Something the article doesn't do a great job of covering is how overall emergency medical incidents went way down more than expected - which is what some of these field hospitals (and the Navy ships) were for.
The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down? Or did people just die at home afraid to go to the hospital?
In SF in normal times, over 50% of trauma cases are from car accidents. My completely unscientific theory is that commuting/traffic is way more stressful and physically taxing than people think.
> The "excess deaths" surpassed COVID-19 fatalities in those states by a combined 4,563 people. Experts suspect that unconfirmed coronavirus cases could be responsible for some of those deaths, but it might also be related to a shift in other causes of death. For example, some doctors speculate people might be dying from illnesses from which they would normally recover because the pandemic has changed access to health care.
> “Our ER, as well as many others, are seeing far fewer patients because people are scared to come in.”
There are graphs.
This has added to a lot of the confusion and misinformation surrounding coronavirus response, since people are hearing that hospitals and ERs around the country are seeing fewer patients -- dramatically fewer, in some cases -- and conflating that with the coronavirus risk being unexpectedly low, which isn't true.
The original risk associated with Covid19 was lack of hospital resources. With most hospitals having plenty of capacity, the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.
> the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.
Not quite true, NYC was over stressed and there is at least one mass grave and are still corpses in refrigerator trucks.
Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer.
One can't extrapolate from the success of social distancing to imply that _not_ doing social distance would be less harmful.
>The results of our original experiment turned out to be different than our expectations
To the contrary, the proposed solution worked as expected. The social distancing combined with state-level quick action reduced the severity of the predicted disaster. In addition, people who would normally go to the ER "just in case" did not for fear of contagion. Or because they lost medical insurance. Or because visiting a GP became difficult and so there were fewer referrals. All reducing strain on hospital resources.
Certainly, The predictions of what would happen without out social distancing still stand as the data behind it is unchanged. And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors.
Since Sweden dropped from the narrative when it showed serious differences from its neighbors, it hints that criticism of social distancing is either (justifiably) emotional or (unjustifiably) politically. If it were from an honest appraisal by epidemiologists or economist, there would concrete counter projections and remedies rather than imprecise claims about it's success and ambiguous calls as to what a new policy should be.
It is horrible that the US death total exceeds the Vietnam war and that there is serious economic hardship. That is the terrible truth for natural disasters when no plans are in place (let alone actual preparation) and the response is slow. I hope the lesson from this disaster is that we are prepared next time rather than convincing ourselves nothing serious happened.
I wish people would stop comparing US coronavirus deaths to the Vietnam war. The comparison is intended to increase the perceived gravity of coronavirus pandemic - "Remember that war 50 years ago which had massive cultural & social impact? This is just as big!" - but implying the Vietnam war's impact was based on American bodycount is just wrong at best and appalling at worst.
The Vietnam war had such an impact because the US military went on such an insane spree of war crimes and civilian massacres that America permanently lost its standing as a moral authority gained in WW2. Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing, and the disaster was prolonged for an entire decade because the country was too proud to admit it was in over its head. McNamara and then Nixon knew the war was unwinnable, but the US could not appear defeated. And so the atrocities continued. Many in the US realized all of this and became permanently disillusioned with their country.
Apologies for the off-topic rant but this comparison has been making its way through a lot of circles that really should know better. If you find yourself wishing you knew more about this topic, I recommend the Ken Burns documentary The Vietnam War or the book Kill Everything that Moves.
> Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing
It was a civil war, initiated by the North, in which mostly Vietnamese killed other Vietnamese. The Americans intervening was absolutely a shit-show (and of course colonial history), but for the central point of your rant to stand, you’d need to show fewer Vietnamese would have died without American intervention, and that’s not a simple given.
You should spend some time talking to American Vietnamese with families who were persecuted in the immediate aftermath of the war, or who were lucky enough to escape.
The US didn't "intervene" what? Vietnam was colonized by France. Northern Vietnam was fighting for unification and liberation from French colonial power. The US lent their support to France in Vietnam because France was flirting with the Soviet Union in post-WW2 as the cold war took shape. France slowly withdrew as the US took on more and more of a role in the conflict, first as advisors then in active combat roles and finally as a full military force.
The Vietnamese were largely supportive of Ho Chi Minh and there was supposed to have been a democratic reunification vote, which didn't happen. That's how the civil war started, and North Vietnam would have easily steamrolled the South (since they managed to steamroll both the South and the USA). Most civilian casualties came from horribly targeted anti-insurgency or massive American bombing raids. It's a pretty easy argument there would have been many, many fewer civilian casualties without US involvement.
You appear to be conflating the two Indochina wars, and seem to be claiming I said America didn’t intervene when I used the expression “American intervention” so I’m not sure we’re even going to be able to find a common fact base to discuss this.
> It's a pretty easy argument there would have been many, many fewer civilian casualties without US involvement.
The history of Communism in Asia would like a word with you.
I'm not conflating them, it's just impossible to talk about one without the other; it was pretty much just one long war with America steadily increasing its involvement.
Given that communism actually won in Vietnam, we don't even have to work with hypotheticals. There were certainly deaths but nothing to the level of the death toll American military power exacted on the populace.
Regarding the word intervene what I meant is that I believe it is not a good descriptor of what the US did. Makes it sound like some kind of spontaneous humanitarian mission rather than them undemocratically propping up a failing state.
> Given that communism actually won in Vietnam, we don't even have to work with hypotheticals. There were certainly deaths but nothing to the level of the death toll American military power exacted on the populace.
Have you ever heard of the Khmer rouge in Cambodja, and how north Vietnam played a fundamental role establishing it?
You are jokig, right? I mean, the Vietnam and China-backed communist regime of neighboring Cambodja, who murdered millions implementing the same political reforms that killed millions in communist China, is only guilty of crimes against humanity because the US bombed them? Is that your argument?
And yet it was Vietnam that overthrew the Khmer Rouge, which was supported by China and the US. The ideology of the Khmer Rouge was very different from that of the Viet Minh. It was an ideology that demonized industry, cities and workers - all very much the opposite of the ideology of the Viet Minh (and of most of the Communist Party of China). It's not for nothing that the Khmer Rouge ideology has been called "Stone-Age Communism."
Vietnam was concerned Cambodja's regime was too China-friendly, but the millions being killed under the banner of advancing socialism did not featured as a pressing concern by neither China nor Vietnam.
The Khmer Rouge's ideology had almost nothing in common with the ideology of the Vietnamese Communists, or really any Marxist movement. It's difficult to see how an ideology that is intensely hostile towards all forms of industrial society and even towards the very existence of cities has anything to do with an ideology that has rapid industrial development as one of its central pillars. After the Vietnamese overthrew the Khmer Rouge, they put a very different type of government in place.
There were, of course, geopolitical calculations on all sides, which is why the United States and China supported the Khmer Rouge. I don't think moral revulsion alone often leads any government to declare war on another.
> It was a civil war, initiated by the North, in which mostly Vietnamese killed other Vietnamese.
No. It was initiated by the South, when it refused (with US support) to participate in a national UN-monitored election, which Ho Chi Minh would likely have won.
Edit: Statement of Eisenhower, from Wikipedia:[0]
> I have never talked or corresponded with a person knowledgeable in Indochinese affairs who did not agree that had elections been held as of the time of the fighting, possibly eighty percent of the population would have voted for the Communist Ho Chi Minh as their leader rather than Chief of State Bảo Đại. Indeed, the lack of leadership and drive on the part of Bảo Đại was a factor in the feeling prevalent among Vietnamese that they had nothing to fight for.
Some years before the war started, the factions that became the North (majority) and South (minority) participated in negotiations at Geneva. The deal stipulated national elections, with interim partition (North and South) after a delay to allow migration. But the South faction, realizing that it would lose, declined to participate. And that's what precipitated the conflict.
It's crucial to keep in mind that it was the North faction that had been fighting for independence from France. And that the South Faction comprised largely the colonial bureaucracy and Catholics.
> The Vietnam war had such an impact because the US military went on such an insane spree of war crimes
I agree with this. But, while this is before my time (my parents' generation), my understanding is US attitudes against the war were partly self interested in the short term: many boomer teenagers and 20somethings didn't want to get sent off to participate in such massacres, and much more they didn't want to die for it. Their parents didn't want them killed either. A lot of people knew somebody who had been killed.
If there had been no conscription there would have been less antiwar sentiment.
A similar scenario played out in the 2000s in Iraq, but without conscription.
> "Remember that war 50 years ago which had massive cultural & social impact? This is just as big!" - but implying the Vietnam war's impact was based on American bodycount is just wrong at best and appalling at worst.
But the impact of the Vietnam war on the US was primarily due to the number of casualties, wasn't it?
I mean, you wouldn't see many protests if the US government was sending college kids to southeast Asia to chill and soak in the sun, wouldn't you? Their sons arriving dead or maimed had something to do with it.
Americans by and large don't mind sacrificing their young as long as they get good value for it. With Vietnam they saw soldiers sacrificed for utterly pointless things like defending Khe Sanh or taking Hamburger Hill (both were abandoned right after victory), all while their leadership was telling them they weren't even seeking military victory. Meanwhile half the country was calling the troops babykillers (not without reason) and young people being drafted into the mess were faced with the moral choice of going to prison or running away to Canada (with the associated accusations of cowardice and shame brought on their family by idiots) or turning off their conscience and shipping off to Vietnam to kill some people posing absolutely no threat to their freedom or way of life. No matter how you look at it, it's way more complicated than boiling it down to US deaths.
I don't think the comparison is trying to describe the Vietnam War's impact in terms of body count, but instead to describe the pandemic's impact in terms of an enormous societal issue, which IMHO it is. People have a hard time with large numbers (remember Stalin saying one death is a tragedy, 1 million is a statistic). So having markers to help with comparison is normal.
It's fair to say that NYC was stretched to the limit, and certainly stretched farther than anyone would want, but it is hard to make a claim that hospitals were overwhelmed anywhere like predicted. New York hospitalizations peaked at 18,825[0], while Cuomo predicted they would need 30,000 additional ventilators. The expanded bed capacity in New York reached 90,000 at Cuomo's command[0]. There is no known case of an american not receiving a ventilator if needed [1][2].
And, remember disease models did not just predict unmitigated spread. They absolutely incorporated percentages of social distancing into their models. The original imperial college study predicted that a high income county with around 50% social contact reduction would still exceed hospital capacity by 700%.
Cuomo's New York model that predicted 30,000 additional ventilators absolutely incorporated lockdown measures, if they didn't they have some serious explaining to do.
Of course I still agree a lockdown was needed, and agree the lockdown did about as well as it could. But is there any reason to not revisit data and determine if we could do better?
Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer.
-- NYC has maybe peaked but the rest of the country is still rising.
NYTimes: "“If you just look at the total number of cases, you’re going to miss what’s underneath it,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It’s not a leveling-off. It’s a painful handoff.”"
> And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors.
Not only that, but as a percentage of population, Sweden's fatality rate is far ahead of that of the USA, and still climbing at a faster rate than America:
This is inaccurate (at least in implication): this mass grave has been around and in use for 150 years. It's being used more heavily, obviously, but then that's no different than saying "more people than normal are dying in NYC"
> not getting access to hospital resources is much lower than expected
I don't know how you can say 'lower than expected'. Many interventions were non-medical, depending on social behaviour (e.g. adhering to social distancing), effectiveness of governance and enforcement, as well as economic and political (e.g. supply of test kits, ventilators). And even then, we were dealing with a new virus, there was limited data about all kinds of variables. For example, if people are intubated twice as long in the US due to high levels of obesity compared to China, you need twice as much ventilator capacity.
Point being, we always had to deal with a very wide confidence interval.
Now combine that with the fact we're looking to predict an exponential number, rather than something linear, and you can get wildly different outcomes. In New York the doubling time began around 2 days. That meant the difference between hospitalising 50k or 100k was a matter of starting social distancing two days later. The difference between 50k and say 1.6 million, was just 10 days. Hospital resources can't expand that fast, at best you can add 30% extra beds and shift all bed-use to dealing with corona with emergency interventions, but you can't just scale 3000%.
That's where the field hospitals came in. Not because it was guaranteed or fully expected to need them, but because there was a good chance, and there was too little information to conclude they wouldn't be necessary.
Yeah. It's really a shame that there were all these efforts to prevent our health care system from being overwhelmed. Oh well. It looks like enough people would like to run this particular experiment that we just might get to see what it looks like after all. Yay?
I don't understand your comment. We made decisions based on information. The results of our original experiment turned out to be different than our expectations. Further, others were hurt substantially due to these decisions. Those hurt are requesting (or demanding) to change course so as to not be hurt further. Seems reasonable to change course, with each US State (or country) changing course differently based on their circumstances.
> Further, others were hurt substantially due to these decisions.
If anything the US government failed to act to attenuate the expected economic impact that emergency anti-epidemic policies would naturally have on the most vulnerable elements of society.
It's also very ironic, if not hipocritical, to abuse the most vulnerable and victimized elements of society, who have been systematically ignored and sacrificed , to argue against undoing policies aimed at defending society's best interests.
I don't know why you think we came out so far different from expectations - New York hospitals were overwhelmed, they hadn't shut down in time to prevent a large wave of cases - other locales that have gotten lucky or shut down have avoided feeling that wave so far... Changing course doesn't seem advisable as growth rates haven't subsided into the negative except in small locales.
New York was the exception to the rule. Most hospitals were not overwhelmed. In fact, many hospitals flirted with financial disaster when governors prevented elective procedures. I can speak specifically to AZ which outside of some very small Indian Reservation medical centers, is well below capacity[1]
Seattle's Army hospital closed without a single patient[2].
Growth rates, especially in AZ, were never large to begin with.
I would be cautious about using the past tense. New case rates have not come down much from peak - and I expect them to spike in the next few weeks as people let their guard down and things reopen.
Deaths lag infections by several weeks. Over 2200 people died yesterday.
I agree that with re-opening, we will see a bump in infections, and therefore deaths. However, there is only one path out of this and that is herd immunity. We can accelerate herd immunity via vaccine, but either way its herd immunity. That means that we want as many people sick as our hospital system can handle, but not more. That means playing a game of optimization. Further, different states (New York vs. Arizona) should have different plans because their situations are vastly different (population density, current herd infection status, etc).
Further, we can't just optimize for Covid19 deaths, we have to look at the whole situation, which includes suicides due to shelter-in-place orders, child abuse and other domestic violence, malnutrition due to hunger from unemployment, negative impacts of poverty.
this will certainly be a case study for future generations.
> That means that we want as many people sick as our hospital system can handle, but not more.
This would be the optimal situation, but it requires at least:
* Widespread testing available to any who need it for any reason;
* Careful, centralized monitoring and resource allocation;
* Plenty of PPE, critical care equipment, and disposable goods;
* A cooperative public willing to follow a constantly shifting set of recommendations.
And the country as a whole has basically none of those things. California is better-resourced and managed (for this particular thing) than other states, so they're gonna give it a shot. The rest of the country is just gambling.
This disease does not cooperate with this kind of response because of the lag time from initial infection to critical illness. Reports on this vary from like 3 days to 20-odd days. Coupled with the disease's high rate of infection, this means that a hospital can go from 50% full to 150% full very quickly. If a state government with an impossibly obedient population set a tripwire at 50% hospital capacity and shut everything down the minute they hit that mark, then they're still going to overflow a couple of weeks later as symptoms progress for those that were infected just before the shut-down.
The virus needs to be studied in further detail before we haphazardly aim for herd immunity. There is still no proof that the immunity gained from it, lasts more than a few months.
Imagine the fall out if a government pushes for herd immunity, knowingly sacrificing 5-10% of the population, and it turns out that country gets wave after wave of fatalities due to the herd not having a lasting immunity.
Growth rates are dependent upon testing, which is inadequate. And what little testing has been done by AZ shows a very large growth rate[1]. And the graph of growth rates by the AZ governor makes the same mistake in excluding the last 4-7 days of the graph's range. It's nonsense.
Some hospitals in NYC were overwhelmed, but that was limited to Queens and Brooklyn: the NPR piece notes that Javits Center, which was turned into a hospital in Manhattan, treated about 1100 people total, after being built to handle 1900 at a time. The three other NY field hospitals on that list, all close to NYC, treated zero patients. One of those is in the same county just north of NYC that had the initial outbreak here.
I think there's no question that COVID-19 has been a disaster here, but it's going to be heavily debated whether the lockdown saved us or just made things worse on net.
The low occupancy rate of field hospitals is evidence that either the lockdown worked, or that it was unnecessary. It excludes the case in which the lockdown was obviously necessary and just barely worked, since that's the case in which those field hospitals would themselves have been overwhelmed or nearly so, as well as the existing ICUs.
Without regard to the actual effectiveness, the fact that the field hospitals went mostly empty will fuel acrimonious debate about said effectiveness.
Yup, makes me wonder why Cuomo didn't shut down the subway system (or at least limit use based on some sort of need)? The media's given him props for leadership in his briefings, but ignored this massive sources of infections. Meanwhile, various narratives swirl about why NYC is being hit so much harder than elsewhere, like it's some sort of mystery.
