Why don't you just take it up with the experts, they both have blogs. I can't be bothered with this condescending "I'll teach you where you've gone wrong" crap. — Isaac

You just stated in your previous comment that you've been asking for the basic statistics all this time.

But yes, explaining a position requires explaining it. If you don't want to debate, probably a debate forum isn't a good place to be.

Prof Sir David Spiegelhalter {Professor of Mathematical Statistics at Cambridge), - "there will be a substantial overlap, Many people who die of Covid [the disease caused by coronavirus] would have died anyway within a short period," — Isaac

This statement depends on what he means by "substantive". Most people might think it to be "a lot", but in this context it is just some measurable effect.

That does not mean there will be no extra deaths - but, Sir David says, there will be "a substantial overlap".

"Many people who die of Covid [the disease caused by coronavirus] would have died anyway within a short period," he says.

Knowing exactly how many is impossible to tell at this stage. — BBC

This is the context. The statement here does not support the idea that this effect is large, just that we will see it.

If he thought it was the majority or "nearly all" he would have said so.

The basic math he uses is "Nearly 10% of people aged over 80 will die in the next year, Prof Sir David Spiegelhalter at the University of Cambridge points out, and the risk of them dying if infected with coronavirus is almost exactly the same".

I'm not sure he's trying to mislead lay people on purpose, as many will interpret that statement to mean your risk of dying this year is the same with or without Covid. Rather, coincidentally, risk of death of Covid happens to be similar to your yearly risk of death. The missing key element he or the reporter leave out is that based on this information the risks are commutative. So, with an unmitigated spread where all ~80 year olds get Covid, 10% of them die, but then another 10% of those remaining go onto die within the year; so 19% total deaths this year.

Now, if we include other risk factors, yes, we could expect less due to this; but unless the disease somehow targets those 10% that would normally die (10% of 80 year olds die and then significantly fewer die for a whole year), the the change is small.

Furthermore, it's simply irresponsible to not mention that maybe surviving Covid increases the risk profile in these groups, so you get more deaths due to long term lung damage instead of less deaths due to overlap.

In otherwords, this expert does not support your position but has made an ambiguous easily misunderstood statement about a lack of knowledge.

It seems the journalist paraphrased a longer rambling explanation of the details with "knowing exactly how many is impossible to tell at this stage". So, it's clearly not a prediction in any case.

Prof Neil Ferguson, the lead modeller at Imperial College London, has suggested it [the deaths of those who would have died anyway] "might be as much as half or two thirds of the deaths we see, because these are people at the end of their lives or who have underlying conditions. — Isaac

I read the article where this citation comes up. I'm going to give the benefit of the doubt for Prof Ferguson that he was temporarily hallucinating about statistics at the time, as he himself was recovering from Covid. And again, it's a "who knows" kind of statement.

But if you read his modelling paper Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand then you see an unmitigated death toll from Covid of 2.2 million in the United States from May to July.

Total US deaths in 2018 was 2.8 million. There's simply no way Prof Ferguson is saying you could have 2.2 million deaths in 3 months and then going less half to a third of otherwise expected deaths happening for the rest of the year.

Likewise, if you read the paper of the expert you're citing, you'll see a massive overburdening of the health care system in unmitigated spread as well as the problem of it happening again and again and again each time a lockdown is lifted.

When he talks about "half to two thirds would have died anyways" he seems to be talking about a situation where social distancing is done really, really well and the disease is limited to being like a hospital disease that kills terminally ill people since they cluster around hospitals.

And again, without mentioning that the effects of Covid could replenish these risk groups that would likely die within the year, it is simply a mistake on the part of this expert. Experts can still make these kinds of errors in interviews, which is why citations of published papers are usually preferred supporting evidence.

I don't know if he's specifically revised this statement, but 2 days ago he was interviewed and said:

“What we really need is the ability to put something in their place. If we want to reopen schools, let people get back to work, then we need to keep transmission down in another manner.

“And I should say, it’s not going to be going back to normal. We will have to maintain some level of social distancing – a significant level of social distancing – probably indefinitely until we have a vaccine available.”

