> The "excess deaths" surpassed COVID-19 fatalities in those states by a combined 4,563 people. Experts suspect that unconfirmed coronavirus cases could be responsible for some of those deaths, but it might also be related to a shift in other causes of death. For example, some doctors speculate people might be dying from illnesses from which they would normally recover because the pandemic has changed access to health care.
> “Our ER, as well as many others, are seeing far fewer patients because people are scared to come in.”
There are graphs.
This has added to a lot of the confusion and misinformation surrounding coronavirus response, since people are hearing that hospitals and ERs around the country are seeing fewer patients -- dramatically fewer, in some cases -- and conflating that with the coronavirus risk being unexpectedly low, which isn't true.
The original risk associated with Covid19 was lack of hospital resources. With most hospitals having plenty of capacity, the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.
> the risk of getting Covid19 and not getting access to hospital resources is much lower than expected, so it was true.
Not quite true, NYC was over stressed and there is at least one mass grave and are still corpses in refrigerator trucks.
Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer.
One can't extrapolate from the success of social distancing to imply that _not_ doing social distance would be less harmful.
>The results of our original experiment turned out to be different than our expectations
To the contrary, the proposed solution worked as expected. The social distancing combined with state-level quick action reduced the severity of the predicted disaster. In addition, people who would normally go to the ER "just in case" did not for fear of contagion. Or because they lost medical insurance. Or because visiting a GP became difficult and so there were fewer referrals. All reducing strain on hospital resources.
Certainly, The predictions of what would happen without out social distancing still stand as the data behind it is unchanged. And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors.
Since Sweden dropped from the narrative when it showed serious differences from its neighbors, it hints that criticism of social distancing is either (justifiably) emotional or (unjustifiably) politically. If it were from an honest appraisal by epidemiologists or economist, there would concrete counter projections and remedies rather than imprecise claims about it's success and ambiguous calls as to what a new policy should be.
It is horrible that the US death total exceeds the Vietnam war and that there is serious economic hardship. That is the terrible truth for natural disasters when no plans are in place (let alone actual preparation) and the response is slow. I hope the lesson from this disaster is that we are prepared next time rather than convincing ourselves nothing serious happened.
I wish people would stop comparing US coronavirus deaths to the Vietnam war. The comparison is intended to increase the perceived gravity of coronavirus pandemic - "Remember that war 50 years ago which had massive cultural & social impact? This is just as big!" - but implying the Vietnam war's impact was based on American bodycount is just wrong at best and appalling at worst.
The Vietnam war had such an impact because the US military went on such an insane spree of war crimes and civilian massacres that America permanently lost its standing as a moral authority gained in WW2. Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing, and the disaster was prolonged for an entire decade because the country was too proud to admit it was in over its head. McNamara and then Nixon knew the war was unwinnable, but the US could not appear defeated. And so the atrocities continued. Many in the US realized all of this and became permanently disillusioned with their country.
Apologies for the off-topic rant but this comparison has been making its way through a lot of circles that really should know better. If you find yourself wishing you knew more about this topic, I recommend the Ken Burns documentary The Vietnam War or the book Kill Everything that Moves.
> Two million Vietnamese civilians paid the ultimate price for America's geopolitical theorizing
It was a civil war, initiated by the North, in which mostly Vietnamese killed other Vietnamese. The Americans intervening was absolutely a shit-show (and of course colonial history), but for the central point of your rant to stand, you’d need to show fewer Vietnamese would have died without American intervention, and that’s not a simple given.
You should spend some time talking to American Vietnamese with families who were persecuted in the immediate aftermath of the war, or who were lucky enough to escape.
The US didn't "intervene" what? Vietnam was colonized by France. Northern Vietnam was fighting for unification and liberation from French colonial power. The US lent their support to France in Vietnam because France was flirting with the Soviet Union in post-WW2 as the cold war took shape. France slowly withdrew as the US took on more and more of a role in the conflict, first as advisors then in active combat roles and finally as a full military force.
