11 ms·

Ontario doctors sign letter to Premier advising against sweeping lockdowns

109 points by mrfusion 6y ago

zenincognito 6y ago
Not sure if these doctors have followed what has been happening in Melbourne, Australia. We have been in lockdown since early June and went from 700 cases per day to 15 per day so it has technically worked. However, it has completely destroyed businesses and affected a lot of smaller retailers. Our premier has been called "Dictator Dan" by most of murdock media including WAPO but the support among public has stayed strong. Suppression is a good strategy when the world is devoid of a vaccine.
- Johanx64 6y ago
  If the virus hasn't been stopped completely all you are doing are dragging feet indefinitely (with all the catastrophical damage that comes along with it). It hasn't worked - literally nothing had qualitatively changed since day 1 when I said that exactly this would happen. All we have is better testing methods and a ravaged economy, yet fundamentaly we are at square zero.
  - ISL 6y ago
    There is an important win: A bunch of people who would have died are still alive. That said, the right strategy is to focus on hammering the virus to zero quickly through old-school epidemiology techniques. If we had done so early, the problem wouldn't be this bad. It would have been expensive, but less-expensive than our present path. The bright side of combating an exponential foe: Once you start to win, winning gets easier.
    - Johanx64 6y ago
      A lot of people that shouldn't and wouldn't have died are dead. Even more are unemployed, starving, homeless and in severe distress as a direct consequence. I sincerely doubt that it would amount to a net win, after everything else and all the externalities get factored in (it's never done unfortunately)
      - wolco2 6y ago
        Those are the effects of moving society online. New winners and losers will emerge. A strong social safety net is helpful transitioning the losers back to productive winners. This was going to happen over a longer period of time anyhow.
      - ineedasername 6y ago
        Those aren't either/or decisions. Appropriate responses and better safety nets could have minimized both issues.
    - DarthGhandi 6y ago
      What numerical value would you place on saving 100 lives? Virtually all of them over 80. $500m? $1b? $100b? Just for comparison about 80 young Australians died from suicide this week alone.
      - ry454 6y ago
        About zero, really. Unless some of those 80+ year olds are prominent scientists, etc. The numeric value $1 billion means $1 billion worth of human labor or energy. The amount of this energy is finite, and it's around $80 trillions currently. We can multiply it by 10-100, the exact number doesn't matter, what maters is that it's not a lot bigger than $1 billion. Saying that saving a human life is worth any dollar amount, is same as saying that our society, all 7-something billion people, should spend all their energy on saving that one life. A human body is really just a vehicle, like a car. When it approaches 80 yo mark, it's worth about nothing. It's just some people believe, with religious rigor, that they're bound to this car forever.
      - zacharycohn 6y ago
        Economists value a human life at $10,000,000 USD (there's a great Planet Money podcast about this). Therefore, 100 lives would be worth about a billion dollars.
        logicchains 6y ago
        That's the value of an average life. Health economists at e.g. the NHS actually use https://en.wikipedia.org/wiki/Quality-adjusted_life_year https://en.wikipedia.org/wiki/Quality-adjusted_life_year, to account for the fact that e.g. an 80 year old has fewer years of life left than a 10 year old.
        amscanne 6y ago
        Medical decisions in the USA suggest that the statistical value of a “quality-adjusted life year” is ~$128,000 on average. Obviously the question of “life years” is critical in this context. Everyone would be in favor of sacrificing more to save healthy children than people who are 80+. (No one wants to see anyone die needlessly, but the children can live happy lives for another half-century.)
    - deathgrips 6y ago
      >There is an important win: A bunch of people who would have died are still alive. If they had instead dropped a nuclear bomb on Melbourne, 0 people would have died from Covid19.
    - mensetmanusman 6y ago
      True. I don’t think experts honestly thinks you can hammer the virus to zero though based on our knowledge of human behavior. Case in point, HIV has killed around 50 million over the past few decades, and we know exactly how it spreads, and it is quite easy to stop. If we can’t stop HIV, without a vaccine there is no way we can stop something airborne (which we now know SARS-CoV2 is).
  - Paradigma11 6y ago
    We also have far better treatment methods and many ppl who get sick now would have died earlier.
- xyzzy_plugh 6y ago
  It's worth pointing out that this would be a second lockdown, as Ontario has already started to loosen restrictions after the initial lockdown (where cases also dropped to <100 during the summer).
  - darcys22 6y ago
    Thats pretty much what happened in Melbourne. We started relaxing the restrictions and the second wave started. We followed with very strong lockdowns that brought us down from the ~700 new daily cases to the current ~15 new daily cases.
- war1025 6y ago
  > Suppression is a good strategy when the world is devoid of a vaccine Part of this is just fear talking though. My family was very concerned about the virus for the first couple months. Then people we knew in our age demographic (20s-30s) started catching it. Invariably it's been a day or two of fever and a week or so of cold symptoms. Absolutely people who are at elevated risk because of age or pre-existing conditions should lock down to whatever extent they feel is necessary. But the general feeling here (central Iowa) seems to be more and more that the lockdown is far worse than the virus. Because of that, we get raked over the coals pretty well daily by everyone in the media. But our schools are open, our universities are open, and people are more or less back to normal life. Cases are stable. Deaths are low and mostly restricted to the very old. We seem to have settled on an acceptable (to us) middle ground. I'm sure businesses are still hurting, but very few have shut their doors permanently. I get the feeling that's a very different picture than many places.
  - zacharycohn 6y ago
