6 ms·

As far as I can tell, there is one big unknown that makes planning particularly difficult: What are the long-term health effects from being infected? If it tur

As far as I can tell, there is one big unknown that makes planning particularly difficult: What are the long-term health effects from being infected? If it turns out that some significant percentage of the population is going to have a negative impact over the course of their lives from this, should we continue to hunker down until a vaccine or better treatments are found?

irq11 7y ago
This is not an unknown. We have very good data on outcomes. The media has been diving ever-further into niche stories of bad outcomes in order to drive clicks, but the numbers of cases driving these narratives are vanishingly small. For the vast majority (>98%) of those who are under 60 and otherwise healthy, this disease is on par with the flu. Even amongst those who are more vulnerable, the rate of long-term sequelae is low. It’s the people who end up in the ICU who are experiencing the most long-term effects, and those people are a single-digit percentage of a single-digit percentage of those infected.
- macintux 7y ago
  This disease has been here for 6 months. The degree of certainty in your assessment seems unwarranted. I want to believe it, but optimism and certainty given the novelty of this virus seem strange bedfellows.
  - xamuel 7y ago
    As rossdavidh correctly pointed out, if we don't get a vaccine soon (which we probably won't), then herd immunity is virtually the only way out anyway. Even if it turns out there are long term health problems, that doesn't really change that calculus. Very few people can completely isolate themselves indefinitely (remember, the virus doesn't just magically not spread in supermarkets), and if everyone did that, most of us would starve and the few who didn't starve would inherit a post-civilization ruin.
    - mlyle 7y ago
      It does change the economic break even point a little bit. If intervention A reduces infection count 10% in the time to a vaccine, whether it's worth it depends upon whether it prevents 20,000 deaths, or 20,000 deaths and 40,000 long term illnesses. The threshold to herd immunity depends upon contact rate. So interventions well short of "lockdown" may not completely prevent the spread of the virus but still reach equilibrium at a lower number of people infected.
      - xamuel 7y ago
        You're right, the question of where the break even point is is quite complex. Aside from the numbers you posted, it also depends on the economic side effects of "intervention A": better to be one of the 40,000 with long-term illnesses in a functional society, than to avoid the long-term illnesses but live in a non-functional society because we destroyed the whole economy.
        macintux 7y ago
        The economy is a human construct, subject to redefinition if needed. It’s not some inevitable product of the natural world. Sacrificing lives unnecessarily to “save the economy” is perverse in that the economy is supposed to serve us, not the other way around. I’m not saying we should stay in lockdown forever, but I’d rather our leaders think creatively with a default view of “let’s be cautious with a global pandemic that has so far shown great destructive powers when left unchecked”.
        xamuel 7y ago