The Vietnamese were largely supportive of Ho Chi Minh and there was supposed to have been a democratic reunification vote, which didn't happen. That's how the civil war started, and North Vietnam would have easily steamrolled the South (since they managed to steamroll both the South and the USA). Most civilian casualties came from horribly targeted anti-insurgency or massive American bombing raids. It's a pretty easy argument there would have been many, many fewer civilian casualties without US involvement.
You appear to be conflating the two Indochina wars, and seem to be claiming I said America didn’t intervene when I used the expression “American intervention” so I’m not sure we’re even going to be able to find a common fact base to discuss this.
> It's a pretty easy argument there would have been many, many fewer civilian casualties without US involvement.
The history of Communism in Asia would like a word with you.
I'm not conflating them, it's just impossible to talk about one without the other; it was pretty much just one long war with America steadily increasing its involvement.
Given that communism actually won in Vietnam, we don't even have to work with hypotheticals. There were certainly deaths but nothing to the level of the death toll American military power exacted on the populace.
Regarding the word intervene what I meant is that I believe it is not a good descriptor of what the US did. Makes it sound like some kind of spontaneous humanitarian mission rather than them undemocratically propping up a failing state.
> Given that communism actually won in Vietnam, we don't even have to work with hypotheticals. There were certainly deaths but nothing to the level of the death toll American military power exacted on the populace.
Have you ever heard of the Khmer rouge in Cambodja, and how north Vietnam played a fundamental role establishing it?
You are jokig, right? I mean, the Vietnam and China-backed communist regime of neighboring Cambodja, who murdered millions implementing the same political reforms that killed millions in communist China, is only guilty of crimes against humanity because the US bombed them? Is that your argument?
And yet it was Vietnam that overthrew the Khmer Rouge, which was supported by China and the US. The ideology of the Khmer Rouge was very different from that of the Viet Minh. It was an ideology that demonized industry, cities and workers - all very much the opposite of the ideology of the Viet Minh (and of most of the Communist Party of China). It's not for nothing that the Khmer Rouge ideology has been called "Stone-Age Communism."
Vietnam was concerned Cambodja's regime was too China-friendly, but the millions being killed under the banner of advancing socialism did not featured as a pressing concern by neither China nor Vietnam.
The Khmer Rouge's ideology had almost nothing in common with the ideology of the Vietnamese Communists, or really any Marxist movement. It's difficult to see how an ideology that is intensely hostile towards all forms of industrial society and even towards the very existence of cities has anything to do with an ideology that has rapid industrial development as one of its central pillars. After the Vietnamese overthrew the Khmer Rouge, they put a very different type of government in place.
There were, of course, geopolitical calculations on all sides, which is why the United States and China supported the Khmer Rouge. I don't think moral revulsion alone often leads any government to declare war on another.
> It was a civil war, initiated by the North, in which mostly Vietnamese killed other Vietnamese.
No. It was initiated by the South, when it refused (with US support) to participate in a national UN-monitored election, which Ho Chi Minh would likely have won.
Edit: Statement of Eisenhower, from Wikipedia:[0]
> I have never talked or corresponded with a person knowledgeable in Indochinese affairs who did not agree that had elections been held as of the time of the fighting, possibly eighty percent of the population would have voted for the Communist Ho Chi Minh as their leader rather than Chief of State Bảo Đại. Indeed, the lack of leadership and drive on the part of Bảo Đại was a factor in the feeling prevalent among Vietnamese that they had nothing to fight for.
Some years before the war started, the factions that became the North (majority) and South (minority) participated in negotiations at Geneva. The deal stipulated national elections, with interim partition (North and South) after a delay to allow migration. But the South faction, realizing that it would lose, declined to participate. And that's what precipitated the conflict.
It's crucial to keep in mind that it was the North faction that had been fighting for independence from France. And that the South Faction comprised largely the colonial bureaucracy and Catholics.
