The San Francisco Bay Area shelter-in-place order is being extended through May • Hacker News Board

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#171

Post by justin66 » Mon, Apr 27, 2020, 9:53 PM UTC

maverick2007 wrote: post #129

justin66 wrote: post #79

Earlier quoted context omitted.

The only thing that is going to keep the curve flat (this is kind of a mind-numbing terminology) is human behavior. Exponential growth is still a thing, and we aren't anywhere near achieving herd immunity. (a physician friend mentioned the other day that we're not truly certain yet that COVID 19 sufferers cannot be reinfected, although that's the popular assumption. So there's also that)

Out of curiosity because I have little to no knowledge of immunology: what do you think that means if someone that already had the disease can be reinfected? Does that have any implication on the efficacy of a vaccine?

The physician I talked to was basically trying to rain on my parade when I said "hey, it will be great when there's a vaccine and we can all go back to normal." Maybe, maybe not.

I don't know that much about it, but sometimes people infected with a coronavirus can get sick again, not as ill as they were previously, but contagious. [1] COVID 19 hasn't been analyzed well enough, long enough to say for certain.

There were some scary stories early on, a month or two ago, about people becoming reinfected with full blown cases of COVID 19, but they really felt more like uncertain anecdotes. I strongly suspect the immunologists will know a lot more about this in just a few weeks. Researchers are already giving people test vaccines and sending them out into the world.

In a nasty - hypothetical - reality where people regularly get reinfected: things do not go back to normal, and we have to figure a lot of difficult social stuff out.

[1] https://www.washingtonpost.com/health/coronavirus-immunity-r...

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#172

Post by exmadscientist » Mon, Apr 27, 2020, 9:54 PM UTC

maverick2007 wrote: post #129

justin66 wrote: post #79

Earlier quoted context omitted.

The only thing that is going to keep the curve flat (this is kind of a mind-numbing terminology) is human behavior. Exponential growth is still a thing, and we aren't anywhere near achieving herd immunity. (a physician friend mentioned the other day that we're not truly certain yet that COVID 19 sufferers cannot be reinfected, although that's the popular assumption. So there's also that)

Out of curiosity because I have little to no knowledge of immunology: what do you think that means if someone that already had the disease can be reinfected? Does that have any implication on the efficacy of a vaccine?

Unfortunately, yes. Consider the common cold: yes, it does mutate fast, but the other big barrier to producing a vaccine is that immunity to it doesn't last very long at all. So if COVID-19 immunity truly doesn't last long, that's a problem.

I doubt this is likely to be the case, though. Antibodies to SARS seemed to have long lifetimes (several years), and COVID is likely to be similar. It is certainly possible that for some people, immunity fades much faster for reasons specific to that person, and that may be what is being picked up in these reports.

It is also possible it's just shoddy lab work. There has been a ton of that going around lately, and it's not just caused by pressure from the situation. Not all scientists are equally competent....

(Disclaimer: my knowledge of immunology is likely little better than yours, but I did at least used to be a Real Scientist in a different field.)

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#173

Post by guygurari » Mon, Apr 27, 2020, 9:55 PM UTC

gridspy wrote: post #154

guygurari wrote: post #127

Earlier quoted context omitted.

We don’t know enough so let’s stop the economy while we find out? That is not typically how we do things, because it’s not a rational response. For example, we didn’t know whether holding a mobile phone close to our ear for extended periods of time leads to serious health issues, and there was suspicion that it does. But we didn’t prohibit it — we let people decide for themselves, and it does seem the risk was lower…

People are not showing up in the ER unable to breathe because they know someone who holds their Cellphone to their ear. Covid-19 is not a theoretical threat.

Many people die in traffic accidents every day, but we don’t ban cars. Everything we do involves some risk. There needs to be a rational discussion on how much lock down is appropriate. We need to look at other countries like Sweden and Austria and learn from them. We need to look at the real costs of a depression. What we have now is “People are dying so let’s lock down everything”.

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#174

Post by primeradical » Mon, Apr 27, 2020, 9:56 PM UTC

CPLX wrote: post #166

primeradical wrote: post #156

Earlier quoted context omitted.

The only people losing civil liberties are the people that die after contracting the virus because we failed to social distance for the necessary amount of time. The "performance metric" you're looking for is the number of tests we conduct. Unless we're testing hundreds of thousands every day, we have no choice but to continue to shelter in place or stay at home. We are not even close to the amount of testing we need…

OK I'll take your bait. What if we have enough tests, then what's the rule?

