Since we're on the topic, shouldn't this (hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?
The line I've heard repeatedly is we're waiting for "total" herd immunity, as in ensuring almost all of a population is potentially protected from the virus. Frequently quoting fall / end of 2021, potentially into 2022.
Shouldn't the only benchmark be those with medium-to-high risk of hospitalization? (Determination of risk however you'd like to do it.)
Put another way, you wouldn't shut the world down if a bunch of people got sick for a few days. You may, and indeed we have, shut it down if a large part of the population were at risk of hospitalization or death. In many developed countries, that population is looking at full inoculation (for those who want it) sometime this spring.
> Since we're on the topic, shouldn't this (hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?
Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?
Hospitalizations are weeks delayed from COVID# or %Positive spikes. Its a slow moving disease: taking 5 to 14 days before people feel sick, and then a week or two AFTER that before people decide to go to the hospital.
As such, if you see a spike of hospitalization, you're already 3-weeks late to the results (ie: hospital spikes are associated with infections that occurred 3+ weeks ago).
In contrast, watching COVID# or %Positive numbers gets you much closer to the ~5-14 day period where symptoms appear (and thanks to contact tracing, some people may test themselves before symptoms arrive: gaining a few precious days in the information war). Hospitalizations and Deaths are strongly correlated (with a few weeks delay). So you're effectively gaining a week-or-two worth of information.
Its better to be only 1-2 weeks behind (watching COVID#), rather than being 3-4 weeks behind (watching Hospitalization#).
> hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?
From a control theory perspective, it's one of the worst measures because it's delayed. Much more efficient to measure cases - then you don't need restricted social life as long.
I agree completely. The only reason they used for shutting everything down at first was so hospitals don't get overrun. That's clearly not happening right now in most places. Also, it's not uncommon for the flu to cause hospitals to exceed capacity and we don't shut down for that.
I don't know about all states as they have different rules, but in Washington they track:
1. Trend in 14-day rate of new COVID-19 cases per 100,000 population, shown as Trend in case rate;
2. Trend in 14-day rate of new COVID-19 hospital admissions per 100,000 population, shown as Trend in hospital admission rate;
3. Average 7-day percent occupancy of ICU staffed beds, shown as Percent ICU occupancy;
4. 7-day percent positive of COVID-19 tests, shown as Percent positivity.
And there are phased reopening plans, where restrictions are slowly lifted based on different tresholds for the above. So if the above 4 metrics meet some treshold we might go into phase 2 where now indoor dining at half capacity is permitted for example. If the numbers than stay under the treshold and eventually keep going down, we'd go to phase 3, etc. If the numbers get worse after moving to phase 2 we'd go back to phase 1 with more restrictions.
Seems pretty reasonable to me. They're always kind of revising the tresholds to some extent as well, so it's not set in stone. But it makes sense for me to take a staged approach to reopening and just make sure we're truly over Covid before going all back to normal (so it doesn't come back).
> The line I've heard repeatedly is we're waiting for "total" herd immunity
It depends which line you are considering; if wearing masks yes.
If "reopening and returning to normal" that remark is most resembles a hyperbole.
In the United States, on April 16th 2020, the Coronavirus task force outlined a 3 phase plan dependent on 3 criteria based on 2 week averages
1) Hospital Vacancy,
2) New cases decreasing (from where they were), and
3) Percent positive testing rate under 10% (that suggests that the tests numbers are close to accurate and not in community spread)(5% is the standard that Europe uses as a liberal goal, 2.5% is the recommended)
For an answer on those 3 in the US (today)
1) Hospitals are just now where they were on April 16
2) New cases is about 3x where they were April 16
3) We've been under 10% since 1/21 (now at a 7 day average of 5%)
So the goal posts haven't gotten harder. They did get easier; restaurants shouldn't have been open for socially distanced dining based on the plan until 1/21.
