Which is exactly what people said would happen if stay-home orders managed to flatten the curve.

I hate this all so much. I am honestly super depressed about how short-sighted many people I know are proving to be.

There's much we have yet to learn about this thing. We might not figure it out satisfactorily for years. Remember zika?

And it's certainly less severe among those infected than was predicted (at least per capita infections, if not overall). As long as people/ officials/ experts deny that, (or exclusively credit flattening the curve, or fail to admit how wrong they were, where appropriate) don't expect the public to take fear-based guidance from the same sources as credible.

As of today the USA has 75,000+ dead and counting. That is pretty fucking bad.

No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago. Yet very few seem willing to admit that, because (I'm guessing) they think it might mean losing some amount of fear based leverage or control. Or don't want to give people false confidence to disregard rules. Or whatever the motivation.

And the public in general is perceptive of that, especially the ones less inclined to blindly trust government.

When the original concern was overcrowding hospitals, and the new risk is ERs closing or laying off staff from under-use, the nature and magnitude of the healthcare infrastructure risk has completely changed.

Which means either:

1) we were wrong and it isn't as bad as we thought, or

2) that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good. And that's strictly looking at healthcare, before even taking into account economic considerations beyond the hospitals being able to stay open.

It's a lot less bad than it was estimated 3 months ago because most states understood the severity of the situation and hunkered down as much as they could.

>> that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good

Our "deaths per day" number averages 2000. I don't know how this can be remotely perceived as some sort of massive success other than relative to the original estimates that were based on doing nothing.

Unfortunately, right now we're saving it from gluttony only to have it starve.

...are also all groups less likely to go to a hospital / ER even in GOOD times, and even when they do, tend to be treated like crap (e.g. assumed to be "drug-seeking", have their pain dismissed, often end up overlooked in triage, etc.)

This is the same old haves vs. have-nots story we've been telling, taken to a while new level -- if you're wealthy enough to be able to work from home, you've likely just been hunkering down and wondering what all the fuss is about.

It's not about fear-based leverage, it's about one group of people refusing to admit they're too insulated from the rest of society to see that the lower rungs that keep everything running are getting massacred.

It's like the Y2k bug. There were forecasts of doom, so we did something about it, so then there was no doom. That doesn't mean the original alarm bells weren't justified.

Framing the situation as we were right or wrong is weird though. No one has a time machine to go and come back with the truth, as if someone knew exactly how this would play out but was keeping it a secret.

It was a total mystery 3 months ago. We're only barely starting to tease it apart now. Given that, the conservative option, the choice that kills the fewest people, is what we did.

We could have avoided overshooting if we'd known 3 months ago what we know now. The problem is we didn't have knowledge from the future. 3 months ago it was clear this would have an extreme impact, economically.

What would you have done differently, given what we didn't know back then? (Also keeping in mind we still don't know all that much about this disease.)

The field hospitals were built at roughly the same time the lockdowns started. You seem to be saying the decision to build them should be made independently of doing anything else.

But I generally agree with your sentiment about hindsight and acting conservatively. Though that includes knowing what the conservative option even is. Do we also burn money and spray disinfectant on the streets? Are we manufacturing a recession for nothing?

“3 months ago” was February 8 so not sure what you think was being said at that point.

1.75-2 months ago, when social distancing measures actually began and the whole #FlattenTheCurve started, the White House announced that they had a model that with all the #FlattenTheCurve measures in place, they expected between 100,000 and 200,000 to die of the virus by August 1st. https://apnews.com/6ed70e9db88b80439a087fdad8238009

So far 75,000 have died, with two and a half months to go and over a 1,000 dying every day still. It seems like the original prediction of over 100K by august 1st with full preventative measures is well on the way to being hit.

What are you talking about when you say it’s less bad than what we were told 3 months ago? What do you think you were told?

Predictions were being made before the first confirmed cases in the US, but we were still in containment mode vs suppression.

The China travel ban, for example, was implemented by Feb 1st, from quick glance. (Edit: made Jan 31 & took effect Feb 2)

We were worried about overwhelming the healthcare system. But it's dying from lack of patients.

