[aclimatt]

Since we're on the topic, shouldn't this (hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?

The line I've heard repeatedly is we're waiting for "total" herd immunity, as in ensuring almost all of a population is potentially protected from the virus. Frequently quoting fall / end of 2021, potentially into 2022.

Shouldn't the only benchmark be those with medium-to-high risk of hospitalization? (Determination of risk however you'd like to do it.)

Put another way, you wouldn't shut the world down if a bunch of people got sick for a few days. You may, and indeed we have, shut it down if a large part of the population were at risk of hospitalization or death. In many developed countries, that population is looking at full inoculation (for those who want it) sometime this spring.

Should that not be the "end" of it?

[dragontamer]

> Since we're on the topic, shouldn't this (hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?

Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?

Hospitalizations are weeks delayed from COVID# or %Positive spikes. Its a slow moving disease: taking 5 to 14 days before people feel sick, and then a week or two AFTER that before people decide to go to the hospital.

As such, if you see a spike of hospitalization, you're already 3-weeks late to the results (ie: hospital spikes are associated with infections that occurred 3+ weeks ago).

In contrast, watching COVID# or %Positive numbers gets you much closer to the ~5-14 day period where symptoms appear (and thanks to contact tracing, some people may test themselves before symptoms arrive: gaining a few precious days in the information war). Hospitalizations and Deaths are strongly correlated (with a few weeks delay). So you're effectively gaining a week-or-two worth of information.

Its better to be only 1-2 weeks behind (watching COVID#), rather than being 3-4 weeks behind (watching Hospitalization#).

[mynegation]

> Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?

Because it is not given and - if given - is not reassuringly close to 1. Correlation is positive, alright. But if you calculate hospitalization as percentage of cases, even adjusting for a lag, it is far from constant. Eg in Canada this ratio was 6x time higher in the first wave than in the second. It strongly depends on testing policies and hospital admission criteria.

[_ph_]

Sure, over the whole run of the pandemic the case count has to be adjusted for changes in the testing regime. But in many countries the testing has been reasonably constant for many months, so the case count is a good indicator of the state of things.

[leereeves]

The most vulnerable people are being vaccinated right now, so we should expect (hope?) that the number of hospitalizations and deaths will decrease significantly even if the number of cases does not.

[psychlops]

I'm curious about your data set. The correlation of cases to deaths using data from covidtracking.com for the US over the past year is 0.28-0.3 when I ran it. I slid it by two, three and four weeks.

[rflrob]

I'm not sure that a simple sliding correlation really captures how treatments, protocols, and behaviors have changed over time. Leaving aside the winter holidays case peak (which is much more multi-modal than the others), I see two peaks:

* A peak of cases around Apr 11, followed by a peak of hospitalizations on Apr 22, with a peak of deaths also around Apr 22.

* A peak of cases around Jul 22, followed by a peak of hospitalizations around July 26, followed by a peak of deaths around August 4.

If I were going to do a more detailed analysis, I would want to try breaking out individual states/counties (subject to some reasonable population minimum), such that multiple distinct trends nationally don't interfere with each other in the data.

[psychlops]

Totally agree. I ran it for New Jersey with the similar results, but it is brute force. Scratching the surface quickly leads to many more variables. For example, more testing would lead to more cases. Then, of course, we'd need to look at how the testing was done (eg random or hospital entry) and what test it was.

I really wish that stochastic testing were discussed more seriously.

[scrollaway]

> Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?

As we vaccinate the people at the highest risk of hospitalization, the correlation will change: Numbers may stay very similar, but hospitalizations should go way down.

[hntrader]

This, and also hospitalizations are a less exploitable metric. Self-selection bias isn't much of a problem, and the number of tests being done doesn't influence the results.

I would look at either hospitalizations or deaths once vaccinations reach a large percentage of the population.

[dragontamer]

> As we vaccinate the people at the highest risk of hospitalization, the correlation will change: Numbers may stay very similar, but hospitalizations should go way down.

Then we'll know in 2 weeks to change the policy and account for it.

Note that vaccinations will *also* cause the %positive and case# to decline. USA is approaching 15% vaccinated at over 95% efficacy means that you'll have 15% fewer cases (as well as 15% fewer hospitalizations later on). I'm not convinced that cases will become desynchronized with hospitalizations: my expectation is that vaccination will cause a decline in both case# and hospitalization#, roughly in proportion.

But if case# and hospitalization# become less correlated, then it won't take long (~2 weeks to see the first effects, maybe 4-weeks to be sure of the effects) to see such a split in the time-delayed correlation.

-------

EDIT: Why the downvotes? Today, there's a new study being pre-pub'd that shows that Pfizer's mRNA vaccine is ~90% effective at stopping the spread of the virus (https://thehill.com/policy/healthcare/539783-pfizer-vaccine-...).

When you have a vaccine that's both 90% effective at stopping the spread and 95% effective at stopping hospitalizations, then the spread and hospitalization numbers will both go down severely (that is: #cases and #hospitalizations reported both go down).

This assumption that #cases and #hospitalizations will become "desynchronized" isn't necessarily written in stone. Its possible both numbers drop down dramatically in the coming weeks as vaccines are distributed... indeed, its highly likely IMO.

[scrollaway]

Pretty much all countries are distributing vaccine to the elderly / at-risk population first. We're doing that for the obvious reason that the most-at-risk population is most-at-risk, and thus most at risk of hospitalization.

Concretely, that means hospitalization rates should decline a LOT faster than community spread. This is going to be less visible in countries that have their shit together and are able to vaccinate very fast / have already moved on to genpop, but in most of the EU (sigh), we've just finished vaccinating care homes and 75+. So now, a couple of weeks from now, we should see hospitalization numbers sharply decline because that share of the population represents the most hospitalizations, and will now be mostly immune.

So despite being at like, 5% total vaccinated, we should see a decline in hospitalizations of up to 75%.

Furthermore, given that most of the spread happens outside the most-at-risk in the first place (since those most at risk were those with the most protective measures before vaccines), 5% vaccinations should not mean 5% less cases total.

