COVID topic vol 2

[Peanut]

Edited for errors, maybe not enough

Since I'm here, this also recently got my hackles up:

https://unherd.com/thepost/genomics-exp ... o-control/

"Engelthaler is also one of the few epidemiologists to have publicly spoken out against school closures, for which there is 'no scientific evidence.' 'Privately, behind closed doors, there’s definitely been a lot of discussion from the very beginning that there’s no scientific evidence that shutting down schools actually helps to stop a pandemic…Epidemiologists knew that from the beginning, but that was not a popular opinion to take publicly and seems to have been kind of left to the side.'"

The interview is mostly focused on the contagiousness of the old new mutation, D14G, which he compares to the common cold, i.e., unstoppable. (This is not the new, new B117 mutation.) Agree we saw at least two large societies achieve the impossible, but also agree their methods are not really replicable globally with a disease of this profile. And maybe they did it with the OG less contagious, relatively speaking, strain?

[ZAFCorrection]

@peanut

Some other peeps wrote a non-peer-reviewed rebuttal of the years lost due to school closures paper: https://ikashnitsky.github.io/pppr-jama ... sponse.pdf

It reads like a longer, better-edited version of salty reviewer comments, in case anyone wants to know what that is like. Their big problems with the original paper seem to be bad calculations based on transcription errors (would need to comb the original paper to verify), metanalysis methodology (have no idea about that), and the logic of getting to the conclusion of YLLs lost. The latter concern seems to boil down to questioning logical leaps based on limited data that may not be entirely accurate.

Which, ya. No shit. This situation is unprecedented. Data is going to be limited and of impeachable relevance. Based on one of the rebuttal author's tweets, I get the vibe that the correct answer is to settle down and wait for updated R0 values, because everything else is fake news.

ETA:

The thing that keeps ticking over in my head is, unless you were one of the five people in the world who were in pandemic lockdown mode in 2018 or 2019 (i.e. before COVID-19 was a thing), you were a deaths-vs-the-economy bean counter. Flu was already killing/damaging people, it was spreading by the same mechanisms and facilitated by the same behavior patterns as are relevant to COVID-19, and people were making at least an implicit judgment that the benefit of mingling was greater than the excess casualties it would cause (however small the number, it was not zero). Accepting that we are cool letting people die (as is the case with almost any action or policy applied across enough people), it would save a lot of time to estimate the numbers for various interventions and the numbers we can tolerate.

[Viktor K]

The thing that keeps ticking over in my head is, unless you were one of the five people in the world who were in pandemic lockdown mode in 2018 or 2019 (i.e. before COVID-19 was a thing), you were a deaths-vs-the-economy bean counter.

This criticism/implied hypocrisy is faulty in an apples to oranges kind of way.

For example, Flu has a vaccine. Flu is less contagious. Hospitals are designed for flu surges. Flu is less deadly*?.

* I think, right?

[ZAFCorrection]

@Viktor K

You are correct in all the mitigating factors you describe, but the point still stands that flu kills people. Individual and collective choices lead to those deaths in terms of contributing to spread and healthiness. There is a finite and non-zero number of deaths caused by business as usual, and people are accepting of that number.

Note also that I am not necessarily calling anyone out for hypocrisy in terms of the number. Covid is demonstrably more deadly and overall more destructive than the flu. It is perfectly plausible to me that someone could find the flu worth ignoring while being all-in on large-scale interventions to mitigate the spread of covid. My point is that the number clearly exists and should be investigated for planning purposes. Also, people should stop pretending like they don't have a number when they clearly do. Maybe I am calling out a bit of hypocrisy. Or maybe unwarranted piousness.

[Viktor K]

I get that. But what's the point/implications here? It's like...

"people will tolerate a certain level of death from collective and individual actions"

That's fine. I think "all deaths should be mitigated as much as possible", so everything that can be done should be done to mitigate COVID deaths. Ideally at a global level. Under the current international system, it's mostly at a state level. In the US, it's practically at an individual level.

The US has not responded to the virus well. It's very disappointing, given the resources at the US disposal, and the success of other states. And the continual lifting + easing of restrictions, and state-by-state variations, have led to preventable excess COVID deaths.

