7 ms·

The infection rate is expected to rise as lockdowns are eased. The question is if treatment capacity is overwhelmed.

oezi 6y ago
If we are willing to accept 0.5% to 2% fatalities per infection, then we can let infection rates rise. Otherwise we should have tried to keep it in an acceptable very low level. I personally find it astonishing that we are accepting >100 deaths per day.
- moduspol 6y ago
  You won't believe how many fatalities we accept to drive cars!
  - alexilliamson 6y ago
    Not 100 per day?
    - paulgb 6y ago
      100 per day in the US alone in 2018. https://en.m.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year https://en.m.wikipedia.org/wiki/Motor_vehicle_fatality_rate_...
      - alexilliamson 6y ago
        The parent was talking about Germany. In the US we're currently at 2-3k coronavirus deaths so still much larger than auto deaths.
        paulgb 6y ago
        Ok, that's fair. I interpreted "we" from moduspol as "we as a society" but I agree that the German numbers are more relevant here. (Incidentally, using traffic death numbers as a baseline for a rate of fatalities we should accept is bad anyway because those numbers are also higher than we should tolerate, IMO.)
    - deleted 6y ago
      [deleted]
    - moduspol 6y ago
      Actually, a little more. https://www.asirt.org/safe-travel/road-safety-facts/ https://www.asirt.org/safe-travel/road-safety-facts/ 38,000 a year ~= 104 / day
    - oezi 6y ago
      No, Germany had 3100 deaths due to traffic in the whole year 2019. Less than 10 per day.
    - mytailorisrich 6y ago
      More than 300 people die every day from preventable causes in Germany, excluding Covid-19. (based on 120,000 preventable deaths in 2016: https://www.oecd.org/germany/health-at-a-glance-germany-EN.pdf https://www.oecd.org/germany/health-at-a-glance-germany-EN.p... )
  - ellofromoversea 6y ago
    Apples and oranges Worry about invisible death from a cube neighbor sneezing is not going to generate the sanity needed to be productive If you all are so uninterested in having to cope with the reality of this, the 2nd amendment puts relief within arms reach for yourself alone You want to consider it the perspective of ratio alone? Ok. You’re just 1 in 7 billion+ right? Why should I care about your existence... is effectively the narrative you’re peddling by clustering humans into an abstract math object? Ok well I don’t care if you are one of those people in the math object you think matters Annotate the math as if you’re inside the object. Then grow some nuts and live it Typical American, throw everyone else at the fight Edit: Oh no my fake internet points! An online community that is a minority of the populace doesn’t like what I put before them! But even as a collective their value to humanity as a whole is statistically unimportant so who cares?
  - newacct583 6y ago
    We don't, though! Automobiles are heavily regulated by a staggeringly large bureaucracy that works at all levels from driver training to equipment design to collision analysis science to traffic pattern analysis to infrastructure maintenance. We spend enormous amounts of money because we "don't accept" the high fatality rates seen in automobiles. And it works. Check out the charts here for very clear proof: https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in... And now we're doing the same kind of thing (in, obviously, very different ways) to fight the covid pandemic. And it's working too, though better in some areas than others. Germany in TFA is worried that maybe their R0 might have slipped above 1.0 and started growing again. Outside NYC, the US epidemic is still large and still growing.
    - moduspol 6y ago
      We accept it by allowing cars to be driven. That we separately take other steps to lessen the number does not negate the fact that we still accept it. And it's the same thing with COVID-19. We can't quarantine everyone indefinitely, this is unlikely to end without us reaching herd immunity, and the quarantine itself causes non-negligible suffering. We have to approach this rationally.
      - newacct583 6y ago
        We don't quarantine everyone, not remotely. Best estimates are that about 20% of the US economy is halted right now. Hyperbole doesn't help. Why is trying to minimize a US death toll on the order of hundreds of thousands[1] at the cost of a 20% GDP hit not a "rational" choice? It may not be your personal choice, but it seems to be to most people. And it's absolutely a well-understood tradeoff by everyone involved. No one went into this blind to the costs. [1] Maybe only ("only") mid-tens-of-thousands if you use the kind of life-years-saved metric that seems to be en vogue among the "open up" set.