[dragontamer]

The #1 group in the USA was not "at-risk" population, but doctors, nurses, and other front-line staff. The idea is that these groups are seeing many, many COVID19 patients and therefore have a big risk at spreading the virus around.

Once this "Priority 1A" group was vaccinated, then age 75+ individuals were vaccinated in Priority 1B. Even then, Postal Office employees and Grocery Store workers (other "high impact" workers) are in the 1B and 1C prioritization queues.

With efforts being to reopen schools, 1B also includes school-teachers (stop-the-spread focus). So a 21-year-old healthy school teacher is prioritized over a 67-year old obese person (despite the 67-year old's higher risk factors).

---------

So at least in the USA: there's a significant effort being placed on high-impact "stop the spread" kind of vaccination effort. There is an element of "save lives", but stopping the spread also saves lives. So its a difficult calculus. (USA has some risk-factor prioritizations... 1B with 75+ age, and 1C with 65+ age + comorbidities like obesity. But again, Grocery Store workers are in 1C as well).

I realize other countries have different priorities. But hey, I live in the USA so my understanding of things will have a USA-slant. These 1B / 1C things are also CDC recommended. Different states (like Texas) are more aggressively stop-the-spread than CDC guidelines (while other states may lean more towards risk-factor based "save lives / prevent hospitalizations"). 50-different states, 50+ different policies. Welcome to America.

[maxerickson]

Federal long term care program started early January in most states, long before they had finished medical workers.

Michigan reports having given at least 1 shot to about 40% of over 75. Eligibility overlaps quite a lot rather than dictating the precise order.

See the coverage metrics tab for age group coverage in MI: https://www.michigan.gov/coronavirus/0,9753,7-406-98178_1032...

[MR4D]

Group 1C is pretty much "everyone".

To take directly from the CDC [0], "Other essential workers, such as people who work in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health."

Doesn't that cover pretty much everyone on HN ?

[0] - https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommend...

------

Second, shouldn't the focus be #1 - stop deaths; #2 - stop hospitalizations; #3 Stop the disease (which is what "spreading" actually is)

[CraigJPerry]

>> approaching 15% vaccinated at over 95% efficacy means that you'll have 15% fewer cases

That’s not how it works, you’re missing a variable (prevalence).

[ptaipale]

...meaning that to reduce the number of cases evenly, we'd have to choose people to vaccinate by random, but we're not doing that; we're choosing by risk, and those at higher risk of severe disease are less likely to contract an infection because they move around less and meet fewer people.

However, we could speculate that perhaps we should in fact put more priority on the groups that have most infections, not highest risk? Because the restrictions impact their lives (of young people) most.

However, I'm quite sure that the priorisation of old people will continue, except possibly in places where priorisation is done by money (the rich purchasing vaccinations).

[CraigJPerry]

>> those at higher risk of severe disease are less likely to contract an infection

If you were running a business and there was a relatively low incidence of an utterly catastrophic outcome, you’d buy insurance for the eventuality.

If you were running another business with a high occurrence of a mild outcome, you’d price it into the cost of doing business.

Insurance = vaccine. Cost of business = stimulus cheques.

[vmchale]

> hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?

From a control theory perspective, it's one of the worst measures because it's delayed. Much more efficient to measure cases - then you don't need restricted social life as long.

[standardUser]

It's an important metric because earlier indicators aren't as useful. The rate of new cases is tricky because we don't really care if someone gets COVID-19 anymore than we care if they get the common cold, assuming they have only mild symptoms and fully recover. Hospitalizations are the first unambiguous metric we have to know there is a serious problem that may require a dramatic response.

[ceejayoz]

> It's an important metric because earlier indicators aren't as useful.

Sure they are. They're less precise, but they're more useful, because they're more likely to let you combat the spike before it gets out of control.

It's like a smoke alarm. Maybe it's going off because it's over-sensitive and someone just took a shower... but it's a better early warning system than waiting for active flames to appear.

[Veserv]

You use cases to determine if you need to react to stop spread since you get results faster. You use hospitalization to determine the time-lagged efficacy of your interventions since it is more precise. What is more useful depends on what you are trying to get out of it. In this particular case, we are discussing the efficacy of vaccination and how that might influence restriction lifting, so you want to err on the side of caution and accuracy and use hospitalization.

[standardUser]

I agree, but once vaccinations are widespread and we are confident that severe illness will be very rare, it would be hard to take drastic measures based only on the rate of new cases. There could be a huge surge of cases but we would expect a low hospitalization rate, so we would likely want to wait.

[ceejayoz]

Once vaccinations are widespread, yes.

Until then, getting out in front of a spike remains necessary.

[km3r]

Immunity through vaccination + natural immunity is getting closer to 'widespread' now (in the US). We are likely near 30%, and of that 30%, a growing proportion is the most vulnerable sections of the population. A spike in cases now would be increasing less connected to a future rise in hospitalizations. I think its fair to say, that if we do not see a spike within the next 3-4 weeks, we are in the clear for future spikes. By April 1st, we should be nearing 40%, with the difference primarily being now vaccinated old and immune compromised people.

[inglor_cz]

In the wild phase of the pandemic, yes.

But once enough people are vaccinated, the pattern may change. For example, you may still catch quite a lot of cases through PCR testing which is very sensitive, but the share of asymptomatic cases will be much higher and the share of people who are going to suffer a severe case much smaller.

The entire societal signature of the disease will change depending on vaccination levels and maybe even particular vaccines used.

[teawrecks]

The point isn't that we use hospital admissions as a metric to infer cases or some other metric, it IS the metric that matters. The problem over the last year wasn't that there exists a person who is at risk, it's that there didn't exist any healthcare system capacity to treat them.

From very early on in the pandemic, it seemed to me like our goal for optimal balance between caution/risk was to try and maintain the highest level of hospital occupancy that is sustainable. If every single person quarantines perfectly, then our hospitals are empty, but so is every business. If no one quarantines, our businesses are full, but so are hospitals and everyone's viral load; i.e. maximum mortality.

