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A case for ending lockdown

• ryankemper 6y ago
  If it's not obvious, I wrote this. The intent is to be a fairly comprehensive coverage of what we know about COVID-19 and what it means for our policy. Note that the article is written from a US-based perspective although I suspect it's relevant to a broader audience. In general, I believe that the case against lockdown has been highly stigmatized and thus many people have not been exposed to a convincing argument of why some of us feel that our response has actually made things worse. I encourage any pull requests (see the very final section). If you're short on time, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#section-6-tl-dr-simple-words-only https://www.ryankemper.io/post/2020-04-29-the_case_for_endin..., which has a readability score (Flesch-Kincaid, etc) of around a middle school level and is extremely brief and to the point. For those who have a bit more time but still not enough for the whole article, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#section-2-how-serious-is-covid-19 https://www.ryankemper.io/post/2020-04-29-the_case_for_endin.... In particular understanding the age-stratified risk distribution, and how it differs from Influenza, is super important. Finally I'd also recommend checking out the proposal, which ironically is the shortest section: https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#section-4-pareto-mitigation-an-evidence-based-approach https://www.ryankemper.io/post/2020-04-29-the_case_for_endin... Thanks for any feedback.
  • mdasen 6y ago
    I'm a bit confused by the Gitlab logo on your site. Do you work for Gitlab? Is Gitlab endorsing your article?
    • ryankemper 6y ago
      Oof, good observation and I should definitely clarify here. I have no affiliation with Gitlab whatsoever. This is my personal blog that I made when I quit my previous job a couple months ago. I ended up repurposing the blog because I couldn't figure out how to get a table of contents working on a generic markdown file (i.e. I originally was just going to link to plain markdown in my git repo), but I was able to quickly figure out how to get it working with hugo. I used Netlify / Hugo via Gitlab to do so, so the Gitlab logo just happened to be part of the default theme. I'll look into removing it for clarity later.
    • ryankemper 6y ago
      Circling back: https://gitlab.com/ryankemper/nfhugo/-/commit/1a8ead81ff65d730a9032cc14e380fa95a29f550 https://gitlab.com/ryankemper/nfhugo/-/commit/1a8ead81ff65d7...
  • JadeNB 6y ago
    Having, as you suggested, skipped just to the TL;DR, this bit jumped out at me as something that we very much don't know is true, and that it's dangerous to assume is true without proof: > Once you get sick, you can’t get sick again for a long time. Eventually you might be able to get sick again, but it will not be very bad. When enough people have gotten sick and then gotten better, the sickness can’t spread any more. (Incidentally, at one point you leave out the 'z' from "hospitalization".)
    • mrfusion 6y ago
      That’s a popular point with the talking heads on the media but I’d encourage you to read up on it. Best estimates look like 1-4 years of immunity [1] 1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30985-5/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
      • JadeNB 6y ago
        I hadn't seen the Lancet article—I was getting my latest information from the Quanta article also on the front page (https://www.quantamagazine.org/what-can-other-coronaviruses-tell-us-about-sars-cov-2-20200429)—and https://www.quantamagazine.org/what-can-other-coronaviruses-... I guess it's a matter of language and personal preference, but "this global pandemic will be in abeyance for a year or so" doesn't match my informal understanding of "a long time". I also believe, as sibling postpawl (https://news.ycombinator.com/item?id=23025675 https://news.ycombinator.com/item?id=23025675) points out, that there is still at least a divergence of opinions here, and that it is dangerous to get it wrong. (Personally, while I think voicing unpopular opinions is definitely a role we need in society, it seems to me that dismissing widely accepted opinions as due just to "talking heads on the media" puts disputants in an adversarial position that makes it more likely for people to hunker down in their existing opinions, and less likely for anyone's mind to change. Your refutation would have been more, not less, convincing to me if it had just pointed to the Lancet article.)
        • mrfusion 6y ago
          You make a good point. Sorry about my reply. I’m so used to getting downvoted these days I’m trying out different writing styles. (Maybe this one is a fail)
  • mrfusion 6y ago
    I see a lot of good points here. Thanks for creating this.
  • nostromo 6y ago
    I wish you the best. This debate has taken on all the fervor of a holy war, and putting out an contrarian position has been hugely unpopular. One thing I'd add: employment and health insurance are tied together in the US. The lock down dramatically increased unemployment, the majority of whom will not pay expensive Cobra costs, and will soon be uninsured. The opposite of what was intended may happen: we are now less prepared to deal with an increase in demands on healthcare than we were a month ago, as uninsured people tend to avoid hospitals until they're absolutely necessary.
    • ryankemper 6y ago
      Thanks. That point about health insurance is great and I think I should weave that into the part that talks about furloughing medical workers. I'll see about doing so after I take a break to eat some food. (As an aside, I'm pretty comfortable writing and can write pretty quickly but as you can imagine just getting to this first draft took a lot out of me.)
  • japhyr 6y ago
    > This is a living document and we encourage contributions in the form of pull requests. Who is "we"? I understand your use of "we" to speak from the perspective of us as a society through most of the article, but this makes it sound like there's more than one author.
    • ryankemper 6y ago
      s/we/I I chose to use "we" both because it fits with the semi-formal tone better, but more importantly because I want to give others a chance to open PRs if they choose to do so, so I was basically future-proofing for a possible scenario where I wasn't the only contributor.
      • ryankemper 6y ago
        FWIW, I will probably circle back here and switch to "I", since I think it's probably worth it to avoid confusion.
        • mchusma 6y ago
          I may submit a PR then it would become "we".
          • ryankemper 6y ago
            Thanks. I'm going to leave it as is. As another commentator has mentioned, use of the singular "we" is very common in academic writing anyway, not that I'm saying that this blog post of mine is "real" scientific research or anything
    • DarthGhandi 6y ago
      This is fairly common for many styles of writing even when it's clearly just one author. Considering he's open to pull requests it makes even more sense. https://academia.stackexchange.com/questions/2945/choice-of-personal-pronoun-in-single-author-papers https://academia.stackexchange.com/questions/2945/choice-of-...
  • newbie789 6y ago
    >...which has a readability score (Flesch-Kincaid, etc) of around a middle school level... This might not be the most condescending thing I've ever read on HN, but it's definitely gunning for one of the funniest. Genuinely, what is the purpose of making an argument about a complex topic and then suggesting that skipping nuance and detail is an acceptable route to forming an opinion? If you're so certain on this topic and think that your tl;dr section cuts to the quick of the issue so well that people with a middle school reading level should obviously understand and agree with your point, what is the purpose of the post as a whole? To be clear, I think this is silly on multiple levels but the babytalk bit made me lol
  • ohlookabird 6y ago
    Thanks, will definitely read it, but on a first glance I couldn't see any information on your background or experience in the field of epidemiology or a related science. It would definitely help to put your thoughts into context and if you have a background in this field it would give your collection of thoughts more weight. With all the misinformation going around I resorted to mainly listen to scientists in the relevant fields directly (if you speak German, the NDR podcast with Prof. Drosten is really nice in my opinion). Therefore I think it really helpful if research institutions and researchers themselves who are in that field (!) are vocal (but reserved and competent) about studies and thoughts. For instance, today the four big research institutions in Germany (Max Planck, Helmholtz, Leibnitz, Frauenhofer) published a joint message in favor of social distancing and contact restrictions: https://www.nytimes.com/reuters/2020/04/29/world/europe/29reuters-health-coronavirus-germany-scientists.html https://www.nytimes.com/reuters/2020/04/29/world/europe/29re... Edit: I only found the German press release so far: https://www.mpg.de/14759871/corona-stellungnahme https://www.mpg.de/14759871/corona-stellungnahme
    • ryankemper 6y ago
      I have no directly relevant credentials whatsoever and don't claim to. (I actually considered saying as such in the writeup but it's already so verbose that I felt it wasn't worth it). I'm just a dude that likes to read research papers. As an aside, there is totally an archetype of the software engineer that thinks they're equipped to dive into unrelated fields, and I definitely match that trope. I will say in my defense though, that I try to build simple mental models and take them to their logical conclusion, which is a quality that I see in people I admire, and conversely a quality that I find lacking in people that I feel don't have a lot of insight. Many might disagree but I am a very strong believer that arguments should be evaluated on their merits, rather than credentials. Indeed having credentials makes it that much easier to fall prey to cognitive distortions.
      • meheleventyone 6y ago
        > I have no directly relevant credentials whatsoever and don't claim to. IMO this should be a disclaimer in bold right at the very top of the article.
  • williamstein 6y ago
    I found a typo: "incredible stess" --> "incredible stress". This is well written. Thank you. It's wrong that this post is currently flagged.
    • ryankemper 6y ago
      Thank you. https://gitlab.com/ryankemper/writings/-/commit/ca2771bbe1df37512b8e560f540dedb6ac8e4704 https://gitlab.com/ryankemper/writings/-/commit/ca2771bbe1df...
    • dang 6y ago
      We turned off the flags. I haven't read the article, but it seems thoughtful enough, and the thread substantive enough, to count as on topic here.