He said that despite the “billions of pounds per day” cost to the economy – by putting in place infrastructure to tackle the virus – it was a “small price to pay” to tackle the outbreak of the virus.

Pressed on whether the government was moving towards an exit strategy, Prof Ferguson went on: “I’m not completely sure. I would like to see action accelerated. I don’t have a deep insight into what’s going on in government but decisions certainly need to be accelerated and real progress made. — independent reporting a BBC 4 interview

This doesn't seem the position of someone who thinks up to two thirds of people dying of Covid are those that would have died within the year.

No, you gave a small number of minor factors without any citations to back them up and nothing to counter the cited evidence I provided of the major factors which do overlap. — Isaac

You didn't disagree with future contingencies affecting heart disease outcome; therefore, I need not cite it as you seem to agree and I used common knowledge examples.

So, if you don't point and say "I'd need proof to assume stressful events that might happen in the future could impact heart outcomes" then I can't know you don't also accept this common wisdom.

Instead, you cited evidence that supports my view, that risk factors are very large groups such as heart disease, obesity, etc. not evidence that it is only the "severe risk subgroups doctors say will likely die anyways soon" nor any evidence that such groups exist despite doctors not knowing about them.

If you provide citations that support my point, why do I need to do anything?

And again, no where have I said factors don't overlap, the point at issue is whether these overlapping factors are coming from large groups that have small factors (many with a small chance of death in both sets; i.e. risk of death from both selectors) or small groups with big factors (few with a large chance of death from each).

Yes, and you've yet to demonstrate, with evidence, that the selection is small (relative to the group {at most risk}, nor that there is 'some other' selector rather than exactly the same one. — Isaac

This is your hypothesis, and there's no evidence for it, therefore "there is no reason to assume it", therefore it's not a reasonable risk to take.

Furthermore, it wold overturn the prevailing view in medicine that most deaths in a given year are fundamentally unpredictable (there are very, very small groups in "90% risk of death this year" but there are very, very large groups with "10%, 5%, 1%, 0.5%, 0.1%" and and most deaths come from these groups in a given year because although probabilities are small membership is large).

But if you are not aware just how sensitive "selector collisions" are to the summed probabilities of selectors being small, then it's difficult to intuit these large number statistical theorems (which are clearly at play with the evolution of Covid, otherwise nearly every country wouldn't be experiencing the same simultaneously, just managing better or worse, as there would be dominating small number variations that result in very different outcomes due to pure chance).

So I will explain these theorems and why chances of the overlap you are talking about become so small as risk groups become large and chances of death from both Covid and underlying conditions are small that the broad facts about the pandemic support my position without the need for laborious analysis taking into consideration all sorts of subtleties.

There is a clear dominating driver of events which is Covid, once containment fails, kills enough people in a short period of time as to overwhelm health systems; society (relatively rich societies anyway) simply can't function without a health system and so, even the most "initially downplayed to the max" governments take social distancing action and try to ramp up resources to deal with the situation (with the exception of Brasil, so a convenient, although tragic, control case for this analysis).

There is. Loans, postponing leave, postponing retirement, postponing investment plans. There's all sorts of ways of borrowing from the future. — Isaac

Not physical resources. A loan doesn't help a doctor today treat a Covid patient, only real material and human resources (which cannot come from the future).

Right. So you're wrong when you say that governments can deal with these problems through rationing then aren't you? — Isaac

Government have already implemented rationing successfully, even some chains voluntarily implemented rationing.

For instance, in Japan there is a limit to masks you can buy and a large fine for buying more (because rationing obviously works to prevent perverse distribution of resources in an emergency).

Yes, that's what I've been repeatedly asking you to do. — Isaac

You have not been repeatedly asking me to do this, and I have not volunteered as calculations don't actually solve the disagreement.

Your claim is that within these risk groups such as heart disease, there is a hidden risk group of "weakest heart" and these are those dying of Covid and are subsequently culled from the heard and don't die / burden the health system later.

Demonstrating how my point about these groups being large makes the overlap small using calculations doesn't solve the above difference. And, it seemed you accepted that my point about large groups held, so there was not need for me to demonstrate it.

I gave lot's of reasons why there is no such subgroup of "weakest heart" as lot's of factors affecting real death from heart disease are in the future and therefore Covid cannot select for.

