5 ms·

I guess I’m not sure what definition of “works” you are using? Humans have a tendency to see the thing in front of them and claim, I did X, and then Y happened

by zaroth 7y ago

I guess I’m not sure what definition of “works” you are using? Humans have a tendency to see the thing in front of them and claim, I did X, and then Y happened, so X must have helped cause Y. When in fact no such thing has been proven. I think there are a lot of things different about those examples you gave, and absolutely no scientific way to draw a conclusion about a particular intervention having a particular effect. Here’s an interesting comparison between Australia and Canada for example, who both responded similarly but have ended up in markedly different situations. [1] So instead I would offer a different framework for the discussion. In the end there are only two simple questions with COVID. 1) When we hit the endpoint, what is the total prevalence in the population, and is it lower than the natural saturation point? So my guess for #1 is that at the endpoint, we will see that basically everyone who could have gotten it did get it. To put it another way, I suspect only the highest risk population taking the most extraordinary precautions will end up not having antibodies to SARS-CoV-2, everyone else at some point being naturally exposed. In other words, I assume we will reach whatever the top of the S curve for COVID would naturally be based on the biological nature of the virus. Essentially, I am assuming that vaccines will not play a large role, because it will have played out before they become available, and/or because we don’t have any coronavirus vaccines and it’s probably harder to make one than we think. 2) How long do we stretch things out to get to that endpoint, and therefore, how many lives are saved through increased availability of medical care and, on the flip side, how much economic cost is incurred? My hope here—based on some very preliminary data—is that we are actually much further along than the testing might indicate (e.g. 5% overall prevalence and much higher in certain metros, vs 0.2%) From a health care perspective I think that the only effective treatments we have today are minimally invasive and extremely scalable — oxygen therapy and frequent repositioning. We are learning that ventilators have proven to be basically lethal to COVID patients, therefore increased availability and usage of ventilators presumably just increases the death rate. There have been no controlled studies either way at this point so no one can say for sure. At this point because we have no effective cure or treatment, and because initial antibody testing seems to indicate COVID is extremely widespread despite the shutdown, I am very skeptical of the current approach paying off both in terms of delaying spread & saving lives through higher availability of care. [1] - https://www.theglobeandmail.com/opinion/article-canada-and-australia-a-tale-of-two-covid-19-responses/ https://www.theglobeandmail.com/opinion/article-canada-and-a...

nl 7y ago
> Here’s an interesting comparison between Australia and Canada for example, who both responded similarly but have ended up in markedly different situations. Well no - Australia required quarantine of all returning overseas travellers from March 15, Canada advised self isolation from March 25. That's a huge difference. Again - correct, thoughtful interventions worked. > Essentially, I am assuming that vaccines will not play a large role, because it will have played out before they become available, and/or because we don’t have any coronavirus vaccines and it’s probably harder to make one than we think. I've seen the "we don’t have any coronavirus vaccines" meme too. People don't seem to realise we've only had one serious coronavirus before (SARS) and it isn't anywhere as nearly contagious. There just hasn't been much work done on coronavirus vaccines before. We do however have anti-viral treatments (eg Tamilflu), and it's likely we'll either get a working vaccine or a anti-viral drug that provides some relief in the next 12-18 months. > My hope here—based on some very preliminary data—is that we are actually much further along than the testing might indicate (e.g. 5% overall prevalence and much higher in certain metros, vs 0.2%) Either way, it's a long way off the required 80% for herd immunity. > We are learning that ventilators have proven to be basically lethal to COVID patients This is absolutely untrue. There have been people sharing data showing that the mortality rate of people on ventilators is higher than those who aren't, but that is because ventilators are only used on people who are closer to death. It's true that in some cases oxygen is sufficient for some people.
- zaroth 7y ago
  Regarding Australia, yes, they discuss that specifically in the article I linked. That particular intervention is a lot easier to enforce when you don’t have a long land border with a country going through an outbreak, and a very large number of citizens presently in the neighboring country. Australia’s borders are closed, and they never really had a lot of community spread. Canada had significant community spread, and earlier, and a larger population returning from hotspot areas. The point is a careful and thoughtful examination shows that a country’s geographic, social, and economic “natural affordances” are largely responsible for the differing COVID case loads, much less than the effective dollar amount “spent” on interventions. Spending on an intervention includes the economic hit as well as the direct cost. E.g. Australia was able to get a lot more bang for their buck because they’re an island and didn’t have a large segment of their population traveling in hotspots. I think we agree on the vaccines. The point isn’t there’s something specific about coronavirus. It’s not a “meme” that we don’t have a coronavirus vaccine. We actually don’t have one. That just means we might not have as much experience ramping up a new one as we do, for example, with influenza, and there may be things we need to learn along the way. A working vaccine or treatment in 12-18 months is a long way off. If we are anywhere near 5% prevalence that means we are a lot closer to 65% (when herd immunity starts being noticing beneficial) than you might think, since it is non-linear. Regarding ventilators, even in the general (non-COVID) case if you find yourself on one you’re about 50/50 not going to walk away from it. But with COVID it appears ventilators exacerbate the swelling in the lungs and in NY 80%+ of ventilated patients have died. [1]. That’s what I mean by “proven to be basically lethal”. We know the vast majority of COVID patients on ventilators die, far more than just the average ventilator death rate for pneumonia, using the same O2 saturation markers. So doctors are moving away from ventilators and no longer using the typical O2 saturation cutoffs for ventilating because interestingly patients with lower O2 levels are not in the typical level of distress. It seems the CO2 is still getting out even though the oxygen is not getting in... more like hypoxia. > It's true that in some cases oxygen is sufficient for some people. We can agree on more than that. Luckily the fact is that oxygen therapy is sufficient for the vast majority of cases. Just do the math on hospitalizations and deaths in NY with the known variable that 80% that were ventilated died. QED the vast majority were not ventilated. [1] - https://www.nytimes.com/aponline/2020/04/08/health/ap-us-med-virus-outbreak-ventilator-deaths.html https://www.nytimes.com/aponline/2020/04/08/health/ap-us-med...

