The intent is to be a fairly comprehensive coverage of what we know about COVID-19 and what it means for our policy. Note that the article is written from a US-based perspective although I suspect it's relevant to a broader audience.

In general, I believe that the case against lockdown has been highly stigmatized and thus many people have not been exposed to a convincing argument of why some of us feel that our response has actually made things worse.

I encourage any pull requests (see the very final section).

If you're short on time, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_endin..., which has a readability score (Flesch-Kincaid, etc) of around a middle school level and is extremely brief and to the point.

For those who have a bit more time but still not enough for the whole article, I'd recommend at least reading https://www.ryankemper.io/post/2020-04-29-the_case_for_endin.... In particular understanding the age-stratified risk distribution, and how it differs from Influenza, is super important. Finally I'd also recommend checking out the proposal, which ironically is the shortest section: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...

Thanks for any feedback.

I have no affiliation with Gitlab whatsoever.

This is my personal blog that I made when I quit my previous job a couple months ago. I ended up repurposing the blog because I couldn't figure out how to get a table of contents working on a generic markdown file (i.e. I originally was just going to link to plain markdown in my git repo), but I was able to quickly figure out how to get it working with hugo. I used Netlify / Hugo via Gitlab to do so, so the Gitlab logo just happened to be part of the default theme. I'll look into removing it for clarity later.

> Once you get sick, you can’t get sick again for a long time. Eventually you might be able to get sick again, but it will not be very bad. When enough people have gotten sick and then gotten better, the sickness can’t spread any more.

(Incidentally, at one point you leave out the 'z' from "hospitalization".)

1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

(Personally, while I think voicing unpopular opinions is definitely a role we need in society, it seems to me that dismissing widely accepted opinions as due just to "talking heads on the media" puts disputants in an adversarial position that makes it more likely for people to hunker down in their existing opinions, and less likely for anyone's mind to change. Your refutation would have been more, not less, convincing to me if it had just pointed to the Lancet article.)

No worries; I also missed that you're not the original author. COVID + policy is a perfect storm of temper-stoking conversational topics.

From WHO a few days ago: https://www.who.int/news-room/commentaries/detail/immunity-p...

I considered going for a deeper debunking but held off for the initial draft. I might circle back if people feel it's valuable. Let me take a quick stab though:

When we talk about immunity we need to realize the term is used imprecisely by laypeople (btw I'm totally a layman if it's not already clear).

I think of it simplistically as two components:

(1) The presence of actively circulating antibodies in the bloodstream. This is what the (oddly controversial) serology studies are measuring. It is thought that having a significant quantity of these antibodies prevents infection - i.e., what most people envision when they talk about immunity.

(2) Even after the antibodies have faded, there are still Memory B Cells, which lay dormant up to decades, waiting for exposure to the characteristic antigen (in this case, an antigen telling them that they have encountered SARS-CoV-2), at which point they resume and rapidly scale up production of antibodies.

The thinking here is that reinfection is likely possible after a sufficient length of time - whether that's a couple months or a couple years isn't yet known - but when you do get infected, your immune system will respond sooner, more strongly, and thus you will achieve a far lower peak viral load meaning a less serious infection with reduced transmisibility.

This is a robust mechanism that we see across tons of disease, including common cold coronaviruses. In my completely uncredentialed opinion, this effect is so common and well-supported that we should essentially assume it happens until we really have proof that it doesn't. I know that might sound backwards, but it really is such an enduring mechanism.

--

Here's another argument you might prefer. We know that at least hundreds of thousands of people have successfully recovered from COVID-19. Loosely, we can divide the immune system into the "non-specific" and the "adaptive" subsystems. Given that we have seen extensive recovery from this illness and that those who have recovered have detectable levels of antibodies, and furthermore that there is a case of a women who could not manufacture antibodies due to a rare auto-immune disorder who failed to recover, it stands to reason that the same mechanism that provides medium-term immunity is the mechanism responsible for recovery.

That is to say, that it's very farfetched to think that people are recovering purely from non-specific immune responses and that the detectable presence of circulating antibodies is just a red herring. But I suppose you could try arguing that if you wished.

Specifically this part:

> People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice.

So, first of all, I think the concern is on its face totally unwarranted because people likely do have immunity to reinfection for several months, but regardless the presence of the immunological memory (provided they avoid getting infected with Measles which causes immunological amnesia) means that the second infection will be really not very bad and unlikely to transmit easily.

But more importantly:

Our public health organizations (and the media) have adopted the following belief: It is worth it to either mislead the public or to outright lie in order to achieve compliance. If it's not clear from the article, I find such a position detestable, not only on ideological grounds but also because functionally it causes people to endanger their health by engaging in superstition.

This is my theory on why we've seen so many articles from previously-respectable organizations like CNN that seem to focus on the narrative that young people are dropping like flies from this. Why? Because they believe that if young people are not scared shitless for their personal health, that they will not comply with the lockdown measures.

So, the WHO is really not trying to hide their motivation here.

Now the irony is I oppose immunity passports on ideological grounds, at least when used _within_ a society. As far as being used as a literal passport, that's fine by me. If the rest of the world wants to practice containment, it's welcome to do so, but I think from an evidence-based perspective, containment seems like an incredibly dangerous proposition.

This whole thing has really shaken my understanding of people.

In Italy it's pretty evident from the communication from the government, the experts (which released a "disaster story" of possible 150,000 ICU cases in a month, a number so high that should have been at least explained) and the media (including tabloids).

Since Germany has started reopening, media here (but, according to what I read - but please correct me if need be - not the case with the major German papers) started saying that "infections are accelerating elsewhere! See? Our model of lockdown is the only one that works!"

It might be true, but it should be grounded in facts and not in misrepresentation of them.

P.S.: Since you mentioned a critique of the widely-used model for this epidemic, do you have any more links to dig further? I simply do not know enough and I want to inform myself more.

The most important point of criticism is this section: https://www.lesswrong.com/posts/QuzAwSTND6N4k7yNj/seemingly-...

I don't mean this is as a criticism, but it struck me as some dissonance as I was reading.

I've also heard that there might be criticism to other models like the Imperial College one, but so far I've never found anything with some substance.

The IMHE model, after re-estimating, _was_ too optimistic. My argument does not hinge on the IMHE model being too pessimistic; but rather simply that the IMHE model is basically useless and thus we shouldn't base policy on it.

I expect us to have well over 100,000 COVID-19 deaths - indeed probably 3x that but I admit I haven't sat down and done the age-bracket-weighted mortality napkin math. (Basically, take each age group's IFR and multiply by that age group's population in the US, after multiplying by some constant <1 which represnts the sum of herd immunity threshold plus overshoot)

So basically, I think that COVID-19 mortality is going to be way worse than the model predicts, but given the way I view the cost of lockdown, etc, I still think the approach I am proposing is superior to locking down.

Does that make sense?

Some models (not published) from our expert panel in Italy are instead, in my ignorant view, very pessimistic (they say they elaborated 90 of them). The lockdown will be "eased" (quotes, for most people it's the same as before) on May 4th and one of the predictions said we'd get 150K ICU cases (as I wrote in the parent post). This looks very hyperbolic, at least on paper, because there are many measures still in place, so it's not the same as "no social distancing, no protection, everyone free".

In this case they keep mentioning uncertainty and the argument is that otherwise the public may behave in a way they don’t want. Whatever your opinion on the arguments, that’s not science and it is also poor politics because sooner or later they’ll lose credibility and really that’s all they have.

New tests for neutralizing antibodies like proposed by some groups[1] will make sure the antibodies not only are there, but that they actually work.

[1] https://www.researchsquare.com/article/rs-24574/v1

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

https://mobile.twitter.com/who/status/1254160937805926405

Remember the other famous WHO announcement at the beginning of this outbreak: “No evidence of human-to-human transmission”

Also, the WHO said shit like this: https://nypost.com/2020/03/20/who-haunted-by-old-tweet-sayin...

Typo fixed! I think I've found at least 15 typos total now. Oops...

One thing I'd add: employment and health insurance are tied together in the US. The lock down dramatically increased unemployment, the majority of whom will not pay expensive Cobra costs, and will soon be uninsured. The opposite of what was intended may happen: we are now less prepared to deal with an increase in demands on healthcare than we were a month ago, as uninsured people tend to avoid hospitals until they're absolutely necessary.

I'll see about doing so after I take a break to eat some food. (As an aside, I'm pretty comfortable writing and can write pretty quickly but as you can imagine just getting to this first draft took a lot out of me.)