I'm not sure that the data bear that out. Manhattan is the best-served borough, but the least infected. Just this week, Cuomo mentioned some surprising findings: essential workers and homeless, who make up most people on the subway, do not make up a significant number of infected showing up at hospitals, but those do who had been sheltering at home (self-reported, I imagine).
Not sure what data you're referring to. The article I saw in early March said that ridership was down over 70% in Manhattan vs only 15-20% in Queens and Brooklyn. Those numbers have now apparently fallen much further, but I've not seen a breakdown by Burrow.
New York hospitals weren't happy by any means, but their peak load was an order of magnitude less than what local leaders said they were preparing for.
"I don't want to be hurt" was an option that was swept off the table the moment we went into this disaster with a dysfunctional federal government.
Our choices since then have been "economic hardship and misery" or "economic hardship and misery with a spicy side dish of death and suffering". Covid19 has been the leading cause of death in America for a month now [1]. Some time tomorrow, it will have killed a confirmed 80,000 Americans [2] and America has consistently had 1/3rd of the world's critically-ill cases for weeks [ibid]. There is no way we are going to get out of this with less than 100,000 dead.
Amazingly, the same country that had endless investigations into the deaths of two people in Benghazi and went to war over the deaths of 3,000 Americans on September 11, 2001 -- subsequently spending $6.4 trillion in war operations [3] -- is finding 100,000 dead to be "pretty good", and the economic cost of mitigating further death to be just a little bit too expensive.
As usual, some of this is explained by political misinformation campaigns that too many people are falling for [4][5][6][7], but still, the same talking points get repeated into forums like this one, even though most Americans would prefer economic pain over a higher death toll for now [8][9][10].
I'm just gobsmacked that the disinformation is taking root so easily, because arguing that can really trivially be reduced to, "I don't think enough people are dying to justify the measures meant to prevent people from dying."
Hopefully states like California that are following more conservative, evidence-based approaches to relaxing restrictions, will relieve some of the tension.
I hate to reply so pithily to your well-researched comment, but your basic premise seems to be false here. California recognizes that economic restrictions are causing severe harm and began rolling them back today.
> California recognizes that economic restrictions are causing severe harm and began rolling them back today
But the OP wrote,
> Hopefully states like California that are following more conservative, evidence-based approaches to relaxing restrictions, will relieve some of the tension.
You are both correct: California is rolling back economic restrictions, but they are following a conservative, evidence-based approach to relaxing them. The OP's basic premise, however, is not at all false, and I sincerely hope you don't have the impression that the state is just throwing a switch and going back to "normal." It's not.
Or I should say, we're not. I don't know where you're located, but I'm in California -- the Bay Area, specifically. We don't even have official guidance on how restaurants are going to re-open yet, an the California Restaurant Association -- the business group that represents restaurants, and clearly has an economic motivation to get back to business -- has actively lobbied for the re-opening of their member businesses to happen slowly and very carefully.
I would like nothing more than to be able to start going back to my favorite restaurants and bars. But the reality is that for the last month, the daily number of new Covid-19 cases and of deaths hasn't been materially dropping in the US in the way it has in countries like the UK, Italy, and Germany, which strongly suggests that our collective behavior throughout April remained too relaxed in most states. The paradox of this pandemic is that the looser the restrictions we place on ourselves are, the more economic damage we're likely to face over the long term, not less, because we'll start cycling through repeated outbreaks, being forced to close businesses, districts, and even regions ad hoc, and running a much greater risk of overwhelming hospitals with bursts of new cases virtually all at once in stricken locales.
> the more economic damage we're likely to face over the long term,
What I don’t quite understand is how people expect the economy to “just go back to normal”... like, even if you “reopen” everything, ease all restrictions, it’s not like people are goingback to living as usual.. they’re still going to keep by themselves, because that’s an individually sensible decision... are you going to attend a conference, a wedding, a dinner party / restaurant where you’ll be near 100+ people? Of course not, you’ll be making sure you stay healthy! The economic damage will happen and persist, and governments can’t just legislate against that!
It's the same crowd that believes that the economy would have just been fine if we had treated this like we do the flu; ignoring that 2M dead Americans has a funny effect on the economy.
It saddens me that those who for some reasoning fall prey for this line of reasoning don't just hurt themselves in the process, and actively contribute to spread and worsen all problems to everyone they ever contact with.
We might be on the same page here, then. I agree it would be dumb to just immediately reopen all businesses with no thought about how to mitigate risks or delay the least safe ones. But I see a lot of people propose that relaxing restrictions doesn't matter, that it's just not an important priority relative to the virus, and that goes too far.
And that is the nature of the problem. It is far easier to throw out a random anecdote then to prove or disprove it.
I remember hearing a story of a solder that sent a single bullet into a pole mounted transformer. The oil leaked out, it over heated and exploded. Power went out to the block, maybe taking connected devices with it.
A two second act that cost less than a dollar, destroyed something that was orders of magnitude more expensive and took orders of magnitude more time to put in place.
The majority of Americans across the board support the lock down, and continue to support going slowly with relaxing restrictions. Only a small, yet well-funded minority want things relaxed ASAP.
> The fallout from such fear has concerned U.S. doctors for weeks while they have tracked a worrying trend: As the pandemic took hold, the number of patients showing up at hospitals with serious cardiovascular emergencies such as strokes and heart attacks has shrunk dramatically.
> Across the U.S., doctors call the drop-off staggering, unlike anything they've seen. And they worry a new wave of patients is headed their way — people who have delayed care and will be sicker and more injured when they finally arrive in emergency rooms.
My father needs medical help RN but everyone is putting him off just sending RX over phone no (pain pills though) saying "stay home". ASAP they open we all wheeling him in there for a MRI if we have to camp outside in a waiting line so be it.
I don't know where you are, but in my area (east of NYC) the ERs are non-COVID and strictly separated. Weigh the risk, but know that the ERs are not necessarily warzones. Call the hospital and ask them, but don't delay care just because you don't know the real risks. I've been (physically) to an urgent care clinic, a specialist's office, and a dentist in the past week, because I waited two months for care, and I'm feeling pretty stupid (I'm high risk). The protocols are different, waaaaahhy more strict, but they are treating people.
> The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down? Or did people just die at home afraid to go to the hospital?
It's at this point that the news media needs to look inwards and wonder if they made such a big hysteria over covid that they failed to point out that people should still go to the ER. I bet many of those who died at home had symptoms of heart attacks/strokes, etc, but didn't want to go out of a mistaken sense of magnanimity (I don't want to take the bed of a COVID patient) as well as a false sense that the hospitals were in any danger of being overloaded (they were not, given the steps we took).
I think you've explained why this isn't getting covered well. The news media does not do introspection. They're all rah-rah about their power to change the world and how important it makes them, but they almost never consider the possibility that they could've made it worse.
> false sense that the hospitals were in any danger of being overloaded
They were overloaded in Wuhan, Milan, Madrid and Brussels, and came within a hair of capacity in Paris and New York. What "false sense" are you talking about, exactly? There was real risk. Are you saying that the media reported overloads that didn't exist?
Your argument seems a bit vague to me. You could just as easily argue, with perfectly symmetric evidence, that it's good that "the media" "gave a false sense" of hospital capacity, because it prevented an actual overload of the system. Why is your version better, except that in yours you get to have a more personally pleasing enemy?
Pretty much all criticism of "the media" is like this.
> What "false sense" are you talking about, exactly? There was real risk. Are you saying that the media reported overloads that didn't exist?
Um... Cuomo said he needed 40k new ventilators to make sure hospitals had all they needed after he instituted a shelter in place order. He needed nowhere near that amount. That is hysteria. I don't understand why this is controversial.
> What "false sense" are you talking about, exactly?
The fact that we were being told to expect Italy/New York levels of hospital overruns ALL OVER the country (hint: field hospitals that hardly got used weren't just deployed in NYC)? And that we're still being told that hospitals ALL OVER the country are in danger of being brought to their knees by re-opening state economies right now? Meanwhile, the nurses that aren't furloughed are making nightly dance videos during their shifts.
I don't remember that at all. I remember being warned (correctly) that this was a possibility, and that lockdowns were needed to "flatten the curve" and prevent it. That kind of framing was pervasive. But I remember it being very explicitly presented as a caution and not an inevitability.
And as it happened, people took heed. And it worked. We beat it.
Can you cite the specific coverage you're thinking of?
Basically: this seems like a bit much to me. The media warned us of something. We listened. The warning worked. And now you want to attack "the media" because the thing they warned us might happen didn't... because they warned us.
What about option #3 - going to hospital puts you in danger of catching COVID?
If you have pre-existing conditions, catching COVID is a lot more dangerous than if you don't.
Who typically goes to the hospital for medical treatment?
People with pre-existing conditions.
"I don't want to go to the ER, because I might catch COVID from another patient, or doctor" is a very justifiable fear.
This is just the consequence of the virus spreading to the community - not the consequence of mitigating the spread of the virus through the community.
> "I don't want to go to the ER, because I might catch COVID from another patient, or doctor" is a very justifiable fear.
The mortality risk of undetected/unaddressed heart problems, etc, far supercedes the risk from COVID-19. You could find some limited examples where that's not true but it is overwhelmingly the case.
It is becoming increasingly clear that the level of panic associated with COVID-19 is absolutely divorced from the ground truths.
But it doesn't just affect non-COVID-19 mortality. It may be that our response is even making COVID-19 mortality worse in some cases:
"Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes. Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic." (My note: So the irony here is incredible, these weren't just non-COVID-19 patients afraid to come in but _people who actually had life-threatening COVID-19_.)
"Third, the COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental health condition because of high susceptibility to stress compared with the general population."
and
"Finally, many people with mental health disorders attend regular outpatient visits for evaluations and prescriptions. However, nationwide regulations on travel and quarantine have resulted in these regular visits becoming more difficult and impractical to attend."
> It is becoming increasingly clear that the level of panic associated with COVID-19 is absolutely divorced from the ground truths.
No, it's becoming increasingly clear that people are incapable of telling the difference between their personal health[1], and the health of society as a whole.
The risk of COVID to me is low. The risk to society of me going about my daily business as if nothing has happened is high. There are social adjustments that do little to reduce my risk, but decrease overall risk, and unsurprisingly, people who don't understand, or don't care about the difference between the two, push back on them.
And now we get to look forward to a torrent of people who will be complaining that the horse didn't bolt because we closed the barndoor.
[1] You are pointing out a few anecdotes of people not going to the ER when they should. I don't deny that a few people are making that mistake. But if we're going by anecdotes, I can point out a million and one anecdotes of people not taking basic health precautions - that I don't even need to go to a newspaper for - since I can see them out of my window.
> The risk of COVID to me is low. The risk to society of me going about my daily business as if nothing has happened is high. There are social adjustments that do little to reduce my risk, but decrease overall risk, and unsurprisingly, people who don't understand, or don't care about the difference between the two, push back on them.
This is not a fair characterization. Rather, it could be said that the externalities of suspension of elective surgeries, widespread business closures, widespread social isolation and unprecedented fear (which is certainly disproportionate to the risk, _even in those with comorbidities_), are all factors that those who are parroting the "Stay home!" party line are neglecting.
I don't think it's fair to say that those who argue against the path we've taken are doing so because of their purely personal risk factors. When highly interconnected systems - like the global supply chain - unravel, it's very hard to predict the full ramifications there. It might be good to start with the impact of these lockdowns on the global food supply and the estimates of 100+ million extra cases of starvation. (I generally try to focus on other factors because quite frankly, to flip your rhetorical technique around, I think that many in favor of these lockdowns don't really care too much about how lockdowns impact conditions in third-world countries and thus I largely try to talk about the direct first-world impact).
I don't think those in favor of lockdown are trying to do harm, their intentions are good. But the poor understanding of key concepts such as _what an economy actually is_ is leading to a number of irrational statements being made: for example, the argument that re-opening business is "trading human lives for money". The actual reality is much more nuanced.
While on the contrary, perhaps it's just been in my online interactions, but arguing against lockdown/indefinite containment is consistently characterized as either motivated by self-interest or due to the perceived personal risk being low. In essence, the "you clearly don't care about old peoples' lives" argument.
--
I've been doing a pseudo-experiment where I've been asking acquaintances of mine what they think the overall infection fatality rate of COVID-19 is, and also what they think their personal risk is. Everyone I've talked to has overestimated the mortality risk both to others and to themselves by an order of magnitude. For example, many have told me that they think the infection fatality rate is 2.2% overall, or 4-5%, etc.
In one case a largely healthy young 20-something estimated their personal risk of death at 2%. That's multiple orders of magnitude off.
This pseudo-experiment of mine proves nothing, but it's an interesting insight into what people think. (Many of my social groups are very transparently "liberal"-leaning and disproportionate panic in the US is split on party lines so that's not very surprising).
> This is not a fair characterization. Rather, it could be said that the externalities of suspension of elective surgeries, widespread business closures, widespread social isolation and unprecedented fear (which is certainly disproportionate to the risk, _even in those with comorbidities_), are all factors that those who are parroting the "Stay home!" party line are neglecting.
Pundits advocating for reopening are deliberately conflating those things, as if the ROI on having a movie theater, or a hairdresser open is the same as allowing a tumor removal brain surgery to proceed.
It's not. Nobody's advocating that everything should be closed forever, but there's an enormous space between "Let's figure out how to get people the medical care they need, because elective medical procedures cannot be postponed forever", and "Everything's fine, everyone go back to work".
The fact that you're bringing up the global food supply is testament to this. Most of the food supply disruptions were caused by direct impact of the virus, with food workers getting sick - not overly aggressive closures. Food is an essential service, no government on the planet told food producers, or food logistics workers to stay home. [1] Yet, the re-open folks are pushing hard on the fiction that we're all going to starve to death, because clothing retailers aren't operating. Meanwhile, the reason you can't get ground meat is because 80% of the people working at the local meatpacking plant are sick, because the plant manager refuses to provide PPE, sanitary working conditions, or even to send sick employees home.
[1] There were temporary border closures for migrant agricultural workers in the US, but they were very quickly lifted, once the government realized that Americans don't pick strawberries. Canada never closed itself to TFWs, neither did most of Europe.
> Pundits advocating for reopening are deliberately conflating those things, as if the ROI on having a movie theater, or a hairdresser open is the same as allowing a tumor removal brain surgery to proceed.
How does brain surgery get paid for? Let’s even assume a single payer system for a minute. Where do the tax revenues come from?
This is an unreasonable response with full information though. Had the media done their job in most parts of the country and reported that hospitals were not actually seeing many covid patients, people would have been more willing to go to the hospital. Instead, every news outlet, including local ones, reported on one or two slightly overloaded hospitals in New York City, which is a thousand or so miles away for most Americans, and completely unimportant when you have a heart attack, stroke, whatever.
Instead, people had to make do with partial information and many people -- believing incorrectly that their local hospitals were overwhelmed and needed them to stay home -- chose to do so.
All news media is bad at reporting on science and medicine, but they've kicked it into an extra gear for this pandemic. I've seen endless articles pointing out the newest, barely-supported piece of evidence that might mean COVID-19 is even worse than we thought. And you never see the follow up article when that turns our to be pure BS. At one point a couple weeks back someone at the WHO said they don't know exactly how immunity works yet with this virus, which was followed by a flood of articles screaming about how we can't become immune (with a little "maybe" shoved in somewhere way below the headline).
And have you ever watched local television news? Millions of Americans do every night. It's the worst of the worst, and their over-the-top tactics are a well worn joke. "Is your refrigerator going to kill you and your children? Tune in at eleven to find out, only on FUTV News".
> of evidence that might mean COVID-19 is even worse than we thought.
As a scientist I say sometimes that one of the unnoticed victims of SARS-CoV-2 is media reporting. Some newspapers here (Italy) really love gruesome details, to be honest, but they conveniently forget talking about the frequency of said details.
I mean, if you have a respiratory disease that can blow your head off (this is just an absurd example), you prepare differently depending if it happens in 50% of the cases or in 0.5%. This is completely lost in news reporting.
In addition, the news (but sadly, some experts too!) treat SARS-CoV-2 as a magic virus that does everything different from any other known biological entity. While I was initially surprised to hear those cases of meningitis, I then found in the literature that other coronaviruses can infect the central nervous system (e.g. [1]).
It doesn't mean this complication less severe, when it occurs. But it's not a feature of this virus alone.
At one point a couple weeks back someone at the WHO said they don't know exactly how immunity works yet with this virus, which was followed by a flood of articles screaming about how we can't become immune (with a little "maybe" shoved in somewhere way below the headline).
Care to share a link or two? I’m skeptical that any respected news outlets reported that we can’t become immune.
The CNN headline for the article you linked to is:
"WHO says no evidence shows that having coronavirus prevents a second infection"
The second paragraph of the article literally quotes a published brief from WHO:
"There is no evidence yet that people who have had Covid-19 will not get a second infection," WHO said in a scientific brief published Friday.
The headline is literally taken from the WHO's actual words. There's a case to be made that these sort of articles need to be more deeply contextualized with respect to how science works and what the implications of findings are (and what they aren't), but that gets into deeper questions about scientific literacy -- not just for journalists, but for their audience -- but it's hard to point at this and say that this reporting is making it look like the WHO was saying something that they weren't.