With the vaccines now available, it seems like our goal should still be be to maintain the highest level of sustainable medical system occupancy.

[_coveredInBees]

Call me a renegade, but I think the only goal should be to minimize the total number of deaths from Covid. Trying to maximize sustainable medical system occupancy is almost certainly not aligned with the former goal.

[arrosenberg]

No perfect solutions there. If there was perfect quarantine, we would still lose additional lives from suicide, domestic violence, etc. from the increased stress. There is definitely a balance to be struck, and making sure we have capacity to treat all of the sick seems to be as good as any.

[_coveredInBees]

Yeah, making sure we have capacity to treat anyone sick is certainly one of the highest priorities (and the reason there was such a scramble trying to contain the virus from wreaking havoc if we went past that). And I get that there are other "costs" to the virus and lockdown and a holistic, balanced view is useful. Heck, I have two young children who have been remote schooling for almost a year now while both parents work full-time.

I just object with the parent's following statement:

> With the vaccines now available, it seems like our goal should still be be to maintain the highest level of sustainable medical system occupancy.

If we are still trying to maintain the highest level of sustainable medical system occupancy while the percentage of population that has been vaccinated is slowly increasing, it would actually mean we are doing a horrible job in trying to limit preventable deaths when a fully vaccinated populace + herd immunity is not too far away. Maybe when a much larger percentage of the population is vaccinated, the spread and rate of deaths will be low enough that this may change, but we are still nowhere near that stage.

[choward]

I agree completely. The only reason they used for shutting everything down at first was so hospitals don't get overrun. That's clearly not happening right now in most places. Also, it's not uncommon for the flu to cause hospitals to exceed capacity and we don't shut down for that.

[smileysteve]

> was so hospitals don't get overrun. That's clearly not happening right now in most places

Citation needed.

Up to 3 weeks ago, California, the Southeast were in field hospital territory.

Anecdotally, Alabama hospitals have been in overflow since July.

Georgia re-established a field hospital in January at their conference center [1] hospitalizations only stopped dropping beginning at the end of January

[1]https://www.11alive.com/article/news/health/coronavirus/geor...

[choward]

That's why I said "in most places".

And that article is from December.

https://www.covid-georgia.com/today-in-georgia/hospitalizati...

[runako]

The link you sent doesn't have these numbers, but many metro Atlanta hospital systems are still diverting patients from their emergency rooms (because they are full). There is currently an operational field hospital being run at the convention center. The field hospital was still operational as low the weekend.

You can see ER status by hospital here: https://georgiarcc.org . Flip through the counties where most people live and you'll see a lot of full ERs.

You should choose another region to support your argument, it's not going so well here in Georgia right now.

[smileysteve]

In order for "most places" find a state that is close to their ordinary vacancy rates of 30%.

[choward]

Why? How is that relevant?

[smileysteve]

From December 22nd, for a hospital to be ready in 7 days.

[Solvitieg]

This is what I found bizarre about NZ's approach. Their goals was 0 _cases_ in the entire country. It's a great accomplishment but perhaps unnecessary.

[tialaramex]

Because zero is magic. If you know your number of cases doubles every week when you aren't locked down, it seems as though it hardly matters what you do right? Five cases, six cases, ten cases, it's going to get out of control no matter.

But if your base is zero then double that is still zero. That's why they've pursued elimination and why it has worked.

[statstutor]

On an island nation with an 80%+ urban population, your choice is either to aim for 0 cases, or to expect unbounded cases and new more virulent mutations (for the whole world to deal with the consequences).

This was predictable in advance, and with hindsight I still would prefer 0 cases.

[_ph_]

At 0 cases you can fully return back to "normal" life. If you have a small amount of cases, this will always grow exponentially without countermeasures.

[laurencerowe]

The big advantage of getting to zero is that after the initial severe lockdown life gets mostly back to normal.

[ghaff]

Almost zero.

And normal only in the sense that many people don't care that much if very few people are allowed to enter the country.

[choward]

Not really. They still have outbreaks and do lockdowns. I wouldn't call that "mostly back to normal". https://apnews.com/article/new-zealand-coronavirus-pandemic-...

[tialaramex]

That's true. They do have outbreaks, about half a dozen people this time, perhaps related to a job at a laundry working with quarantine facilities.

For several days Auckland residents couldn't go to the pub.

Normally of course they can go to the pub. Or a night club. Or a packed stadium to watch sports.

But it's true that for several days last week in Auckland they weren't allowed to do that. And the same back in... September maybe? And according to you that isn't "mostly back to normal" so we can assume you believe it isn't "mostly back to normal" anywhere and never will be. That's just not a very useful benchmark.

[orra]

It's pretty contagious, to be fair.

Still, I think you're right when you say perhaps unnecessary: some countries have successfully suppressed COVID without eliminating it. That said, it's some but not many countries.

I'm a bit ambivalent. Regardless, it certainly wasn't necessary for NZ to close their border to asylum seekers.

[peterburkimsher]

Edit: [removed]

[orra]

> Media are reporting that wealthy migrants are still being welcomed

Ouch, that article links to one from May 2020. It said the Avatar film crews were allowed to fly in, whilst families were separated.

[didibus]

I don't know about all states as they have different rules, but in Washington they track:

1. Trend in 14-day rate of new COVID-19 cases per 100,000 population, shown as Trend in case rate;

2. Trend in 14-day rate of new COVID-19 hospital admissions per 100,000 population, shown as Trend in hospital admission rate;

3. Average 7-day percent occupancy of ICU staffed beds, shown as Percent ICU occupancy;

4. 7-day percent positive of COVID-19 tests, shown as Percent positivity.

And there are phased reopening plans, where restrictions are slowly lifted based on different tresholds for the above. So if the above 4 metrics meet some treshold we might go into phase 2 where now indoor dining at half capacity is permitted for example. If the numbers than stay under the treshold and eventually keep going down, we'd go to phase 3, etc. If the numbers get worse after moving to phase 2 we'd go back to phase 1 with more restrictions.

