> I personally know someone whose father likely died due to being unable to access health care in a timely fashion, as well as someone else who died of cancer after their chemotherapy was postponed. And I also know of two suicides in my extended social group in the past few months. It's tough to pin specific blame on lockdown for things like that. But it's certainly plausible that deaths like that would lead to excess deaths.
Sure, but we can look at when the excess deaths happened. Instead of being evenly distributed across the lockdown period, or peaking towards the end when people had longer without access to support, they came exactly when you'd expect deaths from an epidemic wave to peak before plummeting to normal levels towards the end of the lockdown period. Undoubtedly, individual deaths have resulted from lockdown, but the pattern of excess deaths matches COVID rather than lockdown being behind the aggregate increase.
...but why would excess lockdown deaths happen in a uniformly distributed way? Lockdown itself wasn't applied in a uniform fashion: hospitals figured out pretty quickly that lack of care was killing people and modified policies to mitigate that damage. My own advice to friends and family was "probably best not to go to the hospital for that" in March, and back to normal in April when I realized that the numbers weren't as bad as portrayed. Anecdotally, all of the deaths I mentioned happened close to the beginning of lockdown in their respective countries.
Again, this isn't idle speculation: genuine mainstream health authorities believe lockdown has killed significant numbers of people. This is not a controversial position.
> ...but why would excess lockdown deaths happen in a uniformly distributed way?
No, the question is why does the excess deaths distribution perfectly align with the expected and recorded COVID death spike and drop so sharply afterwards when lockdown was still in place.
It's uncontroversial that lockdown has killed and saved significant numbers of people for reasons other than COVID, but similarly it is entirely uncontroversial that the aggregate increase in excess deaths was caused by COVID. The idea that the inflection point COVID-time-to-death days after the start of lockdown is better explained by unannounced changes in policy or your personal advice to friends and family, on the other hand is about as scientifically credible as blaming 5G.
All of your analysis falls apart at one crucial point: all of the data we have are for Covid19 IFR given the massive lockdowns and dedicated hospital infrastructure.
If you look at regions that were ineffective in handling the spread and had their hospital capacity overwhelmed, mortality jumps through the roof - I think it was higher than 10% in Lombardia before the lockdowns. And remember that hospitals can't work at anywhere close to 100% ICU occupancy for extended periods of time, so if the high inflow persists, mortality is likely to increase much more.
The vast difference between Covid19 and influenza is anyway plain to see if you look at ICU rates, even with all the lockdowns.
So even though your analysis sounds convincing at first read, it is a very bad interpretation of the data. The reality is that Covid19 is a much worse disease than Influenza, and that drastic measures are required to keep it under control (barely).
I am genuinely baffled by the number of people who are slipping around this point. We don’t regularly have hospital ITUs stuffed full of people with influenza, threatening to overwhelm capacity. We don’t generally have city-, region- and country-wide lockdowns where transmission is massively curtailed. Even a very casual look at what happened in different countries makes it clear that this disease has an obviously different character.
It really feels lately like there’s some kind of weird “iamverysmart” syndrome banging around on HN in particular - every single post mentioning COVID is full of these shallow armchair analyses that seem to think rejecting all prevailing wisdom is an inherent good. It’s totally possible to be critical of the global response and analyses of it without this honestly fucking weird assumption that everyone else except you is a mindless sheep.
It's not as simple as that.
Early on, people with low blood oxygen were put on ventilators quickly, which both took a great toll on the system, and didn't help (or even made things worse).
If you look at the graphs now (I looked at 30 countries just an hour ago), you'll see that many countries in Europe have a very visible "second wave", including Denmark, Austria, the UK, France, Spain and even Sweden - but almost no deaths; and unlike the first wave, despite more people diagnosed with SARS-COV-2, much less people need treatment, and there is no lack of beds anywhere (although there is a lot of fatigue, which is a more complicated discussion).
Given you know what to do, such as prawning, vitamin D, and more (and more importantly - what not to do - no early ventilation, for example) - then, we no longer have hospital ICUs stuffed full of people with COVID19 either.
A lot has changed since April, but when I look at arguments, some sides still hold the data from early April (assuming up to 5% IFR, and the Ferguson predictions), while some do not acknowledge that April happened and only look at the stats in Aug-Sep. Not surprisingly, such arguments aren't really converging and each side tends to assume the other side is an idiot or insane.
It's not as simple as that.
I don't know about that. Everything you say is reasonable and not at all an example of the effect I was talking about.
It's totally fine to say "hey it looks like the CFR/IFR is declining because we have better treatment methods". This is a good-faith point, backed up by some easily observable data, and something that can evolve into a discussion about how to effectively manage the disease. It's not a point that I've heard any rational person object to.
