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I've seen you say similar things in a few other threads, and myself and others have said, every time: the risk to everyone is that the hospitals become overwhel

I've seen you say similar things in a few other threads, and myself and others have said, every time: the risk to everyone is that the hospitals become overwhelmed. They are not right now because of stay-at-home orders. What you think of as failure - hospitals currently low utilization - is in fact success.

crocodiletears 6y ago
You can ease up on the lockdown without ending it. That's what I read the parent to be implying.
- newacct583 6y ago
  Ease up how? I mean, what's the specific proposal? The lockdown isn't "total" anyway -- very large numbers of people are still working at full salary (including, it must be pointed out, probably more than half the readers of this very site). There's little to no low hanging fruit of safe jobs that can be reopened. Just go look at the California list of "essential" jobs and tell us what needs to be added. Fundamentally this is just a complicated strawman. People are arguing against "lockdown" but not in favor of another option. But we were all here in late march and we know what this disease does without containment.
  - skellington 6y ago
    Are you not aware that "lockdown" covers a wide continuum of practices?! Ease up can mean a lot of things between what we have now and no lockdown whatsoever. What level of easing depends on the goal and the data showing what level of control is being achieved.
    - newacct583 6y ago
      I'm painfully aware, which is why I asked the question. Who would you like to see back to work, and are you certain they're not already on the list of essential positions?
  - CPLX 6y ago
    > Ease up how? I mean, what's the specific proposal? Not sure how to put this but if you're advocating for the side that wants to confine seven million people to their homes and shut down nearly all commerce you're the one that has to come up with the specific proposal. The objection is that there doesn't seem to be any kind of numerical metric to determine the success of this shelter in place policy. It's public policy. So what are the stated goals of that policy, and what are the criteria for determining success? It is a serious fucking problem that people aren't even really trying to answer that question any more.
    - newacct583 6y ago
      > shut down nearly all commerce That doesn't seem right. I got tacos from down the street last night. I got paid a week ago. I bought some home office related junk from Amazon yesterday. I need to go shopping tonight. That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all. So I ask again: who do you want to go back to work before the virus case load drops? Be specific.
      - CPLX 6y ago
        > That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all. You're kidding right? The drop in GDP between 1929 and 1932 was about 15% or so. You're saying I'm the one being hyperbolic for calling a drop of twice that size in three months a total free fall? I apologize I forgot about Jeff Bezos and your local taco guy. I'll try to be more optimistic, like you are doing here, by predicting an instant drop of economic activity to twice the severity of the Great Depression. And sure I'll take your bait on specifics anyways. I think we should pick policies just restrictive enough to keep hospitalizations below system capacity and no more. There really isn't any other reasonable choice, the current policy is just delaying the inevitable for no clear reason and without any specific vision of what success looks like. You realize that if we have the same number of cases, and deaths, but with 3-4x the economic destruction, that's a spectacular policy failure right?
  - CamperBob2 6y ago
    Ease up by returning to normal economic activities, but with mandatory masks and gloves for most workers and consumers, while strongly encouraging social distancing. My current belief, based on experiences reported in other countries, is that this would be enough. There's not much evidence that total physical lockdown is necessary for everyone regardless of their level of vulnerability. Not a doctor, not medical advice, etc.
  - smallgovt 6y ago
    Um, I'm not sure if you're being serious, but there are plenty of ways to gradually re-open. As an example: step 1) re-open elementary schools step 2) re-open middle schools step 3) re-open high schools & colleges step 4) re-open all small businesses that do not result in gatherings of more than 2 people in one place, then 5, then 10, then 20, then 50 I'm not saying that's the right approach but there is certainly middle ground between current shutdowns and a total re-opening of society.
    - wgerard 6y ago
      I think the problem at this point is two-fold: 1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month. 2) For better or for worse, we've conditioned people to be wary of contact with other people. A movie theater that's 10% full is still hemorrhaging money, perhaps worse than if it was closed entirely (no payroll costs/etc). I'm not sure what the breakdown is, so this could certainly be hyperbole, but it's entirely possible that people will just feel uncomfortable doing things with groups of >10 until a vaccine is available. A restaurant with 25% of its normal business will likely still need to shut down, reduce staff, etc. Sure, we may not have 22MM people filing for unemployment but it might still be 10MM, which is still extremely abnormally large. All that to say, there's a real possibility that gradual re-openings don't actually accomplish anything because the root fear (i.e. catching covid-19) hasn't been resolved in the minds of many people, especially in dense urban areas.
      - maerF0x0 6y ago
        > 1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month. Though it could make sense to re-open them a month early, health concerns permitting. They already got a "summer break" and can make up for lost time
        Pfhreak 6y ago
        They most certainly did not get a summer break. My kid is absolutely still participating in school, and quarantine is pretty stressful for a kid. This hasn't been just loafing around, relaxing, and playing.
  - crocodiletears 6y ago
