Author Topic: How long can we wait while flattening the curve?  (Read 675352 times)

HBFIRE

  • Handlebar Stache
  • *****
  • Posts: 1311
  • Age: 45
  • Location: Huntington Beach, CA
Re: How long can we wait while flattening the curve?
« Reply #3050 on: July 13, 2020, 04:59:58 PM »

I’m not going down the old folks are less valuable road with anyone.


Not expecting a response, was just clarifying my statement.

deborah

  • Senior Mustachian
  • ********
  • Posts: 15962
  • Age: 14
  • Location: Australia or another awesome area
Re: How long can we wait while flattening the curve?
« Reply #3051 on: July 13, 2020, 05:38:10 PM »
More younger people than older people are getting covid19. Sure, more older people are dying, but a lot of the people who don’t are suffering severe complications. Possibly lifelong complications. It is important that we protect everyone from such a nasty disease.

HBFIRE

  • Handlebar Stache
  • *****
  • Posts: 1311
  • Age: 45
  • Location: Huntington Beach, CA
Re: How long can we wait while flattening the curve?
« Reply #3052 on: July 13, 2020, 06:28:58 PM »
This is interesting.

Once the US death data reported by the states is adjusted to put the dates into the weeks the deaths actually occurred, the trends look much differrent than something like worldometer. The states report the deaths as if they all happened this past week. The CDC includes the actual date of these deaths in their data. Per the CDC's data, more than half of the 6,617 deaths reported during the week ending July 11th actually occurred the week ending May 2 or earlier.

https://twitter.com/kylamb8/status/1281778023935737858

July 11: 2,340
July 4: 2,868
June 27: 3,064
June 20: 5,226
June 13: 5,665
June 6: 6,809
May 30: 7,769
May 23: 10,960
May 16: 11,545
May 9: 9,387
May 2: 12,590
« Last Edit: July 13, 2020, 06:31:20 PM by HBFIRE »

Gremlin

  • Pencil Stache
  • ****
  • Posts: 581
Re: How long can we wait while flattening the curve?
« Reply #3053 on: July 13, 2020, 07:19:30 PM »
This is interesting.

Once the US death data reported by the states is adjusted to put the dates into the weeks the deaths actually occurred, the trends look much differrent than something like worldometer. The states report the deaths as if they all happened this past week. The CDC includes the actual date of these deaths in their data. Per the CDC's data, more than half of the 6,617 deaths reported during the week ending July 11th actually occurred the week ending May 2 or earlier.

https://twitter.com/kylamb8/status/1281778023935737858

July 11: 2,340
July 4: 2,868
June 27: 3,064
June 20: 5,226
June 13: 5,665
June 6: 6,809
May 30: 7,769
May 23: 10,960
May 16: 11,545
May 9: 9,387
May 2: 12,590
This looks suspiciously like a concept that actuaries refer to as a development triangle.  I'm surprised it takes as long as it has to report this sort of volume of deaths, but it is what it is.  This suggests to me that the lag between reporting of case numbers and the reporting of deaths is actually going to be significantly LONGER in the US than in other Western nations.  Since if half the COVID deaths reported last week actually occurred 10 weeks or more ago and that pattern is relatively constant, then it stands to reason that half the COVID deaths occurring today won't be reported until 10 or more weeks have elapsed from now.  That implies a very, very ugly scenario is playing out as we speak.

marty998

  • Walrus Stache
  • *******
  • Posts: 7372
  • Location: Sydney, Oz
Re: How long can we wait while flattening the curve?
« Reply #3054 on: July 13, 2020, 07:24:51 PM »
Great. Can we shut this thread down for 10 weeks to avoid all the nonsense claims in the meantime?

lost_in_the_endless_aisle

  • Guest
Re: How long can we wait while flattening the curve?
« Reply #3055 on: July 13, 2020, 07:30:07 PM »
This is interesting.

Once the US death data reported by the states is adjusted to put the dates into the weeks the deaths actually occurred, the trends look much differrent than something like worldometer. The states report the deaths as if they all happened this past week. The CDC includes the actual date of these deaths in their data. Per the CDC's data, more than half of the 6,617 deaths reported during the week ending July 11th actually occurred the week ending May 2 or earlier.

https://twitter.com/kylamb8/status/1281778023935737858

July 11: 2,340
July 4: 2,868
June 27: 3,064
June 20: 5,226
June 13: 5,665
June 6: 6,809
May 30: 7,769
May 23: 10,960
May 16: 11,545
May 9: 9,387
May 2: 12,590
This looks suspiciously like a concept that actuaries refer to as a development triangle.  I'm surprised it takes as long as it has to report this sort of volume of deaths, but it is what it is.  This suggests to me that the lag between reporting of case numbers and the reporting of deaths is actually going to be significantly LONGER in the US than in other Western nations.  Since if half the COVID deaths reported last week actually occurred 10 weeks or more ago and that pattern is relatively constant, then it stands to reason that half the COVID deaths occurring today won't be reported until 10 or more weeks have elapsed from now.  That implies a very, very ugly scenario is playing out as we speak.
According to that data, only the latest week was massively impacted by back-dated deaths from a number of weeks ago. The technique used to adjust them out of the weekly reporting was to instead just take the sum of deaths (based on attributed week of death) over the last four weeks. Why 4 weeks? I don't know but it looks like it won't make a big difference to use 3 or 5 or 6 to the conclusion. For most weeks, more than half of deaths are reported within 3 weeks so we will probably not need to wait 10 weeks to determine what was actually happening last week. The other conclusion is that (taking all of this analysis at face value) it's still too early to conclude that CFR is trending down as drastically as supposed thus far.

Bloop Bloop

  • Handlebar Stache
  • *****
  • Posts: 2139
  • Location: Melbourne, Australia
Re: How long can we wait while flattening the curve?
« Reply #3056 on: July 13, 2020, 07:58:03 PM »
I’m not going down the old folks are less valuable road with anyone.

My opinion is that someone who has not had the benefit of a full life yet is both ethically of higher importance to protect and carries more economic value on average.  This is just my opinion.

I struggle to see how anyone could disagree with this.

Kris

  • Walrus Stache
  • *******
  • Posts: 7335
Re: How long can we wait while flattening the curve?
« Reply #3057 on: July 13, 2020, 08:07:18 PM »
I’m not going down the old folks are less valuable road with anyone.

