8 ms·

As you may have noticed, many states have attempted to end the shutdown, and then quickly reinstated it when death tolls increased dramatically.

matz1 6y ago
The case raise dramatically but not the death tolls.
- Jweb_Guru 6y ago
  That's not actually true, but I've seen this talking point often enough that I know it's not really worth engaging in this discussion.
- zaarn 6y ago
  Death tolls require some time to go up. If you lift lockdown, lots of people get infects. It takes a few days, maybe a week to show symptoms bad enough to go to a doctor for testing. This is the point in time when cases begin to go up. Imagine if you lifted the lockdown for a day and went back. One to two weeks after that, people will get more seriously ill, requiring hospitalization. Initially this can be treated easy at a (presumably) low-load hospital with no issue, the death toll is low. One more week and you have the majority of cases in the hospital, this is where most people will die. A month after you lifted the lockdown. Now imagine not locking down after that one day. After 1 month, you're at the peak of Day 1 infections, the next day the peak of day 2 infections etc. It compounds fast and can overwhelm a hospital. Once a hospital is unable to care for all patients properly, triage will be applied. People with good recovery chances will receive treatment, those who are risk groups will not. That's when your death toll will explode very suddenly.
  - matz1 6y ago
    Of course, the death require some time to show up, some time in 2 weeks, some time in 70 years... Hospital are frequently overwhelmed even before this particular virus, its not new and yet we didn't require shutdown back then.
    - zaarn 6y ago
      Well, most direct deaths show fairly fast after the patient has died. There are some indirect damages that might kill someone 70 years on but we don't know that yet. The issue isn't how long it takes "for death to show up", it's that patients who are infected don't drop dead on the spot. They develop symptoms, go to a doctor, get bad enough to be forced in to a hospital, treatment stops helping until eventually the succumb to the condition. That can take a while, especially if doctors are fighting for the patients life. And yes, sometimes hospitals can be overwhelmed by single events, though in the US this seems to be an issue of lack of social healthcare than anything, but generally there isn't a single disease that puts hospitals into a state of triage (that is until Covid when hospitals in various places in the world did have to triage)
      - matz1 6y ago
        Yes, all disease could have delayed death/long lasting permanent damage. And in regard with hospital overwhelmed, its nothing new, this is from 2018, hospital have to setup triage tents: https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie...
        yesplorer 6y ago
        Triage tents don't fall from the sky. They require extensive planning and logistics. And sometimes you build them and they go unused as has been done during this very pandemic because luckily predictions were wrong.[0] [0] https://www.militarytimes.com/news/coronavirus/2020/04/29/many-field-hospitals-went-largely-unused-will-be-shut-down/ https://www.militarytimes.com/news/coronavirus/2020/04/29/ma...
        matz1 6y ago
        Um yes, i didn't argue that it shows up magically.
        zaarn 6y ago
        Triage tent != Triage. A triage tent is used to sort patients between codes, ie emergencies and non-emergencies when space inside the hospital is unavailable. Actual triage means when the hospital itself rejects patients because they do not have the resources to treat everyone anymore. From what it reads in the article, the hospitals weren't unable to treat patients on that level yet. >Yes, all disease could have delayed death/long lasting permanent damage. And we don't know what Covid-19 brings but that isn't even the point so I'm wondering why you brought it up anyway.
- TeaDrunk 6y ago
  I was watching case raise 40-30% a few weeks ago and now deaths are also up 30-40%. Seems like it tracks for me
- mrfusion 6y ago
  Provide sources if you can.
- dragonwriter 6y ago
  > The case raise dramatically but not the death tolls. Death toll is a trailing indicator (IIRC, it tends to be about 10 days from infection to symptom onset in symptomatic cases, a little bit longer to hospitalization, a few more days to death where it occurs, and that's getting longer because of better care protocols with more experience, so the degree to which death is a trailing indicator is increasing), we've gotten better at managing serious cases (which is better for ventilator capacity since we are using less per case, but worse for overall hospital capacity, IIRC, because we're using more bed-days per hospitalization.) The fact that cases over time are skewing younger also depresses the death rate but that's somewhat misleading as to impact, because seriously ill younger people are less likely to die but also more likely to have long hospitalization and post-hopsitalization convalescence, and that's only considering immediate consequences and not the increasing array of significant delayed health consequences that are being identified.
makomk 6y ago
Which is in itself kind of a problem. What's the endgame here - what are all these lockdowns helping to push us towards? We can't just lock down forever, it's fundamentally unsustainable and the damage compounds over time, and it doesn't look like there's a way out that doesn't involve a large death toll. Nor is there much prospect of salvation from (say) vaccination or treatment any time soon.
- zaarn 6y ago
  With a lockdown you slow down the infection. This has a few goals at the same time. First, you lessen the load of the healthcare system. If a lot of people get sick at the same time, hospitals would be swamped and more people would die because care is impossible. Second, you can bring the disease from an exponential growth to sub-exponential, potentially containing it mostly (this is what happened for example in Germany, where tracking individual infections is now possible again). Third, you buy yourself time until a vaccine is available. Even if no vaccine is going to appear in the near future, as long as you slow it down long enough (1-2 years) from reaching saturation in the population, that's lives saved.
- codingdave 6y ago
  > What's the endgame here To slow the spread so that our medical facilities have the capacity to handle the sick, and we don't have to let people die due to lack of healthcare resources.
WalterBright 6y ago
From what I understand from the latest news reports, the primary way to stop the spread is with masks. So if we can reopen but with masks, that may be effective enough.
- TeaDrunk 6y ago
  Masks allow people to do chores and errands and the like but it is still recommended for people not to be indoors with other people for extended periods of time or to not keep space from others. (Not to mention that many people either refuse to wear masks or don’t wear masks properly covering nose and mouth).
  - matz1 6y ago
    Yes, recommendation is preferable than mandatory enforcement.
    - mcphage 6y ago
      Which is why wearing clothes is a merely a recommendation, and walking around naked isn't illegal anywhere.
      - catalogia 6y ago
        You're being sarcastic, but there are plenty of places were that is true and those places haven't descended into madness.
        mcphage 6y ago
        Undoubtedly. The US isn't one of those places, however—and the the mandate for clothing hasn't led to a descent into authoritarianism, either.
        catalogia 6y ago
        The US is not a legal monoculture; there are some parts of the US where public nudity is permitted. Example (NSFW, article contains some nudity): https://en.wikipedia.org/wiki/Social_nudity_in_San_Francisco https://en.wikipedia.org/wiki/Social_nudity_in_San_Francisco Laws concerning toplesness also vary across the US. It's legal in many places for women to go topless, yet rarely does anybody actually do so. My point here is that laws are not actually the reason most people wear clothing; their personal preferences are the reason. Where clothing laws don't exist or aren't enforced, virtually everybody still wears clothes. (Also, I think this all has very little to do with covid-19.)