    I'd encourage you to read through this thread: https://www.reddit.com/r/AskReddit/comments/j2pb9a/serious_people_from_reddit_who_survived_corona/ https://www.reddit.com/r/AskReddit/comments/j2pb9a/serious_p...
- ketamine__ 6y ago
  > We have been in lockdown since early June and went from 700 cases per day to 15 per day so it has technically worked. Victoria hasn't exited lockdown. How can you say it worked? > Suppression is a good strategy when the world is devoid of a vaccine. I have heard the argument that suppression is a good strategy because a vaccine is soon to be approved. If we can't develop a vaccine I would hope suppression wouldn't be the strategy.
  - p1necone 6y ago
    It worked because less people died. Some people (myself included) are more concerned with human lives than opening businesses faster.
    - ketamine__ 6y ago
      Are your people (and yourself) more concerned with human lives than children getting an education and not falling behind? If so, how long should children suffer? As long as it takes?
      - II2II 6y ago
        Take a look at the provincial breakdown. The Atlantic provinces are in a position where kids are going to school, restrictions are being lifted, and the number of cases are in the single digits per week. For the most part, there is not spread within these provinces so efforts can focus upon verifying that people coming into the province aren't infected and ensuring the population complies with far less extreme measures so that the virus does not gain a foothold in the region yet again. Even parts of the country with a far greater number of infections than the Atlantic provinces are seeing numbers stabilize (e.g. Alberta) or decline (e.g. British Columbia). This is not the case in Ontario, where the spread is essentially uncontrolled. Measures need to be put into place because the living will continue to suffer as long as that spread is uncontrolled, and yes the loss of life matters as well. A few weeks to stabilize the situation will ensure that lives are not lost needlessly.
      - wolco2 6y ago
- semerda 6y ago
  I have been following this mess. I’m an Aussie in CA. Even when a vaccine is available it’s not going to be 100% effective. Contrast it to another RNA based virus (but faster mutating) like influenza. The annual shot effectiveness fluctuates based on what is the dominant strain socially circulating. Therefore, the science Dan is subscribed to means Vic will be locked down indefinitely. Sure ppl love the lockdowns but the reality will hit hard when they realize there is no such thing as “pause” in the economy. It’s a hard stop followed by CPR. What ever happened to real science; you know, the one where we learn and adapt as new information is made available. I’m pretty sure we now know a lot more about this virus, demographics most at risk, it’s disease management etc... As Frank Herbert says; Fear is the mind killer.
  - bawolff 6y ago
    Comparing a not yet existant vaccine to a vaccine for a virus that's totally different is silly. Especially comparing it to the flu, as that's a virus that mutates much more often than most viri. In any case no vaccine is 100% effective. The goal is typically to be effective enough that the virus dies out faster than it spreads. Which solves the problem. There are a lot of covid vaccine trials going on. The different candidates have different properties. It has yet to be seen which candidates are succesful.
    - SpicyLemonZest 6y ago
      While you're correct to point that out, I'm not aware of any health experts who expect that the current crop of vaccine candidates are sufficient to stop the disease from spreading. The hope is that it will spread slower and/or be less severe.
      - bawolff 6y ago
        I'm definitely no expert on this, but it seems a little early to say. There's 321 candidates in development (albeit some very early stage) and none have fully passed trials yet. I think the effiacy of various candidates isn't clear yet (i may be totally wrong)
    - 6y ago
- koyote 6y ago
  I feel like everyone is talking about Melbourne's lockdown as if it was their first lockdown. This is their second lockdown. They virtually eliminated it during the first lockdown and brought the virus back in via hotel quarantine leaks (as proven by genomic testing). There is nothing indicating that the same thing won't happen again. NSW's contact tracing team has been excellent but I have not heard anyone detail how Victoria's team is up to scratch now (a part from throwing some money at Salesforce). There is no long-term strategy in this whatsoever, the hope is that the vaccine is available and effective before the inevitable 3rd wave hits a still highly susceptible population.
  - gregoryl 6y ago
    VIC contact tracing has now adopted the same process as NSW
    - koyote 6y ago
      Do you have a source on that? I know that they sent some people up to see what NSW was doing but haven't actually heard them say what, if anything, they were going to adopt. There is this 'funny' article from a couple of days ago though; seems like a lot of lies and smoke: https://www.afr.com/policy/health-and-education/nsw-denies-it-is-copying-victoria-s-contact-tracing-system-20200928-p56022 https://www.afr.com/policy/health-and-education/nsw-denies-i... Gladys also indicated that a large part of NSW's tracing success was the tight integration and information sharing between government agencies. Something that, if you read between the lines, is apparently not the case in Victoria.
  - spfzero 6y ago
    I wonder about this hope for a vaccine, and if it is a reasonable thing to base policy on. There is still no vaccine for HIV, after several decades of trying and many billions spent. None for SARS1, Mers, the commom cold. There are influenza vaccines, but still no effective ones in terms of preventing a significant number of deaths every year.
    - lbeltrame 6y ago
asdfasgasdgasdg 6y ago
Honestly I don't find it to be newsworthy that you can find 21 doctors to sign just about anything. They are people, and people believe all kinds of stuff.
- MattGaiser 6y ago
  Especially when they have another petition in the article arguing for the opposite.
  - neom 6y ago
    Interesting that on one (lockdown) side is mostly doctors in University Health Network and Unity Health Toronto (arguable the top hospitals in Canada), and the other (don't lockdown) letter is mostly professors at McMaster and University of Toronto (arguably the top medical schools in Canada).
    - MattGaiser 6y ago
      Probably just circulating petitions within their networks. The numbers are small enough that this could be little more than grabbing some colleagues through the intranet.