> The Vietnam war had such an impact because the US military went on such an insane spree of war crimes
I agree with this. But, while this is before my time (my parents' generation), my understanding is US attitudes against the war were partly self interested in the short term: many boomer teenagers and 20somethings didn't want to get sent off to participate in such massacres, and much more they didn't want to die for it. Their parents didn't want them killed either. A lot of people knew somebody who had been killed.
If there had been no conscription there would have been less antiwar sentiment.
A similar scenario played out in the 2000s in Iraq, but without conscription.
> "Remember that war 50 years ago which had massive cultural & social impact? This is just as big!" - but implying the Vietnam war's impact was based on American bodycount is just wrong at best and appalling at worst.
But the impact of the Vietnam war on the US was primarily due to the number of casualties, wasn't it?
I mean, you wouldn't see many protests if the US government was sending college kids to southeast Asia to chill and soak in the sun, wouldn't you? Their sons arriving dead or maimed had something to do with it.
Americans by and large don't mind sacrificing their young as long as they get good value for it. With Vietnam they saw soldiers sacrificed for utterly pointless things like defending Khe Sanh or taking Hamburger Hill (both were abandoned right after victory), all while their leadership was telling them they weren't even seeking military victory. Meanwhile half the country was calling the troops babykillers (not without reason) and young people being drafted into the mess were faced with the moral choice of going to prison or running away to Canada (with the associated accusations of cowardice and shame brought on their family by idiots) or turning off their conscience and shipping off to Vietnam to kill some people posing absolutely no threat to their freedom or way of life. No matter how you look at it, it's way more complicated than boiling it down to US deaths.
I don't think the comparison is trying to describe the Vietnam War's impact in terms of body count, but instead to describe the pandemic's impact in terms of an enormous societal issue, which IMHO it is. People have a hard time with large numbers (remember Stalin saying one death is a tragedy, 1 million is a statistic). So having markers to help with comparison is normal.
It's fair to say that NYC was stretched to the limit, and certainly stretched farther than anyone would want, but it is hard to make a claim that hospitals were overwhelmed anywhere like predicted. New York hospitalizations peaked at 18,825[0], while Cuomo predicted they would need 30,000 additional ventilators. The expanded bed capacity in New York reached 90,000 at Cuomo's command[0]. There is no known case of an american not receiving a ventilator if needed [1][2].
And, remember disease models did not just predict unmitigated spread. They absolutely incorporated percentages of social distancing into their models. The original imperial college study predicted that a high income county with around 50% social contact reduction would still exceed hospital capacity by 700%.
Cuomo's New York model that predicted 30,000 additional ventilators absolutely incorporated lockdown measures, if they didn't they have some serious explaining to do.
Of course I still agree a lockdown was needed, and agree the lockdown did about as well as it could. But is there any reason to not revisit data and determine if we could do better?
Luckily, social distancing worked better than expected: peak daily US death was reduced to approximately 2,700 rather than approximately 3,000. And the curve was flatten more than expected with the death rate remaining at peak longer.
-- NYC has maybe peaked but the rest of the country is still rising.
NYTimes: "“If you just look at the total number of cases, you’re going to miss what’s underneath it,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It’s not a leveling-off. It’s a painful handoff.”"
> And if that isn't enough, there is the 10x fatality rate of Sweden vs its neighbors.
Not only that, but as a percentage of population, Sweden's fatality rate is far ahead of that of the USA, and still climbing at a faster rate than America:
This is inaccurate (at least in implication): this mass grave has been around and in use for 150 years. It's being used more heavily, obviously, but then that's no different than saying "more people than normal are dying in NYC"
> not getting access to hospital resources is much lower than expected
I don't know how you can say 'lower than expected'. Many interventions were non-medical, depending on social behaviour (e.g. adhering to social distancing), effectiveness of governance and enforcement, as well as economic and political (e.g. supply of test kits, ventilators). And even then, we were dealing with a new virus, there was limited data about all kinds of variables. For example, if people are intubated twice as long in the US due to high levels of obesity compared to China, you need twice as much ventilator capacity.