> You may, and indeed we have, shut it down if a large part of the population were at risk of hospitalization or death
I wouldn't really call 1% of the population "a large part" of it. It's just, our healthcare capacity relative to the size of the overall population is miniscule. So even a disease that threatens .1% of the population with death and 1% with hospitalization is enough to overwhelm the healthcare system. And apparently policy makers aren't willing to let people die due to overwhelmed hospitals - they would rather shut down the entire economy than let that happen.
History will tell if that was the right decision. Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year, but everyone notices and remembers economic depressions that last a decade.
It's generally a political challenge for a free society to get the power and the megaphones back from the people they were given to during a crisis.
After an acute terrorism threat ends, it's hard to get power back from the military and the police.
In this case, it will be hard to take back power and the narrative from the public health establishment.
While they perform a crucial role in our society, they will tend to value safety over freedom and quality of life to an extent that would be crippling if we let them continue to set the agenda after the acute phase of the crisis has passed.
So far there was a tight coupling between the number of positive tested people and the hospitalisation count. It was important to base politics on the positive test results because they are several weeks "ahead" of the hospitalisation trend. It would have been foolish to not use those weeks for necessary actions.
Now, with the vacinations, things change a bit. As soon we can show a significant reduction in hospitalisation, of course this needs to taken into respect. But with the vacinations, I would also expect the infection count to drop, as there are good indications that the vacinations reduce the infection count to drop.
I know somebody who's had this. Despite never being hospitalized, after getting sick they had to take a long medical leave from work in hopes of getting their strength back. That's worlds away from "sick for a few days".
No. People (extraordinarily healthy people) are suffering pulmonary embolisms (and thus hospitalized) weeks after they have been cleared from the virus. There is a very, very, very long tail to this disease outside of the initial 2 - 4 weeks of being sick.
In US State Ohio recently, the benchmark for restrictions was changed to the number of people hospitalized for COVID in the state. When it fell below a threshold, bars and restaurants were allowed to stay open later.
Nobody has figured out what "long covid" is, or how long it lasts. The anecdotes I've heard about the effects to the relatively young mean I'd just assume not open up.
It's preferable to have very low infection numbers, to reduce the likelihood of mutations taking hold.
Doesn't mean you go on forever waiting for 0 infections, you just wait a bit longer than the minimum number of vaccinations to go back to activities with highest risks of transmission.
The problem with that sort of thinking is if you let the virus circulate and multiply you are risking mutations that are resistant to the vaccines. There already are two mutations that are already somewhat resistant to the vaccines according to initial anecdotal evidence.
But practically speaking most nations are taking this approach and have been reducing social distancing measures when hospitalization rates go down. (Often with negative results.)
Yes 100%. As soon as the "vulnerable" have received their vaccine we should remove all restrictions even if the vaccine doesn't 100% prevent the "old fat cigarette smoking weak people" from dying from this cough virus because after the vaccination there is nothing more we can do.
Vaccines are the single most effective way to prevent disease after clean water. It is the cherry on top of a cake in terms of what humans can achieve medically. A vaccine is literally the dream to achieve for any illness which could affect us. As a result, as soon as we have deployed our best and most effective weapon against this virus we must open up again. If the vaccine doesn't prevent fat people from dying then nothing will and we just have to accept that fat people will die due to their own wrong doings. After all that's how the world is designed to work.
As long as one believes that chronic covid does not exist or alter one's life expectancy and the comfort of the elderly is our top priority then yes. Once the olds are safe the virus shall run wild through the young.
> Since we're on the topic, shouldn't this (hospital admissions) be the almost singular criterion to influence public policy / restrictive measures?
No. This is the "flatten the curve" logic which was a horrible misjudgment. Having the disease in circulation in the community is not only doing tremendous damage to many, many people (even if the hospitals aren't full), but is also allowing the virus to mutate and potentially escape immunity protections or become more deadly. If you re-open as soon as the hospitals start to free up again, you just start moving the pendulum back in the direction of crisis.
