[aclimatt]

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.

Should that not be the "end" of it?

[dragontamer]

> 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#).

[mynegation]

> Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?

Because it is not given and - if given - is not reassuringly close to 1. Correlation is positive, alright. But if you calculate hospitalization as percentage of cases, even adjusting for a lag, it is far from constant. Eg in Canada this ratio was 6x time higher in the first wave than in the second. It strongly depends on testing policies and hospital admission criteria.

[psychlops]

I'm curious about your data set. The correlation of cases to deaths using data from covidtracking.com for the US over the past year is 0.28-0.3 when I ran it. I slid it by two, three and four weeks.

[scrollaway]

> Given the high correlation between COVID# cases (or %Positive) and hospitalizations, why not just use COVID# and "gain" 2 weeks of information?

As we vaccinate the people at the highest risk of hospitalization, the correlation will change: Numbers may stay very similar, but hospitalizations should go way down.

[vmchale]

> 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.

[standardUser]

It's an important metric because earlier indicators aren't as useful. The rate of new cases is tricky because we don't really care if someone gets COVID-19 anymore than we care if they get the common cold, assuming they have only mild symptoms and fully recover. Hospitalizations are the first unambiguous metric we have to know there is a serious problem that may require a dramatic response.

[inglor_cz]

In the wild phase of the pandemic, yes.

But once enough people are vaccinated, the pattern may change. For example, you may still catch quite a lot of cases through PCR testing which is very sensitive, but the share of asymptomatic cases will be much higher and the share of people who are going to suffer a severe case much smaller.

The entire societal signature of the disease will change depending on vaccination levels and maybe even particular vaccines used.

[teawrecks]

The point isn't that we use hospital admissions as a metric to infer cases or some other metric, it IS the metric that matters. The problem over the last year wasn't that there exists a person who is at risk, it's that there didn't exist any healthcare system capacity to treat them.

From very early on in the pandemic, it seemed to me like our goal for optimal balance between caution/risk was to try and maintain the highest level of hospital occupancy that is sustainable. If every single person quarantines perfectly, then our hospitals are empty, but so is every business. If no one quarantines, our businesses are full, but so are hospitals and everyone's viral load; i.e. maximum mortality.

With the vaccines now available, it seems like our goal should still be be to maintain the highest level of sustainable medical system occupancy.

[choward]

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.

[smileysteve]

> was so hospitals don't get overrun. That's clearly not happening right now in most places

Citation needed.

Up to 3 weeks ago, California, the Southeast were in field hospital territory.

Anecdotally, Alabama hospitals have been in overflow since July.

Georgia re-established a field hospital in January at their conference center [1] hospitalizations only stopped dropping beginning at the end of January

[1]https://www.11alive.com/article/news/health/coronavirus/geor...

[Solvitieg]

This is what I found bizarre about NZ's approach. Their goals was 0 _cases_ in the entire country. It's a great accomplishment but perhaps unnecessary.

[didibus]

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).

[smileysteve]

> 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.

[umvi]

> 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.

[orra]

> So even a disease that threatens .1% of the population with death

The IFR for COVID is likely ten times that, at least in societies with decent numbers of older people.

> Almost nobody notices or remembers blips of abnormally high "excess deaths" for a particular year

This isn't a bad flu season in a 5 year cycle. The excess deaths caused by COVID last year are not just 'abnormally high'. They're more like once in a lifetime abnormally high.

[NovaJehovah]

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.

[addicted]

The “public health establishment”.

Is this a joke considering the vast majority of Western countries have basically ignored their “public health establishments” for almost all of the past year? Ironically (or not) the only country that has really followed their “public health establishment” until recently was Sweden. Which isn’t surprising because theirs was the only one not asking the government to make tough choices.

[dragonwriter]

> In this case, it will be hard to take back power and the narrative from the public health establishment.

Sitting in California where county sheriffs basically comprehensively vetoed the public health establishment throughout the crisis, I don't see that likely to be a real problem.

[_ph_]

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.

[wpietri]

I take it you haven't been following what's going on with "Long Covid". But even among people who aren't hospitalized, there's lasting harm: https://www.medpagetoday.com/infectiousdisease/covid19/91270

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".