Point being, we always had to deal with a very wide confidence interval.
Now combine that with the fact we're looking to predict an exponential number, rather than something linear, and you can get wildly different outcomes. In New York the doubling time began around 2 days. That meant the difference between hospitalising 50k or 100k was a matter of starting social distancing two days later. The difference between 50k and say 1.6 million, was just 10 days. Hospital resources can't expand that fast, at best you can add 30% extra beds and shift all bed-use to dealing with corona with emergency interventions, but you can't just scale 3000%.
That's where the field hospitals came in. Not because it was guaranteed or fully expected to need them, but because there was a good chance, and there was too little information to conclude they wouldn't be necessary.
Yeah. It's really a shame that there were all these efforts to prevent our health care system from being overwhelmed. Oh well. It looks like enough people would like to run this particular experiment that we just might get to see what it looks like after all. Yay?
I don't understand your comment. We made decisions based on information. The results of our original experiment turned out to be different than our expectations. Further, others were hurt substantially due to these decisions. Those hurt are requesting (or demanding) to change course so as to not be hurt further. Seems reasonable to change course, with each US State (or country) changing course differently based on their circumstances.
> Further, others were hurt substantially due to these decisions.
If anything the US government failed to act to attenuate the expected economic impact that emergency anti-epidemic policies would naturally have on the most vulnerable elements of society.
It's also very ironic, if not hipocritical, to abuse the most vulnerable and victimized elements of society, who have been systematically ignored and sacrificed , to argue against undoing policies aimed at defending society's best interests.
I don't know why you think we came out so far different from expectations - New York hospitals were overwhelmed, they hadn't shut down in time to prevent a large wave of cases - other locales that have gotten lucky or shut down have avoided feeling that wave so far... Changing course doesn't seem advisable as growth rates haven't subsided into the negative except in small locales.
New York was the exception to the rule. Most hospitals were not overwhelmed. In fact, many hospitals flirted with financial disaster when governors prevented elective procedures. I can speak specifically to AZ which outside of some very small Indian Reservation medical centers, is well below capacity[1]
Seattle's Army hospital closed without a single patient[2].
Growth rates, especially in AZ, were never large to begin with.
I would be cautious about using the past tense. New case rates have not come down much from peak - and I expect them to spike in the next few weeks as people let their guard down and things reopen.
Deaths lag infections by several weeks. Over 2200 people died yesterday.
I agree that with re-opening, we will see a bump in infections, and therefore deaths. However, there is only one path out of this and that is herd immunity. We can accelerate herd immunity via vaccine, but either way its herd immunity. That means that we want as many people sick as our hospital system can handle, but not more. That means playing a game of optimization. Further, different states (New York vs. Arizona) should have different plans because their situations are vastly different (population density, current herd infection status, etc).
Further, we can't just optimize for Covid19 deaths, we have to look at the whole situation, which includes suicides due to shelter-in-place orders, child abuse and other domestic violence, malnutrition due to hunger from unemployment, negative impacts of poverty.
this will certainly be a case study for future generations.
> That means that we want as many people sick as our hospital system can handle, but not more.
This would be the optimal situation, but it requires at least:
* Widespread testing available to any who need it for any reason;
* Careful, centralized monitoring and resource allocation;
* Plenty of PPE, critical care equipment, and disposable goods;
* A cooperative public willing to follow a constantly shifting set of recommendations.
And the country as a whole has basically none of those things. California is better-resourced and managed (for this particular thing) than other states, so they're gonna give it a shot. The rest of the country is just gambling.