        Johanx64 6y ago
        The problem with "pro-quarantine" arguments is that they miss that: a) they are not going to "save hundreds of thousands of deaths", because quarantine doesn't stop the virus it only slows it down, in other-words quarantine will spread out those deaths in time, but many of those deaths are still going to happen (in due time) b) 20% GDP hit will inevitably directly and indirectly kill, make homeless and starve a lot of people c) in 2nd and 3rd world contries the distruption of the global economy to this degree will kill a metric ton of people d) it's impossible to keep quarantine for extended periods of time, because then it's going to be way more than 20% GDP hit. The only question is which approach is going to kill more people and do more damage in the long run. To me it seems obvious that extended general quarantine is going to do an order of magnitude more damage (than doing the sane thing - like isolating at risk groups).
  - tinus_hn 6y ago
    Don’t forget smoking and pollution.
- goodcanadian 6y ago
  I personally find it astonishing that we are accepting >100 deaths per day. Who is we? In the UK, for example, the baseline expected death rate is around 2000 per day. Sure, adding another 500 to that is a big deal, but it is maybe not as big a deal as everyone seems to think it is.
  - oezi 6y ago
    (German here. 100 deaths per day is more than any all terror deaths over the last couple of years) The death toll due to covid is already is visible on all averaged yearly death per day/week charts and we have not even gotten to 1% of population having gotten the disease. That is a big deal.
    - umvi 6y ago
      > The death toll due to covid is already is visible on all averaged yearly death per day/week charts and we have not even gotten to 1% of population having gotten the disease. That is a big deal. Only when one year is taken into account. How about decade averages? I bet tobacco is #1 on the list and covid does not even make top 10
      - Saaster 6y ago
        Let's keep moving those goalposts 'til the other team can't even see the goal anymore!
- luckylion 6y ago
  > I personally find it astonishing that we are accepting >100 deaths per day. Close to a million people die in Germany in any given year, we're always accepting >100 deaths per day. The question in 12 months will be whether the death rate significantly increased or whether it primarily moved the cause of death, so more people died from Covid-19 and less died of atypical pneumonia, old age, cancer, heart disease or the flu.
- nil-sec 6y ago
  It is not possible. The number of active cases peaked 2 weeks ago and is dropping ever since. What do you suggest? Keep everything closed for a minimum of 18 months? What do we do if we never find a vaccine? It is absolutely the right move to open up carefully once your healthcare system has enough capacity.
  - oezi 6y ago
    Well, we could have at least waited until masks are widely available and we have a contact tracing system that is able to trace all contacts of contacts of those infected each day. At 1000 infected per day in Germany, this would be 100.000 to 400.000 contacts traced by day. And of course, we should have kept up the social distancing.
    - nil-sec 6y ago
      Masks are widely available! There isn't a single person without mask in the supermarkets. Not one. Social distancing is widely observed. I don't know where you get your information from but my experience is very different.
      - greedo 6y ago
        What region are you referencing with your anecdote? Where I live, mask usage isn't even close to 50% unless the store requires it, and that's including bandit scarves, masks not covering noses, homemade masks of dubious quality, ad infinitum. Social distancing is not well observed at the grocery store when I have to shop.
        nil-sec 6y ago
        NRW. I believe that there are differences though.
- rjtavares 6y ago
  That number has to be put in perspective. There's barely any excess mortality in Germany since COVID hit (meaning it's within normal variation). That's success any way you look at it.
- mchusma 6y ago
  The consensus IFR is generally in a lower range, from 0.2% to 1%. Here is meta analysis that pegs the range from about 0.5-1%. https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v1 https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v... But note this includes estimates from February, with a lot more unknowns, and fails to take into account improved treatments (Remdisivir, Plasma, ventilator use improvements, etc). Moving forward, given treatment improvements, I think a consensus IFR range would likely be 0.1% to 0.7%.
newacct583 6y ago
