5 ms·

death is easy to measure quickly but the QALY impacts are not.

by cmrx64 6y ago

Gibbon1 6y ago
As a 55 and over with a dad who's 85 and over one can excuse me for not being on the herd immunity train. I also have friends who've gotten sick and suffered impaired health. Figure the 80/20 rule. 80 people suffer impaired health for every 20 that die. We're talking about 1 in 50 having damaged health.
- arcticbull 6y ago
  The "herd immunity train" doesn't mean we should get people in high-risk categories (even 55+, let alone 85+) infected. It means we should get the lowest risk people infected, which blankets the high-risk people in coverage. Regardless of where you stand on that plan, it's worth calling out.
  - graeme 6y ago
    Not obvious this works though. 70% is herd immunity threshold when there is no epidemic. With an active epidemic it may be 95%. Here are some epidemiologists arguing that: https://www.nytimes.com/2020/05/01/opinion/sunday/coronavirus-herd-immunity.html https://www.nytimes.com/2020/05/01/opinion/sunday/coronaviru... 538 made a model to play with: https://fivethirtyeight.com/features/without-a-vaccine-herd-immunity-wont-save-us/ https://fivethirtyeight.com/features/without-a-vaccine-herd-... So, the plan may be wrong. Proponents may have sincere but incorrect beliefs.
    - Gibbon1 6y ago
      Basically herd immunity overshoot is a thing and shows up both in the historical data and in all models. There is also the problem that as a virus takes years to burn through clusters of susceptible people. Currently it would take over a 100 years to achieve herd immunity in California.
    - makomk 6y ago
      Note that in order for this kind of overshoot to happen, you basically have to have no social distancing whatsoever - not even voluntary changes to behaviour. If there is any then it decreases the reproductive number R further, meaning that it drops below one and the epidemic peaks before enough people have been infected to provide herd immunity after everything returns to normal, and then herd immunity is only reached during the overshoot past the peak. (As I understand it, the UK government's original plans couldn't have lead to herd immunity in the first wave without this, since they were planning on substantial measures to reduce spread even under those plans.)
  - mattmanser 6y ago
    How do you achieve that? It's already ripping through care homes because the people who work in them are unable to shield themselves and simultaneously actually go to work and do their job.
    - arcticbull 6y ago
      Honestly? And I'm genuinely surprised that this wasn't the first course of action: keep the staff locked in with the residents. You're either locked in at work, or you're locked in at the nursing home so it doesn't much matter does it? For what it's worth there are less drastic options. Kingston, Ontario for instance was able to avoid having even a single infection within a nursing home. [1] [1] https://www.theglobeandmail.com/canada/article-with-an-early-focus-on-seniors-residences-kingston-has-so-far/ https://www.theglobeandmail.com/canada/article-with-an-early...
      - mattmanser 6y ago
        Because no-ones going to pay for them to do that. And most of the staff would quit. They have families, children, partners. You think they'll give up 12 weeks of their lives locked in with their wards? You really sound like a dangerous idiot, glad you're not in power.
        exdsq 6y ago
        That’s not as crazy an idea as you make it sound. Furlough those who can’t and hire those who were let go and can. The government could help support costs.
        arcticbull 6y ago
        > Because no-ones going to pay for them to do that. And most of the staff would quit. Seriously? Cost is now the factor? I think we can find it in our 3 trillion dollar stimulus budget. > They have families, children, partners. You think they'll give up 12 weeks of their lives locked in with their wards? Is this a pandemic or is this stay and home tea party time? > You really sound like a dangerous idiot, glad you're not in power. Thanks man, regardless of whether you agree with me or not, I'd point you at the HN post guidelines.
  - Gibbon1 6y ago
    You seem incapable of understanding that people in demographic groups cluster. The problem is most of my dads friends and associates are over 60. You can only get herd immunity by infecting 60-70 percent of THEM. A high infection rate in the under 45 set does NOTHING to protect them.
