Author Topic: How long can we wait while flattening the curve?  (Read 675431 times)

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1500 on: May 01, 2020, 01:23:18 PM »
Even if such a model could be constructed (you'd need to quantify a lot of unknowns) you'd still have to have an honest discussion about how much money we're willing to spend to save a life (whether young, old, immunocompromised/not, etc).

Since nobody will do that, we're stuck with the path we're on, I suppose.

The US government quite specifically values a statistical life saved at around $10 million. This calculation makes no explicit discounts for age or sickness, but in a way, we're kind of having that conversation already whenever we push to open up a little more.

If we open up to the point where additional deaths valued at $10 million is greater than economic transactions recaptured, we've implicitly said that older and sick life is worth less money.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1501 on: May 01, 2020, 01:48:15 PM »
This discussion is obviously going on in every government across the globe.  No one wants to unnecessarily shut down and destroy their economy, absolutely no one. 

This is basically my line of thinking. Donald Trump is a nakedly self-interested person who wants to win the election in November very badly, if only so that he gets to be the center of attention again for the next four years. A healthy economy is his best chance at that. He is incredibly thirsty to open up, and wanted to do so weeks ago. The guy is desperate for smart and well-informed people to come in to his office and make the case that we can crank up the economy again. The fact that he hasn't moved in a significant way to lift Federal guidance says all you need to know. He's tried to score political points on twitter but that's about it.


nereo

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Re: How long can we wait while flattening the curve?
« Reply #1502 on: May 01, 2020, 01:56:15 PM »
This crisis has minted an amazing amount of market timers, and now armchair epidemiologists and economists.  It's kind of amazing to think some mustachian without a degree in either epidemiology or economics knows better than literally the entire field of experts that devote their lives to studying these things.

Unfortunately, in recent decades we've developed a culture where questioning expert opinions has become common place, and all too often people convince themselves that they know more than the people who literally spend their entire careers studying.  Often they bring up some topic as if no one has ever thought of it before (and which has been extensively studied and often dismissed for good reason).

Global climate change created an army of denialists that suddenly thought they could detect flaws in the analysis of literally petabytes of data made by thousands of independent researchers.  Anti-vaxxers suddenly knew more about medicine after reading a few hundred pages of blog posts than doctors who had spent 7+ years in training.  Now we've got market economists and epidemiologists. 

Kris

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Re: How long can we wait while flattening the curve?
« Reply #1503 on: May 01, 2020, 02:02:49 PM »
This crisis has minted an amazing amount of market timers, and now armchair epidemiologists and economists.  It's kind of amazing to think some mustachian without a degree in either epidemiology or economics knows better than literally the entire field of experts that devote their lives to studying these things.

Unfortunately, in recent decades we've developed a culture where questioning expert opinions has become common place, and all too often people convince themselves that they know more than the people who literally spend their entire careers studying.  Often they bring up some topic as if no one has ever thought of it before (and which has been extensively studied and often dismissed for good reason).

Global climate change created an army of denialists that suddenly thought they could detect flaws in the analysis of literally petabytes of data made by thousands of independent researchers.  Anti-vaxxers suddenly knew more about medicine after reading a few hundred pages of blog posts than doctors who had spent 7+ years in training.  Now we've got market economists and epidemiologists.
.

ender

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Re: How long can we wait while flattening the curve?
« Reply #1504 on: May 01, 2020, 02:04:49 PM »
This discussion is obviously going on in every government across the globe.  No one wants to unnecessarily shut down and destroy their economy, absolutely no one. 

This is basically my line of thinking. Donald Trump is a nakedly self-interested person who wants to win the election in November very badly, if only so that he gets to be the center of attention again for the next four years. A healthy economy is his best chance at that. He is incredibly thirsty to open up, and wanted to do so weeks ago. The guy is desperate for smart and well-informed people to come in to his office and make the case that we can crank up the economy again. The fact that he hasn't moved in a significant way to lift Federal guidance says all you need to know. He's tried to score political points on twitter but that's about it.

This isn't true.

A leadership based response to COVID that actually was cohesive and meaningful would have done a lot more for his re-electibility.

Kris

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Re: How long can we wait while flattening the curve?
« Reply #1505 on: May 01, 2020, 02:08:33 PM »
This discussion is obviously going on in every government across the globe.  No one wants to unnecessarily shut down and destroy their economy, absolutely no one. 

This is basically my line of thinking. Donald Trump is a nakedly self-interested person who wants to win the election in November very badly, if only so that he gets to be the center of attention again for the next four years. A healthy economy is his best chance at that. He is incredibly thirsty to open up, and wanted to do so weeks ago. The guy is desperate for smart and well-informed people to come in to his office and make the case that we can crank up the economy again. The fact that he hasn't moved in a significant way to lift Federal guidance says all you need to know. He's tried to score political points on twitter but that's about it.

This isn't true.

A leadership based response to COVID that actually was cohesive and meaningful would have done a lot more for his re-electibility.

Ha, yeah, but asking that of Trump is like asking a duck to write the Eroica Symphony.

Trump’s economy, to paraphrase a famous quote, was born on third base and thinks it hit a triple.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1506 on: May 01, 2020, 02:11:36 PM »
This discussion is obviously going on in every government across the globe.  No one wants to unnecessarily shut down and destroy their economy, absolutely no one. 

This is basically my line of thinking. Donald Trump is a nakedly self-interested person who wants to win the election in November very badly, if only so that he gets to be the center of attention again for the next four years. A healthy economy is his best chance at that. He is incredibly thirsty to open up, and wanted to do so weeks ago. The guy is desperate for smart and well-informed people to come in to his office and make the case that we can crank up the economy again. The fact that he hasn't moved in a significant way to lift Federal guidance says all you need to know. He's tried to score political points on twitter but that's about it.

This isn't true.

A leadership based response to COVID that actually was cohesive and meaningful would have done a lot more for his re-electibility.

Hmm. Maybe. His approval rating has fluctuated from barely below water (initial COVID response, right after election) down to around 37% (fired FBI Director). I think people's thoughts on Trump's ability to be president are pretty baked in at this point. He bungles things all the time and his approval rating barely budges. The election hinges on three things,

1.) Can his opponent generate excitement and urgency?
2.) Do people have jobs?
3.) Are people dying in the hundreds of thousands?

#3 is a relative newcomer on the scene, and unfortunately for Trump, it's diametrically opposed to #2.

Neither should matter if #1 happens though. Trump is an incompetent president and most people don't like him. As long as those people show up to vote, it should be open and shut.

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1507 on: May 01, 2020, 02:11:54 PM »
so apparently I need to watch more YouTube videos...