It's not. The goal with more successful efforts like the one in Germany isn't just "flattening the curve", it's containment. Once the infection rate is low enough you have enough testing capacity to test everyone who gets sick, and all their contacts, and thus you can find and quarantine new outbreaks before they start spreading generally. But this only works with a very low infection rate. Once your testing capacity (which is still, basically everywhere, much smaller than hospitals' ability to treat the same outbreak) is overwhelmed, you lose control and end up back where everyone else is. People are watching this closely.
- deleted 6y ago
  [deleted]
- nomel 6y ago
  How does this work with a significant percentage being asymptotic?
  - NomDePlum 6y ago
    That's were contact tracing and testing are key. If when a person is identified as having COVID you can identify who they have had contact with and test them you can reduce or ideally totally prevent onward infections. Effectively breaking the chain.
  - newacct583 6y ago
    Precisely because the asymptomatic cases get caught by being traced from the symptomatic people in their contacts!
this_user 6y ago
> The question is if treatment capacity is overwhelmed. It eventually will be if R0 is greater 1.0. The government's position is that it needs to stay below one. The official metric to that effect is the number of new infections per 100,000 people. If it crosses above 50 for any administrative district, lockdown measures ought to be tightened. As of today, there are four above that threshold.
- corty 6y ago
  R_0 is always above 1, or the virus wouldn't even exist in the first place. You mean R_eff
  - deleted 6y ago
    [deleted]
  - baobabKoodaa 6y ago
    You have misunderstood what R0 and R_effective mean. R0 certainly can, and often does, go below 1. The only difference between R0 and R_effective is that R0 assumes everyone in the population is suaceptible to the virus.
- moduspol 6y ago
  It won't if we reach herd immunity, which is when this will end regardless of containment attempts.
  - KarlKemp 6y ago
    I’m amazed how this idea seems to endure, even in the face of dozens of countries showing reductions of 90%+ (Italy, Spain, Germany, Austria, Australia, Switzerland, Iceland, Norway, South Korea, France, etc) or even complete elimination (China, NZ). Just because the US and UK can’t get their act together doesn’t mean it’s impossible.
    - moduspol 6y ago
      It's not over until those countries' policies are back to how they were prior to the outbreak (borders open, travel allowed, no lockdowns). Until then, it's just hoping for the best for when they do.
deleted 6y ago
[deleted]
cactus2093 6y ago
This is just one of many questions. Right now even with the best treatment, 1% of people die. Your statement implies that if we could guarantee hospitals would never get overwhelmed we would happily let this wash over the whole population and kill 1% of us. That should be avoided (and would also hurt the economy just like the lockdown is, it’s not an either/or choice).
- moduspol 6y ago
  This isn't going to end until we reach herd immunity. Herd immunity doesn't imply all of us get infected. And the fatalities of this are not among a random 1%, it's primarily known groups that can be quarantined or protected separately.
  - s9w 6y ago
    It ends way before herd immunity with other viruses.
    - moduspol 6y ago
      Not all viruses have symptom-less 14-day periods where someone can be infected and spreading it to others without knowing. But yes, it could end before herd immunity. Or it could be like the flu, and mutate / continue indefinitely.
      - lbeltrame 6y ago
        Just to be precise: 14 days is not the median. The median is far lower (4-6 days), and I think we need studies on how early during the asymptomatic period one can actually spread the virus, because last I heard (but I lack reliable evidence), it was 2 or 3 days before symptoms showed up.
      - mikem170 6y ago
        >Or it could be like the flu, and mutate / continue indefinitely. I gather that is unlikely, coronaviruses don't mutate like the flu. In fact, according to experts, it is most likely that this coronavirus will decrease in severity over time and become endemic like the other several coronaviruses that are responsible for 15% of common colds. Or, alternatively, occasionally returning like a bad flu year. https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/ https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor... I remember reading in other places this may have happened before, something about a really bad flu year in the 1870's that may have been another coronavirus introducing itself to humanity.

