4 ms·

I don't think you quite understand what happens to the fatality rate once hospitals become overwhelmed. That 1% IFR will quickly become 3-5% IFR.

luckylion 7y ago
That's a different argument. I'm saying that "lockdown until we have a vaccine or great treatment" might mean "lockdown until 2030". We already see heavy economic damages, civil unrest and riots after 4-8 weeks. Make that 40, 80 or 200 weeks and the world will be very different.
- cycrutchfield 7y ago
  A handful of peabrained astroturf protestors does not equal "civil unrest and riots". Also nobody is arguing for "lockdown until we have a vaccine", that is a strawman. The strategy has always been to buy time for testing capacity to get high enough to support less restrictive mitigation efforts. Along the way we will likely pick up additional things like antibody testing to identify the immunized and treatment options that work (clinical trials still in progress).
  - luckylion 7y ago
    Are you suggesting the riots in the banlieus in France are done by "astroturf protestors"? And "flattening the curve" to buy time until we get a vaccine or a very successful treatment was literally in the comment I replied to. Not as in "we must lockdown until then", but as a goal we may reach if we continue with strict measures. It's fine to want that, we just have to be aware that it might not happen (or might not happen soon) and that it isn't free.
    - cycrutchfield 7y ago
      There are different mitigation options other than just heavy suppression via lockdown. Flattening the curve doesn't imply lockdown, for instance.
      - luckylion 7y ago
        Like "wear masks in public to lower transmission probability"? Anything that will let us carry on in a way that's close to normal is fine. "Flattening the curve" was, at least here, generally translated into "stay at home if possible, keep 2m distance in public, close non-essential stores and offices". And those aren't sustainable, and they come at a price.
  - lbeltrame 7y ago
    > Also nobody is arguing for "lockdown until we have a vaccine" Some pepole in Italy were actually arguing for stronger limitations for 18-24 months until a vaccine was ready, and IIRC someone mentioned on HN a similar strategy (2 months closed - 1 months open) suggested for the UK. So, there are people (in the authority chain) proposing for that. Whether they'll get listened to or not, it is another matter entirely. Personally I hope they don't.
treis 7y ago
That isn't supported by any facts and is totally wrong. Our ability to treat viral pneumonia is very limited. We aren't saving 60-90% of patients that otherwise would die which your numbers imply. We can move the needle a bit and maybe save 20% of them. As an example, 90% of patients that go on ventilators still die. Even in a situation where hospitals are getting overwhelmed it won't make much difference. Much of the care that happens is pointless. That 85 year old obese patient with chronic heart failure ain't making it no matter what you do. So if we are getting overwhelmed we can triage and not see much impact on fatality rates because patients like that are dying either way.
- Slartie 7y ago
  > As an example, 90% of patients that go on ventilators still die. That’s in New York, and probably because they only put the really worst cases on ventilators because there weren’t enough ventilators. In Germany, that number of deaths on ventilators is at around 30%. This shows that this quota is entirely useless to make your argument, and that maybe you should curb your intuition a bit when it comes to estimating percentages of potentially saveable people, especially if those estimates are then used to effectively sentence people to certain death.
  - treis 7y ago
    Do you have a cite for that 30% number?
    - Slartie 7y ago
      Sorry, just saw your request. I'm taking that number from the Robert Koch Intitute daily status reports, which is basically the central official report regarding COVID-19 in Germany. Here's the one from today (in English): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-04-25-en.pdf?__blob=publicationFile https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus... The interesting table is on page 6, where there's the percentage of ventilated patients on ICU, which is 73%, so we know most ICU patients are ventilated, which means we can treat someone being on ICU as roughly equal to someone being ventilated. Right below is the number of discharges from ICU, and the percentage of deaths, which is 30% of all discharges. Since almost all ICU patients end up being ventilated, we can conclude that these about 30% of deaths mostly happened on ventilation, and most of the 70% recoveries also happened on ventilation. I know that my calculation doesn't exactly result in the real percentage of deaths on ventilation, but the error range of my estimation does not allow the actual percentage of deaths on ventilation to even come close to 90%.

