6 ms·

If we are lucky, and there is a miracle, the mortality rate will be < 0.2%. Even more of a miracle and the R0 is ~6 and most people are asymptomatic. However,

If we are lucky, and there is a miracle, the mortality rate will be < 0.2%. Even more of a miracle and the R0 is ~6 and most people are asymptomatic. However, we could still be on course for a second wave, like 1919, then we are totally fucked. But we don't know, and really didn't know when europe went into lockdown. It looked like the mortality was ~7% which would have been devastating. I have yet to see any double blind study that suggests _any_ drug makes an impact. Barring vitamin D, but thats a metastudy, and also its too late for most people (you need a month.) In short, he asking us to make a massive gamble. Yes, the poor are suffering, but helicoptering money is a piece of piss compared to re-building a community. if the US had decent unemployment insurance, like germany, then unemployment would be 10% of what it is now.

cm2187 7y ago
We might be lucky to have a low mortality rate but why does it require a miracle? All new evidence seems to suggest a <0.5% fatility rate and a large number of infected people with mild or no symptoms.
- ericmay 7y ago
  I think initial concerns were the mortality rate would be much, much higher without the sometimes draconian shelter in place measures. It may be lower now because we are able to devote more intense resources (ventilators) to those who are sick. Burry seems to overlook that without implementing social distancing policies we may have had a huge surge in sick people all at once, which would have left many without access to potentially life saving equipment. Cases where a ventilator or other resources save someone and lower the overall mortality rate would have resulted in more deaths because you’ve simply got far too many sick people. With that being said, I’m sympathetic toward the concerns about the economic cost, and think that we need to really focus on a reopen plan in May or June. Workers who can WFH should probably continue to do so, but if we’ve been able to flatten the curve it’s probably time to go back outside and see what happens. I’ll also say with respect to Burry that although he is a trained physician, it doesn’t make him an expert in epidemiology, so, frankly, I don’t really care for his opinion on the subject any more than anyone else who is moderately educated.
  - cm2187 7y ago
    I agree directionally, but the numbers matter as well. Depending on what study we look at, the survival rate of covid19 patients that require a ventilator is anywhere between 0% and 50%. For the sake of argument let’s assume the other patients can be treated in field hospitals that scale reasonably well, it means running out of ventilators would “only” double the mortality rate. But double a rate that is <0.5% may still be <0.5%.
  - travisoneill1 7y ago
    Only 1/3 of people with COVID who require ventilation survive, so lack of ventilators will raise mortality, but only by 50%.
    - DanBC 7y ago
      Ventilators are also used by people who don't have covid-19, so lack of access to ICU is going to affect more than just covid-19 patients.
      - cm2187 7y ago
        Fine. Assume all ventilators used for non covid19 patients. The maths stay the same.
        DanBC 7y ago
        You haven't counted length of stay before death or transfer to a different ward (covid-19 patients stay in ICU longer before they die or recover), nor iatrogenic harm caused by non-intensivist doctors and nurses suddenly being pulled into ICU work.
  - amalter 7y ago
    Additionally, COVID-19 is a new disease and we have no data about the long term effects. This is true anecdotal, but I’m following a cohort of 5 MD friends who all experienced “walking COVID” (aka reached the loss of smell symptom, but required no hospitalization). This cohort is 35-45 and all previously highly athletic. They are between +20 and +45 days from being “symptom free”. Not one of them can perform cardiac challenged activities. I’ve heard things like “I get winded carrying groceries up the stairs” to “I cannot perform even a single push-up”. So before we take this big risk of letting the virus “burn” through the population, shouldn’t we understand just a bit more? Sure, maybe we’ll get lucky and the IFR will just be 2-10x flu. But there are worrying signs of permanent heart, lung and kidney damage. These costs will also stay with us long term. Mortality isn’t the concern when dealing with an unknown virus.
