I disagree.

I think the endgame is clear in the US. Most states have dropped all restrictions and those that haven’t will suffer economically and politically until they drop their restrictions. The only question is how much economic and political suffering individual cities and states will tolerate.

Virginia voters threw out their entire Democrat government and governor and will likely join the list of states banning restrictions.

In the end I don’t think it will be about Covid at all. One by one we’ll move on because the people will demand an end to restrictions.

You've been downvoted, but you're not wrong. Witness the number of people who have left California.

I’m not making a values argument either way. It just seems apparent that people are tired of restrictions, and those people seem more likely to vote. The result in Virginia was shocking and should have been a wake up call to Democrats.

I wonder if people would be OK with less restrictions, no vaccine mandates but perma n95 in public indoor and outdoor spaces ?

Because whether we like it or not the virus is still going to be around and kill people and saturate hospitals.

So, to me, the question seems to be:

  will living with the virus means "we don't treat covid patients anymore, if you get covid, tough luck, you are free to choose to wear a mask if you want, beyond that don't expect anything from public authorities"

>I wonder if people would be OK with less restrictions, no vaccine mandates but perma n95 in public indoor and outdoor spaces ?

The second and third most populous states in the nation have banned Covid restrictions. I think the answer to your question is… absolutely not.

I think you wanted to say the answer to my question is `yes`.

> Because whether we like it or not the virus is still going to be around and kill people and saturate hospitals.

Still be around and kill people? Sure, but that's true of the seasonal flu, and even the common cold in rare cases. Saturate hospitals? No.

> Still be around and kill people? Sure, but that's true of the seasonal flu,

I wish people would stop comparing it to the flu, it's highly misleading.

1. With restrictions in place covid killed more.

2. One in ten people still experience illness 12 weeks after the infection. Covid gets into the nervous system by crossing the neural-mucosal interface. Way more people that wouldn't have ended up in hospitals with a flu do ended up in hospitals with Covid. Even with vaccines. Long covid is no joke. Etc.

> and even the common cold in rare cases. Saturate hospitals? No.

Hopium and wishful thinking.

According to a UC study last summer, there hasn't been an abnormal number of people leaving California. https://www.universityofcalifornia.edu/press-room/uc-studies...

"Despite California losing a congressional seat for the first time in history due to slow population growth and some high-profile technology companies and billionaires leaving the state, there is no evidence of an abnormal increase in residents planning to move out of the state"

Recently released (days ago) US census data disagrees. Only New York had higher outmigration in absolute numbers than California.

California would be expected to have the largest outmigration given that it has the largest population.

It’s an outlier even on a percentage change basis. One of only a handful of states losing over 0.5% of residents since the pandemic started.

The “bottom five” for percentage change is, in order… DC, NY, Illinois, Hawaii, California.

"Better than New York" is damning with faint praise.

The primary concern form day one has been the capacity of our healthcare systems. "Peak pandemic mortality" includes scores of people dying from unrelated illness due to lack of care. Does anyone truly think its acceptable to let people die in ambulances outside of hospitals because a highly contagious disease filled all the hospital beds and medical staff is too fatigued to work? Maybe people with a political axe to grind pretend to think that.

I think the real problem is that in most countries the healthcare system was "optimized" to such extent that even seasonal flu was almost clogging it every year. And now SURPRISE, any disease, even a tad bit more deadly and contagious than the seasonal flu would make it collapse. TOTALLY UNEXPECTED.

As always, the standard gimmick of neoliberalism is to pin the blame for the collateral damage of its policies on the relatively powerless people who refuse its self-serving "solutions."

We've banned this account for using HN primarily for ideological battle. It also appears to be a single-purpose account, which goes against the intended spirit the site (curiosity), and therefore is not allowed here.

Would you please not create accounts to break HN's rules with? If you don't want to be banned on HN, you can email us at [email protected] and give us reason to believe that you'll use the site as intended in the future.

https://news.ycombinator.com/newsguidelines.html

Which non-“neoliberal” (whatever that means) country had plenty excess hospital capacity to handle peak Covid case counts?

Cuba?

