8 ms·

Is there a realistic objective to lock-downs other than avoiding overrun hospitals?

by brink 6y ago

tonyedgecombe 6y ago
Time to develop a vaccine. Time to develop better treatments. Keep a lid on the virus with track and trace (I'm doubtful we can achieve this in the UK).
philipswood 6y ago
This is a disease of governments and health systems. As an individual the odds aren't too worrying in isolation. Everything functioning well, few people get sick and those are treatable and death rates are low. But it's exponential growth. So cases can swamp any realistic health system left unchecked. At this stage the low fatalities (0.5%) goes out of the window and start looking at just under 10%. So a good strategy seems to be to slow the spread to managable rates at which level actual disease impacts are quite low. Imagine, in the limit, theoretically, you could keep everyone seperate and expose a batch size you could treat, lead them through and then take the next batch. You could have death rates under 0.5%. The only other realistic objectives I see are tactical: ramping up treatment ability and postponing cases until a cure/preventative measure is available and when disease progression and treatment are better understood.
- SuoDuanDao 6y ago
  If I understand your reasoning, the difference between hospice care and staying at home with bedrest & fluids is a 9.5% death rate. Is that actually the model you work with? My understanding is that most COVID patients sick enough to get a ventilator die anyway.
  - paypalcust83 6y ago
    Your understanding is wrong and shows a lack of compassion for human life. Ventilated patients die because they already had extreme damage done to their lungs from a lack of interventional treatment and then are overpressurized which further damages their lungs which finally kills them. The Great Ventilator Rush was an exercise in futility and ignorant mass murder.
    - klmadfejno 6y ago
      This is mostly bullshit. Using ventilators was fairly standard care for the set of symptoms. It has come to light that alternate treatments are probably better in some circumstances. But you're writing this as if the disease is treatable. It's still not treatable. Most people who end up ventilators are, in fact, sick enough that they're likely to die. The parent said nothing that lacked compassion for human life. Accusing doctors who are risking their lives trying to save patients with the best of their knowledge mass murderers is magnitudes more heartless.
  - redis_mlc 6y ago
    > My understanding is that most COVID patients sick enough to get a ventilator die anyway. Yes, 66% to 90% mortality rate.
  - orwin 6y ago
    I don't know this is not more widespread, but you have 3 type of care. Non-intrusive ventilators or oxygen masks (or the nasal oxygen stuff), instrusive ventilator and the last one is artificial blood oxygenation, i will count this as intrusive ventilation as it is often used with intrusive ventilation. Around 10% of known cases needs hospitalisation. Among them, 70% to 80% of cases only needs oxygen and not respiratory help. So you can't give them oxygen, they'll either die or have permanent right heart or brain damage. Those will likely be fine after a dozen day at the hospital. If your oxygen levels are really, really low, you will need an intrusive ventilator. And yes, the death rate in those cases is absurdly high (between 60 and 90%). Note: 10% of known cases is NOT 10% of cases. Note 2: IMO this 10% number should be way higher as hypoxemia is far more widespread than previously thought, even for people with mild symptoms, even for kids (i only have anecdotal data on this so don't use it as an argument until papers are written and consensus is made). Still, if you have covid with only mild symptoms, please go to the hospital to take your oxygen saturation level.
- klmadfejno 6y ago
  > At this stage the low fatalities (0.5%) goes out of the window and start looking at just under 10%. A lot of people are throwing out numbers somewhat randomly here. If we had no hospitals at all, the worst possible case would be everyone requiring hospitalization dies. Right now among the elderly it's about 40% of those who require hospitalization end up dying. Thus the worst case would be 100% or a 2.5x increase. Among the middle aged, hospitalization survival rates are about 10%, so a 10x increase in death rates worst case. Neither of these worst case scenarios are especially realistic because hospitals are pretty good at surging; and if people need to be triaged, you triage the people who are most likely to die anyway (thereby changing the actual death rate very little). Thirdly, a good chunk of people who get hospitalized would just survive on their own anyway. There is the non trivial problem that other healthcare concerns (like unrelated heart attacks) are harder to treat. That doesn't mean it's negligible. A 1 percentage point increase in mortality is a lot of people. But a 20x increase from 0.5% to 10% is preposterous and apocalyptic.