    - tastroder 6y ago
      Interesting. How's the discussion between those groups going there? The chasm here in Germany seems to range between a majority of epidemiologists and virologists advising on sensible measures going forward and a few economics folks, a bunch of private clinic doctors and a vocal group of clearly right wing / conspiracy people. The latter group either sings the tiring "it's just the flu" or "people die for many reasons anyway" song and can be seen on Twitter, discovering basic epidemiological models in real time. Their arguments are very similar to those of flat earthers honestly, precluding any notion of a grounded debate on what measures are sensible in order to keep the health system in working order and shield those that are vulnerable.
      - 6y ago
zaroth 6y ago
I think an argument can be made the government ordered lockdowns (stay at home / shelter in place) orders were appropriate in March when we knew much less about who was most vulnerable, and did not have a well vetted treatment protocol / decision tree or any known therapeutics. Given the tremendous public health and economic costs of lockdowns, the fear of the unknown (e.g. predicted 2% demographic wide CFR) may have justified the multi-trillion dollar cost, and an unknown number of lives lost, due to lockdowns. Forced mandatory lockdowns today would be unethical and actually counter-productive. Given our vastly increased knowledge of the highly stratified risk profile of SARS-CoV-2, the public health case cannot be ethically made to forcibly confine the general population to their homes; separating them from their livelihoods, their community, their ordinary healthcare, and their mental and physical wellness routines. Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance. Government programs could better support at-risk populations which are self isolating by focusing on the minority of people who are acutely at-risk. IFR Age 0.003% 0-19 0.02% 20-49 0.5% 50-69 5.4% 70-79 5.4%++ 80+ https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
- sdesol 6y ago
  > Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance you forgot to include "provided they can afford to".
  - mb7733 6y ago
    True, but re-introducing lockdown doesn't help anyone afford anything. More like the opposite.
    - sdesol 6y ago
      I think "doesn't help anyone" is a bit of a stretch, since many tech workers actually did quite well during the lockdown, since they were forced to spend less due to a lack of options. I'm in Ontario so what is being discussed does have an affect on me and I really don't know if a lockdown is the answer. What I do know is our Premier (Doug Ford) is a fuck up. We should be much more prepared by now and this lock-down talk is him panicking because we have no way better way to manage outbreaks.
refurb 6y ago
I would be curious if someone ran a health economics analysis on lockdowns. The UK sets the value of 1 quality adjusted life year (QALY) at 20-30k GBP. Basically, if a new medical technology costs more than that they say “no, it’s not worth it” (though there are exceptions). It shouldn’t be hard to figure out the cost of the shutdown and divide it by the number of QALYs gained.
- dguaraglia 6y ago
  The problem with such attempts at a 'rational' explanation of why one or the other approach works better is that we are talking about an irrational issue. It's easy for 30-something people with no preconditions to think they can rationalize themselves out of a lockdown... but the moment their parents and grandparents start dying, all of a sudden all rationality goes out of the window.
- kvb 6y ago
  I think it is pretty hard to compute the cost, because what's the counterfactual? Even if you don't force a shutdown people may still opt to isolate themselves and businesses may opt to close, and the degree to which they do so is probably dependent on the dynamics of the pandemic, so you're going to be pretty sensitive to modeling errors.
  - refurb 6y ago
    That’s a fair point, but even a rough estimate would be interesting. Say all increased gov’t spending to support people who lost their jobs during the shutdown. It’s a known number. Sure it would be very rough, but just knowing the relative magnitude would be interesting. Is it $1,000 per QALY or $100,000 per QALY?
GhostVII 6y ago
I really don't like how all the media seems to be focused on case counts, they started rising significantly a couple of weeks ago in Ontario, and yet hospitalization are still only ~15% what they were at the peak. Hospitalizations are definitely going up, and probably will continue to do so, but I see headlines talking about how we are breaking the record number of cases, without acknowledging that comparing case counts between now and a few months ago is useless. I've been largely supportive of Ontario's lockdowns so far, lets not overreact just because our testing capacity has increased. And whatever happened to flattening the curve to ensure hospitalizations stay below capacity? I still haven't heard what the new plan is, obviously in many places we are locking down much longer than is required to just keep hospitals below capacity.
- wolco2 6y ago
  The hospitalization occurs later in the chain. This time period could be compared with February. In a month hopitalizations will be up. The case count is very misleading. The maximum number of new cases is limited by the maximum number of tests processed. Current figure is 700/cases 40,000 tests. The only way to increase the 700 cases is to increase maximum tests processed daily or pick more likely positive people to admin the test to. There could be 100,000 getting sick each day but the case count will only reflect a shadow of that information.
  - xyzzy_plugh 6y ago
    Right, and just because hospitalizations are 15% what they were at peak, doesn't mean that the case count at peak was correct -- there were likely many more unconfirmed cases at peak, as testing was not yet widely available.
  - spfzero 6y ago
    What’s happening now might be that more and more people are getting tested, not because they had serious symptoms, but because they need to show a positive test for some travel or other requirement, of they are just being careful because they have older family members etc. So there would appear to be more cases, even if there were in reality fewer people getting seriously sick from Covid.
deleted 6y ago
[deleted]
walterbell 6y ago