My whole position is based on a well known statistical fact that as selection from a group becomes a small, the chance of colliding with some other small selector is small. If we are both picking 1 out of a hundred hats at random, it's unlikely we'll pick the same hat. Now, it's not random given the whole population, there are risk groups, but if these risk groups are large (such as heart disease or obesity) then collision remain small (1 out of a thousand instead of 1 out of million). The set we're selecting from needs to become very small or then the number of selection very big of one or both selectors for there to be collisions.

However, for your benefit I will bring out all the theorems and things we "certainly" (highly, highly likely) know about the pandemic so far, to demonstrate why overlap will be very small of all kinds; both confounding causes of death and overlap with "would die soon anyways".

In other words, with overlap we only need to re-assign resources (which everyone agrees is doable), without overlap we need to produce a net increase in resources (which many think is not doable, so why bother >> herd immunity bullshit). — Isaac

For instance, if you want to debate your arguments even assuming your premise, the above simply doesn't hold. Even if there's overlap, I've been mostly talking about overlap of a temporal nature (people dying now that would die in the near future, such as within a year), and there's no way to re-assign resources from the future to the present. Furthermore, lot's of health-care resources simply don't apply to respiratory infection, and therefore can't be reassigned; therefore, for both reasons, even if your overlap theory is true, there needs to be "net increase in resources".

True, it is not doable to scale in parallel to a unmitigated pandemic; yes, the fascists say "why bother, let's keep the economy humming and the dividends flowing". But this is a false dichotomy. We can lower infection rate by social distancing to something that is below health care capacity (such as many countries have demonstrated) or then at least not so far beyond capacity to reach a total health system collapse (every country late to the game is doing). We can at the same time scale resources as best we can.

5. We will have to come out of lockdown soon (partially) and continued promotion of the idea that Covid-19 is some random reaper stalking the land takes resources away from those who really need them as the hysterical-selfish (by far the largest population group) panic-buy themselves their ppe/food parcel combo (Disney-themed, Bluetooth-enabled version, only £9.99 on Amazon), — Isaac

Again, nor I, nor anyone else has here has claimed it's a "random reaper", just "random within risk groups that are large enough and existing risks low enough that Covid deaths do not coincide with 'weakest heart' deaths type hypothesis". Furthermore, people aren't panic buying due to such a fear in any case, most young people and even a lot of elderly people don't fear getting the virus, but people are panic buying because they think other people are panic buying or then not even panic but in the hopes of price gauging, because of the lock-downs not the virus itself.

while doctors make do with paper towels and some sellotape. — Isaac

Both the panic buying in itself and doctors going without due to panic and hoarding are false dichotomies. Government can easily solve such a problem through rationing, and many governments have. In the US this would be socialism and "a republican" administration doesn't want to set precedents that socialism can help on some issues (except giving corporations as well as 2 week old companies created by sycophants money).

No one is debating these facts, but once numbers get large the ambiguities get small, as a large amount of people dying of pneumonia in a region during respiratory epidemic is very likely.

The graph I just posted (if true or close to true) demonstrates the basic problem, as it would mean (if everyone got the disease) about double total deaths in the year (there is less infants that die, but there's some excess in the 60s range) happening in a short period of time would be a total disaster.

Furthermore, many people that recover still needed hospitalization and care not just at an alarming rate, but also for a long duration of time (2-3 weeks).

There's simply no way statistical coincidence with other causes of death explain the phenomena of overloaded health systems, nor any reason to expect we'd have some large effect of abatement of those other causes of death after the initial overload.

If you really want me to go into the calculations that explain my position, I can do so.

I'd rather hope to be discussing things with people intelligent enough to know the difference between a fact which is unhelpful and one which is wrong. — Isaac

If you think this applies to me in this discussion, please argue the point. I said maybe you are affected by attempting to overcompensate your bias; maybe not. Either way, you are still wrong about believing the real overlap that really does exist could be big enough to result in effects you think are possible.

The source I previously mentioned.

And you elected Trump, so what's the problem? — ssu

The problem is that the right has all sorts of dogmas that excuse Trump's corruption, even make it a good thing.

