9 ms·

The original risk associated with Covid19 was lack of hospital resources. With most hospitals having plenty of capacity, the risk of getting Covid19 and not get

The original risk associated with Covid19 was lack of hospital resources. With most hospitals having plenty of capacity, the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.

thaumaturgy 6y ago
Yeah. It's really a shame that there were all these efforts to prevent our health care system from being overwhelmed. Oh well. It looks like enough people would like to run this particular experiment that we just might get to see what it looks like after all. Yay?
- abfan1127 6y ago
  I don't understand your comment. We made decisions based on information. The results of our original experiment turned out to be different than our expectations. Further, others were hurt substantially due to these decisions. Those hurt are requesting (or demanding) to change course so as to not be hurt further. Seems reasonable to change course, with each US State (or country) changing course differently based on their circumstances.
  - munk-a 6y ago
    I don't know why you think we came out so far different from expectations - New York hospitals were overwhelmed, they hadn't shut down in time to prevent a large wave of cases - other locales that have gotten lucky or shut down have avoided feeling that wave so far... Changing course doesn't seem advisable as growth rates haven't subsided into the negative except in small locales.
    - SpicyLemonZest 6y ago
      New York hospitals weren't happy by any means, but their peak load was an order of magnitude less than what local leaders said they were preparing for.
    - abfan1127 6y ago
      New York was the exception to the rule. Most hospitals were not overwhelmed. In fact, many hospitals flirted with financial disaster when governors prevented elective procedures. I can speak specifically to AZ which outside of some very small Indian Reservation medical centers, is well below capacity[1] Seattle's Army hospital closed without a single patient[2]. Growth rates, especially in AZ, were never large to begin with. [1] - https://azgovernor.gov/sites/default/files/covidpresentation42220finalweb.pdf https://azgovernor.gov/sites/default/files/covidpresentation... [2] - https://www.military.com/daily-news/2020/04/10/armys-seattle-field-hospital-closes-after-3-days-without-treating-single-patient.html https://www.military.com/daily-news/2020/04/10/armys-seattle...
      - TylerE 6y ago
        I would be cautious about using the past tense. New case rates have not come down much from peak - and I expect them to spike in the next few weeks as people let their guard down and things reopen. Deaths lag infections by several weeks. Over 2200 people died yesterday.
        abfan1127 6y ago
        I agree that with re-opening, we will see a bump in infections, and therefore deaths. However, there is only one path out of this and that is herd immunity. We can accelerate herd immunity via vaccine, but either way its herd immunity. That means that we want as many people sick as our hospital system can handle, but not more. That means playing a game of optimization. Further, different states (New York vs. Arizona) should have different plans because their situations are vastly different (population density, current herd infection status, etc). Further, we can't just optimize for Covid19 deaths, we have to look at the whole situation, which includes suicides due to shelter-in-place orders, child abuse and other domestic violence, malnutrition due to hunger from unemployment, negative impacts of poverty. this will certainly be a case study for future generations.
        TylerE 6y ago
        Strongly disagree. We are learning how to help patients survive. If I must catch it, I want to catch it as far in the future as posslbe.
    - randallsquared 6y ago
      Some hospitals in NYC were overwhelmed, but that was limited to Queens and Brooklyn: the NPR piece notes that Javits Center, which was turned into a hospital in Manhattan, treated about 1100 people total, after being built to handle 1900 at a time. The three other NY field hospitals on that list, all close to NYC, treated zero patients. One of those is in the same county just north of NYC that had the initial outbreak here. I think there's no question that COVID-19 has been a disaster here, but it's going to be heavily debated whether the lockdown saved us or just made things worse on net.
      - tptacek 6y ago
        How are you connecting the occupancy rate of field hospitals to the effectiveness (or ineffectiveness) of the lockdown?
        randallsquared 6y ago
        The low occupancy rate of field hospitals is evidence that either the lockdown worked, or that it was unnecessary. It excludes the case in which the lockdown was obviously necessary and just barely worked, since that's the case in which those field hospitals would themselves have been overwhelmed or nearly so, as well as the existing ICUs. Without regard to the actual effectiveness, the fact that the field hospitals went mostly empty will fuel acrimonious debate about said effectiveness.
