Covid-19: the harms of exaggerated information and non‐evidence‐based measures • Hacker News Board

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#91

Post by joe_the_user » Tue, Mar 24, 2020, 3:53 AM UTC

rumblecat wrote: post #56

jtsnow wrote: post #22

Ioannidis continues to push this evidence-based approach, but I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. They argue that one doesn't need raw evidence to act if the statistical evidence shows that the risks are catastrophic. They published a paper on January 26th which lays out arguments for why conventional risk management approaches are inadequate in these situations…

Risk management is the correct way to go when uncertainty is high. Containment was the correct approach at the time. When evidence starts coming in, then you can start applying evidence based approaches. > Mortality rate: Mortality and morbidity rates are also downward biased, due to the lag between identified cases, deaths and reporting of those deaths [1] > Among 3,711 Diamond Princess passengers and crew, 712 (19.…

Whereas, if you compare fatality rates reported by Germany, SK, HK, Singapore and other high testers vs China, Italy and Spain, it's pretty clear the latter are under-diagnosing mild/asymptomatic cases, which increase their fatality rate by a factor of 10 or more.

South Korea has 1% fatality rate at the end of their epidemic, they showed .5% in the middle of this. Germany has .2% rate but it has crept up to .4% and I suspect it will continue to creep to 1%, and if they get overwhelmed it could go higher. China has a less than 1% rate outside of Wuhan, since outside that area, the health care system wasn't overwhelmed [1]. The extra deaths in Wuhan could be attributed to the health care system getting overwhelmed rather than under counting - 20 or 10% of those infected require intensive care. You quote 10% of the infected on the Diamond Princess as requiring hospitalization. With an overwhelmed health care system, that might be the death rate.

Which is to say that we have more evidence but that evidence seems to point to a desperate need for containment.

[1] You can compare all the statistics at: https://covid19info.live

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#92

Post by RobertRoberts » Tue, Mar 24, 2020, 3:56 AM UTC

acqq wrote: post #14

fraggle222 wrote: post #3

Earlier quoted context omitted.

What we need is more data. What is the % of Covid-19 cases that require hospitalization (and are people actually going to hospitals when they don't need to?) ? Is it 20x that of flu or 2x? We need random testing throughout the population to know true mortality rate and herd immunity.

We have the data we need. We know how fast it grows, we know how bad it is. It's at least order of magnitude (as in, surely ten times) worse than flu: https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F... As shown, in Italy there were 55 times more deaths per week (two weeks already) than the peek during the flu season. And it continues to grow. > are people actually going to hospitals when they don't need…

Consider this, if the news reported "Old people with pre-existing conditions should quarantine themselves because a deadly virus may kill them", that would be rational advice based on data.

Instead, the entire economy has been shut down, and the solution? Test everyone regardless of risk or value of testing. This is not rational, and many scientists and doctors are saying this.

Doctors and nurses should be tested regularly as they are more susceptible to contraction do to proximity, and the elderly or those in contact with areas of high infection or high risk of fatality.

Poorly reported sensationalism in the news needs a proper counter balance. And society needs something to overcome their power to induce irrational panic so easily.

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#93

Post by defen » Tue, Mar 24, 2020, 3:57 AM UTC

robocat wrote: post #84

Firstly, there is 10 weeks of evidence on what other countries have done to avoid transmission. Taiwan, Vietnam, South Korea, China, and Japan all show a variety of strategies and have some successes under their belts. Sure, it’s messy social data, and they have systematic differences from other countries, but it’s real data about what is working. Ioannidis says: “If we assume that case fatality rate among individual…

> “If we assume that case fatality rate among individuals infected by SARS-CoV-2 is 0.3% in the general population — a mid-range guess from my Diamond Princess analysis — and that 1% of the U.S. population gets infected (about 3.3 million people), this would translate to about 10,000 deaths.”

Why would we use the Diamond Princess CFR instead of China's, or Italy's, or South Korea's? Where does the idea of 1% come from? Both of those numbers sound ridiculously optimistic to me. Furthermore, death isn't the only negative outcome - what do we know about permanent organ damage (lungs, heart, liver, kidneys) in survivors?