My opinion is that someone who has not had the benefit of a full life yet is both ethically of higher importance to protect and carries more economic value on average.  This is just my opinion.

I struggle to see how anyone could disagree with this.

So, okay, are we saying that there’s an equation of worth of life? So, like, a one-year-old is worth 100%, and a two-year-old is worth 99%, and a three-year-old is worth 98%, and so on...? Is that how we determine life worth?

Because it sounds like y’all are really committed to quantifying it. Is this correct?

If it’s not this equation, could you tell me what your math looks like?

MudPuppy

  • Handlebar Stache
  • *****
  • Posts: 1468
Re: How long can we wait while flattening the curve?
« Reply #3058 on: July 13, 2020, 08:08:32 PM »
I believe the math goes


They wanna > they need ta

Bloop Bloop

  • Handlebar Stache
  • *****
  • Posts: 2139
  • Location: Melbourne, Australia
Re: How long can we wait while flattening the curve?
« Reply #3059 on: July 13, 2020, 08:13:48 PM »
I’m not going down the old folks are less valuable road with anyone.

My opinion is that someone who has not had the benefit of a full life yet is both ethically of higher importance to protect and carries more economic value on average.  This is just my opinion.

I struggle to see how anyone could disagree with this.

So, okay, are we saying that there’s an equation of worth of life? So, like, a one-year-old is worth 100%, and a two-year-old is worth 99%, and a three-year-old is worth 98%, and so on...? Is that how we determine life worth?

Because it sounds like y’all are really committed to quantifying it. Is this correct?

If it’s not this equation, could you tell me what your math looks like?

https://en.wikipedia.org/wiki/Quality-adjusted_life_year

"Critics point out that the QALY figures oversimplify how actual patients would assess risks and outcomes. Proponents of the approach acknowledge its imperfections but consider the QALY better than alternative measures."

People who spout that "all lives are equal" and that public policy cannot compare the value of one life to another life obviously have never thought about the fact that we sacrifice myriad lives on the roads every year as a blood gift to the gods of convenience and speedy commutes.

HBFIRE

  • Handlebar Stache
  • *****
  • Posts: 1311
  • Age: 45
  • Location: Huntington Beach, CA
Re: How long can we wait while flattening the curve?
« Reply #3060 on: July 13, 2020, 08:13:57 PM »

So, okay, are we saying that there’s an equation of worth of life? So, like, a one-year-old is worth 100%, and a two-year-old is worth 99%, and a three-year-old is worth 98%, and so on...? Is that how we determine life worth?

Because it sounds like y’all are really committed to quantifying it. Is this correct?

If it’s not this equation, could you tell me what your math looks like?

I wont try to quantify it as I think we were speaking in general principle -  yes I think if you must make the tough comparison, a 20 year old with her life ahead of her and hasn't had the benefit of living a full life is more important to protect than say a 90 year old -- from both an ethical and an economic standpoint. This is precisely the type of decision that Italian doctors faced.  I'm sure people will disagree with this opinion.  I'm open to hearing the flaws in this reasoning.  It would make an interesting ethics discussion, but would also derail this thread.
« Last Edit: July 13, 2020, 08:18:18 PM by HBFIRE »

SunnyDays

  • Magnum Stache
  • ******
  • Posts: 3489
Re: How long can we wait while flattening the curve?
« Reply #3061 on: July 13, 2020, 08:18:00 PM »
One could also make the argument that an older person has made contributions to society and so deserves as much support as possible, whereas a child has done nothing yet so deserves little.  Not saying this is any more logical than valuing the young more.  Either one has merit.  How does a person decide?

HBFIRE

  • Handlebar Stache
  • *****
  • Posts: 1311
  • Age: 45
  • Location: Huntington Beach, CA
Re: How long can we wait while flattening the curve?
« Reply #3062 on: July 13, 2020, 08:20:47 PM »

This looks suspiciously like a concept that actuaries refer to as a development triangle.  I'm surprised it takes as long as it has to report this sort of volume of deaths, but it is what it is.  This suggests to me that the lag between reporting of case numbers and the reporting of deaths is actually going to be significantly LONGER in the US than in other Western nations.  Since if half the COVID deaths reported last week actually occurred 10 weeks or more ago and that pattern is relatively constant, then it stands to reason that half the COVID deaths occurring today won't be reported until 10 or more weeks have elapsed from now.  That implies a very, very ugly scenario is playing out as we speak.

Look more closely at the previous weeks in the data. Last week was an extreme outlier in delayed reporting, not the normal pattern. It appears to simply be an artificial data dump not based on anything about the virus.

Kris

  • Walrus Stache
  • *******
  • Posts: 7335
Re: How long can we wait while flattening the curve?
« Reply #3063 on: July 13, 2020, 08:21:19 PM »

So, okay, are we saying that there’s an equation of worth of life? So, like, a one-year-old is worth 100%, and a two-year-old is worth 99%, and a three-year-old is worth 98%, and so on...? Is that how we determine life worth?

Because it sounds like y’all are really committed to quantifying it. Is this correct?

If it’s not this equation, could you tell me what your math looks like?

I wont try to quantify it as I think we were speaking in general principle -  yes I think if you must make the tough comparison, a 20 year old with her life ahead of her and hasn't had the benefit of living a full life is more important to protect than say a 90 year old -- from both an ethical and an economic standpoint. This is precisely the type of decision that Italian doctors faced.  I'm sure people will disagree with this opinion.  I'm open to hearing the flaws in this reasoning.  It would make an interesting ethics discussion, but would also derail this thread.

I am sort of okay with this, but the thing is, Covid isn’t the trolley problem. It doesn’t give you a 20-year-old on one track and a 90-year-old on the other, and you get to pull the lever.

Honestly, this sort of discussion seems kind of silly to me, especially because it’s the kind of discussion that is usually had by people who theoretically think of themselves as low-risk, and therefore don’t put themselves on the “track”.

AnnaGrowsAMustache

  • Handlebar Stache
  • *****
  • Posts: 1941
  • Location: Noo Zilind
Re: How long can we wait while flattening the curve?
« Reply #3064 on: July 13, 2020, 08:34:52 PM »
This is interesting.

