7 ms·

It's disturbing how the goalposts have been changing around the shelter-in-place orders. The original argument was to "flatten the curve" to prevent hospitals

It's disturbing how the goalposts have been changing around the shelter-in-place orders. The original argument was to "flatten the curve" to prevent hospitals from becoming overwhelmed. By that logic, areas where the hospitals have not been overwhelmed (which is most of the United States) should be gradually reducing restrictions, and only maintaining the restrictions necessary to prevent hospitals from becoming overwhelmed. Lately, the prevailing argument seems to be that we need to shelter in place because virus cases will increase if we don't. That was not the original justification. Of course cases will increase! The question ought to be, will they increase to the extent that they overwhelm hospital capacity? Most of the people quoted in the article agreed with shelter-in-place orders in the first place, and now they are being labeled as "skeptics" for sticking with the original rationale.

vwcx 6y ago
Public health is a constantly changing landscape made up of frequently shifting inputs and analysis. It’s only in recent decades that our desire for absolutes has really given people the idea that these things should be simple. Every country on earth has to move the goalposts during a pandemic — this is a sign the system is still working.
- toomuchtodo 6y ago
  But then you must provide additional economic support to those impacted accordingly, as you regulate public behavior through updates to public health orders.
  - ceejayoz 6y ago
    Most countries are doing that. The one-off $1,200 in the US is fairly unique.
    - RandomInteger4 6y ago
      Can you provide citations to which countries exactly you're referring to by the phrase "most countries?"
      - ceejayoz 6y ago
        https://www.washingtonpost.com/world/europe/europe-seeks-to-limit-coronavirus-crisis-with-unprecedented-offers-to-pay-private-sector-salaries/2020/03/24/1f099a5a-6abe-11ea-b199-3a9799c54512_story.html https://www.washingtonpost.com/world/europe/europe-seeks-to-... > France, Germany, Denmark, Britain and others have decided to take over the payrolls of struggling companies, so that workers don’t get laid off. The hope is that by paying people to stay home, governments can slow the virus’s spread while also averting an economic depression. > Since many European countries had similar social safety net programs already, albeit in far more limited form, the salary supports were relatively easy to expand, almost literally overnight in many places, amid widespread consensus. When they imposed their economically devastating lockdowns, countries were thus able to signal to workers that their livelihoods would remain intact and to businesses that they wouldn’t immediately implode.
        DuskStar 6y ago
        > France, Germany, Denmark, Britain and others have decided to take over the payrolls of struggling companies Didn't the US largely do this too, via a forgivable loan to companies?
        ceejayoz 6y ago
        Sorta. It's only partially forgivable, the rules are complex, and it ran out of the first round of funds in under two weeks.
- philjohn 6y ago
  And now that we know more about the mortality rate, what comorbidities lead to a worse prognosis etc., models that project deaths, hospital stays and the capacity of the health service to cope have been refined. That's not to mention that many places in rural America have no capacity to deal with a pandemic - just think about the hospital in the Netflix Pandemic documentary ...
peterwoerner 6y ago
Its extremely frustrating how we continue to be lied to and continue to having moving goalposts. There is a real question whether we should try to squash curve or let it spread. I would rather squashing the curve, but I don't think we as Americans have the discipline to squash it.
- deleted 6y ago
  [deleted]
tfigueroa 6y ago
As we learn more about all of the factors that affect shelter-in-place, those goalposts are going to change. There’s nothing disturbing about it.
WalterBright 6y ago
They're all just winging it. The software model being used is garbage: https://lockdownsceptics.org/code-review-of-fergusons-model/ https://lockdownsceptics.org/code-review-of-fergusons-model/ The "Ferguson Model" is described here: https://www.nature.com/articles/d41586-020-01003-6 https://www.nature.com/articles/d41586-020-01003-6
- creato 6y ago
  This model is not the only reason governments have acted. They also saw what happened in Wuhan, Italy, NYC, etc. Also, the US federal government doesn't use it, they use a model from UW: https://www.vox.com/future-perfect/2020/5/2/21241261/coronavirus-modeling-us-deaths-ihme-pandemic https://www.vox.com/future-perfect/2020/5/2/21241261/coronav...
  - WalterBright 6y ago
    Is the UW model based on the Ferguson code or not? The article I cited says Microsoft is doing a rewrite of the Ferguson code, and the UW model is funded by Bill Gates' foundation, and we all know that Bill is closely connected to Microsoft.
    - joshuamorton 6y ago
      Given that the UW model chronically underestimates the US death toll, can you explain the reasoning behind "we shouldn't trust the model, but also we should still reopen"?
