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Old 03-25-2020, 09:09 PM
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Can someone explain to me why what we are doing isn't overreacting


I'm sure I'll get a lot of hostility for this but hear me out.

Back when the death rate was considered to be 2-4%, that is a pretty high number. We're looking at worst case scenario, 60-70% of the human race gets the infection and 2-4% die, that means up to 200 million dead.

A huge number and sheltering in place makes a lot of sense.

But isn't newer research showing the death rate is closer to 0.5%, possibly even lower? If so, then global death rates would be closer to 25 million. Still a huge number, but about 60 million die each year and most of those 25 million are people who are not far from death anyway.

I think this point is serious because some diseases main and harm young people for life. The spanish flu killed people in their primes due to a cytokine storm. Other infections like smallpox or malaria infect children and either end their lives, or disable them for life. But the coronavirus seems to mostly kill people who have lived their productive years.

Obviously, there are good reasons to take all these precautions. Governments all over the world of a wide range of government types and ideologies are taking this virus seriously and listening to educated experts who say to shelter in place, reduce contact, etc. So obviously, its a very serious issue.

I guess I'm starting to get confused as to why a virus with a 0.5% mortality rating is this big of a deal that we are looking at endless trillions in economic damage and a global depression. The major strain of smallpox had a 30% mortality rate, and I don't believe they shut society down when they were vaccinating against that disease. a case fatality rate of 0.5% is about on par with malaria, and societies with that don't shut down. To my knowledge the spanish flu didn't lead to large scale lockdowns, endless trillions in global debt spending and initiative a global depression and it had a higher death rate.

I know about bending the curve and trying to buy time so we can invent drug regimens, research vaccines, manufacture more PPE, etc. And I know that even though the virus is just starting (it'll be much much worse in April and May), hospitals are already overrun and running out of PPE.

Again, obviously this is all being done for a good reason because people far more educated than me are calling for it to happen. I'm just confused as to what exactly that reason is if the death rate is far lower than we thought.

TL;DR - why is a disease with a 0.5% or possibly lower mortality rating where most of the deaths are among people who are going to die soon anyway serious enough to warrant all these precautions and shutdowns? Do societies shut down like this over smallpox (before vaccines) or malaria? We could be looking at endless trillions in spending globally on sheltering in place as well as a global depression after this is all over. Obviously people way smarter than me think this is a good idea, I'm just curious if someone can explain it to me in a way that makes sense to me.
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Last edited by Wesley Clark; 03-25-2020 at 09:12 PM.
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Old 03-25-2020, 09:15 PM
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The death rate isn't a magic property of the disease. It varies city to city. 0.5% is a best case estimate, if we flatten the curve. Right now in italy it's more like 10%.
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Old 03-25-2020, 09:18 PM
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Maybe you could share where you are getting your 0.5% figure? Even South Korea is above 1.0% now. I have not heard 0.5% anywhere. If you have something, please post it.

As far as sheltering in place goes, here are some statistics:
March 10 - San Francisco 17 cases, NYC 32
March 24 - San Francisco 152 cases, NYC 14,776

Now NYC has more people in SF, may be denser, but that's still a wildly different outcome. We are getting wildly different outcomes from locale to locale and it DOES matter how things are handled.
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Old 03-25-2020, 09:21 PM
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Part of your assumptions are possibly incorrect: the mortality rate among younger people may be higher than you suspect.
But I think the answer to your question is: it’s who is dying, and how.
The people dying will be people we know. And some will die because someone chose for someone else to get the last ventilator. This is difficult to accept in our society.
We don’t tend to do straight math on death anyway. We will spend money on digging a kid out of a well which could save a multiple of kids in a famine area.
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Old 03-25-2020, 09:26 PM
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We're not:

https://www.vox.com/future-perfect/2...t-overreacting

When I used to teach CPR, first aid, and emergency medicine, I always emphasized the reality. I always taught worst-case scenarios, in addition to the standard stuff. I wanted my students know they may break bones during CPR, the victim might vomit into your face, a bad hand position on a female victim could send the wire in her underwire bra go through your hand (or into her!), etc.

The point was to always be prepared for the worst, but hope for the best. But the critical issue was you had a greater chance performing CPR on someone you care about, someone you love, than on a stranger. In order to save a life you have to fall back on your training, A-B-C, 1-2-3, etc., and not allow your emotions to cloud your life-savings.

Because it's only after the EMTs or paramedics arrive and take over that you realize it was your mother, or your father, or your newborn baby's life you just saved. Then you can go into a corner, allow your emotions to surface and cry your eyes out. Been there, done that. They all survived.

None of this half-hearted shit on COVID-19. Full-court press. Damn the torpedoes, full speed ahead. Anything less will be a disaster none of us have ever experienced.
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Old 03-25-2020, 09:33 PM
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Originally Posted by Wesley Clark View Post
I'm sure I'll get a lot of hostility for this but hear me out.

Back when the death rate was considered to be 2-4%, that is a pretty high number. We're looking at worst case scenario, 60-70% of the human race gets the infection and 2-4% die, that means up to 200 million dead.

A huge number and sheltering in place makes a lot of sense.

But isn't newer research showing the death rate is closer to 0.5%, possibly even lower? If so, then global death rates would be closer to 25 million. Still a huge number, but about 60 million die each year and most of those 25 million are people who are not far from death anyway.
An ADDITIONAL 25 million deaths isn't a big deal? That's more people than were killed in WWI.
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Old 03-25-2020, 09:48 PM
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An ADDITIONAL 25 million deaths isn't a big deal? That's more people than were killed in WWI.
Well again, how I see it is that resources are finite.

Lets say that in between the deficit spending and global depression, the world loses 100 trillion over the next decade. Hopefully it won't be nearly that large. Many of those 25 million who die will be past their productive years and will be dead fairly soon anyway.

That has to come from somewhere. Part of it will come from reducing education, or childhood nutrition programs, or renewable energy investments, or R&D and infrastructure spending to build a better world for the next generation. So possibly we are extracting tons of wealth to save the elderly that we could've used to raise the next generation of children.

