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The biggest thing I've been trying to get friends to understand (from 2 weeks ago on the we have to shut things down train, and now on the opposite "look not in

The biggest thing I've been trying to get friends to understand (from 2 weeks ago on the we have to shut things down train, and now on the opposite "look not interacting with any other human being for 2 months might not be the best course of action train") is the non-linearity of how infection rate responds to decreasing the amount of social contacts. ie; in most models you can get about a 50% gain with just a 25% reduction in social contact, after that it is diminishing returns all the way down to the bottom of trying to wring small population level effects out of reducing contacts from "very little to very very little" In my mind, people are still underestimating the effects of large gatherings (and by large here I even mean 100 people in a nightclub) and overestimating the effects of seeing one friend in your house that sees another one friend the next day etc. Don't want to get into an overall debate here about what level of distancing is appropriate or acceptable, would like to see an interactive model that does a good job showing how different types of distancing interventions have very different effects and that once you get to a certain point it gets very hard to get much more overall connection out of the system...

listsfrin 7y ago
There is official health institute report from Italy: https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho... This is just a panic created on social media.
- llamataboot 7y ago
  maybe examine the prevalence of all those conditions in the US?
  - runin2k1 7y ago
    "More than 99% of Italy’s coronavirus fatalities were people who suffered from previous medical conditions" What were the most common pre-existing conditions? "More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease." How common are those conditions in the United States? High Blood Pressure - 1 in 3 Diabetes - 9 in 100 Heart Disease - 1 in 10
    - listsfrin 7y ago
      When I studied medicine 15 years ago 130-139 mm Hg was not considered high blood pressure. We were young students and we were toying everyday measuring our blood pressure. Most males had over 130. It seems times are changing: https://www.cdc.gov/bloodpressure/facts.htm https://www.cdc.gov/bloodpressure/facts.htm We have "evolved"!
      - runin2k1 7y ago
        Your initial proposal was that most of the Covid related deaths were due underlying conditions. Now you propose that the underlying condition most present isn't really a condition.
        listsfrin 7y ago
        You made me curios about it so I did a quick internet search for what is considered high blood pressure in Italy. I found https://www.epicentro.iss.it/ben/2002/settembre02/2_en https://www.epicentro.iss.it/ben/2002/settembre02/2_en (the same health institute that provided the study I was talking about above). I quote: "The prevalence of borderline hypertension was calculated by determining the number of persons who had systolic pressures between 140 and 160 mm Hg or who had diastolic pressures between 90 and 95 mm Hg." This is more inline with what I've been thought in med school in my time.
    - s1artibartfast 7y ago
      I would be careful not to confuse correlation with causation here. Most old people have medical conditions. For example, about 75% of older people have high blood pressure [1] so seeing a 75% rate in the virus fatalities should not mean much. I suspect age and immune function drive mortality, and the other factors are merely along for the ride. [1] https://www.uptodate.com/contents/treatment-of-hypertension-in-older-adults-particularly-isolated-systolic-hypertension https://www.uptodate.com/contents/treatment-of-hypertension-...
- notenoughhorses 7y ago
  "More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease." I feel like a huge number of Americans have high blood pressure and heart disease. Seems like it will still be very serious for a large number of people.
- chimprich 7y ago
  > This is just a panic created on social media. Don't be ridiculous. You can discuss the distribution of deaths, but the deaths are real. A 2% death rate is still 2%. That's huge. It still has the potential to overwhelm any country's health system.
  - listsfrin 7y ago
    The deaths were always real. Putting the whole planet on hold because some 80 years old with three associated illnesses died is a bit borderline SF and a bit borderline stupid.
