Day 112: COVID-19 Missing Correlations?

 

“We know everything about Sars-CoV-2 and nothing about it. We can read every one of the (on average) 29,903 letters in its genome and know exactly how its 15 genes are transcribed into instructions to make which proteins. But we cannot figure out how it is spreading in enough detail to tell which parts of the lockdown of society are necessary and which are futile. Several months into the crisis we are still groping through a fog of ignorance and making mistakes. There is no such thing as ‘the science.’” — Matt Ridley

Hat tip to Al French of Damascus for directing my attention to the Matt Ridley piece from which the quote starts the entire discussion of where we are in this epidemic.

Ridley introduces a new word into my vocabulary: nosocomial. That is the word that medical personnel use to refer to infections acquired within a medical facility or place where one receives medical care. Another quote from Ridley’s piece:

The horrible truth is that it now looks like in many of the early cases, the disease was probably caught in hospitals and doctors’ surgeries. That is where the virus kept returning, in the lungs of sick people, and that is where the next person often caught it, including plenty of healthcare workers. Many of these may not have realised they had it, or thought they had a mild cold. They then gave it to yet more elderly patients who were in hospital for other reasons, some of whom were sent back to care homes when the National Health Service made space on the wards for the expected wave of coronavirus patients.

The evidence from both Wuhan and Italy suggests that it was in healthcare settings, among the elderly and frail, that the epidemic was first amplified. But the Chinese authorities were then careful to quarantine those who tested positive in special facilities, keeping them away from the hospitals, and this may have been crucial. In Britain, the data shows that the vast majority of people in hospital with Covid-19 at every stage have been ‘inpatients newly diagnosed’; relatively few were ‘confirmed at the time of admission’. The assumption has been that most of the first group had been admitted on an earlier day with Covid symptoms. But maybe a lot of them had come to hospital with something else and then got the virus.

When we think of the nosocomial phenomena we tend to think of hospitals. But nursing homes and any form of group elderly care would also qualify. Are we missing some correlations?

The other day Governor Andrew Cuomo of New York issued a report citing 66% of those hospitalized in New York had been “staying at home” before they became ill. How many of these patients’ “home” was a nursing home or other form of group care for the elderly? They did not say.

There is another report back on April 13 that 2,400 of the deaths in New York from COVID-19 occurred in nursing homes or assisted living facilities — not at hospitals. That was about 25% of recorded deaths from COVID-19 at the time. Did that pace continue? If those deaths are counted as “hospitalizations” before death and those nursing home and assisted living residents who were actually hospitalized are segregated out of the “home” statistics for the hospitalized in that report, what percentage of total COVID-19 illness is attributable to nursing homes, assisted living, and hospital care as opposed to all other infections?

A final note from the Ridley article:

Once the epidemic is under control in hospitals and care homes, the disease might die out anyway, even without lockdown.

Could it be that simple? If not simple, could it at least conform to the 80-20 rule — focus our attention on these facilities and gain most of the benefit?

[Note: Links to all my COVID-19 posts can be found here.]

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  1. Arahant Member
    Arahant
    @Arahant

    Good questions.

    • #1
  2. MarciN Member
    MarciN
    @MarciN

    And we have known all of this since the outbreak in Italy.

    I am out of patience today with the public policy makers.

    • #2
  3. Hugh Member
    Hugh
    @Hugh

    Interesting questions.  Thank you.

    • #3
  4. Al French of Damascus Moderator
    Al French of Damascus
    @AlFrench

    Rodin: The other day Governor Andrew Cuomo of New York issued a report citing 66% of those hospitalized in New York had been “staying at home” before they became ill.

    I’m confused about what this means. If you have been “staying at home” within the stay-at-home guidelines, how did you get the virus? If you got it while shopping, or from someone making deliveries to your house, how is the statistic useful?

    • #4
  5. MarciN Member
    MarciN
    @MarciN

    Al French of Damascus (View Comment):

    Rodin: The other day Governor Andrew Cuomo of New York issued a report citing 66% of those hospitalized in New York had been “staying at home” before they became ill.

    I’m confused about what this means. If you have been “staying at home” within the stay-at-home guidelines, how did you get the virus? If you got it while shopping, or from someone making deliveries to your house, how is the statistic useful?