In the UK they use the NICE program to determine if a medical intervention is cost effective. I think its about $50,000 per quality adjusted life year. So if there is a medication that'll extend your lifespan by 3 months but costs $200,000, the NHS won't cover it. You can cover a lot of medical care for 200k and the NHS decides its better to spend it on medical care for the young and middle aged and early seniors than to spend it on slightly extending lifespans of terminal patients and the very old.

If this lockdown saves 25 million lives, but it costs 100 trillion dollars, that is 4 million per life saved. Since many of those saved are going to be people past their productive years.

http://www.youtube.com/watch?v=hXVjhSNcqww&t=0m17s
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Last edited by Wesley Clark; 03-25-2020 at 09:51 PM.
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Old 03-25-2020, 10:06 PM
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If this lockdown saves 25 million lives, but it costs 100 trillion dollars, that is 4 million per life saved. Since many of those saved are going to be people past their productive years.
You keep making this point about "people past their productive years." Because fuck them, right? Nothing more than withered husks, those people. I mean, I could see throwing six, maybe seven hundred bucks toward keeping Grandpa upright out of sentimental value, but $4 million??? That's a full .0001% of the annual U.S. federal budget!!!
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Old 03-25-2020, 10:16 PM
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The higher mortality rates tend to be in places where the medical system is overwhelmed. In order to achieve the 0.5% or even 1%, we would need a scenario where there are only a few people at a time getting sick. When you start having large numbers of ill, including nurses and doctors getting sick, the mortality number seems more like 5 to 10% rather than the 0.5% you mention.

Last edited by FlikTheBlue; 03-25-2020 at 10:16 PM.
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Old 03-25-2020, 10:20 PM
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But isn't newer research showing the death rate is closer to 0.5%, possibly even lower? If so, then global death rates would be closer to 25 million.
Worldwide as of today, we have about 471,000 confirmed cases with 21,200 deaths. That's a global mortality rate of 4.5% - nine times higher than your estimate. In that worst case scenario, we're looking at 175 million deaths - I.e, 2% of the entire human race or one in every fifty human beings. In raw numbers, it's nearly twice the total death count of WWII.

That's not an acceptable loss.

Last edited by Smapti; 03-25-2020 at 10:23 PM.
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Old 03-25-2020, 10:22 PM
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Op, you look for money (in numbers that you make up), to “come from somewhere”. Much, likely most, is just money that just isn’t made when it could’ve been.
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Old 03-25-2020, 10:28 PM
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You're not alone in asking this question. And you're also not alone in making the basic mistake of not looking at the costs of not doing anything.

When the entire hospital system has collapsed from sheer numbers and you wind up getting seriously ill from something other than coronavirus will you still be asking this question? What do you think the economic reality will be then? Are you looking forward to an economy with no health care? What's the price of that? What's the long-term effect?

Others have recognized that your made-up numbers are silly and totally unrealistic, so I'll just wonder about something else you said. You talk about the UK and its choices in normal-time. Have you also noticed that the UK has turned totally around and is locking down the country? Why aren't you asking them what the price of individual lives are? Could it be that something significant has changed since times were normal?
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Old 03-25-2020, 10:44 PM
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When the entire hospital system has collapsed from sheer numbers and you wind up getting seriously ill from something other than coronavirus will you still be asking this question? What do you think the economic reality will be then? Are you looking forward to an economy with no health care? What's the price of that? What's the long-term effect?
This was the point I was going to make as well. With hospitals overwhelmed for a long time, regular health care and emergencies and operations are all going to take a back seat to coronavirus. Break a bone? Appendix acting up? Kid has an ear infection? Elective surgery? Rotten tooth? Heart attack? Stroke? Colonoscopy? Forget about it - the system is fully engaged in keeping coronavirus people alive - you may have to wait or take a back seat or go somewhere else.
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Old 03-25-2020, 10:52 PM
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If all you care about is the money, have you happened to think about what is going to happen to Granny's savings? Instead of dying peacefully in her sleep, everything she might have left to folks will be spent on her health care. Kids and grandkids who might have enjoyed getting a windfall will just end up with a handful of medical bills to deal with.

Some of those old, unproductive folks are the volunteers who do a whole bunch of scut work that nobody ever notices. The local Lion's clubs I have known recycle paper to pay for eye care for the poor. I don't know if you think that having folks help that way is productive, but I do.

Libraries usually have volunteers who accept donations, have book sales and raise money to buy needed books which improves the community. Yeah, I'm sure you think those folks aren't very productive either.

Hospitals out here and begging for volunteers because all of their very unproductive old folks volunteers are afraid of getting sick so they need other volunteers. Many of the worthless layabouts are sewing masks for their hospital, but are certainly not productive enough to be worth caring about.

Parks, shelters, food banks and more all depend of those unproductive old people.

I know that the coming depression will raise my taxes, but if all of those unproductive old folks die off, my taxes won't cover the loss of services those worthless old people allow me to enjoy.

Last edited by flatlined; 03-25-2020 at 10:54 PM.
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Old 03-25-2020, 10:59 PM
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1. We don’t know what the mortality rate is. But it seems to be a lot lower in places that took sensible precautions and physical distancing earlier.

2. Most countries have very limited surge capacity in their emergency rooms and critical care units. This includes staff, equipment, beds and ventilators.

3. The economic cost is not “endless trillions”. I don’t think it is wrong to ask what the cost is, but it is disingenuous, since the economic costs of ignoring a pandemic are also exceedingly high independent of lives lost. Events would still be cancelled and more would be affected.

4. One has a choice between overreacting and underreacting. Overreacting is safer, builds system capacity for future problems, promotes research and likely saves lives. But countries like Mexico have not reacted much. So we will see what happens. Things look quite scary in some countries.

5. The disturbing thing about this is the high contagion rate and the fact healthy men age 30-50 can be severely affected. The comparison to malaria is not apt.