      - mgleason_3 6y ago
        Yup, makes me wonder why Cuomo didn't shut down the subway system (or at least limit use based on some sort of need)? The media's given him props for leadership in his briefings, but ignored this massive sources of infections. Meanwhile, various narratives swirl about why NYC is being hit so much harder than elsewhere, like it's some sort of mystery.
        randallsquared 6y ago
        I'm not sure that the data bear that out. Manhattan is the best-served borough, but the least infected. Just this week, Cuomo mentioned some surprising findings: essential workers and homeless, who make up most people on the subway, do not make up a significant number of infected showing up at hospitals, but those do who had been sheltering at home (self-reported, I imagine).
  - thaumaturgy 6y ago
    "I don't want to be hurt" was an option that was swept off the table the moment we went into this disaster with a dysfunctional federal government. Our choices since then have been "economic hardship and misery" or "economic hardship and misery with a spicy side dish of death and suffering". Covid19 has been the leading cause of death in America for a month now [1]. Some time tomorrow, it will have killed a confirmed 80,000 Americans [2] and America has consistently had 1/3rd of the world's critically-ill cases for weeks [ibid]. There is no way we are going to get out of this with less than 100,000 dead. Amazingly, the same country that had endless investigations into the deaths of two people in Benghazi and went to war over the deaths of 3,000 Americans on September 11, 2001 -- subsequently spending $6.4 trillion in war operations [3] -- is finding 100,000 dead to be "pretty good", and the economic cost of mitigating further death to be just a little bit too expensive. As usual, some of this is explained by political misinformation campaigns that too many people are falling for [4][5][6][7], but still, the same talking points get repeated into forums like this one, even though most Americans would prefer economic pain over a higher death toll for now [8][9][10]. I'm just gobsmacked that the disinformation is taking root so easily, because arguing that can really trivially be reduced to, "I don't think enough people are dying to justify the measures meant to prevent people from dying." Hopefully states like California that are following more conservative, evidence-based approaches to relaxing restrictions, will relieve some of the tension. [1]: https://thehill.com/homenews/news/492053-coronavirus-now-leading-cause-of-death-in-us https://thehill.com/homenews/news/492053-coronavirus-now-lea... [2]: https://www.worldometers.info/coronavirus/country/us/ https://www.worldometers.info/coronavirus/country/us/ [3]: https://www.cnbc.com/2019/11/20/us-spent-6point4-trillion-on-middle-east-wars-since-2001-study.html https://www.cnbc.com/2019/11/20/us-spent-6point4-trillion-on... [4]: https://www.washingtonpost.com/politics/inside-the-conservative-networks-backing-anti-quarantine-protests/2020/04/22/da75c81e-83fe-11ea-a3eb-e9fc93160703_story.html https://www.washingtonpost.com/politics/inside-the-conservat... [5]: https://www.washingtonpost.com/technology/2020/04/19/pro-gun-activists-using-facebook-groups-push-anti-quarantine-protests/ https://www.washingtonpost.com/technology/2020/04/19/pro-gun... [6]: https://www.vox.com/2020/4/19/21225195/stay-at-home-protests-trump-tea-party-reelection https://www.vox.com/2020/4/19/21225195/stay-at-home-protests... [7]: https://www.desmoinesregister.com/story/news/politics/2020/04/22/iowa-family-behind-reopen-covid-19-protests-popping-up-across-country/3005696001/ https://www.desmoinesregister.com/story/news/politics/2020/0... [8]: https://www.newsweek.com/americans-coronavirus-restrictions-lifted-too-quickly-poll-1502743 https://www.newsweek.com/americans-coronavirus-restrictions-... [9]: https://www.nytimes.com/2020/05/08/us/politics/coronavirus-reopening-polls.html https://www.nytimes.com/2020/05/08/us/politics/coronavirus-r... [10]: https://fivethirtyeight.com/features/most-americans-think-its-too-soon-to-return-to-what-life-was-like-pre-pandemic/ https://fivethirtyeight.com/features/most-americans-think-it...
  - greedo 6y ago
    The majority of Americans across the board support the lock down, and continue to support going slowly with relaxing restrictions. Only a small, yet well-funded minority want things relaxed ASAP.
  - rumanator 6y ago
    > Further, others were hurt substantially due to these decisions. If anything the US government failed to act to attenuate the expected economic impact that emergency anti-epidemic policies would naturally have on the most vulnerable elements of society. It's also very ironic, if not hipocritical, to abuse the most vulnerable and victimized elements of society, who have been systematically ignored and sacrificed , to argue against undoing policies aimed at defending society's best interests.