It is worth noting though – the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths. This is much better, but those numbers are increasing pretty rapidly and without careful management risks getting out of control.
"hey it looks like the CFR/IFR is declining because we have better treatment methods"
It's a claim not many are making because it's not clear it's really true.
Firstly, the bulk of the falling IFR is due to more widespread testing driving up numbers of known infections and sero-surveys indicating that even more people than that may have been infected. It's not primarily driven by better survival rates, although they did get better.
At this point it seems clear that mass ventilation was a mistake. It was actually killing people rather than saving them because it's a last-ditch resort. COVID wasn't actually deadly enough to justify this and the large scale usage was driven more by the lack of reliable information, the somewhat unusual form of presenting pneumonia in early patients, the belief that it was an extremely deadly virus and the fact that ventilators force all air coming out of the patients lungs through high quality filters, so doctors are trained that ventilation stops infected patients pumping virus into hospitals.
But doctors are smart and pretty quickly figured out that the ventilation was making things worse, that they couldn't keep the hospitals virus-free anyway, and at any rate they were about to run out of the machines so their hands were forced and they had to try something new. After that usage of ventilation went back to more normal policies, with supplemental oxygen being deemed sufficient for even quite extreme cases, because of course almost all cases need little or no hospital treatment.
Meanwhile many drugs were tried and some were hailed as drugs that could help, e.g. remdesivir or hydroxychloroquine. But later on more controlled studies done under calmer conditions concluded they actually seemed to have no effect.
Given this progress of events it's hard to argue that treatment methods actually got better, except in a very technical sense that most people wouldn't really mean. They got better in the sense that they returned to normal for this kind of virus and stopped making the situation worse. If there had been no mass panic at the start it's likely treatments would never have got so extreme to start with.
the UK, as an example, currently already has about 30% of the cases in hospital versus the peak in late April, and about 15% of the deaths
The UK has also quadrupled its testing rate since April. The numbers aren't directly comparable.
without careful management it risks getting out of control
I don't believe that's been proven at all. The analysis was done many times by now: every government intervention tried so far has no correlation with the course of the disease. That means attempts at management have failed and it has in fact been out of control the whole time, but, fortunately for us, our bodies are generally pretty good at fighting diseases except in the last years of our lives or when immunocompromised in some way, so that hasn't led to disaster.
When it comes to hospitalizations and fatality rates, people are talking past each other by only looking at part of the picture. The two main camps I see are:
1) Covid19 is far more deadly, look at all these excess deaths!
2) The IFR is low, about the same as the seasonal flu, so we really didn't need the lockdowns.
Both are half true.
Basically, we have decent herd immunity for existing viruses. Even with an identical IFR, the viruses are acting differently because we lack(ed) any real herd immunity for the new virus - so everyone was getting infected at once, which means everyone getting sick at once and risking overwhelming hospitals (this is the part people in camp 2 miss). On the flip side, because we do have decent herd immunity with existing viruses, either due to prior exposure or vaccine, seasonal flu doesn't spread nearly as far (this is the part people in camp 1 miss). A lot less people getting infected means a lot less people getting sick or dying, which explains the excess death despite the same IFR.
But IFR are not identical. That part is simply lie. It is not just taking part each other.
Seasonal flu has also much different spreading. You are spreading it for very short time and then you get clearly sick. Which makes limiting speed much easier.
Yeah, that was a bit lazy of me, but I was primarily making a point about why the two groups don't seem to be able to agree. That said the IFR does keep getting revised downwards, and last I remember it was still higher, but the same magnitude as seasonal flu.
That's not quite right either.
People in camp (2) don't miss the risk of overwhelmed hospitals. We remember that we were constantly told they were about to be overwhelmed back in April and they never were. Sweden has the lowest ICU capacity in Europe by far, yet never had overwhelmed hospitals despite very visibly turning its back on the policies supposedly required to avoid it. How can this be reconciled with there being genuine risk?
It's apparent when you look at what happened back then that there was no actual risk of anything except running out of ventilators, a problem that was in turn caused by the panic - doctors were told this was a very deadly disease so were putting people on ventilators unnecessarily, partly because ventilation ensures all the air a patient breathes out is filtered, so they thought it was a way to keep hospitals clean. Once doctors realised ventilation was doing more harm than good and the age skews of the patients started to become publicly known, they backed off the ventilator use and there was never any shortage, of either ventilators nor beds.
We don’t regularly have hospital ITUs stuffed full of people with influenza, threatening to overwhelm capacity
Who/where is we, here? Because that's absolutely not true for many countries, where seasonal flu is routinely reported by the press as creating overloaded hospitals. Here are some examples:
https://www.healio.com/news/infectious-disease/20190205/bad-flu-seasons-test-us-hospitals https://www.healio.com/news/infectious-disease/20190205/bad-...