- flohofwoe 7y ago
  As far as I understand it, fatality rate is only low as this as long as the health care system isn't overwhelmed, so that people in serious conditions can be treated (and the number of serious cases is a lot higher than 0.5%). As soon as hospitals are at their capacity, a lot more people will die which otherwise had survived (and this will also affect people which are in critical conditions for entirely different reasons).
  - rumanator 7y ago
    This. I don't understand how the whole point of flattening the curve was already forgotten. The whole point of the lockdown is not to act as a magic wand to make the pandemic vanish. The whole point is that, as it stands, emergency services are already operating beyond capacity. This means that your friends and loved ones risk needlessly dying for no reason just because they weren't able to have medical treatment, including from non-covid19 issues.
    - gremlinsinc 7y ago
      Also, if you're high risk (I may be - obesity) this is a scary disease, and honestly the longer you wait to get infected the better your chances. More local medical doctors will have experience treating it, there will be more studies on drugs, more help available etc. Your chances go up astronomically on a long enough time scale. So why rush it? I have the luxury of being a freelancer working from home, so this is mostly my normal, but I know it hurts a lot of people, but so does being dead - or having lung issues for life or neurological ones. Some broadway actor lost his leg over the weekend because of this. TLDR; It definitely helps w/ hospitals so they can still function it also gives time to find and create better treatments.
  - bob33212 7y ago
    We don't know yet how much of a difference that makes. For example how many infected 80 year olds without medical treatment die compared to those that do get medical treatment. Medical treatment is certainly going to have a better mortality rate but not 100%.
- kgwgk 7y ago
  Where do you get that <0.5% fatality rate from? It seems to have caused already the death of between 0.1% (lab-confirmed) and 0.2% (excess deaths) of the population of NYC.
  - cm2187 7y ago
    Now that we start doing anti-body tests, there seems to be multiple studies surfacing all pointing to a much higher than anticipated number of people infected. A few sources pointing in that direction: https://mobile.twitter.com/AmeshAA/status/1249446561010106370 https://mobile.twitter.com/AmeshAA/status/124944656101010637... https://mobile.twitter.com/AmeshAA/status/1249020677551796224 https://mobile.twitter.com/AmeshAA/status/124902067755179622... https://www.youtube.com/watch?v=_LG-so-8qwg https://www.youtube.com/watch?v=_LG-so-8qwg
    - kgwgk 7y ago
      What would you say that the number of infected people in NYC may be? If 20% of them are infected, the infection fatality rate observed is already in the 0.5%-1% range.
      - cm2187 7y ago
        I did that calculation for a similar objection a few days ago: https://news.ycombinator.com/item?id=22881103 https://news.ycombinator.com/item?id=22881103
        kgwgk 7y ago
        Ok. If we take the observed data (0.15% mortality rate in the overall population) we can make hypothesis like “infection rate is 30%” and “infection fatality rate is 0.5%”. But being consistent and plausible doesn’t make them true. 15% and 1% are also plausible, as far as I know.
bob33212 7y ago
It is a similar situation to hurricane evacuations. A forced evacuation will save lives, but forced evacuations that turn out to be a false alarm because the storm changed direction causes people to ignore future evacuations leading to more deaths. There is no right answer
- gremlinsinc 7y ago