What PCR testing "cycle threshold" value is being used by Ontario labs? https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html https://www.nytimes.com/2020/08/29/health/coronavirus-testin... > In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found ... One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37 ... Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said. Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said. A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less.
- deleted 6y ago
  [deleted]
- lbeltrame 6y ago
  When I used to do RT-PCR for research, 40 cycles would mean (to me) that I had nothing in my solution and I had to redo the experiment. The precautionary principle (anti-scientific, because it assumes the worst even without evidence of such) is what drives such decisions, even if, according to Oxford's CEBM, there is little to no correlation between a PCR positive sample at 37+ cycles and actual presence of an infectious virus. That is why antigen testing, although less sensitive, is important. A PCR test without symptoms does not tell if you have the virus you had the virus, and if you are infectious (assembled virus present in the respiratory tract) or not. Also, RNA in the throat can degrade slowly, and be present for a long time (this is not unique to this virus). An antigen test will identify the virus proteins, and as such, a higher probability that a positive test detects an infectious virus.
graeme 6y ago
I live in Quebec nearby. The government seems to have learned nothing. As best I can tell they’re banning even two people meeting outside. And yet they let people go to workplaces and not wear masks when seated. Same in classrooms. They are completely ignoring ventilation and have a feb/march view of this virus as being fomite and droplet based. It is the strangest thing.
- wolco2 6y ago
  The going to school /work keeping movies / bars / restaurants / massage parlours open but limiting groups / strip joints (that's happening in Ontario) feel like political compromise without any science. These powerful entities will keep their doors open the less powerful will be shutdown meanwhile they all should be shutdown or opened at the same time.
  - graeme 6y ago
    Oh they shut those too in quebec, to be clear. Bars restaurants etc
  - nostoc 6y ago
    Even if it's somewhat arbitrary which kind of gatherings are still allowed, forbidding half of the gatherings still has an impact on the transmission rate. Which means if you cut out bars but allow churches (max 25 persons in Quebec btw), you still cut down a lot of spreading. I don't agree with keeping religious gatherings, but it doesn't mean there is no science behind these decisions.
minkowski 6y ago
The interesting part of this letter isn't any novel or lucid argument but what it's arguing against, which in the context of the mentioned earlier Ontario Hospital Assocation statement almost comes across as a straw man. The letter spends most of its time arguing against near-total lockdowns such as Ontario experienced from March through June even though almost nobody is currently proposing this - even the OHA statement only advocates a temporary closure of indoor venues such as restaurants and banquet halls in affected areas (albeit including large cities such as Toronto and Ottawa) - with a parenthetical warning about the harms of "rotating" school closures to childrens' health, even though this wasn't really proposed. In fact, the earlier statement explicitly proposed closing food service venues in order to prevent school closures and elective surgery cancellations. Likewise, they mention overdose deaths and social and economic determinants of health as if the broader health sector were oblivious to these or hadn't proposed any solutions. (The current government is quite conservative and broadly opposes overdose prevention, basic income experiments, social housing, etc., so these are unlikely to be realized, so perhaps this is a resigned ultra-realist approach, but in that case, why write it in the first place?) A cynical part of me wonders whether this letter being circulated by CTV (as opposed to the motivations of those signing it, about which I have no idea) isn't just to give political cover on talk radio and TV news for the government's current wait-and-see approach, which health workers (and progressives generally) are against. [Slightly unrelated, but potentially relevant given the "doctors say" headline: the government was recently playing radio advertisements explaining how much it "consulted" with the health sector on safely reopening schools but not mentioning the fact that it ignored the main recommendation of reducing class sizes.]
just-juan-post 6y ago
A wise choice seeing as how the overall fatality rate is less than 0.3% See below: Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence Study Sept 2020, Annals of Internal Medicine https://www.acpjournals.org/doi/10.7326/M20-5352 https://www.acpjournals.org/doi/10.7326/M20-5352 People aged 40 or below have a 0.01% chance of dying. People over the age of 70 have a 1.17% chance of dying. Overall the chance of dying from the virus is 0.26%.
- mattigames 6y ago
  If only fatalities was the only issue at hand, but millions of people will suffer lasting damage due covid for decades to come
  - logicchains 6y ago
    What research paper are you basing that on? Hundreds of millions of people will suffer lasting damage due to poverty and malnutrition resulting from the global economic effects of lockdowns: https://www.washingtonpost.com/world/2020/09/25/pandemic-pushes-hundreds-millions-people-toward-starvation-poverty/ https://www.washingtonpost.com/world/2020/09/25/pandemic-pus...
    - mattigames 6y ago
      Articles: https://www.healthline.com/health-news/lifelong-lung-damage-the-serious-covid-19-complication-that-can-hit-people-in-their-20s#Whos-at-risk https://www.healthline.com/health-news/lifelong-lung-damage-...? https://www.newscientist.com/article/2247086-the-coronavirus-is-leaving-some-people-with-permanent-lung-damage/ https://www.newscientist.com/article/2247086-the-coronavirus... Papers: https://k4.ersnet.org/prod/v2/Front/Program/Session?e=259&session=12607 https://k4.ersnet.org/prod/v2/Front/Program/Session?e=259&se... https://pubs.rsna.org/doi/full/10.1148/radiol.2020200843 https://pubs.rsna.org/doi/full/10.1148/radiol.2020200843 https://www.ajronline.org/doi/pdf/10.2214/AJR.20.22969 https://www.ajronline.org/doi/pdf/10.2214/AJR.20.22969
legulere 6y ago
What a load of bollocks. Countries like Germany have shown that you can keep infection numbers low without harming your economy too much.

