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This has me a bit confused: I look at the stats on cases and deaths per capita across various U.S. states, including California (which was very locked down, at

This has me a bit confused: I look at the stats on cases and deaths per capita across various U.S. states, including California (which was very locked down, at least in theory) and Florida (which was flippant towards risks of contagion), and many states in between. The per capita cases+deaths are nearly identical across many states with very different approaches. This left me really wondering which measures were and weren't necessary. Anyone seen good studies or analysis on this? Legitimate question, please no political commentary.

xwolfi 5y ago
Either you lock people downs and those would reject it will go out nonetheless. Or you don't and people who are at risk will lock themselves down. There's no particular benefit to one or the other so states do what match their current constituents. And that's exactly what you'd expect in a democracy.
vmception 5y ago
No state had an optimal viral mitigation strategy. The optimal strategy being impractical or even impossible. Densely populated places that would have acted flippantly would have been much worse. Densely populated places with mixed unit housing had hurt themselves with the strategy they chose. So basically California and New York could just barely keep numbers as close to Florida numbers by locking down hard. The methods California and New York chose could have been even more optimized, but not possible for a US government to do.
amanaplanacanal 5y ago
Where I live, the restrictions have explicitly been tuned so as to not overwhelm hospital facilities. Minimizing deaths was not a stated goal. They measured new cases and how many hospital bed were available, then adjusted restrictions accordingly per County. So for example, you might see no indoor dining in one County, but indoor dining allowed at 25% capacity the next County over. They seem to have done a pretty good job given the stated goal.
melling 5y ago
People are lumping the numbers together for the entire pandemic. During the first wave New York and New Jersey got hit really hard. Basically, it was too late to do anything.
NicoJuicy 5y ago
I think you should population density as a variable. You could be less restrictive in a rural area, while the same policies would have been very harmful in cities.
mattnewton 5y ago
I don’t have anything to add except that California is huge and very unevenly applied “lockdown” - there are many towns a where businesses remained open or reopened frequently, but the big cities did have large shelter in place efforts. It would be interesting to compare on the municipal level if the data was that granular.
- dubyah 5y ago
  Low income / essential workers & overcrowded homes are a far more significant factor that often go unmentioned when people try to compare the outcomes between state & municipal public health interventions. This was observed well before the winter surge. https://calmatters.org/projects/overcrowded-housing-california-coronavirus-essential-worker/ https://calmatters.org/projects/overcrowded-housing-californ... How do you isolate when there's more members than actual rooms in the home & only one one restroom?
- shoguning 5y ago
  According to a study in PNAS, shelter-in-place policies in the US did not work: https://www.pnas.org/content/118/15/e2019706118 https://www.pnas.org/content/118/15/e2019706118 Another study in Eur J Clin Inv had similar findings comparing countries: https://onlinelibrary.wiley.com/doi/10.1111/eci.13484 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484 COVID went wild basically everywhere. There were a few strong exceptions: China (apparently), Australia, New Zealand and some others. What these had in common was very strict police enforcement, which led to some dramatic scenes like people getting welded into their houses in China, or houses in Australia getting broken into by police on suspicion of too many people gathering. In my _opinion_, lockdowns didn't work elsewhere because most cases are not from casual public transmission in places like stores, restaurants etc. Rather, events like kickbacks, dinner parties, and practices like in-home workers (nannies, cleaners etc) continued throughout the pandemic, or resumed shortly after the original March 2020 shockwave. While strident police enforcement of physical distancing could eliminate cases, and seemed to in a few places, the half measures used by most of the world did little-to-nothing positive while being an economic and cultural disaster. Personally, I never caught COVID and rarely socialized during the pandemic. All the cases I heard of stemmed from the kind of thing I mention above: private dinner parties, nannies and so forth, rather than casual public transmission. You, or any individual may have taken social distancing seriously but it's clear many or most did not, including people on both political "sides", up to and including governors, members of congress etc.
ceejayoz 5y ago
I suspect there’ll be decades worth of study of this. Hopefully it’ll help the next time.
- Fomite 5y ago
  I'm an infectious disease epidemiologist, and there absolutely will be decades spend unravelling this. To address the parent question - one thing to keep in mind is that states are extremely heterogeneous, and "Did or did not lock down/mask mandate/etc." isn't actually a binary variable, but a very difficult to measure continuous response of both policy and compliance.
soared 5y ago
To really understand it you’d need to look at cultural, geographic, climate, demographic, etc differences that apply to transmission rates. I’d be curious to see it though, and a similar one for other illnesses.
stolenmerch 5y ago
https://twitter.com/IAmTheActualET/status/1390368965994631175 https://twitter.com/IAmTheActualET/status/139036896599463117...
- kennywinker 5y ago
  There is literally no such thing as a red state or a blue state, so not surprising it doesn't map to anything.
  - api 5y ago
    It's almost perfectly urban vs. rural. Urban areas in "red" states are generally blue, and vice versa. "Blue states" are just those with mostly urban populations. It became more extreme during the Trump era with many historically red suburbs around cities turning blue and some rural areas turning more red.
