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Axiom of Choice

Coronavirus - discussion of what ifs and hypotheticals

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4 minutes ago, ballrific said:

Surly surprised me, I figured this thread would have been nuked by lunch time...

What fucking country do you live in?

OP was posted at 2:30ish Central

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Posted (edited)
22 minutes ago, Dahobbs said:

I guess my larger point is this: even if we did this plan, there would still be economic turmoil. And, not guarantee of better outcome than general isolation. I don't think we have an option of dealing with a massive pandemic like this in ways that aren't severely damaging to the economy. We can look for the best of a bunch of bad answers, but let's not pretend we ever had the option of avoiding severe economic distress. 

Good points.  Consider the hypothetical of how we would have reacted if the coronavirus outbreak occurred twenty years ago.  I don't think we would have taken such drastic measures (if you disagree with this premise, then just consider a scenario in which we do not take such drastic measures).  More people would die due to the spread of the virus. But when considering all factors including the overall impact on quality of life, lost time, related mental and physical health issues, duration and recovery from event, etc, is our approach better overall?  To me that is not so clear.  

 

11 minutes ago, bernorange said:

You are getting dangerously close to the same questions I posed here:

https://www.surlyhorns.com/board/index.php?/topic/13864-pondering-the-morality-of-quarantine-regulation/

 

On 2/24/2020 at 9:25 PM, bernorange said:

Actually, I started the thread with a philosophical intent.  

Ha, there is where you went wrong in this forum.  

Edited by Axiom of Choice

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4 minutes ago, Axiom of Choice said:

Consider the hypothetical of how we would have reacted if the coronavirus outbreak occurred twenty years ago. 

You must not have been around 20 years ago.  We had a different apocalypse going on with Y2K.   

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5 minutes ago, Sbbruin said:

You must not have been around 20 years ago.  We had a different apocalypse going on with Y2K.   

VrtK0Nf5aWRwqAaAnhXWANlRfHcpLH_81EiR2Q8_

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Posted (edited)
21 minutes ago, Sbbruin said:

You must not have been around 20 years ago.  We had a different apocalypse going on with Y2K.   

Maybe you are right.  My perception is that reactions are more extreme these days due to numerous constant streams of sensationalism.  

Edited by Axiom of Choice

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5 minutes ago, Sbbruin said:

You must not have been around 20 years ago.  We had a different apocalypse going on with Y2K.   

Funny thing, people now claim we overreacted. It is a classic problem: the more successful your actions are at preventing an ill, the more it looks like you actions were unnecessary. Y2K was a big deal. And a lot of companies and people  spent a lot of money and time to make sure nothing mission critical broke. Y2K should be the story of our successful ability to address a crisis, instead it is a punchline. We learned the wrong lesson. I hope we don't learn the wrong one this time. 

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10 minutes ago, Sbbruin said:

You must not have been around 20 years ago.  We had a different apocalypse going on with Y2K.   

This actually isn't that great of a comparison in terms of actual response to the threat. There were folks working on updating all the old COBOL and FORTRAN code for literal years leading up to Y2K, and the fact it was such a non-event is a testament to the superb project planning and technical effort behind it.

Shit, Office Space came out in '99 and that was the driving force behind the shitty job that Peter had.

COVID-19 is not in any way comparable to Y2K. We are not prepared for it.

Also, damn you dahobbs for beating me to the punch lol

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It’s fascinating that the highly successful doctor chimes in essentially agreeing with the op in theory (even if it’s unworkable in practice), while the mob shouts him down as ignorant.

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1 hour ago, Digdogger said:

When did Spring Break become so ugly?  Seriously that was hard to watch.  

When you sobered up. 

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12 minutes ago, formermav43 said:

It’s fascinating that the highly successful doctor chimes in essentially agreeing with the op in theory (even if it’s unworkable in practice), while the mob shouts him down as ignorant.

I think most agree with the theory--allotting all available resources to isolating just those in the higher risk categories--to at least some extent. It's just so incredibly unworkable in practice that it's not worth entertaining.