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #1508 on: May 01, 2020, 02:14:12 PM »
This discussion is obviously going on in every government across the globe.  No one wants to unnecessarily shut down and destroy their economy, absolutely no one. 

This is basically my line of thinking. Donald Trump is a nakedly self-interested person who wants to win the election in November very badly, if only so that he gets to be the center of attention again for the next four years. A healthy economy is his best chance at that. He is incredibly thirsty to open up, and wanted to do so weeks ago. The guy is desperate for smart and well-informed people to come in to his office and make the case that we can crank up the economy again. The fact that he hasn't moved in a significant way to lift Federal guidance says all you need to know. He's tried to score political points on twitter but that's about it.

This isn't true.

A leadership based response to COVID that actually was cohesive and meaningful would have done a lot more for his re-electibility.

Do these look like the kind of guys that appreciate a science based cohesive and meaningful response?


MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1509 on: May 01, 2020, 02:20:05 PM »
That image is part of possibly my favorite lockdown meme so far


T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1510 on: May 01, 2020, 02:30:06 PM »

Daisyedwards800

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Re: How long can we wait while flattening the curve?
« Reply #1511 on: May 01, 2020, 02:39:06 PM »
Per a model cited by CNBC today, if we keep current social distancing, 117k deaths through June, partial reopening is 370k deaths through June, and full reopening is 950k deaths through June.

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #1512 on: May 01, 2020, 02:52:21 PM »
Wonderful news coming from the good people
of the Keystone State this week:

https://www.pennlive.com/news/2020/04/umpc-argues-covid-19-not-as-deadly-as-feared-says-its-hospitals-will-shift-back-to-normal.html
Yikes.  My stepfather is a cancer patient at UPMC and goes weekly for treatment.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1513 on: May 01, 2020, 02:54:50 PM »
Wonderful news coming from the good people
of the Keystone State this week:

https://www.pennlive.com/news/2020/04/umpc-argues-covid-19-not-as-deadly-as-feared-says-its-hospitals-will-shift-back-to-normal.html

That is good news. Especially about the hospitals. I'm a bit skeptical of running with the 0.25% number in the sub-headline though. I don't doubt that the doctor is doing his due diligence on this, but the quote sounds like ballpark math. But that's on the journalist more than anything. And the subhead is technically accurate even when graded against my own analysis. 0.25% is within my range of reasonable outcomes, though I do believe it's probably higher.

Per a model cited by CNBC today, if we keep current social distancing, 117k deaths through June,

This seems reasonable. We're at about 2K deaths per day right now. a straight line decline to zero gets us another 60K by June's end. obviously that's not what the curve will actually look like, but it passes a rudimentary reasonableness check.

partial reopening is 370k deaths through June, and full reopening is 950k deaths through June.

Both of these numbers seem aggressive to me. Even if it does get that bad, it will take weeks for deaths to start to materialize. Who knows though? I'd have to see the model and assumptions.

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #1514 on: May 01, 2020, 05:09:10 PM »
We're pointing out that in many places the cure is indeed worse so far. A lot worse.
The US obviously hasn't applied the cure, or you wouldn't have over 60,000 dead - and counting. You've had late and half-arsed responses put in piecemeal and ad hoc in random places across the country. If you ran your military like that you'd spend two decades fighting goatherds and still have to sue for peace with them. Oh wait...


Let's look at lives lost due to the lockdown vs those lost due to the virus. Lives vs the economy and freedoms and all that are arguable; but if your cure kills more people than it saves, or less, that's not really arguable.



In Australia we got onto it early on, and things were more or less co-ordinated. With the benefit of hindsight we can see what helped and what didn't - basically, closing the borders, quarantining new arrivals and testing and tracing ensured that daily new cases would decline; the rest of the restrictions didn't do much. But that's because we got onto it early - you can test and trace people after 100 cases, if you try it after 10,000 cases, by the time you get to the 10,000th one you've got another 50,000 cases.


If you get onto it later, then a lockdown may be necessary. But it has to be co-ordinated across the country.


Nonetheless, the lockdown has costs. I'm working on an article for this. We get,
- less road deaths
- less pollution deaths
- more suicides and overdoses as goes with unemployment
- more deaths from cancer and heart disease as people are reluctant to visit medical facilities for fear of infection, and health authorities put off non-urgent scans etc


We've had basically 6 weeks of lockdown so far, and have 10% unemployment (up from 5.1%). This will have avoided 105 road and pollution deaths, and caused 597 other deaths, for a net increase of 491 deaths. Given our current mortality rate for the virus, this would be equivalent to 35,760 cases.


If we go to 3 months of lockdown - as seems to be the minimum talked about - we'll hit 15% unemployment. This will save 210 lives, and take 1,210 lives, for a net increase of 1,000 deaths, which we would expect from the virus if we had 72,742 infections.


Should we go for 6 months of lockdown (our state Premier's emergency powers extend till September 30th, and the federal government handouts end then, too), we would see 20% unemployment on most models. This would avoid 420 road and pollution deaths, and cause 2,017 other deaths, for a net increase of 1,597 deaths, equivalent to 116,171 infections.


In fact we have had, at the most recent figures from yesterday, 93 virus deaths from a total of 6,767 infections. Something between the last two scenarios seems most likely, which is to say that the lockdown will cause 1,200 or so extra deaths. And so if all that has avoided around 100,000 infections in Australia, we're overall better off. Certainly, closing the borders and quarantining early on gave us most of our infection reduction; arguably a tough lockdown cemented it. But what we're doing now is mostly pointless.


This modelling does not hold for a country which moves late and piecemeal. Here in Australia we are looking at virus deaths OR other deaths. In places like the UK with overwhelmed health systems they are looking at virus deaths AND other deaths. It's not really much use trying to slow down after you hit the brick wall.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #1515 on: May 01, 2020, 09:37:46 PM »
This discussion is obviously going on in every government across the globe.  No one wants to unnecessarily shut down and destroy their economy, absolutely no one.  It's completely self evident by the amount of states and countries placing varying levels of lockdowns and restrictions in place, and in many cases loosening or tightening restrictions.  Many people here simply disagree with how the choices the government has made and think they are too restrictive...or not restrictive enough.  I'm skeptical that anyone in this thread truly has the correct answer, and if they do it's surely by blind luck.  I'm also skeptical any government has got it perfectly correct either.  I guess time will tell.

This crisis has minted an amazing amount of market timers, and now armchair epidemiologists and economists.  It's kind of amazing to think some mustachian without a degree in either epidemiology or economics knows better than literally the entire field of experts that devote their lives to studying these things.

So if the analysis is going on behind the scenes, why are the figures/actuarial numbers not being released, much less reported, much less discussed? Are we peons too dumb to be able to understand the concept of QALY and the concept that lives do not have an infinite value?