6. Much remains unknown about this and it is easy to fear the unknown. Is a vaccine possible? Will it come in waves? Can you be reinfected?
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Old 03-25-2020, 11:03 PM
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Since many of those saved are going to be people past their productive years.
What kind of person talks of other people as tho they were inanimate objects who's only purpose is to serve?
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Old 03-25-2020, 11:05 PM
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None of the arguments I've read about sacrificing COVID patients to the economic altars take into account that the stock market was really overdue for a correction. Trump may have otherwise artificially kept it going until the November elections - but at some point it was going to down-cycle like it always has. The COVID crisis has likely made it happen sooner, sharper and worse - but from a historical standpoint it was already overdue for a bear market. How much worse COVID will have made it we'll never really know - but it should be recognized that COVID isn't the sole contributing factor to the unemployment, retirement fund losses and other financial issues that people will soon be suffering through.
The good news is if people and their governments don't let 2-5% of the people die - the economy will likely rebound 'bigly' within a few years.
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Old 03-25-2020, 11:09 PM
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Worldwide as of today, we have about 471,000 confirmed cases with 21,200 deaths. That's a global mortality rate of 4.5% - nine times higher than your estimate. In that worst case scenario, we're looking at 175 million deaths - I.e, 2% of the entire human race or one in every fifty human beings. In raw numbers, it's nearly twice the total death count of WWII.



That's not an acceptable loss.
The confirmed cases is an underestimate of the true number of cases. The only question is whether the true number is only a few times higher, or considerably more than that.

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Old 03-25-2020, 11:21 PM
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One epidemiologist explained it this way: With a 2% death rate, everyone in the US will know someone who died from Covid-19. A grandparent, a colleague, a work buddy, a buddy.
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Old 03-25-2020, 11:48 PM
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I gotta say I think the social distancing and quarantine we did was a good thing but it can't keep on much longer and maybe it already served its purpose by staggering the amount of people in the hospital or on ventilators hitting the system at once.

But I don't get the big emergency either the number as of writing this of global deaths is over 21,000 and that's not anything to sniff at but even if that number doubles, triples, quintuples or more it's still essentially a drop in the bucket.

In 2018 worldwide something like 140,000 died of measles, over a million deaths from auto accidents, then other accidental deaths, influenza deaths, but those deaths are just static in the background and nobody really freaks out about it. Why is this any different?
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Old 03-25-2020, 11:56 PM
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In 2018 worldwide something like 140,000 died of measles, over a million deaths from auto accidents, then other accidental deaths, influenza deaths, but those deaths are just static in the background and nobody really freaks out about it. Why is this any different?
The issues are:
1) This disease appears to be substantially more contagious than, say, influenza.
2) Unlike measles or the flu, there is no vaccine yet for this virus, and no one has had it before. This means that none of us are already immune to it (though it's likely that a large percentage of people will get only mild symptoms, if any symptoms at all, from it). And, if you aren't immune, if you get exposed to it, even if you're asymptomatic, you can be spreading it to other people.
3) Without social distancing and "flattening the curve", the issue is that you have very ill people all getting ill at the same time as each other. Virtually no country has a health care system that can take care of a sudden influx of critically ill people all at once. Yes, a lot of people die in car accidents, but those happen more-or-less equally spaced over the year.

If you have not already done so, read about what's happened in Italy over the past couple of weeks. The number of critically-ill people have completely overwhelmed the healthcare system there.

Last edited by kenobi 65; 03-26-2020 at 12:01 AM.
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Old 03-26-2020, 12:12 AM
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I gotta say I think the social distancing and quarantine we did was a good thing but it can't keep on much longer and maybe it already served its purpose by staggering the amount of people in the hospital or on ventilators hitting the system at once.

But I don't get the big emergency either the number as of writing this of global deaths is over 21,000 and that's not anything to sniff at but even if that number doubles, triples, quintuples or more it's still essentially a drop in the bucket.
First of all, social distancing and quarantine isn’t something “we did”; it is something we are doing right now, and while it may not materially change the number of people who contract the virus and who have a serious response, it will change the distribution in time of when those responses occur, which in turn affects the finite amount of resources (ventilators, beds, medical personnel) available to treat those seriously ill but survivable patients. This isn’t just about the extremely sick and elderly who are going to die off anyway (as if we should just write them off as a cost of doing business) but people who are perfectly healthy except for a mild underlying condition like asthma or who have a previous illness making them temporarily susceptible.

The ‘big emergency’ isn’t the current number of global deaths; it is the difference between the projected number of deaths if we do nothing vice those if we practice good public health guidance. If we just say, “Oh, a couple of weeks seems good,” which is a conclusion supported by no evidence whatsoever and which professional epidemiologists view as wholly inadequate, then all we’ve done is shift the inevitable tragedy a few days at best. In order to effect a meaningful difference in outcome we need to institute severe public health measures for eight to twelve weeks. Otherwise, we might as well just start euthanizing people with severe symptoms right now and save people on the front line of the medical community the trauma of having to make decisions about where to allocate resources and who to give up on.

This notion that ‘the economy’ is a diety we have to be beholden to regardless of how many lives need to be sacrificed is cargo cult thinking at its absolute worst. ‘The economy’ is a human creation, and while we can’t totally predict how markets respond, we can make the conscious choice to freeze normal speculative behavior, give loan guarantees and debt relief to service industry businesses so they can temporarily close with assurance that they will be able to reopen after the crisis, provide subsidy from the vast reserves of wealth that industrialized nations hold to tide over the most needy, and focus on dealing with the actual problem of contagion and treatment, and ensure that critical industries are still operational, we can return to normal life in a few months. Or we can let many tens of millions—perhaps hundreds of millions—of actual people die, many unnecessarily, all in the service of ’the economy’. We actually have the power, should we collectively decide to exert it, to put all nonessential elements of ‘the economy’ on hold and focus on the absolutely essential.