matz1 6y ago

The case raise dramatically but not the death tolls.

Jweb_Guru 6y ago
That's not actually true, but I've seen this talking point often enough that I know it's not really worth engaging in this discussion.
zaarn 6y ago
Death tolls require some time to go up. If you lift lockdown, lots of people get infects. It takes a few days, maybe a week to show symptoms bad enough to go to a doctor for testing. This is the point in time when cases begin to go up. Imagine if you lifted the lockdown for a day and went back. One to two weeks after that, people will get more seriously ill, requiring hospitalization. Initially this can be treated easy at a (presumably) low-load hospital with no issue, the death toll is low. One more week and you have the majority of cases in the hospital, this is where most people will die. A month after you lifted the lockdown. Now imagine not locking down after that one day. After 1 month, you're at the peak of Day 1 infections, the next day the peak of day 2 infections etc. It compounds fast and can overwhelm a hospital. Once a hospital is unable to care for all patients properly, triage will be applied. People with good recovery chances will receive treatment, those who are risk groups will not. That's when your death toll will explode very suddenly.
- matz1 6y ago
  Of course, the death require some time to show up, some time in 2 weeks, some time in 70 years... Hospital are frequently overwhelmed even before this particular virus, its not new and yet we didn't require shutdown back then.
  - zaarn 6y ago
    Well, most direct deaths show fairly fast after the patient has died. There are some indirect damages that might kill someone 70 years on but we don't know that yet. The issue isn't how long it takes "for death to show up", it's that patients who are infected don't drop dead on the spot. They develop symptoms, go to a doctor, get bad enough to be forced in to a hospital, treatment stops helping until eventually the succumb to the condition. That can take a while, especially if doctors are fighting for the patients life. And yes, sometimes hospitals can be overwhelmed by single events, though in the US this seems to be an issue of lack of social healthcare than anything, but generally there isn't a single disease that puts hospitals into a state of triage (that is until Covid when hospitals in various places in the world did have to triage)
    - matz1 6y ago
      Yes, all disease could have delayed death/long lasting permanent damage. And in regard with hospital overwhelmed, its nothing new, this is from 2018, hospital have to setup triage tents: https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie...
      - yesplorer 6y ago
        Triage tents don't fall from the sky. They require extensive planning and logistics. And sometimes you build them and they go unused as has been done during this very pandemic because luckily predictions were wrong.[0] [0] https://www.militarytimes.com/news/coronavirus/2020/04/29/many-field-hospitals-went-largely-unused-will-be-shut-down/ https://www.militarytimes.com/news/coronavirus/2020/04/29/ma...
        matz1 6y ago
        Um yes, i didn't argue that it shows up magically.
      - zaarn 6y ago
        Triage tent != Triage. A triage tent is used to sort patients between codes, ie emergencies and non-emergencies when space inside the hospital is unavailable. Actual triage means when the hospital itself rejects patients because they do not have the resources to treat everyone anymore. From what it reads in the article, the hospitals weren't unable to treat patients on that level yet. >Yes, all disease could have delayed death/long lasting permanent damage. And we don't know what Covid-19 brings but that isn't even the point so I'm wondering why you brought it up anyway.
TeaDrunk 6y ago
I was watching case raise 40-30% a few weeks ago and now deaths are also up 30-40%. Seems like it tracks for me
mrfusion 6y ago
Provide sources if you can.
dragonwriter 6y ago
> The case raise dramatically but not the death tolls. Death toll is a trailing indicator (IIRC, it tends to be about 10 days from infection to symptom onset in symptomatic cases, a little bit longer to hospitalization, a few more days to death where it occurs, and that's getting longer because of better care protocols with more experience, so the degree to which death is a trailing indicator is increasing), we've gotten better at managing serious cases (which is better for ventilator capacity since we are using less per case, but worse for overall hospital capacity, IIRC, because we're using more bed-days per hospitalization.) The fact that cases over time are skewing younger also depresses the death rate but that's somewhat misleading as to impact, because seriously ill younger people are less likely to die but also more likely to have long hospitalization and post-hopsitalization convalescence, and that's only considering immediate consequences and not the increasing array of significant delayed health consequences that are being identified.

