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California’s Roadmap to Modify the Stay-at-Home Order [pdf]

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Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#211

Post by saalweachter »

apatters wrote: post #180
Animats wrote: post #129

Earlier quoted context omitted.

That's a good question. If control measures are undertaken to "flatten the curve" down to the capacity of the medical system, we'd expect to see new infections per day and deaths per day level out, maybe decline a little, but not decline a lot. Which is what the actuals show for the areas worst off.[1] At some point, there's saturation, and "herd immunity". For this virus, that's somewhere in the 60%-80% range of the…

It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here? - Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. - Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most peo…

> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.

"Significantly less than 200 million Americans catching it" is still on the table.

"Herd immunity" is just the point at which the reproduction rate of the disease falls below 1 because the average infected person does not encounter anyone else to infect (because everyone else has already been infected) before they recover. It's not a binary switch, though -- as the percent of the population that has recovered grows, the reproduction rate shrinks steadily.

This means, for instance, that if we had X infected individuals before the lock downs, and then -- because we can't stay completely locked down forever -- we at some point have X infected individuals again after the lock downs end, we're actually in a much better place, because the reproduction rate of the disease is lower and that X will become 2X much slower than it would have before the lock downs.

This also synergizes with stay-at-home orders, which also reduce the reproduction rate of the disease. Right now we're relying entirely on stay-at-home to reduce the reproduction rate to as close to (or below) 1 as possible, but in a month or two, once a portion of the population has recovered, we'll be able to rely on a mix of "herd immunity" and stay-at-home to achieve the same thing; it's entirely reasonable that we can drag it out for years, and that less than 50 or 100 million Americans will catch it before a vaccine is developed.

It isn't hopeless.

> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.

We're currently losing 12-17 years of life per death, based on the statistics out of New York. It's older folks, sure, but it's hardly just taking people off their death beds.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#212

Post by _delirium »

vanniv wrote: post #160
wbl wrote: post #153

Earlier quoted context omitted.

The government has the power to check temperatures, force people to use a contact tracing app, require masks etc.

It actually largely doesn't have that power. I mean, it does until challenged, and it could impose restrictions on entering government buildings -- but the government really doesn't have an unlimited authority to declare arbitrary restrictions on the right of people to peaceably assemble. Not legally, anyway.

At least at the state level, states' general police powers have usually been interpreted to give pretty broad authority to enforce measures like quarantines and mandatory isolation if necessary to protect public health. There's a bit of recent case law from the 2014 Ebola quarantines: a few nurses who had had contact with a suspected case (but had no symptoms) were put under mandatory quarantine, and sued for unlawful detention, but courts upheld the quarantine.

There's some limit to these powers, e.g. a quarantine in SF in the year 1900 was struck down as being racially discriminatory in a way not justified by public health (only ethnic Chinese were quarantined). But courts are reluctant to second-guess this kind of thing unless it seems like a pretext.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#213

Post by oh_come_on »

zaidf wrote: post #206

For everyone who has tracked California’s response over the past month (the good and the bad), the #1 problem is obvious: a) California’s testing and reporting infrastructure is absolutely abysmal, arguably the worst in the country b) there are very few signs that it will improve anytime soon California leaders haven’t had to confront this publicly because much of the last one month had been focused almost exclusivel…

There’s no way that California is less effective then red states like Texas

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#214

Post by apatters »

digitaltrees wrote: post #195
apatters wrote: post #180

Earlier quoted context omitted.

It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here? - Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. - Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most peo…

It’s not 0.5% it’s closer to 2%. You don’t have a normal economy if people don’t want to go out in public or the supply chain is interrupted as workers get sick. A pandemic will harm the economy no matter what we do, these efforts, it is hoped, will reduce the impact while also saving lives and the hospital system.

What's your source for 2%? A recent study which was featured on Hacker News estimated the infection fatality rate at 0.66%. [1]

I have seen a number of studies putting the case fatality rate at 2-3%, but this number cannot be generalized to the entire population because current testing is skewed toward the most serious cases. [2]

Long-term mortality in the total population may look something like 0.66% * 0.7 assuming there are no advances in treatment (possible but unlikely, given the unprecedented efforts that are underway, and how naive we were on day one).

In general more recent studies estimating IFR should be more accurate, early ones came with a lot of caveats. If there is a better estimate of IFR than 0.66%, I would like to read it.

[1] https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

[2] https://en.wikipedia.org/wiki/Case_fatality_rate

[3] https://news.ycombinator.com/item?id=22828691

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#215

Post by sergiotapia »

viklove wrote: post #203
sergiotapia wrote: post #198

Earlier quoted context omitted.

Whatever number you arrive at is your concern. You want to shelter in place go for it. What I don't want is the government shutting down everything. Leave it to the individual.

And when 3-5 million people die over the course of a year you won't blame the government?