No, lots of people do actually think that, but we believe that three main methods can be employed to mitigate this:

1. aggressive triage based on chances and QALY remaining

2. increased healthcare funding

3. voluntary isolation of individuals who see lockdown as being preferable to their personal coronavirus risk

Will it result in more deaths than February 2020? Sure. But we don't have that choice because sars2 exists now.

We think it's better to ration healthcare and therefore doom an unlucky minority, versus rationing life itself for everyone (via lockdowns and restrictions) and slow killing everyone.

As far as I can tell, most of the lockdown debate centres around an erroneous idea that we can just do X, Y, Z, and then immunosuppressed Harriet can rejoin the world and avoid contracting coronavirus.

But she just can't. Even the original strain would have eventually infected her with high probability unless we continued to cycle lockdowns or she voluntarily isolated.

From examining Swedish death spike data, you can see that viruses like COVID occur about once a decade, the last being Swine Flu in 2009:

https://swprs.org/wp-content/uploads/2020/10/sweden-monthly-...

Its just that, using Swedish data again, Western societies are significantly more aged: eg. there 120,000 80-84 year old men (prime COVID death territory) in 2020, vs only 101,000 in 2009. Its similar in many other Western countries: about 20% more elderly people, in absolute numbers.

As such, the 'same' types of respiratory viruses will simply kill more people.

The decisions is thus a social and political one: do we lockdown and force 6-monthly vaccinations on everyone, based on elderly deaths that will occur anyway simply due to the baby boomer cohort entering their twilight years?

I think we need to just get more efficient at end-of-life care, focusing on simpler treatments and comfort, as well as euthanasia-on-demand for anyone over age 75.

I think taking a shot every six month is totally worth it if that will let your grandma live two years longer.

IMO casual masking (stores, airplanes, etc) and a shot every 6 months isn't the annoying part about covid, it's the economic damage of lockdowns, school closures, social gatherings missed, extreme isolation of the vulnerable, travel not happening and the supply chain logjams it has been creating everywhere as a result. You can't go to an office consistently and have face to face lunches coworkers with as a result.

"Our vaccines are working exceptionally well. They continue to work well for Delta with regard to severe illness and death - they prevent it, but what they can't do anymore is prevent transmission."

CDC Director Rochelle Walensky

It would seem fairly important to actually ask the grandmas what they think about this, rather than decide on their behalf.

The four elderly members of our immediate family are all fairly adamant that the young have suffered enough, and "hell, yes" they want to see their grandkids, and no, they aren't asking about vaccinations and negative tests.

I'm minded to respect their opinions.

Yes, and we don't ask them either if they'd feel better if we took them, we just do it for them, it's understood.

I agree. However, the currently existing vaccines don’t seem to do anything at all to stop the spread, so your biannual vaccination does not help grandma much.

How are you estimating what the spread would have been in the absence of vaccination to draw that conclusion?

I'm afraid you have no more relevant knowledge in the subject then I do, which means your claims shouldn't be considered as an authoritative in any way, despite being stated as such. I'm out of here.

"U.S. COVID-19 Deaths in 2021 Surpass 2020 Total"

https://www.webmd.com/lung/news/20211122/us-covid-deaths-202...

> Does anyone truly think its acceptable to let people die in ambulances outside of hospitals because a highly contagious disease filled all the hospital beds and medical staff is too fatigued to work? Maybe people with a political axe to grind pretend to think that.

Given widespread availability of vaccines, I think it is acceptable to turn away any non vaccinated people without medical exemptions to preserve hospital capacity.

In the US, hospitals aren't legally allowed to turn away non vaccinated people due to EMTALA. Also note that there is no 100% reliable way for hospitals to determine a particular patient's vaccination status.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMT...

Regardless of the legality of turning people away the commenter you’re responding to sounds pretty heartless.

Yep. We really need to stop this "us versus them" mentality. This looks like a war between the vaccinated and the unvaccinated, while the "people above" are doing their own greedy thing and laughing at us fighting each other.

I wish I could tell people that:

The vaccine does not prevent transmission as much as you think it does.

You do not spread as easily as you think you do, and you can personally attempt to reduce it even further.

You are vaccinated, and if it is indeed effective and you believe in it, you should not be worried much.

The unvaccinated are people too who probably do not have any malicious intent, and most likely pose little, or no risk to you.

