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As others say, this is way too much to say "meh", but I do think it needs a rethink of the lockdown strategies. Lockdowns kill people; people with cancer, peop

As others say, this is way too much to say "meh", but I do think it needs a rethink of the lockdown strategies. Lockdowns kill people; people with cancer, people who need surgeries, people who lose income to support themselves. Clearly, so does Covid, and we need to balance it. Can we do better, as societies, if we aggressively protecting old and vulnerable people, and let fitter people continue with their lives? This can avoid the economic collapse of lockdowns, bring about some degree of herd immunity, and yes, trading some lives saved by lockdown for lives saved by "normality". Suppose 70% of the society is under 50, and has a IFR of 0.1%. Take UK (65mn people), and suppose everyone in that group gets it. That would lead to 45k fatalities (very close to what was already experienced), plus herd immunity, and lack of economic collapse. It's clearly not so simple, but it's start. I'm in no position to question the research, but I spoke once to a professor of respiratory diseases at UCL, who quoted that mild Covid cases often do not register in antibody testing (for reasons unclear), so I wonder if even the 0.3% is an overestimate.

claudeganon 6y ago
> Lockdowns kill people Agreed. But what causes lockdowns? An uncontrolled pandemic. What does uncontrolled pandemic also cause? Collapse of healthcare infrastructure, which is a civil emergency that also results in countless deaths. Lockdowns, as implemented in places like the US, are a reactive measure because of a system-wide failure to adopt and maintain proactive measures needed to control things. You don’t arrive at “herd immunity” without them, but mass deaths, both from the disease and being unable to receive other routine or emergency healthcare.
- rich_sasha 6y ago
  I'm not demonizing lockdowns. They have a use, for sure, and they save lives. I just mean, they have their own downsides too, and we should use new data to evaluate how we implement them. It is now clear societies cannot really afford full, long-term, unconditional lockdowns. We have to pick and choose what we do, stratifying by age/health conditions seems a good way about it to me.
  - claudeganon 6y ago
    Nowhere outside of places New Zealand and Taiwan has had long-term, unconditional lockdowns, and nowhere in the US has reached anywhere near this level of restrictions. I live in a state that ostensibly had “extreme” lockdowns and whole cities and communities decided themselves exempt from the orders with zero consequences. It’s also impossible to stratify people on the basis of health in the US because not everyone is cognizant of their health status or risk factors, certainly the government has no insight into these beyond the crudest levels. Age also doesn’t really work because the lack of social safety nets mean older workers have to remain employed or rely on younger cohorts in order to survive.
    - rich_sasha 6y ago
      UK put everyone who cannot work due to Covid on 80% of their salary (sort of). So surely it could do that to a smaller cohort too. That US cannot do it is no reason to not consider it.
      - claudeganon 6y ago
        Oh, certainly. Apologies for my US-centric framing. I hope the rest of the world follows South Korea, Taiwan, Vietnam’s example and not our’s. South Korea has only had limited, regional lockdowns and never closed their borders. If everyone followed their examples, lockdowns would likely be unnecessary to begin with.
      - makomk 6y ago
        The UK did this once. It's probably not going to happen again, certainly not on such generous terms, and one lockdown was not enough to stop Covid - just to delay it until right on top of the winter flu season.
hef19898 6y ago
Depends on the social security network, doesn't it?
- rich_sasha 6y ago
  It does. This is part of what I mean: if say 70% of the country can go about its business as normal, this frees a lot of resources for the state to help the remaining 30%. Stable-ish economies can foot the bill for this as well. Simply caching away the unfit is not what I meant.
  - hef19898 6y ago
    Me neither. In Europe we are lucky enough that most countries can maintain social networks for quite a while despite having mass unemployment and the like. But this only buys time. Hopefully enough.
lima 6y ago
There's plenty of evidence of long-term damage even in young and barely symptomatic cases - it's not a binary "dead/not dead" outcome. What if the virus causes substantial disease burden years to decades down the road? We can't know, and should take every precaution to prevent its spread.
- logicchains 6y ago
  For example? I haven't seen a single paper showing such long-term consequences in healthy people are significantly more likely than from other viral infections. We'd especially expect to be seeing a large number of such cases in Sweden, should it be common, given they had no lockdown and a large number of infections.