Retric 6y ago
The shutdown largely worked. Comparing predictions of what happens without a shutdown is kind of missing the point. What will happen as we try to return to normal yet another situation.
- buzzkillington 6y ago
  We get the pandemic and mass unemployment.
TomMckenny 6y ago
> the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true. Not quite true, NYC was over stressed and there is at least one mass grave and are still corpses in refrigerator trucks. Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer. One can't extrapolate from the success of social distancing to imply that _not_ doing social distance would be less harmful. >The results of our original experiment turned out to be different than our expectations To the contrary, the proposed solution worked as expected. The social distancing combined with state-level quick action reduced the severity of the predicted disaster. In addition, people who would normally go to the ER "just in case" did not for fear of contagion. Or because they lost medical insurance. Or because visiting a GP became difficult and so there were fewer referrals. All reducing strain on hospital resources. Certainly, The predictions of what would happen without out social distancing still stand as the data behind it is unchanged. And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors. Since Sweden dropped from the narrative when it showed serious differences from its neighbors, it hints that criticism of social distancing is either (justifiably) emotional or (unjustifiably) politically. If it were from an honest appraisal by epidemiologists or economist, there would concrete counter projections and remedies rather than imprecise claims about it's success and ambiguous calls as to what a new policy should be. It is horrible that the US death total exceeds the Vietnam war and that there is serious economic hardship. That is the terrible truth for natural disasters when no plans are in place (let alone actual preparation) and the response is slow. I hope the lesson from this disaster is that we are prepared next time rather than convincing ourselves nothing serious happened.
- ahelwer 6y ago
  I wish people would stop comparing US coronavirus deaths to the Vietnam war. The comparison is intended to increase the perceived gravity of coronavirus pandemic - "Remember that war 50 years ago which had massive cultural & social impact? This is just as big!" - but implying the Vietnam war's impact was based on American bodycount is just wrong at best and appalling at worst. The Vietnam war had such an impact because the US military went on such an insane spree of war crimes and civilian massacres that America permanently lost its standing as a moral authority gained in WW2. Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing, and the disaster was prolonged for an entire decade because the country was too proud to admit it was in over its head. McNamara and then Nixon knew the war was unwinnable, but the US could not appear defeated. And so the atrocities continued. Many in the US realized all of this and became permanently disillusioned with their country. Apologies for the off-topic rant but this comparison has been making its way through a lot of circles that really should know better. If you find yourself wishing you knew more about this topic, I recommend the Ken Burns documentary The Vietnam War or the book Kill Everything that Moves.
IkmoIkmo 6y ago
> not getting access to hospital resources is much lower than expected I don't know how you can say 'lower than expected'. Many interventions were non-medical, depending on social behaviour (e.g. adhering to social distancing), effectiveness of governance and enforcement, as well as economic and political (e.g. supply of test kits, ventilators). And even then, we were dealing with a new virus, there was limited data about all kinds of variables. For example, if people are intubated twice as long in the US due to high levels of obesity compared to China, you need twice as much ventilator capacity. Point being, we always had to deal with a very wide confidence interval. Now combine that with the fact we're looking to predict an exponential number, rather than something linear, and you can get wildly different outcomes. In New York the doubling time began around 2 days. That meant the difference between hospitalising 50k or 100k was a matter of starting social distancing two days later. The difference between 50k and say 1.6 million, was just 10 days. Hospital resources can't expand that fast, at best you can add 30% extra beds and shift all bed-use to dealing with corona with emergency interventions, but you can't just scale 3000%. That's where the field hospitals came in. Not because it was guaranteed or fully expected to need them, but because there was a good chance, and there was too little information to conclude they wouldn't be necessary.