Plus, most of the "experts" I've heard quoted have been medical experts in infectious diseases - not experts on the flow-on effects of depression, joblessness, missed cancer diagnoses, etc. Of course if you speak to someone whose job is to minimise covid deaths, then he or she is going to advocate for tougher lockdown measures.

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #1516 on: May 01, 2020, 09:47:29 PM »

@MudPuppy, I don't think the small subset of the population that are active preppers and the small subset of the population that are protesting the lockdown overlap in membership to any significant degree. 

I am a member of neither group, I just am making an observation.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1517 on: May 02, 2020, 02:05:48 AM »
I agree that the Venn diagram in not a circle. It’s an amusing meme, nothing more.

former player

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Re: How long can we wait while flattening the curve?
« Reply #1518 on: May 02, 2020, 02:27:10 AM »

This modelling does not hold for a country which moves late and piecemeal. Here in Australia we are looking at virus deaths OR other deaths. In places like the UK with overwhelmed health systems they are looking at virus deaths AND other deaths. It's not really much use trying to slow down after you hit the brick wall.
The UK obviously has a high rate of death, and probably higher than the official statistics for COVID-19 deaths (there's a steep increase in deaths not attributed to COVID-19, but the NHS is not short of beds or ventilators.  It does have ongoing problems providing enough PPE.  Does that count as "overwhelmed"?  The big numbers of cases are coming out of London, which has much the same problems of international movements and crowded public transport and housing as New York but has enough beds and is dealing properly with the bodies, and care homes, where the response has been very late and totally inadequate.

Plus of course we had Boris, whose arrogance led him into stupidity at the start and delayed the necessary lockdown by at least two weeks against what should have happened.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1519 on: May 02, 2020, 05:51:09 AM »
This crisis has minted an amazing amount of market timers, and now armchair epidemiologists and economists.  It's kind of amazing to think some mustachian without a degree in either epidemiology or economics knows better than literally the entire field of experts that devote their lives to studying these things.

Unfortunately, in recent decades we've developed a culture where questioning expert opinions has become common place, and all too often people convince themselves that they know more than the people who literally spend their entire careers studying.  Often they bring up some topic as if no one has ever thought of it before (and which has been extensively studied and often dismissed for good reason).

Global climate change created an army of denialists that suddenly thought they could detect flaws in the analysis of literally petabytes of data made by thousands of independent researchers.  Anti-vaxxers suddenly knew more about medicine after reading a few hundred pages of blog posts than doctors who had spent 7+ years in training.  Now we've got market economists and epidemiologists.

I disagree.  The professional epidemiological opinions are all across the board, there is no consensus on what to do and how effective policy is.  Statistical modelling is inexact and uncertain, so there is a lot to be reasonably debated, questioned and challenged.  Those that are professionally educated in a field suffer from the same biases us novices do, in some cases they are more likely to be irrational because their livelihood depends on their views and predictions having value -- confirmation bias continues to be a big problem in even the hard sciences.

Regarding climate change (a field I am in), there are lots of different predictions regarding that, a huge amount of varying opinion, even professionally -- the data from the UN IPCC is a good consensus.  But, meteorology has much better data than medicine does, and it doesn't deal with humans directly (thank God).  The idea that humanity can currently significantly alter or stop climate change is inaccurate, even if the US stopped C02 emissions today it wouldn't do anything significant to alleviate future warming.  The debate on the subject has become so irrational, political and unscientific there in my opinion will not be a rational response, so we get manipulated Swedish adolescents with diagnosed mental disorders telling us what to do.

Regarding vaccine, there is a wide amount of varying policies -- each European nation has a different vaccine schedule and different vaccines.  Some nations vaccinate their children a lot, others only a fraction.  Ironically, in the US the biggest group that avoids many vaccines (the Amish) have a higher life expectancy than the average person even though they on occasion have disease outbreaks.

https://vaccine-schedule.ecdc.europa.eu/

So yeah, if a human is behind it I think it is perfectly valid to question.  Especially if that human has a political or financial connection to the outcome.

So which epidemiologist do you believe and how do you want to live your life?

https://unherd.com/2020/04/which-epidemiologist-do-you-believe/
« Last Edit: May 02, 2020, 05:59:47 AM by T-Money$ »

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #1520 on: May 02, 2020, 06:54:55 AM »
Ironically, in the US the biggest group that avoids many vaccines (the Amish) have a higher life expectancy than the average person even though they on occasion have disease outbreaks.
Amish also do 14-18,000 steps a day, mostly outside (good old vitamin D - lowers blood pressure!), eat meals prepared from fresh ingredients, tend not to drink and smoke a lot*, and have tight supportive communities. This is not really true of the Western population as a whole.

*Some prohibit it, others just minimise it. According to Triumphs of Experience, which looked at men over several decades, the health-protective effect of being part of a religious community is mostly down to their discouraging excessive drinking and smoking! I'm sure community helps in other ways, though - for example, men tend not to go to the doctor for health problems... until their wife makes them.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #1521 on: May 02, 2020, 07:38:35 AM »

@MudPuppy, I don't think the small subset of the population that are active preppers and the small subset of the population that are protesting the lockdown overlap in membership to any significant degree. 

I am a member of neither group, I just am making an observation.

The idiots protesting in my state capitol are not preppers. If they were, they wouldn’t have been threatening elected lawmakers with firearms over their mistaken belief that the government was forbidding them from  planting their gardens a full month before it’s even considered safe to plant here (i.e., when one can reasonably expect that a hard frost won’t kill their plants). Also, they wouldn’t have needed to clog up local grocery stores and gas stations on their way out of town. Preppers would have been fully stocked and would not have needed to leave their bunkers for months.

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #1522 on: May 02, 2020, 09:26:56 AM »
This crisis has minted an amazing amount of market timers, and now armchair epidemiologists and economists.  It's kind of amazing to think some mustachian without a degree in either epidemiology or economics knows better than literally the entire field of experts that devote their lives to studying these things.

Unfortunately, in recent decades we've developed a culture where questioning expert opinions has become common place, and all too often people convince themselves that they know more than the people who literally spend their entire careers studying.  Often they bring up some topic as if no one has ever thought of it before (and which has been extensively studied and often dismissed for good reason).

Global climate change created an army of denialists that suddenly thought they could detect flaws in the analysis of literally petabytes of data made by thousands of independent researchers.  Anti-vaxxers suddenly knew more about medicine after reading a few hundred pages of blog posts than doctors who had spent 7+ years in training.  Now we've got market economists and epidemiologists.

I disagree.  The professional epidemiological opinions are all across the board, there is no consensus on what to do and how effective policy is.  Statistical modelling is inexact and uncertain, so there is a lot to be reasonably debated, questioned and challenged.  Those that are professionally educated in a field suffer from the same biases us novices do, in some cases they are more likely to be irrational because their livelihood depends on their views and predictions having value -- confirmation bias continues to be a big problem in even the hard sciences.

