> People seem to forget that the expected total death count from day 1 was, and still is, expected to be the same no matter what actions taken

This is so wrong. One has to really wonder what motivates you. Mask wearing alone, a simple action, dramatically lowers predicted infection rates

There is yet no evidence that explicitly ties the use of a face mask to lower rates of SARS-CoV-2 transmission. A lot of the published evidence is either inconsistent, or indirect (measurement of droplets, but that doesn't take physical barriers like nose and mouth, or the viral load required to overcome the non adaptive immune system). In fact, it has been argued that non pharmacological interventions should be evaluated with better evidence [1].

A Danish clinical trial enrolling 3000 people will probably give some more concrete answers.

OTOH, hand washing and distance are definitely useful to reduce spread.

P.S. Feel free to state your disagreement explicitly instead of downvoting.

[1] https://blogs.bmj.com/bmj/2020/08/28/margaret-mccartney-we-n...

Is there clinical evidence for handwashing and distancing is effective? Study with a nice chart saying the benefit for each additional foot?

Great explanation of the issues here: https://medium.com/incerto/the-masks-masquerade-7de897b517b7

I'm not saying that masks don't work. But whether they are effective at reducing transmission and, if so, in what measure are open questions. The literature is at this point inconclusive[1]. Even the latest Lancet paper on masks and distancing attracted some criticism[2].

Of course,I agree that absence of evidence is not evidence of absence. But, as the BMJ post I quoted earlier says, instead of just saying "wear a mask", the best idea would also promote trials to verify their effectiveness (like the Danish trial). It's done all the time for drugs, why not masks?

[1] https://www.cebm.net/covid-19/masking-lack-of-evidence-with-...

[2] https://pubpeer.com/publications/6AF113CE946CABB0FBB811697E5...

This article is flawed in numerous ways.

"missing the compounding effect" - What about the compounding effect of numerous people putting a plague vector directly on their respiratory system?

"Mistaking Absence of Evidence for Evidence of Absence" - The argument isn't that because there's no evidence it's guaranteed to not work. The argument is that without solid evidence constitutional rights should not be infringed.

And on and on.

Hand washing won't help, we've always known this.

It will do something, in a very complicated way, but compared to things that really matter that we haven't been able to push like mask wearing(you disagree) and social distancing and being outside, hand washing has been a huge distraction, which is the same as saying it's helped increase the spread.

Please don't take HN threads further into flamewar. Posting like this is basically arson, or criminal negligence. I'm sure you don't mean to cause harm, but this has been a problem for a long time:

https://news.ycombinator.com/item?id=23730601

https://news.ycombinator.com/item?id=23299305

https://news.ycombinator.com/item?id=20135818

https://news.ycombinator.com/item?id=18257769

https://news.ycombinator.com/item?id=16055379

https://news.ycombinator.com/item?id=15695133

https://news.ycombinator.com/item?id=14540750

https://news.ycombinator.com/item?id=13859103

https://news.ycombinator.com/item?id=12995487

https://news.ycombinator.com/item?id=12995486

If you can't or won't fix this, we're going to have to ban you. Most accounts would be banned by now after a lot less than that. Can you please review https://news.ycombinator.com/newsguidelines.html and stick to the rules from now on?

Thanks for your work keeping the site sane, Dang. Apologies. I get overly emotional.

That's just being human. We don't hold it against you at all.

It's America's obsession with self righteous indignation. "How dare you not go along with the mob and put on your mask. What kind of horrible person are you?" Americans, of which I am one, have this mentality that if someone disagrees, they are a terrible, horrible person that must be crushed by your rightness.

Yep. Completely agree. There's very little middle ground anymore. It's just pure righteous indignation from all sides.

Trump bad, guns good, abortion good, q anon good...and on and on.

I personally blame the media, where most people get their information, for presenting things in an extremely one sided non-nuanced manner, no matter, what party or group you hail from.

It makes it impossible to empathize with the other side or see other ideas if it's presented already by the media as unquestionable ideas.

However, it's also on the population for being intellectually lazy and not validating or verifying what they see on the news media.

I think parent’s point is that these measures are intended to stretch out the curve so the peak is lower (not overwhelming) but the area under the curve is the same (same total deaths). The hope is of course that a vaccine chops off its right tail.