  • cjhopman 6y ago
    I'm sorry but I can't take serious something that claims to take an impartial look at all the evidence related to the lockdown but then tries its damnedest to present all possible negatives it could without doing the same for positives. For example, there's clear evidence that the lockdown has decreased lives lost to traffic accidents but that appears nowhere here. And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented. Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives. Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated". This thing is so littered with bias and lack of facts that it is not useful for any serious consideration of this. I'm sure it's great for people who already have their mind set in one direction, though.
    • ryankemper 6y ago
      The positive externalities is not a bad point. Where I'm having trouble is, it seems that if we wouldn't pass a law ordering people to not drive around in normal times, then it feels wrong to point to it as a positive when it's induced by people not being able to do anything. That being said, I think it does make sense to account for positive externalities. Can you think of others that are lockdown-specific? The classic ones right now are pollution. > Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives. I'm not sure if that is a great example of only looking at the negatives. This is one dimension where the effects of the lockdown are basically exclusively negative as opposed to being a mixed bag. So this feels like something that absolutely _should_ be mentioned. Particularly when factoring in the irony of it increasing mortality from other non-COVID-19 infectious diseases. > Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated". I don't think this is at all fair either, but I must admit I chuckled a bit. It is a funny thought. > And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented. So, this is the biggest hole that I personally see in my argument, so I very much agree here. The trouble I ran into is, this is such an unprecedented situation that it would have felt ridiculous if I just started making up mortality predictions. So it felt like a good balance to highlight the _potential_ for increased mortality. I do think that means I likely need to soften the language around lockdown causing more mortality to accentuate the fact that it's merely _likely_ that it does. -- Is there anything else you can think of? Thanks for the feedback.
  • new_realist 6y ago
    Do you think that your experience of looking for a job in the middle of the lockdown might have introduced subconscious bias into your argument?
    • ryankemper 6y ago
      No, not at all. I quit my job of my own volition, and have several years of living expenses in liquid financial assets. Most people are not that lucky. Additionally, the two companies that I had narrowed the search down to did not freeze hiring. Pretty lucky, since tons of companies did, although I constrained my search to remote jobs only so that's probably why. I accepted a job offer and start soon, actually. That being said, I do think that the general experience of being jobless during this has made me more sympathetic of those that truly lost their jobs than I otherwise would have. Which is not to say that I wouldn't have been sympathetic, I absolutely would have, but the fact that I had to deal with COBRA and other fun artifacts definitely made things a bit more tangible for me. Excellent point/question.
  • deleted 6y ago
    [deleted]
  • diffeomorphism 6y ago
    The mortality rates you quote are for the case when the number of cases is low and the hospital system is working. To see what happens otherwise look at Madrid, look at the UK aiming to "protect the NHS". If you had unlimited hospital capacities your analysis would make sense, but that is the whole point(!). If you can flatten the curve, then covid is manageable, if you can't your hospital system collapses and suddenly everything not just covid is much more deadly.
    • ryankemper 6y ago
      Out of curiosity, to what extent do you feel we successfully flattened the curve in New York? Given that recent serology results showed between 15-20% prevalence, it does seem like it could have been significantly worse. But just to be clear we should note that we ended up having a massive excess of capacity as far as ventilators and beds were concerned (I'm guessing the real bottleneck is trained staff but am not sure)
      • scott_s 6y ago
        I am unaware of a "massive excess of capacity" in NY; quite the opposite. Where do you make that conclusion from? NY, to my knowledge, has been well over capacity and has had to take severe measures. Hospitals have had more patients than they can deal with and the staff is overworked. Elective procedures have been cancelled, no visitors are allowed, doctors and nurses who ordinarily work elsewhere are working in Covid-19 units. Chicago is not doing well either. To put my chip down: yes, I do think we succeeded in flattening the curve in NY. We started the lockdown late, so we could not prevent it from getting very bad, but had we not done a lockdown, it probably would have been worse for longer.
        • ryankemper 6y ago
          By massive excess I was referring to vents/tents. Estimates of vents needed were far too high due to the models being relied upon (i.e. not because we surprised ourselves with how flat the curve got given the seroprevalence was not expected from policymakers as far as I can tell). Still, I _don't_ know about how we are doing in terms of healthcare workers. That's almost certainly the bottleneck and it may be that it's still a bottleneck. I'd have to do some research to say for sure. It's very possible my statement was not correct in that light. Meta: I'm currently constrained to using one arm since I had a not-so-fun ER visit today, so I'm not really firing on all cylinders right now. So, if you happen to look into the NY capacity matter on your end, I would love to hear your findings.
  • etherio 6y ago
    I am sorry, but you are repeatedly presenting positives aspects for opening up without presenting any of the negatives. And even these positives are very hypothetical: > Sometimes lightning does strike twice On the other hand, you say > Remember, flattening the curve does not reduce deaths in the long-run, except insofar as it avoids overrunning hospitals, which we have already achieved. If some countries have achieved this containment in the hospitals, not all, it is only by doing the lockdown, I can't believe you would think that opening up would not overrun the hospitals, if we open up, they will be flooded with new victims and those deaths will NOT be hypothetical. Although you bring up many valid points, in my opinion this is where your statement fails. Opening up WILL cause new deaths. I believe a gradual opening would be much more efficient only once the rise has already been slowed down.
  • hkai 6y ago
    I've read the whole thing and I have these comments: - I think the part about the freedoms is unnecessary because I feel the vast majority of the pro-lockdown people do not share your enthusiasm for freedom and public discourse. While your main argument may shift their opinion, the part about liberty may cause them to stop reading and discard your other arguments. - I think some claims would sound more persuasive if there were more links to research. For example, the claim about 0.1-0.7% mortality. There's a study about China (0.66% mortality) and a bunch of others that could support your point. You could also add mortality stats for influenza in the US from the CDC website (I think it's 0.13% on average). - The TLDR sounds bitter and childish, in my opinion. Overall a great summary and I'll share that with others.
    • UncleSlacky 6y ago
      I laughed at this: > Other countries do not even have the concept of freedom of speech/assembly embedded into their founding documents. as it was clear that the author hadn't done any research on this - many countries explicitly or implictly have these in their founding documents.
      • ryankemper 6y ago
        Yes, the statement as I wrote it was imprecise enough to be false. I am going to circle back and fix it. In short, the important distinction is not that it's embedded into the founding documents, but that we do not place the limitations on free speech that other countries do. i.e. places like UK, germany, france - while they may have the phrase "free speech" in their documents, the limitations put on it are extreme enough that they're basically referring to a totally different concept. So, it would be more accurate to say that other countries do not share our concept of free speech, in that ours has _very_ few limits put on it.
      • ryankemper 6y ago
        Circling back: https://gitlab.com/ryankemper/writings/-/commit/6daa56a4a05f9903b51f78133deaad584243eb64 https://gitlab.com/ryankemper/writings/-/commit/6daa56a4a05f...
  • arh68 6y ago
    I think your argument is well-written (aside from s/effects/affects/ in effects an extremely limited..) but just not convincing. I think this part goes way too far presuming intent, really hurts your case without a qualifier. > Those advocating a policy of containment, and with it, totalitarian-style lockdown, are not doing so based upon scientific evidence, but rather upon superstition and tribalism. And to be so critical of "omission", the TLDR says nothing of air-to-air transmission while eating, like in a restaurant.
• chente 6y ago
  Everyone is an epidemiologist in a pandemic.
  • nostromo 6y ago
    The article is more about policy than epidemiology.
    • ohlookabird 6y ago
      The former should however follow recommendations of the latter I think. If you agree, then policy isn't independent of epidemiology.
      • goalieca 6y ago
        I disagree. Epidemiology is a science that generates facts and modelling with various degrees of accuracy. What you do with the science is in the realm of public policy and politics
      • ryankemper 6y ago
        I agree (I think). Personally I believe the two are related. Epidemiology must inform the policy. And similarly we can only understand epidemiology if we understand the basic building blocks of immunity. That, in fact, is why I have an initial section that's just about these deceptively simple concepts that we all need to understand. I wish our leaders had actually metaphorically sat the American people down and explained the basics. The average person really does not know what a virus is, or how diseases are transmitted. So, I actually entirely agree with the position that this is something that relates to epidemiology. Where I differ is that I don't believe in gatekeeping, I think if someone has taken the effort to synthesize research into a policy proposal, however poorly, it seems at least worth debating the ideas on their merits. The experts who know more than me (and they do, at least some of them) should be able to convince a rational/reasonable person that their position is the correct one without resorting to credential-waving. -- BTW I do read quite a lot of research papers, but I don't naturally have much interest in epidemiology. Just to give you an idea, I usually end up reading papers about stuff like: moist wound healing, and the role of red light therapy in fibroblast differentiation, and more broadly the role of electromagnetism in wound healing and neuronal galvanotropism. Weird stuff like that that's connected by invisible threads. So, why did I read a bunch of epidemiology/COVID-related research papers? Well, the state of discourse here in the US, and also globally, has hit such a level of insanity that I decided that I needed to figure out what the facts were. (I'm not saying I have "figured out the facts" perfectly, or even at all, just that I am trying to) Honestly, it might sound ridiculous, but the turning point for me was reading that Venice Skate park was filled in with sand to prevent people from skating there. That is what informed my intuition that we are collectively being driven by superstition, and therefore what motivated me to read a bunch of research papers and reach my own conclusion about what's going on. My ultimate conclusion? Well, the writeup is pretty clear on that one.
