Mustachians are skeptical, right? What are your thoughts about COVID response?

[lost_in_the_endless_aisle]

Look at India - compared to their massive population and insane density, they are faring incredibly well, despite having a healthcare system that is less adequately prepared to deal with a pandemic. Why is that? Could climate be a reason? Seems plausible.

Are they doing incredibly well? Based on what?

India's CFR is ~half of what the US is seeing. What is known about India and its healthcare system that might explain such a discrepancy?

CFRs have to be considered with care. They are more a measure of how well countries detect cases and are not a good measure across countries for quality of care or of many other metrics. Additionally, India is in a case-growth phase, and since deaths are a lagging indicator, their true CFR is understated without taking this into account. Here are some numbers:

1) US overall CFR: 3.0%
2) India overall CFR: 1.6%
3) US recent 4 week lagged CFR: 1.4%

India CFR will go up when the deaths associated with current accelerating cases catch up, unless this reckoning is delayed through additional increased testing. 40% of Indian cases have happened within the last 4 weeks, so those cases have still mostly not resolved into deaths or recoveries. In the US, just 17% of total cases have been registered in the last 4 weeks.

On a broader note, I'm not sure India is doing well. They were doing well but had a much later acceleration to their epidemic. However, that timing is consistent with RYG's suggestion that sub-tropical climates should expect a later, broader peak. It's still too early to determine winners and losers.

[bacchi]

Look at India - compared to their massive population and insane density, they are faring incredibly well, despite having a healthcare system that is less adequately prepared to deal with a pandemic. Why is that? Could climate be a reason? Seems plausible.

Are they doing incredibly well? Based on what?

India's CFR is ~half of what the US is seeing. What is known about India and its healthcare system that might explain such a discrepancy?

CFRs have to be considered with care. They are more a measure of how well countries detect cases and are not a good measure across countries for quality of care or of many other metrics.

While true, I was hinting at what is recorded on the death certificate. If the cause of death is blank, it's not a covid death.

India has a LOT of blank lines for cause of death.

On a broader note, I'm not sure India is doing well. They were doing well but had a much later acceleration to their epidemic. However, that timing is consistent with RYG's suggestion that sub-tropical climates should expect a later, broader peak. It's still too early to determine winners and losers.

The increase in infections is also consistent with the India lockdown expiring in May.

[lost_in_the_endless_aisle]

Look at India - compared to their massive population and insane density, they are faring incredibly well, despite having a healthcare system that is less adequately prepared to deal with a pandemic. Why is that? Could climate be a reason? Seems plausible.

Are they doing incredibly well? Based on what?

India's CFR is ~half of what the US is seeing. What is known about India and its healthcare system that might explain such a discrepancy?

CFRs have to be considered with care. They are more a measure of how well countries detect cases and are not a good measure across countries for quality of care or of many other metrics.

While true, I was hinting at what is recorded on the death certificate. If the cause of death is blank, it's not a covid death.

India has a LOT of blank lines for cause of death.

On a broader note, I'm not sure India is doing well. They were doing well but had a much later acceleration to their epidemic. However, that timing is consistent with RYG's suggestion that sub-tropical climates should expect a later, broader peak. It's still too early to determine winners and losers.

The increase in infections is also consistent with the India lockdown expiring in May.

Right, cause-of-death determination and a lot of other noise go into CFR as well.

India's case rise has been fairly uniform except for a transition at the end of July from exponential to linear growth. Interestingly there is this paper on why many countries' case growth rates end up being linear.

[partgypsy]

Anyways as far as having a beef with lockdowns, as far as I know most places in the US are opening up. True in my city and state in fact I can return to work. I think opening up with masking and social distancing will work, if we could also do contact tracing. That's not in place as far as I understand. As well as consistent public messaging for masking as social distancing (to avoid things like covid parties)

[Cranky]

The bars have to close at 10PM. That is pretty much the only thing that is legally mandated and mostly enforced in my area.

[Laura33]

Yes, I am skeptical.  But I am also frustrated with the version of contrarianism that knee-jerks to the conclusion that general knowledge is wrong.

RSM, you are asking the wrong question.  You cannot demand proof in a novel pandemic before taking action, because by definition you don't know enough to guarantee you have the "right" answer.  You just have to evaluate the data you do have, make projections based on comparison to other diseases and other incidents, and make the best decision you can -- then be prepared to shift course when better data comes in.  It's sort of like environmental laws:  the science is always debatable, so it's EPA's job to review the data out there and make the best call it can, with the understanding that nothing is certain and they might be wrong.  And no matter what you decide, someone out there is going to be able to cite data that contradicts your conclusion.

The reason we cannot have a rational conversation about the COVID response is that (i) most of the information we have is correlative and/or conjectural, and (ii) the issue has all become completely politicized.  As a result, the particular data points or correlations that you see as compelling tend to be the ones that correspond to your belief system.  And since nothing is definitive yet, no one can "prove" anyone is wrong; instead, we just point out flaws in the other side's data, and by doing so, reaffirm our belief in the rightness of our own. 

What do I think?  Does it matter?  Yes, I have looked at the data as closely as I can, and yes, I understand the scientific method and understand the limitations on what we know, and so I think my opinion is as well-formed as anyone who isn't working with the data/issue every day.  But my opinion is just as biased as everyone else's.  I think that a coherent, consistent national message based on the best available data at the time would have been very helpful.  No, it wouldn't have been perfect, but it would have been much more helpful than having two completely different messages coming from the right and the left (particularly including messages from the right that suggested that the disease was only a political ploy by the left to make the President look bad, which immediately discredits any further information about the disease or from the scientists fighting it). 

I applaud my state's response; we have a Republican governor, who I never voted for, but I absolutely would vote for him now, simply because he has acted like a grown-up and managed to convey that he is looking to the science and is going to do what is necessary, but is also not going to keep people out of work to the extent they can work safely.  I think we have intuitive evidence that masks work, simply by reducing the huge quantities of crap people expel into the air around them, which is particularly important when you have a disease that is so contagious without visible symptoms.  We know for a fact that it is not going to prevent transmission.  But we've had some suggestive data from early on indicating that exposure to a lower viral load may mean that the ensuing disease is less severe, which would be a huge win if true and IMO the strongest possible argument for using masks regularly.  We have also seen observationally that the disease seems to spread like wildfire when people are in cramped quarters indoors for extended periods of time -- meatpacking plants, choirs, funerals, bars, poor neighborhoods with shared housing arrangements, etc.  We have also developed dramatically improved treatments since the early days (at least per my friend the ER doc, which is by definition anecdotal).  So where we are today, I think it is reasonable to reopen most activities safely, with required masks and social distancing, and with things outdoors as much as possible.  I think it makes sense to tie activities to metrics -- i.e., if you see the number of tests and the positivity rate both go up, that's a very bad sign, and you probably want to limit things for a period; OTOH, areas with very low numbers shouldn't have many restrictions at all.  I do not have a firm conclusion on things like schools, because there are powerful arguments on both sides; I would love to see schools open safely, but I do not believe that most school systems have the resources to implement the necessary safety precautions. 

[Dicey]

As usual, wise words from @Laura33. Thank you.

[ReadySetMillionaire]

Yes, I am skeptical.  But I am also frustrated with the version of contrarianism that knee-jerks to the conclusion that general knowledge is wrong.

RSM, you are asking the wrong question.  You cannot demand proof in a novel pandemic before taking action, because by definition you don't know enough to guarantee you have the "right" answer.  You just have to evaluate the data you do have, make projections based on comparison to other diseases and other incidents, and make the best decision you can -- then be prepared to shift course when better data comes in.  It's sort of like environmental laws:  the science is always debatable, so it's EPA's job to review the data out there and make the best call it can, with the understanding that nothing is certain and they might be wrong.  And no matter what you decide, someone out there is going to be able to cite data that contradicts your conclusion.

The reason we cannot have a rational conversation about the COVID response is that (i) most of the information we have is correlative and/or conjectural, and (ii) the issue has all become completely politicized.  As a result, the particular data points or correlations that you see as compelling tend to be the ones that correspond to your belief system.  And since nothing is definitive yet, no one can "prove" anyone is wrong; instead, we just point out flaws in the other side's data, and by doing so, reaffirm our belief in the rightness of our own. 

What do I think?  Does it matter?  Yes, I have looked at the data as closely as I can, and yes, I understand the scientific method and understand the limitations on what we know, and so I think my opinion is as well-formed as anyone who isn't working with the data/issue every day.  But my opinion is just as biased as everyone else's.  I think that a coherent, consistent national message based on the best available data at the time would have been very helpful.  No, it wouldn't have been perfect, but it would have been much more helpful than having two completely different messages coming from the right and the left (particularly including messages from the right that suggested that the disease was only a political ploy by the left to make the President look bad, which immediately discredits any further information about the disease or from the scientists fighting it). 

