a realistic calculation of risk should be looking at your risk of dying, your risk of serious illness, your risk of permanent illness and/or long-term effects, _and_ your risk of medical bankruptcy. one dude got a bill for a million dollars when he finally was able to leave the ICU.
COVID-19 is going to have a long tail...
[1] Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19), Puntmann et al, JAMA Cardiology, 2020
Yet we know that while heart attack risk is elevated for a few weeks after a bout of flu, it reverts to baseline for virtually all otherwise healthy patients.
The myth of long-term COVID heart damage is, as of the evidence yet, media scaremongering. We have no reason to believe that COVID behaves any different than any other common respiratory infection in this regard.
[1] https://academic.oup.com/cardiovascres/advance-article/doi/1...
https://www.smh.com.au/national/seizures-and-battered-heart-...
[1]https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12470
So... not like the flu in scale or scope.
Where is proof of causality between coronavirus and these afflictions?
I’m not arguing for total lockdown. I’m arguing for avoiding the more risky activities that involve heavy breathing in close quarters so total lockdown can be avoided. Local governments mostly know this, and have set policies accordingly. In general they should do a better job of compensating businesses in the short term since it’s not the gym owner’s fault (for example) that his business happens to have been risky right now.
I don’t think it’s good behavior to go out of your way to circumvent a public health policy based on a personal risk tolerance.
Obviously there is not going to be a total lockdown in the the US no matter what happens. Regardless of the potential benefits, that option isn't even remotely politically feasible. People simply won't comply, and there aren't enough police to enforce it.
Obviously the political situation and what’s feasible is different, but I hope restrictions on group sizes and a small number of activities is not infeasible. They are not “lockdown”, they are the way to avoid lockdown.
Again there is no political possibility of a future strict lockdown in the US. So for better or worse it has already been avoided.
There are some obvious ones, like: no new cases in the city/county reported in 14 days.
For some reason, it seems people thought this would take a month or two, and then everything will be back to normal. But it wouldn't. Two months is a ramp-up period, a default if you do nothing. "Flattening the curve" measures were always going to extend the partial lockdowns until late this year. We knew that in March.
The "more trivial things" like normal social interaction, employment, and healthy exercise?
I've never seen a more pointed example of most people's abject inability to perform utilitarian reasoning than this pandemic. If you think causing at least tens of thousands of suicides since the start of the lockdowns, impoverishing millions of people for years to come, and drastically reducing almost everyone's quality of life is a reasonable tradeoff for buying (on expectation) an extra few months of life for geriatrics, you are not rational.
Yep, me neither. If more people could, we wouldn't have this problem, because people who could would stay home. And going to the gym is indeed one of the "more trivial things".
I suppose the problem is that it's hard to impress on people the seriousness of the situation. If instead of a virus, you had a madman or enemy soldiers going through the street and shooting every two hundredth person at random (even with a heavy bias towards the elderly), everyone would stay home and keep crying the government needs to do more.
If a single-basis-point-scale increase in annual death rates is enough to make you “stay home”, you should never go outside in the first place.
On expectation, my marginal increase in risk of death from depression from becoming a shut-in is higher than the marginal increase in risk of death from contracting covid.
The primary problem with this disease is the asymptomatic spread.
I've included everyone I come into contact with. The risk to them is insufficient to justify me becoming a hermit. If they have a vastly different risk profile from me, they'll become a hermit of their own accord and I don't have to worry about them catching it from me.
> The primary problem with this disease is the asymptomatic spread.
If that's the "primary problem", then it's probably not something to worry about, don't you think?
If you think an 85 year old dying 3 months earlier is the same as a 27 year old killing themselves, you’re beyond help.
> Again, wow. I'm sorry you hate your gramma... You're the one that's not rational, and I expected the HN crowd to be better at digesting statistics.
Absolutely moronic emotional appeals and accusations of being irrational within a few sentences of each other? You are a hopeless midwit.
Have you ever seriously contemplated death? If you have, those numbers don’t seem very good, not at all.
Not to mention these are stats for DEATH. Meaning these are the worst case scenario. Dead. The chances of getting seriously ill, like major suffering, are much higher. Would you want to experience that? Would you wish that on others in your community?
Suck it up and do some pushups for gods sake.
I know this is a morbid topic, but it gets to a fundamental truth. How valuable is a human life? Is it worth significantly damaging the future of the young through economic depression and increased social isolation and mental illness to extend the life old old people by a year, 5 years?
There is no easy solution. We can hibernate as much of the non-essential economy with lock-downs and mandate the wearing of masks. But this, will extend the economic hardship we are under, which will put further economic strain on young people, who now have had to contend with the great recession and now likely a depression. We can do like sweeden and try and isolate and protect the vulnerable, and keep the economy open, or we can do nothing. Each of these choices has trade-offs in terms of economic hardship and lives. Not just the lives of people who get COVID, but those who commit suicide due to social isolation, economic hardship, and other factors related to COVID.