Countries like Australia and New Zealand have shown that if you keep up lockdown measures for just a month or two after the hospitals free up (AND if you institute and keep real travel quarantine restrictions), you can get the virus to effectively ZERO community spread and keep it there. We can achieve this, and we ought to be aiming for it.
To play devil's advocate, clearly the world can handle a certain amount of locking-down, the social distancing, the mask wearing, etc., so it seems it is better if we just accept these restrictions indefinitely because we can save more people. Maybe we're fine not having mass gatherings, not eating indoors, and not leaving the house without a mask if it means saving the vulnerable. After all, it could be that COVID stays in the body like herpes and creates a different set of problems years later. Until we know for sure, the safest course of action for the public is for them to remain quarantined.
After all, how bad is your life, really? If your life is tolerable, that means the restrictions are tolerable as well.
EDIT: It's like nobody knows what playing "devil's advocate" means anymore. I think it's valid to ask that, if all the measures we are taking are objectively good, whether we should take them from now on.
Thinking more about headlines like this, I wish we could just replace the word "linked" with the words "correlates with"
Society really needs to use either the term correlation or causation more often so we can always have the "correlation does not imply causation" discussion and hammer that home until it's common knowledge and common sense.
The word "link" to me is a weasel word meant to plant the thought "causation" when only correlation is merited.
"By the fourth week after receiving the initial dose, the Pfizer and Oxford-AstraZeneca vaccines were shown to reduce the risk of hospitalisation from Covid-19 by up to 85 per cent and 94 per cent, respectively.
Among those aged 80 years and over - one of the highest risk groups - vaccination was associated with an 81 per cent reduction in hospitalisation risk in the fourth week, when the results for both vaccines were combined."
I wanted to highlight this part for folks reading. My brothers Mother in Law is now hospitalized due to COVID, and there is a high likelyhood that she will not survive COVID due to lung scarring. She got her first COVID vaccination about a week before she got COVID.
You are not out of the woods just because you got your first dose COVID vaccine! It will take time for it to take affect.
Until we have challenge trials, how do we know whether or not other variables, such as natural herd immunity and seasonality are not also significant contributing factors to the 'substantial reduction'?
Because its still winter and herd immunity from natural infections is a gradual process not a steep cliff? At the very least it seems like those factors could be accounted for.
The numbers from Israel seem to show the 60+ age group that has been vaccinated with two doses is seeing a sharp drop in hospital admissions compared to the under 60 group that is still mostly unvaccinated. This should rule out the herd immunity and seasonality arguments.
We are so lucky we had 2020 science to deal with this rather than in previous decades. I wonder how our current efforts will seem to scientists from decades in the future!
I'm really worried that will be "locked down" indefinite even when hospitalizations go down. I'm also worried that when an actually deadly virus hits our shores we'll be more hesitate to do lockdowns. So basically governments used their once in a 50 year lockdown on this. It mainly killed people that were fat (why the US had a higher mortality) and old. Except no one every said lose weight, exercise and get fresh air. What happens when Ebola hits us.
When something with ~30-50% mortality starts doing a COVID there won't be room for anti-vaxxers and anti-lockdown people. With COVID you can get sick and live. With something like ebola you get sick and die, or you go through the most traumatic event of your life. It doesn't leave a middle ground of disbelief. So I think there would be the political will for a second lockdown if our next global pandemic looks like ebola. A second COVID probably might not be scary enough though.
Yes! I am from the Indian Subcontinent, I know people who went back to the country to get the Oxford vaccine, because the rollout is great and it is "open season" over there already. Converse is also true- rich people who were doubtful about a vaccine manufactured in India booked came to US to get both Moderna and Pfizer shots.
It's already the case, look at all the exceptions for the wealthy and powerful getting vaccines early, be that politicians, celebrities, athletes, connected individuals, and the numerous cases we each may know of. I won't say more but I do know a few personally who got the vaccine too early.
I don't think so. There's simply not excess vaccines to go around at this point. I imagine this might happen more in the future when a larger percentage of some nations are vaccinated.