  Look at NYC. They've been on lockdown weeks. The first responders and hospitals are STILL fighting a losing battle. Imagine if we weren't on lockdown and there were a ton of other emergencies like car crashes, accidental impalement, etc... a lot of non-covid emergencies are probably still happening, but we'd probably triple or quadruple the load on an already stressed hospital system. It'd be disastrous. The proof is right there in NYC. Now they're - their own thing. Not sure this would play out in most other cities being smaller than NYC, but if Italy has any bearing - Bergamo ran out of burial plots in the cemetary and had to start stacking bodies in churches like it's the 1420's. The right answer is caution > mass destruction. Another good case study is comparing the sweden to switzerland or denmark. I don't have high hopes in a vaccine before at least 2-3 years since the fastest vaccine ever took 5 years, but drugs to mitigate symptoms and outcomes -- the longer we slow it, the more lives saved when we do have a good treatment. HIV doesn't have a vaccine, but it does have decent treatment options now, I think covid will be easier to find good treatments but we just need time for all the studies to bear fruit.
JackFr 7y ago
> if the US had decent unemployment insurance, like germany, then unemployment would be 10% of what it is now. I’m not sure I understand how better UI reduces unemployment. But more importantly unemployment only captures half the problem. Businesses are not designed to go into hibernation. If asked you to hold your breath for two hours, it’s gonna be tough for you to start breathing again when I give the all clear.
- boudin 7y ago
  All those are man made problem and have solution. Our system is not designed to be paused, but can be changed to do so. To pause the spread of a virus is much harder.
  - okr 7y ago
    Do you have an idea on how to implement a pause function into the economy? We live with the flue, but actually a pause could help there too to stop the spread in the season. Who pushes the pause button? How do the businesses agree on pushing their pause button at the same time? Should there be a pausing fund? Paid in by all businesses that make business overseas? I find this interesting. Reminds me a little bit on traffic jams. If cars were automated, all cars could start/stop at the same time.
    - rswail 7y ago
      We have a pause function, it is when governments issue public health and safety orders. The people that push the pause button are elected governments, There is a pausing fund, it is taxes and government borrowing through the national debt.
      - okr 7y ago
        I agree. But did not consider it as a solution. :)
    - boudin 7y ago
      I don't have the magical answer, but there's some elements in place to allow companies to stop their activities for a short amount of time (like furlough with a pay, like it's done in some countries, not sure how it works in the USA). Looking at how beneficial reducing trade and manufacturing has been for the environment, i can't help but think that we need to be able to take the same kind of action we've been taking for COVID-19 to address the other big challenges we're facing.
cmiles74 7y ago
I disagree that he's asking people to take a big gamble. While it seems unrealistic to me, Dr. Burry made a point of tying his recommendation to widespread, rapid testing and contact tracing. If these things were in place, I do think letting people that aren't in the most vulnerable population groups out and about might be reasonable. "A more nuanced approach would be for at risk groups — the obese, old and already-sick — to shelter in place, to execute widespread mandatory testing, and to ID and track as necessary while allowing society to function. Again, Trump should get the massive contract manufacturers like Flextronics to make testing machines." That said, we are still having problems getting the tests out and people are still complaining that it will take days to get results back. I personally know a pharmacist with an at-risk child who can't get a test as of last week. So this seems like wishful thinking to me. https://www.theatlantic.com/health/archive/2020/03/next-covid-19-testing-crisis/609193/ https://www.theatlantic.com/health/archive/2020/03/next-covi...
- xtiansimon 7y ago
  I think you missed this gem: > "Vaccines are not coming anytime soon, so natural immunity is the only way out for now."
gremlinsinc 7y ago
I've got vitamin D deficiency (gastric sleeve surgery)... usually forget my supplement. Been taking it religiously for a month... hope that helps if I get it (obese + sleep apnea + 40 are my only co-morbidities -that and I do get bronchitis a lot had it earlier in the spring from nasal drip.)

