7 ms·

Great observation. I see the same pattern in other countries, too. One reason for this I believe is the lack of “goal clarity”. What’s the goal we’re aiming for

by baxtr 6y ago

Great observation. I see the same pattern in other countries, too. One reason for this I believe is the lack of “goal clarity”. What’s the goal we’re aiming for? I see several options: 1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal 2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking 3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.

kelnos 6y ago
I think the goal a couple/few months ago was #2, but in the meantime we've learned that there might be some bad long-term consequences to contracting the disease that weren't previously known, like possible permanent respiratory damage. Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity. But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.
- SpicyLemonZest 6y ago
  All American public health officials I've heard have been pretty clear about their goals: we're trying to titrate our social distancing, finding the least severe restrictions necessary to keep cases from spiraling out of control and then staying there until a vaccine. There were some early proposals to drive the pandemic extinct before reopening, but they've been uniformly abandoned in the US because they weren't working.
ganafagol 6y ago
I think it's a mix between 1 and 2. Eradication is unrealistic. But the optimum is _not_ the point where every last hospital bed is used. It's where the balance between lockdown and infections is the most societally acceptable. That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health). Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not. Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.
- colechristensen 6y ago
  I believe the goal is/should be a transmission rate of < 1. As long as we can keep it so each infected person has a probability of infecting less than one other person on average, we will be relatively fine. Eradication in the US seems unreasonable, and just keeping hospitals less than overflowing not enough.
  - 9nGQluzmnq3M 6y ago
    If you can persistently keep the rate < 1, you will by mathematical definition eradicate the disease. (0.99 * 0.99 * 0.99 ... eventually sums to zero.) Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
    - colechristensen 6y ago
      We're at 26k cases per day in the US, yes if you continue with r<1 for long enough you have few enough cases that you change strategy to eradication, but that isn't really important. Saying what your strategy is now doesn't mean you're bound to it for months or years, you have to shift based on reality, we're not just dealing with a mathematical model. Focusing on the rate as the metric of attention seems very much like the right thing to be at the center of public policy.
    - 6y ago
dvirsky 6y ago
It looks like policy makers are sort of starting to work under the assumption that a vaccine is around the corner (the plan AFAIK is if all goes well to start around October in the US). Assuming that's correct, I guess the goal is/should be somewhere between 1 and 2. Keep as few people as possible from getting it for a few more months, while not collapsing society/economy completely.
- greedo 6y ago
  I've seen nothing to indicate that a vaccine will be ready in three months. We wouldn't even have completed a Phase 3 clinical trial by then. Fauci has said he's optimistic that we might get a vaccine by the New Year, but he wasn't clear on whether that was a good candidate being identified, or a vaccine being widely available.
  - dvirsky 6y ago
    That is the most optimistic scenario, but it's still possible: https://www.telegraph.co.uk/news/2020/06/22/best-scenario-will-see-oxford-coronavirus-vaccine-ready-roll/ https://www.telegraph.co.uk/news/2020/06/22/best-scenario-wi...
throwawaygh 6y ago
I think a lot of countries do have clarity. The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony. We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity. On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win. And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win. I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.
- aspenmayer 6y ago
  If you don’t know what you want, you can’t be disappointed you didn’t get it. If you don’t know what you’ll get, you won’t be beholden to citizens for not getting it or getting it done. It may seem careless, but it’s also convenient to avoid accountability by avoiding responsibility, and avoiding responsibility by avoiding acknowledgement or awareness of an issue.
  - convolvatron 6y ago
    this seems true. but it kind of implies that there is a _secret_ agenda. it would kinda be more comforting if there was, but its not really clear.
    - aspenmayer 6y ago
      I didn’t mean to imply such an agenda exists in America. Sovereign democracy in Russia is one example of what such a secret (or even explicitly public) agenda would look like. https://en.wikipedia.org/wiki/Sovereign_democracy https://en.wikipedia.org/wiki/Sovereign_democracy https://en.wikipedia.org/wiki/Vladislav_Surkov https://en.wikipedia.org/wiki/Vladislav_Surkov https://www.economist.com/europe/2013/05/11/an-ideologues-exit https://www.economist.com/europe/2013/05/11/an-ideologues-ex...
- ErikAugust 6y ago
Tempest1981 6y ago
I feel bad that we're putting a continuous load + risk on US healthcare workers, 3+ months and counting. They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?
- piva00 6y ago
  That is also what a lot of people forget: the people on the frontline are... People. They also suffer, they also get tired and they also get extremely fed up and burnt out if they have to work months and months with no end in sight. We are not being treated by robots and the longer the pandemic lasts the more healthcare professionals suffering (physically and mentally) we will see, the more churn we will get and less care capacity we will have...
somerandomness 6y ago
It’s definitely 2 for most western countries
siruncledrew 6y ago
When I think about the vaccine side, I still wonder how long that will take. I don’t know how it works, will there just be almost immediate economies of scale to vaccinate people? If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure? It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).
dehrmann 6y ago
> I think that was and is China’s goal I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.
lucideer 6y ago
> Maybe it’s unclear to policy makers, too. I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).
Farox 6y ago
In Germany its 50 cases per 100'000 in a borough. After that lock downs are supposed to happen again. (with discretion, if, for example, cases can be isolated) What other country do you think of that doesn't have clarity?
- baxtr 6y ago
  To me, it is definitely unclear what the goal is in Germany. Is it eradication like New Zealand? Is it controlled herd immunity? Remember that Merkel said that around 70% of the population will get infected anyways. If that’s true, hospitals should not be empty. Instead controlled infection should take place. But that’s not what we have seen. We have seen an eradication strategy. Highly confusing

by baxtr 6y ago

kelnos 6y ago

I think the goal a couple/few months ago was #2, but in the meantime we've learned that there might be some bad long-term consequences to contracting the disease that weren't previously known, like possible permanent respiratory damage. Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity. But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.

