Official Covid-19 Discussion Thread

[Gold Dragon]

It would also reduce hospitalization rates by the same factor. Other studies put the undercounting factor lower, around 20x, so I think it depends on the location, but everywhere there has been significant undercounting, and it matters.

Whether the hospitalization rate is 10% or 20% (because of undetected cases) doesn't matter when you have a fixed number of beds/ICU staff in the hospitals that get filled up with either of those percentages after a set number of days of uncontrolled Covid19 spread.

For example, NYC has been pushed to the brink but has actually had enough capacity to deal with every patient during this wave.

Enough capacity is a bit of a misrepresentation. They needed to turn central park into a field hospital, bring in a military hospital boat with 1000 beds and have 1000 ventilators donated by China to just deal with Covid19 cases. And what quality of care do think they have been able to deliver to their usual heart attack, stroke, surgical and trauma patients in this time?

It's rather critical to understand will the next wave be smaller or bigger than the current one? If smaller and the justification for measures is to avoid overwhelming the healthcare system, then in NYC at least we should stop the measures and let the second smaller wave happen sooner rather than later.

Yes, being able to predict the future would be nice. But our best models are full of uncertainties and if you just take the most optimistic projections and plan as if they will be guaranteed to be true, you are basically a gambler putting your life savings on the knicks winning the championship.

If our case counts were actually close to accurate then one would assume the next wave would be many times larger, but thankfully the data are starting to come in showing that not to be the case.

The data you want is impossible to get. It would involve testing the entire population (or a random representative sample of the population) on a regular basis. When a country has difficulty testing just symptomatic patients, getting enough testing to get an accurate case count on the upswing of the 1st wave is an unrealistic ask.

But here in Australia where I am, where the case numbers have been kept low and have been dropping for weeks because of early lockdowns and social distancing, we will soon be able to open up the lockdown and have the capacity to test the general population to get a more accurate count.

[Vaclac]

It would also reduce hospitalization rates by the same factor. Other studies put the undercounting factor lower, around 20x, so I think it depends on the location, but everywhere there has been significant undercounting, and it matters.

Whether the hospitalization rate is 10% or 20% (because of undetected cases) doesn't matter when you have a fixed number of beds/ICU staff in the hospitals that get filled up with either of those percentages after a set number of days of uncontrolled Covid19 spread.

For example, NYC has been pushed to the brink but has actually had enough capacity to deal with every patient during this wave.

Enough capacity is a bit of a misrepresentation. They needed to turn central park into a field hospital, bring in a military hospital boat with 1000 beds and have 1000 ventilators donated by China to just deal with Covid19 cases. And what quality of care do think they have been able to deliver to their usual heart attack, stroke, surgical and trauma patients in this time?

It's rather critical to understand will the next wave be smaller or bigger than the current one? If smaller and the justification for measures is to avoid overwhelming the healthcare system, then in NYC at least we should stop the measures and let the second smaller wave happen sooner rather than later.

Yes, being able to predict the future would be nice. But our best models are full of uncertainties and if you just take the most optimistic projections and plan as if they will be guaranteed to be true, you are basically a gambler putting your life savings on the knicks winning the championship.

If our case counts were actually close to accurate then one would assume the next wave would be many times larger, but thankfully the data are starting to come in showing that not to be the case.

The data you want is impossible to get. It would involve testing the entire population (or a random representative sample of the population) on a regular basis. When a country has difficulty testing just symptomatic patients, getting enough testing to get an accurate case count on the upswing of the 1st wave is an unrealistic ask.

But here in Australia where I am, where the case numbers have been kept low and have been dropping for weeks because of early lockdowns and social distancing, we will soon be able to open up the lockdown and have the capacity to test the general population to get a more accurate count.