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2 minutes ago, aggie08 said:

I think most agree with the theory--allotting all available resources to isolating just those in the higher risk categories--to at least some extent. It's just so incredibly unworkable in practice that it's not worth entertaining.

Maybe. But some of the rhetoric on this thread indicates otherwise.

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18 minutes ago, formermav43 said:

It’s fascinating that the highly successful doctor chimes in essentially agreeing with the op in theory (even if it’s unworkable in practice), while the mob shouts him down as ignorant.

People are crazy sensitive right now and honestly the title likely had people pissed the second they clicked on the thread.  Hell, when I initially clicked I was about to lay into OP too...but the post (not the title) was thought out and made you think...it also had some good points. 

I'm not for fatwa but people right now have a very short fuse. 

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3 hours ago, Hefeweizen said:

Is that why they’re calling it the boomer remover?  I wondered where that came from!

Boomer doomer in my knock of the woods

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37 minutes ago, formermav43 said:

It’s fascinating that the highly successful doctor chimes in essentially agreeing with the op in theory (even if it’s unworkable in practice), while the mob shouts him down as ignorant.

It's crazy how quickly consent gets manufactured and how certain people are about it.  This is complex problem with numerous factors involved for billions of people in a massive range of circumstances.  Yet many seem to innately know the best possible way the world should react in the face of this new infectious disease as if it were a straightforward problem routinely dealt with. 

 

16 minutes ago, ChiTownDoc said:

People are crazy sensitive right now and honestly the title likely had people pissed the second they clicked on the thread.  Hell, when I initially clicked I was about to lay into OP too...but the post (not the title) was thought out and made you think...it also had some good points. 

I'm not for fatwa but people right now have a very short fuse. 

I did not give the title much thought at all.  I typed the post first and didn't really know what to call it.  I honestly did not mean for it to be incendiary.  

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Good post and kudos to the OP for having the balls to post it. 

The more I've thought about it the past couple of days, the more I'm wishing there would be more discussion of the costs versus the benefits. Thus far the discussion from president to the school board to the mega SURLY DT thread has been, WE GOTTA SHUT IT ALL DOWN RIGHT NOW NO MATTER THE COSTS! PEOPLE ARE DYING! LOOK AT ITALY!

No offense, but the old people who may or may not die from this aren't going to live forever anyway. They'll die from this or something else in the near future instead. My maternal grandmother is 94. My dad is is 83. I love them both, but that doesn't change the calculus. Maybe that's heartless, but we've had actuaries for years making these types of evaluations. It's the way the world works. 

I'm not sure I want people to be losing their jobs and the economy to go into the shitter and kids to miss out on 1/3 of the school year and prom and track meets and graduation and Little League and whatever else just so either one of the old people in my life might live a couple more years. I mean yeah, let's do our best to protect them and isolate those at risk, but let's also think of the big picture and not go crazy doing it. 

And sure, there are young people who are getting sick, but that percentage is infinitesimally small and the number of healthy young people getting sick is even smaller still. The plural of anecdote is not data. The tweet from the young guy yesterday that was meant to be so scary also just casually brushed off the fact that HE HAS ASTHMA. That's not minor and it means his risk is probably not comparable to other people his age. 

Not to mention that data keeps bubbling to the surface that maybe it's not as bad as we think it is. Selection bias is rampant because we're only testing the people who are sick. It appears that a lot of people already have it who aren't getting sick. 

Guess what I'm saying is, I'm not sure if all of this panic - and that's what it is - is going to be worth the cost in the long run. People need to catch their breath. 

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11 minutes ago, Axiom of Choice said:

It's crazy how quickly consent gets manufactured and how certain people are about it.  This is complex problem with numerous factors involved for billions of people in a massive range of circumstances.  Yet many seem to innately know the best possible way the world should react in the face of this new infectious disease as if it were a straightforward problem routinely dealt with. 

 

I did not give the title much thought at all.  I typed the post first and didn't really know what to call it.  I honestly did not mean for it to be incendiary.  

I'd change the title of the thread to "contrarian perspective" or something like that. I think it would be valuable to have a thread that isn't knee deep in panic. 