• mistersquid 6y ago
  > Remember, flattening the curve does not reduce deaths in the long-run, except insofar as it avoids overrunning hospitals, which we have already achieved. Flattening the curve is not beneficial for its own sake; indeed, it worsens the economic damage, and thus it should only be practiced unti we know that we won’t overwhelm hospitals. The area under the curve remains the same. We strongly belief that a rational examination of the evidence will show that practicing containment “until the vaccine” (which will take years and is not guaranteed to be possible, although we personally believe that we eventually will have an effective vaccine) is a foolish policy that will lead to far more mortality than simply “biting the bullet”. The problem with the analysis and exhortation to end the lockdown is contained in the above. Flattening the curve is a way of maintaining hospital capacity and is an ongoing effort. Saying "we have already achieved" it is nonsensical. What does make sense is maintaining hospital capacity and following a reopening protocol along the lines of: 1. Reopen sections of economy, relaxing stay-at-home for some workers. 2. Monitor for outbreaks. 3. Test and contact tracing. 4. In case of new outbreaks: quarantine and strengthen stay-at-home. 5. Repeat 1-4. And continuing this until - Advent of treatments for COVID-19 - Advent of vaccine for SARS-CoV-2 - Herd immunity has been achieved. The essay linked in the OP refutes the simple argument that lockdown must be maintained by presenting an overwhelming number of details about COVID-19, its lethality, elective vaccination, secular superstition, and all other manner of irrelevant topics. The reason for the lockdown is to maintain healthcare capacity in the face of a virus that is highly contagious. A workable and moral framework for ending lockdown looks something like what I've outlined above. The OP provides no suggestions on how lockdown might end, other than gathering an enormous amount of tangential evidence to prove "The Case for Ending Lockdown".
  • ryankemper 6y ago
    I'm not going to dive into your full post, but suffice to say that you are advocating a policy of capital-c Containment. Your implicit assumption is that we can avoid infection sufficiently long enough such that the future utility of vaccines and as-of-yet-undiscovered treatments outweighs the cost. My position is that the cost of lockdown massively outweighs the cost of COVID-19 itself, and furthermore I am suspicious of the belief that we can effectively contain it without boarding people in their houses. > The reason for the lockdown is to maintain healthcare capacity in the face of a virus that is highly contagious. And yet the lockdown has, overall, scaled _down_ our healthcare capacity amidst the most serious pandemic in a century. Why is that? I can already foresee an argument of "oh well, the lockdown is fine, we just need to pass government regulations that pays hospitals to maintain this extra capacity". And my argument to that is, beyond a general distrust of government incompetence, paying somebody to sit around will not maintain their skills in the same way as paying them to actually perform the preventative care that we hired them for in the first place. > The OP provides no suggestions on how lockdown might end But I literally provided a proposal. The proposal is to have at-risk members of population - and yes, we can identify who is at risk really quite easily with the data we now have - quarantine as we've all been doing. Meanwhile, the rest of society is no longer forbidden from transacting and producing value. Again, if you look at the fatality rate data, you will see that if we can just protect everyone over 60 - and especially everyone over 70 - we will mitigate probably 80% of the deaths. Unfortunately, even _with_ the lockdown, we have utterly failed to do so thus far in many parts of the country. In particular, I strongly oppose the moral panic around people going to the beach, public parks, etc. Unlike our politicians, I strongly believe that these activities can be done safely and that there is insufficient evidence to show that they were ever a serious transmission vector in the first place.
• sethc2 6y ago
  Why was this flagged? I don’t even necessarily agree with the author’s arguments and conclusion, and honestly I have no clue what to think with all the information I hear that is constantly changing from the various tribes. But when something gets flagged simply because he advocates for ending the lockdown, I go from thinking the lockdown is probably necessary and trust the decision is made for reasons I don’t understand, to thinking like the paranoid conspiracy theorist that this is just a totalitarian power grab, and figure the need to suppress dissent means that it is more likely his position is the right one. If the ideas he is presenting are so stupid then people can decide that for themselves and don’t need some moral busybody protecting us from thinking for ourselves by flagging anything that states the opposite of what their tribe thinks is true.
  • ryankemper 6y ago
    Out of curiosity, do you know if it being flagged means it's now invisible to others? Or is "flagged" the intermediate state between a normal submission and a dead one?
    • sethc2 6y ago
      Not sure. All I know is I saw the article on the main page, navigated away and when I came back it was gone. I searched for the title and then found it but it was flagged. I was thinking of sharing on Facebook but I'd probably get banned, even if i still feel we should probably keep the lockdown for a little bit longer, because apparently the moral authorities have decided it is off limits to suggest we should end the lockdown or even discuss whether we should.
    • dang 6y ago
      It's the latter. It's possible for a submission to get so many flags that it also gets killed, but the software doesn't do that once there are lots of comments.
      • sethc2 6y ago
        That seems like a pretty good algorithm.
• daly 6y ago
  LIsten to a real epidemiologist: (https://www.microbe.tv/twiv/ https://www.microbe.tv/twiv/) episode 607.
• cy_hauser 6y ago
  I just hate these blogs saying this virus is akin to the the flu. Does the flu leave bodies in trucks, apartments, and bagged on the streets? Does the flu kill dozens of workers in meat processing plants every year. Does the flu take more than ten years of life from the average person it kills? Also, suicide death rates are still wildly unknown but deaths by traffic fatalities are way down. We need to get help to people feeling suicidal. Before the virus and now especially.
  • ryankemper 6y ago
    > I just hate these blogs saying this virus is akin to the the flu Author here. That's a mischaracterization of what I said. But yes it is true that overall mortality is similar to the flu. I settled on COVID-19 being 3x as deadly, but that figure is up to debate. The important thing to understand is the varying risk profiles. The flu kills the very young and very old, whereas COVID-19 primarily kills the very old. > Does the flu leave bodies in trucks, apartments, and bagged on the streets? Yes, pandemic flu absolutely does. > Does the flu kill dozens of workers in meat processing plants every year Yup. Pandemic flu absolutely would. > Does the flu take more than ten years of life from the average person it kills? Could you clarify this point? I don't quite understand what you're saying. The flu takes away more wellbeing-years per death because it kills infants and young children whereas COVID-19 almost never does.
    • URSpider94 6y ago
      Two comments. One, saying something that is 300% larger than another is “similar” is stretching the definition of similarity. Two, both the numerator and the denominator matter in the death rate. In a given year, maybe 20% of the population get the seasonal flu. We could potentially see 80+% of the population contract covid. That’s another 4x multiplier of fatalities, but also hospitalizations.
      • ryankemper 6y ago
        The latter point is precisely why I was careful to say "pandemic flu" when responding to the above. But yes, the point is very valid. A novel disease with the same IFR of an established disease will kill a lot more in the year that it is introduced. (BTW, something that occurred to me is that the fact that infants are largely spared from COVID-19 is even more of a blessing than it already seems. Once this passes through our population, new infections will be in those who are not immune which will primarily be infants/young children, who we know thus far have had really good outcomes relative to adults. That means the enduring legacy of this will be much better than what we see with Influenza) > One, saying something that is 300% larger than another is “similar” is stretching the definition of similarity. I defined "ballpark" in the article as less than an order of magnitude. But, I think this is a thought exercise that might help: Imagine that SARS-CoV-2 doesn't exist, but we learn that this flu season is going to be extra deadly. Instead of the ~50k of deaths last year, we know that there will be ~150k deaths. Would we rationally take the same extreme of measures that we have taken for Covid? (Or, conversely, should we already have been taking these measures for past flu seasons)? Also I think you're very aware of this, but just for any on-lookers: don't look at the flu comparisons as intending to minimize COVID-19; but rather comparing to flu gives us an existing mental model that most people are familiar with that helps us figure out what measures make sense and what don't.
• Fuzzwah 6y ago
  > SARS-CoV-2 is a virus that can make you sick. Some people don’t feel sick at all, some people feel a little bit sick, and a very small group of people, especially old people, get very sick and might die. Maybe mention something about the long term issues that it appears could be a reality for even those who "don’t feel sick at all, some people feel a little bit sick"? Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission.
  • ryankemper 6y ago
    > Maybe mention something about the long term issues that it appears could be a reality for even those who "don’t feel sick at all, some people feel a little bit sick"? Have you seen any scientific literature alleging this possibility in those who are not seriously ill? Not to sound like the WHO, but I have not personally come across any evidence that this is at all true. And indeed it seems highly non-credible. > Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission. This is true, but now they can't let anyone into their country until the whole island has been vaccinated. That could get very tricky. Well, I suppose they could do what Taiwan and other countries have done and aggressively test&quarantine all entrants. That's certainly possible.
    • URSpider94 6y ago
      The popular press has summarized an article from NEJM discussing five strokes in relatively young patients with either asymptomatic or mild covid cases. Yes, it’s anecdotal. https://www.google.com/amp/s/www.forbes.com/sites/robertglatter/2020/04/27/why-is-covid-19-coronavirus-causing-strokes-in-young-and-middle-aged-people/amp/ https://www.google.com/amp/s/www.forbes.com/sites/robertglat...