      - WalterBright 6y ago
        Just because it's junk science doesn't mean I have better scientific analyses at my disposal.
      - thu2111 6y ago
        The UW model can't be said to estimate or underestimate anything at all - it's just curve fitting and is being constantly updated because the moment they issue an update, it's immediately out of line with reality. And not just out of line but outside the uncertainty bounds too. There's a review of the performance of the model and its updates here: https://www.nationalreview.com/corner/coronavirus-pandemic-projection-models-proving-unreliable/ https://www.nationalreview.com/corner/coronavirus-pandemic-p...
reader_1000 6y ago
Yes, original intent was to flatten the curve. However, as more people got sick, we learned that covid may cause permament damages on patients. Therefore if there is a way to prevent people from getting the diease at all, I think that is path we should follow . If not possible, we should still slow down the spread of the disease until vaccination efforts start to give results or we have better medication.
- runamok 6y ago
  All of the above should (hopefully) improve with time: vaccination (which will take on the order of years and not weeks or months), more effective treatment, more learning about the disease and risk factors, more ventilators and PPE produced and more widespread testing. The US is especially poorly suited to deal with a lot of people with a life-long debilitating illness from damaged lungs.
- pacala 6y ago
  > we learned that covid may cause permament damages on patients It stands to reason that a disease that outright kills 0.1-1% of the people infected also gets a fraction of people near death, which means it damages them hard enough that they almost die. This effect is entirely consistent with other diseases, for example non-covid19 pneumonia. As of now we have not learned: * What fraction of people develop long term effects. * By age group. * How do these effects compare with long term effects of other diseases, like influenza or influenza-triggered pneumonia. * Do these effects heal over a period of time, say a few months?
ryanmarsh 6y ago
I can’t make sense of any of the virus or the response. The data (writ large) is a mess, response has been contradictory at all levels, nothing seems logical, the models aren’t open source, the rationale opaque, the secondary and third order social issues (according to popular media narrative) also completely bizarre, and what little ground truth I’ve been able to obtain is altogether a completely different reality. I’m absolutely done with any and all media. When it mattered most (literally life and death) it was click bait, politics, and outright fakery. There needs to obviously be a public health retrospective on this but also a policy and communication retro as well. I want to read a book on WHAT ACTUALLY HAPPENED. I want people with subpoena power and a 500 page report. This whole thing has just been bizarre. I can’t help but feel like I’m being punked.
- chasd00 6y ago
  I know _exactly_ how you feel. the only number I look at anymore is the one week average hospitalizations in my state. the projections have been wildly wrong, they remind me of 2016 political polls. I've tuned out all other news pretty much, even HN is getting bizarrely disconnected from reality. see the comment wondering "has testing increased? I haven't read anything". this is getting crazy.
  - ryanmarsh 6y ago
    even HN is getting bizarrely disconnected from reality Notice what gets downvoted.
- alexpetralia 6y ago
  There is sort of a Teflon approach to mainstream media which goes something like: contradiction is acceptable so long as the experts tell us so. And the experts include the WHO.
ceejayoz 6y ago
> The original argument was to "flatten the curve" to prevent hospitals from becoming overwhelmed. I don't think anyone sensible ever said "flatten the curve, and we're done!" Flattening the curve was the first and most urgent step, to avoid the overwhelming of medical systems like what happened in northern Italy. Quite a few countries took advantage of that time to ramp up testing. Certain ahem countries kinda squandered it.
vvanders 6y ago
The initial goal was both to flatten the curve and to ramp up wide scale testing. The federal government has largely failed in the latter, you can't reopen if you can't isolate and so we've wasted lots of the time that was gained.
- RickJWagner 6y ago
  According to today's RealClearPolitics, the US has administered 9,444,525 tests, by far the most listed. The second closest is Germany, with 2,755,770. 'Largely failed' doesn't seem fair. https://www.realclearpolitics.com/ https://www.realclearpolitics.com/
  - awalsh128 6y ago
    You can't use a total measure because it doesn't take into account the proportionality. It should be measured per 1M population. Germany is 32k to the US 25k. https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/ We should probably also consider the number of tests in the most affected areas but I have no numbers on that.
fao_ 6y ago