oezi 6y ago

If we are willing to accept 0.5% to 2% fatalities per infection, then we can let infection rates rise. Otherwise we should have tried to keep it in an acceptable very low level. I personally find it astonishing that we are accepting >100 deaths per day.

moduspol 6y ago
You won't believe how many fatalities we accept to drive cars!
- alexilliamson 6y ago
  Not 100 per day?
  - paulgb 6y ago
    100 per day in the US alone in 2018. https://en.m.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year https://en.m.wikipedia.org/wiki/Motor_vehicle_fatality_rate_...
    - alexilliamson 6y ago
      The parent was talking about Germany. In the US we're currently at 2-3k coronavirus deaths so still much larger than auto deaths.
      - paulgb 6y ago
        Ok, that's fair. I interpreted "we" from moduspol as "we as a society" but I agree that the German numbers are more relevant here. (Incidentally, using traffic death numbers as a baseline for a rate of fatalities we should accept is bad anyway because those numbers are also higher than we should tolerate, IMO.)
  - deleted 6y ago
    [deleted]
  - moduspol 6y ago
    Actually, a little more. https://www.asirt.org/safe-travel/road-safety-facts/ https://www.asirt.org/safe-travel/road-safety-facts/ 38,000 a year ~= 104 / day
  - oezi 6y ago
    No, Germany had 3100 deaths due to traffic in the whole year 2019. Less than 10 per day.
  - mytailorisrich 6y ago
    More than 300 people die every day from preventable causes in Germany, excluding Covid-19. (based on 120,000 preventable deaths in 2016: https://www.oecd.org/germany/health-at-a-glance-germany-EN.pdf https://www.oecd.org/germany/health-at-a-glance-germany-EN.p... )
- ellofromoversea 6y ago
  Apples and oranges Worry about invisible death from a cube neighbor sneezing is not going to generate the sanity needed to be productive If you all are so uninterested in having to cope with the reality of this, the 2nd amendment puts relief within arms reach for yourself alone You want to consider it the perspective of ratio alone? Ok. You’re just 1 in 7 billion+ right? Why should I care about your existence... is effectively the narrative you’re peddling by clustering humans into an abstract math object? Ok well I don’t care if you are one of those people in the math object you think matters Annotate the math as if you’re inside the object. Then grow some nuts and live it Typical American, throw everyone else at the fight Edit: Oh no my fake internet points! An online community that is a minority of the populace doesn’t like what I put before them! But even as a collective their value to humanity as a whole is statistically unimportant so who cares?
- newacct583 6y ago
  We don't, though! Automobiles are heavily regulated by a staggeringly large bureaucracy that works at all levels from driver training to equipment design to collision analysis science to traffic pattern analysis to infrastructure maintenance. We spend enormous amounts of money because we "don't accept" the high fatality rates seen in automobiles. And it works. Check out the charts here for very clear proof: https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in... And now we're doing the same kind of thing (in, obviously, very different ways) to fight the covid pandemic. And it's working too, though better in some areas than others. Germany in TFA is worried that maybe their R0 might have slipped above 1.0 and started growing again. Outside NYC, the US epidemic is still large and still growing.
  - moduspol 6y ago
    We accept it by allowing cars to be driven. That we separately take other steps to lessen the number does not negate the fact that we still accept it. And it's the same thing with COVID-19. We can't quarantine everyone indefinitely, this is unlikely to end without us reaching herd immunity, and the quarantine itself causes non-negligible suffering. We have to approach this rationally.
    - newacct583 6y ago
      We don't quarantine everyone, not remotely. Best estimates are that about 20% of the US economy is halted right now. Hyperbole doesn't help. Why is trying to minimize a US death toll on the order of hundreds of thousands[1] at the cost of a 20% GDP hit not a "rational" choice? It may not be your personal choice, but it seems to be to most people. And it's absolutely a well-understood tradeoff by everyone involved. No one went into this blind to the costs. [1] Maybe only ("only") mid-tens-of-thousands if you use the kind of life-years-saved metric that seems to be en vogue among the "open up" set.
      - Johanx64 6y ago