    I'm not an expert. I'd lean towards loosening restrictions on non-essential businesses, imposing strict capacity guidelines, and adjusting the strictness of the guidelines by region at fixed intervals with a fixed lead time. Add some worker protections so people who don't feel comfortable working don't lose their jobs during when they reopen, and don't exempt them from receiving unemployment so reopening doesn't turn them into a burden for the nonessential employer. I'm lucky right now, to be an 'essential' employee making roughly twice minimum wage, working for an employer with deep pockets. I'm not coming from a place of personal inconvenience, because my job's gotten exponentially easier since people became afraid to go out. Most of our part time staff is gone, and I'm worried that SMBs will soon start dropping like flies. We've proven that lockdowns work, really well. now we need to find a balance in order to prevent the economy we as a society return to from being a small collection of megacorps wandering through a graveyard of small businesses and unemployment.
    - deleted 6y ago
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- trhway 6y ago
  The one-size-fit-all lockdown was a reasonable first knee-jerk reaction given the situation. It isn't a tool to fight pandemic, it is just a breather to prepare the long-term sustainable tools and system - like production of tests, certified masks, etc., identifying/quarantining vulnerable population, putting contact tracing in place, adjusting various social distancing rules to be tighter/looser where it possible and makes sense, etc. - to actually fight pandemic. Yet it seems that the lockdown time has so far been almost wasted in that regard and the lockdown itself seems to be taken as the main tool to fight the pandemic (probably also coupled with the naive idea that this virus can be made to go away completely). That doesn't look good. We may get temporarily lucky - the hot and dry weather will slow down the spread until of course October/November when with such an approach we would be back to square 1.5 at best, and that if the virus doesn't mutate to become more virulent and/or deadly (the 2nd wave of the Spanish flu for example was more deadly than the first) For example - the construction was stopped at near by site. It is a huge 3 acre site where you can easily set social distance of say 10-20ft and have the clad in PPE crew working without any risk of virus spreading.
cpncrunch 6y ago
Here in BC we don't have such restrictive conditions, and yet we still have very few cases. Vancouver has about 76% of the population of SF, but has half the number of cases. Restricting people to be at home has no benefit, no logic behind it, but has significant repercussions on mental health.
- akozak 6y ago
  Seriously? No benefit, no logic?
  - cpncrunch 6y ago
    Correct. Driving somewhere doesnt increase risk, any more than walking near your home. In a large city you are probably better driving outside the city.
  - MrGando 6y ago
    I mean, his argument has very little logic. He's just using numbers to tell the story that he wants to hear. "Correlation doesn't imply causation"
    - cpncrunch 6y ago
      What is the logic behind restricting driving? (See my other comment here as well).
      - jacquesm 6y ago
        That (1) driving is a pre-cursor to contact with others and (2) driving requires contact with others (gassing up, toll booths, parking attendants, snacks, LE and so on) and (3) driving could lead to accidents which might in turn lead to you ending up in the ER or requiring ambulance transport.
        cpncrunch 6y ago
        Walking or driving can be a precursor to contact, but as mentioned in my previous comment, if you live in a large city it is difficult to physically distance yourself when walking outside. You are probably better driving to a more remote location for exercise. Generally there is sufficient distance from other people when gassing up, so that seems like a very low risk for a short period of time, compared to walking in a city. You are also at risk of requiring ambulance transport if you do DIY work at home. So best just sit in a dark room because you don't want electricity workers to have to go to work, or Netflix employees to have to go into work, etc.
glofish 6y ago
No one is advocating going back to usual. Just to stop the irrational hope and actions that seem to target impossible benchmarks - you can't eradicate the disease, not a chance - instead, learn to live with it. And you do that one step at the time, not locking down further.
amluto 6y ago
If we expect a roughly fixed number of people to eventually need hospitalization, then underutilizing hospital capacity is a waste of very expensive shutdown time. The shutdown is preventing quite a bit of sickness, disability and death from occurring during the course of the shutdown. If we could indeed maintain a shutdown forever, and if that would reduce the total amount of sickness, death, etc, then maybe it follows that an indefinite shutdown would have value to weigh against the cost. But those are some seriously questionable assumptions. What actually seems to be happening is that we are delaying people getting sick, and the value of that is not self-evident. I am suspicious that much of the COVID-19 response is based on pretending that it is a severe pandemic flu with a comparable fatality rate. With a flu, shutting the world down until summer or until a new flu vaccine can be mass produced has clear value. But COVID-19 is not the flu.
daodedickinson 6y ago
I don't know about San Francsico, but, in much of the less population dense US West, the deaths from denial of so-called "non-critical" procedures are getting out of control, and hospitals and medical facilities are losing way too many employees.
ravenstine 6y ago
The problem I see with that statement is that it's difficult, if not impossible to falsify. Hospitals are nowhere near being overwhelmed, in general, which means that they have some capacity to handle an outbreak if we lift restrictions gradually. I know people who work at hospitals in places like LA, and they've reported that activity is relatively slow. (of course in part because fewer people are going to the ER for other issues) Lives are being ruined by furthering a draconian lockdown. I know several people who have not only been laid off, but had their businesses destroyed and their dreams crushed. Someone in my neighborhood spent their life savings on starting a gourmet burgers and brews joint next to a movie theater, which would have undoubtedly succeeded in normal conditions. They're getting very few curbside orders because they opened after the pandemic started and nobody is familiar with the brand. They're almost certainly screwed, especially if some semblance of foot traffic doesn't begin coming back in the next month. I, too, was in the early stage of starting a brick and mortar business