I applaud my state's response; we have a Republican governor, who I never voted for, but I absolutely would vote for him now, simply because he has acted like a grown-up and managed to convey that he is looking to the science and is going to do what is necessary, but is also not going to keep people out of work to the extent they can work safely.  I think we have intuitive evidence that masks work, simply by reducing the huge quantities of crap people expel into the air around them, which is particularly important when you have a disease that is so contagious without visible symptoms.  We know for a fact that it is not going to prevent transmission.  But we've had some suggestive data from early on indicating that exposure to a lower viral load may mean that the ensuing disease is less severe, which would be a huge win if true and IMO the strongest possible argument for using masks regularly.  We have also seen observationally that the disease seems to spread like wildfire when people are in cramped quarters indoors for extended periods of time -- meatpacking plants, choirs, funerals, bars, poor neighborhoods with shared housing arrangements, etc.  We have also developed dramatically improved treatments since the early days (at least per my friend the ER doc, which is by definition anecdotal).  So where we are today, I think it is reasonable to reopen most activities safely, with required masks and social distancing, and with things outdoors as much as possible.  I think it makes sense to tie activities to metrics -- i.e., if you see the number of tests and the positivity rate both go up, that's a very bad sign, and you probably want to limit things for a period; OTOH, areas with very low numbers shouldn't have many restrictions at all.  I do not have a firm conclusion on things like schools, because there are powerful arguments on both sides; I would love to see schools open safely, but I do not believe that most school systems have the resources to implement the necessary safety precautions.

A very good and thoughtful post, @Laura33 .

I maintain my position about the burden of proof, perhaps because of my generally conservative political leanings, but moreso from my strong beliefs in the constitutional system of government. My very first question about any policy decision is, "What does the Constitution say about this?" Whether it's the environment or public health, I start there.

I do not believe it is controversial from either side of the aisle to say that if a government is going to restrict individual liberty and freedom, that implicates Due Process, Equal Protection, and the First Amendment. Each of those doctrines compels the government to prove that its measures are appropriately tailored and proven to achieve the desired end (over-simplifying there, as you know Laura).

While you may disagree with the results of this District Court Judge's analysis, which struck down PA's stay-at-home orders, he certainly raises all the right issues -- https://www.scribd.com/document/476017344/Judge-Stickman-s-order-in-Butler-County-v-Wolf#download

What is the applicable standard of review? Does this violate the First Amendment? Equal Protection? Some quotes that stuck out to me --

"Good intentions toward a laudable end are not alone enough to uphold governmental action against a constitutional challenge.  Indeed, the greatest threats to our system of constitutional liberties may arise when the ends are laudable, and the intent is good."

"The response to a pandemic (or any emergency) cannot be permitted to undermine our system of constitutional liberties or the system of checks and balances protecting those liberties."

"[Defendants] were not merely coming up with a draft of some theoretical white paper, but rather, determining who could work and who could not, who could earn a paycheck and who would be unemployed--and for some--which businesses would live, and which would die."

"Closing [a local furniture store] did not keep at home a consumer looking to buy a chair or lamp, it just sent him to Walmart.  Refusing to allow the Salon Plaintiffs to sell shampoo or hairbrushes...just sent the consumer to Walgreens or Target."

"The Constitution cannot accept the concept of a 'new normal' where the basic liberties of the people can be subordinated to open-ended emergency mitigation measures. Rather, the Constitution sets certain lines that may not be crossed, even in an emergency."

I happen to agree with all of these points. As a threshold matter, I have a huge problem with unelected officials of the *executive* branch enacting such broad-sweeping measures. If state representatives did this, that's another matter; but unelected executives deciding what businesses can stay open and what can't better have the goods in proving that what they are doing is justified.

What adds to that, exponentially for me, and in terms of Due Process and Equal Protection, is the *indefinite* nature of these orders. I simply do not believe the government has a compelling enough interest to take the drastic measures they have taken that have such an incredible effect on individual liberty -- indefinitely.

It is simple to sit here and say "well, this is a novel virus, it's life and death." But that in and of itself cannot be justification to suspend a constitutional system of government that is founded upon individual liberty. We are six months into this thing, so I am absolutely going to put the burden of proof on government to say, "Here, this works, and here's why."

I wear masks. I socialize exclusively outdoors. I have not eaten inside a restaurant since this began. I wash hands thoroughly. Basically anything they have convinced me on, I am understandable.

But broad-sweeping economic shutdowns? Remote schools? These are huge decisions with catastrophic consequences, and I do not believe government has met their burden of proof.

Again, I appreciate your respectful disagreement. If only the folks on Twitter and our media platforms could explain things as eloquently as you.

[ctuser1]

ReadySetMillionaire - I think you are probably misunderstanding the scientific process AND the idea of skepticism!!

When the pandemic started, there wasn't enough data. So any decisions taken at that time would be very imprecise, and a lot of those decisions would turn out to be wrong. If you turn to scientific methods, they will only produce a massive range of possible outcomes without giving you a clear and precise answer.

So what do you do?

The best course of action in that scenario is to rely on human judgement of experts WITHOUT ideological inputs and with the full knowledge that:
1. Many experts will disagree, for very good reasons.
2. Many of the conclusions experts will arrive at based on their educated hunch, but based on imprecise data, will prove to be incorrect in future.

Why is this still the best course of action? Because anything else is significantly worse!!

Now, if it turns out that any of those experts advising the government was influenced by political motives - he should be fired and never allowed to participate in any government programs again.

The questions you highlighted indicate absolutist positions that are untenable in real world. The kind of burden of proof you demand, if analogous standards are applied to any other sphere of legal question, will make all activity grind to a halt!! Almost all activities demand a compromise on conflicting sets of freedoms. I am infringing on a lung-cancer patient's right to live when I drive. As a society we all have accepted that, including people who are at a higher risk of lung cancer.
Similarly, I would likely be infringing on a person with pre-existing contra-indication's right to live if I engaged in risky behavior like not-socially-distancing or not wearing masks. Should I have that right to infringe on someone else's right to live? That really is the question to me. A temporary restraint on that till things are figured out is very much in keeping with that correct "balance".

So I'd like to dispute your assertion that a sufficient burden of proof was not met. When rights and liberties conflict - priorities have to be decided. Life takes precedence over property - IMO.

Was the judge in question ideologically motivated? You don't want to leave constitutional questions to someone who is known to be an authoritarian communist (i.e. "nobody has any liberty") or a libertarian (i.e. "my rights to do what I want is more important than your right to live").

The way the judge frames these questions seem pretty tilted to me!! I view an ideologically motivated judge with the same skepticism as an ideologically motivated scientist - FWIW.

[ReadySetMillionaire]

ReadySetMillionaire - I think you are probably misunderstanding the scientific process AND the idea of skepticism!!

When the pandemic started, there wasn't enough data. So any decisions taken at that time would be very imprecise, and a lot of those decisions would turn out to be wrong. If you turn to scientific methods, they will only produce a massive range of possible outcomes without giving you a clear and precise answer.

So what do you do?

The best course of action in that scenario is to rely on human judgement of experts WITHOUT ideological inputs and with the full knowledge that:
1. Many experts will disagree, for very good reasons.
2. Many of the conclusions experts will arrive at based on their educated hunch, but based on imprecise data, will prove to be incorrect in future.

Why is this still the best course of action? Because anything else is significantly worse!!

Now, if it turns out that any of those experts advising the government was influenced by political motives - he should be fired and never allowed to participate in any government programs again.

The questions you highlighted indicate absolutist positions that are untenable in real world. The kind of burden of proof you demand, if analogous standards are applied to any other sphere of legal question, will make all activity grind to a halt!! Almost all activities demand a compromise on conflicting sets of freedoms. I am infringing on a lung-cancer patient's right to live when I drive. As a society we all have accepted that, including people who are at a higher risk of lung cancer.
Similarly, I would likely be infringing on a person with pre-existing contra-indication's right to live if I engaged in risky behavior like not-socially-distancing or not wearing masks. Should I have that right to infringe on someone else's right to live? That really is the question to me. A temporary restraint on that till things are figured out is very much in keeping with that correct "balance".

So I'd like to dispute your assertion that a sufficient burden of proof was not met. When rights and liberties conflict - priorities have to be decided. Life takes precedence over property - IMO.

Was the judge in question ideologically motivated? You don't want to leave constitutional questions to someone who is known to be an authoritarian communist (i.e. "nobody has any liberty") or a libertarian (i.e. "my rights to do what I want is more important than your right to live").

The way the judge frames these questions seem pretty tilted to me!! I view an ideologically motivated judge with the same skepticism as an ideologically motivated scientist - FWIW.

I appreciate the thoughtful response. I generally agree with you that the emergency at the outset potentially justified extreme government measures. Where it gets much murkier (to me) is when the orders are indefinite.

Contrary to your assertion about my framework being impossible "in the real world," every single law that has ever been passed in the United States has gone through my "framework." Every federal law must emanate from the enumerated powers in the Constitution and cannot infringe upon the Bill of Rights. Every state or local law must emanate from their own charter documents and also cannot infringe upon the state or federal Bill of Rights.

All laws must meet this balancing test. State prohibitions on smoking indoors were challenged on First Amendment grounds, but government met its burden of proof showing that the measures were reasonably necessary to prevent particular harms. Same with seatbelts and other safety laws, and actually every single law that has ever been passed.