> Lately, the prevailing argument seems to be that we need to shelter in place because virus cases will increase if we don't. That was not the original justification. Of course cases will increase! The question ought to be, will they increase to the extent that they overwhelm hospital capacity? But that was the original reasoning. "Flattening the curve" is reducing the number of virus cases that happen. The number of cases of the virus will increase -- the number of PEOPLE with life-threatening or life-changing injuries will increase, if we don't reduce the number of people spreading the virus.
- twblalock 6y ago
  > "Flattening the curve" is reducing the number of virus cases that happen. No, that is absolutely incorrect. Flattening the curve was not intended to reduce the total number of cases. It was intended to reduce the rate at which those cases occurred, i.e. to spread them out over time, so that hospitals did not get overwhelmed. It is a rate limit. In the long run, the only way to shrink the total number of cases is a vaccine.
  - DuskStar 6y ago
    Vaccine or extermination. But extermination means no international travel, and a stronger lockdown. Which looks like it worked for NZ, but won't for the US.
georgespencer 6y ago
It seems far simpler to maintain one blanket guideline ("stay at home") than multiple contradictory ones from region to region. And what do you do when a hospital does become overwhelmed? Re-instate shelter-in-place and change the guideline back?
prennert 6y ago
My understanding is that overwhelming the health care system becomes easier the more spread the decease is. The real problem will be the lag in detecting the result of any public health measure with this virus. If only deaths can be measured the measurements will lag a few weeks potentially. With appropriate testing I guess the lag will still be a few days. Now in the first wave you only had a few starting points as there were few sick people in few clusters. Today you have sick people all around the place. If the delay of measures are delayed in the second wave as much as in the first, the second wave will be much larger and it will be far less concentrated into clusters. So this makes any policy change risky unless the measurement latency is very short. On top of this the impact of different policies is not known. So opening slowly makes it least somewhat scientific (understanding what works and what does not) Of course the lockdown has a lot of negatives as well. I don't think many people dispute that. So it's a real a trade-off. But one that is very hard to get right because of all the unknowns, measurement latency (covid cases and side effects), and general emerging complexity of the problem. On top of all this, this problem hits so many areas of public and private life. It's hard to nail down messaging to meet everybody. So bottom line is it's hard to get right, therefore easy to criticize.
mnm1 6y ago
So in a rapidly changing, novel situation never experienced before we should be held to the faulty reasoning of the past rather than adapting and changing plans to reach the best outcome? "I think the same thing today as two days ago. It doesn't matter that aliens landed on earth in the meantime. That won't change my mind about aliens not existing."
WWLink 6y ago
One problem: The curve hasn't actually flattened in some places. Those places should continue to encourage as few people out and about as possible.
yongjik 6y ago
> The question ought to be, will they increase to the extent that they overwhelm hospital capacity? Sigh, America has been dealing with this for two months and people still don't get exponential increase. Apologies for repeating myself, but: let's look at California as an example. In 3/19, California issued stay-at-home order over the whole state. Two weeks later, in 4/2, California had 10,701 patients, which is 10 times more than 3/19 (1,006 patients), or 18% average daily increase. This is with an already enforced lockdown. In other words, if hospitals are 90% idle now, they are only two weeks away from becoming full. Combine with the fact that people carry it without symptoms for ~a week, and we are only one week away from getting overwhelmed. California is still getting two thousand new patients every day. That's twice the worst day of South Korea! We haven't made any victory against the disease; every day California sees more patients than the total number of patients we had when lockdown started. So, sorry but you can't just say "I originally supported this but I'm getting tired, can we just give up?" Well, I mean, you can say it, but I have no obligation to take you seriously.
- twblalock 6y ago
  > Sigh, America has been dealing with this for two months and people still don't get exponential increase. Don't be insulting. > So, sorry but you can't just say "I originally supported this but I'm getting tired, can we just give up?" Well, I mean, you can say it, but I have no obligation to take you seriously. That's not what I said, and I didn't see anyone in the article say that either. You are responding with the least charitable interpretation of the article and my post.
  - joshuamorton 6y ago
    They clearly addressed the question in your post: > The question ought to be, will they increase to the extent that they overwhelm hospital capacity? Yes, yes it would, or at least the time it takes for us to be able to answer this question is longer than the point of no return.
  - deleted 6y ago
    [deleted]
- 6y ago

