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.
- 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.
- 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.