The only thing she has seen personally was her ex-husband dying alone in the old folks home because visitation was disallowed. He didn’t get COVID, he died of loneliness, as far as she could tell. So she’s going out to social engagements because she thinks the cure is worse than the disease.

While being younger we're trying to maximize time. Even time with the elderly. Different cost functions.

This is a complex system, and there aren't really systemic experts.

I actually happened to do exactly that in late Feburary, and he pointed out that about 1% of the population die every year naturally, and WWII killed double-digits in many countries, so COVID-19 killing ~3% was certainly something civilization could survive (remember that the early fatality rate estimates were much higher than they are now, and the vast differences in fatality rate by age weren't yet known).

Dunno what he might have said to if I had been a patient. But certainly part of that job is to put things in perspective!

Was this because of the excess COVID deaths or just because some the services that normally handle deaths were deemed non-critical and so the chain of services that handle bodies just had glitches?

Or, to look at it scientifically, did the uptick in NYC deaths per week in March and April put the total deaths per week above, say, (average + 3 sigma) over the past couple of years. Honest question, I do not know this answer but knowing this would help put the numerical base behind an emotional statement.

For your second question, On your "how many" question: nobody I know says that 200k deaths do not constitute something worthy of attention. But on average, over 3 million people die per year in the US. 650k per year (according to CDC) just from heart disease, much of it preventable with better habits and good exercise.

If 200k deaths is enough to force major life restrictions on everyone (and spend over $5 trillion to limit economic fallout), should we bring the same machinery to focus on heart disease as well: force video taped gym sessions and cardio exercises? require wearable monitors? prohibit admittance to public transport without a gym validation stamp or a doctor note?

Those sound aggressive, sorry! That was not the intent; but just from a purely objective approach I do not see why the answer to those should be an automatic "no" if we accept COVID policies as automatic "yes". My 2c.

This survey[0] answers (in the affirmative) your question:

"During March 11–May 2, 2020, a total of 32,107 deaths were reported to DOHMH; of these deaths, 24,172 (95% confidence interval = 22,980–25,364) were found to be in excess of the seasonal expected baseline. Included in the 24,172 deaths were 13,831 (57%) laboratory-confirmed COVID-19–associated deaths and 5,048 (21%) probable COVID-19–associated deaths, leaving 5,293 (22%) excess deaths that were not identified as either laboratory-confirmed or probable COVID-19–associated deaths (Figure)."

[0] https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e5.htm

To nitpick though, it does not quite answer the question of whether "the bodies were piling up" because totals exceeded pre-COVID processing capacity or because the processing chain broke down. That is, was the level during Spring of 2020 (higher than average Spring, your link shows it) also higher than previous spikes that included other seasons.

Could your place of employment handle a 2-month long, 5x spike? Would the processing chain break down? Would it make a difference which it was?

For example, if my employer promises not to reduce cafeteria service and a month later says "no cafeteria for employees today due to a conference; we cannot feed that many people; go away" a hungry employee should check if we had such spikes before and if so how well we did. If indeed it was a unique surge, OK. But if every year we have similar spikes and they never turned employees away, "we did reduce service" is a better explanation than "we cannot serve such volumes" :).

https://www.marketwatch.com/story/new-york-city-expands-morg...

"Without the makeshift morgues, the city can accommodate between 800 and 900 bodies, Aja Worthy-Davis, the executive director for the Office of Public Affairs for the Office of Chief Medical Examiner, told MarketWatch on Monday.

"“Between the tent and the refrigerated trucks, we have space for between 3,500 and 3,600,” Worthy-Davis said."

And then there's this, which is interesting....

https://www.cityandstateny.com/articles/policy/health-care/w...

"That unprecedented number of deaths over the course of a few months has led funeral homes to experience a backlog, which has, in turn, overwhelmed city and hospital morgues with bodies waiting to be picked up by funeral homes.

"For some in this business, the crisis has served as a reminder of just how much families need to have their deceased loved ones cared for with respect. “We got swamped and weren't able to offer services at the time,” D’Arienzo, the funeral director, said of the backlog funeral homes were experiencing. “Families were so desperate, it just ignited a fire under me to make sure that we're always prepared.”"

So the problem looks like funeral homes not picking up bodies. Which makes sense; I don't think they're in the processing capacity business.

https://www.theguardian.com/us-news/2020/apr/10/new-york-fun...

Has the interesting comment: "<p>New York’s governor, Andrew Cuomo, this week signed an executive order allowing out-of-state funeral directors to come into the state to help relieve pressure on funeral services. The move came after the <a href="https://www.nfda.org/news/in-the-news/nfda-news/id/4984/an-o..." data-link-name="in body link" class="u-underline">National Funeral Directors Association</a> wrote an open letter letter to the governor, saying hundreds of people were willing to help."