Seems pretty reasonable to me. They're always kind of revising the tresholds to some extent as well, so it's not set in stone. But it makes sense for me to take a staged approach to reopening and just make sure we're truly over Covid before going all back to normal (so it doesn't come back).

[smileysteve]

> The line I've heard repeatedly is we're waiting for "total" herd immunity

It depends which line you are considering; if wearing masks yes.

If "reopening and returning to normal" that remark is most resembles a hyperbole.

In the United States, on April 16th 2020, the Coronavirus task force outlined a 3 phase plan dependent on 3 criteria based on 2 week averages

1) Hospital Vacancy,

2) New cases decreasing (from where they were), and

3) Percent positive testing rate under 10% (that suggests that the tests numbers are close to accurate and not in community spread)(5% is the standard that Europe uses as a liberal goal, 2.5% is the recommended)

For an answer on those 3 in the US (today)

1) Hospitals are just now where they were on April 16

2) New cases is about 3x where they were April 16

3) We've been under 10% since 1/21 (now at a 7 day average of 5%)

So the goal posts haven't gotten harder. They did get easier; restaurants shouldn't have been open for socially distanced dining based on the plan until 1/21.

[umvi]

> You may, and indeed we have, shut it down if a large part of the population were at risk of hospitalization or death

I wouldn't really call 1% of the population "a large part" of it. It's just, our healthcare capacity relative to the size of the overall population is miniscule. So even a disease that threatens .1% of the population with death and 1% with hospitalization is enough to overwhelm the healthcare system. And apparently policy makers aren't willing to let people die due to overwhelmed hospitals - they would rather shut down the entire economy than let that happen.

History will tell if that was the right decision. Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year, but everyone notices and remembers economic depressions that last a decade.

[orra]

> So even a disease that threatens .1% of the population with death

The IFR for COVID is likely ten times that, at least in societies with decent numbers of older people.

> Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year

This isn't a bad flu season in a 5 year cycle. The excess deaths caused by COVID last year are not just 'abnormally high'. They're more like once in a lifetime abnormally high.

[umvi]

> The IFR for COVID is likely ten times that, at least in societies with decent numbers of older people.

Right I purposely picked a disease less deadly than covid that could still overwhelm the healthcare system

> This isn't a bad flu season in a 5 year cycle. The excess deaths caused by COVID last year are not just 'abnormally high'. They're more like once in a lifetime abnormally high.

Right, and I still maintain that those excess deaths will be largely forgotten within the next few years or so by the majority of the populace. 500k excess deaths in 2020 followed by several years with fewer than normal deaths (since an abnormal amount of old people that otherwise would have died weren't around to die). Great Depression 2.0 on the other hand is something that wouldn't be forgotten for a lifetime for the people that live through it.

[mplanchard]

This kind of cavalier attitude towards half a million people dying bothers me, particularly when it’s very likely that our death totals are significantly higher than they could have been with better adherence to guidelines, better guidelines to begin with, etc. Those excess deaths won’t be so quickly forgotten by people who have lost family and friends.

Should we be pragmatic in public policy? Of course. You can’t prevent all the deaths, and we’ve got to keep individuals and businesses afloat as well as we can. But we need to go into these discussions with clear eyes about the real cost that each of those lost lives represent, both in a compassionate sense and in a practical sense (a not insignificant proportion of those dying were still working, still contributing to society, were young with many productive years ahead of them, etc.).

I really don’t think we’ll look back on this and think, “Eh, a half a million people died, oh well,” particularly not with a more historical lens, but I could definitely be mistaken.

[umvi]

> This kind of cavalier attitude towards half a million people dying bothers me

> I really don’t think we’ll look back on this and think, “Eh, a half a million people died, oh well,”

Well, we look back on the past 2 decades (2000-2020) and think "eh, 700k+ people (mainly the elderly) have died from influenza, oh well." But actually most people don't even think that. Most people just... don't even keep track of how many people die of the flu because they don't care. Why would covid be any different 20 years from now? To be honest most people probably wouldn't even care how many people were dying of covid if the media wasn't shoving the statistic in everyone's face 24/7. Just like most people don't care to know how many people die in the USA per year in general (~3 million) and what the breakdown of those deaths are in terms of causes.

[mplanchard]

35k per year from influenza is literally an order of magnitude less than the current death toll (but we should still take it seriously! I hope COVID normalizes masks during flu season). You or I are much more likely to know or be connected to someone who died of COVID this past year than of the normal seasonal flu in any given year.

675k Americans died in the 1918 Flu, and we’re still talking about that one. We may very well surpass that in raw numbers (although not in percent of population) with COVID.

And lots of people care about the 3 million people that die every year! We’re constantly trying to make driving safer, investing in new therapies for heart disease and cancer, etc. I’ve seen many articles about the increase in suicide in the US over the past decade, written with the hope of stirring action and driving change. There’s no reason to accept potentially preventable deaths as a matter of course.

[orra]

> I really don’t think we’ll look back on this and think, “Eh, a half a million people died, oh well,” particularly not with a more historical lens, but I could definitely be mistaken.

Agreed, it's horribly callous.

[NovaJehovah]

It's generally a political challenge for a free society to get the power and the megaphones back from the people they were given to during a crisis.

After an acute terrorism threat ends, it's hard to get power back from the military and the police.

In this case, it will be hard to take back power and the narrative from the public health establishment.

While they perform a crucial role in our society, they will tend to value safety over freedom and quality of life to an extent that would be crippling if we let them continue to set the agenda after the acute phase of the crisis has passed.

[addicted]

The “public health establishment”.

Is this a joke considering the vast majority of Western countries have basically ignored their “public health establishments” for almost all of the past year? Ironically (or not) the only country that has really followed their “public health establishment” until recently was Sweden. Which isn’t surprising because theirs was the only one not asking the government to make tough choices.