before the lockdown. Fortunately, I hadn't opened up anywhere yet. Because my business relied on the existence of gyms, I would have been massively screwed. If there is a god, I'll thank him now for not putting me through the ordeal of owing tens of thousands of dollars to the bank. Now I'm not even going to bother opening up because there may not be any appreciable business in the next year or so, which also means people whom I would have employed have to look elsewhere and may be out of work. Low hospital utilization seems to have become our only metric for success. I think that's crap, especially now that it's coming out that way more people have had this virus than the numbers suggested. We can put on masks, wash our hands, and all that, but this idea that "the new normal" is to have little to no proximity with other human beings is demoralizing and wrong. Life isn't just about staying alive. EDIT: To bring up anecdotes is not a fallacy, and I won't apologize for it. Some ignorant boob happened to bring up NYC, and their comment to mine got flagged, but I still want to reply to that point. You can't focus in on a particular city and then claim that, without draconian intervention, that NYC will be coming to a neighborhood near you. It's more complicated than that, and the more data we are getting, the more it's looking like we could begin to take measures to ease the restrictions in a reasonable way in parts of the world where it makes sense. But people like to point at the raw numbers rather than looking at the science or the per-capita numbers. By using the logic of "but look at NYC!", we should keep the entire world closed until every city on the planet has no more cases, which is highly improbable and destructive.
cs702 6y ago
If many people get very sick simultaneously, they would not only overwhelm hospitals, they would also inflict a disorderly, involuntary shutdown of large swaths of the economy, driven by fear -- instead of the orderly, voluntary shutdown we have at present, driven by government mandate. We all want to avoid a disorderly shutdown driven by fear.
- SnowProblem 6y ago
  Your definition of voluntary is entirely different from mine.
  - ryandrake 6y ago
    The current so-called shutdown (at least where I live) seems to be mostly voluntary. People are out and about horsing around all the time. There's no difference in traffic before and after on my street. It's pretty much being ignored by many people, and there's no visible enforcement. It seems more like a stay-at-home suggestion than an order.
marcell 6y ago
What is your evidence that hospitals in America in general, and in California, are anywhere near being overwhelmed? I've cited evidence which shows the opposite--they are very far from being overwhelmed.
- yongjik 6y ago
  On 3/16 San Francisco and some other cities issued the shelter-in-place order, and CA had 472 patients. Two weeks later, on 3/30, CA had 6,932 patients. That's 21% average daily increase, with an existing shelter-in-place order. With 21% daily increase, it takes 12 days to go from 10% to 100% hospital utilization. And change of policy usually takes a week or more to affect the curve. Which means, we are ~5 days away from an invisible deadline, after which hospitals will be overrun no matter what. That's not nearly far enough for my liking.
  - marcell 6y ago
    First, it's not clear or obvious that the 21% daily increase rate would increase indefinitely. Infection rate slows more people get infected, and new potential victims decrease. Second, all regions saw giant, double digit growth rates at first, and then lower growth rates. Sweden is taking a more laissez faire approach, and their growth rate has dropped from over +20% d/d to +1% d/d [1] There isn't data to support the idea that we'd have 100% utilization in the Bay Area without shelter in place. [1] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...
  - in_cahoots 6y ago
    Shelter in place is irrelevant here, it had just been instituted and it takes roughly 10 days to go from symptoms to hospitalization.
- glofish 6y ago
  I live in a county of little over 100K residents, one death occurred over the outbreak, a 91 year old person died of COVID19. Over the weeks we had a total about 65 known cases, all sent to recuperate at home, with a single patient in the hospital. The hospital has an entire wing dedicated to COVID patients that did not actually materialize. No care is provided to other patients that might need it (unless it is an emergency). Every appointment was rescheduled months into the future. Everyone must stay home on the account of better erring on the side of caution.
mattkrause 6y ago
Exponential growth also means that 10% utilization isn't a ridiculous amount of headroom: it's <4 doublings, each of a few days, from overwhelming the system with new patients. An R0 of 2 is towards the low end of estimates without social distancing. Zhang et al. estimate it as [2.06, 2.52] from the Diamond Princess data; Sanche et al. reported [3.8, 8.9] from data from Wuhan.
- usaar333 6y ago
  Without social distancing or contact tracing. The Bay Area's r is probably around 0.8 at this point with Santa Clara even lower (EDITED - see notes below). Some restrictions can be relaxed.
  - MrGando 6y ago
    > The Bay Area's r is probably under 0.8 at this point Could you tell me where are you getting this magic number ballpark estimate from? (somewhere concrete, not just your gut and imagination)
    - usaar333 6y ago
      Various data points. This is an upper bound, more calculated for Santa Clara county. International comparisons to lockdown level and case count changes. Assuming serial interval of 4 and > 10x non-detection rate on March 31 and 3x now gives you this. Knowing people were dying if the disease in early February implies very high lack of detection when SIP was in place. (Likely over 800 infections a day when Santa Clara activated SIP) Edit: More detailed explanation above.
  - killion 6y ago
    Rt of .88 according to https://rt.live https://rt.live I agree some restrictions could be relaxed. Hospitals were a good first step. More of the outdoors could be a good next one.
    - usaar333 6y ago
akira2501 6y ago
> What you think of as failure - hospitals currently low utilization - is in fact success. What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals. If this is truly a concern, and our rights our primary, then we should be building more hospitals so that we no longer have to make this Faustian bargain. It seems impractical and short-sighted to continue these measured based upon this single metric, especially when there are so many other ways to have a lasting impact on the problem. Aside from that, I don't personally believe it's the purpose of the government to save lives at any cost. Even the Police won't give you that guarantee.