For instance in the Bay Area, the SIP's argument was justified primarily from hospital capacity (https://www.sccgov.org/sites/covid19/Pages/order-health-offi...). It wasn't (as has since become) suppress the transmission rate until a test, trace, isolate system can be restored. [1]

Even on April 7, Santa Clara (https://www.mercurynews.com/2020/04/07/coronavirus-santa-cla...) was still projecting 2500-12000 cases by May 1. The higher end of that was highly unlikely even then (that would require cases growing faster than Seattle had been pre-SIP). In retrospect, even the best case scenario was also too pessimistic - at current rates Santa Clara won't hit 2500 until after May 21 -- double the time the "best case" had estimated.

Compare the communication to say Germany or New Zealand, where clear numbers, confidence metrics, range of possibilities, and objectives are outlined.

[1] Which actually has already happened. I'm not exactly sure what the goal is at this point - we have metrics but it's a bit unclear what they are based on (esp. the hard to reach testing numbers).

Compare that to diseases like Ebola, which we typically clamp down hard and fast on.

I'm now very mildly asthmatic and had pneumonia and bronchitis often as a child. I know what not breathing, and chronicly not having a strong respiratory system can be like and most people don't. I think that really factors into why people aren't taking it as seriously, going out whatever.

Contrast that with the fact I basically haven't left my Brooklyn apartment in 8 or 9 weeks even though my asthma and breathing issues largely subsided years ago and I would be considered less than mildly asthmatic now, I imagine other people with my profile are acting similarly.

I do want to mention that we know that somewhere between 25-50% of COVID-19 cases appear to be entirely asymptomatic (as opposed to pre-symptomatic). So almost half of people who get it won't even realize it, of those with symptoms, only a small fraction will go on to experience the serious respiratory issues that characterize COVID-19.

So it makes sense that you know first-hand how horrible breathing problems are. But I just wanted to be clear that, it's actually not irrational for someone to not want to stay inside for months to avoid a disease that in their specific case would almost certainly be mild. It just goes into what a person's priors are.

Like you said though it comes down to priors, and I'll add risk tolerance, and some pro-social behavior (I won't risk my neighbor even if it might be fine for me). I work in startups and have a few failed companies under my belt my risk tolerance in business is very high but not with health, you read that as 25-50% of cases are asymptomatic and an even smaller percent develop the very horrible symptoms, I read that as there is a 75%-50% chance I'd be symptomatic and a non 0 chance I'd be seriously ill with symptoms I'm already averse to through experience with them even though I'm otherwise young and healthy.

Edit: I'll add in, besides the above my biggest motivator for staying inside is that even if I was fine, to me its untenable to potentially spread it to someone who has a higher chance of not being fine through no fault of their own.

Which is not a big number at all, at least, not big enough to suggest that infecting more people is a solution. Considering that the chances to have symptoms and die rise exponentially with age, the estimated 25-50% are young and lucky ones. Still, it is known that even kids (unlucky, i.e. not in great proportion) do die:

https://www.thesun.co.uk/news/11576622/uk-death-toll-rises-a...

"Six-week-old baby dies of coronavirus as UK death toll hits 31,241 after 626 more killed"

France, March:

https://www.france24.com/en/20200327-16-year-old-girl-become...

"16-year-old girl becomes France’s youngest coronavirus victim"

etc.

By the way, from the older investigations about how people self-report their respiratory illnesses, it is already known that some significant percentage would not report anything and when asked claim not to have any symptoms even when they demonstrably do have them.

Even now, in the middle of coronavirus pandemics, there are people who "become used" to less oxygen in their blood, and behave as "not ill" even as their body becomes permanently damaged by the low concentration of the oxygen destroying their tissues.

So "asymptomatic" in the sense "the patient or the person filling up the questionnaire didn't feel being ill" is totally different from "the doctors didn't find any symptoms."

Plus anecdotally I'm in NYC and since the stay at home order reached full strength the 3 day rolling average of infections has been decreasing. I can only see that being attributed to two things -- mask wearing and stay at home. Mask wearing came later in our lockdown so I'm going to say stay at home has been effective especially with what I've seen the infection number for COVID, I believe that's the R0 (Rt?) number, was something like 2.5 to much higher.