It's just poor communication, anybody who parrots 'evidence' to the average audience will know full well that 'no evidence' => 'evidence _against_ something'. That's a really, really basic way to mess up when communicating this. I don't know why it's so bad. I think this is certainly a case where an educated journalist should not simply consume literally the WHO's output, and should instead term it in ways commonly understood to be closer to the truth.
The final 3 paragraphs of the 9-paragraph CNN article are a quote from a non-WHO expert doctor on the subject of the article. It does look like they tried to contextualize it and not just literally repeat the WHO announcement.
I would put more blame on the WHO for this than CNN in any case. It’s fair to say the way the WHO reported this was misunderstood, but the WHO themselves tweeted the same type of wording out directly on Twitter.
You are wrong because - a) Risk of death among the sickest and weakest is way higher than the "normal", across all age groups. b) We do not know much about the virus. It appears to have strange trait of being more deadly if initial exposure was higher. In Russia, for example ~7% (!) of all Covid deaths are deaths of medical workers, many of them are relatively young and apparently healthy. c) We also do not know what are long term consequences of the disease, even if you survived it just fine.
When we talk about flu stats: most people have some immunity to the flu thanks to flu shots (even if they haven't gotten one for this past year) and general herd immunity, which we DO NOT HAVE for this virus, and won't gain without either a vaccine or a few million dead from this thing running rampant.
The stats you're quoting are WITH the level of serious intervention we've had so far, which is why as certain states are reopening, we're starting to see the numbers ticking back up again and looking just as bad if not worse.
I don't think he did compare it to the flu. But look, as unpopular as that comparison is, we just don't have numbers that support the original estimates that caused lock downs of 2 million dead in the US. The media pushed worst case over and over, and still is.
I think an uncomfortable stat this coming year will be just how few people will have been reported to died in 2020 of regular flu. It's not saying Covid19 isn't bad in any way to realize that number, will be almost nothing, and that will be suspicious to people going forward for NextTime.
We don't have those numbers because of the lockdowns, which were obeyed in part because of the media coverage. The alternative would have been China's approach of physically locking people inside their homes, or much lower compliance and higher infection and death rates.
There is the small matter that deniers make the claim that government lockdowns are forcing people to stay home, not work, etc. When the data tends to show people were starting to shelter in place well before governments took action.
Sweden didn't have an official lockdown, but they encouraged safer behavior and already have more work from home and single people living alone than other places. That would not have worked in the US, and in truth it didn't work as well as their neighbors.
They certainly have, but not due to a 'shutdown' like the ones that were being encouraged in every other country. The media stats said that we were in for 2m deaths in the United States if the government did not shut things down. That was wrong. A proper media response would have anticipated that -- even if the gov't didn't shut things down -- people would have been more cautious by making individual decisions. That would have lead to a better government response.
The inferred IFR from serological prevalance and deaths in NYC is ~1%. NYC's demographics skew favorably compared to the nation, but assuming ~60% of the country would get COVID-19 if not for restrictions, 2 million is right on the money.
And this also ignores those who survive COVID-19. Roughly 5% are being hospitalized with potential long term effects. Everyone assumes that we're over the hump. The only place in the US that I would consider over the hump is NYC. Everywhere else has nowhere to go until herd immunity is reached.
How do you square this with what happened in Lombardy, Spain, France and other places in which the healthcare systems were overwhelmed and tens of thousands of people died in just a few weeks?
Do you know how many flu deaths happened in Italy during the 2016/17 flu season?
Compare that to the Coronavirus deaths. The numbers are really close.
Italy isn’t particularly an outlier in terms of Coronavirus severity when you look at their historical flu numbers compared to the rest of Europe. Their Coronavirus deaths follow the same trend as with their flu fatalities. Really nothing surprising in Italy, but the media lost their minds over it.
Yes you are exactly right. It has always been normal to send the dead bodies to neighboring towns, when your crematoriums are full, and they did it every year in Lombardy. No one just noticed previously. I think we need to blame their mayor, for not encouraging building bigger better crematorium.
I asked you about the collapse of the healthcare system in Lombardy, within a few weeks of the virus appearing. When has the flu done that?
You're presenting what happened in Lombardy as some sort of mass hysteria. Was the healthcare system overwhelmed, or was that a mass hallucination?
There have been 30,000 confirmed CoVID-19 deaths in Italy, which is about double a normal flu season. What do you think that number would have been without any social distancing measures? As I see it, the numbers are not that difficult to estimate. About 70% of people would need to catch CoVID-19 before herd immunity brought R below 1. With an IFR of 0.5%, and a population of 60 million people, that would mean about 200,000 deaths. Is that enough to "lose one's mind over"?
* Not enough doctors, nurses, beds and medical supplies to treat all (or even most of) the patients.
* Extremely stark triage decisions. Deciding not to treat patients who would normally be treatable, instead leaving them to die.
* Doctors and nurses working to the limit of exhaustion.
* Normal care essentially stopping. All medical resources being focused on one disease.
* Morgues unable to handle the number of dead.
Finally, double the regular number of flu deaths occurred in just a few weeks, and that was with extreme social distancing measures. Without those measures, the death toll would have been far higher.
You're describing this as some sort of mass hallucination. I don't see how that's a defensible position.
> but I'm not sure you can say it 'collapsed' (what does that even mean anyway).
If there was any doubt that you're being disingenuous and purposely deceitful, the fact that you've decided to resort to petty arguments on semantics to desperately avoid facing the facts is enough to clear up that doubt.
My parents are in their 80s so your statement was very surprising. At 80 the expected death risk is under .6% per year, so you’re off by about two orders of magnitude.
By mid-February the media as a whole was already raising alarm bells, and the stock market began crashing on February 24 as a result of media coverage of the virus.
> “The press was covering their hoax of the day because they thought it would bring down the president,” Mulvaney concluded. “The reason you’re seeing so much attention to [the coronavirus] today is that they think this is going to be what brings down the president. That’s what this is all about.”
CNN international version or what I get here in Europe has been showing body count 24/7, going as far as making the actual content smaller for the overlay.
Considering you said "We need herd immunity sooner than later. Let's get to 80% ASAP!" just yesterday, I'm not surprised there are other posts people weren't taking at face value.
I also remember the take downs of the various antibody studies all pointing to infection being much more widespread than originally thought. As if it was bad news the IFR was going down.
I lack the intelligence to connect the dots but I sincerely feel there's a large bias, if not outright agenda, here to advise prolonging and deepening the economic destruction.
>> which is what some of these field hospitals (and the Navy ships) were for.
Small detail about the navy ships: they are setup for battlefield injuries. The wards are all open (think what you see on old episodes of MASH) with little to no separation between patients. That is fine for traumatic injuries (earthquakes, fires, war etc) but less than useful for control of infectious disease. The plan was for them to take non-covid patients to relieve hospitals but it never really worked out. The risk of a ship becoming a hotspot should one covid infection slip through into an open ward was too great.
This is not entirely correct. The US Comfort in NYC specifically is as you described, but, lost 1/2 it's capacity by setting up with protections between beds. It still saw almost no people because the need just wasn't there. Under 80 people last I heard. I am not aware of any reports that said fear was a factor in it not being used, do you have that source?
1) Hospitals generally get paid (by someone) for treating patients. So they want to run at 100% capacity, even with covid patients.
2) You can't really just "build an ICU." You can stand up a field hospital that's able to provide similar, degraded services. But it's not going to be the same.
Imagine if someone said "set up a datacenter in a field," and then a customer had a choice to colo their server in a purpose-built DC or your field DC. Which do you think they'd pick?
3) The units that staffed these facilities were heavily augmented by military reserves.
Corpsmen may have non-medical civilian jobs, but what do you think military reserve critical care nurses and doctors do for a living?
If these field hospitals were packed to the brim, all of those people would be locked in place. Possibly while they were needed in their civilian positions, in their home cities (although the military seems to have done a pretty good job about preferentially pulling non-Covid-civilian personnel).
4) Exponential growth with unknown but high R_t. +1 week before we locked down would have looked very different.
... all of that to essentially say that these facilities were designed as surge capacity, in the event they were needed. We intentionally filled up hospitals first.
USD$660M seems like a reasonable price to pay, strictly as insurance, given the very real risk that hospitals would have been overfilled and covid-related mortality would have spiked due to lack of care.
> USD$660M seems like a reasonable price to pay, strictly as insurance, given the very real risk that hospitals would have been overfilled and covid-related mortality would have spiked due to lack of care.
I think this is under-appreciated. In contrast to the $0.6 billion spent on field hospitals, the US spent some $2000 billion on the CARES act to mitigate economic harms of the virus and response to it.
> That is fine for traumatic injuries (earthquakes, fires, war etc) but less than useful for control of infectious disease.
Military hospitals (including ship-based hospitals) have been planning and preparing to deal with biological warfare (i.e., communicable diseases) for many, many decades, and even before that they were well acquainted with communicable diseases. It was not uncommon in the past for communicable diseases to kill more soldiers than died in actual combat.
That is one reason the U.S. Public Health Service is a uniformed service -- so their personnel could operate in war zones without the risk of being shot as spies if they were captured.
>The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down?
besides the deaths-at-home, shouldn't it be considered that the low-impact low-energy lifestyle that is being promoted right now is less strenuous on the body in the short term?
I imagine that the lack of deaths, after deaths-at-home are cancelled from the number, is just seeing a lag time where the lack of physical effort reduces short-term deaths but increases long-term deaths due to lapse in fitness.
How much stress is replaced by "I have no job, and my phone is blowing up with debt collectors, and I have to decide if I buy food or pay bills, do I have corona, etc?"
What missing from this is for large numbers of Americans, losing their jobs, phone being cut off, debt collectors calling is the normal. Difference between now and before is they have an excuse. Sorry landlord, can't pay rent cause I'm not working like all your other tenants. Mortgage holders are kinda bending over backwards not to ruin their paper as well.
If the banks and mortgage lenders wanted to look like great people (ha!), they could easily push payments during the months of COVID lock downs to the end of the note. If they want to look like f*king heroes, they could even make those months go interest free. The payments aren't being forgiven and wiped out, they are readjusting the amortization tables. The same could be applied to car note. Credit card companies could give you a couple of months of no interest on existing balances. Of course, none of the groups mentioned have ever been accused of being decent.
Landlords/renters are different, and I don't have a decent suggestion for that.
At least as a self employed person, unemployment seems...tenuous. And confusing.
I’m a photographer. The website says I’m supposed to report income the week I work, not when I actually receive payment. If someone gives me a deposit for a wedding next year should I count it? Should I be reporting the deposits I got last year when I cover a wedding this year?
I’m allowed to deduct expenses, but they don’t go in to more detail. If I spend more than I make in a week can I carry over the rest of the expense?
It’s pretty stressful just knowing if you’re doing it correctly.
Just an anecdote, but my father lives in Tennessee, and applied for unemployment 6 weeks ago. The website reports he has been paid every week, but he still hasn't seen any money. He has spent about 12 hours on the phone with various agencies and has no answer to why he has not been paid. From what he can tell this is not an uncommon situation in TN.
> Or did people just die at home afraid to go to the hospital?
Probably yes. In the UK there is a significant surge in non covid related deaths above historical stats. Bear in mind also the definition of a covid 19 related death is, err, generous in the first place
Not saying you’re wrong, I do think there would be some of that but I am looking at a way to quantify it, especially since my friend is convinced that the lockdown is worse than the virus.
Now I realise that some people that would normally die are not (car accidents etc), but at the same time if the lockdown itself was causing significant mortality you wouldn’t expect the excess mortality to drop to normal levels, would you? You would expect a small offset from 0 unless the savings from car crashes are exactly the same compared to “lockdown deaths” - and if they are, and the lockdown is saving “extra” lives then is it not still worth it?
We have to wait and see for England to see if it falls back to normal or below normal levels.
> Spain has a “hard lockdown” too. Their excess mortality has returned to a normal level according to momo
That's probably inaccurate. I've been following MOMO's graphs, and the yellow-band portions (most recent weeks) grossly underreport and are subject to upward correction. Data points get larger and larger as they age. For example, "Spain Week 11" was pretty small when first reported (in week 12?), was larger the next week, and larger still a week later.
The implication is they would have died soon, like in the next 6 months.
About half of Covid deaths are in nursing homes. The median lifespan after entering a nursing home is 5 months, and the mean is 13 months.
Coronavirus is very infectious, so if it enters a nursing home, it could easily spread and wipe out everyone who was on the brink of dearth, or on a fragile state.
Well, it's worth keeping in mind that the risk of death from a coronavirus infection is comparable to the annual risk of death from all causes. Coronavirus infection though is a once per lifetime risk, whereas all-cause mortality occurs every year.
Just as a random comparable, the annual risk of getting cancer if you're 35 years old is around 0.1%, and the annual risk of having a heart attack is around 0.5% (higher for men, lower for women). All of those diseases would have similar average lifetime lost as covid, but the risk is continuous, not a once per lifetime occurance.
Presumably he means they would've happened in the same time period otherwise it's a meaningless statement. On a long enough timescale everyone who died of Covid would've died anyway.
Whether it's meaningless depends on the timescale. For zero months its very meaningful while for infinity months it's completely meaningless. And in-between it's meaningful, e.g. they would have died in the next 12 months.
I read that data as showing that the USA has had a sharp excess death event for each of the last four weeks reported. I'm seeing a much greater excess death rate than the official Covid19 reports.
I don't know the stats, but I live next to a busy fire station that responds to paramedic calls and is doubled up with trucks due to a COVID outbreak in another house.
Today (a Friday, I am working on my front porch, and heard sirens about 4 times from 7AM-3PM). Typically, that number would be 5x that. It's been like that since mid-march.
All cause mortality is down 9% over the last couple of months in Rome (sorry, on mobile, not easy to add reference which I would have to trawl for) - just to get in front of any covid-seriousness deniers, Rome has not been badly hit.
In Australia, significant decreases in STEMI (serious heart attack presentations) although nothing published yet. Everyone wondering what’s going on - going to be some interesting studies coming out after this in terms of population health and additional/reduced morbidity and mortality
Less pollution, pollution especially PM smaller than 2.5 you get from the tail of an exhaust pipe sitting in front of you in traffic is not good for cardiovascular health and also is known to cause strokes. We have a significant decline in pollution and people driving.
> Or did people just die at home afraid to go to the hospital?
Sadly I think this is a partial answer. Working as a paramedic, for all the times I saw people saying “y’know, maybe I don’t really need to go to the ER”, there were also the people who really did need to but were too scared. Be it 90 year olds with severe lacerations or heart attacks, there was a fear that we had to manage and balance.
Friend of mine is a trauma nurse at Stanford and she said their most common trauma patient is from bicycle accidents. Just an anecdote, but an interesting one.
Considering that 27k residents of NYC alone (not counting the rest of the state included in that chart) died[1] between March 11 and April 25 (not counting the 10 days before included in that chart), I'm going to go out on a limb and say you're working with a made-up chart there.
I've seen other variations of that same chart, meaning... the bars/colors/numbers were the same, but dates changed, and the citation data in the footer changed as well.
If you've ever lived in the Third World, you know that their news sources are total rubbish so people come to rely on the people they trust. But then that was hijacked through SMS/WhatsApp forwards that are things like this (everyone knows you won't type out a link from a picture).
It's actually such good propaganda, and I think it didn't really manifest fully formed (i.e. no one came up with the full concept) but through an evolutionary process as some was more effective than others. I am fascinated by the viral evolution of these things.
Check again. Your link backs up the chart I posted. Medicare paying hospitals 8k per covid patient and 39k per ventilator use simply with symptoms, no test required, also does not help. But keep the downvotes coming.
Probably ~20% more for covid than non-covid, based on what I've followed from CARES, but I wouldn't focus the incentive problem on ventilators. And you're right. Excess deaths are way up, so I assume there is a problem with my chart. But heart attacks and strokes are also way down, and in every article I've read (NPR, WaPo) there's an assumption that they just aren't coming in. Has nobody read the covid classification guidelines? I stand by that non-covid cases are being massively misclassified as covid.
Maybe, or maybe it's increased suicide, domestic violence, other coronaviruses, and even covid. Suicide for example is about as deadly as the flu during a normal year and peaks right about now. The excess mortality does require an explanation though, agree. I'm sure some heart attacks and strokes are happening at home, but 60-80%? Seems unlikely.
> Check again. Your link backs up the chart I posted.
The chart you posted shows a total of just over 20k deaths in all of New York state between March 1st and April 25th, while the link I posted shows 27k deaths in NYC alone between March 11th and April 25th.
Your chart also shows about 4k non-coronavirus deaths, again across the whole state for that period, while the NYC-only stats show more than 10k "Deaths not known to be confirmed or probable COVID-19" in less than that amount of time.
Now repeat with double the population to account for the rest of the state (with lower coronavirus incidence) and another 10 days (about 20% of the time period in question) that had the normal incidence of non-coronavirus deaths.
So, no, nothing about that chart matches up to reality.