It's quite concerning to imagine the next pathogen, or a new strain coming out of the US. As we've already seen, COVID continues to mutate in various ways. I believe the mink mutation was more deadly, and the variant in the UK more contagious. Although, latest predictions are it does not affect the efficacy of the US vaccines.

One can't ignore the US leadership during COVID, and the impact that any US president can have on public policy, especially during time of crisis. Who is in the white house will also affect the country's response (and certainly affected the COVID response).

With regards to flu, for example. People should be vaccinated. Theoretically, the flu could probably be eliminated as well with a global lockdown? I don't know, but I think humans still should seek to minimize deaths e.g. find a cure for cancer, not kill each other, solve tragedies of the commons, prevent as many people from dying from the flue as possible, etc. And I think there is evidence that humans as a whole work towards this.

I don't think morally, you could say to someone: "Hey, it sucks you're dying right now. But society said your death did not constitute an unacceptable addition. Still 300,000 deaths before we're going to worry about your cause of death."

[ZAFCorrection]

@Victor K

"all deaths should be mitigated as much as possible"

Like I said, unless you spent your life social distancing before it became mandatory, I'm not sure your behavior bears out that attitude. Unless you have some unstated caveat such as "as long as it does not inconvenience me beyond a certain point," which is again what I was saying.

To go to the absurd, a paperclip maximizer might decree that everyone should commit suicide, immediately reducing covid deaths to zero. We don't do that because we want to live in some fashion. Again, we are trading some numbers for other numbers.

[Viktor K]

@ZAF I don’t follow your logic over several of your posts now. I did social distance before it was mandatory, I don’t think that validates or invalidates the point you’re making though either way. Or the judgement you seem to be passing on.. me? That + I don’t think it’s worth it to continue and engage with you with regards to judging the current US response (foes list ).

I am open to hearing any evidence that the US is a shining example for how to best handle a pandemic, because I’m not seeing that.

That being

* local government determined restrictions
* no mask mandate
* open borders
* no and/or voluntary contact tracing
* loose and/or non existent enforcement

I think on a global level, countries that do not control their outbreaks (e.g. USA and many/most outside of Southeast Asia), are actually creating risk for those who do not. In the way of providing a reservoir for the virus (endemic) and continuing to contribute to the spread (pandemic).

[7Wannabe5]

@A Life of FI:

I agree that hospitals, like every other business in our peak industrial society, tend towards being maximized towards Efficiency rather than Resilience. However, since I've had a chronic, occasionally acute, medical condition my entire life, raised two children, taken care of more than my fair share of old people, etc. , I am not exactly a stranger to hospital emergency rooms, and this was something different and beyond. Medicine is a lot like education. Serious downside is you have no choice about dealing with the 20% of clients who are going to give you 80% of your problems. So, for instance, as might be statistically predicted, there was one mentally ill patient making trouble in the midst of all of the presumed Covid zombies, including me, when I was in the emergency room lobby. However, this hospital was in an affluent suburban zip code where I had been a substitute teacher at the high school for a semester, so I knew that it was likely to be not as overloaded with problem patients and or gunfire emergencies as some other locales. Analogous to how I know that in every teacher's lounge I visit as a substitute teacher, I will find teachers who are bitching about something, but it is only in the rough, chronically over-loaded inner city schools that I will find a 29 year old marathon runner who wishes she could do more for the kids she teaches, but tells me how she can't even date on Friday nights, because she falls asleep as soon as she gets home from school.

Also, one of the nurses told me that the nearest large hospital had stopped taking patients that evening, but they had to keep taking patients because they were a Level 1 center.

But regardless of whether either of our experiences are representative, if we are being told more hospital capacity is needed why is it not being added in large numbers? I only see two possible answers:

1) The people running things are incompetent - And this would be at the Federal, State and private health care levels, or

2) This is the way hospital administrators run hospitals and they don't see a need for a big capacity expansion.

3) The primary limiting factor in expansion is trained staff. Staff can't be trained quickly enough to provide resilience in face of epidemic.

