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At this point people advocating the position you’re advocating for are in a state of denial (this is my opinion, not a matter of fact, obviously). Your assumpti
by __blockcipher__ 6y ago
At this point people advocating the position you’re advocating for are in a state of denial (this is my opinion, not a matter of fact, obviously). Your assumption is that we can effectively prevent the majority of the nation from exposure via lockdown.
Not only does evidence seem to point against that, but when you do the math on mortality due to suicide and overdose it’s not clear that containment would even save more lives in the long run.
Here’s how you can tell people’s philosophical positions: if they talk about fear of a “second wave” they are Containers, since that implies the initial “wave” will not infect the majority; ie the virus is successfully contained (EDIT: See https://news.ycombinator.com/item?id=22961927 https://news.ycombinator.com/item?id=22961927 for the caveat here).
Ironically, leaders like Fauci are verbally saying that containment is not the strategy, yet every word that he says and the IMHE model everyone is relying on are all the result of a Containment ideology.
The alternative is what I would call Pareto mitigation. The vulnerable portion of the population self isolates, while the rest of us are _allowed_ to resume working and living more or less normally (still no large gatherings presumably).
I'd like to take this moment to put out a brief PSA that the serological data coming out, while not 100% reliable, is all telling more or less the same story. Let's look at these IFRs (the second link is CFRs but for Italian healthcare workers who presumably are all getting tested so I'm treating it as a de-facto IFR):
https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antibody_study_of_blood_donors_reveals_3/fnzkn4k/ https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...
https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_italian_progression_of_covid19/foatvgv/ https://old.reddit.com/r/COVID19/comments/g6nmtf/update_on_i...
(I'm linking to the reddit comments instead of the actual study because they're really nice tables and the links are still there for anyone who wants to double check)
As others have said, for those around age 45 or less, Covid is equally or less dangerous than Influenza. And particular for those under 30 the flu is an order of magnitude more deadly at least.
In the general population overall, Covid is undeniably more deadly than the flu, but only about 3-5x (and I think 3x personally right now).
Recall that the flu is characterized by deaths in the very young and very old, while being less harmful to those "in between", purportedly due to the "cytokine storm" which is a scorched earth reaction of the immune system. Covid is very different, it is extraordinarily deadly to the very old, extraordinarily non-deadly to the very young, and about the same as the flu to those in between.
A disease with such a "spiky" (highly variable) mortality rate based on your risk factors is precisely the kind of disease that is most effectively treated with risk-informed self quarantine rather than a national lockdown.
Unemployment is correlated with a 2-3x higher chance of suicide, of which perhaps half can be explained away by mental health confounds [1]. There's unique factors in play here - rampant social isolation and widespead fearmongering, propagated even by health experts and "trusted" news sources at times - that lead me to believe that the spike in suicide and overdoses will actually be much higher than predicted by just unemployment alone.
We're currently at 50,000 suicides per year in the US as a base rate, it is not unimaginable that we would see at least 50,000 _extra_ suicide deaths attributable to a mixture of lockdown and the general socioemotional environment.
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I haven't even gotten to the philosophical battle of "freedom versus security". I am, ideologically, someone who drank the koolaid and really believes in freedom and civil liberties over "security" (which I view as illusory anyway), but _even just viewed through the lens of reducing mortality_, the evidence is stacking up that lockdown is going to do more harm than good.
Is the evidence fully settled? Of course not. But it's shocking to me how many people seem to be operating off of the projected CFR's we had in early February, shouting from the rooftops about "1 in 20" people dying (random recent case in point: https://news.ycombinator.com/reply?id=22952764&goto=threads%3Fid%3D__blockcipher__%2322952764 https://news.ycombinator.com/reply?id=22952764&goto=threads%...). I don't know whether it's just that a large swath of the population already had clinical anxiety which is further magnified by social isolation and social media and news headlines, or whether something else is at play, but I'm very concerned about the state of discourse in the United States right now, and more broadly, the entire world. In fact, ironically I feel a bit luckier to be in the US than some of these other countries because in the US _every_ issue is partisan, which while entirely irrational means that roughly half the country will be in favor of ending the lockdown at any given time (the position I am advocating for, within reason, insofar as hospitals are not overwhelmed), as opposed to other places where you can get given a $1600 ticket for driving a car by yourself, based off of a superstition that _being outside_ causes Covid as opposed to exposure to infected respiratory droplets...
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EDIT: Lastly I should mention that in a perfect world we could have voluntary variolation; I would love to be able to expose myself to a controlled dose of SARS-CoV-2 and self isolate for several weeks to ensure that I can never pass on Covid to someone else. Unfortunately that would be very hard to make a reality due to the political environment, even though I am advocating for it to be totally voluntary. I was heartened to see this recent paper toying with a variant of that approach: https://www.medrxiv.org/content/10.1101/2020.04.12.20062687v1 https://www.medrxiv.org/content/10.1101/2020.04.12.20062687v... (I don't agree with an "Immunity Card" for ideological reasons but I'm glad we have a paper attempting to model it out which does show benefit of voluntary self exposure)
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v057p00594.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v05...
- nostromo 6y ago> when you do the math on mortality due to suicide and overdose it’s not clear that containment would even save more lives in the long run. I'm waiting for people to do the analysis of mass unemployment from lockdown leading to people losing their healthcare, just in time for the pandemic to widen or return this summer or fall. You're exactly right to consider all of the externalities of our current approach.
- __blockcipher__ 6y agoI hadn't thought of it specifically in terms of our broken employer-based healthcare system. That's a really good point. I quit my job Feb 7, before all this unfolded. And COBRA costs me $612.54 per month. For the same reason I was able to quit my job, I will be totally fine. I have over 5 years of living expenses in liquid assets, so I will be fine. But for someone who was living paycheck to paycheck and lost their job because it's not the type of job that can work from home, how the hell could they possible afford healthcare? Along those lines, I do really think that part of the reason so many people don't see the harm in locking down for the next several months is because, like me, they work in the tech industry and really have not been affected by this as far as employment goes.
- guscost 6y agohttps://www.usatoday.com/story/opinion/2020/04/21/behind-protests-two-americas-one-unemployed-and-one-gets-paychecks-column/5167453002/ https://www.usatoday.com/story/opinion/2020/04/21/behind-pro...
- mlyle 6y agoHey, I'm in broad agreement with you, but, a nit ... > Here’s how you can tell people’s philosophical positions: if they talk about fear of a “second wave” they are Containers, since that implies the initial “wave” will not infect the majority; ie the virus is successfully contained. Here in the SF Bay Area we pretty effectively blunted the first wave with public health controls, which meant health care was not stressed much. Despite the Stanford serosurvey saying that we have 3% with a history of infection, the real number is probably more like 1%. Daily case counts are decreasing, so the initial "wave' did not infect the majority. It's not enough to decrease Rt noticeably at all. We need to figure out how to loosen up controls in a way that provides economic benefits, keeps a nice constantish burn towards herd immunity, but with enough safety margin to prevent catastrophe that New York got too close to. Instead, our public health seems to be further tightening instead of experimenting with small measures to relax the controls. There's a loud contingent advocating what would effectively be permanent controls.