Two more things: 1) introducing (or the halting thereof) infections to at risk populations (the whole NY nursing/retirement home fiasco, or the Italy hospitals being points of transmission, or dorm style living in Wuhan) and 2) approaching ~50% of herd immunity.

1) When did NY state stop putting exposed/infected patients into those facilities? That's going to have a outsized result in the stats, given the segment vulnerability. Same for Italy hospitals being overwhelmed without PPE.

2) Not saying it's what is at play (yet) here, but infections will naturally decrease as a greater percentage of the population gains immunity. It's what has to happen as the population approaches herd immunity. (So about 30% if herd immunity is 60%, which is plausible, given the recent estimates of 20+% of the NYC population with antibody presence.)

It's why exponential growth (for resource limited kinetics) ends up being an S curve and not a runaway exponential curve. The inflection point might not be at exactly 50% for a number of reasons, but it's good for a rough starting point.

Additionally, it will be difficult to distinguish if the stay-at-home orders are effective due to the entire population participating, or if it's tied to specific population segments. Meaning the percent of the population active vs stay-at-home isn't independent of transmission numbers. The active sub-population might be closer to herd immunity than the stay-at-home crowd.

This gets more complicated as you take into account the risk levels of particular patients.

There's potentially a lot more going on. We need some scientific causation, not just correlation.

https://arxiv.org/pdf/2004.14621.pdf

That's two, I think the second one is better though as it uses more recent data and from more states and they raise a point that I think speaks to why the studies are not more prevalent and that is that many stay at home orders went into effect middle to end of March so the effects would only really be seen at the end of April.

I imagine you'll see more of these popping up in the coming weeks.

I said that there was a measurable connection between them. Any epidemiologist will acknowledge this.

The point is that it could be seen and measured in this case. But when they attempted to find a connection between shutting down early or late (in the USA), no effect was found. The point being, the shocked horror that people already "forgot" the lessons learned last month is silly if that lesson wasn't learned and wasn't even true. The claim could do with some actual evidence.

And I'm not even saying it's not true. I'm just saying this is the only attempt I've seen to actually analyze it, and it came up the opposite way. Can you point me to anything that shows the claim is true?

https://www.wsj.com/articles/do-lockdowns-save-many-lives-is...

if we'd been more levelheaded, we would have suggested the public should either

1) physically distance, or

2) wear a mask

in enclosed spaces and face-to-face situations.

if you're an essential worker or particularly vulnerable, you'd do both where possible. that's it. that likely would have provided all the risk reduction we needed to get the spread under control.

the message would have been simple, the effects likely as good, and we wouldn't have left a hundred million poeple on the edge of (or in) economic and psychological collapse.

but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want.

Every discussion involving advertising or app marketing here inevitably attracts tons of comments adopting a let's-be-real-here, this-is-just-how-it-is tone about the realities of the industry. And yet these same people are also experts on the news industry and know the exact opposite is true there, that "de-politicized" or "balanced" news is somehow a thing that is not only possible but stupidly trivial to produce.

I mean, I get it, I utterly despise crabbed, shoddy, stupid journalism, too. But don't pretend there's some trivial fix. It is the way it is because of a combination of economic and ultimately social pressures. It is as much a symptom as a cause.

but as individuals, we each have the capacity to center ourselves emotionally, clear our heads, and think critically about the coercive messages we're being fed. we have that power, and it is effective.

Lockdowns were invented by panicking authoritarian politicians. The ruling class showed its true nature and was all too eager to copy China's brutal boot-on-throat approach to crisis management.

I generally hate the phrase "check your privilege", but in this case it fits perfectly.

I sympathize with those who are affected negatively by the situation, but I wish, for example, those who decide to buy a larger car would also sympathize with those who prefer clean air and less noise.

Telling people in the city, that you decided to move to, that they should be conscientious of your decidedly non-city wants, is kind of pretentious.

regarding trump, luckily our governmental structures are designed to withstand such incompetence. i'm more concerned that the legislative process is torching money in the wrong places.

Given our extreme response, the high death toll should be more shocking to people.