Regarding climate change (a field I am in), there are lots of different predictions regarding that, a huge amount of varying opinion, even professionally -- the data from the UN IPCC is a good consensus.  But, meteorology has much better data than medicine does, and it doesn't deal with humans directly (thank God).  The idea that humanity can currently significantly alter or stop climate change is inaccurate, even if the US stopped C02 emissions today it wouldn't do anything significant to alleviate future warming.  The debate on the subject has become so irrational, political and unscientific there in my opinion will not be a rational response, so we get manipulated Swedish adolescents with diagnosed mental disorders telling us what to do.

Regarding vaccine, there is a wide amount of varying policies -- each European nation has a different vaccine schedule and different vaccines.  Some nations vaccinate their children a lot, others only a fraction.  Ironically, in the US the biggest group that avoids many vaccines (the Amish) have a higher life expectancy than the average person even though they on occasion have disease outbreaks.

https://vaccine-schedule.ecdc.europa.eu/

So yeah, if a human is behind it I think it is perfectly valid to question.  Especially if that human has a political or financial connection to the outcome.

So which epidemiologist do you believe and how do you want to live your life?

https://unherd.com/2020/04/which-epidemiologist-do-you-believe/

Yes, and unfortunately things are compounded because most information people get is mediated through news sources, so you are dealing with "the way one expert's predictions have been spun for your consumption" and not even the actual expert's predictions and not necessarily the consensus among the profession.  Even when we talk about professional consensus, let's not even get into issues with groupthink or with political pressure to hold certain opinions (what friends who are experts will tell you off the record is not always what they would be willing to say on the record). 

Mainstream sources are on average more responsible than alternative sources, but that's still faint praise and not even always true.  (If it were, why weren't we seeing videos of Chinese people being welded into their homes or dragged screaming into white vans in early February... I could go on.). 

It's a complicated world out there and so while respect should be paid towards expert opinion I don't think "trust the authorities and have no independent thoughts of your own" is really the best advice.  I mean the whole FIRE movement involves a lot of ignoring common wisdom and charting your own course.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1523 on: May 02, 2020, 10:53:56 AM »
It's a complicated world out there and so while respect should be paid towards expert opinion I don't think "trust the authorities and have no independent thoughts of your own" is really the best advice.  I mean the whole FIRE movement involves a lot of ignoring common wisdom and charting your own course.

Of course not. But if you're going to question expertise and authority, you should come ready to defend your dissenting opinions. To be fair, some people have done this. I think at this point, we've all seen the video from the Swedish epidemiologist defending looser lockdowns. And that's within the range of reasonable disagreement IMO.

Most of the disagreement I've seen has been baseless, anti-authority goalpost moving.

First it was, "It's just the flu." Then it was, "Well Swine Flu killed 12K people and not even 100 have died from COVID, this response is obviously politically motivated.

Then people started dying, and it became in vogue to question early rough estimates. "The fatality rate is much lower than reported because a million billion people actually have the disease." There is some truth to this, of course. If the mortality rate really was 5%+ like reported numbers in the US suggest, then we're fucked. But the skeptic crowd cherrypicks any study that comes along ostensibly supporting the belief that COVID is no deadlier than the flu.

Then COVID became the leading cause of death in the United States for the past 3+ weeks. So the argument became, "This is killing people who were on death's door anyway." Then reporting came out form the Times, the Post, and the CDC that no, excess mortality is really happening. And in greater numbers than reported COVID deaths. Then the argument is a vague, unqauntifeid increase in suicides and diseases of despair. Again, there's a kernel of truth here, but don't expect an attempt to quantify it.

All too often, this discussion breaks down into the "pro-lockdown side" acknowledging that we're dealing with two shitty options here, and we've taken what the best data we have tells us is the less shitty option. In the meantime, we're working to make that option less shitty by offering economic relief and figuring out the safest ways to open up. Meanwhile, the contrarian side does the aforementioned goalpost shifting and often seems to be aruging from the assumption that the lockdown does nothing to stem the spread of the virus. We're competing against a fantasy world where excess mortality beyond what we've seen does not exist, and does not also drag on the economy.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1524 on: May 02, 2020, 12:12:44 PM »
I’d like to note that the age-adjusted mortality rates in the US continued their decades-long decrease in the years after the Great Recession. This included suicides. Only about 8 years later (2016-2017) did suicides increase in the 18-44 category. The CDC provides this data here:

https://www.cdc.gov/nchs/products/databriefs/db342.htm

So someone will have to provide data showing an increase in suicides if they’re going to use that as an argument against the lockdown (in the US, not sure about other countries’ trends).


The good news is that NY/NJ has a definite downtrend in both cases and deaths. Other states are plateauing it seems (CA, WA, MI). Overall trend in the US is about 2000 deaths a day for the last week. I looked at the correlation between increase in testing and increase in reported cases (comparing 4-17 to 5-1), and oddly there wasn’t a significant correlation. This suggests that the rate of infection is decreasing overall (otherwise one would assume they would be correlated).

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1525 on: May 02, 2020, 12:21:25 PM »
It's a complicated world out there and so while respect should be paid towards expert opinion I don't think "trust the authorities and have no independent thoughts of your own" is really the best advice.  I mean the whole FIRE movement involves a lot of ignoring common wisdom and charting your own course.

Of course not. But if you're going to question expertise and authority, you should come ready to defend your dissenting opinions. To be fair, some people have done this. I think at this point, we've all seen the video from the Swedish epidemiologist defending looser lockdowns. And that's within the range of reasonable disagreement IMO.

Most of the disagreement I've seen has been baseless, anti-authority goalpost moving.

First it was, "It's just the flu." Then it was, "Well Swine Flu killed 12K people and not even 100 have died from COVID, this response is obviously politically motivated.

Then people started dying, and it became in vogue to question early rough estimates. "The fatality rate is much lower than reported because a million billion people actually have the disease." There is some truth to this, of course. If the mortality rate really was 5%+ like reported numbers in the US suggest, then we're fucked. But the skeptic crowd cherrypicks any study that comes along ostensibly supporting the belief that COVID is no deadlier than the flu.

Then COVID became the leading cause of death in the United States for the past 3+ weeks. So the argument became, "This is killing people who were on death's door anyway." Then reporting came out form the Times, the Post, and the CDC that no, excess mortality is really happening. And in greater numbers than reported COVID deaths. Then the argument is a vague, unqauntifeid increase in suicides and diseases of despair. Again, there's a kernel of truth here, but don't expect an attempt to quantify it.

