[Sivad]

Agreed.
Shouldn't we err on the side of caution ?

Oh, is that what we're doing? Crashing the global economy and imposing martial law around the world is "erring on the side of caution" ? If "err on the side of caution" means panic like imbeciles by taking extreme measures that aren't even remotely warranted then you all have most definitely "erred on the side of caution".

Not even to mention showing solidarity with the generation of your parents and grandparents ?

Solidarity with the generation that deindustrialized the West, outsourced the jobs, imposed neoliberal austerity, forced millions of economic refugees to flood into our society, crashed the economy, took us into a slew of bullshit wars, turned the culture into a decadent soulless consumer orgy, rotted out every institution from news media to science to government until they were totally fake mockeries of what they purported to be? That's the generation I'm supposed to be in solidarity with? Even while they're in the act of throwing my generation under the bus at this very moment?

Why are you and a few others so hangup with the age thing ?

Intergenerational inequity is a major problem in our society. Massive wealth and power gaps between the generations didn't come about by accident, they're the result of an extremely selfish generation that just stopped caring about what kind of world they were leaving for their children.

Even primitive societies show respect for their older citizens.

Well maybe the older members of primitive societies earned respect by actually demonstrating wisdom and decency. Or maybe "respect your elders" is just some bullshit old people came up with to keep themselves on top of the heap. Either way, the older citizens in this society are selfish assholes who don't merit respect because they haven't earned it.

[Rancid]

Shouldn't we err on the side of caution ?
Not even to mention showing solidarity with the generation of your parents and grandparents ?
Why are you and a few others so hangup with the age thing ?

1- Generally speaking, yes, but not an absolute yes. In decision making of any kind, there is always an opportunity cost. This should always be considered before action is taken. That is, we shouldn't just do things blindly (like waste resources by spraying trees and bushes with disinfectant willy nilly), especially when we have data in front of us.

2- Yes, we should. The rhetorical element of this question implies you think I don't care about older people, which is false. Like I challenged DrLee, I'd like for you to find a quote where I say we should let old people die and we should not protect them. I'd like for you to find where I've said I will not isolate or socially distance myself from others. I'd like for you to quote where I said I will not cancel my travel plans (i was supposed to be traveling today on an airplane as a matter of fact). If you didn't mean to imply I don't care about old people, then you can disregard the challenge.

3- I'm not hung up on age, I'm hung up on facts. It's important to understand the facts.

With respect to lung damage, it's far too early to tell. So it's dishonest to say young people are at risk of lung damage. 12 people isn't enough, and science has a replication problem as it is. It's a data point, but it's not enough of a data point. To make a broader point beyond lung damage, sure, we can be cautious, but at a minimum, let's recognize the cost of that caution. That doesn't mean we don't take precautions, but we should at least understand the cost of that precaution. This is kind of like the climate change argument. We should be cautious, but at the same time, realize the cost of that caution, and realize that maybe all the precautions may not be worth it (notice I said 'may', and not 'are', since no one would know which precautions are worth it and which aren't until maybe years from now).

Sidenote:
My speculation here is that the economic costs will destroy more lives than SARS-CoV-2 itself. That doesn't mean I'm saying we shouldn't take precautions though.

[Patrickov]

Sidenote:
My speculation here is that the economic costs will destroy more lives than SARS-CoV-2 itself. That doesn't mean I'm saying we shouldn't take precautions though.

With the collapse of the stock market (and some currencies) recently and the stoppage of many human activities due to the response to the epidemic, this is probably closer to fact than speculation.

[Pants-of-dog]

The deadliness of this virus is dependent on many factors that are not inherently part if the disease itself.

For example, one factor is the availability of ventilators for patients who cannot breathe easily on their own. If there are enough ventilators for everyone, the fatalities will be a lot lower than if there are none.

[fokker]

Some interesting readings:

https://www.propublica.org/article/a-me ... g-patients
https://www.nbcnews.com/health/health-n ... g-n1164756

[Sivad]

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

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

MARCH 17, 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

https://www.statnews.com/2020/03/17/a-f ... able-data/

[Donna]

I don't think the world is overreacting per se, rather, the world is uniting around our hospitals and healthcare workers. Ultimately this is the purpose for the shut-downs and social distancing, so that ICUs don't collapse.

[Sivad]

WSJ: Rethinking The Coronavirus Shutdown
The Wall Street Journal, 20 March 2020

No society can safeguard public health for long at the cost of its economic health.

Financial markets paused their slide Thursday, but no one should think this rolling economic calamity is over. If this government-ordered shutdown continues for much more than another week or two, the human cost of job losses and bankruptcies will exceed what most Americans imagine. This won’t be popular to read in some quarters, but federal and state officials need to start adjusting their anti-virus strategy now to avoid an economic recession that will dwarf the harm from 2008-2009.

The vast social-distancing project of the last 10 days or so has been necessary and has done much good. Warnings about large gatherings of more than 10 people and limiting access to nursing homes will save lives. The public has received a crucial education in hygiene and disease prevention, and even young people may get the message. With any luck, this behavior change will reduce the coronavirus spread enough that our hospitals won’t be overwhelmed with patients. Anthony Fauci, Scott Gottlieb and other disease experts are buying crucial time for government and private industry to marshal resources against the virus.

Yet the costs of this national shutdown are growing by the hour, and we don’t mean federal spending. We mean a tsunami of economic destruction that will cause tens of millions to lose their jobs as commerce and production simply cease. Many large companies can withstand a few weeks without revenue but that isn’t true of millions of small and mid-sized firms.