Once the US death data reported by the states is adjusted to put the dates into the weeks the deaths actually occurred, the trends look much differrent than something like worldometer. The states report the deaths as if they all happened this past week. The CDC includes the actual date of these deaths in their data. Per the CDC's data, more than half of the 6,617 deaths reported during the week ending July 11th actually occurred the week ending May 2 or earlier.

https://twitter.com/kylamb8/status/1281778023935737858

July 11: 2,340
July 4: 2,868
June 27: 3,064
June 20: 5,226
June 13: 5,665
June 6: 6,809
May 30: 7,769
May 23: 10,960
May 16: 11,545
May 9: 9,387
May 2: 12,590
This looks suspiciously like a concept that actuaries refer to as a development triangle.  I'm surprised it takes as long as it has to report this sort of volume of deaths, but it is what it is.  This suggests to me that the lag between reporting of case numbers and the reporting of deaths is actually going to be significantly LONGER in the US than in other Western nations.  Since if half the COVID deaths reported last week actually occurred 10 weeks or more ago and that pattern is relatively constant, then it stands to reason that half the COVID deaths occurring today won't be reported until 10 or more weeks have elapsed from now.  That implies a very, very ugly scenario is playing out as we speak.

And one that people seem incapable of seeing. There are going to be some mightily surprised folk in the next month or two. But it's too late to stop the rot now, and it will be two months past two late then. Sigh

Gremlin

  • Pencil Stache
  • ****
  • Posts: 581
Re: How long can we wait while flattening the curve?
« Reply #3065 on: July 13, 2020, 09:03:53 PM »

This looks suspiciously like a concept that actuaries refer to as a development triangle.  I'm surprised it takes as long as it has to report this sort of volume of deaths, but it is what it is.  This suggests to me that the lag between reporting of case numbers and the reporting of deaths is actually going to be significantly LONGER in the US than in other Western nations.  Since if half the COVID deaths reported last week actually occurred 10 weeks or more ago and that pattern is relatively constant, then it stands to reason that half the COVID deaths occurring today won't be reported until 10 or more weeks have elapsed from now.  That implies a very, very ugly scenario is playing out as we speak.

Look more closely at the previous weeks in the data. Last week was an extreme outlier in delayed reporting, not the normal pattern. It appears to simply be an artificial data dump not based on anything about the virus.

...maybe.  But the numbers also don't add to the totals.  According to the figures, there's a further 7,126 deaths to be allocated somewhere in that table.  Top row shows 126,444 deaths, but the triangle only shows 119,318 deaths.  Do we just assume those 7,126 haven't died until they're allocated at some point in the future.  But that's still 10,958 short of the 137,402 reported deaths in total to 11 July.  Again, they have to fit in somewhere. 

So I went and looked at the original CDC source - not the Twitter account.  And this is what they said...

Quote
Provisional death counts are based on death certificate data received and coded by the National Center for Health Statistics ... It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged

So not a record of deaths at all, but simply an indication of the timing of processing of death certificate data.  That makes a fair bit more sense.  Not sure that supports the original assertion that
Quote
more than half of the 6,617 deaths reported during the week ending July 11th actually occurred the week ending May 2 or earlier.

Instead this shows that more than half of the 6,617 death certificates processed that week are from people dying May 2 more earlier.

Abe

  • Magnum Stache
  • ******
  • Posts: 2647
Re: How long can we wait while flattening the curve?
« Reply #3066 on: July 13, 2020, 10:26:23 PM »
The data I've been using for my graphs comes from NY Times. They are collating records from county and state health departments, so is more up-to-date than the CDC data. I'd hesitate to use national data at this point due to the processing lag noted. County departments in general are getting a daily update of COVID deaths, ICU status and admissions in order to manage patient volumes and distribute amongst hospitals if necessary. Thus those data can be considered accurate on at least a weekly basis, if not daily. Reports to the CDC, since they are not essential for clinical planning, are likely considerably delayed.

Updates for specific hotspots:

Houston - admissions to regular and ICU rooms is starting to slow down. Currently above max normal capacity, but within surge capacity using ERs and ORs.

California - cases continuing to rise across all southern california counties, except San Diego. Two counties have maxed their ICU capacity and are transferring patients to LA, Orange & San Diego. LA is at 95% capacity for ICU, Orange & San Diego ~70%

Florida - 85-90% ICU capacity overall across the state. Several major systems in overflow status.

Arizona - 90% capacity over last two weeks, stabilized with transfers to California and Nevada.

I'll add North Carolina due to reports from friends there - several counties have maxed ICU capacity, overall 75% usage across the state and climbing.

Overall pattern is that ICU capacity is manageable with hospital shutdowns, if no further waves occur. Survival is improving for a variety of factors, but mortality remains around 20-30% in ICU.
« Last Edit: July 13, 2020, 10:44:48 PM by Abe »

former player

  • Walrus Stache
  • *******
  • Posts: 8823
  • Location: Avalon
Re: How long can we wait while flattening the curve?
« Reply #3067 on: July 14, 2020, 12:37:06 AM »
I’m not going down the old folks are less valuable road with anyone.

My opinion is that someone who has not had the benefit of a full life yet is both ethically of higher importance to protect and carries more economic value on average.  This is just my opinion.

I struggle to see how anyone could disagree with this.
Economists do.  Y'all are apparently calculating monetary value using the human capital approach (a rather old fashioned method which only measures the value of production lost) rather than the individual/social willingness-to-pay approach which is more common these days.

Interestingly in relation to road safety, it seems that countries where road safety is better put a higher ceiling on their willingness to pay.  Correlating this to pandemics might explain why the EU has done so much better than the USA.  There's a good explanation here -

https://ec.europa.eu/transport/road_safety/specialist/knowledge/measures/monetary_valuation_of_road_safety_en

former player

  • Walrus Stache
  • *******
  • Posts: 8823
  • Location: Avalon
Re: How long can we wait while flattening the curve?
« Reply #3068 on: July 14, 2020, 12:42:14 AM »
Abe: does it make a difference to ICU stats that the preferred treatment these days seems to be CPAP equivalent rather than ventilators, with the result that more people might be treated outside an ICU than would have been thought appropriate earlier on in the pandemic?  If so then stats on ICU usage might be a less consistent marker over time.  Would percentage of hospital deaths outside ICU be a marker for this?  Although I guess as treatments get better/affected populations get younger that also is subject to change.

Disclaimer: not a statistician.