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I did not see you mention what would happen if you were in a bad car accident or accidently fell down a flight of stairs if the hospitals are overwhelmed due to "not going crazy" about social isolation. Or what if a healthy young person gets a snake bite?  They might end up dead too.

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11 minutes ago, crimsonlonghorn said:

Good post and kudos to the OP for having the balls to post it. 

The more I've thought about it the past couple of days, the more I'm wishing there would be more discussion of the costs versus the benefits. Thus far the discussion from president to the school board to the mega SURLY DT thread has been, WE GOTTA SHUT IT ALL DOWN RIGHT NOW NO MATTER THE COSTS! PEOPLE ARE DYING! LOOK AT ITALY!

No offense, but the old people who may or may not die from this aren't going to live forever anyway. They'll die from this or something else in the near future instead. My maternal grandmother is 94. My dad is is 83. I love them both, but that doesn't change the calculus. Maybe that's heartless, but we've had actuaries for years making these types of evaluations. It's the way the world works. 

I'm not sure I want people to be losing their jobs and the economy to go into the shitter and kids to miss out on 1/3 of the school year and prom and track meets and graduation and Little League and whatever else just so either one of the old people in my life might live a couple more years. I mean yeah, let's do our best to protect them and isolate those at risk, but let's also think of the big picture and not go crazy doing it. 

And sure, there are young people who are getting sick, but that percentage is infinitesimally small and the number of healthy young people getting sick is even smaller still. The plural of anecdote is not data. The tweet from the young guy yesterday that was meant to be so scary also just casually brushed off the fact that HE HAS ASTHMA. That's not minor and it means his risk is probably not comparable to other people his age. 

Not to mention that data keeps bubbling to the surface that maybe it's not as bad as we think it is. Selection bias is rampant because we're only testing the people who are sick. It appears that a lot of people already have it who aren't getting sick. 

Guess what I'm saying is, I'm not sure if all of this panic - and that's what it is - is going to be worth the cost in the long run. People need to catch their breath. 

There absolutely needs to be a cold, emotionless deep dive into the number of lives that we think these actions saved vs. the effects on the economy and unemployment, and what we should do differently next time...

...after the worst is behind us. Right now, all we can do is hope for the best, and prepare for the worst. There's not enough real data on this virus yet to do the kind of calculus you suggest. All we have is literally every expert in the field saying that we should have been doing way more, way sooner. Politicians suck, but can anyone really fault them for taking the course of action that might lead people to say that they overreacted vs. risking being accused of not doing enough and causing people to die?

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There absolutely needs to be a cold, emotionless deep dive into the number of lives that we think these actions saved vs. the effects on the economy and unemployment, and what we should do differently next time...
...after the worst is behind us. Right now, all we can do is hope for the best, and prepare for the worst. There's not enough real data on this virus yet to do the kind of calculus you suggest. All we have is literally every expert in the field saying that we should have been doing way more, way sooner. Politicians suck, but can anyone really fault them for taking the course of action that might lead people to say that they overreacted vs. risking being accused of not doing enough and causing people to die?

The expert on the field thing is absolutely true. And hopefully the correct path. But here is the funny thing about experts in the field.

1. They don’t always have a track record of leading people down the correct path just because they are experts. Sometimes they are so programmed to fight one thing they fail to step back and see the really big picture.
2. They’re human. They’re getting attention right now for being experts. Most of them are probably dispassionate about that...maybe I hope.


There's a little boy and on his 14th birthday he gets a horse... and everybody in the village says, "how wonderful. The boy got a horse" And the Zen master says, "we'll see." Two years later, the boy falls off the horse, breaks his leg, and everyone in the village says, "How terrible." And the Zen master says, "We'll see." Then, a war breaks out and all the young men have to go off and fight... except the boy can't cause his legs all messed up. and everybody in the village says, "How wonderful."

Now the Zen master says, "We'll see."

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3 minutes ago, Surly Bevo said:


The expert on the field thing is absolutely true. And hopefully the correct path. But here is the funny thing about experts in the field.

