How long can we wait while flattening the curve?

[T-Money$]

Updated cumulative COVID deaths by age group in Minnesota.

So not to be callous, but how many of those deaths from COVID in the 80+ age range would have normally occurred from influenza or even a common cold that lead to pneumonia? Especially for those living in nursing homes, where by definition you are usually not in great health.

I guess there's no way of knowing right now if this simply accelerated the end for the most vulnerable and there will be a dip in normal deaths in that age range for the next few years.

I'm sure there will be many studies in the coming years looking at the combination of age and comorbidities among those who died. With the data that's normally released by the government/media (exact age or decade range) there's no way to distinguish between the healthy 75-year old who died and the one who was a lifelong-smoker that's obese and has diabetes.

My grandma almost made it to 100 but recently died from natural causes/old age.

I've read the average fatality from COVID (the median age in the US is approximately 78) only had one to two years of life left.

The U.S. has currently spent about $8 trillion dollars on economic response alone to COVID.

Using South Dakota and Minnesota as comparisons (South Dakota had limited COVID response, no lockdowns, etc., whereas Minnesota has had a much greater response) I think we can estimate that lockdowns, business closures, etc. have reduced the fatality rate by no more than half. 

That means at the very best the United States has spent $13,000,000 for each year of human life potentially saved.

By the way, studies have shown the COVID death rate could have been reduced in half if people were not obese.   So instead of a national plan to lose weight (which would have also decreased cardiovascular death, cancer death and in general healthcare spending) we chose to spend at least $13,000,000 for each year of life saved, at a bare minimum.

This doesn't factor in the mental anguish, excessive death not directly related to COVID disease, unemployment (especially with the working poor and minorities, etc.).

This has to be one of the worst uses of available resources ever in the history of mankind.  But, this is what irrational hysteria does.

A generation of people have been abused in an attempt to keep the elderly obese alive.  It is absolutely appalling. 

COVID is bad for select age groups, it is less worse than the flu for those on the left side of the median age. 

All that was done was a adjustment of risk.  Those at risk reduced their risk while the overwhelming majority of the population were forced to greatly increase various risks (financial, mental, physical health) for a disease that does not effect them.

Inhumane.   Moral hazard at its finest.

Society hasn't even begun to have an argument or to understand the incredible damage that has been done for not much gain at all. 

[scottish]

Before you start complaining about moral hazard,  I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

[marty998]

Before you start complaining about moral hazard,  I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

Exactly. You can't say the response is a waste of time if the people are not faithfully implementing that response. All you're left with is the now proven knowledge that many people are callous and indifferent to the lives of others.

[Villanelle]

I watched this TEDx talk.
https://www.youtube.com/watch?v=xp0O2vi8DX4

At about 6:30 into it, she talks about a study about how we learn from good or bad news changes with age. Basically after about 40-50 the ability to learn from bad news decreases.

Maybe this is why some older people are not responding the way some others expect. Note: I wrote "some," not "all.

I myself have thought that if I was a few decades older and had the choice of
1. isolate at home, see almost no one, decline in health due to lack of exercise and maybe die in 5 years or
2. continue seeing people, maintain my current fitness level and maybe die in a few months.
It's highly likely I'd choose option 2. A few elderly people I know have expressed in the past, before the pandemic, that they were at peace with death coming soon. So their choice to continue living their lives makes a lot of sense to me.

Except it's not a binary choice between sitting in the dark on the sofa and Doing All the Things.  My parents (late 70s) still play tennis 2-4 times a week. They play singles now, instead of doubles.  The dog still gets walked three times a day (total of an hour plus).  They have happy hour with the neighbors, over their fence (so very socially distant).  They still work in their yard and talk on the phone with friends.  They still have weekly zoom happy hour with their children. 

They are still living their life.  Perhaps not at 100%, but it's closer to 100 than 0.  There's certainly joy and quality of life and exercise and socialization. 

Then there is the fact that while someone might be at peace with death coming soon *for themselves*, their choices bring death or an increased possibility to death.  That seems to be the piece most people miss.  They choices aren't just about themselves.

There are large parts of this country where outdoor activity is difficult for several months per year. There are also parts of this country where internet access is spotty and/or detrimentally expensive. There's a lot of overlap in those two categories too, which can make adapting to current circumstances difficult for anybody, but especially for older folks.

Okay, but it's still nowhere near the binary decision that was presented.  Can't go outside?  Like, truly, truly can't?  (Because one can certainly go for a 20-30 minute walk in sub-freezing temps with snow on the ground, so how many people/places are we really talking?  Very few.)  Have a dance party in your living room.  Find a yoga video.  Lift soup cans and water containers.  Go up and down your stairs a dozen times. 

No internet?  Call a friend or neighbor or family member to chat.  Read an engrossing book that makes you feel things.  Stand at your fence, with a neighbor 10 feet away on the other side, and chat for 10-15 minutes (even in the cold!). 

So again, there are ways to not sit at home alone in the dark with your body and mind wasting away, that don't involve living life as it was pre-Covid.  To even imply otherwise is asinine.

I think we agree on some things. It's a lot easier to modify existing behaviors than to eliminate them. And you're absolutely correct that it's not a binary decision. That goes for just about everything in this pandemic, including how we view other's actions. I like the safe sex vs abstinence metaphor in this article:

https://www.theatlantic.com/ideas/archive/2020/12/tis-the-season-for-shame-and-judgment/617335/

"Very few people want to get infected or get others sick. When people take risks, it often reflects an unmet need: for a paycheck, for social connection, for accurate information about how to protect themselves. Acknowledging and meeting people’s needs will reduce risk behavior; finger-wagging won’t."

"Rather than imposing rules that neglect the realities of human behavior and then reprimanding people for breaking them, the message could be a more pragmatic and compassionate one: We understand that this is hard and that social connection is important for health, so we will support you in gathering more safely."

Is it safer for my 80 year old neighbor to go for a 20-30 min walk, alone down a country road with no sidewalks in ice/snow or to drive a couple of miles to the gym for exercise and potentially a little social interaction? It would honestly be fascinating to try and determine which of those actions is more likely to result in a worse outcome for them. And considering human nature, which are they more likely to actually do (vs just sitting at home wasting away), the uncomfortable and risky walk in isolation, or the comfortable one with different risks that could also get them some socialization? There are ways to get around a lot of things, but the more difficult/uncomfortable that it is to do, the less likely it is to occur.

COVID is new and scary. It's potentially lethal. But based on demographic data for every location that I've seen, it's survived by the statistical majority of those who contract it in every individual age group, and it's not really close. 70% survival rate or better in the 80+ age group for every location that I've bothered to calculate. A substantial percentage of deaths are in Long Term Care facilities too, which may indicate that an active, healthy person has even better odds than that of surviving the virus. So, do they take a chance that they might contract the virus at the gym, or take a chance with the snow/ice on a narrow road?

You agree that it's not binary, then present another arbitrarily binary decision.  Why can't your neighbor call someone and speak with them?  Why can't she walk around her property or exercise in her home?  Perhaps you should reach out to her and see if she need assistance setting up Zoom or Skype or Facetime, or renting exercise videos from the library?  Perhaps you should call her just to chat for 20 minutes? 

[OtherJen]

Before you start complaining about moral hazard,  I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

Exactly. You can't say the response is a waste of time if the people are not faithfully implementing that response. All you're left with is the now proven knowledge that many people are callous and indifferent to the lives of others.

My county's sheriff has been on a ventilator for two weeks (barely got to enjoy being re-elected before being hospitalized), and one of my K-8 classmates died of COVID earlier this week at 42 years of age. My patience with those who whine at any check on their selfishness is gone.