Who is "we"? I understand your use of "we" to speak from the perspective of us as a society through most of the article, but this makes it sound like there's more than one author.

I chose to use "we" both because it fits with the semi-formal tone better, but more importantly because I want to give others a chance to open PRs if they choose to do so, so I was basically future-proofing for a possible scenario where I wasn't the only contributor.

https://academia.stackexchange.com/questions/2945/choice-of-...

This might not be the most condescending thing I've ever read on HN, but it's definitely gunning for one of the funniest.

Genuinely, what is the purpose of making an argument about a complex topic and then suggesting that skipping nuance and detail is an acceptable route to forming an opinion?

If you're so certain on this topic and think that your tl;dr section cuts to the quick of the issue so well that people with a middle school reading level should obviously understand and agree with your point, what is the purpose of the post as a whole?

To be clear, I think this is silly on multiple levels but the babytalk bit made me lol

With all the misinformation going around I resorted to mainly listen to scientists in the relevant fields directly (if you speak German, the NDR podcast with Prof. Drosten is really nice in my opinion). Therefore I think it really helpful if research institutions and researchers themselves who are in that field (!) are vocal (but reserved and competent) about studies and thoughts. For instance, today the four big research institutions in Germany (Max Planck, Helmholtz, Leibnitz, Frauenhofer) published a joint message in favor of social distancing and contact restrictions: https://www.nytimes.com/reuters/2020/04/29/world/europe/29re...

Edit: I only found the German press release so far: https://www.mpg.de/14759871/corona-stellungnahme

I'm just a dude that likes to read research papers. As an aside, there is totally an archetype of the software engineer that thinks they're equipped to dive into unrelated fields, and I definitely match that trope. I will say in my defense though, that I try to build simple mental models and take them to their logical conclusion, which is a quality that I see in people I admire, and conversely a quality that I find lacking in people that I feel don't have a lot of insight.

Many might disagree but I am a very strong believer that arguments should be evaluated on their merits, rather than credentials. Indeed having credentials makes it that much easier to fall prey to cognitive distortions.

IMO this should be a disclaimer in bold right at the very top of the article.

https://gitlab.com/ryankemper/writings/-/commit/05b4b616c5e0...

This doesn't really pass the sniff test. You wrote 7500 words on this topic, but felt that including "I have zero experience in any relevant fields" would be overly verbose? Are you sure there wasn't another reason?

arguments should be evaluated on their merits, rather than credentials

It's not about credentials, it's about relevant knowledge and experience, without which it can be very difficult to actually properly evaluate the merits.

https://gitlab.com/ryankemper/writings/-/commit /05b4b616c5e0017b0f80682533399c8696d897b5

When you lack the expertise to do that effectively, you should listen to the experts (ideally those that demonstrate that they are evaluating ideas based on their merits).

The trick is determine which questions you have the expertise to evaluate for yourself and which you are better of relying on experts to evaluate.

Unfortunately, this is an area where a large number of non-experts vastly overestimate the difficulty of the material vs their own level of knowledge. This leads to the increasing proliferation of misinformation and misleading analysis like yours.

Credentials are not the only way to acquire or demonstrate expertise. You say you are a "dude that likes to read research papers", how many epidemiological research papers have you read? How much time have you spent discussing those papers with epidemiological experts? Did you reach out to any of those experts to have them take a first pass as fixing any mistakes you made before you decided to post it publicly

Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.

You are being irresponsible.

Ideas need to be evaluated on their merits in all cases, especially in times of controversy.

Which is why it is important that people with the expertise evaluate those ideas on their merits.

What doesn't help is when less informed laymen think they can accurately judge the validity of ideas put forward by slightly more informed laymen.

What active hurts is when those less informed laymen start spreading their half-balked ideas and trying to impact policy without making an effort to get their ideas validated by people with the experience to find the simple, obvious errors they are making.

Me posting this is literally me doing that, so your visible irritation is very oddly placed.

> Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.

This is not a fair characterization; I was very clear that this represented my "first draft" and that I was looking for feedback specifically to have people poke holes in it.

Fortunately, a lot of people did have substantive contributions that pointed out errors or places where the arguments were weak, as opposed to merely engaging in sanctimonious gatekeeping as you are doing.

Where was this made clear? The closest I can see is at the very end where you call it a living document and will accept pull requests that match the "style and intentions of this document" which to me sounds like you are only interested in meeting pull requests that strength your argument to further your intended narrative.

I appreciate your adding a disclaimer about your lack of relevant experience, but even it says nothing about this being a "first draft" that you expect to have holes poked in.

So I fully stand behind my characterization and I find your use of the term "sanctimonious gatekeeping" to far less of a "fair characterization".

The part I don't concede is this notion:

> Instead you decided to broadcast your ignorance with confidence about an area already ripe with misinformation that is costing people their lives.

In that, it strays far too close to the dangerous notion of "advocating for ending the lockdown, however flawed, is killing people". Which is a notion I cannot and probably never will be able to get behind.

I have no problem with advocating to end the lockdown. We need to do it as soon as practicable. You ar correct in supposing that a lockdown that lasts longer than necessary ends lives. I think there are some good steps we can take towards that, such as reopening underutilized hospitals in areas where that utilization has plateued.

You are doing more than that, you are trying to summarize everything we know about covid. In an environment with so much misinformation about covid floating around that is demonstrably dangerous, it behooves is to be extra care to not feed into that cycle.

And having no credentials makes it even easier to make blatantly wrong assessments, to read the data incorrectly, to completely misunderstand terms of art, to accidentally believe that because you are smart, you can evaluate another field easily with some hard thinking.

Having no credentials means you are likely to not know what you don't know, and so gloss over an entire section of a field when making conclusions. It means not having worked with similar data before to help build a "sniff test" for when something in your work doesn't look right.

The difference between no credentials and credentials in assessing a complex topic and communicating that to a broad audience is as a vast as the difference between the seasonal flu and coronavirus.

This is well written. Thank you. It's wrong that this post is currently flagged.

And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented.

Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives. Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated".

This thing is so littered with bias and lack of facts that it is not useful for any serious consideration of this. I'm sure it's great for people who already have their mind set in one direction, though.

That being said, I think it does make sense to account for positive externalities. Can you think of others that are lockdown-specific? The classic ones right now are pollution.

> Or look at one of the following sections "General vaccination on the decline". This is a wonderful example of the only looking at negatives.

I'm not sure if that is a great example of only looking at the negatives. This is one dimension where the effects of the lockdown are basically exclusively negative as opposed to being a mixed bag. So this feels like something that absolutely _should_ be mentioned. Particularly when factoring in the irony of it increasing mortality from other non-COVID-19 infectious diseases.

> Imagine that flu vaccination dropped 90% and that flu cases dropped 99%, this thing would report that as a negative because, "hey, look at how many people aren't getting vaccinated".

I don't think this is at all fair either, but I must admit I chuckled a bit. It is a funny thought.

> And then when actually looking at it, it's full of pleas to emotion and claims without any data backing them. Take "Addiction and Overdose", there's no real data discussed (other than historical data about deaths unrelated to lockdowns or distancing or economy). Is there no data that supports the implication (if not outright claim) that lockdown will increase the cost or deaths from addiction/overdose? For anyone reading this, if it feels like it's a good, thorough examination you should absolutely discount any points like this where there's no supporting evidence presented.

So, this is the biggest hole that I personally see in my argument, so I very much agree here. The trouble I ran into is, this is such an unprecedented situation that it would have felt ridiculous if I just started making up mortality predictions. So it felt like a good balance to highlight the _potential_ for increased mortality. I do think that means I likely need to soften the language around lockdown causing more mortality to accentuate the fact that it's merely _likely_ that it does.

--

Is there anything else you can think of? Thanks for the feedback.

We absolutely pass a ton of laws to make driving around safer, including restricting driving around when it's particularly dangerous (for example, when a person has had a bit to drink).

> Pareto Mitigation: An evidence-based approach

I love how this uses "evidence-based" as a dogwhistle followed by proposing an approach without providing any sort of evidence about the efficacy of the approach.

> Those who have lost their jobs tend to be those workers who are in a lower socio-economic bracket and have jobs that do not allow one to “work from home”.

This is presented without evidence. I think there's a reasonable chance this is the case, but many essential businesses/industries employ primarily lower socio-economic classes so who knows. This is just presented like you should agree with it.