All too often, this discussion breaks down into the "pro-lockdown side" acknowledging that we're dealing with two shitty options here, and we've taken what the best data we have tells us is the less shitty option. In the meantime, we're working to make that option less shitty by offering economic relief and figuring out the safest ways to open up. Meanwhile, the contrarian side does the aforementioned goalpost shifting and often seems to be aruging from the assumption that the lockdown does nothing to stem the spread of the virus. We're competing against a fantasy world where excess mortality beyond what we've seen does not exist, and does not also drag on the economy.

I think you make a good argument. 

Someone earlier in this thread posted a research study from Mt. Sinai Hospital in New York dated April 26th.  It showed the average age of their fatal COVID-19 cases was 75 with a BMI of 32.   That's above the average life expectancy for someone with that BMI (obese).  I don't mean to dismiss the deaths from COVID at all, but I think it is appropriate to keep these fatalities in a proper context.

Deep down disagreements probably stem from how each of us view the world, and what we think can be accomplished with human intervention:

https://unherd.com/thepost/thomas-sowells-conflict-of-visions-epidemiology-edition/

Why on Earth there isn't a consensus recommendation to reduce the amount of obesity in light of COVID-19 research I have no idea (well, I know the answer but I find it a disservice), it seems like such a significant risk factor for death of all ages.  In absence of a vaccine removing the most likely complication seems like a really worthwhile goal, with no drawbacks. 

https://www.mrmoneymustache.com/2012/01/09/you-cant-cure-obesity-with-bigger-pants/

https://www.mrmoneymustache.com/2012/01/19/how-to-be-slim/

Supposedly we are all Mustachians to some degree.

« Last Edit: May 02, 2020, 12:25:25 PM by T-Money$ »

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #1526 on: May 02, 2020, 12:29:19 PM »
It's a complicated world out there and so while respect should be paid towards expert opinion I don't think "trust the authorities and have no independent thoughts of your own" is really the best advice.  I mean the whole FIRE movement involves a lot of ignoring common wisdom and charting your own course.

Of course not. But if you're going to question expertise and authority, you should come ready to defend your dissenting opinions. To be fair, some people have done this. I think at this point, we've all seen the video from the Swedish epidemiologist defending looser lockdowns. And that's within the range of reasonable disagreement IMO.

Most of the disagreement I've seen has been baseless, anti-authority goalpost moving.

First it was, "It's just the flu." Then it was, "Well Swine Flu killed 12K people and not even 100 have died from COVID, this response is obviously politically motivated.

Then people started dying, and it became in vogue to question early rough estimates. "The fatality rate is much lower than reported because a million billion people actually have the disease." There is some truth to this, of course. If the mortality rate really was 5%+ like reported numbers in the US suggest, then we're fucked. But the skeptic crowd cherrypicks any study that comes along ostensibly supporting the belief that COVID is no deadlier than the flu.

Then COVID became the leading cause of death in the United States for the past 3+ weeks. So the argument became, "This is killing people who were on death's door anyway." Then reporting came out form the Times, the Post, and the CDC that no, excess mortality is really happening. And in greater numbers than reported COVID deaths. Then the argument is a vague, unqauntifeid increase in suicides and diseases of despair. Again, there's a kernel of truth here, but don't expect an attempt to quantify it.

All too often, this discussion breaks down into the "pro-lockdown side" acknowledging that we're dealing with two shitty options here, and we've taken what the best data we have tells us is the less shitty option. In the meantime, we're working to make that option less shitty by offering economic relief and figuring out the safest ways to open up. Meanwhile, the contrarian side does the aforementioned goalpost shifting and often seems to be aruging from the assumption that the lockdown does nothing to stem the spread of the virus. We're competing against a fantasy world where excess mortality beyond what we've seen does not exist, and does not also drag on the economy.

Great discussion.  Now, what about the people who were questioning the authorities back in February because we believed it was actually much more serious than the CDC and the WHO were letting on?  Presumably we were also totally wrong for not 100% believing everything the experts were saying at the time? 

As recently as mid-February, it was the mainstream, consensus expert opinion that Americans should be more worried about the flu than coronavirus and there were many MSM news articles to that effect.  Indeed, people like me were mocked on facebook for getting our information from "the Youtube" rather than the experts.  Turns out in that case that "the Youtube" scooped the experts. 
« Last Edit: May 02, 2020, 12:40:29 PM by LWYRUP »

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #1527 on: May 02, 2020, 02:04:57 PM »
Great discussion.  Now, what about the people who were questioning the authorities back in February because we believed it was actually much more serious than the CDC and the WHO were letting on?  Presumably we were also totally wrong for not 100% believing everything the experts were saying at the time?
The issue is not whether you question authority or not. The issue is whether you are a persistent seeker of the truth, or rationalizer of preexisting motivations and beliefs. Or to put it another way, how much your beliefs and statements conform to reality. Authority tends to offer a pretty good signal about what beliefs are correct, but it's not universal. BTW, the WHO was taking this very seriously even as early as late January. There was no point in February where they were downplaying the severity of the disease.
« Last Edit: May 02, 2020, 02:06:51 PM by obstinate »

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #1528 on: May 02, 2020, 02:32:27 PM »
Let me be clear - I'm a former statistician but by no means an epidemiologist. I believe that the disease is very serious and can kill a lot of people.

My disagreement has to do with the value of a life - I believe that the lives of the very elderly, bluntly, are worth far less when we're talking about society-wide sacrifices. I think that is the disconnect for me.

I agree that it's a shame this has become a partisan issue for many people.

-W

Buffaloski Boris

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Re: How long can we wait while flattening the curve?
« Reply #1529 on: May 02, 2020, 02:33:43 PM »
This crisis has minted an amazing amount of market timers, and now armchair epidemiologists and economists.  It's kind of amazing to think some mustachian without a degree in either epidemiology or economics knows better than literally the entire field of experts that devote their lives to studying these things.

Unfortunately, in recent decades we've developed a culture where questioning expert opinions has become common place, and all too often people convince themselves that they know more than the people who literally spend their entire careers studying.  Often they bring up some topic as if no one has ever thought of it before (and which has been extensively studied and often dismissed for good reason).

Global climate change created an army of denialists that suddenly thought they could detect flaws in the analysis of literally petabytes of data made by thousands of independent researchers.  Anti-vaxxers suddenly knew more about medicine after reading a few hundred pages of blog posts than doctors who had spent 7+ years in training.  Now we've got market economists and epidemiologists.

Experts, such as they are, have become their own worst enemies.  It's not enough to be correct, the trick is in convincing others that you are correct.  A lot of experts seems to have forgotten that and from a cultural perspective have undermined their own credibility and those of other experts. The arrogance of so many experts is part of the problem as well. 