Re: NYC capacity - let me get this straight... we locked down to buy time to rapidly expand healthcare capacity, but then once we've done that and want to ask why we're keeping the lockdown on, that expanded capacity no longer counts? NYC actually continues to have capacity to deal with those other issues you mention too, but there is a very real problem of perception where people are afraid to go to the hospital because they believe the hospitals to be more overwhelmed than they are. That navy ship was to be used for non coronavirus patients but sat mostly empty because there were very few such patients still going to the hospital. This article makes it clear this is happening even in canada where the truth is that there is lots of capacity right now, but some people wanting to scare the population into compliance with the measures are convincing those who actually should go to the hospital that it's too overwhelmed to go. https://nationalpost.com/news/canada/hidden-death-toll-doctors-say-people-dying-as-they-avoid-ers-due-to-covid-fears

Re: uncertainty in modeling. It's hard to take this seriously, since the entire justification for locking down is based on modeling. In that case we correctly modeled exponential growth to understand that even if cases are currently low they will be much higher soon. The other very basic feature of epidemic models is that such exponential growth continues until enough of the population is no longer susceptible. But we're only supposed to take seriously aspects of modeling that justify continued lockdown and not ask the obvious question raised by them of what happens if we dont stay locked down forever and we still have the vast majority of the population susceptible?

Re: the data I would like. It's actually antibody data we need to figure out the proportion of the population still susceptible to the disease, which is a different test from the diagnostic test. And it only needs to be a survey of the population we're interested in. It's already been done in Santa Clara, but would be more interesting in Milan or NYC since we want to understand how big the peak could be and they are much closer to it. For these reason understanding what percentage of the population has been infected in Australia isnt as interesting, we dont need to test to know that Australia has had far fewer cases per capita so far than the US and is therefore much further away from its ultimate peak.
The most infuriating misleading talking point is the claim that the sooner/more effectively we lock down the sooner it will be over. That would only be true if complete eradication were achieved, which I dont think anyone except perhaps New Zealand is aiming for. Absent eradication, lowered infections achieved through social distancing just means more susceptible people to be infected at the end of the social distancing, and therefore a longer total time before this is over.

[Kevin Willis]

Vaclac sit back and read what you sent - there are some flaws in your logic. I am not going to participate because this is not my discussion but review it, you're making some assumptions there.

[Vaclac]

Vaclac sit back and read what you sent - there are some flaws in your logic. I am not going to participate because this is not my discussion but review it, you're making some assumptions there.

Please enlighten me. I understand not wanting to get involved in a discussion because it is time consuming, but if you're going to say someone has flaws in their logic, you are getting involved and you should point out what they are. Its fair to say every argument, including this one on both sides rests on assumptions - the question is if any of them are incorrect in a way that matters. I would actually be comforted if I were wrong and the choices we were collectively making were actually the right ones, rather than catastrophic. I recognize there are no good choices, but everyone seems focused exclusively on minimizing covid deaths over the next few months and to regard any questions about how effective it will be in the longer term or the costs incurred by our choices, whether economic, social, or indeed, other health costs, as out of bounds.

[Gold Dragon]

Re: NYC capacity - let me get this straight... we locked down to buy time to rapidly expand healthcare capacity, but then once we've done that and want to ask why we're keeping the lockdown on, that expanded capacity no longer counts?

Your understanding of the reason for the lockdown is incorrect. The main reason for lockdowns are to control infection spread and also to buy time to develop management options. Expanding capacity is one of those management strategies, but far from the only one needed.

NYC actually continues to have capacity to deal with those other issues you mention too, but there is a very real problem of perception where people are afraid to go to the hospital because they believe the hospitals to be more overwhelmed than they are. That navy ship was to be used for non coronavirus patients but sat mostly empty because there were very few such patients still going to the hospital.

Yes, people are avoiding getting medical treatment because of fear of getting coronavirus. Our health minister in Australia (who was a GP in a previous life) made a plea in a press conference for the public to see their doctor to counter that fear. Getting rid of lockdowns will not change that fear.

As for hospital capacity, the Comfort and Javits being at less than capacity it is because of the transfer criteria into the Comfort and Javits.

https://nypost.com/2020/04/09/usns-comfort-and-javits-center-mostly-empty-amid-coronavirus/

The Navy-manned, 500-bed Comfort, which docked last week on the city’s West Side — and was this week reconfigured to take high-severity coronavirus cases — has just over 60 patients, Navy officials said Thursday.

And the Army-manned, 1,000-bed Javits Center field hospital — now serving lower-severity COVID-19 cases — had only 225 patients, officials said Thursday.

Meanwhile, cramped hospitals are being told that nearly all of their patients don’t fit the “criteria” for admission at either facility, frustrated staffers and public officials complain.