luckylion 7y ago

That's a different argument. I'm saying that "lockdown until we have a vaccine or great treatment" might mean "lockdown until 2030". We already see heavy economic damages, civil unrest and riots after 4-8 weeks. Make that 40, 80 or 200 weeks and the world will be very different.

cycrutchfield 7y ago
A handful of peabrained astroturf protestors does not equal "civil unrest and riots". Also nobody is arguing for "lockdown until we have a vaccine", that is a strawman. The strategy has always been to buy time for testing capacity to get high enough to support less restrictive mitigation efforts. Along the way we will likely pick up additional things like antibody testing to identify the immunized and treatment options that work (clinical trials still in progress).
- luckylion 7y ago
  Are you suggesting the riots in the banlieus in France are done by "astroturf protestors"? And "flattening the curve" to buy time until we get a vaccine or a very successful treatment was literally in the comment I replied to. Not as in "we must lockdown until then", but as a goal we may reach if we continue with strict measures. It's fine to want that, we just have to be aware that it might not happen (or might not happen soon) and that it isn't free.
  - cycrutchfield 7y ago
    There are different mitigation options other than just heavy suppression via lockdown. Flattening the curve doesn't imply lockdown, for instance.
    - luckylion 7y ago
      Like "wear masks in public to lower transmission probability"? Anything that will let us carry on in a way that's close to normal is fine. "Flattening the curve" was, at least here, generally translated into "stay at home if possible, keep 2m distance in public, close non-essential stores and offices". And those aren't sustainable, and they come at a price.
- lbeltrame 7y ago
  > Also nobody is arguing for "lockdown until we have a vaccine" Some pepole in Italy were actually arguing for stronger limitations for 18-24 months until a vaccine was ready, and IIRC someone mentioned on HN a similar strategy (2 months closed - 1 months open) suggested for the UK. So, there are people (in the authority chain) proposing for that. Whether they'll get listened to or not, it is another matter entirely. Personally I hope they don't.

treis 7y ago

That isn't supported by any facts and is totally wrong. Our ability to treat viral pneumonia is very limited. We aren't saving 60-90% of patients that otherwise would die which your numbers imply. We can move the needle a bit and maybe save 20% of them. As an example, 90% of patients that go on ventilators still die. Even in a situation where hospitals are getting overwhelmed it won't make much difference. Much of the care that happens is pointless. That 85 year old obese patient with chronic heart failure ain't making it no matter what you do. So if we are getting overwhelmed we can triage and not see much impact on fatality rates because patients like that are dying either way.

Slartie 7y ago
> As an example, 90% of patients that go on ventilators still die. That’s in New York, and probably because they only put the really worst cases on ventilators because there weren’t enough ventilators. In Germany, that number of deaths on ventilators is at around 30%. This shows that this quota is entirely useless to make your argument, and that maybe you should curb your intuition a bit when it comes to estimating percentages of potentially saveable people, especially if those estimates are then used to effectively sentence people to certain death.
- treis 7y ago
  Do you have a cite for that 30% number?
  - Slartie 7y ago
    Sorry, just saw your request. I'm taking that number from the Robert Koch Intitute daily status reports, which is basically the central official report regarding COVID-19 in Germany. Here's the one from today (in English): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-04-25-en.pdf?__blob=publicationFile https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus... The interesting table is on page 6, where there's the percentage of ventilated patients on ICU, which is 73%, so we know most ICU patients are ventilated, which means we can treat someone being on ICU as roughly equal to someone being ventilated. Right below is the number of discharges from ICU, and the percentage of deaths, which is 30% of all discharges. Since almost all ICU patients end up being ventilated, we can conclude that these about 30% of deaths mostly happened on ventilation, and most of the 70% recoveries also happened on ventilation. I know that my calculation doesn't exactly result in the real percentage of deaths on ventilation, but the error range of my estimation does not allow the actual percentage of deaths on ventilation to even come close to 90%.