MattGaiser 5y ago
You would need to look at everything from ages to whether the lockdowns where enforced to how people lived (high or low density) to how deaths were counted. It would be an interesting study.
andrei_says_ 5y ago
Count of covid cases and deaths has been highly politicized and manipulated in Florida to the point of firing people for reporting them. Not sure how possible it is to get accurate info in this environment.
- jmahyoung 5y ago
  Somewhat related, on the opposite point. Elon Musk among others said the counting of deaths was manipulated upwards, with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already. I think there is a desire to overcount which must not be glossed over either.
  - belltaco 5y ago
    >I think there is a desire to overcount which must not be glossed over either So there was overcounting, but somehow excess mortality in 2020-2021 is higher than in normal years? How? >with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already A high percentage of people in the US have "serious health conditions" like diabetes, obesity, high blood pressure etc. If Covid accelerated their deaths then it should be counted as a covid death because they would likely be otherwise alive now. If you want to get pedantic there's a measure called QALY(quality adjusted life years). Musk said there would be zero cases in the US by April 2020 among other dumb predictions, so I don't think he's the best person to go to for Covid related information since his domain is technology and not epidemiology. https://www.forbes.com/sites/joewalsh/2021/03/13/elon-musks-false-covid-predictions-a-timeline/?sh=5acaf495b6d2 https://www.forbes.com/sites/joewalsh/2021/03/13/elon-musks-...
    - briandear 5y ago
      > So there was overcounting, but somehow excess mortality in 2020-2021 is higher than in normal years? How? People dying of heart attacks because they didn’t seek timely care because of fear of going to the hospital. Medical screenings postponed. Undetected cancers. Suicides. There is a direct correlation between unemployment rates and disease. My annual physical, due in July 2020 was cancelled. How many other people’s were as well? Also one also should note increases in deaths of despair. That’s a real thing. Excess deaths can’t be called “covid,” without proof that they were. How would else know Covid was the cause and not the flu? Are we just assuming excess deaths were Covid? The uncomfortable truth is that lockdown proponents don’t want to admit that their policies may have caused more damage than the disease from which they were claiming to protect us. I don’t know the answer. My point is that excess deaths aren’t necessarily Covid deaths. That’s an assumption, not a fact.
jeffbee 5y ago
I think the flaw in this premise is believing that the regulations promulgated at the state level had any real impact on the public response. It's not the "lockdown" that keeps people at home, it's the disease. In some states they did not order restaurants to close, but that doesn't imply that attendance at restaurants in those places was normal.
- chmod600 5y ago
  Schools in Florida have been open since last fall. That's a pretty huge difference, with little difference in pandemic deaths.
danenania 5y ago
I've always thought the main driver of spread was probably not the political football issues like masks in public and businesses being open or closed, but what people are doing behind closed doors with family and friends. Lockdowns don't have much effect on this.
- clairity 5y ago
  exactly. the measures were always about keeping us simultaneously busy and anxious and not about their actual effectiveness. it’s been so frustrating to see discussion after discussion about the minutiae of masking when they’re so minor to the overall picture. what mattered above all was indoor, familiar social proximity (where we’d be most likely to be exchanging spit for prolonged periods), exactly where our strong social norms dictate the least amount of vigilance.
  - danenania 5y ago
    I think the intentions were good, but it's also probably true that public health officials have been reluctant to admit when there just wasn't much they could do about the situation that would make a major difference, save for employing totalitarian enforcement measures that no one wanted. Masks in public are not all that burdensome, so imo the mandates were reasonable regardless of the actual impact, but I wish they would have re-evaluated closing businesses a lot sooner, since that did a ton of economic damage, and the benefit there seems very questionable. I doubt the CA statistics would have been any different if they had never banned outdoor dining, for instance, or even just kept most businesses running normally but with an indoor mask requirement. Comparing CA to TX and FL, it's also pretty hard now to argue that closing playgrounds and schools made much difference either, and that has had a severely negative impact on kids. I understand doing it in the first place when everything was unknown, but they should have been quicker to revise in response to new information.
    - clairity 5y ago
      outside of the totalitarian choices, which were entirely untenable in the US, we really had no good options to slow, much less stop, the pandemic. nearly all of it was theater. the best mitigation would have been to get people to generally distance around familiars indoors and don a mask if you’re going to spend time in close proximity or face-to-face for a while. that would have required families to treat each other as threats rather than safeties, which is why that was not tenable. it’s so much easier to treat strangers as threats. this best mitigation would have led us to violate a visceral belief about the world, creating significant cognitive dissonance, and that’s why we instead focused so much on ineffective measures to protect ourselves from strangers with masks and lockdowns that didn’t tackle the core infection vector through familiars. it’s really not that difficult to unravel what was happening, even at the beginning. watching us dance around this elephant in the room as if it didn’t exist has been no less than maddening.