Spud

  • Stubble
  • **
  • Posts: 161
  • Location: Southwest England, UK.
Re: How long can we wait while flattening the curve?
« Reply #3069 on: July 14, 2020, 12:51:19 AM »
In the UK, masks will become mandatory in all shops from Friday July 24. If you don't comply, you'll be fined £100. This will give rise to a culture of wearing masks in almost all indoor public spaces.

marty998

  • Walrus Stache
  • *******
  • Posts: 7372
  • Location: Sydney, Oz
Re: How long can we wait while flattening the curve?
« Reply #3070 on: July 14, 2020, 03:32:31 AM »

So, okay, are we saying that there’s an equation of worth of life? So, like, a one-year-old is worth 100%, and a two-year-old is worth 99%, and a three-year-old is worth 98%, and so on...? Is that how we determine life worth?

Because it sounds like y’all are really committed to quantifying it. Is this correct?

If it’s not this equation, could you tell me what your math looks like?

I wont try to quantify it as I think we were speaking in general principle -  yes I think if you must make the tough comparison, a 20 year old with her life ahead of her and hasn't had the benefit of living a full life is more important to protect than say a 90 year old -- from both an ethical and an economic standpoint. This is precisely the type of decision that Italian doctors faced.  I'm sure people will disagree with this opinion.  I'm open to hearing the flaws in this reasoning.  It would make an interesting ethics discussion, but would also derail this thread.

I am sort of okay with this, but the thing is, Covid isn’t the trolley problem. It doesn’t give you a 20-year-old on one track and a 90-year-old on the other, and you get to pull the lever.

Honestly, this sort of discussion seems kind of silly to me, especially because it’s the kind of discussion that is usually had by people who theoretically think of themselves as low-risk, and therefore don’t put themselves on the “track”.

@Kris you wonder if those pushing for the QALY assessment to be done volunteer to bump their own parents from ICU so a random 20 year old stranger gets the bed in their place.


Kris

  • Walrus Stache
  • *******
  • Posts: 7335
Re: How long can we wait while flattening the curve?
« Reply #3071 on: July 14, 2020, 07:00:20 AM »

So, okay, are we saying that there’s an equation of worth of life? So, like, a one-year-old is worth 100%, and a two-year-old is worth 99%, and a three-year-old is worth 98%, and so on...? Is that how we determine life worth?

Because it sounds like y’all are really committed to quantifying it. Is this correct?

If it’s not this equation, could you tell me what your math looks like?

I wont try to quantify it as I think we were speaking in general principle -  yes I think if you must make the tough comparison, a 20 year old with her life ahead of her and hasn't had the benefit of living a full life is more important to protect than say a 90 year old -- from both an ethical and an economic standpoint. This is precisely the type of decision that Italian doctors faced.  I'm sure people will disagree with this opinion.  I'm open to hearing the flaws in this reasoning.  It would make an interesting ethics discussion, but would also derail this thread.

I am sort of okay with this, but the thing is, Covid isn’t the trolley problem. It doesn’t give you a 20-year-old on one track and a 90-year-old on the other, and you get to pull the lever.

Honestly, this sort of discussion seems kind of silly to me, especially because it’s the kind of discussion that is usually had by people who theoretically think of themselves as low-risk, and therefore don’t put themselves on the “track”.

@Kris you wonder if those pushing for the QALY assessment to be done volunteer to bump their own parents from ICU so a random 20 year old stranger gets the bed in their place.

Or bumping themselves.
« Last Edit: July 14, 2020, 07:58:06 AM by Kris »

LightTripper

  • Handlebar Stache
  • *****
  • Posts: 2404
  • Location: London, UK
  • Rural Londoner. Lazy workaholic. Confused.
Re: How long can we wait while flattening the curve?
« Reply #3072 on: July 14, 2020, 07:54:21 AM »
That's really not what QALYs should be about.

I am a fan of QALYs because they force you to face very starkly the consequences of your decisions, and to understand where additional resources should be focused to do the most good.

This does not mean I am relaxed about pulling the plug on my parents in order to give priority to a 20 year old.  I agree that saving the 20 year old will create more expected "QALYs", but I want there to be sufficient resources to ensure that everybody gets a fighting chance, and nobody is being triaged into a corridor. 

For me, that is what flattening the curve was all about: and unless we get rather lucky on one or more fronts, exactly what we need to be getting ready for this autumn/winter too.  But yes, it had a cost.  And if we end up living with Covid for a long time, there will be some very difficult decisions to be made about the trade-offs involved. 

Simply saying "save all lives at all costs" sounds nice but in the end most of us will draw the line somewhere (e.g. however much we want to help everybody and minimise loss of life, we may as a society decide it's not a good use of resources to build a safety barrier on a road in the middle of nowhere that may save one life every thousand years).  QALYs force us to really think about these uncomfortable realities.

To take another example, just because I may accept that a domestic violence centre (say) may generate more QALYs than a particular cancer treatment (for example), doesn't mean I shouldn't do both.  But understanding the good that those two things can do can help me decide how much tax I need to raise (and hopefully help me convince voters that both are worth doing).  And if voters disagree, and instead elect somebody who promises to cut taxes, hopefully QALYs can help inform those cuts so they do as little harm as possible.

former player

  • Walrus Stache
  • *******
  • Posts: 8823
  • Location: Avalon
Re: How long can we wait while flattening the curve?
« Reply #3073 on: July 14, 2020, 09:21:46 AM »
Right. But QALY only really works for medical decisions.  You use a different calculation for road traffic safety costs.  (Which apparently Bloop for one doesn't understand as he keeps trying to bring road safety into a conversation on health costs.)

LightTripper

  • Handlebar Stache
  • *****
  • Posts: 2404
  • Location: London, UK
  • Rural Londoner. Lazy workaholic. Confused.
Re: How long can we wait while flattening the curve?
« Reply #3074 on: July 14, 2020, 11:10:15 AM »
Personally I suspect we would make better decisions if we used QALYs for both (or CBA).  Certainly studies done in the UK have suggested that the implied thresholds for the cost of saving a life are not equal across the two, which means we are not saving the most lives we can with our taxes.

Anyway, I am not really aligning with Bloop (sorry Bloop).  I am all for being cautious.  There are just too many unknowns about this virus and this autumn/winter could be horrific.  I don't want to live in that world either, and certainly don't want to worry that my personal decisions have contributed to it in any way if it happens.