The link you posted shows 11k/16k deaths from COVID. Nothing about 27k. And the chart I posted doesn't show total deaths in NYC, but some selection of morbidities. Is it wrong? Probably. But official data also says heart attacks and strokes are massively down (60-80%), and covid is way up, and there are big incentive problems. I stand by the point.
11460 confirmed covid-19 deaths
5213 probable but unconfirmed covid 19 deaths
10964 not know to be probable and not confirmed deaths (all non-covid deaths)
Which adds up to 27637 total deaths.
Your graph shows ~ 20000 total deaths. That's significantly different.
Also, the sources for the graph you posted are:
1. https://gis.cdc.gov/grasp/fluview/mortality.html
which as far as I can get it to show, only counts deaths from pneumonia regardless of cause. So I really don't understand why they listed that as a source for the graph as that information isn't displayed.
2. covidtracking.com
Which could be the source of their numbers for covid deaths but that leaves no source for their totals.
Where are we getting this data from? The data covering late April is especially suspicious. See the section “takes about 8–16 weeks for nationwide data to become a reliable metric of total deaths.” in this article. https://arcdigital.media/debunking-coronavirus-trutherism-c2...
(Make sure you stick around for the animated gif, "CDC pneumonia death figures over time", which shows how things change over time.)
Thanks for publicly stating that your original source was inaccurate. Not enough people do this when debating hot topics, and I seriously respect you for doing so.
The awful news - This isn't just NY. This is around me too, where our hospitals have been damn near completely empty with next to 0 infections. I know very specifically of one death where the individual was told to stay home vs going into the empty hospital. He eventually got to the hospital, but it was too late.
The great irony is that, in trying to prevent hospitals from being overwhelmed leading to unnecessary deaths, we cleared out hospitals too soon, to prepare for a surge that never happened, and lead some people to unnecessary suffering and maybe death.
People without jobs had to get surgery now, before their CORBA ran out.
The point isn’t that the curve didn’t exist or that it’s relative magnitude wasn’t higher in some cities. The point is that hospitals generally weren’t overrun, therefore, the measures we took effectively flattened the curve enough that all these overflow medical resources weren’t put to use.
And yet, a large part of the reason we weren't overrun is because our initial estimates of hospital beds and ventilators needed were far too high on a per-infected-person basis.
So yes, we definitely cut down transmission, but it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation; other clinical outcomes result in either the individual dying quite quickly (imagine a nursing home patient with multiple comorbidities), or in the patient recovering in 1-2 weeks. But there's that uncanny valley of people healthy enough to not immediately die but in bad enough shape that they need these aggressive interventions.
This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally. It also makes it easier to centralize the resources where you do need it. For example it's much more feasible for government programs to handle food delivery, grocery delivery, and all these other logistical concerns when you only need to provide it for 10-40% of the country as opposed to 80% of it.
Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago, which does mean that there was room for another doubling or too before transmission started naturally slowing down to a noticeable extent. So we absolutely could have had a lot more patient volume, but again the # of hospitalizations/invasive ventilation cases is much more related to the # of vulnerable people infected as opposed to the number overall.
(The classic argument here is that by fighting transmission in all members of the population, that the at-risk are better protected. For a number of reasons I think such an approach is misguided but I won't go into the full argument against that here)
> a large part of the reason we weren't overrun...
I think there is an argument the system was overrun, at least in part. Sharing ventilators is an extreme situation, and the lack of PPE is a deadly risk. Staff wearing rubbish bags is not a sign of a system coping.
> it's not clear that we would have incurred excess deaths due to capacity overrun. The biggest botteleneck is the presence of people on invasive ventilation
I think it is an important point. What is implicit in your comment but I think is worth reminding people is that the survival rate of covid patients under invasive ventilation is about 10%. If everything else could scale up, it means we would only increase the death rate by less than 10% if the ICUs would be overrun.
> This is a big part of why I think we could have exposed much more people to the virus with only marginal increase in hospitalizations, by encouraging those who are not at risk to live as normally
This is largely what Sweden has been doing. They've succeeded in that they've kept a healthy margin of hospital/ICU beds free, but people are unhappy with the overall number of deaths. They've also largely failed at keeping the spread out of nursing homes (they have a similar 50% deaths-from-nursing-homes ratio to other countries).
"Serology in NY has shown us that we have maybe 1/8 of the population with antibodies as of a few weeks ago,"
Perhaps 15% of NYC has been infected, but not the US as a whole. And the efficacy of the antibody tests has proven problematic.
And good like trying to control the rate at which you "exposed much more people to the virus." As we've seen, all it takes is a few superspreaders to blast your "controlled" exposure into an exponential growth rate.
To be clear, I've been talking about NY because it's the classic example of hospital overrun. So talking about prevalence in the rest of the country is irrelevant.
> And the efficacy of the antibody tests has proven problematic.
This statement is too vague to be of use. You should probably try to debunk specific serology studies rather than making hand-wavey dismissals..
---
(BTW I didn't respond to your other comment because it was in very bad faith as far as the "sacrificing at the altar of herd immunity" comment goes)
I've heard of some people getting stuff scheduled way out at suburban hospitals, often out of network, and clearing out their health savings accounts to get essential surgery. That's fucked up.
>ER admissions are down 50% or more depending in county.
This isn't as significant as you might think...
There is a large (very large in some communities) percentage of ER visits that aren't for real emergencies; rather, they are used for routine stuff, for which people with good insurance would go to their pediatrician or Urgent Care Clinic.
If you are broke, have crappy or no insurance, and can't afford a scrip of antibiotics, when your kid gets a fever or sore throat, you go to the ER. That's routine for -- I would bet -- hundreds of thousands of people throughout the year.
OTOH, if I have a really nasty cold which doesn't share symptoms of coronavirus, I am absolutely NOT going to the ER or urgent care even though I normally would. The urgent care center near my house is full hazmat suits and a tent outside to do front line covid screening.
I think the effect you're describing does exist, but its certainly not the whole story. The fact is as well there's PLENTY of actual data available on this so we need not even be extrapolating based on our assumptions. The problem is any data that doesn't line up with our assumptions gets discarded because we don't know which datasets are good and reliable.
"I am absolutely NOT going to the ER or urgent care even though I normally would"
That's a very dangerous assumption to make. Most hospitals in US are not overwhelmed. People should not be scared to receive necessary healthcare. The public messaging from authorities (and the media) should reflect that. At the very least, contact ER or urgent care (or better yet, your primary care physician if you have one), and follow their direction.
So I saw, am still seeing, all the doctors and nurses in NYC pleading for help. But there were thousands of empty covid-specific beds open in that state. Why where they not sending patients to these field hospitals? Is this about money? Would private hospitals loose out on payments if they transfered patients?
I feel sorry for the frontline workers in NYC, but I don't know how to reconcile knowledge that there were open covid-specific beds availible just down the road.
> But there were thousands of empty covid-specific beds open in that state. Why where they not sending patients to these field hospitals?
There is a somewhat similar situation in the UK, where hospitals are dealing with a lot of COVID patients, but the 'Nightingale' hospitals, our equivalent of these field hospitals, are mostly empty.
Something i have heard, but do not have a source for, is that the Nightingale hospitals were built on the assumption that COVID patients just needed a bed and a ventilator, but it turns out that COVID causes multiple organ failure, treating which needs a wider range of facilities, and can progress very quickly from respiratory symptoms to that, so they aren't actually much use.
> but it turns out that COVID causes multiple organ failure, treating which needs a wider range of facilities, and can progress very quickly from respiratory symptoms to that, so they aren't actually much use.
Just to be clear, COVID-19 contributes to organ failure in very limited cases from a statistical sense. So this is absolutely something that is happening, but just wanted to be clear that we are not seeing hordes of people keeling over from strokes, organ failure, etc.
It's known that the complications that come into play when the body has entered a cytokine-storm type state are very far-reaching. For the same reason that inflammation is a critical part of the healing process, systemic inflammation can cause incredible damage to organs and other physiological systems.
The burden of proof is on the person claiming the widespread organ failure. I can't provide a study saying it doesn't happen because there's not studies saying it does happen for those studies to debunk :)
But, here's one group of case reports that is commonly held up as evidence of the supposed strokes in young people / widespread organ failure / etc:
Quite a few still don't. Check out findthemasks.com for a map of almost 4,000 institutions seeking donations in the US. We also list a number of countries worldwide.
I used to live in new england. No part of NY is further than a few hours drive from any other part of the state, especially during lockdown traffic. The Stony Brook facility was on Long Island, only a 60-mile drive from downtown NYC. An ambulance/bus in a hurry could easily make the drive in under an hour.
These patients can't all just go for an afternoon drive on their ventilators. That would mean tying up an ambulance + staff for at least 12 hours. We aren't talking about an "afternoon drive" in these circumstances.
>> "It was very disappointing," Gonzalez said. "Everybody was here, ready to work, ready to get patients in."
Many of these hospitals treated literally zero patients. Hospitals weren't overwealmed by people in care homes. They were overwealmed by people in the hospital. I don't see why some subset of those patients couldn't have been shipped to these field hospitals. NY was asking for volunteers to come from all over the country to relieve their struggling hospital system. But there were federal hospitals standing idle a short drive away? Why weren't they loading the not-yet-crititcal patients into busses and taking them to Stony Brook (capacity 1038, patients treated 0)?
The field hospital concept to increase capacity to reduce deaths was based on, in the UK, the Imperial paper which was based on, frankly a non realistic interpretation of the input data from China and Italy.
Meaningless admission/overadmission rates which are clearly vastly wrong/misinterpreted and in turn based on a huge percentage of over 75s being hospitalised and a majority of them in turn needing ventilation.
Except in reality patients of that age are rarely ventilated because they wouldn't survive such an invasive treatment and if they are the recovery is 6-8 months and long and painful and has poor recovery outcomes. That predicate was wrong in the paper.
Secondly the field hospitals built could only receive patients who had no other underlying or exacerbating conditions because the FHs lack the staff and equipment to care for them. Given that practically every person who died from a respiratory covid infection had such issues it rendered them fairly pointless.
The paper also didn't do much to deal with the fact this activity will cause a surge in deaths of non covid related fatalities. Whole other issue
I've been wondering a lot about that as well. It seems to me it may be a combination of factors.
1) New York was the area hardest it, it got hit initially, it has incredibly high concentration of people, and since it got hit early we had the least amount of information about the virus. Because of the small geographic area, high population density, and quick spike of infections you get a subset of hospitals strained for resources in that area, but not the whole nation. Similar to pulling a hose and it gets caught on something which makes it harder to pull, it isn't there isn't enough slack in the hose, it is that there isn't enough slack in the hose at one spot.
2) There has been a heavy politicization of the whole 'Rona situation and so different factions are either trying to downplay it, or exacerbate it to try and score political points.
3) Fear gets more clicks than, sunny day stories.
4) Pushing an over the top message of worry may convince people to be more cautious who otherwise wouldn't be. Like if you want a 3% raise, you don't go in and ask your boss for a 3% raise, ask him for 5% or 7% that way he can negotiate you down to a 3% and still feel like he won, and kept you for less than you wanted and you still get what you wanted.
5)There is an alternative possiblity. There is a grand conspiracy by either, the deep state, the Illuminati, the elite, the superwealthy, secret neo-Nazis, the Communists, the bicoastal liberal elite, the CIA, to kill people by the millions using COVID-19 and it turns out the conspiracy is really bad at it.
EDIT:
I also want to make clear I don't want to downplay the situation of various healthcare workers who have been heroically making sacrifice. I believe many of them are honestly expressing their opinion and are worried about PPE or other issues, and may have experienced it; however there are probably hundreds of thousands of people involved in the New York healthcare system, if only 1% of 100,000 people feel overwhelmed at some point and post a video, or send a tweet about it that is 1,000 stories, but may not represent a consensus view.
No one seems to be covering whistle-blowers like Nicole Sirotek except the shitty tabloids. I want some other NYC reporters to investigate/interview all the doctors/nurses that have been brought in from other regions (blured out/anonymously)
Maybe that video is fake, but I am wondering how many of these deaths might be due to malpractice.
I’ve seen it covered only by the NY Post and several tabloids. There are a couple possibilities in my mind. Of course editorial discretion is one, but what if they looked into her story and couldn’t confirm basic facts? It’s hard to write a story around that unless the underlying thing gets a lot of currency. Sometimes newspaper ombudsmen are interested in finding out why a story wasn’t reported. Perhaps send tips there?
Building a field hospital for a pandemic and not needing it is literally dead last in my list of wasteful government expenditures to be angry about. The rationale that lead to making the hospital was incredibly clear, and that we didn’t need said hospital is a source of relief more than anything else.
The problem is much media, and especially social media, is using things like these unused field hospitals to justify that the problem was never that bad to begin with.
Which is exactly what people said would happen if stay-home orders managed to flatten the curve.
I hate this all so much. I am honestly super depressed about how short-sighted many people I know are proving to be.
They're not mutually exclusive. It could be (is likely) that the problem never was as bad to begin with and that it was lessened by flattening the curve. Even ERs have been seeing only 40-50% of normal patient numbers and have been cutting staff and shifts. You don't see that except for the fact that experts assumed and/or modeled very very wrong. And that the population has been scared to the unhealthy extent such that they think the virus risk is worse than not seeking treatment for heart attacks and strokes.
There's much we have yet to learn about this thing. We might not figure it out satisfactorily for years. Remember zika?
And it's certainly less severe among those infected than was predicted (at least per capita infections, if not overall). As long as people/ officials/ experts deny that, (or exclusively credit flattening the curve, or fail to admit how wrong they were, where appropriate) don't expect the public to take fear-based guidance from the same sources as credible.
I agree that it's pretty bad. You're sort of making my point, though. People forcing the issue to be binned into either a "bad" or "not bad".
No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago. Yet very few seem willing to admit that, because (I'm guessing) they think it might mean losing some amount of fear based leverage or control. Or don't want to give people false confidence to disregard rules. Or whatever the motivation.
And the public in general is perceptive of that, especially the ones less inclined to blindly trust government.
When the original concern was overcrowding hospitals, and the new risk is ERs closing or laying off staff from under-use, the nature and magnitude of the healthcare infrastructure risk has completely changed.
Which means either:
1) we were wrong and it isn't as bad as we thought, or
2) that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good. And that's strictly looking at healthcare, before even taking into account economic considerations beyond the hospitals being able to stay open.
>> No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago.
It's a lot less bad than it was estimated 3 months ago because most states understood the severity of the situation and hunkered down as much as they could.
>> that we've been so successful in flattening the curve (and scaring people from going out, including to the hospital for critical treatment), that we've overshot our goal to the point of doing more damage than good
Our "deaths per day" number averages 2000. I don't know how this can be remotely perceived as some sort of massive success other than relative to the original estimates that were based on doing nothing.
Stopping people from getting the virus was, unfortunately, not the goal. American epidemiologists don't and didn't believe that's something we can achieve in the short term.
3) We were wrong about the kinds of people who were going to catch this (e.g. poor folks, people of color, people in nursing homes, prisoners, people who work jobs they can't freely leave in meatpacking plants), who while they'll fill up a coffin just the same as anybody...
...are also all groups less likely to go to a hospital / ER even in GOOD times, and even when they do, tend to be treated like crap (e.g. assumed to be "drug-seeking", have their pain dismissed, often end up overlooked in triage, etc.)
This is the same old haves vs. have-nots story we've been telling, taken to a while new level -- if you're wealthy enough to be able to work from home, you've likely just been hunkering down and wondering what all the fuss is about.
It's not about fear-based leverage, it's about one group of people refusing to admit they're too insulated from the rest of society to see that the lower rungs that keep everything running are getting massacred.
Of course it's less bad, we did something about it.
It's like the Y2k bug. There were forecasts of doom, so we did something about it, so then there was no doom. That doesn't mean the original alarm bells weren't justified.
Framing the situation as we were right or wrong is weird though. No one has a time machine to go and come back with the truth, as if someone knew exactly how this would play out but was keeping it a secret.
It was a total mystery 3 months ago. We're only barely starting to tease it apart now. Given that, the conservative option, the choice that kills the fewest people, is what we did.
We could have avoided overshooting if we'd known 3 months ago what we know now. The problem is we didn't have knowledge from the future. 3 months ago it was clear this would have an extreme impact, economically.
What would you have done differently, given what we didn't know back then? (Also keeping in mind we still don't know all that much about this disease.)
> There were forecasts of doom, so we did something about it, so then there was no doom. That doesn't mean the original alarm bells weren't justified.
The field hospitals were built at roughly the same time the lockdowns started. You seem to be saying the decision to build them should be made independently of doing anything else.
But I generally agree with your sentiment about hindsight and acting conservatively. Though that includes knowing what the conservative option even is. Do we also burn money and spray disinfectant on the streets? Are we manufacturing a recession for nothing?
> No one's saying it's not bad. At least I'm not. It's just a lot less bad than what we were told 3 months ago. Yet very few seem willing to admit that, because (I'm guessing) they think it might mean losing some amount of fear based leverage or control. Or don't want to give people false confidence to disregard rules. Or whatever the motivation.
“3 months ago” was February 8 so not sure what you think was being said at that point.