Then the math gets really ugly. If herd immunity requires north of 60% to have been infected, that means 197M Americans. Of those 197M, roughly 5% will require hospitalization, and 1% will die. That equates to 10M hospitalizations and 1.9M deaths. Even being generous and lowering the IFR to .1%, means 190K deaths. Now this make be spread out over the next 7 months, but the butcher's bill will be paid. Hopefully we'll get a vaccine by then, or some therapeutic drugs, but I'm not optimistic.

The problem is that the only experts we're listening to are doctors and epidemiologists, when we should also be listening to economists. Both sets of people should be in a room together hashing out policy through an adversarial process that charts a middle ground between two bad outcomes.

Flattening the curve to well below capacity at the expense of further suffocating the economy, just means that we're completing ignoring economic externalities that is going to take years or even more than a decade to fully recover from.

Maybe we can listen to economists coming out of this too then; On things like

- Healthcare attached to employment

- UBI

- Sick Leave

- Servers wages

- Gig Economy

- Taxation and Austerity

We would have been better off economically if we had listened to much of the general consensus before.

For most of the things you specifically mentioned, there's not much consensus today.

So off by an inch now potentially means being off by miles later on. If the doubling period wasn't lengthened enough, a hospital at 50% capacity will be in serious trouble very soon.

"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."

Also poverty lowers life expectancy. If we are not careful about how and when we open the economy back up, we can cost the hundreds of millions of people months to years off their lives. This has to be weighed against the amount of lives that are being saved right now.

This gets ugly fast. How much do you value your life versus how much an economist who has never met you does? Then run that same test on your young child or elderly grandparent. It might be the best measure we have, but it’s a terrible one.

Yes, it's uncomfortable to think about, but that doesn't change it. Would you like your partner, parents or friends to die in a car accident? Of course not. Do you accept the reality of daily deaths of random people by car accidents as part of the price we pay for the quality of life we enjoy? Most likely yes.

But questioning how many deaths per day by cars would be too much, that's where it gets very uncomfortable very fast. Is it a hundred in the US? A thousand? It's certainly not a million or there wouldn't be anyone left after not even a year, but a thousand? And what if 900 of these would be people aged 70 and over?

It's uncomfortable to think about, even more so to say what number you arrive at, but that doesn't make it a thought crime.

The extent of the lockdowns means foot shortages are starting, and massive numbers of people are facing starvation. We're approaching the point where this may end up worse than if we hadn't done any lockdown at all.

Getting a middle-ground between medical professionals and economists would (hopefully) have avoided the worst of both outcomes.

Arguably, that's the job of the policy makers, and worldwide we've seen major failures because it was not carried out as it should (in one direction or the other).

If anything a strong economy provides the least marginal utility to the rich relative to the poor. Once you've got wealth, you have the optionality to properly hedge so that you make money on the way up and on the way down (or at least limit losses on the way do).

Sometimes the calculus is that lives will be lost for the better general well being of society long term. We don't eliminate cars and roads and for people to walk everywhere in order to eliminate motor vehicle deaths. We don't ever lock down to prevent deaths from the seasonal flu.

"Essential work only" is a long way to fall from 21st century American standards of living.

I hate to go all “what about the flu”, but seriously. Tens of thousands of people die from the flu every year. Think about how many we’d save if we just locked down permanently. Or how many auto deaths we’d prevent if we all banned cars. And yet we don’t do either of those things, because as a society we’ve determined that those deaths are an acceptable tradeoff, for, you know, life to go on.

Basically every economist is acknowledging that you can't get the economy back to normal until the health crisis is under control. You can lift the ban on people going to movie theaters and restaurants if you want, but no one is actually going to do it if they don't feel safe doing so. Example: air travel is down 95+% even though there are no laws against flying places.

not a great example. people don't just fly for fun; they are going somewhere to do something. you're not allowed to do most of the stuff that you would travel for in the first place.

Let's quantify that. At risk encompasses people who are obese. That's roughly 30% of the population. It includes people with heart disease, and diabetes. Roughly 30% of the population suffers from that. Sure there's some overlap in these groups, so we'll call it an even 30%. That's over 100M Americans. Have some humanity.