[fuzzy math]

Before you start complaining about moral hazard,  I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

Take the US response out of the equation.  The impression that so many seem to carry here is that the US response has put them in a category which is out of line with death rates in other countries. Ask yourself where you think the US ranks in deaths. Then look at Spain, Italy, UK and Belgium, all of whom have deaths per million rates higher than the US. In fact the US is ranked 12th in the world for deaths per million.
Would you argue that all of those countries did not follow hygiene recommendations? Do you remember many of those countries being locked down with police in the streets?

[Paper Chaser]

I watched this TEDx talk.
https://www.youtube.com/watch?v=xp0O2vi8DX4

At about 6:30 into it, she talks about a study about how we learn from good or bad news changes with age. Basically after about 40-50 the ability to learn from bad news decreases.

Maybe this is why some older people are not responding the way some others expect. Note: I wrote "some," not "all.

I myself have thought that if I was a few decades older and had the choice of
1. isolate at home, see almost no one, decline in health due to lack of exercise and maybe die in 5 years or
2. continue seeing people, maintain my current fitness level and maybe die in a few months.
It's highly likely I'd choose option 2. A few elderly people I know have expressed in the past, before the pandemic, that they were at peace with death coming soon. So their choice to continue living their lives makes a lot of sense to me.

Except it's not a binary choice between sitting in the dark on the sofa and Doing All the Things.  My parents (late 70s) still play tennis 2-4 times a week. They play singles now, instead of doubles.  The dog still gets walked three times a day (total of an hour plus).  They have happy hour with the neighbors, over their fence (so very socially distant).  They still work in their yard and talk on the phone with friends.  They still have weekly zoom happy hour with their children. 

They are still living their life.  Perhaps not at 100%, but it's closer to 100 than 0.  There's certainly joy and quality of life and exercise and socialization. 

Then there is the fact that while someone might be at peace with death coming soon *for themselves*, their choices bring death or an increased possibility to death.  That seems to be the piece most people miss.  They choices aren't just about themselves.

There are large parts of this country where outdoor activity is difficult for several months per year. There are also parts of this country where internet access is spotty and/or detrimentally expensive. There's a lot of overlap in those two categories too, which can make adapting to current circumstances difficult for anybody, but especially for older folks.

Okay, but it's still nowhere near the binary decision that was presented.  Can't go outside?  Like, truly, truly can't?  (Because one can certainly go for a 20-30 minute walk in sub-freezing temps with snow on the ground, so how many people/places are we really talking?  Very few.)  Have a dance party in your living room.  Find a yoga video.  Lift soup cans and water containers.  Go up and down your stairs a dozen times. 

No internet?  Call a friend or neighbor or family member to chat.  Read an engrossing book that makes you feel things.  Stand at your fence, with a neighbor 10 feet away on the other side, and chat for 10-15 minutes (even in the cold!). 

So again, there are ways to not sit at home alone in the dark with your body and mind wasting away, that don't involve living life as it was pre-Covid.  To even imply otherwise is asinine.

I think we agree on some things. It's a lot easier to modify existing behaviors than to eliminate them. And you're absolutely correct that it's not a binary decision. That goes for just about everything in this pandemic, including how we view other's actions. I like the safe sex vs abstinence metaphor in this article:

https://www.theatlantic.com/ideas/archive/2020/12/tis-the-season-for-shame-and-judgment/617335/

"Very few people want to get infected or get others sick. When people take risks, it often reflects an unmet need: for a paycheck, for social connection, for accurate information about how to protect themselves. Acknowledging and meeting people’s needs will reduce risk behavior; finger-wagging won’t."

"Rather than imposing rules that neglect the realities of human behavior and then reprimanding people for breaking them, the message could be a more pragmatic and compassionate one: We understand that this is hard and that social connection is important for health, so we will support you in gathering more safely."

Is it safer for my 80 year old neighbor to go for a 20-30 min walk, alone down a country road with no sidewalks in ice/snow or to drive a couple of miles to the gym for exercise and potentially a little social interaction? It would honestly be fascinating to try and determine which of those actions is more likely to result in a worse outcome for them. And considering human nature, which are they more likely to actually do (vs just sitting at home wasting away), the uncomfortable and risky walk in isolation, or the comfortable one with different risks that could also get them some socialization? There are ways to get around a lot of things, but the more difficult/uncomfortable that it is to do, the less likely it is to occur.

COVID is new and scary. It's potentially lethal. But based on demographic data for every location that I've seen, it's survived by the statistical majority of those who contract it in every individual age group, and it's not really close. 70% survival rate or better in the 80+ age group for every location that I've bothered to calculate. A substantial percentage of deaths are in Long Term Care facilities too, which may indicate that an active, healthy person has even better odds than that of surviving the virus. So, do they take a chance that they might contract the virus at the gym, or take a chance with the snow/ice on a narrow road?

You agree that it's not binary, then present another arbitrarily binary decision.  Why can't your neighbor call someone and speak with them?  Why can't she walk around her property or exercise in her home?  Perhaps you should reach out to her and see if she need assistance setting up Zoom or Skype or Facetime, or renting exercise videos from the library?  Perhaps you should call her just to chat for 20 minutes?

A good number of your suggestions are already taking place, but have been deemed inadequate substitutions for other options. That's why I linked the article that I did. Socialization is critical to health and mental wellbeing. For some people, a zoom call or telephone call don't cut it as full replacements. They're not living as they were before COVID, but they do continue to do some of the things they've deemed priorities that are worth the risk to them.

[Villanelle]

I watched this TEDx talk.
https://www.youtube.com/watch?v=xp0O2vi8DX4

At about 6:30 into it, she talks about a study about how we learn from good or bad news changes with age. Basically after about 40-50 the ability to learn from bad news decreases.

Maybe this is why some older people are not responding the way some others expect. Note: I wrote "some," not "all.

I myself have thought that if I was a few decades older and had the choice of
1. isolate at home, see almost no one, decline in health due to lack of exercise and maybe die in 5 years or
2. continue seeing people, maintain my current fitness level and maybe die in a few months.
It's highly likely I'd choose option 2. A few elderly people I know have expressed in the past, before the pandemic, that they were at peace with death coming soon. So their choice to continue living their lives makes a lot of sense to me.

Except it's not a binary choice between sitting in the dark on the sofa and Doing All the Things.  My parents (late 70s) still play tennis 2-4 times a week. They play singles now, instead of doubles.  The dog still gets walked three times a day (total of an hour plus).  They have happy hour with the neighbors, over their fence (so very socially distant).  They still work in their yard and talk on the phone with friends.  They still have weekly zoom happy hour with their children. 

They are still living their life.  Perhaps not at 100%, but it's closer to 100 than 0.  There's certainly joy and quality of life and exercise and socialization. 

Then there is the fact that while someone might be at peace with death coming soon *for themselves*, their choices bring death or an increased possibility to death.  That seems to be the piece most people miss.  They choices aren't just about themselves.

There are large parts of this country where outdoor activity is difficult for several months per year. There are also parts of this country where internet access is spotty and/or detrimentally expensive. There's a lot of overlap in those two categories too, which can make adapting to current circumstances difficult for anybody, but especially for older folks.

Okay, but it's still nowhere near the binary decision that was presented.  Can't go outside?  Like, truly, truly can't?  (Because one can certainly go for a 20-30 minute walk in sub-freezing temps with snow on the ground, so how many people/places are we really talking?  Very few.)  Have a dance party in your living room.  Find a yoga video.  Lift soup cans and water containers.  Go up and down your stairs a dozen times. 

No internet?  Call a friend or neighbor or family member to chat.  Read an engrossing book that makes you feel things.  Stand at your fence, with a neighbor 10 feet away on the other side, and chat for 10-15 minutes (even in the cold!). 

So again, there are ways to not sit at home alone in the dark with your body and mind wasting away, that don't involve living life as it was pre-Covid.  To even imply otherwise is asinine.