LogicX 5y ago
I’ve asked myself this question. I have no hard data to back this up, but wonder If it’s related to outside time and vitamin D absorption, which seems to have an affect on covid. Ex: did NYC have a tougher time than Florida as a result of this, and even with all the protocols in NYC, they could do only as well as Florida with no rules.
- taxicabjesus 5y ago
  NYC has a combined sewer system [0] [1] that overflows when it rains more than .... ~1/10 of an inch per hour (iirc). The fecal-> aerosol transmission route is certainly very important: https://news.ycombinator.com/item?id=27156256 https://news.ycombinator.com/item?id=27156256 "Who do you share a bathroom with" is very important for tracking transmission. In NYC, everyone shares a bathroom. [0] https://www1.nyc.gov/site/dep/water/combined-sewer-overflows.page https://www1.nyc.gov/site/dep/water/combined-sewer-overflows... [1] https://www.riverkeeper.org/campaigns/stop-polluters/sewage-contamination/cso/ https://www.riverkeeper.org/campaigns/stop-polluters/sewage-...
candu 5y ago
IMHO if you want to understand what an effective response looks like - don't look at North America or Europe. Think Vietnam, Australia, New Zealand, and many parts of Africa, all of which had vastly better outcomes. Of course, I'm not an epidemiologist or public health expert, so while I have some guesses I'm not sure what exactly they did that was more effective - but there's no question that it was more effective. If I was going to look for case studies to understand what to do next time, I'd start there. If I was going to look for case studies to understand what not to do next time, well...
- NicoJuicy 5y ago
  Those places all have low population density or are literally islands, that's not comparable at all.
- t8e56vd4ih 5y ago
  > Of course, I'm not an epidemiologist and no geographer either apparently :D
  - TheRealSteel 5y ago
    What do you mean?
    - danenania 5y ago
      It doesn't account for Africa, but many of best-performing countries have been island countries (Australia, NZ, Taiwan, Iceland, etc.). Islands have some fairly obvious advantages in fighting a pandemic, and it shows in the statistics. I believe Hawaii has also done much better than other US states. I'm not sure whether that's what the comment was referring to though.
      - octodog 5y ago
        None of Thailand, Vietnam and Mongolia are islands and their handling of covid is world class compared to parts of Europe and the US. These countries are also far poorer and in the case of Thailand especially that has been a major contributing factor, as they've been less able to afford closing their country to tourism.
deleted 5y ago
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codelord 5y ago
This is from earlier: https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/ https://www.cebm.net/covid-19/excess-mortality-across-countr... Interestingly Sweden that got famous for defying lockdowns saw an uptick of 1.5% excess mortality per 100K people compared to 12.9% for the US that was relatively more locked down. I'm not sure what to make of it, but it sure is an interesting data point.
- aaronblohowiak 5y ago
  I would not typify the US as "mostly locked down"
  - scrollaway 5y ago
    Indeed, and Sweden also had the benefit of the lockdowns in the rest of Europe. I don't think you can compare Sweden to the entirety of the US. A single state maybe.
  - jmahyoung 5y ago
    Would you typify the US as more Locked Down than Sweden? Because their numbers are better. If their approach was worse why are their numbers not worse?
    - nicoburns 5y ago
      I've heard it suggested that there was a lot of voluntary distancing and othet measures taken in sweden. It wouldn't suprise me if there was more actual distancing in "not locked down" sweden than in "locked down" US. But perhaps the protests etc I've seen on TV wetrre exagerated?
    - raydev 5y ago
      Fewer travellers in and out of Sweden.
- AptExtrapolatio 5y ago
  Simple. US has obesity as a significant comorbidity factor.
kortex 5y ago
You would likely need to look at county by county data. Austin TX is probably closer to Albany NY behaviorally, than it is to Kent County TX. Schoharie County NY is probably closer to your average TX county. America isn't red state vs blue state, it's rural vs urban.
marcosdumay 5y ago
What is more likely is that the name of the interventions had very little correlation with the features that actually matter. Just because 2 places declare a "lockdown", it doesn't mean that they are doing any similar policy.
PeterisP 5y ago
One aspect is that IIRC California got a much earlier spread than Florida, so any measures taken in Florida to reduce the spread (including by people on their own initiative) effectively happened at an earlier stage.
orblivion 5y ago
It seemed like a lot of the states that did well despite opening early were southern states where it isn't really winter when it's winter. Also I've heard the claim that (to be as apolitical as I can here) in Florida they secured the elderly population more quickly and carefully than in New York. You may want to look into that claim.
- wernercd 5y ago
  I'd say "Florida secured their elderly population more quickly and carefully than in New York" misses the fact that New York ACTIVELY put its elderly in harms way by requiring nursing homes take patients. If New York ONLY ignored the problem that'd be one thing... but they actively made decisions that led to a large number of deaths - and more importantly those decisions were AGAINST the CDC guidelines.
  - orblivion 5y ago
    Heh, well there you go. I wanted to avoid that point to avoid politics (per the OP's request), but yes. Also I think I heard NY wasn't the only state that did this.
    - exegete 5y ago
      NJ also did this
      - EricE 5y ago
        Michigan too. all with disastrous results.
    - wernercd 5y ago
      Well, truth be told, I didn't bring up the politics of it.. just the simple truth. WHY they made the decisions is a rabbit hole... but the facts are simple.
  - belltaco 5y ago