To throw out this framework because of an emergency -- when it is arguably most needed -- is an affront to our constitutional democracy. The burden must always remain on the government.

I would posit that the questions you pose in terms of risk calculus actually prove my point. We engage in risk management every day without much government involvement. The government generally does not step in with a heavy hand for literally everything that involves risk because it throws off the balance between an individual's choice to evaluate the risks and make his or own decision and government over-protection.

Obviously we can respectfully disagree. But we are six months into this thing. Any government setting forth any particular measure must reasonably be able to prove that their particular measures are appropriately tailored to meet the desired end. The failure to meet that burden --especially when the orders emanate from the executive branch -- renders the regulations unconstitutional.

***

Note, of course, that this is not to say that the regulations are bad. I am sure we may agree on a lot of the appropriate measures. This just means that government has to prove itself. It has to show its case. If it can do that, as it has done with hand-washing, masks, general social distancing, etc., then that's fine. But it is the failure to meet this burden that renders the regulation unconstitutional.

[ctuser1]

I appreciate the thoughtful response. I generally agree with you that the emergency at the outset potentially justified extreme government measures. Where it gets much murkier (to me) is when the orders are indefinite.

Agreed as stated, without reservations.
Would you think it would be better if the government was explicit that the regulations are for a maximum of "3 years or less"? Because by then either the virus would be gone (like spanish flu), or a vaccine will arrive, or we will learn to live in a new normal.

Contrary to your assertion about my framework being impossible "in the real world," every single law that has ever been passed in the United States has gone through my "framework." Every federal law must emanate from the enumerated powers in the Constitution and cannot infringe upon the Bill of Rights. Every state or local law must emanate from their own charter documents and also cannot infringe upon the state or federal Bill of Rights.
All laws must meet this balancing test. State prohibitions on smoking indoors were challenged on First Amendment grounds, but government met its burden of proof showing that the measures were reasonably necessary to prevent particular harms. Same with seatbelts and other safety laws, and actually every single law that has ever been passed.

I did not question the legal framework. I questioned the real-world logical framework of interpreting the legal codes.

Legal codes lay down the rights. The anti-mask-protester has a right to dress as he pleases, and my diabetic neighbour has a right to live. They seem to be conflicting in this case. The legal code does not seem to answer which right takes precedence - we have to use a real world logical framework (and legal precedence etc) to arrive at that answer.

Are you arguing that we don't *know* that masks save lives? Let's say that the scientific method (i.e. some form of statistical hypothesis testing) yielded with a low precision (say, 70% confidence interval, or 1-sigma or something) that masks saves lives. Would that be a sufficient temporary "proof" till further data and research comes in - which will likely take some time, years?

Does the anti-mask-activist have any burden of proof here? Can my diabetic neighbour demand a certain burden of proof from the said protester before he infringes on her freedom to live? When there is a doubt, which right do you prioritize? My neighbours right to live or anti-maskers right to not have to wear a mask?

To throw out this framework because of an emergency -- when it is arguably most needed -- is an affront to our constitutional democracy. The burden must always remain on the government.

Government is not the party that is harmed here. My diabetic neighbour is. How much time did the judge you cited spent trying to consider that right?

I would posit that the questions you pose in terms of risk calculus actually prove my point. We engage in risk management every day without much government involvement. The government generally does not step in with a heavy hand for literally everything that involves risk because it throws off the balance between an individual's choice to evaluate the risks and make his or own decision and government over-protection.

We have determined certain set of behaviors that can potentially harm others is accepteable.

Has the society (including my diabetic neighbour, who I consider very much a part of society, even though she is frail and old) decided that the anti-mask and anti-social-distancing activities are accepteable risks? Has it had enough time to arrive at a decision on this?

Obviously we can respectfully disagree. But we are six months into this thing. Any government setting forth any particular measure must reasonably be able to prove that their particular measures are appropriately tailored to meet the desired end. The failure to meet that burden --especially when the orders emanate from the executive branch -- renders the regulations unconstitutional.

Let's again switch focus from the government to my diabetic neighbour. Government is just the proxy for her in this case.
What burden of proof does she have to meet to demand that others don't engage in activities that puts her life at risk??

On the face, we may disagree with the definition of the word reasonable. Other countries took steps they considered reasonable (e.g. Canada) and brought this virus under control. We, obviously, did not!! So is it reasonable to take similar steps as Canada did? Or something else?

To me it seems that rights come with responsibility. The data indicates that we as a country failed in our responsibility to take appropriate measures (easily demonstrated when we compare with other countries). What percentage of our time should we spend discussing the failure at that responsibility, vs. infringement of "some people"'s rights to infringe on "some other people"s rights to live?

[ReadySetMillionaire]

FWIW, I’m pro-mask in indoor and mass gathering situations. I believe government has met its burden of proof there. The infringement upon liberty is minimal and the cost to the citizen is minimal. The health benefit is somewhat debatable but if it is positive, the minimal infringement upon liberty is worth it.

And in case I am not making myself clear, I am mostly discussing this in the context of the extreme measures — lockdowns, business closures, stay-at-home, etc. I do not believe these will survive constitutional scrutiny if implemented again.

On a general point though, framing everything the way you do is a recipe for an authoritarian government. The thought that the government all of a sudden has near unlimited authority because a virus is transmissible is simply not acceptable to me. The government authority must be limited and work within the Bill of Rights.

This is illustrated by our response to Spanish Flu, which was far, far, far worse than what we are facing. The government’s interventions lasted about 4-6 weeks. After that it was “common sense” measures (as currently defined by CDC).

The idea that government can significantly suspend liberty indefinitely — even for three years — to prevent spread of a virus is counter to a constitutional government.

[ctuser1]

On a general point though, framing everything the way you do is a recipe for an authoritarian government.

I do know that!! I do have a habit of taking a point to it's logical extreme, in part as a "bargaining chip". When I frame it as "my diabetic neighbor's right to live" - it is a logically extreme position aimed at showing the ridiculousness of the the other logically extreme position in ideological vogue in today's US.

The above is borderline rude and too aggressive in most contexts, but is very efficient at showing the ridiculousness of the current way most things are framed.

----------------------------------------------

Trying to tone down my rhetoric, my frustration is with the fact that none of these ongoing debates would have been necessary if we had just done the common-sense measures that other countries had taken. If we had locked down hard when it was first warranted, had not politicized masks, etc. then we would not have had community transmission in so many places. We have 10 times the population, and 23 times the COVID deaths compared to Canada!!

I hold a certain part of the population, with a certain ideology, responsible for this. The failure at our responsibilities (that I instinctively blame on some people) makes any push-back a little hard to swallow, at least for me.

They are the ones who caused the extreme measures to become necessary, and now they are the ones asking to cause further damage!!#$%#$

-----------------------------------------------------------

A fun thought experiment: would consideration of such extreme measures have been necessary if people in the US banded together like others in other countries did and adhered to common-sense measures?

Assuming you answer no, aren't our energy better off directed towards that root cause rather than hair-splitting constitutional debates in the middle of a crisis?

If you answer yes, then we'd probably disagree on this.

[Laura33]

OK, this is fun, now that we're having a rational conversation and not just pointing fingers and spouting talking points!  @ReadySetMillionaire, my thoughts in response:

I am always surprised at the way these political winds and theories shift, because I think I am espousing the more traditionally "conservative" opininion.  My view is based on the 10th Amendment:  the powers granted to the federal government are limited; anything not specifically enumerated in the Constitution is reserved to the state, or the people thereof. 

Historically, the way this has been interpreted is that the state has tremendous authority and freedom to take the steps it believes necessary to protect the public health.  These limits are constrained at the federal level only to the extent they infringe on other rights granted by the Constitution -- so, for example, a supposed health measure that is a cover for racial discrimination.  Every past pandemic has entailed state and local orders that are far more draconian than most of what we are seeing now (I am not going to represent "all," because I have not done the research necessary to support that broad claim, but think things like mandatory quarantine/sanitoriums for tuberculosis).  If you want an illustration of the breadth of the state's ability to act in defense of the public health, look no further than abortion laws.  A transvaginal ultrasound is quite a bit more significant an infringement on individual rights than wearing a mask.*

Your argument is, fundamentally, inconsistent with traditional federalist notions of state sovereignty.  You are advocating for a broader construction of the Bill of Rights, which grants a far more powerful role to the federal government and, in particular, the federal judiciary, to second-guess state decisions.  Now, I don't necessarily disagree with that; but it is not traditional conservatism.

Your approach strikes me as more toward the more recent libertarianist view, which focuses on the "or to the people" part of the 10th Amendment.  This approach places individual rights at the highest point of the pyramid, limited only to the extent the federal Constitution expressly authorizes.  Ergo, to justify any regulation of an individual, for any reason, the state must pass a very high threshold demonstrating that its interest in regulating is sufficient and that the regulation is sufficiently narrowly tailored to protect individual rights to the maximum extent possible. 

