A case for ending lockdown

FWIW, I will probably circle back here and switch to "I", since I think it's probably worth it to avoid confusion.

Here's more random stream of consciousness about this:

> Pareto Mitigation: An evidence-based approach

I love how this uses "evidence-based" as a dogwhistle followed by proposing an approach without providing any sort of evidence about the efficacy of the approach.

> Those who have lost their jobs tend to be those workers who are in a lower socio-economic bracket and have jobs that do not allow one to “work from home”.

This is presented without evidence. I think there's a reasonable chance this is the case, but many essential businesses/industries employ primarily lower socio-economic classes so who knows. This is just presented like you should agree with it.

It's also not clear that those that are more disadvantaged are actually worse off here. There has been a very large increase in the amount and accessibility of unemployment benefits.

There seems to be excessive use of bolding random segments of sentences. I don't know if this is just a stylistic thing, but ¯\_(ツ)_/¯.

On suicides, it seems like most of the argument should be verifiable from data (i.e. by its claims, we should be able to see an actual increase in suicide deaths). Is that data not available yet?

> A preventable decline in preventative care

Even the (supposedly evidence-based) proposed approach would likely lead to exactly the same decline in preventative care. This error is repeated throughout the document where there's this idea that the changes that we've seen are due to lockdown and will just go away otherwise (except, of course, for when the change is positive and, clearly, the not-quite-lockdown approach recommended would continue that positive change).

> Be wary of “hero culture”

This is maybe the strangest section. Why does this just talk about a hero culture related to real scientists? Do we think that people are more likely to think some nerdy scientist is a hero rather than our heroic manly president? This seems like it should be a point in support of lockdown to me (tbh, it seems like it shouldn't be a point at all, it's just an attempt to discredit experts).

> The Soul of the Country is at Stake

OMG. I skipped this in first skim. Yeah, this makes me think I've wasted my time even thinking about this thing, this is clearly a plea to the emotions of a specific subset of the population. I'm done.

> Maybe mention something about the long term issues that it appears could be a reality for even those who "don’t feel sick at all, some people feel a little bit sick"?

Have you seen any scientific literature alleging this possibility in those who are not seriously ill? Not to sound like the WHO, but I have not personally come across any evidence that this is at all true. And indeed it seems highly non-credible.

> Also, while the the goal of flattening the curve was focused on lowering the impact on health care, as seen in Australia and New Zealand it can also result in stopping nearly all local transmission.

This is true, but now they can't let anyone into their country until the whole island has been vaccinated. That could get very tricky.

Well, I suppose they could do what Taiwan and other countries have done and aggressively test&quarantine all entrants. That's certainly possible.

> Specifically, once the proportion of recovered in the population reaches 1/(1-R_0), there are no longer enough vectors (infectable indviduals) remaining for a serious outbreak to occur. It’s worth noting that this is the same principle that vaccination relies upon; vaccination is just an artificial way to build immunity without having to undergo a full infection.

I should learn to never read anything from random people working in areas they don't have any expertise in. This whole section is wrong.

The idea that vaccination and epidemics need the same percent of immunity is completely 100% wrong. An active epidemic is going to infect way more people before dying out than the simple, naive herd immunity calculation will give you. In fact, while an r0 of 2 indicates that you get herd immunity with just 50% of the population, a typical active epidemic with the same r0 would infect 80+% before dying out.

This is clear when you think for about 1 second about it. The `1/(1-R_0)` value gives you the point where infected people infect 1 more person, it doesn't give the point when the infection stops spreading.

> While it is true that some health care providers are experiencing a decline in demand due to, for example, people no longer seeking medical attention for (e.g.) coronary problems and other non-respiratory ailments, this is not the health care capacity that matters with regard to coronavirus infections.

Right, but in this case it's leading to workers getting furloughed. So that is a direct lowering of capacity, although I suppose one could argue that those workers will be called back when shit hits the fan. But if that's the case...why not have them doing important preventative care in the meantime, since we know our hospitals are not overwhelmed yet? Basically anything that doesn't require people being in hospital beds for days since that would take away resources for future COVID-19 victims.

> Finally, those less-vulnerable members of the population you are imagining actually end up hospitalized at a rate between 2.5% and 7.4%.

This appears to be a hospitalization rate that is not accounting for all the hidden infections, which is why that number is so high. That's why the serological studies are so important. Otherwise, we need to estimate how many "cases" there will be (meaning, "serious cases" essentially), which is a lot more difficult than finding the true IFR / hospitalization rate and then multiplying by age-stratified population size. In particular, the CDC numbers are very at odds with the hospitalization rate of some of the serological studies I cited in my article. And it's not just a factor of 2x, it seems to be a massive difference. For example they show a 2.5% hospitalization rate for ages 18-49 whereas the number I've been using shows a .8% hospitalization rate for ages 40-49 at the high end, and then a .2% hospitalization rate for ages 20-29 at the low end.

I will need some time to dig into https://projects.propublica.org/graphics/covid-hospitals, but I'm having trouble finding where they give their estimated hospitalization rates. I did note that the article has the following quote:

> “You will have people on gurneys in hallways," Cuomo said at a press conference on Monday, later adding that New York would need up to 110,000 total hospital beds, around twice the number it currently has. “That is what is going to happen now if we do nothing."

And we know now that this was absolutely not the case. Recall that New York ended up not really needing the USS Comfort, and we now know that at least 15% of the population has been infected per the serology studies. So the fact that that prediction was wrong makes it feel like other predictions using the same model will be very wrong. I'll see if I can find the paper that the Harvard team published.

And then this quote seems to imply they're operating off of the bogus 20% hospitalization rate that I mentioned in the article:

> According to the Harvard scenario where 40% of adults in the country contract the disease, about half a million people in the San Francisco region may get infected, with more than 100,000 residents requiring hospitalization.

Anyway, moving on:

> The idea of cordoning off the vulnerable when those who are most vulnerable are essential workers in groceries, transit, delivery not to mention the non-essential service workers, hospitality staff, janitors, teachers, etc. What you are proposing can have no basis in reality.

It's not clear to me why this is the case. Those essential workers who are vulnerable would be quarantined (whereas right now I believe they are not quarantined which is a problem). So, the 70 year old working as a bank teller would stay at home, collect unemployment (I wish we had a better system of unemployment but that's another matter), and the bank would presumably try to fill the role with someone else who is available to work in the meantime.

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Thanks for the discussion.