[dragonwriter]

> In this case, it will be hard to take back power and the narrative from the public health establishment.

Sitting in California where county sheriffs basically comprehensively vetoed the public health establishment throughout the crisis, I don't see that likely to be a real problem.

[NovaJehovah]

That didn't stop thousands of businesses from being closed.

But regardless, the narrative is just as important. After some threshold of vaccine distribution, people need to be convinced that it's ok to return to normal life, and that they don't need to cower in fear in their homes or wear masks for years and years just because we haven't completely eliminated covid. There's a cost to all of this.

[dragonwriter]

> After some threshold of vaccine distribution, people need to be convinced that it's ok to return to normal life, and that they don't need to cower in fear in their homes or wear masks for years and years.

No one has suggested people should cower in fear, and people seem pretty happy going about without masks, or with masks worn in an openly defiant manner (under the chin, off of one ear, etc.) in public places with prominent mask mandate signage today, so, again, I don't think the issue you are alluding to is even remotely serious. As a society, whatever the formal provisions of law say, we haven't given public health authorities the power in practice that you argue we will have problems with when we need to take it away.

[NovaJehovah]

All the "long covid" stuff is essentially fear mongering. There's no science behind it.

The implication is that everyone should be terrified, stay home as much as possible, and wear masks as long as there's any chance of catching covid. Even after being vaccinated.

Sure, people flout the restrictions, and they are met with social disapproval for doing so.

The worst thing is the hugely negative psychological effect this is all having on children. It shouldn't be taken lightly.

[scarby2]

> The implication is that everyone should be terrified, stay home as much as possible, and wear masks as long as there's any chance of catching covid. Even after being vaccinated.

Apparently there is insufficient data to back up that the vaccine reduces transmission. That much is mostly true. It doesn't seem like they're trying particularly hard to find out.

Why are we not studying unvaccinated household members of vaccinated individuals and comparing with household members of the unvaccinated. Could be as simple as adding a data collection step after receiving a test result, given that it's pretty much a given you will infect people you live with we should notice a large difference very quickly.

[orra]

> All the "long covid" stuff is essentially fear mongering. There's no science behind it.

That's not true. Studies are showing large fractions, say 10-25% of COVID patients are suffering symptoms after a month.

COVID infections have demonstrably damaged pretty much every organ in the body.

That's very different from the initial assumption, whence all policy, that COVID is like the flu, and passes in two weeks if it doesn't kill you.

> Even after being vaccinated.

However, these vaccines are stupidly effective. Once enough people are vaccinated, COVID will die out in the community, just like measles. You're right that we can't fear COVID forever.

[_ph_]

So far there was a tight coupling between the number of positive tested people and the hospitalisation count. It was important to base politics on the positive test results because they are several weeks "ahead" of the hospitalisation trend. It would have been foolish to not use those weeks for necessary actions.

Now, with the vacinations, things change a bit. As soon we can show a significant reduction in hospitalisation, of course this needs to taken into respect. But with the vacinations, I would also expect the infection count to drop, as there are good indications that the vacinations reduce the infection count to drop.

[wpietri]

I take it you haven't been following what's going on with "Long Covid". But even among people who aren't hospitalized, there's lasting harm: https://www.medpagetoday.com/infectiousdisease/covid19/91270

I know somebody who's had this. Despite never being hospitalized, after getting sick they had to take a long medical leave from work in hopes of getting their strength back. That's worlds away from "sick for a few days".

[Mediterraneo10]

I have been following "long COVID" reports. Firstly, much of the mass media coverage is misleading, often intentionally so in pursuit of clicks and advertising revenue. A lot of the people claiming to have debilitating "long COVID" were never actually tested positive for COVID in the first place. They are the broadly the same demographic that, before COVID, were claiming to have "chronic Lyme" or whatever. Certainly mainly of them do have symptoms and distress, but it is questionable what relationship they have to COVID.

Then, if one starts digging into more serious discussion – even your link above – one finds that "long term" in medical parlance may mean a series of months but not necessarily years, and similar months-long impacts are known from diseases that we have generally tolerated among society. It also isn’t clear that these lingering symptoms affect enough people to impact the economy if measures are lifted once hospitalizations fall.

[rcpt]

Here: https://www.medrxiv.org/content/10.1101/2021.01.16.21249950v...

Hundreds of thousands of people. Average age mid 40s and sliced by hospitalized or not. Controlled against people who had the flu during lockdown.

Double digit percentages have issues 6 months on. Unsurprisingly not very different from SARS 1 and those people are still sick since 2003.

[Mediterraneo10]

Yes, indeed, the various studies (and yours is a typical example) show mainly an older demographic reporting symptoms stretching into months, and include the observation that it was mainly (even if not exclusively) a severe course of the disease that preceded lingering symptoms. But a lot of the attitudes that restrictions must be kept in place to prevent "long COVID" are held by younger people who are very afraid of coming down with the phenomenon, yet they are not significantly at risk of it according to these studies.

[rcpt]

I struggle to see how you reached that interpretation of the paper.

[timr]

Table 3 and Figure 2 make it clear that the hazard ratios for patients with hospitalization and/or encephalopathy are multiples higher for those without hospitalization and/or encephalopathy.

Intracranial haemorrhage is 3-4x more likely in hospitalized patients; ~5x higher in those with encephalopathy. For stroke, 2-3x for both. For first mood disorder, 1.5x/2x more likely.

They don't break down the cross-tabs by age (as they should), but given the patterns here, I would expect to see a strong correlation.

The sicker you are, the sicker you are.

[Mediterraneo10]

Average age 40, as you said yourself. And then as the authors of this paper find, "Risks were greatest in, but not limited to, those who had severe COVID-19."

[orra]

> A lot of the people claiming to have debilitating "long COVID" were never actually tested positive for COVID in the first place.

Worth keeping in mind it was impossible to get a COVID test for a large fraction of the first wave.

[NortySpock]

> A lot of the people claiming to have debilitating "long COVID" were never actually tested positive for COVID in the first place.