“It’s bulls–t,” one staffer at the overcrowded Metropolitan Hospital Center in East Harlem told The Post of a 25-point checklist for transferring patients to Javits.

The worker, who spoke on condition of anonymity, said the hospital recently asked Javits to take 95 of their COVID-19 patients, but only one made the cut.

Re: uncertainty in modeling. It's hard to take this seriously, since the entire justification for locking down is based on modeling.

This is incorrect. The justification for lockdowns was not based on models but actual hard data from China and Italy.

It's actually antibody data we need to figure out the proportion of the population still susceptible to the disease, which is a different test from the diagnostic test.

The serology test is a useful tool but is still being developed and should not be relied upon too greatly because 1) we don't know what level of serology actually confers immunity 2) if there is immunity, we don't know how long that immunity will last. The testing that needs to be ramped up immediately is actually not serology but PCR testing. Yes we need serology to be developed as well in parallel and at some point it will be helpful in identifying immunity. It is not there yet and won't be for a while because there are too many unknowns that we need to buy more time to figure out.

The most infuriating misleading talking point is the claim that the sooner/more effectively we lock down the sooner it will be over.

No, you have misunderstood if you think that is the reason presented of why we are locking down. If you ever looked at the flattening the curve diagrams, the flattened curve is always longer than the unflattened curve. However, if you can successfully flatten the curve early and effectively, you can open up societal and economic restrictions much earlier because you will have a much smaller case load that can be managed with less restrictive measures, but over a longer period of time.

[Kevin Willis]

Vaclac sit back and read what you sent - there are some flaws in your logic. I am not going to participate because this is not my discussion but review it, you're making some assumptions there.

Please enlighten me. I understand not wanting to get involved in a discussion because it is time consuming, but if you're going to say someone has flaws in their logic, you are getting involved and you should point out what they are. Its fair to say every argument, including this one on both sides rests on assumptions - the question is if any of them are incorrect in a way that matters. I would actually be comforted if I were wrong and the choices we were collectively making were actually the right ones, rather than catastrophic. I recognize there are no good choices, but everyone seems focused exclusively on minimizing covid deaths over the next few months and to regard any questions about how effective it will be in the longer term or the costs incurred by our choices, whether economic, social, or indeed, other health costs, as out of bounds.

It's ok. I understand where Golden Dragon is coming from clearly and based off what you posted I knew he would point out your flaws. The other thing to note is he lives in Australia where they are one of the best countries in the world in terms of managing it. He will have some insight, plus I was enjoying reading your discussion with him. I thought you made some incorrect assumptions that would be easy for him to address and you should review it.

[Gold Dragon]

More on the Comfort and Javitz.

https://www.navy.mil/strategic/FAQ_USNSComfort_V5.pdf

Q: Is this change in procedure a result of some of the negative press surrounding the small
number of patients that the Comfort has taken since arriving in NYC?
A: This is a complex situation that requires us to continually assess the situation on the ground
and the needs of the New York City hospitals. In order to admit more patients and relieve the
pressure on the hospitals, it’s necessary that we reassess our patient admission criteria to see how
we can take on more patients. In order to protect our providers and our patients, we will continue
to look at ways to increase our patient population while mitigating the chance of transmitting
COVID-19 on board.

[Vaclac]

No, you have misunderstood if you think that is the reason presented of why we are locking down. If you ever looked at the flattening the curve diagrams, the flattened curve is always longer than the unflattened curve. However, if you can successfully flatten the curve early and effectively, you can open up societal and economic restrictions much earlier because you will have a much smaller case load that can be managed with less restrictive measures, but over a longer period of time.