    - jansan 7y ago
      Quote from the movie The Big Short: "Every 1 percent unemployment goes up, 40,000 people die, did you know that?". That is probably an exaggeration, but I really hope people in power know what they are doing at the moment.
    - deelowe 7y ago
      It's not going to be 80 year olds dying if the hospitals are overwhelmed. 40% of people in ICU in italy are 19-40, basically, those who make up the majority of the workforce.
      - jansan 7y ago
        I highly doubt that number. Do you have a reliable source for that?
        chimprich 7y ago
        It looks startling, but could be true. Reportedly, the health workers in Italy had to do some fairly brutal prioritisation in triage. If you have a lot more patients requiring ICU than you have stations, you end up with a high proportion of younger patients in ICU even if they are a low proportion overall.
- elhudy 7y ago
  >705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care. That's not a shocking number to you? 15% - 20% of people aged 20-44 ended up hospitalized? Even if no deaths were involved, that many young people ending up in the hospital is concerning.
  - k1t 7y ago
    It really comes back to the testing. There could be a million people 20-44 who didn't get tested and didn't need to visit a hospital. If you only test people who arrive at a hospital with serious symptoms, it's not surprising that many of them go on to be admitted.
nbnoll 7y ago
I agree that having a more "realistic" model that simulates people's social interactions is important, especially as we look to predicting longer term effects. This is something that is on the long-term roadmap for our model here, although as of now its on the back-burner while we deal with more immediate concerns like hospital allocation.
- llamataboot 7y ago
  yeah, it's hard to get to that out of a stock/flow differential model (that's what this is under the hood right?) but if we had some sense of effect of different measures on R we could at least build in different "presets" thanks for your work here! wasn't meaning to disparage it, just calling out a lack of anything clear I could offer friends to help that understand that point...
  - nbnoll 7y ago
    Yes, under the hood its a coupled set of ODEs with the ability to be stochastically sampled. But this means the entire susceptible population can interact with the entire infected population every time step w/ some small probability -- hence no structure. And no worries, not offense taken!
Leary 7y ago
Nassim Nicholas Taleb discussed how superspreaders have a big effect[1] [1]: https://www.youtube.com/watch?v=LX_bqMQfWlw https://www.youtube.com/watch?v=LX_bqMQfWlw
ouid 7y ago
I think japan has shown us one thing. The absolutely dominant effect of closing schools. 1-5000 people in close proximity with high levels of social mixing and a very low rate of symptomatic infection. It's absolutely perfect for incubating the virus.
- elhudy 7y ago
  The tough part being: our teachers are already vastly underpaid.
  - swiley 7y ago
    Except they can work from home, and now that they’re actually required to their commute cost is way cheaper.
    - elhudy 7y ago
      Some teachers CAN work from home (not PE, Home-Econ teachers, etc.), but it's a less-than-ideal situation. Are children self-motivated enough to work from home? I know many adults who aren't. Without adults to keep children accountable a total work-from-home schooling is likely to create gaps in the kid's education. And which type of child is the least likely to have an adult around keeping them accountable? Impoverished children.
      - swiley 7y ago
        A counter argument is that keeping kids physically proximate often exposes them to violence which makes school a lot harder and tends to really mess people up. Lots of modern jobs worth doing will end up remote (at least occasionally and often permanently) so it’s probably a good idea to start training them when they’re younger anyway.
  - s1artibartfast 7y ago
    Luckily, every teacher I know is still being paid. Even those who are completely off and don't have to teach virtual classes.
qznc 7y ago
The Washington Post has a nice visualization. Not aiming at realism but easy to understand: https://www.washingtonpost.com/graphics/2020/world/corona-simulator/ https://www.washingtonpost.com/graphics/2020/world/corona-si...
s1artibartfast 7y ago
Do you have a source that you could share on the topic? I have been trying to inform myself and balance my behavior and think it would be very helpful.