    >If New York ONLY ignored the problem that'd be one thing So where would recovered nursing home residents go? Keep staying in the hospital which would mean active covid patients would die in the streets? Or the streets?
duped 5y ago
Many of the people behaving poorly in Florida weren't Florida residents
dukeofdoom 5y ago
Nursing homes had the biggest outbreaks. Perhaps only prolonged exposure in confined spaces between elderly people was the only pathway that mattered. In some ways I think of it like a fire spreading. There will be spots that burn easily and quickly. But once they burn out, the fire has nowhere else to go that burns as well.
injinj 5y ago
"We found that states with higher income inequality experienced a higher number of deaths due to COVID-19." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313247/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313247/
sjg007 5y ago
Population density is the reason.
cortesoft 5y ago
California was an early hotspot for the virus, and had a huge amount of cases early on when treatments weren’t great. There was also a big surge over the holidays. The places hit hardest were very dense cities... viruses spread very well in big cities, regardless of mitigation steps.
exegete 5y ago
Some of the States with the strictest measures were the ones that got hit hard early before much was known about the virus (NJ, NY, CA) so their death tolls could be expected to be higher. Additionally many States that were more relaxed also are more rural so one would expect some differences from that too. Hoping there will be a retrospective on all of this.
sam_4675 5y ago
I agree. These numbers and methodology are highly suspect to me, particularly given the large self granted estimate range. Obviously lots of room for error. Not very useful analysis imo.
deleted 5y ago
[deleted]
drummer 5y ago
Assessing mandatory stay‐at‐home and business closure effects on the spread of COVID‐19 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484
nscalf 5y ago
I don't want to be a conspiracy theorist here, but Florida has seemed like a pretty untrustworthy source of info on their covid numbers. There is even an ongoing battle with a data scientist who was fired, according to her, for refusing to fake the covid numbers. Just at a glance, Florida's reported covid numbers seem to be so anomalous compared to the rest of the country, even though when you think of Florida you think of groups at high risk from covid. I can't say they're actually lying about their numbers, but it's enough of an outlier to reasonably remove it from the data set.
- nradov 5y ago
  Please stop spreading misinformation. Rebekah Jones was never asked to falsify any numbers. She is simply a liar. https://www.nationalreview.com/2021/05/rebekah-jones-the-covid-whistleblower-who-wasnt/ https://www.nationalreview.com/2021/05/rebekah-jones-the-cov...
  - nscalf 5y ago
    The information that a former Florida state data science employee was fired and alleges it’s because she refused to falsify data is not misinformation. She may be lying, it the information I stated was 100% true. Also, don’t come at people with far right propaganda networks as your source of knowledge.
wunderforce 5y ago
At least one study was done in Florida comparing counties that had mask mandates vs those that did not. The general conclusion matches your observation, mask mandates did not appear to have a material effect on any covid related metrics (infections, hospitalizations, deaths, ect.) This is a bit nuanced because lots of people wore masks without a mandate, but it is also true that many people are pretty anti mask and definitely won't wear one if not forced to. From my perspective it is pretty clear that masks did not have a large enough protective effect to show up in aggregate data. As far as lockdowns go, they work until you end them, at which point you have just delayed the inevitable. If you want to look at the data yourself, I would highly recommend the following site run by a prof at University of Illinois (use the population normalized graphs): http://91-divoc.com/pages/covid-visualization/ http://91-divoc.com/pages/covid-visualization/ Having a hard time finding the primary study I mentioned but I have provided links with some (population normalized) data below. Florida counties (scroll down to second graph near the bottom for the start of the discussion): https://rationalground.com/after-nine-months-we-still-know-masks-dont-work/ https://rationalground.com/after-nine-months-we-still-know-m... Various graphs showing infection rate pre and post mask mandate: https://rationalground.com/mask-charts/ https://rationalground.com/mask-charts/ More mask graphs, mostly US states: https://rationalground.com/post-thanksgiving-mask-charts-still-no-evidence-that-masks-work/ https://rationalground.com/post-thanksgiving-mask-charts-sti...
- thu2111 5y ago
  As far as lockdowns go, they work until you end them, at which point you have just delayed the inevitable. Where in the data can you see this? Lockdowns don't appear to work. If they did, then places that didn't use them or cancelled them very early would have had drastically higher numbers than other places that kept them and the curves would be clearly moved around. But that isn't visible in the data. That said, I'm glad you posted those links and agree with you on the lack of effectiveness of mask mandates. I've been posting links like those and various other studies for the past year because it was clear within weeks that these measures weren't having any impact. Sometimes those posts got upvoted but mostly, down down down. Very interesting that the top comment on this thread is one pointing out that lockdowns and mask mandates don't work: it used to be quite the taboo to point that out in this forum. And just recently there were the threads about the WIV, where again, many posts that a year ago would have been sitting at -4 and near-unreadably gray were sitting near the top. It's good to see that some rationality is returning to these discussions, because the data is public and easy to browse. It's not hard to flip through a bunch of countries and observe that you can't figure out when lockdowns/mask mandates started/ended with any reliability by looking at the data, even though affecting the data is the only justification for those measures' existence.