> People seem to forget that the expected total death count from day 1 was, and still is, expected to be the same no matter what actions taken...

Could you provide some sort of source for this? This seems completely illogical as our goal has never been heard immunity.

I’d guess jb775 saw a clip with a conservative lawmaker or pundit making this point. It’s been floating around the news lately. Take a look at the recent argument between Sen. Rand Paul and Dr. Fauci[0]. Essentially republicans are trying to push this idea that the number of infections and deaths from COVID-19 are inevitable and any government intervention can only impact the timing. In other words the area under the curve is constant.

They don’t want people thinking that if action was taken by the U.S. gov sooner (Feb instead of Apr) we would have dramatically fewer deaths and cases, which is probably a more scientifically accurate view but with all the data being so new this debate is ripe for political distortion.

[0] https://youtu.be/Yk2p2oyXxTc

I only watched the start, but he describes the curve as having number of deaths as the Y axis - every description of "flattening the curve" that I have seen has number of cases as the Y axis. The point being to stop the number of cases overwhelming healthcare so that more people die - not just to rearrange when people who were going to die anyway actually die.

I don't know if that is a mistake or intentionally misleading - I would hope the former.

Note: I'm from the UK.

>They don’t want people thinking that if action was taken by the U.S. gov sooner (Feb instead of Apr)..

Why do you single out "conservatives" when Democratic politicians were telling people during the Chinese Lunar New Year there was nothing to worry about?

This wasn't a partisan blunder.

Do as they say, not as they do.

Not to take sides, but that was the basis of the whole flatten the curve thing — or how it was presented to most people atleast.

The basis for it was reducing impact on health care systems, and to limit second, and future wave impact.

Doing the first saved a lot of people because treatment was available. Secondary saves were non covid patients who could get service because capacity remained more available.

Had we had better safety compliance, we would have reduced even more than we did and may have normalized things such that the wave upon us now would be much less.

Death rates are dead/recovered and that is driven by infections.

Lower infections means fewer entering the death equation. More health care available means more recovered and all of that means far fewer dead people.

It actually didn't save anyone because there was never any risk of hospital overload when panic didn't set in: Sweden has one of the lowest ICU capacities in Europe and never saw hospital overload.

A few places did, but that's because they over-reacted and quarantined lots of their medical staff. That's the reaction not the virus.

Sweden’s compliance and low population density looks very different from most countries.

Social distancing[edit] On 16 March 2020, the agency recommended that people over 70 should limit close contact with other people, and avoid crowded areas such as stores, public transport and public spaces.[112] At the end of March, 93% of those older than 70 said that they were following the recommendations from the health service to some extent, with the majority having decreased their contacts with friends and family.[113] In May, the agency looked at easening the recommendations for the 'young elderly' of good health, but ultimately decided against it.

The US might be keeping school systems closed, but movie theaters for example are open across most of the country. Mask compliance for example tracks closely with where areas that are currently experiencing outbreaks in the US. That likely says more about overall compliance than the effectiveness of masks.

PS: It’s random mixing between groups that really spreads diseases. Individual classrooms where people see the same people every day may have outbreaks, but that’s all local transmission.

It does not matter so much if you die in the hospital or in your home, in the end you are still dead.

Deterring people to go to the hospitals, that are destined to save lifes, so they die at home instead, is not brilliant advice. They can (and will) sell it as a success, but Swedden still had much more people killed than their twin country Norway. The fact that those hospital rooms where not occupied despite having some elders in need of specialized care, is a failure, not a success.

> was never any risk of hospital overload

I think that many physicians in the planet would tell a very different history.

Sweden didn't deter people from going to the hospitals. That's what happened in places like the UK, where the government literally told people to "protect the NHS", and the UK has consequently had one of the highest death rates in Europe.

but Swedden still had much more people killed than their twin country Norway.

So what? Zero deaths was not ever a goal of lockdowns, and cannot have been because there's no logical way to get from that policy to that outcome. You've done what lockdown advocates always do when Sweden comes up: not just shift the goalposts but move them entirely out of the field.

At any rate, Norway may simply have not had the disease spread through the population yet, or they may have just got lucky - seasonal flu always hits some countries and not others for unexplained reasons. It doesn't ultimately matter. Sweden disproved epidemiological models, and thus the actions taken on their basis were not justified.