This disease does not cooperate with this kind of response because of the lag time from initial infection to critical illness. Reports on this vary from like 3 days to 20-odd days. Coupled with the disease's high rate of infection, this means that a hospital can go from 50% full to 150% full very quickly. If a state government with an impossibly obedient population set a tripwire at 50% hospital capacity and shut everything down the minute they hit that mark, then they're still going to overflow a couple of weeks later as symptoms progress for those that were infected just before the shut-down.
The virus needs to be studied in further detail before we haphazardly aim for herd immunity. There is still no proof that the immunity gained from it, lasts more than a few months.
Imagine the fall out if a government pushes for herd immunity, knowingly sacrificing 5-10% of the population, and it turns out that country gets wave after wave of fatalities due to the herd not having a lasting immunity.
Growth rates are dependent upon testing, which is inadequate. And what little testing has been done by AZ shows a very large growth rate[1]. And the graph of growth rates by the AZ governor makes the same mistake in excluding the last 4-7 days of the graph's range. It's nonsense.
Some hospitals in NYC were overwhelmed, but that was limited to Queens and Brooklyn: the NPR piece notes that Javits Center, which was turned into a hospital in Manhattan, treated about 1100 people total, after being built to handle 1900 at a time. The three other NY field hospitals on that list, all close to NYC, treated zero patients. One of those is in the same county just north of NYC that had the initial outbreak here.
I think there's no question that COVID-19 has been a disaster here, but it's going to be heavily debated whether the lockdown saved us or just made things worse on net.
The low occupancy rate of field hospitals is evidence that either the lockdown worked, or that it was unnecessary. It excludes the case in which the lockdown was obviously necessary and just barely worked, since that's the case in which those field hospitals would themselves have been overwhelmed or nearly so, as well as the existing ICUs.
Without regard to the actual effectiveness, the fact that the field hospitals went mostly empty will fuel acrimonious debate about said effectiveness.
Yup, makes me wonder why Cuomo didn't shut down the subway system (or at least limit use based on some sort of need)? The media's given him props for leadership in his briefings, but ignored this massive sources of infections. Meanwhile, various narratives swirl about why NYC is being hit so much harder than elsewhere, like it's some sort of mystery.
I'm not sure that the data bear that out. Manhattan is the best-served borough, but the least infected. Just this week, Cuomo mentioned some surprising findings: essential workers and homeless, who make up most people on the subway, do not make up a significant number of infected showing up at hospitals, but those do who had been sheltering at home (self-reported, I imagine).
Not sure what data you're referring to. The article I saw in early March said that ridership was down over 70% in Manhattan vs only 15-20% in Queens and Brooklyn. Those numbers have now apparently fallen much further, but I've not seen a breakdown by Burrow.
New York hospitals weren't happy by any means, but their peak load was an order of magnitude less than what local leaders said they were preparing for.
"I don't want to be hurt" was an option that was swept off the table the moment we went into this disaster with a dysfunctional federal government.
Our choices since then have been "economic hardship and misery" or "economic hardship and misery with a spicy side dish of death and suffering". Covid19 has been the leading cause of death in America for a month now [1]. Some time tomorrow, it will have killed a confirmed 80,000 Americans [2] and America has consistently had 1/3rd of the world's critically-ill cases for weeks [ibid]. There is no way we are going to get out of this with less than 100,000 dead.
Amazingly, the same country that had endless investigations into the deaths of two people in Benghazi and went to war over the deaths of 3,000 Americans on September 11, 2001 -- subsequently spending $6.4 trillion in war operations [3] -- is finding 100,000 dead to be "pretty good", and the economic cost of mitigating further death to be just a little bit too expensive.
As usual, some of this is explained by political misinformation campaigns that too many people are falling for [4][5][6][7], but still, the same talking points get repeated into forums like this one, even though most Americans would prefer economic pain over a higher death toll for now [8][9][10].
I'm just gobsmacked that the disinformation is taking root so easily, because arguing that can really trivially be reduced to, "I don't think enough people are dying to justify the measures meant to prevent people from dying."
Hopefully states like California that are following more conservative, evidence-based approaches to relaxing restrictions, will relieve some of the tension.