cm2187 7y ago

We might be lucky to have a low mortality rate but why does it require a miracle? All new evidence seems to suggest a <0.5% fatility rate and a large number of infected people with mild or no symptoms.

ericmay 7y ago
I think initial concerns were the mortality rate would be much, much higher without the sometimes draconian shelter in place measures. It may be lower now because we are able to devote more intense resources (ventilators) to those who are sick. Burry seems to overlook that without implementing social distancing policies we may have had a huge surge in sick people all at once, which would have left many without access to potentially life saving equipment. Cases where a ventilator or other resources save someone and lower the overall mortality rate would have resulted in more deaths because you’ve simply got far too many sick people. With that being said, I’m sympathetic toward the concerns about the economic cost, and think that we need to really focus on a reopen plan in May or June. Workers who can WFH should probably continue to do so, but if we’ve been able to flatten the curve it’s probably time to go back outside and see what happens. I’ll also say with respect to Burry that although he is a trained physician, it doesn’t make him an expert in epidemiology, so, frankly, I don’t really care for his opinion on the subject any more than anyone else who is moderately educated.
- cm2187 7y ago
  I agree directionally, but the numbers matter as well. Depending on what study we look at, the survival rate of covid19 patients that require a ventilator is anywhere between 0% and 50%. For the sake of argument let’s assume the other patients can be treated in field hospitals that scale reasonably well, it means running out of ventilators would “only” double the mortality rate. But double a rate that is <0.5% may still be <0.5%.
- travisoneill1 7y ago
  Only 1/3 of people with COVID who require ventilation survive, so lack of ventilators will raise mortality, but only by 50%.
  - DanBC 7y ago
    Ventilators are also used by people who don't have covid-19, so lack of access to ICU is going to affect more than just covid-19 patients.
    - cm2187 7y ago
      Fine. Assume all ventilators used for non covid19 patients. The maths stay the same.
      - DanBC 7y ago
        You haven't counted length of stay before death or transfer to a different ward (covid-19 patients stay in ICU longer before they die or recover), nor iatrogenic harm caused by non-intensivist doctors and nurses suddenly being pulled into ICU work.
- amalter 7y ago
  Additionally, COVID-19 is a new disease and we have no data about the long term effects. This is true anecdotal, but I’m following a cohort of 5 MD friends who all experienced “walking COVID” (aka reached the loss of smell symptom, but required no hospitalization). This cohort is 35-45 and all previously highly athletic. They are between +20 and +45 days from being “symptom free”. Not one of them can perform cardiac challenged activities. I’ve heard things like “I get winded carrying groceries up the stairs” to “I cannot perform even a single push-up”. So before we take this big risk of letting the virus “burn” through the population, shouldn’t we understand just a bit more? Sure, maybe we’ll get lucky and the IFR will just be 2-10x flu. But there are worrying signs of permanent heart, lung and kidney damage. These costs will also stay with us long term. Mortality isn’t the concern when dealing with an unknown virus.
flohofwoe 7y ago
As far as I understand it, fatality rate is only low as this as long as the health care system isn't overwhelmed, so that people in serious conditions can be treated (and the number of serious cases is a lot higher than 0.5%). As soon as hospitals are at their capacity, a lot more people will die which otherwise had survived (and this will also affect people which are in critical conditions for entirely different reasons).
- rumanator 7y ago
  This. I don't understand how the whole point of flattening the curve was already forgotten. The whole point of the lockdown is not to act as a magic wand to make the pandemic vanish. The whole point is that, as it stands, emergency services are already operating beyond capacity. This means that your friends and loved ones risk needlessly dying for no reason just because they weren't able to have medical treatment, including from non-covid19 issues.
  - gremlinsinc 7y ago
    Also, if you're high risk (I may be - obesity) this is a scary disease, and honestly the longer you wait to get infected the better your chances. More local medical doctors will have experience treating it, there will be more studies on drugs, more help available etc. Your chances go up astronomically on a long enough time scale. So why rush it? I have the luxury of being a freelancer working from home, so this is mostly my normal, but I know it hurts a lot of people, but so does being dead - or having lung issues for life or neurological ones. Some broadway actor lost his leg over the weekend because of this. TLDR; It definitely helps w/ hospitals so they can still function it also gives time to find and create better treatments.
- bob33212 7y ago
  We don't know yet how much of a difference that makes. For example how many infected 80 year olds without medical treatment die compared to those that do get medical treatment. Medical treatment is certainly going to have a better mortality rate but not 100%.
kgwgk 7y ago
Where do you get that <0.5% fatality rate from? It seems to have caused already the death of between 0.1% (lab-confirmed) and 0.2% (excess deaths) of the population of NYC.
- cm2187 7y ago
  Now that we start doing anti-body tests, there seems to be multiple studies surfacing all pointing to a much higher than anticipated number of people infected. A few sources pointing in that direction: https://mobile.twitter.com/AmeshAA/status/1249446561010106370 https://mobile.twitter.com/AmeshAA/status/124944656101010637... https://mobile.twitter.com/AmeshAA/status/1249020677551796224 https://mobile.twitter.com/AmeshAA/status/124902067755179622... https://www.youtube.com/watch?v=_LG-so-8qwg https://www.youtube.com/watch?v=_LG-so-8qwg
  - kgwgk 7y ago
    What would you say that the number of infected people in NYC may be? If 20% of them are infected, the infection fatality rate observed is already in the 0.5%-1% range.
    - cm2187 7y ago
      I did that calculation for a similar objection a few days ago: https://news.ycombinator.com/item?id=22881103 https://news.ycombinator.com/item?id=22881103
      - kgwgk 7y ago
        Ok. If we take the observed data (0.15% mortality rate in the overall population) we can make hypothesis like “infection rate is 30%” and “infection fatality rate is 0.5%”. But being consistent and plausible doesn’t make them true. 15% and 1% are also plausible, as far as I know.