As for physicians, luckily the opinion of a doctor here or there is not sufficient to change actual data or observed reality. Fortunately most doctors are sensible: there are plenty who have been outspoken against lockdown precisely because it emptied the hospitals and clinics leaving them with a huge backlog of patients who they could have saved but now cannot.

This is an arbitrary distinction to compare Sweden to Norway(who also had no mask mandate), cherry picked to fit your narrative.

Sweden had deaths on par with the average of all of European countries less than Italy, Spain, the UK, etc.

Take in mind that the family structure is different in South and North Europe. Southern Europe homes are often multigenerational. Having gransons and grandpas living together increases the risk. Many granpas live alone in Swedden. Their results would be even worse if we remove this structural difference.

If we can't compare Swedden With Norway, maybe you would prefer Denmark?

645 danish killed versus 5875 Sweddish. Even if we correct the difference in population, is still much lower (around 1290 versus 5875). They are not much different populations genetically. Do you have any hypothesis that would explain the difference?

Wheres your evidence that Italy has more multigenerational households than Sweden? Do you have a citation? That's scientifically unsubstantiated and almost like you made it up on the spot based on anecdotal information.

Also, you're cherry picking again to suit your narrative. Sweden is part of Europe and should be compared as such.

It's disingenuous to keep promoting this demon-ization of Sweden narrative with unsubstantiated, and cherry picked comments.

Sweden did the right thing. Other countries did not. It's that simple.

You can find easily those data in Eurostat of course, that is the official channel for those things in EU.

Mean age of youngsters leaving parental home to live in their own home. Data from 2019:

- Italy: 30.1 Years old.

- European Union: 26.2 Years old

- Swedden: 17.8 Years old.

So... Yes, definitely I would say that they are very different societies. This, most probably, saved Swedden several deaths.

> Sweden is part of Europe and should be compared as such.

For your information, Czechia is an European country, same as Denmark

Sounds like that would be an easy graph to draw.

Correlate all of the countries covid death per capita with age youngsters leave the home.

See if that's a valid observation and holds true across countries... or just a single data point that you pulled out of thin air.

Have there been any actual studies to support this hypothesis or are you making this up to support your narrative?

It seems to be just an endless rabbit hole of unsubstantiated correlations and cherry picking.

Too busy watching Susanna Hoffs videos in internet currently, (I prefer to choose my own rabbit holes, thanks), but I will make all this studies next year, all of then, each one. Maybe. If I'm very bored. Mortally bored. I promise.

(Homework for the weekend?... LOL, who do you think I am? your secretary?)

I would just think someone would want to be accurate with their facts is all.

To add context, If Swedden would have the same population as Spain, the number of killed people at the current ratio would be 26907. In Czechia (a country with a similar population that Swedden) would be 2489 instead. Less than ten times lower.

Swedden has not such stellar results as they are trying to sell.

Reevaluate that for the US.

In this demonstration of a simple infection model (the SIR model) you can see this worked out at https://www.youtube.com/watch?v=k6nLfCbAzgo&feature=youtu.be... that "not only do you flatten the curve, you also stop everyone from getting the disease in the long run."

A bit later they point out that flattening the curve increases the chance of getting to a vaccine or viable treatment; which is another way to reduce the total number of infections.

The problem with that is that in real life transmissibility is not a fixed parameter you can keep down forever. People eventually get lockdown fatigue and/or realize the opportunity cost is not worth it for them. So the area under the curve is roughly the same in the long run. That is, unless we can get a vaccine or effective treatment fast enough.

Like I said, "simple infection model (the SIR model)".

Which more rigorous models have the area under the curve as roughly the same, as you describe it?

I believe any model which has herd immunity, where personal immunity comes after a period of infection, must have the possibility of overshooting the minimum heard immunity density when the infection rate is high enough. As in the SIR model.

Lower the infection rate and there's lower overshoot.

My point is that that the argument you made - i.e. that lower transmissibility aka. "flatten the curve" lowers total mortality in the SIR model - doesn't hold unless you assume that you can keep transmissibility down forever (and unless a vaccine or treatment comes out fast enough). That is, I'm not presenting a new argument, merely refuting your argument, over the SIR model you used, adding the assumption that transmissibility can't be kept down indefinitely - which I believe is very reasonable given what we are observing.