1.75-2 months ago, when social distancing measures actually began and the whole #FlattenTheCurve started, the White House announced that they had a model that with all the #FlattenTheCurve measures in place, they expected between 100,000 and 200,000 to die of the virus by August 1st. https://apnews.com/6ed70e9db88b80439a087fdad8238009
So far 75,000 have died, with two and a half months to go and over a 1,000 dying every day still. It seems like the original prediction of over 100K by august 1st with full preventative measures is well on the way to being hit.
What are you talking about when you say it’s less bad than what we were told 3 months ago? What do you think you were told?
I don't entirely blame the media. Some of this is over-pessimism on public health officials.
For instance in the Bay Area, the SIP's argument was justified primarily from hospital capacity (https://www.sccgov.org/sites/covid19/Pages/order-health-offi...). It wasn't (as has since become) suppress the transmission rate until a test, trace, isolate system can be restored. [1]
Even on April 7, Santa Clara (https://www.mercurynews.com/2020/04/07/coronavirus-santa-cla...) was still projecting 2500-12000 cases by May 1. The higher end of that was highly unlikely even then (that would require cases growing faster than Seattle had been pre-SIP). In retrospect, even the best case scenario was also too pessimistic - at current rates Santa Clara won't hit 2500 until after May 21 -- double the time the "best case" had estimated.
Compare the communication to say Germany or New Zealand, where clear numbers, confidence metrics, range of possibilities, and objectives are outlined.
[1] Which actually has already happened. I'm not exactly sure what the goal is at this point - we have metrics but it's a bit unclear what they are based on (esp. the hard to reach testing numbers).
I'm with you on how depressing it is, my biggest take away from this entire thing so far is that people's ability to link cause and effect is much lower than I had previously estimated.
I'm now very mildly asthmatic and had pneumonia and bronchitis often as a child. I know what not breathing, and chronicly not having a strong respiratory system can be like and most people don't. I think that really factors into why people aren't taking it as seriously, going out whatever.
Contrast that with the fact I basically haven't left my Brooklyn apartment in 8 or 9 weeks even though my asthma and breathing issues largely subsided years ago and I would be considered less than mildly asthmatic now, I imagine other people with my profile are acting similarly.
I think it totally makes sense why you would feel that way.
I do want to mention that we know that somewhere between 25-50% of COVID-19 cases appear to be entirely asymptomatic (as opposed to pre-symptomatic). So almost half of people who get it won't even realize it, of those with symptoms, only a small fraction will go on to experience the serious respiratory issues that characterize COVID-19.
So it makes sense that you know first-hand how horrible breathing problems are. But I just wanted to be clear that, it's actually not irrational for someone to not want to stay inside for months to avoid a disease that in their specific case would almost certainly be mild. It just goes into what a person's priors are.
For sure and to be completely clear, I don't want to stay inside, I just think it's the most responsible move.
Like you said though it comes down to priors, and I'll add risk tolerance, and some pro-social behavior (I won't risk my neighbor even if it might be fine for me). I work in startups and have a few failed companies under my belt my risk tolerance in business is very high but not with health, you read that as 25-50% of cases are asymptomatic and an even smaller percent develop the very horrible symptoms, I read that as there is a 75%-50% chance I'd be symptomatic and a non 0 chance I'd be seriously ill with symptoms I'm already averse to through experience with them even though I'm otherwise young and healthy.
Edit: I'll add in, besides the above my biggest motivator for staying inside is that even if I was fine, to me its untenable to potentially spread it to someone who has a higher chance of not being fine through no fault of their own.
> we know that somewhere between 25-50% of COVID-19 cases appear to be entirely asymptomatic (as opposed to pre-symptomatic).
Which is not a big number at all, at least, not big enough to suggest that infecting more people is a solution. Considering that the chances to have symptoms and die rise exponentially with age, the estimated 25-50% are young and lucky ones. Still, it is known that even kids (unlucky, i.e. not in great proportion) do die:
By the way, from the older investigations about how people self-report their respiratory illnesses, it is already known that some significant percentage would not report anything and when asked claim not to have any symptoms even when they demonstrably do have them.
Even now, in the middle of coronavirus pandemics, there are people who "become used" to less oxygen in their blood, and behave as "not ill" even as their body becomes permanently damaged by the low concentration of the oxygen destroying their tissues.
So "asymptomatic" in the sense "the patient or the person filling up the questionnaire didn't feel being ill" is totally different from "the doctors didn't find any symptoms."
Have you seen any attempts to actually put cause and effect together for stay-at-home orders and number of deaths? The only attempt I've seen to quantify it found no statistical connection between the two, but high connection between population density and deaths.
Just a quick search on scholar shows me at least 5 studies into the impacts for a more rigorous analysis.
Plus anecdotally I'm in NYC and since the stay at home order reached full strength the 3 day rolling average of infections has been decreasing. I can only see that being attributed to two things -- mask wearing and stay at home. Mask wearing came later in our lockdown so I'm going to say stay at home has been effective especially with what I've seen the infection number for COVID, I believe that's the R0 (Rt?) number, was something like 2.5 to much higher.
>I can only see that being attributed to two things
Two more things: 1) introducing (or the halting thereof) infections to at risk populations (the whole NY nursing/retirement home fiasco, or the Italy hospitals being points of transmission, or dorm style living in Wuhan) and 2) approaching ~50% of herd immunity.
1) When did NY state stop putting exposed/infected patients into those facilities? That's going to have a outsized result in the stats, given the segment vulnerability. Same for Italy hospitals being overwhelmed without PPE.
2) Not saying it's what is at play (yet) here, but infections will naturally decrease as a greater percentage of the population gains immunity. It's what has to happen as the population approaches herd immunity. (So about 30% if herd immunity is 60%, which is plausible, given the recent estimates of 20+% of the NYC population with antibody presence.)
It's why exponential growth (for resource limited kinetics) ends up being an S curve and not a runaway exponential curve. The inflection point might not be at exactly 50% for a number of reasons, but it's good for a rough starting point.
Additionally, it will be difficult to distinguish if the stay-at-home orders are effective due to the entire population participating, or if it's tied to specific population segments. Meaning the percent of the population active vs stay-at-home isn't independent of transmission numbers. The active sub-population might be closer to herd immunity than the stay-at-home crowd.
This gets more complicated as you take into account the risk levels of particular patients.
There's potentially a lot more going on. We need some scientific causation, not just correlation.
That's two, I think the second one is better though as it uses more recent data and from more states and they raise a point that I think speaks to why the studies are not more prevalent and that is that many stay at home orders went into effect middle to end of March so the effects would only really be seen at the end of April.
I imagine you'll see more of these popping up in the coming weeks.
I said that there was a measurable connection between them. Any epidemiologist will acknowledge this.
The point is that it could be seen and measured in this case. But when they attempted to find a connection between shutting down early or late (in the USA), no effect was found. The point being, the shocked horror that people already "forgot" the lessons learned last month is silly if that lesson wasn't learned and wasn't even true. The claim could do with some actual evidence.
And I'm not even saying it's not true. I'm just saying this is the only attempt I've seen to actually analyze it, and it came up the opposite way. Can you point me to anything that shows the claim is true?
or, you could be angry that it became highly politicized and many media outlets absolutely overhyped the danger for clicks and political points.
if we'd been more levelheaded, we would have suggested the public should either
1) physically distance, or
2) wear a mask
in enclosed spaces and face-to-face situations.
if you're an essential worker or particularly vulnerable, you'd do both where possible. that's it. that likely would have provided all the risk reduction we needed to get the spread under control.
the message would have been simple, the effects likely as good, and we wouldn't have left a hundred million poeple on the edge of (or in) economic and psychological collapse.
but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want.
> but that doesn't punch the emotional and neurochemical pathways the way politicians and news peddlers want
Every discussion involving advertising or app marketing here inevitably attracts tons of comments adopting a let's-be-real-here, this-is-just-how-it-is tone about the realities of the industry. And yet these same people are also experts on the news industry and know the exact opposite is true there, that "de-politicized" or "balanced" news is somehow a thing that is not only possible but stupidly trivial to produce.
I mean, I get it, I utterly despise crabbed, shoddy, stupid journalism, too. But don't pretend there's some trivial fix. It is the way it is because of a combination of economic and ultimately social pressures. It is as much a symptom as a cause.
i certainly didn't suggest the systemic fix was trivial, and that the equilibrium we've reached around news and advertising isn't cogent and compelling.
but as individuals, we each have the capacity to center ourselves emotionally, clear our heads, and think critically about the coercive messages we're being fed. we have that power, and it is effective.
no, the virus didn't somehow get more contagious in march, it had just spread farther/deeper. the same measures would have reduced risk equally in either case. only the likelihood of need (that those measures would have non-trivially helped prevent spread) would have gone up on a per-interaction basis.
So did the WHO. They have been excoriated by millions for supposedly saying you shouldn't wear a mask. But from the beginning they were advising that you keep your distance from others, cough into your sleeve, and wear a mask if you get sick (otherwise, save them for health care workers).
Lockdowns were invented by panicking authoritarian politicians. The ruling class showed its true nature and was all too eager to copy China's brutal boot-on-throat approach to crisis management.
The idea that politicians wanted to lockdown and trash the economy is laughable. Even now politicians are eager to open up, even though plenty of states are still in the exponential growth stage.
Considering how Google and Apple are basically mandating WFH for the rest of this year, these lockdowns aren't for them; they're for all the other people who need a way to take care of themselves without giving their bosses the finger.
TBH, even if it was an overreaction, the effects were by and large positive, regardless of the pandemic. Work from home, less traffic, more family time, slowdown of economy, pausing of a lot of wasteful, useless activity. I really enjoyed walking around with almost no cars on the roads and listening to birds.
It fits perfectly if by privilege you mean not pursuing a career with high intensity and instead living a frugal, simple life that is less affected by a slowdown of the global economy.
I realize this, yet, the fact that I can afford this leisure is largely due to my personal choices of forgoing some of the luxuries these people afford.
I sympathize with those who are affected negatively by the situation, but I wish, for example, those who decide to buy a larger car would also sympathize with those who prefer clean air and less noise.
i agree that frugal living is the bee's knees (i do it myself!), but nobody likes a wagging finger over an extended hand, especially if you construct a dichotomy simply for that purpose.
in the US we still aren't even following these simple rules consistently (even in NYC where I live). I agree with your point, I blame the guy in charge of everything who's repeatedly tried to downplay the severity, causing the rest of the system to seemingly overreact to compensate for people refusing to follow the rules.
it's ok if we don't follow the rules perfectly and consistently for sufficient risk reduciton. but people absolutely flouting them is problematic, and the majority of that is likely a reaction to the overhyping in the first place.
regarding trump, luckily our governmental structures are designed to withstand such incompetence. i'm more concerned that the legislative process is torching money in the wrong places.
I always emphasize to my family that we shut down the whole country, the outbreak was relatively well contained to a few areas, and it has still almost certainly already killed more than 100,000 people and may well kill over 200,000.
Given our extreme response, the high death toll should be more shocking to people.
And we're not even close to the end of this. If the IFR holds up at what we're seeing, we already have another 50K deaths that will happen in the next few weeks.
Then the math gets really ugly. If herd immunity requires north of 60% to have been infected, that means 197M Americans. Of those 197M, roughly 5% will require hospitalization, and 1% will die. That equates to 10M hospitalizations and 1.9M deaths. Even being generous and lowering the IFR to .1%, means 190K deaths. Now this make be spread out over the next 7 months, but the butcher's bill will be paid. Hopefully we'll get a vaccine by then, or some therapeutic drugs, but I'm not optimistic.
That's the rub though. You want these to be used. The original goal we were sold is to flatten the curve, which means to use up all the base load capacity, but not exceed the base load capacity. Riding the line of base load capacity was going to be imperfect and we would see usage of these field hospitals as a signal that we are redlining our capacity and need to pull back.
The problem is that the only experts we're listening to are doctors and epidemiologists, when we should also be listening to economists. Both sets of people should be in a room together hashing out policy through an adversarial process that charts a middle ground between two bad outcomes.
Flattening the curve to well below capacity at the expense of further suffocating the economy, just means that we're completing ignoring economic externalities that is going to take years or even more than a decade to fully recover from.
This is an event where the need for hospital capacity grows exponentially, and we can't scale up medical resources that quickly.
So off by an inch now potentially means being off by miles later on. If the doubling period wasn't lengthened enough, a hospital at 50% capacity will be in serious trouble very soon.
Please don't take HN threads further into flamewar. It's possible to disagree without going all the way to an extreme like this, and necessary in order to be in harmony with the site guidelines. Would you mind reviewing https://news.ycombinator.com/newsguidelines.html? Note this one:
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
I am not sure you put much thought into this. A life's worth is not infinite, so there must be some value associated with it. If the cost of doing something exceeds the values of the lives it is saving it is prudent to stop doing it. This is not unique to COVID-19, choices like this are made every day. We could prevent a lot of deaths by limiting the speed limit to 15 mph, but we don't because we value quicker transport more than those lives lost.
Also poverty lowers life expectancy. If we are not careful about how and when we open the economy back up, we can cost the hundreds of millions of people months to years off their lives. This has to be weighed against the amount of lives that are being saved right now.
> A life's worth is not infinite, so there must be some value associated with it. If the cost of doing something exceeds the values of the lives it is saving it is prudent to stop doing it.
This gets ugly fast. How much do you value your life versus how much an economist who has never met you does?
Then run that same test on your young child or elderly grandparent.
It might be the best measure we have, but it’s a terrible one.
Yes, it's uncomfortable to think about, but that doesn't change it. Would you like your partner, parents or friends to die in a car accident? Of course not. Do you accept the reality of daily deaths of random people by car accidents as part of the price we pay for the quality of life we enjoy? Most likely yes.
But questioning how many deaths per day by cars would be too much, that's where it gets very uncomfortable very fast. Is it a hundred in the US? A thousand? It's certainly not a million or there wouldn't be anyone left after not even a year, but a thousand? And what if 900 of these would be people aged 70 and over?
It's uncomfortable to think about, even more so to say what number you arrive at, but that doesn't make it a thought crime.
The extent of the lockdowns means foot shortages are starting, and massive numbers of people are facing starvation. We're approaching the point where this may end up worse than if we hadn't done any lockdown at all.
Getting a middle-ground between medical professionals and economists would (hopefully) have avoided the worst of both outcomes.
> Getting a middle-ground between medical professionals and economists would (hopefully) have avoided the worst of both outcomes.
Arguably, that's the job of the policy makers, and worldwide we've seen major failures because it was not carried out as it should (in one direction or the other).
Rich people? How about all the millions of common middle and lower class people whose lives as they know it is completely over as they are now in a hole that it's going to take years for them to dig themselves out of.
If anything a strong economy provides the least marginal utility to the rich relative to the poor. Once you've got wealth, you have the optionality to properly hedge so that you make money on the way up and on the way down (or at least limit losses on the way do).
Sometimes the calculus is that lives will be lost for the better general well being of society long term. We don't eliminate cars and roads and for people to walk everywhere in order to eliminate motor vehicle deaths. We don't ever lock down to prevent deaths from the seasonal flu.
> "Economists need to be part of the planning, so we can determine exactly how many deaths is best" is the worst take anyone has ever had and you should be ashamed.
I hate to go all “what about the flu”, but seriously. Tens of thousands of people die from the flu every year. Think about how many we’d save if we just locked down permanently. Or how many auto deaths we’d prevent if we all banned cars. And yet we don’t do either of those things, because as a society we’ve determined that those deaths are an acceptable tradeoff, for, you know, life to go on.
You claim that we should listen to the economists but you don't seem to have any clue what the economists are actually saying and are just putting words into their mouths.
Basically every economist is acknowledging that you can't get the economy back to normal until the health crisis is under control. You can lift the ban on people going to movie theaters and restaurants if you want, but no one is actually going to do it if they don't feel safe doing so. Example: air travel is down 95+% even though there are no laws against flying places.
> Example: air travel is down 95+% even though there are no laws against flying places.
not a great example. people don't just fly for fun; they are going somewhere to do something. you're not allowed to do most of the stuff that you would travel for in the first place.
Let's quantify that. At risk encompasses people who are obese. That's roughly 30% of the population. It includes people with heart disease, and diabetes. Roughly 30% of the population suffers from that. Sure there's some overlap in these groups, so we'll call it an even 30%. That's over 100M Americans. Have some humanity.
I think people are more upset with the fact that they are unemployed and their states are locked down. The initial request from my governor was "2 weeks to flatten the curve". After two months, and hearing we never reached near capacity, and our local emergency hospital is also winding down, why are we still closed? Now we're told it could until June
We literally have to talk about goals as they come up. It's not that complicated. It makes no sense to keep saying "flatten the curve" as a goal once we achieve that goal, and it makes no sense to say "wait for it to burn out" during a period of skyrocketing growth.
Once we get over the exponential growth, we then have to wait for it to drop. Otherwise we'd just go right back to exponential growth.
All you people acting like "oh, the curve flattened, now we can go back to normal" are the kind of people that caused three massive spikes in the 1918 flu.
We're very likely to have a second spike that is way worse than the first because of this attitude.
