Would a more deadly virus have induced greater compliance with US lockdown restrictions?

post by rockthecasbah · 2020-12-20T18:24:40.433Z · LW · GW · 2 comments

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    gbear605
    Stuart Anderson
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Relative to other pandemics and our initial fears, Covid has a low infection fatality rate (IFR). The IFR varies between societies depending on age and obesity distributions, such that it was more severe in the US than in India. Estimates of the US initial IFR are about .5% of infected persons.

Some American persons have not complied with social distancing guidelines and some states have refused to apply restrictions. Justifications vary. Some argue that the virus is not severe enough and we are over-preventing Covid (example 1, example 2). Others argue that lockdowns violate some moral/political right or whatever (example).

If the virus were more severe such that all IFR's were increased, would the US people have responded differently? At a 5% IFR with no change infectivity would a would a New Zealand path become likely?

Answers

answer by gbear605 · 2020-12-20T19:14:04.714Z · LW(p) · GW(p)

I don't know about a New Zealand path, but I do think that there would have been a much more significant response.

Consider that to a significant degree, populations seem to be fairly good at maintaining COVID-19 spread to a constant rate (ie. an R_t of around 1). This seems to be based on feedback mechanisms that operate through hearing news of the virus, through official channels, mainstream media, and social media. For instance, if you hear that the government is telling you not to go out and that the hospitals are full and that many people are dying, you will likely comply, but once those are working, you will become less cautious, causing the cycle to repeat.

I would suspect based on this that a more dangerous disease (either higher IFR or higher infectivity) would result in more cautious behavior, likely causing a flatter behavior rather than the peaks that we have had with COVID-19, but the response would be substantially the same. That said, if it was especially more dangerous (black death or smallpox levels), then a substantially different response might be possible.

answer by Stuart Anderson · 2020-12-21T06:18:15.970Z · LW(p) · GW(p)

If you want people to avoid sickness then they must see the effects of it.

If you want people to avoid death then they must see the effects of it.

Getting people to avoid abstract and largely non-existent threats is hard work. Lots of people require at least some evidence to be convinced.

If you want people to follow your lead, then you actually have to lead, and lead in good faith. Between the bullshit coming out of the World Economic Forum (and their allies) and Bill and Melinda Gates literally smiling with glee in interviews when talking about plagues, I have zero faith in 90% of what is coming out of governments right now. Anyone that uses the word opportunity in a conversation about covid is labelling themselves as someone that probably needs to be put against a wall and shot, should things come to hostilities. When people that are making bank from their own lockdown rules (which they frequently flout) are telling me that I am the one that has to follow all the rules and pay all the costs, then I think they're full of shit.

So in short, what is required for compliance here is evidence of illness and death, and good faith leadership. Do you think that is common in America? I don't know, I'm not American.

Getting people to accept illness and death as inevitable and a normal part of the human experience is pretty much impossible these days. Most people have no experience of dead bodies, let alone had one lying in repose in their parlour. Everyone thinks they're special and that they should never die, that death is somehow a disease or injustice rather than a logical part of life.

I am in Australia and we are locking down where I am, again. I don't get to see my dying father, again. All over 30 whole infections. You want me to take this seriously? Where are the field hospitals? Where are the mass graves? This is the fucking flu and nothing more. Yes, people die from the flu, and yes, that's a cost of doing business (ie. being alive). 

We cannot keep going like this for the next 10 years. At some point we are going to have to accept that illness, debility, and death are part of life.

comment by Walker Vargas · 2020-12-21T17:19:07.350Z · LW(p) · GW(p)

This isn't the flu. America has had 318,000 deaths so far. That's ~8.5 years worth of flu deaths. One of those years was from the last 26 days. If the world had America's almost 1 death per 1,000 people mortality rate, that would be about 7.8 million deaths. There are 1.7 million deaths globally. That's 6 million people spared! And frankly America is in at least a half banked lockdown.

If your country has almost no cases, that isn't something to complain about. Mass graves would mean that your country had failed to the point that they were having difficulty manages all of the corpses. This point will vary country to country, but it is a lot harder for a first world country to hit that point than you seem to think.

comment by Stuart Anderson (stuart-anderson) · 2020-12-24T03:48:54.615Z · LW(p) · GW(p)

This isn't the flu.