1. They don’t always have a track record of leading people down the correct path just because they are experts. Sometimes they are so programmed to fight one thing they fail to step back and see the really big picture.
2. They’re human. They’re getting attention right now for being experts. Most of them are probably dispassionate about that...maybe I hope.


There's a little boy and on his 14th birthday he gets a horse... and everybody in the village says, "how wonderful. The boy got a horse" And the Zen master says, "we'll see." Two years later, the boy falls off the horse, breaks his leg, and everyone in the village says, "How terrible." And the Zen master says, "We'll see." Then, a war breaks out and all the young men have to go off and fight... except the boy can't cause his legs all messed up. and everybody in the village says, "How wonderful."

Now the Zen master says, "We'll see."

I thought it ends with the Knicks saying, ‘fuck you, you’re fired’.

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6 hours ago, Axiom of Choice said:

The coronavirus will likely kill less than 10 people below the age of 25 in the US.  This is based on the deaths by percentage within age groups of Italy and South Korea and assuming 25% of the population will contract the virus, and an overall mortality rate of 1% (death/actually infected, not CFR or death/confirmed cases).  To give some comparison, about 3,100 people below the age of 25 died in the US from the H1N1 epidemic in 2009 (Link 1, Link 2).  Using the same measures, the coronavirus will kill about 5,000 between the age of 30-50 in the US.  About 4,000 people between the age of 25-50 died in the US from the H1N1 epidemic in 2009.  Overall, less people under the age of 50 will die from coronavirus than the H1N1 2009 pandemic.  Also, these total death numbers are assuming more people will contract the coronavirus than the number of people who contracted H1N1.  Among those who have contracted the diseases, for people below 50 the H1N1 is much more deadly than the coronavirus.  The numbers start to look a lot worse for the coronavirus when the age groups increase.  But in summary, this pandemic is mostly killing off the elderly.  Early reports on the average age of coronavirus deaths in Italy is 81 years old.

It seems crazy to me that we are cancelling schools, canceling weddings and all other social events, essentially putting young people’s lives on hold (for how long exactly?  6, 12, 18 months?) for something that is not a serious threat to them.  For young people, this thing is much less deadly than other flu strains in recent decades.  We are also crippling the economy and putting much of this burden and stress on young working people.  I’m not trying to belittle the pandemic overall or discount the impact on the elderly.  It is obviously a serious matter and we need to take many precautions.  But I think a better approach would be to take extreme caution with the elderly and at risk groups and let others go on with their lives.  
 

Can we change the damn title?  I really think this is a worthy discussion but too many are gonna drive by neg and we're all missing out.  And once again, when I saw the title, I also wanted to neg and leave

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2 hours ago, crimsonlonghorn said:

I'd change the title of the thread to "contrarian perspective" or something like that. I think it would be valuable to have a thread that isn't knee deep in panic. 

 

1 minute ago, ChiTownDoc said:

Can we change the damn title?  I really think this is a worthy discussion but too many are gonna drive by neg and we're all missing out.  And once again, when I saw the title, I also wanted to neg and leave

I would change the title, but it doesn't give me the option edit posts past a certain time.  Not sure how to do it at this point.  

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4 minutes ago, Axiom of Choice said:

 

I would change the title, but it doesn't give me the option edit posts past a certain time.  Not sure how to do it at this point.  

That's for mods.  Can one of you bat signal them with the hashtag?  I'm slow like that. 

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There absolutely needs to be a cold, emotionless deep dive into the number of lives that we think these actions saved vs. the effects on the economy and unemployment, and what we should do differently next time...
...after the worst is behind us. Right now, all we can do is hope for the best, and prepare for the worst. There's not enough real data on this virus yet to do the kind of calculus you suggest. All we have is literally every expert in the field saying that we should have been doing way more, way sooner. Politicians suck, but can anyone really fault them for taking the course of action that might lead people to say that they overreacted vs. risking being accused of not doing enough and causing people to die?


Any snapshot in the middle of this thing is almost worthless. We’re blaming people for not having the right reaction to an unprecedented event and murky early info. It’s going to take a long time to really know what mistakes were made, by whom, and when.