This crisis—which in terms of a global pandemic is on the mild end of the spectrum—has really shown how people respond to an global threat, and frankly, it doesn’t give a lot of hope for dealing with actual existential problems like global climate change, catastropic asteroid impact, an engineered persistent biothreat, or even the next totally natural global influenza epidemic. This is in part because various nations in lead economic roles have selected in their leadership for utter incompetence, narcissism, and greed, but it also reflects on the unwillingness of those with means to express empathy or concern for the people who are already living in the margins of society through no fault of their own.

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Old 03-26-2020, 12:15 AM
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One mistake you're making is the same mistake EVERYONE made until well into this epidemic - underestimating the incredible infectiousness of this disease (which means a rate of transmission that's through the roof), combined with the fact that it's infectious all the way through its incubation period. This means that when and if you decide that actually you were wrong and you'd like to slow the rate of infection, whatever you do will do absolutely nothing for five days at least, and it takes maybe 10 days to 2 weeks for the full effect of whatever you did to actually be seen, and you get to decide if it was enough.

So this is how it looks in practise. You're the mayor of a city of 1 million, you've calculated that if the disease just sweeps through it will take out 1% which is 10,000 and this is sad but survivable.

Here's some other plausible ballpark numbers: You have 200 ICU beds in your city (20 per 100,000 - that's the norm in the US), 5% of infections need an ICU bed, and half of them are normally full (with other illnesses). Say on March 20th 0.1% of your population has an infection, which means that 1,000 are infected, 50 need ICU beds and of those, 40 will be okay with that care, but 10 will die anyway. Oh, and your growth in the infection rate is 20% (very low, for the 'not doing anything' scenario. Here's how it plays out from here.

March 21st. 200 more people are infected, 10 need an ICU bed. Your ICU occupancy rate is 100 non-covid, 60 covid, 40 free. If this has been growing steadily all feb/march then one of those covid patients resolves (either by dying or getting better), so now you have 41 free beds.
March 22nd. 240 new infections, 12 need a bed, 1 case resolves so you have 30 free beds
March 23rd. 288 new infections, 14 need a bed, 1 resolves and you have 17 free beds. You realise you're going to run out of beds VERY quickly if this keeps up, so you announce sweeping restrictions. Total lockdown! Nothing happening in the town except essential infrastructure, healthcare, groceries
March 24th. nothing happens to the infection rate, it's still 20%, because all the new cases are people who actually got infected 5 to 10 days ago before there was a lockdown. 345 new cases, 17 need a bed, 1 resolves, so now you've got one ICU bed for all tomorrow's cases
March 25th. nothing happens to the infection rate, 415 new cases, 21 need a bed, one gets it, the other 20 are all going to die. 16 of them would have lived if the hospital hadn't been overwhelmed.
March 26th.nothing happens to the infection rate. 497 new cases, 25 need a bed, 2 can get one because today TWICE as many old cases resolved, other 23 die, 18 of them excess-deaths (would have lived with care)
March 27th.nothing happens to the infection rate (we're still getting the cases that were infected on the 22nd and before, right?). 598 new cases, 30 need ICU, 28 can't get it, 22 excess deaths
March 28th. Finally the infection rate twitches down slightly, to 18% (this is based off the Italy data). That still translates to 645 new cases, 32 ICU need, 30 can't get it, 24 excess deaths
March 29th. Infection rate 16%, 676 new cases, 34 ICU need, now we're up to 4 resolving per day but that still means 30 out of luck and 24 excess deaths, again
March 30th. Infection rate 14%, 683 new cases, 34 ICU need, 4 resolve, 30 no bed, 24 excess deaths.

It's now been a week since you decided you needed to do something about slowing the spread of the disease and in that time 100 of your citizens died purely from lack of medical care, rather than from the disease.

Here's how it goes in week 2

March 31: 12% rate 671 cases, 4 resolve, 30 no bed, 24 excess deaths
April 1: 10% rate 626 cases, 8 resolve, 23 no bed, 18 excess deaths. OK that's still bad but it's less than yesterday. Maybe you're winning!
April 2: 8% rate 551 cases, 8 resolve, 15 no bed, 12 excess deaths
April 3: 8% rate 595 cases, 8 resolve, 22 no bed, 17 excess deaths
April 4: 8% rate 643 cases, 12 resolve, 20 no bed, 16 excess deaths
April 5: 8% rate 695 cases, 12 resolve, 23 no bed, 18 excess deaths
April 6: 8% rate 750 cases, 12 resolve, 25 no bed, 20 excess deaths.

At this point you realise that 8% is as low as your rate of increase is likely to go, because people still have a certain degree of contact/transmission risk through healthcare workers, grocery stores and other essential services. Your total number of infections in the city is now about 10,000 - that's 1% of the population, nowhere near herd-immunity levels or even bringing-down-the-transmission-rate levels. You've got about another month till it starts to reach vaguely-plausible lessened-transmission levels, during which time you keep having about 1% of new cases die because sadly they're just gonna, and a growing number, getting up to four times that dying because they couldn't get a hospital bed. By the end of the outbreak you actually have close to 50,000 dead in the city, the vast majority of which died through lack of medical care. Oh, and I never modelled-in '20% of your ICU staff had to go into isolation because they caught the disease off their patients, and now you only have 160 beds'

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  #24  
Old 03-26-2020, 12:23 AM
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If you have not already done so, read about what's happened in Italy over the past couple of weeks. The number of critically-ill people have completely overwhelmed the healthcare system there.
Not only overwhelmed the healthcare system but are essentially being abandoned in place because there aren’t even the people to take care of them en masse. People are literally being left to die in care facilities. Yes, these people are elderly, and most will probably die of other causes in a few years anyway, but they are now dying without notice, without compassion, and in absence of their families or anyone to ease their suffering.

I know this guy is kind of dry, and if you’re not a quant he throws out a lot of numbers that may not be very exciting, but he is doing factual analysis of what data is available of comparison on fatality rates between countries who have made some effort to delay the spread of the virus and those that have done virtually nothing, and the differences are stark. Frankly, at this point, the United States, Britain, and many other supposedly “developed” nations are on the same path, and the lesser stable nations are going to experience worse. History will record that we had the analytical tools and communications technology to do something to avert this, even if we couldn’t stop it, and we failed to act because “numbers”.