The UKs adoption of First Dose First is amazing and inspiring in a time when governments worldwide seem unable to operate effectively.
There are 2 things every country can do to save lives that have effectively zero cost and zero negative externalities:
- lifting lingering vaccine bans (the US's ban of AZ is most glaring)
- first dose first - the evidence is overwhelming at this point.
These two things, which could be done almost certainly by Biden alone (in the US), would allow possibly everyone who wants a vaccine to get one by the end of March, instead of July with the current projections. And this decision is effectively zero risk.
[+] [-] aclimatt|5 years ago|reply
The line I've heard repeatedly is we're waiting for "total" herd immunity, as in ensuring almost all of a population is potentially protected from the virus. Frequently quoting fall / end of 2021, potentially into 2022.
Shouldn't the only benchmark be those with medium-to-high risk of hospitalization? (Determination of risk however you'd like to do it.)
Put another way, you wouldn't shut the world down if a bunch of people got sick for a few days. You may, and indeed we have, shut it down if a large part of the population were at risk of hospitalization or death. In many developed countries, that population is looking at full inoculation (for those who want it) sometime this spring.
Should that not be the "end" of it?
[+] [-] dragontamer|5 years ago|reply
Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?
Hospitalizations are weeks delayed from COVID# or %Positive spikes. Its a slow moving disease: taking 5 to 14 days before people feel sick, and then a week or two AFTER that before people decide to go to the hospital.
As such, if you see a spike of hospitalization, you're already 3-weeks late to the results (ie: hospital spikes are associated with infections that occurred 3+ weeks ago).
In contrast, watching COVID# or %Positive numbers gets you much closer to the ~5-14 day period where symptoms appear (and thanks to contact tracing, some people may test themselves before symptoms arrive: gaining a few precious days in the information war). Hospitalizations and Deaths are strongly correlated (with a few weeks delay). So you're effectively gaining a week-or-two worth of information.
Its better to be only 1-2 weeks behind (watching COVID#), rather than being 3-4 weeks behind (watching Hospitalization#).
[+] [-] vmchale|5 years ago|reply
From a control theory perspective, it's one of the worst measures because it's delayed. Much more efficient to measure cases - then you don't need restricted social life as long.
[+] [-] choward|5 years ago|reply
[+] [-] didibus|5 years ago|reply
1. Trend in 14-day rate of new COVID-19 cases per 100,000 population, shown as Trend in case rate;
2. Trend in 14-day rate of new COVID-19 hospital admissions per 100,000 population, shown as Trend in hospital admission rate;
3. Average 7-day percent occupancy of ICU staffed beds, shown as Percent ICU occupancy;
4. 7-day percent positive of COVID-19 tests, shown as Percent positivity.
And there are phased reopening plans, where restrictions are slowly lifted based on different tresholds for the above. So if the above 4 metrics meet some treshold we might go into phase 2 where now indoor dining at half capacity is permitted for example. If the numbers than stay under the treshold and eventually keep going down, we'd go to phase 3, etc. If the numbers get worse after moving to phase 2 we'd go back to phase 1 with more restrictions.
Seems pretty reasonable to me. They're always kind of revising the tresholds to some extent as well, so it's not set in stone. But it makes sense for me to take a staged approach to reopening and just make sure we're truly over Covid before going all back to normal (so it doesn't come back).
[+] [-] smileysteve|5 years ago|reply
It depends which line you are considering; if wearing masks yes.
If "reopening and returning to normal" that remark is most resembles a hyperbole.
In the United States, on April 16th 2020, the Coronavirus task force outlined a 3 phase plan dependent on 3 criteria based on 2 week averages
1) Hospital Vacancy,
2) New cases decreasing (from where they were), and
3) Percent positive testing rate under 10% (that suggests that the tests numbers are close to accurate and not in community spread)(5% is the standard that Europe uses as a liberal goal, 2.5% is the recommended)
For an answer on those 3 in the US (today)
1) Hospitals are just now where they were on April 16
2) New cases is about 3x where they were April 16
3) We've been under 10% since 1/21 (now at a 7 day average of 5%)
So the goal posts haven't gotten harder. They did get easier; restaurants shouldn't have been open for socially distanced dining based on the plan until 1/21.
