California’s Roadmap to Modify the Stay-at-Home Order [pdf] • Hacker News Board

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

#351

Post by altcognito » Wed, Apr 15, 2020, 11:25 AM UTC

wjossey wrote: post #307

glaugh wrote: post #257

Earlier quoted context omitted.

Whenever I see the IHME charts[1] (which are great) I think “I wish I could see the what the model predicted before today’s date so I can assess it.” This shows laudable transparency, in my view. (Also the model was directionally correct, it’s not like it was entirely the wrong shape.) [1] https://covid19.healthdata.org/united-states-of-america/cali...

The IHME model is proving to be wildly inaccurate on the downslope due to bad data coming out China. Their projections will continue to creep up in terms of deaths over the next few weeks because the predicted drop offs won’t be happening, sad to say. If you want to see examples, check out their predictions on Italy. Their figures have been underestimating by over 50%, and the gaps will widen each day over the upcomi…

A significant portion of this probably is compliance, but I'm with you completely on "the numbers out of China, particularly at the tail end are farcical". There was a drop off a cliff in cases.

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

#352

Post by altcognito » Wed, Apr 15, 2020, 11:37 AM UTC

xienze wrote: post #96

Ninjak8051 wrote: post #53

Earlier quoted context omitted.

Additionally, notice that the orange data points (actual hospitalizations) are significantly under the "With Intervention" plot. So why even include the slide? Clearly the assumptions behind the "With Intervention" plot do not match reality TODAY, let alone in a few weeks. Not a good sign if people are making actual decisions based on this.

> Clearly the assumptions behind the "With Intervention" plot do not match reality TODAY, let alone in a few weeks. I feel like I’m taking crazy pills with the way people are talking about this whole thing still being out of control, when data shows the situation is even better than the most optimistic models were predicting. And by that I mean, pretend I was on HN 3 weeks ago predicting 25K deaths in the USA by toda…

I think there was genuine concern that the quarantine as implemented would not be enough. You can see lots of stories locally wherever you are about how people aren't obeying the order. Italy was still in a lot of trouble despite having had some quarantine measures in place. Hindsight shows the quarantine was effective enough to get numbers down. The US, despite reacting too late, did lockdown fully relatively quickly.

I would agree that modeling after NYC seems like a bad idea given the lack of density and public transportation. On the other hand, Michigan looked pretty exponential, and as the lagging cases came in from other states, they also began to look fairly exponential as well. Despite cases staying elevated for now, the exponential growth has died down.

The US missed the worst of hospitals being overrun and it running away in multiple cities.

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

#353

Post by simonh » Wed, Apr 15, 2020, 11:41 AM UTC

jml7c5 wrote: post #152

citilife wrote: post #117

Earlier quoted context omitted.

Something weird happened in California, where 20% of their tests were coming back positive, then all the sudden 04/04/2020 they started seeing https://raw.githubusercontent.com/lettergram/covid19-analysi... They also barely tested at all prior to 04/04/2020: https://raw.githubusercontent.com/lettergram/covid19-analysi... In generally though, the rate of positive tests is increasing nation wide: https://raw.githubuser…

>Something weird happened in California, where 20% of their tests were coming back positive, then all the sudden 04/04/2020 they started seeing This is not surprising. When tests were scarce, tests would be rationed to those most suspected of infection.

The cases reported per country, or state are only a narrow window into what is actually happening. The most advanced medical testing company in the world, Roche, is Swiss-German so Germany's testing capability relative to most countries is off the charts. Combined with a highly distributed, yet also highly co-ordinated health care system they have been ahead of the curve in testing on every conceivable metric. As a result they have reported relatively high case totals, because they have been doing mass testing for a long time, but very low death rates because this enabled them to effectively isolate cases quickly.

As countries increase their testing capacity it is quite possible some countries (or states) will end up eventually reporting accelerating numbers of diagnoses even if the actual new case rate in the population is falling.

One way to mitigate that is to report only cases requiring hospital admission. This isn't ideal by any stretch, but is a reasonable proxy for the spread of the virus and at least gives a good indication of the impact on the health care system.

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

#354

Post by altcognito » Wed, Apr 15, 2020, 11:50 AM UTC

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…

I discount any comments that argue IFR as the sole basis for how quickly we can let the disease spread to save jobs on a short term basis.

Hospitalization is a more important factor as it the death count goes up dramatically without intensive care.

These comments always come with a healthy dose of "people aren't seeing reality!?!?", which is a bonus given the level speculation surrounding IFR and the variance therein.

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

#355

Post by Loughla » Wed, Apr 15, 2020, 12:35 PM UTC

altcognito wrote: post #352

xienze wrote: post #96

Earlier quoted context omitted.

> Clearly the assumptions behind the "With Intervention" plot do not match reality TODAY, let alone in a few weeks. I feel like I’m taking crazy pills with the way people are talking about this whole thing still being out of control, when data shows the situation is even better than the most optimistic models were predicting. And by that I mean, pretend I was on HN 3 weeks ago predicting 25K deaths in the USA by toda…

I think there was genuine concern that the quarantine as implemented would not be enough. You can see lots of stories locally wherever you are about how people aren't obeying the order. Italy was still in a lot of trouble despite having had some quarantine measures in place. Hindsight shows the quarantine was effective enough to get numbers down. The US, despite reacting too late, did lockdown fully relatively quickl…

>The US missed the worst of hospitals being overrun and it running away in multiple cities.