- bobthepanda 6y ago
  The last rounds of major public (or notionally public) buildouts of infrastructure where profits be damned were funded by the feds, because the states and localities do not have the financial resources to add this along to whatever else they are currently funding, and even if they did you'd see a patchwork that mostly fails the truly underserved. This is extremely unlikely due to the current administration.
- Skunkleton 6y ago
  > What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals. What rights do you think you have here? Businesses are controlled through licensing and zoning. Outdoor spaces are regulated. Which right are you referring to?
  - SpicyLemonZest 6y ago
    The Bay Area shelter-in-place orders purport to ban you from inviting friends over, which is neither licensed nor regulated.
    - deleted 6y ago
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- throwawaySAc5U5 6y ago
smallgovt 6y ago
What is your reaction to Sweden's COVID track? They didn't shut down daily life, and their hospitals are doing just fine. In fact, COVID cases and deaths have plateaued. Source: https://www.bbc.com/news/world-europe-52395866 https://www.bbc.com/news/world-europe-52395866
- zizee 6y ago
  From the linked article: > data suggests the vast majority of the population have taken to voluntary social distancing, which is the crux of Sweden's strategy to slow the spread of the virus.
- beamatronic 6y ago
  Educated, rule-following population that values science and logic. Here we have “Tiger King”
  - recursive 6y ago
    They have Tiger King also, by VPN if necessary.
- bsder 6y ago
  This is my reaction: "This Japanese Island Lifted Its Coronavirus Lockdown Too Soon and Became a Warning to the World" https://time.com/5826918/hokkaido-coronavirus-lockdown/ https://time.com/5826918/hokkaido-coronavirus-lockdown/ Restrictions could start easing if you could manage an outbreak swiftly. This requires: 1) Enough tests that actually worked so you can SPOT an outbreak before it goes 3 weeks. 2) Enough resources in the medical system to handle an actual spike without collapsing 3) Enough protective equipment that won't disappear in the face of panic buying This is the MINIMUM. Are we there yet? Otherwise, you get Hokkaido.
  - SpicyLemonZest 6y ago
    I don't know if we're there yet, because the government won't say!
- 6y ago
siglesias 6y ago
There are a couple of flaws with this reply. 1. This doesn't appear to be a falsifiable position with respect to being overly conservative. Any action that results in the hospitals not being overwhelmed will be taken as somehow likely causing the hospitals not to be overwhelmed. It's not clear by this logic how hospital capacities are ever chosen given various uncertainties in the environment. 2. It commits a status quo bias. Only the risks of deviating from shelter in place are considered. On the one hand we have a virus with a CFR of around 0.5% with fairly well understood vulnerabilities to various parts of the population. On the other we have a completely unprecedented shutdown triggering a 2T spending package and causing record unemployment, with an unknown end goal. Is the risk of continuing down this path somehow less than the risks to the hospitals based on our knowledge of disease?
- twomoretime 6y ago
  > with fairly well understood vulnerabilities to various parts of the population. I don't think the virus is as well understood as you believe, which is why opening back up now may be premature. Regardless, the riskiest pre-existing conditions appear to be obesity and hypertension. 57-75% of Americans are obese according to the dedicated Wikipedia page. Also bear in mind there is considerable variance among obesity rates per locale. What's the CFR in obese patients? Edit: if you can't tell me the CFR in obese patients, you shouldn't be rushing to open everything back up. I don't know why people are silently downvoting but there is nothing incorrect or inconsistent about my comment and I'm just making a suggestion based on what little evidence exists.
  - siglesias 6y ago
    Whatever the effects are, what do you think three months of lockdown and closed gyms will do to the obesity rate?
    - twomoretime 6y ago
      Would you rather be obese or dead? Point is there will be more than enough cases to overwhelm hospitals if the virus spreads in earnest. In this respect our population is potentially more vulnerable than, say, much of Europe or parts of Asia. I don't know why my comment is even being downvoted. There is literally nothing factually incorrect or logically inconsistent about it yet every time I post anything regarding COVID19 I get immediate downvotes.
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Skunkleton 6y ago
People should remember that the mortality rate for COVID-19 is under 3% _with_ medical care. If it isn’t available the mortality rate goes way up to around 20%.
- rhexs 6y ago
  Please cite your sources for this amazing claim.
  - Skunkleton 6y ago
    Wuhan hit about 17% in the early days when their hospitals were overloaded. I though that was common knowledge? I also thought it was common knowledge that about 1 in 5 symptomatic cases require medical care.
    - rhexs 6y ago
      So, as expected, no source. "Common knowledge"...really?
      - Skunkleton 6y ago
        The cdc has revised their estimates down in wuhan from 17% to 12%, and hospitalization rates have also gone down as testing has improved over the last few weeks. On the flip side there is mounting evidence that many COVID-19 deaths are not being counted. [1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm [2] https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article [3] https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.html https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...
icelancer 6y ago
>> They are not right now because of stay-at-home orders. Can you produce evidence of this? What of the evidence that indicates SIP orders have had no effect, or potentially were detrimental? https://www.wsj.com/articles/lockdowns-wont-stop-the-spread-11586474560 https://www.wsj.com/articles/lockdowns-wont-stop-the-spread-... https://rt.live/ https://rt.live/
- scott_s 6y ago
  We were on an exponential growth path before. Now we’re not. It’s impossible to prove that an intervention made things not happen, but this is the predicted outcome.