        The problem with "pro-quarantine" arguments is that they miss that: a) they are not going to "save hundreds of thousands of deaths", because quarantine doesn't stop the virus it only slows it down, in other-words quarantine will spread out those deaths in time, but many of those deaths are still going to happen (in due time) b) 20% GDP hit will inevitably directly and indirectly kill, make homeless and starve a lot of people c) in 2nd and 3rd world contries the distruption of the global economy to this degree will kill a metric ton of people d) it's impossible to keep quarantine for extended periods of time, because then it's going to be way more than 20% GDP hit. The only question is which approach is going to kill more people and do more damage in the long run. To me it seems obvious that extended general quarantine is going to do an order of magnitude more damage (than doing the sane thing - like isolating at risk groups).
- tinus_hn 6y ago
  Don’t forget smoking and pollution.
goodcanadian 6y ago
I personally find it astonishing that we are accepting >100 deaths per day. Who is we? In the UK, for example, the baseline expected death rate is around 2000 per day. Sure, adding another 500 to that is a big deal, but it is maybe not as big a deal as everyone seems to think it is.
- oezi 6y ago
  (German here. 100 deaths per day is more than any all terror deaths over the last couple of years) The death toll due to covid is already is visible on all averaged yearly death per day/week charts and we have not even gotten to 1% of population having gotten the disease. That is a big deal.
  - umvi 6y ago
    > The death toll due to covid is already is visible on all averaged yearly death per day/week charts and we have not even gotten to 1% of population having gotten the disease. That is a big deal. Only when one year is taken into account. How about decade averages? I bet tobacco is #1 on the list and covid does not even make top 10
    - Saaster 6y ago
      Let's keep moving those goalposts 'til the other team can't even see the goal anymore!
luckylion 6y ago
> I personally find it astonishing that we are accepting >100 deaths per day. Close to a million people die in Germany in any given year, we're always accepting >100 deaths per day. The question in 12 months will be whether the death rate significantly increased or whether it primarily moved the cause of death, so more people died from Covid-19 and less died of atypical pneumonia, old age, cancer, heart disease or the flu.
nil-sec 6y ago
It is not possible. The number of active cases peaked 2 weeks ago and is dropping ever since. What do you suggest? Keep everything closed for a minimum of 18 months? What do we do if we never find a vaccine? It is absolutely the right move to open up carefully once your healthcare system has enough capacity.
- oezi 6y ago
  Well, we could have at least waited until masks are widely available and we have a contact tracing system that is able to trace all contacts of contacts of those infected each day. At 1000 infected per day in Germany, this would be 100.000 to 400.000 contacts traced by day. And of course, we should have kept up the social distancing.
  - nil-sec 6y ago
    Masks are widely available! There isn't a single person without mask in the supermarkets. Not one. Social distancing is widely observed. I don't know where you get your information from but my experience is very different.
    - greedo 6y ago
      What region are you referencing with your anecdote? Where I live, mask usage isn't even close to 50% unless the store requires it, and that's including bandit scarves, masks not covering noses, homemade masks of dubious quality, ad infinitum. Social distancing is not well observed at the grocery store when I have to shop.
      - nil-sec 6y ago
        NRW. I believe that there are differences though.
rjtavares 6y ago
That number has to be put in perspective. There's barely any excess mortality in Germany since COVID hit (meaning it's within normal variation). That's success any way you look at it.
mchusma 6y ago
The consensus IFR is generally in a lower range, from 0.2% to 1%. Here is meta analysis that pegs the range from about 0.5-1%. https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v1 https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v... But note this includes estimates from February, with a lot more unknowns, and fails to take into account improved treatments (Remdisivir, Plasma, ventilator use improvements, etc). Moving forward, given treatment improvements, I think a consensus IFR range would likely be 0.1% to 0.7%.