  • lbeltrame 6y ago
    Disclaimer: I don't believe long term issues may not arise. I simply don't know. That said, most evidence I've read is fairly anecdotal, or made up mainly by case reports. Has anyone compiled so far (this is a honest question, I don't know) the incidence (this is what matters) of different issues post-recovery?
• deleted 6y ago
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• danieltillett 6y ago
  Ryan since you have asked for comments here are some from me. 1. The true IFR is hard to estimate at this point, but looks to be around 1%. This is a very difficult question to answer with the data we have and all the limitations. 2. There is little evidence that we can reach herd immunity levels of infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is too high and the immunity too short lived. 3. The IFR has a threshold where it dramatically increases when the number of new cases overwhelms the hospital capacity. We have seen this to a certain extend in Wuhan, Northern Italy and NYC. 4. As treatments improves the IFR should fall. This mean if we can shift an infection to the future we should see less people die. Flattening the curve is more than just avoiding overwhelming the hospital system, it is also about shift cases to a time when we have improved treatments. 5. Sweden has shown that it doesn’t matter if you have an official lockdowns or not, most people will self isolate on their own. There is little extra economic damage from imposing official lockdown policies since all the damage is done by people avoiding infection on their own.
  • sethc2 6y ago
    My feeling is the author seems pretty open to criticism. You should open a PR incorporating your reasoning into the document. Be respectful but make it better. I'd hope the best ideas would win out but then again the author has the authority to merge or not. To the author maybe you should give one other person you respect whose opinion differs from yours the ability to merge PRS as well. Maybe...
  • ryankemper 6y ago
    > 1. The true IFR is hard to estimate at this point, but looks to be around 1%. This is a very difficult question to answer with the data we have and all the limitations. An IFR of 1% seems too high. This doesn't seem to line up with data from the Diamond Princess (~1% IFR in a population biased towards elderly). We can also look as a lower bound at the Theodore Roosevelt (the navy ship), which had I believe 840 positives, 4 hospitalizations, 1 death (https://www.sandiegouniontribune.com/news/military/story/2020-04-23/coronavirus-testing-on-theodore-roosevelt-complete-but-crew-wont-move-back-on-board-yet https://www.sandiegouniontribune.com/news/military/story/202...), and this is a population heavily biased towards the young and fit thus why it's a nice lower bound. > 2. There is little evidence that we can reach herd immunity levels of infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is too high and the immunity too short lived. The unconstrained R0 doesn't mean we can't reach immunity, it just means that almost every single person needs to get it, which to me still seems preferable to years-long lockdown. But the more interesting point of yours is the part about short-lived immunity. I'm going to copy-paste a portion of https://news.ycombinator.com/item?id=23025880 https://news.ycombinator.com/item?id=23025880 to avoid repeating myself too much: I think of immunity simplistically as two components: (1) The presence of actively circulating antibodies in the bloodstream. This is what the (oddly controversial) serology studies are measuring. It is thought that having a significant quantity of these antibodies prevents infection - i.e., what most people envision when they talk about immunity. (2) Even after the antibodies have faded, there are still Memory B Cells, which lay dormant up to decades, waiting for exposure to the characteristic antigen (in this case, an antigen telling them that they have encountered SARS-CoV-2), at which point they resume and rapidly scale up production of antibodies. The thinking here is that reinfection is likely possible after a sufficient length of time - whether that's a couple months or a couple years isn't yet known - but when you do get infected, your immune system will respond sooner, more strongly, and thus you will achieve a far lower peak viral load meaning a less serious infection with reduced transmissibility. So in short, I'd like to see what makes you think the reinfection immunity window is short, but regardless of the window length, we can hopefully agree that the immunological memory cells will stick around for a while. > 3. The IFR has a threshold where it dramatically increases when the number of new cases overwhelms the hospital capacity. We have seen this to a certain extend in Wuhan, Northern Italy and NYC. Agreed. My only caveat is this effect is probably not _as_ dramatic as it initially looked, but it is definitely dramatic. > As treatments improves the IFR should fall. This mean if we can shift an infection to the future we should see less people die. Flattening the curve is more than just avoiding overwhelming the hospital system, it is also about shift cases to a time when we have improved treatments. Also agreed. I thought about paying lip service to this notion but decided to leave it out of the first draft. Basically my assumption (and it is an assumption) is that the treatments we discover will do a little bit but not a lot. So probably what we've learned thus far about proning, managing oxygen levels etc doesn't leave a ton of room for improvement without a miracle therapeutic. I think antivirals and other treatments will help a small amount but not nearly enough to justify postponing infection. But yes, at this point I think we can say that in a scenario of successful full containment+vaccine, we would have less area under curve as far as the "overshoot" is concerned and also to a lesser extent the improvement in treatments. > Sweden has shown that it doesn’t matter if you have an official lockdowns or not, most people will self isolate on their own. There is little extra economic damage from imposing official lockdown policies since all the damage is done by people avoiding infection on their own. I have to strongly disagree with this. In fact I view this as a strong point in favor of "my" side: we can get the majority of the benefits of the lockdown without actually locking down. The magnitude of economic damage is much more than just the demand dropoff. We've forced closures of businesses that actually would have been able to stay open. And particularly small businesses which are not well equipped to weather systemic shocks. But to be clear, I absolutely agree that even without a lockdown we would see very sizeable demand drop-off and thus there would still be some sizeable amount of furloughing, layoffs etc. -- Thanks so much for the points. In particular I'd really like to hear more from you about (2), since that is the point I disagree most with, and after that, point (1). 3-5 I have very few objections as discussed
• sethc2 6y ago
  I appreciate the article. I think your argument I find most dubious is the idea that we have lessened health care capacity by sheltering at place and closing businesses. Even if we have furloughed hospital workers, and I'm not saying that isn't a huge blow to those people and their livelihoods, and stopped elective surgeries, and I'm also not saying that those elective surgeries aren't things that don't matter, I think in terms of the next 6 months, the chance that our hospitals have less capacity to deal with serious illnesses that lead to death seem unlikely. If anything the decrease in deaths from other things, like drunk driving, and influenza might offset the loss in capacity from those furloughed. I agree that if the timeframe is long enough it is very likely to ultimately lead to more deaths from missing elective surgeries and preventative healthcare, and I think the argument for Pareto-efficiency and only asking those who are at risk to shelter in place isn't dismissed with this argument, but I don't think a time frame of say 6 months to a year would lead to more deaths in the way you state. I think you should maybe specify (or point out to me where you state this if I missed it, i'm not a careful reader) what kind of timeframe you believe that the combination of lack of capacity and missing out on preventive measures would start to lead to more deaths and indicate where you think we would reach pareto efficiency. Have we already passed the point of pareto efficiency? Was it never good at all, and the most efficient thing to do was no response? I personally think you wouldn't see the effects you are talking about for probably at least a year, and I'm hoping it doesn't last that long. I think you might start to see an increase in deaths from other things like, overdose, alcohol, and suicide, in a shorter timeframe than that though, and that is something that probably should be weighed in picking the best time to end the lockdown too.
• deleted 6y ago
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• URSpider94 6y ago
  Nice article, I think you’ve gotten a lot right, and i think analyses like this get down to the point where we can have a rational discussion. Here are some counterpoints: 1. Looking at NYC, the fatality rate is roughly 0.5%. This is based on a 20% positive antibody sample, which is getting large enough that the false positives aren’t overwhelming the data any longer. 2. If we take that as a given, then if 100% of the population becomes infected, we will have 1.5 million deaths. If we assume something more like 60%, then just one million people will die. If we lower the mortality rate to 0.3%, then maybe we are more like 750,000. I have a hard time believing it will be much lower, considering that 0.1% of NYC’s population has already died from covid-19 3. Additionally, if we give up on social distancing, then those people will die in a large wave, overwhelming our hospitals. 4. I would love to see a plan that keeps seniors safe and lets everyone else out. So far, that plan is not forthcoming. It’s hard to see how we keep them safe if their family living with them and their caregivers are all infected. So far, we’ve done a piss poor job of keeping them safe in senior living facilities, even with a lockdown. 5. On the comment that the same number of people will die with a flattened curve - that’s only true if hospitals don’t get overwhelmed, which may well still happen. Additionally, it turns out that the herd immunity point, where transmission drops below 1, is actually a function of the base transmission rate. We can actually reach herd immunity at a lower infection percentage if we are socially distanced, and thus avoid some of the deaths. Ultimately, I think we will find ways to back off the lockdown, but health departments will be on the look-out and will be titrating the degree of lockdown as cases rise and fall. It’s hard to see e.g. restaurants getting back to anything close to full occupancy any time in the next year, and most of them don’t make enough profit per table to operate half-full (or less). EDIT: additional point to add: yes, it seems that covid deaths will be heavily weighted to seniors. But so is mortality in general. Let’s roughly assume that the mortality rate for covid is 0.08% for 25-35 year olds. Guess what? The average annual mortality for 25-35 year olds is around 0.08%, so it will roughly DOUBLE if covid sweeps through the entire population this year. Covid could easily become the single largest killer of young adults this year.