That is exactly what corona viruses are. 

Flu can kill, and the flu killing is nothing new to the human race. The question asked was whether behaviour can be altered for even further compliance with arbitrary directions in America here, not whether it is warranted. 

I didn't do a very deep examination of that, but considering I'm being negged here for virus heresy it probably doesn't matter that much. For the sake of completeness my position is in relation to engineering compliance in the absence of direct experience of the negative stimulus. How do you increase compliance with a measure that people see no convincing reason for?

OP also explicitly raised the subject of perception of the severity of the pandemic being an issue of resistance to compliance here. If they hadn't then I either wouldn't have discussed it at all or I would have split it out into a comment. It is very clear that disagreement exists, whether or not you personally agree with the direction of that disagreement.

Mass graves would mean that your country had failed to the point that they were having difficulty manages all of the corpses.

Please name the country, any country, where the bodies are stacked in the street and the mass graves are overflowing? 

This is a flu with a 0.3% mortality, not the Black Death. Covid couldn't create that level of death even if we attempted to engineer every possible advantage for it. By contrast, smoking causes one out of every five deaths in America but I'm going to go out on a limb and say that you don't advocate for a proportionately greater response to smoking than you do to covid. Why is that?

Being led by your own fear is every bit as stupid as being led by any other emotion at the expense of rationality. It makes you subject to costly mistakes that five minutes of objective examination would likely prevent.

That's 6 million people spared! 

How many people will die as a direct result of economic losses from lockdowns? Swapping deaths by illness in the short term for a far larger number of deaths by poverty seems like false economy to me.

Every course of action taken here has benefits and costs. I am of the opinion that business as usual with minor measures to reduce the risk of vulnerable populations is the best approach. That will result in the fewest overall deaths and the swiftest recovery. However, I'm not terrified of death, so my worldview is modulated by that lack of blinding terror. 

comment by Viliam · 2020-12-26T17:13:21.457Z · LW(p) · GW(p)

By contrast, smoking causes one out of every five deaths in America but I'm going to go out on a limb and say that you don't advocate for a proportionately greater response to smoking than you do to covid. Why is that?

Smoking is not contagious. And there are already responses against second-hand smoking, e.g. in many countries it is no longer allowed to smoke in restaurants. And yes, smokers complained about their freedoms a lot when the law was new.

There is no realistic way to protect the lives of me and my family from corona without pressuring other people to change their behavior. There is no way for you to credibly precommit not to spread the virus further in case you get it (because during the first few days, you won't know).

I am of the opinion that business as usual with minor measures to reduce the risk of vulnerable populations is the best approach.

Seems to me that minor measures do not reduce the risk of vulnerable populations much.

Also the timing of measures is critical. If you start applying them soon enough, you can stop the virus. If you start applying them too late, you can barely slow it down. Unfortunately, people who object against major measures usually also object against early measures, because early enough even minor measures seem unnecessarily big.

comment by Stuart Anderson (stuart-anderson) · 2020-12-29T01:35:15.761Z · LW(p) · GW(p)

Smoking is not contagious.

Okay, consider the case of STIs. Sex is entirely optional. Is it not reasonable to police people's sex lives to the degree we have with covid if it is a question of actual harm rather than fear? 

And yes, smokers complained about their freedoms a lot when the law was new.

Then they got used to being less free and/or understood that there was no pragmatic way to restore their agency, so that suddenly made the use of force acceptable? I can think of a lot of areas where force could be applied to the individual for the benefit of society, the question is where's the line?

If you are allowed to make choices then you are allowed to choose wrong. Agency and responsibility must be married, and likewise where agency is absent so too must be responsibility. If the government wants people at home and doing nothing that would be trivial to achieve: just pay them to do so. The compliance rate would be more than sufficient to satisfy your targets for lockdowns.

There is no realistic way to protect the lives of me and my family from corona without pressuring other people to change their behavior.

Well, that's not true, and I'm willing to bet you have the masks, sanitiser, and Vit D to prove it. 