  - philipswood 6y ago
    Admittedly I'm in "consider a cow to be a sphere"-territory here. For clarity's sake: I'm comparing (roughly) stats like Italy and UKs deaths/known_cases ratios (which are closer to 10% than 1%) and Like a new New Zealand which is between 1% and 0.1%. But looking quickly at the data one order of magnitude is totally justified. "Hospitals are pretty good at surging" must break down against exponential growth at some stage. I doubt whether exponentially increasing your treatment capability would be possible in most cases.
    - klmadfejno 6y ago
      Deaths / known case is mostly useless though, and the differences between two countries doesn't say anything about the relevance of hospital overruns because nobody has really suffered from that. Even lombardy likely didn't lose that many extra people due to hospital capacity. Age distribution and health distribution is the main driver of differences between areas.
mytailorisrich 6y ago
Lockdowns, like quarantines, are primarily aimed at stopping the spread of infectious diseases. Hopefully keeping the number of hospital patients under control is a side effect.
Finnucane 6y ago
Possibly slowing transmission enough to buy yourself some time to develop treatment and vaccine. The problem epidimiologists were looking at was that with no immunity, treatment, or vaccine, there was nothing to stop the spread to a large percentage of the population very quickly, potentially leading to hundreds of thousands of deaths in the US, at least. And yeah, the medical system would have collapsed under that load, as happened in parts of Italy. The other problem doctors are worried about is people with life-threatening conditions--heart attack, stroke, etc. not going to hospital out of fear.
hardlianotion 6y ago
I think that lockdowns are there in order to get time to put systems for managing an outbreak in place. So one would hope that effective track and trace, isolation and public space management protocols and construction of overflow treatment capacity would be priorities when a lockdown is underway, as lockdown is unsustainable over medium term and up.
Gibbon1 6y ago
Lock down kills the exponential growth. In California at the current infection rate it would take 130 years to infect another 5% of the population. Buys time: That allows epidemiologists to understand exactly what the risk factors are. So governments and businesses can begin to fine tune suppression measures. Gives the biotech industry time to develop cheap and fast tests. Which you need to do contact tracing. Hopefully they can develop immunotherapy agents to prevent exposed people from developing the disease. Time for public health officials to raise a small army to do contact tracing. Allows doctors time to understand how best to treat the disease. For a disease with a serious mortality morbidity rate even partly effective treatments are important. Allows sane people to grok what they need to do to keep themselves safe. And allows society to begin to reign in careless people, loons and deniers. Also give again sane people the opportunity to stay safe by not allowing businessmen like Musk to force them into unsafe working conditions.
bakuninsbart 6y ago
You can try to bring the rate of new infections down to a level where they can be traced, and newly infected can be isolated early. This allows society to go more or less back to normal. That's what some Asian countries did successfully and what others are now seeking to replicate.
IkmoIkmo 6y ago
Well, yes... Assuming the mortality figure of 1-2% is correct, no lockdowns would lead to a few billion infections worldwide, which would lead to 50-100 million dead. This is roughly what world war II caused in the span of 5 years or so of planetary warfare. Second to that, hundreds of millions more would need to be hospitalised. You'd essentially see any other healthcare be completely overwhelmed, e.g. cancer treatment or conceiving a child in the hospital. You'd see tons of excess mortality from these second hand effects as well. Third, in general, and in particular without proper care, you'd see many people suffer permanent organ damage. We see this to be true for many who have recovered from Corona, but with permanently damaged lung or liver capacity. Not to mention the trauma and PTSD for hundreds of millions even those who survive, who'll have experienced what it's like to (nearly) suffocate for weeks. Experiences like these would occur in every community and would likely completely shatter certain individuals, families even communities, their religious beliefs, their sense of security etc. The notion we'd let something like this happen in the 21st century. It'd be a paradigm change in our thinking for many of us who believed our live, societies, governments etc were stable and provided order. Situations like these would be ripe for abuse by political or religious extremists, violence, scape-goating etc.