thaumaturgy 6y ago

Yeah. It's really a shame that there were all these efforts to prevent our health care system from being overwhelmed. Oh well. It looks like enough people would like to run this particular experiment that we just might get to see what it looks like after all. Yay?

abfan1127 6y ago
I don't understand your comment. We made decisions based on information. The results of our original experiment turned out to be different than our expectations. Further, others were hurt substantially due to these decisions. Those hurt are requesting (or demanding) to change course so as to not be hurt further. Seems reasonable to change course, with each US State (or country) changing course differently based on their circumstances.
- munk-a 6y ago
  I don't know why you think we came out so far different from expectations - New York hospitals were overwhelmed, they hadn't shut down in time to prevent a large wave of cases - other locales that have gotten lucky or shut down have avoided feeling that wave so far... Changing course doesn't seem advisable as growth rates haven't subsided into the negative except in small locales.
  - SpicyLemonZest 6y ago
    New York hospitals weren't happy by any means, but their peak load was an order of magnitude less than what local leaders said they were preparing for.
  - abfan1127 6y ago
    New York was the exception to the rule. Most hospitals were not overwhelmed. In fact, many hospitals flirted with financial disaster when governors prevented elective procedures. I can speak specifically to AZ which outside of some very small Indian Reservation medical centers, is well below capacity[1] Seattle's Army hospital closed without a single patient[2]. Growth rates, especially in AZ, were never large to begin with. [1] - https://azgovernor.gov/sites/default/files/covidpresentation42220finalweb.pdf https://azgovernor.gov/sites/default/files/covidpresentation... [2] - https://www.military.com/daily-news/2020/04/10/armys-seattle-field-hospital-closes-after-3-days-without-treating-single-patient.html https://www.military.com/daily-news/2020/04/10/armys-seattle...
    - TylerE 6y ago
      I would be cautious about using the past tense. New case rates have not come down much from peak - and I expect them to spike in the next few weeks as people let their guard down and things reopen. Deaths lag infections by several weeks. Over 2200 people died yesterday.
      - abfan1127 6y ago
        I agree that with re-opening, we will see a bump in infections, and therefore deaths. However, there is only one path out of this and that is herd immunity. We can accelerate herd immunity via vaccine, but either way its herd immunity. That means that we want as many people sick as our hospital system can handle, but not more. That means playing a game of optimization. Further, different states (New York vs. Arizona) should have different plans because their situations are vastly different (population density, current herd infection status, etc). Further, we can't just optimize for Covid19 deaths, we have to look at the whole situation, which includes suicides due to shelter-in-place orders, child abuse and other domestic violence, malnutrition due to hunger from unemployment, negative impacts of poverty. this will certainly be a case study for future generations.
        TylerE 6y ago
        Strongly disagree. We are learning how to help patients survive. If I must catch it, I want to catch it as far in the future as posslbe.
  - randallsquared 6y ago
    Some hospitals in NYC were overwhelmed, but that was limited to Queens and Brooklyn: the NPR piece notes that Javits Center, which was turned into a hospital in Manhattan, treated about 1100 people total, after being built to handle 1900 at a time. The three other NY field hospitals on that list, all close to NYC, treated zero patients. One of those is in the same county just north of NYC that had the initial outbreak here. I think there's no question that COVID-19 has been a disaster here, but it's going to be heavily debated whether the lockdown saved us or just made things worse on net.
    - tptacek 6y ago
      How are you connecting the occupancy rate of field hospitals to the effectiveness (or ineffectiveness) of the lockdown?
      - randallsquared 6y ago
        The low occupancy rate of field hospitals is evidence that either the lockdown worked, or that it was unnecessary. It excludes the case in which the lockdown was obviously necessary and just barely worked, since that's the case in which those field hospitals would themselves have been overwhelmed or nearly so, as well as the existing ICUs. Without regard to the actual effectiveness, the fact that the field hospitals went mostly empty will fuel acrimonious debate about said effectiveness.
    - mgleason_3 6y ago
