The point is a careful and thoughtful examination shows that a country’s geographic, social, and economic “natural affordances” are largely responsible for the differing COVID case loads, much less than the effective dollar amount “spent” on interventions. Spending on an intervention includes the economic hit as well as the direct cost. E.g. Australia was able to get a lot more bang for their buck because they’re an island and didn’t have a large segment of their population traveling in hotspots.
I think we agree on the vaccines. The point isn’t there’s something specific about coronavirus. It’s not a “meme” that we don’t have a coronavirus vaccine. We actually don’t have one. That just means we might not have as much experience ramping up a new one as we do, for example, with influenza, and there may be things we need to learn along the way.
A working vaccine or treatment in 12-18 months is a long way off.
If we are anywhere near 5% prevalence that means we are a lot closer to 65% (when herd immunity starts being noticing beneficial) than you might think, since it is non-linear.
Regarding ventilators, even in the general (non-COVID) case if you find yourself on one you’re about 50/50 not going to walk away from it. But with COVID it appears ventilators exacerbate the swelling in the lungs and in NY 80%+ of ventilated patients have died. [1]. That’s what I mean by “proven to be basically lethal”. We know the vast majority of COVID patients on ventilators die, far more than just the average ventilator death rate for pneumonia, using the same O2 saturation markers.
So doctors are moving away from ventilators and no longer using the typical O2 saturation cutoffs for ventilating because interestingly patients with lower O2 levels are not in the typical level of distress. It seems the CO2 is still getting out even though the oxygen is not getting in... more like hypoxia.
> It's true that in some cases oxygen is sufficient for some people.
We can agree on more than that. Luckily the fact is that oxygen therapy is sufficient for the vast majority of cases. Just do the math on hospitalizations and deaths in NY with the known variable that 80% that were ventilated died. QED the vast majority were not ventilated.
[1] - https://www.nytimes.com/aponline/2020/04/08/health/ap-us-med...
I was referring to the idea that is going around that "we don’t have any coronavirus vaccines" is somehow significant and means it is especially hard to make one.
> Regarding ventilators
I think the NY Times article is good, but it's important to note that this is evolving and treatments are changing. But saying "some doctors say they're trying to keep patients off ventilators as long as possible, and turning to other techniques instead" is very different to "ventilators have proven to be basically lethal to COVID patients".
That makes ventilation an absolutely last ditch effort. It means if the ~60,000 ventilators already in US hospitals before this started were each used just once ever to ventilate a COVID patient, you would expect 48,000 of those patients to die.
I’m sure this also has a pretty significant effect on the ICU utilization rate as a percentage of hospitalizations.
And this is besides the fact that early serological testing points to the overall hospitalization rate being significantly lower than 10%.
You seem to believe that the ventilators are causing deaths. There's plenty of evidence to show that once Covid-19 takes hold it is particularly viscous because of the number of things that it does to the body.
Some of the things that go wrong in some cases include: lung damage (obviously), kidney damage, liver damage, strokes, encephalitis, seizures, heart damage, meningitis, bloody diarrhea etc[1].
I agree the death date of people on ventilators are horrifying. But I don't think there is much evidence that ventilators are causing that rather than being administered to people who already have serious symptoms.
[1] https://www.sciencemag.org/news/2020/04/how-does-coronavirus...
All we have is anecdotal reports, plus the fact that significantly more COVID patients die on ventilation than the average pneumonia patient who is [invasively] ventilated.
Since doctors were ventilating patients at the same O2 saturation points as usual, we can say at least that something is markedly different with COVID induced ARDS from typical ARDS that makes invasive ventilation particularly insufficient, if not actively harmful.
Well no - Australia required quarantine of all returning overseas travellers from March 15, Canada advised self isolation from March 25. That's a huge difference.
Again - correct, thoughtful interventions worked.
> Essentially, I am assuming that vaccines will not play a large role, because it will have played out before they become available, and/or because we don’t have any coronavirus vaccines and it’s probably harder to make one than we think.
I've seen the "we don’t have any coronavirus vaccines" meme too. People don't seem to realise we've only had one serious coronavirus before (SARS) and it isn't anywhere as nearly contagious. There just hasn't been much work done on coronavirus vaccines before.
We do however have anti-viral treatments (eg Tamilflu), and it's likely we'll either get a working vaccine or a anti-viral drug that provides some relief in the next 12-18 months.
> My hope here—based on some very preliminary data—is that we are actually much further along than the testing might indicate (e.g. 5% overall prevalence and much higher in certain metros, vs 0.2%)
Either way, it's a long way off the required 80% for herd immunity.
> We are learning that ventilators have proven to be basically lethal to COVID patients
This is absolutely untrue. There have been people sharing data showing that the mortality rate of people on ventilators is higher than those who aren't, but that is because ventilators are only used on people who are closer to death.
It's true that in some cases oxygen is sufficient for some people.