9 ms·

The question ever since it became clear that this coronavirus was endemic has been what a "manageable end game" is: that is, what level of risk and mortality ar

The question ever since it became clear that this coronavirus was endemic has been what a "manageable end game" is: that is, what level of risk and mortality are we prepared to accept, given that deaths from Covid will never be zero. This is, in my opinion, the primary underlying disagreement. Some people think that no amount of deaths from Covid is acceptable. Some people believe that even the peak pandemic mortality is acceptable. And others fall somewhere in between, by, for example, focusing on hospital capacity. I don't think there is any long-term solution to Covid as a social issue, something we talk about and can't move past, until some kind of consensus is reached on this.

epgui 5y ago
And from my point of view as someone in the field, arguments on either side are almost always based on an intuitive gut feeling about morality. Very few people actually try to wrangle with putting numbers on the cost (in dollars) of a human life, or the economic burden of disease. There are no right or wrong numbers, but only if you begin there can you say you're rationally considering the economic or political tradeoffs. Edit: and deaths could absolutely reach zero. If we threw everything and the kitchen sink at the problem, we would eradicate it in absolutely no time. The underlying question is the same here, namely whether the cost of eradicating the disease would be larger or smaller than what we would gain from doing it.
- ummonk 5y ago
  I think you overestimate our ability to “eradicate it in absolutely no time”. Eliminating it from both human and animal reservoirs (and permanently quarantining any immunocompromised carriers) worldwide would be a long and arduous process.
  - epgui 5y ago
    You make a great point about animal reservoirs, but the transmission bandwidth between humans and animals is afaik much lower than between humans. If you accept this assumption, and if we also assume that we really wanted to eradicate this thing, we could limit human transmission such as to reduce Rt well below 1 by implementing well-coordinated and strict policies. Then you're left with the "leaky bucket" of transmission between humans and animals... But this is a known vulnerable point which could be monitored effectively and very cheaply.
    - nradov 5y ago
      This is completely unrealistic. Effective continuous monitoring for animal to human transmission would never be cheap. In much of the developing world it's not even remotely feasible. Have you ever been to places like rural Mexico? The virus is here to stay. Eradication is a total fantasy, just a distraction and waste of time.
    - retrac 5y ago
      Here in Canada, we've been trying to eradicate rabies from the wild for half a century or so now. There are orally-active rabies vaccines we litter the landscape with in edible treat format. We cull rabid animals and quarantine or cull their known animal contacts. It's common knowledge that exposure to possible vectors means you need to go to the hospital. Tens of thousands of people are treated preventatively each year. Despite all this, human cases of rabies still happen. Fortunately it's rather hard to spread rabies between humans and it's symptomatic by the time it becomes infectious. In the case of an easily airborne virus even with such measures available like vaccination and prophylaxis for possible exposure, it seems daunting to the point of impossible even in a very wealthy country. In the developing world it would be certainly hopeless.
      - epgui 5y ago
        Yeah, eradication of a disease in the wild is a whole other matter. But so rabies also is another matter. Cases are relatively rare here (hello, fellow Canadian!), and surveillance is relatively good for the little burden of disease it brings. https://www.canada.ca/en/public-health/services/diseases/rabies/surveillance.html https://www.canada.ca/en/public-health/services/diseases/rab... Genetic surveillance is just around the corner, and will soon be / is now within reach even of developing countries, with solutions like Oxford Nanopore's ultra-portable sequencers. https://www.youtube.com/watch?v=6RRSxWtJPUw https://www.youtube.com/watch?v=6RRSxWtJPUw
- bcrosby95 5y ago
  Depending upon the specific agency, agencies in the USA value a statistical life at anywhere from $7-$10 million.
  - epgui 5y ago
    As a Canadian, I usually use the US DoT numbers (in the same ballpark as what you said) for my mental maths. A couple extra things to consider: - what’s the date on these figures? - can we extrapolate this to other countries? - are these figures generally accepted, or are they controversial? - how do you account for age, sex (differences in life expectancy, child bearing capacity, etc), education level or professional skill, etc?
    - novok 5y ago
      Ironically enough, I think the data set comes from lawsuits that determine all of those conditions. A surgeon for example with all of their future surgeon income ruined by a bad car accident + medical care can be around $30 million, while someone who is relatively old with no chances of future income + medical care would typically get less AFAIK. It probably averages out to that $7-10 million figure.
parkingrift 5y ago
I disagree. I think the endgame is clear in the US. Most states have dropped all restrictions and those that haven’t will suffer economically and politically until they drop their restrictions. The only question is how much economic and political suffering individual cities and states will tolerate. Virginia voters threw out their entire Democrat government and governor and will likely join the list of states banning restrictions. In the end I don’t think it will be about Covid at all. One by one we’ll move on because the people will demand an end to restrictions.