(Yeah, the Guardian doesn't want me to see the article.)

As you said, the problem seemed to be with funeral homes not picking up bodies. I wonder if this was primarily due to increased deaths (which I do not doubt) or restrictions that made the funeral homes not able or not willing to handle the funerals.

[0] https://www.nytimes.com/2020/04/29/nyregion/bodies-brooklyn-...

"During March 11–May 2, 2020, a total of 32,107 deaths were reported to DOHMH; of these deaths, 24,172 (95% confidence interval = 22,980–25,364) were found to be in excess of the seasonal expected baseline. Included in the 24,172 deaths were 13,831 (57%) laboratory-confirmed COVID-19–associated deaths and 5,048 (21%) probable COVID-19–associated deaths, leaving 5,293 (22%) excess deaths that were not identified as either laboratory-confirmed or probable COVID-19–associated deaths (Figure)."

During those roughly 2 months, there were 32,107 deaths; in a normal year there would be about 32,107 - 24,172 = 7,935 deaths. Normally, that would be ~100 deaths/day; during that time there were ~500 deaths/day. ("New York" deaths peaked at about 800/day, although I'm not sure if that was NYC or the state.)

Edit: Dang it. I'll leave this here anyway.

The correct question to ask is, "What is the cost of not sheltering in place?" The answer seems to be between two million and three million deaths in the US from COVID alone[0]. Of course, there would be even more deaths due to ICUs being full and even more acute shortages of PPE for medical personnel.

We would also experience profound second- and third-order effects of millions of additional deaths on the economy.

> should we... force video taped gym sessions and cardio exercises? require wearable monitors? prohibit admittance to public transport without a gym validation stamp or a doctor note?

I hope you've taken the opportunity to read this again. To be charitable, it does not meet the high standards I think we hold ourselves to at HN. People suffering from heart disease don't infect others with a potentially fatal virus.

Other countries have applied strict shelter in place and mask rules with great success. In the US, compliance with such rules has been made political, and questioning it--often with straw man arguments like those above--has become the mark of supposed contrarian rebels.

As a result we have something of the worst of both worlds. Sadly, as more Americans irresponsibly refuse to apply basic COVID safety measures, more people get infected, thus supplying rhetorical ammunition to critics like those in this thread.

https://www.washingtonpost.com/graphics/2020/health/coronavi...

This does not mean that the total estimates of 2-3M for the US are proven wrong. But it is a strong counterargument to that estimate that should be addressed if we base our response on the estimate of 2-3M of COVID deaths with no strict measures. My 2c.

I will also push back on your "compliment" to me of not meeting the high standards of HN (you note you are being charitable; I wonder what the "objective" characterization). You lecture me to re-read my post and think about my mistakes (at least that is how I understood it; if I understood it wrongly, sorry). I did re-read it and still see my questions as valid. If the answers to them are obvious, great; but this does not make asking them unethical. Sorry for this rant, I will take the downvotes for it if they come.

Sweden is actually seeing a second wave. Its death rate is still low.

* Are mask and shelter in place laws worthwhile to avoid two to three million additional deaths due to COVID?

Various countries had various levels of lockdown, and none had anywhere remotely close to that fraction of their population die.

Taking Brazil, they had about 62 excess deaths per 100k (who knew Brazil was so dangerous in general?). I'm rounding down because I can't be bothered getting a calculator, so using 50.

Taking this level of excess deaths and applying it to the US, we get 600k excess deaths (so 3x the reported total). Using the excess death numbers for the UK, 90 odd, and again lazily rounding, we'd get 1.2 mn excess deaths this year.

I think the OP's point was actually pretty reasonable, and will look much more accurate in a few years when we have better excess deaths data and (hopefully) this pandemic is over.

Out of curiosity, how many deaths do you consider little enough to be ignored? 400,000? (Smoking) 35,000? (Traffic accidents) 5? (Amoeba infecting the brain)

If you say none, do you agree that the measure still needs to fit the threat? Stopping driving would eliminate that cause of death, but it would cause other problems.

But are those being ignored (not sure about the Amoeba bit)? Do we routinely mock those who say smoking is bad? Do we ignore traffic fatalities by ripping seat belts and air bags out of vehicles? Are autonomous vehicles widely derided as not useful?

The response absolutely needs to be proportionate to the risk. I never said anything different. In fact, in NYC most of the city is open again, because the impact and risk have been reduced -- by taking the virus seriously and a broad segment of the population are taking steps to protect themselves and others. What's more, widespread testing and tracing enable us to identify outbreaks and limit their spread.

I don't see that as overreaction. I see it as taking a public health issue seriously and engaging the populace in mitigating/minimizing it.