But recognising that there are costs as well as benefits to shutting down?  Yup.

And that whatever policy you put in place, you have to take people with you?  Also yes.  In fact one of the reasons I have been so frustrated by the UK response isn't so much what we've done as the way they've done it - with all this bluster and bravado and bullshitting about hitting meaningless targets - which I think has really missed the mark in building a sense of community and reliance on one another, and trust in one another, that is invaluable in the countries that have managed to foster that).

Gremlin

  • Pencil Stache
  • ****
  • Posts: 581
Re: How long can we wait while flattening the curve?
« Reply #3075 on: July 14, 2020, 04:12:57 PM »

Economists do.  Y'all are apparently calculating monetary value using the human capital approach (a rather old fashioned method which only measures the value of production lost) rather than the individual/social willingness-to-pay approach which is more common these days.

I've been wondering for the past few weeks whether someone was going to bring this up.  This has always struck me as completely hypocritical that on a early retirement website - a concept which wouldn't exist if not for ideals underpinning willingness-to-pay - that there are a number of posters who, in this one very specific instance, are unwilling to consider any alternative to a human capital model. 

Rosy

  • Magnum Stache
  • ******
  • Posts: 2742
  • Location: Florida
Re: How long can we wait while flattening the curve?
« Reply #3076 on: July 14, 2020, 04:50:24 PM »
This is interesting.

Once the US death data reported by the states is adjusted to put the dates into the weeks the deaths actually occurred, the trends look much differrent than something like worldometer. The states report the deaths as if they all happened this past week. The CDC includes the actual date of these deaths in their data. Per the CDC's data, more than half of the 6,617 deaths reported during the week ending July 11th actually occurred the week ending May 2 or earlier.

https://twitter.com/kylamb8/status/1281778023935737858

July 11: 2,340
July 4: 2,868
June 27: 3,064
June 20: 5,226
June 13: 5,665
June 6: 6,809
May 30: 7,769
May 23: 10,960
May 16: 11,545
May 9: 9,387
May 2: 12,590

... and just why would that be surprising since we all know that reporting deaths has a huge lag time?
Sometimes we see dumps of thousands in one day.

HBFIRE

  • Handlebar Stache
  • *****
  • Posts: 1311
  • Age: 45
  • Location: Huntington Beach, CA
Re: How long can we wait while flattening the curve?
« Reply #3077 on: July 14, 2020, 05:03:51 PM »

... and just why would that be surprising since we all know that reporting deaths has a huge lag time?
Sometimes we see dumps of thousands in one day.

This last week was the most significant one by a big margin.  It's just something to keep in mind when looking at trending data.

Bloop Bloop

  • Handlebar Stache
  • *****
  • Posts: 2139
  • Location: Melbourne, Australia
Re: How long can we wait while flattening the curve?
« Reply #3078 on: July 14, 2020, 07:19:40 PM »

Economists do.  Y'all are apparently calculating monetary value using the human capital approach (a rather old fashioned method which only measures the value of production lost) rather than the individual/social willingness-to-pay approach which is more common these days.

I've been wondering for the past few weeks whether someone was going to bring this up.  This has always struck me as completely hypocritical that on a early retirement website - a concept which wouldn't exist if not for ideals underpinning willingness-to-pay - that there are a number of posters who, in this one very specific instance, are unwilling to consider any alternative to a human capital model.

Can you elaborate on this? Willingness to pay in a private goods / property context is different, in my eyes, from allocation of scarce public resources. For example I might well be willing to pay $100k for a sports car, or convert that money into time in order to fund an early retirement, because that is what I want for myself. It would be stupid for public money to be spent on either purchase, because it's not 'for the greater good'. But that doesn't mean it's hypocritical to advocate that citizens each have the freedom to do what they like with their own money versus the public purse.

Right. But QALY only really works for medical decisions.  You use a different calculation for road traffic safety costs.  (Which apparently Bloop for one doesn't understand as he keeps trying to bring road safety into a conversation on health costs.)

No, I don't follow your reasoning. Traffic safety may well be funded on a "how much can we get funding for" basis. But it should follow the same assessment of relative cost vs relative reward. As LightTripper suggested, when considering things like road upgrades, speed limit changes, traffic calming devices etc, the most fair outcomes are gotten when we prioritise changes that will save a lot of lives. And remember that in choosing to set a speed limit at, say, 80km/h instead of 40km/h, we are accepting a certain annual loss of life for mere convenience.


deborah

  • Senior Mustachian
  • ********
  • Posts: 15962
  • Age: 14
  • Location: Australia or another awesome area
Re: How long can we wait while flattening the curve?
« Reply #3079 on: July 14, 2020, 08:04:08 PM »
It is noteworthy that it's been reported today that in Australia we have managed to have only 15% of people admitted to the ICU with Covid19 die. The UK and China recorded 40% and 44%, while in the USA it's about 70%. If we can all get the death rate down significantly, the debate changes somewhat.

Shane

  • Handlebar Stache
  • *****
  • Posts: 1665
  • Location: Midtown
Re: How long can we wait while flattening the curve?
« Reply #3080 on: July 14, 2020, 08:43:42 PM »
Just saw this article and wondering what the significance is, if any, to the Trump Administration's changing of the reporting procedures for Covid data:

White House tells hospitals to bypass CDC on COVID-19 data reporting

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 23129
  • Age: 42
  • Location: Toronto, Ontario, Canada
Re: How long can we wait while flattening the curve?
« Reply #3081 on: July 14, 2020, 09:05:09 PM »
Trump didn't have the level of control over the CDC he needed to sufficiently hide the problem, so this step makes a lot of sense.  CDC wasn't staying on brand.

habanero

  • Handlebar Stache
  • *****
  • Posts: 1145
Re: How long can we wait while flattening the curve?
« Reply #3082 on: July 14, 2020, 11:38:44 PM »
It is noteworthy that it's been reported today that in Australia we have managed to have only 15% of people admitted to the ICU with Covid19 die. The UK and China recorded 40% and 44%, while in the USA it's about 70%. If we can all get the death rate down significantly, the debate changes somewhat.
70% of US ICU patients die? Do you have a source for that? The figure seems absurdly high.