For instance, Randians may see Trump's corruption as simply "following self interest" which is a good thing in their system. Of course, the immediately use the left's standards of corruption and the idea "greed is bad" when criticizing the left or government in general. So Hillary is a corrupt greedy and basically evil politician, like all bureaucrats and politicians, but Trump is a savvy business person who knows how to make the system work for him, and if he does it corruptly and gets ahead that's just winning, and of course he is bringing that savviness into his new life as a politician to enrich himself. This world view basically reduces to the dogma that business people being naturally greedy creates good but bureaucratic being naturally greedy not only creates bad but makes them evil; without any attempt to resolve these two groups are coming from the same homogeneously greedy humanity that is postulated nor resolve what happens when "good greedy business people" get involved in politics or bureaucratic processes.

Likewise, the evangelical right have created a dogma that Trump is literally or metaphorically the reincarnation of an old testament king, which God worked through to do the good. Trump is behaving as they'd expect an old testament king to behave (an old testament king does what they will, takes the women they want, the money they want, isn't accountable to anything) so therefore this is evidence of the theory working.

However, the left doesn't have similar dogmas to justify corruption on the left. There is a legitimate self criticism in the desire to reduce and remove corruption as well as a legitimate response to criticism from the right. The right can therefore use the left's standards of right and wrong against the left, because the left tends to believe those are real legitimate standards (not just politically expedient value signalling that can be resolved by the talking points of the day regardless of even a surface scrutiny of those talking points nor if they contradict yesterday's talking points).

Pointing out the right is hypocritical in using "greed is bad" with regard to left politicians and not right politicians, and hypocritical of assuming Trump can be the reincarnation of an old testament king (to do good mysteriously through doing bad, basically) but not Obama (who's literally the anti-Christ) doesn't help win an election.

What helps winning an election is nominating someone who can be easily defended against charges of corruption (due to a long track record easily explained by a lack of corruption) and who doesn't have super cringe videos of interaction with children (the argument Biden is simply not self-aware doesn't help, nor the argument that it's actually normal stranger-child interaction that "happens to have bad optics for a politician" as people can verify in their own lives that no one interacts with children in these ways; the constant touching and prodding of children even fathers don't do, much less grandfathers much less strangers; normal touching is holding hands, a pat on the head or some sort of fun game that involves touching like tag; the idea that these videos aren't a major problem for the Democrats is crazy; they'll be circulated and recirculated and the emotional impact will be enormous; the idea he's an out-of-touch, not self-aware, hyper-doting pan-grandpa to a creepily cringe level isn't a good argument, which is basically what apologists for Biden about these videos argue; nor the argument he's just trying to "get a good photo" stand-up to 1 second of thought, as he's not the photographer nor actually looking at what he's adjusting, and no one normal thinks "oh, this child may ruin the picture, I need to be continuously on this problem" to begin with). What's the apology? "Oh, no, no, no, Biden's not a pedophile, he just loves children so much!" Yeah, sure, maybe, but choosing a candidate where scrutiny starts at such a statement is sub-optimum strategy.

True, on some level "what about Trump" can justify supporting Biden in a pick-your-poison analysis, even if the worst accusations about Biden are true, but whataboutism doesn't win new converts, it just helps keep existing converts in the cult, and Trump win's handily if it's about who has the bigger cult following, and so the progressive left concludes that nominating Biden demonstrates the DNC rather lose to Trump than win with Bernie (or any candidate remotely credible, due to legitimately being not corrupt); Trump's given all the donor class huge tax breaks, he's pretty good if things are looked at objectively from the donor class point of view. And progressive leftists have been saying this for a while; Biden is just an ultimate confirmation for this point of view.

Am I too pessimistic in thinking that I should throw out Mills "On Liberty", and buy a new copy of Hobbes "Leviathan"? — graham hackett

There are two meanings of liberty.

We can mean liberty in the sense of individual freedom of action as you have been considering.

However, there is another meaning of liberty which is "equal political participant"; arguably the original meaning. The concepts naturally go together, as an equal political participant and first class citizen naturally has lots of liberty of action and expression, as much as anyone else (otherwise, by definition, there would be some higher political class with such liberties that actually manages things).