The point here is whether by pressure you mean ask or whether you mean force. If you are asking then I'm going to need a lot more than I'm scared as a reason to comply. You have the means to negotiate, so what are you offering here? If you are threatening force, then it boils down to how much I care. Pragmatically, I don't care that much, but I'm in a good financial position and I'm not going to be out on the street if I couldn't work. I'd imagine if my life was different I'd have more pragmatic objections. Ideologically, you will die waiting before I'll give up my rights in the service of your fears. 

Seems to me that minor measures do not reduce the risk of vulnerable populations much.

Given that the immunocompromised have been following similar protocols with success for longer than either of us has been alive I see no reason to believe your assertion here.

Again we circle back around to the constant terror of death and refusal to accept the reality of it. You could trivially put your hand on the wrong surface tomorrow and end up with a myocardial infection that could kill you before you even figure out you're that sick. An artery in your brain could explode. You could get an aortic dissection. There are no shortage of things that can come out of nowhere and drop you like a rock. You are not safe and you will never be safe from injury, illness, and death. On the contrary, all these things are assured.

Risk of no longer living is an inherent quality of living.

Also the timing of measures is critical. If you start applying them soon enough, you can stop the virus. If you start applying them too late, you can barely slow it down. 

Where is the evidence of that in this case?

Covid is the flu. The reason it has spread around so easily is because it is the flu. We are not quarantining ourselves out of the flu. We are unlikely to be able to vaccinate ourselves out of this particular flu.

Covid (et al.) is endemic at this point. If we are lucky it will mutate into a highly infectious but low mortality variant and solve the problem itself. Thanks to evolution the odds of that are pretty high.

What we want here isn't to prevent infection as much as it is to prevent injury and death. If we could get enough people infected without unacceptable risk then we'd have herd immunity without having to wait 18-24 months for a vaccine that might work for a few months at best.

Unfortunately, people who object against major measures usually also object against early measures, because early enough even minor measures seem unnecessarily big.

We come back to the original question: what does it take to convince people to do something they don't see a reason for? Quarantine (etc.) is a huge ask for a lot of people, that's the stick so where's the carrot? 

Convincing you is trivial. It's already happened. You are not the 'problem' here. Repeating the things that convinced you like they're a mantra isn't going to work. People like you are already on board this train. You want to convince people that are not like you, and that's going to require an adjustment to your strategy. Consider someone like me that thinks the mortality rate of covid entirely acceptable and doesn't live in fear of illness and death. What are you going to say to me to get me to do as you wish here? Scaremongering isn't going to work, so what else are you going to try?

If I wasn't being punished for virus heresy here we could probably have a completely ordinary conversation about the techniques for changing people's minds, how to negotiate, the nature of incentives and disincentives, etc. As it stands there's little point in that because the conversation is so tainted. I could lay out a perfect plan for getting more people to be compliant and there'd still be half the users making the sign of the cross and spitting at me because I refused to follow dogma.

comment by Viliam · 2020-12-29T22:22:04.424Z · LW(p) · GW(p)

In case of STIs, knowingly infecting someone is considered a crime in some countries. (Which is another reason why many people avoid testing for STIs; so they are never left in the uncomfortable situation of having to give up sex.) And you can protect yourself from STIs by insisting that your partners take tests and behave responsibly. You don't get an STI by simply sitting in a train with an infected stranger.

If the government wants people at home and doing nothing that would be trivial to achieve: just pay them to do so.

I agree that this would be good. If we have enough money for bank bailouts, we should have more than enough to help people at the bottom. Unfortunately, politics doesn't work like this.

I'm willing to bet you have the masks, sanitiser, and Vit D to prove it.

Yes, all of the above. And more importantly, we have the privilege of staying at home (I can work from home, my wife still has a few months left of maternal leave) that other families do not. But this all (except the part of staying at home) only reduces the probability. There are doctors in hospitals, who have the proper education and professional equipment, who literally see people dying of covid so they are properly motivated... and they sometimes get infected, too.