[+] [-] umvi|5 years ago|reply
I wouldn't really call 1% of the population "a large part" of it. It's just, our healthcare capacity relative to the size of the overall population is miniscule. So even a disease that threatens .1% of the population with death and 1% with hospitalization is enough to overwhelm the healthcare system. And apparently policy makers aren't willing to let people die due to overwhelmed hospitals - they would rather shut down the entire economy than let that happen.
History will tell if that was the right decision. Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year, but everyone notices and remembers economic depressions that last a decade.
[+] [-] NovaJehovah|5 years ago|reply
After an acute terrorism threat ends, it's hard to get power back from the military and the police.
In this case, it will be hard to take back power and the narrative from the public health establishment.
While they perform a crucial role in our society, they will tend to value safety over freedom and quality of life to an extent that would be crippling if we let them continue to set the agenda after the acute phase of the crisis has passed.
[+] [-] _ph_|5 years ago|reply
Now, with the vacinations, things change a bit. As soon we can show a significant reduction in hospitalisation, of course this needs to taken into respect. But with the vacinations, I would also expect the infection count to drop, as there are good indications that the vacinations reduce the infection count to drop.
[+] [-] wpietri|5 years ago|reply
I know somebody who's had this. Despite never being hospitalized, after getting sick they had to take a long medical leave from work in hopes of getting their strength back. That's worlds away from "sick for a few days".
[+] [-] dev1n|5 years ago|reply
[+] [-] qndreoi|5 years ago|reply
[+] [-] bluGill|5 years ago|reply
[+] [-] maxerickson|5 years ago|reply
Doesn't mean you go on forever waiting for 0 infections, you just wait a bit longer than the minimum number of vaccinations to go back to activities with highest risks of transmission.
[+] [-] unknown|5 years ago|reply
[deleted]
[+] [-] rhino369|5 years ago|reply
Anyone who wants to hole up until they get the vaccine should be able to.
But I'll take the low risk.
[+] [-] hristov|5 years ago|reply
But practically speaking most nations are taking this approach and have been reducing social distancing measures when hospitalization rates go down. (Often with negative results.)
[+] [-] dustinmoris|5 years ago|reply
Yes 100%. As soon as the "vulnerable" have received their vaccine we should remove all restrictions even if the vaccine doesn't 100% prevent the "old fat cigarette smoking weak people" from dying from this cough virus because after the vaccination there is nothing more we can do.
Vaccines are the single most effective way to prevent disease after clean water. It is the cherry on top of a cake in terms of what humans can achieve medically. A vaccine is literally the dream to achieve for any illness which could affect us. As a result, as soon as we have deployed our best and most effective weapon against this virus we must open up again. If the vaccine doesn't prevent fat people from dying then nothing will and we just have to accept that fat people will die due to their own wrong doings. After all that's how the world is designed to work.
[+] [-] rcpt|5 years ago|reply
[+] [-] garmaine|5 years ago|reply
No. This is the "flatten the curve" logic which was a horrible misjudgment. Having the disease in circulation in the community is not only doing tremendous damage to many, many people (even if the hospitals aren't full), but is also allowing the virus to mutate and potentially escape immunity protections or become more deadly. If you re-open as soon as the hospitals start to free up again, you just start moving the pendulum back in the direction of crisis.
Countries like Australia and New Zealand have shown that if you keep up lockdown measures for just a month or two after the hospitals free up (AND if you institute and keep real travel quarantine restrictions), you can get the virus to effectively ZERO community spread and keep it there. We can achieve this, and we ought to be aiming for it.
