[phobosanomaly]

Read the exceptions in the actual order.

https://www.lamayor.org/sites/g/files/wph446/f/page/file/202...

It isn't as odious as it's made to seem.

You can still grab takeout from a restaurant, buy weed, go to the grocery store, do your laundry, go to an outdoor fitness class, go to youth sports, surf at the beach, do some outdoor lap swimming, get your nails done, go to the zoo, etc. The request to fill out an online form is a very, very basic attempt at contact tracing that is pretty non-invasive.

City of LA was facing a situation where its hospitals were going to wind up being effectively closed due to loss of capacity. Seems like a decent justification for extraordinary measures. Look at Barstow Community right now. 114% of inpatient beds occupied by COVID patients (as-of 12/15). Imagine if LA hospitals looked like that. It would be apocalyptic.

https://www.npr.org/sections/health-shots/2020/12/09/9443799...

As it is, even with that order having gone into effect, ICU capacity in LA county as-of the 11th is 2.7%.

https://www.kqed.org/news/11850757/california-icu-capacity-s...

Plus, if you look at a map of what actually constitutes the City of LA proper, it's a pretty tiny, but extremely high-density slice of the 'Greater LA Area.'

If you really, really want to wander around DTLA, just tell the cops you're walking to the grocery store. They're not walking around arresting anyone who steps outside.

This is a tool that lets city authorities put the brakes on people doing egregiously stupid stuff. They're not stopping people on the street like the gestapo for going about their business.

So, in short the parent comment seemed to express a knee-jerk reaction to a policy without offering an attempt at a reasoned assessment of the context and policy alternatives facing the City, as well as a pragmatic appreciation for the reality of enforcement on the ground. If they offered a viable alternative that seemed reasonable and well thought-out rather than just calling it an "absurd big liberal govt policy" I wouldn't have downvoted. Doesn't matter who runs the city, Repub or Dem, if when you call 911 there's nowhere for the ambulance to take you.

[thu2111]

That >100% of beds can be occupied with COVID should raise some questions about those stats.

ICU beds are flexible, it's more of a designation than a hard constant. Sweden doubled their ICU capacity in a few weeks without much difficulty back in March. So it's normal for ICU to run near "capacity" because it'd be kind of wasteful if it didn't.

Remember also that "COVID patient" means "patient who tested positive for COVID", it doesn't mean that's the primary thing wrong with them. Hospitals are super-spreading sites, lots of patients turn up for something uninfected and pick up COVID in hospital. So the stats have to be interpreted carefully, even if you accept the premise that poor planning in the hospital system is justification to tell people they can't go outside. Also consider that COVID spreads inside, not out!

[phobosanomaly]

As an alternate perspective, that >100% of beds can be occupied by people with COVID could terrify you. People in gurneys lined up along hallways, PPE running low, overflow tents in the parking lots, nurses WAY over ratio handling more patients than is safe, doctors burned-out and scared.

So, any patient in a hospital that tests positive should be going into a negative-pressure room so that the hospital doesn't become a super spreader event. When you get too many patients, it becomes impossible to actually do that, and it gets kind of scary both for people with non-COVID issues, as well as the staff. Doctors, and nurses, and ER techs, and social workers, and respiratory therapists, and security, and janitors, and radiology techs, and CNAs aren't disposable.

The other issue is that you need doctors and nurses to run the ICU. Critical care physicians and nurses are in high demand all over the country right now, and LA may not be able to double their number of ICU specialist staff on a week-by-week basis.

Sweden has a universal, socialized healthcare system, so they are able to allocate resources nationally based on demand. In the United States, it's a checkerboard of private, nonprofit, and county facilities, each with different structures, policies, health record systems, profit sources, etc. so planning and coordination becomes very complex.

Again, the order does not prevent people from going outside, there is a long, long list of exempted activities in the actual order.

I have turned this problem over in my head a lot, and I really can't think of a good alternate policy approach specific for the highly dense urban setting of LA city proper. I don't have a good answer along the lines of 'this is what they should be doing instead.'

[thu2111]

People in gurneys lined up along hallways, PPE running low, overflow tents in the parking lots, nurses WAY over ratio handling more patients than is safe, doctors burned-out and scared.

'Terrified' is all relative, right? Such things are reported in recent years with nobody panicking like in 2020:

https://www.nbcnews.com/health/health-news/saline-solution-s...

“This is a serious situation and right now we are at the limits of our conservation and adaptation strategy,” said Dr. Paul Biddinger, director of the Center for Disaster Medicine and vice chairman for emergency preparedness at Massachusetts General Hospital in Boston. “We have seen an increase in the number of flu cases compared to last year. If this continues the current trend, we are worried that this will stress our system and make us run out of IV fluids,” added Dr. O’Neill Britton, chief medical officer at Mass General.

https://time.com/5107984/hospitals-handling-burden-flu-patie...

"Hospitals Overwhelmed by Flu Patients Are Treating Them in Tents"

A lot of things that are actually not that alarming and do not cause mass deaths, have been recast this year into apocalyptic end-of-days events that must not be allowed to happen at literally any cost. It's not rooted in anything hard or real, it's to do with the scale of the original projections (which were all wrong).

[phobosanomaly]

Happy to hear your alternate policy proposal.

If you were mayor of the City of Los Angeles, what would you do differently, and what would be your justification to the citizens for your policy?

Do you feel the policy you outlined would be judged to be significantly better than the current policy by the majority of voters of the City of Los Angeles?

If so, how much better, and measured by which metrics?

Do you feel that there would be pushback against your policy by City Council, Public Health Officials, Public Safety Officials, or other key stakeholders?

What would be the risks if your policy was wrong and you had misjudged the situation? What would be your contingency plans?