Do you have a citation for this claim?

[Mediterraneo10]

I was talking about the innumerable "long COVID" media coverage where some ordinary person is invited to tell the whole story of how they got ill, felt terrible, and still feel terrible, but nowhere did they actually go to the doctor and get a formal positive COVID test. They are just guessing that they had this disease that was going around. And now dedicated Facebook groups etc. are popping up whose membership has complaints and claims that are extremely similar to the "chronic Lyme" groups that flourished just before COVID.

I was obviously not referring to actual scientific studies of long-term COVID effects, but as I said, those studies don’t say quite what the more sensationalistic mass-media coverage is saying.

[wpietri]

There is a big difference between "formal positive COVID test" and "just guessing". For the case I mentioned above, tests were effectively unavailable at time of illness. But later on, multiple doctors said that from the symptoms and the follow-on illness, it was probably COVID.

Your insistence on denying distinctions like this makes you look like a person arguing a case, not somebody trying to jointly get at the truth. Which from my perspective, makes you much worse at arguing your case.

[metalliqaz]

I have been "fatigued" for 3+ years due to having children. Life goes on.

[Broken_Hippo]

"fatigued" from not getting enough sleep or being physically active is not the same thing as folks get from diseases. When you are fatigued from children, you can sleep and take care of it. It is solvable.

It isn't like that with disease.

The worse I've had is the complete inability to stand long enough to make a simple dinner, for example, and this was after napping and sitting most of the day. I'm lucky: Mine passed. Some people live with this day after day after day, and this is more similar to what folks with disease-related fatigue.

[ben_]

Don't be so crass, people are suffering because of this that didn't chose to

[colecut]

That is a not insignificant percentage of parents

[psnatch]

Amusing - me too. Obviously you raise the false equivalency, though.

[dev1n]

No. People (extraordinarily healthy people) are suffering pulmonary embolisms (and thus hospitalized) weeks after they have been cleared from the virus. There is a very, very, very long tail to this disease outside of the initial 2 - 4 weeks of being sick.

[standardUser]

Small percentages of people suffer complications from many different types of illnesses. At a certain point, human beings simply have to live with a small chance of a bad outcome from ailments that are normally mild.

[dev1n]

This isn't some small percentage of people this is 3 - 8% [1] of people hospitalized! Despite not finding data for people not hospitalized many report suffering from and being hospitalized for failures of the pulmonary, endocrine, and digestive system.

Sometimes people have strokes from sneezing.

See I can make generalizing statements about bullshit too.

[1]: https://annalsofintensivecare.springeropen.com/articles/10.1...

[umvi]

> This isn't some small percentage of people this is 3 - 8% [1] of people hospitalized

And what percentage of people that get covid are hospitalized? Let's estimate and say 3% of people that get covid end up hospitalized. 3-8% of 3% is, frankly, a small percentage of people.

You can make any percentage seem large and scary with the right framing (https://xkcd.com/1252/)

[dev1n]

And the same can’t be true for making percentages seem small and insignificant? What exactly are you trying to prove?

[standardUser]

I was talking about the near future when most people are vaccinated, as we have ample proof that hospitalizations are extremely rare for vaccinated individuals.

[DanBC]

1 in 10 patients die within months of leaving hospital. https://twitter.com/ShaunLintern/status/1362863221305192450?...

https://www.independent.co.uk/news/health/coronavirus-hospit...

> More than one in 10 Covid patients died within five months of being discharged from hospital, while almost a third of those who survived the virus had to be readmitted, new research has warned.

> Papers released by the governments Scientific Advisory Group for Emergencies (Sage) also revealed half of patients in hospital with the virus suffered complications, with one in four struggling when they got back home.

> Younger patients under the age of 50 were more likely to suffer complications.

ICNARC gives us some age data: https://www.icnarc.org/Reporting

[standardUser]

I was talking about the near future when most people are vaccinated, as we have ample proof that hospitalizations are extremely rare for vaccinated individuals.

[aantix]

>People (extraordinarily healthy people) are suffering pulmonary embolism

What are the numbers?

[rcpt]

I've posted elsewhere but

Here: https://www.medrxiv.org/content/10.1101/2021.01.16.21249950v...

[aantix]

Where in that study does it show the the numbers for the pre-COVID healthy cohort?

[rcpt]

I believe what you're asking about is covered in table 1 and figure 2.

They're reporting hazard ratios after propensity score matching with people who had the flu during the same time period.

[dev1n]

Do you only care about people if an event is statistically significant?

[vorpalhex]

For public health choices? Yes! 1 in a million events should not be optimized for.

[dev1n]

This is not a 1 in a million event. There are studies like my comment above that back this statement whole heartedly. This is a virus with proven neuroinvasive potential that affects large swaths of otherwise incredibly healthy people.

You can't compare these supposed 1 in a million events to something like doing perf testing on a 64 node raspberry pi kubernetes cluster.

[qndreoi]

In US State Ohio recently, the benchmark for restrictions was changed to the number of people hospitalized for COVID in the state. When it fell below a threshold, bars and restaurants were allowed to stay open later.

[bluGill]

Nobody has figured out what "long covid" is, or how long it lasts. The anecdotes I've heard about the effects to the relatively young mean I'd just assume not open up.

[maxerickson]

It's preferable to have very low infection numbers, to reduce the likelihood of mutations taking hold.

Doesn't mean you go on forever waiting for 0 infections, you just wait a bit longer than the minimum number of vaccinations to go back to activities with highest risks of transmission.

[garmaine]

With both travel restrictions and lockdown, It takes about 6 weeks to get to (effectively) zero new cases. Not forever.

[rhino369]

That depends on how many cases you started with and how low you can get the transmission rate.

No way could the EU or USA get to zero in 6 weeks. It took Victoria Australia about 6 weeks to get from 500 cases to 20. America and Europe have a 100X more than 500 cases.

And the longer you need to lockdown, the less restrictive the lockdowns can be.

