12 ms·

Your definition of mild is a 'relativisation' of the problem. Since you mentioned H1N1, Covid has already surpassed its death rate in just just 3.5 months and

Your definition of mild is a 'relativisation' of the problem. Since you mentioned H1N1, Covid has already surpassed its death rate in just just 3.5 months and it is on its way to cause 1.5 - 2 mil or more deaths world wide just for the first year... even with the huge restrictions all the countries are doing. Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization. H1N1 was never this bad, and we are no near achieving any herd immunity. "The 2009 H1N1 pandemic was estimated to be associated with 151,700 to 575,400 deaths worldwide during the first year it circulated."

guscost 6y ago
> we are no near achieving any herd immunity. The observation of widespread cross-reactive T Cell immune response does not support this claim. If 50% of the population is less susceptible, this would dramatically alter the herd immunity threshold. The binary condition "totally susceptible or totally immune" is merely a fiction used in some models, and any individual variation away from "totally susceptible" has the same effect: https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v3 https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v... If NYC does not see a second wave, and their seropositive numbers stay below or around 30%, this is why.
- arrrg 6y ago
  If that‘s true that‘s nice – but not an argument against lockdown measures before we can be reasonably certain that‘s true, by the way. Given that we cannot time travel and all. Also, other countries well below 30 percent seropositivity also don’t show signs for second waves, so that‘s an indication that your explanation isn’t the only possible one.
  - guscost 6y ago
    The more informed members of the anti-lockdown faction have been predicting this would happen for months, and they have taken a lot of flak for it.
    - arrrg 6y ago
      We don’t know whether that’s true still and what the impact exactly is. Also, healthcare systems were overwhelmed nevertheless and with measures (lockdowns) in place. So yeah, pretty awful argument.
      - guscost 6y ago
        Andrew Cuomo sent around 5,000 non-critical COVID-19 patients into nursing homes entirely because of fear that healthcare systems would be overwhelmed. The fear was unjustified: During the same time period the Javits Center, the USS Mercy, and at least four leased hotels sat practically empty: https://www.militarytimes.com/news/your-military/2020/04/14/with-empty-beds-at-the-javits-center-and-on-the-comfort-uniformed-health-workers-are-going-straight-into-nyc-hospitals/ https://www.militarytimes.com/news/your-military/2020/04/14/... https://nypost.com/2020/05/02/nyc-hotels-meant-for-recovering-coronavirus-patients-nearly-empty/ https://nypost.com/2020/05/02/nyc-hotels-meant-for-recoverin... https://www.amny.com/coronavirus/brooklyn-field-hospital-shuts-after-21-million-construction-and-zero-patients/ https://www.amny.com/coronavirus/brooklyn-field-hospital-shu... I agree that ICU capacity, PPE inventory, and non-infected personnel were all in short supply at times and in places, but it's not such a simple conclusion as you claim. Consider that early venting seems to have been a terrible blunder, which also used up valuable ICU capacity: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00692-6 https://annalsofintensivecare.springeropen.com/articles/10.1...
        dragonwriter 6y ago
        > During the same time period the Javits Center, the USS Mercy, and at least four leased hotels sat practically empty. The USNS Mercy was sent to Los Angeles, you probably mean to refer to USNS Comfort which was in New York. But both Mercy and Comfort were offered by the Feds for non-COVID-19 patients only.
        guscost 6y ago
        Right, thanks. How about the leased hotels? The field hospital in Brooklyn? The Javits Center? Why were patients sent to NURSING HOMES before any of these? The same question can be asked about the Comfort of course, but I guess we can shift responsibility to the Feds for that fuck-up.
__blockcipher__ 6y ago
> Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization. Can I get a source here? Are you basing this off of the "case hospitalization rate"? Because that number will overestimate the true hospitalization rate by a factor of 2-100x depending on where you're talking about. Same principle of looking at CFR vs IFR (although ironically CFR will start trending down, not just in the real sense as doctors get better at not overreacting with early intubation, but also in a numerical sense as states like Florida are clearly misrepresenting their case numbers which will make the denominator larger) As one example, in the population of people who can actually still get bad outcomes but have the best outcomes - people in their 20's - the implied hospitalization rate from serology studies gives us something like 1 out of 500 young people getting hospitalized (see https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-corona https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c...). So that gives us a lower bound, and a semi-decent upper bound would be the 3.4% hospitalization rate in the 60-69 age group. (They don't seem to report >69 years, which would be way worse) <--- Note that study I found a couple months ago at least, so there are probably better numbers out somewhere now, but I lost some motivation to keep doing SARS-2 research once BLM started because it became clear that it was never really about saving lives in the first place. Although that's a topic for another day)