SpicyLemonZest 6y ago
All American public health officials I've heard have been pretty clear about their goals: we're trying to titrate our social distancing, finding the least severe restrictions necessary to keep cases from spiraling out of control and then staying there until a vaccine. There were some early proposals to drive the pandemic extinct before reopening, but they've been uniformly abandoned in the US because they weren't working.

ganafagol 6y ago

I think it's a mix between 1 and 2. Eradication is unrealistic. But the optimum is _not_ the point where every last hospital bed is used. It's where the balance between lockdown and infections is the most societally acceptable. That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health). Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not. Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.

colechristensen 6y ago
I believe the goal is/should be a transmission rate of < 1. As long as we can keep it so each infected person has a probability of infecting less than one other person on average, we will be relatively fine. Eradication in the US seems unreasonable, and just keeping hospitals less than overflowing not enough.
- 9nGQluzmnq3M 6y ago
  If you can persistently keep the rate < 1, you will by mathematical definition eradicate the disease. (0.99 * 0.99 * 0.99 ... eventually sums to zero.) Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
  - colechristensen 6y ago
    We're at 26k cases per day in the US, yes if you continue with r<1 for long enough you have few enough cases that you change strategy to eradication, but that isn't really important. Saying what your strategy is now doesn't mean you're bound to it for months or years, you have to shift based on reality, we're not just dealing with a mathematical model. Focusing on the rate as the metric of attention seems very much like the right thing to be at the center of public policy.
  - 6y ago

dvirsky 6y ago

It looks like policy makers are sort of starting to work under the assumption that a vaccine is around the corner (the plan AFAIK is if all goes well to start around October in the US). Assuming that's correct, I guess the goal is/should be somewhere between 1 and 2. Keep as few people as possible from getting it for a few more months, while not collapsing society/economy completely.

greedo 6y ago
I've seen nothing to indicate that a vaccine will be ready in three months. We wouldn't even have completed a Phase 3 clinical trial by then. Fauci has said he's optimistic that we might get a vaccine by the New Year, but he wasn't clear on whether that was a good candidate being identified, or a vaccine being widely available.
- dvirsky 6y ago
  That is the most optimistic scenario, but it's still possible: https://www.telegraph.co.uk/news/2020/06/22/best-scenario-will-see-oxford-coronavirus-vaccine-ready-roll/ https://www.telegraph.co.uk/news/2020/06/22/best-scenario-wi...

throwawaygh 6y ago

I think a lot of countries do have clarity. The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony. We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity. On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win. And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win. I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.

aspenmayer 6y ago
If you don’t know what you want, you can’t be disappointed you didn’t get it. If you don’t know what you’ll get, you won’t be beholden to citizens for not getting it or getting it done. It may seem careless, but it’s also convenient to avoid accountability by avoiding responsibility, and avoiding responsibility by avoiding acknowledgement or awareness of an issue.
- convolvatron 6y ago
  this seems true. but it kind of implies that there is a _secret_ agenda. it would kinda be more comforting if there was, but its not really clear.
  - aspenmayer 6y ago
    I didn’t mean to imply such an agenda exists in America. Sovereign democracy in Russia is one example of what such a secret (or even explicitly public) agenda would look like. https://en.wikipedia.org/wiki/Sovereign_democracy https://en.wikipedia.org/wiki/Sovereign_democracy https://en.wikipedia.org/wiki/Vladislav_Surkov https://en.wikipedia.org/wiki/Vladislav_Surkov https://www.economist.com/europe/2013/05/11/an-ideologues-exit https://www.economist.com/europe/2013/05/11/an-ideologues-ex...
ErikAugust 6y ago

Tempest1981 6y ago

I feel bad that we're putting a continuous load + risk on US healthcare workers, 3+ months and counting. They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?

piva00 6y ago
That is also what a lot of people forget: the people on the frontline are... People. They also suffer, they also get tired and they also get extremely fed up and burnt out if they have to work months and months with no end in sight. We are not being treated by robots and the longer the pandemic lasts the more healthcare professionals suffering (physically and mentally) we will see, the more churn we will get and less care capacity we will have...

somerandomness 6y ago

It’s definitely 2 for most western countries

siruncledrew 6y ago

When I think about the vaccine side, I still wonder how long that will take. I don’t know how it works, will there just be almost immediate economies of scale to vaccinate people? If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure? It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).

dehrmann 6y ago

> I think that was and is China’s goal I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.

lucideer 6y ago

> Maybe it’s unclear to policy makers, too. I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).

Farox 6y ago

In Germany its 50 cases per 100'000 in a borough. After that lock downs are supposed to happen again. (with discretion, if, for example, cases can be isolated) What other country do you think of that doesn't have clarity?

baxtr 6y ago
To me, it is definitely unclear what the goal is in Germany. Is it eradication like New Zealand? Is it controlled herd immunity? Remember that Merkel said that around 70% of the population will get infected anyways. If that’s true, hospitals should not be empty. Instead controlled infection should take place. But that’s not what we have seen. We have seen an eradication strategy. Highly confusing