The best protection against this kind of disease is to keep the reproduction rate so low that it most likely doesn't even get anywhere near you. All precautions you take, they mostly benefit the other guy who would otherwise get infected through you.

Covid is the flu.

On the scale from flu to ebola, it is much closer to flu. Numerically, covid kills as many people in one week as flu kills in one year. Also, killing is not the only bad thing that can happen to infected people. On the scale from flu to ebola, it is not obvious at which point what should be done; the choice is arbitrary.

If we could get enough people infected without unacceptable risk then we'd have herd immunity

I admit I never understood how exactly this is supposed to work. How much is "enough"? Would perhaps "fifty percent" be a reasonable value for a thought experiment?

So, you have a disease that is contagious like flu and fifty percent of population have it. From my perspective, it seems almost inevitable that everyone else gets it too, unless they completely isolate themselves from everyone. My family could do it, yeah -- unless one of us gets sick and needs help from a doctor... who is either part of the infected fifty percent so we just invited covid to our home, or is also isolating from everyone and won't see us. What about maybe 90% of people who cannot isolate the same way my family can?

If you decide to spread covid left and right just because you can, it's not really my family you put in risk. It's all the people less privileged than us, who need to leave their homes regularly in order to pay their bills, and now every time they leave their homes, the risk they return with covid is slightly increased. And their choice is to starve or watch their parents die.

I think the big picture of what you're saying is something like "if you want people to do something they don't want to, provide some incentives". I think this would be nice, but isn't necessary. For example, we do not provide incentives to people so that they don't murder others; we stick with disincentives only. Similar arguments about freedom could be made: some people are less afraid of death, some people have a higher survival chance in a dog-eat-dog world; perhaps the proper solution would be to pay them some kind of danegeld. But we don't.

comment by Stuart Anderson (stuart-anderson) · 2020-12-31T17:35:57.026Z · LW(p) · GW(p)

you can protect yourself from STIs by insisting that your partners take tests and behave responsibly.

No, you can't. The only power you have is to choose to have sex with them or not.

You have no practical or legal force to compel medical treatment (testing) here, nor do you have any ability to compel conduct. That's kind of the point: the risk clearly exists, you can alter your own choices to ensure safety, but you want to take risks and you want other people to alter their choices to make that safer for you. You can ask them, but you can't force them. That's the sticking point.

I agree that this would be good. If we have enough money for bank bailouts, we should have more than enough to help people at the bottom. Unfortunately, politics doesn't work like this.

I never said it was good, just that it would be effective.

We didn't have enough money for bailouts, and economically they should have been allowed to fail. Yes, that would have been brutal, but that also would have reset the economic baseline instead of kicking the can down the road. 

I'd like to say we should have stuck with the gold standard for the sake of stability but I've got crypto holdings so I'd be a hypocrite if I did. The simple fact is that economic value is consensus based at this point and we're never going back.

we have the privilege of staying at home (I can work from home, my wife still has a few months left of maternal leave) that other families do not.

And there it is. Why do you think I'm yammering on about having people able to work? You're okay, plenty aren't. What about them?

But this all (except the part of staying at home) only reduces the probability.

You want perfect safety? No, you don't get that because nobody gets that, and nobody can have that.

The perfect example of that is all the deleterious effects we are seeing from people being at home. All the sorts of problems that occur in the home (domestic violence, child abuse, suicide, drug use, etc.) are skyrocketing during lockdown. 

Safety doesn't exist.

The best protection against this kind of disease is to keep the reproduction rate so low that it most likely doesn't even get anywhere near you.

All choices have costs. As you pointed out, you get to stay in your house and still eat. Others don't. The worst costs in this scenario are not borne by you, and they would probably never be borne by you here. Why should I be listening to you over people that are hungry and on the verge of homelessness? Why don't their needs matter too?

Numerically, covid kills as many people in one week as flu kills in one year.

  1. Those stats may be suspect. My country's stats put mortality at 0.3%. I don't have a breakdown of mortality by age, but I've seen median age breakdowns in the UK in the mid 80's.
  2. The number of people that die from the flu in a given year is miniscule. I'm prepared to accept a hell of a lot more death than that.

