9 ms·

There appears to be a weird blind-spot when discussing COVID outcomes - anything short of death appears to be discounted or ignored. So hospital issues, long CO

by _jal 5y ago

There appears to be a weird blind-spot when discussing COVID outcomes - anything short of death appears to be discounted or ignored. So hospital issues, long COVID, etc. just don't exist, so catching it either didn't matter or you're dead. On a planet where that was true, that sort of reasoning would make sense. (As it does if you're trying to encourage other people to ignore risks.) What I don't understand is why so many people seem to view it that way.

wizzwizz4 5y ago
It's the human tendency to optimise the quantifiable and ignore the unquantified. (The unquantified is often partially quantifiable, but that would take effort, and the statistics aren't currently on the dashboard…) See also: https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law > When a measure becomes a target, it ceases to be a good measure.
- zepto 5y ago
  > It's the human tendency to optimise the quantifiable and ignore the unquantified. Are you sure that isn’t just a modern trend now that we are able to quantify so much stuff?
  - Talanes 5y ago
    Modern society is just the result of countless generations of the human tendency to quantify. We just have so many things quantified now that our problems tend to be more "using the wrong quantifications" rather than "not having the right quantifications."
    - zepto 5y ago
      > Modern society is just the result of countless generations of the human tendency to quantify. Is it? I see no evidence to justify this statement at all. Care to show some? The vast majority of how society is organized seems to eschew quantification in favor of descriptive qualification. Most laws, and governance, for example are formed that way. The use of metrics in governance has been dramatically increasing as our methods of quantification have developed, but that is definitely a modern development.
      - Talanes 5y ago
        Descriptive qualification is a necessary stepping stone to qualification though, so of course society built on it first. Something must be described and defined before it can be counted. Modernity emerges from humanity first; influences it second.
        zepto 5y ago
        So what? Weaving is a necessary stepping stone to making lounge suits. That doesn’t mean humanity has been destined to wear lounge suits all along.
        Talanes 5y ago
        The lounge-suit example is so much more specific than the topic at hand, that's just a farcical comparison. Any sort of broad logic will break down if you try and stretch it 1:1 to more narrow situations.
      - xboxnolifes 5y ago
        > The vast majority of how society is organized seems to eschew quantification in favor of descriptive qualification. > The use of metrics in governance has been dramatically increasing as our methods of quantification have developed, but that is definitely a modern development. These two statements seem slightly contradictory. If quantified metrics in governance has increased as our ability to quantify things has increased, then it would seem that laws did not favor descriptive qualification, they merely relied on it due to lack of ability to quantify. Or put another way: The only times we don't quantify things is when we cannot.
        zepto 5y ago
        > The only times we don't quantify things is when we cannot. Just because something has increased recently doesn’t mean there is an inbuilt human tendency for it. For example the wearing of lounge suits for business is a modern development. I don’t think you are going to claim that means there was a ‘human tendency’ for lounge suits all along.
  - xboxnolifes 5y ago
    I'm not much of a history buff, but I can't recall a good example of cultures or societal periods with emphasis on optimizing the unquantifiable (Or having no optimization preference at all). The only decent examples that I can think are in laws, and that only seems to be favored because things are difficult to be quantified, not because the unquantifiable was more preferred.
    - zepto 5y ago
      Can you think of a historical period in the distant part where there is evidence of a preference for quantification? It seem like you are simply assuming that was present.
      - xboxnolifes 5y ago
        Assuming we are talking about innate and not cultural qualities: If I do not assume we optimize for the quantifiable, I must assume either (1) we optimize for the unquantifiable, (2) we do not favor one way or the other (innately), or (3) human nature has changed over a very short (few thousand year) time period. I was trying to rule out (1). (3) Seems pretty easy to rule out purely on our understanding of evolution. And (2) would follow after ruling out (1) and accepting the original assumption. But onto this: > Can you think of a historical period in the distant part where there is evidence of a preference for quantification? Tax law.