American's can't have this discussion in a mature manner because it has been poisoned by politics.
I’ve been comparing flu stats for Australia. 2019 a BAD flu season was over 400 deaths. A NORMAL season is roughly 150 deaths. I think 146 in 2018. 2020 has 36 deaths.
Melbourne deaths peaked at 25 for a single day. The current outbreak in VIC totally blows past the flu death rate for the entire country.
Total COVID deaths in Australia (450) already matches a bad flu season in a “locked down” environment and we still have 5 months to go for 2020.
Thankfully in Australia it’s possible to make mask wearing mandatory.
https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject...
When I was trying to google data I don’t think I ever came across the ABS site in the results. 2016 was also 400ish deaths.
The flu certainly makes for a better comparison for discussion's sake than something like smallpox or the bubonic plague. Let's not forget the Spanish flu was also a flu.
When you look at overall mortality it's not similar to the flu. It's worse. Covid is a bigger killer, with a major reason being the lack of population resistance, vaccination, treatment protocols etc.
I think most discussion misses this point, it is similar in some ways and not in others.
In my view a rational and evidence-based approach would have focused on protecting vulnerable populations from day one. Such policies received little emphasis. Instead, we panicked and implemented measures that destroyed the jobs of healthy people who were living paycheck to paycheck. It's hard to imagine a worse response than one that fails to focus on the core problem and injures millions in the process.
Saying its just a flu, also discounts the potential life long impacts of a COVID infection, which appears to damage the hearts and lungs of some people who survived.
The broader point is, that there is no one right answer, all answers cause pain and suffering for different groups. To dumb it down to a black and white response does a massive disservice.
Can't really make a comparison with a long standing disease when covid19 is still doing its first rounds.
https://www.nytimes.com/interactive/2020/08/12/us/covid-deat...
How many more quarter millions of souls is a sufficient amount to sacrifice on behalf of gym fetishists?
(I was planning a return to the gym following an involuntary multi-year lapse this past January. On advising my doctor I was delaying plans, their first response was to dismiss my concerns as germophobic. They've since apologised.)
However, I do want to address the young and increased social isolation and mental illness. Took my toddler for an annual checkup recently and asked about all this as he's been out of daycare since March and had concerns about development.
The pediatrician's answer, which I found compelling was: this is a big deal, and it's going to have an impact, and therefore we should be a little lax to help create some comfort around the house. That said, all the psychologists in the world are looking at this and starting to work on the impact and how we get kids back to "normal" or ease the harm this has on them. There is going to be expertise and guidance on this.
Of course, that likely doesn't apply to the anti-science crowd.
I am remarkably lucky. I am fairly resilient and being stuck working from home hasn't negatively impacted my mental health. I've been promoted during the crisis. I am financially secure.
Not everyone is like me. Many people have suffered horribly due to the crisis, becoming unemployed, unable to see friends, they don't have their usual coping mechanisms. My point was, how we choose to deal with this is a choice, each choice has consequences. Currently we are saving older lives, at the expense of damaging the futures of younger generations. Is this the right balance? I don't know. I don't claim to know. But as a society, this is what we need to answer, how valuable is each human life.
Should we choose harsh lockdowns to extend the lives of older people by x years on average? What is the cost in economic and mental health harm to younger generations? How do we balance these needs?
These are the discussions we should be having, instead of decrying anyone who disagrees with the harshest of measures as a witch.
Looking at current number of deaths as the outcome for the decision to open stuff up only makes sense if you think we would have seen the same infection rate.
If the infection rate is high enough and fast enough, we surpass the healthcare system's capacity to help with hospitalization, and then we see a large increase in the mortality rate for those infected, as some of those with bad, but not fatal infections that recovered in the hospital don't recover out of the hospital. The faster the spread, the worse (higher) that number is.
> The economic impact would be roughly that of everybody taking a really long vacation.
People come back from vacations. The economic impact would be more like those people all quit at the same time.
> it does not seem like that is the calculus going into our policy decisions here in August.
It is. They're looking at worst case scenarios for COVID-19, and how likely they are, compared to worst case scenarios for the economy, and how likely they are.
Worst case for the economy is a depression, which may take years or decades to recover from, but the workers are still there, still trained, and we can hopefully get them back to work with stimulus, even if it takes a long time.
Worst case for COVID-19 is that instead of hundreds of thousands of dead, we see millions of dead. What's the economic impact of one of every 50 or 100 families loses a parent, and how that affects they flexibility and ability to recover from financial bumps? What's the impact to Apple or Google if a high level exec that's spears a division dies (what's happened at Apple since Job died, and he had plenty of time to groom a successor)? What about the 20 employees of small business that was struggling but surviving when the owner dies? The economic impact of people actually disappearing forever is sometimes equivalent of the cost and time to train a replacement (which is generally multiple months of salary for any non-trivial position), and that's when it can actually be replaced adequately.
Even if you want to completely ignore the humanitarian aspect of it, there's good economic reason to not want people to die, and why locking things down, while economically disastrous, maybe still be less economically disastrous than NOT doing so.