The exact problem with covid is that it does not burn hot. Covid is not going to kill most people that get it, in fact most people that get it probably won't even know. That's why covid will be impossible to stop.

Also, killing is not the only bad thing that can happen to infected people. On the scale from flu to ebola, it is not obvious at which point what should be done; the choice is arbitrary.

Both epidemiology and economics exist. This can be modelled mathematically for a given population. In an ideal world governments would have done all this modelling and kept it up to date, along with their protocols for dealing with pandemics. If you don't have those figures you're just guessing as to what's the best course of action.

As you say, the choice is arbitrary. Everything we do here ends in injury and death of some kind, the only questions are who, when, and how many? If you lock down then people lose their jobs and that will have run on effects (including injury and death), if you don't lock down more people will get covid, complications thereof, and some will die. People are going to suffer and die, just like they do every day. 

Personally I think the entire point of crisis management is to reduce total suffering rather than simply immediate suffering, but that's my own bias. The vast majority of people are not going to be like me and take an actuarial approach to life and death.

I admit I never understood how exactly this is supposed to work. How much is "enough"? Would perhaps "fifty percent" be a reasonable value for a thought experiment?

Again, this is a mathematical problem that can be modelled.

If I had to spitball it I would look at the workforce and children and aim at getting them back to school and work. Covid complications and mortality within those populations is tiny. The real issue is the aged and to a lesser extent those with significant comorbid conditions. Life is never safe for these people to begin with, so covid does represent an elevated risk (even if not a huge one).

Nothing particularly special is required for the workforce and children to get them exposure - just send them back to work and school and let proximity do the rest. 

The only other aspect at this point is that we do have some vaccines now, so barring medical advice to the contrary we should prioritise those most likely to get covid and suffer injury or mortality from that. The elderly and those with comorbidities seem like good candidates for that. It's not like they weren't the prime influenza vaccination targets before anyway, so it's just more of the same.

From my perspective, it seems almost inevitable that everyone else gets it too, unless they completely isolate themselves from everyone.

Welcome to herd immunity. Protection that works by people only getting sick once and then being unable to get sick again so they can no longer act as vectors.

If covid clears in 14 days then provided you don't come into contact with the infected during that period you're at no risk. So with herd immunity you start with a huge spike of infections that tails off to a point that there's basically nobody left to create new infections from.

The problem with covid in this context is that covid is a slow burn and it mutates to evade immunity. Sometimes we get lucky and a less infectious or less hot version (ordinary flu) or we get unlucky and we get covid (or worse). Evolution is a bitch like that. This is why coronaviruses are endemic and we'll never be without them.

unless one of us gets sick and needs help from a doctor... who is either part of the infected fifty percent so we just invited covid to our home

I don't know what your exposure to infectious disease protocols is like but you go to the doctor, the doctor does not come to you. 

I may well be bitching and moaning here but I follow the protocols to the letter because I won't get medical treatment otherwise, and because this is good practice for the real pandemic that is way overdue.

This is probably also an excellent time to point out that emergency preparedness skills should include medical training and supplies. In the context of covid a good measure is to buy one of those cheap pulse oximeters that clip on your finger. It takes five seconds to get a reading on O2 saturation that could be the difference between dying or not.

What about maybe 90% of people who cannot isolate the same way my family can?

This is one of the primary reasons that herd immunity is a good strategy. Even with full lockdowns and masks and litres of sanitiser everywhere people are still getting infected. It doesn't matter what we do, this is going to spread exactly because there are people that can't lock down.

Barring martial law, pest houses, etc. we are not stopping covid in its tracks. Doing the former would come with a mortality spike that even my cold dead heart would baulk at.

If you decide to spread covid left and right just because you can, it's not really my family you put in risk. It's all the people less privileged than us, who need to leave their homes regularly in order to pay their bills, and now every time they leave their homes, the risk they return with covid is slightly increased. And their choice is to starve or watch their parents die.

Nothing I suggest puts your family at appreciable risk. You are safe either way.