  - lima 6y ago
    It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious. This is like saying "COVID isn't worse than the flu" - even if it was true, having another flu-sized disease burden would already be bad, so it's a bit of a weird goalpost. That being said, there's a lot of literature describing post-covid symptomes and hypothesized mechanisms of action, like [1]. The virus has been around for less than a year, so a quantitative comparison with something we have studied for decades makes no sense. [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/
    - logicchains 6y ago
      >It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious. But it does make it highly inconsistent to adopt policies so extremely destructive to economic and mental health when the same wasn't done for other viruses with similar long-term effects.
      - 6y ago
nradov 6y ago
Antibody tests do miss many cases, especially those with mild or no symptoms. Some patients are able to fight off the infection before antibodies are produced, or antibody production fades away quickly. https://www.bmj.com/content/370/bmj.m3364 https://www.bmj.com/content/370/bmj.m3364
mrkurt 6y ago
The sad reality is that broad, indiscriminate lockdowns are the only real tool available to some "world powers". We know we can manage the covid pandemic with ubiquitous testing and targeted temporary lockdowns. But there is no testing capacity. Which means ... it's not really possible to rethink the lockdown strategies. Given a choice between a thing that directly kills people, and something that more people die from in indirect ways, people are always going to default to preventing the direct deaths.
- logicchains 6y ago
  It's not even clear that lockdowns prevent deaths. A recent peer-reviewed study found lockdowns aren't associated with a statistically significant decrease in the number of deaths; what matters is social distancing: https://www.jpost.com/israel-news/social-distancing-more-important-than-lockdowns-in-covid-19-fight-tau-644754 https://www.jpost.com/israel-news/social-distancing-more-imp...
- rich_sasha 6y ago
  It feels to me in some cases there is a bit of a point of principle here: "look, we're inflicting so much pain on everyone, just to make sure you're safe". If an evil alien race came and threatened to kill everyone unless we isolate everyone over 45, I'm sure humanity could do it. If we can't be smart about fighting the pandemic, that's a super sad statement about humanity's ingenuity.
- dx87 6y ago
  We could do age-based lockdowns. Stores near me have ~2 hour periods in the day where you can only shop if you're 65+, I don't see why they can't make that the only time 65+ people are allowed to enter.
- makomk 6y ago
  One of the more... interesting things about Covid-19 is that the countries everyone thinks are stuck with indiscriminate lockdown as their only tool due to lack of testing capacity actually have the most testing capacity, and the one everyone points to as a mass testing success story has about an order of magnitude less in per capita terms and is likely severely limited in their ability to actually detect cases as a result. It's the result of cached facts from like 6 months ago that have never been refeshed because the media have carefully avoided drawing attention to the new information in order to preserve their narrative, whilst using language that leads people to think it's still true.
thrav 6y ago
This is more or less what Texas has decided to do. I’m in California, but my entire family is there, and many of my younger family members are going about their lives relatively normally. At least one of my cousins caught it and their whole young family (parents 30’s, kids <10) were fine. My 90+ year old grandparents are obviously being kept very isolated. Their kids (my parents’ generation - 60’s) are being careful, but not cancelling their entire 2020. Everybody hated on Texas because of the Lt. Governor’s over the top declaration of sacrificing grandparents for the economy, but there are definitely aspects of their approach that I prefer to what’s happened in California.
- segmondy 6y ago
  You have no idea how it would affect you or your family members until it does. This person lost 8 family members. https://www.cnn.com/2020/10/14/us/phoenix-arizona-aguirre-family-covid-deaths/index.html https://www.cnn.com/2020/10/14/us/phoenix-arizona-aguirre-fa...
  - gridlockd 6y ago
    "Then, despite all precautions against the virus, a family member got sick. Then another and another and another. Now, seven months after the shutdown, seven people in Ricardo Aguirre's extended family and his father, Jesús, 67, have died of Covid-19 complications." Two observations: First, this happened despite all precautions. Secondly, extended families can be hundreds of people, including many elderly. Lastly, in a large-enough population you will inevitably find clusters that are more affected by some illness than the average person. That's why you need to observe solid data, not a media spectacle, to come to rational conclusions.