An example; globalism.  20-30 years ago, the professional political class and a whole lot of economists were singing it's praises.  And from my perspective     I'd have to agree: I'm probably a net beneficiary.  But that same globalism has come at a terrible price for a lot of the working class in the US.  They might have listened to the experts once, but they'll never listen to them on that again. 

Here' a more positive example of an expert who did it right: Dr. Fauci.  This guy is an expert in his field. But more importantly, he has a very persuasive way about him and has done a very good job of persuading Americans to treat COVID as a real threat. That's really the key here.  He could have had less impeccable credentials, but he successfully convinced many millions of of the danger. 

SunnyDays

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Re: How long can we wait while flattening the curve?
« Reply #1530 on: May 02, 2020, 02:43:47 PM »

The issue is not whether you question authority or not. The issue is whether you are a persistent seeker of the truth, or rationalizer of preexisting motivations and beliefs. Or to put it another way, how much your beliefs and statements conform to reality. Authority tends to offer a pretty good signal about what beliefs are correct, but it's not universal. BTW, the WHO was taking this very seriously even as early as late January. There was no point in February where they were downplaying the severity of the disease.
[/quote]

Agree.  This is called Confirmation Bias and the opportunity to seek it has become unlimited in the internet age because everyone and their dog can publicize their opinions (including us on this site).  Shear numbers of any given opinion makes it seem like fact.  So more and more people believe stupider and stupider things.

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #1531 on: May 02, 2020, 02:45:37 PM »
Great discussion.  Now, what about the people who were questioning the authorities back in February because we believed it was actually much more serious than the CDC and the WHO were letting on?  Presumably we were also totally wrong for not 100% believing everything the experts were saying at the time?
The issue is not whether you question authority or not. The issue is whether you are a persistent seeker of the truth, or rationalizer of preexisting motivations and beliefs. Or to put it another way, how much your beliefs and statements conform to reality. Authority tends to offer a pretty good signal about what beliefs are correct, but it's not universal. BTW, the WHO was taking this very seriously even as early as late January. There was no point in February where they were downplaying the severity of the disease.

On the WHO, they refused to call it a pandemic until March 11.  This is totally out of line with precedent and caused many government to delay implementing critical life-saving measures based on that guidance.  They also ignored warnings from Taiwan in December.   I could go on but I'm wary about getting into long debates on this -- I spent a month obsessing about this virus (on reddit, not here) and honestly needed to stop for my mental health so I'd rather not get sucked back in. 

On the questioning authority point generally, I think everyone on earth thinks that they are a persistent seeker of the truth and its those other people who disagree with them that are just rationalizing.  So I mean I agree with you but I think the statement is not really actionable.

My only point here is that argument from authority is a legitimate argument but it's a pretty weak one and frequently falsified.  Also, even though I am personally highly credentialed I find an obsessive focus on credentialism to be anti-intellectual.  It puts people in silos, under the theory that you need a PhD to speak on a subject competently, when at max most people can really only get one advanced degree in a lifetime (some get two like MD-PhDs but there is serious opportunity cost to that) and so they should purportedly only be able to speak competently on one topic.  There are a lot of intellectually curious people capable of speaking competently on many different topics, and aggregating knowledge from different fields is pretty fun anyways. 

Also, as long as I'm on my soapbox, making fun of stupid people can certainly create a burst of dopamine but it's like shooting fish in a barrel, so why bother?  I understand where you are coming from where you say "my moron neighbor Bill listens to infowars and ignores all the experts and so now I hate people that ignore experts" but I mean we're having two different conversations here.  I'm willing to stipulate Bill is an idiot.  I still think following the expert-of-the-day is not the way to live life, and is boring to boot.  Listening to a wide variety of well-informed people with a grain of salt for ALL of them is a lot more fun and I think you learn more in the end. 
« Last Edit: May 02, 2020, 03:27:18 PM by LWYRUP »

almcclur

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Re: How long can we wait while flattening the curve?
« Reply #1532 on: May 02, 2020, 03:38:25 PM »
The proportion of people I know dying vs the official death count seems off compared with the total people I know vs the official population as well.  I know I'm in a bit of a hot spot in the state, but even considering that it seems like the official death count doesn't jive with what I'm experiencing and I suspect it's being under reported. 

Maybe all these people are suiciding due to lockdown? Or are coincidentally having lung and heart problems unrelated to covid-19?

I've been fascinated with this too bc I know no one who is sick at all. Several people have said they got a flu that wasn't the flu earlier in the winter, but down here in Texas our numbers have stayed low, so it's like watching a different world on the news. The media seems obsessed with NY which is understandable, but I'm not sure how accurate a picture that is for the rest of the country. It's hard to know what's real.

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #1533 on: May 02, 2020, 05:02:29 PM »
Very interesting seeing the variety and breadth of analysis, comments, and opinions here.  I assume people who are good with/like working with numbers/figures/money/investing are drawn to this.

The same 'flattening the curve' questions/analysis is going on elsewhere on finance sites, including my favorite - MONEVATOR - lots of similar discussions and comments/links.  Now mainly about how to remove restrictions:

https://monevator.com/weekend-reading-under-infected-over-optimistic/

Plus a neat tracker that shows how the different strains of COVID have spread across the world versus time (known cases that is!):

https://nextstrain.org/ncov/north-america?animate=2019-12-04,2020-04-28,0,0,30000

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #1534 on: May 02, 2020, 05:10:29 PM »
"Regarding different strains producing different viral loads. There is the well publicised paper from China (Zhejiang University School of Medicine https://www.medrxiv.org/content/10.1101/2020.04.14.20060160v2 This implied that the strains in Europe/NY produced larger viral loads and mortality rates than say the Seattle cluster in the US or parts of Asia/Australasia. If you look at https://nextstrain.org/ncov/global then you can see clear clusters of different strains and how they migrated"

"I haven’t seen any other preprints on this topic but it’s been getting attention for a few weeks on conference calls to possibly help explain varying mortality rates, especially NY. Demographics, population density, mass transport etc explain this to some degree but attention has moved toward looking at the various strains. Initial thoughts (two months ago) seemed to imply the strains were fairly similar but it seems that researchers are questioning that. I was on a call over a week ago with a US uni computational virology lab (who are heavily involved in nextstrain) and they found that adding in some level of “strain lethality” as an explanatory variable did help predict why the Seattle cluster and NY cluster produced quite different mortality rates. Like everything else we know far too little."

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1535 on: May 02, 2020, 05:17:44 PM »
BTW, the WHO was taking this very seriously even as early as late January. There was no point in February where they were downplaying the severity of the disease.

Took the words right out of my mouth. I've been tracking and modeling COVID for my company since January. The WHO has published near daily situation reports since January 21st, and by late January, they put forth a pretty stark mortality estimate.