Merry Christmas!

Will it be you turning these people away?

Always puzzles me to see people suggesting all these “just let them die” silver bullet algorithms.

It wouldn't be explicit turning away, but if your in a triage situation, most doctors and medical systems will focus on the most time serious and the people they are most able to save if they have limited capacity. And if your not vaccinated, the ability to save you will be less than the vaccinated and the people with other acute medical issues that are not COVID. That is what will happen in practice in such a regime.

> And if your not vaccinated, the ability to save you will be less than the vaccinated

Is there any evidence that this is true at the point of presenting with equal acute symptoms? Sure, your symptoms are likely to be less acute if you are vaccinated, but that's not the issue, the issue is response to treatment given similar symptoms.

Would you also be of the opinion that, due to the widespread availability of healthy food options and Richard Simmons exercise videos it's acceptable to turn away the overweight to preserve hospital capacity?

That's not how healthcare works, besides that it puts the rest of the population at risk. This isn't the best comment in this thread by a long shot.

> Given widespread availability of vaccines, I think it is acceptable to turn away any non vaccinated people without medical exemptions to preserve hospital capacity.

Person A is "fully vaccinated", last dose five months ago, hasn't taken a Covid test since.

Person B is unvaccinated, but had a PCR test yesterday and is negative for Covid19.

Let's say you're clinically vulnerable, which of A or B would you rather sit next to during a meal?

When you say "unvaccinated" here are you using the currently-accepted official definition which includes people that have received a COVID-19 EUA vaccination/booster within the last 14 days? Do you think that this would be likely to make people that were were concerned about side-effects from the vaccines more or less likely to get vaccinated?

> The primary concern from day one has been the capacity of our healthcare systems.

This is clearly not the case for the vast swaths of our public health institutions who have supported and eagerly carried out mass terminations of healthcare workers who refuse the Covid vaccines.

Capacity of healthcare systems shouldn’t be the primary concern, preventative immune defense and avoiding hospitalization in the first place should be.

> what level of risk and mortality are we prepared to accept

IMO, the rational answer to this question is 'the same risk and mortality that we have already accepted from influenza.' There is a lot of variability there, of course, but it is way above zero in any case.

That would seem to make sense if covid displaced flu entirely. But flu + equivalently harmful covid is twice as bad as historical flu.

Influenza B is thought to have been made extinct recently due to the pressures introduced by SARS-CoV-2

https://www.webmd.com/lung/news/20211025/covid-pandemic-may-...

Wow, webmd made it really hard to find the primary source for that.

To be clear, they are attributing this drop off of this flu strain to be likely due to pandemic mitigation efforts, as well as maybe lucky timing and some specifics of how this strain spreads

Since it doesn’t seem plausible to repeat the wide scale pandemic mitigation controls any time soon, I doubt we can keep wiping out flu strains, but we could certainly reduce the damage the flu does if we want to

https://www.nature.com/articles/s41579-021-00642-4

Double the normal flu rate would be just 20% of what we're seeing this year from covid.

I don't think this is quite right. The risk from COVID is in addition to the risk from influenza, and much of the mitigation affects both. Changes like common mask wearing may not have been considered 'worth it' for only lessening mortality and the economic costs of influenza, but the economic benefits alone of reduced productivity due to influenza and COVID combined may mean it is the obvious choice now for governments and businesses to push mask wearing everywhere they can. Similar for vaccination when your yearly flu jab becomes a yearly flu + COVID jab.

I am not convinced. Influenza has a pretty wide range, typically 12-52K a year (in the US). Doubling that top number would put it about 20% of the covid deaths we are seeing in 2021. Both diseases disproportionately punish people who are the least productive members of society (based on age alone); I don't think businesses are going to be volunteering to enforce mask mandates themselves. And the government is already showing considerably less enthusiasm than a year ago. Citizens are tiring of the masks, as evidenced by the waning compliance rate.

Vaccines, on the other hand, seem promising. Though the effective mutation rate seems quite a lot lower than influenza and there are good reasons to believe that the covid boosters will be considerably more durable than the original shots. If it really did come down to getting a booster every year, though, I think a lot of people would be okay with that if it meant no more attempts at lockdowns and mask mandates.