Neither approach is all good or all bad, of course.  More power to the states is more likely to allow fast, effective action, and provides the most likely forum for both health and economic considerations to be weighed on a societal level.  OTOH, too much power can lead to authoritariasm, and decisions that are politically-driven won't necessarily be the right ones.  On the flip side, more power to individuals will maximize individual freedom, which is great for the strong and pretty crappy for the vulnerable;  if taken to the extreme, this approach can lead to anarchy.   

My own personal view:  I think recent events have illustrated the need for a functioning federal government.  A pandemic requires national coordination, because viruses don't care about political borders.  It requires access to the best scientific knowledge, i.e., coordination across states and disciplines. It requires an efficient allocation of resources, which is implemented much more smoothly than requiring the states to bid against each other for limited supplies.  It also requires a careful weighing of both the health and economic impacts of any proposed approach on all parties involved -- which, again, requires access to experts in every area, and well-trained decisionmakers to make well-informed decisions.  But I also think any policy should be flexible to adapt to local needs and conditions, meaning that the states and localities should have significant authority to determine which approaches are appropriate for their circumstances and how they should be implemented.

So, yeah, in this arena, I put individual rights at the bottom of the list, because no individual has all of the knowledge and perspective to make the hard decisions, and because natural self-interest will always find reasons why the individual should not be the one to make the hard sacrifices.  I believe this is entirely consistent with the Constitution, because the fundamental purpose of the Bill of Rights is to protect the weak from the strong, and that's exactly what these health measures are trying to do.  So I believe the feds' and states' decisions should be given reasonable deference -- not unlimited, of course, but consistent with how other agency decisions are typically viewed.  Does the PA order pass muster?  I have no idea -- haven't looked at it.  But I disagree with the court's framing of the issues.

Oh:  the one thing I'm really not persuaded by is the argument that unelected bureaucrats are making these decisions, given that the solution is to let unelected federal court judges (the ultimate arbiters of Constitutional interpretation) substitute their own judgment for the bureaucrats'.  At least with local/state regulators, if you don't like the decisions, you have the right and ability to vote the people who appointed them out of office.

*No, I am not suggesting they are equivalent, nor do I want to open a political conversation about abortion.  But there is a common legal thread here, i.e., actions that one party may be compelled by law to take (or forbidden from taking) in order to protect another's life. 

[vand]

As an aside - has anyone watched this guy's videos (Ivor Cummins)? He seems to be making good points, and I can't find any reason he'd have an agenda. As an engineer, his way of sharing the raw data is very compelling: https://www.youtube.com/watch?v=8UvFhIFzaac

I saw that video and it closely matches my current mental model of the pandemic. It's still too early to declare a particular interpretation right but the argument in the video is compelling wrt current empirical data across a diverse set of countries with differing policies.

I have followed Ivor's work for a few years and he is always scrupulously fair in his presentation of data; see his previous work on Vitamin D and Diet (big can of worms I know).

WRT to current Covid policy, it's very difficult to know what to make of it. I do think that on the whole most governments are doing their best to strike a balance between protecting the vulnerable, keeping our civil liberties intact, and supporting the economy, but there is also an inevitably an increasing politicisation of all of these aspects. 

[ReadySetMillionaire]

(I hate myself for how much I enjoy these debates @Laura33 -- we should get a beer some time).

Your Tenth Amendment analysis is certainly spot on and very interesting. I have not dug as deep as you obviously have on its historical interpretation, so I have some reading to do. Where I was going more with my post was the reality that the federal Bill of Rights have been "incorporated" upon the States. Whether this is good constitutional law is beside the point because it is a reality since the late 1800s/early 1900s (I think).

I come at this from the Ohio law perspective. The general powers you describe regarding quarantine and isolation (re tuberculosis) are statutorily defined, very specific, and the confinement of any individual is limited to 14 days unless the government could show why the quarantine/isolation should be continued. The same statute has a relatively broad clause bestowing authority upon the health director "to make special orders for the spread of contagious diseases." Multiple (elected) state judges threw out our health director's order as violating the state Constitution because the order went well beyond these 14 day limits.

Further, these state statutes generally require the government to show that the affected individual is contagious, exposed, or infected. Here, the government has flipped that burden on its head and effectively accused everyone of being possibly contagious. Again, multiple state courts threw out the health director's order on this ground.

***

If you read the federal court's decision, I think the PA orders were set up to fail. They divided businesses in two categories -- "life sustaining" and "non-life sustaining." There was basically no process to categorize these businesses. These categories further were not defined in writing. And government officials admitted under oath that the "non-life sustaining" businesses could be shut down again *without any process for appeal.* That certainly seems to violate even the most elementary Due Process analysis.

I go back to @ctuser1 's point about prioritizing life over property -- choosing "life" over "business" is not as simple as it sounds. I have clients who have lost everything. I have a classmate from high school who is now homeless (his brother just posted on Facebook yesterday asking if anyone knew where he was). I have multiple friends who teach in a poorer school district and something like 30% of kids have not logged in for a single class.

***

These are really, really hard calls. But obviously, I fall on the other side -- I think we need to return to our general system of individual choice so we can learn to live with the virus. And I fall on this side because this is actually what the science says:

There are no historical observations or scientific studies that support the confinement by quarantine of groups of possibly infected people for extended periods in order to slow the spread of influenza. A World Health Organization (WHO) Writing Group, after reviewing the literature and considering contemporary international experience, concluded that “force isolation and quarantine are ineffective and impractical.” Despite this recommendation by experts, mandatory large-scale quarantine continues to be considered as an option by some authorities and government officials.

The interest in quarantine reflects the views and conditions prevalent more than 50 years ago, when much less was known about the epidemiology of infectious diseases and when there was far less international and domestic travel in a less densely populated world. It is difficult to identify circumstances in the past half-century when large-scale quarantine has been effectively used in the control of any disease. The negative consequences of large-scale quarantine are so extreme (forced confinement of sick people with the well; complete restriction of movement of large populations; difficulty in getting critical supplies, medicines, and food to people inside the vquarantine zone) that this mitigation measure should be eliminated from serious consideration.

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.552.1109&rep=rep1&type=pdf&

Again, I am discussing these types of measures, not masks or other benign recommendations. If government is going to implement measures that scientists say have "extreme" negative consequences, government absolutely has to be able to justify its decision. Right now, and after six months of data, I do not believe government can meet its burden.

If government wants to mandate masks, hand-sanitizer at business entrances, and isolation of positive cases, I'm probably for it. But the *mandatory* stay-at-home stuff and shutting down thousands of businesses is probably a thing of the past.

[ReadySetMillionaire]

A fun thought experiment: would consideration of such extreme measures have been necessary if people in the US banded together like others in other countries did and adhered to common-sense measures?

Assuming you answer no, aren't our energy better off directed towards that root cause rather than hair-splitting constitutional debates in the middle of a crisis?

If you answer yes, then we'd probably disagree on this.

I generally believe *individuals* did pull together early on. Google and Apple data showed that movement was down 40-50%, which is enormous. Companies completely re-organized to make PPE. The city where I work sent everyone home for three weeks ... and paid everyone. There was a lot of effort to combat this, albeit the national government left a lot wanting.

Leaving that aside (and I have been incredibly critical of the Trump administration re C19), I do not think it is sound to compare a country as large and diverse (politically, demographically, culturally, etc.) as the United States to other demographically monolithic countries that are the size of Wisconsin. As I said in another thread (or maybe this one), some countries that locked down harder than the US (Peru, Italy, Spain, UK, Belgium) have done worse than the US. Some that locked down less (Brazil, Sweden) have done better. Some that locked down more (Germany, Netherlands, Denmark) have done better. Some that locked down the same (Mexico) have done about the same.

It is all over the map. And there are too many variables for a dumbass like me to interpret. That begs the question, "Why not trust the scientists," but as Nate Silver just pointed out, there is a huge difference between the "scientists" pushing panic porn on TV and the incredibly debated position right now as to the efficacy of lockdowns. This is not like climate deniers where some random professor from Vermont State Technical is arguing that the earth is actually cooling. There are scientists from NYU, Stanford, Harvard, Chicago, Michigan, etc. and Nobel Laureates that think lockdowns are bad policy.

To your second question, absolutely not. The Constitution must be the north star of any policy debate. Anything less and you end up with horrible policy that history eventually condemns.

[RetiredAt63]

^^  just to comment.  From the Canadian viewpoint we are doing well but not great.  We were 26th last I looked, which is good not great.  Being next to you makes us look good.   ;-)

You are seeing us as a country, but our provinces have jurisdiction over health (i.e.Covid) and education (how do we handle schools).  Our federal government does not have direct jurisdiction.  What you are seeing is the federal government acting in a supportive and advisory role.  The PM going into self-quarantine when his wife tested positive supported the advice of health professionals.  Legally this is no different than your federal/state split.

The federal government, in its own powers, has provided financial support to individuals, businesses, and provinces. It has made trade deals for equipment and potential vaccines, and anything else basically in its jurisdiction.

[Sanitary Stache]

I am appreciating this discussion.  Many words have been put into an order that I find helpful to organize my own preferences. 