When you have enough tests, you know who has the virus and who doesn't. All those infected (and all the people they've contacted) can quarantine or seek the care they need, and those who aren't infected can all go get haircuts.

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#175

Post by forgotmylogin2 » Mon, Apr 27, 2020, 9:57 PM UTC

marcell wrote: post #5

Blanket lockdown has to end. This policy has outlived its usefulness, and is harming people's quality of life without a clear goal. The initial premise of the "flatten the curve" memes was to avoid overwhelming hospitals. The shelter-in-place has not only had this effect, it's been too effective. Hospital utilization in the bay area is at around 10% when you count surge capacity that has been added [1]. Meanwhile, da…

+1.

Continuing a lockdown of this severity makes no sense. San Francisco has only had 22 Covid deaths. A city the size of SF would be expected to see 5x as many cancer deaths as that in a normal month [1] and 7x as many heart disease deaths [2]. Instead, we're maintaining a policy that discourages people from seeking preventative treatment for these diseases on the basis that we don't want them contracting a less deadly disease.

The lockdown has proven to be excessive. The doomsday predictions have not come to pass, and we're entering a time of year that is known to be correlated with reduced rates of viral spread (Flu infection rates are 30x higher in the winter than the summer [3]). We need to get people back to work now. Social distancing should still be maintained where feasible but a blanket lockdown will cause way more harm than good.

[1] https://www.cdc.gov/cancer/dcpc/research/articles/cancer_202... [2] https://www.cdc.gov/heartdisease/facts.htm [3] https://www.cdc.gov/flu/weekly/index.htm

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#176

Post by arblify » Mon, Apr 27, 2020, 9:57 PM UTC

CPLX wrote: post #90

primeradical wrote: post #49

Earlier quoted context omitted.

To anyone reading the comment above, it is extremely poor advice and should not be followed. Stay at home and shelter in place orders are not solely for the purpose of protecting ones-self from contracting the virus. They also serve to limit the spread from unsuspecting carriers. You can carry and spread the virus unknowingly and this will result in susceptible people contracting it and dying. The only way we know th…

> The only way we know that shelter in place orders worked is if they feel like an overreaction after this is all over with. That's the only way to know? You think it's reasonable to take away the civil liberties of seven million people indefinitely without at least trying to come up with a better performance metric than that? You have literally no interest in setting up any kind of plan to assess how the policy is w…

I think you're right, we do need a plan, but we need trained epidemiologists and other public health figures to define that plan. Many features of disease spread are counterintuitive and we need people with training to help us, the public, understand the problem and reasonable solutions. When people like Michael Osterholm tell me that it is possible one or two million people will die in the United States, I believe him and I'm willing to go along with the plan. That said, I would like to see more clear definition of where the risk lies, how we can take small chances that have a low chance of going catastrophically wrong, and how we can responsibly try to revert to some kind of normality.

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#177

Post by jstarfish » Mon, Apr 27, 2020, 9:57 PM UTC

cobookman wrote: post #80

primeradical wrote: post #49

Earlier quoted context omitted.

To anyone reading the comment above, it is extremely poor advice and should not be followed. Stay at home and shelter in place orders are not solely for the purpose of protecting ones-self from contracting the virus. They also serve to limit the spread from unsuspecting carriers. You can carry and spread the virus unknowingly and this will result in susceptible people contracting it and dying. The only way we know th…

So when do you lift the stay in place? When there's 0 cases? If so, what if that never happens?

When someone comes up with a sane, sensible and actionable plan.

Waiting it out for a vaccine. Even/odd days. Provisioning of masks for everybody. Enough toilet paper to ensure basic sanitation. Enough COVID tests to effectively gauge progress or regress. Rationing. Put all unemployed Americans on the military payroll and make them take turns delivering supplies.

We could look at what any other country who has made even nominal progress with this epidemic have done, pick any single step at random and it would be one made in the right direction.

Instead we've all been told to stay home just long enough to lose our jobs, file some papers and (maybe) receive a paltry stipend, we don't even have the testing infrastructure to know how bad this really is (confirmed cases aren't increasing if the supply of tests isn't keeping up with demand!), and that isn't stopping our syphilitic warlock from telling everybody to take anti-parasitics, drink Lysol and get back out there before it affects his re-election campaign.