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To what?

Boomer Remover?

Young people party up while old people can fuck off and die thread?

Fuck the olds, party on young people

 

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6 hours ago, Axiom of Choice said:

It seems crazy to me that we are cancelling schools, canceling weddings and all other social events, essentially putting young people’s lives on hold (for how long exactly?  6, 12, 18 months?) for something that is not a serious threat to them.  
 

So you've been too lazy to watch any of the doctors on tv 24/7 for the last month and now you want us to explain it to you?

You've got the entire internet in front of you right now.  Figure it out. 

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Posted (edited)

I am curious to see how people envision the logistics working. This is how I see it going:

- Tell everyone over 50 to work from home and isolate themselves.

- Have others deliver them essentials (food and medicine) where possible.

- Everyone else carries on as normal.

- Susie Public is pissed that their boss is being protected by the government, but her and her kids aren't.

- Some of the olds say, "Fuck this, I'm healthy. If other people can go out, so can I."

- People shame the olds that dare visit a grocery store.

- A dozen or so people under 50 die anyway, leading to outrage that further steps weren't taken, the government caves, and we're where we are now...just a few weeks later.

Edited by aggie08

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7 minutes ago, blacklab said:

To what?

Boomer Remover?

Young people party up while old people can fuck off and die thread?

Fuck the olds, party on young people

 

BL is like "fuck yall I'm old"

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Can we change the damn title?  I really think this is a worthy discussion but too many are gonna drive by neg and we're all missing out.  And once again, when I saw the title, I also wanted to neg and leave
Yeah, my comment was based mostly on the title and how it would be handled by drive by shag negs.

I agree, it doesn't seem that kids are going to really be affected and thats not why sports/schools are shutting it down. It's that kids could be carriers along with young, healthy folks and be contagious around the 50+ crowd/parents/grandparents.

Yeah, sure, I'm on board with thinking 80+ yr olds "will eventually die of something" but no one knows enough right now to apply a broad brush such as "everyone is overreacting and data shows it wont kill kids, so let the kids be in their sports/schools and we'll be fine".

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Posted (edited)
10 minutes ago, TexArcher said:

you want us to explain it to you?

Yes.  Explain, discuss.  Same as any other message board thread. 

 

Just saw thread title was changed. Thanks to whoever changed it.  

Edited by Axiom of Choice

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I think one of the best if scenarios after reading surly the last few years is there there are some folks on this site the truly could have cured the world of this the first week with how brilliant they are. Instead the remained in place at Buffalo Wild Wings serving food hiding their extreme brilliance from the world

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1 minute ago, Axiom of Choice said:

Yes.  Explain, discuss.  Same as any other message board thread. 

Okay.  Communicable diseases are communicable.  Everyone can pass this along whether it kills them or not, so everyone should be isolated to protect the more vulnerable.  The good of the herd is more important than whether these twits have an epic spring break or not.  The end.

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4 hours ago, Dahobbs said:

Funny thing, people now claim we overreacted. It is a classic problem: the more successful your actions are at preventing an ill, the more it looks like you actions were unnecessary. Y2K was a big deal. And a lot of companies and people  spent a lot of money and time to make sure nothing mission critical broke. Y2K should be the story of our successful ability to address a crisis, instead it is a punchline. We learned the wrong lesson. I hope we don't learn the wrong one this time. 

As a young man, I spent a considerable amount of time in the late 90's working on Y2K projects. I  remember all of the old timers working as consultants because no one understood COBOL. I used to talk so much shit to those old dudes. "Why you guys so tired? I've been working over 24 hours straight, took an hour off to bang my girlfriend. Dude check out my website, Object Oriented, Bitches!, you should definitely invest in pets.com fuck your pension."

Hope those guys avoid the Covid if they are still around.