For instance, I tend to agree that the "lockdowns" were arbitrary and not within the power of state executive branch employees.  My state called it a "shutdown" and issued "stay home stay safe" orders that did get lifted within 6 weeks, or at least begin to be lifted.  I think most of the business closures were arbitrary, but I thought it made good sense in the context of PUA expanded unemployment benefits and the PPP loans.  Similarly, the decision as to who is an "essential" worker seemed arbitrary.

I think I see something of a conflict between the idea of individualism and the fact that early on it seemed as if the country was acting for the community benefit.  I know that blame laying is not helpful, but I do feel, in myself, a certain willingness to follow a leader when it comes to coordinated community activities, and thus do lay blame for the breakdown of coordinated effort among citizens on the President's mixed messaging. 

There was surly a surfeit of leadership beyond the State level.  Not to say the Federal Government needed to employ any authority beyond financial assistance and leadership.  Only that the President should have led.  I feel my little state has done very well and ended the arbitrary shut downs in a reasonable time frame.  I attribute most of this to our leadership.  Our governor and our Health Commissioner standing up every day and telling us a consistent verifiable message.  I still prefer to avoid getting Covid-19 as best I can, but recognize that I am living closer to my ideal existence than it is for other people.

So, my thoughts on Covid response = President failed to seize the moment to organize a strong majority toward a common goal, State's implemented varied and arbitrary restrictions, the virus is not gone.

[Laura33]

[snip for length of continued posts]

So it sounds like your case was based on Ohio law and didn't need to be a federal Constitutional issue after all -- if the state has already determined to limit its own authority in health-related matters, then of course it can't arbitrarily expand its powers beyond those limits.  But that is a fundamentally different issue (and should thus be a fundamentally different analysis) than whether those actions violate the federal Constitution.

I will also say that I agree with you on what the answer "should" be at this point -- from what I recall, the idea of a lockdown was to catch this thing before it went out of control and we overwhelmed the hospitals and hit massive community spread.  We largely succeeded in flattening the curve, because the first states to follow NY (including mine) paid attention and took significant and early action; we failed in avoiding massive community spread for a number of reasons.  But in any event, that horse left the barn a long time ago, so we need to move to reasonable methods to manage this disease as a chronic issue vs. an acute one, which requires a different analysis.  Requiring a whole bunch of businesses to shut down is a reasonable short-term response to deal with an acute issue; but in terms of long-term management of a health threat, it is a cudgel where a scalpel is better suited.

I just continue to disagree that that analysis should be founded in individual rights -- that the starting assumption is that no action is authorized that infringes on individual rights of any sort, and the state must thus prove its case before it does anything, as compared to the more traditional historic view that states are given a good deal of power and discretion in managing public health crises and basically get the benefit of the doubt unless you can prove that they overreached.  I think you could reasonably overturn a shutdown order at this point under any analysis, because it is not effective when you already have community spread, and it imposes tremendous personal costs on workers and businesses everywhere.  But the problem with attacking a shutdown order under the guise of "individual rights" is that the "individual rights" claim goes much further than that.  Wearing a mask -- which you and I agree is a reasonable thing to do based on what we know -- is in fact the key flashpoint of the "individual rights" crowd; refusing to wear a mask has now somehow come to symbolize one's commitment to personal freedom and limited government overreach.  See the recent Kerri Walsh kerfluffle or any Trump campaign rally. 

The reality is that many, many people arguing that the analysis should begin with individual rights are not merely protesting governmental overreach that is leaving them out of work and homeless; they are very directly arguing that the government does not have the right to require them to do anything even as simple as wearing a mask.  Their fundamental argument is that the government has no right to interfere with their inalienable right to behave however they'd like -- even if that "interference" is the minimal inconvenience of wearing a mask, and even when the best available evidence right now indicates that that kind of "freedom" puts more vulnerable people at risk. 

[deborah]

Australia is the same size as the contiguous US and has a similar setup to both the US and Canada, in that our states and territories have jurisdiction over health. Until the smallest state (Victoria) recently accidentally let covid19 escape from quarantine, we were doing very well indeed. Victoria now has it more or less under control, at the expense of about 700 lives, mainly of people in old aged care. Like @RetiredAt63 says about Canada, our federal government has done similar things, and they have worked.

It appears to me to be rather silly to be talking about rights during an emergency. I live close to where our fires were in Australia late last year and early this year. For months we had smoke and I had to stay indoors for most of summer. For several weeks my local (several streets away) air pollution station measured us as having the worst in the world. For several weeks I could see fire from my front door. What were the fire fighters doing? Bulldozing fire breaks on people’s property, dumping pink fire retardant from planes on all sorts of places, taking fire fighters onto people’s land without their permission... I’m sure the same thing is happening over there at the moment. Is a judge going through your constitution working out whether this can be done? Don’t be silly! They’re trying desperately to put out the fires.

Are there mistakes being made? Of course. It happens. The fire I could see from my home, that was absolutely enormous, was accidentally started by a fire fighting helicopter that was doing stuff in a remote area in case it caught fire. Unfortunately there was so much smoke around from other fires a hundred miles away that they had to use their landing lights to land. The lights set off a grass fire that they didn’t know about because there was already too much smoke. The next day, that fire was detected, but it was already too big for them to be able to put it out. 

Every emergency has mistakes and people don’t know enough even now to fight covid19 as well as we’ll be able to in a few years. Unfortunately, countries not treating it like the emergency it is have let it get away and shatter global economies. As the greatest nation on earth you had a responsibility not just to your own citizens, but to all people to try to get on top of it - nationally and globally - especially since for the past seventy five years you have tried to get all other countries to do what you want them to do.

[OtherJen]

Last weekend, I had a conversation with an evangelical Trump Voter about how he believed that mask mandates were an infringement on his civil rights. He wasn’t against masks, per se, and wore them, but believed that it should be solely his choice.

My responses that the mandates are 1. temporary and 2. implemented because people refused to protect others agains viral spread fell on deaf ears. I do wish I’d thought of laws against drunk driving (should we be allowed to choose whether we drive drunk, without penalty of law, because our right to do what we want supersedes others’ right to reasonable safety?) and old blackout mandates and curfews during war-time (temporary, but would it have been an infringement of personal liberty when one wanted to shine a light through their window at night even though doing so may have gotten the entire neighborhood destroyed?).

Yes, we have rights and freedoms in the USA. Those come with responsibilities.

[ReadySetMillionaire]

@Laura33 -- again a thoughtful response. The fact that we seem to have a fundamental disagreement is perfectly okay. Your position is well reasoned and well supported, and despite the fact that I am almost as good of a writer as you, I doubt I will be able to bring you over to my side.

I guess my starting point actually predates the Constitution and derives from the Declaration of Independence --

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it

By my reading, this idea permeates the entire Constitution from start to finish. Thus, it is actually the individual, and not the state, that governs. The government serves at the privilege of individuals, and once they lose faith, they can "alter or abolish it."

This may seem academic to some, but this is foundational from my perspective.

Last weekend, I had a conversation with an evangelical Trump Voter about how he believed that mask mandates were an infringement on his civil rights. He wasn’t against masks, per se, and wore them, but believed that it should be solely his choice.

My responses that the mandates are 1. temporary and 2. implemented because people refused to protect others agains viral spread fell on deaf ears. I do wish I’d thought of laws against drunk driving (should we be allowed to choose whether we drive drunk, without penalty of law, because our right to do what we want supersedes others’ right to reasonable safety?) and old blackout mandates and curfews during war-time (temporary, but would it have been an infringement of personal liberty when one wanted to shine a light through their window at night even though doing so may have gotten the entire neighborhood destroyed?).

Yes, we have rights and freedoms in the USA. Those come with responsibilities.

The seatbelt, drunk driving, smoking indoors, and other similar examples are all interesting discussions. I think those are somewhat different because the science is absolutely unequivocal that seatbelts save lives, driving drunk puts you at greater risk of getting in an accident, smoking causes secondhand smoke, etc. In other words, and to use my prior phrasing, government absolutely met its burden of proof in demonstrating that these behaviors unequivocally cause harm to secondary people, meaning that the minor infringements on individual choice yielded a net societal benefit.

I know this is unpopular to say, but you cannot unequivocally say the same about masks.  The WHO, CDC, FDA, Surgeon General, etc. were not pulling the "don't wear masks" opinion out of their ass. Those opinions were based on decades of research demonstrating that masks were largely ineffective in stopping the spread of influenza. I know I am not a scientist but my general understanding is that, in terms of transmission (not the rate in particular, just its manner), flu and C19 spread in a similar manner.

I am not quite sure that the science switched so much as the politics did ("we need to do something"), but to me, given that *some* science demonstrates a benefit, and the infringement is minimal, I am okay with temporary government mandates. In any event, the people protesting masks are not doing so just because "muh freedom" (yes, some do this), but most of them are saying, "Government said masks don't work, now government says masks do work, and I'm not going to wear a mask until governments proves to me they work." I don't think this is that unreasonable of an opinion, although I do come out on the "just wear a mask for a while man" side.

Again, I would reiterate that my broad-sweeping criticism is about the much harsher policies, which I do not believe demonstrated hardly any net benefit and caused enormous consequences.