crocodiletears 6y ago

You can ease up on the lockdown without ending it. That's what I read the parent to be implying.

newacct583 6y ago
Ease up how? I mean, what's the specific proposal? The lockdown isn't "total" anyway -- very large numbers of people are still working at full salary (including, it must be pointed out, probably more than half the readers of this very site). There's little to no low hanging fruit of safe jobs that can be reopened. Just go look at the California list of "essential" jobs and tell us what needs to be added. Fundamentally this is just a complicated strawman. People are arguing against "lockdown" but not in favor of another option. But we were all here in late march and we know what this disease does without containment.
- skellington 6y ago
  Are you not aware that "lockdown" covers a wide continuum of practices?! Ease up can mean a lot of things between what we have now and no lockdown whatsoever. What level of easing depends on the goal and the data showing what level of control is being achieved.
  - newacct583 6y ago
    I'm painfully aware, which is why I asked the question. Who would you like to see back to work, and are you certain they're not already on the list of essential positions?
- CPLX 6y ago
  > Ease up how? I mean, what's the specific proposal? Not sure how to put this but if you're advocating for the side that wants to confine seven million people to their homes and shut down nearly all commerce you're the one that has to come up with the specific proposal. The objection is that there doesn't seem to be any kind of numerical metric to determine the success of this shelter in place policy. It's public policy. So what are the stated goals of that policy, and what are the criteria for determining success? It is a serious fucking problem that people aren't even really trying to answer that question any more.
  - newacct583 6y ago
    > shut down nearly all commerce That doesn't seem right. I got tacos from down the street last night. I got paid a week ago. I bought some home office related junk from Amazon yesterday. I need to go shopping tonight. That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all. So I ask again: who do you want to go back to work before the virus case load drops? Be specific.
    - CPLX 6y ago
      > That's the problem with not being specific, you find yourself spouting silly hyperbole instead of argument. No, "almost all commerce" isn't shutdown, that's not remotely true. We're looking, depending on how pessimistic you want to be, at like a 20-30% drop in GDP. And that's big, but it's simply not almost all. You're kidding right? The drop in GDP between 1929 and 1932 was about 15% or so. You're saying I'm the one being hyperbolic for calling a drop of twice that size in three months a total free fall? I apologize I forgot about Jeff Bezos and your local taco guy. I'll try to be more optimistic, like you are doing here, by predicting an instant drop of economic activity to twice the severity of the Great Depression. And sure I'll take your bait on specifics anyways. I think we should pick policies just restrictive enough to keep hospitalizations below system capacity and no more. There really isn't any other reasonable choice, the current policy is just delaying the inevitable for no clear reason and without any specific vision of what success looks like. You realize that if we have the same number of cases, and deaths, but with 3-4x the economic destruction, that's a spectacular policy failure right?
- CamperBob2 6y ago
  Ease up by returning to normal economic activities, but with mandatory masks and gloves for most workers and consumers, while strongly encouraging social distancing. My current belief, based on experiences reported in other countries, is that this would be enough. There's not much evidence that total physical lockdown is necessary for everyone regardless of their level of vulnerability. Not a doctor, not medical advice, etc.
- smallgovt 6y ago
  Um, I'm not sure if you're being serious, but there are plenty of ways to gradually re-open. As an example: step 1) re-open elementary schools step 2) re-open middle schools step 3) re-open high schools & colleges step 4) re-open all small businesses that do not result in gatherings of more than 2 people in one place, then 5, then 10, then 20, then 50 I'm not saying that's the right approach but there is certainly middle ground between current shutdowns and a total re-opening of society.
  - wgerard 6y ago
    I think the problem at this point is two-fold: 1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month. 2) For better or for worse, we've conditioned people to be wary of contact with other people. A movie theater that's 10% full is still hemorrhaging money, perhaps worse than if it was closed entirely (no payroll costs/etc). I'm not sure what the breakdown is, so this could certainly be hyperbole, but it's entirely possible that people will just feel uncomfortable doing things with groups of >10 until a vaccine is available. A restaurant with 25% of its normal business will likely still need to shut down, reduce staff, etc. Sure, we may not have 22MM people filing for unemployment but it might still be 10MM, which is still extremely abnormally large. All that to say, there's a real possibility that gradual re-openings don't actually accomplish anything because the root fear (i.e. catching covid-19) hasn't been resolved in the minds of many people, especially in dense urban areas.
    - maerF0x0 6y ago
      > 1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month. Though it could make sense to re-open them a month early, health concerns permitting. They already got a "summer break" and can make up for lost time
      - Pfhreak 6y ago
        They most certainly did not get a summer break. My kid is absolutely still participating in school, and quarantine is pretty stressful for a kid. This hasn't been just loafing around, relaxing, and playing.
- crocodiletears 6y ago
  I'm not an expert. I'd lean towards loosening restrictions on non-essential businesses, imposing strict capacity guidelines, and adjusting the strictness of the guidelines by region at fixed intervals with a fixed lead time. Add some worker protections so people who don't feel comfortable working don't lose their jobs during when they reopen, and don't exempt them from receiving unemployment so reopening doesn't turn them into a burden for the nonessential employer. I'm lucky right now, to be an 'essential' employee making roughly twice minimum wage, working for an employer with deep pockets. I'm not coming from a place of personal inconvenience, because my job's gotten exponentially easier since people became afraid to go out. Most of our part time staff is gone, and I'm worried that SMBs will soon start dropping like flies. We've proven that lockdowns work, really well. now we need to find a balance in order to prevent the economy we as a society return to from being a small collection of megacorps wandering through a graveyard of small businesses and unemployment.
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trhway 6y ago
The one-size-fit-all lockdown was a reasonable first knee-jerk reaction given the situation. It isn't a tool to fight pandemic, it is just a breather to prepare the long-term sustainable tools and system - like production of tests, certified masks, etc., identifying/quarantining vulnerable population, putting contact tracing in place, adjusting various social distancing rules to be tighter/looser where it possible and makes sense, etc. - to actually fight pandemic. Yet it seems that the lockdown time has so far been almost wasted in that regard and the lockdown itself seems to be taken as the main tool to fight the pandemic (probably also coupled with the naive idea that this virus can be made to go away completely). That doesn't look good. We may get temporarily lucky - the hot and dry weather will slow down the spread until of course October/November when with such an approach we would be back to square 1.5 at best, and that if the virus doesn't mutate to become more virulent and/or deadly (the 2nd wave of the Spanish flu for example was more deadly than the first) For example - the construction was stopped at near by site. It is a huge 3 acre site where you can easily set social distance of say 10-20ft and have the clad in PPE crew working without any risk of virus spreading.