 

 

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So, another huge problem with this plan specific to SARS2-CoV, we don't know much about it at all. If any of your assumptions are slightly wrong (e.g., CFR for those 50 and younger), you could easily be looking at hundreds of thousands of dead or more (even assuming you managed to avoid exposure to the older folks). It is after all a novel virus to us all: we don't know what the long term side effects will be, we don't really know how it will effect our population, we don't really know all the risk factors and disease rates. We have a bunch of partial data, and haven't had the time to do any rigorous scientific testing. If your assumptions are right, if our initial data is predicative, if there are no long term effects, and if we were able to avoid exposure to the elderly, then maybe your plan works better. That's a lot of ifs.  It seems to me the conservative plan of limiting the spread as much as possible to buy us time to learn more is the safer play. Not that I'm against a risky play here and there, but I'm not sure a public health crisis is the time to try one. Maybe we can try your plan if/when a round 2 occurs and we have a lot more information. 

Also, to go back on my point about hospitalizations:

https://www.cnn.com/2020/03/19/health/coronavirus-age-victims/index.html

The CDC analyzed the cases of about 2,500 patients in the United States whose ages were known. Of the 508 patients known to have been hospitalized, 20% were notably younger — between ages 20 and 44, while 18% were between ages 45 and 54, the report says. The highest percentage of hospitalized patients was at 26% between ages 65 and 84.

Those numbers suggest a much higher level of hospitalization of younger folks than I was guesstimating above. Again, even if not a lot of people die (at first), we simply don't have the ability to treat millions of people that require hospitalization all at once. And that failure then leads to more deaths, whether due to COVID-19 or other issues that can't be treated due to an overwhelmed system. And, that would then lead to economic collapse. 

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11 hours ago, F250 said:

As a young man, I spent a considerable amount of time in the late 90's working on Y2K projects. I  remember all of the old timers working as consultants because no one understood COBOL. I used to talk so much shit to those old dudes. "Why you guys so tired? I've been working over 24 hours straight, took an hour off to bang my girlfriend. Dude check out my website, Object Oriented, Bitches!, you should definitely invest in pets.com fuck your pension."

Hope those guys avoid the Covid if they are still around.

 

 

No one understands COBOL. 

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Posted (edited)

Good article. 

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

Quote

A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data

By JOHN P.A. IOANNIDIS

The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco.

At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.

Draconian countermeasures have been adopted in many countries. If the pandemic dissipates — either on its own or because of these measures — short-term extreme social distancing and lockdowns may be bearable. How long, though, should measures like these be continued if the pandemic churns across the globe unabated? How can policymakers tell if they are doing more good than harm?

Vaccines or affordable treatments take many months (or even years) to develop and test properly. Given such timelines, the consequences of long-term lockdowns are entirely unknown.

The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.

This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.

The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.

Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

That huge range markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.

Could the Covid-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes. In fact, such “mild” coronaviruses infect tens of millions of people every year, and account for 3% to 11%of those hospitalized in the U.S. with lower respiratory infections each winter.

These “mild” coronaviruses may be implicated in several thousands of deaths every year worldwide, though the vast majority of them are not documented with precise testing. Instead, they are lost as noise among 60 million deaths from various causes every year.

Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases. In the U.S., for example, so far this season 1,073,976 specimens have been tested and 222,552 (20.7%) have tested positive for influenza. In the same period, the estimated number of influenza-like illnesses is between 36,000,000 and 51,000,000, with an estimated 22,000 to 55,000 flu deaths.

Note the uncertainty about influenza-like illness deaths: a 2.5-fold range, corresponding to tens of thousands of deaths. Every year, some of these deaths are due to influenza and some to other viruses, like common-cold coronaviruses.

In an autopsy series that tested for respiratory viruses in specimens from 57 elderly persons who died during the 2016 to 2017 influenza season, influenza viruses were detected in 18% of the specimens, while any kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.

If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths. This sounds like a huge number, but it is buried within the noise of the estimate of deaths from “influenza-like illness.” If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year. At most, we might have casually noted that flu this season seems to be a bit worse than average. The media coverage would have been less than for an NBA game between the two most indifferent teams.

Some worry that the 68 deaths from Covid-19 in the U.S. as of March 16 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?

The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.