[Buffaloski Boris]

Interesting debate. I take the “individual” side of the argument for a different reason. Practicality. There is a lot of talk about what can theoretically be done in the US, but not so much about what measures will actually be obeyed. This is a disobedient culture. Another lockdown? Good luck with that.

[Cranky]

Ohio was never all that locked down. There was never any enforcement.

[Buffaloski Boris]

Ohio was never all that locked down. There was never any enforcement.

And that’s probably not going to change. Especially now.  WYSIWYG.

[ReadySetMillionaire]

Ohio was never all that locked down. There was never any enforcement.

The enforcement was invisible through threat of revocation of state funding and licenses. It was very, very real.

I am a nobody with a small practice and received more calls in one month than I ever have asking to sue the government. I would have done it had I not also been working for the city (which is also trying to enforce the same policies, thus giving me a conflict).

[Buffaloski Boris]

Ohio was never all that locked down. There was never any enforcement.

The enforcement was invisible through threat of revocation of state funding and licenses. It was very, very real.

I am a nobody with a small practice and received more calls in one month than I ever have asking to sue the government. I would have done it had I not also been working for the city (which is also trying to enforce the same policies, thus giving me a conflict).

He who pays the piper calls the tune. Government money always comes with strings attached.

The next lockdowns will be met with passive noncompliance. A business license is irrelevant if you’re operating in the shadow economy or are out of business.

[ReadySetMillionaire]

Ohio was never all that locked down. There was never any enforcement.

The enforcement was invisible through threat of revocation of state funding and licenses. It was very, very real.

I am a nobody with a small practice and received more calls in one month than I ever have asking to sue the government. I would have done it had I not also been working for the city (which is also trying to enforce the same policies, thus giving me a conflict).

He who pays the piper calls the tune. Government money always comes with strings attached.

The next lockdowns will be met with passive noncompliance. A business license is irrelevant if you’re operating in the shadow economy or are out of business.

I have multiple attorney colleagues who stated that at least one of their clients said they would use violent force if it ever happened again. I don't think it will barring a huge hospitalization surge.

[Buffaloski Boris]

I have multiple attorney colleagues who stated that at least one of their clients said they would use violent force if it ever happened again. I don't think it will barring a huge hospitalization surge.

I agree that generally speaking there won't be shutdowns.  Some politicians will try it, though.  And will quickly find out that governments derive their power from the obedience of the governed, not their consent. 

The pandemic is going to go endemic in the US.  Best to figure out ways to live with it. 

[Laura33]

I am not quite sure that the science switched so much as the politics did ("we need to do something"),

Yes, the politics switched, but it was in the other direction -- IIRC, the first "don't wear a mask" was driven by the concern that a mask mandate would leave emergency workers without sufficient N95 masks given the shortage.  It was the initial "masks don't work" that was politics.

(It is absolutely true that cloth masks don't work on airborne viruses.  But the coronavirus isn't airborne as that word is used in the medical/scientific community -- it is spread through aerosolized droplets.  IIRC, at the time, the thought was that the virus spread through larger droplets -- remember all the focus on sanitizing surfaces, and the idea of 6' apart was because the larger droplets fall to the ground quickly.  And the spread of larger droplets is most definitely reduced by cloth masks.  I think they are now finding that the virus can be spread by smaller droplets as well, which suggests that cloth masks aren't as effective as they originally hypothesized; but that is counterbalanced by the indication that maths may lower the viral load and thus result in less serious versions of the disease, which would absolutely help the goal of attaining herd immunity) 

Tangent:  the thing that bothers me is that the burden of proof seems to be whether Action X will stop the spread of the virus.  That's absolutely the wrong question to be asking.  The right question is whether various actions reduce risk, and to what degree?  Because risk reduction is cumulative.  If wearing a mask reduces risk by 50%, and staying 6' apart reduces risk by 50%, and staying outdoors reduces risk by 50%, doing those three basic things will reduce your risk by almost 90%.  Now, I don't know the actual numbers; I've seen some suggestions that the risk reduction associated with each of these things is much higher, around 70-80%. 

But the other factor is that we can't possibly know the actual numbers until we have a ton more data.  Which is why I go back to @deborah's comment that you need to give the people responsible for making decisions in an emergency a lot of leeway.

Oh:  remember that the rights set forth in the Declaration of Independence were subsequently embodied in the Constitution and Bill of Rights.  So the Constitution trumps the Declaration.  ;-) 

OK, this has been massively fun, but I do actually have some critical deadlines today (that are now more critical than ever given that I putzed away a good chunk of yesterday having fun here), so I'm off for now.  Sigh.

[fuzzy math]

I’ll echo Dicey here:  I was already taking it seriously but when my best friend since high school got hospitalized in Mid - July it hit home - when he was put on a ventilator 2 weeks later after seeming to be on the mend that was an even bigger deal.  After 6 weeks on the ventilator and a tracheotomy they’re still trying to completely wean him off of the ventilator.  He’s stable enough now that they’re probably going to transfer him to a long term acute care facility so he’s probably going to live.  He’ll have lost his career, possibly his home, and quality of life (hopefully not, but it’s definitely within the realm of possibilities) and spent 2+ months of his life in the hospital.  He’s 38 years old.  Yes, the mortality rate is lower, yes, he will probably be counted as “recovered” but I guarantee you that there are thousands of terrible stories like his that are being glossed over as “recoveries”. 

Points I’d like to drive home:

1. This is a financial forum - how do you think his long term finances will be affected?  I see caution in this pandemic as analogous to investing conservatively for the long haul.

2. He’s 38 years old.  Yes, he’s overweight and hasn’t taken good care of himself but he’s still only 38.  Nobody really knows who will get hit hard and who will not.

3. This is not a cherry-picked news story or a friend-of-friend story, this is someone I have known for 25 years, someone whose family I have lived with.

4.  Humans are terrible at believing things without being personally affected.  There is plenty of evidence and data to support the seriousness of this pandemic- I do not suggest asking for more as at this point, that is essentially asking to be personally affected.

5.  Outcomes are not binary.  It isn’t Death or Recovery.  There’s a whole rainbow of bad outcomes hidden in the “recovered” statistics.

Sorry about your friend. I hope he achieves a quality of life in the months ahead.

That being said, situations like his are not unique to COVID. I had a patient a month ago, in his 30s that is facing a lifetime of being in care facilities. His illness? He got pancreatitis, got septic, went into full blown ARDS (respiratory failure), got fluid resuscitated, got intubated, got kidney damage, and will likely be trached (on a tracheostomy / ventilator) for the rest of his life. His neurological status was pretty bad too.

People who work in ICUs are used to seeing these situations. They come from infectious origins that can be community based (flu, whatever "en vogue virus" is hitting in a particular season), or non transmittable (pancreatitis, or the guy I took care of who aspirated on Jello after eating too soon before his anesthesia had worn off and went into ARDS too).  Bad shit happens to people of all ages.

ANY ILLNESS that requires intubation is usually a result of a situation where the patient suffers short term instability that's severe enough to cause long term organ damage. We simply cannot remove enough risk from life to keep people from being intubated.

Also, here's a good article explaining short term heart changes on MRI in athletes who have the common cold. How widespread is this in the general population? We don't know and we likely don't care because it seems to just be something that happens and resolves. We are only catching these things for COVID and sensationalizing them on the news because 100% of our efforts are focused on finding any potential problem that can arise from COVID.

https://jcmr-online.biomedcentral.com/articles/10.1186/1532-429X-11-S1-O3

[chemistk]

I don’t really mean to just jump into the middle of probably the best (most pleasant, civil) discourse I’ve yet seen on this topic, but my ire is not with the lockdowns or the subsequent behavior recommendations (and in some few places, requirements).

My ire is more fundamental – that we as a society through the stubborn perception of “my rights will always be more important than yours” have failed to recognize that small individual actions which contribute to the general welfare of the greater population can inherently improve one’s own liberty on a longer scale and lead to a more peaceful and pleasant society.

The pervasive disobedient mindset of the old joke/warning “I’m from the government and I’m here to help” has morphed into something where we tell ourselves and others that our own judgement is the best. It’s an inherent bias of self-preservation that we must trust our own instincts to preserve our life – a common thread among living creatures but as a species we’ve flukishly (evolutionarily speaking) managed to overcome it to a certain extent.

Where we’ve regressed is glaringly apparent here. It’s clear now that the messaging around mitigation and protection tactics was grossly lacking at the outset of this pandemic. So naturally there will be a distrust of the government and the changing messages as things evolved, but the regression is the absolute ignorance of the general population. It [the ignorance] skews toward one side of the aisle but no political affiliation makes one immune from forgetting that we don’t each live in our own little world.

In lieu of acting toward the betterment of our society, many have decided that they – in the act of self-interest and arguably an animalistic sense of self preservation – know better than the ‘experts’. It’s easy to see why, with the seeds of dissension and obfuscation of the truth sown everywhere over the last few decades (or longer?). We’re at a point now where we’ve subconsciously programmed a wide segment of the population to act selfishly and stupidly, ~briefly donning my tinfoil hat~ to pave the way for more untenable acts to take place without so much as a second glance. But that’s not the point. 