Literally noone is saying "go back to normal". If the goal was to get it to burn out, the initial statement should have been "we need to isolate until it burns out".
"The epidemic is beginning to burn out" is also very different from "everything can go back to normal now". We saw how quickly this can get out of hand if left unchecked last month. If people rush to get back to normal and pretend that things are fine, it's just going to happen again.
It's depressing that people think 25% of the workforce can be out of work for an indeterminate period of time without massive, potentially society-ending effects.
I can only assume you mean without drastic changes to our current economic system, because otherwise in this modern age of automation that seems entirely possible.
Specifically, I think that first world societies can afford to give 25% of the workforce a paid sabbatical without ceasing to exist. And I find it depressing that there are people who think this is a shock that rich societies cannot absorb.
Sure, it'll be painful. Taxes will have to go up afterwards, the retirement age might have to rise. But it's possible.
That's not the result of having "forgotten". It's the dual squeeze of pitiful government response for workers (a single $1200 check vs. near full-benefits in Europe) combined with a hysterical "we gotta open up" corporate funded protest campaign from the extreme right.
Don't forget the gaslighting "100k people dead is doing a good job" BS.
People are being hoodwinked while they're scared shitless.
I do truly believe that almost any reasonable person will look at the death rate and realize that the US has fucked up the response in a big huge way. The conspiracy people saying that the death rates are a lie are not that many. This is one where the silent majority does realize whats going on and how bad the administration is fucking it up.
Anyone can go look and see that south korea, a far more urbanized state is open for business right now.
They'll have that mindset regardless of the reasoning for it. We'll just all have to watch as they show up on the news going "I never believed this could happen to me!".
> Don't forget the gaslighting "100k people dead is doing a good job" BS.
It always looked bad and looks worse the closer 100k becomes. It can’t be too long before some measures will say it has been exceeded. Then what will the claim be?
Goalposts can be moved - in fact, hasn't that happened before? Next claim will be 150k, then 300k. It will never be enough to actually do anything until/unless Prince Prospero or his castle gets sick.
Not all countries in Europe are going full benefits. Mine has given peanuts to all those people who cannot work at all due to the lockdown (and only a tiny fraction got the money). Or worse, it has offered them loans.
Just to be clear, the epidemic only "burns out" when somewhere between 50-90% of the population has immunity. Almost certainly closer to 80%+ unless we discover that a significant portion of the population is resistant to infection due to genetic differences or possible cross-immunity with other milder human CoVs.
By suppressing the transmission of this virus, we have failed to build immunity in most of the population. As a result any serious lifting of suppression measures will lead to moderate-severe outbreaks.
On balance, I believe that the most effective method is to resume life as normal, and focus on encouraging the at-risk to shelter, along with providing them appropriate government support. Whereas the approach we've taken has destroyed our economy in a very real sense, which will increase mortality even in the absence of a global food crisis.
The suspension of elective surgeries on a broad basis was very clearly a mistake, but unfortunately it's the type of mistake that no-one will admit was a mistake.
We postponed absolutely important surgeries as a result of this, even in areas like, for example, my county in Central California, which has very low prevalence of COVID-19. Here in California we "only" suspended elective surgeries for a month and now have a backlog that we're still working through.
So, just to say it explicitly: the fear that "things will never be normal again" is unfounded, at least in those who are operating off a mental model wherein COVID-19 is 10x as deadly as we previously thought.
The fact that we chose a strategy of indefinite postponement was our mistake. Because now people are beginning to realize that if we "go back to normal" then "the lockdown was for nothing". I consider this to just be a sunk cost fallacy, I believe quite frankly that ultimately the lockdown "was for nothing" (that is to say that, at the time it may have been justified based off the projected numbers, but with what we know now we should know that we only shot ourselves in the foot).
TL;DR: I believe that we need to resume normal operation of society, and make strong efforts to protect the at-risk. Trying to indefinitely postpone exposure to COVID-19 is a loosing battle. We've adopted a strategy of indefinite containment/postponement that relies on hunkering down and waiting for a _temporally unbounded event_. Given that lockdown-associated damage increases the longer containment is maintained, we are trading off a linear component of damage for a speculated future improvement in outcomes due to vaccines/a game-changer treatment. That to me is eminently foolish.
Most decision-making heuristics don't just try to blindly increase expected value (decrease expected loss) but also factor in uncertainy. In general it's acceptable to trade off a little EV for a lot more uncertainty. (Unfortunately in the case of the lockdown, I believe we incurred -EV along with far more uncertainty, for a net loss across all dimensions)
Describe how you expect 100M at risk Americans to shelter, while the remaining 229M party like it's 1999? For example, I work with a team of 9; two have diabetes and are overweight, one has hypertension, one has heart issues. One has a mother with cancer he takes care of. I have two children who in your scenario would be going to school and bring home SARS-CoV-2 for dinner. My wife also works in public service, and prior to the shutdown, interacted with hundreds of people per day. So I'm sure my coworkers will be thrilled that you're willing to sacrifice them up on the alter of herd immunity.
And the risk seems fairly small if you look at the numbers. But then you're some sort of conspiracy nut. In Philadelphia, half of the cases are in nursing homes, and more than half are of people older than 60 years of age. There is risk to opening the country, but telling old people to stay home seems more sane than keeping people from being able to make ends meet
I don't think you're a conspiracy nut, and you're right that the risk is fairly small right now in places where there have been few confirmed cases. But an exponential growth rate means the risk not small for very long. Covid-19 is the leading cause of death in the US right now. That we don't have the ability to test people before they go back to work is a huge problem. We can't even catch when someone has a fever.
> In Philadelphia, half of the cases are in nursing homes, and more than half are of people older than 60 years of age
That has little to do with the infection rate and a lot to do with who gets tested. In nursing homes people are getting monitored all day. There are many countries that are far more dense than the US that are currently open, because they test everywhere and prevent people effected from being out.
At least 0.16% of NYC is dead from COVID-19, and that number will rise as both the disease continues and we go back and discover cases we missed. If those numbers hold nationwide, you’re talking about half a million people dying or more.
I personally wouldn’t want to argue for putting half a million in an early grave for the sake of opening up.
The risk of the second wave is precisely the indication that our indefinite containment strategy was fundamentally flawed. We didn't actually avoid mortality in a permanent sense, we just postponed it. Which is why many on the side that you are advocating for are beginning to express the notion that we need to be on guard for the next _months-years_. Not just the next _weeks_.
As briefly as possible: Containment only has real utility if we can develop a game-changer that drastically alters COVID-19 outcomes, and that we don't have to wait so long for it that lockdown-induced mortality eclipses the time-adjusted benefit. It's a risky strategy that requires waiting for an uncertain, temporally-unbounded event, which in turn means that the "indefinite postponement" strategy incurs unbounded cost. We simply don't know enough to make definitive predictions about upper bounds on time-to-discover-incredible-treatment.
Whereas in a no-lockdown, natural herd immunity strategy, we are experiencing a fairly well-bounded spike in short-medium term mortality. I've been using Ferguson's 2.2 million figure for the US which is based off 82% population infection with an IFR of 0.9%, with the population equally susceptible at the physical level (behavioral differences are modelled, I believe). That's an excellent upper bound, it's certainly not the mortality we should _expect_. So we have a much tighter certainty, we will experience somewhere between 200,000-2.2 million deaths due to COVID-19.
When weighed against the alternative, which again is to incur unbounded risk from lockdown-associated mortality, the correct path becomes quite clear in my opinion. A very marginal increase in all-cause mortality in the whole population could very easily offset the spike in COVID-19 mortality which is constrained to fairly limited subsets of the population overall.
It's not an epidemic any longer and hasn't been for a while. It's a full blown global pandemic headed towards being endemic long term.
All three are very different scenarios that require different strategies and where we should have very different expectations for what is and is not achievable.
People are praising countries like New Zealand, but what's their endgame? Be in a situation where their citizens can't even safely travel from their country until global herd immunity is achieved because every vacation or business trip is a chance to end up being sick far from home?
This isn't going away just like the seasonal flu and common cold are not ever going to go away.
> People are praising countries like New Zealand, but what's their endgame? Be in a situation where their citizens can't even safely travel from their country until global herd immunity is achieved because every vacation or business trip is a chance to end up being sick far from home?
Yes. And I’ll have this over every alternative I’ve seen so far. I’m in New Zealand.
Well look at Wuhan, Europe, etc. Had people in the US taken the lockdown seriously, we would have ended with an Rt below 1.0 (ideally WAY below 1) so we would be more than ready to reopen now. Instead, people keep doing crap and getting infected, and here we are stuck at home for two months.
It’s more like experts telling you that models predict you’ll need 50 fire extinguishers to put out a kitchen fire, you express skepticism, and you’re branded a science-denying lunatic.
If you trust the same kind of "Scientific Modeling" that create Hurricane Path Predictions. Notorious for being hysterically wrong.
Then sure... that's wonderfully "clear"...
If, instead, you look at "models" and "projections" as junk science that's easy to prove wrong by simply looking at any model and how horribly wrong it's been in the past?
Like... the COVID models have been horribly wrong so far...
Which models on COVID are you referring to that are horribly wrong?
Also curious why you think the US was so badly effected compared to say south korea or thailand?
Do you think it would be safe for everyone to go back to relative normal? What would your prediction of the effect be? What data would you trust to validate that prediction?
I'm asking out of genuine curiosity how someone who I'm assuming is well meaning can get to this position. I'm happy enough to be convinced if your prediction turns out correct as there will be plenty of different states that are going to do a variety of strategies.
"Which models" the ones projecting 2.2 million deaths... the ones based on 4% fatality rates.
"do you think it would be safe" With the data thats coming out? Yes. Absolutely. COVID is turning out to only be a little more dangerous than the Flu and "lockdowns" are not slowing or stopping the spread of the virus.
"How can someone get to this position"
Honestly... January WHO was saying COVID didn't pass person to person and models were predicting 2.2 million dead in the US alone.
I'm not making a prediction... I'm casting aspersions on the "predictions" that have been used to feed opinions like "do you think it would be safe?" as if we are all going to die - 99.5% of those who get it survive. Worse than the flu but not worth shutting everything down (which hasn't stopped it at all - look at New York).
Personally I know we can protect those who need extra protections (Old, ill, etc) without unproven shutdowns based on faulty models fed with bad data.
Why do I feel this way? Because I know that hurricane predictions are "Scientific models" and are wrong just like "market predictions" and all other forms of prediction based models based on past data.
"In Italy, the death rate stands at about 13 percent, and in the United States, around 4.3 percent, according to the latest figures on known cases and deaths. Even in South Korea, where widespread testing helped contain the outbreak, 2 percent of people who tested positive for the virus have died, recent data shows."
Granted... those death rates are "known" cases which gets cut when you add no/low symptoms to the "unknown infected".
We are still gathering data and the numbers vary greatly depending on country and testing methods.
Which is my biggest point... it goes from 4%+ down to .5% or lower depending on how you spin the numbers.
Hard to take "projections" seriously with THAT much unknown data.
"The CDC modeled four scenarios and estimated that 200,000 to 1.7 million U.S. residents could die, the Times reported."
"Think of the number: 2.2 — potentially 2.2 million people if we did nothing. If we didn’t do the distancing, if we didn’t do all of the things that we’re doing." -Trump
Or at the very least have leaders who are brave to disclaim dramatic actions like constructing field hospitals as precautionary and say that the models may not come true in from the start. Instead we have leaders that use the worst "scientific" projections as received truth to get public support, then cargo-cult their policy without being frank about it (china did X, south korea did Y, so we must). That is what I think causes backlash.
I have a really good friend who works for one of the bigger hospital networks in Michigan. He says they are fortunate to have jobs because even though their hospitals are all empty. He told me staff isn’t being let go or furloughed for now but the staff spends their shift walking around and cleaning things. Even without rooms and equipment being used. Just to stay busy.
My wife is an operating room circulating nurse at Beaumont in Michigan (Metro Detroit).
Lots of people without the title of nurse (RN) are furloughed or laid off. Entire hospitals are closed and covid19 patients transferred to other hospitals. Cleaning and supporting staff has been cut down to bare minimums to save costs. She is being sent home early most days due to low volume, impacting her pay too.
She worked covid19 ER shifts receiving walk in patients coughing like hell. That dried up a month ago and she had the choice to stay home or work night shifts on the floor medicating and caring exclusively for covid19 patience. So she did night shifts for two weeks. Now she is back on her regular position, underemployed.
She laughed about the field hospitals. Now, here in Michigan, we are all, including Nurses and hospitals, sitting around most of the day doing nothing and waiting for some miracle.
There was never a capacity issue she knows of. Only shortages of PPE.
To me it appears that the quarentine was effective? Look at the chart above - on March 21st the stay at home order went into effect in michigan. They peaked 2 weeks later at 1200 active cases in the hospital. Now its dropped back to the same amount as just before the stay at home order went into effect.
Underemployed seems like... a good position to be in right now, no?
Depends on the way you look at this, and what your politics are.
Underemployed hospitals means a lot of procedures are not happening right now. Lots of chemo and similar things. Those will be facing long waiting lists once the state opens back up. If you even get those patients to come back in the next months. I think the risks are somewhat distorted. If you are skipping chemo because you are scared of Covid19, you may be missing something. And yes, chemo was deemed not essential as far as I can tell. I think they call those excess deaths, and it's very hard to say how those will shape up.
From a resident perspective, I see a flat curve with plenty of capacity, even of ventilators, and still a closed up state. But that's getting us into politics. The governor is following a timeline of opening up to normal maybe within 4-6 month. As long as sections are closed up, you need to sustain comfortable unemployment benefits to keep people even halfway in line to play along. Soon the money for that will run dry. It seems like she can extend stay-at-home orders without democratic agreement, but once the money runs dry, she cannot make a budget by herself. So things will get ugly eventually.
There are a number of people who didn't get the care they needed because surgeries for critical things like removing rotting teeth or even some heart surgery were marked as non-critical. They should have kept hospitals running, reprioritized their current schedules, and started cancelling once they saw the influx.
The way this was executed was terrible. The whole point was that hospitals didn't get overloaded so people with critical needs can get treated. It's the absolute definition of irony that cancelling everything had the exact same effect.
The priorities all major surgeries and try to work with patients to push off the ones in terms of severity. That way hospital could at least keep taking people. If they have to cancel everyone in a week; that's still better than not taking anything at all right now (and being overloaded this/next months as everyone comes in needing things)
Surprised to see this comment come so late. It's true. The regular hospitals were hotbeds for covid infections, so it made sense to keep the non-covid patients as separate as possible from the covid ones. Hence, the field hospitals. It would be terrible to come into the hospital with a broken bone and come out of it with the virus. It makes sense to avoid transporting infected patients whenever possible because it could lead to a new outbreak in a different location.
The Navy hospital ship in LA was planned as a reserve for serious non-covid cases. I think because of the early statewide action we didn't need it, but better to plan reserves than to fall short.
In any large complex system, you can't necessarily predict the bottlenecks, but if you want the system to guarantee a high capacity to handle issues, you need to broadly overresrouce the initial layout (esp if the resources take time to line up). This means by definition - even a good plan will have idle resources somewhere.
I'm higher-risk due to past lung disease and have been taking this incredibly seriously due to not wanting to go through pneumonia again.
I've been taking the social distancing stuff seriously, wearing a mask every time I go out, and have taken steps to get deliveries when I can to ensure I maximize the time at home.
The sky's not falling but I am a bit "scared" as you put it.
I'm scared. Not enough to be curled in a ball in the corner, but enough to be taking social distancing seriously. My wife has medical history that puts her at higher risk, plus she's in her 50s (and me in my 40s) so we're both at slightly higher risk just based on age.
People should be scared. This isn't over, and this idiotic preemptive celebration/busines reopening is going to render a lot of our sacrifices in vain.
Seems a bit hyperbolic to me. All signs point to greater spread than previously known in places like NYC, meaning majority of people who had it either had no symptoms or extremely mild symptoms and didn’t even notice.
I'm in the camp that a disease that has 80,000 people dead is not a hyperbolic thing to be afraid of. I have a good friend who is a nurse who still doesn't have enough PPE to protect herself, gets tested constantly and has colleagues who are in the ICU right now.
I also agree with you that its probably a lot more prevalent. We already know that its possible to have no symptoms. But that doesn't take away that for many people it is actually a horrible virus that has killed huge amounts of people and we have no idea how prevalent it actually is because we can't do community testing yet. If you're wrong many more people die.
I'm honestly not sure how to say it. What we do about the pandemic determines whether people live or die.
I'm not at all trying to intimidate the person - I'm just reminding that the stakes here are pretty high and any direction we go (continued lockdown, gradual opening, sudden opening) has an effect on how many people will ultimately die.
Not even to say that human life is that sacred - almost any society if they're honest clearly don't act according to that principle. The parent poster said that government is overreacting to the problem and that he's not met anyone who's scared, and then said fear over early reopening causing a 2nd wave is hyperbolic.
This is a lot of people that are already dead - I'm making a rhetorical argument that its absolutely not hyperbolic to consider the possibility that the cases and deaths could ramp upwards sharply.