109 points by mrfusion 6y ago

Not sure if these doctors have followed what has been happening in Melbourne, Australia. We have been in lockdown since early June and went from 700 cases per day to 15 per day so it has technically worked. However, it has completely destroyed businesses and affected a lot of smaller retailers. Our premier has been called "Dictator Dan" by most of murdock media including WAPO but the support among public has stayed strong. Suppression is a good strategy when the world is devoid of a vaccine.

Johanx64 6y ago
If the virus hasn't been stopped completely all you are doing are dragging feet indefinitely (with all the catastrophical damage that comes along with it). It hasn't worked - literally nothing had qualitatively changed since day 1 when I said that exactly this would happen. All we have is better testing methods and a ravaged economy, yet fundamentaly we are at square zero.
- ISL 6y ago
  There is an important win: A bunch of people who would have died are still alive. That said, the right strategy is to focus on hammering the virus to zero quickly through old-school epidemiology techniques. If we had done so early, the problem wouldn't be this bad. It would have been expensive, but less-expensive than our present path. The bright side of combating an exponential foe: Once you start to win, winning gets easier.
  - Johanx64 6y ago
    A lot of people that shouldn't and wouldn't have died are dead. Even more are unemployed, starving, homeless and in severe distress as a direct consequence. I sincerely doubt that it would amount to a net win, after everything else and all the externalities get factored in (it's never done unfortunately)
    - wolco2 6y ago
      Those are the effects of moving society online. New winners and losers will emerge. A strong social safety net is helpful transitioning the losers back to productive winners. This was going to happen over a longer period of time anyhow.
    - ineedasername 6y ago
      Those aren't either/or decisions. Appropriate responses and better safety nets could have minimized both issues.
  - DarthGhandi 6y ago
    What numerical value would you place on saving 100 lives? Virtually all of them over 80. $500m? $1b? $100b? Just for comparison about 80 young Australians died from suicide this week alone.
    - ry454 6y ago
      About zero, really. Unless some of those 80+ year olds are prominent scientists, etc. The numeric value $1 billion means $1 billion worth of human labor or energy. The amount of this energy is finite, and it's around $80 trillions currently. We can multiply it by 10-100, the exact number doesn't matter, what maters is that it's not a lot bigger than $1 billion. Saying that saving a human life is worth any dollar amount, is same as saying that our society, all 7-something billion people, should spend all their energy on saving that one life. A human body is really just a vehicle, like a car. When it approaches 80 yo mark, it's worth about nothing. It's just some people believe, with religious rigor, that they're bound to this car forever.
    - zacharycohn 6y ago
      Economists value a human life at $10,000,000 USD (there's a great Planet Money podcast about this). Therefore, 100 lives would be worth about a billion dollars.
      - logicchains 6y ago
        That's the value of an average life. Health economists at e.g. the NHS actually use https://en.wikipedia.org/wiki/Quality-adjusted_life_year https://en.wikipedia.org/wiki/Quality-adjusted_life_year, to account for the fact that e.g. an 80 year old has fewer years of life left than a 10 year old.
      - amscanne 6y ago
        Medical decisions in the USA suggest that the statistical value of a “quality-adjusted life year” is ~$128,000 on average. Obviously the question of “life years” is critical in this context. Everyone would be in favor of sacrificing more to save healthy children than people who are 80+. (No one wants to see anyone die needlessly, but the children can live happy lives for another half-century.)
  - deathgrips 6y ago
    >There is an important win: A bunch of people who would have died are still alive. If they had instead dropped a nuclear bomb on Melbourne, 0 people would have died from Covid19.
  - mensetmanusman 6y ago
    True. I don’t think experts honestly thinks you can hammer the virus to zero though based on our knowledge of human behavior. Case in point, HIV has killed around 50 million over the past few decades, and we know exactly how it spreads, and it is quite easy to stop. If we can’t stop HIV, without a vaccine there is no way we can stop something airborne (which we now know SARS-CoV2 is).
- Paradigma11 6y ago
  We also have far better treatment methods and many ppl who get sick now would have died earlier.
xyzzy_plugh 6y ago
It's worth pointing out that this would be a second lockdown, as Ontario has already started to loosen restrictions after the initial lockdown (where cases also dropped to <100 during the summer).
- darcys22 6y ago
  Thats pretty much what happened in Melbourne. We started relaxing the restrictions and the second wave started. We followed with very strong lockdowns that brought us down from the ~700 new daily cases to the current ~15 new daily cases.
war1025 6y ago
> Suppression is a good strategy when the world is devoid of a vaccine Part of this is just fear talking though. My family was very concerned about the virus for the first couple months. Then people we knew in our age demographic (20s-30s) started catching it. Invariably it's been a day or two of fever and a week or so of cold symptoms. Absolutely people who are at elevated risk because of age or pre-existing conditions should lock down to whatever extent they feel is necessary. But the general feeling here (central Iowa) seems to be more and more that the lockdown is far worse than the virus. Because of that, we get raked over the coals pretty well daily by everyone in the media. But our schools are open, our universities are open, and people are more or less back to normal life. Cases are stable. Deaths are low and mostly restricted to the very old. We seem to have settled on an acceptable (to us) middle ground. I'm sure businesses are still hurting, but very few have shut their doors permanently. I get the feeling that's a very different picture than many places.