  • ryankemper 6y ago
    Thanks. The NYC data is something I want to add in there eventually. I agree with your assessment and reached a similar number myself. The main thing that gives me some doubt is it seems plausible that we'll retroactively find that the deaths directly attributable to COVID-19 were somewhat overstated, in the sense that my understanding is a presumed COVID-19 diagnosis is accepted in lieu of having a positive test. (Which BTW I don't necessarily disagree with because testing was and is a bottleneck so the overstatement is almost certainly less than the understatement would have been if being more rigorous). We also know that there is [financial incentive](https://www.factcheck.org/2020/04/hospital-payments-and-the-covid-19-death-count/ https://www.factcheck.org/2020/04/hospital-payments-and-the-...) to code deaths as COVID related. I'm really curious how the influenza mortality data ends up looking for these months - the key question being, do we see a large dropoff in Influenza deaths that might indicate that basically any ILI is being written up as COVID-19? The above being said, I think the new york numbers are a perfect upper bound for something close to what a worst case scenario looks like. Although we'd have to look at the age breakdown and obesity rates there; it's definitely very imaginable that there might be other cities in the US with relatively more at-risk individuals. (BTW I didn't explain it thoroughly in the writeup but New York's data is why I gave a really broad range of .1-.7% net IFR - and it should be clear but this is still very napkin math-y on my part) I'm also curious if NY serological data includes <18 year olds - if it doesn't include children we need to account for that when extrapolating in the 100% infection scenario. Anyway, the above is all a really drawn out way of saying that I agree :P > Additionally, if we give up on social distancing, then those people will die in a large wave, overwhelming our hospitals. If we gave up everything, certainly. I think with mitigation targeted at the at-risk, that's less likely. For me "ending lockdown" doesn't mean that everyone stops wearing masks and/or trying to maintain physical distance where possible. But I do want to avoid a scenario where we're mandating that people wear masks outside as opposed to just encouraging them to. But I do agree that just because we haven't overwhelmed hospitals yet doesn't mean that we're in the clear. I was considering saying as much in the doc but wanted to keep the word count down for the first iteration. However I do think that since pretty much every city has at least some low amount of infection, and that we will have some capacity to do some clever shuffling of ventilators, tents, etc, that hospital overrun isn't nearly as much of a risk at this point overall. > 4. I would love to see a plan that keeps seniors safe and lets everyone else out. So far, that plan is not forthcoming. It’s hard to see how we keep them safe if their family living with them and their caregivers are all infected. So far, we’ve done a piss poor job of keeping them safe in senior living facilities, even with a lockdown. Yeah, really the best thing would be voluntary exposure of people surrounding the at-risk individuals. But I don't foresee that actually happening. I really think nursing homes are the low-hanging fruit here, and as you indicated it seems like we've already kind of screwed that one up in a lot of places. But essentially, in the alternative of full containment+waiting for vaccine, it seems to me much harder for the caregivers surrounding the extremely-at-risk to be able to avoid getting infected and passing it on to the at-risk, whereas in a scenario where they can get it over with then they don't have to worry at all going forward. But that requires being able to detect that you're sick before infecting the at-risk individual so that you can isolate while recovering, which obviously requires really good testing capacity. Basically, it would be great if we could selectively redirect the bulk of our testing capacity for individuals in these situations. But there's not a very clear way to do that, the last thing we want is having a bureaucrat decide if you're eligible for a test or not. So perhaps the best we can do is - and this is a theme here - encouraging those who are surrounding at-risk individuals to get tested extremely frequently. -- Lastly just wanted to call out this: > I think you’ve gotten a lot right, and i think analyses like this get down to the point where we can have a rational discussion. That means a lot. I really want us as a society to get to a point where there is broad agreement on what the facts on the ground are, so that differences in policy come down to differences in philosophy/values rather than where it feels like we're at now as a society, which is basically two warring factions each with non-intersecting sets of facts ("the death rate is 5%!" versus "no the death rate is .03!)
• dmode 6y ago
  It seems like everyone is an expert on infectious disease these days. From site reliability engineers to electric car manufacturers.
• drcongo 6y ago
  Never has the phrase "a little knowledge is a dangerous thing" been more apt.
• stupidcar 6y ago
  What about the situation in northern Italy? In the absence of a lockdown, the healthcare system did collapse, or came very close to doing so and this was only averted when the government implemented draconian quarantine policies. The article claims that the survival of the healthcare system in places that implemented a lockdown has nothing to do with the lockdown, but then gives no evidence at all to back up that assertion.
  • katktv 6y ago
    I also just have to point out that Sweden, the country that didn't implement lockdown, has 6 times higher amount of COVID-19 cases than other Scandinavian countries when adjusted. https://www.nationalreview.com/corner/coronavirus-fatality-rate-how-sweden-compares-to-its-scandinavian-neighbors/ https://www.nationalreview.com/corner/coronavirus-fatality-r...
    • dxsh 6y ago
      Sweden has much larger nursing homes than, for example, Norway, and most deaths in Sweden are from nursing homes. The time integral of the curve over 1 year will tell the real story.
      • danesparza 6y ago
        So are you arguing those numbers are acceptable because of the size of nursing homes in Sweden? Or am I missing something in your 2 sentences?
        • icebraining 6y ago
          I think they're saying that Norway would also have the same number of deaths as Sweden if they had the same number of nursing homes.
        • giantDinosaur 6y ago
          Come on. He's pointing out both an explanatory factor, i.e. larger groups of vulnerable clustered together, and also saying that the total deaths may end up being very similar between countries and that it is too early to tell. Without a vaccine or effective treatment, there's no long term alternative to something akin to the Swedish strategy.
• bronzeage 6y ago
  This is cherry picking hopeful data. Tests have false positives, the serological tests detect all coronaviruses including common human CoV which cause common cold. The state of hospitals in Italy tell a different story. It might not be numbers, but it is more reliable indication of what letting this go rampant means.
  • tinus_hn 6y ago
    An argument could be made that that would lead to cherry picking hopeless data.
    • disgruntledphd2 6y ago
      Lombardy (the region of Northern Italy where this was concentrated) has a very very good health system. And it still collapsed. Don't get me wrong, lockdowns are super problematic and the economic hit is going to be really, really bad but it's better than letting health systems collapse. For instance, Ireland (where I live) had 220 ICU beds before this started; we upped that to around 500 and around 350 were filled at the highest point. And this was with a lockdown (started March 12th, massively tightened March 26th). Our health service would have collapsed without the measures that have been taken, so I totally see why lockdowns have been introduced almost everywhere. The best case scenario for this kind of event is that you react too quickly, everything's OK and then people complain that all the measures you took weren't necessary.
      • tinus_hn 6y ago
        What is your point? Cherry picking is fine because everything is terrible? My cherry is so important it must be picked?
      • lbeltrame 6y ago
        > Lombardy (the region of Northern Italy where this was concentrated) has a very very good health system. To be honest, it was good, but it was not as good as people hoped. Massive errors like allowing infections to run rampant in the hospital in Alzano Lombardo contributed a lot to the spread of the disease in the area around Bergamo and Brescia. ICUs were also at 80% utilization when the pandemic hit, because beds have been slashed a lot in the past years.
• docdeek 6y ago
  > Encourage at-risk groups to self quarantine, and utilize testing to protect them...Those with obesity and COPD Author suggests self-quarantine for the obese instead of quarantine/lockdown for everyone. The CDC suggests that +42% of the US adult population is obese [0]. Are we really going to isolate or quarantine 4 out of 10 US adults and imagine the economy can get back on track? [0]: https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html
  • cies 6y ago
    > Are we really going to isolate or quarantine 4 out of 10 US adults and imagine the economy can get back on track? It's a good start. Also "encourage" is different from "enforce".
    • TeMPOraL 6y ago
      "Encourage" is different from "enforce", but very similar to "doesn't work". Once isolation becomes voluntary, the job market will make sure that people won't isolate even if they wanted to. A common thread of the current pandemic measures is that people get to protect themselves in ways that would destroy their careers if they weren't mandated top-down by the government.
      • imglorp 6y ago
        I wonder if it becomes an EEO issue (in the US). They can't compel a vulnerable WFH person to rejoin an open plan sardine office, nor can they fire them for not rejoining without attracting attention for discrimination. I know a tech worker who used to wheel an oxygen tank to the office: I imagine that person is more than a little concerned right now. It also implies that a partly WFH workforce cannot be sidelined: once one person is remote the whole culture needs to be organized around remote process.
      • cies 6y ago
        > Once isolation becomes voluntary, the job market will make sure that people won't isolate even if they wanted to. Depends on your labour laws, and facilities more than on the market IMHO.