At least 75k Americans died of a horrible respiratory disease in a little over a month with the country fully locked down and people are still arguing that it's not that bad because many of the cases don't end up in the hospital?
People die every day of all causes. We don't shut down the country because of car accidents, do we?
I'm not saying we should not be doing anything, but we have existing protocols to deal with respiratory epidemics, which are not a new thing at all (they happen every winter).
We did not have to "innovate" with those lockdowns, prompted by completely wrong doomsday predictions amplified by the hysterical media.
Are car accidents contagious? If you crash your car, do two other cars crash? If they did, we'd certainly lock things down.
> I'm not saying we should not be doing anything, but we have existing protocols to deal with respiratory epidemics, which are not a new thing at all (they happen every winter).
Good lord. Last flu season, 35 million Americans got the flu and 34,200 died. We have 1.3M confirmed Covid cases so far and 78k deaths (the real total of both is surely much higher). If that 6% CFR is 5x too high due to mild cases that haven't been counted and we made it to 35M infected, we'd have over 400,000 dead.
I'm getting the strong feeling that we're going to find out exactly how deadly this thing can be since people are so ignorantly dismissive of how serious we should be taking it.
The idea of field hospital is to move non covid related patients to the file hospitals and let the regular hospital to be covid only. This way there is much smaller chance to get covid while getting routine medical care. Reliable source told me medical facility utilization rates aredown more than 50% in non covid hot spot area. People are simply deferring non emergency medical service. They are also not so sure if they need to quarantine non symptomatic covid case away from home, like china did. So the field hospitals are built as an option if needed.
Its not that people are deferring medical service, they are being deferred. I have a friend who needs brain surgery to remove a cancerous tumor, and its deferred until non-emergency surgeries can open up.
I am curious, where do you think Covid is going to go :)?
Social distancing will get us to less than R1, but then once we open back up it looks like it will grow past R1. It is going to be here until we get a vaccine or herd immunity.
Do you mean where the virus is going to go, or where this situation will go?
Yes, most likely it will not get burnt out in the US until we have vaccine, herd immunity or the 3rd option, which is coalition/state/county level containment.
My comment reflected on the subject of these emergency field hospitals. Its A) not efficient to keep these up for the time being B) its unlikely we will be caught underestimating the virus the 2nd/3rd/xth time around.
And something else to just reiterate. There are multiple steps between "keeping the field hospitals operational" and "shutting them down". Just like there are multiple steps between "social distancing" and "opening back up". :)
Gotcha. I was worried you thought Covid might just disappear or something magically :)
Efficiency is not always the goal in situations like this. It might be wiser for them to be inefficient but prepared, and keep the hospitals up and running. Especially if they have to nationalize the entire health care system to prevent a collapse (even if its temporary).
I think it’s pretty clear that a lot of things have been going wrong in this effort and there was probably a lot of waste. This is to be expected when it’s required to act quickly with lack of good data.
I only hope the political systems will allow a serious retrospective of the measures and learning from that. I am very afraid that the partisans and conspiracy theorists will take over soon and no rational decisions for the future will be made so we will stay unprepared for the next pandemic.
After speaking with a few doctors who worked setting up these hospitals, it was almost like a parade or a show rather than anything serious. The doctors who worked there were ready to take on the patients, but the decisions came from the top not to allow it to happen...
I guess it's true that hospital utilization for non-COVID cases declined, but in NYC hospitals, they were still stuffing people in the hallways while these sites idled. Is that not a scandal? Some contractors made a lot of money building these sites. Did the people building them know before-hand that they didn't fulfill the list of features for actual utilization when they signed the contracts that were evaluated under an accelerated, non-competitive review?
I don't want to diminish the efforts of the people that built these sites and stood ready to treat patients. That's heroic. My skepticism is aimed at the bosses.
or .. the numbers were wrong and we never needed half these facilities, or to bring the world economy to a grinding halt. Our European counterparts are probably fine, but low-income Americans have lost a lot.. more than we can repay.
Which numbers were wrong, and when? You can actually see a leveling off of the deaths and hospitalizations in CO within the 2 weeks following the initial stay-at-home order. I would take any numbers regarding "infections" with a grain of salt because those are so susceptible to the number of people able and willing to get tested, and how those test results are reported back up to the state. Every state seems to have differences in that approach.
exactly. they panic hired a bunch of contractors with no real operating plan on how to utilize them, and now taxpayers are footing the bill for the contracting company CEO's third mansion.
The lockdown isn't causing the economic crisis, the pandemic is. The economy would grind to a halt anyway without lockdown measures if the pandemic were spreading unchecked and a million [1] people were dying in the space of a few months. Everyone would be barricading themselves in their homes and not going out to restaurants and movie theaters.
[1] (70% infected to get herd immunity * 0.5% fatality rate * 330 million people = >1 million people).
I think that until we get everyone tested we aren't going to know the real fatality rate. Some portion of people, perhaps larger than we expect, experience this virus as a cold that passes normally. Some people never even realize they have it. Until we have tested everyone and know for sure how many people have it asymptomatically that fatality rate is likely an overestimate and we can't really know by how much.
The 0.5% estimate is based on seroprevalence studies (which take into account the asymptomatic infected). The crude case fatality rate is more like 5%, which is definitely an overestimate.
Also >0.2% of NYC has already died, so it's not possible for the fatality rate to be substantially below 0.5%.
Not sure why you're so heavily downvoted but if you took the total deaths across NYC and divided by the entire population of NYC, you get a strict lower bound IFR of 0.14% which makes this at least 3x deadlier than the flu. If you figure more like 1/5 of NYC has been infected, your IFR is more like 18x as deadly as the flu.
“ The plan was for the Javits Center to take patients from overwhelmed hospitals in the city. But in practice it wasn't that easy. Some hospitals complained that the intake process was too complicated. And they sent few patients to Javits — even as they resorted to treating patients in the hallways”
What does it mean for an intake process to be complicated? Isn’t it straight forward like loading the patient + printouts of medical records into an ambulance, driving to the new place, and then transferring them into a bed?
This is great news! "Shelter in place" orders flattened the curve as was predicted and as we hoped. We were ready (mostly) for the worst case, and people complying with these orders meant we never hit it.
Next up, I hope we don't end up needing these field hospitals because of states re-opening things too soon.
That's not what the article said. It was highlighting how despite some hospitals being overrun, these field hospitals still went unused because there were no plans in place to utilize them.
We didn't flatten the curve enough to make these hospitals useless. We simply didn't use them despite needing them.
That's a gracious reading. If there had been an absolute need for more beds, plans would have been developed to make use of the space.
Instead, it might imply hospitals were dealing with increased load, perhaps needing more beds than they had but not so much of an increased load to justify implementing and following a plan to use these facilities.
That's going to be the biggest challenge here - how do we transition from acute to chronic care of this pandemic. I hope someone is creating lessons learned and new operating plans for all this stuff so that they can react efficiently over the coming months and years to pocket outbreaks which are sure to occur.
We don't know that, as weird as that sounds. We have no idea if there's significant or lasting immunity from having it, whether it's seasonal like the flu, or what the longterm behavior of the virus and it's likelihood to evolve is.
Which makes having longterm plans very difficult because we don't know what we should be planning for.
There's still areas all over the world which have not been hit too badly solely by luck - for instance, here in Alberta Calgary has been hit with an order of magnitude more cases than Edmonton without a great reason why. Regardless of the potential of immunity, these lightly hit areas are still open for initial infection and community outbreaks. I can't see why they wouldn't occur - on a long enough timeline luck just runs out.
This is false. Tends of thousands of people died and many more suffered unnecessarily because the federal government refused to take timely action. We did as well as we did for as long as we did through heroic efforts by state governments, local governments, and NGOs.
To claim that we were somehow prepared and executed on a preparedness plan is at best a dangerous misreading of the events, and at worst outright political propaganda.
How so? Both political parties fucked this up, but one party more than another stands to gain from pretending like they didn't.
Edit: also my statements are factual as far as I can tell. We had since January to prepare, and instead our leaders -- political party aside -- decided to fuck around and play misinformation games with the public instead.
Well, you're making statements but not backing them up with sources (if we learn one thing from the pandemic it let it be that provenance of information matters more than the information itself.)
You're also, apparently, trying to influence people's opinions of government.
So... propaganda.
But really: Dude, I'm sorry. I was just really cranky this morning and I was being snarky. I apologize. You are obviously not propagandizing there. I was being an idiot. I'm sorry.
Those model predictions are not for the first 3 months, but for the whole epidemic. We could very likely breach some of those predictions in the next 1-2 years.
Also, the Imperial College paper was one of the more extreme models. It is the one that supposedly scared the White House and lots of states into action. In this way, it was not a best case estimate, but was self-selected to be an outlier.
The article is presenting this as some sort of scandal, that we spent a lot of money to urgently build things that we didn't end up needing. This way of thinking about things is why we are generally not well prepared for unlikely disasters: most work you put in will not be needed.
Instead we should see this as really positive: we were working to make sure that if stay-at-home (which has cost far more than $600M) didn't work we would have space to treat people, and then we kept the infections low enough that we didn't need to use it.
I think the article takes a very balanced stance. It is pointed out multiple times the that people are glad the hospitals are mostly unused, that they now exist if there is a surge, and that the excess bed capacity is very helpful during a crisis like this. The real criticism is nothing like you've paraphrased.
> They praised the Army Corps for quickly providing thousands of extra beds, but experts said there wasn't enough planning to make sure these field hospitals could be put to use once they were finished.
>The Army Corps limited the competition in awarding the projects to speed the process, which usually takes six to nine months, according to agency documents. Officials noted they were able to complete the contract award for the Stony Brook project in a "little more than three days."
>The two Long Island field hospitals were completed in late April. They never opened to the public and didn't treat any patients.
>The plan was for the Javits Center to take patients from overwhelmed hospitals in the city. But in practice it wasn't that easy. Some hospitals complained that the intake process was too complicated. And they sent few patients to Javits — even as they resorted to treating patients in the hallways.
Seemingly like all of the US coronavirus reactions we dragged our feet at multiple points, had no reliable central coordination, and large sums of money was made against the backdrop of human suffering.
the Detroit area "field hospitals" (convention centers) had very strict restrictions on who could be admitted- you had to be sick, but not too sick. In practice only a handful of patients were eligible and admitted before they closed.
I am starting to suspect that the whole exercise amounted to a giveaway to the convention center owners who previously were forced to shut down.
>I think the article takes a very balanced stance.
Not really. It just does the usual cowardly trick of complaining about something by selectively citing cherry-picked experts. Rather than this quote salad I'd very much prefer honest, direct criticism where the outlet or the authors make it clear what is their stance and why.
That is the responsible thing to do. It wouldn't present opinion as news (as is the case with this article) and it would give a better opportunity for people to respond to criticism.
I prefer outlets that do their very best to attempt to remain impartial and present a "just the facts and all the facts please" view, even if we all know it's not 100% achievable.
I agree with you, this article is not that. If you listen to any economist, healthcare provider, or logistics expert, they will all tell you that this was the prudent choice given the worst-case tail scenario, and that this resource is one that has continuing value for some time.
But this article takes all that information and manages to paint that information in a negative light. It is "an opinion of the author" piece that even manages to express the opposite opinion FROM the expert opinions it reports.
Nothing personal, but I found it a bit ironic that your own criticism of the parent amounted to simply asserting "Not really" without addressing any specific points. You didn't say which experts you would have chosen, and why, and how you know that the author of the article has purposefully attempted to cherry pick specific people. Its one thing to simply dismiss someones work, its quite another to provide constructive criticism with actionable material.
Speaking only of the headline, it should be a banner ad for successful preparation and containment; it should not hint at overkill or wasted money, which it does (unless there actually was money wasted on overkill that the article wishes to expose). Even on a psychological basis, it made the populous feel more secure that the authorities were doing their best to cope. And economically speaking, it's standard economic theory that injecting money into the slowing economy will have a near term beneficial effect beyond just the direct recipients of the money.
That's just the headline, and the people who write the articles famously don't write the headlines, but still, the headline is a bad headline.
The opening is: "As hospitals were overrun by coronavirus patients in other parts of the world, the Army Corps of Engineers mobilized in the U.S., hiring private contractors to build emergency field hospitals around the country. The endeavor cost more than $660 million, according to an NPR analysis of federal spending records. But nearly four months into the pandemic, most of these facilities haven't treated a single patient."
The motivating event is that we're starting to decommission these facilities, but the author instead chooses to emphasize how much they cost and how few patients were treated.
It's also a bit cynical to say "nearly four months into the pandemic", as if there have been four months where the hospitals could have been seeing patients in the US but didn't.
Also, in the big picture this cost is trivial. 660m is less than $2 per person. Compare that to the 3T bailout or so (numbers change so quickly I can't keep up), which is around $10,000 per person.
Its not cynical, if the entire point is to flatten the curve below maximum capacity. Flattening significantly below capacity (or increasing capacity and not using it) only extends the required time in lockdown (based on some admittedly questionably assumptions, but assumptions currently being relied on).
And no matter how much you trivialize costs, it's always better to spend on resources that will be used that ones that won't. Like funding the ERs that are currently dealing with the double whammy of covid patients and seeing only 40-50% of normal patient numbers (and therefore 40-50% of normal income).
Plus we really don't want to flatten the curve to the point where people start losing aquired immunity before we've reached levels for herd immunity. Then it's no longer a curve, but a never-ending line. At least until a successful vaccine is developed.
Funny I wrote a longer response that I trimmed down to just my broken windows fallacy jab where I talked about how building, stocking, and manning field hospitals that remain underutilized is wasting resources, akin to hoarding spare windows.
Did we read the same article? It praised the actions of building the hospitals, while stating what you said in that it shows we weren't as prepared as we should be for a pandemic.
>we kept the infections low enough that we didn't need to use it.
The article specifically said the hospitals were needed despite being unused. The problem was existing hospitals didn't have policies in place to use them, so instead doctors were treating patients in overrun hallways while these beds lay empty.
The cost of these field hospitals is negligible and I am not upset about them. But I am upset that the healthcare system seems to have been nowhere near capacity. Which means we are paying the full cost of the lockdown while not getting the full return in term of herd immunity, which we will pay later on with more lockdowns probably starting in fall. In other words we overreacted and flattened the curve too much.
For the first go-around, with minimal available data, that seems like the much better way to err - it would've been very, very difficult to fix a mistake in the other direction. We've got more data now, and can do a better job of toeing the line with upcoming waves.
It's not like we can't unflatten the curve if we really want to.
That is a reasonable objection. But now that we have this data, there doesn't seem to be any appetite to bump up the curve, i.e. it's not about flattening the curve anymore, it is targetting zero infection until an hypothetical vaccine. Very different objective, no debate about it. And no herd immunity.
There's plenty of appetite for opening back up, which'll almost certainly bump up the curve. No one's saying outright "let's have more infections!", but it'll be the end result of the reopening policies.
I am not sure that it is the policy. In the US or Europe, all governments have warned that they would back down from opening up if they see a rise in new cases.
Sure, they're going to have to ride the rollercoaster up and down for a while. I suspect we'll absolutely see further lockdowns; the question is going to be how long we can go before declaring one.
More data is good for determining how far we can let things grow before locking down, but it's confounded a bit by social factors like people getting tired of the bumpy ride and not following them as well after a while.
Moreover, the point of the shutdown was to keep the virus from spreading, and yet the number of cases is still rising in most places in spite of it. As states are talking about reopening, it's just going to rise faster. The article notes that the field hospitals aren't being taken down, in case we need them. Since the spread seems likely to accelerate soon, it seems to early to say "we didn't use these field hospitals."
Yes, I had the same thought. I was actually surprised and happy that we managed to pull that off.
All my life I have had this weird thought: If someday aliens will come down and tell us to move some random huge mountain 10 miles to the left, in one month (it doesn't have to look the same). If we can't do it they will wipe us out. I wonder if we would be able to pull together and somehow do it. And then my mind thinks through all the crazy iterations of ways to start trying. I keep thinking that we will globally waste 2 weeks planning it.
I guess not everyone is threatened by death in Covid, but it does seem amazing some of the things we have been able to pull together during this.
Easy one. We all come together to agree that the mountain will be mapped 10 miles to the left relative to its current position. Everything else will also be shifted slightly to account for that.
An earth-destroying asteroid is the more realistic form of this. We could get anywhere from days to years of notice it was going to hit (if years, it would just be a probable hit) and have to put together our Armageddon/Deep Impact mission to divert it. There are plenty of papers published on what we could do and the idea has had millions of dollars in funding, but it would need billions. We're screwed if the notice period is days, but we'd have a good chance to build something in months.
If people are really upset about this, they should take a look at the US Defense/Military budget.
We prepared for a worst case scenario for a developing situation we knew very little about, and ended up not needing it. This should be viewed as a good thing.
Right. This obsession with government is austerity is part of why we're in this mess to begin with: A more robust response in January and February would have saved tens of thousands of lives and could have greatly reduced the scale of any lockdown measures. It would have meant spending tens of billions of $$$ towards testing and tracing infrastructure which in the age of trillion-dollar bailouts seems like a bargain.
Your analysis misses an important point, which is opportunity cost. Every action has costs and putting resources toward one area means taking them away from another.
