[umvi]

Are just the ERs empty? Or the whole hospital as well? If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well. What's the endgame? We can't just keep the country shut down indefinitely. Life must move on. Even though there's still a lot of fear, I think reopening the country is the best option (while still maintaining social distancing, etc).

[6nf]

To echo your point:

In New South Wales, Australia the medical sector had 1000 ICU bed capacity in January. When covid hit, it was rapidly expanded and currently over 2000 ICU beds are available.

At the same time all elective surgeries got banned (e.g. hip replacements etc) because some of those would end up in ICU.

At the peak of the outbreak NSW used 100 of those 2000 beds. Currently only about two dozen ICU beds are occupied. About 1% of capacity.

[roca]

The good news for Australia is that you are probably eliminating the virus and will be able to reopen everything soon, safely. The key point of the comment you are responding to --- "If hospitals are empty, it's time to stop sheltering in place, because it means it's working too well" does not apply to Australia, because it assumes a "flatten the curve until we reach herd immunity" strategy which is not Australia's strategy.

The real problem in the USA and most other Western countries is that there is no clear strategy to defeat the virus. The actions being taken are mostly consistent with "flatten the curve and wait for herd immunity", but that pretty much guarantees crippling economic damage and mass death.

[jfnixon]

Australia (and New Zealand) have no clear strategy to defeat the virus. They have won the opening battle and are claiming the war is over. Unless Oz and NZ cut themselves off from the rest of the planet, no, the virus war isn't over.

Herd immunity through vaccine or infection is the only rational strategy for a disease like C19. There is no vaccine, and possibly will never be a vaccine. Sorry to be a realist.

[6nf]

Australia's strategy started off as 'flattening the curve' and as far as I know officials never stated that eradication is now the strategy. There's still about a thousand confirmed live cases and of course there's many thousands more that are not symptomatic or otherwise carrying covid without being diagnosed. Eradication as far as I can tell is not realistic.

[roca]

NZ, at least, has a clear strategy to defeat the virus: eradicate the virus internally, mandatory 14-day quarantine for everyone entering the border (and only NZ residents plus a few essential workers are allowed to enter) to keep it out, intense contact tracing and testing to snuff out outbreaks from cases that slip through. (I think this is also the Australian govt strategy but I haven't been watching their press conferences.)

Sure, the war isn't over, but it's at least plausible this will be effective for a long time. Versions of it are working in China and a number of other countries that were able to stop the spread in time.

If there is never a vaccine, then there will be harder decisions for all these countries in the future about how to deal with countries that failed to defeat the virus. It seems fine to worry about that later.

[pmiller2]

No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.

[manigandham]

Why do cases matter? It should be the death rate that peaks, and that's measurable without testing. In fact it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.

[pmiller2]

Death rate is the proxy for cases. What matters when attempting to contain the disease is prevalence of the disease.

[jfnixon]

I think this is backwards. We have been using infection rates as a proxy for death rates, since deaths are a lagging indicator. It is certain we are missing a huge percentage of cases, and expanding testing will uncover those. It is completely unclear that uncovering more mild and asymptomatic cases will result in more deaths, so new cases are a bad proxy for future deaths.

[pmiller2]

Maybe in an ideal world, but we're not actually measuring infection rates. Dead is pretty objective, and easy to measure, and, we know that the number of deaths will roughly track the number of infections. That's why things like deaths and hospitalizations are what the state of California is watching closely.

[manigandham]

Is that the actual goal? Seems like we're well past containment now with infections in the millions. But if death rates are staying low and healthcare has enough capacity, then what does widespread testing accomplish?

Might as well save it for the people who actually get sick and need confirmation for treatment or cause of death.

[tdeck]

> it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.

Citation?

[sfj]

> Opening things back up prematurely, without sufficient testing, is just going to get people killed.

But how many will get killed? Allowing people to drive down the street also kills people. What's the limit?

[pmiller2]

Well, do you have research on how many excess deaths there would be if states started opening up now? California is taking a cautious approach by only opening in stages after cases have stabilized, and only after testing is present. Do you have a better plan than what a group of public health experts have come up with?

[umvi]

> Do you have a better plan than what a group of public health experts have come up with?

As far as I can tell, public health experts (and basically all medical experts) are in over their heads on this one. It's like 1970s computer scientists issuing guidance on a stuxnet-esque infection. Sure, they are the experts in that they know more about computer science than other people, but they also have no experience with something like stuxnet-esque worms and so... how valuable is their expertise? "We recommend turning off all computers until further notice to stop the spread of stuxnet. Meanwhile, we will take 6-12 months or more to try and reverse engineer it and then we will issue further guidance." Except... "turn off your computer for a year" isn't going to fly with the general population. After so many months there will be riots and people will start disobeying.