        zepto 5y ago
        ‘Tax law’ is not a historical period, nor is it evidence of a preference for quantification in general. Given your apparent desire to be logical about this, it seems almost absurd that you would give this answer.
        xboxnolifes 5y ago
        Tax law throughout all time. I didn't think it was necessary to clarify that point.
- mhb 5y ago
  Fine. What also isn't on the dashboard is the lost QALYs which is pretty much the point of TFA.
heavyset_go 5y ago
> What I don't understand is why so many people seem to view it that way. It's classic minimization. You see it all the time when someone is motivated to ignore reality, or is suffering from a condition that makes it hard to accept reality. A heroin addict might say that shooting heroin isn't a big deal because they haven't died from it yet, even if they have a history of overdosing.
nsainsbury 5y ago
I don't think anyone is ignoring long COVID and hospital issues. Hospital capacity is discussed front and center daily and is the primary justification given for lockdowns. Also, please see this recent meta-analysis which found that when you actually add a control group, most "long COVID" symptoms disappear in children. A higher study quality was associated with lower prevalence of almost all symptoms. Original tweet: https://twitter.com/ShamezLadhani/status/1472622893154639876 https://twitter.com/ShamezLadhani/status/1472622893154639876 Link to study: https://www.journalofinfection.com/article/S0163-4453(21)00555-7/fulltext https://www.journalofinfection.com/article/S0163-4453(21)005...
- dijonman2 5y ago
  How many hospitalizations are due to covid and how many just happen to test positive?
  - nsainsbury 5y ago
    Appears to be very very common (as high as 2/3 'with' covid vs 'for' covid). See: https://twitter.com/MonicaGandhi9/status/1478401273317654528 https://twitter.com/MonicaGandhi9/status/1478401273317654528
    - hhmc 5y ago
      Surely it can't be a pure binary split of 'for' covid vs 'with' covid. Having covid presumably worsens outcomes for unrelated causes, in some cases turning a non emergency condition into an emergency condition.
CountDrewku 5y ago
You can say the opposite about the other side as well... Anything short of eradication (which is impossible) means nonstop lockdowns, masking, vaccine mandates and making the unvaccinated pariahs. What I don't understand is why you would shut down schools and enforce silly unhelpful mask mandates on them when the science shows children do not spread the disease in any meaningful way and are not badly affected by it. This is the "blind" spot I see.
- ModernMech 5y ago
  Schools in my district are shut down because there aren’t enough substitute teachers to fill in for sick or retired faculty. The older ones are getting sick and dying, or quitting before they do. The younger ones don’t want to be paid $35k a year to be screamed at by parents for not teaching subjects the way parents want them to be taught. Browse /r/teachers some time. It used to be a sub full of teachers venting steam about their students and sharing helpful tips. These days it’s just one post after another about teachers who are fed up and either quitting or planning to quit. They are proposing a new subreddit to handle the influx of complaints. If your “stay open” analysis begins and ends with the immune system and virus response of the students, then your analysis is incomplete because you are missing a huge dynamic that is at play here.
  - alisonkisk 5y ago
  - galaxyLogic 5y ago
    Good point. Also flights are cancelled not because of a government mandate but because personnel to fly the planes are sick with Covid. It would be bad business to fly with a sick crew.
  - CountDrewku 5y ago
    My mother was a teacher for 20+ years and my wife is a teacher. I know exactly how schools are handling this. They're quarantining people that aren't sick, that's why they don't have staff. They've scared away substitutes with unscientific fear mongering about super spreader events in school. This is a problem of over-testing and unnecessary quarantining not a shortage.
onlyrealcuzzo 5y ago
And also the abnormally high ratio of people who die within 1 year of catching Covid from other reasons: https://www.medicalnewstoday.com/articles/covid-19-survivors-have-an-increased-risk-of-death-12-months-post-infection https://www.medicalnewstoday.com/articles/covid-19-survivors... 233% increase in chance of death for people less than 65... 183% increase for people 65+: https://www.frontiersin.org/articles/10.3389/fmed.2021.778434/full https://www.frontiersin.org/articles/10.3389/fmed.2021.77843...
- btown 5y ago
  The article actually says it's 233% increase in chance of death for people younger than 65, which is even scarier: > For people younger than 65 who were hospitalized with COVID-19, the risk of death in the 12 months after the infection was 233% higher than it was for people who did not have the disease, results published in the journal Frontiers in Medicine have shown. https://www.frontiersin.org/articles/10.3389/fmed.2021.778434/full https://www.frontiersin.org/articles/10.3389/fmed.2021.77843...