xwolfi 5y ago

Either you lock people downs and those would reject it will go out nonetheless. Or you don't and people who are at risk will lock themselves down. There's no particular benefit to one or the other so states do what match their current constituents. And that's exactly what you'd expect in a democracy.

vmception 5y ago

No state had an optimal viral mitigation strategy. The optimal strategy being impractical or even impossible. Densely populated places that would have acted flippantly would have been much worse. Densely populated places with mixed unit housing had hurt themselves with the strategy they chose. So basically California and New York could just barely keep numbers as close to Florida numbers by locking down hard. The methods California and New York chose could have been even more optimized, but not possible for a US government to do.

amanaplanacanal 5y ago

Where I live, the restrictions have explicitly been tuned so as to not overwhelm hospital facilities. Minimizing deaths was not a stated goal. They measured new cases and how many hospital bed were available, then adjusted restrictions accordingly per County. So for example, you might see no indoor dining in one County, but indoor dining allowed at 25% capacity the next County over. They seem to have done a pretty good job given the stated goal.

melling 5y ago

People are lumping the numbers together for the entire pandemic. During the first wave New York and New Jersey got hit really hard. Basically, it was too late to do anything.

NicoJuicy 5y ago

I think you should population density as a variable. You could be less restrictive in a rural area, while the same policies would have been very harmful in cities.

mattnewton 5y ago

I don’t have anything to add except that California is huge and very unevenly applied “lockdown” - there are many towns a where businesses remained open or reopened frequently, but the big cities did have large shelter in place efforts. It would be interesting to compare on the municipal level if the data was that granular.

dubyah 5y ago
Low income / essential workers & overcrowded homes are a far more significant factor that often go unmentioned when people try to compare the outcomes between state & municipal public health interventions. This was observed well before the winter surge. https://calmatters.org/projects/overcrowded-housing-california-coronavirus-essential-worker/ https://calmatters.org/projects/overcrowded-housing-californ... How do you isolate when there's more members than actual rooms in the home & only one one restroom?
shoguning 5y ago
According to a study in PNAS, shelter-in-place policies in the US did not work: https://www.pnas.org/content/118/15/e2019706118 https://www.pnas.org/content/118/15/e2019706118 Another study in Eur J Clin Inv had similar findings comparing countries: https://onlinelibrary.wiley.com/doi/10.1111/eci.13484 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484 COVID went wild basically everywhere. There were a few strong exceptions: China (apparently), Australia, New Zealand and some others. What these had in common was very strict police enforcement, which led to some dramatic scenes like people getting welded into their houses in China, or houses in Australia getting broken into by police on suspicion of too many people gathering. In my _opinion_, lockdowns didn't work elsewhere because most cases are not from casual public transmission in places like stores, restaurants etc. Rather, events like kickbacks, dinner parties, and practices like in-home workers (nannies, cleaners etc) continued throughout the pandemic, or resumed shortly after the original March 2020 shockwave. While strident police enforcement of physical distancing could eliminate cases, and seemed to in a few places, the half measures used by most of the world did little-to-nothing positive while being an economic and cultural disaster. Personally, I never caught COVID and rarely socialized during the pandemic. All the cases I heard of stemmed from the kind of thing I mention above: private dinner parties, nannies and so forth, rather than casual public transmission. You, or any individual may have taken social distancing seriously but it's clear many or most did not, including people on both political "sides", up to and including governors, members of congress etc.

ceejayoz 5y ago

I suspect there’ll be decades worth of study of this. Hopefully it’ll help the next time.

Fomite 5y ago
I'm an infectious disease epidemiologist, and there absolutely will be decades spend unravelling this. To address the parent question - one thing to keep in mind is that states are extremely heterogeneous, and "Did or did not lock down/mask mandate/etc." isn't actually a binary variable, but a very difficult to measure continuous response of both policy and compliance.

soared 5y ago

To really understand it you’d need to look at cultural, geographic, climate, demographic, etc differences that apply to transmission rates. I’d be curious to see it though, and a similar one for other illnesses.

stolenmerch 5y ago

https://twitter.com/IAmTheActualET/status/1390368965994631175 https://twitter.com/IAmTheActualET/status/139036896599463117...

kennywinker 5y ago
There is literally no such thing as a red state or a blue state, so not surprising it doesn't map to anything.
- api 5y ago
  It's almost perfectly urban vs. rural. Urban areas in "red" states are generally blue, and vice versa. "Blue states" are just those with mostly urban populations. It became more extreme during the Trump era with many historically red suburbs around cities turning blue and some rural areas turning more red.