May every worthless politician worried about their “numbers” be held to reckoning for their cowardice.

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Old 03-26-2020, 12:39 AM
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What kind of person talks of other people as tho they were inanimate objects who's only purpose is to serve?
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Old 03-26-2020, 12:44 AM
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The way I see it, It’s true there is evidence out there that there could be a very substantial number of unconfirmed/untested/asymptomatic cases, possibly even enough to make the true chance of any given person dying if infected closer to the flu’s actual mortality rate. There’s no way to know this yet though, and the stakes are too high to assume anything. If it’s true that it’s ultimately “only” equal or 2x as deadly as the flu, that’s certainly much better news for our global future compared to more pessimistic opinions out there. (I think it’s much more likely that there are 10 or more unconfirmed cases for every confirmed case than this having a true mortality rate over 1%) But a highly contagious novel disease spreading unchecked through the population, even if only with a .1% mortality rate, will still break the health systems worldwide on the level of what’s happening Italy. If everybody who died of the flu in Italy did so in a few weeks, it would break them too. And it doesn’t help that those who need critical care are frequently needing it for many weeks, and need expensive equipment not in adequate supply. After it’s first pass through the global population, after immunities are built up, “seasons” set in, vaccines of any degree of effectiveness introduced, its global impact could easily be reduced to just another flu - the flu is a big killer tho, so doubling or tripling that is still pretty bad, but yes in that scenario, life is basically back to normal. Still the initial wave is the big problem and why it’s worth these measures to slow it, combined with the fact we really don’t know the true death rate and can’t bank on assumptions.
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Old 03-26-2020, 01:21 AM
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To me, the issue is best explained in this article. Essentially, the takeaway is that neither the mortality, nor the infectiousness of the virus is just a fixed number, and depends critically on how we handle it. If we do nothing, infectiousness remains at a R0 of somewhere between 2 and 3 (perhaps 2.3), which will very quickly overwhelm the surge capacity of every country's health care system, which is in turn what leads to a mortality rate possibly in excess of 5%: that's the 'hundreds of millions will die' scenario. (It goes without saying that even if one doesn't care about a few hundred million deaths, the economic impact of this will also be devastating.)

Decreasing social contact decreases the effective number of infections per COVID-19 case. Only in this way can we bring down the number of infections at any given moment, which keeps the health care system from being overwhelmed; only then do we have a chance of bringing the morality rate down to something like 1%, or even less.

This isn't going to be a one-time effort; it will require a long-term strategy of tightening and relaxing social distancing measures to manage effective transmission rates and, once the initial outbreak has come under control, prevent another exponential increase. This will hurt the economy, undoubtedly; but I can't think of any scenario in which the alternative won't be worse.
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Old 03-26-2020, 01:55 AM
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I gotta say I think the social distancing and quarantine we did was a good thing but it can't keep on much longer and maybe it already served its purpose by staggering the amount of people in the hospital or on ventilators hitting the system at once.

But I don't get the big emergency either the number as of writing this of global deaths is over 21,000 and that's not anything to sniff at but even if that number doubles, triples, quintuples or more it's still essentially a drop in the bucket.

In 2018 worldwide something like 140,000 died of measles, over a million deaths from auto accidents, then other accidental deaths, influenza deaths, but those deaths are just static in the background and nobody really freaks out about it. Why is this any different?
These deaths are significant in that they are an extremely sudden uptick in "normal" death rates, and there's good reason to believe it will get a hell of a lot worse.

Glancing at worldometers right now, there have been 468,905 cases total, with 21,200 deaths.

Of the 333,000 active cases, 14,774 are serious or critical. Add in the 21,200 deaths, and that's roughly 36,000 people who required hospital care. I don't know the average breakout of "asymptomatic" vs "minor" vs "moderate" etc. but let's say that of the 430,000 or so "non-serious" cases (468,905 - 36000), 30% lost 2 or more weeks of work. So you've got 129,000 people losing 2 weeks of work. There's a significant cost right there.

We have 7.8 billion people on this planet. Let's round that to 8 billion to simplify the math, and let's say we've had 500,000 cases so far, also to simplify the math.

Let's guess that the actual number of infections is 10 times higher than the official number - so 5 million cases as opposed to 500,000. Your fatality rate is now 22,000 / 5,000,000 - or 0.44%. So, yeah, about a half a percent.

5 million people is .0625% of the world's population. That is 1/1600th of the world. We have a long way to go before this burns itself out.

Let's further assume that ultimately, half the people on the planet (that's 4 billion) will ultimately become infected and that the current ratios of mild/moderate/severe/dead continue to hold.

36,000 serious cases in 5,000,000 infections. If we have 5 billion infections, we multiply that 36,000 by 1,600. That gives us 57.6 million serious cases. A WAG on deaths (using the 21000 so far) would 33.million deaths worldwide. Since I'm American, and we have about 1/30th of the world's population, that's 1 million dead right here. Ignoring the coronavirus, we have about 2.8 million deaths a year in the US. We'd be increasing our death rate by about a thild (another WAG - some of those 2.8 million who would have died from other causes will die of COVID instead).

I'm obviously making a lot of assumptions and wild-assed guesses regarding actual infection numbers and the percentage of people who will ultimately catch this. but my numbers aren't that wildly off from what I've seen running about the interwebs.

Are you scared?

I sure as hell am.

If the true infection figures are a LOT higher than the 10 to 1 I posited above, things get better of course. If it's 100:1, then my extrapolations would lead to about 3.3 million dead worldwide (and 100,000 in the US). The thing is, nobody knows what the real rate is.

Last edited by Mama Zappa; 03-26-2020 at 01:56 AM.
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Old 03-26-2020, 02:08 AM
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Whatever the correct fatality numbers are, aren't the current numbers the rate with proper medical treatment? Might not the rate increase dramatically if we allow the healthcare system to become overwhelmed?

Won't overwhelming the healthcare system also increase deaths from other causes?