An entirely new area for emergency or observation patients who were not presumed Covid had been created out of what seemed to be a lobby or part of the former cafeteria. It was largely open air with just white curtains dividing the patient "rooms." This is where they wheeled me on Day 3 after my Covid test came back negative. I could hear everything going on at the nurse's station, so I knew that overnight 2 patients had been tested and moved from the open air Non-Covid area to the Presumed Covid area. I also knew that they were calling in substitute nurses from an agency. The nurse I had the following morning was new to the hospital. The "funniest" thing was that they had aides who appeared to me to be teenagers from the vocational education program at the high school training each other on how to apply EKG hookups.

Returning to my teaching analogy, the situation reminded me most of the time when I was substitute teaching in inner city area with extremely high proportion of recent immigrants, and I had to help with the 30 extra kids they weren't expecting to show up for kindergarten, half of whom couldn't speak English, and the air conditioner in the old building wasn't working and it was over 90, and the room they gave us had no supplies, and the lunch truck didn't show up. That same week I went to a champagne served Greening of the City event at a cultural center just a few miles away from the school. Humans at that event, who had for the most part come from elsewhere, were communicating that lack of organic food in school lunches was a problem that needed to be addressed. I might suggest that for every crisis situation there exists a similarly ill-informed because removed elite perspective.

Of course, it is possible that my perspective is somewhat more removed from the direct economic fall-out of this crisis, because I previously made some effort to create escape hatches. Dunno.

Our numbers will decline in the late spring and people will say "Yeah! The vaccine works. If only those idiots could have controlled themselves for a few months more until the vaccine arrived." Then next fall the dry tinder will reignite once again and we will blame those who refused the vaccination. No one will tell the truth. The vaccine works okay for those who were not vulnerable to the ravages of Covid-19 in the first place and does not work well for those who are vulnerable.

If you would offer up some actual numbers, for instance U.S. Daily Covid Death Rate First Week of November 2021, I would quite possibly be willing to stake some money against this proposition. Or we could go the other way with U.S. Unemployment Rate if you like, although IMO, this is much more multi-factor dependent, so I probably won't bet as much. All comers welcome! PYMWYMI!

ETA: Obviously, I am not going to bet on death statistics related to current school-age humans, because I will be too dead to collect and who the fuck knows what is going to happen over the course of the next 60 years? Likely they will die earlier than my generation due to global climate change or other aspects of resource depletion, which the Covid lockdown only helped with a little bit. It's not like the schools are actually preparing them for the "careers" of the future anyways.

[ZAFCorrection]

@Viktor K

I have not been specifically talking about the US response for awhile now. To my knowledge, most western countries have been following the path of half-heartedly implementing social distancing guidelines while the intelligentsia defines narrowly the problem such that paperclip maximizer logic is technically appropriate. Because it is vulgar to admit you have finite resources and interest in solving a problem.

But ya, let's boil that down to some facebook-level red/blue debate.

[A Life of FI]

3) The primary limiting factor in expansion is trained staff. Staff can't be trained quickly enough to provide resilience in face of epidemic.

If we are short medical professionals then why did hospitals/governments not start preparing more 10 months ago when they told us the hospitals would be overrun. In WW2 we needed a huge increase in medical professionals and when we declared war immediately set about doing it:

“Anticipating a shortage of critical technical skills, plans called for the activation of training facilities for nonprofessional enlisted specialists”

“In order to meet the demand for trained medical soldiers, common specialists, and commissioned Officers, the capacity of existing MRT Centers was expanded. At the same time, the period of Basic Training for Fillers and Replacements was reduced.”

“The European Theater of Operations medical establishment expanded dramatically in preparation of and after D-Day…to a grand total of 212,777”

https://history.amedd.army.mil/booksdoc ... EFAULT.htm

https://www.med-dept.com/articles/ww2-u ... rch%201945.

I am estimating that this wasn’t done now as the people who can increase hospital capacity believe it is not needed. I was speaking with a person last week who was ER doctor who retired early just a few years ago and is still licensed and was willing to go back and work if needed, but he said he checked around and no one needed him. One would think that if there was a shortage of medical professionals the State Medical Boards would be calling such people proactively.