      Yup, makes me wonder why Cuomo didn't shut down the subway system (or at least limit use based on some sort of need)? The media's given him props for leadership in his briefings, but ignored this massive sources of infections. Meanwhile, various narratives swirl about why NYC is being hit so much harder than elsewhere, like it's some sort of mystery.
      - randallsquared 6y ago
        I'm not sure that the data bear that out. Manhattan is the best-served borough, but the least infected. Just this week, Cuomo mentioned some surprising findings: essential workers and homeless, who make up most people on the subway, do not make up a significant number of infected showing up at hospitals, but those do who had been sheltering at home (self-reported, I imagine).
- thaumaturgy 6y ago
  "I don't want to be hurt" was an option that was swept off the table the moment we went into this disaster with a dysfunctional federal government. Our choices since then have been "economic hardship and misery" or "economic hardship and misery with a spicy side dish of death and suffering". Covid19 has been the leading cause of death in America for a month now [1]. Some time tomorrow, it will have killed a confirmed 80,000 Americans [2] and America has consistently had 1/3rd of the world's critically-ill cases for weeks [ibid]. There is no way we are going to get out of this with less than 100,000 dead. Amazingly, the same country that had endless investigations into the deaths of two people in Benghazi and went to war over the deaths of 3,000 Americans on September 11, 2001 -- subsequently spending $6.4 trillion in war operations [3] -- is finding 100,000 dead to be "pretty good", and the economic cost of mitigating further death to be just a little bit too expensive. As usual, some of this is explained by political misinformation campaigns that too many people are falling for [4][5][6][7], but still, the same talking points get repeated into forums like this one, even though most Americans would prefer economic pain over a higher death toll for now [8][9][10]. I'm just gobsmacked that the disinformation is taking root so easily, because arguing that can really trivially be reduced to, "I don't think enough people are dying to justify the measures meant to prevent people from dying." Hopefully states like California that are following more conservative, evidence-based approaches to relaxing restrictions, will relieve some of the tension. [1]: https://thehill.com/homenews/news/492053-coronavirus-now-leading-cause-of-death-in-us https://thehill.com/homenews/news/492053-coronavirus-now-lea... [2]: https://www.worldometers.info/coronavirus/country/us/ https://www.worldometers.info/coronavirus/country/us/ [3]: https://www.cnbc.com/2019/11/20/us-spent-6point4-trillion-on-middle-east-wars-since-2001-study.html https://www.cnbc.com/2019/11/20/us-spent-6point4-trillion-on... [4]: https://www.washingtonpost.com/politics/inside-the-conservative-networks-backing-anti-quarantine-protests/2020/04/22/da75c81e-83fe-11ea-a3eb-e9fc93160703_story.html https://www.washingtonpost.com/politics/inside-the-conservat... [5]: https://www.washingtonpost.com/technology/2020/04/19/pro-gun-activists-using-facebook-groups-push-anti-quarantine-protests/ https://www.washingtonpost.com/technology/2020/04/19/pro-gun... [6]: https://www.vox.com/2020/4/19/21225195/stay-at-home-protests-trump-tea-party-reelection https://www.vox.com/2020/4/19/21225195/stay-at-home-protests... [7]: https://www.desmoinesregister.com/story/news/politics/2020/04/22/iowa-family-behind-reopen-covid-19-protests-popping-up-across-country/3005696001/ https://www.desmoinesregister.com/story/news/politics/2020/0... [8]: https://www.newsweek.com/americans-coronavirus-restrictions-lifted-too-quickly-poll-1502743 https://www.newsweek.com/americans-coronavirus-restrictions-... [9]: https://www.nytimes.com/2020/05/08/us/politics/coronavirus-reopening-polls.html https://www.nytimes.com/2020/05/08/us/politics/coronavirus-r... [10]: https://fivethirtyeight.com/features/most-americans-think-its-too-soon-to-return-to-what-life-was-like-pre-pandemic/ https://fivethirtyeight.com/features/most-americans-think-it...
- greedo 6y ago
  The majority of Americans across the board support the lock down, and continue to support going slowly with relaxing restrictions. Only a small, yet well-funded minority want things relaxed ASAP.
- rumanator 6y ago
  > Further, others were hurt substantially due to these decisions. If anything the US government failed to act to attenuate the expected economic impact that emergency anti-epidemic policies would naturally have on the most vulnerable elements of society. It's also very ironic, if not hipocritical, to abuse the most vulnerable and victimized elements of society, who have been systematically ignored and sacrificed , to argue against undoing policies aimed at defending society's best interests.