by zaroth 7y ago

nl 7y ago

> Here’s an interesting comparison between Australia and Canada for example, who both responded similarly but have ended up in markedly different situations. Well no - Australia required quarantine of all returning overseas travellers from March 15, Canada advised self isolation from March 25. That's a huge difference. Again - correct, thoughtful interventions worked. > Essentially, I am assuming that vaccines will not play a large role, because it will have played out before they become available, and/or because we don’t have any coronavirus vaccines and it’s probably harder to make one than we think. I've seen the "we don’t have any coronavirus vaccines" meme too. People don't seem to realise we've only had one serious coronavirus before (SARS) and it isn't anywhere as nearly contagious. There just hasn't been much work done on coronavirus vaccines before. We do however have anti-viral treatments (eg Tamilflu), and it's likely we'll either get a working vaccine or a anti-viral drug that provides some relief in the next 12-18 months. > My hope here—based on some very preliminary data—is that we are actually much further along than the testing might indicate (e.g. 5% overall prevalence and much higher in certain metros, vs 0.2%) Either way, it's a long way off the required 80% for herd immunity. > We are learning that ventilators have proven to be basically lethal to COVID patients This is absolutely untrue. There have been people sharing data showing that the mortality rate of people on ventilators is higher than those who aren't, but that is because ventilators are only used on people who are closer to death. It's true that in some cases oxygen is sufficient for some people.

zaroth 7y ago
Regarding Australia, yes, they discuss that specifically in the article I linked. That particular intervention is a lot easier to enforce when you don’t have a long land border with a country going through an outbreak, and a very large number of citizens presently in the neighboring country. Australia’s borders are closed, and they never really had a lot of community spread. Canada had significant community spread, and earlier, and a larger population returning from hotspot areas. The point is a careful and thoughtful examination shows that a country’s geographic, social, and economic “natural affordances” are largely responsible for the differing COVID case loads, much less than the effective dollar amount “spent” on interventions. Spending on an intervention includes the economic hit as well as the direct cost. E.g. Australia was able to get a lot more bang for their buck because they’re an island and didn’t have a large segment of their population traveling in hotspots. I think we agree on the vaccines. The point isn’t there’s something specific about coronavirus. It’s not a “meme” that we don’t have a coronavirus vaccine. We actually don’t have one. That just means we might not have as much experience ramping up a new one as we do, for example, with influenza, and there may be things we need to learn along the way. A working vaccine or treatment in 12-18 months is a long way off. If we are anywhere near 5% prevalence that means we are a lot closer to 65% (when herd immunity starts being noticing beneficial) than you might think, since it is non-linear. Regarding ventilators, even in the general (non-COVID) case if you find yourself on one you’re about 50/50 not going to walk away from it. But with COVID it appears ventilators exacerbate the swelling in the lungs and in NY 80%+ of ventilated patients have died. [1]. That’s what I mean by “proven to be basically lethal”. We know the vast majority of COVID patients on ventilators die, far more than just the average ventilator death rate for pneumonia, using the same O2 saturation markers. So doctors are moving away from ventilators and no longer using the typical O2 saturation cutoffs for ventilating because interestingly patients with lower O2 levels are not in the typical level of distress. It seems the CO2 is still getting out even though the oxygen is not getting in... more like hypoxia. > It's true that in some cases oxygen is sufficient for some people. We can agree on more than that. Luckily the fact is that oxygen therapy is sufficient for the vast majority of cases. Just do the math on hospitalizations and deaths in NY with the known variable that 80% that were ventilated died. QED the vast majority were not ventilated. [1] - https://www.nytimes.com/aponline/2020/04/08/health/ap-us-med-virus-outbreak-ventilator-deaths.html https://www.nytimes.com/aponline/2020/04/08/health/ap-us-med...