I think we agree on some things. It's a lot easier to modify existing behaviors than to eliminate them. And you're absolutely correct that it's not a binary decision. That goes for just about everything in this pandemic, including how we view other's actions. I like the safe sex vs abstinence metaphor in this article:

https://www.theatlantic.com/ideas/archive/2020/12/tis-the-season-for-shame-and-judgment/617335/

"Very few people want to get infected or get others sick. When people take risks, it often reflects an unmet need: for a paycheck, for social connection, for accurate information about how to protect themselves. Acknowledging and meeting people’s needs will reduce risk behavior; finger-wagging won’t."

"Rather than imposing rules that neglect the realities of human behavior and then reprimanding people for breaking them, the message could be a more pragmatic and compassionate one: We understand that this is hard and that social connection is important for health, so we will support you in gathering more safely."

Is it safer for my 80 year old neighbor to go for a 20-30 min walk, alone down a country road with no sidewalks in ice/snow or to drive a couple of miles to the gym for exercise and potentially a little social interaction? It would honestly be fascinating to try and determine which of those actions is more likely to result in a worse outcome for them. And considering human nature, which are they more likely to actually do (vs just sitting at home wasting away), the uncomfortable and risky walk in isolation, or the comfortable one with different risks that could also get them some socialization? There are ways to get around a lot of things, but the more difficult/uncomfortable that it is to do, the less likely it is to occur.

COVID is new and scary. It's potentially lethal. But based on demographic data for every location that I've seen, it's survived by the statistical majority of those who contract it in every individual age group, and it's not really close. 70% survival rate or better in the 80+ age group for every location that I've bothered to calculate. A substantial percentage of deaths are in Long Term Care facilities too, which may indicate that an active, healthy person has even better odds than that of surviving the virus. So, do they take a chance that they might contract the virus at the gym, or take a chance with the snow/ice on a narrow road?

You agree that it's not binary, then present another arbitrarily binary decision.  Why can't your neighbor call someone and speak with them?  Why can't she walk around her property or exercise in her home?  Perhaps you should reach out to her and see if she need assistance setting up Zoom or Skype or Facetime, or renting exercise videos from the library?  Perhaps you should call her just to chat for 20 minutes?

A good number of your suggestions are already taking place, but have been deemed inadequate substitutions for other options. That's why I linked the article that I did. Socialization is critical to health and mental wellbeing. For some people, a zoom call or telephone call don't cut it as full replacements. They're not living as they were before COVID, but they do continue to do some of the things they've deemed priorities that are worth the risk to them.

Of course it's not a full replacement.  It's something in between "nothing" and "same as it ever was".  Which is a big part of the point.  There is a lot of area between the extremes you keep posting.  You presented staying at home and wasting away, or life as usual.  All the things I've mentioned cover the vast territory between those things.  Sure, they aren't as great as "life as it used to be" (minus, you know, the higher chances of death and increase suffering to ones self or ones community that goes with that), but they also aren't as dire as wasting away in the dark, or walking half an hour on dangerous roads in the snow. 

[Paper Chaser]

I watched this TEDx talk.
https://www.youtube.com/watch?v=xp0O2vi8DX4

At about 6:30 into it, she talks about a study about how we learn from good or bad news changes with age. Basically after about 40-50 the ability to learn from bad news decreases.

Maybe this is why some older people are not responding the way some others expect. Note: I wrote "some," not "all.

I myself have thought that if I was a few decades older and had the choice of
1. isolate at home, see almost no one, decline in health due to lack of exercise and maybe die in 5 years or
2. continue seeing people, maintain my current fitness level and maybe die in a few months.
It's highly likely I'd choose option 2. A few elderly people I know have expressed in the past, before the pandemic, that they were at peace with death coming soon. So their choice to continue living their lives makes a lot of sense to me.

Except it's not a binary choice between sitting in the dark on the sofa and Doing All the Things.  My parents (late 70s) still play tennis 2-4 times a week. They play singles now, instead of doubles.  The dog still gets walked three times a day (total of an hour plus).  They have happy hour with the neighbors, over their fence (so very socially distant).  They still work in their yard and talk on the phone with friends.  They still have weekly zoom happy hour with their children. 

They are still living their life.  Perhaps not at 100%, but it's closer to 100 than 0.  There's certainly joy and quality of life and exercise and socialization. 

Then there is the fact that while someone might be at peace with death coming soon *for themselves*, their choices bring death or an increased possibility to death.  That seems to be the piece most people miss.  They choices aren't just about themselves.

There are large parts of this country where outdoor activity is difficult for several months per year. There are also parts of this country where internet access is spotty and/or detrimentally expensive. There's a lot of overlap in those two categories too, which can make adapting to current circumstances difficult for anybody, but especially for older folks.

Okay, but it's still nowhere near the binary decision that was presented.  Can't go outside?  Like, truly, truly can't?  (Because one can certainly go for a 20-30 minute walk in sub-freezing temps with snow on the ground, so how many people/places are we really talking?  Very few.)  Have a dance party in your living room.  Find a yoga video.  Lift soup cans and water containers.  Go up and down your stairs a dozen times. 

No internet?  Call a friend or neighbor or family member to chat.  Read an engrossing book that makes you feel things.  Stand at your fence, with a neighbor 10 feet away on the other side, and chat for 10-15 minutes (even in the cold!). 

So again, there are ways to not sit at home alone in the dark with your body and mind wasting away, that don't involve living life as it was pre-Covid.  To even imply otherwise is asinine.

I think we agree on some things. It's a lot easier to modify existing behaviors than to eliminate them. And you're absolutely correct that it's not a binary decision. That goes for just about everything in this pandemic, including how we view other's actions. I like the safe sex vs abstinence metaphor in this article:

https://www.theatlantic.com/ideas/archive/2020/12/tis-the-season-for-shame-and-judgment/617335/

"Very few people want to get infected or get others sick. When people take risks, it often reflects an unmet need: for a paycheck, for social connection, for accurate information about how to protect themselves. Acknowledging and meeting people’s needs will reduce risk behavior; finger-wagging won’t."

"Rather than imposing rules that neglect the realities of human behavior and then reprimanding people for breaking them, the message could be a more pragmatic and compassionate one: We understand that this is hard and that social connection is important for health, so we will support you in gathering more safely."

Is it safer for my 80 year old neighbor to go for a 20-30 min walk, alone down a country road with no sidewalks in ice/snow or to drive a couple of miles to the gym for exercise and potentially a little social interaction? It would honestly be fascinating to try and determine which of those actions is more likely to result in a worse outcome for them. And considering human nature, which are they more likely to actually do (vs just sitting at home wasting away), the uncomfortable and risky walk in isolation, or the comfortable one with different risks that could also get them some socialization? There are ways to get around a lot of things, but the more difficult/uncomfortable that it is to do, the less likely it is to occur.

COVID is new and scary. It's potentially lethal. But based on demographic data for every location that I've seen, it's survived by the statistical majority of those who contract it in every individual age group, and it's not really close. 70% survival rate or better in the 80+ age group for every location that I've bothered to calculate. A substantial percentage of deaths are in Long Term Care facilities too, which may indicate that an active, healthy person has even better odds than that of surviving the virus. So, do they take a chance that they might contract the virus at the gym, or take a chance with the snow/ice on a narrow road?

You agree that it's not binary, then present another arbitrarily binary decision.  Why can't your neighbor call someone and speak with them?  Why can't she walk around her property or exercise in her home?  Perhaps you should reach out to her and see if she need assistance setting up Zoom or Skype or Facetime, or renting exercise videos from the library?  Perhaps you should call her just to chat for 20 minutes?

A good number of your suggestions are already taking place, but have been deemed inadequate substitutions for other options. That's why I linked the article that I did. Socialization is critical to health and mental wellbeing. For some people, a zoom call or telephone call don't cut it as full replacements. They're not living as they were before COVID, but they do continue to do some of the things they've deemed priorities that are worth the risk to them.

