mfb said:
I didn't focus on anything in particular. I compared "we don't know how restrictions will affect the economy, it might be worse than acting, we should wait with actions" (paraphrased, that's how I understood your comments) with your more recent comment.
No, I'm pretty sure I never suggested waiting as a general strategy before taking action of any kind -- perhaps case-by-case basis action, though, which could be earlier or later. Thinking-through your options isn't "waiting", especially if you should have already done it. Deciding not to do social distancing isn't choosing a less aggressive path that favors the economy over human lives if you're doing electronic contact tracing instead (see: Korea). The reality for us, here, is that most of the optionality passed us by before the choices were made.
While I held out hope - and bought stock - late in February, by the second week in March it was spreading-through my county and I had no illusions about a shutdown not being necessary at that point. But I always think you need a plan.
My concern about not considering health-vs-economy is still a big concern. It gets worse the longer the shutdown lasts, and worse as the death estimates go up. We're seeing predictions of more deaths
and higher economic cost over time. And we're
still not having a serious discussion of it in the general public. Not having the discussion before doing anything was bad, and another 6 weeks have gone by and we're still not addressing it. How many more deaths and trillions of dollars does it have to cost before we even
ask if we're on the right path?
Yes, in an ideal world everyone who is sick doesn't get in contact with others and none of that is needed. We don't live in such a world. Scenarios need to be realistic to be relevant.
I've certainly never suggested any such thing. I can't fathom where you got that from except to speculate that you have "social distancing" blinders on and aren't considering the other options. If true, don't feel bad: that's where the West's head is at right now in general. And that's basically my entire complaint that we're discussing here.
Huh - they went free for COVID-19 coverage, but I guess it's just in the US. No need for the frowney face; when I do this to someone else, I provide quotes as needed.
Key quote:
JAMA via NYT said:
Now five weeks into the crisis, a paper published in the journal
JAMA about New York state’s largest health system suggests a reality that, like so much else about the novel coronavirus, confounds our early expectations.
Researchers found that 20 percent of all those hospitalized died — a finding that’s similar to the percentage who perish in normal times among those who are admitted for respiratory distress.
But the numbers diverge more for the critically ill put on ventilators.
A total of 1,151 patients required mechanical ventilators. Of the 320 for whom final outcomes are known (either death or discharge), 88 percent died. That compares with about 80 percent of patients who died on ventilators before the pandemic, according to previous studies — and with the death rate of about 50 percent that some critical-care doctors had optimistically hoped for when the first cases were diagnosed.
NYC is an example of a hospital system that can't treat patients well because there are so many of them, that can easily skew statistics.
I'm not sure that's true. Yes, I know we've seen the videos and photos of hospitals with patients in the hallways, but field hospitals went unfilled by a wide margin. But regardless, note in particular the stat that
even in normal times, an 80% death rate is typical.
I don't have an oxygen mask at home. Do you?
Sure, patients with a higher risk are more likely to have an oxygen system somewhere, and there are portable systems, and you can visit the patients at home and whatever
No, but I'm reasonably certain if shipped one I could figure out how to wear it. And yes, I have a couple of relatives with COPD who wear masks or tubes most of the time.
...but in all these cases we are back to the original problem: We need some resources for COVID-19 patients, resources that are now missing elsewhere. You can't have the full healthcare system capacity for all other diseases and oxygen masks for every COVID-19 patient who might need one at the same time. In your scenario "what if we let all patients handle that on their own" people who need an oxygen mask might die because they don't get one.
Of course. Again, I'm not suggesting we actually do this, I'm suggesting it as a logic exercise to predict the upper bound of additional deaths from hospital overcrowding. If you've got a better method or better yet a source that's actually attempted to model it, I'm all ears.
Remember, this is not my claim we're discussing: "Flattening the curve" was predicated on preventing deaths from hospital overcrowding. In order to evaluate that choice, we need to know how many deaths it prevents. In a perfect world, the people proposing the actions would be backing their proposals with models, but instead we have replaced that with the infinite value of human life assumption. I don't think I've ever seen any effort by proponents of flattening the curve to show how many lives it could save via avoiding hospital overcrowding.
I have mentioned this several times in this thread (at least
from March on).
I note that while in that post you put some numbers to hospital bed requirements, you vaguely alluded to but made no attempt to quantify the additional deaths of overwhelming them.
Not if they just died because hospitals were overwhelmed.
As you showed, you made this claim at least as early as March 1, without attempting to quantify it. How can you claim it is important to not overwhelm the healthcare system if you can't or won't put a number on the death toll that will result?
Well, the 1000 deaths per day could easily be 500, or 200, or 50, or even lower. That depends on (a) when actions were taken and (b) how they evolve over time.
It doesn't depend much on when the actions were originally taken, because we're "resetting" when we re-open. It just impacts the duration of the shutdown until re-opening is possible. In general the goal is to get the case rate down to where contact-tracing will successfully hold down the number of new cases. In my area, that criteria is 50 cases per day per 100,000 people, and the effect is that different places will open at different times versus the start, which happened in the entire state pretty much at once.
But 50 cases per day per 100,000 people if applied nationwide is 165,000 cases per day, or ~3,800 deaths per day. V50 is right that some places like NYC won't be able to support that rate indefinitely, but there are still some prime targets available. And that's if contact tracing works, which I don't think it will. And again, to my earlier point;
today's models are predicting that it won't work and we're going to re-open anyway.
Plenty of people say we'll probably look at a half-open-half-closed state for a while. How open, and what exactly are the least impactful things to keep closed? Time will tell.
So, as before: we should be weighing the options and making decisions based on cost/benefit.
Extinction might work for islands, but closing land borders completely (or requiring quarantine for everyone crossing) is unrealistic.
Don't tell China or Korea that. But seriously, there's nothing special about a land border in most of the world. They are controlled and can be closed.