__blockcipher__ 6y ago
Also I forgot to address your other points. I was not claiming that H1N1 was as bad or worse than COVID-19, to be clear. Obviously COVID-19 is the worst pandemic we've had in over a century. But that's mostly a function of the fact that we haven't had a truly bad pandemic (the scary ones like SARS-1 fizzled out, presumably because the virus was very symptomatic and very deadly). The point is that, we didn't lose our shit over flu pandemics which actually kill children, and actually cause more significant recurring deaths than COVID-19 will do to what I already explained about COVID-19 targetting the unhealthy/old. If you want my argument in a nutshell: - The most stable solution to the problem of COVID-19 is to build widespread population immunity. Also, banking on vaccines as an artificial way to get to herd immunity is a foolish strategy, because we're relying on a temporally unbounded future event, which is an awful idea. - Lockdown not only increase all-cause mortality by making every other health condition in the world worse (both directly through social isolation and depriving exercise, as well as through suspending elective surgeries, as well as the widespread culture of fear/etc leading to people to not go to the hospital), but I actually believe that it increases COVID-19 mortality. The same factors of social isolation, stress/fear, unemployment and lost sleep are at play, but also particularly the prevention of exercise (which plays an immunoregulatory role besides the other positive effects), and even more particularly, being cooped up outside = no sunlight = no vitamin d. Vitamin D is actually a ridiculously important vitamin as far as respiratory infections go - I didn't realize how strong the effect was, I encourage you to research it. Additionally, nitric oxide, also produced by sun exposure and not provided by a vitamin d supplement, decrease blood pressure so helps cardiac events, and is even being directly studied as a COVID-19 treatment (perhaps due to immunoregulatory effects?) - Because I don't believe in practicing containment, for the above reasons and others I don't feel like going into at this point, I believe that any attempt to artificially slow spread in the general population is counterproductive. So, insofar as universal masking works, we should not be wearing masks. Insofar as lockdowns actually work, we shouldn't be locking down. And if they don't work (and I think the evidence is not there, and thus they likely have either no effect or possibly make spread worse, particularly with masking and school closures) - well, then why are we doing them?
- gojomo 6y ago
  While I don't agree that the data supports your anti-mask, large-gatherings-are-OK preferences, I appreciate you making the strongest possible case for what has often been mocked as a "let 'er rip" response. It's helpful to see the collected data & reasoning for that idea. In particular, even given much of your argument, I believe it's still wise for most people, and especially those with any extra risk factors, which likely include some yet-unknown among the outwardly-healthy, to avoid getting this for as long as possible. The end point – nearly everyone having an upgrade immunity to the somewhat-novel threat – is the same. But the upgrade is slower, to minimize collateral damage, and involves more conscious processes, including at some point synthesized vaccines, rather than purely natural/chaotic. Every week brings better understanding of risks & treatments. Every week gives more opportunity for the pull of 'optimal virulence' (https://en.wikipedia.org/wiki/Optimal_virulence https://en.wikipedia.org/wiki/Optimal_virulence) to eventually select for even-milder strains. At least partially-effective vaccines for high-risk/front-line workers may arrive before the end of the year. Delays prevent overwhelming health facilities – or increasing average initial infectious loads – which each seem to risk synergistic escalations of mortality rates. That said, it's not implausible that the right strategy for those least-at-risk – the young & very-healthy – is to mostly go about their normal day, and not worry much about getting an mild case from other mild (presymptomatic/asymptomatic) shedders. The risks are offset by the value of adding to their internal (and thus society's) immunity library against Covid-19 & related viruses. But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.
henrikschroder 6y ago
> and we are no near achieving any herd immunity. I wouldn't be so sure about that, actually. Sweden's response has been widely reported on, and even more widely mis-reported on. Sweden chose the least amount of restrictions in the EU, and mobility analysis shows that although the Swedish people changed behaviour drastically, they did it the least of the EU countries. People were doing the most distancing in late March, same as everywhere else, and have been slowly easing up ever since. And yet, the death rate has been going down steadily in Sweden since mid-April. Testing has been too low for a long time, but is finally up at reasonable numbers. And yet, the positive test rate has been cratering the past few weeks. The Swedish public health agency have done a bunch of random samplings of antibodies to measure the immunity rate, and it always came back at much lower levels than expected. The peanut gallery was quick to crow that Sweden's "herd immunity" strategy was a complete failure, zombie apocalypse etc, but the reason people were surprised that the antibody levels were so low is because it didn't match the actual spread. Something is pushing the death rate and case levels down in Sweden, it clearly isn't lockdown or distancing measures, and it clearly isn't sars-cov-2-specific antibodies. There are reports out now that a lot of people seem to have immunity or resistance through T-cell response, presumably as a result of earlier coronavirus exposure. Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower. And all of these things together suggest that herd immunity is easier to achieve than we initially thought, and that regions that have been heavy hit, but that now see very little death and cases, might be very close to it.
- __blockcipher__ 6y ago
  > Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower. Yes, this is a great point that often gets missed. This is the principle of vector exhaustion: by definition, those more likely to get infected will get infected first. Insofar as someone more likely to get infected is also more likely to infect others, that means that we see a non-linearity to herd immunity. Getting that first group of highly infectious people immune works wonders.