    This has a lot to do with the viral load of your initial exposure to this virus. This article explains a lot of this in language that is understandable to the nonmicrobiologist. :-)

     

    • #5
  6. Stina Member
    Stina
    @CM

    Al French of Damascus (View Comment):

    Rodin: The other day Governor Andrew Cuomo of New York issued a report citing 66% of those hospitalized in New York had been “staying at home” before they became ill.

    I’m confused about what this means. If you have been “staying at home” within the stay-at-home guidelines, how did you get the virus? If you got it while shopping, or from someone making deliveries to your house, how is the statistic useful?

    How are QUARANTINES useful?

    • #6
  7. Arahant Member
    Arahant
    @Arahant

    Stina (View Comment):
    How are QUARANTINES useful?

    A real quarantine means people wait in a certain area for forty days before being allowed to come into the country/city/etc. They are very useful. This sheltering in place nonsense is not terribly useful, and the initial excuse was to flatten the curve so hospitals wouldn’t be overwhelmed.

    • #7
  8. Mendel Inactive
    Mendel
    @Mendel

    The Ridley article makes a number of good points, although it does oversimplify some of the scientific debate, gets a few minor details wrong, and pretends there’s certainty on some topics for which there are presently just indications. Plus, there’s some arrogance involved in starting off an essay with “nobody knows what’s going on yet because this is difficult stuff” and then ending it along the lines of “but actually, I know what’s going on and have one simple trick to fix it all”.

    I don’t think there’s a simple trick to get out of this pandemic at the moment, although the possibility of getting lucky (by the virus being much less transmissible over the summer, somebody discovering a truly game-changing medication, rapid vaccine development, etc.) is certainly omnipresent. However, if we strip off some of his oversimplification and take a more sober look at a few of his main points, there are lessons.

    His point about schools is still far from settled. He depicts it as a nearly open-and-shut case, but the data is still quite conflicting.

    However, he is absolutely right that one epidemiological study after another is showing how hard it is to actually spread this virus. It’s somewhat puzzling given how rapidly it did indeed spread in many different countries. I’m not convinced that his answer (it’s almost all due to hospitals and assisted living facilities) is completely right, although it probably explains the explosive death rates in a few countries. However, it certainly does seem as though something akin to the 80/10 rule might be in effect (i.e. 80% of transmission by only 10% of infected people).

    My proposal for weeks now has been for patially lifting lockdowns such that we avoid/prohibit larger gatherings, especially in enclosed spaces, while allowing (and encouraging) smaller indoor gatherings and somewhat larger outdoor gatherings. I am convinced there are suitable compromises that would allow for most economic activity to resume while containing the majority of transmission, but presently nobody seems interested in trade-off style proposals.

    • #8
  9. Mendel Inactive
    Mendel
    @Mendel

    MarciN (View Comment):

    And we have known all of this since the outbreak in Italy.

    I am out of patience today with the medical community and public policy makers.

    Actually we haven’t. Many of the studies Ridley cites have only come out in the past three weeks or so, well after the peak in Italy.

    • #9
  10. MarciN Member
    MarciN
    @MarciN

    Mendel (View Comment):

    MarciN (View Comment):

    And we have known all of this since the outbreak in Italy.

    I am out of patience today with the medical community and public policy makers.

    Actually we haven’t. Many of the studies Ridley cites have only come out in the past three weeks or so, well after the peak in Italy.

    Wow, I really really don’t like to argue with you. You know more about this subject than just about anyone. :-)

    But I have to say that it was very obvious that the infections were spreading outward from the Lombardy healthcare facilities, both long term and critical care. In fact, as I recall, that understanding of what was occurring in Lombardy drove the global desire for personal protective equipment for people working in healthcare settings.

    • #10
  11. Roderic Reagan
    Roderic
    @rhfabian

    The obvious way to increase our knowledge of what works to control the virus is to try it different ways and see what happens.  We are in the process of doing that.  Some states have eased restrictions and it seems to be going well.  Since ending some restrictions 11 days ago Texas has not seen a significant increase in new cases.  Gov. Abbott will no doubt ease restrictions further.  Georgia is having good results, too.

    Can you guess what the headline was for news from Texas?  Texas Daily New Cases Tops 1000!  Which, as I said, was not a significant difference.

    Some state and local governments just don’t even want to try it.   That’s rational for some of them such as NYC since they are very much still in the woods.   Ah, federalism!