MattGaiser 5y ago

You would need to look at everything from ages to whether the lockdowns where enforced to how people lived (high or low density) to how deaths were counted. It would be an interesting study.

andrei_says_ 5y ago

Count of covid cases and deaths has been highly politicized and manipulated in Florida to the point of firing people for reporting them. Not sure how possible it is to get accurate info in this environment.

jmahyoung 5y ago
Somewhat related, on the opposite point. Elon Musk among others said the counting of deaths was manipulated upwards, with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already. I think there is a desire to overcount which must not be glossed over either.
- belltaco 5y ago
  >I think there is a desire to overcount which must not be glossed over either So there was overcounting, but somehow excess mortality in 2020-2021 is higher than in normal years? How? >with comorbidity being counted as a COVID death even when the patient had 2 or more serious health conditions already A high percentage of people in the US have "serious health conditions" like diabetes, obesity, high blood pressure etc. If Covid accelerated their deaths then it should be counted as a covid death because they would likely be otherwise alive now. If you want to get pedantic there's a measure called QALY(quality adjusted life years). Musk said there would be zero cases in the US by April 2020 among other dumb predictions, so I don't think he's the best person to go to for Covid related information since his domain is technology and not epidemiology. https://www.forbes.com/sites/joewalsh/2021/03/13/elon-musks-false-covid-predictions-a-timeline/?sh=5acaf495b6d2 https://www.forbes.com/sites/joewalsh/2021/03/13/elon-musks-...
  - briandear 5y ago
    > So there was overcounting, but somehow excess mortality in 2020-2021 is higher than in normal years? How? People dying of heart attacks because they didn’t seek timely care because of fear of going to the hospital. Medical screenings postponed. Undetected cancers. Suicides. There is a direct correlation between unemployment rates and disease. My annual physical, due in July 2020 was cancelled. How many other people’s were as well? Also one also should note increases in deaths of despair. That’s a real thing. Excess deaths can’t be called “covid,” without proof that they were. How would else know Covid was the cause and not the flu? Are we just assuming excess deaths were Covid? The uncomfortable truth is that lockdown proponents don’t want to admit that their policies may have caused more damage than the disease from which they were claiming to protect us. I don’t know the answer. My point is that excess deaths aren’t necessarily Covid deaths. That’s an assumption, not a fact.

jeffbee 5y ago

I think the flaw in this premise is believing that the regulations promulgated at the state level had any real impact on the public response. It's not the "lockdown" that keeps people at home, it's the disease. In some states they did not order restaurants to close, but that doesn't imply that attendance at restaurants in those places was normal.

chmod600 5y ago
Schools in Florida have been open since last fall. That's a pretty huge difference, with little difference in pandemic deaths.

danenania 5y ago

I've always thought the main driver of spread was probably not the political football issues like masks in public and businesses being open or closed, but what people are doing behind closed doors with family and friends. Lockdowns don't have much effect on this.

clairity 5y ago
exactly. the measures were always about keeping us simultaneously busy and anxious and not about their actual effectiveness. it’s been so frustrating to see discussion after discussion about the minutiae of masking when they’re so minor to the overall picture. what mattered above all was indoor, familiar social proximity (where we’d be most likely to be exchanging spit for prolonged periods), exactly where our strong social norms dictate the least amount of vigilance.
- danenania 5y ago
  I think the intentions were good, but it's also probably true that public health officials have been reluctant to admit when there just wasn't much they could do about the situation that would make a major difference, save for employing totalitarian enforcement measures that no one wanted. Masks in public are not all that burdensome, so imo the mandates were reasonable regardless of the actual impact, but I wish they would have re-evaluated closing businesses a lot sooner, since that did a ton of economic damage, and the benefit there seems very questionable. I doubt the CA statistics would have been any different if they had never banned outdoor dining, for instance, or even just kept most businesses running normally but with an indoor mask requirement. Comparing CA to TX and FL, it's also pretty hard now to argue that closing playgrounds and schools made much difference either, and that has had a severely negative impact on kids. I understand doing it in the first place when everything was unknown, but they should have been quicker to revise in response to new information.
  - clairity 5y ago
    outside of the totalitarian choices, which were entirely untenable in the US, we really had no good options to slow, much less stop, the pandemic. nearly all of it was theater. the best mitigation would have been to get people to generally distance around familiars indoors and don a mask if you’re going to spend time in close proximity or face-to-face for a while. that would have required families to treat each other as threats rather than safeties, which is why that was not tenable. it’s so much easier to treat strangers as threats. this best mitigation would have led us to violate a visceral belief about the world, creating significant cognitive dissonance, and that’s why we instead focused so much on ineffective measures to protect ourselves from strangers with masks and lockdowns that didn’t tackle the core infection vector through familiars. it’s really not that difficult to unravel what was happening, even at the beginning. watching us dance around this elephant in the room as if it didn’t exist has been no less than maddening.