Of course it's not a full replacement.  It's something in between "nothing" and "same as it ever was".  Which is a big part of the point.  There is a lot of area between the extremes you keep posting.  You presented staying at home and wasting away, or life as usual.  All the things I've mentioned cover the vast territory between those things.  Sure, they aren't as great as "life as it used to be" (minus, you know, the higher chances of death and increase suffering to ones self or ones community that goes with that), but they also aren't as dire as wasting away in the dark, or walking half an hour on dangerous roads in the snow.

And the point I'm trying to make, is that everybody is taking precautions that they feel are necessary or prudent. For some, that means not leaving their home for months, and for most others it means something else. Pretty much everybody has done something in recent months that they've deemed worth the increased risk that comes with leaving their home. It's easy to say "why don't they just..." on a keyboard from a very different situation thousands of miles away through the lens of your risk tolerance.
My neighbors are a lot like extended family to me. I want them to be around for a long time, but what I want doesn't really matter when it comes to their choices about how they choose to live whatever remains of their lives. They're taking the precautions that they feel are appropriate based on their own risk tolerance and their situation.

[scottish]

Before you start complaining about moral hazard,  I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

Take the US response out of the equation.  The impression that so many seem to carry here is that the US response has put them in a category which is out of line with death rates in other countries. Ask yourself where you think the US ranks in deaths. Then look at Spain, Italy, UK and Belgium, all of whom have deaths per million rates higher than the US. In fact the US is ranked 12th in the world for deaths per million.
Would you argue that all of those countries did not follow hygiene recommendations? Do you remember many of those countries being locked down with police in the streets?

So you're saying that the richest country in the world is doing well because they rank 12th out of 200 countries in total death rate?   That's the best the US can do?   Really?

The city where I live is generally following hygiene recommendations and we're not having much of a second wave at all.   Gyms, stores and restaurants are all open.   We see 40 new cases a day in a city of 1M.

So yeah, I would argue that places with a big second wave are not following hygiene recommendations.     Even Sweden is doing better than all of those countries - and they had an approach grounded in personal responsibility.

[sui generis]

Can someone give context about what percent occupancy hospitals and ICUs generally operate at at this time of year vs. where we are now? Because I also have been concerned about all the numbers about low availability in ICUs and high occupancy of hospitals, but then have seen passing references to local hospitals last winter (i.e. before any COVID cases) being at 115% and of course that our awesome US for-profit hospital system operates on the philosophy that the hospitals should not be wasting any money, so need to be at a super high occupancy rate constantly (see e.g., http://hospitalmedicaldirector.com/what-is-the-ideal-hospital-occupancy-rate/) all things being equal (i.e. no global pandemic). I definitely am not trying to encourage and advocate for irresponsibily filling up our hospitals and ICUs, but I also would like to know if something like sparatana's reference to 1.7% ICU capacity might be completely standard (or even very good?) particularly for this time of year (see above article which makes an offhand comment about ICU capacity at 100% like NBG).  I just need a level set to understand what kind of numbers one freaks out at and what numbers might only seem freak-out-worthy but are actually "normal" for our (fucked up) system.  I haven't found the answer to this precisely by googling. I've found things like this that do seem to indicate we are higher than the typical status on *average over the course of the year* but is winter always higher?  https://www.cdc.gov/nchs/data/hus/2017/089.pdf  I dunno, something like daily capacity compared over a series of years would be helpful to know what's normal and how far off we are from that now. 

In my county we currently have ICU capacity of 35%, but are under the same strict lockdown orders as the worst off areas.  I see they have justified this by showing the transmission rate and that we'd exceed ICU capacity in a few weeks if nothing is done, and that seems smart to me, but I also am no longer sure that exceeding capacity (of ICU or the hospital in general) is actually an abnormal thing?

[Abe]

ICUs usually are around 70-80% of available beds. In the winter they approach 100%. We do not normally exceed capacity and start using other units or our peri-op areas as pseudo-ICUs. I don’t recall that happening in my 15 years in medicine nor have I heard of that at any hospital I’ve worked at. This included an extremely busy trauma center earlier in my training (though the trauma ICU usually was overflowing into other ICUs, they had capacity so total usage remained below 100%) and large state hospitals.

The caveat being that in a normal years, since ICU workers (including maintenance staff) get the flu vaccine, not as many people are out sick. Taking care of a covid or any other critical patient is not possible if you are also sick with covid. Many of our most experienced ICU nurses and physicians are in the high risk age group, and are getting ill. Thus bed capacity may be available, but can’t be used due to lack of workers. This has not happened on a national scale since the 1918 pandemic. If we continue to have more workers out, capacity will be irrelevant. LA county is approaching this situation, for example. There are no reserves from other areas because everyone is bursting at the seams.

[habanero]

If we continue to have more workers out, capacity will be irrelevant. LA county is approaching this situation, for example. There are no reserves from other areas because everyone is bursting at the seams.

This is what's happening in Sweden now. The ICUs and hospitals are under severe strain which at first seems odd as ICU patients are roughly half of what they were at the peak in April and they still had spare capacity then. They don't lack beds or equipment. They lack people. Quite a lot of health care workers have quit their jobs because they were completely worn out and quitting was the only way to get some time off, the rest work long and strainious shifts. There is also less slack in the system now as lots of other elective stuff was postponed this spring when Covid hit, but eventually they will have to deal with some of those patients as well. One doctor on TV said "we are paying back on debt incurred this spring" which also adds to the strain on the system. They might request neighbouring countries for assistance quite soon if the situation doesn't improve. ICU cases are flattening out in Swden now, that might be a sign of improvement but it can also mean there just aren't anywhere to put patients. Last week the Stockholm area had 1 ICU bed available.

Total number of patients hospitalized with Covid in Sweden is now higher than at the peak earlier this year, btw.

[fuzzy math]

Can someone give context about what percent occupancy hospitals and ICUs generally operate at at this time of year vs. where we are now? Because I also have been concerned about all the numbers about low availability in ICUs and high occupancy of hospitals, but then have seen passing references to local hospitals last winter (i.e. before any COVID cases) being at 115% and of course that our awesome US for-profit hospital system operates on the philosophy that the hospitals should not be wasting any money, so need to be at a super high occupancy rate constantly (see e.g., http://hospitalmedicaldirector.com/what-is-the-ideal-hospital-occupancy-rate/) all things being equal (i.e. no global pandemic). I definitely am not trying to encourage and advocate for irresponsibily filling up our hospitals and ICUs, but I also would like to know if something like sparatana's reference to 1.7% ICU capacity might be completely standard (or even very good?) particularly for this time of year (see above article which makes an offhand comment about ICU capacity at 100% like NBG).  I just need a level set to understand what kind of numbers one freaks out at and what numbers might only seem freak-out-worthy but are actually "normal" for our (fucked up) system.  I haven't found the answer to this precisely by googling. I've found things like this that do seem to indicate we are higher than the typical status on *average over the course of the year* but is winter always higher?  https://www.cdc.gov/nchs/data/hus/2017/089.pdf  I dunno, something like daily capacity compared over a series of years would be helpful to know what's normal and how far off we are from that now. 

In my county we currently have ICU capacity of 35%, but are under the same strict lockdown orders as the worst off areas.  I see they have justified this by showing the transmission rate and that we'd exceed ICU capacity in a few weeks if nothing is done, and that seems smart to me, but I also am no longer sure that exceeding capacity (of ICU or the hospital in general) is actually an abnormal thing?