deborah

  • Senior Mustachian
  • ********
  • Posts: 15962
  • Age: 14
  • Location: Australia or another awesome area
Re: How long can we wait while flattening the curve?
« Reply #3083 on: July 15, 2020, 12:23:42 AM »
It is noteworthy that it's been reported today that in Australia we have managed to have only 15% of people admitted to the ICU with Covid19 die. The UK and China recorded 40% and 44%, while in the USA it's about 70%. If we can all get the death rate down significantly, the debate changes somewhat.
70% of US ICU patients die? Do you have a source for that? The figure seems absurdly high.
https://www.smh.com.au/national/best-doctors-and-nurses-australia-leads-world-in-covid-19-icu-survival-rates-20200714-p55byq.html - see the graph.

lost_in_the_endless_aisle

  • Guest
Re: How long can we wait while flattening the curve?
« Reply #3084 on: July 15, 2020, 12:36:55 AM »
It is noteworthy that it's been reported today that in Australia we have managed to have only 15% of people admitted to the ICU with Covid19 die. The UK and China recorded 40% and 44%, while in the USA it's about 70%. If we can all get the death rate down significantly, the debate changes somewhat.
70% of US ICU patients die? Do you have a source for that? The figure seems absurdly high.
https://www.smh.com.au/national/best-doctors-and-nurses-australia-leads-world-in-covid-19-icu-survival-rates-20200714-p55byq.html - see the graph.
Example of how dumb the media is. 471 ICU intakes in the US? That's probably not a representative sample given that tens-hundreds of thousands of ICU admissions have occurred in the US since the start of the epidemic. Second example: 671 ICU cases in Italy...
Also: "figures for China, the US and Italy are not national figures but the best available from published local studies."
What local studies? I guess the disclaimers are all in the fine print but it seems disingenuous to draw such conclusions off of tiny samples where the potential sampling bias is unclear.

Kyle Schuant

  • Handlebar Stache
  • *****
  • Posts: 1314
  • Location: Melbourne, Australia
Re: How long can we wait while flattening the curve?
« Reply #3085 on: July 15, 2020, 01:17:35 AM »
This says 64.3% survival in the US now, up from under 20%: https://www.washingtonpost.com/health/more-covid-19-patients-are-surviving-ventilators-in-the-icu/2020/07/03/2e3c3534-bbca-11ea-8cf5-9c1b8d7f84c6_story.html

This has 74% survival in Italy. https://www.cidrap.umn.edu/news-perspective/2020/04/experts-italy-asia-share-covid-19-icu-experience-warnings

And we're at 85%.

Your medical system isn't as good as ours to begin with, and past a certain level of numbers, any system gets overwhelmed and people who could have survived end up dying. Our hospitals were dealing with under 100 covid patients in ICU nationally, the US Italy got that many at one hospital. Quality begins lower, and declines with quantity.

Those are the unfortunate facts of the matter.

lost_in_the_endless_aisle

  • Guest
Re: How long can we wait while flattening the curve?
« Reply #3086 on: July 15, 2020, 01:34:26 AM »
This says 64.3% survival in the US now, up from under 20%: https://www.washingtonpost.com/health/more-covid-19-patients-are-surviving-ventilators-in-the-icu/2020/07/03/2e3c3534-bbca-11ea-8cf5-9c1b8d7f84c6_story.html

This has 74% survival in Italy. https://www.cidrap.umn.edu/news-perspective/2020/04/experts-italy-asia-share-covid-19-icu-experience-warnings

And we're at 85%.

Your medical system isn't as good as ours to begin with, and past a certain level of numbers, any system gets overwhelmed and people who could have survived end up dying. Our hospitals were dealing with under 100 covid patients in ICU nationally, the US Italy got that many at one hospital. Quality begins lower, and declines with quantity.

Those are the unfortunate facts of the matter.
You might be conflating ICU with invasive ventilator use with mere ICU admissions. The 85% in deborah's linked article is over all ICU admissions, while the survival rate with invasive mechanical ventilation is stated to be 78%. There is also a potential difference in case severity that results in ICU admission between countries. A lower standard for criticality for admission to the ICU will result in higher ICU survival rates so it's not easy to interpret these numbers. Also, different criteria for mechanical ventilation will also result in differences in that metric. You would probably have to control for specific clinical symptom severity to actually measure the difference in outcomes as a function of disease severity and treatment regimen. Finally, you would have to control for the underlying health of those afflicted. In the US, many of the earlier severe cases clustered among very elderly assisted care residents as a result of the NY State government's interesting policies on that front.

deborah

  • Senior Mustachian
  • ********
  • Posts: 15962
  • Age: 14
  • Location: Australia or another awesome area
Re: How long can we wait while flattening the curve?
« Reply #3087 on: July 15, 2020, 01:50:00 AM »
Actually, there are other articles that say that some ICUs in some hospitals in the US did have that rate. For instance, this article gives some very sobering stats https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03006-1/tables/1 from some individual hospitals. I agree that it’s probably not representative, but I was looking at it from the perspective that hospitals are now understanding better how to treat patients, and that death tolls are actually reducing NOT because the virus is getting less virulent, but because our medical professionals have managed to understand it better, and to reduce the deaths with better treatments.

former player

  • Walrus Stache
  • *******
  • Posts: 8823
  • Location: Avalon
Re: How long can we wait while flattening the curve?
« Reply #3088 on: July 15, 2020, 02:37:56 AM »

Economists do.  Y'all are apparently calculating monetary value using the human capital approach (a rather old fashioned method which only measures the value of production lost) rather than the individual/social willingness-to-pay approach which is more common these days.

I've been wondering for the past few weeks whether someone was going to bring this up.  This has always struck me as completely hypocritical that on a early retirement website - a concept which wouldn't exist if not for ideals underpinning willingness-to-pay - that there are a number of posters who, in this one very specific instance, are unwilling to consider any alternative to a human capital model.

Can you elaborate on this? Willingness to pay in a private goods / property context is different, in my eyes, from allocation of scarce public resources. For example I might well be willing to pay $100k for a sports car, or convert that money into time in order to fund an early retirement, because that is what I want for myself. It would be stupid for public money to be spent on either purchase, because it's not 'for the greater good'. But that doesn't mean it's hypocritical to advocate that citizens each have the freedom to do what they like with their own money versus the public purse.

Right. But QALY only really works for medical decisions.  You use a different calculation for road traffic safety costs.  (Which apparently Bloop for one doesn't understand as he keeps trying to bring road safety into a conversation on health costs.)