I want to add ", so far" to the end of that sentence. I do not hold hope that this will be true as we fight among ourselves to reopen various portions of the country/economy.

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

#356

Post by ajross » Wed, Apr 15, 2020, 12:42 PM UTC

orangecat wrote: post #264

ajross wrote: post #33

Earlier quoted context omitted.

> don't necessarily need shelter-in-place rules Is there a cite for that? Because that's not the way the data looks. Everywhere was growing with roughly the same exponent before lockdown. The numbers were bigger in NY because it grew longer pre-detection, but there's no reason to believe that everywhere else was any different. Really this disease's growth constant looks shockingly consistent almost everywhere in the…

Edit to show the point better: Go here (easily the best visualization site, FWIW), scroll to the bottom where you can see a log chart of per-capita infection rates normalized to a single "start time" metric, and compare the Idaho chart with the New York one. Number of cases is largely a proxy for how many tests are being done ( https://fivethirtyeight.com/features/coronavirus-case-counts... ). Looking at deaths is mo…

But growing with the same exponent! The point was that Idaho doesn't need special mitigation rules, because unmitigated Idaho is somewhere around 2 weeks "behind" New York. Even here people seem not to get that point. The outbreaks are smaller outside the international cities because they were later, not because they're inherently better controlled.

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

#357

Post by lbeltrame » Wed, Apr 15, 2020, 12:45 PM UTC

khuey wrote: post #222

apatters wrote: post #214

Earlier quoted context omitted.

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…

The CFR in Italy is nearly 13%. Even if you make incredibly generous assumptions that there are no unreported deaths and they're only catching 10% of cases that still leaves the infection fatality rate at twice the number you propose

Testing is severely undercounting cases here. People who just experience fever are told to self-isolate and aren't tested. Not all of these (luckily) end up hospitalized, so those are never, ever counted.

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

#358

Post by lbeltrame » Wed, Apr 15, 2020, 12:54 PM UTC

yodsanklai wrote: post #134

throwaway237683 wrote: post #123

Earlier quoted context omitted.

Isn't it amazing that an absolutely massive privacy invasion that is called contact tracing is already accepted as _inevitable_ if we are ever to be allowed to step out of our homes? Talk about cynicism.

> if we are ever to be allowed to step out of our homes? In France, we need to fill a form every time we want to leave our homes. Any non-work related trip should be limited to one hour and 1km, at most once a day. This was decided with no vote or concertation within a couple of days. It also applies to people who live in rural area. They even fly drones in the mountains in order to catch lonely hikers breaking the r…

Did they take inspiration from Italy? That's the same stuff we are subject to every day. And yes, even here we have DDR Volkspolizei-like behavior from people eager to "denounce" those who "break the rules".

The way this lockdown has been implemented is going to cause a lot of problems at the society level afterwards.

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

#359

Post by SpicyLemonZest » Wed, Apr 15, 2020, 12:59 PM UTC

TeMPOraL wrote: post #329

dehrmann wrote: post #319

Earlier quoted context omitted.

> I feel like I’m taking crazy pills with the way people are talking about this whole thing still being out of control A week ago, I remember reading how the Bay Area was bracing for a bracing for a surge and it was the calm before the storm. The Santa Clara county covid-19 dashboard told a different story: day-over-day, new cases were roughly the same for the past two weeks. 2+ weeks into the lockdown, there was obv…

Isn't this just California being in the "3.6 roentgen, not great, not terrible" phase? I.e. number of new cases reported is limited by the number of tests that are able to be made?

Every region (and almost every country) is generally believed to be severely undercounting cases because of limited testing. There's not much reason to believe the problem is worse in California than elsewhere, and a severe surge would be evident in hospitalization and death rates no matter how bad testing is.

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

#360

Post by lbeltrame » Wed, Apr 15, 2020, 12:59 PM UTC

yodsanklai wrote: post #125

standardUser wrote: post #52

It's worth looking at Denmark, Austria, Czechia and other European countries that have already started loosening restrictions this week. Like California, they locked down fast and flattened the curve. Now, Denmark is opening school and all three (plus Germany and parts of Italy) are opening smaller non-essential shops. I haven't found great info on how well these countries have implemented contact tracing, but they d…

I don't think Europe is doing particularly well either. Well, at least France where I live. France is going to release lockdown in a month. My impression is that this is mostly for economical reasons because it was unsustainable. I'm not confident we'll deal with the epidemics much better this time. The gvt still hasn't released their roadmap, but they hope to improve their testing capacity, the availability of masks…

At least in a couple of months we'll know the result of trials for some repurposed drugs (there's quite a bunch slated to end in June). I don't expect miracles or super effectiveness, but some of these might be beneficial enough to take some load off the hospital system.