        There's this boogeyman floating around that "the economy" consists of a bunch of billionaires drawing lines on charts, drinking champagne and laughing at the proles. If any of that is going on and is costing lives, by all means, put an end to it. But when I talk about "the economy", I mean the process that puts food on plates and electricity in houses. Someone has to grow the food, someone has to transport it, someone has to store it, distribute it. Sure, we could round up the world's billionaires and force them to do that, but unfortunately there aren't enough of them to do it for everyone, so someone else will have to do it too. And someone will have to service the cars and trains those workers take to get to work, and someone will have to watch their kids, and someone will have to provide toys to the people watching their kids, etc. etc. etc. THAT'S what I mean by "the economy".
- lisper 7y ago
  > We have very good data on outcomes Not long-term outcomes. (And even short-term our data is not "very good" because we still have no idea what the actual infection rate is.)
- macintux 7y ago
  Quote from a virologist who caught it: > Many people think COVID-19 kills 1% of patients, and the rest get away with some flulike symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We are learning while we are sailing. That’s why I get so annoyed by the many commentators on the sidelines who, without much insight, criticize the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair. https://www.sciencemag.org/news/2020/05/finally-virus-got-me-scientist-who-fought-ebola-and-hiv-reflects-facing-death-covid-19 https://www.sciencemag.org/news/2020/05/finally-virus-got-me...
  - irq11 7y ago
    Yeah, I read that anecdote, too. Saying “many people” is meaningless. A tenth of a percent of a million people is a thousand people. That’s “many people”, but the rate is quite low. Facts: in the US, the hospitalization rate for covid is around 4.6 per 100,000. It’s half that for people under age 50. The rate of serious disease is very, very low...and this includes high-risk groups: https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm
ibejoeb 7y ago
I can't understand the amount of intrigue surrounding this. It's not some kind of mysterious alien pathogen; there are 6 other coronaviruses that infect humans, and hundreds that infect other animals. There have been numerous outbreaks in the past 20 years. They're very well researched. Still, I'm not holding my breath for a vaccine since these other diseases, like SARS and MERS, are several orders of magnitude more letha. > some significant percentage of the population is going to have a negative impact Is there any evidence at all that this is some kind of feature of this disease? It's even starting to look like most people who become infected never even develop the associated disease.
- mlyle 7y ago
  This causes a whole lot more people to be hospitalized with severe illness. Severe illness tends to result in morbidity even if you survive. A fair number of people with SARS-CoV-1 ended up with chronic fatigue ailments, etc, afterwards, too. We don't know, but there's almost certainly going to be more lasting morbidity from this epidemic than the common cold. If it's a little bit, it doesn't change the calculation much. If 1/4th of those hospitalized develop significant morbidity though, that sucks.
  - ibejoeb 7y ago
    > This causes a whole lot more people to be hospitalized with severe illness. Sure. And the other ones kill. > If 1/4th of those hospitalized develop significant morbidity Am I wrong, or is it that the overwhelming majority of people who are hospitalized already have a comorbidity? Where does 1/4 come from? Why not 100%?
rossdavidh 7y ago
From what I'm reading, the best case for a vaccine is 3 years (both development and production on a large enough scale). By which point, it's a moot point because the vaccine will have gotten to herd immunity levels long before that. In other words, hunkering down won't really change the fact that the vaccine, if it comes at all, won't come in time.