Less privileged that you, don't you mean? Don't assume that we are of the same class, because we more than likely are not. Furthermore, I am far more expendable than you. One of the first things I did when this started to kick off and I thought it might be a big deal (based on reports from Wuhan. Funny how they aren't locked down now) was contact my people to see what they needed. If someone had to be in the business of taking risks to increase survival then I thought it should be me. The group had the least to lose if I was incapacitated or died.

If the choice is to starve or let the parents die then you let the parents die. You are a parent. Look at your child and ask yourself if you'd risk stunting their development through lack of food or risk your own death to avoid that. You'd gladly choose your own death a thousand times over, and you'd be right every time. That is what it means to be a parent: understanding that it is no longer about you, it's about your responsibilities.

All choices have costs. Lockdown or no lockdown both have costs. As you quite rightly point out, plenty of people can't hide away even if they want to. There is no single choice here that is going to please everyone or work for everyone. There will be casualties either way.

I think the big picture of what you're saying is something like "if you want people to do something they don't want to, provide some incentives". I think this would be nice, but isn't necessary. For example, we do not provide incentives to people so that they don't murder others; we stick with disincentives only. Similar arguments about freedom could be made: some people are less afraid of death, some people have a higher survival chance in a dog-eat-dog world; perhaps the proper solution would be to pay them some kind of danegeld. But we don't.

More like "if you want people to do something you want then you first need to understand why they aren't like you". 

I think the fundamental flaw in most people's reasoning in regards to covid lockdowns is that they fixate on their own concerns and rationales for their choice to lockdown rather than looking at others situations and beliefs. These are people that are choosing the right course of action for themselves based on what they are experiencing and what they know. You are not going to change their minds with what changed your mind because they aren't you. 

If as an example someone objects to imposition on rights in the context of lockdowns then that's a showstopper in America (ie. an average citizen can take this to court and they will win). You voluntarily locked down, so have others. The choice is possible, so the fundamental question in this instance is "How do you get someone to choose lockdown voluntarily when they value freedom of assembly?". As dumb as it sounds I think you could get a lot of those people on board simply by saying "We respect your rights and we will not impede nor censure you in any way for exercising them. That being said, for reasons of public health we are implementing a voluntary lockdown and we humbly ask that you consider your fellow citizens as well as yourselves at this time in choosing whether to take part or not. Rights and responsibilities go together and the choice is always yours". 

It's a really simple notion that has effectively been forgotten in modern times but you get far further by being reasonable. IMO that starts with people saying "We aren't the same and we don't have the same beliefs, but we both have common interests and there's room for us to get compromises we can accept here". Nobody is looking to kill anyone else here but there is clearly enormous disagreement about what's a problem, what isn't, and what should and shouldn't be done about it all. Ideally we all (and that applies to the entire world) should have had these conversations years ago before any of this was even a problem, but we are here now, and as far as I'm concerned that merely increases the urgency for pragmatic negotiations and strategies. I (probably stupidly) have faith in people, if you can actually get people to the table and say "We aren't leaving until we sort this out" then you can actually get somewhere.

The more we fight with each other the less we can devote to dealing with this pandemic. People have forgotten how to point in the same direction over common interests. These days it's all about cutting off your nose to spite your face. That's an ideological problem that makes everything worse, not just covid. I have no clue whatsoever as to how to tackle that one.

comment by Viliam · 2020-12-31T21:55:45.821Z · LW(p) · GW(p)

If I understand your model of herd immunity correctly, it's like a binary split of population, where everyone in group A gets infected at the same time, and becomes healthy 14 days later, while group B spends 14 days (plus some safety margin) in shelters, so at the end both groups are healthy and the pandemic is over -- at least within the country.

I believe this is something that works as a mathematical model, but not in reality, because the differences between the map and territory are big enough to make it fall apart. Specifically, getting infected by covid is hard to do reliably. I don't remember the exact numbers, but when you had two people living in the same household and one of them got covid, there was a two-digit probability the other also got infected, and two-digit probability the other did not get infected. So in a zero-precaution situation (for group A), some people would get infected quickly, some in a month, some in two months... Also, it is possible to get infected by covid repeatedly -- I don't know what is the shortest interval, but there are many people who got infected both in spring and autumn 2020. Which means the group B would never be able to safely leave their shelters.