[jgalt212]

Yes, but you're still stuck with a population who remains very susceptible to the diseases. Lockdowns, as I'm sure Australia will discover, are not a complete solution to the problem.

[siquick]

We're pretty happy here in Australia with how few of our friends and family have been affected by COVID. Life is practically back to normal and has been this way in Sydney for a while. Vaccination roll-out started this week.

You'd be hard pushed to find a single person who would trade our state's response with pretty much any other countries response.

[jgalt212]

I'd rather be lucky than good.

-- Lefty Gomez

[rhino369]

Yes, absolutely that should be the "end" of it. Especially since we are already giving the vaccine to front line works who aren't old or in danger.

Anyone who wants to hole up until they get the vaccine should be able to.

But I'll take the low risk.

[pipeoperator]

Everyone can empathise with wanting life to get back to normal. However the problem with folk wanting to take the individual risk is that the “low” percentage of people needing medical help can still overburden health care systems.

This potentially means that people with other illness / disease can’t / don’t see a doctor in time, and others in a society take the brunt.

Yes, let’s open up; but let’s not throw caution to the wind either.

[leesalminen]

> can still overburden health care systems

But they haven’t. The prevailing opinion I’m seeing on HN recently is that the US didn’t do a “real” lockdown which is why there are still so many cases. They opine that Americans largely didn’t “comply” with the government orders rendering any potential positive effects from lockdowns moot.

If you take that at face value, then shouldn’t we have had an overwhelmed medical system by now?

The Denver convention center was turned into a makeshift hospital for almost a year. They never had a single patient. My relatives lost their low-paying jobs and are still jobless today.

Remember the military hospital ships that were sent to NY and LA? They never saw a single COVID patient?

At this point I just don’t see any evidence that our healthcare system overwhelmed in any meaningful way. It’s FUD.

Don’t try and post an article about how some random ICU was at 80% capacity. ICUs are designed to be near operating capacity because it’s a waste of resources to over supply.

[dragonwriter]

> If you take that at face value, then shouldn’t we have had an overwhelmed medical system by now?

We did, in many cases, had overwhelmed medical systems at the local peaks, which were not nationally synchronized.

> Remember the military hospital ships that were sent to NY and LA? They never saw a single COVID patient?

You mean the ones that the military explicitly restricted to not taking COVID patients?

Yeah, I remember that. Funny how they never saw any COVID patients.

[leesalminen]

The US Navy reports that the Hospital Ship Mercy treated fewer than 200 patients in total.

“ By the time of Comfort’s departure, the approximately 1,200-person crew and 1,000-bed hospital had treated just 182 patients, of which approximately 70 percent had COVID-19”

So I guess we were both wrong.

https://www.navytimes.com/news/your-navy/2020/04/30/hospital...

[dragonwriter]

> The US Navy reports that the Hospital Ship Mercy treated fewer than 200 patients in total.

Mercy treated 77 patients and was not reconfigured for COVID, Comfort treated more after being converted to COVID just before local cases dropped from their peak for the wave the ship was present for.

It completed reconfiguration to take COVID patients on April 7, just before new cases in both NYC and NYS started rapidly dropping. It almost entirely missed the time it was needed.

I think they are both evidence that both the response and the systems for utilizing new resources wet optimized for the real needs, but neither shows that healthcare systems weren't overwhelmed.

[dragonwriter]

> So I guess we were both wrong.

Er, how was I wrong, again?

[pipeoperator]

This is a worldwide pandemic, not restricted to the borders of the US. People in countries around the world complied with quarantine, but their healthcare systems were still under real pressure. If they were not overwhelmed, it was a close run thing only prevented by social distancing.

Hospitals cancelled and delayed medical procedures around the world due to this: Italy, Spain, the UK, etc.

While the worst case scenarios of healthcare systems on their knees have not panned out, it’s disingenuous to suggest that the impact is imaginary or FUD.

[leesalminen]

It’s not clear to me how illustrating the flaws in one country’s healthcare system should affect the decision of another’s who hasn’t experienced the same flaws even with greater per-capita cases of the virus.

My comment was geared towards America because I’m an American talking on a forum operated by an American company.

Italy can lock down to their heart’s content- that’s their prerogative.

[willyt]

For an average person, Italy, Spain and the UK have better healthcare systems than the US by most metrics. The US is only better for some very obscure and exotic diseases that require expensive and rare treatments that most US citizens wouldn’t be able to afford or wouldn’t be covered for under their health care plans.

[hristov]

The problem with that sort of thinking is if you let the virus circulate and multiply you are risking mutations that are resistant to the vaccines. There already are two mutations that are already somewhat resistant to the vaccines according to initial anecdotal evidence.

But practically speaking most nations are taking this approach and have been reducing social distancing measures when hospitalization rates go down. (Often with negative results.)

[dustinmoris]

> Should that not be the "end" of it?

Yes 100%. As soon as the "vulnerable" have received their vaccine we should remove all restrictions even if the vaccine doesn't 100% prevent the "old fat cigarette smoking weak people" from dying from this cough virus because after the vaccination there is nothing more we can do.

Vaccines are the single most effective way to prevent disease after clean water. It is the cherry on top of a cake in terms of what humans can achieve medically. A vaccine is literally the dream to achieve for any illness which could affect us. As a result, as soon as we have deployed our best and most effective weapon against this virus we must open up again. If the vaccine doesn't prevent fat people from dying then nothing will and we just have to accept that fat people will die due to their own wrong doings. After all that's how the world is designed to work.

[rcpt]

As long as one believes that chronic covid does not exist or alter one's life expectancy and the comfort of the elderly is our top priority then yes. Once the olds are safe the virus shall run wild through the young.

[garmaine]

> Since we're on the topic, shouldn't this (hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?

No. This is the "flatten the curve" logic which was a horrible misjudgment. Having the disease in circulation in the community is not only doing tremendous damage to many, many people (even if the hospitals aren't full), but is also allowing the virus to mutate and potentially escape immunity protections or become more deadly. If you re-open as soon as the hospitals start to free up again, you just start moving the pendulum back in the direction of crisis.