    • #11
  12. Jerry Giordano (Arizona Patrio… Member
    Jerry Giordano (Arizona Patrio…
    @ArizonaPatriot

    Some of the Ridley article is interesting.  I agree with Mendel that he may have a point about the — what’s that 50-cent word? — nosocomial method of transmission being important.

    Some of the Ridley article is silly.  We know everything and we know nothing.  Maybe he’s just trying to invoke Dickens, but give me a break.  The idea that someone has deciphered the genetic code of the virus, so we should somehow know everything about it, is just silly.  It’s like the old “we can put a man on the moon” argument.  We still don’t know much about how biological systems work, in terms of which genes do what.  Sure, we’ve deciphered the genetic code.  It’s like a 100-page book in Japanese on fuel injection systems, when you don’t know Japanese and you don’t know much of anything about an engine.

    I did not like the way that the article asserts that testing has somehow helped.  Perhaps it has, and perhaps it has not, but correlation does not prove causation and testing alone is unlikely to help much.  Remember my post blaming it on the Romans?  There was quite a strong correlation at the time.

    Testing might help some, if those who test positive then self-quarantine (or are required to do so).  Of course, depending on how the testing is set up, the test facility itself could be quite a good nosocomial source of infection.

     

    • #12
  13. Steven Seward Member
    Steven Seward
    @StevenSeward

    Jerry Giordano (Arizona Patrio… (View Comment):

    Some of the Ridley article is interesting. I agree with Mendel that he may have a point about the — what’s that 50-cent word? — nosocomial method of transmission being important.

    Some of the Ridley article is silly. We know everything and we know nothing. Maybe he’s just trying to invoke Dickens, but give me a break. The idea that someone has deciphered the genetic code of the virus, so we should somehow know everything about it, is just silly. It’s like the old “we can put a man on the moon” argument. We still don’t know much about how biological systems work, in terms of which genes do what. Sure, we’ve deciphered the genetic code. It’s like a 100-page book in Japanese on fuel injection systems, when you don’t know Japanese and you don’t know much of anything about an engine.

    I did not like the way that the article asserts that testing has somehow helped. Perhaps it has, and perhaps it has not, but correlation does not prove causation and testing alone is unlikely to help much. Remember my post blaming it on the Romans? There was quite a strong correlation at the time.

    Testing might help some, if those who test positive then self-quarantine (or are required to do so). Of course, depending on how the testing is set up, the test facility itself could be quite a good nosocomial source of infection.

    Ridley made some really interesting points, but I was not persuaded on his “testing, testing, testing” hypothesis either.  For one, his  assertion that the countries that test the most have the fewest deaths is just not true.  If the Worldometers website is accurate at all, some of the countries with the highest rates of testing are San Marino, Spain, Belgium, Isle of Mann, Ireland, and Italy.  These are places with some of the highest deaths per capita in the World, in fact San Marino is undisputed #1.  South Korea’s much vaunted testing rate is only a smidgen above 1%, enough to put them behind at least 60 other countries.

     

    • #13
  14. Southern Pessimist Member
    Southern Pessimist
    @SouthernPessimist

    Matt Ridley is one of the journalists observing the debates involving science whom I follow fairly closely. His books on rational optimism, genetics and evolution are entertaining and worthy of carefully consideration. He has been a cheerful warrior in the battle against the fraud of global warming/ climate change. Before the article quoted above, he was one of the first science journalists to warn that this virus was the wolf that the boy who cried wolf was always shouting about. He is right to admit that he didn’t know then what we need to know now. His point that data is far more valuable than projections and models has apparently not been understood by the media.

    • #14
  15. Old Bathos Moderator
    Old Bathos
    @OldBathos

    I would love to get the data on the percent of US COVID cases that CANNOT be traced to

    a) The NYC subway
    b) A hospital
    c) A nursing home
    d) A waiting room of a medical provider
    e) Social services

    Hiding at home except for visits to various medical providers is like hunkering down in a WWI trench except for the one day a week one skips and dances out in no man’s land. The period of safety is rather wasted with a single high-risk outing.

    I recall reading one wag arguing (oddly but cogently) that granny would be better off going to the Safeway and risk a low COVID dose exposure than to send her caretaker who could get that same low-dose exposure and then become an asymptomatic (high load) dispenser far more dangerous to granny.  

    In any event, the longer the Great Lockdown persists, the less evidence we see that it worked at all. And the contrary, incomplete guidance from the ‘experts’ is on a par with silver bullets, garlic and crosses.