[Mediterraneo10]

I have been following "long COVID" reports. Firstly, much of the mass media coverage is misleading, often intentionally so in pursuit of clicks and advertising revenue. A lot of the people claiming to have debilitating "long COVID" were never actually tested positive for COVID in the first place. They are the broadly the same demographic that, before COVID, were claiming to have "chronic Lyme" or whatever. Certainly mainly of them do have symptoms and distress, but it is questionable what relationship they have to COVID.

Then, if one starts digging into more serious discussion – even your link above – one finds that "long term" in medical parlance may mean a series of months but not necessarily years, and similar months-long impacts are known from diseases that we have generally tolerated among society. It also isn’t clear that these lingering symptoms affect enough people to impact the economy if measures are lifted once hospitalizations fall.

[metalliqaz]

I have been "fatigued" for 3+ years due to having children. Life goes on.

[dev1n]

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.

[standardUser]

Small percentages of people suffer complications from many different types of illnesses. At a certain point, human beings simply have to live with a small chance of a bad outcome from ailments that are normally mild.

[aantix]

>People (extraordinarily healthy people) are suffering pulmonary embolism

What are the numbers?

[qndreoi]

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.

[bluGill]

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.

[maxerickson]

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.

[garmaine]

With both travel restrictions and lockdown, It takes about 6 weeks to get to (effectively) zero new cases. Not forever.

[rhino369]

Yes, absolutely that should be the "end" of it. Especially since we are already giving the vaccine to front line works who aren't old or in danger.

Anyone who wants to hole up until they get the vaccine should be able to.

But I'll take the low risk.

[pipeoperator]

Everyone can empathise with wanting life to get back to normal. However the problem with folk wanting to take the individual risk is that the “low” percentage of people needing medical help can still overburden health care systems.

This potentially means that people with other illness / disease can’t / don’t see a doctor in time, and others in a society take the brunt.

Yes, let’s open up; but let’s not throw caution to the wind either.

[hristov]

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.)

[dustinmoris]

> Should that not be the "end" of it?

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]

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.

[garmaine]

> 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.

[scrollaway]

> 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.

It's too late for that anywhere that isn't super remote like AU/NZ. Even South Korea and Japan, isolated as they are and with very strict measures, controls on lockdown, and a population that strictly follows them, cannot get / is not getting to zero community spread: It's doing regular, short, strict lockdowns instead.

This is the model that the west should adopt but instead a lot of countries are faffing around. Belgium has been in a five-months-long semi-lockdown that is leaving everyone severely depressed, is hugely damaging to the economy, and has plateau'd the spread to very non-zero numbers so the disease is still very much present. Worst of both worlds.

[ravenstine]

Should we have an "end"?

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.

[samr71]

Assuming this is not sarcasm, this can be taken to any logical extreme of "tolerable". I'm sure there are many other new restrictions we can put in place that would make people's lives (more) miserable, that are nevertheless "tolerable".

Furthermore, can the world really handle the restrictions in place indefinitely? We've been locked down for a year, and it's certainly starting to feel like the wheels are coming off for many. The economic devastation alone has been staggering.

Epidemiologically speaking, sure, doing this forever would save the most amount of people from COVID. But we can't just look at this from that point of view.

[ghaff]

The vast majority of people are not fine with any of those things for an extended period. In fact, in the US, once late spring/summer roll around people are going to be out and about.

[AndrewBissell]

Have you actually looked into the numbers regarding what lockdowns have done to mental health, not to mention the economic impacts which are going to feed back into people's well being in all sorts of ways? Just because your subjective experience of being a shut-in for nearly a year has been a tolerable one does not mean that has been the case for large numbers of people.

I want my kids to go to a harvest festival again with a live band and tons of people like the one they did in fall 2019. No, this is not something worth giving up simply to preserve a few years of life for some nonzero number of society's most vulnerable and aged. And no, I'm not any more willing to wait five years to see whether there's some lurking complications from the disease, any more than people have been willing to do that with the vaccines which are being distributed.

[leesalminen]

That sounds pretty close to fighting words to me.