Covidmas: The Feedback So Far
One of my goals in writing this series is to encourage productive conversation. Productive can be interpreted differently, but to me a productive conversation is one where there actually is disagreement.
Far, far too many conversations these days end with everyone nodding in agreement because everyone is walking on egg shells worrying that someone will get offended. This may make us feel good in the moment, but it is highly ineffective at making long-term progress.
Thus, I want to address a couple notes I’ve received so far on the first three pieces of this series. It’s a bit of a cop out: I don’t have the next pieces ready yet, but I do really want to address the points/challenges that several people shared with me as an effort to further the conversation in a productive way.
In response to Covid In a Historical Context, Sam wrote:
I always find these comparisons somewhat amusing. You state that science and technology have progressed yet still point to the Spanish Flu while ignoring the added impact of lack of understanding of how viruses behave in 1918 or the historical context of infected soldiers returning from Europe to all over the world. Do you think our medical technology hasn’t improved since 1918?
It’s also very interesting to see you point to lack of historically significant deaths yet also call out the ‘overreaction’ to the virus. You are completely discounting the fact that the ‘overreaction’ you mention is controlling the overall impact of the disease itself. They are not independent. What you need to do is look at what deaths *would* have been if the reaction to the virus was what you would consider a reasonable reaction. I’m unsure what parts of the response you think are an overreaction, so please elaborate.
I’ve seen the same logic applied here (Australia) by conservative commentators, they point to the fact that only 908 people have died here so we overreacted but, the medical data shows that had we not reacted at all, the deaths would have been ~399,8400. Assuming 80% of population infected and a CFR of 2%. Even at 60% of population infected and a CFR of 1% we’d still be looking at 149,940 deaths. Pretty good job, I’d say.
The points about social media I kind of agree with, I think it’s led to misinformation spreading and has certainly increased polarisation but, when it comes to COVID, I’ll listen to the infectious disease experts who state COVID is a big deal. That’s what we did here and it saved at least 100k lives no matter how you skin it.
My response:
There are a few points I want to raise here in response to some of your questions and feedback.
Regarding over-reactions: I should be clear that I am not advocating for a zero intervention, live-life-as-normal approach, which admittedly bears repeating as there sadly are some people who think that. I will get into this in more detail in subsequent (separate) pieces on masks and lockdowns, but in general I think masks make sense when indoors in public, and that having large gatherings of a ton of people in small spaces is a bad idea. So I’m not really going to raise a fuss over (indoor) mask mandates or reasonable capacity limits. My answer is always going to be that I’d prefer people willingly choose this rather than relying on government dictates, but again, I can work with it.
Regarding the potential death counts, most research now suggests 2% overall fatality is way too high, and that even 1% is too high. Of course, this depends on the mix of the population given how drastic the age differential is. But the number is lower than if you just divide deaths by cases because we know many cases are asymptomatic and thus still go undetected. Recent estimates put this in the range of 0.5 to 0.3%. Still bad, sure. But your case of Australia at 60% infections points to 46,000 deaths as a theoretical maximum.
Regarding Australia and its response, I frankly do believe that the response, particularly in Victoria, was a human rights violation and disproportionate. I can “get” the logic behind it: if you do impose a strict lockdown early and before the virus spreads too far, then it can be kept under control. That did “work” for Australia, but the cat was out of the bag here in the U.S. as soon as New York had it’s outburst. Washington state actually did a good job of controlling their early outbreak. NY did not, and it seeded much of the country (there are studies on this tracing virus lineage). Basically put: a lockdown in February may have worked here. But trying to lockdown now would do absolutely nothing aside from further damaging the economy.