It's also not clear that those that are more disadvantaged are actually worse off here. There has been a very large increase in the amount and accessibility of unemployment benefits.

There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(?)_/¯.

On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?

> A preventable decline in preventative care

Even the (supposedly evidence-based) proposed approach would likely lead to exactly the same decline in preventative care. This error is repeated throughout the document where there's this idea that the changes that we've seen are due to lockdown and will just go away otherwise (except, of course, for when the change is positive and, clearly, the not-quite-lockdown approach recommended would continue that positive change).

> Be wary of “hero culture”

This is maybe the strangest section. Why does this just talk about a hero culture related to real scientists? Do we think that people are more likely to think some nerdy scientist is a hero rather than our heroic manly president? This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts).

> The Soul of the Country is at Stake

OMG. I skipped this in first skim. Yeah, this makes me think I've wasted my time even thinking about this thing, this is clearly a plea to the emotions of a specific subset of the population. I'm done.

For these, it could be good to compare what has happened in countries or areas with different responses to these. I.e compare sweden vs norway.

Thanks for the feedback. I think the dog-whistle part is quite true. I will need to circle back and add citations where I can. Particularly given that one of the thematic elements is that the lockdown is not based upon evidence.

> There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(?)_/¯.

I was worried about this being distracting. I think particularly bolding segments within a sentence is definitely distracting, so I will (eventually) try to clean that up.

> On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?

As far as I know it's not, but I'm not entirely sure where to go looking for weekly suicide data. I've only been able to find data over much longer intervals. This is where being an actual expert would probably help! :P

> this is clearly a plea to the emotions of a specific subset of the population

Just to bite of a piece of this before I conclude here, I personally think that a shift to censorship on such a wide scale is absolutely something to raise a bit of moral panic about. The new usage of the term "disinformation" has hit a point of Orwellian double-speak.

Sorry to bombard you with replies, but I realized I never addressed this.

I think you might have a different idea of what "hero" means, basically all I meant is that we tend to elevate these figures (Fauci in this case) up as "heroes" and therefore act like they are infallible and thus you cannot express an opinion that contradicts them. That is what I was arguing against.

It's not about "hero" in the sense of, like, what a young child would imagine a hero is. So in the sense I'm using it, people totally do view the "nerdy scientist" (Fauci) as a hero. And I understand why they do.

> This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts)

No, it's not discrediting them, it's just saying: evaluate policies and statements on their merits, not based on simply who said them.

I hope that makes sense.

Thanks again for all your thoughtful feedback. You clearly put time into it (and a good bit of frustration, understandably :P)

What you should do is take the time and effort to educate yourself before contradicting them, (such as about basic things like how herd immunity interacts with R0 in a pandemic) and you should present caveats and disclaimers that are online with your own lack of experience, expertise and knowledge.

There might potentially valuable insights in your article, but their value is overshadowed by the way you present all your ignorance with confidence and surity.

I should learn to never read anything from random people working in areas they don't have any expertise in. This whole section is wrong.

The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.

This is clear when you think for about 1 second about it. The `1/(1-R_0)` value gives you the point where infected people infect 1 more person, it doesn't give the point when the infection stops spreading.

First, `1/1-R_0`. This is exactly what Wikipedia says: https://en.wikipedia.org/wiki/Herd_immunity#Mechanics

And it makes intuitive sense that once you infect <= 1.00 people, growth is no longer exponential. So I don't think that point is wrong at all.

> The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.

This doesn't make any sense to me. Vaccination is just an artificial way to build immunity. So I don't understand your active epidemic point at all. Or put another way, as the proportion of % recovered goes up, we start approaching the eventual limit where `1/1-R_0`->1. That is to say, in your example we start with R_0 = 2, then as people recover that value slowly starts decreasing until it hits 1 at the herd immunity threshold. It's not clear to me what the discrepancy you're detecting is here.

See here for a good explanation https://twitter.com/CT_Bergstrom/status/1252077930286444545

So then, it does seem that if we successfully contained the virus, and then avoided infection spread until a hypothetical future vaccine is developed, that we could avoid the number of infections required by some amount.

Just to tie it back to the broader lockdown vs not lockdown debate, we could probably say that a successful full containment strategy+vaccination could decrease the net area under the curve. As far as policy is concerned I still think the costs of locking down for that long (particularly given that the time is unbounded) is not worth it, but that is a very valid point that I will need to circle back and weave into the document.

And you also think, that politicians are doing an economycal suicide just because they like it?

Srsly, wouldn't you assume and shouldn't you assume, that there are experts calculating and estimating that shit on every single day and trying there best to find a reasonable way out of this?

Yes, I am a person that makes and is currently making mistakes.

> And you also think, that politicians are doing an economycal suicide just because they like it?

I analyzed the "game theory" of this a bit here: https://www.ryankemper.io/post/2020-04-29-the_case_for_endin...

> Hanlon’s Razor is very relevant here; we think it is not reasonable to assume that they were trying to usher in a techno-totalitarian state. Rather, they were trying to prevent mortality, but their incentive structure is such that it is much worse to have done nothing and later find out that the virus was worse than we thought, than what actually happened, which is to have undertaken actions that were self-destructive and then discovered that the virus was way less deadly than we thought.

There are plenty of people coming to me and say stuff like 'uh why does that take so long' 'i can do that quickly in an hour' etc. and at the end of the day they are wrong.

In those cases, i would just love for people to accept my expertise and let me do what i'm good at because it costs time dealing with this stuff.

And you know, all those speculations of people who are sitting down for a few hours, writing something, gathering a little bit of data left, a little bit of data right THIS IS RIDICULOUS.

You are not an economist, you are not a doctor, you are not a virologist, you are not the statistics guy. Apparently you are a SRE.

What do you think, your statement actually does? I tell you what it does, if it even does anything: It works against all the experts trying to actually do their fucking job on estimating and deciding on a daily bases about human lives.

Do you know what i decided when corona started? I will, this time, just try to be as undisruptive to the society as i can. I don't have to argue against or for it, i will trust the experts and politicians on this one.

Not everyone needs to form an opinion and also state it.

And yes it might be harder for you to believe in your president right now, i do get that. But let me give you a tip: Whenever everyone would love to stop quarantaen today, i will try to avoid public spaces as long as i can, because the risk of having corona, is actually for me, a bigger problem then just staying low for a few month.

Name any that were correct. Or that bothered reading the Chinese papers published months ago. I'll take an SRE over those demonstrated flakes anyday.

> because the risk of having corona, is actually for me, a bigger problem then just staying low for a few month.

It's not all about you, and your selfish rant is horseshit.

It's about public health policy. I think HNers don't understand the difference.

I think getting your opinion out there is important, but to be honest, the article needs a heck of a lot more in terms of disclaimers, and much less in terms of confident statements and grandstanding.

I've worked through the best available data. My conclusions:

1) The economic costs of ending the lock-down may be astronomical. This is especially true with what we learn about COVID19 and lung damage (or potentially other organ damage). If even a small fraction of the population is on long-term disability, the costs go up super-quickly.

2) The fundamental costs of the lockdown are cheap. With reasonable economic mitigations, the costs should be that everyone upgrades their car, computer, or similar maybe 6-18 months later, plus an extra 1-5 percent of the GDP.

3) Most of the economic damage of the lockdown, like a cytosine storm, is self-inflicted: bankruptcies, defaults, layoffs, etc. There are reasonable way to manage most of those (and the rest require a very modest stimulus). We haven't taken those steps because we're stupid.

4) If we don't put in systems to manage the economic costs, we'll be super-vulnerable to the next pandemic.

5) This is something which will come up again, and it's also something which is a national security issue. Engineering something like the next COVID19 as a bioweapon is, at this point, within the scope of even poor countries (North Korea, most countries in Africa, etc.), and there's a Moore's Law where the resources go down super-quickly (larger organized crime organizations could probably do this as well now). The point isn't that poor countries are more likely to do this (they're not), but that with 200 countries in the world, the odds that SOMEONE is likely to do this are increasingly high.

I have a feeling a lot of people advocating ending the lockdown are doing so on the basis that only old and infirm people die, as if the other option is either an asymptomatic infection or a quick recovery from something flu-like.

But I’ve witnessed some very serious infections, so this colors my perception and pushes me toward continuing lockdowns. To your point, the disease can be debilitating foR relatively young, healthy people. Have you ever gotten the flu and then had to re-learn how to swallow after spending a month in the hospital?