guscost 6y ago

> we are no near achieving any herd immunity. The observation of widespread cross-reactive T Cell immune response does not support this claim. If 50% of the population is less susceptible, this would dramatically alter the herd immunity threshold. The binary condition "totally susceptible or totally immune" is merely a fiction used in some models, and any individual variation away from "totally susceptible" has the same effect: https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v3 https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v... If NYC does not see a second wave, and their seropositive numbers stay below or around 30%, this is why.

arrrg 6y ago
If that‘s true that‘s nice – but not an argument against lockdown measures before we can be reasonably certain that‘s true, by the way. Given that we cannot time travel and all. Also, other countries well below 30 percent seropositivity also don’t show signs for second waves, so that‘s an indication that your explanation isn’t the only possible one.
- guscost 6y ago
  The more informed members of the anti-lockdown faction have been predicting this would happen for months, and they have taken a lot of flak for it.
  - arrrg 6y ago
    We don’t know whether that’s true still and what the impact exactly is. Also, healthcare systems were overwhelmed nevertheless and with measures (lockdowns) in place. So yeah, pretty awful argument.
    - guscost 6y ago
      Andrew Cuomo sent around 5,000 non-critical COVID-19 patients into nursing homes entirely because of fear that healthcare systems would be overwhelmed. The fear was unjustified: During the same time period the Javits Center, the USS Mercy, and at least four leased hotels sat practically empty: https://www.militarytimes.com/news/your-military/2020/04/14/with-empty-beds-at-the-javits-center-and-on-the-comfort-uniformed-health-workers-are-going-straight-into-nyc-hospitals/ https://www.militarytimes.com/news/your-military/2020/04/14/... https://nypost.com/2020/05/02/nyc-hotels-meant-for-recovering-coronavirus-patients-nearly-empty/ https://nypost.com/2020/05/02/nyc-hotels-meant-for-recoverin... https://www.amny.com/coronavirus/brooklyn-field-hospital-shuts-after-21-million-construction-and-zero-patients/ https://www.amny.com/coronavirus/brooklyn-field-hospital-shu... I agree that ICU capacity, PPE inventory, and non-infected personnel were all in short supply at times and in places, but it's not such a simple conclusion as you claim. Consider that early venting seems to have been a terrible blunder, which also used up valuable ICU capacity: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00692-6 https://annalsofintensivecare.springeropen.com/articles/10.1...
      - dragonwriter 6y ago
        > During the same time period the Javits Center, the USS Mercy, and at least four leased hotels sat practically empty. The USNS Mercy was sent to Los Angeles, you probably mean to refer to USNS Comfort which was in New York. But both Mercy and Comfort were offered by the Feds for non-COVID-19 patients only.
        guscost 6y ago
        Right, thanks. How about the leased hotels? The field hospital in Brooklyn? The Javits Center? Why were patients sent to NURSING HOMES before any of these? The same question can be asked about the Comfort of course, but I guess we can shift responsibility to the Feds for that fuck-up.

