from jump this thing was seen as both deadly and a massive resource suck

and also that, although it might not kill you, it might still put young healthy people into a hospital bed for weeks receiving O2 and treatment. that was the fear coming out of China and Italy.

but looking at the NYC data, regardless of how you peg the IFR based on the sero study results, the hospitalization rate is only 3-4x the death rate. and the hospitalization rate lessens with age, just like CFR.

to me, that's a complete game changer. not from an overall deaths perspective, but from a perspective of how to plan around this disease. you can give some people real confidence that contracting the disease is less dangerous than many other normal activities. and you can strongly advise the most vulnerable to cordon off as much as possible. we can make plans to funnel resources to THAT objective rather than anything related to overall hospital capacity. that's where the hospitalizations largely come from, mitigate there.

but I haven't seen a single public health official give as much as a sigh of relief with regard to the modeled overestimation of healthcare resources. and I'm wondering what gives? what am I missing?

the IFR is grim, but the way to lower that further is to keep the most susceptible out of the denominator

It's worth talking about but I don't think you can do it here. Has to be on the politics forum or it's going get locked/deleted. Mods have become very strict on this forum and it's headed for pub status.

To me there are two drivers for what you're seeing:

- the first is that irrational fear is driving policy, not logic

- the second is that people think it's somehow wrong to discuss the defining characteristic of COVID19, because they think it's unseemly or prejudiced or some other silliness

The refusal to define our response primarily by the huge difference in risk between the old/compromised and the rest of the population is just nonsensical. It's like playing football and refusing to use your scouting report which shows the opponent's exact tendencies to formulate your gameplan.

I was 100% alarmist in Feb/Mar with regard to resource management and triage

but that's not where we're at. sero studies in NYC and Italy are pegging the IFR at ~1%. assume that however you want, average, worst-case, best-case(?)

the resources need to be funneled into preventing the people that fuel that 1% from contracting the disease

I think Texas and Georgia opening up will reveal the truth one way or another.

I hope the OP is correct with the analysis.

Agree w/Cone.

It seems that the likely reasonable approach is "open with masks/stand apart"

it's the unwillingness of the public health officials to take a win, pivot, and remessage that I don't get

DTP02 said:

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To me there are two drivers for what you're seeing:

- the first is that irrational fear is driving policy, not logic

- the second is that people think it's somehow unseemly to discuss the defining characteristic of COVID19, because they think it's unseemly or prejudiced or some other silliness

The refusal to define our response primarily by the huge difference in risk between the old/compromised and the rest of the population is just nonsensical. It's like playing football and refusing to use your scouting report which shows the opponent's exact tendencies to formulate your gameplan.

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I disagree that irrational fear is driving policy. It's more likely that confirmation bias is driving policy to some significant extent.

Bias researcher believes, and regularly writes into grant applications, things like "emergent viruses are an important threat to public health, so give me hundreds of thousands of dollars to support my work".

Now that an emergent virus has come, the experts are going with what they "know". The challenge is they don't have to balance divergent policy considerations on a regular basis, so they do what we all do...highlight the risks they know and pass over risks that are less familiar.

Cone, you have done a 180. Glad to see you are willing to think for yourself and formulate your opinion on data.

I really haven't though

this thing is still just as deadly as envisioned

it just doesn't seem like the cataclysmic resource sinkhole that it was thought to be

and as such it's leading us to new uncomfortable questions, like balancing economic imperative versus generational warfare. I hope we can square that circle.

Media could be doing stories like this but they won't. Only full blown panic news, 24/7. They are just as culpable for the economic destruction as the virus

Cone, I think it has proven to be much less deadly than the news has been portraying it. Much less. Good thread though. News media is not going to report anything positive like you just posted.

Quarantine the sick and at risk. Let the healthy and low risk live their lives.

I'm afraid that the answer is probably that politicians don't want to be blamed for deaths, and its all too easy for the media to report virus death numbers and lay that at the feet of politicians. Until the public starts holding politicians equally responsible for the damage being done to the economy by the lockdown, the easy choice for politicians is to be seen to be doing everything possible (regardless of how effective) to keep reported covid deaths down.