    It is maddening to see all the silly, useless masks on fellow grocery store customers and those six-foot markers on the floor and know that if we had instead taken a very small fraction of the money lost in the Great Shutdown and used it to build safety zones around vulnerable people and places where those resources were most needed, we likely would have had more “cases” (as we call positive tests on people 90%+ of whom are not sick) but fewer deaths.

    • #15
  16. MarciN Member
    MarciN
    @MarciN

    MarciN (View Comment):

    And we have known all of this since the outbreak in Italy.

    I am out of patience today with the public policy makers.

    I am mad at myself for posting this comment. I saw my daughters in video chats yesterday, and they both looked tired. I’m concerned about them and everyone else these days. But I shouldn’t have criticized so harshly the people on the front lines of dealing with this virus. I think they are doing their best to manage an extremely difficult situation.

    I spent the afternoon reading about the steps Massachusetts is taking toward reopening on May 18. Our governor has been trying to make that date since he first announced it. Every day he gives us an optimistic update no matter how bad the numbers are. I really love this governor. :-) I wish him well. No one has tried harder to see a glimmer of light than he has. :-)

    At any rate, this is the program Massachusetts is embarking on.

    We are one month into the contact-tracing program. Although I share everyone’s concerns about the potential the program has for violating the privacy of individuals, I like the way Massachusetts is handling it. I don’t think they are trespassing on privacy the way South Korea has done. I’m not seeing any indication that the state will be tracking people using the location data from their smartphones.

    Also, Massachusetts is not revealing the name of the person who has tested positive in the calls the state is making to people saying they might have been exposed and asking them to please self-quarantine. The callers will also keep in touch with those agreeing to stay home, and they will be putting those people in touch with others who can run errands for them and connect them to medical resources for help if they need treatment.

    The program amounts to the contact tracers’ calling people who may be have been exposed. I think that may be helpful to people. Also, the state is adhering to the rather loose CDC guidelines for the length of quarantine periods, and the guidelines are reasonable and doable I think.

    This means we will be quarantining individuals, not places. It is so important that we do so.

    The state is also setting up separate covid-19 treatment facilities to avoid contaminating the hospitals. This will allow the healthcare system to get back to normal quickly.

    And the state is embarking on some impressive research to gain understanding of the virus and our immunity to it.

    All of these steps together will allow us to reopen the state for business and prepare us for the next wave we believe is coming in November.

    So I shouldn’t have been so negative this morning. :-) We will get out of this mess. :-)

    • #16
  17. MISTER BITCOIN Member
    MISTER BITCOIN
    @MISTERBITCOIN

    Could it be that simple? If not simple, could it at least conform to the 80-20 rule — focus our attention on these facilities and gain most of the benefit?

    YES and YES

    Once the epidemic is under control in hospitals and care homes, the disease might die out anyway, even without lockdown.

    deaths appear to peak during week 6 and rapid decline after week 8 regardless of country or lockdown

    https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

    you have to ‘click’ on Table 1

    look at April 11, 18 and 25

     

    • #17
  18. Mendel Inactive
    Mendel
    @Mendel

    MarciN (View Comment):

    Mendel (View Comment):

    MarciN (View Comment):

    And we have known all of this since the outbreak in Italy.

    I am out of patience today with the medical community and public policy makers.

    Actually we haven’t. Many of the studies Ridley cites have only come out in the past three weeks or so, well after the peak in Italy.

    Wow, I really really don’t like to argue with you. You know more about this subject than just about anyone. :-)

    But I have to say that it was very obvious that the infections were spreading outward from the Lombardy healthcare facilities, both long term and critical care. In fact, as I recall, that understanding of what was occurring in Lombardy drove the global desire for personal protective equipment for people working in healthcare settings.

    My apologies Marci, I thought you were referring to the studies about heterogeneous transmission. You are correct that the issue of transmission in hospitals became clear very early on.

    • #18
  19. Mendel Inactive
    Mendel
    @Mendel

    Southern Pessimist (View Comment):
    His point that data is far more valuable than projections and models has apparently not been understood by the media.

    Oddly enough this sentiment has been embraced by much of the science and public health world.

    I’m reasonably well tapped into the world of scientific/public health experts on Covid-19, and it’s interesting how few of them pay attention to modeling, and how much they do focus on hard data.