Is there a realistic objective to lock-downs other than avoiding overrun hospitals?

by brink 6y ago

Is there a realistic objective to lock-downs other than avoiding overrun hospitals?

Time to develop a vaccine. Time to develop better treatments. Keep a lid on the virus with track and trace (I'm doubtful we can achieve this in the UK).

philipswood 6y ago

This is a disease of governments and health systems. As an individual the odds aren't too worrying in isolation. Everything functioning well, few people get sick and those are treatable and death rates are low. But it's exponential growth. So cases can swamp any realistic health system left unchecked. At this stage the low fatalities (0.5%) goes out of the window and start looking at just under 10%. So a good strategy seems to be to slow the spread to managable rates at which level actual disease impacts are quite low. Imagine, in the limit, theoretically, you could keep everyone seperate and expose a batch size you could treat, lead them through and then take the next batch. You could have death rates under 0.5%. The only other realistic objectives I see are tactical: ramping up treatment ability and postponing cases until a cure/preventative measure is available and when disease progression and treatment are better understood.

SuoDuanDao 6y ago
If I understand your reasoning, the difference between hospice care and staying at home with bedrest & fluids is a 9.5% death rate. Is that actually the model you work with? My understanding is that most COVID patients sick enough to get a ventilator die anyway.
- paypalcust83 6y ago
  Your understanding is wrong and shows a lack of compassion for human life. Ventilated patients die because they already had extreme damage done to their lungs from a lack of interventional treatment and then are overpressurized which further damages their lungs which finally kills them. The Great Ventilator Rush was an exercise in futility and ignorant mass murder.
  - klmadfejno 6y ago
    This is mostly bullshit. Using ventilators was fairly standard care for the set of symptoms. It has come to light that alternate treatments are probably better in some circumstances. But you're writing this as if the disease is treatable. It's still not treatable. Most people who end up ventilators are, in fact, sick enough that they're likely to die. The parent said nothing that lacked compassion for human life. Accusing doctors who are risking their lives trying to save patients with the best of their knowledge mass murderers is magnitudes more heartless.
- redis_mlc 6y ago
  > My understanding is that most COVID patients sick enough to get a ventilator die anyway. Yes, 66% to 90% mortality rate.
- orwin 6y ago
  I don't know this is not more widespread, but you have 3 type of care. Non-intrusive ventilators or oxygen masks (or the nasal oxygen stuff), instrusive ventilator and the last one is artificial blood oxygenation, i will count this as intrusive ventilation as it is often used with intrusive ventilation. Around 10% of known cases needs hospitalisation. Among them, 70% to 80% of cases only needs oxygen and not respiratory help. So you can't give them oxygen, they'll either die or have permanent right heart or brain damage. Those will likely be fine after a dozen day at the hospital. If your oxygen levels are really, really low, you will need an intrusive ventilator. And yes, the death rate in those cases is absurdly high (between 60 and 90%). Note: 10% of known cases is NOT 10% of cases. Note 2: IMO this 10% number should be way higher as hypoxemia is far more widespread than previously thought, even for people with mild symptoms, even for kids (i only have anecdotal data on this so don't use it as an argument until papers are written and consensus is made). Still, if you have covid with only mild symptoms, please go to the hospital to take your oxygen saturation level.
klmadfejno 6y ago
> At this stage the low fatalities (0.5%) goes out of the window and start looking at just under 10%. A lot of people are throwing out numbers somewhat randomly here. If we had no hospitals at all, the worst possible case would be everyone requiring hospitalization dies. Right now among the elderly it's about 40% of those who require hospitalization end up dying. Thus the worst case would be 100% or a 2.5x increase. Among the middle aged, hospitalization survival rates are about 10%, so a 10x increase in death rates worst case. Neither of these worst case scenarios are especially realistic because hospitals are pretty good at surging; and if people need to be triaged, you triage the people who are most likely to die anyway (thereby changing the actual death rate very little). Thirdly, a good chunk of people who get hospitalized would just survive on their own anyway. There is the non trivial problem that other healthcare concerns (like unrelated heart attacks) are harder to treat. That doesn't mean it's negligible. A 1 percentage point increase in mortality is a lot of people. But a 20x increase from 0.5% to 10% is preposterous and apocalyptic.
- philipswood 6y ago
  Admittedly I'm in "consider a cow to be a sphere"-territory here. For clarity's sake: I'm comparing (roughly) stats like Italy and UKs deaths/known_cases ratios (which are closer to 10% than 1%) and Like a new New Zealand which is between 1% and 0.1%. But looking quickly at the data one order of magnitude is totally justified. "Hospitals are pretty good at surging" must break down against exponential growth at some stage. I doubt whether exponentially increasing your treatment capability would be possible in most cases.
  - klmadfejno 6y ago
    Deaths / known case is mostly useless though, and the differences between two countries doesn't say anything about the relevance of hospital overruns because nobody has really suffered from that. Even lombardy likely didn't lose that many extra people due to hospital capacity. Age distribution and health distribution is the main driver of differences between areas.