newacct583 6y ago

It's not. The goal with more successful efforts like the one in Germany isn't just "flattening the curve", it's containment. Once the infection rate is low enough you have enough testing capacity to test everyone who gets sick, and all their contacts, and thus you can find and quarantine new outbreaks before they start spreading generally. But this only works with a very low infection rate. Once your testing capacity (which is still, basically everywhere, much smaller than hospitals' ability to treat the same outbreak) is overwhelmed, you lose control and end up back where everyone else is. People are watching this closely.

deleted 6y ago
[deleted]
nomel 6y ago
How does this work with a significant percentage being asymptotic?
- NomDePlum 6y ago
  That's were contact tracing and testing are key. If when a person is identified as having COVID you can identify who they have had contact with and test them you can reduce or ideally totally prevent onward infections. Effectively breaking the chain.
- newacct583 6y ago
  Precisely because the asymptomatic cases get caught by being traced from the symptomatic people in their contacts!

this_user 6y ago

> The question is if treatment capacity is overwhelmed. It eventually will be if R0 is greater 1.0. The government's position is that it needs to stay below one. The official metric to that effect is the number of new infections per 100,000 people. If it crosses above 50 for any administrative district, lockdown measures ought to be tightened. As of today, there are four above that threshold.

corty 6y ago
R_0 is always above 1, or the virus wouldn't even exist in the first place. You mean R_eff
- deleted 6y ago
  [deleted]
- baobabKoodaa 6y ago
  You have misunderstood what R0 and R_effective mean. R0 certainly can, and often does, go below 1. The only difference between R0 and R_effective is that R0 assumes everyone in the population is suaceptible to the virus.
moduspol 6y ago
It won't if we reach herd immunity, which is when this will end regardless of containment attempts.
- KarlKemp 6y ago
  I’m amazed how this idea seems to endure, even in the face of dozens of countries showing reductions of 90%+ (Italy, Spain, Germany, Austria, Australia, Switzerland, Iceland, Norway, South Korea, France, etc) or even complete elimination (China, NZ). Just because the US and UK can’t get their act together doesn’t mean it’s impossible.
  - moduspol 6y ago
    It's not over until those countries' policies are back to how they were prior to the outbreak (borders open, travel allowed, no lockdowns). Until then, it's just hoping for the best for when they do.

deleted 6y ago

[deleted]

cactus2093 6y ago

This is just one of many questions. Right now even with the best treatment, 1% of people die. Your statement implies that if we could guarantee hospitals would never get overwhelmed we would happily let this wash over the whole population and kill 1% of us. That should be avoided (and would also hurt the economy just like the lockdown is, it’s not an either/or choice).

moduspol 6y ago
This isn't going to end until we reach herd immunity. Herd immunity doesn't imply all of us get infected. And the fatalities of this are not among a random 1%, it's primarily known groups that can be quarantined or protected separately.
- s9w 6y ago
  It ends way before herd immunity with other viruses.
  - moduspol 6y ago
    Not all viruses have symptom-less 14-day periods where someone can be infected and spreading it to others without knowing. But yes, it could end before herd immunity. Or it could be like the flu, and mutate / continue indefinitely.
    - lbeltrame 6y ago
      Just to be precise: 14 days is not the median. The median is far lower (4-6 days), and I think we need studies on how early during the asymptomatic period one can actually spread the virus, because last I heard (but I lack reliable evidence), it was 2 or 3 days before symptoms showed up.
    - mikem170 6y ago
      >Or it could be like the flu, and mutate / continue indefinitely. I gather that is unlikely, coronaviruses don't mutate like the flu. In fact, according to experts, it is most likely that this coronavirus will decrease in severity over time and become endemic like the other several coronaviruses that are responsible for 15% of common colds. Or, alternatively, occasionally returning like a bad flu year. https://www.statnews.com/2020/02/04/two-scenarios-if-new-coronavirus-isnt-contained/ https://www.statnews.com/2020/02/04/two-scenarios-if-new-cor... I remember reading in other places this may have happened before, something about a really bad flu year in the 1870's that may have been another coronavirus introducing itself to humanity.