listsfrin 7y ago

There is official health institute report from Italy: https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says https://www.bloomberg.com/news/articles/2020-03-18/99-of-tho... This is just a panic created on social media.

llamataboot 7y ago
maybe examine the prevalence of all those conditions in the US?
- runin2k1 7y ago
  "More than 99% of Italy’s coronavirus fatalities were people who suffered from previous medical conditions" What were the most common pre-existing conditions? "More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease." How common are those conditions in the United States? High Blood Pressure - 1 in 3 Diabetes - 9 in 100 Heart Disease - 1 in 10
  - listsfrin 7y ago
    When I studied medicine 15 years ago 130-139 mm Hg was not considered high blood pressure. We were young students and we were toying everyday measuring our blood pressure. Most males had over 130. It seems times are changing: https://www.cdc.gov/bloodpressure/facts.htm https://www.cdc.gov/bloodpressure/facts.htm We have "evolved"!
    - runin2k1 7y ago
      Your initial proposal was that most of the Covid related deaths were due underlying conditions. Now you propose that the underlying condition most present isn't really a condition.
      - listsfrin 7y ago
        You made me curios about it so I did a quick internet search for what is considered high blood pressure in Italy. I found https://www.epicentro.iss.it/ben/2002/settembre02/2_en https://www.epicentro.iss.it/ben/2002/settembre02/2_en (the same health institute that provided the study I was talking about above). I quote: "The prevalence of borderline hypertension was calculated by determining the number of persons who had systolic pressures between 140 and 160 mm Hg or who had diastolic pressures between 90 and 95 mm Hg." This is more inline with what I've been thought in med school in my time.
  - s1artibartfast 7y ago
    I would be careful not to confuse correlation with causation here. Most old people have medical conditions. For example, about 75% of older people have high blood pressure [1] so seeing a 75% rate in the virus fatalities should not mean much. I suspect age and immune function drive mortality, and the other factors are merely along for the ride. [1] https://www.uptodate.com/contents/treatment-of-hypertension-in-older-adults-particularly-isolated-systolic-hypertension https://www.uptodate.com/contents/treatment-of-hypertension-...
notenoughhorses 7y ago
"More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease." I feel like a huge number of Americans have high blood pressure and heart disease. Seems like it will still be very serious for a large number of people.
chimprich 7y ago
> This is just a panic created on social media. Don't be ridiculous. You can discuss the distribution of deaths, but the deaths are real. A 2% death rate is still 2%. That's huge. It still has the potential to overwhelm any country's health system.
- listsfrin 7y ago
  The deaths were always real. Putting the whole planet on hold because some 80 years old with three associated illnesses died is a bit borderline SF and a bit borderline stupid.
  - jansan 7y ago
    Quote from the movie The Big Short: "Every 1 percent unemployment goes up, 40,000 people die, did you know that?". That is probably an exaggeration, but I really hope people in power know what they are doing at the moment.
  - deelowe 7y ago
    It's not going to be 80 year olds dying if the hospitals are overwhelmed. 40% of people in ICU in italy are 19-40, basically, those who make up the majority of the workforce.
    - jansan 7y ago
      I highly doubt that number. Do you have a reliable source for that?
      - chimprich 7y ago
        It looks startling, but could be true. Reportedly, the health workers in Italy had to do some fairly brutal prioritisation in triage. If you have a lot more patients requiring ICU than you have stations, you end up with a high proportion of younger patients in ICU even if they are a low proportion overall.
elhudy 7y ago
>705 were aged 20 to 44, according to the Centers for Disease Control and Prevention. Between 15% and 20% eventually ended up in the hospital, including as many as 4% who needed intensive care. That's not a shocking number to you? 15% - 20% of people aged 20-44 ended up hospitalized? Even if no deaths were involved, that many young people ending up in the hospital is concerning.
- k1t 7y ago
  It really comes back to the testing. There could be a million people 20-44 who didn't get tested and didn't need to visit a hospital. If you only test people who arrive at a hospital with serious symptoms, it's not surprising that many of them go on to be admitted.

nbnoll 7y ago

I agree that having a more "realistic" model that simulates people's social interactions is important, especially as we look to predicting longer term effects. This is something that is on the long-term roadmap for our model here, although as of now its on the back-burner while we deal with more immediate concerns like hospital allocation.

llamataboot 7y ago
yeah, it's hard to get to that out of a stock/flow differential model (that's what this is under the hood right?) but if we had some sense of effect of different measures on R we could at least build in different "presets" thanks for your work here! wasn't meaning to disparage it, just calling out a lack of anything clear I could offer friends to help that understand that point...
- nbnoll 7y ago
  Yes, under the hood its a coupled set of ODEs with the ability to be stochastically sampled. But this means the entire susceptible population can interact with the entire infected population every time step w/ some small probability -- hence no structure. And no worries, not offense taken!

Leary 7y ago

Nassim Nicholas Taleb discussed how superspreaders have a big effect[1] [1]: https://www.youtube.com/watch?v=LX_bqMQfWlw https://www.youtube.com/watch?v=LX_bqMQfWlw

ouid 7y ago

I think japan has shown us one thing. The absolutely dominant effect of closing schools. 1-5000 people in close proximity with high levels of social mixing and a very low rate of symptomatic infection. It's absolutely perfect for incubating the virus.

elhudy 7y ago
The tough part being: our teachers are already vastly underpaid.
- swiley 7y ago
  Except they can work from home, and now that they’re actually required to their commute cost is way cheaper.
  - elhudy 7y ago
    Some teachers CAN work from home (not PE, Home-Econ teachers, etc.), but it's a less-than-ideal situation. Are children self-motivated enough to work from home? I know many adults who aren't. Without adults to keep children accountable a total work-from-home schooling is likely to create gaps in the kid's education. And which type of child is the least likely to have an adult around keeping them accountable? Impoverished children.
    - swiley 7y ago
      A counter argument is that keeping kids physically proximate often exposes them to violence which makes school a lot harder and tends to really mess people up. Lots of modern jobs worth doing will end up remote (at least occasionally and often permanently) so it’s probably a good idea to start training them when they’re younger anyway.
- s1artibartfast 7y ago
  Luckily, every teacher I know is still being paid. Even those who are completely off and don't have to teach virtual classes.

qznc 7y ago

The Washington Post has a nice visualization. Not aiming at realism but easy to understand: https://www.washingtonpost.com/graphics/2020/world/corona-simulator/ https://www.washingtonpost.com/graphics/2020/world/corona-si...

s1artibartfast 7y ago

Do you have a source that you could share on the topic? I have been trying to inform myself and balance my behavior and think it would be very helpful.