• dmode 6y ago
  Oh boy, I just wasted my time reading this, and I really wish the headline would have flagged that this is written by a "site reliability engineer" and not an epidemiologist with credentials. Feel like there would be a revolution in HN if this was the other way around - an epidemiologist writing about site reliability engineering after reading a few articles for 2 weeks. Should we not exercise restraint, thoughtfulness and humility instead of writing commentary and articles in areas where we have rudimentary understanding ? It is really an insult to experts in this area who have studied viruses for decades, have considered a variety of factors, have conducted academic studies, and have build complex models, all to be outdone by a "site reliability engineer". As for the article itself, it is so full of misinformation, oversimplification, and hyperbole, where should I even begin. 1) Claiming absolute authority on fatality rate as 3x of influenza, when global experts have yet to agree on a number [https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate.html https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate...] 2) Then basing the article on an absolute fatality rate, when the fact remains that fatality rate depends on a number of different scenarios include health, immunity, age, hospitalization, ICU beds, and may be even weather etc. [2] To lump all of that into a single number simply hides the cost of COVID. Just in Michigan alone, 35% of COVID deaths are within the black community. Not having a grasp on how this impacts along racial and economic lines demonstrate a very rudimentary understanding of public policy. Ask yourself, if the fatality rate is 1% on average, but 10% for black people, will you still call for opening the economy [2] https://fivethirtyeight.com/features/why-its-so-freaking-hard-to-make-a-good-covid-19-model/ https://fivethirtyeight.com/features/why-its-so-freaking-har... 3) Repeated references to comparison with influenza, but not mention of the massive R0 differences between the two [3]. Influenza has a R0 of 1.3, while COVID is estimated to have an Ro of 5.5. And this matters, because now COVID is not only more fatal, but is also spreads faster. Both the denominator and numerator are deadlier for COVID, which is a compounding factor that the article doesn't discuss at all. if 20% of US population get impacted, we will have a death toll of 600K at 1% fatality rate. That will be 10x than that of the worst strain of influenza. [3] https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article 4) There are a lot of reference to negative externalities of lockdown [without much data to back-up], but no mention of the positive ones. Such as plummeting car fatality rates, plummeting crime rates, and plummeting pollution [4] [4] https://www.nationalgeographic.com/science/2020/04/pollution-made-the-pandemic-worse-but-lockdowns-clean-the-sky/ https://www.nationalgeographic.com/science/2020/04/pollution... 5) A strange out of context reference to social isolation and related deaths. The linked article and current situation are very different. People are isolating from others, but they are very much spending more quality time with their loved ones. I don't see any data on spike in depression during this period, and anecdotal evidence suggests that people are refreshing their relationship with their loved ones. 6) Section 4 presents a half baked plan of "opening" up without broader discussion of trade-offs and implications. For example, opening up but encouraging "at-risks" group to self quarantine. This is not how US workplaces work. Let's stay I am a at-risk worker with chronic lung disease, but I also work at a factory floor and my health insurance is through my employer. How am I supposed to self-quarantine when my employer will simply ask me to show up and if I don't I will lose my job and insurance ? And there won't be any government dollars to support 7) There is no discussion on how we can support the re-opening without ability to test people at scale. How will you know that the server at a restaurant or your gym instructor is not infected without massive upgrades to testing infrastructure ? These are some basic observations from the article. I can keep going as every paragraph in this article has some questionable conclusions. I also feel the "soul of the nation" feels very hyperbolic.
• Ajunne 6y ago
  It's been a long time, but I see we've returned to "I'm not an epidemiologist or virologist but a software engineer, and I'm writing a blog post because I know things better".
• deleted 6y ago
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• sunkenvicar 6y ago
  Thanks for the article. HN basement dwellers out in full force means you’ve done well. Keep writing!
• StavrosK 6y ago
  For a peek into the future, Greece has just ended its lockdown and started reopening everything, after having 0-2 deaths per day for a few days. The number of deaths in total is around 120 after two months, last I checked. The plan was to shut everything down, ramp up testing and ICU beds, then reopen and carefully watch the situation. Let's see how it goes.
• quezzle 6y ago
  This should be flagged. Why is a software engineer qualified to present this? Just misinformation spoken with a tone of authority.
  • throwaway0a5e 6y ago
    >This should be flagged. >Why is a software engineer qualified to present this? The opinions of software engineers about subject outside their area of expertise is the bulk of the commentary on this site. I don't think it's realistic to expect a community to enforce a restriction on submissions when such a restriction would hit so close to home. That would require a level of cognitive dissonance that even HN is probably not capable of. I agree with you that people should STFU about things they are not experts in, or at the very least not present their opinions on such things with some veil of authority.
    • quezzle 6y ago
      One of the big issues in the pandemic is the spread of misinformation. I don’t think media channels ... and I’m including HN here ... should be giving a megaphone to random opinions. Now it the time for experts voices to be amplified, not random people with an opinion. I notice in the comments dang supports this post which is a surprise.
      • dntbnmpls 6y ago
        > One of the big issues in the pandemic is the spread of misinformation. Along with censorship and blind worship of authority. > Now it the time for experts voices to be amplified, not random people with an opinion. Which experts? The experts you agree with or are politically aligned with? Or all experts? > I notice in the comments dang supports this post which is a surprise. An even greater surprise is the attempt to censor people who are giving their honest and fair opinion and assessment - which is not misinformation. The experts have spoken and people have the right to discuss and offer their opinions. Using your logic, hacker news shouldn't exist because only the "experts" should be allowed a voice.
• sgt101 6y ago
  Well section 2 presents two cherry picked studies that are off the consensus for IFR (0.4%) and so have been latched onto by those who want them to be true and want everyone else to believe them. And then goes on to demonstrate a novel example of simpsons paradox with an italian study. Just junk. Bin it.
• tonetheman 6y ago
  I feel like this is misguided. At least he did not tell everyone to drink bleach or inject light into your body.
• nraynaud 6y ago
  does that mean that China was right to try to ignore the issue for a few days at the beginning?
• mchusma 6y ago
  Thank you for the time and effort in the write up as well as your engagement, it is what we need. 2 points: while I sort of get your "order of magnitude lik a flu" point I think it undermines your argument because you get lumped in with crazies. In your comments you also seem to conflate pandemic flu with seasonal flu, so I would suggest using "seasonal flu" if that is what you mean to avoid confusion. I think there are compelling arguments for ending the lockdown while still believing it is 10x worse than the flu. I don't like conflating the points myself, and rather prefer to just look at the actual IFR/R0 numbers. I don't know if this warrants a section, but I will say that I believe that the issue you discuss in this article is the lockdown, which is a political discussion. You have a lot of people on here asking for your credentials, or asking if you are an epidemiologist or virologist. While scientists can help inform us as a society on things like the IFR and R0, at the end of the day the core item under discussion here is a societal choice. In the US as a society appear to make a decision that infectious disease deaths up to about 70,000 people annually (a bad seasonal flu) do not warrant any official lockdown measures. The question of the threshold for various political responses is in fact a political question, not a question for virologists, therefore is the domain of all citizens. The author is as much an expert on this particular question as really anyone else. There has been a troubling severe censorship going on across platforms, including YouTube which would presumably not allow you to post this as a speech as it contradicts WHO guidelines, and our own "Hacker news" which ironically celebrates the culture of people building things of their own merit, not tied to past credentials, yet for a while has flagged this open and reasonable attempt to understand a political question.
  • mchusma 6y ago
    One other quick note on my point above about case for lockdown. I am sure there are a ton of unknowns on the actual costs of the lockdown, but a back of the envelope suggest maybe 2 weeks of GDP seem directionally correct for the US, or about $1T. Assuming a QALY value of $100k. If you assume the official lockdown saved even 500k lives (only considering official lockdown, not other measures like voluntary social distancing, etc). If you assume the QALY for the group that died is 6 (I read this estimate somewhere but don't have source, seems to make ballpark sense because deaths are weighted towards elderly with comorbitities). Then you have a value of 100k500k6=$300B vs about $1T cost. You can play around with these variables, for example if you feel in the US our value for a QALY should be 2x Canada and 4x UK, then use $200k. If you feel that the majority of the viral suppression was from masks, distancing, and other voluntary efforts, then you might reduce the lives saved by the lockdown estimate down to 100k. Again, I dislike "like the flu" arguments, because I think we can just debate the actual merits of a policy. In this case, using almost any assumptions, the lockdown doesn't make sense versus other health measures we could be spending money on.
• grumple 6y ago
  The premise of this post is extremely flawed: > Weeks and months later, facts on the ground show that the purported collapse of the healthcare system did not occur. Yes, because we locked down population centers quickly. That's the whole point. ICUs have still been over capacity though. Without the lockdowns, it's obvious we'd have a lot more dead people the past month. > Moreover, this was not due to success in seriously curtailing the spread in hard-hit areas like New York, but was rather due to the aforementioned discovery that COVID-19, while extremely deadly in certain subsets of the population, was not nearly as deadly overall as previously thought. This is a lie followed by possible truth. New York and other cities were under pretty extreme lockdowns (all non-essential businesses closed, social distancing, but most people have been staying inside) for the past two months. If one asserts that had no or little effect, well... HN doesn't take kindly to what I'd like to say. Let's just say that you're delusional. > An analysis of the flawed IMHE model is outside the scope of this article Ah, how convenient - lying about the effect of the lockdowns and attributing it instead to (nothing? since ICUs have clearly been over capacity while we've cut down transmission rates) then ignoring analysis of them. I didn't really dive into the rest of the article since I don't really like reading words written by intellectually dishonest people.
