningfully, and for them, they won't go to the hospital with a mild cough or with no symptoms at all and so aren't counted in the denominator. You're advocating growing the numerator without growing the denominator to make your case seem stronger than it is.
> It is dishonest to point to a severe flu season and talk about "flu killing 60k people per year". The range is 12k to 61k. https://www.cdc.gov/flu/about/burden/index.html
I don't think it's crazy to compare a "bad COVID year" to a "bad flu year" do you? Our response to a bad flu year is exactly the same as our response to a good flu year. Most people don't really know there is such a thing.
[1] https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho...
Not no evidence [0][1], it's currently my biggest fear about this virus. There's a few possibilities here:
* The tests are picking up dead virus remains
* Their tests were bad and they didn't actually recover
* Their body didn't create enough antibodies and the immunity was weak
* The virus is biphasic - symptoms stop for a while only to return later, and they never actually recovered
My hope is that what we've been seeing turns out to be among the first causes here, but we've been hearing about possible reinfections for months.
[0] https://www.reuters.com/article/us-china-health-reinfection-...
[1] https://www.npr.org/sections/coronavirus-live-updates/2020/0...
Additionally, I’d note that nearly all higher income individuals take steps to reduce their auto death risks including buying safer vehicles, living closer to work, and using professional drivers when drunk or otherwise impaired.
As for your final paragraph, it is wholly unreasonable to imply that covid (which is killing thousands of Americans per day despite a massive distancing effort) is less serious than the flu (which has persisted over a much longer period of time and which was not subject to special responses).
I didn't say or imply that. It's worse than the flu, probably 5-10X worse. Not bad, not great.
I'm suggesting that people are freaking out because there's "bodies on the street" and we're all in serious danger (we're overwhelmingly just not) when the death toll to date is about half of what we paid zero attention to whatsoever over the same time period.
My argument is that we shouldn't be nearly as freaked out about COVID as we are, and we should be more freaked out about the flu.
There's reason to take precautions, especially if you're in a risk category, but not at all to the extent of the panic we've seen to date.
In fact Sweden's plan of literally just that is going great, they've not shut anything down, and told people to stay home if they're sick (shocking, I know) and the serious-case infection growth rate has flattened out by itself. [1, 2]
[1] https://www.bloomberg.com/news/articles/2020-04-19/sweden-sa...
[2] https://aatishb.com/covidtrends/?location=Canada&location=Sw...
1.: Study is not complete yet and is of 500 people in the hardest hit area in Germany[1]
2.: Why do you compare deadly car accidents in the US with COVID-19 mortality rate in Germany?
3.: COVID-19 Mortality rate in the US is 5.3%[2]
[1] https://www.tagesschau.de/regional/nordrheinwestfalen/corona...
Re 2: Because much of the audience here is American, and there's not a similar study of the US population.
Re 3: No, the COVID-19 mortality rate is not 5.3%. The case fatality rate is 5.3%. Those are not the same, for an obvious reason -- currently the overwhelming majority of tests are carried out on people who go to hospital because they're sick. It's adverse selection bias.
For instance, it'd be like trying to measure the fatality rate of skydiving by measuring the odds that someone who ends up in the hospital with a skydiving injury dies. You'd think it's 99% fatal, but of course, it's not.
All you know is the numerator, not the denominator.
[1] https://www.stanforddaily.com/2020/04/17/santa-clara-county-...
[0] https://www.telegraph.co.uk/news/2020/04/17/no-evidence-peop...
[1] https://www.aljazeera.com/news/2020/04/200413110301074.html
38,000 people die every year in crashes on US roads. COVID deaths are at 39k and the first COVID-19 death was on Feb. 29. 50 days ago.
Also, it's not a fair comparison between the flu and COVID because the flu has that unfortunate feature known as horizontal gene transfer. That's why you can get re-infected by the flu each year, and why in spite of a massive vaccination campaign the flu causes 45,000,000 illnesses each year in the US alone (and 60,000 deaths) -- and 650,000 deaths worldwide.
Each year. And each upcoming year. COVID will, based on what we know so far, happen once.
There is also a big assumption in considering the risk to be front-loaded. This is not the flu, but it could very well come back next year or in ten years in a different form. We just don't know yet this virus with enough confidence to do this assumption. Anyway, it is a bit strange that the ability for this virus to mutate next year would impact the risk of dying by going out tomorrow which, I think, the person your responded to was thinking about.
Finally, you're saying the flu deaths this year is double what the coronavirus has done, but again the uncertainty is high: the CDC estimation for the flu is from 24,000 to 62,000 deaths this season [1]. So it could be the double, but it could be actually lower. Let's not do things like chosing the estimate that better suits the argument without saying it's a high end of the estimate.
[1] - https://www.kcrg.com/content/news/Americas-2019-2020-flu-sea...
There has been no evidence of substantial mutations so far in COVID. There's no evidence that COVID will come back in a new and different form, any more than there's evidence I'll come back next week as a velociraptor. I mean, it could happen, but it's not something I'll plan for until I start sprouting scales and and a giant tail. Mutations are pretty random and the vast majority of mutations are harmful to the virus.