- zacharycohn 6y ago
  I'd encourage you to read through this thread: https://www.reddit.com/r/AskReddit/comments/j2pb9a/serious_people_from_reddit_who_survived_corona/ https://www.reddit.com/r/AskReddit/comments/j2pb9a/serious_p...
ketamine__ 6y ago
> We have been in lockdown since early June and went from 700 cases per day to 15 per day so it has technically worked. Victoria hasn't exited lockdown. How can you say it worked? > Suppression is a good strategy when the world is devoid of a vaccine. I have heard the argument that suppression is a good strategy because a vaccine is soon to be approved. If we can't develop a vaccine I would hope suppression wouldn't be the strategy.
- p1necone 6y ago
  It worked because less people died. Some people (myself included) are more concerned with human lives than opening businesses faster.
  - ketamine__ 6y ago
    Are your people (and yourself) more concerned with human lives than children getting an education and not falling behind? If so, how long should children suffer? As long as it takes?
    - II2II 6y ago
      Take a look at the provincial breakdown. The Atlantic provinces are in a position where kids are going to school, restrictions are being lifted, and the number of cases are in the single digits per week. For the most part, there is not spread within these provinces so efforts can focus upon verifying that people coming into the province aren't infected and ensuring the population complies with far less extreme measures so that the virus does not gain a foothold in the region yet again. Even parts of the country with a far greater number of infections than the Atlantic provinces are seeing numbers stabilize (e.g. Alberta) or decline (e.g. British Columbia). This is not the case in Ontario, where the spread is essentially uncontrolled. Measures need to be put into place because the living will continue to suffer as long as that spread is uncontrolled, and yes the loss of life matters as well. A few weeks to stabilize the situation will ensure that lives are not lost needlessly.
    - wolco2 6y ago
semerda 6y ago
I have been following this mess. I’m an Aussie in CA. Even when a vaccine is available it’s not going to be 100% effective. Contrast it to another RNA based virus (but faster mutating) like influenza. The annual shot effectiveness fluctuates based on what is the dominant strain socially circulating. Therefore, the science Dan is subscribed to means Vic will be locked down indefinitely. Sure ppl love the lockdowns but the reality will hit hard when they realize there is no such thing as “pause” in the economy. It’s a hard stop followed by CPR. What ever happened to real science; you know, the one where we learn and adapt as new information is made available. I’m pretty sure we now know a lot more about this virus, demographics most at risk, it’s disease management etc... As Frank Herbert says; Fear is the mind killer.
- bawolff 6y ago
  Comparing a not yet existant vaccine to a vaccine for a virus that's totally different is silly. Especially comparing it to the flu, as that's a virus that mutates much more often than most viri. In any case no vaccine is 100% effective. The goal is typically to be effective enough that the virus dies out faster than it spreads. Which solves the problem. There are a lot of covid vaccine trials going on. The different candidates have different properties. It has yet to be seen which candidates are succesful.
  - SpicyLemonZest 6y ago
    While you're correct to point that out, I'm not aware of any health experts who expect that the current crop of vaccine candidates are sufficient to stop the disease from spreading. The hope is that it will spread slower and/or be less severe.
    - bawolff 6y ago
      I'm definitely no expert on this, but it seems a little early to say. There's 321 candidates in development (albeit some very early stage) and none have fully passed trials yet. I think the effiacy of various candidates isn't clear yet (i may be totally wrong)
  - 6y ago
koyote 6y ago
I feel like everyone is talking about Melbourne's lockdown as if it was their first lockdown. This is their second lockdown. They virtually eliminated it during the first lockdown and brought the virus back in via hotel quarantine leaks (as proven by genomic testing). There is nothing indicating that the same thing won't happen again. NSW's contact tracing team has been excellent but I have not heard anyone detail how Victoria's team is up to scratch now (a part from throwing some money at Salesforce). There is no long-term strategy in this whatsoever, the hope is that the vaccine is available and effective before the inevitable 3rd wave hits a still highly susceptible population.
- gregoryl 6y ago
  VIC contact tracing has now adopted the same process as NSW
  - koyote 6y ago
    Do you have a source on that? I know that they sent some people up to see what NSW was doing but haven't actually heard them say what, if anything, they were going to adopt. There is this 'funny' article from a couple of days ago though; seems like a lot of lies and smoke: https://www.afr.com/policy/health-and-education/nsw-denies-it-is-copying-victoria-s-contact-tracing-system-20200928-p56022 https://www.afr.com/policy/health-and-education/nsw-denies-i... Gladys also indicated that a large part of NSW's tracing success was the tight integration and information sharing between government agencies. Something that, if you read between the lines, is apparently not the case in Victoria.
- spfzero 6y ago
  I wonder about this hope for a vaccine, and if it is a reasonable thing to base policy on. There is still no vaccine for HIV, after several decades of trying and many billions spent. None for SARS1, Mers, the commom cold. There are influenza vaccines, but still no effective ones in terms of preventing a significant number of deaths every year.
  - lbeltrame 6y ago

