10 ms·

Well, one thing's for sure - the USA will reach herd immunity more quickly than the rest of the world at the current rate. The thing that bugs me about covid-1

by umvi 6y ago

Well, one thing's for sure - the USA will reach herd immunity more quickly than the rest of the world at the current rate. The thing that bugs me about covid-19 is how we only try to optimize for reducing deaths of that one thing (covid-19), while letting other types of collateral damage resulting from said optimizations pile up unaccounted for as side effects. Experts are clearly very bad at predicting second and third order side effects resulting from covid-19 death reduction optimization. To use a computer analogy, it's like going to extreme measures to refactor all programs so that Covid19Exception kills as few processes as possible, meanwhile processes left and right are dying at elevated rates due to HeartExceptions and BrainExceptions (and in a few months CancerExceptions) and the OOM Killer is on the prowl but nobody is noticing because they are hyperfocused on Covid19Exceptions.

tomrod 6y ago
The economic harm is generally recognized, and an EU type policy is seen as an better than most piecemeal implementations. Ironically, US consumer wages went up by adding $600 to US folks cashflow.[0] There are two big elephants in the room to consider: 1. Ongoing health effects from Covid. Hopefully not as bad, expensive, and detrimental as polio. 2. Chance for negative mutation. These two items alone add a lot of economic uncertainty. [0] https://www.vox.com/2020/5/29/21274416/household-income-surge-april-cares-act-coronavirus-stimulus https://www.vox.com/2020/5/29/21274416/household-income-surg...
svaha1728 6y ago
First we assumed that since it was a coronavirus the summer wouldn't be a problem. Now we assume that if we just hurry up and infect everyone we can reach herd immunity. That is another assumption, it isn't yet clear if infection with the COVID-19 virus makes a person immune to future infection. It might be true, but the most certain among us don’t seem to be the smartest.
- umvi 6y ago
  > Now we assume that if we just hurry up and infect everyone we can reach herd immunity. Well, how long will it take to reach 60% with/without heavy preventative measures? If SIP/masks/social distancing drag out the timeline so it takes 5 years to reach herd immunity... you'll have a mental health crisis of the millennium to deal with in addition to covid-19.
  - amanaplanacanal 6y ago
    We ought to have a vaccination long before five years, but who knows? We are learning as we go on this one.
PragmaticPulp 6y ago
> Well, one thing's for sure - the USA will reach herd immunity more quickly than the rest of the world at the current rate I know that the US has one of the higher per-capita infection rates (though not the highest in the world), but we’re not even close to herd immunity. Less than 1% of the US population is confirmed to have contracted the virus, while even generous herd immunity estimates require 60% of the population to have developed immunity.
- nkurz 6y ago
  > while even generous herd immunity estimates require 60% of the population to have developed immunity The second half of the article purportedly being discussed claims that because of the variability of R0, the herd immunity threshold might be much lower than this. For example, "The paper’s 10 authors, who include Gomes and Langwig, estimate that the threshold for naturally acquired herd immunity to COVID-19 could be as low as 20% of the population." Are you taking this into account when you claim that a 60% threshold is "generous"?
  - ardit33 6y ago
    if we keep the current restrictions.... that's the stipulation
- war1025 6y ago
  I'm pretty sure I saw a metric somewhere that only something like 23% of the population ever caught the 1918 flu.
  - deleted 6y ago
    [deleted]
- ziga 6y ago
  > Less than 1% of the US population is confirmed to have contracted the virus CDC estimates based on seroprevalence data that for every case reported there are actually 10 other infections: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/comm...
rgbrenner 6y ago
I think you've misunderstood what the experts are attempting to do. They're not trying to get 0 covid deaths at the expense of all else. COVID can easily overwhelm the hospital system all by itself. We saw that in Italy and China... and hospital systems in several parts of the US are already near capacity. Once they're overwhelmed, there will be no room left in the hospitals, and they'll have to do one of two things: Start sending covid patients home, which will increase the covid death rate and/or start refusing patients with other injuries/diseases.. which will increase the deaths in those cases. The restrictions are all about preventing the hospitals from being overwhelmed, and causing more people to die than currently. It just seems like they're so focused on covid, because it spreads so rapidly that it can overwhelm hospitals in a very short period of time. Unfortunately with the numbers in Texas, Florida, and elsewhere... and with how long it takes for restrictions to have an effect... it's very likely we'll see what an overwhelmed hospital system looks like very soon.
- umvi 6y ago