If your policies are workable, let's get them concisely outlined and email them to some key interest groups so that they can start getting them out to the public and key stakeholders.

Do you have experience in Public Administration and Public Health? If you're an epidemiologist or city official, your credentials will give your policies more weight and your knowledge and experience will be highly valued since it likely takes into account a variety of 'Chesterton's Fences' that a layperson wouldn't have considered.

Even if you have no knowledge of the field, you might have some great ideas.

[thu2111]

Policy proposal in three parts:

1. I'd observe Sweden and follow the actions of Tegnell, as Sweden has had a pretty good pandemic so far.

2. To placate those who are worried I'd focus on raising hospital capacity as much as possible.

3. I'd get a grip on testing. Doctors are all trained not to do indiscriminate testing without any other signs of problems, a lesson that has been forgotten now. I'd end mass testing entirely and focus all testing on people who present with symptoms (this would still be a high level of over-testing because COVID symptoms were worked out by looking at anyone who tested positive so is polluted by a lot of FP noise).

Key metrics are hospital loads and excess deaths. It would be acceptable for the latter to go up by, say, 3x the level a normal flu season would see before starting to impose any population controls.

Pushback: of course there would be. They've all been told by "experts" who know nothing about disease that millions will die unless everyone is locked in their homes right now because exponential growth always lasts forever, don't you know, and they're all terrified of seeming to place anything above health outcomes. But if I were the mayor then they'd ultimately report to me, I guess (I don't live in the US so don't know much about mayoral politics).

The risk if the policy was wrong would be hospitals would get over-full. The contingency plan would be to buy capacity from hospitals in further away regions and invest in rapid buildouts of ambulances, helicopters etc to make it easy to shift capacity around and load balance between hospitals, including to neighbouring regions that disagreed. But I don't think that's likely because we know what happens if you ignore the projections: basically nothing. Look at Swedish all-cause death stats for the year. It'll come in a bit higher than 2018, probably a few percent higher. Nothing important.

W.r.t emailing key interest groups. It's way too far gone for that. People have been proposing rational and sensible alternative plans for the last 8 months, they're all ignored.

I have no experience in public health or epidemiology, thank god. If I did I wouldn't be able to consider alternatives because I'd be a part of the public sector/academic system in which personal reputation as a 'nice guy' or 'clever specialist' is the primary determinant of personal success. I'm much happier in the private sector where what matters is getting results, not the perception of niceness or reasonableness or cleverness.

[phobosanomaly]

Sweden seems to be grappling with the fallout of that approach:

"Health officials in Sweden have warned that intensive care units (ICUs) in and around Stockholm are under severe pressure and close to capacity for the first time during the pandemic."

"Although the city’s hospitals could increase the number of beds allocated to ICUs, there are insufficient specialist staff to support them, said Björn Eriksson, director of Region Stockholm Healthcare."

https://www.bmj.com/content/371/bmj.m4833

Again, placing a gurney in a closet doesn't make it an ICU bed. You need specialized staff, which are in short supply.

Consider the scale as well that you'll be working with as mayor of LA:

The population of the city of Los Angeles proper is 3.8 million, but the population of the greater LA area (19 million) is almost twice the population of the entire country of Sweden (10 million). Los Angeles has to make policy with limited control inside of a very complex environment.

The homeless population of Los Angeles is estimated to be around 66,000 people. That's twice that of the entire country of Sweden.

The state of California, alone, has 40 million people, and open borders with Arizona, a state with nearly the population of Sweden (7 million) and zero state-level mask restrictions.

Los Angeles County is currently seeing 134 deaths per day from Coronavirus, even with California in lockdown.

https://www.latimes.com/california/story/2020-12-16/l-a-coun...

> "The risk if the policy was wrong would be hospitals would get over-full."

This is not the risk. The risk is that thousands of people would die, both from Corona and the fact that hospitals will be closed to all patients Corona or not.

> "They've all been told by "experts" who know nothing about disease that millions will die unless everyone is locked in their homes right now"

300,000 people have died in the United States so far as a result of Coronavirus. People are projecting we might reach a million by the end of 2020. If we continued on the current trajectory that would be an almost certain bet.

> "The contingency plan would be to buy capacity from hospitals in further away regions and invest in rapid buildouts of ambulances, helicopters etc to make it easy to shift capacity around and load balance between hospitals, including to neighbouring regions that disagreed."

Who would pay for this? We have a private healthcare system, not a public one. The City of LA is not in the business of purchasing and operating helicopters for medical use. There is no budget for that. Private companies like Reach handle the overwhelming majority of medvac and transport helicopters in the U.S.. Ambulances are operated by a checkerboard of private companies and City/County fire. We don't have a socialized, universal healthcare system so it's basically impossible to coordinate resources like this. How would you 'buy' capacity? Billing is through private insurance. Would the city agree to pay all costs related to patients in a hospital in another county? I bet the hospitals wouldn't agree to that since it's almost guaranteed they wouldn't get paid.

One thing that limits the ability to transpose Sweden's policies on the United States is the sheer scale here. California is massive. The U.S. is massive. Individual states are the size of whole European countries, they effectively operate as a schengen area with no restrictions on the flow of people, and spotty mask compliance depending on where you are. And forget grand ideas of coordinating from one city or county to the next. Our system is private, and private companies get to do whatever they want. Unless they're going to be well-paid for something, you can bet they're not going to go along with it.

> "I'm much happier in the private sector where what matters is getting results, not the perception of niceness"

I don't know that putting California, and Los Angeles in another lockdown is being interpreted as niceness here. Lots of people are pissed, people are losing their businesses, but many many people are also dying and becoming very ill. Both Newsom and Garcetti are making some very difficult choices to get results.

I genuinely don't mind that you have a different take on the situation. I'm happy to just sit and discuss this stuff.