It's worth considering we live with coronaviridae all the time, something like 15% of the common cold is attributable to coronaviridae. [2] There's as much evidence of the common cold becoming Ebola as there is of me becoming a velociraptor.
The flu death range is likely more to do with how good a job we do guessing which the predominant strain will be in a given year, as the flu vaccine efficacy rate ranges from 10% to 60% each year. [1]
[1] https://www.cdc.gov/flu/vaccines-work/effectiveness-studies....
[2] https://www.webmd.com/cold-and-flu/cold-guide/common_cold_ca...
Also there is not enough evidence to believe COVID happens only once per person[1]
South Korea, the country with the best testing so far has reported 116 people re-infected[2], so there IS evidence about it happening.
[0] https://www.advisory.com/daily-briefing/2020/04/17/organ-dam...
[1] https://www.telegraph.co.uk/news/2020/04/17/no-evidence-peop...
[2] https://www.aljazeera.com/news/2020/04/200413110301074.html
There's also no evidence it doesn't. What we do know is that the disease hasn't mutated significantly to date, and we see strong antibody response. [1] In time, we'll have a vaccine and it may require a number of booster shots, but what we know so far suggest reason for optimism, not pessimism.
[1] https://www.washingtonpost.com/health/the-coronavirus-isnt-m...
The flu season overlapped with a period that included initial reports and fear of a novel respiratory disease and then historic, mandatory countermeasures (for the vast majority of the population) against communicable respiratory disease; it would be bizarre if there wasn't a big drop in flu deaths.
Would be nice to have the benefits of both: very little motorized traffic AND no viral threat. We have no control over the latter, but we most certainly have some control over the former.
4,500 ≈ average deaths per month in 2017 [1]
6,125 = confirmed COVID-19 deaths from 2020-04-01 through 2020-04-15 [2]
[1]: https://www.health.ny.gov/statistics/vital_statistics/2017/t...
[2]: https://github.com/nychealth/coronavirus-data/blob/master/ca...
Note that 6,125 doesn’t include COVID-19 deaths or non COVID-19 deaths, and is for the first half of April only.
Generally though, covid deaths go up exponentially while road tolls likely don't go down the same way, our trade off is probably only likely if you get in early.
In other news we're likely taking the first step of getting out of out ~1 month lock down later this coming week - our idea of getting out has been described as "lockdown with KFC", roughly equivalent to California's
https://www.nejm.org/doi/full/10.1056/NEJMms2009984?query=RP
Cancers are not getting diagnosed early almost 50% in recent weeks than usual. That means worse stages at diagnosis and worse prognosis
https://www.iknl.nl/nieuws/2020/door-de-covid-19-crisis-zijn...
See https://twitter.com/javierluraschi/status/125160533393750016...
https://www.economist.com/united-states/2020/04/16/could-ame...
Oh, we could pretty much save the planet and live happily ever after if we could keep it like this.
Only to find some rock barreling down on us some day, but ah... I digress.
I can google you some local media articles if you want to double-check via google translate.
It makes sense though. People spend more time together in close quarters. People lost jobs. Lots of stress all around. Perfect storm for beating that bastard you meet in the kitchen.
Everything you said above are really down in North Korea, and have been so for decades. I doubt they're doing OK
The Fed has spent at least $2 trillion dollars on this already. Probably closer to $6 trillion by the time we are done. It is an unimaginably large cost to shut things down relative to any possible benefit.
That's a failure of imagination.
Looking at the non-spending costs of lost productivity, opportunity costs, etc., it’s a staggering number.
I suppose it’s impossible to know if we’re striking the right balance at the moment, but it’ll be interesting to see the analysis after it’s over.
I’m not saying our response is wrong by the way. But it’s a jaw dropping number. It’s a building a moon base, or universal healthcare for a decade, or a mission to mars, or high speed trains up and down America’s coasts number.
I mean yes, of course it is. But does it do anything to stare and point at it with your jaw dropped? What does the alternate timeline look like where the government had no need to distribute significant amounts of money to employees and businesses?
Early antibody studies have shown that prevalence is much, much higher than positive case count would indicate.
Potentially 50x - 85x more cases than positive tests based on the Santa Clara / Stanford study.
In Boston last week they mass tested at the Pine St homeless shelter and found 50% of them positive and 100% of those were asymptomatic.
If when the dust settles the reality is that the curve wasn’t flattened at all, most everyone was already exposed, and the true IFR was more like 0.25%.... then we flushed $6 trillion down the toilet.
Isn't that like going all in with two aces in texas hold'em poker, and saying "If when the dust settles the reality is that the other guy had a 7 and a 2, and the board was a 3, 4, 5, 6 and a J, then I flushed all my stack down the toilet"? You make the decisions based on the information you have at the time. If you're forced to make a probabilistic call based on what you know then, your decision doesn't become wrong based on the future outcome.
And if you look at New York City for example, can you imagine any scenario where when the dust settles it turns out that we didn't have to do any of that social distancing and stimulus injecting?
Are you making the case that one of the possibilities in this forest of unknowns is that maybe we didn't have to do anything? How does that match up with what we're seeing happening in say, NYC?