Retric 6y ago

The shutdown largely worked. Comparing predictions of what happens without a shutdown is kind of missing the point. What will happen as we try to return to normal yet another situation.

buzzkillington 6y ago
We get the pandemic and mass unemployment.

TomMckenny 6y ago

> the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true. Not quite true, NYC was over stressed and there is at least one mass grave and are still corpses in refrigerator trucks. Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer. One can't extrapolate from the success of social distancing to imply that _not_ doing social distance would be less harmful. >The results of our original experiment turned out to be different than our expectations To the contrary, the proposed solution worked as expected. The social distancing combined with state-level quick action reduced the severity of the predicted disaster. In addition, people who would normally go to the ER "just in case" did not for fear of contagion. Or because they lost medical insurance. Or because visiting a GP became difficult and so there were fewer referrals. All reducing strain on hospital resources. Certainly, The predictions of what would happen without out social distancing still stand as the data behind it is unchanged. And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors. Since Sweden dropped from the narrative when it showed serious differences from its neighbors, it hints that criticism of social distancing is either (justifiably) emotional or (unjustifiably) politically. If it were from an honest appraisal by epidemiologists or economist, there would concrete counter projections and remedies rather than imprecise claims about it's success and ambiguous calls as to what a new policy should be. It is horrible that the US death total exceeds the Vietnam war and that there is serious economic hardship. That is the terrible truth for natural disasters when no plans are in place (let alone actual preparation) and the response is slow. I hope the lesson from this disaster is that we are prepared next time rather than convincing ourselves nothing serious happened.

ahelwer 6y ago
I wish people would stop comparing US coronavirus deaths to the Vietnam war. The comparison is intended to increase the perceived gravity of coronavirus pandemic - "Remember that war 50 years ago which had massive cultural & social impact? This is just as big!" - but implying the Vietnam war's impact was based on American bodycount is just wrong at best and appalling at worst. The Vietnam war had such an impact because the US military went on such an insane spree of war crimes and civilian massacres that America permanently lost its standing as a moral authority gained in WW2. Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing, and the disaster was prolonged for an entire decade because the country was too proud to admit it was in over its head. McNamara and then Nixon knew the war was unwinnable, but the US could not appear defeated. And so the atrocities continued. Many in the US realized all of this and became permanently disillusioned with their country. Apologies for the off-topic rant but this comparison has been making its way through a lot of circles that really should know better. If you find yourself wishing you knew more about this topic, I recommend the Ken Burns documentary The Vietnam War or the book Kill Everything that Moves.

IkmoIkmo 6y ago

> not getting access to hospital resources is much lower than expected I don't know how you can say 'lower than expected'. Many interventions were non-medical, depending on social behaviour (e.g. adhering to social distancing), effectiveness of governance and enforcement, as well as economic and political (e.g. supply of test kits, ventilators). And even then, we were dealing with a new virus, there was limited data about all kinds of variables. For example, if people are intubated twice as long in the US due to high levels of obesity compared to China, you need twice as much ventilator capacity. Point being, we always had to deal with a very wide confidence interval. Now combine that with the fact we're looking to predict an exponential number, rather than something linear, and you can get wildly different outcomes. In New York the doubling time began around 2 days. That meant the difference between hospitalising 50k or 100k was a matter of starting social distancing two days later. The difference between 50k and say 1.6 million, was just 10 days. Hospital resources can't expand that fast, at best you can add 30% extra beds and shift all bed-use to dealing with corona with emergency interventions, but you can't just scale 3000%. That's where the field hospitals came in. Not because it was guaranteed or fully expected to need them, but because there was a good chance, and there was too little information to conclude they wouldn't be necessary.