No, I don't follow your reasoning. Traffic safety may well be funded on a "how much can we get funding for" basis. But it should follow the same assessment of relative cost vs relative reward. As LightTripper suggested, when considering things like road upgrades, speed limit changes, traffic calming devices etc, the most fair outcomes are gotten when we prioritise changes that will save a lot of lives. And remember that in choosing to set a speed limit at, say, 80km/h instead of 40km/h, we are accepting a certain annual loss of life for mere convenience.

You know what? I started an explanation but 1) it will only give you the opportunity to make more illogical arguments and 2) life's too short and I've other things to get done today.

Try Google.

(Also, in relation to road traffic safety, stop making the amateur's mistake of looking only at what remains to be done and the cost of that as against what has already been done and the cumulative costs of that.  Thanks.)

Abe

  • Magnum Stache
  • ******
  • Posts: 2647
Re: How long can we wait while flattening the curve?
« Reply #3089 on: July 15, 2020, 03:35:38 AM »
Abe: does it make a difference to ICU stats that the preferred treatment these days seems to be CPAP equivalent rather than ventilators, with the result that more people might be treated outside an ICU than would have been thought appropriate earlier on in the pandemic?  If so then stats on ICU usage might be a less consistent marker over time.  Would percentage of hospital deaths outside ICU be a marker for this?  Although I guess as treatments get better/affected populations get younger that also is subject to change.

Disclaimer: not a statistician.

It’s true that more people are managed out of the ICU with non-invasive ventilation, but again that shows the number of very sick people is high since ICUs are being reserved for unstable patients needing ventilation. If anything, ICU admissions probably more accurately reflect severely ill people now than earlier in the pandemic, when a lot of people were admitted for monitoring but weren’t intubated. Hope that answers your question!

This also is related to the question of icu mortality. If one only admits the sickest patients, requiring ventilation, then the survival will be lower than a situation where people aren’t intubated but being monitored for risk of intubation. That latter scenario will be in a relatively resource-rich environment. I’d rather have a patient on cpap or high flow in the ICU ready for intubation if needed than doing it on the floor and wheeling him over while we look for a icu room.
« Last Edit: July 15, 2020, 03:41:41 AM by Abe »

OtherJen

  • Walrus Stache
  • *******
  • Posts: 5267
  • Location: Metro Detroit
Re: How long can we wait while flattening the curve?
« Reply #3090 on: July 15, 2020, 06:30:04 AM »
This isn’t great (and yes, I know, it’s one doctor at one hospital): Miami Hospital ICU Doctor: New Influx Of Patients Is Younger Than Before

Quote
That's one big change. Much younger patients, pretty much healthy. Not really major past medical history.

We are not seeing that much obesity. I know there are some reports about obesity, but at least in the ICU, I would guess maybe 20% of patients are obese. Most of them are pretty young and healthy patients.

And also they get sicker than the previous [wave]. Mortality has not been a major issue because they are younger patients. But I think as the days go on, we might also see a change in mortality.

ender

  • Walrus Stache
  • *******
  • Posts: 7402
Re: How long can we wait while flattening the curve?
« Reply #3091 on: July 15, 2020, 07:34:28 AM »
https://www.smh.com.au/national/best-doctors-and-nurses-australia-leads-world-in-covid-19-icu-survival-rates-20200714-p55byq.html - see the graph.

I'm a little confused why this article attempts to compare Australia/USA. USA has massively more cases than Australia (3.5M vs 10k according to https://www.worldometers.info/coronavirus/ so about 350x as many cases) but they use barely over 2x the ICU data they are using...

It seems pretty obvious to me that some of their datasets are woefully insufficient to draw the conclusions they are doing so.

While it's certainly possible that Australia is doing considerably better than the USA for ICU survival, it's hard for me to be remotely confident in that comparison from their data set (same with comparing against Italy/China). Comparing against the UK seems more reasonable since the cases/ICU ratio is closer (UK has had about 30x as many cases as Australia and their numbers are around 50x for tracked ICU cases so at least the same ballpark).

But unless the ICU admittance rate in Australia is around 175x what it is in the USA, it seems like a bit of a silly comparison.

habanero

  • Handlebar Stache
  • *****
  • Posts: 1145
Re: How long can we wait while flattening the curve?
« Reply #3092 on: July 15, 2020, 09:34:49 AM »
Sweden has an IC survival rate of a bit over 70%. If you remove the 80+ age group it is over 80%.

In general, patients > 80 years are not sent to the ICU as it is quite often not deemed worthwile but they receive care in the care home they live in. Same story in Norway, albeit with much fewer cases. More than half the deaths occur outside the hospital (read: in care homes) both in Norway and Sweden.


boy_bye

  • Handlebar Stache
  • *****
  • Posts: 2471
Re: How long can we wait while flattening the curve?
« Reply #3093 on: July 15, 2020, 12:14:52 PM »
Trump didn't have the level of control over the CDC he needed to sufficiently hide the problem, so this step makes a lot of sense.  CDC wasn't staying on brand.

I don't know if it would be possible to design a WORSE "leader" to get the US through this. It's so frustrating! There are a lot of smart and moral people here! We could be doing so much better!

JGS1980

  • Pencil Stache
  • ****
  • Posts: 907
Re: How long can we wait while flattening the curve?
« Reply #3094 on: July 15, 2020, 12:32:11 PM »
Trump didn't have the level of control over the CDC he needed to sufficiently hide the problem, so this step makes a lot of sense.  CDC wasn't staying on brand.

I don't know if it would be possible to design a WORSE "leader" to get the US through this. It's so frustrating! There are a lot of smart and moral people here! We could be doing so much better!

Alas, the inherent weakness of democracy as a system of government. I assure you I personally could not get elected dog-catcher...

HBFIRE

  • Handlebar Stache
  • *****
  • Posts: 1311
  • Age: 45
  • Location: Huntington Beach, CA
Re: How long can we wait while flattening the curve?
« Reply #3095 on: July 15, 2020, 02:24:28 PM »

New Data on T Cells and the Coronavirus

Interesting takeaways:

- there are people who have both CD4+ and CD8+ T cells that recognize protein antigens from the new coronavirus even though they have never been exposed to SARS, MERS, or the new virus

- A new paper from Nature confirms that convalescent patients from the current epidemic show T-cell responses (mostly CD4+ but some CD8+ as well) to various epitopes of the N (nucleocapsid) protein. Turning to patients who had caught SARS back in 2003 and recovered, it is already known (and worried about) that their antibody responses faded within two or three years. But this paper shows that these patients still have (17 years later!) a robust T-cell response to the original SARS coronavirus’s N protein, which extends an earlier report of such responses going out to 11 years.

