6 ms·

> When the term exponential heaves into view then we should quite rightly shit ourselves and do as we are told. And yet we didn't collectively shit ourselves t

> When the term exponential heaves into view then we should quite rightly shit ourselves and do as we are told. And yet we didn't collectively shit ourselves to nearly the same extent for any of the other novel viruses that have popped up in the last couple decades and spread exponentially. Exponential spread is the default state of things. It's only when a virus becomes widespread in a population that the exponential spread ceases, as you indicated in your reference to R. To use a contrived example: Imagine a new virus SARS-CoV-1337 with an R of 250 and an infection fatality rate of .00000001%. Would it warrant the response we've made to SARS-CoV-2? Clearly not. Therefore we need to look at the actual outcomes associated with the virus, and then counterbalance those against the externalities introduced by suppressing spread. Implicitly everyone in favor of lockdown is assuming that the mortality avoided by hunkering down until a theoretical game-changer (vaccine, highly effective antiviral, monoclonal antibodies etc) is available at scale, is a bigger benefit than the negatives incurred by trying to prevent spread (lockdown/containment). My personal opinion is that the externalities of our current approach (I'm speaking from a US-based perspective) far exceed the cost of COVID-19 itself.

joshuamorton 6y ago
> My personal opinion is that the externalities of our current approach (I'm speaking from a US-based perspective) far exceed the cost of COVID-19 itself. How many lives would need to be saved to encourage the current lockdown, in your opinion?
- ryankemper 6y ago
  Let's back up a bit to talk about the two strategies. (1) Containment lets you indefinitely avoid COVID-19-induced mortality in the short-medium term, at the expense of ongoing, mounting costs to wellbeing and the economy. These costs are certainly non-linear, for example businesses can generally only survive a given number of days/weeks based off their capital expenditure and thus it's not quite as simple as a linear relation. But for our purposes, it's easiest to think of the wellbeing and economic cost as being in direct proportion to how long we spend in containment. The postponement of mortality only becomes the true avoidance of mortality when we get a "game-changer": a vaccine or a highly effective treatment that seriously improves outcomes. Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment. (2) My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. These groups are encouraged to shelter at home and are supported in doing so. Bans on freedom of movement, transaction, etc are lifted. Non-at-risk individuals are encouraged to return to work. Given that we inflicted psychological harm on millions of individuals, we also would probably want a policy where someone is allowed to not work, but they must formally quit their job in order to be allowed to collect unemployment for up to a year (we likely also need to adjust unemployment because it's just way too high relative to wage earners right now). What we need to avoid is a case where someone "chooses" (in scare quotes because we have done true psychological damage to people) not to work for a year but their company can't let them go, since otherwise the company cannot replace them with a working employee. So in short, we let people do what they want, we strongly encourage the at-risk to shelter at home and put out appropriate public health messaging in proportion to the real risk (which means overall WAY less fearmongering since we're so out of whack currently). The uncertainty benefit is something we should implicitly factor in as well. The ultimate end state of my proposal is much more "known" than with containment (because we have no bound on containment worst-case scenario but we can use Ferguson to get a decent bound for mitigation). We're not sure how much mortality we will see, but with a 0.9% IFR and 82% of the population being infected we get about 2.2 million deaths per Ferguson (https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...). I think that's a great upper bound to use. BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO. --- The last thing I want to say is that I actually think in terms of wellbeing-years or quality-adjusted-life-years, and not just "lives". My belief is that the life of a healthy 12 year old is several times more valuable than the life of an 80 year old with heart disease, to use an example. So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.
  - joshuamorton 6y ago