bob33212 7y ago

It is a similar situation to hurricane evacuations. A forced evacuation will save lives, but forced evacuations that turn out to be a false alarm because the storm changed direction causes people to ignore future evacuations leading to more deaths. There is no right answer

gremlinsinc 7y ago
Look at NYC. They've been on lockdown weeks. The first responders and hospitals are STILL fighting a losing battle. Imagine if we weren't on lockdown and there were a ton of other emergencies like car crashes, accidental impalement, etc... a lot of non-covid emergencies are probably still happening, but we'd probably triple or quadruple the load on an already stressed hospital system. It'd be disastrous. The proof is right there in NYC. Now they're - their own thing. Not sure this would play out in most other cities being smaller than NYC, but if Italy has any bearing - Bergamo ran out of burial plots in the cemetary and had to start stacking bodies in churches like it's the 1420's. The right answer is caution > mass destruction. Another good case study is comparing the sweden to switzerland or denmark. I don't have high hopes in a vaccine before at least 2-3 years since the fastest vaccine ever took 5 years, but drugs to mitigate symptoms and outcomes -- the longer we slow it, the more lives saved when we do have a good treatment. HIV doesn't have a vaccine, but it does have decent treatment options now, I think covid will be easier to find good treatments but we just need time for all the studies to bear fruit.

JackFr 7y ago

> if the US had decent unemployment insurance, like germany, then unemployment would be 10% of what it is now. I’m not sure I understand how better UI reduces unemployment. But more importantly unemployment only captures half the problem. Businesses are not designed to go into hibernation. If asked you to hold your breath for two hours, it’s gonna be tough for you to start breathing again when I give the all clear.

boudin 7y ago
All those are man made problem and have solution. Our system is not designed to be paused, but can be changed to do so. To pause the spread of a virus is much harder.
- okr 7y ago
  Do you have an idea on how to implement a pause function into the economy? We live with the flue, but actually a pause could help there too to stop the spread in the season. Who pushes the pause button? How do the businesses agree on pushing their pause button at the same time? Should there be a pausing fund? Paid in by all businesses that make business overseas? I find this interesting. Reminds me a little bit on traffic jams. If cars were automated, all cars could start/stop at the same time.
  - rswail 7y ago
    We have a pause function, it is when governments issue public health and safety orders. The people that push the pause button are elected governments, There is a pausing fund, it is taxes and government borrowing through the national debt.
    - okr 7y ago
      I agree. But did not consider it as a solution. :)
  - boudin 7y ago
    I don't have the magical answer, but there's some elements in place to allow companies to stop their activities for a short amount of time (like furlough with a pay, like it's done in some countries, not sure how it works in the USA). Looking at how beneficial reducing trade and manufacturing has been for the environment, i can't help but think that we need to be able to take the same kind of action we've been taking for COVID-19 to address the other big challenges we're facing.

cmiles74 7y ago

I disagree that he's asking people to take a big gamble. While it seems unrealistic to me, Dr. Burry made a point of tying his recommendation to widespread, rapid testing and contact tracing. If these things were in place, I do think letting people that aren't in the most vulnerable population groups out and about might be reasonable. "A more nuanced approach would be for at risk groups — the obese, old and already-sick — to shelter in place, to execute widespread mandatory testing, and to ID and track as necessary while allowing society to function. Again, Trump should get the massive contract manufacturers like Flextronics to make testing machines." That said, we are still having problems getting the tests out and people are still complaining that it will take days to get results back. I personally know a pharmacist with an at-risk child who can't get a test as of last week. So this seems like wishful thinking to me. https://www.theatlantic.com/health/archive/2020/03/next-covid-19-testing-crisis/609193/ https://www.theatlantic.com/health/archive/2020/03/next-covi...

xtiansimon 7y ago
I think you missed this gem: > "Vaccines are not coming anytime soon, so natural immunity is the only way out for now."

gremlinsinc 7y ago

I've got vitamin D deficiency (gastric sleeve surgery)... usually forget my supplement. Been taking it religiously for a month... hope that helps if I get it (obese + sleep apnea + 40 are my only co-morbidities -that and I do get bronchitis a lot had it earlier in the spring from nasal drip.)