>If you say none, do you agree that the measure still needs to fit the threat? Stopping driving would eliminate the cause of death, but it would cause other problems.

I didn't say anything even approaching that. Please don't try to put words in my mouth.

Some preventive measures are clearly justified. Wearing a mask requires little more effort than wearing a seat belt and refusing to wear one is pretty childish at this point.

Losing precious time with family is a lot harder and a sacrifice few people would consider making in the face of traffic fatalities.

I agree. In fact, I've had to come to the realization that I may never be able see and hug my ailing mother ever again, as she lives on the other side of the country.

I hope that isn't the case, but it may well be so.

The point is that we didn't ban smoking or driving. We did ban being close to other people.

Not being close to other people is the most effective measure to stop this pandemic. Wearing a mask while sitting in a badly ventilated room with many others is considered high risk by most experts. While the lockdown let the infection numbers collapse the mask requirements showed little impact so far.

So banning being close is what happened and helped.

Actually, we did. Especially in places where masks are currently required. When was the last time you could just light up a cigarette or cigar (or a joint for that matter) in a restaurant, bar, shop or other indoor venue?

I bet that kids born today will not consider wearing a mask when you're sick to be this outrageous affront to freedom, since they'll be used to it by the time they grow up.

That's very different than forcing everyone to wear masks all the time just in case anyone is ever sick.

Maybe I should have used: In case you say none

> I didn't say anything even approaching that. Please don't try to put words in my mouth.

Neither did GP umvi say anything approaching

>>> [...] 200,000+ deaths in the US doesn't constitute something serious and worthy of attention and efforts to mitigate/minimize the impact [...]

Since we all now agree that no mitigation measures are bad and total measures are bad, we’re back to arguing what is the right middle ground.

How about social distancing, mask wearing, basic hygiene, widespread testing/tracing, keeping the sick away from the healthy, limited restrictions in areas with outbreaks/clusters, etc.?

You know, the stuff that the public health experts have been recommending throughout?

I'm not sure that there's really much argument to be had that such measures (given that they've been pretty much standard procedure for disease outbreaks for decades) are appropriate and effective.

I thought 8 months ago experts agreed that paper masks were useless for the general public.

30? years ago herd immunity was an agreed approach for measles. 10 months ago it was the general approach to the common cold in kindergardens.

EDIT: I personally think that pebbles in the shoes would be more effective than masks because it would make people stay at home even more.

Herd immunity, to my knowledge, has never developed for the common cold, because there are several hundred viruses responsible and they're rather changeable. The general approach, as I recall it, was, "we can't do anything about it, but it doesn't kill too many people, and those at risk can get flu and pneumonia vaccinations."

And herd immunity for measles is due to vaccination. If measles were a novel disease, you would be seeing lockdowns that make San Quentin look open and free.

> if 200,000+ deaths in the US doesn't constitute something serious and worthy of attention and efforts to mitigate/minimize the impact of COVID-19

Nobody said they don't. There's a difference between something being serious and worthy of attention, and it being the sort of existential threat that would justify disrupting civilization to the extent we have.

Let's see here... According to https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e5.htm, there were 32,107 deaths in NYC in March-May, an excess of 24,172. There are about 8.4 million people in NYC, according to the Goog.

That would mean that, normally, there would be about 9 deaths/10,000 residents. In those two months, though, there were about 38 deaths/10k. The other 99.62% survive. Yay, you!

"Nobody said they don't. There's a difference between something being serious and worthy of attention, and it being the sort of existential threat that would justify disrupting civilization to the extent we have."

"existential threat"? "disrupting civilization"?

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/heal...

With disease, caused by a practically invisible virus, we wash our hands, we keep our distance, we wear a mask, but it still seems likely that we will eventually get it anyway. It seems unavoidable, especially because we can't tell who is spreading it. I think the equivalent of being a non-smoker is just hiding out in your house for 18 months and not seeing another human at all, close family and friends included.

And that's the problem.

You still have March / April info in your head and it's stuck there.

You're scared of living in the present because your brain living in the past.

Huh? Because I don't want to see that again, I'm living in the past?

Should I ignore previous experience as unimportant?

I'd point out that because NYC took strong action back then, we are now mostly open. And I'm glad we are.

I don't think we should lock back down. Rather I think it's important to do the myriad other things (social distancing, mask wearing, basic hygiene, widespread testing/tracing, etc.) that will keep the number of cases at a relatively low level (cf. https://www1.nyc.gov/site/doh/covid/covid-19-data.page ) to avoid such unwanted draconian measures.

Ignoring the risk posed by not doing the things that will limit the spread just increases the likelihood that the virus will be uncontrolled and make "lockdowns" more and not less likely.

I remember what happened in March-May precisely because I want to avoid further lockdowns, not because I support them.