In Slovakia, covid in spring 2020 was managed very efficiently; best results in the entire Europe, if I remember correctly. We started in early March with face masks, when most experts (including most experts in Slovakia) were saying that masks don't work and we shouldn't buy them because doctors need them. Schools were closed, people were discouraged from using mass transit. When 0.017% of population got infected, we believed it was pretty bad ("oh my sweet summer child!"), and had one week of lockdown, which reduced the number of infections again. In June schools were opened again, for one month.

Result: only one week of lockdown, two months kids out of school, only 28 people died of covid. In my opinion, this is an experimental proof that impressive results can be achieved with relatively minor inconvenience -- as long as you do not hesitate and do the inconvenient thing quickly.

Then in autumn we fucked up everything, and got the same results as the rest of Europe. People returned from vacations abroad and immediately put their kids in schools, so since September the numbers started growing exponentially. Government ignored everything until end of October... then we got mandatory testing and lockdowns, but it was too late, 1% of population was infected, which made tracking logistically impossible, so by now we have about 2000 dead and lockdowns and the number of sick people keeps growing slowly.

I am posting these data to illustrate that I reject the dilemma "deaths or lockdown". If you do the smart thing, you can have minimum deaths and minimum lockdowns. If you do the stupid thing, you get lots of lockdowns and also lots of deaths.

Unfortunately, what stops us from doing the smart thing is... well, the people who fight hard against lockdowns in principle, including in situations where a short lockdown would be able to save the day. Because you can't make me and it's hopeless anyway and herd immunity and...

By the way,

In the context of covid a good measure is to buy one of those cheap pulse oximeters that clip on your finger. It takes five seconds to get a reading on O2 saturation that could be the difference between dying or not.

this information is only actionable if the hospitals still have some capacity left. Here, now, they don't.

comment by Stuart Anderson (stuart-anderson) · 2021-01-01T13:32:40.306Z · LW(p) · GW(p)

It's not a binary split, it's a rolling, overlapping set of infections. Each individual infection lasts for 14 days, so we have a tri-state of uninfected, infected, and immune which everyone has to move through, just not at the same time.

Getting infected by covid may not be reliable, but it is no different to any other flu. You don't see people spluttering and coughing en masse year 'round because people get sick and then they get better and remain immune from that particular strain. If we can do that with a normal flu, year on year, then covid is no different.

If by your own admission the window for a sharp lockdown is narrow then I think it's fair to say we missed that (thanks China) in December of 19 or January of 20. Now that covid is endemic a sharp lockdown will only work provided there is equally sharp border controls. As your example shows, even a country that does it right is screwed the second they open the front door.

Covid infections and outcomes are statistics we have, any mortality statistics from lockdowns are speculation and projections. We won't know if we made the right choices for another 5-10 years. I'd love to say here's the data that proves a case either way but that data is always going to be complex (which is why statistics is a difficult discipline and actuaries get paid as much as they do). My opinion here is exactly that and no more.

You couldn't even make your own people comply, so I think that problem is a lot closer to home and more universal than you'd prefer. It isn't hopeless, it's just that life is what it is. Death is a part of life. As for herd immunity, we will have that, with or without a vaccine, sooner or later. No pandemic lasts forever, and that's been true since long before allopathic medicine even existed.

A pulse oximeter will exclude a lot of things that are not covid, so it has utility. Furthermore, if hospital capacity is at breaking point then you are at a point where you either bug in or you bug out. If you're bugging in then you should consider supplementary oxygen or oxygen concentrators. If nobody else can help you, you help yourself. That's what being prepared means.

comment by Viliam · 2021-01-01T16:28:38.781Z · LW(p) · GW(p)

There is the perverse relation that sooner lockdowns are more effective but less politically defensible. It can even backfire -- the good outcome of Slovakia in first wave was ironically used as "evidence" by people saying that covid is harmless or completely made up.