  > COVID can easily overwhelm the hospital system all by itself. 1. Is there anything a hospital can actually do to save someone with a serious case of covid-19? As far as I know, ventilators are ineffective (and may even make things worse?). If 100 people with serious covid-19 are taking up ICU beds, how many will live due to direct hospital intervention? If it's a very low %, it seems like a no-brainer to turn away covid-19 cases in favor or other, more treatable diseases. Otherwise it's like letting people with prion disease use up all the ICU beds despite their condition being pretty much untreatable. 2. Anti-covid measures can do the inverse. Remember back in March/April/May when all the hospitals in the USA were empty due to SIP? Most hospitals ended up dismantling their temporary covid-19 field hospitals due to lack of use.
  - deleted 6y ago
    [deleted]
  - rgbrenner 6y ago
    1. Ventilators are likely effective: https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patients-on-ventilators-usually-survive https://www.npr.org/sections/health-shots/2020/05/15/8567680... New treatments are being developed every day, so those numbers may get better. 2. IMO, dismantling the field hospitals was a terrible idea. They built them early, locked down, then saw the decline and people started thinking we were going to eradicate it like in New Zealand. It was never going to happen.
tedunangst 6y ago
There's a similar binary analysis on the other side, where a patient that recovers after two weeks on a ventilator counts as a success, but that outcome isn't quite equivalent to never getting sick.
- glandium 6y ago
  Especially when you see so many people who count as a success who are actually still sick, who knows for how much longer. We still have no idea what the long term implications are for people who "recover" from Covid-19.
watwut 6y ago
It is not true that "we" would not cared about other effects. Among other things, we include vocal groups that don't care about deaths at all or claim it is just like flu. It includes also anything in between. Countries that locked soon are opening up and then locking parts of activities selectively - but this time with easier and cheaper tests, with everyone having masks and so on. There are proposals about closing and opening schools in two weeks schedules. Economies were open in step by step way.
graeme 6y ago
> To use a computer analogy, it's like going to extreme measures to refactor all programs so that Covid19Exception kills as few processes as possible, meanwhile processes left and right are dying at elevated rates due to HeartExceptions and BrainExceptions (and in a few months CancerExceptions) and the OOM Killer is on the prowl but nobody is noticing because they are hyperfocused on Covid19Exceptions. What makes you think uncontrolled covid will have no negative effect on heart, brain and cancer? If hospitals turn into covid centers you can’t safely treat those high risk groups. Further, there’s lots of possible long run effects in survivors we don’t know enough about yet. So there is an unbounded downside risk to covid infections. Finally, we don’t know if immunity persists. We hope it does, but it might not, in which case letting it run through the populace will lead to more deaths when people catch it a second time. Plenty of countries eliminated it by acting early. The US had that option and discarded it, and now is in a worse situation. Maybe the right approach given this worse position is to charge ahead, but you’re ignoring a lot of second order effects yourself.
compumike 6y ago
Your assumption is that there is a tradeoff to be made. This is a common assumption, but I believe it's incorrect. As I showed by analyzing the pandemic as a classical feedback system [1], the long-term policy curve isn't just a simple tradeoff (i.e. "optimizing for reducing deaths of that one thing"), but is actually like an inverted parabola [2] with three regions. But you are correct that our current public policy (by which I mean aggregate US public behavior, not just official policy) is currently targeting one of the worst long-term outcomes, which includes both higher-than-necessary COVID-19 deaths, AND higher-than-necessary collateral economic and other damage. I believe that with a different strategy we can probably reduce Covid19Exception and simultaneously reduce HeartException and CancerException. [1] https://www.circuitlab.com/blog/2020/05/28/surprising-covid-19-strategy-how-to-reduce-economic-damage/ https://www.circuitlab.com/blog/2020/05/28/surprising-covid-... [2] https://cdn.circuitlab.com/misc/20200526_SurprisingCOVID19Strategy_ThreeRegions_sm.png https://cdn.circuitlab.com/misc/20200526_SurprisingCOVID19St...
- ScottBurson 6y ago
  Very interesting analysis! I've also read that in the 1918 Spanish Flu pandemic, the cities with the most stringent lockdowns were the ones whose economies recovered the fastest -- so your model has some empirical support.
newacct583 6y ago
> I feel uninterested in R-nought (or R) when there is evidence for a huge variance around how many people each person will infect. The USA literally, literally did the opposite. We tried, in the initial outbreak, in a few areas, to reduce infections to a manageable steady state. It worked. Then most of the country threw those rules out the window and engaged in some combination of "opening up", relaxed enforcement, and what amounts to a straight up propaganda effort by much of the executive branch and the largest TV news network to convince people that no containment effort was needed. And.... here we are. Covid is controlled pretty much every except in the USA right now. Our outbreak is as bad as it's ever been.