Its not unusual at all. Bigger hospitals have multiple ICUs - cardiac, medicine (lung issues - where most COVID pts end up now), sometimes a separate surgical / trauma ICU. Its not unusual for elective procedures that would fill up one of these ICUs post op to be canceled a few times a year due to lack of beds.
The big difference this year is that the medical ICU now has to have a separate space for their regular needs, and a second MICU dedicated to COVID patients. Some smaller hospitals that have 1 ICU mix COVID / non COVID patients in the same unit. That gets kind of tricky, and can lead to higher infections within the hospital.
Not all ICU nurses are the same either. Medical vs cardiac ICU nurses can often have very different skill sets.

Empty hospitals go bankrupt. End of story. Hospitals depend on steady admission rates, and like was mentioned above they're typically 80% full even in the summer (when respiratory illnesses and cardiac problems tend to be less prevalent). In a normal winter, its not uncommon for the hospital nurse manager to be planning elaborate juggling of patients to other lower care units throughout the day to make room for new ICU admissions. The only difference is you never heard the news screaming about it every day.

[fuzzy math]

The caveat being that in a normal years, since ICU workers (including maintenance staff) get the flu vaccine, not as many people are out sick are expected to come to work sick and are threatened with being fired for calling in sick too often, hospitals have historically made do with less nurses under the assumption that they would just come to work no matter what.

I can't tell you how many times I (or my colleagues) have come to work sick. Now there's an actual policy where I can get in trouble FOR coming to work sick, AND I can't be punished for calling in. Also the temp checks will now catch people if they're sick, so it is not an option even if you wanted to come in sick. Back in March, my coworker actually yelled at me for staying home when I (likely) had COVID. I've seen a surgeon get an IV in the OR at the end of a surgery after nearly passing out.

Hospital administrators seem dumbfounded that their policy changes now result in less staff. If they'd done the decent thing in years past, we wouldn't be in as shitty of a position we are in now.

 There is also less slack in the system now as lots of other elective stuff was postponed this spring when Covid hit, but eventually they will have to deal with some of those patients as well. One doctor on TV said "we are paying back on debt incurred this spring" which also adds to the strain on the system.

This was a huge issue. Hospitals were empty in March / April / May even in areas where COVID was really rare at the time. My hospital census (normally 350+) was down in the low 200s for weeks on end. Lots of hospitals lost lots of money from that, had to lay off staff and are now struggling to re-hire equal numbers of staff. So now they're not going to pause anything, they're trying to recoup both $$ and time lost from the spring. 

Patients avoiding seeing any Dr, canceled surgeries, lack of ability to do outpatient testing (required pre op for surgery) and strict no visitor policies kept patients from coming. That backlog took months to fix. Now we're dealing with sicker inpatients as a result of those lost months, plus the normal patients we'd expect at this time of year, plus COVID, plus all those rescheduled surgeries.

[Michael in ABQ]

Updated cumulative COVID deaths by age group in Minnesota.

So not to be callous, but how many of those deaths from COVID in the 80+ age range would have normally occurred from influenza or even a common cold that lead to pneumonia? Especially for those living in nursing homes, where by definition you are usually not in great health.

I guess there's no way of knowing right now if this simply accelerated the end for the most vulnerable and there will be a dip in normal deaths in that age range for the next few years.

I'm sure there will be many studies in the coming years looking at the combination of age and comorbidities among those who died. With the data that's normally released by the government/media (exact age or decade range) there's no way to distinguish between the healthy 75-year old who died and the one who was a lifelong-smoker that's obese and has diabetes.

My grandma almost made it to 100 but recently died from natural causes/old age.

Michael, I can't believe our society is still having this argument. Covid is BAD. It is much WORSE than the Flu or run of the mill Pneumonia. If you don't believe this at this stage, than you are either an idiot or you are arguing in bad faith. I highlighted Flu and Pneumonia for you. Running tally of Covid deaths is now over 295,000 deaths in the US and increasing by 3K per day right now.  Yes, we will all die from something, but hopefully we will not die sooner than we must due to the current pandemic. This does not even count "excess deaths" that are due to Covid19 but not formally diagnosed. CDC estimates for excess deaths are now 75K and also growing.

Straight from the CDC, 2018 data:

Deaths and Mortality
Data are for the U.S.

Death rate: 867.8 deaths per 100,000 population
Source: National Vital Statistics System – Mortality Data (2018) via CDC WONDER

Number of deaths: 2,839,205
Life expectancy: 78.7 years

Number of deaths for leading causes of death:
Heart disease: 655,381
Cancer: 599,274
Accidents (unintentional injuries): 167,127
Chronic lower respiratory diseases: 159,486
Stroke (cerebrovascular diseases): 147,810
Alzheimer’s disease: 122,019
Diabetes: 84,946
Influenza and Pneumonia: 59,120
Nephritis, nephrotic syndrome and nephrosis: 51,386
Intentional self-harm (suicide): 48,344

https://www.cdc.gov/nchs/fastats/deaths.htm

I'll ignore the ad hominem attack. I recognize that COVID is worse than the flu - far worse for older folks and those with comorbidities. Not 20x worse but at least 5x or more. I appreciate the data and based on that it is obviously doing more than accelerating a year or two worth of deaths. However, I would still like to see some data on those 300k deaths in the US and how many were those with comorbidities such as high blood pressure, obesity, diabetes, pre-existing respiratory issues, etc. My hypothesis is that COVID is generally killing those who are already in relatively poor health. So overall it may be accelerating death several years on average, not normally killing off those who are relatively healthy and are likely to live into their 80s and beyond.

[mathlete]

Diabetes, hypertension and obesity are serious health conditions that shave years and quality from life. But they’re manageable and we don’t generally consider a person with these conditions to be on death’s door or anything.

Insurers posting reduced earnings tells us what we need to know. If all these people were just going to die next year than earnings would largely be unchanged.

[Abe]

Every deadly illness accelerates death, and thus the question is what we call quality-adjusted life-years. That is a complicated analysis that will take some time to figure out for a variety of technical data-gathering and analytical reasons (not the least of which is what defines quality).

A large percentage of patients who have died of covid-19 in the US did not have significant comorbidities that contributed to their death, as determined by the treating physician signing the death certificate. Obviously this is subject to reporting errors but it’s important not to overstate the relationship between comorbidities and death. Many of the comorbidities are so Common in the older population as to be a nearly meaningless distinction.
Tables for above: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#AgeAndSex
This is in line with data from the UK I had previously posted.

So yes, there is some acceleration of the natural timeline, but these are not majority people in the last stage of life with a terminal illness.

[mm1970]

Before you start complaining about moral hazard,  I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

Take the US response out of the equation.  The impression that so many seem to carry here is that the US response has put them in a category which is out of line with death rates in other countries. Ask yourself where you think the US ranks in deaths. Then look at Spain, Italy, UK and Belgium, all of whom have deaths per million rates higher than the US. In fact the US is ranked 12th in the world for deaths per million.
Would you argue that all of those countries did not follow hygiene recommendations? Do you remember many of those countries being locked down with police in the streets?

UK peak deaths: 4/21/20 (death is a lagging indicator, cases and deaths went down after the lock down).
UK lockdowns: 3/23/20, 10/31/20, 12/14/20
https://www.cnn.com/2020/11/30/uk/coronavirus-england-lockdown-uk-gbr-intl/index.html

Italy peak deaths: 3/27/20 (death is a lagging indicator)
Italy lockdowns: 3/9/20, 11/6/20

Spain peak deaths: 3/31/20

Belgium peak deaths: 4/10/20

US peak deaths: 12/9/20
US lockdowns...?

US death rate: 91.44 per 100k

Denmark: 16.25
Australia: 3.63
Japan: 1.96
South Korea: 1.14
Taiwan: 0.03

TLDR, these countries death rates are overall higher because they shut down TOO LATE in the spring, and the bulk of their deaths occurred shortly after the shutdowns.