- The above point may indicate that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between antibody responses that seem to be dropping week by week in convalescent patients but few (if any) reliable reports of actual re-infection.

- There is likely past zoonotic coronavirus transmission in humans, unknown viruses that apparently did not lead to serious disease, which have provided some people with a level of T-cell based protection to the current pandemic.


boy_bye

  • Handlebar Stache
  • *****
  • Posts: 2471
Re: How long can we wait while flattening the curve?
« Reply #3096 on: July 15, 2020, 07:23:46 PM »
Trump didn't have the level of control over the CDC he needed to sufficiently hide the problem, so this step makes a lot of sense.  CDC wasn't staying on brand.

I don't know if it would be possible to design a WORSE "leader" to get the US through this. It's so frustrating! There are a lot of smart and moral people here! We could be doing so much better!

Alas, the inherent weakness of democracy as a system of government. I assure you I personally could not get elected dog-catcher...

Eh, I wouldn't say "democracy" is the major reason we ended up with this president but that's a topic for another thread.

deborah

  • Senior Mustachian
  • ********
  • Posts: 15962
  • Age: 14
  • Location: Australia or another awesome area
Re: How long can we wait while flattening the curve?
« Reply #3097 on: July 15, 2020, 07:53:01 PM »
Trump didn't have the level of control over the CDC he needed to sufficiently hide the problem, so this step makes a lot of sense.  CDC wasn't staying on brand.

I don't know if it would be possible to design a WORSE "leader" to get the US through this. It's so frustrating! There are a lot of smart and moral people here! We could be doing so much better!

Alas, the inherent weakness of democracy as a system of government. I assure you I personally could not get elected dog-catcher...

Eh, I wouldn't say "democracy" is the major reason we ended up with this president but that's a topic for another thread.
The democracies of the world are ranked here https://en.wikipedia.org/wiki/Democracy_Index - most have done well with covid19.

Mr. Green

  • Magnum Stache
  • ******
  • Posts: 4494
  • Age: 40
  • Location: Wilmington, NC
Re: How long can we wait while flattening the curve?
« Reply #3098 on: July 15, 2020, 08:20:24 PM »

New Data on T Cells and the Coronavirus

Interesting takeaways:

- there are people who have both CD4+ and CD8+ T cells that recognize protein antigens from the new coronavirus even though they have never been exposed to SARS, MERS, or the new virus

- A new paper from Nature confirms that convalescent patients from the current epidemic show T-cell responses (mostly CD4+ but some CD8+ as well) to various epitopes of the N (nucleocapsid) protein. Turning to patients who had caught SARS back in 2003 and recovered, it is already known (and worried about) that their antibody responses faded within two or three years. But this paper shows that these patients still have (17 years later!) a robust T-cell response to the original SARS coronavirus’s N protein, which extends an earlier report of such responses going out to 11 years.

- The above point may indicate that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between antibody responses that seem to be dropping week by week in convalescent patients but few (if any) reliable reports of actual re-infection.

- There is likely past zoonotic coronavirus transmission in humans, unknown viruses that apparently did not lead to serious disease, which have provided some people with a level of T-cell based protection to the current pandemic.
That is interesting. One of the theories on the origin of this coronavirus is that it has been circulating in humans for some time in previously unharmful form before mutating into a harmful one. The thought was it helped explain why it's just so dang good at attaching to ACE2 receptors, which some scientists believe is an "evolved" state.

Gremlin

  • Pencil Stache
  • ****
  • Posts: 581
Re: How long can we wait while flattening the curve?
« Reply #3099 on: July 15, 2020, 08:47:33 PM »

Economists do.  Y'all are apparently calculating monetary value using the human capital approach (a rather old fashioned method which only measures the value of production lost) rather than the individual/social willingness-to-pay approach which is more common these days.

I've been wondering for the past few weeks whether someone was going to bring this up.  This has always struck me as completely hypocritical that on a early retirement website - a concept which wouldn't exist if not for ideals underpinning willingness-to-pay - that there are a number of posters who, in this one very specific instance, are unwilling to consider any alternative to a human capital model.

Can you elaborate on this? Willingness to pay in a private goods / property context is different, in my eyes, from allocation of scarce public resources. For example I might well be willing to pay $100k for a sports car, or convert that money into time in order to fund an early retirement, because that is what I want for myself. It would be stupid for public money to be spent on either purchase, because it's not 'for the greater good'. But that doesn't mean it's hypocritical to advocate that citizens each have the freedom to do what they like with their own money versus the public purse.

Because willingness to pay isn't simply a financial concept.  It could also mean a willingness to pay a social price by an individual. In the post below, you seem to very strongly advocate that everyone should be able to self-assess their own willingness to pay a social cost being asked.


Because the risk (economic, health or otherwise) to individuals, or certain groups, can be higher/lower than for the general population, "learning to live with" the disease can mean different things for different people. Some groups might be subject to more or less onerous conditions. There might not be a consensus on which groups or which conditions those might be. And that's okay. Everyone probably has to do something to help the community, but that "something" is going to vary in intensity and duration.

You're okay with not having a consensus on willingness to pay a social price.  For the sake of example, that implies it's okay for a bunch of Melbourne security guards not being willing to pay a social price that others, including yourself, would expect.  Except your more recent posts suggest you're not.  Human (social) capital wins out in your more recent posts because someone else has made a (social) willingness to pay decision that disadvantages you.

But even if we limit it to simply a financial concept, it still strikes me as hypocritical.  The human capital model is one predicated, not on the value of your future years lived, but actually on QALY as a proxy for your future human capital.  There is even a version of QALY that explicitly incorporates this - it projects forward only to the conclusion of the individual's working life and then turns negative.  In other words, you only have a positive value under this model up to the point that you retire.  If you believe this stuff, then logically it makes sense - your only value to society is the work you do, you may have assets but society is indifferent to whether it's you or your beneficiaries who utilise those assets.  I'll leave it to you to think through why early retirement as a concept is inconsistent with this kind of mantra.