Even cash-rich businesses operate on a thin margin and can bleed through reserves in a month. First they will lay off employees and then out of necessity they will shut down. Another month like this week and the layoffs will be measured in millions of people.

The deadweight loss in production will be profound and take years to rebuild. In a normal recession the U.S. loses about 5% of national output over the course of a year or so. In this case we may lose that much, or twice as much, in a month.

Our friend Ed Hyman, the Wall Street economist, on Thursday adjusted his estimate for the second quarter to an annual rate loss in GDP of minus-20%. Treasury Secretary Steven Mnuchin’s assertion on Fox Business Thursday that the economy will power through all this is happy talk if this continues for much longer.

If GDP seems abstract, consider the human cost. Think about the entrepreneur who has invested his life in his Memphis ribs joint only to see his customers vanish in a week. Or the retail chain of 30 stores that employs hundreds but sees no sales and must shut its doors.
Or the recent graduate with $20,000 in student-loan debt—taken on with the encouragement of politicians—who finds herself laid off from her first job. Perhaps she can return home and live with her parents, but what if they’re laid off too? How do you measure the human cost of these crushed dreams, lives upended, or mental-health damage that result from the orders of federal and state governments?

Some in the media who don’t understand American business say that China managed a comparable shock to its economy and is now beginning to emerge on the other side. Why can’t the U.S. do it too? This ignores that the Chinese state owns an enormous stake in that economy and chose to absorb the losses. In the U.S. those losses will be borne by private owners and workers who rely on a functioning private economy. They have no state balance sheet to fall back on.

The politicians in Washington are telling Americans, as they always do, that they are riding to the rescue by writing checks to individuals and offering loans to business. But there is no amount of money that can make up for losses of the magnitude we are facing if this extends for several more weeks. After the first $1 trillion this month, will we have to spend another $1 trillion in April, and another in June?

By the time Treasury’s small-business lending program runs through the bureaucratic hoops—complete with ordering owners that they can’t lay off anyone as a price for getting the loan—millions of businesses will be bankrupt and tens of millions will be jobless.

[Pants-of-dog]

If the only “damage” is lost economy, we are doing fine.

[Stormsmith]

I don't think the world is overreacting per se, rather, the world is uniting around our hospitals and healthcare workers. Ultimately this is the purpose for the shut-downs and social distancing, so that ICUs don't collapse.

*like*

(My like button doesn't work)

[Rancid]

I don't think the world is overreacting per se, rather, the world is uniting around our hospitals and healthcare workers. Ultimately this is the purpose for the shut-downs and social distancing, so that ICUs don't collapse.

Once this has passed, do you think governments around the planet will increase their standby capacity of ICUs, ventilators, etc. etc?

[Donna]

Once this has passed, do you think governments around the planet will increase their standby capacity of ICUs, ventilators, etc. etc?

Yes, very likely. It's possible the world will change entirely in other respects as well due to the economic impact and the renewed role of government in society. It could amount to a severe blow to neoliberalism and globalization.

[Sivad]

*like*

you like that feel good bullshit, eh? doesn't matter if it's braindead vacuous as long as it's warm and fuzzy.

[Stormsmith]

Yes, and it's far from brain dead.

[Sivad]

Yes, very likely. It's possible the world will change entirely in other respects as well due to the economic impact and the renewed role of government in society. It could amount to a severe blow to neoliberalism and globalization.

And there we have it, Donna thinks coronavirus is good for her political agenda so Donna hypes the shit out of it regardless of facts. That's what these progs do on all of these issues, it doesn't matter what the reality is, honesty and intellectual integrity always take a backseat to political convenience. Actually, they don't just take a backseat, the progs have dispensed with them entirely. In their view facts and reality are just trivial encumbrances that get in the way of politics.

[Donna]

And there we have it, Donna thinks coronavirus is good for her political agenda so Donna hypes the shit out of it regardless of facts. That's what these progs do on all of these issues, it doesn't matter what the reality is, honesty and intellectual integrity always take a backseat to political convenience. Actually, they don't just take a backseat, the progs have dispensed with them entirely. In their view facts and reality are just trivial encumbrances that get in the way of politics.

It's just an analysis. My parents fall into multiple risk categories, so by no means am I a fan of coronavirus, Sivad. I'm legitimately concerned about this pandemic and as a big government gal I don't even necessarily have any complaints with how the Trump administration has been handling the crisis (such as evoking the Defence Production Act or using stimulus monies to support workers). I can do without the "Chinese virus" snipes, but it's kind of expected.

[Pants-of-dog]

And there we have it, Donna thinks coronavirus is good for her political agenda so Donna hypes the shit out of it regardless of facts. That's what these progs do on all of these issues, it doesn't matter what the reality is, honesty and intellectual integrity always take a backseat to political convenience. Actually, they don't just take a backseat, the progs have dispensed with them entirely. In their view facts and reality are just trivial encumbrances that get in the way of politics.

@Donna discussed an end to neoliberalism and globalisation.

Since you oppose this, can we assume you support neoliberalism and globalisation?

[Sivad]

@Donna discussed an end to neoliberalism and globalisation.

Since you oppose this, can we assume you support neoliberalism and globalisation?

So I'm either a dishonest shill or I love neoliberalism? Really? That's the fakakta logic you're working with?

[Pants-of-dog]

So I'm either a dishonest shill or I love neoliberalism? Really? That's the fakakta logic you're working with?

Is that a yes?

[ness31]

Oy-vey!

I learnt some Yiddish today thanks to Sivad!!