In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns. Unfortunately, we do not know if these measures work. School closures, for example, may reduce transmission rates. But they may also backfire if children socialize anyhow, if school closure leads children to spend more time with susceptible elderly family members, if children at home disrupt their parents ability to work, and more. School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease.

This has been the perspective behind the different stance of the United Kingdom keeping schools open, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.

Flattening the curve to avoid overwhelming the health system is conceptually sound — in theory. A visual that has become viral in media and social media shows how flattening the curve reduces the volume of the epidemic that is above the threshold of what the health system can handle at any moment.

Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated. If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse: Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity.

One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health. Unpredictable evolutions may ensue, including financial crisis, unrest, civil strife, war, and a meltdown of the social fabric. At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.

In the most pessimistic scenario, which I do not espouse, if the new coronavirus infects 60% of the global population and 1% of the infected people die, that will translate into more than 40 million deaths globally, matching the 1918 influenza pandemic.

The vast majority of this hecatomb would be people with limited life expectancies. That’s in contrast to 1918, when many young people died.

One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.

John P.A. Ioannidis is professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.

About the Author

John P.A. Ioannidis

 jioannid@stanford.edu

 @METRICStanford

 

 

 

 

Edited by crimsonlonghorn

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12 hours ago, RollLeft said:

It warrants a conversation, i'm not sure now is the time.    

Yes, let's do major damage and collapse the economy and ruin people's lives first, then that will be a much better time to decide if we did the right thing or not.

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16 hours ago, crimsonlonghorn said:

I'm not sure I want people to be losing their jobs and the economy to go into the shitter and kids to miss out on 1/3 of the school year and prom and track meets and graduation and Little League and whatever else just so either one of the old people in my life might live a couple more years. I mean yeah, let's do our best to protect them and isolate those at risk, but let's also think of the big picture and not go crazy doing it. 

Guess what I'm saying is, I'm not sure if all of this panic - and that's what it is - is going to be worth the cost in the long run. People need to catch their breath. 

Fast forward 5 years and the economy is still in turmoil because of the damage that was done from actions taken to keep the coronavirus from spreading. People that were retirement age had savings decimated and are now relying on the government to support thereby keeping the economy in a hole. Older generations now turning to their kids for support and help who also had savings decimated therefore don't have the level of savings needed to continue a growing economy. eek!!

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So we suck it up, keep being Americans and deal with it. Retirement? we need to think about realities. Where do we save money at the local level? Do we need football in every high school? 

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Posted (edited)
10 minutes ago, InkaUtexas said:

So we suck it up, keep being Americans and deal with it. Retirement? we need to think about realities. Where do we save money at the local level? Do we need football in every high school? 

Or maybe start with all the other sports that anyone other than the parents don't care about... throw in getting rid of Title IX while we are at it. 

I'm not sure this would really save that much though... let's get rid of wasteful city spending and cut all property taxes. That might be a fun way to start.

Edited by ZB'Tejas

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Just now, ZB'Tejas said:

Or maybe start with all the other sports that anyone other than the parents care about... throw in getting rid of Title IX while we are at it. 

I'm not sure this would really save that much though... let's get rid of wasteful city spending and cut all property taxes. That might be a fun way to start.

Sure, I think we need to get back to Extra Curricular being something every tax payer does not need to cover. 

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17 hours ago, crimsonlonghorn said:

Good post and kudos to the OP for having the balls to post it. 

The more I've thought about it the past couple of days, the more I'm wishing there would be more discussion of the costs versus the benefits. Thus far the discussion from president to the school board to the mega SURLY DT thread has been, WE GOTTA SHUT IT ALL DOWN RIGHT NOW NO MATTER THE COSTS! PEOPLE ARE DYING! LOOK AT ITALY!

No offense, but the old people who may or may not die from this aren't going to live forever anyway. They'll die from this or something else in the near future instead. My maternal grandmother is 94. My dad is is 83. I love them both, but that doesn't change the calculus. Maybe that's heartless, but we've had actuaries for years making these types of evaluations. It's the way the world works. 