  • ausbah 6y ago
    this is a good example of people saying the response was overblown, because the response had its intended effect
    • ModernMech 6y ago
      My other favorite example is y2k. New Years 2000 came and went and the world didn’t end. Was y2k overblown hysteria, or did we take it seriously and do the work necessary to prevent catastrophic system failure? Probably a little hysteria involved, sure, but I don’t think anyone here would argue we should have just let systems go unpatched and hoped for the best.
      • __s 6y ago
        An issue is when there's an issue which people with information are trying to work around, word gets out & the risk becomes exaggerated to societal collapse. Nevermind that a plague could come & kill half the population & society wouldn't collapse. So when people get the idea that we're trying to stop society from collapsing, they expect we'll still see society almost collapse. But instead we're averting a much lower risk (which is still very costly) & so the final price we pay is nowhere near "if we hadn't done X, society would've collapsed" Basically we need to moderate both opinions which effectively work together: the "there's no problem to begin with" group feels validated by the "the world is ending" group being way off the mark This happens with global warming too. Some people think everything's going to fall apart within the next 10 years. They're wrong. So others claim there isn't a problem, because they were wrong
• wheelerwj 6y ago
  > I’m a software / site reliability engineer okay, thanks. Seriously, the list of scientist and medical organizations advising through this period is so long, I don't know why anyone who isn't at equally experienced tries to counter-claim their insights. I'm not saying we shouldn't do our own research and arrive at our own conclusion, but if you arrive at a different conclusion, you're almost certainly the one whose incorrect. It's so likely that you're wrong, that you must question the logic and data you used to arrive at your conclusion.
  • lbeltrame 6y ago
    > Seriously, the list of scientist and medical organizations advising through this period is so long, I don't know why anyone who isn't at equally experienced tries to counter-claim their insights. Scientists and organizations are made up of people, and thus they can make errors like everyone else. Our expert panel yesterday in Italy pulled out catastrophic scenarios (150K people requiring ICU) that were heavily criticized, not only by "regular" commentators but also scientists. I don't mean that experts can't be trusted. quite the opposite. They play an important role in advising for a proper public policy to manage the current epidemic, but with such a large number of unknowns, mistakes can and will happen. And when they occur, they must be pointed out regardless of where they come from.
  • ashtonkem 6y ago
    I’ve started explicitly telling people in my life that I’m not interested in their non-expert opinions when they weigh in on when we should open up.
    • hkai 6y ago
      Would you also agree with WHO's expert advice against wearing masks and against restricting travel? These are literally the world's top experts, so you should just accept what they say and do not challenge that. Is this correct?
      • ashtonkem 6y ago
• sadalienvulcan 6y ago
  In the "Debunking the claim that it’s “just the economy”" section of the original post [0], the author is arguing that "economic damage leads to lives lost". But the kind of economic damage this causes doesn't have to. The reason it does is a result of the policy decisions our governments make. The author references a study from LSE [1a], saying: > Their analysis focuses on the UK, but they conclude that maintaining lockdown in the UK beyond June 1 will lead to a net reduction in wellbeing-years. The referenced paper weighs up the benefits of lifting the lockdown at a particular point in time vs the costs of extending it. They do this using a metric called wellbeing-years. They list the possible positive and negative outcomes of lifting the lockdown then convert these into wellbeing-years. These are used to calculate the total value of lifting the lockdown at the start of May, June, July and September. They summarise these findings in Table 4 of the paper [1b]. It shows that there will be negative total value to maintaining the lockdown beyond 1st June, as the original post says. Table 4 suggests the highest cost of lockdown is reduced incomes and the reduction in wellbeing it brings [1b]. But surely the UK government could increase their income support so that there is no loss in wellbeing? This would change the balance of the cost-benefit analysis considerably (and maybe saving lives is worth the money). So how much would this cost then? In Appendix 2 [1c], they calculate that £750,000 of lost income is worth 7.5 wellbeing-years (one year of a persons life at the average wellbeing of 7.5/10). This implies that a single wellbeing-year is worth £100,000 of lost income. Looking at Table 4, lifting the lockdown in September instead of May would cause reductions in income equivalent to (48+66+86+103)10,000 = 303,000 wellbeing-years. That represents £100,000 303,000 = £30.3 billion in lost income we'd need to make up. Luckily, the 6 wealthiest people in the UK are worth a combined £39.4 billion [2]. Repatriating that wealth and distributing it as income relief would completely remove the negative impact of lost income. Doing so would tip the balance in favour of extending lockdown to 1st September. This is important because lifting the lockdown in September rather than May would result in 145,000 fewer COVID-19 deaths [1d]. Using that papers analysis to justify ending the UKs lockdown early is akin to saying: I value preserving the private wealth of 6 people over the lives of 145,000 others. [0]: https://www.ryankemper.io/post/2020-04-29-the_case_for_ending_lockdown/#debunking-the-claim-that-it-s-just-the-economy https://www.ryankemper.io/post/2020-04-29-the_case_for_endin... [1a]: http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf [1b]: Results, Table 4, http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page=10 http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page... [1c]: Appendix 2, "The monetary value of Life-Years", http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page=17 http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page... [1d]: Section 3.6, "COVID-19 Deaths", http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page=8 http://cep.lse.ac.uk/pubs/download/occasional/op049.pdf#page... [2]: https://www.theguardian.com/news/2019/dec/03/uk-six-richest-[2] https://www.theguardian.com/news/2019/dec/03/uk-six-richest-...: https://www.theguardian.com/news/2019/dec/03/uk-six-richest-people-control-as-much-wealth-as-poorest-13m-studypeople-control-as-much-wealth-as-poorest-13m-study https://www.theguardian.com/news/2019/dec/03/uk-six-richest-...
• jillesvangurp 6y ago
  I think this is summarizing what a lot of people with a working brain probably already are thinking privately. In general, I think there are too many arm chair scientists with opinions right now and this is not helping. Part of the reason is that we're all sitting at home mildly bored and frustrated with the sudden restrictions on our life. My general attitude is that I understand people are afraid and considering I don't like scaring people, I'm open to adapting to their needs right now and am trying to be mindful. So, doing the right thing for me is not blaming people for being irrational and trying to adapt to their emotional needs. However, I am very worried about the self inflicted economic pain and misery and how that is going to affect me personally as well as people I care about. E.g. my parents are retired and already had their pension devalued a few times in the last decade. Stuff like this is likely to cause more cuts. They are well off regardless but there are many pensioners who get to ride out their remaining years/decades with a significant cut in income and no chance to fix that. Stuff like this happens when we trigger a global recession/depression out of fear. Another thing that I observe happening is that lockdown policies and the resulting bureaucracy, constantly changing rules, etc. are by and large coming from people who are interpreting what they are hearing from others. A few weeks ago when everything was extremely scary this was understandable. But we're past that now. Most of what they hear is either without much scientific basis/merit, severely watered down/dumbed down pseudo scientific babble, or worse flat out wrong information. Also these decision makers have agendas that go beyond trying to do the right thing. E.g. a lot of politicians have enormous egos and are under a lot of pressure to be seen doing something. Add populism to the mix or overzealous anti vaxers, and you have a perfect storm of mass hysteria and a lot of completely pointless policy. Add lawyers to the mix, and you get a lot of ass coverage on top. Bureaucrats when faced with demands raining down from the top, oblige by coming up with lots of rules and demands for more budget. Politicians oblige, and you get more of the same. So, a scientist might say something like "Sure, whatever, go wear a non medical mask if it makes you feel good. It might even help though I'm not aware of any studies to that effect. But go knock yourself out. " In the hands of bureaucrats that turns into the police issueing crippling fines for small businesses tolerating customers without masks in their shops. This is actually happening in Germany. In France people have to print a form stating their intentions when leaving their house and the police is very busy enforcing that. In Sweden, restaurants are open as normal and the government seems to have shown some restraint with imposing measures. France got hit really hard early on but is now improving. Germany and Sweden are largely fine already. Germany has enjoyed a widely published low death rate despite being quite late with locking down. The point is, they are doing widely different things (including doing nothing) with more or less similar outcomes. It's fine. The world is not ending. IMHO we are well prepared in case this virus comes back. We'll detect it earlier, act more decisively and hopelessly less stupidly. So, lift the restrictions and allow people to self restrain and decisively act locally based on testing/incidents/common sense.
• MisterTea 6y ago
  "I’m a software / site reliability engineer based out of Santa Barbara, California." From someone living in NYC: fuck off. You have no business telling anyone anything regarding health and safety.
• kaolti 6y ago
  Going back to the basics on this one. Has any government presented a cost benefit analysis of all the available options to address this situation? Like most things in life this isn't black and white, so where is the analysis of the pros and cons, worst case projections, etc of not doing anything / going into lockdown / other alternatives. I for one have not seen it. Shouldn't such an analysis be the basis of any decisions we make? It follows therefore that it needs to be first of all DONE, then publicly presented and argued from all angles before a decision is made. But, no. A decision has been made and presented to us. We can rest assured, they say, the science CLEARLY shows that this is the right decision. Then - at least in the UK - later they admitted that the economic impact and the following consequences have not yet been looked into. The arguments should not be about lockdown or not. It is fair and everyone duty to scrutinise government decisions, not because they should have done the exact opposite, but simply because they haven't presented a robust case for what they're doing. Let's not forget, it is their ONLY job to represent us - a job all of us are paying for -, and do things that are in our best interest, yet they fail to properly justify decisions. Anyone who without question agrees to locking down the economy might want to consider that bailouts, stimulus packages, unemployment benefits, and anything else the government does is paid for with our money. Add to this the borderline misleading way covid deaths are classified and a dozen other similar issues and you have yourself a very interesting situation which should be raising questions in everyone.