[Michael in ABQ]

Every deadly illness accelerates death, and thus the question is what we call quality-adjusted life-years. That is a complicated analysis that will take some time to figure out for a variety of technical data-gathering and analytical reasons (not the least of which is what defines quality).

A large percentage of patients who have died of covid-19 in the US did not have significant comorbidities that contributed to their death, as determined by the treating physician signing the death certificate. Obviously this is subject to reporting errors but it’s important not to overstate the relationship between comorbidities and death. Many of the comorbidities are so Common in the older population as to be a nearly meaningless distinction.
Tables for above: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#AgeAndSex
This is in line with data from the UK I had previously posted.

So yes, there is some acceleration of the natural timeline, but these are not majority people in the last stage of life with a terminal illness.

Very interesting, thank you for posting this link.

[fuzzy math]

UK peak deaths: 4/21/20 (death is a lagging indicator, cases and deaths went down after the lock down).
UK lockdowns: 3/23/20, 10/31/20, 12/14/20
https://www.cnn.com/2020/11/30/uk/coronavirus-england-lockdown-uk-gbr-intl/index.html

Italy peak deaths: 3/27/20 (death is a lagging indicator)
Italy lockdowns: 3/9/20, 11/6/20

Spain peak deaths: 3/31/20

Belgium peak deaths: 4/10/20

US peak deaths: 12/9/20
US lockdowns...?

US death rate: 91.44 per 100k

TLDR, these countries death rates are overall higher because they shut down TOO LATE in the spring, and the bulk of their deaths occurred shortly after the shutdowns.

12/9/20
Death rate per day / population  ON THE UNITED STATES' PEAK DAY
In order by rank

Italy deaths 887 / 60,421,000  = 0.001468%
Belgium deaths 121 / 11,612,000 = 0.001042%
US deaths 3263 / 331,886,000 = 0.0009831%
UK deaths 616 / 68,048,000  = 0.0009052 %
Spain deaths  325 /48,763,000 = 0.0006664%


If we use 2nd wave peak days for each country we get a ranking like this

Belgium (Nov 18) deaths 223 / 11,612,000 = 0.001920%   (I even threw out an outlier for Belgium of 345 deaths as to not skew their data)
Italy (Dec 3) deaths 993 /  60,421,000 = 0.001643%
Spain (Nov 24) deaths 537 /48,763,000 = 0.001101%
UK (Nov 25) deaths 696 / 68,048,000 = 0.001022%
US (Dec 9) deaths 3263 / 331,886,000 = 0.0009831%


It might FEEL to you like the US has deaths that are out of line compared to other nations, but the data says otherwise.

[deborah]

It might FEEL to you like the US has deaths that are out of line compared to other nations, but the data says otherwise.

It depends. The US is doing as badly as a lot of European countries, and a few South American countries. However, there are an awful lot of countries that are doing much better. Do you really want to compare yourselves to countries that are doing so poorly in the pandemic? The whole world has an average death rate from the pandemic less than a quarter of that of the USA.

Of course, there are probably a number of countries that aren't reporting properly, so the world death rate may be incorrect. We need a democracy so that we might get reasonable figures. Let's compare the USA with Timor-Leste. A country that is one of our closest neighbours, and every so often has a fun time with its President. According to the Economist Intelligence Unit, both the USA and Timor-Leste rate similarly on its democracy scale. It shares a long porous land border with Indonesia, who are having bad time with the pandemic. As it had a hard time separating from Indonesia, it has little infrastructure (especially health infrastructure), and would have a hard time getting help from them. It has had no deaths from covid-19 at all, although it's had a few cases.

Or maybe you would rather be compared to South Korea or Japan which are at the nearest level of democracy to the US according to the same scale (but a little higher), and have both had a lot fewer deaths per million than the USA?

[Goldielocks]

UK peak deaths: 4/21/20 (death is a lagging indicator, cases and deaths went down after the lock down).
UK lockdowns: 3/23/20, 10/31/20, 12/14/20
https://www.cnn.com/2020/11/30/uk/coronavirus-england-lockdown-uk-gbr-intl/index.html

Italy peak deaths: 3/27/20 (death is a lagging indicator)
Italy lockdowns: 3/9/20, 11/6/20

Spain peak deaths: 3/31/20

Belgium peak deaths: 4/10/20

US peak deaths: 12/9/20
US lockdowns...?

US death rate: 91.44 per 100k

TLDR, these countries death rates are overall higher because they shut down TOO LATE in the spring, and the bulk of their deaths occurred shortly after the shutdowns.

12/9/20
Death rate per day / population  ON THE UNITED STATES' PEAK DAY
In order by rank

Italy deaths 887 / 60,421,000  = 0.001468%
Belgium deaths 121 / 11,612,000 = 0.001042%
US deaths 3263 / 331,886,000 = 0.0009831%
UK deaths 616 / 68,048,000  = 0.0009052 %
Spain deaths  325 /48,763,000 = 0.0006664%


If we use 2nd wave peak days for each country we get a ranking like this

Belgium (Nov 18) deaths 223 / 11,612,000 = 0.001920%   (I even threw out an outlier for Belgium of 345 deaths as to not skew their data)
Italy (Dec 3) deaths 993 /  60,421,000 = 0.001643%
Spain (Nov 24) deaths 537 /48,763,000 = 0.001101%
UK (Nov 25) deaths 696 / 68,048,000 = 0.001022%
US (Dec 9) deaths 3263 / 331,886,000 = 0.0009831%


It might FEEL to you like the US has deaths that are out of line compared to other nations, but the data says otherwise.

I think countries with large land areas (geography plays a role in the % death rate) may have different outcomes, statistically.  For example, NYC peak deaths recently was 26 deaths /day out of a population 18.8 million.  That is 0.001383%.  https://www1.nyc.gov/site/doh/covid/covid-19-data.page  New York was just the first populated area I thought to look at. 

[Abe]

Here are two graphs:

1.  A graph of health security index (pre-covid predicted ability of a country to handle epidemics: https://www.ghsindex.org/) and reported deaths per 100k (https://coronavirus.jhu.edu/data/mortality). I labeled the worst 20% countries in terms of deaths per capita.
2. Case fatality rate by country
3. Deaths per 100k population by country

[frugalnacho]

...so is the current argument that on a deaths per capita basis the USA is not technically the worst, but is in like the 4th or 5th percentile?  We are 12th in the world, but you have to include San Marino (pop 34k), Andorra (pop 77k), and Montenegro (pop 630k), which all seem like very small sample sizes that could be skewed.   

[Davnasty]

...so is the current argument that on a deaths per capita basis the USA is not technically the worst, but is in like the 4th or 5th percentile?  We are 12th in the world, but you have to include San Marino (pop 34k), Andorra (pop 77k), and Montenegro (pop 630k), which all seem like very small sample sizes that could be skewed.

Also important to remember is that not every country is counting Covid deaths the same way. Belgium for example counts deaths suspected to be Covid related rather than only counting deaths with a positive test. I haven't been able to find up to date numbers on excess death per capita, but as of 2 months ago, Belgium actually had less excess deaths per 100,000 than the US, despite a much higher count of deaths officially attributed to Covid.

https://www.statista.com/chart/23209/excess-all-cause-mortality-per-100000-inhabitants/

Over the last 2 months US deaths have increased steadily while Belgium peaked about a month ago and has been falling since. I would assume the excess death gap between the US and Belgium has grown accordingly.

[Abe]

I don’t have an opinion one way or other on who’s the worst. It’s a somewhat irrelevant and morbid argument. There’s been quite a lot of death on both sides of the Atlantic. Belgium is bit of an outlier as discussed above, and the distribution of case fatality rates being fairly close together otherwise suggests everyone is doing about the same. Anyone can parse the data how they wish, hence the multiple graphs to look at. Regardless, a grim toll in many countries and a sadder holiday season for many people.