    > So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years. This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd. > BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO. Are you accounting for the other side effects of Covid? Life long lung capacity loss due to pneumonia side effects, weird not well understood side effects like strokes in young people etc? Most of the people I see minimizing the risk and saying we should reopen seem to entirely ignore those dangers. > Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment. This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years). > My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. You realize that this is what's being done now, essentially, its just that tests are so severely limited that that isn't useful. We can't, for example, consistently test employees at nursing homes to make sure that they aren't infectious. Until we can do that, returning to normal is asking nursing home employees to shelter even more tightly than individuals are now, or it's sacrificing lives. It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought.
    - ryankemper 6y ago
      > This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd. You're right, that was my mistake. I got a rough 20 million life-years by taking Ferguson's worst-case scenario and then applying the "COVID-19 takes average 10 years of lives" claim (which is a false claim). Thus arriving at the implied scenario that lockdown proponents say could happen but that I think is an impossible to reach number. (For context I use Ferguson's 2.2 million as an upper bound, but that 2.2 million scenario involves an overwhelming portion of the deaths being people who were already at death's door. Thus I think 2.2 million is possible but highly unlikely due to the other factors I mentioned, whereas the 20 million life-years figure I view as basically impossible to hit because it implies that same worst-case scenario but with the wrong distribution of age) At that point I thought to myself "wait, I forgot to account for the negative externalities". But as you indicated, that logic was wrong. So, allow me to retroactively change my answer to just 20 million life-years period. Thanks for pointing that out. > It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought. No, I understand their criteria but fundamentally disagree with the entire approach of containment, as I explained in the GP comment you replied to. > This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years). I don't believe that the US can use the same strategy that China, South Korea, or Taiwan has been using. They have much better control of their borders and are a much more homogenous and compliant population.
gerdesj 6y ago
No we didn't (collectively shit ourselves) and we did not really heed the lesson that SARS-COV-1 gave us. I really hope we don't see a leet SARS. It will probably have a really cool Tik Tok page though. I take it that your term "externalities" (I haven't heard it before) is referring to the side effects eg economic of our attempts to deal with it. The cost of COVID-19 to an individual seems to range from "meh" to death by lung destruction. There are some identified risk factors - being male, smokers (some "initial immunity" but worse outcomes), skin colour (this looks like correlation rather than causality but needs working through), being old (70+ is the current threshold), diabetes. Until you know (test, test, test again) that you have actually had the disease then I suspect you will be always looking over your shoulder. Once you know you've had it and hopefully survived then you can plan forwards. There are many reports of additional snags post infection eg renal problems and lung damage, not to mention the mental trauma. I'm speaking as a UK bod with a small company to worry about that still has a few months left in the bank. I'm alright Jack but I worry about my fellow people.
- ryankemper 6y ago
  > No we didn't (collectively shit ourselves) Agree to disagree on that one :) > and we did not really heed the lesson that SARS-CoV-1 gave us Agreed. > I take it that your term "externalities" (I haven't heard it before) is referring to the side effects eg economic of our attempts to deal with it. Exactly, see https://en.wikipedia.org/wiki/Externality#Negative https://en.wikipedia.org/wiki/Externality#Negative. Just keep in mind that the economy is not some abstract notion, but rather is you and me and everyone else. In other words, economic damage isn't something that just hurts rich shareholders, it hurts everyone because there's less wealth. Suspension of elective surgeries, which happened all over the country here in the US, is one of the best examples of such externalities that were caused by panic and bad policy rather than reality. For example, here in California we suspended all elective surgeries for a month. But we never were close to being overrun, and given that the vast majority of these surgeries are out-patient, there was never a need to pre-emptively cancel them. Lastly remember "elective surgery" sounds a lot like "non-essential work" but basically any pre-scheduled surgery is elective: organ transplants, hip replacements, arthroscopic labral repair (I'm waiting on that one currently), etc. > Until you know (test, test, test again) that you have actually had the disease then I suspect you will be always looking over your shoulder. That's why the strategy I advocate for does not rely on the availability of testing capacity, because the goal is not to practice indefinite containment. If you've decided that you want 80% of society to behave as normal and gradually become infected and recover, then PCR testing loses a lot of its utility. It's mostly useful