The fact that many lockdowns and restrictions have targeted certain behaviors is just plain telling. Elected and appointed officials feel they need to control the population by predicting where people will act selfishly and stupidly rather than trusting that ‘people’ would act in the best interests of everyone. Lowest common denominator and all that. Instead of examining the data, having a rational conversation, debating some of the finer points, and deciding that protecting our neighbors would be a positive thing, the individualistic “I’ll get mine and screw you if you don’t get yours” types chewed the mask and social distancing and stay at home recommendations and spat them back in the faces of the scientists (yes, them, not the talking heads) who have been working for centuries to advance society through our understanding of things we couldn’t even imagine that we could understand. And they’re happy to do that in the name of “hurr durr muh rights muh guns muh entitlements” {that’s an attempt at an across the aisle caricature FYI}.

In my mind the question has never been whether or not to disobey but to just take a fucking second to not make something an argument. That’s a failure of our education system, our media, our politics, and of how we raise our children. We’ve learned to demonize anything that makes us uncomfortable. We’ve learned to radicalize some of the simplest discussions. We’ve conditioned ourselves to believe that every time someone tells us to do something that we didn’t think of first, it’s an affront to our personal rights. Or, on the other side of the aisle – when we’re presented with something we don’t agree with that we must make everyone act in such a way that we don’t feel personally offended by whatever it is they’ve said or done.

In a better society, most of us would have recognized that a deadly virus has emerged and that we should take the necessary precautions to ensure our most vulnerable members are preserved. Epidemiologists would have informed us of some basic mitigation strategies. Protections would have been in place for those who were out of work because they were ill. The populace would continue living life as normal, with some modifications, until a point when we’re ready to deal with the illness on a longer term scale (vaccine, endemic insertion, etc.). Pretending it doesn’t exist or isn’t a threat as well as pretending that we could eradicate such an illness entirely were not, are not, and never will be realistic or reasonable strategies.

Instead, we had to tell people that they’re no longer allowed to congregate because we’re too selfish and short sighted to act in a way that benefits everyone. We have to whoop and holler and break windows and file lawsuits because we’re not allowed to drink at our favorite bar past 10PM and have to wear a little piece of plasticky paper over our face. Things we could have done out of compassion and in the interest of the general public.

This is, of course, a naïve argument. The seeds of dissension are always floating in the air, growing like a weed whenever they find a spot to take root. It’s cute to think that we would ever be at a point where our neighbor was more important than ourselves. Decades of greed, lies, broken trust, and empty promises have ensured that we look at our neighbor with suspicion rather than admiration.

To the OP’s question – I simultaneously abhor and applaud the lockdowns. They weren’t necessary because we as individuals theoretically posses the critical thinking skills and compassion to understand that our neighbors are important. I overheard a conversation between two coworkers (anti-mask) who somehow could express sympathy for those who were ill/had passed away and also in the same conversation lambaste our governor and lament how masks were just a symbol for submission to socialism. To protect others from those individuals (or the people who throw “covid parties”) is exactly and unfortunately the reason we need to have lockdowns.

Of course, when tasking local, state, and federal leadership with protecting their populations, you inevitably get a continuum of good and bad strategies, muddying the waters now and for a long time into the future – until some arbitrary point where we can “let history show who did it best” (as if a dart thrown at a wall of ideas couldn’t possibly yield the best strategy). We entrust the burden of proof with science, but the most fundamental aspect of science is that an absolute proof is never, ever possible. Sometimes a reasonable assumption can never be reached. Science is wrong so much more than it is right. We can simultaneously shore up arguments on a scientific basis and at the same time be completely skeptical of a conclusion because of its scientific origins.

In the end, we’ve all forgotten that our greatest tool as a species and as a population is common sense. Not the perverted variant of common sense that many love to use today, but the built in synergy between our lizard brain and our higher thinking – that I can act in a way that keeps others safe while also keeping my own life and liberty intact. When science succeeds, we can build off that success and enhance our ways of approaching a problem. When science fails, we can take that skepticism and question what or why or when or how until a reasonable conclusion has been reached. Hiding at home for 6 months is not a reasonable conclusion. Throwing a “covid party” because the virus isn’t real is also not a reasonable conclusion.

The crescendo of this synergy would have made lockdowns irrelevant. We wouldn’t feel like we’re inching towards a totalitarian state nor would we be concerned to step outside.

That’s my problem. I’m not skeptical that the lockdowns were and are ineffective. I’m not skeptical of masks. I’m convinced that society no longer has the tools it needs to act in such a way that we can all be happy and safe. This, the coronavirus, is just one failure in a machine full of damaged parts.

[Rusted Rose]

+1 chemistk.

And, curiously in step with the lack of common sense and logic that now reigns in the US all the way to the "top": now that we have the least trustworthy government in US history, the stubborn and disobedient and such are planning to vote to KEEP IT IN PLACE (oh, and to add more ignorant ideologues and cronies to it).

How's that for sense?

[bacchi]

That’s my problem. I’m not skeptical that the lockdowns were and are ineffective. I’m not skeptical of masks. I’m convinced that society no longer has the tools it needs to act in such a way that we can all be happy and safe. This, the coronavirus, is just one failure in a machine full of damaged parts.

Yeah, well written, chemitsk.

[hal]

To answer the OP's original question, my skepticism re: COVID relates to spread and the public messaging.

There is evidence that aerosol spread is a much bigger deal than what public officials made out initially, which is why masks worn indoors are a big deal. I'm skeptical of media outlets that shame people enjoying the outdoors. It particularly irritates me when I see photos of people going to the beach -- where it's a wide open space with fresh air. Indoor facilities with poor ventilation are the problem with a virus that can spread through aerosols.

Another example to be skeptical about is the messaging that we get about 3 W's -- Wear, Wait, Wash. That's great and all, but other countries with better outcomes, such as Japan, have more effective messaging based on avoiding 3 C's -- closed spaces, crowded places, and close-contact.

Here's a helpful read: 'Why Aren't We Talking More About Ventilation' by Zeynep Tufekci. Tufekci, I should note, was one of the first and loudest voices arguing for masks when our governments were telling us that they wouldn't help us. Here's a NY Times profile on her and how she's been getting "the big things right" on Covid-19. I appreciate her skepticism on Twitter, too.

[Cranky]

Ohio was never all that locked down. There was never any enforcement.

The enforcement was invisible through threat of revocation of state funding and licenses. It was very, very real.

I am a nobody with a small practice and received more calls in one month than I ever have asking to sue the government. I would have done it had I not also been working for the city (which is also trying to enforce the same policies, thus giving me a conflict).

People may well have complained and called their lawyer, but as far as I can see - nothing actually happened. People came and went as they pleased. Restaurants served food outside. Most stores were open. The movie theatres closed because there weren’t any new movies, so it didn’t matter what the governor said.

In my neighborhood, I could see that many people had big family Easter gatherings, groups of kids played outside, there were Memorial Day parties, grad parties, 4th of July parties.

Kids sports leagues were playing by the end of May.

That’s not much of a lockdown.

[Buffaloski Boris]

I wanted to take a moment to echo that this is an outstanding thread and several of you are giving us your best and I appreciate it. Ya make me proud to be here.

[Metalcat]

That’s my problem. I’m not skeptical that the lockdowns were and are ineffective. I’m not skeptical of masks. I’m convinced that society no longer has the tools it needs to act in such a way that we can all be happy and safe. This, the coronavirus, is just one failure in a machine full of damaged parts.

Yeah, well written, chemitsk.

I happen to live in an area where rule compliance has been excellent, people are generally quite cooperative, and the normal ending of a conversation or an email is now "stay safe". We tend to get more public outcry when there aren't enough restrictions in place, or when people feel restrictions are being lifted too quickly.

So it makes it really fascinating to read a thread like this and get a better understanding of where these very different cultural reactions are coming from.

The quote above is so disheartening though, I can't imagine what it's like to live within a community where you don't feel you can trust the social fabric of your own society.

[Bloop Bloop]

I am sceptical of the messaging that "we are all in this together" and therefore we all have to take equal measures (masks, lockdowns etc) to mitigate the spread of the virus.

I think there is plenty of evidence to suggest that some risk factors objectively increase the risk of either being harmed by the virus or transmitting it. In relation to the latter, being part of a large household, working in certain industries such as health care or abattoirs, and spending lots of time in confined indoor spaces with others (cf. outdoor exercise) seem to be objective risk factors.

It therefore makes little sense to me why we are telling for example small business owners who work professional jobs and work/live alone to lock themselves down in the same way (with the same exclusions) as abattoir workers who live in large extended families. The latter should really be subject to much more stringent regulations, or perhaps the former should be subject to more lax regulations.

Some things like masks are a small enough burden to enforce universally. Other things like work and travel lockdowns should be enforced on a more individual-by-individual basis. My state government already has a permitted worker scheme and permitted childcare scheme requiring people to self-assess whether they have exemptions for work/childcare yet they refuse to discriminate on arguably much more important public health grounds (size of family & type of occupation).

[ReadySetMillionaire]

Thanks for the fun debate, @Laura33 -- hope your deadlines went well.