[pmiller2]

And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on? Do you know what contained the outbreak in China, South Korea, and other countries?

[umvi]

> And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on?

Nobody alive on earth right now has ever experienced anything like this before at this scale. So by definition, there are no "veterans", there is no one with any experience whatsoever, just people who did case studies of past pandemics when air travel didn't exist and people that ran some simulations. Inexperienced people, no matter how expert they are, are terrible at predicting the future (re: the last 20 years of climate change expertise). "Oops, the model was wrong again, but we learned more for next time!"

> Do you know what contained the outbreak in China

How do we know it's contained? China kicked out all western journalists and nobody can audit any of their numbers. China is not exactly a clean/sanitary place, I wouldn't put it past CCP to simply cover it up to save face. Or maybe they realized it's not really as bad as it seems and they just let it run rampant.

How is Japan faring so well despite not sheltering in place and not testing?

[kalleboo]

> Do you have a better plan than what a group of public health experts have come up with?

Sweden's response is also based on public health experts. And in Sweden, the apolitical public health agency is fully in charge, politicians meddling with their work is against the Swedish constitution. And the Swedish public health agency has stated that their response takes into account comprehensive long-term public health and not just short-term.

Is Sweden's response wrong? Maybe. But do you have a better plan than what a group of public health experts have come up with?

[sfj]

I think that, instead of requiring locking everyone in their homes to save a few, we should give people the option to isolate themselves from everyone else. This would entail free rent and clean food delivery sponsored by the government.

This would then reduce covid-19 to a risk factor on par with every other self-inflicted risk. If you worry about your health, stay home, if not go live your life. It would actually be compatible with our constitution as well, which would be nice.

[AstralStorm]

One thing I'm not seeing happening is surveys and epidemiology related to impact of various measures undertaken, to keep the ones most effective and lose the others that are superfluous.

This could be done by comparing measures taken in a big random sample of confirmed cases with big random sample of general population.

[umvi]

> Opening things back up prematurely, without sufficient testing, is just going to get people killed.

Yep, some people will die. That's unavoidable. Tens of millions die every year. Hundreds of millions will die per year in a few decades. That's life.

If you are at-risk, you should continue to avoid contact with others. But there's currently no cure for covid-19 other than your own immune system. The sooner the disease runs its course, the sooner we can return to normal. Sheltering in place forever means you prolong the propagation of the disease to excruciatingly long timescales.

[pmiller2]

No, it's entirely avoidable. I'm referring to unnecessary deaths from COVID-19, which, as we've seen here in California, and the Bay Area specifically, have not hit numbers suggested by initial models because we implemented shelter in place.

I don't see anything more to your argument than what the woman standing with a sign saying "I want a haircut" is saying. Your attitude is dangerous. People will die unnecessarily if state leaders do as you suggest. This is what the modeling says, and you have offered nothing to suggest otherwise.

[postalrat]

Are you willing at all to consider the models were flawed and shelter in place is only delaying deaths a few months?

[pmiller2]

Not until you can demonstrate that to me.

[6nf]

Lets wait a few months and see

[_y5hn]

Are you willing to educate yourself about R?

[fzeroracer]

Bold of you to assume that a disease can just run its course and then end. Would you say the same thing about the Chickenpox or some of the earlier flu pandemics we've seen? Are you willing to bet on a far deadlier second wave not occurring?

[umvi]

> Bold of you to assume that a disease can just run its course and then end.

Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception)

> Would you say the same thing about the Chickenpox

Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again.

> Are you willing to bet on a far deadlier second wave not occurring?

Yes - "Survival of the fittest"

If there is a second wave, it will only affect survivors of the first wave, and as far as I can tell, the vast majority of first-wave survivors had mild-to-no symptoms. Kids are barely affected at all, it seems.

[pmiller2]

> Yes - "Survival of the fittest"

Are you suggesting that people who have the ability to isolate themselves at home while still earning a living are somehow "fitter"? As I suggested before, your argument as a whole amounts to nothing more than the woman who waves the sign saying "I want a haircut". Is your life more important than your barber or stylist's? If not, why are you asking them to risk it for you?

[umvi]

No, I'm suggesting those that are most vulnerable to covid-19 (old, immuno-compromised, etc) will die off in the first wave and won't be around if there is a second wave. You can't die twice. Thus the mortality rate would plummet.