    - drran 6y ago
      > First, this happened despite all precautions ... in this family.
- nradov 6y ago
  Florida went even further and removed all state level lockdown orders on September 25. So far it's too early to tell what effect that will have on the death rate. Case numbers are roughly flat. https://www.worldometers.info/coronavirus/usa/florida/ https://www.worldometers.info/coronavirus/usa/florida/ I'm not advocating for other states to follow Florida's approach. But it serves as a natural experiment. Depending on what happens to their daily death rate over the next couple weeks that will tell us a lot about the effectiveness (or lack thereof) of lockdowns.
tdfx 6y ago
This same comment posted 3 or 4 months ago would have been downvoted into oblivion. Now it's the top comment on this article. It's good to see peoples' perspective is becoming more reasonable on this issue.
- rich_sasha 6y ago
  It was! I just refuse to optimise my posting for karma...
bearjaws 6y ago
Only two states have continued preventing elective surgeries, one state (Texas) that was overwhelmed stopped but has since re-allowed them. Around 60,000 cancer patients will be under-treated due to corona virus. The current estimates are that 10,000 people will die due to missed treatment. Just for the "fun" of it, lets assume all of them died due to under-treatment, that is still 1/4th the death toll of the virus itself. If the goal is fewer deaths, why don't we encourage more treatment AND continue practicing social distancing? We can have both in this case. I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid...
- rich_sasha 6y ago
  In Poland, cancer prevention literally got obliterated this year. That's thousands people whose cancers could be found early and treated, but won't be. That's not to mention any other long-term disease. Just the GDP drop, and the ensuing under-financing of healthcare etc, I think may well easily kill more people than Covid.
- logicchains 6y ago
  >I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid... Are you sure? The economic fallout of lockdowns is pushing millions of people in poorer countries into poverty, and causing thousands of children to starve: https://www.france24.com/en/20200728-coronavirus-linked-hunger-kills-10-000-children-per-month-says-un https://www.france24.com/en/20200728-coronavirus-linked-hung...
- gridlockd 6y ago
  In medicine, people like to talk about quality-of-life-adjusted years. Why? Because there's no point in making somebody live more years that are subjectively bad (e.g due to treatment side-effects), rather than less years that are subjectively good. When it comes to policy-making that affects us all, it's time to extend that to the collective level. We need to ask ourselves, how much suffering can younger generations be expected to endure to make the older generations live statistically a bit longer? Remember, the average COVID death is in their eighties, which is already beyond life expectancy.
jmull 6y ago
You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people? > and lack of economic collapse In your model you’re calling for a strong lockdown of 30% of the population. How is that not going to have a powerful negative impact on the economy? Also, as a practical matter, I doubt society will accept a strategy that minimizes the impact of covid-19 on one group of people at the expense of another group of people when the other group of people are politically powerful (and, not incidentally, a great number of various types of leaders are part of the other group).
- bitcurious 6y ago
  > You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people? > In your model you’re calling for a strong lockdown of 30% of the population Why ask a question and then assume an answer? Precautionary measures for the elderly can be food delivery, direct financial support, free N95 masks, free healthcare, priority vaccination, etc.
  - jmull 6y ago
    Food delivery and direct financial support don’t protect people from getting covid by themselves. They would help people isolate... so you’re still talking about locking people down to protect them. Free N95 masks would help to the extent it increases the number of people wearing them. But that’s hardly aggressive. Aggressive would be mandating that old/vulnerable people wear masks (which is another form of lockdown). Free healthcare would help with the financial situation of those that get the virus and survive, which isn’t exactly the goal. Priority vaccination... well, there is no safe and effective vaccine. Maybe that will be a good path six months from now. But if we had one, the goal would be to vaccinate everyone. Priority would be nice, but would ultimately only shorten the months-long window for infection (vs those without priority) by a matter of weeks. So that would be helpful, but not a game changer.