Further the hospitals are laying off staff where I am and one has shut down for lack of patients. In addition there are loads of people working in plastic surgery and other such non-essential fields that could be easily trained quickly to treat patients. It’s much easier to train them to treat a flu like illness than to train someone who is not a medical professional to treat all kinds of different aliments and major injuries like they did in WW2.

And if they really need more than the retired medical professions and those working in non-essential medical fields we should have been being bombarded with advertisements from the Federal and State Governments over the last 9 months to go sign up for medical training to meet this need, like the recruiting during WW2.

One thing though that is similar to WW2 is that we have run up the national debt to the same extreme level of GDP (which was the highest level ever) but are spending the vast majority of this money on the symptoms of the problem rather than the alleged cause – which is the fact that the hospitals will be overrun. That is we are paying corporations and people not to operate/work and subsidize their losses from not operating/working but not expanding hospital capacity. It’s like having an old leaky roof but allocating all your money, not to fix the roof, but rather replace the floors, walls and furniture that have been ruined by the leaks and repeating this process of replacements over and over for a year.

https://www.longtermtrends.net/us-debt-to-gdp/

Of course, it is possible that my perspective is somewhat more removed from the direct economic fall-out of this crisis, because I previously made some effort to create escape hatches. Dunno.

My concern is not for myself but rather those that are negatively affected. I am experiencing the opposite of economic fall-out but rather an economic benefit as my stocks and new worth reach new highs. But it takes time for one to build escape hatches and the average 20 some year old doesn’t have many/any escape hatches. They haven’t had the time to accumulate the wealth or life experience necessary to build them.

Imagine the situation when the 22-year-old who just graduated from college and maybe has a little bit of college debt, rent to pay and can’t count on support from their parents loses their job due to the fact that their company can’t operate or the 25-year-old business owner who has to shut his business. These people come under enormous stress due to this although the decisions they have made in life might very reasonable/good.

Going further is it really fair even for the 40-year-old who finds themselves without escape hatches to suffer. To be clear I am not saying you want to see them suffer, if you are concerned with helping poor intercity children I would guess you don’t want to see anyone suffer, but I could believe that you are more focused on the suffering from the virus than the suffering from the effects of the measures implemented to reduce to the suffering from the virus.

And further how does making them stay home change the risk for vulnerable people who are isolating - the nursing homes could be completely isolated if we wanted to do it and very likely for less money than we have spent so far. Then we might not need to even think about increasing hospital capacity. In not isolating the nursing homes we again appear to be spending our money on remodeling the inside of the house repeatedly instead of fixing the leaky roof.

[theanimal]

I really enjoyed Econtalk's latest episode which discussed much of what has been talked about in the last few pages here.

https://www.econtalk.org/jay-bhattachar ... -pandemic/

[7Wannabe5]

@A Life of FI:

I think over-run morgues is more critical than over-run hospitals. Although I do agree more efforts could have been made.

As to directing my sympathy at young ambitious adults of 20 or 25, it is my belief that they would be better served with a modicum of my respect. And I wouldn’t wish to deceive them with the notion that this trouble or all the troubles they are likely to face could have been managed out of existence by somebody else.

[A Life of FI]

@7Wannabe5

I am not saying that we take on the troubles of the 20 or 25-year-old but rather that they not be loaded by everyone else with the cost of a risk that does not even relate to them and that they have no power to do anything about.

If society decides it is important to save the lives of elderly people, then we should isolate them - which can be done at a reasonable cost.

However it is unfair for politicians, government employees, wealthy people, teachers, most upper income people, who can work from home, etc. to continue to have their incomes and see their networth’s increase while comfortably staying at home, while people not in these classes to be stripped of their incomes and made to struggle.

These lower/middle classes do not have any power to increase hospital capacity or isolate the elderly - only the upper classes can affect this.

I would think if the politicians in-charge of this were made to lose their incomes and then start sliding towards bankruptcy (as they often don't seem to have a lot of money) until hospital capacity was expanded and the nursing homes isolated these things would happen in a flash.