__blockcipher__ 6y ago

> Also, the non lethal, non-mild cases, are at least 15%, which means hospitalization. Can I get a source here? Are you basing this off of the "case hospitalization rate"? Because that number will overestimate the true hospitalization rate by a factor of 2-100x depending on where you're talking about. Same principle of looking at CFR vs IFR (although ironically CFR will start trending down, not just in the real sense as doctors get better at not overreacting with early intubation, but also in a numerical sense as states like Florida are clearly misrepresenting their case numbers which will make the denominator larger) As one example, in the population of people who can actually still get bad outcomes but have the best outcomes - people in their 20's - the implied hospitalization rate from serology studies gives us something like 1 out of 500 young people getting hospitalized (see https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-corona https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c...). So that gives us a lower bound, and a semi-decent upper bound would be the 3.4% hospitalization rate in the 60-69 age group. (They don't seem to report >69 years, which would be way worse) <--- Note that study I found a couple months ago at least, so there are probably better numbers out somewhere now, but I lost some motivation to keep doing SARS-2 research once BLM started because it became clear that it was never really about saving lives in the first place. Although that's a topic for another day)

__blockcipher__ 6y ago

Also I forgot to address your other points. I was not claiming that H1N1 was as bad or worse than COVID-19, to be clear. Obviously COVID-19 is the worst pandemic we've had in over a century. But that's mostly a function of the fact that we haven't had a truly bad pandemic (the scary ones like SARS-1 fizzled out, presumably because the virus was very symptomatic and very deadly). The point is that, we didn't lose our shit over flu pandemics which actually kill children, and actually cause more significant recurring deaths than COVID-19 will do to what I already explained about COVID-19 targetting the unhealthy/old. If you want my argument in a nutshell: - The most stable solution to the problem of COVID-19 is to build widespread population immunity. Also, banking on vaccines as an artificial way to get to herd immunity is a foolish strategy, because we're relying on a temporally unbounded future event, which is an awful idea. - Lockdown not only increase all-cause mortality by making every other health condition in the world worse (both directly through social isolation and depriving exercise, as well as through suspending elective surgeries, as well as the widespread culture of fear/etc leading to people to not go to the hospital), but I actually believe that it increases COVID-19 mortality. The same factors of social isolation, stress/fear, unemployment and lost sleep are at play, but also particularly the prevention of exercise (which plays an immunoregulatory role besides the other positive effects), and even more particularly, being cooped up outside = no sunlight = no vitamin d. Vitamin D is actually a ridiculously important vitamin as far as respiratory infections go - I didn't realize how strong the effect was, I encourage you to research it. Additionally, nitric oxide, also produced by sun exposure and not provided by a vitamin d supplement, decrease blood pressure so helps cardiac events, and is even being directly studied as a COVID-19 treatment (perhaps due to immunoregulatory effects?) - Because I don't believe in practicing containment, for the above reasons and others I don't feel like going into at this point, I believe that any attempt to artificially slow spread in the general population is counterproductive. So, insofar as universal masking works, we should not be wearing masks. Insofar as lockdowns actually work, we shouldn't be locking down. And if they don't work (and I think the evidence is not there, and thus they likely have either no effect or possibly make spread worse, particularly with masking and school closures) - well, then why are we doing them?