vwcx 6y ago

Public health is a constantly changing landscape made up of frequently shifting inputs and analysis. It’s only in recent decades that our desire for absolutes has really given people the idea that these things should be simple. Every country on earth has to move the goalposts during a pandemic — this is a sign the system is still working.

toomuchtodo 6y ago
But then you must provide additional economic support to those impacted accordingly, as you regulate public behavior through updates to public health orders.
- ceejayoz 6y ago
  Most countries are doing that. The one-off $1,200 in the US is fairly unique.
  - RandomInteger4 6y ago
    Can you provide citations to which countries exactly you're referring to by the phrase "most countries?"
    - ceejayoz 6y ago
      https://www.washingtonpost.com/world/europe/europe-seeks-to-limit-coronavirus-crisis-with-unprecedented-offers-to-pay-private-sector-salaries/2020/03/24/1f099a5a-6abe-11ea-b199-3a9799c54512_story.html https://www.washingtonpost.com/world/europe/europe-seeks-to-... > France, Germany, Denmark, Britain and others have decided to take over the payrolls of struggling companies, so that workers don’t get laid off. The hope is that by paying people to stay home, governments can slow the virus’s spread while also averting an economic depression. > Since many European countries had similar social safety net programs already, albeit in far more limited form, the salary supports were relatively easy to expand, almost literally overnight in many places, amid widespread consensus. When they imposed their economically devastating lockdowns, countries were thus able to signal to workers that their livelihoods would remain intact and to businesses that they wouldn’t immediately implode.
      - DuskStar 6y ago
        > France, Germany, Denmark, Britain and others have decided to take over the payrolls of struggling companies Didn't the US largely do this too, via a forgivable loan to companies?
        ceejayoz 6y ago
        Sorta. It's only partially forgivable, the rules are complex, and it ran out of the first round of funds in under two weeks.
philjohn 6y ago
And now that we know more about the mortality rate, what comorbidities lead to a worse prognosis etc., models that project deaths, hospital stays and the capacity of the health service to cope have been refined. That's not to mention that many places in rural America have no capacity to deal with a pandemic - just think about the hospital in the Netflix Pandemic documentary ...

peterwoerner 6y ago

Its extremely frustrating how we continue to be lied to and continue to having moving goalposts. There is a real question whether we should try to squash curve or let it spread. I would rather squashing the curve, but I don't think we as Americans have the discipline to squash it.

deleted 6y ago
[deleted]

tfigueroa 6y ago

As we learn more about all of the factors that affect shelter-in-place, those goalposts are going to change. There’s nothing disturbing about it.

WalterBright 6y ago

They're all just winging it. The software model being used is garbage: https://lockdownsceptics.org/code-review-of-fergusons-model/ https://lockdownsceptics.org/code-review-of-fergusons-model/ The "Ferguson Model" is described here: https://www.nature.com/articles/d41586-020-01003-6 https://www.nature.com/articles/d41586-020-01003-6

creato 6y ago
This model is not the only reason governments have acted. They also saw what happened in Wuhan, Italy, NYC, etc. Also, the US federal government doesn't use it, they use a model from UW: https://www.vox.com/future-perfect/2020/5/2/21241261/coronavirus-modeling-us-deaths-ihme-pandemic https://www.vox.com/future-perfect/2020/5/2/21241261/coronav...
- WalterBright 6y ago
  Is the UW model based on the Ferguson code or not? The article I cited says Microsoft is doing a rewrite of the Ferguson code, and the UW model is funded by Bill Gates' foundation, and we all know that Bill is closely connected to Microsoft.
  - joshuamorton 6y ago
    Given that the UW model chronically underestimates the US death toll, can you explain the reasoning behind "we shouldn't trust the model, but also we should still reopen"?
    - WalterBright 6y ago
      Just because it's junk science doesn't mean I have better scientific analyses at my disposal.
    - thu2111 6y ago
      The UW model can't be said to estimate or underestimate anything at all - it's just curve fitting and is being constantly updated because the moment they issue an update, it's immediately out of line with reality. And not just out of line but outside the uncertainty bounds too. There's a review of the performance of the model and its updates here: https://www.nationalreview.com/corner/coronavirus-pandemic-projection-models-proving-unreliable/ https://www.nationalreview.com/corner/coronavirus-pandemic-p...