[+] [-] ravenstine|5 years ago|reply
To play devil's advocate, clearly the world can handle a certain amount of locking-down, the social distancing, the mask wearing, etc., so it seems it is better if we just accept these restrictions indefinitely because we can save more people. Maybe we're fine not having mass gatherings, not eating indoors, and not leaving the house without a mask if it means saving the vulnerable. After all, it could be that COVID stays in the body like herpes and creates a different set of problems years later. Until we know for sure, the safest course of action for the public is for them to remain quarantined.
After all, how bad is your life, really? If your life is tolerable, that means the restrictions are tolerable as well.
EDIT: It's like nobody knows what playing "devil's advocate" means anymore. I think it's valid to ask that, if all the measures we are taking are objectively good, whether we should take them from now on.
[+] [-] malandrew|5 years ago|reply
Society really needs to use either the term correlation or causation more often so we can always have the "correlation does not imply causation" discussion and hammer that home until it's common knowledge and common sense.
The word "link" to me is a weasel word meant to plant the thought "causation" when only correlation is merited.
[+] [-] kop316|5 years ago|reply
Among those aged 80 years and over - one of the highest risk groups - vaccination was associated with an 81 per cent reduction in hospitalisation risk in the fourth week, when the results for both vaccines were combined."
I wanted to highlight this part for folks reading. My brothers Mother in Law is now hospitalized due to COVID, and there is a high likelyhood that she will not survive COVID due to lung scarring. She got her first COVID vaccination about a week before she got COVID.
You are not out of the woods just because you got your first dose COVID vaccine! It will take time for it to take affect.
[+] [-] loveistheanswer|5 years ago|reply
[+] [-] bawolff|5 years ago|reply
[+] [-] hinkley|5 years ago|reply
Do you think we got a break at the beginning that we didn't identify in the numbers?
[+] [-] aqme28|5 years ago|reply
A challenge trial just reduces the time and number of people it takes--not everything needs a challenge trial.
[+] [-] Guest19023892|5 years ago|reply
https://i.imgur.com/Tu3ckZN.jpg
https://i.imgur.com/1eP5sbi.jpg
[+] [-] wayanon|5 years ago|reply
[+] [-] kuu|5 years ago|reply
There seems to be a light at the end of this tunnel :)
[+] [-] chrisjs95|5 years ago|reply
[+] [-] ImaCake|5 years ago|reply
[+] [-] unknown|5 years ago|reply
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[+] [-] unknown|5 years ago|reply
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[+] [-] unknown|5 years ago|reply
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[+] [-] wcfields|5 years ago|reply
Eg, if the wait time is long for my group in the US/UK/Wherever, can I book a flight to UAE or Cuba to get a vaccine at the airport?
[+] [-] sjf|5 years ago|reply
[+] [-] esalman|5 years ago|reply
[+] [-] Dumblydorr|5 years ago|reply
[+] [-] cogman10|5 years ago|reply
[+] [-] unix_fan|5 years ago|reply
[+] [-] mchusma|5 years ago|reply
There are 2 things every country can do to save lives that have effectively zero cost and zero negative externalities:
- lifting lingering vaccine bans (the US's ban of AZ is most glaring)
- first dose first - the evidence is overwhelming at this point.
These two things, which could be done almost certainly by Biden alone (in the US), would allow possibly everyone who wants a vaccine to get one by the end of March, instead of July with the current projections. And this decision is effectively zero risk.
[+] [-] 11thEarlOfMar|5 years ago|reply
[+] [-] tus89|5 years ago|reply
[+] [-] goldforever|5 years ago|reply
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[+] [-] ahmedshaikh|5 years ago|reply
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[+] [-] LeCow|5 years ago|reply
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[+] [-] robertofmoria|5 years ago|reply
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[+] [-] jorgeleo|5 years ago|reply
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[+] [-] guilhas|5 years ago|reply
Also when vaccination started, we can clearly see a spike in deaths. Are those "linked"?
https://www.dailymail.co.uk/news/article-9273943/Why-Covid-r...