gojomo 6y ago
While I don't agree that the data supports your anti-mask, large-gatherings-are-OK preferences, I appreciate you making the strongest possible case for what has often been mocked as a "let 'er rip" response. It's helpful to see the collected data & reasoning for that idea. In particular, even given much of your argument, I believe it's still wise for most people, and especially those with any extra risk factors, which likely include some yet-unknown among the outwardly-healthy, to avoid getting this for as long as possible. The end point – nearly everyone having an upgrade immunity to the somewhat-novel threat – is the same. But the upgrade is slower, to minimize collateral damage, and involves more conscious processes, including at some point synthesized vaccines, rather than purely natural/chaotic. Every week brings better understanding of risks & treatments. Every week gives more opportunity for the pull of 'optimal virulence' (https://en.wikipedia.org/wiki/Optimal_virulence https://en.wikipedia.org/wiki/Optimal_virulence) to eventually select for even-milder strains. At least partially-effective vaccines for high-risk/front-line workers may arrive before the end of the year. Delays prevent overwhelming health facilities – or increasing average initial infectious loads – which each seem to risk synergistic escalations of mortality rates. That said, it's not implausible that the right strategy for those least-at-risk – the young & very-healthy – is to mostly go about their normal day, and not worry much about getting an mild case from other mild (presymptomatic/asymptomatic) shedders. The risks are offset by the value of adding to their internal (and thus society's) immunity library against Covid-19 & related viruses. But: these people should remain diligent about limiting their interactions with the higher-risk. So even more important than the 'regional' strategies now in place, would be for people to declare & behave consistently with their own personal risk-tolerance. At an extreme, this might include wearing some outward declaration of your risk-profile, and segregating shared facilities, by place or time, to minimize interactions between "let 'er rip" & "avoiding" subpopulations.

henrikschroder 6y ago

> and we are no near achieving any herd immunity. I wouldn't be so sure about that, actually. Sweden's response has been widely reported on, and even more widely mis-reported on. Sweden chose the least amount of restrictions in the EU, and mobility analysis shows that although the Swedish people changed behaviour drastically, they did it the least of the EU countries. People were doing the most distancing in late March, same as everywhere else, and have been slowly easing up ever since. And yet, the death rate has been going down steadily in Sweden since mid-April. Testing has been too low for a long time, but is finally up at reasonable numbers. And yet, the positive test rate has been cratering the past few weeks. The Swedish public health agency have done a bunch of random samplings of antibodies to measure the immunity rate, and it always came back at much lower levels than expected. The peanut gallery was quick to crow that Sweden's "herd immunity" strategy was a complete failure, zombie apocalypse etc, but the reason people were surprised that the antibody levels were so low is because it didn't match the actual spread. Something is pushing the death rate and case levels down in Sweden, it clearly isn't lockdown or distancing measures, and it clearly isn't sars-cov-2-specific antibodies. There are reports out now that a lot of people seem to have immunity or resistance through T-cell response, presumably as a result of earlier coronavirus exposure. Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower. And all of these things together suggest that herd immunity is easier to achieve than we initially thought, and that regions that have been heavy hit, but that now see very little death and cases, might be very close to it.

__blockcipher__ 6y ago
> Another thing to consider is also that if you vaccinate people to reach herd immunity, you effectively pick people at random and give them immunity. But if a virus spreads naturally through a population, it won't pick people at random, it will pick the best spreaders first, and when those have either died or recovered, it will pick the next best spreaders and so on. The remaining population will successively contain worse and worse candidates for natural spread, which means that the threshold for herd immunity is much lower. Yes, this is a great point that often gets missed. This is the principle of vector exhaustion: by definition, those more likely to get infected will get infected first. Insofar as someone more likely to get infected is also more likely to infect others, that means that we see a non-linearity to herd immunity. Getting that first group of highly infectious people immune works wonders.