- kQq9oHeAz6wLLS 5y ago
  You've been downvoted, but you're not wrong. Witness the number of people who have left California.
  - parkingrift 5y ago
    I’m not making a values argument either way. It just seems apparent that people are tired of restrictions, and those people seem more likely to vote. The result in Virginia was shocking and should have been a wake up call to Democrats.
    - redis_mlc 5y ago
    - johnchristopher 5y ago
      I wonder if people would be OK with less restrictions, no vaccine mandates but perma n95 in public indoor and outdoor spaces ? Because whether we like it or not the virus is still going to be around and kill people and saturate hospitals. So, to me, the question seems to be: will living with the virus means "we don't treat covid patients anymore, if you get covid, tough luck, you are free to choose to wear a mask if you want, beyond that don't expect anything from public authorities"
      - parkingrift 5y ago
rootusrootus 5y ago
> what level of risk and mortality are we prepared to accept IMO, the rational answer to this question is 'the same risk and mortality that we have already accepted from influenza.' There is a lot of variability there, of course, but it is way above zero in any case.
- phonypc 5y ago
  That would seem to make sense if covid displaced flu entirely. But flu + equivalently harmful covid is twice as bad as historical flu.
  - eo3x0 5y ago
    Influenza B is thought to have been made extinct recently due to the pressures introduced by SARS-CoV-2 https://www.webmd.com/lung/news/20211025/covid-pandemic-may-have-driven-a-flu-strain-into-extinction https://www.webmd.com/lung/news/20211025/covid-pandemic-may-...
    - rsfern 5y ago
      Wow, webmd made it really hard to find the primary source for that. To be clear, they are attributing this drop off of this flu strain to be likely due to pandemic mitigation efforts, as well as maybe lucky timing and some specifics of how this strain spreads Since it doesn’t seem plausible to repeat the wide scale pandemic mitigation controls any time soon, I doubt we can keep wiping out flu strains, but we could certainly reduce the damage the flu does if we want to https://www.nature.com/articles/s41579-021-00642-4 https://www.nature.com/articles/s41579-021-00642-4
  - rootusrootus 5y ago
    Double the normal flu rate would be just 20% of what we're seeing this year from covid.
- stubish 5y ago
  I don't think this is quite right. The risk from COVID is in addition to the risk from influenza, and much of the mitigation affects both. Changes like common mask wearing may not have been considered 'worth it' for only lessening mortality and the economic costs of influenza, but the economic benefits alone of reduced productivity due to influenza and COVID combined may mean it is the obvious choice now for governments and businesses to push mask wearing everywhere they can. Similar for vaccination when your yearly flu jab becomes a yearly flu + COVID jab.
standardUser 5y ago
The primary concern form day one has been the capacity of our healthcare systems. "Peak pandemic mortality" includes scores of people dying from unrelated illness due to lack of care. Does anyone truly think its acceptable to let people die in ambulances outside of hospitals because a highly contagious disease filled all the hospital beds and medical staff is too fatigued to work? Maybe people with a political axe to grind pretend to think that.
- guimplen 5y ago
  I think the real problem is that in most countries the healthcare system was "optimized" to such extent that even seasonal flu was almost clogging it every year. And now SURPRISE, any disease, even a tad bit more deadly and contagious than the seasonal flu would make it collapse. TOTALLY UNEXPECTED.
  - DrHilarius 5y ago
    As always, the standard gimmick of neoliberalism is to pin the blame for the collateral damage of its policies on the relatively powerless people who refuse its self-serving "solutions."
    - xyzzyz 5y ago
      Which non-“neoliberal” (whatever that means) country had plenty excess hospital capacity to handle peak Covid case counts?
      - Maarten88 5y ago
        Cuba?
    - dang 5y ago
      We've banned this account for using HN primarily for ideological battle. It also appears to be a single-purpose account, which goes against the intended spirit the site (curiosity), and therefore is not allowed here. Would you please not create accounts to break HN's rules with? If you don't want to be banned on HN, you can email us at hn@ycombinator.com and give us reason to believe that you'll use the site as intended in the future. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
2muchcoffeeman 5y ago
I agree that in most countries this is the underlying disagreement. I wonder if we thought this through at a global community though. Imagine if China didn’t or couldn’t pursue a zero covid policy. What happens when the world’s manufacturer closes? We’ve already seen huge supply chain issues.
- throwaway55421 5y ago
  It's not the case that they would need to close. Across the Western world the vast majority of the economic and social issues have been caused by legalities rather than pandemic reality. For example, for better or worse, if the 10 day isolation and testing regime did not exist in the UK then staff shortages would not either. People aren't actually getting ill en masse - we've just recalibrated what ill means.
  - jlokier 5y ago
    > staff shortages would not either That's just hilarious. There are so many reasons for staff shortages in the UK right now. Covid isn't even the main one.