I definitely have seen the flatten the curve diagram when it was first circulated a month ago to justify lockdowns. It was initially comforting but seemed simplistic and too good to be true, so I tried to understand it more. The actual epidemiological models, including the famous imperial college one that allegedly caused the UK to reverse course told a rather different story if you looked closely at them. What they projected was that if social distancing were maintained forever (or equivalently we choose to only care about the next few months) then we would have far fewer deaths. What they (and any other model I have seen including a Harvard one) show is that social distancing can reduce a first wave but the next wave post social distancing will be just as huge as the initial one would have been. Or they show what happens if you trigger social distancing on and off, and they show that requires most of the time needs to be spent in the lockdown mode over the course of many years. Instead of being honest with us, we were sold this comforting image of a single flatter wave with social distancing even though that's not what any actual model shows.
A New York Times article illustrates this frustrating dishonesty well.
https://www.nytimes.com/interactive/2020/03/25/opinion/coronavirus-trump-reopen-america.html?action=click&module=Opinion&pgtype=Homepage
The headline and initial pictures here are clearly trying to illustrate the disastrous consequences of early opening. But actually the entire reduction is because of an assumed strong seasonal effect and the choice to cut off the time period right before the pick up of cases in the fall that is implied by such a strong seasonality assumption. To the Times credit they allow you to play with the model (though I think far more people just see the initial headline and figures, which are incredibly misleading). If you turn off the strong seasonal assumption you see that the only effect of longer social distancing is the delay in the peak, not the reduction of it. Now, perhaps there will be a strong seasonal factor in the spreading of this virus - I dont know. But if there is that just means we can buy relatively more time with relatively shorter social distancing here in the Northern Hemisphere, but it still means that next wave is coming in the fall. And you can see the very beginning of that wave right before they choose to cut it off.

[jaymeister15]

I think it’s completely fair to start discussing specific timelines and the plan for reopening.

The most recent projections in Ontario have shown to be to be significantly off. I know projection models for this type of thing are tough to do and never going to be completely accurate, but at what point are we allowed to question decisions that are being made based on projections that are turning out to be completely off?

The most recent projection released by the Government had a “best case scenario” of 1,200 people being in the ICU at today’s date. As of today there are only 247 people in ICU and 847 total hospitalized across the province.

Projected deaths by the end of the month also appear they are going to be significantly off, even with these outbreaks in long term care homes. 365 deaths out of 553 deaths in the province have been people over the age of 80, and almost every other one being over 60 and/or having underlying conditions.

When does it make sense to let the vast majority of the province that has an extremely low risk of hospitalization or serious complications get back to work? You can still isolate and protect the higher risk portion of the population while getting the economy restarted

[Gold Dragon]

If you turn off the strong seasonal assumption you see that the only effect of longer social distancing is the delay in the peak, not the reduction of it. Now, perhaps there will be a strong seasonal factor in the spreading of this virus - I dont know. But if there is that just means we can buy relatively more time with relatively shorter social distancing here in the Northern Hemisphere, but it still means that next wave is coming in the fall. And you can see the very beginning of that wave right before they choose to cut it off.

1. We are in warmish weather here for our autumn with temps in the 20s for most of our peak. Did it help reduce our cases? Maybe slightly but we still were tracking along the same exponential curve as everyone else until our lockdown measures kicked in. I wouldn’t put too much stock in the summer being a major factor.

2. We are going in circles. Yes if nothing changes on the ground and restrictions are simply lifted then all the lockdown does is delay your cases and deaths. I mentioned this several posts ago. Lockdowns limit infection rate and buy time to make changes that do impact cases and deaths:

A. Increase health capacity (beds, staff, ppe)
B. Learn about covid19 and reduce transmission rates (masks, societal awareness, behavioral change, risk/benefit of restrictions)
C. Investigate treatments
D. Ramp up public health control measures (testing, contact tracing, isolation)

[Vaclac]

If you turn off the strong seasonal assumption you see that the only effect of longer social distancing is the delay in the peak, not the reduction of it. Now, perhaps there will be a strong seasonal factor in the spreading of this virus - I dont know. But if there is that just means we can buy relatively more time with relatively shorter social distancing here in the Northern Hemisphere, but it still means that next wave is coming in the fall. And you can see the very beginning of that wave right before they choose to cut it off.

1. We are in warmish weather here for our autumn with temps in the 20s for most of our peak. Did it help reduce our cases? Maybe slightly but we still were tracking along the same exponential curve as everyone else until our lockdown measures kicked in. I wouldn’t put too much stock in the summer being a major factor.