For instance, serfs did not have liberties of a political sense of equally participating in politics compared to aristocrats. They also didn't have liberties of the physical actions sense in terms of where they could go, what they could sell, etc. So although serfs "becoming equal" really only matters in terms of political participation (as there will always be rules) the visceral experience of "not having liberty" is being subject to those rules that apply to second class citizens and not first class citizens and so the two ideas are easily confused one for the other.

Getting rid of rules beyond the ideal of equal participation has no expected bearing on both kinds of liberties. For instance, if getting rid of a rule creates endemic corruption and subjugation by a new aristocratic class that has all the meaningful levers of power, then one has "given up essential Liberty, to purchase a little temporary Grift and deserve neither Liberty nor Grift."

So a situation like a pandemic which obviously requires changes to our general liberty of action, need not change political liberties of being a equal political participant.

Countries that can be said to have genuine political liberty of this sense (Switzerland, Scandinavia, New Zealand and a few others) the pandemic creates no "authoritarian anxiety", as there was none to begin with. Of course, there's lot's of discussion of what's best to do, as with any subject of government policy, but there is no fear that the pandemic will remove this liberty of political expression and participation and that the government can somehow "take advantage" (they will simply be voted out if they don't manage in a way generally approved).

However, countries that don't have much political liberty in this sense (where people objectively aren't equal political participants; either due to electoral design, endemic corruption and disenfranchisement, or simply being a straight up totalitarian state not even pretending to be democratic) then the pandemic amplifies authoritarian anxiety, as well as the real risk of even more of it, as the people don't have a sense of "being in control of a transparent and accountable government" before the crisis, and so the emergency powers and chaos of the pandemic simply bring this fact to the fore with very real reasons things may go even further away from genuine political participation (that the first class citizens that have the real liberties in both senses of the word, don't let a crisis "go to waste").

In other words, those who have liberty shall be given more and those that do not have liberty shall lose even that liberty which they had.

Note the repeat of hypertension, CVD, diabetes... — Isaac

This data supports my point not yours. Hypertension, diabetes, etc. are very large risk groups from which my analysis follows.

If risk groups are large, then the "people who we would expect to die this year from the existing pattern" are unlikely to intersect "people who actually die from Covid". There is some intersection, but it is small; there is also a small change in simply the absolute numbers that makeup the group due to people dying from Covid. But both these small effects would only be relevant with a large portion of people actually getting infected, and in such a scenario it is a very real the possibility that long term lung damage or other treatment complications replenishes the risk groups (this maybe a small amount too, but the effects under consideration are also small).

Furthermore, you've simply ignored the other reasons we shouldn't expect Covid deaths to be displacing near-future-otherwise-deaths even if there was unknown "weakest heart" kind of groups within these groups, such as diabetes, hypertension etc. such as the simple fact we're early in the outbreak.

Yes, people dying tend to have underlying conditions. But no, people dying are not "going to die soon anyway" in any meaningful sense. Covid does not select for "going to die anyway" nor "the weakest part of the spectrum within these groups" (and such a spectrum does not exist in well ordered nor static sense; a lot of chance is at work).

The reason I argue this point, is because it is a widespread misunderstanding that Covid is "culling the weakest". It lines up with certain political ideologies that want laissez faire survival of the fittest, which I understand you don't empathize with; nevertheless, not emphathizing with a political bias does not automatically protect oneself from misgivings propagated or that happen to line up with such a bias (indeed sometimes we can be so concerned of our own biases that we jump on inconvenient impressions to convince ourselves we are managing our biases).

So, I have no problem continuing to argue the point.

To support your position you have to demonstrate that the vast majority of factors defining the most vulnerable people in the group suffering from heart disease, lung conditions, cancer etc are not the same as the factors defining the most vulnerable people in the group of Covid-19 sufferers. — Isaac

First, I've already explained why those factors can't be the same as some of those factors are in the future. So I guess deal with those first.

Second, I've already explained why it's highly unlikely for those factors to be the same even in the present; for instance, inoculant load is a factor highly suspect to be a big factor in outcomes for Covid but cannot be a factor in any other underlying health condition as it's Covid specific.