reader_1000 6y ago

Yes, original intent was to flatten the curve. However, as more people got sick, we learned that covid may cause permament damages on patients. Therefore if there is a way to prevent people from getting the diease at all, I think that is path we should follow . If not possible, we should still slow down the spread of the disease until vaccination efforts start to give results or we have better medication.

runamok 6y ago
All of the above should (hopefully) improve with time: vaccination (which will take on the order of years and not weeks or months), more effective treatment, more learning about the disease and risk factors, more ventilators and PPE produced and more widespread testing. The US is especially poorly suited to deal with a lot of people with a life-long debilitating illness from damaged lungs.
pacala 6y ago
> we learned that covid may cause permament damages on patients It stands to reason that a disease that outright kills 0.1-1% of the people infected also gets a fraction of people near death, which means it damages them hard enough that they almost die. This effect is entirely consistent with other diseases, for example non-covid19 pneumonia. As of now we have not learned: * What fraction of people develop long term effects. * By age group. * How do these effects compare with long term effects of other diseases, like influenza or influenza-triggered pneumonia. * Do these effects heal over a period of time, say a few months?

ryanmarsh 6y ago

I can’t make sense of any of the virus or the response. The data (writ large) is a mess, response has been contradictory at all levels, nothing seems logical, the models aren’t open source, the rationale opaque, the secondary and third order social issues (according to popular media narrative) also completely bizarre, and what little ground truth I’ve been able to obtain is altogether a completely different reality. I’m absolutely done with any and all media. When it mattered most (literally life and death) it was click bait, politics, and outright fakery. There needs to obviously be a public health retrospective on this but also a policy and communication retro as well. I want to read a book on WHAT ACTUALLY HAPPENED. I want people with subpoena power and a 500 page report. This whole thing has just been bizarre. I can’t help but feel like I’m being punked.

chasd00 6y ago
I know _exactly_ how you feel. the only number I look at anymore is the one week average hospitalizations in my state. the projections have been wildly wrong, they remind me of 2016 political polls. I've tuned out all other news pretty much, even HN is getting bizarrely disconnected from reality. see the comment wondering "has testing increased? I haven't read anything". this is getting crazy.
- ryanmarsh 6y ago
  even HN is getting bizarrely disconnected from reality Notice what gets downvoted.
alexpetralia 6y ago
There is sort of a Teflon approach to mainstream media which goes something like: contradiction is acceptable so long as the experts tell us so. And the experts include the WHO.

ceejayoz 6y ago

> The original argument was to "flatten the curve" to prevent hospitals from becoming overwhelmed. I don't think anyone sensible ever said "flatten the curve, and we're done!" Flattening the curve was the first and most urgent step, to avoid the overwhelming of medical systems like what happened in northern Italy. Quite a few countries took advantage of that time to ramp up testing. Certain ahem countries kinda squandered it.

vvanders 6y ago

The initial goal was both to flatten the curve and to ramp up wide scale testing. The federal government has largely failed in the latter, you can't reopen if you can't isolate and so we've wasted lots of the time that was gained.

RickJWagner 6y ago
According to today's RealClearPolitics, the US has administered 9,444,525 tests, by far the most listed. The second closest is Germany, with 2,755,770. 'Largely failed' doesn't seem fair. https://www.realclearpolitics.com/ https://www.realclearpolitics.com/
- awalsh128 6y ago
  You can't use a total measure because it doesn't take into account the proportionality. It should be measured per 1M population. Germany is 32k to the US 25k. https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/ We should probably also consider the number of tests in the most affected areas but I have no numbers on that.