2. We are going in circles. Yes if nothing changes on the ground and restrictions are simply lifted then all the lockdown does is delay your cases and deaths. I mentioned this several posts ago. Lockdowns limit infection rate and buy time to make changes that do impact cases and deaths:

A. Increase health capacity (beds, staff, ppe)
B. Learn about covid19 and reduce transmission rates (masks, societal awareness, behavioral change, risk/benefit of restrictions)
C. Investigate treatments
D. Ramp up public health control measures (testing, contact tracing, isolation)

On the weather, I agree. I was just pointing out that the vast difference in deaths from different lengths of social distancing in the NYT depended entirely on that assumption, and I was trying to walk through the implications even if you wanted to credit that assumption.

As far as the things we should be doing (ie your A through D) I agree we should be doing them. I disagree that we should continue lockdowns as long as we are doing them. We will be learning more about covid and hopefully at least somewhat improving treatment for years, so we will have to stop the lockdowns even while we are continuing to do those things. There is a huge cost to each additional day of lockdown, but that doesn't seem to be creating any urgency to end them. We should continue lockdowns precisely as long as the marginal benefits of each day of lockdown exceed the marginal costs. Instead, in Canada at least, we have had shifting explanations, with the current one being we can't lift lockdowns if it will cause a second wave. If stuck to, that means keeping lockdowns for over a year until there's a vaccine.

[dafan590]

t rump is an idiot if he reopens US prematurely....US cases are going up continuiously still

trudeau better not follow what US does, because 2nd wave is coming.

[Vaclac]

t rump is an idiot if he reopens US prematurely....US cases are going up continuiously still

trudeau better not follow what US does, because 2nd wave is coming.

No doubt a second wave is coming. What disturbs me is that the majority of people apparently think we should not open our economy as long as there will be a second wave when we do. That is an irrational standard that will require us to keep the economy closed for a catastrophically long time. Economic collapse much worse than the great depression will have serious real consequences for people and it is what will happen if we actually maintain lockdown until a vaccine, which is what would be required for there to be no second wave. Already the damage is severe, but if lifted soon perhaps there could be a relatively quick recovery. The longer this goes on the more businesses will go permanently bust and/or governments borrowing way beyond their means, requiring either massive inflation or massive austerity. Those outcomes will no doubt destroy lives but the majority of people either seem not to realize it or not to care.

[VicG]

I am not particularly engaged in Canadian politics, but this Andrew Scheer press conference to demand in-person sittings seems like a pretty poorly thought out decision. Has really turned me (a neutral) totally off the PCs.

[beanbag]

t rump is an idiot if he reopens US prematurely....US cases are going up continuiously still

trudeau better not follow what US does, because 2nd wave is coming.

No doubt a second wave is coming. What disturbs me is that the majority of people apparently think we should not open our economy as long as there will be a second wave when we do. That is an irrational standard that will require us to keep the economy closed for a catastrophically long time. Economic collapse much worse than the great depression will have serious real consequences for people and it is what will happen if we actually maintain lockdown until a vaccine, which is what would be required for there to be no second wave. Already the damage is severe, but if lifted soon perhaps there could be a relatively quick recovery. The longer this goes on the more businesses will go permanently bust and/or governments borrowing way beyond their means, requiring either massive inflation or massive austerity. Those outcomes will no doubt destroy lives but the majority of people either seem not to realize it or not to care.

Why do you think "opening things up" will save the economy and these businesses? They can open whatever the **** they want to open, I'm not going outside.

[execoftheyear]

t rump is an idiot if he reopens US prematurely....US cases are going up continuiously still

trudeau better not follow what US does, because 2nd wave is coming.

No doubt a second wave is coming. What disturbs me is that the majority of people apparently think we should not open our economy as long as there will be a second wave when we do. That is an irrational standard that will require us to keep the economy closed for a catastrophically long time. Economic collapse much worse than the great depression will have serious real consequences for people and it is what will happen if we actually maintain lockdown until a vaccine, which is what would be required for there to be no second wave. Already the damage is severe, but if lifted soon perhaps there could be a relatively quick recovery. The longer this goes on the more businesses will go permanently bust and/or governments borrowing way beyond their means, requiring either massive inflation or massive austerity. Those outcomes will no doubt destroy lives but the majority of people either seem not to realize it or not to care.

kind of hard to gauge when the perfect time is to lift the lockdown measures when you don't know when a vaccine will be developed. 18 months is the best case scenario according to a lot of medical experts but that isn't guaranteed. It could even take up to 10 years.