Yes corona is mostly deadly to older people, but even for those who do not die there are negative health outcomes which impact their ability to work and take care of themselves. What is the economic impact of that? Why is it not factored into the cost/benefit analysis of opening up?

We need to know the incidence of these issues. Response needs to be completely different in case they're the majority of cases, or if they happen in the minority.

So far the evidence collected from what I've seen is case reports, so nothing clear or definitive.

I have no expertise in this area, but Wikipedia does not say:

    1/(1 - R_0)

    1 - (1/R_0)

(The irony in me having said it was "exactly" what Wikipedia says is not lost on me :P)

https://gitlab.com/ryankemper/writings/-/commit/093ade629447...

Say R0 is 2, 1/(1 - R0) means that we already hit herd immunity before SARS-CoV-2 even existed!

Right: it's (after you correct the typo) the point where the number of active cases does not increase over time.

This is one clear lesson that can be drawn from the pandemic.

Consider that many governments with professional public health departments, including those of the richest countries in the world, downplayed the unfolding disaster, completely blew it on containment as a result, and are now reduced to using _extremely_ expensive lockdown measures to try to buy time until someone can come up with a better idea.

Meanwhile, plenty of randos on the internet did the straightforward epidemiological math in January/February and correctly deduced what was coming.

I think a clearer lesson is that, sometimes, the designated professional experts will fail to outsmart a fairly simple and very well known system of differential equations.

If you find this conclusion terrifying, well, I agree.

Governments are ultimately run on a day to day basis by politicians. Proactive measures to prevent a crisis are a much tougher action to justify, especially if they negatively affect people in a way more direct than just spending their tax dollars, than reacting to a crisis. If anything I think this crisis should teach us something about how governments make choices.

I did some little thinking and modelling of my own late Feb, and reached the correct conclusions by following a simple exponential model, having very basic understanding of epidemiology, and being mindful of error bars (mostly ones created by me being a layman in the field).

On the other hand, I trusted WHO and CDC on masks around February; even posted things to HN to that extent. I now regret it and consider it a failure of not doing enough first-principles reasoning, and not digging into the feeling of confusion I had when reading the official advice.

What I got blindsided by was supply chain impacts. I read the daily updates on /r/supplychain with fascination; while I realized things are interconnected, I didn't realize just how much and in what non-obvious ways.

Bottomline, the lesson I draw from the pandemic is to trust myself a bit more, and attempt to carefully reason from first principles more often.

--

[0] - https://www.ecdc.europa.eu/en

Plenty of epidemiologists did the math and were talking about the situation on Twitter in January and February. I know because I was following them before China locked down. There were articles and interviews in the press from actual experts (Marc Lipsitch, Neil Ferguson, Michael Mina, Michael Osterholm) during that time.

There were science journalists (Helen Branswell, Kai Kupferschmidt) writing back then who were great at contextualizing the emerging information about the epidemic.

Dr Nancy Messonnier at the CDC warned that "Disruption to everyday life might be severe" on February 25th.

Meanwhile, randos were racking up karma across the internet with their back of the napkin bullshit.

Additionally, the two companies that I had narrowed the search down to did not freeze hiring. Pretty lucky, since tons of companies did, although I constrained my search to remote jobs only so that's probably why.

I accepted a job offer and start soon, actually.

That being said, I do think that the general experience of being jobless during this has made me more sympathetic of those that truly lost their jobs than I otherwise would have. Which is not to say that I wouldn't have been sympathetic, I absolutely would have, but the fact that I had to deal with COBRA and other fun artifacts definitely made things a bit more tangible for me.

Excellent point/question.

Still, I _don't_ know about how we are doing in terms of healthcare workers. That's almost certainly the bottleneck and it may be that it's still a bottleneck. I'd have to do some research to say for sure. It's very possible my statement was not correct in that light.

Meta: I'm currently constrained to using one arm since I had a not-so-fun ER visit today, so I'm not really firing on all cylinders right now. So, if you happen to look into the NY capacity matter on your end, I would love to hear your findings.

NYC built more hospital capacity as a response to the dire situation in their hospitals. That some of that extra built capacity is unused is not evidence of overreaction. I also find it odd to separate out the availability of doctors and nurses from the physical beds when our primary question here is whether the hospitals are strained; a bed is of no use with doctors and nurses to help the patient.

I'm honestly curious: have you not read the news papers articles talking to doctors and nurses who have personally witnessed the over capacity hospitals in NYC and Chicago?

On the other hand, you say > Remember, flattening the curve does not reduce deaths in the long-run, except insofar as it avoids overrunning hospitals, which we have already achieved.

If some countries have achieved this containment in the hospitals, not all, it is only by doing the lockdown, I can't believe you would think that opening up would not overrun the hospitals, if we open up, they will be flooded with new victims and those deaths will NOT be hypothetical.

Although you bring up many valid points, in my opinion this is where your statement fails. Opening up WILL cause new deaths.

I believe a gradual opening would be much more efficient only once the rise has already been slowed down.

- I think the part about the freedoms is unnecessary because I feel the vast majority of the pro-lockdown people do not share your enthusiasm for freedom and public discourse. While your main argument may shift their opinion, the part about liberty may cause them to stop reading and discard your other arguments.

- I think some claims would sound more persuasive if there were more links to research. For example, the claim about 0.1-0.7% mortality. There's a study about China (0.66% mortality) and a bunch of others that could support your point. You could also add mortality stats for influenza in the US from the CDC website (I think it's 0.13% on average).

- The TLDR sounds bitter and childish, in my opinion.

Overall a great summary and I'll share that with others.

> Other countries do not even have the concept of freedom of speech/assembly embedded into their founding documents.

as it was clear that the author hadn't done any research on this - many countries explicitly or implictly have these in their founding documents.

In short, the important distinction is not that it's embedded into the founding documents, but that we do not place the limitations on free speech that other countries do.

i.e. places like UK, germany, france - while they may have the phrase "free speech" in their documents, the limitations put on it are extreme enough that they're basically referring to a totally different concept.

So, it would be more accurate to say that other countries do not share our concept of free speech, in that ours has _very_ few limits put on it.

https://gitlab.com/ryankemper/writings/-/commit/6daa56a4a05f...

I think this part goes way too far presuming intent, really hurts your case without a qualifier.

> Those advocating a policy of containment, and with it, totalitarian-style lockdown, are not doing so based upon scientific evidence, but rather upon superstition and tribalism.

And to be so critical of "omission", the TLDR says nothing of air-to-air transmission while eating, like in a restaurant.

That, in fact, is why I have an initial section that's just about these deceptively simple concepts that we all need to understand. I wish our leaders had actually metaphorically sat the American people down and explained the basics. The average person really does not know what a virus is, or how diseases are transmitted.

So, I actually entirely agree with the position that this is something that relates to epidemiology. Where I differ is that I don't believe in gatekeeping, I think if someone has taken the effort to synthesize research into a policy proposal, however poorly, it seems at least worth debating the ideas on their merits. The experts who know more than me (and they do, at least some of them) should be able to convince a rational/reasonable person that their position is the correct one without resorting to credential-waving.

--

BTW I do read quite a lot of research papers, but I don't naturally have much interest in epidemiology. Just to give you an idea, I usually end up reading papers about stuff like: moist wound healing, and the role of red light therapy in fibroblast differentiation, and more broadly the role of electromagnetism in wound healing and neuronal galvanotropism. Weird stuff like that that's connected by invisible threads.

So, why did I read a bunch of epidemiology/COVID-related research papers? Well, the state of discourse here in the US, and also globally, has hit such a level of insanity that I decided that I needed to figure out what the facts were. (I'm not saying I have "figured out the facts" perfectly, or even at all, just that I am trying to) Honestly, it might sound ridiculous, but the turning point for me was reading that Venice Skate park was filled in with sand to prevent people from skating there. That is what informed my intuition that we are collectively being driven by superstition, and therefore what motivated me to read a bunch of research papers and reach my own conclusion about what's going on.

My ultimate conclusion? Well, the writeup is pretty clear on that one.

So...do you have any feedback about the content here?

It seems to me these are big questions that necessitate a healthy debate considering all the pros and cons of lockdown measures. There's a lot of moving parts and dimensions: time, which activities should be resumed or kept closed, who should observe what protective measures, travel restrictions, etc. We need people, experts from various fields AND layfolk, to have a real dialog about them. "Lockdown until vaccine unless proven otherwise" is simply not going to work.

