A Third Solution • Hacker News Board

Re: A Third Solution

#21

Post by marcell » Fri, Apr 24, 2020, 10:47 PM UTC

johnnyo wrote: post #12

marcell wrote: post #6

> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1] The coronavirus infection fat…

The things that generally kill Americans (heart disease, cancer, car crashes, diabetes, etc) aren’t contagious, so this is a bad analogy.

No analogy is perfect, but people need context to understand fatality rates, and see what risk is acceptable. Society doesn't have a goal of 0% death rates. We all accept some risk of death as a cost of continued existence.

New data is showing that the fatality rate from covid-19 is more like existing risk we were all previously exposed to in the course of our existence, and not like a second version of smallpox.

Re: A Third Solution

#22

Post by pb » Fri, Apr 24, 2020, 10:47 PM UTC

caymanjim wrote: post #13

This isn't a unique idea. This is the mainstream view. Everyone knows we need more testing and that testing is the only way to effectively ease distancing rules. That was a pretty extensive writeup to say what we've been hearing from all rational information outlets for a month.

I have not found any mainstream sources that advocate screening everyone every day (which is very different from simply doing "more testing"). Would love some pointers if I'm wrong.

Re: A Third Solution

#23

Post by JoeAltmaier » Fri, Apr 24, 2020, 10:47 PM UTC

jawns wrote: post #11

> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity. > Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of re…

Straw-man. Many scenarios exist to get most of the benefits without resorting to 'everybody simultaneously'.

E.g. 'test and release' where only folks who've been tested are 'released' into the public. Track outbreaks and retest those cohorts thoroughly. And so on.

Re: A Third Solution

#24

Post by jawns » Fri, Apr 24, 2020, 10:47 PM UTC

pb wrote: post #16

jawns wrote: post #11

> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity. > Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of re…

It's daily screening for exactly that reason. Is there something I should change to make that more clear?

But how realistic is daily screening on a wide scale? You're going to face major issues with compliance.

Re: A Third Solution

#25

Post by texasbigdata » Fri, Apr 24, 2020, 10:48 PM UTC

762236 wrote: post #15

One way to achieve ubiquitous screening is for people to perform regular VO2max tests (loosely speaking; you can do submaximal exercises for this). You quickly figure out if you have a stress on your immune system (by watching various metrics), and there are sports-science papers showing this (because they use it to avoid overtraining, which also appears as a stress on the immune system). This is of course not easy t…

Your "sick" vo2 might be above my "healthy" vo2.

So you first need to get 300 Americans on a max treadmill test to baseline, then.....

Re: A Third Solution

#26

Post by rguzman » Fri, Apr 24, 2020, 10:48 PM UTC

pb wrote: post #16

jawns wrote: post #11

> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity. > Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of re…

It's daily screening for exactly that reason. Is there something I should change to make that more clear?

it is pretty clear, but the conclusion of the parent is still pretty strong:

> Sounds like a logistical nightmare.

Re: A Third Solution

#27

Post by pdonis » Fri, Apr 24, 2020, 10:48 PM UTC

jawns wrote: post #11

> If we were able to identify and quarantine everyone who is contagious, including those who are asymptomatic, then we could let everyone else out of lockdown and resume ordinary social and economic activity. > Even with imperfect screening, if we are able to prevent 90% of disease transmission, then the virus’s reproductive number, or R0, will drop below one and the pandemic will quickly fade. There is no risk of re…

> I'm not sure this "test and release" strategy works unless absolutely everybody gets tested simultaneously.

They don't all have to get tested literally simultaneously; but the "release" part of the strategy can't start until the "test" part has covered everybody, or at least close enough to "everybody" that the difference doesn't matter. Note that that's how the strategy is stated in what you quote: if we can identify everyone who is contagious, then we can release everyone else. The "if" has to be complete before the "then" starts; that's what "if"-"then" means.

Re: A Third Solution

#28

Post by centimeter » Fri, Apr 24, 2020, 10:48 PM UTC

JoeAltmaier wrote: post #17

marcell wrote: post #6

> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1] The coronavirus infection fat…

That's a terrible analysis, for reasons well-covered all over HN and elsewhere. This is a whole different thing from 'another flu'. We have to address it head-on. Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.

> for reasons well-covered all over HN and elsewhere.

I've yet to see a compelling argument that LY or QALY analysis is the wrong approach.

> This is a whole different thing from 'another flu'. We have to address it head-on

It sounds like you're not actually offering any relevant response to the parent comment, but just repeating the taglines we all saw in the article.

> Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.

Every political action has victims and beneficiaries. At the moment, we're hurting billions of people (almost the entire world population) to buy (on average) a few expected life-months for a very small section of the population.

Your model of "people dying is bad" is true but not sufficient to make rational decisions.

Re: A Third Solution

#29

Post by tlb » Fri, Apr 24, 2020, 10:48 PM UTC

762236 wrote: post #15

One way to achieve ubiquitous screening is for people to perform regular VO2max tests (loosely speaking; you can do submaximal exercises for this). You quickly figure out if you have a stress on your immune system (by watching various metrics), and there are sports-science papers showing this (because they use it to avoid overtraining, which also appears as a stress on the immune system). This is of course not easy t…

Doesn't a VO2max test take 20 minutes, plus a shower afterwards? That sounds significantly more expensive than collecting vials of saliva.

Also, you'd definitely need to do those VO2max tests in separate, sealed rooms because infected people would be huffing out maximum virus.

Re: A Third Solution

#30

Post by marcell » Fri, Apr 24, 2020, 10:49 PM UTC

JoeAltmaier wrote: post #17

marcell wrote: post #6

> First of all, it’s not “just the flu”. It is something much more dangerous. Catching this virus is a bit like playing a round of Russian roulette. You’ll probably be fine, but you could end up dead I think this is mischaracterizing it. People have to die eventually. One year of existence has a mortality rate of 1%. For a 75-84 year old individual it is nearly 5%. Above 85 it's 14%. [1] The coronavirus infection fat…

That's a terrible analysis, for reasons well-covered all over HN and elsewhere. This is a whole different thing from 'another flu'. We have to address it head-on. Throwing people (a million people?) under the bus is not going to fly, not politically and not morally.

Every year around 3 or 4 million people die in America from a variety of causes. This is sad, but at some point, everyone has to die.

Data is showing that the infection fatality rate is around 0.5%-1%, and is concentrated in older people. [1] is one study, but there are many others. Given this data, it's clear that our current response is out of proportion with reality.

[1] https://www.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...