[former player]

I think Davnasty probably has it right: in the long run the comparison will be on excess deaths rather than the differently flawed recording systems of each country. 

Given that testing is still a bit of a lottery in many places and that this virus apparently has a range of effects (eg sticky blood leading to heart attacks and strokes) outside what seems to be considered the norm for the disease (fever, cough, loss of sense of smell) looking at excess mortality probably includes a high perecentage of deaths directly attributable to covid19 rather than just being knock-on effects from the unavailability of medical services for other conditions.

[LightTripper]

Even leaving aside the measurement of deaths (which I agree makes countries hard to compare), if you want to consider how well a country is doing relative to another in terms of how effective its policy response was you also need to know things like:
- How densely packed is the population;
- How many people can work from home;
- How many people usually use public transport;
- How many people live in multi-generational family groups;
- How many old/vulnerable people live in care homes (and how stable and well paid are the staff of those care homes)?

Without taking account of those factors a country which has handled the outbreak "optimally" might still have a higher rate of excess deaths than one which has not - just because of its population characteristics and geography.

As individuals, we can all take responsibility for doing what we can (masks, distancing, avoiding unnecessary socialising) - but none of us are going to go and live under a rock, and everybody's judgements about what is "necessary" will be different.  That might mean sailing close to the wind of local rules in some respects, but going nowhere near the boundaries in others.  For example, I have broken the rules of my country by going for a walk with another family which made us a group of 8 outdoors (the maximum permitted here is 6, including even small children).  However, I have no intention of taking up the government relaxation of rules at Christmas that would allow me to meet indoors with other households, which just seems like insanity to me.

To what extent is government policy a driver of my (good or bad) behaviour?  Somewhat, but only really as a guide.  I take more notice of the government scientists explaining the nature of the risks, and of the changing level of infections over time.  In the end if the death rates get too high people police their own behaviour, even if government does nothing at all.  But I do think the "tone" set by government can be very important in making people feel the duty we owe to our fellow humans, and understand why certain actions are important or risky.  Unfortunately simply comparing even excess deaths across countries does not get us very far towards understanding how good or poor those government responses have been.

[Michael in ABQ]

Even leaving aside the measurement of deaths (which I agree makes countries hard to compare), if you want to consider how well a country is doing relative to another in terms of how effective its policy response was you also need to know things like:
- How densely packed is the population;
- How many people can work from home;
- How many people usually use public transport;
- How many people live in multi-generational family groups;
- How many old/vulnerable people live in care homes (and how stable and well paid are the staff of those care homes)?

Without taking account of those factors a country which has handled the outbreak "optimally" might still have a higher rate of excess deaths than one which has not - just because of its population characteristics and geography.

As individuals, we can all take responsibility for doing what we can (masks, distancing, avoiding unnecessary socialising) - but none of us are going to go and live under a rock, and everybody's judgements about what is "necessary" will be different.  That might mean sailing close to the wind of local rules in some respects, but going nowhere near the boundaries in others.  For example, I have broken the rules of my country by going for a walk with another family which made us a group of 8 outdoors (the maximum permitted here is 6, including even small children).  However, I have no intention of taking up the government relaxation of rules at Christmas that would allow me to meet indoors with other households, which just seems like insanity to me.

To what extent is government policy a driver of my (good or bad) behaviour?  Somewhat, but only really as a guide.  I take more notice of the government scientists explaining the nature of the risks, and of the changing level of infections over time.  In the end if the death rates get too high people police their own behaviour, even if government does nothing at all.  But I do think the "tone" set by government can be very important in making people feel the duty we owe to our fellow humans, and understand why certain actions are important or risky.  Unfortunately simply comparing even excess deaths across countries does not get us very far towards understanding how good or poor those government responses have been.

Another factor is the overall demographics. 80% of US COVID deaths have occurred in those 65+

Look at most of Africa, there's very few people in their 70s, 80s, and 90s. They can have millions of cases but if it's all in younger people there's not going to be many deaths.

Just as an example, 16.5% of the US population is over 65. In Uganda it's 2%, in Kenya 2.4%, Nigeria 2.7%. Sub-Saharan Africa as a whole is about 3% over 65. South Africa is about the highest at just 5% (also has by far the most COVID deaths overall and per capita).

Looking at Europe Italy is 23%, Greece, 22%, Belgium 19%, Norway 17%. For the EU as a whole its 19.2% over 65.

[Poundwise]

I think a lot of states in the US could have avoided their summer/autumn Covid surges if they had watched and learned from areas (other countries, and northeastern states such as NY/NJ/CT) that experienced early surges. 

This is the way I assess risk and why I take Covid very seriously:

Where I live in NY, about 1 in 600 people have died of Covid. Not 1 in 600 people who had it-- just 1 in 600 people, period. Numbers are a bit worse in NYC. They did a random sample of the population for antibodies in the summer and estimated about 20% of people here have had it. If this survey was accurate, if everyone else catches it over the next 6 months we could expect 5 times as many people to die, that is 5 in 600, simplified to 1 in 120 people killed by Covid in this area. Let's make it 1 in 200 to be generous, account for deaths that occurred since the antibody survey, allow for improvements in treatment, etc.

1/200 = .5% chance of dying if you catch it, and if people continue to refuse to take precautions eventually everybody will catch it. So if I have 20 people whom I love, the chance that they'll all survive the next 6 months is roughly (1 - .005)^20 = (.995 to the 20th power) = about .90
100% - 90% = 10%, which means that I have close to a 1 in 10 chance of losing a loved one in the next year if everybody catches Covid. Nice.

Of course, one can weight these odds by the ages and health of ones' loved ones (my family is mostly middle aged people with a scattering of old and young ones).  But using the national case fatality figures has too much variability in the way cases and deaths are reported, and variability in healthcare.

Thank goodness vaccines are around the corner.

[jrhampt]

I think a lot of states in the US could have avoided their summer/autumn Covid surges if they had watched and learned from areas (other countries, and northeastern states such as NY/NJ/CT) that experienced early surges. 

Absolutely.  This is what drives me nuts, that no one learned from us, that everyone has to know someone who dies before they learn.

[fuzzy math]

It depends. The US is doing as badly as a lot of European countries, and a few South American countries. However, there are an awful lot of countries that are doing much better. Do you really want to compare yourselves to countries that are doing so poorly in the pandemic? The whole world has an average death rate from the pandemic less than a quarter of that of the USA.

Or maybe you would rather be compared to South Korea or Japan which are at the nearest level of democracy to the US according to the same scale (but a little higher), and have both had a lot fewer deaths per million than the USA?

I will requote what scottish said before that caused me to comment. Would you argue that Italy and Spain with their mandatory in home months long lockdowns were not following hygiene recommendations?

I think you need to answer the question:
 "How many deaths and how much economic response could have been avoided if people had acted responsibly and followed hygiene recommendations?"

My next response was to mm1970 who claimed that those European countries only had high death rates in the spring, and I showed that their rates now are similar to that of the US.

TLDR, these countries death rates are overall higher because they shut down TOO LATE in the spring, and the bulk of their deaths occurred shortly after the shutdowns.

so @deborah , does it really matter whom I want to be compared to? Will it change a thing? Nowhere did I speak about feelings, I only presented data to show that despite the US' response, our death rates are not out of line with other heavily afflicted countries. So many people here are desperate in their hand wringing to show that the US has had an outrageous number of excess deaths, and attribute it all to behavior. The variety in behaviors exhibited by different countries who are having similar outcomes seems to point to that not being a powerful statement.

Countries with lockdowns (UK, Spain), countries without lockdowns (US - although nearly the entire country experienced a 2 month "stay at home order"), countries with huge initial death curves (Italy, Sweden, NY state if used as its own country), countries with comparatively smaller initial death numbers (US) are ALL HAVING 2nd waves of equal percentages now. The only difference is that for Sweden and others they hit their max daily deaths early on. The US hitting its highest death toll now, but still being exactly in line with those European countries quoted doesn't show anything except that we had lower death rates in March/April. The data presented is data. Its not a moral call. You and others can continue to assign whatever moral judgments to it that you'd like. I'm simply providing numerical perspective.