    Even more frustrating is how much criticism has been mounted by scientists against the IHME model. It has been nearly universally panned by mainstream science.

    And yet these models continue to garner so much attention not only by the media but also by decision makers. It’s a strange world in which most of the public and most of the scientific world place little faith in modeling, yet the normal interfaces between science and the public (i.e. the media and politicians) still cling to them.

    • #19
  20. Hammer, The Member
    Hammer, The
    @RyanM

    Mendel (View Comment):

    Southern Pessimist (View Comment):
    His point that data is far more valuable than projections and models has apparently not been understood by the media.

    Oddly enough this sentiment has been embraced by much of the science and public health world.

    I’m reasonably well tapped into the world of scientific/public health experts on Covid-19, and it’s interesting how few of them pay attention to modeling, and how much they do focus on hard data.

    Even more frustrating is how much criticism has been mounted by scientists against the IHME model. It has been nearly universally panned by mainstream science.

    And yet these models continue to garner so much attention not only by the media but also by decision makers. It’s a strange world in which most of the public and most of the scientific world place little faith in modeling, yet the normal interfaces between science and the public (i.e. the media and politicians) still cling to them.

    The IHME model is based in Seattle, and our governor’s “4-phase plan” for ending the lockdown is pretty much verbatim their recommendations. But don’t get me started on WA government.

    I’m f—in over it.  Honestly just banking on that last sentence being correct, that “…the disease will just die off anyway,” writing off this last year as a complete loss, and hoping to start fresh in 2021.

    Of course, when flu season hits… If we can save just one life…

    • #20
  21. Hammer, The Member
    Hammer, The
    @RyanM

    Mendel (View Comment):

    The Ridley article makes a number of good points, although it does oversimplify some of the scientific debate, gets a few minor details wrong, and pretends there’s certainty on some topics for which there are presently just indications. Plus, there’s some arrogance involved in starting off an essay with “nobody knows what’s going on yet because this is difficult stuff” and then ending it along the lines of “but actually, I know what’s going on and have one simple trick to fix it all”.

    I don’t think there’s a simple trick to get out of this pandemic at the moment, although the possibility of getting lucky (by the virus being much less transmissible over the summer, somebody discovering a truly game-changing medication, rapid vaccine development, etc.) is certainly omnipresent. However, if we strip off some of his oversimplification and take a more sober look at a few of his main points, there are lessons.

    His point about schools is still far from settled. He depicts it as a nearly open-and-shut case, but the data is still quite conflicting.

    However, he is absolutely right that one epidemiological study after another is showing how hard it is to actually spread this virus. It’s somewhat puzzling given how rapidly it did indeed spread in many different countries. I’m not convinced that his answer (it’s almost all due to hospitals and assisted living facilities) is completely right, although it probably explains the explosive death rates in a few countries. However, it certainly does seem as though something akin to the 80/10 rule might be in effect (i.e. 80% of transmission by only 10% of infected people).

    My proposal for weeks now has been for patially lifting lockdowns such that we avoid/prohibit larger gatherings, especially in enclosed spaces, while allowing (and encouraging) smaller indoor gatherings and somewhat larger outdoor gatherings. I am convinced there are suitable compromises that would allow for most economic activity to resume while containing the majority of transmission, but presently nobody seems interested in trade-off style proposals.

    And yes, I am going to give you crap about your use of the phrase “trade-offs,” because you’re using it incorrectly. Sowell said: “there are no solutions, only trade-offs,” in reference to the fact that everything has a cost (particularly those things the government gives for “free.”) Not “if you want your freedoms, you gonna have to give up something in return…”  if anything, it would be most accurately applied to the lockdowns themselves. You may or may not save lives, but you will give up many in return. Not solving the problem, just shifting it.

    • #21
  22. Mendel Inactive
    Mendel
    @Mendel

    Jerry Giordano (Arizona Patrio… (View Comment):
    I did not like the way that the article asserts that testing has somehow helped. Perhaps it has, and perhaps it has not, but correlation does not prove causation and testing alone is unlikely to help much.

    Steven Seward (View Comment):
    If the Worldometers website is accurate at all, some of the countries with the highest rates of testing are San Marino, Spain, Belgium, Isle of Mann, Ireland, and Italy. These are places with some of the highest deaths per capita in the World, in fact San Marino is undisputed #1. South Korea’s much vaunted testing rate is only a smidgen above 1%, enough to put them behind at least 60 other countries.