by umvi 6y ago

tomrod 6y ago

The economic harm is generally recognized, and an EU type policy is seen as an better than most piecemeal implementations. Ironically, US consumer wages went up by adding $600 to US folks cashflow.[0] There are two big elephants in the room to consider: 1. Ongoing health effects from Covid. Hopefully not as bad, expensive, and detrimental as polio. 2. Chance for negative mutation. These two items alone add a lot of economic uncertainty. [0] https://www.vox.com/2020/5/29/21274416/household-income-surge-april-cares-act-coronavirus-stimulus https://www.vox.com/2020/5/29/21274416/household-income-surg...

svaha1728 6y ago

First we assumed that since it was a coronavirus the summer wouldn't be a problem. Now we assume that if we just hurry up and infect everyone we can reach herd immunity. That is another assumption, it isn't yet clear if infection with the COVID-19 virus makes a person immune to future infection. It might be true, but the most certain among us don’t seem to be the smartest.

umvi 6y ago
> Now we assume that if we just hurry up and infect everyone we can reach herd immunity. Well, how long will it take to reach 60% with/without heavy preventative measures? If SIP/masks/social distancing drag out the timeline so it takes 5 years to reach herd immunity... you'll have a mental health crisis of the millennium to deal with in addition to covid-19.
- amanaplanacanal 6y ago
  We ought to have a vaccination long before five years, but who knows? We are learning as we go on this one.

PragmaticPulp 6y ago

> Well, one thing's for sure - the USA will reach herd immunity more quickly than the rest of the world at the current rate I know that the US has one of the higher per-capita infection rates (though not the highest in the world), but we’re not even close to herd immunity. Less than 1% of the US population is confirmed to have contracted the virus, while even generous herd immunity estimates require 60% of the population to have developed immunity.

nkurz 6y ago
> while even generous herd immunity estimates require 60% of the population to have developed immunity The second half of the article purportedly being discussed claims that because of the variability of R0, the herd immunity threshold might be much lower than this. For example, "The paper’s 10 authors, who include Gomes and Langwig, estimate that the threshold for naturally acquired herd immunity to COVID-19 could be as low as 20% of the population." Are you taking this into account when you claim that a 60% threshold is "generous"?
- ardit33 6y ago
  if we keep the current restrictions.... that's the stipulation
war1025 6y ago
I'm pretty sure I saw a metric somewhere that only something like 23% of the population ever caught the 1918 flu.
- deleted 6y ago
  [deleted]
ziga 6y ago
> Less than 1% of the US population is confirmed to have contracted the virus CDC estimates based on seroprevalence data that for every case reported there are actually 10 other infections: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/commercial-lab-surveys.html https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/comm...

rgbrenner 6y ago

I think you've misunderstood what the experts are attempting to do. They're not trying to get 0 covid deaths at the expense of all else. COVID can easily overwhelm the hospital system all by itself. We saw that in Italy and China... and hospital systems in several parts of the US are already near capacity. Once they're overwhelmed, there will be no room left in the hospitals, and they'll have to do one of two things: Start sending covid patients home, which will increase the covid death rate and/or start refusing patients with other injuries/diseases.. which will increase the deaths in those cases. The restrictions are all about preventing the hospitals from being overwhelmed, and causing more people to die than currently. It just seems like they're so focused on covid, because it spreads so rapidly that it can overwhelm hospitals in a very short period of time. Unfortunately with the numbers in Texas, Florida, and elsewhere... and with how long it takes for restrictions to have an effect... it's very likely we'll see what an overwhelmed hospital system looks like very soon.