[scottish]

I'm having trouble following your argument.    are you saying that the US did just as well as Europe in terms of following hygiene recommendations?

[mathlete]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

[fuzzy math]

I'm having trouble following your argument.    are you saying that the US did just as well as Europe in terms of following hygiene recommendations?

I'm saying we did less and have similar outcomes.

[fuzzy math]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

US is considerably fatter which evens out age (lower life expectancy)

[Travis]

South Korea is relapsing hard right now. In the summer we were down to 20 new cases per day (out of a 50 million population). We're up to 1000 now, which we haven't seen since the original outbreak in early March.  The cause appears to be fatigue from following the rules. Old people are going to church in large numbers, and young people are out partying.  We (US military) have put large sections of the country back on the "stay away from here" list, and we received a warning on our base's Facebook page that we might revert to severe restrictions on the base itself if this keeps up. The comments section is getting more "COVID isn't real, masks don't work, the vaccine is untested poison" crap and I wonder how many of them are new arrivals who haven't been here for the last 9 months.  A number of people also complained that if we "bounce back," then their Christmas plans are ruined and money is wasted.  Why would you make expensive plans this year for anything? What rock have you been hiding under?  Even if they made these plans 2-3 months ago when the numbers looked great, we've always been balancing on an edge as this relapse has shown.

[middo]

An Australian perspective;

My son is flying in tomorrow from interstate.  We are having Christmas as normal with my father and step-mother.  The extended family we are seeing Christmas eve of Boxing day.  Then on the 28th we are joining another 30,000 people going to the cricket (which is an annual event for us).  There is zero risk of any of us getting, or passing on covid-19.

[Davnasty]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

US is considerably fatter which evens out age (lower life expectancy)

It just evens it out, that's convenient. Citations?

[RetiredAt63]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

Your neighbours to the north are freaking out about their (our) increasing numbers.  We don't even want to think about yours.

[GuitarStv]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

Your neighbours to the north are freaking out about their (our) increasing numbers.  We don't even want to think about yours.

We think about US numbers.  I wish the leaders of Alberta would stop doing everything in their power to try to match them.

[deborah]

@Abe  - that scatter graph of covid19 deaths vs predicted pandemic preparedness looks completely random to me. Would you agree? If I’m reading the graph right, has there been any follow up suggesting why the predicted preparedness was such a poor measure? When I read about it, I noted that they were rather scathing about how prepared even the best prepared nation was, so that could be a partial explanation.

[habanero]

Our institute for public health published revised death rate estimates a couple of weeks ago. That is the first time they do so on national data as there hasn't been enough cases earlier and they have previously used international numbers giving a significantly higher estimate. Their latest is an overall rate of 0.12%: For persons aged below 70% its 0.2% or lower - for 40y or younger its 0.002% for example. For over 80 years its estimated at 4%. This rests on a few key assumptions - the actual number of cases (they assume ~60% go undetected) and that the age distribution of non-detected cases is the same as for the detected cases. Another key element is that our health system has never been under any serious strain (currently 130 hospitalized of which 30 in ICU of which 20 on ventilator - pop 5.4 million). All numbers calculated on the 2nd wave only as they have much better data on actual cases than they had this spring.

Even when looking at actual diagnosed cases for < 40y the rate is 0.04% overall since the start of the pandemic, where the numerator is known but the denominator is guaranteed to be way higher in reallity.

[RetiredAt63]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

Your neighbours to the north are freaking out about their (our) increasing numbers.  We don't even want to think about yours.

We think about US numbers.  I wish the leaders of Alberta would stop doing everything in their power to try to match them.

You have a very valid point.  Unfortunately.

[Prairie Gal]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

Your neighbours to the north are freaking out about their (our) increasing numbers.  We don't even want to think about yours.

We think about US numbers.  I wish the leaders of Alberta would stop doing everything in their power to try to match them.

You have a very valid point.  Unfortunately.

Our government here in AB finally brought in some tougher restrictions, and numbers are starting to head downwards. But, yah, Kenney is Trump-lite. He waited until the province was on fire before doing anything. They used to say that we had a capacity of 70 ICU covid beds, but we currently have 139 people in ICU with covid. We'll see what happens over Christmas. I doubt the anti-maskers are going to let anyone tell them they can't gather with their families in their own homes.

[deborah]

Yesterday there were two cases of community transmission in Sydney - today there are five (the only cases in Australia). Today there are also FOUR HOUR queues at the covid19 testing centres in the area.

https://www.smh.com.au/national/northern-beaches-covid-19-cases-spark-four-hour-wait-at-testing-clinics-20201217-p56ob0.html

[scottish]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

Your neighbours to the north are freaking out about their (our) increasing numbers.  We don't even want to think about yours.

We think about US numbers.  I wish the leaders of Alberta would stop doing everything in their power to try to match them.

You have a very valid point.  Unfortunately.

Our government here in AB finally brought in some tougher restrictions, and numbers are starting to head downwards. But, yah, Kenney is Trump-lite. He waited until the province was on fire before doing anything. They used to say that we had a capacity of 70 ICU covid beds, but we currently have 139 people in ICU with covid. We'll see what happens over Christmas. I doubt the anti-maskers are going to let anyone tell them they can't gather with their families in their own homes.

Kenney's a bit like Trump, but without the brains or charisma!

[middo]

Yesterday there were two cases of community transmission in Sydney - today there are five (the only cases in Australia). Today there are also FOUR HOUR queues at the covid19 testing centres in the area.

https://www.smh.com.au/national/northern-beaches-covid-19-cases-spark-four-hour-wait-at-testing-clinics-20201217-p56ob0.html

Latest seems to be related to an RSL club.  Let's hope that "gold standard" tracing really is gold standard.

[RetiredAt63]

Where comparing the US to Europe, it's important to note that the US Population is considerably younger.

Median Ages:

US - 37.6
UK - 40.5
Belgium - 42
Spain - 44.9
Italy - 46.5

Our most populous peer in Europe, Germany, has about 1/3rd the US death rate. Norway and Finland are doing even better. Our neighbors to the North are doing better as well.

I think it's fair to say that the US is doing pretty poorly relative to peer nations.

Your neighbours to the north are freaking out about their (our) increasing numbers.  We don't even want to think about yours.

We think about US numbers.  I wish the leaders of Alberta would stop doing everything in their power to try to match them.

You have a very valid point.  Unfortunately.

Our government here in AB finally brought in some tougher restrictions, and numbers are starting to head downwards. But, yah, Kenney is Trump-lite. He waited until the province was on fire before doing anything. They used to say that we had a capacity of 70 ICU covid beds, but we currently have 139 people in ICU with covid. We'll see what happens over Christmas. I doubt the anti-maskers are going to let anyone tell them they can't gather with their families in their own homes.

Kenney's a bit like Trump, but without the brains or charisma!

The last few years it has seemed that all the Conservative leaders were emulating the GOP, and Trump.  Sigh.  Of course Ford had his brother the former world famous mayor of Toronto for an example as well.

Back to the pandemic, Ottawa is using half their vaccines and holding on to the second half for the second dose, just in case there are supply issues.  Because of the storage temperatures they have health care workers in nursing homes going to hospitals for vaccination.

Canada has ordered more than we need for the total population, by fall anyone who wants the vaccine should have it.  I'm hoping by then there will be clearer guidelines for teens, children, cancer patients and pregnant women.  Our excess will go to countries that need it but can't afford it.  Kudos to the Oxford Astra-Zeneca group, their vaccine will be sold at cost until the pandemic is over.