makomk 6y ago

Which is in itself kind of a problem. What's the endgame here - what are all these lockdowns helping to push us towards? We can't just lock down forever, it's fundamentally unsustainable and the damage compounds over time, and it doesn't look like there's a way out that doesn't involve a large death toll. Nor is there much prospect of salvation from (say) vaccination or treatment any time soon.

zaarn 6y ago
With a lockdown you slow down the infection. This has a few goals at the same time. First, you lessen the load of the healthcare system. If a lot of people get sick at the same time, hospitals would be swamped and more people would die because care is impossible. Second, you can bring the disease from an exponential growth to sub-exponential, potentially containing it mostly (this is what happened for example in Germany, where tracking individual infections is now possible again). Third, you buy yourself time until a vaccine is available. Even if no vaccine is going to appear in the near future, as long as you slow it down long enough (1-2 years) from reaching saturation in the population, that's lives saved.
codingdave 6y ago
> What's the endgame here To slow the spread so that our medical facilities have the capacity to handle the sick, and we don't have to let people die due to lack of healthcare resources.

WalterBright 6y ago

From what I understand from the latest news reports, the primary way to stop the spread is with masks. So if we can reopen but with masks, that may be effective enough.

TeaDrunk 6y ago
Masks allow people to do chores and errands and the like but it is still recommended for people not to be indoors with other people for extended periods of time or to not keep space from others. (Not to mention that many people either refuse to wear masks or don’t wear masks properly covering nose and mouth).
- matz1 6y ago
  Yes, recommendation is preferable than mandatory enforcement.
  - mcphage 6y ago
    Which is why wearing clothes is a merely a recommendation, and walking around naked isn't illegal anywhere.
    - catalogia 6y ago
      You're being sarcastic, but there are plenty of places were that is true and those places haven't descended into madness.
      - mcphage 6y ago
        Undoubtedly. The US isn't one of those places, however—and the the mandate for clothing hasn't led to a descent into authoritarianism, either.
        catalogia 6y ago
        The US is not a legal monoculture; there are some parts of the US where public nudity is permitted. Example (NSFW, article contains some nudity): https://en.wikipedia.org/wiki/Social_nudity_in_San_Francisco https://en.wikipedia.org/wiki/Social_nudity_in_San_Francisco Laws concerning toplesness also vary across the US. It's legal in many places for women to go topless, yet rarely does anybody actually do so. My point here is that laws are not actually the reason most people wear clothing; their personal preferences are the reason. Where clothing laws don't exist or aren't enforced, virtually everybody still wears clothes. (Also, I think this all has very little to do with covid-19.)