The big unknown at that point was whether or not it would go global. On the US side, I think the NIH and CDC has done a reasonably good job. At large, "experts and authority" deserve a lot of criticism for how late to the game we were on testing in the United States. Who specifically to blame for that is an exercise left to the reader.

So no, I don't think YouTube "scooped" the experts here. That's not a dunk against YouTube though. Independent journalism can produce some great results, and I personally know people who were very early on this thanks to YouTube.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1536 on: May 02, 2020, 05:28:40 PM »
Let me be clear - I'm a former statistician but by no means an epidemiologist. I believe that the disease is very serious and can kill a lot of people.

My disagreement has to do with the value of a life - I believe that the lives of the very elderly, bluntly, are worth far less when we're talking about society-wide sacrifices. I think that is the disconnect for me.

I agree that it's a shame this has become a partisan issue for many people.

-W

That's reasonable. For many reasons I think it's good for the government to start out age-agnostic in terms of valuing life. But when things get as serious as they have now, it's not unreasonable to start bringing expected future life years into the calculation. Or at the very least, discussing doing that.

I will say though, in the same way that we have to quantify additional misery and mortality (drug overdoses and suicides) caused by the lock down, we have to quantify the economic damage caused by mass excess mortality too. If older people die earlier than they were otherwise going to, you're still taking lots of consumption off the table. i.e., a lot of commerce won't be happening because these people died. And that's a lot of excess grief to the survivors. We price in grieving 2.8 million a year. What happens when we grieve 3.8 million instead? And then there is productivity lost by younger people who don't die, but get sick and miss work.

And of course, if people start dying in excess by the hundreds of thousands, that's going to impact behavior, no matter how old the people dying are.

What I'm saying is that there is no realistic, clean scenario where we trade XYZ old people lives for a carbon copy of the economy we had in January.

Your point is well taken though. Maybe we should be having an explicit discussion about the value of older life. I think that discussion is happening implicitly already anyway, but perhaps it's best to put it on the table. Either way, I have no quarrel with you. My biggest headache over the past few months (not just on this forum) is convincing people that this is something to be taken seriously.


iris lily

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Re: How long can we wait while flattening the curve?
« Reply #1538 on: May 02, 2020, 05:57:53 PM »
Let me be clear - I'm a former statistician but by no means an epidemiologist. I believe that the disease is very serious and can kill a lot of people.

My disagreement has to do with the value of a life - I believe that the lives of the very elderly, bluntly, are worth far less when we're talking about society-wide sacrifices. I think that is the disconnect for me.

I agree that it's a shame this has become a partisan issue for many people.

-W

I think I may love you Walt for stating this so clearly. I mean, many dance around the topic of us old people being of less value but yeesh you just out and out said it.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #1539 on: May 02, 2020, 05:58:42 PM »
Your point is well taken though. Maybe we should be having an explicit discussion about the value of older life. I think that discussion is happening implicitly already anyway, but perhaps it's best to put it on the table. Either way, I have no quarrel with you. My biggest headache over the past few months (not just on this forum) is convincing people that this is something to be taken seriously.

This ties into my lament about partisanship. If, last year, you had asked your average liberal and conservative voter (in the US) about the government paying for life-saving/extending intervention for the very old, you would have gotten the following responses:

Liberal: 90% of our healthcare spending is in the last year of life, we're just extending their suffering, these resources could be better used, look at the NHS in Britain and quality life years, etc.

Conservative: Death panels! The government shouldn't decide what treatment is acceptable, no matter what! Life is precious!

Now we have a situation in which literally many young/poor people are suffering to *mostly* save wealthy old people and people have reversed their positions!

I'm stereotyping terribly there, of course. But clearly as a society we should be wrestling with this question. How much is a 7 year old poor kid's future worth who *needs* to be at school because there's nothing good happening at home (I work with lots of those kids and their situation is very bad now) vs the life of an 80 year old retired person?

-W

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #1540 on: May 02, 2020, 06:08:46 PM »
Yes, my apologies, I was exaggerating/spitballing. Thanks for calling me out on that, since I was just saying we need to use better numbers/think more carefully. How embarrassing...

According to the NIH it's ~25% of publicly-spent money. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/

"From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years. Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages. Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures."

I have found other information claiming that the amount is much lower, as well, though it's not clear to me if the different studies are talking about the same thing (ie, it might be very expensive to try to save a 6 year old who was in a car accident - and that counts toward "last year of life" medical spending, but that's very different than keeping a 90 year old on a feeding tube for 10 years).

10-25% is still a TON of money for old folks who are already dying.

-W
« Last Edit: May 02, 2020, 06:16:13 PM by waltworks »

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #1541 on: May 02, 2020, 06:22:30 PM »
BTW, the WHO was taking this very seriously even as early as late January. There was no point in February where they were downplaying the severity of the disease.

Took the words right out of my mouth. I've been tracking and modeling COVID for my company since January. The WHO has published near daily situation reports since January 21st, and by late January, they put forth a pretty stark mortality estimate.

The big unknown at that point was whether or not it would go global. On the US side, I think the NIH and CDC has done a reasonably good job. At large, "experts and authority" deserve a lot of criticism for how late to the game we were on testing in the United States. Who specifically to blame for that is an exercise left to the reader.

So no, I don't think YouTube "scooped" the experts here. That's not a dunk against YouTube though. Independent journalism can produce some great results, and I personally know people who were very early on this thanks to YouTube.

High mortality rate is only one part of the picture (see, e.g., original SARS with a higher mortality rate but much fewer deaths b/c this disease has faster spread, longer incubation period, more asymptomatic and lightly symptomatic cases).  Anyway, look I really can't argue about this stuff for mental health reasons so I am going to stop but there is much to blame the WHO for (and yes, there are others that deserve blame as well).  At the very least, they sure as shit did a terrible job messaging their knowledge to the public.   You should go back and take a look at some of the earlier debates on this forum about this subject if you disagree. 
 
« Last Edit: May 02, 2020, 06:45:43 PM by LWYRUP »

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #1542 on: May 02, 2020, 06:36:17 PM »
What irritates me about the discussion about "old people" dying is that you are talking about a very variable group as it if it were very similar. A 65 year old man in Canada has a life expectancy of 19.3 years (i.e. average age at death will be 84) and a 65 year old woman in Canada has a life expectancy of about 22.1 years (i.e. average age at death will be 87).  And since it is an average, half are expected to make it past those ages. (https://data.oecd.org/healthstat/life-expectancy-at-65.htm).  Yet you are talking about people in this group as if they are all going to die this year anyway.  There is a hell of a lot of ageism on these forums.