fao_ 6y ago

> Lately, the prevailing argument seems to be that we need to shelter in place because virus cases will increase if we don't. That was not the original justification. Of course cases will increase! The question ought to be, will they increase to the extent that they overwhelm hospital capacity? But that was the original reasoning. "Flattening the curve" is reducing the number of virus cases that happen. The number of cases of the virus will increase -- the number of PEOPLE with life-threatening or life-changing injuries will increase, if we don't reduce the number of people spreading the virus.

twblalock 6y ago
> "Flattening the curve" is reducing the number of virus cases that happen. No, that is absolutely incorrect. Flattening the curve was not intended to reduce the total number of cases. It was intended to reduce the rate at which those cases occurred, i.e. to spread them out over time, so that hospitals did not get overwhelmed. It is a rate limit. In the long run, the only way to shrink the total number of cases is a vaccine.
- DuskStar 6y ago
  Vaccine or extermination. But extermination means no international travel, and a stronger lockdown. Which looks like it worked for NZ, but won't for the US.

georgespencer 6y ago

It seems far simpler to maintain one blanket guideline ("stay at home") than multiple contradictory ones from region to region. And what do you do when a hospital does become overwhelmed? Re-instate shelter-in-place and change the guideline back?

prennert 6y ago

My understanding is that overwhelming the health care system becomes easier the more spread the decease is. The real problem will be the lag in detecting the result of any public health measure with this virus. If only deaths can be measured the measurements will lag a few weeks potentially. With appropriate testing I guess the lag will still be a few days. Now in the first wave you only had a few starting points as there were few sick people in few clusters. Today you have sick people all around the place. If the delay of measures are delayed in the second wave as much as in the first, the second wave will be much larger and it will be far less concentrated into clusters. So this makes any policy change risky unless the measurement latency is very short. On top of this the impact of different policies is not known. So opening slowly makes it least somewhat scientific (understanding what works and what does not) Of course the lockdown has a lot of negatives as well. I don't think many people dispute that. So it's a real a trade-off. But one that is very hard to get right because of all the unknowns, measurement latency (covid cases and side effects), and general emerging complexity of the problem. On top of all this, this problem hits so many areas of public and private life. It's hard to nail down messaging to meet everybody. So bottom line is it's hard to get right, therefore easy to criticize.

mnm1 6y ago

So in a rapidly changing, novel situation never experienced before we should be held to the faulty reasoning of the past rather than adapting and changing plans to reach the best outcome? "I think the same thing today as two days ago. It doesn't matter that aliens landed on earth in the meantime. That won't change my mind about aliens not existing."

WWLink 6y ago

One problem: The curve hasn't actually flattened in some places. Those places should continue to encourage as few people out and about as possible.

yongjik 6y ago

> The question ought to be, will they increase to the extent that they overwhelm hospital capacity? Sigh, America has been dealing with this for two months and people still don't get exponential increase. Apologies for repeating myself, but: let's look at California as an example. In 3/19, California issued stay-at-home order over the whole state. Two weeks later, in 4/2, California had 10,701 patients, which is 10 times more than 3/19 (1,006 patients), or 18% average daily increase. This is with an already enforced lockdown. In other words, if hospitals are 90% idle now, they are only two weeks away from becoming full. Combine with the fact that people carry it without symptoms for ~a week, and we are only one week away from getting overwhelmed. California is still getting two thousand new patients every day. That's twice the worst day of South Korea! We haven't made any victory against the disease; every day California sees more patients than the total number of patients we had when lockdown started. So, sorry but you can't just say "I originally supported this but I'm getting tired, can we just give up?" Well, I mean, you can say it, but I have no obligation to take you seriously.

twblalock 6y ago
> Sigh, America has been dealing with this for two months and people still don't get exponential increase. Don't be insulting. > So, sorry but you can't just say "I originally supported this but I'm getting tired, can we just give up?" Well, I mean, you can say it, but I have no obligation to take you seriously. That's not what I said, and I didn't see anyone in the article say that either. You are responding with the least charitable interpretation of the article and my post.
- joshuamorton 6y ago
  They clearly addressed the question in your post: > The question ought to be, will they increase to the extent that they overwhelm hospital capacity? Yes, yes it would, or at least the time it takes for us to be able to answer this question is longer than the point of no return.
- deleted 6y ago
  [deleted]
6y ago