  - onlyrealcuzzo 5y ago
    Thanks for the correction! My mistake - but I would argue it's WAY less scary. Chance of death is already high when you're 80 (4%). An extra 133% is 5.32% chance of death. If you're 16 is 0.02%. An extra 133% is a rounding error.
    - ArnoVW 5y ago
      Extra 133%, not extra 33%. So from 4% to 9.33%, not 5.33%
    - mupuff1234 5y ago
      But if that extra 133% risk is kept throughout your lifetime then back to being scary :/
    - nkozyra 5y ago
      It's an extra ~1,400 deaths in the 15-18 age group.
vitro 5y ago
The quora answer [1] by Franklin Veaux to question "How can a disease with 1% mortality shut down the United States?" explains nicely that it is not binary live/die at all. Mind though that this was written in the beginning of the pandemic when we didn't have the same information as now, so numbers may be imprecise, but the explanation still stands. https://www.quora.com/How-can-a-disease-with-1-mortality-shut-down-the-United-States https://www.quora.com/How-can-a-disease-with-1-mortality-shu...
- alisonkisk 5y ago
  [dead]
- deleted 5y ago
  [deleted]
- asdff 5y ago
  Even if no one died and people only went to the hospital, a huge issue is that they are there in the hospital in need of care and there are finite trained hands in the hospital. Not to mention you still have everyone else coming in with their car accidents and heart attacks at the same time. Better questions to think about are why the U.S. medical system supporting the words largest economy can't trivially expand its capacity to treat a relatively benign respiratory virus on top of its usual duties, or why there is a shortage in the training pipeline, or why people need ER care for other things in the first place.
- galaxyLogic 5y ago
  Nobody wants to get the disease which POSSIBLY could kill them or put them to hospital and perhaps financially bankrupt them and or give them bad long-term health outcomes. That has an effect on the behavior of everybody, except of course those who believe Covid is a "democratic hoax". Also with an evolving disease you don't know what its death-rate will be and it will depend on the preventive measures you and the government take, one of which is "shutting down" another being vaccination, which was not available at the beginning. If there had been no vaccine surely the death-rate had been larger. According to data below the mortality rate is 7.5% in Mexico. In US it is 1.5%, not 1% as implied by whoever posed the question. "Shutting down" will affect the mortality-rate because presumably it will protect the most vulnerable population more. If they don't get infected the mortality rate will be smaller. And as far as I can tell US was never really "shut down" was it? Everybody still got their groceries. Many died of Covid, nobody died of hunger I believe. Subways and buses were running. https://coronavirus.jhu.edu/data/mortality https://coronavirus.jhu.edu/data/mortality
renewiltord 5y ago
Well, the ideal outcome is to use the QALYs (or NHS Adjusted QALYs) to inform discussion, but it is considered a bit gauche (perhaps unfortunately for informed policy making) to identify that maybe the whole and absolute death of an 80 year old with emphysema isn't nearly as significant as some amount of disability to a 25 year old. i.e. there is a one-way ratchet on these measures since one direction is gated by the "trade grandma for a dollar" line.
yupper32 5y ago
Where are you seeing this? I'm seeing the opposite. Most public officials and news articles seem to only care about case numbers, which have very little meaning these days.
bko 5y ago
The reason people care about death is that its a clear signal and would likely scale linearly with the harm covid is doing to society. For instance, more positive tests could be due to testing. Hospitalizations are affected by different policies. I don't even know how you would measure long covid.
nradov 5y ago
Most any serious viral infection can potentially cause post-viral fatigue syndrome. We've known that for decades. COVID-19 is nothing special in that regard. https://pubmed.ncbi.nlm.nih.gov/3063394/ https://pubmed.ncbi.nlm.nih.gov/3063394/ But many cases of "long COVID" appear to be psychosomatic. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785832 https://jamanetwork.com/journals/jamainternalmedicine/fullar... And none of that is really relevant to school closure policy anyway. All of us will eventually get infected. At most closing schools again would only delay the inevitable. Instead we should focus on reducing risk factors by encouraging more people to get vaccinated and aggressively treating chronic metabolic diseases. https://www.medpagetoday.com/opinion/vinay-prasad/94646 https://www.medpagetoday.com/opinion/vinay-prasad/94646
blindmute 5y ago
I've yet to see any convincing evidence that long covid even exists, moreso than long flu exists.