mytailorisrich 6y ago

Lockdowns, like quarantines, are primarily aimed at stopping the spread of infectious diseases. Hopefully keeping the number of hospital patients under control is a side effect.

Finnucane 6y ago

Possibly slowing transmission enough to buy yourself some time to develop treatment and vaccine. The problem epidimiologists were looking at was that with no immunity, treatment, or vaccine, there was nothing to stop the spread to a large percentage of the population very quickly, potentially leading to hundreds of thousands of deaths in the US, at least. And yeah, the medical system would have collapsed under that load, as happened in parts of Italy. The other problem doctors are worried about is people with life-threatening conditions--heart attack, stroke, etc. not going to hospital out of fear.

hardlianotion 6y ago

I think that lockdowns are there in order to get time to put systems for managing an outbreak in place. So one would hope that effective track and trace, isolation and public space management protocols and construction of overflow treatment capacity would be priorities when a lockdown is underway, as lockdown is unsustainable over medium term and up.

Gibbon1 6y ago

Lock down kills the exponential growth. In California at the current infection rate it would take 130 years to infect another 5% of the population. Buys time: That allows epidemiologists to understand exactly what the risk factors are. So governments and businesses can begin to fine tune suppression measures. Gives the biotech industry time to develop cheap and fast tests. Which you need to do contact tracing. Hopefully they can develop immunotherapy agents to prevent exposed people from developing the disease. Time for public health officials to raise a small army to do contact tracing. Allows doctors time to understand how best to treat the disease. For a disease with a serious mortality morbidity rate even partly effective treatments are important. Allows sane people to grok what they need to do to keep themselves safe. And allows society to begin to reign in careless people, loons and deniers. Also give again sane people the opportunity to stay safe by not allowing businessmen like Musk to force them into unsafe working conditions.

bakuninsbart 6y ago

You can try to bring the rate of new infections down to a level where they can be traced, and newly infected can be isolated early. This allows society to go more or less back to normal. That's what some Asian countries did successfully and what others are now seeking to replicate.

IkmoIkmo 6y ago

Well, yes... Assuming the mortality figure of 1-2% is correct, no lockdowns would lead to a few billion infections worldwide, which would lead to 50-100 million dead. This is roughly what world war II caused in the span of 5 years or so of planetary warfare. Second to that, hundreds of millions more would need to be hospitalised. You'd essentially see any other healthcare be completely overwhelmed, e.g. cancer treatment or conceiving a child in the hospital. You'd see tons of excess mortality from these second hand effects as well. Third, in general, and in particular without proper care, you'd see many people suffer permanent organ damage. We see this to be true for many who have recovered from Corona, but with permanently damaged lung or liver capacity. Not to mention the trauma and PTSD for hundreds of millions even those who survive, who'll have experienced what it's like to (nearly) suffocate for weeks. Experiences like these would occur in every community and would likely completely shatter certain individuals, families even communities, their religious beliefs, their sense of security etc. The notion we'd let something like this happen in the 21st century. It'd be a paradigm change in our thinking for many of us who believed our live, societies, governments etc were stable and provided order. Situations like these would be ripe for abuse by political or religious extremists, violence, scape-goating etc.