claudeganon 6y ago

> Lockdowns kill people Agreed. But what causes lockdowns? An uncontrolled pandemic. What does uncontrolled pandemic also cause? Collapse of healthcare infrastructure, which is a civil emergency that also results in countless deaths. Lockdowns, as implemented in places like the US, are a reactive measure because of a system-wide failure to adopt and maintain proactive measures needed to control things. You don’t arrive at “herd immunity” without them, but mass deaths, both from the disease and being unable to receive other routine or emergency healthcare.

rich_sasha 6y ago
I'm not demonizing lockdowns. They have a use, for sure, and they save lives. I just mean, they have their own downsides too, and we should use new data to evaluate how we implement them. It is now clear societies cannot really afford full, long-term, unconditional lockdowns. We have to pick and choose what we do, stratifying by age/health conditions seems a good way about it to me.
- claudeganon 6y ago
  Nowhere outside of places New Zealand and Taiwan has had long-term, unconditional lockdowns, and nowhere in the US has reached anywhere near this level of restrictions. I live in a state that ostensibly had “extreme” lockdowns and whole cities and communities decided themselves exempt from the orders with zero consequences. It’s also impossible to stratify people on the basis of health in the US because not everyone is cognizant of their health status or risk factors, certainly the government has no insight into these beyond the crudest levels. Age also doesn’t really work because the lack of social safety nets mean older workers have to remain employed or rely on younger cohorts in order to survive.
  - rich_sasha 6y ago
    UK put everyone who cannot work due to Covid on 80% of their salary (sort of). So surely it could do that to a smaller cohort too. That US cannot do it is no reason to not consider it.
    - claudeganon 6y ago
      Oh, certainly. Apologies for my US-centric framing. I hope the rest of the world follows South Korea, Taiwan, Vietnam’s example and not our’s. South Korea has only had limited, regional lockdowns and never closed their borders. If everyone followed their examples, lockdowns would likely be unnecessary to begin with.
    - makomk 6y ago
      The UK did this once. It's probably not going to happen again, certainly not on such generous terms, and one lockdown was not enough to stop Covid - just to delay it until right on top of the winter flu season.

hef19898 6y ago

Depends on the social security network, doesn't it?

rich_sasha 6y ago
It does. This is part of what I mean: if say 70% of the country can go about its business as normal, this frees a lot of resources for the state to help the remaining 30%. Stable-ish economies can foot the bill for this as well. Simply caching away the unfit is not what I meant.
- hef19898 6y ago
  Me neither. In Europe we are lucky enough that most countries can maintain social networks for quite a while despite having mass unemployment and the like. But this only buys time. Hopefully enough.

lima 6y ago

There's plenty of evidence of long-term damage even in young and barely symptomatic cases - it's not a binary "dead/not dead" outcome. What if the virus causes substantial disease burden years to decades down the road? We can't know, and should take every precaution to prevent its spread.

logicchains 6y ago
For example? I haven't seen a single paper showing such long-term consequences in healthy people are significantly more likely than from other viral infections. We'd especially expect to be seeing a large number of such cases in Sweden, should it be common, given they had no lockdown and a large number of infections.
- lima 6y ago
  It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious. This is like saying "COVID isn't worse than the flu" - even if it was true, having another flu-sized disease burden would already be bad, so it's a bit of a weird goalpost. That being said, there's a lot of literature describing post-covid symptomes and hypothesized mechanisms of action, like [1]. The virus has been around for less than a year, so a quantitative comparison with something we have studied for decades makes no sense. [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320866/
  - logicchains 6y ago
    >It doesn't even have to be worse than post-viral syndrome caused by other severe viral infections for it to be a problem. There's little immunity to COVID-19 and it's highly contagious. But it does make it highly inconsistent to adopt policies so extremely destructive to economic and mental health when the same wasn't done for other viruses with similar long-term effects.
    - 6y ago