I'm not sure I want people to be losing their jobs and the economy to go into the shitter and kids to miss out on 1/3 of the school year and prom and track meets and graduation and Little League and whatever else just so either one of the old people in my life might live a couple more years. I mean yeah, let's do our best to protect them and isolate those at risk, but let's also think of the big picture and not go crazy doing it. 

And sure, there are young people who are getting sick, but that percentage is infinitesimally small and the number of healthy young people getting sick is even smaller still. The plural of anecdote is not data. The tweet from the young guy yesterday that was meant to be so scary also just casually brushed off the fact that HE HAS ASTHMA. That's not minor and it means his risk is probably not comparable to other people his age. 

Not to mention that data keeps bubbling to the surface that maybe it's not as bad as we think it is. Selection bias is rampant because we're only testing the people who are sick. It appears that a lot of people already have it who aren't getting sick. 

Guess what I'm saying is, I'm not sure if all of this panic - and that's what it is - is going to be worth the cost in the long run. People need to catch their breath. 

Hi Vanessa, welcome to the board.

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Not having a conversation about this is going to do that, now?  If that is what you are trying to accomplish by this thread then you are late to the party. We should have had this conversation weeks ago.   Though at least half of this board would have shunned you.  The damage you described was fated when the decision was made, by those with actual power, to go down the path of self isolating and shutting down cities/businesses/schools of an entire country.  Our leaders have made monumental decisions based upon poor data, considering one primary perspective and asking very few questions about the overall impact of the lives of everyone, imo.  And yes we will have saved some lives, but at what cost?    

More than you know i want to have a conversation about this.  In my opinion now is not the time.  Why? Because it will be easier to say what needs to be said, especially for some on this board, after this all plays out.  Lets carry out the decisions that have been made and save some lives. 

Lets tally what was gained and lost later with better data and then make informed decisions on when/how we will draw the lines to do or not do this shit again.   Jmo.

 

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18 hours ago, ChiTownDoc said:

People are crazy sensitive right now and honestly the title likely had people pissed the second they clicked on the thread.  Hell, when I initially clicked I was about to lay into OP too...but the post (not the title) was thought out and made you think...it also had some good points. 

I'm not for fatwa but people right now have a very short fuse. 

No POTUS is going to decree a lockdown of his strongest demographic in an election year.

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47 minutes ago, crimsonlonghorn said:

Yes, let's do major damage and collapse the economy and ruin people's lives first, then that will be a much better time to decide if we did the right thing or not.

In the alternate world where we do nothing, is the right time to decide after the virus ends millions of lives and completely collapses the economy? Isn't it a bit too late by then?

To me, it is about balancing risks based on known information. The economy of the world can survive short term disruptions while we gather more information. The economy of the world is going to have a much harder time surviving a worldwide, uncontrolled outbreak that kills 1%  to 3% of the world's population (10 to 30 million people) and hospitalizes another 10% to 15% (700 million to over a billion). 

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14 hours ago, TexArcher said:

Okay.  Communicable diseases are communicable.  Everyone can pass this along whether it kills them or not, so everyone should be isolated to protect the more vulnerable.  The good of the herd is more important than whether these twits have an epic spring break or not.  The end.

The reason this extremely simple take is not used in any other area is because it is useless.  For example, it’s possible that  more deaths from automobile accidents occur in the US this year than from the coronavirus.  Everyone wants to reduce car accidents deaths, but what is the best way to achieve this?  Here is what your take would look like if one were to advocate halting all driving to reduce car accidents: 

Automobile accidents are accidents.  Everyone who drives an automobile can cause an accident whether it kills them or not, and these accidents can harm other people.  So everyone should stop driving to protect the more vulnerable.  My grandmother happens to be one of the vulnerable who could be injured.  Are you saying you want my granny injured just so some chronic masturbators can drive around town listening to Kpop and vaping ganja?  What monster would advocate such a thing?  The good of the herd in this one singular aspect I am considering is more important than anything, ever.  The end.  Kaput. 

 

1 hour ago, crimsonlonghorn said:

Thanks for sharing.  Excellent article that well articulates some of the points of discussion.  

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