This uncertainty is the biggest problem and it's making countries/governments face a tough balancing act, keep the lockdown measures to limit deaths and hospitals from being overrun but risk tanking the economy further OR lift the lockdown measures to get the economy back up and running but risk people dying and hospitals overrun. I think the latter also comes with the risk of workers getting sick and causing unsafe working environments which would also lead to economic losses. If a more definitive timeline for a vaccine were to be established, governments will have a better sense of timing of when to lift lockdown measures.

[Vaclac]

t rump is an idiot if he reopens US prematurely....US cases are going up continuiously still

trudeau better not follow what US does, because 2nd wave is coming.

No doubt a second wave is coming. What disturbs me is that the majority of people apparently think we should not open our economy as long as there will be a second wave when we do. That is an irrational standard that will require us to keep the economy closed for a catastrophically long time. Economic collapse much worse than the great depression will have serious real consequences for people and it is what will happen if we actually maintain lockdown until a vaccine, which is what would be required for there to be no second wave. Already the damage is severe, but if lifted soon perhaps there could be a relatively quick recovery. The longer this goes on the more businesses will go permanently bust and/or governments borrowing way beyond their means, requiring either massive inflation or massive austerity. Those outcomes will no doubt destroy lives but the majority of people either seem not to realize it or not to care.

Why do you think "opening things up" will save the economy and these businesses? They can open whatever the **** they want to open, I'm not going outside.

Right, I don't think the economy will return to its pre-covid heights any time soon even if we stop forcing everything to be shut down because some people will still choose not to go outside. But many people will choose to go outside and at least those people can spend money and do work, so we can save relatively more of the economy that way, and of course lessening the collapse is very worthwhile, even if it's not possible to restore it to its pre-covid heights. We aren't going back there. Any decisions we can make now will still have results that are worse than how things were, but we still need to make decisions that cause the least damage possible going forward.

[Section_306]

I think it’s completely fair to start discussing specific timelines and the plan for reopening.

The most recent projections in Ontario have shown to be to be significantly off. I know projection models for this type of thing are tough to do and never going to be completely accurate, but at what point are we allowed to question decisions that are being made based on projections that are turning out to be completely off?

The most recent projection released by the Government had a “best case scenario” of 1,200 people being in the ICU at today’s date. As of today there are only 247 people in ICU and 847 total hospitalized across the province.

Projected deaths by the end of the month also appear they are going to be significantly off, even with these outbreaks in long term care homes. 365 deaths out of 553 deaths in the province have been people over the age of 80, and almost every other one being over 60 and/or having underlying conditions.

When does it make sense to let the vast majority of the province that has an extremely low risk of hospitalization or serious complications get back to work? You can still isolate and protect the higher risk portion of the population while getting the economy restarted

It's slowly going to materialize, our modern day exodus across the Red Sea, but with the recency of this threat to our species, you have to excuse the hyper sensitivity in these uncharted waters as we slowly emerge towards normalcy

[ItsDanger]

The shutdown was to not overwhelm the healthcare system. Preventing a spread of an essentially airborne (indoors) is virtually impossible unless there is martial law and everyone wears hazmat suits. The key is to ascertain the spread of the virus in the general population via antibody testing (which Canada appears to be very slow to execute, probably from WHO direction). I predict the aerosol transmission effect of this virus will diminish in May with higher humidity. Antibody testing in other nations is proceeding and which should have comprehensive results in next 7-10 days.

[mtcan]

t rump is an idiot if he reopens US prematurely....US cases are going up continuiously still

trudeau better not follow what US does, because 2nd wave is coming.

No doubt a second wave is coming. What disturbs me is that the majority of people apparently think we should not open our economy as long as there will be a second wave when we do. That is an irrational standard that will require us to keep the economy closed for a catastrophically long time. Economic collapse much worse than the great depression will have serious real consequences for people and it is what will happen if we actually maintain lockdown until a vaccine, which is what would be required for there to be no second wave. Already the damage is severe, but if lifted soon perhaps there could be a relatively quick recovery. The longer this goes on the more businesses will go permanently bust and/or governments borrowing way beyond their means, requiring either massive inflation or massive austerity. Those outcomes will no doubt destroy lives but the majority of people either seem not to realize it or not to care.

Sick and dead people don't go out to restaurants, go out to the movies and shop for knick knacks.