Perhaps I haven't found these kind of voices because there is not actually a decent argument to be made. Maybe I've just missed them. Maybe epidemiologists aren't, by and large, disposed to think about economic impact, long term health implications of living in lockdown, or other second order effects. Or quite likely they are scared shitless to make anything resembling a pro-opening argument because their field is ridden with groupthink orthodoxy at the moment. Much like we see from whichever (IMO) bad actors were flagging this post.

Germany is having this discussion and Czech republic too. In both cases, epidemiologist recommend slight release of rules (not a big one, but still lowering lockdown).

The problem with the analysis and exhortation to end the lockdown is contained in the above.

Flattening the curve is a way of maintaining hospital capacity and is an ongoing effort. Saying "we have already achieved" it is nonsensical.

What does make sense is maintaining hospital capacity and following a reopening protocol along the lines of:

1. Reopen sections of economy, relaxing stay-at-home for some workers.

2. Monitor for outbreaks.

3. Test and contact tracing.

4. In case of new outbreaks: quarantine and strengthen stay-at-home.

5. Repeat 1-4.

And continuing this until

- Advent of treatments for COVID-19

- Advent of vaccine for SARS-CoV-2

- Herd immunity has been achieved.

The essay linked in the OP refutes the simple argument that lockdown must be maintained by presenting an overwhelming number of details about COVID-19, its lethality, elective vaccination, secular superstition, and all other manner of irrelevant topics.

The reason for the lockdown is to maintain healthcare capacity in the face of a virus that is highly contagious.

A workable and moral framework for ending lockdown looks something like what I've outlined above.

The OP provides no suggestions on how lockdown might end, other than gathering an enormous amount of tangential evidence to prove "The Case for Ending Lockdown".

My position is that the cost of lockdown massively outweighs the cost of COVID-19 itself, and furthermore I am suspicious of the belief that we can effectively contain it without boarding people in their houses.

> The reason for the lockdown is to maintain healthcare capacity in the face of a virus that is highly contagious.

And yet the lockdown has, overall, scaled _down_ our healthcare capacity amidst the most serious pandemic in a century. Why is that? I can already foresee an argument of "oh well, the lockdown is fine, we just need to pass government regulations that pays hospitals to maintain this extra capacity". And my argument to that is, beyond a general distrust of government incompetence, paying somebody to sit around will not maintain their skills in the same way as paying them to actually perform the preventative care that we hired them for in the first place.

> The OP provides no suggestions on how lockdown might end

But I literally provided a proposal. The proposal is to have at-risk members of population - and yes, we can identify who is at risk really quite easily with the data we now have - quarantine as we've all been doing. Meanwhile, the rest of society is no longer forbidden from transacting and producing value.

Again, if you look at the fatality rate data, you will see that if we can just protect everyone over 60 - and especially everyone over 70 - we will mitigate probably 80% of the deaths. Unfortunately, even _with_ the lockdown, we have utterly failed to do so thus far in many parts of the country.

In particular, I strongly oppose the moral panic around people going to the beach, public parks, etc. Unlike our politicians, I strongly believe that these activities can be done safely and that there is insufficient evidence to show that they were ever a serious transmission vector in the first place.

While it is true that some health care providers are experiencing a decline in demand due to, for example, people no longer seeking medical attention for (e.g.) coronary problems and other non-respiratory ailments, this is not the health care capacity that matters with regard to coronavirus infections.

Non-coronavirus medical problems are important, but the widespread increase YOY in mortality across the entire United States is evidence that such medical demand is eclipsed by the demand for treatment related to coronavirus infections. [0]

Second, and I mean this with all due respect, your suggestion "to have at-risk members of population […] quarantine as we've all been doing. Meanwhile, the rest of society is no longer forbidden from transacting and producing value" is not so much a proposal as a flight of fantasy.

The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.

Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%. [1] While the number of infections required to overwhelm hospital capacity is hard to pin down (i.e. forecast), ProPublica 17 Mar 2020 page offers a few different projections. [2] One of those projections forecasts that if 40% of US adults are infected over 12 months, hospitals across the country would experience demand at 100% to 200%+ current capacity.

Those less-vulnerable members of the population who "only" need hospitalization at a rate between 2.5% and 7.4% would be left without medical recourse and would die at a much higher rate than what you are imagining.

[0] https://www.nytimes.com/interactive/2020/04/28/us/coronaviru...

[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm

[2] https://projects.propublica.org/graphics/covid-hospitals

Right, but in this case it's leading to workers getting furloughed. So that is a direct lowering of capacity, although I suppose one could argue that those workers will be called back when shit hits the fan. But if that's the case...why not have them doing important preventative care in the meantime, since we know our hospitals are not overwhelmed yet? Basically anything that doesn't require people being in hospital beds for days since that would take away resources for future COVID-19 victims.

> Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%.

This appears to be a hospitalization rate that is not accounting for all the hidden infections, which is why that number is so high. That's why the serological studies are so important. Otherwise, we need to estimate how many "cases" there will be (meaning, "serious cases" essentially), which is a lot more difficult than finding the true IFR / hospitalization rate and then multiplying by age-stratified population size. In particular, the CDC numbers are very at odds with the hospitalization rate of some of the serological studies I cited in my article. And it's not just a factor of 2x, it seems to be a massive difference. For example they show a 2.5% hospitalization rate for ages 18-49 whereas the number I've been using shows a .8% hospitalization rate for ages 40-49 at the high end, and then a .2% hospitalization rate for ages 20-29 at the low end.

I will need some time to dig into https://projects.propublica.org/graphics/covid-hospitals, but I'm having trouble finding where they give their estimated hospitalization rates. I did note that the article has the following quote:

> “You will have people on gurneys in hallways," Cuomo said at a press conference on Monday, later adding that New York would need up to 110,000 total hospital beds, around twice the number it currently has. “That is what is going to happen now if we do nothing."

And we know now that this was absolutely not the case. Recall that New York ended up not really needing the USS Comfort, and we now know that at least 15% of the population has been infected per the serology studies. So the fact that that prediction was wrong makes it feel like other predictions using the same model will be very wrong. I'll see if I can find the paper that the Harvard team published.

And then this quote seems to imply they're operating off of the bogus 20% hospitalization rate that I mentioned in the article:

> According to the Harvard scenario where 40% of adults in the country contract the disease, about half a million people in the San Francisco region may get infected, with more than 100,000 residents requiring hospitalization.

Anyway, moving on:

> The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.

It's not clear to me why this is the case. Those essential workers who are vulnerable would be quarantined (whereas right now I believe they are not quarantined which is a problem). So, the 70 year old working as a bank teller would stay at home, collect unemployment (I wish we had a better system of unemployment but that's another matter), and the bank would presumably try to fill the role with someone else who is available to work in the meantime.

--

Thanks for the discussion.

I'm more reconciled to the idea of "ending lockdown", and would characterize my position as one of guarded reluctance, especially until such a time that medical and public infrastructure can provide widespread testing.

That said, I think the value of our discussion is more intellectual than practical given the data are secondhand, the data are unreliable, we are not medical experts, even medical experts disagree, and much remains unknown and unknowable about how the coronavirus epidemic will mitigate or exacerbate in response to human behavior.

That said, perhaps you might find the current Federal guidelines for reopening economies interesting if not heartening. [0] I found two things especially interesting: 1) the articulation of criteria for assessing whether, 2) the outline of a phased approach to reopening.

[0] https://www.whitehouse.gov/openingamerica/

I don’t even necessarily agree with the author’s arguments and conclusion, and honestly I have no clue what to think with all the information I hear that is constantly changing from the various tribes. But when something gets flagged simply because he advocates for ending the lockdown, I go from thinking the lockdown is probably necessary and trust the decision is made for reasons I don’t understand, to thinking like the paranoid conspiracy theorist that this is just a totalitarian power grab, and figure the need to suppress dissent means that it is more likely his position is the right one. If the ideas he is presenting are so stupid then people can decide that for themselves and don’t need some moral busybody protecting us from thinking for ourselves by flagging anything that states the opposite of what their tribe thinks is true.

I was thinking of sharing on Facebook but I'd probably get banned, even if i still feel we should probably keep the lockdown for a little bit longer, because apparently the moral authorities have decided it is off limits to suggest we should end the lockdown or even discuss whether we should.

    > I’m a software / site reliability engineer 
    > based out of Santa Barbara, California.

I'm disappointed with the HN community. The past few weeks, most of the medical articles to hit the front page have been written by dabblers.