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#94

Post by Barrin92 » Tue, Mar 24, 2020, 3:58 AM UTC

natalyarostova wrote: post #76

avsteele wrote: post #62

Earlier quoted context omitted.

I find Taleb's argument specious. The risk inherent in a reaction can be pretty catastrophic as well; for example we are now seeing some project 20%+ unemployment in the next quarter. In addition, we do have data on the possible harms from Coronovirus, since we have more CFR data at this point. This puts bounds on possible harms. For more detail see John's other article in statnews. The results of the Diamond Princes…

Well, consider if we reacted late January when he wrote that article it would have been very cheap to contain...

Then the immediate question is, the next time we react early and it turns out we overreacted, is that something you're going to register as well? In particular in authoritarian countries like China which actually have a history of vast overreaction based on a 'security-first' mindset.

Ioannidis actually points to one other example in the article. There are several corona strains already in circulation with fatality rates as high as 8% among the elderly. If this reaction is rational, are we irrational not locking down everything every winter?

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#95

Post by RobertRoberts » Tue, Mar 24, 2020, 3:59 AM UTC

brlewis wrote: post #18

RobertRoberts wrote: post #2

Common sense needs to prevail over mania, numbers over hyperbole and science over conjecture. But even then, this is hard if our data is collected poorly and then poorly disseminated. So what is the answer then? Maybe a strengthening of resolve against all forms of panic? Is there a single event in history has been solved by panic?

>Is there a single event in history has been solved by panic? Surely there's a historical figure who at some point fled in panic. Having survived, they then changed the world. If you're having an asthma attack, running outside in a panic might get you away from the airborne allergen.

All the training I learned in boy scouts, heard from survivalist, people who have survived outrageous circumstances by their own choosing and actions did not attribute their success to panic, but the opposite, keeping a clear head.

It's likely we can find stories of people panicing and surviving, sure. But can a paniced person (one overwhelmed with intoxicating fear) help others? No.

A drowning person will also drown their own lifeguard to attempt to save themselves. This is a well established fact that all trained lifeguards know.

Panic causes irrational and often self destructive choices. And often hurt others.

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#96

Post by joe_the_user » Tue, Mar 24, 2020, 4:01 AM UTC

partiallypro wrote: post #7

RobertRoberts wrote: post #2

Common sense needs to prevail over mania, numbers over hyperbole and science over conjecture. But even then, this is hard if our data is collected poorly and then poorly disseminated. So what is the answer then? Maybe a strengthening of resolve against all forms of panic? Is there a single event in history has been solved by panic?

The craziest stat I heard today was on my local news, and it was about COVID19 in the county, Davidson County (Nashville, TN,) they said of all the active cases in the county only 2 had been hospitalized. That's out of 163. The others were sent home to be quarantined and medicated. I was floored. Why are stats like that not shared? That seems like very valuable information. Hospitalization rates should be one of the…

Sure but most of those are new cases. Do you have any idea what happened with those cases two weeks later or even if it's been two or three weeks for the cases? You'd only expect that 16-32 would require hospitalization in any case. But on the other hand, you can expect 326 visible or invisible cases the next week and gradually things get difficult, if the trend that's been documented continues.

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#97

Post by mikemotherwell » Tue, Mar 24, 2020, 4:02 AM UTC

RobertRoberts wrote: post #87

rglullis wrote: post #31

Earlier quoted context omitted.

This line of thinking is backwards. Usually the problems that we don't solve are the ones where we should have taken stronger measures (i.e, "panicked") earlier instead of waiting for evidence of a threat. We did listen to the ones crying (i.e, "panicking") over Y2K bug and a lot of money was spent on it before January 1st, 2000, so that got solved swiftly. On the other hand: - Had we listened to the ones crying (i.e…

Every circumstance you mentioned was not "solved" with panic, but was solved with thoughtful and persitant action. If you are proposing the only way to "thoughtful and persistent action" is by being induced by panic. Then I would appreciate your evidence of this. For example the 2038 problem is more serious that Y2k. My actions today (as soon as I found out about it) was to alter all current and future systems and pl…

That's not the point being made. Panic was not what was done or suggested, it was the dismissive tone that such concerns were met with by Critics. GP's point was that the claims it was panic were wrong and harmful, not the quote unquote "panic".