Countries like Australia and New Zealand have shown that if you keep up lockdown measures for just a month or two after the hospitals free up (AND if you institute and keep real travel quarantine restrictions), you can get the virus to effectively ZERO community spread and keep it there. We can achieve this, and we ought to be aiming for it.

[scrollaway]

> Countries like Australia and New Zealand have shown that if you keep up lockdown measures for just a month or two after the hospitals free up (AND if you institute and keep real travel quarantine restrictions), you can get the virus to effectively ZERO community spread and keep it there.

It's too late for that anywhere that isn't super remote like AU/NZ. Even South Korea and Japan, isolated as they are and with very strict measures, controls on lockdown, and a population that strictly follows them, cannot get / is not getting to zero community spread: It's doing regular, short, strict lockdowns instead.

This is the model that the west should adopt but instead a lot of countries are faffing around. Belgium has been in a five-months-long semi-lockdown that is leaving everyone severely depressed, is hugely damaging to the economy, and has plateau'd the spread to very non-zero numbers so the disease is still very much present. Worst of both worlds.

[ggm]

It's too late for that anywhere that isn't super remote like AU/NZ.

As an Australian citizen I often wonder how much this super distant story has to do with it.

[garmaine]

Japan does NOT have strict lockdowns in place. I know, I work for a Japanese company. Heck they've been giving out travel vouchers for free travel around the country. Not a model for pandemic response at all.

Australia is hardly isolated. Tons of flights in and out every day, and a vital part of the world economy. Really, any country can be "isolated" if they just close the borders to non-quarantined (REAL quarantine) travel, which is much more important than lockdowns.

[Al-Khwarizmi]

Australia and NZ had the advantage of being quite remote, true. But they had no vaccines.

With vaccines and a decent uptake, the difficulty level to achieve zero spread should go down significantly.

That said, I totally agree that short but strict lockdowns would be much better than permanent half-assed measures.

[ravenstine]

Should we have an "end"?

To play devil's advocate, clearly the world can handle a certain amount of locking-down, the social distancing, the mask wearing, etc., so it seems it is better if we just accept these restrictions indefinitely because we can save more people. Maybe we're fine not having mass gatherings, not eating indoors, and not leaving the house without a mask if it means saving the vulnerable. After all, it could be that COVID stays in the body like herpes and creates a different set of problems years later. Until we know for sure, the safest course of action for the public is for them to remain quarantined.

After all, how bad is your life, really? If your life is tolerable, that means the restrictions are tolerable as well.

EDIT: It's like nobody knows what playing "devil's advocate" means anymore. I think it's valid to ask that, if all the measures we are taking are objectively good, whether we should take them from now on.

[samr71]

Assuming this is not sarcasm, this can be taken to any logical extreme of "tolerable". I'm sure there are many other new restrictions we can put in place that would make people's lives (more) miserable, that are nevertheless "tolerable".

Furthermore, can the world really handle the restrictions in place indefinitely? We've been locked down for a year, and it's certainly starting to feel like the wheels are coming off for many. The economic devastation alone has been staggering.

Epidemiologically speaking, sure, doing this forever would save the most amount of people from COVID. But we can't just look at this from that point of view.

[ghaff]

The vast majority of people are not fine with any of those things for an extended period. In fact, in the US, once late spring/summer roll around people are going to be out and about.

[ravenstine]

Really? That's what people said back when it was proposed that we shut everything down for a few weeks to "flatten the curve". Now look how long we've gone. I'd say Americans have very well tolerated this new way of life and could do so in perpetuity. I wouldn't count the protests and riots last summer since they were politically motivated.

[tdfx]

> I'd say Americans have very well tolerated this new way of life and could do so in perpetuity.

Except for the horrific acceleration of radical politics, rioting in the streets (and Capitol), effective abandonment of the education of the children of the bottom 50% percentile earners, rise in suicides and substance abuse, etc. Locked down masses are going to be increasingly difficult to pacify.

[ghaff]

In spite of lots of grumbling and non-compliance in some regions, people have adapted to things they said weren't really conceivable last year. Yes, people have (generally) accepted extended temporary restrictions. That said, essentially no one is accepting this as a permanent condition and as people are vaccinated, I have a high level of confidence that people are not going to accept continued restrictions. You are, of course, welcome to do whatever works for you.

People certainly didn't permanently hide out before there were vaccinations against diseases like cholera.

[ravenstine]

I kindly disagree. Although I think we'd see next to no resistance if we were told "this is the new normal, deal with it", in reality we'll all be told "by this time next year" in order to keep people hooked on the hopium and ensure the new paradigm.

For the record, I'm not in support of the prevailing COVID containment strategies. Believe me, I'd love to see politicians face some actual backlash over what's been happening.

[ghaff]

I dunno. Based on the traffic around where I live, I'm probably more conservative than most but come widespread vaccination, I'll vote against any politician who tries to keep things locked down and I (and most others) are already casual around things like outdoor masks that are essentially theater. And that's not even considering all the business and other economic constituencies which are frankly more important to the politicians. For example, many organizations will not tolerate physical events being shutdown indefinitely.

Absent vaccines it would have been more complicated. But, at some point, countries say that they've done what they can and things are as they are.

[AndrewBissell]

Have you actually looked into the numbers regarding what lockdowns have done to mental health, not to mention the economic impacts which are going to feed back into people's well being in all sorts of ways? Just because your subjective experience of being a shut-in for nearly a year has been a tolerable one does not mean that has been the case for large numbers of people.

I want my kids to go to a harvest festival again with a live band and tons of people like the one they did in fall 2019. No, this is not something worth giving up simply to preserve a few years of life for some nonzero number of society's most vulnerable and aged. And no, I'm not any more willing to wait five years to see whether there's some lurking complications from the disease, any more than people have been willing to do that with the vaccines which are being distributed.

[leesalminen]

That sounds pretty close to fighting words to me.