cpncrunch 6y ago

Here in BC we don't have such restrictive conditions, and yet we still have very few cases. Vancouver has about 76% of the population of SF, but has half the number of cases. Restricting people to be at home has no benefit, no logic behind it, but has significant repercussions on mental health.

akozak 6y ago
Seriously? No benefit, no logic?
- cpncrunch 6y ago
  Correct. Driving somewhere doesnt increase risk, any more than walking near your home. In a large city you are probably better driving outside the city.
- MrGando 6y ago
  I mean, his argument has very little logic. He's just using numbers to tell the story that he wants to hear. "Correlation doesn't imply causation"
  - cpncrunch 6y ago
    What is the logic behind restricting driving? (See my other comment here as well).
    - jacquesm 6y ago
      That (1) driving is a pre-cursor to contact with others and (2) driving requires contact with others (gassing up, toll booths, parking attendants, snacks, LE and so on) and (3) driving could lead to accidents which might in turn lead to you ending up in the ER or requiring ambulance transport.
      - cpncrunch 6y ago
        Walking or driving can be a precursor to contact, but as mentioned in my previous comment, if you live in a large city it is difficult to physically distance yourself when walking outside. You are probably better driving to a more remote location for exercise. Generally there is sufficient distance from other people when gassing up, so that seems like a very low risk for a short period of time, compared to walking in a city. You are also at risk of requiring ambulance transport if you do DIY work at home. So best just sit in a dark room because you don't want electricity workers to have to go to work, or Netflix employees to have to go into work, etc.

glofish 6y ago

No one is advocating going back to usual. Just to stop the irrational hope and actions that seem to target impossible benchmarks - you can't eradicate the disease, not a chance - instead, learn to live with it. And you do that one step at the time, not locking down further.

amluto 6y ago

If we expect a roughly fixed number of people to eventually need hospitalization, then underutilizing hospital capacity is a waste of very expensive shutdown time. The shutdown is preventing quite a bit of sickness, disability and death from occurring during the course of the shutdown. If we could indeed maintain a shutdown forever, and if that would reduce the total amount of sickness, death, etc, then maybe it follows that an indefinite shutdown would have value to weigh against the cost. But those are some seriously questionable assumptions. What actually seems to be happening is that we are delaying people getting sick, and the value of that is not self-evident. I am suspicious that much of the COVID-19 response is based on pretending that it is a severe pandemic flu with a comparable fatality rate. With a flu, shutting the world down until summer or until a new flu vaccine can be mass produced has clear value. But COVID-19 is not the flu.

daodedickinson 6y ago

I don't know about San Francsico, but, in much of the less population dense US West, the deaths from denial of so-called "non-critical" procedures are getting out of control, and hospitals and medical facilities are losing way too many employees.

ravenstine 6y ago

The problem I see with that statement is that it's difficult, if not impossible to falsify. Hospitals are nowhere near being overwhelmed, in general, which means that they have some capacity to handle an outbreak if we lift restrictions gradually. I know people who work at hospitals in places like LA, and they've reported that activity is relatively slow. (of course in part because fewer people are going to the ER for other issues) Lives are being ruined by furthering a draconian lockdown. I know several people who have not only been laid off, but had their businesses destroyed and their dreams crushed. Someone in my neighborhood spent their life savings on starting a gourmet burgers and brews joint next to a movie theater, which would have undoubtedly succeeded in normal conditions. They're getting very few curbside orders because they opened after the pandemic started and nobody is familiar with the brand. They're almost certainly screwed, especially if some semblance of foot traffic doesn't begin coming back in the next month. I, too, was in the early stage of starting a brick and mortar business before the lockdown. Fortunately, I hadn't opened up anywhere yet. Because my business relied on the existence of gyms, I would have been massively screwed. If there is a god, I'll thank him now for not putting me through the ordeal of owing tens of thousands of dollars to the bank. Now I'm not even going to bother opening up because there may not be any appreciable business in the next year or so, which also means people whom I would have employed have to look elsewhere and may be out of work. Low hospital utilization seems to have become our only metric for success. I think that's crap, especially now that it's coming out that way more people have had this virus than the numbers suggested. We can put on masks, wash our hands, and all that, but this idea that "the new normal" is to have little to no proximity with other human beings is demoralizing and wrong. Life isn't just about staying alive. EDIT: To bring up anecdotes is not a fallacy, and I won't apologize for it. Some ignorant boob happened to bring up NYC, and their comment to mine got flagged, but I still want to reply to that point. You can't focus in on a particular city and then claim that, without draconian intervention, that NYC will be coming to a neighborhood near you. It's more complicated than that, and the more data we are getting, the more it's looking like we could begin to take measures to ease the restrictions in a reasonable way in parts of the world where it makes sense. But people like to point at the raw numbers rather than looking at the science or the per-capita numbers. By using the logic of "but look at NYC!", we should keep the entire world closed until every city on the planet has no more cases, which is highly improbable and destructive.