I believe it's the burden of the proof is on you to present a new, more rigorous model if you want to argue that slowing down transmission significantly lowers overall mortality - as the null hypothesis is that they are not associated.

On the last point, I am aware that under the SIR model, there's the possibility of overshoot, i.e. exceeding the minimum herd immunity threshold. My understanding is that this isn't a significant effect unless you have uncontrolled, explosive expansion, so that most people get infected simultaneously before others develop immunity and can therefore act as a barrier for herd immunity. I don't believe this is the situation right now given the numbers we are seeing.

That said, I believe that the more realistic future is that a vaccine or an effective treatment will be developed in the next months, and that will be the thing that will have made temporarily lowering transmissibility worth it. What I don't believe, because I haven't found any evidence for it that holds basic scrutiny, is that if no vaccine or effective treatment can be developed in a reasonable timeframe, then keeping the measures to slow down transmission as long as possible will have any significant effect on lower overall mortality.

EDIT: To make it clear so people do not misunderstand me, what I believe has no evidence is that without a timely vaccine or effective treatment, slowing down transmission beyond what is necessary to keep the health system from overloading is associated with lower overall mortality.

The argument I make is that jb775's assertion at https://news.ycombinator.com/item?id=24586075 ("People seem to forget that the expected total death count from day 1 was, and still is, expected to be the same no matter what actions taken") is wrong.

I say it's wrong because months ago I heard arguments that models predicted that lowering the curve could also reduce total mortality. And I linked to that video to give evidence that this was part of the general discussion months ago.

The fact that you disagree with that model, or argue that I need to give a stronger evidence for the current information we have, has no bearing on my point.

Eg, when you write "I don't believe this is the situation right now" - that statement is based on knowledge you have now, not knowledge that people had on "day 1".

Fair enough, I understand your point better now. I also remember hearing a lot of arguments for lowering the curve lowering overall deaths back in March - either by heavily suppression or elimination of spread, or by a vaccine or effective treatment.

Nowadays it seems both EU & US hasn't pursued heavy suppression (probably too costly, and legally and culturally difficult), but rather just hoping to keep it somewhat under control until a vaccine comes, hopefully.

And it’s so easily refutable.

Stares like Florida and Texas, which has higher infections than NorthEastern states, had far lower death rates because of what we had learnt about the virus in the intervening months (just a few things we learnt, that ventilators were not very handy, there are several drugs that are more effective than ventilators, even if we are facing a shortage of medical grade PPE cloth masks themselves can be extremely useful, outdoors are much safer than indoors, etc).

The idea that we were always expecting the same number of deaths is nonsensical, but even if someone did believe that in the beginning of the pandemic, it’s been proven incorrect by now.

This makes more sense with the premise that curtailing citizen's rights and greater central planning has always been appealing to some. Evidence for the effectiveness of lockdowns or lack thereof is incidental. "Climate Lockdowns" are already being proposed.

https://www.japantimes.co.jp/opinion/2020/09/23/commentary/w... https://www.weforum.org/agenda/2016/11/shopping-i-can-t-real...

"expected to be the same" is simply not true.

Even simple models like the one described at https://youtu.be/k6nLfCbAzgo?t=920 (I point to the relevant part) shows that reducing the infection rate can also lead to fewer overall deaths.

UCSF's grand rounds last week discussed the observation that when there are outbreaks it appears that without masks the asymptomatic rate is 40% of those infected. With masks it appears to be 85%. Or to flip it around without masks 60% have symptoms. With masks only 15% do.

Okay, okay, I’m as down with the science as anybody but those numbers sound a lot like cherry-picking. They also don’t jive with the info that’s trickled out suggesting that a plurality of infections are happening in the home, at restaurants, or while attending unmasked gatherings.

> People seem to forget that the expected total death count from day 1 was, and still is, expected to be the same no matter what actions taken....

Only if you assume we'll never have vaccine or efficient specific treatment, which is most likely false assumption.

In all other cases expected total death toll can vary by order of magnitude or more depending on how many people get infected before vaccine and/or treatments are widely available.