    - arcticbull 6y ago
      That's... not how herd immunity works. If it was, all your dad's friends would have Polio right now :P It's literally how vaccines work. The proposal (again, without opining on its validity) is the same as vaccination, but comes with much greater risk.
      - RealityVoid 6y ago
        I think he does have a point. Thorough the social measures you take and depending what age groups you expose the most, you can (should) be able to skew the numbers in having more infections in a age group than he other. If you skew the numbers towards the younger population, the end result is _better_ than the normal, presumably uniform, distribution. EDIT: I misunderstood GP's point. I'll still leave my reply as-is since i still think the general idea I was trying to convey is sound.
    - tripletao 6y ago
      The comment above is overstated, but more or less correct. All the naive herd immunity calculations assume a well-mixed population. A large fraction of recovered and immune young people will protect the elderly from contacts with their children, with store clerks, etc., but not from contacts with other elderly. If we successfully protect the elderly, then herd immunity among young people will decrease the probability that the virus gets introduced into a nursing home; but it does nothing to slow the virus's spread once it does. That heterogeneity also goes the good way though, since people in jobs most prone to spreading the virus (doctors, nurses, store clerks, etc.) tend to get infected first and therefore become immune first. There are models suggesting we might reach overall herd immunity with only ~30% infected (https://news.ycombinator.com/item?id=23149725 https://news.ycombinator.com/item?id=23149725), though this is obviously speculative.
  - weddpros 6y ago
    Herd immunity is backwards... You can say "hey, look, the epidemic has died because of herd immunity", but you can't reasonably desire herd immunity if you can avoid it. Think of Ebola and herd immunity for more that a second, and you'll understand what it means: herd immunity is not the only way. Korea proves it too. SARS 2003 died without herd immunity either. What about HIV? Fancy trying herd immunity? Herd immunity shouldn't be a goal.
    - arcticbull 6y ago
      > Herd immunity shouldn't be a goal. Herd immunity is how vaccines work. It's the reason not everyone needs to get the measles vaccine so long as most people do. > Think of Ebola and herd immunity for more that a second, and you'll understand what it means: herd immunity is not the only way. Korea proves it too. SARS 2003 died without herd immunity either. What about HIV? Fancy trying herd immunity? If you can obtain a slice of the population that is not particularly strongly affected by a disease large enough to achieve the same result as you would with a vaccine, it's an avenue. That's true of folks under 45, broadly speaking. You may not like it -- I may not like it -- but it is an effective avenue. It is the goal. This conversation is about different ways to achieve that goal.
      - arcticbull 6y ago
        Ah, I see, you're of the opinion there's some way to eradicate this disease without immunization -- by continued lockdowns? Given the R0 could be 5 and millions infected, that ship has long since sailed IMO, to the extent that I don't really even consider that an option.
    - SpicyLemonZest 6y ago
      That's true. The terminology has gotten a bit confused; most people who say they want to follow a "herd immunity" plan really mean "I don't think we can avoid it". Country A achieving containment doesn't necessarily mean Country B can achieve it, at least not without impossible or unacceptable costs.
    - RealityVoid 6y ago
- bthomas 6y ago
  That's not the 80/20 rule. There must be empirical estimates of that number.
- cmrx64 6y ago
  I'm with you on this one, and the downvotes are peculiar to me. The death rate in the under-45 bracket doesn't matter to me and I don't know why the thread root author focused on it except as reassurance for that age range. What I was trying to call out is that even in that age range that observed death rate shouldn't be reassurance to justify going out-and-about.