Those numbers aren't realistic.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#216

Post by jdminhbg »

charlesju wrote: post #109
mchusma wrote: post #67

A real plan would look like this https://imgur.com/spemOeG specifying the levels of restrictions and the metrics we will use to track the metrics. This allows people to understand what to expect the best possible. We already have huge uncertainty, we don't need to add uncertainty of government response on top of uncertainty of the virus. I think there is huge room to debate the numbers and what goes in what level, bu…

The reason why your solution is not good is because it pigeon holes the government into expectations. The government doesn't have a crystal ball as to how this all plays out, they need to have the flexibility to change how they want to respond to each situation without having to defend an ultimatum. For example, even in your own example here are several situations you didn't account: -- The availability of tests for…

> I think Governor Cuomo said something very interesting the other day, to paraphrase, when he was asked whether he should've started stay at home earlier and if that would've saved lives. Of course it would have, but the interviewer is not taking into account compliance and public sentiment.

That’s great, but right up until the shutdown, De Blasio and other NYC officials were encouraging New Yorkers to go out and support their local theaters, restaurants, and bars. And at no point did initial shutdowns meet with any substantial resistance. This is just retconning the history of the past six weeks to make himself look better.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#217

Post by azakai »

apatters wrote: post #180
Animats wrote: post #129

Earlier quoted context omitted.

That's a good question. If control measures are undertaken to "flatten the curve" down to the capacity of the medical system, we'd expect to see new infections per day and deaths per day level out, maybe decline a little, but not decline a lot. Which is what the actuals show for the areas worst off.[1] At some point, there's saturation, and "herd immunity". For this virus, that's somewhere in the 60%-80% range of the…

It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here? - Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this. - Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most peo…

> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.

We don't know that's inevitable. Korea, Japan and Taiwan suggest another outcome is possible, and while a vaccine may not arrive in 6 months, lots of other things might: better treatments, better masks, better testing, better tracing, etc.

> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.

Death isn't the only metric. A lot more than those dying will be the amount of people that are hospitalized in very serious shape. Some of them will have long-term damage, and some of them will die if the hospitals are overwhelmed.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#218

Post by esoterica »

ninetyfurr wrote: post #50

They should quit padding the numbers if they're so concerned about minimizing fatalities. A man gets hit by a bus and tests positive for Coronavirus, I don't care what the science has to say about it, that is not a Coronavirus death and you can't change my mind.

Do you think it's likely that 26,000 people happened to get hit by a bus right after getting diagnosed with the coronavirus?

4% of the patients diagnosed with coronavirus in the US have already died (and many more of the currently diagnosed patients are still sick and have not yet died but will in the future). It's wildly implausible that a meaningful fraction of 4% of that sample could have coincidentally died within a few weeks of getting diagnosed with the coronavirus, but for entirely unrelated reasons. If 4% of the population were dying every few weeks, humanity would be virtually extinct within a few years. Your "stat-padding" theory doesn't pass a basic smell test.

You can construct far-fetched pathological scenarios for how 1 or 2 people might be wrongly identified as coronavirus victims, but you can't explain away 26k deaths with baseless conspiracy theories.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#219

Post by dnautics »

zaidf wrote: post #206

For everyone who has tracked California’s response over the past month (the good and the bad), the #1 problem is obvious: a) California’s testing and reporting infrastructure is absolutely abysmal, arguably the worst in the country b) there are very few signs that it will improve anytime soon California leaders haven’t had to confront this publicly because much of the last one month had been focused almost exclusivel…

I would argue that reducing the rate of deaths is the #1 problem, followed by reducing the rate of infections, followed by being able to determine the rate of infections.

So, unless you believe california results are 10x off, based on empirical results and your assertion that the testing and reporting infrastructure is "the worst", the state of california has at least done a fair job of managing its effort in the face of a limited resource. Knowing in detail what's going on is strictly secondary to reducing deaths.

Re: California’s Roadmap to Modify the Stay-at-Home Order [pdf]

#220

Post by pfranz »

mchusma wrote: post #178
pfranz wrote: post #138

Earlier quoted context omitted.

The attached spreadsheet is basically I've been waiting to see. I figured from the title of this post that's what this would be. Everyone I talk to is asking, "Now what? Do we just keep doing this until there's a vaccine?" This post is "California's Roadmap" as in California the government, not California the public. They all seem like questions they should have been asking themselves at least a month ago. Sure, keep…

Thanks for chiming in. As I said in another thread I think at least this is the kind of framework for a discussion. Want to add more columns? Great. Want to double a number or halve a number, great. I personally think there is zero downside to publishing the numeric targets. Of you get more data in to change them, just change them (it's at least better than now where they have dates that they just keep changing). I d…

What was touched on in the reply, things like the amount and distribution of testing, the compliance and effectiveness of measures like wearing masks, and other information and treatments could change the criteria marked in green--which means they'd have to be revised publicly causing confusion. Kept internal they can revise it as things change and just announce Level changes publicly.

All of those numbers in green have been called out as likely incorrect at the moment. You can see positive tests jump as more are done in the daily numbers. In situations where people are dying they're often foregoing tests to save them for the living. At some point we'll hopefully have wider testing which will change the numbers and likely the criteria for level changes.

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