asdfasgasdgasdg 6y ago

Honestly I don't find it to be newsworthy that you can find 21 doctors to sign just about anything. They are people, and people believe all kinds of stuff.

MattGaiser 6y ago
Especially when they have another petition in the article arguing for the opposite.
- neom 6y ago
  Interesting that on one (lockdown) side is mostly doctors in University Health Network and Unity Health Toronto (arguable the top hospitals in Canada), and the other (don't lockdown) letter is mostly professors at McMaster and University of Toronto (arguably the top medical schools in Canada).
  - MattGaiser 6y ago
    Probably just circulating petitions within their networks. The numbers are small enough that this could be little more than grabbing some colleagues through the intranet.
  - tastroder 6y ago
    Interesting. How's the discussion between those groups going there? The chasm here in Germany seems to range between a majority of epidemiologists and virologists advising on sensible measures going forward and a few economics folks, a bunch of private clinic doctors and a vocal group of clearly right wing / conspiracy people. The latter group either sings the tiring "it's just the flu" or "people die for many reasons anyway" song and can be seen on Twitter, discovering basic epidemiological models in real time. Their arguments are very similar to those of flat earthers honestly, precluding any notion of a grounded debate on what measures are sensible in order to keep the health system in working order and shield those that are vulnerable.
    - 6y ago

zaroth 6y ago

I think an argument can be made the government ordered lockdowns (stay at home / shelter in place) orders were appropriate in March when we knew much less about who was most vulnerable, and did not have a well vetted treatment protocol / decision tree or any known therapeutics. Given the tremendous public health and economic costs of lockdowns, the fear of the unknown (e.g. predicted 2% demographic wide CFR) may have justified the multi-trillion dollar cost, and an unknown number of lives lost, due to lockdowns. Forced mandatory lockdowns today would be unethical and actually counter-productive. Given our vastly increased knowledge of the highly stratified risk profile of SARS-CoV-2, the public health case cannot be ethically made to forcibly confine the general population to their homes; separating them from their livelihoods, their community, their ordinary healthcare, and their mental and physical wellness routines. Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance. Government programs could better support at-risk populations which are self isolating by focusing on the minority of people who are acutely at-risk. IFR Age 0.003% 0-19 0.02% 20-49 0.5% 50-69 5.4% 70-79 5.4%++ 80+ https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

sdesol 6y ago
> Anyone can always choose to self-isolate based on their own personal risk factors and risk tolerance you forgot to include "provided they can afford to".
- mb7733 6y ago
  True, but re-introducing lockdown doesn't help anyone afford anything. More like the opposite.
  - sdesol 6y ago
    I think "doesn't help anyone" is a bit of a stretch, since many tech workers actually did quite well during the lockdown, since they were forced to spend less due to a lack of options. I'm in Ontario so what is being discussed does have an affect on me and I really don't know if a lockdown is the answer. What I do know is our Premier (Doug Ford) is a fuck up. We should be much more prepared by now and this lock-down talk is him panicking because we have no way better way to manage outbreaks.

refurb 6y ago

I would be curious if someone ran a health economics analysis on lockdowns. The UK sets the value of 1 quality adjusted life year (QALY) at 20-30k GBP. Basically, if a new medical technology costs more than that they say “no, it’s not worth it” (though there are exceptions). It shouldn’t be hard to figure out the cost of the shutdown and divide it by the number of QALYs gained.

dguaraglia 6y ago
The problem with such attempts at a 'rational' explanation of why one or the other approach works better is that we are talking about an irrational issue. It's easy for 30-something people with no preconditions to think they can rationalize themselves out of a lockdown... but the moment their parents and grandparents start dying, all of a sudden all rationality goes out of the window.
kvb 6y ago
I think it is pretty hard to compute the cost, because what's the counterfactual? Even if you don't force a shutdown people may still opt to isolate themselves and businesses may opt to close, and the degree to which they do so is probably dependent on the dynamics of the pandemic, so you're going to be pretty sensitive to modeling errors.
- refurb 6y ago
  That’s a fair point, but even a rough estimate would be interesting. Say all increased gov’t spending to support people who lost their jobs during the shutdown. It’s a known number. Sure it would be very rough, but just knowing the relative magnitude would be interesting. Is it $1,000 per QALY or $100,000 per QALY?

GhostVII 6y ago

I really don't like how all the media seems to be focused on case counts, they started rising significantly a couple of weeks ago in Ontario, and yet hospitalization are still only ~15% what they were at the peak. Hospitalizations are definitely going up, and probably will continue to do so, but I see headlines talking about how we are breaking the record number of cases, without acknowledging that comparing case counts between now and a few months ago is useless. I've been largely supportive of Ontario's lockdowns so far, lets not overreact just because our testing capacity has increased. And whatever happened to flattening the curve to ensure hospitalizations stay below capacity? I still haven't heard what the new plan is, obviously in many places we are locking down much longer than is required to just keep hospitals below capacity.

wolco2 6y ago
The hospitalization occurs later in the chain. This time period could be compared with February. In a month hopitalizations will be up. The case count is very misleading. The maximum number of new cases is limited by the maximum number of tests processed. Current figure is 700/cases 40,000 tests. The only way to increase the 700 cases is to increase maximum tests processed daily or pick more likely positive people to admin the test to. There could be 100,000 getting sick each day but the case count will only reflect a shadow of that information.
- xyzzy_plugh 6y ago
  Right, and just because hospitalizations are 15% what they were at peak, doesn't mean that the case count at peak was correct -- there were likely many more unconfirmed cases at peak, as testing was not yet widely available.
- spfzero 6y ago
  What’s happening now might be that more and more people are getting tested, not because they had serious symptoms, but because they need to show a positive test for some travel or other requirement, of they are just being careful because they have older family members etc. So there would appear to be more cases, even if there were in reality fewer people getting seriously sick from Covid.

deleted 6y ago

[deleted]

walterbell 6y ago

What PCR testing "cycle threshold" value is being used by Ontario labs? https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html https://www.nytimes.com/2020/08/29/health/coronavirus-testin... > In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found ... One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37 ... Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said. Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said. A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less.