Even if we look at it from a purely economic viewpoint, is it possible that the economic costs from letting it spread unchecked might be higher than the costs of what we're currently doing?
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Old 03-26-2020, 02:26 AM
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In really, really simple terms: it may be true that it's much less fatal than we think, because there are so many undiagnosed cases. But, if that's true, it's also a hell of a lot more contagious than we think, so that all comes out in the wash. If 70% of the population got flu every year, that'd be a really different thing.

Look, the economy is fucked. It's fucked if we lose 30 million people, and it's fucked if we shelter in place for 4 months. But the difference afterward is like the difference between Britain post WWII and the US: both countries had a total collapse in domestic demand, but Britain had lost much more productive capacity: more dead, plus terrible loss of factories, roads, etc. Within 10 years, the US recovered--the UK was a much slower process. We can come out of this in one of those two positions. Which makes more sense?
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Old 03-26-2020, 02:48 AM
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With the numbers being talked about it feels like the powerful industrial nations are underreacting and definitely under prepared.
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Old 03-26-2020, 02:56 AM
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The death rate relative to age is also going to be skewed by the overwhelming of medical facilities. The numbers where mortality roughly doubles with each decade of life assume that ICU care is available, that that those that are more aged are more likely to die. Once the system is overloaded the chance of dying increases rapidly at lower ages, simply because the ICU care that made it possible to survive has gone. People in their 50's are already on ventilators.

The question of economic losses is curious one. We keep hearing of massive losses on the stock markets and no doubt soon property. These are of course paper losses. A post virus revival of the markets will likely see at least some of these losses recouped. Other than that the money hasn't actually gone. The losses on the markets does affect those that are reliant on these investments for income - which is ironically the older, retired members of our society. Actual long term damage to a country (I won't say 'economy') is more difficult. Some businesses won't survive. But the prime reason for a business going under is insolvency. These are not ordinary times. It serves no-one to send a debtor into bankruptcy right now. Getting pennies on the dollar just means you are going to accelerate your own insolvency. And it is likely to run right up that chain. Normal rules can't be usefully applied, and with luck, there will be enough structures in place to avoid the structure of the economy unravelling.
The very real danger with letting the contagion run unchecked and 'preserving' the economy is that with a couple of percent of the population dying prematurely, with no apparent help or support from the government, will be a level of social chaos that does vastly more economic damage, and damage that can't be easily mitigated by structured economic efforts. It is one thing to keep a business afloat by placing a stop on loan repayments, it is quite another to refloat a business because it has been declared bankrupt and the assets stripped of and sold, or, worst case, been burned to the ground by looters.
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Old 03-26-2020, 03:16 AM
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I have been explaining it using the old riddle about the lily pad. You know, the pad doubles in size every day and after 30 days it has covered the pond and choked out all other life. When did it cover half the pond?

Of course the answer is the 29th day. Now if you were standing alongside the pond with a biologist on day 29 and she said, "If we don't do something about this lily pad problem it will kill this pond," you would know what she meant. Even on day 27 when it covered 12.5% of the pond it would have made sense.

Well, if you were there with her on day 20 and she said the same thing would you have believed her? Because at that stage the lily pad would have covered less than 0.1% of the pond.

I told people this on Saturday and told them that we were at day 20 and that there would be twice as many cases on Wednesday. And there were. And, given a few weeks to double 10 more times, if left unchecked there will be 1,000 times as many cases.

It's just arithmetic.
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Old 03-26-2020, 03:44 AM
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In really, really simple terms: it may be true that it's much less fatal than we think, because there are so many undiagnosed cases. But, if that's true, it's also a hell of a lot more contagious than we think, so that all comes out in the wash. If 70% of the population got flu every year, that'd be a really different thing.

Look, the economy is fucked. It's fucked if we lose 30 million people, and it's fucked if we shelter in place for 4 months. But the difference afterward is like the difference between Britain post WWII and the US: both countries had a total collapse in domestic demand, but Britain had lost much more productive capacity: more dead, plus terrible loss of factories, roads, etc. Within 10 years, the US recovered--the UK was a much slower process. We can come out of this in one of those two positions. Which makes more sense?
30 million deaths. Is anyone projecting that? That's frightening as fuck. If every person in America got the virus and the death rate was as high as 4%, that's 13+ million people, and even that's a frightening shit-ton. If millions to tens of millions require hospitalization, deaths, including non-virus deaths, will be higher because of an overwhelmed health care system, but 30 million seems like a wildly high number. That's 9% of our population. Even if that's just a worst case, but possible, scenario, I don't think there can be an overreaction.
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Old 03-26-2020, 03:53 AM
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TL;DR - why is a disease with a 0.5% or possibly lower mortality rating where most of the deaths are among people who are going to die soon anyway serious enough to warrant all these precautions and shutdowns?
Quote:
Originally Posted by Ed Yong, from the Atlantic
Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care. There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.
https://www.theatlantic.com/health/a...us-end/608719/

...note the bolded. The modelling shows that even if infection rates are reduced by 95% there would still be just under a million people needing intensive care, but you only have the capacity to safely look after a tenth of those. Abandoning social distance protocols for those "at less risk" would be a fucking disaster of catastrophic proportions.

Yong also notes the following:

Quote:
Originally Posted by Ed Yong
Second, having fallen behind, 4 steps are now necessary & urgent:
- more masks & protective equipment
- wide testing rollout
- adherence to social-distancing
- clear leadership
In New Zealand we've done all four. NZ is locked down, borders are closed, only essential services are open, the messaging from leadership is textbook, its open, honest and consistent. We've had zero deaths so far (but know that it won't stay this way).

In America you are so far behind and I don't see how you will catch up. None of the modelling shows that quarantining only the "most at risk" will prevent the health services being overwhelmed. The only way to do this is to protect the healthcare workers, to roll out widespread testing and tracing, clear and consistent leadership and keeping your distance.