cs702 6y ago

If many people get very sick simultaneously, they would not only overwhelm hospitals, they would also inflict a disorderly, involuntary shutdown of large swaths of the economy, driven by fear -- instead of the orderly, voluntary shutdown we have at present, driven by government mandate. We all want to avoid a disorderly shutdown driven by fear.

SnowProblem 6y ago
Your definition of voluntary is entirely different from mine.
- ryandrake 6y ago
  The current so-called shutdown (at least where I live) seems to be mostly voluntary. People are out and about horsing around all the time. There's no difference in traffic before and after on my street. It's pretty much being ignored by many people, and there's no visible enforcement. It seems more like a stay-at-home suggestion than an order.

marcell 6y ago

What is your evidence that hospitals in America in general, and in California, are anywhere near being overwhelmed? I've cited evidence which shows the opposite--they are very far from being overwhelmed.

yongjik 6y ago
On 3/16 San Francisco and some other cities issued the shelter-in-place order, and CA had 472 patients. Two weeks later, on 3/30, CA had 6,932 patients. That's 21% average daily increase, with an existing shelter-in-place order. With 21% daily increase, it takes 12 days to go from 10% to 100% hospital utilization. And change of policy usually takes a week or more to affect the curve. Which means, we are ~5 days away from an invisible deadline, after which hospitals will be overrun no matter what. That's not nearly far enough for my liking.
- marcell 6y ago
  First, it's not clear or obvious that the 21% daily increase rate would increase indefinitely. Infection rate slows more people get infected, and new potential victims decrease. Second, all regions saw giant, double digit growth rates at first, and then lower growth rates. Sweden is taking a more laissez faire approach, and their growth rate has dropped from over +20% d/d to +1% d/d [1] There isn't data to support the idea that we'd have 100% utilization in the Bay Area without shelter in place. [1] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...
- in_cahoots 6y ago
  Shelter in place is irrelevant here, it had just been instituted and it takes roughly 10 days to go from symptoms to hospitalization.
glofish 6y ago
I live in a county of little over 100K residents, one death occurred over the outbreak, a 91 year old person died of COVID19. Over the weeks we had a total about 65 known cases, all sent to recuperate at home, with a single patient in the hospital. The hospital has an entire wing dedicated to COVID patients that did not actually materialize. No care is provided to other patients that might need it (unless it is an emergency). Every appointment was rescheduled months into the future. Everyone must stay home on the account of better erring on the side of caution.

mattkrause 6y ago

Exponential growth also means that 10% utilization isn't a ridiculous amount of headroom: it's <4 doublings, each of a few days, from overwhelming the system with new patients. An R0 of 2 is towards the low end of estimates without social distancing. Zhang et al. estimate it as [2.06, 2.52] from the Diamond Princess data; Sanche et al. reported [3.8, 8.9] from data from Wuhan.

usaar333 6y ago
Without social distancing or contact tracing. The Bay Area's r is probably around 0.8 at this point with Santa Clara even lower (EDITED - see notes below). Some restrictions can be relaxed.
- MrGando 6y ago
  > The Bay Area's r is probably under 0.8 at this point Could you tell me where are you getting this magic number ballpark estimate from? (somewhere concrete, not just your gut and imagination)
  - usaar333 6y ago
    Various data points. This is an upper bound, more calculated for Santa Clara county. International comparisons to lockdown level and case count changes. Assuming serial interval of 4 and > 10x non-detection rate on March 31 and 3x now gives you this. Knowing people were dying if the disease in early February implies very high lack of detection when SIP was in place. (Likely over 800 infections a day when Santa Clara activated SIP) Edit: More detailed explanation above.
- killion 6y ago
  Rt of .88 according to https://rt.live https://rt.live I agree some restrictions could be relaxed. Hospitals were a good first step. More of the outdoors could be a good next one.
  - usaar333 6y ago

akira2501 6y ago

> What you think of as failure - hospitals currently low utilization - is in fact success. What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals. If this is truly a concern, and our rights our primary, then we should be building more hospitals so that we no longer have to make this Faustian bargain. It seems impractical and short-sighted to continue these measured based upon this single metric, especially when there are so many other ways to have a lasting impact on the problem. Aside from that, I don't personally believe it's the purpose of the government to save lives at any cost. Even the Police won't give you that guarantee.