[Ego]

It is interesting how much this has come to resemble the abortion debate with the roles reversed.

[7Wannabe5]

@A Life of FI:

Well, I would note that during the WWII era which you seek to recommend as more ideal, very young adults were asked to die on the beach in foreign lands. Surely, this generation has the stuff necessary to deal with what is asked of them in this ordeal.

[A Life of FI]

@7Wannabe5

I am not at all against asking them to do this.

However I am against continuing to impose cost on them unnecessarily because the people in-charge are not taking the necessary measures to eliminate these costs.

We know of no plan or deadlines for increasing hospital capacity, but they keep insisting there is a shortage, or isolating nursing homes, but people continue to die of covid in them.

Shouldn't we be trying to limit the suffering of people who can't comfortably work from home and asking the people in-charge why these things haven't been done after 9 months and why not?

[7Wannabe5]

I believe that “tinkering” isn’t the worst possible solution seeking method, and , in fact, it is often the best possible given a highly complex emerging situation. Do I believe that all players in the U.S. still have reasonable degree of freedom to “tinker” towards their own solutions for relieving their own suffering at their own level? More or less,but yes.

Of course, I might just be projecting my own level of Stoic upon the general population, since my best option given my extreme weak lung status at the moment is to continue to shelter with an increasingly rabid Republican (although very fastidious in regard to Covid)grouchy old man who is hoping I will agree to squish myself into a corset and hostess MMF threesomes. IOW, if I can tolerate that, then I don’t really feel sorry for people who are being required to wear a mask at their places of employment. Also, those who are currently collecting unemployment might take the opportunity to relocate to lower cost of living area and/or enroll in virtual courses to improve their future employment options and/or re-invent their entrepreneurial endeavors. I am also currently exploring all of these options myself.

[subgard]

The current low fatality rate of the virus can be attributed to restrictions and hospitals not being overrun yet.

The virulence of many viruses depend a lot on your initial dose. Spend an hour talking face to face with an asymptomatic carrier, and you may find yourself in an icu on a ventilator.
Pick up a small dose of the virus through a face mask while grocery shopping, and you may just get light cold symptoms.
Without masks and social distancing, Sars-CoV-2 is still capable of producing the high fatality rates seen back in March from Italy and New York.

Healthcare workers now have more experience keeping Covid patients alive, each intervention they've learned and refined, shaving a bit off the case fatality rate. When the right time to administer oxygen or ventilate, using dexamethasone, placing patients on their stomachs.
But if hospitals overrun, all that learning is inapplicable.

Completely lifting restrictions would result in (much) greater fatalities from both increased dosing and lack of modern medicine.

The current argument of "Look at the mortality rate now. That's acceptable, let's open everything up." is just factually wrong.

It would be like abolishing all automotive safety measures because the fatalities per mile driven are so low.

[UK-with-kids]

The current argument of "Look at the mortality rate now. That's acceptable, let's open everything up." is just factually wrong.

It would be like abolishing all automotive safety measures because the fatalities per mile driven are so low.

Nice analogy.

And that's before we get onto the fact that road traffic accidents don't grow exponentially from exposure to other road traffic accidents.

[nomadscientist]

Soon we'll have the answer on corona measures effectiveness.

Take the UK for example.

68,000,000 people, 0.5% infection fatality rate, 70% predicted saturated infection rate. That's 240,000 deaths in the do-nothing (which includes private response) scenario.

Currently the UK has 80,000 corona deaths by death certificate listing*.

So if corona ends tomorrow, the UK saved 160,000 lives with average remaining life expectancy of 13 years.

Round it to 2 million life years saved. Probably half that in reality because the pandemic won't end tomorrow, but giving the benefit of the doubt.

UK values a quality-adjusted life year at 20-30k GBP typically, let's call it 30k USD . I'm not going to quality-adjust the LY lost of these mostly elderly people with chronic conditions; again, benefit of doubt.

That implies that our corona mitigations have won us a public health payoff worth $60 billion dollars, or 2% of UK GDP.

Please correct my working.



*some have objected this over-counts, which is surely true of individual cases, but it seems to best match excess mortality