umvi 6y ago
> COVID can easily overwhelm the hospital system all by itself. 1. Is there anything a hospital can actually do to save someone with a serious case of covid-19? As far as I know, ventilators are ineffective (and may even make things worse?). If 100 people with serious covid-19 are taking up ICU beds, how many will live due to direct hospital intervention? If it's a very low %, it seems like a no-brainer to turn away covid-19 cases in favor or other, more treatable diseases. Otherwise it's like letting people with prion disease use up all the ICU beds despite their condition being pretty much untreatable. 2. Anti-covid measures can do the inverse. Remember back in March/April/May when all the hospitals in the USA were empty due to SIP? Most hospitals ended up dismantling their temporary covid-19 field hospitals due to lack of use.
- deleted 6y ago
  [deleted]
- rgbrenner 6y ago
  1. Ventilators are likely effective: https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patients-on-ventilators-usually-survive https://www.npr.org/sections/health-shots/2020/05/15/8567680... New treatments are being developed every day, so those numbers may get better. 2. IMO, dismantling the field hospitals was a terrible idea. They built them early, locked down, then saw the decline and people started thinking we were going to eradicate it like in New Zealand. It was never going to happen.

tedunangst 6y ago

There's a similar binary analysis on the other side, where a patient that recovers after two weeks on a ventilator counts as a success, but that outcome isn't quite equivalent to never getting sick.

glandium 6y ago
Especially when you see so many people who count as a success who are actually still sick, who knows for how much longer. We still have no idea what the long term implications are for people who "recover" from Covid-19.

watwut 6y ago

It is not true that "we" would not cared about other effects. Among other things, we include vocal groups that don't care about deaths at all or claim it is just like flu. It includes also anything in between. Countries that locked soon are opening up and then locking parts of activities selectively - but this time with easier and cheaper tests, with everyone having masks and so on. There are proposals about closing and opening schools in two weeks schedules. Economies were open in step by step way.

graeme 6y ago

> To use a computer analogy, it's like going to extreme measures to refactor all programs so that Covid19Exception kills as few processes as possible, meanwhile processes left and right are dying at elevated rates due to HeartExceptions and BrainExceptions (and in a few months CancerExceptions) and the OOM Killer is on the prowl but nobody is noticing because they are hyperfocused on Covid19Exceptions. What makes you think uncontrolled covid will have no negative effect on heart, brain and cancer? If hospitals turn into covid centers you can’t safely treat those high risk groups. Further, there’s lots of possible long run effects in survivors we don’t know enough about yet. So there is an unbounded downside risk to covid infections. Finally, we don’t know if immunity persists. We hope it does, but it might not, in which case letting it run through the populace will lead to more deaths when people catch it a second time. Plenty of countries eliminated it by acting early. The US had that option and discarded it, and now is in a worse situation. Maybe the right approach given this worse position is to charge ahead, but you’re ignoring a lot of second order effects yourself.

compumike 6y ago

Your assumption is that there is a tradeoff to be made. This is a common assumption, but I believe it's incorrect. As I showed by analyzing the pandemic as a classical feedback system [1], the long-term policy curve isn't just a simple tradeoff (i.e. "optimizing for reducing deaths of that one thing"), but is actually like an inverted parabola [2] with three regions. But you are correct that our current public policy (by which I mean aggregate US public behavior, not just official policy) is currently targeting one of the worst long-term outcomes, which includes both higher-than-necessary COVID-19 deaths, AND higher-than-necessary collateral economic and other damage. I believe that with a different strategy we can probably reduce Covid19Exception and simultaneously reduce HeartException and CancerException. [1] https://www.circuitlab.com/blog/2020/05/28/surprising-covid-19-strategy-how-to-reduce-economic-damage/ https://www.circuitlab.com/blog/2020/05/28/surprising-covid-... [2] https://cdn.circuitlab.com/misc/20200526_SurprisingCOVID19Strategy_ThreeRegions_sm.png https://cdn.circuitlab.com/misc/20200526_SurprisingCOVID19St...

ScottBurson 6y ago
Very interesting analysis! I've also read that in the 1918 Spanish Flu pandemic, the cities with the most stringent lockdowns were the ones whose economies recovered the fastest -- so your model has some empirical support.

newacct583 6y ago

> I feel uninterested in R-nought (or R) when there is evidence for a huge variance around how many people each person will infect. The USA literally, literally did the opposite. We tried, in the initial outbreak, in a few areas, to reduce infections to a manageable steady state. It worked. Then most of the country threw those rules out the window and engaged in some combination of "opening up", relaxed enforcement, and what amounts to a straight up propaganda effort by much of the executive branch and the largest TV news network to convince people that no containment effort was needed. And.... here we are. Covid is controlled pretty much every except in the USA right now. Our outbreak is as bad as it's ever been.