Honestly, that shouldn't be surprising. AFAICT, the only way in which the HN community exceeds some random subreddit is in thinking highly of itself.

HN itself combined with hckrnews.com provides an okay enough ui and mix of random interesting articles that makes it still beat out reddit for me.

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

> The HN community doesn't think anything. It's a collection of millions of people.

You could say the same thing about r/The_Donald. And it would be true there, too. But communities, including HN, do often tend to have particular inclinations and behavior as a group, even if there are many individual members who diverge.

And I'd rather see people seriously discuss the groupthink of those communities rather than just dismiss it due to the fact that it isn't completely universal.

> I'd rather see people seriously discuss the groupthink of those communities

It's difficult to discuss that seriously because there's so little objective basis for the claims people make about it. Perceptions vary wildly, and the claims tend to be grand and dramatic. If you hear enough of them, it becomes unmistakeable that they're not really about HN; for one thing, they're so contradictory.

I'm looking for people to poke holes. And so far I've just heard a lot of, well, that.

Which I agree with, I am not an expert, and have not (I hope) pretended to be one.

    > Do you see any substantive issues with the content

(For what it's worth, I agree that it doesn't make sense to participate in a discussion like this without at least having done some background reading)

More importantly, though, there may be a misunderstanding about what HN is. It's an internet watercooler, the purpose of which is gratifying curiosity and having curious conversation. Inevitably that involves dabbling, speculating, and getting things wrong. That's part of what people do when they converse. Does that have downsides, especially in a crisis? Of course it does. But I don't think it would be a solution to try to stop the community from hammering this out.

More here:

https://news.ycombinator.com/item?id=22578300

https://news.ycombinator.com/item?id=22973700

Alternatively: https://www.youtube.com/watch?v=FzOv14fA-BI

"I don't know anything about zoology, biology, geology, geography, marine biology, crypto zoology, evolutionary theory, evolutionary biology, meteorology, limnology, history, hepatology, palaeontology, or archaeology, but I think ..."

Basically, users flagged it. I think the explanation Dang gave me in his e-mail reply is almost certainly correct, and it doesn't contain anything sensitive so I'll just share it here:

> All I can tell you, though, is that users flagged it. We don't know why they flag things, and can only guess. My guess in this case is that it's a combination of some users having covid-story-fatigue, and other users disagreeing with the view in the article. As you know, this question has become politicized and is getting more polarizing as we go forward.

Also, suicide death rates are still wildly unknown but deaths by traffic fatalities are way down. We need to get help to people feeling suicidal. Before the virus and now especially.

Author here. That's a mischaracterization of what I said. But yes it is true that overall mortality is similar to the flu. I settled on COVID-19 being 3x as deadly, but that figure is up to debate.

The important thing to understand is the varying risk profiles. The flu kills the very young and very old, whereas COVID-19 primarily kills the very old.

> Does the flu leave bodies in trucks, apartments, and bagged on the streets?

Yes, pandemic flu absolutely does.

> Does the flu kill dozens of workers in meat processing plants every year

Yup. Pandemic flu absolutely would.

> Does the flu take more than ten years of life from the average person it kills?

Could you clarify this point? I don't quite understand what you're saying. The flu takes away more wellbeing-years per death because it kills infants and young children whereas COVID-19 almost never does.

(BTW, something that occurred to me is that the fact that infants are largely spared from COVID-19 is even more of a blessing than it already seems. Once this passes through our population, new infections will be in those who are not immune which will primarily be infants/young children, who we know thus far have had really good outcomes relative to adults. That means the enduring legacy of this will be much better than what we see with Influenza)

> One, saying something that is 300% larger than another is “similar” is stretching the definition of similarity.

I defined "ballpark" in the article as less than an order of magnitude. But, I think this is a thought exercise that might help:

Imagine that SARS-CoV-2 doesn't exist, but we learn that this flu season is going to be extra deadly. Instead of the ~50k of deaths last year, we know that there will be ~150k deaths.

Would we rationally take the same extreme of measures that we have taken for Covid? (Or, conversely, should we already have been taking these measures for past flu seasons)?

Also I think you're very aware of this, but just for any on-lookers: don't look at the flu comparisons as intending to minimize COVID-19; but rather comparing to flu gives us an existing mental model that most people are familiar with that helps us figure out what measures make sense and what don't.

I had it. Its o way similar to the flu.

Mortality rate for the "regular flu" are well under the mortality rate for ALL age groups except the under 20 folks. (https://duckduckgo.com/?t=ffab&q=seasonal+flu+death+rate+by+...)

The regular flu does NOT kill significantly more young people than COVID-19. The number of young people killed by either is almost a statistical outlier when comparing against overall deaths.

> Could you clarify this point?

COVID-19 deaths take away far more wellbeing-years per death than the regular flu. (https://wellcomeopenresearch.org/articles/5-75/v1)

Maybe mention something about the long term issues that it appears could be a reality for even those who "don’t feel sick at all, some people feel a little bit sick"?

Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission.

Have you seen any scientific literature alleging this possibility in those who are not seriously ill? Not to sound like the WHO, but I have not personally come across any evidence that this is at all true. And indeed it seems highly non-credible.

> Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission.

This is true, but now they can't let anyone into their country until the whole island has been vaccinated. That could get very tricky.

Well, I suppose they could do what Taiwan and other countries have done and aggressively test&quarantine all entrants. That's certainly possible.

That said, most evidence I've read is fairly anecdotal, or made up mainly by case reports. Has anyone compiled so far (this is a honest question, I don't know) the incidence (this is what matters) of different issues post-recovery?

1. The true IFR is hard to estimate at this point, but looks to be around 1%. This is a very difficult question to answer with the data we have and all the limitations.

2. There is little evidence that we can reach herd immunity levels of infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is too high and the immunity too short lived.

3. The IFR has a threshold where it dramatically increases when the number of new cases overwhelms the hospital capacity. We have seen this to a certain extend in Wuhan, Northern Italy and NYC.

4. As treatments improves the IFR should fall. This mean if we can shift an infection to the future we should see less people die. Flattening the curve is more than just avoiding overwhelming the hospital system, it is also about shift cases to a time when we have improved treatments.

5. Sweden has shown that it doesn’t matter if you have an official lockdowns or not, most people will self isolate on their own. There is little extra economic damage from imposing official lockdown policies since all the damage is done by people avoiding infection on their own.

You should open a PR incorporating your reasoning into the document. Be respectful but make it better. I'd hope the best ideas would win out but then again the author has the authority to merge or not.

To the author maybe you should give one other person you respect whose opinion differs from yours the ability to merge PRS as well. Maybe...

An IFR of 1% seems too high. This doesn't seem to line up with data from the Diamond Princess (~1% IFR in a population biased towards elderly). We can also look as a lower bound at the Theodore Roosevelt (the navy ship), which had I believe 840 positives, 4 hospitalizations, 1 death (https://www.sandiegouniontribune.com/news/military/story/202...), and this is a population heavily biased towards the young and fit thus why it's a nice lower bound.

> 2. There is little evidence that we can reach herd immunity levels of infection with a Coronavirus like SARS-CoV-2 as both the unconstrained R0 is too high and the immunity too short lived.

The unconstrained R0 doesn't mean we can't reach immunity, it just means that almost every single person needs to get it, which to me still seems preferable to years-long lockdown.

But the more interesting point of yours is the part about short-lived immunity. I'm going to copy-paste a portion of https://news.ycombinator.com/item?id=23025880 to avoid repeating myself too much:

I think of immunity simplistically as two components:

(1) The presence of actively circulating antibodies in the bloodstream. This is what the (oddly controversial) serology studies are measuring. It is thought that having a significant quantity of these antibodies prevents infection - i.e., what most people envision when they talk about immunity.

(2) Even after the antibodies have faded, there are still Memory B Cells, which lay dormant up to decades, waiting for exposure to the characteristic antigen (in this case, an antigen telling them that they have encountered SARS-CoV-2), at which point they resume and rapidly scale up production of antibodies.

The thinking here is that reinfection is likely possible after a sufficient length of time - whether that's a couple months or a couple years isn't yet known - but when you do get infected, your immune system will respond sooner, more strongly, and thus you will achieve a far lower peak viral load meaning a less serious infection with reduced transmissibility.

So in short, I'd like to see what makes you think the reinfection immunity window is short, but regardless of the window length, we can hopefully agree that the immunological memory cells will stick around for a while.