The more the factors don't overlap, the smaller the effect of "Covid killing those that would die soon anyway" becomes; though, to be clear, no where have I stated it disappears, it just becomes small.

Smoking, obesity, even age, are risk groups where people can still be expected to live decades, but die from Covid despite such odds.

But it does kill people now who are likely to die soon that aren't likely to die now otherwise, right? — fdrake

Agreed, but this is a small group of both the known terminally ill risk groups and postulated hidden terminally ill groups, and within this group not all have gotten infected at this point (and the initial conversation was about UK numbers essentially next week or a few weeks from now). So the effect is small because these groups are small.

Covid definitely is a disease likely to kill the terminally ill, but it also kills people in very large risk groups that have an average life expectancy far beyond a year. Covid kills a small percentage of these people, again they need to get the disease first also, and so the effect is small on reducing future deaths because not many die and they continue to have the same risks as before.

We know that Covid is not killing only people that doctors expect to die shortly anyways, and it's implausible that there is some hidden extreme-risk sub-group within larger risk groups that Covid happens to kill (and implausible such a sub-group even exists that explains all, or even most, deaths in those risk groups).

since the dead people won't be in that group any more, and certainly can't die from other causes if they're already dead from COVID — fdrake

This is my position, which I have been very clear about since the beginning.

I also gave Isaac the same benefit of the doubt, as I wasn't sure if he meant "significant" in the sense of "big" or in the sense of some measurable statistically significant effect (which can be very small, but still measurable). Why I have stressed I'm talking about some short term observation, such as within a year.

But if you read Isaac's recent comments, he has clarified that he means Covid kills some hidden subgroup of for instance the "weakest heart" within the relatively large "heart disease" risk group. An effect larger than simply reducing these groups by whoever dies of Covid, but that they otherwise continue to have the same risk profile going forward.

I believe we agree that's not the case; that there is some effect of culling the terminally ill (whether known or unknown) but it's not a large effect.

What are these factors then (presumably ones which don't also overlap with factors making death from Covid-19 more likely)? — Isaac

I say "can be easily be other factors", I mention otherwise benign genetic differences (that benign differences can have a significant outcome difference given some new threat, is exactly why we have evolved to have such differences; epidemic is the classic case for why evolution goes this way), but there's also initial inoculation viral load that is highly expected to have a big effect on outcome, and of course timeliness and quality of care, but even with similar care there is variation in response to treatment.

Really? In what way? Presumably proximity to medical services is the key variable in time and place (those more remote will have more difficulty). How is that different with Covid-19? — Isaac

I am talking about the variable of proximity to medical services when one has a heart attack (or ability to get service before said heart attack). This is in the future and totally independent of Covid. These future contingent events that have an effect on heart disease outcome mean that the "weakest hearts" is an oversimplification of who exactly dies of heart disease in a given time; "weakest heart" maybe a subgroup, but there's also a large group that then get's filtered (in the future relative Covid) by proximity to medical care.

If you want to talk about the subgroup of people far from medical care as a constant risk factor; it's not symmetric as a heart attack is much more acute.

Again, how do these categories differ from those which relate to vulnerability to Covid-19 fatality? Stress, for example, suppresses immune response. — Isaac

Again, some future stressful event is a filtering mechanism that is independent of getting Covid today. The person that has heart disease but not the "weakest heart" today, may live to encounter some future event, such as acute stress, that puts them at acute risk of heart attack.

These future events that filter for who actually dies in the risk category is simply the strongest example of why "Covid kills the weakest in these categories" is not sound reasoning.

I mean, COVID is more likely to kill people who are more likely to die anyway. This complicates whatever attribution of death to COVID you do. — fdrake

I don't disagree here. Where I disagree is this effect will be big in terms of reducing deaths from these risk factors going forward.

The original claim I have contention with, is that respiratory deaths may go so low after Covid as to balance Covid deaths. So a incredibly large effect.

There is definitely some overlap, but my contention is it is small; small in the sense that it could be completely ignored in calculating likely deaths in these risk groups (though there can be other causes of big changes, such as the lock-downs). I.e. if you calculate the people who die of Covid that are at risk of heart disease in likely scenario of your choosing, and then calculate the people who will die of heart disease, you can essentially ignore the the fact some people died of Covid in this category other than there simply being slightly less people. That there is not a big culling effect.