And @chemistk -- I wholeheartedly agree.  I know it could be perceived as hypocritical that this thread involves a debate about COVID, but I think at least part of what you are getting at is the same thing that I fear -- that the 1% from each side seem to dominate and eventually overwhelm what should be a public forum into an explosion of a pointless debate. And *everything* has to be debated.

It reminds me of sports. Some time in the early 2000s, sports coverage transitioned from "here are the highlights" to endless debates about whether someone was "clutch," or whether LeBron was better than Kobe. Most of us thought, "Who cares, we just want to watch basketball." Yet it is these one-percenters who tune in, drive ratings, and it continues to this day.

I'm not sure which came first, but this obviously transitioned to news and politics as well.  Matt Taibbi's "Hate Inc." is one of my favorite books of the last decade. Essentially the news has become incentivized to put us in tribes and make us hate each other.  There is obviously a lot of criticism about Fox News (rightly so), but MSNBC frequently offers equally absurd coverage from the left.

We seem to be either bludgeoned by the MAGA truthers, where nothing Trump does is wrong; or the extremely far left, where if Donald Trump said it is good to breathe, they might die from asphyxiation.  The MAGA folks do not accept anything science says as true; the left do not accept anything that does not comport with the science they agree with.

As it relates to COVID, the 1% MAGA folks thought it was a hoax coming out of a Chinese lab. The far left thought we should indefinitely stay at home regardless of cost.  We were prisoners to both of these when the truth was obviously in the middle.

My only hope is that, as the data comes in, we can make more targeted policies and improve our public messaging. The communication about masks was a disaster. The "15 days" timeline was as stupid as it gets. The public health officials need to do better and fight through all the noise that is intentionally designed to make us hate each other.

I generally revert to what my dad says -- 95% of people are well intentioned. Sometimes I wish we would acknowledge that and act that way.

Again, great post. You are spot on about a lot, and your observations are worthy of an op-ed in a major paper.

[Channel-Z]

We are deeply unhealthy as a nation, and in a number of ways, it provides a perfect environment for viral spread. I've been wearing a mask since late April. My county has had a mask mandate since July 1. The positive test rate was around ten percent at that time, and it still is today, despite what I've seen as near total compliance in public businesses. I really thought the virus would hit the wall, run out of fuel at some point this summer. Now I've swung toward pessimism. I don't think government advice would be helpful right now. People need to see the effects for themselves.

[bilmar]

Excellent discussion!

I for one am very disappointed in the politically sanitized & watered down advice we are getting  from the 'experts'. I expect politicians to lie and deflect but not the scientists.

Imagine if you went to your own doctor and asked their opinion. You would expect and likely get a concise straight answer!
Something like  " Doc,  Is it safe for me  to sing in the church choir next week ? No Bob it is not,  unless you know everyone else is not infected - there is an substantial  risk from the singing  and I don't recommend it - I would not go."

Instead,  at the national level,  all we get are vague wishy washy  statements that require interpretation and reading between the lines.

I would really like to see a set of guidelines for personal behaviors and estimated risk analyses so people can make sensible choices. Even if the estimate ranges are large and change over time - give us something to use.

[RetiredAt63]

Excellent discussion!

I for one am very disappointed in the politically sanitized & watered down advice we are getting  from the 'experts'. I expect politicians to lie and deflect but not the scientists.

Imagine if you went to your own doctor and asked their opinion. You would expect and likely get a concise straight answer!
Something like  " Doc,  Is it safe for me  to sing in the church choir next week ? No Bob it is not,  unless you know everyone else is not infected - there is an substantial  risk from the singing  and I don't recommend it - I would not go."

Instead,  at the national level,  all we get are vague wishy washy  statements that require interpretation and reading between the lines.

I would really like to see a set of guidelines for personal behaviors and estimated risk analyses so people can make sensible choices. Even if the estimate ranges are large and change over time - give us something to use.

Here you go, you can use our guidelines.   ;-)

Cases are up here with the school start blip, and our guidelines are masks indoors (that includes public parts of condos and apartment buildings), masks outside where a 2 meter distance can't be done, gathering of no more than 10 indoors and 25 outdoors.  Wash your hands.  Get tested if you have symptoms, even if you think it is a cold or seasonal allergies.  We have a school spread where a teacher with regular allergies thought it was fall allergies, it was Covid.

[Buffaloski Boris]

Excellent discussion!

I for one am very disappointed in the politically sanitized & watered down advice we are getting  from the 'experts'. I expect politicians to lie and deflect but not the scientists.

Imagine if you went to your own doctor and asked their opinion. You would expect and likely get a concise straight answer!
Something like  " Doc,  Is it safe for me  to sing in the church choir next week ? No Bob it is not,  unless you know everyone else is not infected - there is an substantial  risk from the singing  and I don't recommend it - I would not go."

Instead,  at the national level,  all we get are vague wishy washy  statements that require interpretation and reading between the lines.

I would really like to see a set of guidelines for personal behaviors and estimated risk analyses so people can make sensible choices. Even if the estimate ranges are large and change over time - give us something to use.

The answers are out there, it just takes some digging and as @bilmar noted, we can always use the guidelines of other countries. Actually, that's preferable. Results matter.  Other places are doing better than we are by and large.   

[AnnaGrowsAMustache]

The stupidest shit about this entire covid shit show is that none of it is new. Lock downs, not new. Masks, not new. Conspiracy theories, not new. Quarantine is a very old concept. I don't know why today's crop of idiots can't work out that it has worked for thousands of years, therefore will probably work now.....

[RetiredAt63]

The stupidest shit about this entire covid shit show is that none of it is new. Lock downs, not new. Masks, not new. Conspiracy theories, not new. Quarantine is a very old concept. I don't know why today's crop of idiots can't work out that it has worked for thousands of years, therefore will probably work now.....

History in schools is basically political history.  History of health is nonexistent.  People have no idea of how bad influenza, measles, chicken pox, mumps, polio, diphtheria, yellow fever, tuberculosis , and on and on, were, and how they were handled.  People are incredibly complacent about public health now, and are also much less careful about health hygiene.   You know, the basics, like hand washing, using a tissue instead of coughing/sneezing into the air, staying home when sick.

[GuitarStv]

The stupidest shit about this entire covid shit show is that none of it is new. Lock downs, not new. Masks, not new. Conspiracy theories, not new. Quarantine is a very old concept. I don't know why today's crop of idiots can't work out that it has worked for thousands of years, therefore will probably work now.....

History in schools is basically political history.  History of health is nonexistent.  People have no idea of how bad influenza, measles, chicken pox, mumps, polio, diphtheria, yellow fever, tuberculosis , and on and on, were, and how they were handled.  People are incredibly complacent about public health now, and are also much less careful about health hygiene.   You know, the basics, like hand washing, using a tissue instead of coughing/sneezing into the air, staying home when sick.

I remember some pretty in-depth discussions about the history of diseases, the advent of various vaccinations, and the start of hand washing as a medical practice.  Unfortunately, I don't remember if these were part of my bio or history courses.  :P

The recent rise of anti-vaccine people and the shocking increase and acceptance of outright charlatanry in the guise of medicine (acupuncture, chiropractic, homeopathy) has really made me question if we're doing enough basic education in this area . . . a surprising number of otherwise intelligent people seem very ignorant and easily misguided when it comes to health.

[Roland of Gilead]

I think the protections we have on freedoms in the USA are really hindering this in addition to the failures at the federal level in leadership.

In Washington state you have to wear a mask unless you have a medical condition that prevents wearing one.   Because of personal freedom or privacy or whatever bullshit, it is not allowed to ask you if you have a medical condition.   So essentially you have to wear a mask unless you don't want to wear a mask and there is nothing they can do to stop you from spreading.

[RetiredAt63]

The stupidest shit about this entire covid shit show is that none of it is new. Lock downs, not new. Masks, not new. Conspiracy theories, not new. Quarantine is a very old concept. I don't know why today's crop of idiots can't work out that it has worked for thousands of years, therefore will probably work now.....

History in schools is basically political history.  History of health is nonexistent.  People have no idea of how bad influenza, measles, chicken pox, mumps, polio, diphtheria, yellow fever, tuberculosis , and on and on, were, and how they were handled.  People are incredibly complacent about public health now, and are also much less careful about health hygiene.   You know, the basics, like hand washing, using a tissue instead of coughing/sneezing into the air, staying home when sick.

I remember some pretty in-depth discussions about the history of diseases, the advent of various vaccinations, and the start of hand washing as a medical practice.  Unfortunately, I don't remember if these were part of my bio or history courses.  :P

The recent rise of anti-vaccine people and the shocking increase and acceptance of outright charlatanry in the guise of medicine (acupuncture, chiropractic, homeopathy) has really made me question if we're doing enough basic education in this area . . . a surprising number of otherwise intelligent people seem very ignorant and easily misguided when it comes to health.

Odds are it was in your biology class. I discussed this in some of my courses, which is how I found out how ignorant my students were about this.

Of course teenagers think they are invulnerable. We spent a fair bit of time on safety procedures.  Yes we use a fume hood, because the chemicals we are using are toxic/carcinogenic/teratogenic.