LogicX 5y ago

I’ve asked myself this question. I have no hard data to back this up, but wonder If it’s related to outside time and vitamin D absorption, which seems to have an affect on covid. Ex: did NYC have a tougher time than Florida as a result of this, and even with all the protocols in NYC, they could do only as well as Florida with no rules.

taxicabjesus 5y ago
NYC has a combined sewer system [0] [1] that overflows when it rains more than .... ~1/10 of an inch per hour (iirc). The fecal-> aerosol transmission route is certainly very important: https://news.ycombinator.com/item?id=27156256 https://news.ycombinator.com/item?id=27156256 "Who do you share a bathroom with" is very important for tracking transmission. In NYC, everyone shares a bathroom. [0] https://www1.nyc.gov/site/dep/water/combined-sewer-overflows.page https://www1.nyc.gov/site/dep/water/combined-sewer-overflows... [1] https://www.riverkeeper.org/campaigns/stop-polluters/sewage-contamination/cso/ https://www.riverkeeper.org/campaigns/stop-polluters/sewage-...

candu 5y ago

IMHO if you want to understand what an effective response looks like - don't look at North America or Europe. Think Vietnam, Australia, New Zealand, and many parts of Africa, all of which had vastly better outcomes. Of course, I'm not an epidemiologist or public health expert, so while I have some guesses I'm not sure what exactly they did that was more effective - but there's no question that it was more effective. If I was going to look for case studies to understand what to do next time, I'd start there. If I was going to look for case studies to understand what not to do next time, well...

NicoJuicy 5y ago
Those places all have low population density or are literally islands, that's not comparable at all.
t8e56vd4ih 5y ago
> Of course, I'm not an epidemiologist and no geographer either apparently :D
- TheRealSteel 5y ago
  What do you mean?
  - danenania 5y ago
    It doesn't account for Africa, but many of best-performing countries have been island countries (Australia, NZ, Taiwan, Iceland, etc.). Islands have some fairly obvious advantages in fighting a pandemic, and it shows in the statistics. I believe Hawaii has also done much better than other US states. I'm not sure whether that's what the comment was referring to though.
    - octodog 5y ago
      None of Thailand, Vietnam and Mongolia are islands and their handling of covid is world class compared to parts of Europe and the US. These countries are also far poorer and in the case of Thailand especially that has been a major contributing factor, as they've been less able to afford closing their country to tourism.

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codelord 5y ago

This is from earlier: https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/ https://www.cebm.net/covid-19/excess-mortality-across-countr... Interestingly Sweden that got famous for defying lockdowns saw an uptick of 1.5% excess mortality per 100K people compared to 12.9% for the US that was relatively more locked down. I'm not sure what to make of it, but it sure is an interesting data point.

aaronblohowiak 5y ago
I would not typify the US as "mostly locked down"
- scrollaway 5y ago
  Indeed, and Sweden also had the benefit of the lockdowns in the rest of Europe. I don't think you can compare Sweden to the entirety of the US. A single state maybe.
- jmahyoung 5y ago
  Would you typify the US as more Locked Down than Sweden? Because their numbers are better. If their approach was worse why are their numbers not worse?
  - nicoburns 5y ago
    I've heard it suggested that there was a lot of voluntary distancing and othet measures taken in sweden. It wouldn't suprise me if there was more actual distancing in "not locked down" sweden than in "locked down" US. But perhaps the protests etc I've seen on TV wetrre exagerated?
  - raydev 5y ago
    Fewer travellers in and out of Sweden.
AptExtrapolatio 5y ago
Simple. US has obesity as a significant comorbidity factor.

kortex 5y ago

You would likely need to look at county by county data. Austin TX is probably closer to Albany NY behaviorally, than it is to Kent County TX. Schoharie County NY is probably closer to your average TX county. America isn't red state vs blue state, it's rural vs urban.

marcosdumay 5y ago

What is more likely is that the name of the interventions had very little correlation with the features that actually matter. Just because 2 places declare a "lockdown", it doesn't mean that they are doing any similar policy.

PeterisP 5y ago

One aspect is that IIRC California got a much earlier spread than Florida, so any measures taken in Florida to reduce the spread (including by people on their own initiative) effectively happened at an earlier stage.

orblivion 5y ago

It seemed like a lot of the states that did well despite opening early were southern states where it isn't really winter when it's winter. Also I've heard the claim that (to be as apolitical as I can here) in Florida they secured the elderly population more quickly and carefully than in New York. You may want to look into that claim.

wernercd 5y ago
I'd say "Florida secured their elderly population more quickly and carefully than in New York" misses the fact that New York ACTIVELY put its elderly in harms way by requiring nursing homes take patients. If New York ONLY ignored the problem that'd be one thing... but they actively made decisions that led to a large number of deaths - and more importantly those decisions were AGAINST the CDC guidelines.
- orblivion 5y ago
  Heh, well there you go. I wanted to avoid that point to avoid politics (per the OP's request), but yes. Also I think I heard NY wasn't the only state that did this.
  - exegete 5y ago
    NJ also did this
    - EricE 5y ago
      Michigan too. all with disastrous results.
  - wernercd 5y ago
    Well, truth be told, I didn't bring up the politics of it.. just the simple truth. WHY they made the decisions is a rabbit hole... but the facts are simple.
- belltaco 5y ago
  >If New York ONLY ignored the problem that'd be one thing So where would recovered nursing home residents go? Keep staying in the hospital which would mean active covid patients would die in the streets? Or the streets?