So...yeah. Your numbers are wrong. And your assumptions are wrong. Listen to the experts.
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Old 03-26-2020, 04:45 AM
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I've argued in other threads that the death rate is likely to be lower than some of the extrapolations thrown around.
However, I have also said that even if the death rate ends up being close to that of seasonal flu, it's still a deadly serious thing because:

1. The flu is deadly serious. And for the flu, at least at-risk groups can get a vaccine. Covid means overnight there's a Flu II, more than doubling the impact of flu because no vaccine is available for it yet.
2. It looks like Covid is crazy contagious, spreading much faster than flu
3. As it splits into different strains we could end up in a situation where Covid is with us indefinitely. And there's inherent uncertainty with this too; a more virulent strain could emerge. Flu, having been with us for a longer time, is more of a known quantity in that regard.

So the crazy measures to contain this thing were absolutely warranted IMO, and it's such a shame it has not been enough in many places.
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Old 03-26-2020, 05:21 AM
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0,5 - 1 % is the low end of lethality. Its what happens where hospitals can cope. It is the mortality of places that "overreact". If they are successful.
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Old 03-26-2020, 05:27 AM
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The issues are:
1) This disease appears to be substantially more contagious than, say, influenza.
2) Unlike measles or the flu, there is no vaccine yet for this virus, and no one has had it before. This means that none of us are already immune to it (though it's likely that a large percentage of people will get only mild symptoms, if any symptoms at all, from it). And, if you aren't immune, if you get exposed to it, even if you're asymptomatic, you can be spreading it to other people.
3) Without social distancing and "flattening the curve", the issue is that you have very ill people all getting ill at the same time as each other. Virtually no country has a health care system that can take care of a sudden influx of critically ill people all at once. Yes, a lot of people die in car accidents, but those happen more-or-less equally spaced over the year.

If you have not already done so, read about what's happened in Italy over the past couple of weeks. The number of critically-ill people have completely overwhelmed the healthcare system there.
Bolding mine.

All good points, but I'll add one. It's not just about the critically ill people that need hospitalisation. We seem to keep talking about either those with mild/no symptoms, or those that require an ICU bed. In between there are a whole bunch of people who will feel pretty ill, but will just rest and hydrate at home and ride it out. They don't put any pressure on the health care system, but neither are they able to work.

They are doctors, nurses, police officers, fire fighters, prison officers, delivery drivers, pharmacists, care workers, grocery store staff, hospital cleaners, bus drivers, air traffic controllers etc etc

What happens to our entire infrastructure when you have a significant percentage of your workforce unable to work?
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Old 03-26-2020, 06:03 AM
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What happens to our entire infrastructure when you have a significant percentage of your workforce unable to work?
...this NY Times article is harrowing. Its not just Jessica's husband who it taken out of action: Jessica has to become not just his nurse, but a nurse with a patient in quarantine. As you rightly point out: it isn't just the sick.

The bit that made my mind explode was her describing how she had to walk her infected husband, who could barely walk and was coughing behind his mask, three blocks to the clinic to get an x-ray. I just can't even...this is going to get a lot worse before it gets any better.
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Old 03-26-2020, 06:28 AM
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I think if I were in the president's inner circle of advisors, I would remind him that a president's legacy is based on how he handles major crises like this. People remember FDR and Hoover because of their diametrically opposed responses to the Great Depression. Does he want to be revered like the former? Or despised like the latter?

I'm sure at the time there were people who thought the Civilian Conservation Corps was a huge overreaction to the Dust Bowl Disaster. We could have just let mother nature sort itself out. We could have waited for free market solutions to come to the rescue. Farmers losing their cropland and thus their way of life? Maybe we don't need so many farmers then. Maybe those farmers are incompetent and deserve to be weeded out.

Maybe the CCC was an overreaction. Maybe in an alternative universe, the dust miraculously stopped blowing all across the land and things went back to normal all on its lonesome. But I'm guessing there's also an alternative universe where that didn't happen and the country suffered horrifically for it.

If you were a leader, would you rather be known as the guy who let the country be swarmed by a virus just to save a few dollars or the guy who tried to fight the virus, whatever the cost? I think most people would rather be led by the latter. That guy sounds like a bad-ass, while that other guy sounds like a comic book super villain.
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Old 03-26-2020, 06:34 AM
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30 million deaths. Is anyone projecting that? That's frightening as fuck. If every person in America got the virus and the death rate was as high as 4%, that's 13+ million people, and even that's a frightening shit-ton. If millions to tens of millions require hospitalization, deaths, including non-virus deaths, will be higher because of an overwhelmed health care system, but 30 million seems like a wildly high number. That's 9% of our population. Even if that's just a worst case, but possible, scenario, I don't think there can be an overreaction.
It's a made up number, but I was making it up for the world, not the US. However, at least one set of projections I saw for Texas suggested we'd have over 400,000 deaths if we practiced mere "social distancing". Even if 50% of those were "non-productive", that's 200,000 people out of the workforce. We are talking about as many deaths just in Texas as all of the US suffered during WW2. You can't handwave away the economic impact of losing that many people--both the loss of productive capacity and the loss of demand.
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Old 03-26-2020, 06:42 AM
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This country spends whatever it takes, no holds barred, on national security. Is this virus not a national security threat?

This is comparable to WWII in some ways. They had rationing, restrictions, and industries switching from consumer goods to war manufacturing.

The country survived that and came out of it stronger than before.
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Old 03-26-2020, 06:49 AM
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Jonathan Portes, Professor of Economics and Public Policy at King’s College London, debunks the argument about choosing between the economy and the lockdown.

This is a good, clear, common-sense article:

Don't believe the myth that we must sacrifice lives to save the economy

Quote:
... So at the most basic level, this argument ignores what the evidence says. But perhaps more importantly, the idea that the way to minimise the economic damage is to remove the restrictions before they’ve done their job – definitively suppressing the spread of the virus – is a terrible one.