As the economic crisis becomes clearer, that's going to change. You've already seen it in Texas with Abbott shifting gears after initially being rather slow on opening up.

People need to recognize that tradeoffs are involved, and there is nothing unseemly about that, as we make risk utility assessments all the time in every aspect of life, such as how fast cars drive, what kind of side effects we can tolerate in drugs, etc. This is no different, even though some people seem to believe that it is. Given our lack of data at the onset, erring on the side of caution was understandable and prudent, but as the OP points out, we now have data and can better quantify the risks. That should result in changes in approach.

it's striking because the same public health officials that claim victories based on diagnostic or therapeutic advances have not done the same when the domestic data shows something different and better than what we expected.

I really think a lot of the current politic strife we're seeing is an inability to remessage after the initial push. the public health folks set us up to mobilize against something they thought was going to be high cost and dramatic to weather. it turns out for everywhere outside of NYC, the task wasn't so difficult. but instead of issuing a congratulations and attempting to pivot, they are stuck in the same messaging and people aren't buying it.

They absolutely need to remessage. We are stuck nationally with a flatten the curve message but with no objective in mind outside of reducing deaths by some undefined amount. They need to message that there's something in the short term offing worth hunkering down for.

15 days to flatten the curve has morphed into 2 mos and counting. And the government will tell us which stores can be open to kill us.

It is irrational

MASAXET said:

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cone said:

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it's the unwillingness of the public health officials to take a win, pivot, and remessage that I don't get

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See I disagree with this somewhat. Public health officials are actually readily acknowledging this fact and happy about it. Maybe it's not filtering through the news lens, but actual public health officials are working around these sorts of facts (certainly in Harris Co. at least)

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So did they own up to their mistake to spend 10's of millions of dollars on a temporary hospital that saw 0 patients because they have no clue what the eff they're doing?

twk said:

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I'm afraid that the answer is probably that politicians don't want to be blamed for deaths, and its all too easy for the media to report virus death numbers and lay that at the feet of politicians.

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And here lies the rub. This is going to take this squarely to a political conversation, however the obvious effect of politicians making decisions on behalf of the public safety squarely puts them in a place to then be held accountable for public safety when it comes to this virus. Since they are now accountable to it, they don't have the balls to lift the restrictions because if the message gets out of hand (which it will especially for the R's), they can lose their job. "Better safe than sorry" is the modus operandi at the expense of the economy. It's going to take the public protests and outcry to reverse their decisions so they wont be held responsible for it.

I agree with all you guys here and I feel all governments are failing in this affect because there seemed to be no metrics for closure and now there are no metrics for re-opening. This should be based on hospital acuity and that's it. Since we're now at a place where the hospitals are so under populated nurses and doctors are being furloughed, we need to open back up, while closely watching hospital numbers. At the same time, their should be STRONG recommendations on how to slow the spread, i.e. masks, social distancing, and hygiene. You can't make laws on it because you can't be stupid and arrest people for it, but every person in this country has the ability to protect themselves via the same methods barring someone who just runs up and coughs in your face (which could probably be classified as assault).

TLDR...government intervention has created government responsibility which has now become political. Now politicians are worried about political ramifications of their decisions rather than what science, data, and the freedoms of this country dictate they should be doing.

Lester Freamon said:

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Am I missing something? NY hospitalization rates are 20-25%. I use them as an example because of the density of testing there should give us a decent view of denominator.

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We're talking hospital capacity as well. We also need to quit using NYC, a worst case scenario, as the standard. We were encouraged to social distance and then regulations came down about it to help flatten the curve. The reason was our hospitals could not handle the volumes and we needed to help spread out their resources. Well now we see our hospitals have plenty of capacity and it's never been jeopardized in most locales. Saw a doctor in Harris county on the news say well just because we have beds and ventilators that doesn't mean we need to use them, so we still need shelter in place regulations. The metrics are not only shifting, but changing completely.

I was good with doing my part to social distance to help not overburden hospitals. I'm not ok with this changing into destroying our country and sheltering in place for a year until we have heard immunity or a vaccine. That's the rate we're going right now.