for clinical diagnostic reasons, to get a loose handle on spread, and finally to use as validation for other tests like serological tests. > There are many reports of additional snags post infection eg renal problems and lung damage, not to mention the mental trauma. These post-infection snags are quite rare, based off the evidence I've reviewed. Personally I have observed that so many advocating for lockdown make references to the supposed widespread organ failure, strokes in young people, etc, and the evidence just does not support those claims. These outcomes do happen but they are incredibly rare and given that they are logical results of inflammatory cascades (cytokine storm for example), we see the same outcomes in disease like Influenza that we are not losing our collective shit about. > not to mention the mental trauma. I believe the mental trauma caused by the wide-spread panic and fear-mongering is vastly worse than the mental trauma of recovering from COVID-19. 25-50% of people that get COVID-19 are entirely asymptomatic or are paucisymptomatic. For many, it's like getting the flu. And for some - significant numbers, but not as many as we're led to believe - it is a horrendous disease that results in invasive ventilation followed by likely death. --- Not quite mental trauma, but fear of going to the hospital has led to people who actually have COVID-19 to avoid getting treatment because they don't realize they have COVID-19 (yet are experiencing serious adverse conditions): From https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=recirc_mostViewed_railB_article https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...: "Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic." --- Now onto real mental trauma: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30090-0/fulltext https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0... * "Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population." * "Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend. And my favorite, a case study of COVID-19 related paranoid delusions in a schizophrenic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162758/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162758/ --- Sorry for the massive wall of text.
ascorbic 6y ago
This isn't a contrived example though. Thousands of people are dying every day. That's why we care about this one and not your contrived example. When yours is killing a 9/11 every day then we care about it.
- ryankemper 6y ago
  Yes, but my position is that the following externalities are equally or indeed more important to be mindful of: - worsened COVID-19 outcomes due to social isolation - worsened COVID-19 outcomes due to fear of going to a hospital (this is a real effect) - worsened all-cause mortality due to social isolation and a culture of widespread fear - worsened mortality attributable to mass unemployment (note that some small portion of unemployment would have happened without lockdown but the vast majority of damage is self-inflicted and thus directly attributable to lockdown) - worsened quality of life (the missing link that lockdown proponents tend not to address) amidst the entire population - externalities that occur when suspending in-person education, such as the widening inequality gap between students whose parents can afford to buy them personal computers/laptops/tablets and those whose parents cannot. - shifting to a global perspective, the impending global food shortage is predicted to make COVID-19's mortality look like a drop in the bucket Finally, I'd like to point out that COVID-19 deaths here in the US are dominated by the extremely elderly which implies (but does not prove, of course) that our lockdown policies were ineffective at protecting the at-risk groups that we should have been focusing on the whole time
  - ascorbic 6y ago
    And those are the factors that the epidemiologists and policymakers need to balance when setting the policies. But that's a decision that they should be making, with access to all of the available data. It's not a decision for one hot headed billionaire with a large financial incentive to reopen.
    - ryankemper 6y ago
      The epidemiologists who have been advocating for lockdown have very explicitly ignored all of those sources of mortality entirely. They have only focused on COVID-19-attributable deaths and that's it. Now the job of the modellers is to predict COVID-19 mortality under various scenarios, and it's the job of policymakers to counterbalance those predictions against the economic realities, etc. So, it's not necessarily a problem that epidemiologists would focus on predicting just along the dimension of COVID-19 mortality. But unfortunately our policymakers have completely disregarded that need to weigh both the positives and negatives and instead have talked about "following the science" and basically myopically parroted whatever these highly opinionated epidemiologists (Ferguson, everyone at the IMHE, etc) were saying, without mentioning the negative externalities associated with lockdown, except in passing in a way that implies that economic damage will be constrained to shareholder returns (which is completely false).