    I think it’s very likely that testing was a major part of the successes in Germany, South Korea, and Iceland. But it’s still more complex than Ridley portrays it.

    Testing is not some generic commodity. It probably makes a huge difference a) when testing is performed, and b) what actions are triggered based on testing.

    For a), Germany and South Korea attribute much of their success to the fact that they overtested while the virus was still relatively rare in their countries. This is quite consistent with one of the notions in Ridley’s article: leaving aside particulars about hospital transmission or superspreading, it’s very obvious that this virus does not spread homogeneously. Rather, it seems to spread in two discrete modes (very roughly speaking): a slow trickle and then a fast explosion. Germany, Iceland, and several East Asian countries aggressively tested while the virus was still in trickle mode.

    And since the trickle mode is a prerequisite for the explosive mode, it makes sense that aggressive testing early on can prevent an explosion later. However, this also might mean that testing – even dramatically increased testing – is much less effective once transmission really gets rolling within a community.

    To b), it’s pretty obvious that testing alone is worthless if you don’t act in some way on it. All of the countries that have successfully leveraged testing into control of their outbreaks also practiced aggressive isolation/quarantining. In South Korea there was quite a bit of coercion and privacy invasion involved, whereas in Germany and some other Western European countries the success of targeted isolation appears to have been bolstered by a high degree of trust and willing cooperation by private individuals. Neither of those are particularly applicable to the US.

     

    • #22
  23. Mendel Inactive
    Mendel
    @Mendel

    Hammer, The (View Comment):
    And yes, I am going to give you crap about your use of the phrase “trade-offs,” because you’re using it incorrectly. Sowell said: “there are no solutions, only trade-offs,” in reference to the fact that everything has a cost (particularly those things the government gives for “free.”) Not “if you want your freedoms, you gonna have to give up something in return…”

    Bring it on.

    First off, “if you want your freedom, you’re going to have to give up something in return” is a basic principle of American conservatism. It’s reflected in the quip “freedom isn’t free” and is a main reason we have a military. So yes, freedom itself is always a trade-off.

    Second, I’m quite familiar with the works of Sowell as is everyone here. And while his the quote was indeed in reference to government policy, there is near unanimous consensus here that the sentiment applies to everything in life. It is also logically self-evident that “there are only trade-offs” translates to “everyone will feel some degree of detriment even from the most efficient solution.”

    In this particular public health situation, there are many different steps we could be taking between “full lockdown” and “return to complete normalcy (and maybe we shelter the vulnerable)”. But each one of those steps comes with a downside (i.e. a trade-off), as should be expected.

    But I have yet to hear or read a serious discussion on the American right that weighs the advantages and disadvantages of specific individual actions, as would be consistent with a “everything is a trade-off” worldview. Instead, all of the arguments I see are based on the premises of “I want no interventions, and if people die that’s life” or “interventions are only acceptable if they result in discomfort to others but not me (i.e. sequester the vulnerable and leave me alone)”.

    • #23
  24. Mendel Inactive
    Mendel
    @Mendel

    I’d also add that conservatives have no issues with trading off national and personal economic health (and by public and private health) for exaggerated or theoretical notions of safety and health.

    The opportunity costs for the taxpayer money we confiscate for our standing military are staggering. And like the Covid lockdowns, the main purpose of our military is prevention: we don’t actively seek conflicts, and the majority of our servicemembers never fire a shot in anger. Instead, our military acts as a deterrent from attack. It provides us a sense of security.

    Are the trillions we spend on our military really providing a good return in terms of actual security? Might we not have the exact same degree of security if we vastly pared back our conventional forces and focused mainly on our strategic nuclear arsenal? It’s quite plausible, but, like with Covid, we don’t know because we’re not willing to conduct that experiment. And yet most conservatives are more than happy to make this trade-off of economic well-being versus psychological well-being.

    Or take the ridiculous amount of money Medicare and other taxpayer-funded sources pay for heroic end-of-life care for elderly patients with little life expectancy. We shell out tens (and sometimes hundreds) of thousands of dollars on treatments with little chance of success for individual patients with very little life expectancy. Yet when Ezekiel Emanuel proposes cutting back on the billions of taxpayer dollars spent on these patients and repurposing that money toward more effective uses, conservatives label him as Doctor Death.