by _jal 5y ago

wizzwizz4 5y ago

It's the human tendency to optimise the quantifiable and ignore the unquantified. (The unquantified is often partially quantifiable, but that would take effort, and the statistics aren't currently on the dashboard…) See also: https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law > When a measure becomes a target, it ceases to be a good measure.

zepto 5y ago
> It's the human tendency to optimise the quantifiable and ignore the unquantified. Are you sure that isn’t just a modern trend now that we are able to quantify so much stuff?
- Talanes 5y ago
  Modern society is just the result of countless generations of the human tendency to quantify. We just have so many things quantified now that our problems tend to be more "using the wrong quantifications" rather than "not having the right quantifications."
  - zepto 5y ago
    > Modern society is just the result of countless generations of the human tendency to quantify. Is it? I see no evidence to justify this statement at all. Care to show some? The vast majority of how society is organized seems to eschew quantification in favor of descriptive qualification. Most laws, and governance, for example are formed that way. The use of metrics in governance has been dramatically increasing as our methods of quantification have developed, but that is definitely a modern development.
    - Talanes 5y ago
      Descriptive qualification is a necessary stepping stone to qualification though, so of course society built on it first. Something must be described and defined before it can be counted. Modernity emerges from humanity first; influences it second.
      - zepto 5y ago
        So what? Weaving is a necessary stepping stone to making lounge suits. That doesn’t mean humanity has been destined to wear lounge suits all along.
        Talanes 5y ago
        The lounge-suit example is so much more specific than the topic at hand, that's just a farcical comparison. Any sort of broad logic will break down if you try and stretch it 1:1 to more narrow situations.
    - xboxnolifes 5y ago
      > The vast majority of how society is organized seems to eschew quantification in favor of descriptive qualification. > The use of metrics in governance has been dramatically increasing as our methods of quantification have developed, but that is definitely a modern development. These two statements seem slightly contradictory. If quantified metrics in governance has increased as our ability to quantify things has increased, then it would seem that laws did not favor descriptive qualification, they merely relied on it due to lack of ability to quantify. Or put another way: The only times we don't quantify things is when we cannot.
      - zepto 5y ago
        > The only times we don't quantify things is when we cannot. Just because something has increased recently doesn’t mean there is an inbuilt human tendency for it. For example the wearing of lounge suits for business is a modern development. I don’t think you are going to claim that means there was a ‘human tendency’ for lounge suits all along.
- xboxnolifes 5y ago
  I'm not much of a history buff, but I can't recall a good example of cultures or societal periods with emphasis on optimizing the unquantifiable (Or having no optimization preference at all). The only decent examples that I can think are in laws, and that only seems to be favored because things are difficult to be quantified, not because the unquantifiable was more preferred.
  - zepto 5y ago
    Can you think of a historical period in the distant part where there is evidence of a preference for quantification? It seem like you are simply assuming that was present.
    - xboxnolifes 5y ago
      Assuming we are talking about innate and not cultural qualities: If I do not assume we optimize for the quantifiable, I must assume either (1) we optimize for the unquantifiable, (2) we do not favor one way or the other (innately), or (3) human nature has changed over a very short (few thousand year) time period. I was trying to rule out (1). (3) Seems pretty easy to rule out purely on our understanding of evolution. And (2) would follow after ruling out (1) and accepting the original assumption. But onto this: > Can you think of a historical period in the distant part where there is evidence of a preference for quantification? Tax law.
      - zepto 5y ago
        ‘Tax law’ is not a historical period, nor is it evidence of a preference for quantification in general. Given your apparent desire to be logical about this, it seems almost absurd that you would give this answer.
        xboxnolifes 5y ago
        Tax law throughout all time. I didn't think it was necessary to clarify that point.
mhb 5y ago
Fine. What also isn't on the dashboard is the lost QALYs which is pretty much the point of TFA.