epgui 5y ago

And from my point of view as someone in the field, arguments on either side are almost always based on an intuitive gut feeling about morality. Very few people actually try to wrangle with putting numbers on the cost (in dollars) of a human life, or the economic burden of disease. There are no right or wrong numbers, but only if you begin there can you say you're rationally considering the economic or political tradeoffs. Edit: and deaths could absolutely reach zero. If we threw everything and the kitchen sink at the problem, we would eradicate it in absolutely no time. The underlying question is the same here, namely whether the cost of eradicating the disease would be larger or smaller than what we would gain from doing it.

ummonk 5y ago
I think you overestimate our ability to “eradicate it in absolutely no time”. Eliminating it from both human and animal reservoirs (and permanently quarantining any immunocompromised carriers) worldwide would be a long and arduous process.
- epgui 5y ago
  You make a great point about animal reservoirs, but the transmission bandwidth between humans and animals is afaik much lower than between humans. If you accept this assumption, and if we also assume that we really wanted to eradicate this thing, we could limit human transmission such as to reduce Rt well below 1 by implementing well-coordinated and strict policies. Then you're left with the "leaky bucket" of transmission between humans and animals... But this is a known vulnerable point which could be monitored effectively and very cheaply.
  - nradov 5y ago
    This is completely unrealistic. Effective continuous monitoring for animal to human transmission would never be cheap. In much of the developing world it's not even remotely feasible. Have you ever been to places like rural Mexico? The virus is here to stay. Eradication is a total fantasy, just a distraction and waste of time.
  - retrac 5y ago
    Here in Canada, we've been trying to eradicate rabies from the wild for half a century or so now. There are orally-active rabies vaccines we litter the landscape with in edible treat format. We cull rabid animals and quarantine or cull their known animal contacts. It's common knowledge that exposure to possible vectors means you need to go to the hospital. Tens of thousands of people are treated preventatively each year. Despite all this, human cases of rabies still happen. Fortunately it's rather hard to spread rabies between humans and it's symptomatic by the time it becomes infectious. In the case of an easily airborne virus even with such measures available like vaccination and prophylaxis for possible exposure, it seems daunting to the point of impossible even in a very wealthy country. In the developing world it would be certainly hopeless.
    - epgui 5y ago
      Yeah, eradication of a disease in the wild is a whole other matter. But so rabies also is another matter. Cases are relatively rare here (hello, fellow Canadian!), and surveillance is relatively good for the little burden of disease it brings. https://www.canada.ca/en/public-health/services/diseases/rabies/surveillance.html https://www.canada.ca/en/public-health/services/diseases/rab... Genetic surveillance is just around the corner, and will soon be / is now within reach even of developing countries, with solutions like Oxford Nanopore's ultra-portable sequencers. https://www.youtube.com/watch?v=6RRSxWtJPUw https://www.youtube.com/watch?v=6RRSxWtJPUw
bcrosby95 5y ago
Depending upon the specific agency, agencies in the USA value a statistical life at anywhere from $7-$10 million.
- epgui 5y ago
  As a Canadian, I usually use the US DoT numbers (in the same ballpark as what you said) for my mental maths. A couple extra things to consider: - what’s the date on these figures? - can we extrapolate this to other countries? - are these figures generally accepted, or are they controversial? - how do you account for age, sex (differences in life expectancy, child bearing capacity, etc), education level or professional skill, etc?
  - novok 5y ago
    Ironically enough, I think the data set comes from lawsuits that determine all of those conditions. A surgeon for example with all of their future surgeon income ruined by a bad car accident + medical care can be around $30 million, while someone who is relatively old with no chances of future income + medical care would typically get less AFAIK. It probably averages out to that $7-10 million figure.

parkingrift 5y ago

I disagree. I think the endgame is clear in the US. Most states have dropped all restrictions and those that haven’t will suffer economically and politically until they drop their restrictions. The only question is how much economic and political suffering individual cities and states will tolerate. Virginia voters threw out their entire Democrat government and governor and will likely join the list of states banning restrictions. In the end I don’t think it will be about Covid at all. One by one we’ll move on because the people will demand an end to restrictions.