That's fine. People are going to do what they're going to do. I'm not quite willing to let them do it behind nonsense arguments and justifications though.
If someone's unwilling to give up going to the gym, so be it. When they couch it (as some have here) as them actually doing it for the benefit of everyone else by helping the economy, I'm going to loudly and vehemently call bullshit.
If they say they just aren't willing to change and don't care about any of the data, well as long as they actually know the data, then I'll have nothing more to discuss with them.
That said, I don't think this is how people are. I think people are living in a deep cognitive dissonance and refusing to see the facts, not acknowledging them and saying they don't care.
That's not a policy problem, that a problem of educating people that do not want to be educated. Should the rest of the populace just shift our views away from reality so people that don't want to face it can get a better deal out of some policy? That won't lead to an acceptable outcome either, when the policy in question is about public safety.
Preventable deaths.
> American's can't have this discussion in a mature manner because it has been poisoned by politics.
I would say it's deeper than that. American society has been poisoned by individuality to the point where no one wants to do anything to help one another if it doesn't benefit them. It feels there's no concept of civic sense or societal good. Everyone just wants to do whatever they want, regardless of the consequences.
Ask me to inconvenience myself for someone else? Fuck you buddy I got mine /s
Here are the chances of dying in a year, for a given age, from actuarial tables:
25 year olds: 0.16% chance of dying
35 year olds: 0.2% chance of dying
45 year olds: 0.3% chance of dying
55 year olds: 0.7% chance of dying
65 year olds: 2% chance of dying
75 year olds: 3.5%
85 year olds: 10%
95 year olds: 26%
How about, if you’re worried, stay home, stay in. If you’re not worried, go out. Let’s not impinge on freedoms of any groups. Not just little freedoms. Pretty basic ones like, freedoms of assembly.
But there's a few big problems here:
a) As we've seen, some of the most vulnerable people are in situations where "staying in" without letting the virus in is very difficult. This will be worse the more widespread in the wider community?
b) Even if the vulnerable can perfectly protect themselves, this assumes a very selfish calculus of unconcern for everyone else. If your hospitals fall past the tipping point in a "get it over with ASAP" yolo policy, people not only die faster than in a world where there's never a vaccine or effictive treatment, more of them die too due to reduced ability to treat.
c) Who's gonna pay for all the non-wealthy vulnerable people to stay home? Especially in cases where they need to be more isolated, such as those with healthy roommates who will be acting normally, so they need to relocate too? I haven't seen anyone proposing answers to this in the states like TX or GA.
Economic-cost-wise, why is this cost the one that gets people so riled up?
Is it because it also comes with personal inconvenience, and so much of the other ways we spend money fighting death - or trying to extract revenge for death like after 9/11 - doesn't?
Driving, for instance - the government makes us spend a lot more to have safer cars, but other than styles and types of car available as a result, we don't really get impacted by it. It just makes the cars more expensive, and few people care.
Or maybe we're just bad at dealing with adversity without having someone to blame? So we go reaching for "bad guys"?
The ability of politicians to control transmission by making decrees, even dramatic ones, is limited, yes.
The ability of ordinary people to control transmission by taking obvious common sense precautions is not. And those obvious common sense precautions should include, yes, not engaging in activities that have a high risk of transmission.
One problem with age-based stats like this is that it gives the impression that the way to think about risk is along the lines of russian roulette: when someone gets infected, the great actuary in the sky rolls a D100, consults the tables, and if their roll is good, they don't die.
But what if the die was already rolled for some individuals? What if, say, one in 100 people carry a genetic risk factor that means that if they get COVID, they have a much higher risk of dying - regardless of their age? That hypothesis is also compatible with the statistical data we are looking at.
You could also consider, what if some people have particular predisposition to become a superspreader and infect many more people?
If the population contains individuals for whom their individual outcome risk, or their potential impact on other people, is significantly above the average, then by reducing the spread of the disease we reduce the number of such people who ever get infected. You can prevent the D100 having to be rolled for as many people, including people who need to roll much higher to survive.
Why does the timing of the roll matter?
The point is more to get people to think about the difference between aggregate average mortality, vs the individual prognosis of one unlucky COVID patient.
This winds up being a trolley-problem kind of reframing of a moral argument. Philosophically, should you change your behavior between the following two scenarios:
- a group of 100 people all have a 1 in 100 chance of dying of a disease
- a group of 100 people contain one person who will definitely die if they get the disease
?
Does your answer change if you are the one person?
This is wrong and misleading. You're quoting the average fatality rate for "healthy" people, but the distribution doesn't look like that at all. Then, you cherrypick 10% out of nowhere for "parents and school teachers". 10% is the rate for people in their 80s.
Real data: "[t]he estimated IFR is close to zero for younger adults but rises exponentially with age, reaching about 0.3% for ages 50-59, 1.3% for ages 60-69, 4% for ages 70-79, 10% for ages 80-89."[1]
[1] https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v...