I hate to reply so pithily to your well-researched comment, but your basic premise seems to be false here. California recognizes that economic restrictions are causing severe harm and began rolling them back today.
> California recognizes that economic restrictions are causing severe harm and began rolling them back today
But the OP wrote,
> Hopefully states like California that are following more conservative, evidence-based approaches to relaxing restrictions, will relieve some of the tension.
You are both correct: California is rolling back economic restrictions, but they are following a conservative, evidence-based approach to relaxing them. The OP's basic premise, however, is not at all false, and I sincerely hope you don't have the impression that the state is just throwing a switch and going back to "normal." It's not.
Or I should say, we're not. I don't know where you're located, but I'm in California -- the Bay Area, specifically. We don't even have official guidance on how restaurants are going to re-open yet, an the California Restaurant Association -- the business group that represents restaurants, and clearly has an economic motivation to get back to business -- has actively lobbied for the re-opening of their member businesses to happen slowly and very carefully.
I would like nothing more than to be able to start going back to my favorite restaurants and bars. But the reality is that for the last month, the daily number of new Covid-19 cases and of deaths hasn't been materially dropping in the US in the way it has in countries like the UK, Italy, and Germany, which strongly suggests that our collective behavior throughout April remained too relaxed in most states. The paradox of this pandemic is that the looser the restrictions we place on ourselves are, the more economic damage we're likely to face over the long term, not less, because we'll start cycling through repeated outbreaks, being forced to close businesses, districts, and even regions ad hoc, and running a much greater risk of overwhelming hospitals with bursts of new cases virtually all at once in stricken locales.
> the more economic damage we're likely to face over the long term,
What I don’t quite understand is how people expect the economy to “just go back to normal”... like, even if you “reopen” everything, ease all restrictions, it’s not like people are goingback to living as usual.. they’re still going to keep by themselves, because that’s an individually sensible decision... are you going to attend a conference, a wedding, a dinner party / restaurant where you’ll be near 100+ people? Of course not, you’ll be making sure you stay healthy! The economic damage will happen and persist, and governments can’t just legislate against that!
It's the same crowd that believes that the economy would have just been fine if we had treated this like we do the flu; ignoring that 2M dead Americans has a funny effect on the economy.
It saddens me that those who for some reasoning fall prey for this line of reasoning don't just hurt themselves in the process, and actively contribute to spread and worsen all problems to everyone they ever contact with.
We might be on the same page here, then. I agree it would be dumb to just immediately reopen all businesses with no thought about how to mitigate risks or delay the least safe ones. But I see a lot of people propose that relaxing restrictions doesn't matter, that it's just not an important priority relative to the virus, and that goes too far.
And that is the nature of the problem. It is far easier to throw out a random anecdote then to prove or disprove it.
I remember hearing a story of a solder that sent a single bullet into a pole mounted transformer. The oil leaked out, it over heated and exploded. Power went out to the block, maybe taking connected devices with it.
A two second act that cost less than a dollar, destroyed something that was orders of magnitude more expensive and took orders of magnitude more time to put in place.
The majority of Americans across the board support the lock down, and continue to support going slowly with relaxing restrictions. Only a small, yet well-funded minority want things relaxed ASAP.
> The "excess deaths" surpassed COVID-19 fatalities in those states by a combined 4,563 people. Experts suspect that unconfirmed coronavirus cases could be responsible for some of those deaths, but it might also be related to a shift in other causes of death. For example, some doctors speculate people might be dying from illnesses from which they would normally recover because the pandemic has changed access to health care.
> “Our ER, as well as many others, are seeing far fewer patients because people are scared to come in.”
There are graphs.
This has added to a lot of the confusion and misinformation surrounding coronavirus response, since people are hearing that hospitals and ERs around the country are seeing fewer patients -- dramatically fewer, in some cases -- and conflating that with the coronavirus risk being unexpectedly low, which isn't true.