duped 5y ago

Many of the people behaving poorly in Florida weren't Florida residents

dukeofdoom 5y ago

Nursing homes had the biggest outbreaks. Perhaps only prolonged exposure in confined spaces between elderly people was the only pathway that mattered. In some ways I think of it like a fire spreading. There will be spots that burn easily and quickly. But once they burn out, the fire has nowhere else to go that burns as well.

injinj 5y ago

"We found that states with higher income inequality experienced a higher number of deaths due to COVID-19." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313247/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313247/

sjg007 5y ago

Population density is the reason.

cortesoft 5y ago

California was an early hotspot for the virus, and had a huge amount of cases early on when treatments weren’t great. There was also a big surge over the holidays. The places hit hardest were very dense cities... viruses spread very well in big cities, regardless of mitigation steps.

exegete 5y ago

Some of the States with the strictest measures were the ones that got hit hard early before much was known about the virus (NJ, NY, CA) so their death tolls could be expected to be higher. Additionally many States that were more relaxed also are more rural so one would expect some differences from that too. Hoping there will be a retrospective on all of this.

sam_4675 5y ago

I agree. These numbers and methodology are highly suspect to me, particularly given the large self granted estimate range. Obviously lots of room for error. Not very useful analysis imo.

deleted 5y ago

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drummer 5y ago

Assessing mandatory stay‐at‐home and business closure effects on the spread of COVID‐19 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484 https://onlinelibrary.wiley.com/doi/10.1111/eci.13484

nscalf 5y ago

I don't want to be a conspiracy theorist here, but Florida has seemed like a pretty untrustworthy source of info on their covid numbers. There is even an ongoing battle with a data scientist who was fired, according to her, for refusing to fake the covid numbers. Just at a glance, Florida's reported covid numbers seem to be so anomalous compared to the rest of the country, even though when you think of Florida you think of groups at high risk from covid. I can't say they're actually lying about their numbers, but it's enough of an outlier to reasonably remove it from the data set.

nradov 5y ago
Please stop spreading misinformation. Rebekah Jones was never asked to falsify any numbers. She is simply a liar. https://www.nationalreview.com/2021/05/rebekah-jones-the-covid-whistleblower-who-wasnt/ https://www.nationalreview.com/2021/05/rebekah-jones-the-cov...
- nscalf 5y ago
  The information that a former Florida state data science employee was fired and alleges it’s because she refused to falsify data is not misinformation. She may be lying, it the information I stated was 100% true. Also, don’t come at people with far right propaganda networks as your source of knowledge.

wunderforce 5y ago

At least one study was done in Florida comparing counties that had mask mandates vs those that did not. The general conclusion matches your observation, mask mandates did not appear to have a material effect on any covid related metrics (infections, hospitalizations, deaths, ect.) This is a bit nuanced because lots of people wore masks without a mandate, but it is also true that many people are pretty anti mask and definitely won't wear one if not forced to. From my perspective it is pretty clear that masks did not have a large enough protective effect to show up in aggregate data. As far as lockdowns go, they work until you end them, at which point you have just delayed the inevitable. If you want to look at the data yourself, I would highly recommend the following site run by a prof at University of Illinois (use the population normalized graphs): http://91-divoc.com/pages/covid-visualization/ http://91-divoc.com/pages/covid-visualization/ Having a hard time finding the primary study I mentioned but I have provided links with some (population normalized) data below. Florida counties (scroll down to second graph near the bottom for the start of the discussion): https://rationalground.com/after-nine-months-we-still-know-masks-dont-work/ https://rationalground.com/after-nine-months-we-still-know-m... Various graphs showing infection rate pre and post mask mandate: https://rationalground.com/mask-charts/ https://rationalground.com/mask-charts/ More mask graphs, mostly US states: https://rationalground.com/post-thanksgiving-mask-charts-still-no-evidence-that-masks-work/ https://rationalground.com/post-thanksgiving-mask-charts-sti...

thu2111 5y ago
As far as lockdowns go, they work until you end them, at which point you have just delayed the inevitable. Where in the data can you see this? Lockdowns don't appear to work. If they did, then places that didn't use them or cancelled them very early would have had drastically higher numbers than other places that kept them and the curves would be clearly moved around. But that isn't visible in the data. That said, I'm glad you posted those links and agree with you on the lack of effectiveness of mask mandates. I've been posting links like those and various other studies for the past year because it was clear within weeks that these measures weren't having any impact. Sometimes those posts got upvoted but mostly, down down down. Very interesting that the top comment on this thread is one pointing out that lockdowns and mask mandates don't work: it used to be quite the taboo to point that out in this forum. And just recently there were the threads about the WIV, where again, many posts that a year ago would have been sitting at -4 and near-unreadably gray were sitting near the top. It's good to see that some rationality is returning to these discussions, because the data is public and easy to browse. It's not hard to flip through a bunch of countries and observe that you can't figure out when lockdowns/mask mandates started/ended with any reliability by looking at the data, even though affecting the data is the only justification for those measures' existence.