"Bad flu seasons test US hospitals: Hospitals in the United States have implemented new policies based on last year’s severe influenza season, but infectious disease experts agree that America’s health care systems would still be seriously challenged by another bad influenza season."
https://www.independent.co.uk/news/uk/home-news/nhs-winter-pressure-flu-season-capacity-patients-corridors-a-e-vaccine-a8136231.html https://www.independent.co.uk/news/uk/home-news/nhs-winter-p...
"NHS winter pressure: Hospitals report 99 per cent capacity over festive period as flu season looms"
https://www.dailymail.co.uk/health/article-5279685/California-hospitals-looks-like-flu-war-zone.html https://www.dailymail.co.uk/health/article-5279685/Californi...
"Flu drives hospitals into 'war zone' conditions: Tents on the street in California, 'state of emergency' in Alabama, and Boston is using GATORADE to plug shortage of IV drips"
https://www.thelocal.fr/20170111/french-hospitals-stretched-to-capacity-as-flu-spreads https://www.thelocal.fr/20170111/french-hospitals-stretched-...
"Hospitals in France at breaking point as flu epidemic spreads"
etc. Reports like this are common across the world. Partly it's that the press like reporting crisis stories and in any large medical system they can always find health workers willing to give them dramatic quotes. Partly it's that surge capacity is always inherently limited.
every single post mentioning COVID is full of these shallow armchair analyses that seem to think rejecting all prevailing wisdom is an inherent good
I've not seen anyone claim that rejecting all prevailing wisdom is inherently good. That seems like a strawman. The posts arguing about COVID aren't rejecting panic just for the sake of it, they're arguing about it because they disagree that the severity of the problem supports the consequent social policies.
HN is also full of people posting comments decrying the awful people who double check what government officials are claiming against data, facts and logic. Those are equally aggravating to those of us who don't see a problem with critical thinking: especially when the "prevailing wisdom" is a subjective assessment of who thinks what. One that's being seriously distorted by media hype and censorship, to boot. The "wisdom" many governments are listening to is sadly very far from wise.
Certainly in my county, many fewer people are dying even though many more are testing positive. Many more people are getting tested, for job requirements, travel, etc. It results in more positives, naturally. In a county of more than 3 million, we have around 50 in ICU, lowest in many months. As positive tests grow. Two things (at least) might be at work: better treatment is one, the other is that there were far higher numbers of people infected than known, earlier in the year. I’m sure treatment now is better, but I would not be surprised if many more people have been exposed, and have recovered, from this virus than is assumed.
For the US 2018-2019 flu season ( https://www.cdc.gov/flu/about/burden/2018-2019.html https://www.cdc.gov/flu/about/burden/2018-2019.html ):
> CDC estimates that the burden of illness during the 2018–2019 season included an estimated 35.5 million people getting sick with influenza, 16.5 million people going to a health care provider for their illness, 490,600 hospitalizations, and 34,200 deaths from influenza
Covid19 has killed ~220,000 people so far in 2020 in the US.
From the same article you quoted about the epidemic in California (from 2018, mid-January):
> This year's outbreak is on track to becoming one of the worst flu seasons in recent history due to a deadly strand that has so far killed 85 adults and 20 children nationwide as the numbers continue to climb.
Covid19 has killed ~16,000 people so far in 2020 in California.
Related to the UK 2017-18 flu season that saw hospitals stretched ( https://www.theguardian.com/society/2018/jan/18/flu-outbreak-gps-under-huge-pressure-as-deaths-soar-to-120 https://www.theguardian.com/society/2018/jan/18/flu-outbreak... ):
> After 35 more deaths last week, 120 people across the country have died of flu-related symptoms since early October, compared with 45 in the same period in 2016-17.
Covid19 has killed ~43,000 people in the UK so far in 2020.
For the France 2016-2017 flu epidemic ( https://www.researchgate.net/publication/321906828_Influenza_activity_in_France_season_2016-17 https://www.researchgate.net/publication/321906828_Influenza... ):
> During the epidemic wave, a marked excess mortality estimate at 14,400 deaths attributable to influenza was observed.
Covid19 has killed ~34,000 people in France in 2020 so far.
Point being, perhaps it is the old news that were a bit exaggerated; either way, Covid19 is measurably worse than then any recent flu, and this is after extreme lockdown measures compared to any flu pandemic in living memory.
Note: I am fully aware that some of the lower numbers are partial numbers from about the middle of the flu season. Feel free to look up the final numbers for that season as well - they will be at worst half the Covid19 numbers.