death is easy to measure quickly but the QALY impacts are not.

by cmrx64 6y ago

death is easy to measure quickly but the QALY impacts are not.

As a 55 and over with a dad who's 85 and over one can excuse me for not being on the herd immunity train. I also have friends who've gotten sick and suffered impaired health. Figure the 80/20 rule. 80 people suffer impaired health for every 20 that die. We're talking about 1 in 50 having damaged health.

arcticbull 6y ago
The "herd immunity train" doesn't mean we should get people in high-risk categories (even 55+, let alone 85+) infected. It means we should get the lowest risk people infected, which blankets the high-risk people in coverage. Regardless of where you stand on that plan, it's worth calling out.
- graeme 6y ago
  Not obvious this works though. 70% is herd immunity threshold when there is no epidemic. With an active epidemic it may be 95%. Here are some epidemiologists arguing that: https://www.nytimes.com/2020/05/01/opinion/sunday/coronavirus-herd-immunity.html https://www.nytimes.com/2020/05/01/opinion/sunday/coronaviru... 538 made a model to play with: https://fivethirtyeight.com/features/without-a-vaccine-herd-immunity-wont-save-us/ https://fivethirtyeight.com/features/without-a-vaccine-herd-... So, the plan may be wrong. Proponents may have sincere but incorrect beliefs.
  - Gibbon1 6y ago
    Basically herd immunity overshoot is a thing and shows up both in the historical data and in all models. There is also the problem that as a virus takes years to burn through clusters of susceptible people. Currently it would take over a 100 years to achieve herd immunity in California.
  - makomk 6y ago
    Note that in order for this kind of overshoot to happen, you basically have to have no social distancing whatsoever - not even voluntary changes to behaviour. If there is any then it decreases the reproductive number R further, meaning that it drops below one and the epidemic peaks before enough people have been infected to provide herd immunity after everything returns to normal, and then herd immunity is only reached during the overshoot past the peak. (As I understand it, the UK government's original plans couldn't have lead to herd immunity in the first wave without this, since they were planning on substantial measures to reduce spread even under those plans.)
- mattmanser 6y ago
  How do you achieve that? It's already ripping through care homes because the people who work in them are unable to shield themselves and simultaneously actually go to work and do their job.
  - arcticbull 6y ago
    Honestly? And I'm genuinely surprised that this wasn't the first course of action: keep the staff locked in with the residents. You're either locked in at work, or you're locked in at the nursing home so it doesn't much matter does it? For what it's worth there are less drastic options. Kingston, Ontario for instance was able to avoid having even a single infection within a nursing home. [1] [1] https://www.theglobeandmail.com/canada/article-with-an-early-focus-on-seniors-residences-kingston-has-so-far/ https://www.theglobeandmail.com/canada/article-with-an-early...
    - mattmanser 6y ago
      Because no-ones going to pay for them to do that. And most of the staff would quit. They have families, children, partners. You think they'll give up 12 weeks of their lives locked in with their wards? You really sound like a dangerous idiot, glad you're not in power.
      - exdsq 6y ago
        That’s not as crazy an idea as you make it sound. Furlough those who can’t and hire those who were let go and can. The government could help support costs.
      - arcticbull 6y ago
        > Because no-ones going to pay for them to do that. And most of the staff would quit. Seriously? Cost is now the factor? I think we can find it in our 3 trillion dollar stimulus budget. > They have families, children, partners. You think they'll give up 12 weeks of their lives locked in with their wards? Is this a pandemic or is this stay and home tea party time? > You really sound like a dangerous idiot, glad you're not in power. Thanks man, regardless of whether you agree with me or not, I'd point you at the HN post guidelines.
- Gibbon1 6y ago
  You seem incapable of understanding that people in demographic groups cluster. The problem is most of my dads friends and associates are over 60. You can only get herd immunity by infecting 60-70 percent of THEM. A high infection rate in the under 45 set does NOTHING to protect them.
  - arcticbull 6y ago
    That's... not how herd immunity works. If it was, all your dad's friends would have Polio right now :P It's literally how vaccines work. The proposal (again, without opining on its validity) is the same as vaccination, but comes with much greater risk.
    - RealityVoid 6y ago
      I think he does have a point. Thorough the social measures you take and depending what age groups you expose the most, you can (should) be able to skew the numbers in having more infections in a age group than he other. If you skew the numbers towards the younger population, the end result is _better_ than the normal, presumably uniform, distribution. EDIT: I misunderstood GP's point. I'll still leave my reply as-is since i still think the general idea I was trying to convey is sound.
  - tripletao 6y ago
    The comment above is overstated, but more or less correct. All the naive herd immunity calculations assume a well-mixed population. A large fraction of recovered and immune young people will protect the elderly from contacts with their children, with store clerks, etc., but not from contacts with other elderly. If we successfully protect the elderly, then herd immunity among young people will decrease the probability that the virus gets introduced into a nursing home; but it does nothing to slow the virus's spread once it does. That heterogeneity also goes the good way though, since people in jobs most prone to spreading the virus (doctors, nurses, store clerks, etc.) tend to get infected first and therefore become immune first. There are models suggesting we might reach overall herd immunity with only ~30% infected (https://news.ycombinator.com/item?id=23149725 https://news.ycombinator.com/item?id=23149725), though this is obviously speculative.
- weddpros 6y ago
  Herd immunity is backwards... You can say "hey, look, the epidemic has died because of herd immunity", but you can't reasonably desire herd immunity if you can avoid it. Think of Ebola and herd immunity for more that a second, and you'll understand what it means: herd immunity is not the only way. Korea proves it too. SARS 2003 died without herd immunity either. What about HIV? Fancy trying herd immunity? Herd immunity shouldn't be a goal.
  - arcticbull 6y ago
    > Herd immunity shouldn't be a goal. Herd immunity is how vaccines work. It's the reason not everyone needs to get the measles vaccine so long as most people do. > Think of Ebola and herd immunity for more that a second, and you'll understand what it means: herd immunity is not the only way. Korea proves it too. SARS 2003 died without herd immunity either. What about HIV? Fancy trying herd immunity? If you can obtain a slice of the population that is not particularly strongly affected by a disease large enough to achieve the same result as you would with a vaccine, it's an avenue. That's true of folks under 45, broadly speaking. You may not like it -- I may not like it -- but it is an effective avenue. It is the goal. This conversation is about different ways to achieve that goal.
    - arcticbull 6y ago
      Ah, I see, you're of the opinion there's some way to eradicate this disease without immunization -- by continued lockdowns? Given the R0 could be 5 and millions infected, that ship has long since sailed IMO, to the extent that I don't really even consider that an option.
  - SpicyLemonZest 6y ago
    That's true. The terminology has gotten a bit confused; most people who say they want to follow a "herd immunity" plan really mean "I don't think we can avoid it". Country A achieving containment doesn't necessarily mean Country B can achieve it, at least not without impossible or unacceptable costs.
  - RealityVoid 6y ago
bthomas 6y ago
That's not the 80/20 rule. There must be empirical estimates of that number.
cmrx64 6y ago
I'm with you on this one, and the downvotes are peculiar to me. The death rate in the under-45 bracket doesn't matter to me and I don't know why the thread root author focused on it except as reassurance for that age range. What I was trying to call out is that even in that age range that observed death rate shouldn't be reassurance to justify going out-and-about.