heavyset_go 5y ago

> What I don't understand is why so many people seem to view it that way. It's classic minimization. You see it all the time when someone is motivated to ignore reality, or is suffering from a condition that makes it hard to accept reality. A heroin addict might say that shooting heroin isn't a big deal because they haven't died from it yet, even if they have a history of overdosing.

nsainsbury 5y ago

I don't think anyone is ignoring long COVID and hospital issues. Hospital capacity is discussed front and center daily and is the primary justification given for lockdowns. Also, please see this recent meta-analysis which found that when you actually add a control group, most "long COVID" symptoms disappear in children. A higher study quality was associated with lower prevalence of almost all symptoms. Original tweet: https://twitter.com/ShamezLadhani/status/1472622893154639876 https://twitter.com/ShamezLadhani/status/1472622893154639876 Link to study: https://www.journalofinfection.com/article/S0163-4453(21)00555-7/fulltext https://www.journalofinfection.com/article/S0163-4453(21)005...

dijonman2 5y ago
How many hospitalizations are due to covid and how many just happen to test positive?
- nsainsbury 5y ago
  Appears to be very very common (as high as 2/3 'with' covid vs 'for' covid). See: https://twitter.com/MonicaGandhi9/status/1478401273317654528 https://twitter.com/MonicaGandhi9/status/1478401273317654528
  - hhmc 5y ago
    Surely it can't be a pure binary split of 'for' covid vs 'with' covid. Having covid presumably worsens outcomes for unrelated causes, in some cases turning a non emergency condition into an emergency condition.

CountDrewku 5y ago

You can say the opposite about the other side as well... Anything short of eradication (which is impossible) means nonstop lockdowns, masking, vaccine mandates and making the unvaccinated pariahs. What I don't understand is why you would shut down schools and enforce silly unhelpful mask mandates on them when the science shows children do not spread the disease in any meaningful way and are not badly affected by it. This is the "blind" spot I see.

ModernMech 5y ago
Schools in my district are shut down because there aren’t enough substitute teachers to fill in for sick or retired faculty. The older ones are getting sick and dying, or quitting before they do. The younger ones don’t want to be paid $35k a year to be screamed at by parents for not teaching subjects the way parents want them to be taught. Browse /r/teachers some time. It used to be a sub full of teachers venting steam about their students and sharing helpful tips. These days it’s just one post after another about teachers who are fed up and either quitting or planning to quit. They are proposing a new subreddit to handle the influx of complaints. If your “stay open” analysis begins and ends with the immune system and virus response of the students, then your analysis is incomplete because you are missing a huge dynamic that is at play here.
- alisonkisk 5y ago
- galaxyLogic 5y ago
  Good point. Also flights are cancelled not because of a government mandate but because personnel to fly the planes are sick with Covid. It would be bad business to fly with a sick crew.
- CountDrewku 5y ago
  My mother was a teacher for 20+ years and my wife is a teacher. I know exactly how schools are handling this. They're quarantining people that aren't sick, that's why they don't have staff. They've scared away substitutes with unscientific fear mongering about super spreader events in school. This is a problem of over-testing and unnecessary quarantining not a shortage.

onlyrealcuzzo 5y ago

And also the abnormally high ratio of people who die within 1 year of catching Covid from other reasons: https://www.medicalnewstoday.com/articles/covid-19-survivors-have-an-increased-risk-of-death-12-months-post-infection https://www.medicalnewstoday.com/articles/covid-19-survivors... 233% increase in chance of death for people less than 65... 183% increase for people 65+: https://www.frontiersin.org/articles/10.3389/fmed.2021.778434/full https://www.frontiersin.org/articles/10.3389/fmed.2021.77843...

btown 5y ago
The article actually says it's 233% increase in chance of death for people younger than 65, which is even scarier: > For people younger than 65 who were hospitalized with COVID-19, the risk of death in the 12 months after the infection was 233% higher than it was for people who did not have the disease, results published in the journal Frontiers in Medicine have shown. https://www.frontiersin.org/articles/10.3389/fmed.2021.778434/full https://www.frontiersin.org/articles/10.3389/fmed.2021.77843...
- onlyrealcuzzo 5y ago
  Thanks for the correction! My mistake - but I would argue it's WAY less scary. Chance of death is already high when you're 80 (4%). An extra 133% is 5.32% chance of death. If you're 16 is 0.02%. An extra 133% is a rounding error.
  - ArnoVW 5y ago
    Extra 133%, not extra 33%. So from 4% to 9.33%, not 5.33%
  - mupuff1234 5y ago
    But if that extra 133% risk is kept throughout your lifetime then back to being scary :/
  - nkozyra 5y ago
    It's an extra ~1,400 deaths in the 15-18 age group.