Good data is hard to get. First, too many things happen at the same time, it is hard to separate their effects. For example, I find it quite likely that closing schools makes a huge difference. It is one of those things Slovakia did immediately in spring, and refused to do in autumn -- but as they say, correlation is not causation; and you can't make people do controlled experiments. We used to believe at the beginning that kids are immune to covid. Now it seems more like they are asymptomatic but spread the virus... although not enough good data here either. If that is true, then lockdowns while schools are open (and school attendance is mandatory) are completely insane.

Second, people are busy. Like, in spring in Slovakia we pretty much knew who got infected by whom; and when a person died, it was possible to have a wide debate whether a person who had X and Y and covid should actually be counted as "killed by covid" or something else. Now, the hospitals are unable to take care of all the sick people, so no one bothers doing autopsies. Which leads to all kinds of complaints about methodology of calculating actual covid deaths. Okay, but...

...there is something wrong about the chain "too many dead to count properly" -> "dead not counted properly" -> "we do not have solid data" -> "so, maybe no one really died, or only few". Like, each step is defensible separately, but the entire chain definitely is not. Well, there are attempts to justify the entire chain, like attributing the excess deaths directly to lockdowns. Which doesn't quite explain why those people, presumably dying from poverty or depression, need so many ventilators. And the death toll of lockdowns is also ambivalent: more people dying from poverty and depression, but fewer by traffic accidents or flu. Another data point from Slovakia: during spring 2020, the total mortality was lower than during the same periods of previous years, i.e. the lockdowns were net life savers, at least in short term.

We do have an oximeter at home, still unpacked. I hope it stays that way.

comment by Stuart Anderson (stuart-anderson) · 2021-01-02T19:54:01.573Z · LW(p) · GW(p)

Given that good data is hard to get that means that good choices are equally hard to get. That's a huge problem because one of the major thrusts of many people here is appeal to authority. Appeal to authority isn't automatically a negative, but if the authority in question is simply pulling their disaster response out of their ass then why are they any more reliable than anyone else? You collect, verify, and sanitise your data, because garbage in equals garbage out for any calculation, let alone for something as complex as epidemiology and disaster response.

There is going to be a point when this situation is resolved and having samples we can test later to gain accurate data from will ensure the next time this happens that we are better prepared for it. If it were me I'd not just be taking a swab from every cadaver, I'd be putting some of them in the fridge for when I was less busy. You can extrapolate from a small sample of autopsies, and I'm pretty sure you can stuff quite a few bodies into a commercial refrigerator. We can do everything we need to do today without compromising our data gathering. That data is important and we can preserve it without difficulty.

A chain is only as strong as its weakest link. It only takes a single confirmed incident of false COD reporting to cast doubt on all COD reporting. When that goes unaddressed that casts doubt on whomever is administering that agency. Again, an appeal to authority is only as sound as the authority in question. 

The only thing you have when it comes to asking for voluntary compliance is your reputation. If you want people to trust you then you have to be trustworthy. If you are negligent or deceitful then good luck getting people to cooperate with you. By contrast a trusted and respected person or institution doesn't have to fight for cooperation. If the level of trust is high enough then they don't even have to furnish a reason to get compliance.

When it comes to the oximeter, take it out of the packet and test it. Also make sure you know how to use it. This isn't something you want to be dealing with when you are in trouble.

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comment by shminux · 2020-12-20T20:05:19.488Z · LW(p) · GW(p)

I'll just copy my comment on a Zvi's post:

the Covid-19 mortality rate is in the Goldilocks zone for allowing (bad) choices: 

  • If the mortality rate was 20+%, the choices of herd immunity, doing slow full-scale trials or doing nothing would not be on the table. It would be "let's try everything, anything, now, now, now!" and the vaccines made in February would have been produced and used before summer.
  • If the mortality rate was within an order of magnitude of the annual flu (0.1% or so), "do nothing" would have been the only choice

As it is, 0.5%-3% mortality rate is exactly the wrong number, since the right decision is not immediately obvious to everyone. And so we have the largest number of overall deaths and the largest damage to the economy possible from anything short of Oryx & Crake-style plague.

comment by rockthecasbah · 2020-12-27T00:57:37.915Z · LW(p) · GW(p)

Thank you all for answering. I generally concur that the IFR and response are related. The current feedback mechanism cannot be a coincidence.