joshuamorton 6y ago

> My personal opinion is that the externalities of our current approach (I'm speaking from a US-based perspective) far exceed the cost of COVID-19 itself. How many lives would need to be saved to encourage the current lockdown, in your opinion?

ryankemper 6y ago
Let's back up a bit to talk about the two strategies. (1) Containment lets you indefinitely avoid COVID-19-induced mortality in the short-medium term, at the expense of ongoing, mounting costs to wellbeing and the economy. These costs are certainly non-linear, for example businesses can generally only survive a given number of days/weeks based off their capital expenditure and thus it's not quite as simple as a linear relation. But for our purposes, it's easiest to think of the wellbeing and economic cost as being in direct proportion to how long we spend in containment. The postponement of mortality only becomes the true avoidance of mortality when we get a "game-changer": a vaccine or a highly effective treatment that seriously improves outcomes. Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment. (2) My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. These groups are encouraged to shelter at home and are supported in doing so. Bans on freedom of movement, transaction, etc are lifted. Non-at-risk individuals are encouraged to return to work. Given that we inflicted psychological harm on millions of individuals, we also would probably want a policy where someone is allowed to not work, but they must formally quit their job in order to be allowed to collect unemployment for up to a year (we likely also need to adjust unemployment because it's just way too high relative to wage earners right now). What we need to avoid is a case where someone "chooses" (in scare quotes because we have done true psychological damage to people) not to work for a year but their company can't let them go, since otherwise the company cannot replace them with a working employee. So in short, we let people do what they want, we strongly encourage the at-risk to shelter at home and put out appropriate public health messaging in proportion to the real risk (which means overall WAY less fearmongering since we're so out of whack currently). The uncertainty benefit is something we should implicitly factor in as well. The ultimate end state of my proposal is much more "known" than with containment (because we have no bound on containment worst-case scenario but we can use Ferguson to get a decent bound for mitigation). We're not sure how much mortality we will see, but with a 0.9% IFR and 82% of the population being infected we get about 2.2 million deaths per Ferguson (https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...). I think that's a great upper bound to use. BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO. --- The last thing I want to say is that I actually think in terms of wellbeing-years or quality-adjusted-life-years, and not just "lives". My belief is that the life of a healthy 12 year old is several times more valuable than the life of an 80 year old with heart disease, to use an example. So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.
- joshuamorton 6y ago
  > So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years. This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd. > BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO. Are you accounting for the other side effects of Covid? Life long lung capacity loss due to pneumonia side effects, weird not well understood side effects like strokes in young people etc? Most of the people I see minimizing the risk and saying we should reopen seem to entirely ignore those dangers. > Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment. This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years). > My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. You realize that this is what's being done now, essentially, its just that tests are so severely limited that that isn't useful. We can't, for example, consistently test employees at nursing homes to make sure that they aren't infectious. Until we can do that, returning to normal is asking nursing home employees to shelter even more tightly than individuals are now, or it's sacrificing lives. It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought.
  - ryankemper 6y ago
    > This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd. You're right, that was my mistake. I got a rough 20 million life-years by taking Ferguson's worst-case scenario and then applying the "COVID-19 takes average 10 years of lives" claim (which is a false claim). Thus arriving at the implied scenario that lockdown proponents say could happen but that I think is an impossible to reach number. (For context I use Ferguson's 2.2 million as an upper bound, but that 2.2 million scenario involves an overwhelming portion of the deaths being people who were already at death's door. Thus I think 2.2 million is possible but highly unlikely due to the other factors I mentioned, whereas the 20 million life-years figure I view as basically impossible to hit because it implies that same worst-case scenario but with the wrong distribution of age) At that point I thought to myself "wait, I forgot to account for the negative externalities". But as you indicated, that logic was wrong. So, allow me to retroactively change my answer to just 20 million life-years period. Thanks for pointing that out. > It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought. No, I understand their criteria but fundamentally disagree with the entire approach of containment, as I explained in the GP comment you replied to. > This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years). I don't believe that the US can use the same strategy that China, South Korea, or Taiwan has been using. They have much better control of their borders and are a much more homogenous and compliant population.

gerdesj 6y ago

No we didn't (collectively shit ourselves) and we did not really heed the lesson that SARS-COV-1 gave us. I really hope we don't see a leet SARS. It will probably have a really cool Tik Tok page though. I take it that your term "externalities" (I haven't heard it before) is referring to the side effects eg economic of our attempts to deal with it. The cost of COVID-19 to an individual seems to range from "meh" to death by lung destruction. There are some identified risk factors - being male, smokers (some "initial immunity" but worse outcomes), skin colour (this looks like correlation rather than causality but needs working through), being old (70+ is the current threshold), diabetes. Until you know (test, test, test again) that you have actually had the disease then I suspect you will be always looking over your shoulder. Once you know you've had it and hopefully survived then you can plan forwards. There are many reports of additional snags post infection eg renal problems and lung damage, not to mention the mental trauma. I'm speaking as a UK bod with a small company to worry about that still has a few months left in the bank. I'm alright Jack but I worry about my fellow people.