    I’ve said it before and I’ll say again: I think most of the lockdowns have gone too far (or were not necessary in the first place). At the same time, I have no patience for conservatives spouting lofty first principles against the lockdowns which they themselves ignore on a daily basis in other realms of public policy.

    • #24
  25. Steven Seward Member
    Steven Seward
    @StevenSeward

    Mendel (View Comment):

    Southern Pessimist (View Comment):
    His point that data is far more valuable than projections and models has apparently not been understood by the media.

    Oddly enough this sentiment has been embraced by much of the science and public health world.

    I’m reasonably well tapped into the world of scientific/public health experts on Covid-19, and it’s interesting how few of them pay attention to modeling, and how much they do focus on hard data.

    Even more frustrating is how much criticism has been mounted by scientists against the IHME model. It has been nearly universally panned by mainstream science.

    And yet these models continue to garner so much attention not only by the media but also by decision makers. It’s a strange world in which most of the public and most of the scientific world place little faith in modeling, yet the normal interfaces between science and the public (i.e. the media and politicians) still cling to them.

    I think the modeling fiasco has been driven by the Media.  They can’t help themselves when it comes to bad news.  I don’t know this for a fact, but I would think that there were other models out there that had much more reasonable estimates on the death toll, but they  didn’t interest journalists because those more realistic numbers lacked the morbid excitement that drives news as an entertainment.  The laziness or even outright deceitfulness of journalists these days to not verify stories and facts is pervasive.  I have been astounded by the number of conservatives who believed some of these apocalyptic scenarios from the Press, including some Republican Governors.  They should know better.

    On top of all this, the double bonus for news people was the hope that the worst case scenarios might topple the Trump presidency.  It seems that this has bounced back in their face because Trump’s approval numbers have risen  during the crisis.

     

    • #25
  26. The Reticulator Member
    The Reticulator
    @TheReticulator

    Steven Seward (View Comment):
    I think the modeling fiasco has been driven by the Media. They can’t help themselves when it comes to bad news. I don’t know this for a fact, but I would think that there were other models out there that had much more reasonable estimates on the death toll, but they didn’t interest journalists because those more realistic numbers lacked the morbid excitement that drives news as an entertainment. The laziness or even outright deceitfulness of journalists these days to not verify stories and facts is pervasive. I have been astounded by the number of conservatives who believed some of these apocalyptic scenarios from the Press, including some Republican Governors. They should know better.

    This article at VOX tends to steer the blame for acceptance of this model to the White House rather than to journalists, but if you read the fine print it spreads the blame almost everywhere it belongs.  But the criticism of the IMHE model, which you can read in more detail if you follow some of the links, is that it is basically curve fitting based on what has happened over time in other cities, and doesn’t model the mechanisms by which viruses spread. (Somebody on Ricochet posted a link to the VOX article a week ago.)

    • #26
  27. Hammer, The Member
    Hammer, The
    @RyanM

     

    • #27
  28. Steven Seward Member
    Steven Seward
    @StevenSeward

    The Reticulator (View Comment):

    Steven Seward (View Comment):
    I think the modeling fiasco has been driven by the Media. They can’t help themselves when it comes to bad news. I don’t know this for a fact, but I would think that there were other models out there that had much more reasonable estimates on the death toll, but they didn’t interest journalists because those more realistic numbers lacked the morbid excitement that drives news as an entertainment. The laziness or even outright deceitfulness of journalists these days to not verify stories and facts is pervasive. I have been astounded by the number of conservatives who believed some of these apocalyptic scenarios from the Press, including some Republican Governors. They should know better.

    This article at VOX tends to steer the blame for acceptance of this model to the White House rather than to journalists, but if you read the fine print it spreads the blame almost everywhere it belongs. But the criticism of the IMHE model, which you can read in more detail if you follow some of the links, is that it is basically curve fitting based on what has happened over time in other cities, and doesn’t model the mechanisms by which viruses spread. (Somebody on Ricochet posted a link to the VOX article a week ago.)

    Most of the models that I’ve heard in news reports (I purposely don’t watch or listen to news reports but its hard to avoid them) were predicting anywhere from 1.6 Million to 4 Million deaths from Wu Flu in the United States.  I suspect most people hear these numbers before they hear anything from the White House.