kQq9oHeAz6wLLS 5y ago
You've been downvoted, but you're not wrong. Witness the number of people who have left California.
- parkingrift 5y ago
  I’m not making a values argument either way. It just seems apparent that people are tired of restrictions, and those people seem more likely to vote. The result in Virginia was shocking and should have been a wake up call to Democrats.
  - redis_mlc 5y ago
  - johnchristopher 5y ago
    I wonder if people would be OK with less restrictions, no vaccine mandates but perma n95 in public indoor and outdoor spaces ? Because whether we like it or not the virus is still going to be around and kill people and saturate hospitals. So, to me, the question seems to be: will living with the virus means "we don't treat covid patients anymore, if you get covid, tough luck, you are free to choose to wear a mask if you want, beyond that don't expect anything from public authorities"
    - parkingrift 5y ago

rootusrootus 5y ago

> what level of risk and mortality are we prepared to accept IMO, the rational answer to this question is 'the same risk and mortality that we have already accepted from influenza.' There is a lot of variability there, of course, but it is way above zero in any case.

phonypc 5y ago
That would seem to make sense if covid displaced flu entirely. But flu + equivalently harmful covid is twice as bad as historical flu.
- eo3x0 5y ago
  Influenza B is thought to have been made extinct recently due to the pressures introduced by SARS-CoV-2 https://www.webmd.com/lung/news/20211025/covid-pandemic-may-have-driven-a-flu-strain-into-extinction https://www.webmd.com/lung/news/20211025/covid-pandemic-may-...
  - rsfern 5y ago
    Wow, webmd made it really hard to find the primary source for that. To be clear, they are attributing this drop off of this flu strain to be likely due to pandemic mitigation efforts, as well as maybe lucky timing and some specifics of how this strain spreads Since it doesn’t seem plausible to repeat the wide scale pandemic mitigation controls any time soon, I doubt we can keep wiping out flu strains, but we could certainly reduce the damage the flu does if we want to https://www.nature.com/articles/s41579-021-00642-4 https://www.nature.com/articles/s41579-021-00642-4
- rootusrootus 5y ago
  Double the normal flu rate would be just 20% of what we're seeing this year from covid.
stubish 5y ago
I don't think this is quite right. The risk from COVID is in addition to the risk from influenza, and much of the mitigation affects both. Changes like common mask wearing may not have been considered 'worth it' for only lessening mortality and the economic costs of influenza, but the economic benefits alone of reduced productivity due to influenza and COVID combined may mean it is the obvious choice now for governments and businesses to push mask wearing everywhere they can. Similar for vaccination when your yearly flu jab becomes a yearly flu + COVID jab.

standardUser 5y ago

The primary concern form day one has been the capacity of our healthcare systems. "Peak pandemic mortality" includes scores of people dying from unrelated illness due to lack of care. Does anyone truly think its acceptable to let people die in ambulances outside of hospitals because a highly contagious disease filled all the hospital beds and medical staff is too fatigued to work? Maybe people with a political axe to grind pretend to think that.

guimplen 5y ago
I think the real problem is that in most countries the healthcare system was "optimized" to such extent that even seasonal flu was almost clogging it every year. And now SURPRISE, any disease, even a tad bit more deadly and contagious than the seasonal flu would make it collapse. TOTALLY UNEXPECTED.
- DrHilarius 5y ago
  As always, the standard gimmick of neoliberalism is to pin the blame for the collateral damage of its policies on the relatively powerless people who refuse its self-serving "solutions."
  - xyzzyz 5y ago
    Which non-“neoliberal” (whatever that means) country had plenty excess hospital capacity to handle peak Covid case counts?
    - Maarten88 5y ago
      Cuba?
  - dang 5y ago
    We've banned this account for using HN primarily for ideological battle. It also appears to be a single-purpose account, which goes against the intended spirit the site (curiosity), and therefore is not allowed here. Would you please not create accounts to break HN's rules with? If you don't want to be banned on HN, you can email us at hn@ycombinator.com and give us reason to believe that you'll use the site as intended in the future. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

2muchcoffeeman 5y ago

I agree that in most countries this is the underlying disagreement. I wonder if we thought this through at a global community though. Imagine if China didn’t or couldn’t pursue a zero covid policy. What happens when the world’s manufacturer closes? We’ve already seen huge supply chain issues.

throwaway55421 5y ago
It's not the case that they would need to close. Across the Western world the vast majority of the economic and social issues have been caused by legalities rather than pandemic reality. For example, for better or worse, if the 10 day isolation and testing regime did not exist in the UK then staff shortages would not either. People aren't actually getting ill en masse - we've just recalibrated what ill means.
- jlokier 5y ago
  > staff shortages would not either That's just hilarious. There are so many reasons for staff shortages in the UK right now. Covid isn't even the main one.