The fact that the rhetoric started with one and ended with the other makes the whole process feel dishonest.

Once we get over the exponential growth, we then have to wait for it to drop. Otherwise we'd just go right back to exponential growth.

All you people acting like "oh, the curve flattened, now we can go back to normal" are the kind of people that caused three massive spikes in the 1918 flu.

We're very likely to have a second spike that is way worse than the first because of this attitude.

That was not the initial sell to the public.

Specifically, I think that first world societies can afford to give 25% of the workforce a paid sabbatical without ceasing to exist. And I find it depressing that there are people who think this is a shock that rich societies cannot absorb.

Sure, it'll be painful. Taxes will have to go up afterwards, the retirement age might have to rise. But it's possible.

"Society" ending or "Socialism only for the rich" ending?

Don't forget the gaslighting "100k people dead is doing a good job" BS.

People are being hoodwinked while they're scared shitless.

Anyone can go look and see that south korea, a far more urbanized state is open for business right now.

Active disinformation campaigns work.

Saying SK is open while we're not leads to "let's open America" for that mindset.

It always looked bad and looks worse the closer 100k becomes. It can’t be too long before some measures will say it has been exceeded. Then what will the claim be?

Now do the per capita numbers and see that we’re actually doing better on a deaths/million basis than several European countries.

By suppressing the transmission of this virus, we have failed to build immunity in most of the population. As a result any serious lifting of suppression measures will lead to moderate-severe outbreaks.

On balance, I believe that the most effective method is to resume life as normal, and focus on encouraging the at-risk to shelter, along with providing them appropriate government support. Whereas the approach we've taken has destroyed our economy in a very real sense, which will increase mortality even in the absence of a global food crisis.

The suspension of elective surgeries on a broad basis was very clearly a mistake, but unfortunately it's the type of mistake that no-one will admit was a mistake.

We postponed absolutely important surgeries as a result of this, even in areas like, for example, my county in Central California, which has very low prevalence of COVID-19. Here in California we "only" suspended elective surgeries for a month and now have a backlog that we're still working through.

So, just to say it explicitly: the fear that "things will never be normal again" is unfounded, at least in those who are operating off a mental model wherein COVID-19 is 10x as deadly as we previously thought.

The fact that we chose a strategy of indefinite postponement was our mistake. Because now people are beginning to realize that if we "go back to normal" then "the lockdown was for nothing". I consider this to just be a sunk cost fallacy, I believe quite frankly that ultimately the lockdown "was for nothing" (that is to say that, at the time it may have been justified based off the projected numbers, but with what we know now we should know that we only shot ourselves in the foot).

TL;DR: I believe that we need to resume normal operation of society, and make strong efforts to protect the at-risk. Trying to indefinitely postpone exposure to COVID-19 is a loosing battle. We've adopted a strategy of indefinite containment/postponement that relies on hunkering down and waiting for a _temporally unbounded event_. Given that lockdown-associated damage increases the longer containment is maintained, we are trading off a linear component of damage for a speculated future improvement in outcomes due to vaccines/a game-changer treatment. That to me is eminently foolish.

Most decision-making heuristics don't just try to blindly increase expected value (decrease expected loss) but also factor in uncertainy. In general it's acceptable to trade off a little EV for a lot more uncertainty. (Unfortunately in the case of the lockdown, I believe we incurred -EV along with far more uncertainty, for a net loss across all dimensions)

Nearly half the population is at-risk (age, comorbidities, obesity).

> In Philadelphia, half of the cases are in nursing homes, and more than half are of people older than 60 years of age

That has little to do with the infection rate and a lot to do with who gets tested. In nursing homes people are getting monitored all day. There are many countries that are far more dense than the US that are currently open, because they test everywhere and prevent people effected from being out.

I personally wouldn’t want to argue for putting half a million in an early grave for the sake of opening up.

I have to wonder, what do the people pushing to re-open expect will happen in those states?

As briefly as possible: Containment only has real utility if we can develop a game-changer that drastically alters COVID-19 outcomes, and that we don't have to wait so long for it that lockdown-induced mortality eclipses the time-adjusted benefit. It's a risky strategy that requires waiting for an uncertain, temporally-unbounded event, which in turn means that the "indefinite postponement" strategy incurs unbounded cost. We simply don't know enough to make definitive predictions about upper bounds on time-to-discover-incredible-treatment.