deleted 6y ago
[deleted]
lbeltrame 6y ago
When I used to do RT-PCR for research, 40 cycles would mean (to me) that I had nothing in my solution and I had to redo the experiment. The precautionary principle (anti-scientific, because it assumes the worst even without evidence of such) is what drives such decisions, even if, according to Oxford's CEBM, there is little to no correlation between a PCR positive sample at 37+ cycles and actual presence of an infectious virus. That is why antigen testing, although less sensitive, is important. A PCR test without symptoms does not tell if you have the virus you had the virus, and if you are infectious (assembled virus present in the respiratory tract) or not. Also, RNA in the throat can degrade slowly, and be present for a long time (this is not unique to this virus). An antigen test will identify the virus proteins, and as such, a higher probability that a positive test detects an infectious virus.

graeme 6y ago

I live in Quebec nearby. The government seems to have learned nothing. As best I can tell they’re banning even two people meeting outside. And yet they let people go to workplaces and not wear masks when seated. Same in classrooms. They are completely ignoring ventilation and have a feb/march view of this virus as being fomite and droplet based. It is the strangest thing.

wolco2 6y ago
The going to school /work keeping movies / bars / restaurants / massage parlours open but limiting groups / strip joints (that's happening in Ontario) feel like political compromise without any science. These powerful entities will keep their doors open the less powerful will be shutdown meanwhile they all should be shutdown or opened at the same time.
- graeme 6y ago
  Oh they shut those too in quebec, to be clear. Bars restaurants etc
- nostoc 6y ago
  Even if it's somewhat arbitrary which kind of gatherings are still allowed, forbidding half of the gatherings still has an impact on the transmission rate. Which means if you cut out bars but allow churches (max 25 persons in Quebec btw), you still cut down a lot of spreading. I don't agree with keeping religious gatherings, but it doesn't mean there is no science behind these decisions.

minkowski 6y ago

The interesting part of this letter isn't any novel or lucid argument but what it's arguing against, which in the context of the mentioned earlier Ontario Hospital Assocation statement almost comes across as a straw man. The letter spends most of its time arguing against near-total lockdowns such as Ontario experienced from March through June even though almost nobody is currently proposing this - even the OHA statement only advocates a temporary closure of indoor venues such as restaurants and banquet halls in affected areas (albeit including large cities such as Toronto and Ottawa) - with a parenthetical warning about the harms of "rotating" school closures to childrens' health, even though this wasn't really proposed. In fact, the earlier statement explicitly proposed closing food service venues in order to prevent school closures and elective surgery cancellations. Likewise, they mention overdose deaths and social and economic determinants of health as if the broader health sector were oblivious to these or hadn't proposed any solutions. (The current government is quite conservative and broadly opposes overdose prevention, basic income experiments, social housing, etc., so these are unlikely to be realized, so perhaps this is a resigned ultra-realist approach, but in that case, why write it in the first place?) A cynical part of me wonders whether this letter being circulated by CTV (as opposed to the motivations of those signing it, about which I have no idea) isn't just to give political cover on talk radio and TV news for the government's current wait-and-see approach, which health workers (and progressives generally) are against. [Slightly unrelated, but potentially relevant given the "doctors say" headline: the government was recently playing radio advertisements explaining how much it "consulted" with the health sector on safely reopening schools but not mentioning the fact that it ignored the main recommendation of reducing class sizes.]

just-juan-post 6y ago

A wise choice seeing as how the overall fatality rate is less than 0.3% See below: Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence Study Sept 2020, Annals of Internal Medicine https://www.acpjournals.org/doi/10.7326/M20-5352 https://www.acpjournals.org/doi/10.7326/M20-5352 People aged 40 or below have a 0.01% chance of dying. People over the age of 70 have a 1.17% chance of dying. Overall the chance of dying from the virus is 0.26%.

mattigames 6y ago
If only fatalities was the only issue at hand, but millions of people will suffer lasting damage due covid for decades to come
- logicchains 6y ago
  What research paper are you basing that on? Hundreds of millions of people will suffer lasting damage due to poverty and malnutrition resulting from the global economic effects of lockdowns: https://www.washingtonpost.com/world/2020/09/25/pandemic-pushes-hundreds-millions-people-toward-starvation-poverty/ https://www.washingtonpost.com/world/2020/09/25/pandemic-pus...
  - mattigames 6y ago
    Articles: https://www.healthline.com/health-news/lifelong-lung-damage-the-serious-covid-19-complication-that-can-hit-people-in-their-20s#Whos-at-risk https://www.healthline.com/health-news/lifelong-lung-damage-...? https://www.newscientist.com/article/2247086-the-coronavirus-is-leaving-some-people-with-permanent-lung-damage/ https://www.newscientist.com/article/2247086-the-coronavirus... Papers: https://k4.ersnet.org/prod/v2/Front/Program/Session?e=259&session=12607 https://k4.ersnet.org/prod/v2/Front/Program/Session?e=259&se... https://pubs.rsna.org/doi/full/10.1148/radiol.2020200843 https://pubs.rsna.org/doi/full/10.1148/radiol.2020200843 https://www.ajronline.org/doi/pdf/10.2214/AJR.20.22969 https://www.ajronline.org/doi/pdf/10.2214/AJR.20.22969

legulere 6y ago

What a load of bollocks. Countries like Germany have shown that you can keep infection numbers low without harming your economy too much.