vitro 5y ago

The quora answer [1] by Franklin Veaux to question "How can a disease with 1% mortality shut down the United States?" explains nicely that it is not binary live/die at all. Mind though that this was written in the beginning of the pandemic when we didn't have the same information as now, so numbers may be imprecise, but the explanation still stands. https://www.quora.com/How-can-a-disease-with-1-mortality-shut-down-the-United-States https://www.quora.com/How-can-a-disease-with-1-mortality-shu...

alisonkisk 5y ago
[dead]
deleted 5y ago
[deleted]
asdff 5y ago
Even if no one died and people only went to the hospital, a huge issue is that they are there in the hospital in need of care and there are finite trained hands in the hospital. Not to mention you still have everyone else coming in with their car accidents and heart attacks at the same time. Better questions to think about are why the U.S. medical system supporting the words largest economy can't trivially expand its capacity to treat a relatively benign respiratory virus on top of its usual duties, or why there is a shortage in the training pipeline, or why people need ER care for other things in the first place.
galaxyLogic 5y ago
Nobody wants to get the disease which POSSIBLY could kill them or put them to hospital and perhaps financially bankrupt them and or give them bad long-term health outcomes. That has an effect on the behavior of everybody, except of course those who believe Covid is a "democratic hoax". Also with an evolving disease you don't know what its death-rate will be and it will depend on the preventive measures you and the government take, one of which is "shutting down" another being vaccination, which was not available at the beginning. If there had been no vaccine surely the death-rate had been larger. According to data below the mortality rate is 7.5% in Mexico. In US it is 1.5%, not 1% as implied by whoever posed the question. "Shutting down" will affect the mortality-rate because presumably it will protect the most vulnerable population more. If they don't get infected the mortality rate will be smaller. And as far as I can tell US was never really "shut down" was it? Everybody still got their groceries. Many died of Covid, nobody died of hunger I believe. Subways and buses were running. https://coronavirus.jhu.edu/data/mortality https://coronavirus.jhu.edu/data/mortality

renewiltord 5y ago

Well, the ideal outcome is to use the QALYs (or NHS Adjusted QALYs) to inform discussion, but it is considered a bit gauche (perhaps unfortunately for informed policy making) to identify that maybe the whole and absolute death of an 80 year old with emphysema isn't nearly as significant as some amount of disability to a 25 year old. i.e. there is a one-way ratchet on these measures since one direction is gated by the "trade grandma for a dollar" line.

yupper32 5y ago

Where are you seeing this? I'm seeing the opposite. Most public officials and news articles seem to only care about case numbers, which have very little meaning these days.

bko 5y ago

The reason people care about death is that its a clear signal and would likely scale linearly with the harm covid is doing to society. For instance, more positive tests could be due to testing. Hospitalizations are affected by different policies. I don't even know how you would measure long covid.

nradov 5y ago

Most any serious viral infection can potentially cause post-viral fatigue syndrome. We've known that for decades. COVID-19 is nothing special in that regard. https://pubmed.ncbi.nlm.nih.gov/3063394/ https://pubmed.ncbi.nlm.nih.gov/3063394/ But many cases of "long COVID" appear to be psychosomatic. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785832 https://jamanetwork.com/journals/jamainternalmedicine/fullar... And none of that is really relevant to school closure policy anyway. All of us will eventually get infected. At most closing schools again would only delay the inevitable. Instead we should focus on reducing risk factors by encouraging more people to get vaccinated and aggressively treating chronic metabolic diseases. https://www.medpagetoday.com/opinion/vinay-prasad/94646 https://www.medpagetoday.com/opinion/vinay-prasad/94646

blindmute 5y ago

I've yet to see any convincing evidence that long covid even exists, moreso than long flu exists.