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #1543 on: May 02, 2020, 06:50:23 PM »
Let me be clear - I'm a former statistician but by no means an epidemiologist. I believe that the disease is very serious and can kill a lot of people.

My disagreement has to do with the value of a life - I believe that the lives of the very elderly, bluntly, are worth far less when we're talking about society-wide sacrifices. I think that is the disconnect for me.

I agree that it's a shame this has become a partisan issue for many people.

-W

I think I may love you Walt for stating this so clearly. I mean, many dance around the topic of us old people being of less value but yeesh you just out and out said it.

I think you might be able to convince a larger number of people about the strength of your argument if you framed your message differently.  I understand that your field thinks about these things in terms of quality adjusted life years and that's appropriate.  However I personally find it uncomfortable to translate that into one human life being less valuable than another. 

I think it would be fine to point out that health interventions will have more of an impact if those interventions appropriate balance preserving quality adjusted life years while avoiding unnecessary suffering (economic, mental anguish, etc.).  I don't think you need to extrapolate from that and start ranking who is more valuable than whom. 
« Last Edit: May 02, 2020, 07:01:33 PM by LWYRUP »

SunnyDays

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Re: How long can we wait while flattening the curve?
« Reply #1544 on: May 02, 2020, 06:52:27 PM »
I agree there’s ageism at play here.  Why is a younger person’s potential contribution worth more than an older person’s existing contribution?  Is it measured only in economic terms?  We on this forum should know better than that.  North American culture puts too little value on elders.  In other cultures, the elderly are revered for their knowledge and wisdom.  Interestingly, in the animal kingdom (humans ARE animals), an adult will always abandon a youngster if it’s attempts to protect it put the adult at risk.  We do the opposite, for emotional reasons.

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #1545 on: May 02, 2020, 07:27:49 PM »
I understand the skepticism coming from down under, when the appropriate action is swift it will appear to be a complete over reaction and people will be chomping at the bit to open back up.

But I don't understand it at all from the people in the USA, especially those in hard hit areas like NY.  How have you not experienced a bunch of people you know dying?  I'm in Detroit and I know a bunch of people that have died so far.  Most of them were old, but still I'm not accustomed to hearing about this many deaths in such a short time frame.  If the trend from the past couple weeks continues for an entire year I would know several hundred dead people.
@frugalnacho I'll just point out that, despite the couple of very loud voices on this forum suggesting otherwise, the vast majority of Australians don't believe the actions of the various Australian Governments (both State and Federal) have been complete over reactions.  In fact, Newspoll earlier this week showed that the state Premiers and Prime Minister all have overwhelmingly positive satisfaction rates with how they are handling this crisis.  Even the least popular state leader had a 72% satisfaction rate on this issue.  Yes we want to open up, but the vast majority of us would rather it happen with the right controls in place, rather than risking a harder, longer subsequent lockdown from any subsequent wave.  Economically, that would unleash a much longer and more punishing downturn.

boy_bye

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Re: How long can we wait while flattening the curve?
« Reply #1546 on: May 02, 2020, 07:36:46 PM »
lol how much overlap do we think there is between folks who are protesting to open up the country ASAP and those who are believe 'all lives matter'

dang1

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Re: How long can we wait while flattening the curve?
« Reply #1547 on: May 02, 2020, 08:24:55 PM »
Society is willing to spend 90% on healthcare in the last year of life, presumably older folks, because we love having older people around, it's what makes us human.

Animals tend to leave their weaker, older, to be eaten by predators.

Healthy people only need 10% of healthcare spending because they're- healthy.
Furthermore, many 90 year olds on a feeding tube/ in a vegetative state, only alive because of machines, get the plug pulled by their tearful families.

The question we should be wrestling with is, how can we do better, than having the situation where the top 1 percent now owns 50 percent of the world's wealth, and many young/poor people are suffering.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1548 on: May 02, 2020, 08:26:38 PM »
Another logistics issue to discuss is that most epidemiologists agree that if we open up, we will need to do contact tracing (identifying and quarantining people exposed to know covid patients during the time they were contagious). Those people can be quarantined, by law, if necessary. So it won’t be “everyone not old go out and do whatever”, it’ll be “the following must stay at home by order of the health department” for 2 weeks at least. Data from China suggests this will apply from 30-50 people per contagious person. Just another point that this is not a binary situation. In rural areas this would probably be easy to do; elsewhere wit people driving all over or taking mass transit this will be very hard.
« Last Edit: May 02, 2020, 08:31:54 PM by Abe »

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #1549 on: May 02, 2020, 10:22:28 PM »
I think the other important question is whether we can stomach the sheer amount of death that would be involved if we just let things go buck wild.

New York is by no means an upper bound on how bad this thing can be. We still had a strong -- if late -- lockdown, and serology testing is showing we have had around a 20% infection rate. This study should be thought of as an upper bound, since it surveyed grocery store shoppers, who are for obvious reasons more likely to have been exposed. On top of that, we are seeing overall mortality evidence that the death rate is being severely undercounted, maybe by as much as 50%.

So add it up, with some conservative back of the envelope numbers. Let's say that we're only missing 1/3rd of the deaths (1/6th less than the fraction my citation suggests). Let's say that hospitals will not get overwhelmed if an unlimited number of patients come at the same time -- i.e., let's assume the death rate is linear with infection rates at the current proportion. And let's say that only 70% of people would end up being exposed by the time the pandemic passes. We have:

  • 25k deaths
  • adding in the third that is missing: 3/2 * 25k = 37.5k
  • project this death rate from 20% to 70% of population infected linearly = 70/20 * 37.5k = 131.25k
  • fraction of NY population lost to virus = 131.25k/19.45M = 0.67%

Let's say that these folks have an average of 10 QALRs left, to account for the assumption they're mostly old and sick. Let's say you value a whole life of QALRs at $10M, and you assume everyone will have a hundred good years, just to keep the math even. That means the average COVID death comes at a cost of around $1M. The cost to NY State of all these deaths would therefore be on the order of $131B.  But we've already lost 2/7th of those years, so call it $100B.

If you assume that state GDP will be hit by 20% for one year, and we have a $1.5T state GDP, you're at least in the right ballpark of what you'd want to spend, given all these various assumptions about the impact of COVID. Under this highly simplified model, it looks like we're overspending by a factor of three to avoid the excess deaths. But, there is far more than a factor of three of fudge in my numbers, particularly the assumption that death rates increase linearly if lockdown had not been put in place.

I doubt the decision was really made using a model like this. I think it probably went more like: "You're telling me that if I don't do something, everyone will have lost a parent or grandparent, or else know someone who has lost two or three? And my political opponent will correctly be able to make the case that my inaction was the cause of this calamity? OK, we need to do something."
« Last Edit: May 02, 2020, 10:25:07 PM by obstinate »