There's more to life than economic benefits. I'm certainly not willing to spend the rest of my life wearing a mask, regardless of what governments say.

And from my point of view as someone in the field, arguments on either side are almost always based on an intuitive gut feeling about morality.

Very few people actually try to wrangle with putting numbers on the cost (in dollars) of a human life, or the economic burden of disease. There are no right or wrong numbers, but only if you begin there can you say you're rationally considering the economic or political tradeoffs.

Edit: and deaths could absolutely reach zero. If we threw everything and the kitchen sink at the problem, we would eradicate it in absolutely no time. The underlying question is the same here, namely whether the cost of eradicating the disease would be larger or smaller than what we would gain from doing it.

I think you overestimate our ability to “eradicate it in absolutely no time”. Eliminating it from both human and animal reservoirs (and permanently quarantining any immunocompromised carriers) worldwide would be a long and arduous process.

You make a great point about animal reservoirs, but the transmission bandwidth between humans and animals is afaik much lower than between humans. If you accept this assumption, and if we also assume that we really wanted to eradicate this thing, we could limit human transmission such as to reduce Rt well below 1 by implementing well-coordinated and strict policies.

Then you're left with the "leaky bucket" of transmission between humans and animals... But this is a known vulnerable point which could be monitored effectively and very cheaply.

Here in Canada, we've been trying to eradicate rabies from the wild for half a century or so now. There are orally-active rabies vaccines we litter the landscape with in edible treat format. We cull rabid animals and quarantine or cull their known animal contacts. It's common knowledge that exposure to possible vectors means you need to go to the hospital. Tens of thousands of people are treated preventatively each year.

Despite all this, human cases of rabies still happen. Fortunately it's rather hard to spread rabies between humans and it's symptomatic by the time it becomes infectious. In the case of an easily airborne virus even with such measures available like vaccination and prophylaxis for possible exposure, it seems daunting to the point of impossible even in a very wealthy country. In the developing world it would be certainly hopeless.

Yeah, eradication of a disease in the wild is a whole other matter. But so rabies also is another matter. Cases are relatively rare here (hello, fellow Canadian!), and surveillance is relatively good for the little burden of disease it brings.

https://www.canada.ca/en/public-health/services/diseases/rab...

Genetic surveillance is just around the corner, and will soon be / is now within reach even of developing countries, with solutions like Oxford Nanopore's ultra-portable sequencers.

https://www.youtube.com/watch?v=6RRSxWtJPUw

This is completely unrealistic. Effective continuous monitoring for animal to human transmission would never be cheap. In much of the developing world it's not even remotely feasible. Have you ever been to places like rural Mexico?

The virus is here to stay. Eradication is a total fantasy, just a distraction and waste of time.

Depending upon the specific agency, agencies in the USA value a statistical life at anywhere from $7-$10 million.

As a Canadian, I usually use the US DoT numbers (in the same ballpark as what you said) for my mental maths. A couple extra things to consider:

- what’s the date on these figures?

- can we extrapolate this to other countries?

- are these figures generally accepted, or are they controversial?

- how do you account for age, sex (differences in life expectancy, child bearing capacity, etc), education level or professional skill, etc?

Ironically enough, I think the data set comes from lawsuits that determine all of those conditions. A surgeon for example with all of their future surgeon income ruined by a bad car accident + medical care can be around $30 million, while someone who is relatively old with no chances of future income + medical care would typically get less AFAIK. It probably averages out to that $7-10 million figure.

I agree that in most countries this is the underlying disagreement. I wonder if we thought this through at a global community though.

Imagine if China didn’t or couldn’t pursue a zero covid policy. What happens when the world’s manufacturer closes? We’ve already seen huge supply chain issues.

It's not the case that they would need to close.

Across the Western world the vast majority of the economic and social issues have been caused by legalities rather than pandemic reality.

For example, for better or worse, if the 10 day isolation and testing regime did not exist in the UK then staff shortages would not either. People aren't actually getting ill en masse - we've just recalibrated what ill means.

> staff shortages would not either

That's just hilarious.

There are so many reasons for staff shortages in the UK right now. Covid isn't even the main one.