nradov 6y ago

Antibody tests do miss many cases, especially those with mild or no symptoms. Some patients are able to fight off the infection before antibodies are produced, or antibody production fades away quickly. https://www.bmj.com/content/370/bmj.m3364 https://www.bmj.com/content/370/bmj.m3364

mrkurt 6y ago

The sad reality is that broad, indiscriminate lockdowns are the only real tool available to some "world powers". We know we can manage the covid pandemic with ubiquitous testing and targeted temporary lockdowns. But there is no testing capacity. Which means ... it's not really possible to rethink the lockdown strategies. Given a choice between a thing that directly kills people, and something that more people die from in indirect ways, people are always going to default to preventing the direct deaths.

logicchains 6y ago
It's not even clear that lockdowns prevent deaths. A recent peer-reviewed study found lockdowns aren't associated with a statistically significant decrease in the number of deaths; what matters is social distancing: https://www.jpost.com/israel-news/social-distancing-more-important-than-lockdowns-in-covid-19-fight-tau-644754 https://www.jpost.com/israel-news/social-distancing-more-imp...
rich_sasha 6y ago
It feels to me in some cases there is a bit of a point of principle here: "look, we're inflicting so much pain on everyone, just to make sure you're safe". If an evil alien race came and threatened to kill everyone unless we isolate everyone over 45, I'm sure humanity could do it. If we can't be smart about fighting the pandemic, that's a super sad statement about humanity's ingenuity.
dx87 6y ago
We could do age-based lockdowns. Stores near me have ~2 hour periods in the day where you can only shop if you're 65+, I don't see why they can't make that the only time 65+ people are allowed to enter.
makomk 6y ago
One of the more... interesting things about Covid-19 is that the countries everyone thinks are stuck with indiscriminate lockdown as their only tool due to lack of testing capacity actually have the most testing capacity, and the one everyone points to as a mass testing success story has about an order of magnitude less in per capita terms and is likely severely limited in their ability to actually detect cases as a result. It's the result of cached facts from like 6 months ago that have never been refeshed because the media have carefully avoided drawing attention to the new information in order to preserve their narrative, whilst using language that leads people to think it's still true.

thrav 6y ago

This is more or less what Texas has decided to do. I’m in California, but my entire family is there, and many of my younger family members are going about their lives relatively normally. At least one of my cousins caught it and their whole young family (parents 30’s, kids <10) were fine. My 90+ year old grandparents are obviously being kept very isolated. Their kids (my parents’ generation - 60’s) are being careful, but not cancelling their entire 2020. Everybody hated on Texas because of the Lt. Governor’s over the top declaration of sacrificing grandparents for the economy, but there are definitely aspects of their approach that I prefer to what’s happened in California.

segmondy 6y ago
You have no idea how it would affect you or your family members until it does. This person lost 8 family members. https://www.cnn.com/2020/10/14/us/phoenix-arizona-aguirre-family-covid-deaths/index.html https://www.cnn.com/2020/10/14/us/phoenix-arizona-aguirre-fa...
- gridlockd 6y ago
  "Then, despite all precautions against the virus, a family member got sick. Then another and another and another. Now, seven months after the shutdown, seven people in Ricardo Aguirre's extended family and his father, Jesús, 67, have died of Covid-19 complications." Two observations: First, this happened despite all precautions. Secondly, extended families can be hundreds of people, including many elderly. Lastly, in a large-enough population you will inevitably find clusters that are more affected by some illness than the average person. That's why you need to observe solid data, not a media spectacle, to come to rational conclusions.
  - drran 6y ago
    > First, this happened despite all precautions ... in this family.
nradov 6y ago
Florida went even further and removed all state level lockdown orders on September 25. So far it's too early to tell what effect that will have on the death rate. Case numbers are roughly flat. https://www.worldometers.info/coronavirus/usa/florida/ https://www.worldometers.info/coronavirus/usa/florida/ I'm not advocating for other states to follow Florida's approach. But it serves as a natural experiment. Depending on what happens to their daily death rate over the next couple weeks that will tell us a lot about the effectiveness (or lack thereof) of lockdowns.