Hindsight is 20/20. Could you or anyone have said this a few months ago?
EDIT: let me make it clear what I'm saying/implying. Saying stuff about opportunity cost means that you think that this wasn't necessary. Given the fears of overrunning hospitals, I can't see anyone being able to justify not doing this except in hindsight.
No, I’m not saying that it wasn’t necessary. Simply that a more intelligent analysis would have factored in various costs and benefits, as well as the likelihood of actual events vs. perceived ones. Every action has unintended consequences, but this simple fact seems to have been total forgotten with the response to the coronavirus.
Policy makers should adopt some of the modeling tricks from Wall St. and Silicon Valley. Manage risk. Assess sure things and long shots, feed in the parameters, then allocate resources appropriately.
We need better financial instruments, novel forms of insurance, put a price on resilience, to counterbalance the drive towards lean efficiency. So that key suppliers can maintain capacity without assuming all of the risk, for instance.
Perhaps I missed it, but I don't see anywhere in this article where it implies this is a scandal in any way. There's no axiological statement here, just a pretty decent overview of the facts. I agree with you that not having a need for these field hospitals is a good thing (obviously) and I don't see the article implying otherwise.
Right? Moreover they were lamenting that CN was building prefab hospitals in 10 days .. and we were unable to do that and that would leave us with a bed shortage...
What I don't understand is that this disease becoming globally endemic is pretty much a forgone conclusion. With that in mind, when did the goal posts move from flattening the curve to keeping things shutdown indefinitely with no clear criteria for slowly returning to normal and allowing an economic recovery to happen.
With flattening the curve I suspect we'd want to keep the field hospitals due to the lag time in knowing the actual infection and hospitalization rates.
I fear particularly for a subset of countries for whom this could easily be an opportunity for highly punative destruction of rights that has been forming in the background already. South Africa for example.
It's not even a subset of countries. It's all countries, the US included. We're being conditioned to roll over on rights that we've fought hard for over 244 years.
I don't know where you're from, but here in WA we do have clear criteria. What changed is that we realized that we aren't capable of testing people. Everyone expected tests to be easy to create and widely available well before now.
I watched most of the Coronavirus Task Force briefings. Several times Trump suggested Dr. Birx was telling him that these things would not be needed. And she confirmed that she felt they weren't going to be necessary. So it appears the scientists/experts knew it wasn't necessary from a medical standpoint. One could argue whether or not it was politically/emotionally necessary.
Edit: you can see from several posts here that building these things really did bring a lot of emotional comfort to people, which is an important part of dealing with a crisis. People really underestimate psychology in an emergency.
The primary theme of this pandemic is that we don't know almost anything about what is happening or what is going to happen. The list of wrong predictions can and has filled thousands of column inches and hours of briefings.
We expanded our healthcare capacity because of Italy and the humanitarian crisis that was occurring there. It had nothing to do with emotion. If it made people feel nice then I suppose that was a minor unintended benefit.
I agree with your sentiment and I would go one level deeper down the rabbit hole. A lot of what we've been led to believe were blatant lies. Just look at the way people are talking about reopening. There's all this talk of vaccines and testing. Those aren't going to be real solutions. A vaccine is a year away. Closing everything for a year+ would be the end of civilization. As far as testing... think about the scale of testing we would need. You'd have to basically isolate everyone, test them, and then keep the infected isolated. And you'd have to do that over a very short period of time, like a few days. We're not delivering 300+ million tests in a few days. It's not happening. Testing is useful. It's not going to be some panacea of perfection, or even particularly "good." The hard truth is we're going to eat a lot of deaths from this. And none of the experts can possibly know what is the exact right recipe to minimize deaths, either from covid or economic disaster. Any state/country/whatever that gets better results will have done so totally by luck and their solution might not have worked elsewhere for a myriad of reasons. It's all false confidence.
Just look at Remdesivir, or however it's spelled. The news corps are pushing that as a possible treatment. Except guess what? It doesn't seem to reduce your chances of dying. Worth noting, pharma companies are major advertisers for news networks. It's all been bullshit.
South Korea, Taiwan, China, Vietnam, and other countries all used Test, Trace, and Isolate to contain the virus with few cases and deaths.
You don’t actually need 300 million tests if you can stay on top of the virus, so I don’t think this is blatant lies like you’re talking about - in theory we’ve just spent 6 weeks locked down to reduce the number of active virus cases and now could transition to the test/trace/isolate approach we should have taken in February like the successful countries did.
That said I agree the opening seems to be coming too fast and no one I have seen is presenting a model where test/trace/isolate succeeds in the USA - due to political polarization there is no national plan for it. China took 87 days to lift the lockdown on Wuhan and we are going much faster than they did, while having had a much less strict lockdown in the first place.
It’s true that Redemisivir has not been scientifically proven to save lives yet, just to reduce the length of hospital stays (which means hospitals will have more capacity since each individual case stays in the hospital for a shorter time), but scientists think it may be able to reduce death rates if given earlier in the course of infection - clinical trials are still ongoing to see if this is true.
You mentioned feeling like the country is reopening too fast. Can you talk about how many deaths you expect from the virus vs deaths caused by economic distress related issues if we stay closed? I feel like talking about one without the other is missing half the story. The media has framed everything to only talk about virus related death but it's not the only cause of death.
Economic distress could be solved by improvements to the rescue package (The USA is currently able to borrow money at about 1% interest rate over 20-year terms, which is a negative interest rate when accounting for future inflation). Individual workers are already eligible for $600/week of unemployment bonus through July 25 as long as their business doesn’t re-open, for many of them their economic situation is actually better if we waited two months to reopen as they get paid more than they would working their job.
Unfortunately some businesses like restaurants are being poorly served by the PPP and treasury department regulations that don’t allow them to pay enough out of PPP to pay rent in higher-rent locations.
That could be changed, but the Federal government is counting and planning on economic pain to force states to reopen too fast instead, without tests or other measures in place that could reasonably be expected to cap or reduce new virus cases. It’s a very short-sighted plan.
Trump suggests all sorts of things, often directly contradictory, or contradicted shortly thereafter by his own experts. I'm not sure why you'd put any stock in those suggestions at this point.
Trump acknowledges he defied the experts and potentially wasted a bunch of money.
What, exactly, are you imagining is the scandal here? That Trump is lying, he didn't defy the experts, and the potential wasting of money was the fault of experts and not Trump? Is that the scandal you're imagining?
Seems like we were able to build them quickly enough that we prematurely built them.
Wasting tax payer money that could've been invested in things like increasing PPE production for existing hospitals.
The core of the issue is that we couldn't ramp up testing fast enough, leaving us completely blind and then we relied on models that believed the infection was moving far more aggressively than it was.
When you're dealing with exponential growth and high uncertainty, anything you do is likely to either look like a large underreaction or large overreaction in retrospect.
I think there was/is near-infinite money available for Covid-related projects, and spending was more limited by identifying them or bureaucracy or political will. I don't think we would have taken the $660mm and spent in on PPE without this hospital construction; instead, our national debt would just be that much lower.
A late reaction typically requires overcompensation and wasted resources because you don't have sufficient positive control to tell where things are headed.
It's incredible the amount of unknowns even at this point in the epidemic. Anyone who claims to understand what's going on is just frontin. That's my big takeaway so far.
Biggest scam in the history of the world! And like good little sheep we fell and are still falling for this bullshit!!! For a country that supposedly holds personal freedom in high esteem... it’s so fucking pitiful the powers that be must be laughing all the way to their new powers and wealth, almost disappointed how easy it was.
I’m sorry, but is anyone else getting a real “this is good for bitcoin” vibe from the comments here? It seems we are all attributing this to a successful lockdown rather than considering other scenarios. It feels very “rock that wards off tiger”-y to me.
That SARS-CoV-2 was in our environment for months longer than thought, that 20% or more of Americans may already have antibodies, that tons of people suffered from not being able to get essential heart, dental and other surgery in preparation for some mythical surge that wouldn't have even happened anyway. That there's no evidence social distancing did anything at all?
There are tons of other possibilities here. There simply isn't enough data, and won't be until Feb 2021 where we can retroactively look back at data that is cleaned, pruned and properly averaged.
> That SARS-CoV-2 was in our environment for months longer than thought, that 20% or more of Americans may already have antibodies
That would be a reasonable conclusion, perhaps, if the curve was flattening somewhat informally, and not specifically in places that have stronger lockdowns.
> That there's no evidence social distancing did anything at all
There’s reams of evidence in data across the world, and comparing locations in the US, that distancing has a substantial effect. Even most of the nutballs clamoring for radical reopening, like the President and his Republican allies, acknowledge that there is a trade-off in reopening, but argue that the lives to be lost from COVID-19 are a price worth paying for the near-term economic gains.
What data do you think will exist by next year that we don't have now? Doctors have recorded those who died with respiratory distress and other Covid19 symptoms, and that tested positive, as being victims -- that data is here now and shows increased deaths haven't been just to co-morbidities not being treated.
Test results are available to those in power.
The data is around, it's just not public because - I warrant - politicians can't manipulate the story if the public has the full data.
We have never had time series data for any other illness, to this granularity. The data is also terribly dirty.
The CDC doesn't track flu. It tracks pneumonia deaths, and then retroactively uses surveillance data to estimate the number of deaths from different infections.
U Washington also seems to be using entirely different data sets than Johns Hopkins and the metrics for international data is not the same at all. I did a post on some of the issues I found:
> That SARS-CoV-2 was in our environment for months longer than thought, that 20% or more of Americans may already have antibodies
It's generally a good habit to do a little bit of simple arithmetic to see if the claims you are making pass a basic sanity check. If 20% of Americans already have antibodies, then how come NYC has 10x as many deaths per capita as the rest of the country? Did 200% of New Yorkers get infected?
We don't have the testing yet to really get good numbers/samples though. We need more random sampling antibody tests. A number of people claimed they got sick this year after leaving conferences in Las Vegas, but it's all anecdotal without wide scale efforts to just test random people for antibodies in cities in all US states.
NYC's numbers could be due to population density (amount of exposure can increase severity in some viruses, including SARS-CoV-2) and some of the increase could just be medical malpractice:
> Dr. John Ioannidis released the result of his Serology Study in California:
That study showed that the seroprevalance in Santa Clara was less than 2%. That directly contradicts your earlier suggestion that 20% of the country was infected.
The seroprevalence number was also approximately the same size as the confidence interval on the false positive rate of the antibody test they were using, which means the confidence interval for the denominator of the fatality rate goes all the way down to zero, i.e. the fatality rate estimates are complete garbage.
> NYC's numbers could be due to population density (amount of exposure can increase severity in some viruses, including SARS-CoV-2)
Other death hotspots include New Orleans, Detroit, rural Georgia, etc. none of which have high population density.
A possible alternative - and I'm categorically not saying this is true, not even likely - is that Covid19 is more infectious, and more widely infected people. But, that fewer people were susceptible, so there would be more asymptomatic carriers but fewer people hospitalised. If a virus runs out of people to infect then it will peak.
You can prove that scenario wrong by testing (if number of 'already infected' is relatively low then this hypothesis would be wrong and the risk of further peaks is higher; I don't have enough data to attempt to disprove such a hypothesis.
Data from Italy makes for a good head-to-head comparison.
Five regions locked down much sooner than their neighbors, and fared, at least initially, much better.
We don't know when each country really got their first COVID-19 infections. That will always complicate analysis, and it will never be trivial. Never mind that we don't fully understand the virus itself, it's new.
The relationship between the spike and the beginning of spread is changed by the effectiveness of lockdown/other measures. Not to mention other variables like population density, population activity, etc.
I'm not referring to the future models, I'm referring to the "how many cases have we confirmed per day" charts. (You could also do it with the excess death charts, given enough time for that data to settle out.)
> A curve was trending exponential, and flattened with lockdown. What's the alternate scenario for what caused the curve to flatten?
You cannot honestly believe this. 'Trending exponential' is such a useless buzzword. Exponential growth is only scary depending on the exponent itself. Our models on what that exponent were were absolutely, completely off by orders of magnitude. Just look at Sweden, they were estimating 40k deaths by now and only have three thousand something.
Certainly, early action helped flatten the curve, but the original estimates for what the curve would be were incredibly off. There was no overwhelming of hospitals in the US at all, despite warnings that they were imminent, even with behavioral changes. Our country's scientific advisers need to look inward at this point and figure out what went wrong with the models.
> It seems we are all attributing this to a successful lockdown rather than considering other scenarios
The curve in parts of the US without a strong lockdown isn't flattening. NYC just dominated the counts so much that it makes the whole country look like it is flattening if you don't break things out. There's similar indications in data from international experience
So, there's a lot more basis for conclusions than “anti-tiger rock” situation.
The curve has flattened i Sweden too, despite the lack of strong lock down. Countries are different and so on, still I think it is way to early to conclude that there is a causative effect between lock downs and reduced virus spread. My own theory is that improved hand hygiene is what stopped the spread but we'll see what the future data says.
In that discussion I somehow lost whatever karma I had on this BB. Despite being polite and reasonable I was blasted into oblivion by some jerk(s). But with my now (-2) karma I am not above being jerky myself by pointing out that I was right, crooked-v was wrong, and any "field hospitals" the US Army made would indeed be, as I stated then, _field_ _hospitals_ and nothing like what "crooked-v" (https://news.ycombinator.com/user?id=crooked-v ) envisioned:
"Making these spaces fit the physical needs of these hospitals (massive power requirements for equipment, hallways and elevators with certain amounts of clearance for transporting patients, extremely well-controlled ventilation systems, sanitizable surfaces everywhere, rooms laid out with central access for doctors and nurses) would take so much time and effort that it would be more money- and time-efficient to build new buildings with the expertise of a group practiced in building new, reasonably high-quality buildings as fast as possible... like, say, the Army...These need to be modern hospitals, not 19th-century sanitariums where patients just get dumped into a bed and left to die or recover on their own."
- crooked-v, being wrong, wrong, wrong
- narogab, being a jerk and an asshole (but almost always, a _correct asshole).[God, it feels good to let go of that knife].
A similar thing happened here in the UK, we converted an exhibition centre (actually several in different cities) into Covid facilities. In the end we only used a few hundred beds and soon shut them down. What made the difference wasnt that we already had enough beds, but that other mitigating contingencies such as converting other smaller facilities into emergency hospitals happened fast enough, and moving patients out to less heavily hit areas softened the crunch more than anticipated.
I don't think preparing these extra facilities was a mistake at all. There are tons of unknowns and random variables in the progression of an epidemic, if we had needed those beds and din't have them more people would have died, possibly a lot of people. Complaining about waste is exactly like complaining about there being any empty beds in any hospital at any time. We plan for peak demand, including contingencies which may never come. It's like complaining that the military have any soldiers at all that never shot at an enemy, or bullets that never killed anyone. If we'd gone through the epidemic and there hadn't been any spare capacity, we'd used exactly as many beds as we had, that would have been bad preparation.
The line of thinking 'well there was a risk so any amount of money was worth it' - doesn't really hold.
People are rightly upset by 'mask gougers' why would they not in the face of 'hospital bed gougers' charging $500 000 / bed?
Resource utilization always matters, even in the face of life and death, costs have to be justifiable in the context of risk.
I agree that given unknowns, we have to err on one side, but there are and were ways to deal with such unknowns, for example, we have Spain, Italy, Korea etc. as guides.
It's also possible to 'stage' the creation of such projects without having to fully build them out, putting stages in places as necessary.
A 'million or 1/2 million dollars a bed' is utterly outrageous gouging, there's no rationalization for it whatsoever.
Where did I, or anyone else say 'any amount of money' or anything interpretable in that way?
There were credible scenarios, which could not have been discounted at the time, in which that capacity would have been needed. Spain set up emergency hospitals in convention centres, and a morgue in an ice rink. Those were exactly the model we prepared to follow in the UK.
As for the costs structure of the US model, frankly I have no idea. The NHS here works completely differently, suppliers do price gouge we're not immune to it, but that sort of thing can't really happen at the bed-provision level as that's an administrative rather than commercial issue.
These beds look just plain ugly and too small for relaxation that is needed for healing when somebody's sick.
I'm extra scared about the virus, because I know that I would get to a place like this, and I don't have the confidence that I would get the right treatment. I have heared of other people as well who would rather stay at home as much as they can, even if they can't breathe well.
But then when somebody needs the ICU, he really needs it fast, and at that time it's too late to go to hospital.
One development that the medical community discovered later on was that putting patients on the ventilator increased their mortality rate, and they moved toward treating patients as long as possible without relying on a ventilator. See: https://www.modernhealthcare.com/safety-quality/some-doctors...
This information simply didn't exist and was highly hypothetical at the time ventilators were being requested.
The head of a local hospital network has tweeted wondering where all the heart attack and stroke patients went - both in my lightly impacted region and in disaster NYC. Did the rate go down? Or did people just die at home afraid to go to the hospital?
In SF in normal times, over 50% of trauma cases are from car accidents. My completely unscientific theory is that commuting/traffic is way more stressful and physically taxing than people think.
https://www.sfexaminer.com/news/half-of-injuries-treated-at-...