> 3. The IFR has a threshold where it dramatically increases when the number of new cases overwhelms the hospital capacity. We have seen this to a certain extend in Wuhan, Northern Italy and NYC.

Agreed. My only caveat is this effect is probably not _as_ dramatic as it initially looked, but it is definitely dramatic.

> As treatments improves the IFR should fall. This mean if we can shift an infection to the future we should see less people die. Flattening the curve is more than just avoiding overwhelming the hospital system, it is also about shift cases to a time when we have improved treatments.

Also agreed. I thought about paying lip service to this notion but decided to leave it out of the first draft. Basically my assumption (and it is an assumption) is that the treatments we discover will do a little bit but not a lot. So probably what we've learned thus far about proning, managing oxygen levels etc doesn't leave a ton of room for improvement without a miracle therapeutic. I think antivirals and other treatments will help a small amount but not nearly enough to justify postponing infection.

But yes, at this point I think we can say that in a scenario of successful full containment+vaccine, we would have less area under curve as far as the "overshoot" is concerned and also to a lesser extent the improvement in treatments.

> Sweden has shown that it doesn’t matter if you have an official lockdowns or not, most people will self isolate on their own. There is little extra economic damage from imposing official lockdown policies since all the damage is done by people avoiding infection on their own.

I have to strongly disagree with this. In fact I view this as a strong point in favor of "my" side: we can get the majority of the benefits of the lockdown without actually locking down.

The magnitude of economic damage is much more than just the demand dropoff. We've forced closures of businesses that actually would have been able to stay open. And particularly small businesses which are not well equipped to weather systemic shocks.

But to be clear, I absolutely agree that even without a lockdown we would see very sizeable demand drop-off and thus there would still be some sizeable amount of furloughing, layoffs etc.

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Thanks so much for the points. In particular I'd really like to hear more from you about (2), since that is the point I disagree most with, and after that, point (1). 3-5 I have very few objections as discussed

The Diamond Princess has 13 deaths for 712 cases, so 1.8%.

As you can see in your quote, I was talking about IFR. In general - and this is a theme of the writeup BTW - we should be looking at IFR and not CFR. With IFR we can reasonably extrapolate how many deaths we'll have before new infections halt, whereas CFR is borderline impossible to use because we'd need to know how many cases we would expect per infection. At which point, why not just calculate the IFR anyway, right?

See https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v...

> Adjusting for delay from confirmation-to-death, we estimated case and infection fatality ratios (CFR, IFR) for COVID-19 on the Diamond Princess ship as 2.3% (0.75%-5.3%) and 1.2% (0.38-2.7%). Comparing deaths onboard with expected deaths based on naive CFR estimates using China data, we estimate IFR and CFR in China to be 0.5% (95% CI: 0.2-1.2%) and 1.1% (95% CI: 0.3-2.4%) respectively.

You might also want to look at https://www.eurosurveillance.org/content/10.2807/1560-7917.E...

Even if the IFR turned out to be 0.5% in the end (I hope it is) this is still a lot of dead people.

2. Coronavirus are rather unusual for pathogens in that our immunity to them fades very quickly (less than a year on average) and you can get reinfected again. The question is if SARS-CoV-2 the same. We only have limited data so far, but if you have a look at figure 3 of this pre-print paper [0] you will see the antibody response has faded significantly 60 days post infection.

3. I think it was pretty dramatic in Wuhan, Northern Italy and NYC, but I guess this is one of personal opinion. What is certain is if the number of cases had doubled the system there would have broken down completely.

4. We seem to be in agreement.

5. The reports coming out of Sweden suggest that the economic damage there is just as bad as those countries that went into an official lockdown [1,2]. All Sweden seems to have accomplished is the killing of a large number of elderly Swedes.

Most people are not idiots and they won’t put themselves at risk of getting COVID-19 if they have a choice, but there are enough idiots that won’t self isolate to cause problems. If the economic difference of going into lockdown is the same as not, then why not help idiots not be idiots.

0. https://www.medrxiv.org/content/10.1101/2020.04.15.20066407v...

1. https://www.cnbc.com/2020/04/30/coronavirus-sweden-economy-t...

2. https://www.thelocal.se/20200428/swedens-central-bank-leaves...

I think your argument I find most dubious is the idea that we have lessened health care capacity by sheltering at place and closing businesses. Even if we have furloughed hospital workers, and I'm not saying that isn't a huge blow to those people and their livelihoods, and stopped elective surgeries, and I'm also not saying that those elective surgeries aren't things that don't matter, I think in terms of the next 6 months, the chance that our hospitals have less capacity to deal with serious illnesses that lead to death seem unlikely. If anything the decrease in deaths from other things, like drunk driving, and influenza might offset the loss in capacity from those furloughed.

I agree that if the timeframe is long enough it is very likely to ultimately lead to more deaths from missing elective surgeries and preventative healthcare, and I think the argument for Pareto-efficiency and only asking those who are at risk to shelter in place isn't dismissed with this argument, but I don't think a time frame of say 6 months to a year would lead to more deaths in the way you state. I think you should maybe specify (or point out to me where you state this if I missed it, i'm not a careful reader) what kind of timeframe you believe that the combination of lack of capacity and missing out on preventive measures would start to lead to more deaths and indicate where you think we would reach pareto efficiency. Have we already passed the point of pareto efficiency? Was it never good at all, and the most efficient thing to do was no response?

I personally think you wouldn't see the effects you are talking about for probably at least a year, and I'm hoping it doesn't last that long. I think you might start to see an increase in deaths from other things like, overdose, alcohol, and suicide, in a shorter timeframe than that though, and that is something that probably should be weighed in picking the best time to end the lockdown too.

1. Looking at NYC, the fatality rate is roughly 0.5%. This is based on a 20% positive antibody sample, which is getting large enough that the false positives aren’t overwhelming the data any longer.

2. If we take that as a given, then if 100% of the population becomes infected, we will have 1.5 million deaths. If we assume something more like 60%, then just one million people will die. If we lower the mortality rate to 0.3%, then maybe we are more like 750,000. I have a hard time believing it will be much lower, considering that 0.1% of NYC’s population has already died from covid-19

3. Additionally, if we give up on social distancing, then those people will die in a large wave, overwhelming our hospitals.

4. I would love to see a plan that keeps seniors safe and lets everyone else out. So far, that plan is not forthcoming. It’s hard to see how we keep them safe if their family living with them and their caregivers are all infected. So far, we’ve done a piss poor job of keeping them safe in senior living facilities, even with a lockdown.

5. On the comment that the same number of people will die with a flattened curve - that’s only true if hospitals don’t get overwhelmed, which may well still happen. Additionally, it turns out that the herd immunity point, where transmission drops below 1, is actually a function of the base transmission rate. We can actually reach herd immunity at a lower infection percentage if we are socially distanced, and thus avoid some of the deaths.

Ultimately, I think we will find ways to back off the lockdown, but health departments will be on the look-out and will be titrating the degree of lockdown as cases rise and fall. It’s hard to see e.g. restaurants getting back to anything close to full occupancy any time in the next year, and most of them don’t make enough profit per table to operate half-full (or less).

EDIT: additional point to add: yes, it seems that covid deaths will be heavily weighted to seniors. But so is mortality in general. Let’s roughly assume that the mortality rate for covid is 0.08% for 25-35 year olds. Guess what? The average annual mortality for 25-35 year olds is around 0.08%, so it will roughly DOUBLE if covid sweeps through the entire population this year. Covid could easily become the single largest killer of young adults this year.

The above being said, I think the new york numbers are a perfect upper bound for something close to what a worst case scenario looks like. Although we'd have to look at the age breakdown and obesity rates there; it's definitely very imaginable that there might be other cities in the US with relatively more at-risk individuals.

(BTW I didn't explain it thoroughly in the writeup but New York's data is why I gave a really broad range of .1-.7% net IFR - and it should be clear but this is still very napkin math-y on my part)

I'm also curious if NY serological data includes <18 year olds - if it doesn't include children we need to account for that when extrapolating in the 100% infection scenario.

Anyway, the above is all a really drawn out way of saying that I agree :P

> Additionally, if we give up on social distancing, then those people will die in a large wave, overwhelming our hospitals.

If we gave up everything, certainly. I think with mitigation targeted at the at-risk, that's less likely.

For me "ending lockdown" doesn't mean that everyone stops wearing masks and/or trying to maintain physical distance where possible. But I do want to avoid a scenario where we're mandating that people wear masks outside as opposed to just encouraging them to.