bobthepanda 6y ago
The last rounds of major public (or notionally public) buildouts of infrastructure where profits be damned were funded by the feds, because the states and localities do not have the financial resources to add this along to whatever else they are currently funding, and even if they did you'd see a patchwork that mostly fails the truly underserved. This is extremely unlikely due to the current administration.
Skunkleton 6y ago
> What bothers me is the contention that my rights are contingent upon reported capacity of already existing hospitals. What rights do you think you have here? Businesses are controlled through licensing and zoning. Outdoor spaces are regulated. Which right are you referring to?
- SpicyLemonZest 6y ago
  The Bay Area shelter-in-place orders purport to ban you from inviting friends over, which is neither licensed nor regulated.
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throwawaySAc5U5 6y ago

smallgovt 6y ago

What is your reaction to Sweden's COVID track? They didn't shut down daily life, and their hospitals are doing just fine. In fact, COVID cases and deaths have plateaued. Source: https://www.bbc.com/news/world-europe-52395866 https://www.bbc.com/news/world-europe-52395866

zizee 6y ago
From the linked article: > data suggests the vast majority of the population have taken to voluntary social distancing, which is the crux of Sweden's strategy to slow the spread of the virus.
beamatronic 6y ago
Educated, rule-following population that values science and logic. Here we have “Tiger King”
- recursive 6y ago
  They have Tiger King also, by VPN if necessary.
bsder 6y ago
This is my reaction: "This Japanese Island Lifted Its Coronavirus Lockdown Too Soon and Became a Warning to the World" https://time.com/5826918/hokkaido-coronavirus-lockdown/ https://time.com/5826918/hokkaido-coronavirus-lockdown/ Restrictions could start easing if you could manage an outbreak swiftly. This requires: 1) Enough tests that actually worked so you can SPOT an outbreak before it goes 3 weeks. 2) Enough resources in the medical system to handle an actual spike without collapsing 3) Enough protective equipment that won't disappear in the face of panic buying This is the MINIMUM. Are we there yet? Otherwise, you get Hokkaido.
- SpicyLemonZest 6y ago
  I don't know if we're there yet, because the government won't say!
6y ago

siglesias 6y ago

There are a couple of flaws with this reply. 1. This doesn't appear to be a falsifiable position with respect to being overly conservative. Any action that results in the hospitals not being overwhelmed will be taken as somehow likely causing the hospitals not to be overwhelmed. It's not clear by this logic how hospital capacities are ever chosen given various uncertainties in the environment. 2. It commits a status quo bias. Only the risks of deviating from shelter in place are considered. On the one hand we have a virus with a CFR of around 0.5% with fairly well understood vulnerabilities to various parts of the population. On the other we have a completely unprecedented shutdown triggering a 2T spending package and causing record unemployment, with an unknown end goal. Is the risk of continuing down this path somehow less than the risks to the hospitals based on our knowledge of disease?

twomoretime 6y ago
> with fairly well understood vulnerabilities to various parts of the population. I don't think the virus is as well understood as you believe, which is why opening back up now may be premature. Regardless, the riskiest pre-existing conditions appear to be obesity and hypertension. 57-75% of Americans are obese according to the dedicated Wikipedia page. Also bear in mind there is considerable variance among obesity rates per locale. What's the CFR in obese patients? Edit: if you can't tell me the CFR in obese patients, you shouldn't be rushing to open everything back up. I don't know why people are silently downvoting but there is nothing incorrect or inconsistent about my comment and I'm just making a suggestion based on what little evidence exists.
- siglesias 6y ago
  Whatever the effects are, what do you think three months of lockdown and closed gyms will do to the obesity rate?
  - twomoretime 6y ago
    Would you rather be obese or dead? Point is there will be more than enough cases to overwhelm hospitals if the virus spreads in earnest. In this respect our population is potentially more vulnerable than, say, much of Europe or parts of Asia. I don't know why my comment is even being downvoted. There is literally nothing factually incorrect or logically inconsistent about it yet every time I post anything regarding COVID19 I get immediate downvotes.

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Skunkleton 6y ago

People should remember that the mortality rate for COVID-19 is under 3% _with_ medical care. If it isn’t available the mortality rate goes way up to around 20%.

rhexs 6y ago
Please cite your sources for this amazing claim.
- Skunkleton 6y ago
  Wuhan hit about 17% in the early days when their hospitals were overloaded. I though that was common knowledge? I also thought it was common knowledge that about 1 in 5 symptomatic cases require medical care.
  - rhexs 6y ago
    So, as expected, no source. "Common knowledge"...really?
    - Skunkleton 6y ago
      The cdc has revised their estimates down in wuhan from 17% to 12%, and hospitalization rates have also gone down as testing has improved over the last few weeks. On the flip side there is mounting evidence that many COVID-19 deaths are not being counted. [1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm [2] https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article https://wwwnc.cdc.gov/eid/article/26/6/20-0233_article [3] https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.html https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...

icelancer 6y ago

>> They are not right now because of stay-at-home orders. Can you produce evidence of this? What of the evidence that indicates SIP orders have had no effect, or potentially were detrimental? https://www.wsj.com/articles/lockdowns-wont-stop-the-spread-11586474560 https://www.wsj.com/articles/lockdowns-wont-stop-the-spread-... https://rt.live/ https://rt.live/

scott_s 6y ago
We were on an exponential growth path before. Now we’re not. It’s impossible to prove that an intervention made things not happen, but this is the predicted outcome.