ryankemper 6y ago
> No we didn't (collectively shit ourselves) Agree to disagree on that one :) > and we did not really heed the lesson that SARS-CoV-1 gave us Agreed. > I take it that your term "externalities" (I haven't heard it before) is referring to the side effects eg economic of our attempts to deal with it. Exactly, see https://en.wikipedia.org/wiki/Externality#Negative https://en.wikipedia.org/wiki/Externality#Negative. Just keep in mind that the economy is not some abstract notion, but rather is you and me and everyone else. In other words, economic damage isn't something that just hurts rich shareholders, it hurts everyone because there's less wealth. Suspension of elective surgeries, which happened all over the country here in the US, is one of the best examples of such externalities that were caused by panic and bad policy rather than reality. For example, here in California we suspended all elective surgeries for a month. But we never were close to being overrun, and given that the vast majority of these surgeries are out-patient, there was never a need to pre-emptively cancel them. Lastly remember "elective surgery" sounds a lot like "non-essential work" but basically any pre-scheduled surgery is elective: organ transplants, hip replacements, arthroscopic labral repair (I'm waiting on that one currently), etc. > Until you know (test, test, test again) that you have actually had the disease then I suspect you will be always looking over your shoulder. That's why the strategy I advocate for does not rely on the availability of testing capacity, because the goal is not to practice indefinite containment. If you've decided that you want 80% of society to behave as normal and gradually become infected and recover, then PCR testing loses a lot of its utility. It's mostly useful for clinical diagnostic reasons, to get a loose handle on spread, and finally to use as validation for other tests like serological tests. > There are many reports of additional snags post infection eg renal problems and lung damage, not to mention the mental trauma. These post-infection snags are quite rare, based off the evidence I've reviewed. Personally I have observed that so many advocating for lockdown make references to the supposed widespread organ failure, strokes in young people, etc, and the evidence just does not support those claims. These outcomes do happen but they are incredibly rare and given that they are logical results of inflammatory cascades (cytokine storm for example), we see the same outcomes in disease like Influenza that we are not losing our collective shit about. > not to mention the mental trauma. I believe the mental trauma caused by the wide-spread panic and fear-mongering is vastly worse than the mental trauma of recovering from COVID-19. 25-50% of people that get COVID-19 are entirely asymptomatic or are paucisymptomatic. For many, it's like getting the flu. And for some - significant numbers, but not as many as we're led to believe - it is a horrendous disease that results in invasive ventilation followed by likely death. --- Not quite mental trauma, but fear of going to the hospital has led to people who actually have COVID-19 to avoid getting treatment because they don't realize they have COVID-19 (yet are experiencing serious adverse conditions): From https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=recirc_mostViewed_railB_article https://www.nejm.org/doi/full/10.1056/NEJMc2009787?query=rec...: "Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic." --- Now onto real mental trauma: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30090-0/fulltext https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0... * "Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population." * "Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend. And my favorite, a case study of COVID-19 related paranoid delusions in a schizophrenic: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162758/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162758/ --- Sorry for the massive wall of text.

ascorbic 6y ago

This isn't a contrived example though. Thousands of people are dying every day. That's why we care about this one and not your contrived example. When yours is killing a 9/11 every day then we care about it.

ryankemper 6y ago
Yes, but my position is that the following externalities are equally or indeed more important to be mindful of: - worsened COVID-19 outcomes due to social isolation - worsened COVID-19 outcomes due to fear of going to a hospital (this is a real effect) - worsened all-cause mortality due to social isolation and a culture of widespread fear - worsened mortality attributable to mass unemployment (note that some small portion of unemployment would have happened without lockdown but the vast majority of damage is self-inflicted and thus directly attributable to lockdown) - worsened quality of life (the missing link that lockdown proponents tend not to address) amidst the entire population - externalities that occur when suspending in-person education, such as the widening inequality gap between students whose parents can afford to buy them personal computers/laptops/tablets and those whose parents cannot. - shifting to a global perspective, the impending global food shortage is predicted to make COVID-19's mortality look like a drop in the bucket Finally, I'd like to point out that COVID-19 deaths here in the US are dominated by the extremely elderly which implies (but does not prove, of course) that our lockdown policies were ineffective at protecting the at-risk groups that we should have been focusing on the whole time
- ascorbic 6y ago
  And those are the factors that the epidemiologists and policymakers need to balance when setting the policies. But that's a decision that they should be making, with access to all of the available data. It's not a decision for one hot headed billionaire with a large financial incentive to reopen.
  - ryankemper 6y ago
    The epidemiologists who have been advocating for lockdown have very explicitly ignored all of those sources of mortality entirely. They have only focused on COVID-19-attributable deaths and that's it. Now the job of the modellers is to predict COVID-19 mortality under various scenarios, and it's the job of policymakers to counterbalance those predictions against the economic realities, etc. So, it's not necessarily a problem that epidemiologists would focus on predicting just along the dimension of COVID-19 mortality. But unfortunately our policymakers have completely disregarded that need to weigh both the positives and negatives and instead have talked about "following the science" and basically myopically parroted whatever these highly opinionated epidemiologists (Ferguson, everyone at the IMHE, etc) were saying, without mentioning the negative externalities associated with lockdown, except in passing in a way that implies that economic damage will be constrained to shareholder returns (which is completely false).