[fzeroracer]

Okay, I guess I have to explain some things here.

> Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception)

This is objectively wrong and I'll lead into why in the next point.

> Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again.

Chickenpox is not one-and-done. If you catch chickenpox, the virus remains latent and can manifest itself as Shingles.

And to explain a bit of history here: I'm not talking about a second wave of the current strain. I'm talking about a deadlier strain. That was what my reference was to earlier flu pandemics and I highly suggest you do a bit of reading on that. The Spanish flu had mutated to a far deadlier version during the second wave and spread all over the world.

For all the comparisons people make with the flu virus, people seem to ignore that viruses can come and go in waves. The flu did not 'end', it mutates every season and the reason why we're able to keep it under control is because of widespread vaccination preventing it from growing exponentially. You claim that's how most diseases work, but that's not how the flu works. The danger of letting the coronavirus run rampant is severely understated by our complete inability to control it right now.

[umvi]

> Chickenpox is not one-and-done. If you catch chickenpox, the virus remains latent and can manifest itself as Shingles.

The boils covering your entire body is one and done. Shingles is far less severe by comparison (my sister had it in high school and it was just a painful rash on her side that went away after a few weeks- and yes, it was definitely confirmed to be zoster despite her young age) and only reactivates in a small percentage of people who had chickenpox. Shingles kills basically no one compared to chickenpox.

> The danger of letting the coronavirus run rampant is severely understated by our complete inability to control it right now.

There's tons of evidence suggesting the mortality rate is way over-estimated right now and the amount of total cases is way higher than the number of confirmed cases due to people getting it and showing very few, if no, symptoms. This is nothing like the black plague. Hardly anyone is dying, even in places without shelter in place.

[rconti]

The hospitals largely shut down elective surgeries, tried to get rehab patients to other facilities to free up surge capacity, etc.

So, generally, they're less busy than normal.

The problem with opening back up is, we've already seen the growth curve, and that was 2 months ago.

What happens when you multiple that same growth rate against a much higher baseline number of infected people?

[umvi]

Two months ago people weren't wearing masks or practicing social distancing.

[fzeroracer]

I'm going to keep repeating this until people understand the risks: Opening up too early without adequate testing in place means we go through the same problem that Hokkaido did. Which is that you get a second wave of infections and are forced to back into lockdown.

As for the article itself: Reopening the country wouldn't fix that either because it's a catch-22 situation. The people most at risk of dying from COVID-19 don't want to go to the hospital because of the risk. So they put off emergencies until it's too late. You don't solve this problem by reopening the country because the fear and the risk for said people is still there.

My parents are a great example. They have breathing issues which makes them especially at risk. They're afraid of getting routine tests done because catching the coronavirus could be very deadly.

[umvi]

So... you propose just staying on lockdown indefinitely until "adequate testing is in place?" And when will that be? It could be 6 months from now or more so long as the Trump administration is running things.

Lockdown isn't "free" like you seem to think. It has a very heavy cost. And some day (if not already), that cost will outweigh the lives saved from doing it in the first place. Because the combined suicides/mental health/homelessness/domestic violence/etc. increases from lockdown will be greater than [people at risk of covid-19] deaths.

Plus, if lockdowns are keeping hospitals empty, social distancing and masks without the lockdown part would allow us to utilize them more (without them going over capacity).

[macintux]

I have yet to hear anyone explain how we’re going to lose millions of lives due to the lockdown, whereas the risks of opening up without sufficient testing include that as a very real possibility.

Yes, it stinks that people are suffering due to the lockdown, but the government could (if it were so inclined) pay people to stay home indefinitely. It clearly can’t manage the virus, however.

[axguscbklp]

>the government could (if it were so inclined) pay people to stay home indefinitely

I'm a bit skeptical, and would be even if instead of "indefinitely" we were just talking about a couple of years. I'm not necessarily disagreeing, but I'm curious about how the math would work out, in your opinion.

[macintux]

The Federal reserve pumped, I believe, about 1 trillion dollars into the economy in March. That would pay every unemployed worker somewhere around 80k.

Yes, that’s somewhat apples to oranges due to the way the reserve operates, but the money is available if the will is.

[axguscbklp]

Thanks for the explanation. Yes, that makes sense. I originally, for some reason, thought that you were saying that the government could pay the entire country to stay home indefinitely - on re-reading your comment, I see that this is a rather silly misreading on my part of what you actually wrote.