But back to Australia – I just flat out don’t believe that any government should be able to essentially put its citizens under house arrest, no ifs, ands, or buts. Aside from it violating inherent and inalienable principles, I do believe the negative consequences (economic damage, depression and drug overdoses, slowed child development particularly within low income households) will far outweigh the benefit, which I will expand upon in a future piece. I take it from your post that you don’t agree. Thankfully here in the U.S. we have both a Bill of Rights and Federalism. As such, places like California can try a command and control approach, and places like Texas and Florida can try an approach that does treat its citizens with respect. And we can see who wins out. I don’t see too many people hustling out of Texas or Florida to move to California right now, and I do think that trend will continue. And that’s not even to mention that at current Covid case growth rates, California may still surpass Texas and Florida in deaths per capita.
and in response to Covid and Rational Risk Assessment, he also wrote:
You are falling into your own trap. You are equating your personal risk to the risk of the country as a whole. Let’s say 40% of the population gathers in groups of 10. So 132 million people with each having a 1.6% chance of ‘rona. Then you take your 41% chance of getting it. Then you take a 5% hospitalisation rate (actually rather low). That’s 432,960 hospitalisations in a short period or almost 47% of all US hospital beds. You were right! When you take really small numbers and apply them to the whole population it becomes quite apparent that everyone only thinking about themselves is kinda fucked, isn’t it? Also when you only think about your small risk and don’t apply it to everyone else… you miss the big picture. Kind like what happened with the GFC…
I don’t believe your estimates here are even close to valid. I do have a whole piece planned to address hospital capacity, but to address why your estimates are wildly off:
This hospitalization rate is way too high, especially given asymptomatic cases, which again are not captured in case-to-hospitalization ratios. It’s also highly stratified by age, which ties into the next point:
The logic of your case also falls apart because people who are actually at risk from the ‘roni will act in self-interest and isolate and minimize contact. As they should, and as my grandparents did! Sadly, with a virus on the loose, this is necessary no matter what. The question is whether the rest of us need to join them despite no meaningful risk – and destroy businesses and lives in the process. My answer is an unequivocal no.
Thanksgiving travel this year (3-4 weeks ago) was still about 50% of what it was in 2019 – basically what you describe. By your logic here, our hospitals should be overflowing. Despite several articles written by innumerate journalists, this simply isn’t the case. Here is the latest data from Health and Human Services (source linked below). You can download the timeseries data – it’s increasing slowly, but the idea that we are near capacity is a flat-out falsehood. That’s not on you: I know the media has been portraying overflowing hospitals – it’s on them.
My response:
In response to Covid and Rational Risk Assessment, Bryn wrote:
Mortality is clearly an important outcome, but it’s not everything. COVID causes morbidity in many more patients than it kills. The mortality estimates also assume access to healthcare, including hospital admission, ICU care, ventilatory support and even ECMO. If the healthcare system is overwhelmed, mortality will increase.
My response:
Yes, absolutely. And I agree with the unstated that I should have tried to fit more discussion of that into this piece. Unfortunately it was quite long enough as it stood, and I do plan to do two separate pieces: one on hospital capacity and the other on complications and long Covid.
Suffice to say, both are concerns at both a personal and societal level and are fair caveats to the case I laid out here. As I note above re: hospital capacity, the data I’m seeing doesn’t present this as a broad problem, though I am sure localized cases may exist.
And regarding complications, you could apply a factor to the model to say that beyond the deaths, 3x that number will have meaningful complications long-term. In the case of that Thanksgiving dinner, that changes the odds from 1/2000 to 3/2000, which is still in a manageable bucket for many people but it of course depends on the individuals.
And of course it is worth pointing out that we should absolutely respect the challenges, risks, and sacrifices of doctors like yourself in all this. Per what I’ve mentioned a couple times, I do absolutely think people have a responsibility to try to reduce their own risk of getting sick and protect anyone they know who is at risk. This is good obviously for the people in question, but also for hospitals and general societal welfare.
But this also has to come with a balance, nuance, and personalized choices rather than catchall bans, media fear-mongering, and personal catastrophizing that I’m seeing in way too many places.
And that’s all for today! Hopefully this is helpful for people reading this series (a surprising large amount). I can’t guarantee that I’ll get to all feedback on future pieces right away, but I will do my best to ensure that this is a dialogue and is addressing any good faith counterarguments.