There is no leadership. There is no plan. There's a reason this isn't getting better, but letting nature take its course is not the solution.

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#178

Post by ac29 » Mon, Apr 27, 2020, 9:59 PM UTC

alexis_fr wrote: post #164

ravenstine wrote: post #96

Earlier quoted context omitted.

The problem I see with that statement is that it's difficult, if not impossible to falsify. Hospitals are nowhere near being overwhelmed, in general, which means that they have some capacity to handle an outbreak if we lift restrictions gradually. I know people who work at hospitals in places like LA, and they've reported that activity is relatively slow. (of course in part because fewer people are going to the ER fo…

+ Deaths by obesity from staying home, + Home violence, + CO2-increased houses make people much less clever, + Demotivation/decrease of testosterone makes people durably less productive, further hampering our ability maintain the little flow of goods that’s left. We are setting up ourselves for a much more deadly future.

Exercise hasn't been banned, so unless you absolutely can not exercise without a full gym, there shouldn't be any reason to think people will be gaining weight, or having decreased testosterone. Even if you don't want to leave the house, you can still do things like Yoga, lift weights, or any number of other physical activities that need little or no equipment.

I'm not sure what the concern about CO2 is - at least in the Bay Area, we're in prime keep-the-windows-open-all-day weather. And the status quo would be working in offices or other buildings that tend to not even have openable windows, so even if the weather wasn't nice, indoor CO2 shouldn't be a concern.

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#179

Post by usaar333 » Mon, Apr 27, 2020, 10:00 PM UTC

mattkrause wrote: post #139

scott_s wrote: post #29

Earlier quoted context omitted.

I've seen you say similar things in a few other threads, and myself and others have said, every time: the risk to everyone is that the hospitals become overwhelmed. They are not right now because of stay-at-home orders. What you think of as failure - hospitals currently low utilization - is in fact success .

Exponential growth also means that 10% utilization isn't a ridiculous amount of headroom: it's new patients. An R0 of 2 is towards the low end of estimates without social distancing. Zhang et al. estimate it as [2.06, 2.52] from the Diamond Princess data; Sanche et al. reported [3.8, 8.9] from data from Wuhan.

Without social distancing or contact tracing. The Bay Area's r is probably around 0.8 at this point with Santa Clara even lower (EDITED - see notes below). Some restrictions can be relaxed.

Re: The San Francisco Bay Area shelter-in-place order is being extended through May

#180

Post by wgerard » Mon, Apr 27, 2020, 10:00 PM UTC

smallgovt wrote: post #126

newacct583 wrote: post #83

Earlier quoted context omitted.

Ease up how? I mean, what's the specific proposal? The lockdown isn't "total" anyway -- very large numbers of people are still working at full salary (including, it must be pointed out, probably more than half the readers of this very site). There's little to no low hanging fruit of safe jobs that can be reopened. Just go look at the California list of "essential" jobs and tell us what needs to be added. Fundamentall…

Um, I'm not sure if you're being serious, but there are plenty of ways to gradually re-open. As an example: step 1) re-open elementary schools step 2) re-open middle schools step 3) re-open high schools & colleges step 4) re-open all small businesses that do not result in gatherings of more than 2 people in one place, then 5, then 10, then 20, then 50 I'm not saying that's the right approach but there is certainly mi…

I think the problem at this point is two-fold:

1) Schools are about to be done for the academic year, so they're effectively shut down until August anyway. It wouldn't make sense to re-open schools for less than a month.

2) For better or for worse, we've conditioned people to be wary of contact with other people. A movie theater that's 10% full is still hemorrhaging money, perhaps worse than if it was closed entirely (no payroll costs/etc).

I'm not sure what the breakdown is, so this could certainly be hyperbole, but it's entirely possible that people will just feel uncomfortable doing things with groups of >10 until a vaccine is available. A restaurant with 25% of its normal business will likely still need to shut down, reduce staff, etc.

Sure, we may not have 22MM people filing for unemployment but it might still be 10MM, which is still extremely abnormally large.

All that to say, there's a real possibility that gradual re-openings don't actually accomplish anything because the root fear (i.e. catching covid-19) hasn't been resolved in the minds of many people, especially in dense urban areas.