Does anyone believe that, whatever the government said, we could get back to “normal”, or something close to it, any time soon? If we were all allowed to return to work, many or most of us would, quite rationally, choose not to, for fear of catching the virus. And if, as the scientists predict, the result of loosening the restrictions was an acceleration in infections, then pretty soon many firms would simply stop functioning, as workers became sick, or had to stay at home to look after family members.

More broadly, restoring the economy to normal requires, above all, confidence. Amid continuing uncertainty both about their own finances and the wider economy, households won’t spend and businesses won’t invest. And that simply isn’t going to happen until the spread of the diseases has been contained.

Last edited by GreenWyvern; 03-26-2020 at 06:50 AM.
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Old 03-26-2020, 08:51 AM
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Here’s a thought experiment: a bag of 100 M&Ms. 4 of them will kill you. Eat one. I have a gun to your head: EAT ONE! But wait! I have a second bag of 100 M&Ms. only one of those will kill you. You still have to pick one and eat it, but what is it worth to you to switch bags?
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Old 03-26-2020, 08:54 AM
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What kind of person talks of other people as tho they were inanimate objects who's only purpose is to serve?
A utilitarian.

I am middle aged with several comorbidities and no children. If I caught the virus and needed a ventilator, but there was another patient of the same age who had children and no comorbidities, I would expect doctors to triage and prioritize the other patient. The other patient has a higher survival rate and children, so they should get priority. Its called triage and its happening all over due to the virus.

Resources are finite. As another example, when I am elderly if I am looking at going to a nursing home and blowing through my life savings to sit in a bed for a year then die, or die early and leave an inheritance to nieces and nephews, I pick the latter option.
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Old 03-26-2020, 09:01 AM
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The death rate relative to age is also going to be skewed by the overwhelming of medical facilities. The numbers where mortality roughly doubles with each decade of life assume that ICU care is available, that that those that are more aged are more likely to die. Once the system is overloaded the chance of dying increases rapidly at lower ages, simply because the ICU care that made it possible to survive has gone. People in their 50's are already on ventilators.
Not really. Need for hospital care and need for ICU care among hospitalized patients follows the same pattern as death rate, so while an overwhelmed or primitive health system would show significantly increased deaths in all age groups, the pattern of much higher mortality in the elderly and much lower in younger groups would remain unchanged.

Last edited by Shmendrik; 03-26-2020 at 09:02 AM.
  #47  
Old 03-26-2020, 09:07 AM
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Part of the problem is that yes, everyone will know people who died of the virus... but the people who have died and will continue to die from the overreaction aren't nearly as visible.

And a lot of other folks who die from the overreaction will be misattributed as being due to the virus. Like, those overstrained medical services: A lot of that strain is due to people panicking. Most people will develop some sort of respiratory disease over the course of a winter, but most of those diseases aren't cornonavirus. And even of those who do get genuine coronavirus, most will need no medical care at all. But in an environment of panic, people who don't need medical care at all will rush to the ER, and buy up masks and sanitizer that they're not using properly but that the hospitals actually need, and do other counterproductive things.

I'm not saying that we shouldn't react at all. But if what we were doing was the right amount of reaction, why wasn't the CDC recommending it? Could it be because they've spent decades studying problems like this in extensive detail, and determined that it would do more harm than good?
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Old 03-26-2020, 09:16 AM
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A utilitarian.

I am middle aged with several comorbidities and no children. If I caught the virus and needed a ventilator, but there was another patient of the same age who had children and no comorbidities, I would expect doctors to triage and prioritize the other patient. The other patient has a higher survival rate and children, so they should get priority. Its called triage and its happening all over due to the virus.

Resources are finite. As another example, when I am elderly if I am looking at going to a nursing home and blowing through my life savings to sit in a bed for a year then die, or die early and leave an inheritance to nieces and nephews, I pick the latter option.
But having a million or more members of the workforce, and another million "old people" die is NOT good for the whole, it's NOT just a series of personal tragedies.
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Old 03-26-2020, 09:19 AM
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Whatever the correct fatality numbers are, aren't the current numbers the rate with proper medical treatment? Might not the rate increase dramatically if we allow the healthcare system to become overwhelmed?

Won't overwhelming the healthcare system also increase deaths from other causes?

Even if we look at it from a purely economic viewpoint, is it possible that the economic costs from letting it spread unchecked might be higher than the costs of what we're currently doing?

Yes, this is exactly right. Just look at the case in Italy. They got hit earlier and harder than most other places, before we realized exactly how serious this thing could be, and they got overwhelmed. Their death rate is closer to 10%, not the world average of 4%, the hoped-for 2%, or the optimistic 0.5%*.

The faster the cases arrive, the higher the death toll will be, even if in the end, the number of people infected is virtually the same. This is the whole point of the "Flatten the curve" movement.



*And we need to keep pointing out that, yes, even under the most optimistic assumptions that get the rate down to 0.5%, that's still 5-10 times more deadly than typical influenza. So all those people trying to brush this off as "just another flu" are still being complete idiots, under our best possible assumptions.
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Old 03-26-2020, 09:23 AM
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You keep making this point about "people past their productive years." Because fuck them, right? Nothing more than withered husks, those people. I mean, I could see throwing six, maybe seven hundred bucks toward keeping Grandpa upright out of sentimental value, but $4 million??? That's a full .0001% of the annual U.S. federal budget!!!
I was willing to let the comment pass in the OP, but since he's said it a second time, I have to take issue with it.

In the ten years since I retired, I've (with my wife):

-Worked on the 2010 Census effort
-Worked the entire ten years delivering Meals on Wheels
-Developed and implemented a backpack weekend lunch program for at-risk elementary school children in our neighborhood (at our expense)
-Volunteered at a Restore in our city (Habitat for Humanity, for the unfamiliar)
-Supported many charities locally and nationally
-Recently volunteered to work on a Habitat build in New Mexico. Regrettably, these projects have been cancelled for now, but we hope to be able to reengage when this is all over.
-Donated untold amounts of clothing to homeless shelters, and a large amount of items to Goodwill.

I would ask Wesley Clark to enlighten me as to what he considers "productive", and also as to what he himself has done for humanity in the last ten years.
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