  • lkrubner 6y ago
    "Shouldn't such an analysis be the basis of any decisions we make?" No. We can decided to make decisions based purely on the morality of the decision. Given a death rate somewhere between 1% and 3% the question becomes whether we will accept that many deaths, without taking action. There is no need for a cost/benefit analysis, as we can decide the issue entirely on a moral basis.
    • logicchains 6y ago
      You can't know the morality of the action without modelling all the consequences. Morality is a complex thing, and certainly cannot be determined by just a single number (number of deaths from the virus avoided).
• morsch 6y ago
  Background: The COVID-19 pandemic is responsible for increasing deaths globally. Most estimates have focused on numbers of deaths, with little direct quantification of years of life lost (YLL) through COVID-19. As most people dying with COVID-19 are older with underlying long-term conditions (LTCs), some have speculated that YLL are low. We aim to estimate YLL attributable to COVID-19, before and after adjustment for number/type of LTCs. Methods: We first estimated YLL from COVID-19 using standard WHO life tables, based on published age/sex data from COVID-19 deaths in Italy. We then used aggregate data on number/type of LTCs to model likely combinations of LTCs among people dying with COVID-19. From these, we used routine UK healthcare data to estimate life expectancy based on age/sex/different combinations of LTCs. We then calculated YLL based on age, sex and type of LTCs and multimorbidity count. Results: Using the standard WHO life tables, YLL per COVID-19 death was 14 for men and 12 for women. After adjustment for number and type of LTCs, the mean YLL was slightly lower, but remained high (13 and 11 years for men and women, respectively). The number and type of LTCs led to wide variability in the estimated YLL at a given age (e.g. at ≥80 years, YLL was >10 years for people with 0 LTCs, and <3 years for people with ≥6). Conclusions: Deaths from COVID-19 represent a substantial burden in terms of per-person YLL, more than a decade, even after adjusting for the typical number and type of LTCs found in people dying of COVID-19. The extent of multimorbidity heavily influences the estimated YLL at a given age. More comprehensive and standardised collection of data on LTCs is needed to better understand and quantify the global burden of COVID-19 and to guide policy-making and interventions. https://wellcomeopenresearch.org/articles/5-75 https://wellcomeopenresearch.org/articles/5-75
• dangus 6y ago
  > About me > I’m a software / site reliability engineer based out of Santa Barbara, California. People need to stop chiming in on subjects on which they are not experts. Ryan, as a site reliability engineer, I know you’re annoyed annoyed when people on the street talk to you about your job and misinterpret just about everything about how technology works. I had a potential customer of my employer express interest (based on me wearing corporate swag in a public place), ask some questions that became semi-technical, then go on to completely equate being hosted on a cloud service as not having any privacy or security measures or control over our data, completely misinterpreting my answers. This is what you’re doing to doctors and epidemiologists, and whatever other people do scientific research on viruses. And now your personal blog post has spread its influence far enough to be seen by hundreds if not thousands of people who will latch on to your non-expert opinions.
  • ryankemper 6y ago
    As you can tell, I read everyone's feedback. I don't share your views on this matter. I think, particularly given that public policy is relevant to all of us, that it does make sense for even a layperson to engage in the conversation. This is not merely a scientific issue. Rather, we need to don our scientist caps to try to figure out what is likely to happen under different scenarios from an epidemiological standpoint, and then we need to think like economists when analyzing the economic impacts of proposed policies, etc. It's very much an intersectional discipline. While I am very transparently trying to shift peoples' opinions, I am also inviting them to try to shift my opinion. Rather than sink 200 hours into this in order to make it picture-perfect, I wrote a first draft that I feel covers some important points, and shared it to get feedback. As you have seen, some parts were completely wrong, some parts were completely right, and a lot of parts were/are in between. By doing so, I've exposed myself to viewpoints that I would not have otherwise heard, and vice versa. We all get frustrated when people make statements that expose an ignorance on a subject that we are well versed in. But how we choose to respond to it is very telling. So personally, if someone makes a ridiculous statement about my field, but their statement was made in good faith and they are seeking feedback, I will absolutely take the time to try to tell them where I think they got it wrong. Even if I think they got, well, everything wrong.
• ryanwaggoner 6y ago
  If you're going to write a 7500 word article on why most experts are wrong about a subject, you should probably start by providing the reader with some reason to care about what you have to say. Writing with this authoritative tone and no disclaimer as to your lack of expertise and knowledge in any relevant field is dangerously irresponsible. Further, insisting that every reader fully read your treatise and evaluate the claims and arguments "on the merits" is unrealistic, unfair, and fails to acknowledge that virtually all of them also lack the expertise to be able to do so.
• atian 6y ago
  Is anyone else having trouble reading this writing? I've gone through it multiple times but I really cannot extract any point being made other than eager aside references. The title is not fitting at all for the content.
• skdjsjkhfkdsjh 6y ago
  A quick google search of "ashtonkem" indicates that people of that username like to weigh in on a very wide range of subjects. The one on HN has weighed in on software, team management, human physiology, human psychology, economics, to name a few.
  • deleted 6y ago
    [deleted]
• laufj 6y ago
  The immunity section ignores the fact that the virus could mutate, and thus reinfect people immune to the previous form
• jonahbenton 6y ago
  Others have said it already. This piece is so deeply flawed as to be grotesque and macabre, its intellectual self-justification (including a use of Pareto that completely misunderstands the reason we use the term Pareto) blind to actual facts. We are as yet in most cases not at the banality of evil stage specifically with COVID but good lord it is work like this that makes it easy to see in real time how we get there.
• anonymouswacker 6y ago
  I especially liked the comparison of a cytokine storm to the governments' response to the virus. As soon as I read that the antibodies tests were showing that approx. 1/4 of NYC most likely already had the virus, and did a little basic math with the latest data on death rates, I realized that the lockdowns no longer make sense in NYC. I guess that means I am now in the same bandwagon as Musk, Trump, and all the other supposed idiots or deniers that think this virus is not as deadly as it first appeared. Back to work.
• rexgallorum2 6y ago
  There is a fundamental problem with claims that the infection fatality rate (fatality rate for all infections, including undetected infections) is ridiculously low. New York City has seen over 18,000 deaths directly attributed to Covid-19. The actual number may be higher, but probably isn't lower. How many actual (including undetected) cases would there have to be in NYC to produce the given number of deaths at any given IFR? Figures at the low end suggest a number of cases far in excess of the total population, so they are naturally impossible. The real IFR is somewhere between the lowest plausible number based on the total population and the implausibly high case fatality rate (based on detected/confirmed cases). Anyone want to do some math on that?
• 30001 6y ago
  i see the same herd mentality on reddit and hn. everyone just echoing their favorite liberal news source.. too afraid to speak against the groupthink; especially if it may be negative. everyone is looking at the the number of deaths and panicking. "50,000 people died" omg. since march 15 300,000+ americans died of other causes. oh but this is just starting.. only 30k died from flu last year! (well 60k died the year before, thus making 2017-2018 influenza 2x higher fatalities across population). let's just pretend this novel virus spreads throughout the population until herd immunity is obtained at say 0.70. well influenza only reaches 0.1 of pop. so if ifr of cv19 and infuenza is the same puts the deaths from cv19 at 250,000 (based on 7x deaths of 18/19 flu season).. well we've got a long ways to go still lets say this virus is TWICE as deadly as influenza. okay, 500,000 deaths to be expected i'm okay with a 0.2% ifr. not worth staying home for the next 2-5 years until 1) vaccine is proven effective >95% efficacy and 2) production capacity is ~250mil (just for us) (influenza is maybe 30 million units?) flatten the curve! uh, in most municipalities, it's way flat. so why are we staying in? containment! we aren't going to contain this. took us 200+ years to contain smallpox... we going to wait 200 years? save lives! we're saving people from dying of heart disease, cancer, stroke, and influenza. to really assess how bad this virus is, we really just need to wait ten years, then compare the deaths in the past decade to the expected deaths in the same decade. then we can see the excess deaths caused by the cv (and the self inflicted deaths of despair). picture two alternate universe where no one did anything in one universe and the other committed economic suicide. in both universes the same people died over the 10 year period, in one universe everyone goes about life as normal, but in the other universe, they are still fighting a great depression. .. i opine most of hn readers have salaried jobs and can wfh so its really easy to prescribe behavior for others when that behavior has little to no effect on the hn reader. maybe the opinion will change when the tech bubble implodes and half of you are out of jobs. stop looking at this as an emotional issue and look at it as a programming function.. and stop trying to make projections when the input data is garbage. GIGO, right?