    • #28
  29. Hammer, The Member
    Hammer, The
    @RyanM

    Mendel (View Comment):

    But I have yet to hear or read a serious discussion on the American right that weighs the advantages and disadvantages of specific individual actions, as would be consistent with a “everything is a trade-off” worldview. Instead, all of the arguments I see are based on the premises of “I want no interventions, and if people die that’s life” or “interventions are only acceptable if they result in discomfort to others but not me (i.e. sequester the vulnerable and leave me alone)”.

    Perhaps a better phrase would be “all solutions have a cost.”  Regardless, you grossly misrepresent the views of us lofty-minded conservatives… at least my own views.  Maybe there are some caricatures who represent that last line, but I suspect it is a vulgar misstatement across the board.

    I am not a doctor or a virologist, but I do spend every day working with a government system whose stated purpose is the mitigation of harm, and let me assure you, my views are not nearly so crass as “interventions are ok as long as they don’t impact my life!”  Rather, taking a look at both the harm and the intervention, I am daily reminded that our best interventions are generally inadequate to eliminate the harm, yet they very often result in greater harms – like that old joke about punching you in the nose to help you forget the pain in your toe. 

    With respect to this virus, I tend to think of it in this way:  I’ve represented three teenagers who ended up dying of cerebral palsy.  All of them died as a result of some sort of infection or pneumonia.  In talking with doctors about this, it really seems that that is what these sorts of diseases are all about.  Everyone has to die of something, but rarely do people die of the thing they’re actually dying of.  They die of pneumonia.  Colds and flus, oddly, seem to serve that purpose.  They are what gets you in the end.  Or, rather, they are like the last straw.

    It seems to me that covid is essentially a new addition to that group of last straws.  It will either burn out on its own, or it will become less virulent and stick around forever, acting like a seasonal bug.  There is precious little we can do about that.  It is not attacking indiscriminately, it is attacking elderly and infirm, just as other respiratory illnesses tend to do.  It’s not that I consider human lives to be a “trade-off,” it is that I consider this disease to be, very likely, a newly-discovered part of our lives about which we can do very little.  When we react as we have, the primary foolishness is in the idea that this is something we can actually control or eliminate.  Also, we seem to be grossly overstating the impact that it actually has…   (please excuse my long-windedness.  Continued …)

     

    • #29
  30. Hammer, The Member
    Hammer, The
    @RyanM

    (… continuing from #29)

    Yet, for some reason (and I think it is almost entirely media and social media driven), we are reacting to this illness far more like the zombie apocalypse or invasion of the body snatchers than anything else.  Our interventions are extreme, and our desperate need for interventions is unprecedented.  Our willingness to give up basic freedoms and allow centralized control to self-interested politicians with no better access to data than anyone else, and our trust in self-proclaimed “experts” whose primary expertise is trial-and-error, and who tend to live in a very specialized bubble is, again, unprecedented.  We have for some reason decided to compartmentalize, and magnify this single problem of human existence to far beyond every other problem we currently face, at the expense of our ability to deal with any of those other problems.

    And consider the scale of what we’re actually dealing with.  It is probably roughly on par with the flu – something that is hardly nothing, but (importantly) something that we have come to accept as a part of our lives.  Saying that it is 2X “deadlier” than the flu is virtually meaningless, as it serves primarily the same function, seems to operate in roughly the same way, and again, “twice as deadly” must be taken in context…  twice as deadly as the flu (for a disease with no vaccine and few well-tested treatments) is still statistically on par with the flu.  Not something to be totally ignored or disregarded, but also within the bounds of something we are going to need to consider to be a part of our lives for the foreseeable future.

    But more importantly, what about the extremity of our actions?  Here is where that “everything has a cost” comes in.  We could control the flu and even the common cold (which is also not 100% benign) in the same ways we are attempting to control covid.  We could cancel all sporting events, ban large gatherings, all deck out in PPE everywhere we go, wash our hands, sanitize, etc…  It is up for debate whether this would do any good in the long run (our immune systems, for instance, are important), but we could do these things for illnesses we already have, and we don’t.  Why don’t we?  We recognize that the cold/flu operates as I discussed above.  It is an inconvenience to most, and it is the last-straw that kills many.  It is a problem that we keep in mind – but on the long list of problems (poverty, depression, cancers, domestic violence, heart attacks, obesity, international politics… domestic politics like immigration, abortion, etc…), it is not nothing, but neither is it so important that literally everything else is brushed aside.

    So why are we doing this with covid?  

    • #30
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