irq11 7y ago

This is not an unknown. We have very good data on outcomes. The media has been diving ever-further into niche stories of bad outcomes in order to drive clicks, but the numbers of cases driving these narratives are vanishingly small. For the vast majority (>98%) of those who are under 60 and otherwise healthy, this disease is on par with the flu. Even amongst those who are more vulnerable, the rate of long-term sequelae is low. It’s the people who end up in the ICU who are experiencing the most long-term effects, and those people are a single-digit percentage of a single-digit percentage of those infected.

macintux 7y ago
This disease has been here for 6 months. The degree of certainty in your assessment seems unwarranted. I want to believe it, but optimism and certainty given the novelty of this virus seem strange bedfellows.
- xamuel 7y ago
  As rossdavidh correctly pointed out, if we don't get a vaccine soon (which we probably won't), then herd immunity is virtually the only way out anyway. Even if it turns out there are long term health problems, that doesn't really change that calculus. Very few people can completely isolate themselves indefinitely (remember, the virus doesn't just magically not spread in supermarkets), and if everyone did that, most of us would starve and the few who didn't starve would inherit a post-civilization ruin.
  - mlyle 7y ago
    It does change the economic break even point a little bit. If intervention A reduces infection count 10% in the time to a vaccine, whether it's worth it depends upon whether it prevents 20,000 deaths, or 20,000 deaths and 40,000 long term illnesses. The threshold to herd immunity depends upon contact rate. So interventions well short of "lockdown" may not completely prevent the spread of the virus but still reach equilibrium at a lower number of people infected.
    - xamuel 7y ago
      You're right, the question of where the break even point is is quite complex. Aside from the numbers you posted, it also depends on the economic side effects of "intervention A": better to be one of the 40,000 with long-term illnesses in a functional society, than to avoid the long-term illnesses but live in a non-functional society because we destroyed the whole economy.
      - macintux 7y ago
        The economy is a human construct, subject to redefinition if needed. It’s not some inevitable product of the natural world. Sacrificing lives unnecessarily to “save the economy” is perverse in that the economy is supposed to serve us, not the other way around. I’m not saying we should stay in lockdown forever, but I’d rather our leaders think creatively with a default view of “let’s be cautious with a global pandemic that has so far shown great destructive powers when left unchecked”.
        xamuel 7y ago
        There's this boogeyman floating around that "the economy" consists of a bunch of billionaires drawing lines on charts, drinking champagne and laughing at the proles. If any of that is going on and is costing lives, by all means, put an end to it. But when I talk about "the economy", I mean the process that puts food on plates and electricity in houses. Someone has to grow the food, someone has to transport it, someone has to store it, distribute it. Sure, we could round up the world's billionaires and force them to do that, but unfortunately there aren't enough of them to do it for everyone, so someone else will have to do it too. And someone will have to service the cars and trains those workers take to get to work, and someone will have to watch their kids, and someone will have to provide toys to the people watching their kids, etc. etc. etc. THAT'S what I mean by "the economy".
lisper 7y ago
> We have very good data on outcomes Not long-term outcomes. (And even short-term our data is not "very good" because we still have no idea what the actual infection rate is.)
macintux 7y ago
Quote from a virologist who caught it: > Many people think COVID-19 kills 1% of patients, and the rest get away with some flulike symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We are learning while we are sailing. That’s why I get so annoyed by the many commentators on the sidelines who, without much insight, criticize the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair. https://www.sciencemag.org/news/2020/05/finally-virus-got-me-scientist-who-fought-ebola-and-hiv-reflects-facing-death-covid-19 https://www.sciencemag.org/news/2020/05/finally-virus-got-me...
- irq11 7y ago
  Yeah, I read that anecdote, too. Saying “many people” is meaningless. A tenth of a percent of a million people is a thousand people. That’s “many people”, but the rate is quite low. Facts: in the US, the hospitalization rate for covid is around 4.6 per 100,000. It’s half that for people under age 50. The rate of serious disease is very, very low...and this includes high-risk groups: https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

ibejoeb 7y ago

I can't understand the amount of intrigue surrounding this. It's not some kind of mysterious alien pathogen; there are 6 other coronaviruses that infect humans, and hundreds that infect other animals. There have been numerous outbreaks in the past 20 years. They're very well researched. Still, I'm not holding my breath for a vaccine since these other diseases, like SARS and MERS, are several orders of magnitude more letha. > some significant percentage of the population is going to have a negative impact Is there any evidence at all that this is some kind of feature of this disease? It's even starting to look like most people who become infected never even develop the associated disease.

mlyle 7y ago
This causes a whole lot more people to be hospitalized with severe illness. Severe illness tends to result in morbidity even if you survive. A fair number of people with SARS-CoV-1 ended up with chronic fatigue ailments, etc, afterwards, too. We don't know, but there's almost certainly going to be more lasting morbidity from this epidemic than the common cold. If it's a little bit, it doesn't change the calculation much. If 1/4th of those hospitalized develop significant morbidity though, that sucks.
- ibejoeb 7y ago
  > This causes a whole lot more people to be hospitalized with severe illness. Sure. And the other ones kill. > If 1/4th of those hospitalized develop significant morbidity Am I wrong, or is it that the overwhelming majority of people who are hospitalized already have a comorbidity? Where does 1/4 come from? Why not 100%?

rossdavidh 7y ago

From what I'm reading, the best case for a vaccine is 3 years (both development and production on a large enough scale). By which point, it's a moot point because the vaccine will have gotten to herd immunity levels long before that. In other words, hunkering down won't really change the fact that the vaccine, if it comes at all, won't come in time.