But I do agree that just because we haven't overwhelmed hospitals yet doesn't mean that we're in the clear. I was considering saying as much in the doc but wanted to keep the word count down for the first iteration.

However I do think that since pretty much every city has at least some low amount of infection, and that we will have some capacity to do some clever shuffling of ventilators, tents, etc, that hospital overrun isn't nearly as much of a risk at this point overall.

> 4. I would love to see a plan that keeps seniors safe and lets everyone else out. So far, that plan is not forthcoming. It’s hard to see how we keep them safe if their family living with them and their caregivers are all infected. So far, we’ve done a piss poor job of keeping them safe in senior living facilities, even with a lockdown.

Yeah, really the best thing would be voluntary exposure of people surrounding the at-risk individuals. But I don't foresee that actually happening. I really think nursing homes are the low-hanging fruit here, and as you indicated it seems like we've already kind of screwed that one up in a lot of places.

But essentially, in the alternative of full containment+waiting for vaccine, it seems to me much harder for the caregivers surrounding the extremely-at-risk to be able to avoid getting infected and passing it on to the at-risk, whereas in a scenario where they can get it over with then they don't have to worry at all going forward. But that requires being able to detect that you're sick before infecting the at-risk individual so that you can isolate while recovering, which obviously requires really good testing capacity.

Basically, it would be great if we could selectively redirect the bulk of our testing capacity for individuals in these situations. But there's not a very clear way to do that, the last thing we want is having a bureaucrat decide if you're eligible for a test or not. So perhaps the best we can do is - and this is a theme here - encouraging those who are surrounding at-risk individuals to get tested extremely frequently.

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Lastly just wanted to call out this:

> I think you’ve gotten a lot right, and i think analyses like this get down to the point where we can have a rational discussion.

That means a lot. I really want us as a society to get to a point where there is broad agreement on what the facts on the ground are, so that differences in policy come down to differences in philosophy/values rather than where it feels like we're at now as a society, which is basically two warring factions each with non-intersecting sets of facts ("the death rate is 5%!" versus "no the death rate is .03!)

Looking at the total number of excess deaths (for all causes, ignoring if it is COVID-19 or not), I would say that it looks more likely that it is severely undercounted.

You can find the graphs here: https://www.ft.com/coronavirus-latest (look for excess mortality rates for New York City).

I guess you could argue that the huge increase in deaths was caused by side-effects of the lockdown, but that does not really jive with the results from countries like Denmark, which did an early and hard lockdown, and as result show almost no extra mortality.

The article claims that the survival of the healthcare system in places that implemented a lockdown has nothing to do with the lockdown, but then gives no evidence at all to back up that assertion.

https://www.nationalreview.com/corner/coronavirus-fatality-r...

That's the whole point of YPLL and other age adjusted metric that the scientist and academics who study disease, pollution, etc. use.

Makes sense really. Maybe a focused effort should be made to protect nursing homes.

COVID-19 is bad, but if you exclude the nursing homes from the stats it doesnt justify the lockdown damage. Is there a realistic plan to isolate big nursing homes somewhere?

Besides, the circumstances of the deaths are vastly different: deaths at retirement homes vs deaths in general population. Indeed, merely locking down Swedish retirement homes would have made your pro-lockdown argument meaningless.

Comparisons with eg Sweden at this point have always seemed strange to me because the whole point of a herd immunity approach is to increase exposure initially, which will necessarily involve deaths being less spread out. The real question is, after a year, what's the total excess mortality including non-COVID cases due to delayed treatments due to lockdown etc. (which are never included in the models, which focus on one disease, and would take time to manifest) ?

I'm not opposed to shelter in place but the endgame logic has always been unclear, and as such, classist. The right way to do it, for example, is to pay people to stay home.

https://translate.google.com/translate?sl=it&tl=en&u=https%3...

As an addition, not all the measures were correct to "fight" the pandemic in Northern Italy, where I am located. Glaring errors were made in putting patients within nursing homes, with "guarantees" of separation. Well, these guarantees did not hold, and death counts flared up there. To be fair, this also happened in all nursing homes in the country.

Also some regions were more efficient than others, some even started implementing contact tracing in absence of a position from the government (still not clear as of today).

I believe that a more directed lockdown (or avoiding errors like in Alzano Lombardo, near Bergamo, where basically a hospital turned into an "infection center") would've worked miles better than the current situation, where regions with almost no new infections are locked up as much as those with significant counts.

The state of hospitals in Italy tell a different story. It might not be numbers, but it is more reliable indication of what letting this go rampant means.

And it still collapsed.

Don't get me wrong, lockdowns are super problematic and the economic hit is going to be really, really bad but it's better than letting health systems collapse.

For instance, Ireland (where I live) had 220 ICU beds before this started; we upped that to around 500 and around 350 were filled at the highest point.

And this was with a lockdown (started March 12th, massively tightened March 26th).

Our health service would have collapsed without the measures that have been taken, so I totally see why lockdowns have been introduced almost everywhere.

The best case scenario for this kind of event is that you react too quickly, everything's OK and then people complain that all the measures you took weren't necessary.

To be honest, it was good, but it was not as good as people hoped. Massive errors like allowing infections to run rampant in the hospital in Alzano Lombardo contributed a lot to the spread of the disease in the area around Bergamo and Brescia.

ICUs were also at 80% utilization when the pandemic hit, because beds have been slashed a lot in the past years.

Author suggests self-quarantine for the obese instead of quarantine/lockdown for everyone. The CDC suggests that +42% of the US adult population is obese [0]. Are we really going to isolate or quarantine 4 out of 10 US adults and imagine the economy can get back on track?

[0]: https://www.cdc.gov/obesity/data/adult.html

It's a good start. Also "encourage" is different from "enforce".

They can't compel a vulnerable WFH person to rejoin an open plan sardine office, nor can they fire them for not rejoining without attracting attention for discrimination. I know a tech worker who used to wheel an oxygen tank to the office: I imagine that person is more than a little concerned right now.

It also implies that a partly WFH workforce cannot be sidelined: once one person is remote the whole culture needs to be organized around remote process.

Depends on your labour laws, and facilities more than on the market IMHO.

Better than everyone pulling their hair out at home. Plus, why not have people choose themselves whether they're healthy enough to take chances and go out to work?

Because people who chose to take that risk will still go back to their homes and infect people who'd rather not, or can't afford to.

Because people go to work sick otherwise they can't put food on the table, especially in a country where not going to work massively means losing your job in a country without a sensible, humane healthcare system.

Three reasons immediately spring to mind:

1. It's a very well established fact that C19 can transmitted by asymptomatic people. "Healthy enough" does not mean "safe"

2. Ignoring that fact, I know can personally name several people who would absolutely go to work sick.

3. I've have several employers who would say "Do totally have a choice...come in or you're fired and I'll find someone else who will do it". This includes a very vivid memory of a manager telling one employee that she doesn't not have a valid excuse to miss her shift while she was still weeping because her grandmother had died.

(3) is still a valid concern. Government policy could help, but it'd be weird (and provoke a major public backlash, no doubt) if us fat people got a stipend for being fat.

People who aren't virus-free shouldn't be in the general public. That's kinda the point.

If I bought the assumption that getting COVID19 was relatively safe for me, I'd gladly swap jobs to keep someone else safe, especially if it meant moving up in the world. An at-risk individual could do my job, and I'd take their in-person job.

While I think there are better mechanisms, free markets could take care of swapping people around. If you're self-quarantining, and you have a better job than I do, I'll take your job. My job is now vacant for you. That's far from ideal -- you've just taken a pay cut -- but it's far better than mass unemployment.

What we'd need from there would be much cheaper than the successive stimuli (e.g. support for at-risk low-income individuals: like a stimulus check, bigger, but only to people who need it).

Now, to be willing to do this, I'd need to believe COVID19 is relatively safe for me (e.g. <1% odds of death _or significant long-term complications_). That's an assumption I don't buy. By looking at IFR/CFR numbers, we've ignored the much bigger question: how many people end up with permanent lung damage or other organ damage. Until we have a clear answer, I'm in lock-down mode unless I'm forced out.

Note that a company giving a bad reference because you refuse the terms is likely to lose a lawsuit (in the US) since courts will find it reasonable for someone to refuse to come into work given the experts advice at this time. Thus the company will probably just confirm your dates of employment and refuse to say anything more about your performance while working there.