tdfx 6y ago

This same comment posted 3 or 4 months ago would have been downvoted into oblivion. Now it's the top comment on this article. It's good to see peoples' perspective is becoming more reasonable on this issue.

rich_sasha 6y ago
It was! I just refuse to optimise my posting for karma...

bearjaws 6y ago

Only two states have continued preventing elective surgeries, one state (Texas) that was overwhelmed stopped but has since re-allowed them. Around 60,000 cancer patients will be under-treated due to corona virus. The current estimates are that 10,000 people will die due to missed treatment. Just for the "fun" of it, lets assume all of them died due to under-treatment, that is still 1/4th the death toll of the virus itself. If the goal is fewer deaths, why don't we encourage more treatment AND continue practicing social distancing? We can have both in this case. I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid...

rich_sasha 6y ago
In Poland, cancer prevention literally got obliterated this year. That's thousands people whose cancers could be found early and treated, but won't be. That's not to mention any other long-term disease. Just the GDP drop, and the ensuing under-financing of healthcare etc, I think may well easily kill more people than Covid.
logicchains 6y ago
>I am 100% sure that the number of people who have died due to the lock down is a tiny fraction of those that have died of covid... Are you sure? The economic fallout of lockdowns is pushing millions of people in poorer countries into poverty, and causing thousands of children to starve: https://www.france24.com/en/20200728-coronavirus-linked-hunger-kills-10-000-children-per-month-says-un https://www.france24.com/en/20200728-coronavirus-linked-hung...
gridlockd 6y ago
In medicine, people like to talk about quality-of-life-adjusted years. Why? Because there's no point in making somebody live more years that are subjectively bad (e.g due to treatment side-effects), rather than less years that are subjectively good. When it comes to policy-making that affects us all, it's time to extend that to the collective level. We need to ask ourselves, how much suffering can younger generations be expected to endure to make the older generations live statistically a bit longer? Remember, the average COVID death is in their eighties, which is already beyond life expectancy.

jmull 6y ago

You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people? > and lack of economic collapse In your model you’re calling for a strong lockdown of 30% of the population. How is that not going to have a powerful negative impact on the economy? Also, as a practical matter, I doubt society will accept a strategy that minimizes the impact of covid-19 on one group of people at the expense of another group of people when the other group of people are politically powerful (and, not incidentally, a great number of various types of leaders are part of the other group).

bitcurious 6y ago
> You’re proposing “aggressively protecting old and vulnerable people”. ...so does that not mean a strong lockdown for those people? > In your model you’re calling for a strong lockdown of 30% of the population Why ask a question and then assume an answer? Precautionary measures for the elderly can be food delivery, direct financial support, free N95 masks, free healthcare, priority vaccination, etc.
- jmull 6y ago
  Food delivery and direct financial support don’t protect people from getting covid by themselves. They would help people isolate... so you’re still talking about locking people down to protect them. Free N95 masks would help to the extent it increases the number of people wearing them. But that’s hardly aggressive. Aggressive would be mandating that old/vulnerable people wear masks (which is another form of lockdown). Free healthcare would help with the financial situation of those that get the virus and survive, which isn’t exactly the goal. Priority vaccination... well, there is no safe and effective vaccine. Maybe that will be a good path six months from now. But if we had one, the goal would be to vaccinate everyone. Priority would be nice, but would ultimately only shorten the months-long window for infection (vs those without priority) by a matter of weeks. So that would be helpful, but not a game changer.