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#98

Post by paulryanrogers » Tue, Mar 24, 2020, 4:03 AM UTC

guscost wrote: post #65

acqq wrote: post #58

Earlier quoted context omitted.

Taleb's point is that high uncertainties which can result in catastrophic loss are worth of spending money to protect against. In our present case, the real nonsense is US allocating funds for a 1.5 trillion dollar plane, but totally avoiding investing in the response of pandemics... before it can be too late. https://www.newyorker.com/news/news-desk/how-long-will-it-ta... "science can meet the challenges, but there…

Surely you must see that now we're having a moral/ethical/political/religious argument, very far removed from anything resembling science? This is exactly my point. You may believe that you have identified all of "the real nonsense" perfectly well, and your suggestions might be better or worse than mine. But good luck becoming any more certain than you are right now, or proving your case to anyone else. Put another w…

> Put another way: If you believe that X is a "serious enough" risk and I do not, but I believe that Y is a "serious enough" risk and you do not, how do we resolve that disagreement? Who gets the money?

Worst possible outcome for overreacting could be severe economic hardship and domestic unrest.

Worst possible outcome for under-reacting could be millions dead, leading to severe economic hardship and domestic unrest.

If the evidence isn't beyond all doubt I would hope the choice is clear which worst outcome is worth paying to avoid.

EDIT: "paying to avoid" not "paying for"

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#99

Post by cameldrv » Tue, Mar 24, 2020, 4:04 AM UTC

guscost wrote: post #77

cameldrv wrote: post #63

Earlier quoted context omitted.

Right, so do the math. 5% of positives required intensive care. If 197 million Americans get this, That means 10 million people go to intensive care. There are 60,000 ICU beds in the U.S. If 10 million people need the ICU, effectively none get a ventilator and they all die. Now it's true that the cruise ship passengers skewed significantly older, but on the other hand, they were all ambulatory and healthy enough to b…

But on the other other hand, they were all traveling, eating cruise ship food, and probably drinking, all of which could weaken their immune systems. We can add speculative adjustments all day long, but there's no way we're going to get a randomized double-blind study out of it. Also you can't conclude much of anything based on a linear extrapolation, even if you have good data.

What do you need a randomized double blind study for? You're not sure the people on the ship died of COVID?

As for adjustment factors, if you just adjusted for age, you'd get about 50% less mortality if the ship had the same age distribution as the country. So that's 5 million dead. However there are over a million people in the U.S. that are medically compromised and would have a very high fatality rate with COVID.

I also don't see what the problem with a linear extrapolation is.

Finally, I only accounted for deaths due to lack of ventilators. There also wouldn't be enough hospital beds, and that would lead to millions more deaths.

There is simply no reasonable alternative to suppressing the disease. We're talking more deaths than the Holocaust here.

Re: Covid-19: the harms of exaggerated information and non‐evidence‐based measures

#100

Post by odkamkfn » Tue, Mar 24, 2020, 4:05 AM UTC

tmh79 wrote: post #26

partiallypro wrote: post #7

Earlier quoted context omitted.

The craziest stat I heard today was on my local news, and it was about COVID19 in the county, Davidson County (Nashville, TN,) they said of all the active cases in the county only 2 had been hospitalized. That's out of 163. The others were sent home to be quarantined and medicated. I was floored. Why are stats like that not shared? That seems like very valuable information. Hospitalization rates should be one of the…

hospitalization rates are being shared. IIRC, they are generally around 20% of confirmed cases, but the testing rate is low here so hard to know the true numbers

The testing rate is low almost everywhere. The mass testing done in the Italian town Vò suggests that 50-75% of infections are asymptomatic (but still contagious). This matches the findings from the cruise ship "Diamond Princess".

Also note that the populations of both the cruise ship and Vò skew quite a bit older than the world average, and younger people are more likely to be asymptomatic (AFAIK we still don't know how more likely)