Whereas in a no-lockdown, natural herd immunity strategy, we are experiencing a fairly well-bounded spike in short-medium term mortality. I've been using Ferguson's 2.2 million figure for the US which is based off 82% population infection with an IFR of 0.9%, with the population equally susceptible at the physical level (behavioral differences are modelled, I believe). That's an excellent upper bound, it's certainly not the mortality we should _expect_. So we have a much tighter certainty, we will experience somewhere between 200,000-2.2 million deaths due to COVID-19.

When weighed against the alternative, which again is to incur unbounded risk from lockdown-associated mortality, the correct path becomes quite clear in my opinion. A very marginal increase in all-cause mortality in the whole population could very easily offset the spike in COVID-19 mortality which is constrained to fairly limited subsets of the population overall.

All three are very different scenarios that require different strategies and where we should have very different expectations for what is and is not achievable.

People are praising countries like New Zealand, but what's their endgame? Be in a situation where their citizens can't even safely travel from their country until global herd immunity is achieved because every vacation or business trip is a chance to end up being sick far from home?

This isn't going away just like the seasonal flu and common cold are not ever going to go away.

Yes. And I’ll have this over every alternative I’ve seen so far. I’m in New Zealand.

If you trust the same kind of "Scientific Modeling" that create Hurricane Path Predictions. Notorious for being hysterically wrong.

Then sure... that's wonderfully "clear"...

If, instead, you look at "models" and "projections" as junk science that's easy to prove wrong by simply looking at any model and how horribly wrong it's been in the past?

Like... the COVID models have been horribly wrong so far...

Then no... it's not "incredibly clear"

Also curious why you think the US was so badly effected compared to say south korea or thailand?

Do you think it would be safe for everyone to go back to relative normal? What would your prediction of the effect be? What data would you trust to validate that prediction?

I'm asking out of genuine curiosity how someone who I'm assuming is well meaning can get to this position. I'm happy enough to be convinced if your prediction turns out correct as there will be plenty of different states that are going to do a variety of strategies.

"do you think it would be safe" With the data thats coming out? Yes. Absolutely. COVID is turning out to only be a little more dangerous than the Flu and "lockdowns" are not slowing or stopping the spread of the virus.

"How can someone get to this position"

Honestly... January WHO was saying COVID didn't pass person to person and models were predicting 2.2 million dead in the US alone.

I'm not making a prediction... I'm casting aspersions on the "predictions" that have been used to feed opinions like "do you think it would be safe?" as if we are all going to die - 99.5% of those who get it survive. Worse than the flu but not worth shutting everything down (which hasn't stopped it at all - look at New York).

Personally I know we can protect those who need extra protections (Old, ill, etc) without unproven shutdowns based on faulty models fed with bad data.

Why do I feel this way? Because I know that hurricane predictions are "Scientific models" and are wrong just like "market predictions" and all other forms of prediction based models based on past data.

But I've seen higher death rates in public threads as a common theme.

https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate...

"In Italy, the death rate stands at about 13 percent, and in the United States, around 4.3 percent, according to the latest figures on known cases and deaths. Even in South Korea, where widespread testing helped contain the outbreak, 2 percent of people who tested positive for the virus have died, recent data shows."

Granted... those death rates are "known" cases which gets cut when you add no/low symptoms to the "unknown infected".

We are still gathering data and the numbers vary greatly depending on country and testing methods.

Which is my biggest point... it goes from 4%+ down to .5% or lower depending on how you spin the numbers.

Hard to take "projections" seriously with THAT much unknown data.

edit: For the 2.2 million dead projection:

https://www.factcheck.org/2020/03/trump-and-the-coronavirus-...

"The CDC modeled four scenarios and estimated that 200,000 to 1.7 million U.S. residents could die, the Times reported."

"Think of the number: 2.2 — potentially 2.2 million people if we did nothing. If we didn’t do the distancing, if we didn’t do all of the things that we’re doing." -Trump