It's not big now because most people haven't gotten the disease yet.

It may never be a big effect because likely Covid simply doesn't kill those who are about to die in the short term. I've defined short term as a year and explained all the reasons why we wouldn't expect there to be an overlap with "people who would otherwise die this year" and there's no reason to assume such a category even exists now in a predictive sense.

It may be an effect that that is not only not big but is dominated by something that goes in the other direction, such as a large amount of long term lung injury that replenishes the at risk categories, or even increases them.

requires an explicit model of how COVID interacts with the comorbidities, and can't be immediately read off the risk of death of those people who have those characteristics (comorbidity + age) who have confirmed cases and died in hospital (that group selects for comorbidity severity already!) — fdrake

Yes, this is my point. If the comorbidity groups are large, we can't simply assume Covid is killing off some unknown sub-group who are very likely to die in some agreed short term anyway; and once such comorbidity groups are large it is implausible such a subgroup even exists that explains many, much less all, deaths in that group: Some people in the risk group die due to simply being in the risk group, without some hidden mechanism that explains why they in particular died, and even if there are hidden subgroups there's no reason to expect they overlap with the subgroup of people more likely to die of Covid -- some otherwise benign genetic difference may dominate here, exactly why species store up diversity in case some otherwise benign difference is no longer benign given new conditions.

If you take out the entire risk group, then it's a different story, but Covid is not remotely lethal enough; therefore, there's no reason to expect Covid deaths intersect with "would die anyways from underlying conditions in the short term". In a refutable form; Covid discovering for us there are such hidden "weakest, about to die" subgroups in otherwise large risk-groups with little success so far in a finer grained differentiation, would be the greatest medical discovery of all time.

The exact same factor. — Isaac

Yes, there is the same factor.

But having a factor of risk does not mean you will die within a short period of time, it is just a factor.

You are making a completely unfounded addition to the risk group observation that Covid somehow selects to the weakest members of those risk groups -- essentially the terminally ill but we don't know it. There's no reason to assume such a thing. If Covid was a disease of the terminally ill, such as a hospital disease that kills only those with essentially failed immune systems, we would know it by now. There's no reason to assume that there's some hidden group of "true terminally ill people" that make up "actual expected deaths within a year" that we don't know about but will discover because Covid kills them and then they do not live to be killed of their other risk factor. Furthermore, I don't think any doctor would agree such a "hidden terminally ill" group exists, but would say there's a large element of chance within these large risk groups, such as heart disease or smoking or cancer.

Therefore, the only way to have a culling effect is if a disease killed a large proportion of such people, otherwise, with a small amount of killing that Covid does, small in the sense of seeing such an overlap between "Covid deaths" and "people who are about to die anyways", the same "elements of chance" continue to operate in determining who has a turn for the worse, who responds well to treatment and who doesn't, who encounters deteriorating life conditions, develops an addictions, has an accident or some other complicating factor, with respect to Covid as well as whatever other conditions such people continue to have.

In other words, there is not some well ordered spectrum from "good to worse" of heart disease, or lung disease, and that people simply move progressively towards "worse" and then fall off the edge and die. There is a large element of intrinsic randomness and re-ordering due to contingent events, which is why these groups are large and not already separated in a finely grained way with excellent predictors of who in particular is going to die in a given time frame. It's an extremely small group of people who doctors are "certain" will die in any relatively short time frame, such as a year.

Those most likely to die in the "heart disease" group are those with the weakest hearts (for various reasons), those are the same people who, within that group, are more likely to die from Covid-19. It is the inability of the heart to support recovery which causes the fatality, not some dice-rolling random factor. The exact same factor. — Isaac

No, this simply isn't true. You are taking a truism too far.

Also, note that you also have to deal with the fact that right now it's a small group of people who have been infected, and so the effect you describe would not be noticeable much anyways simply because the vast majority of "those with the weakest heart" have not yet gotten the disease. And even if you deal with that, you still have to deal with the fact that long term lung injury or treatment complications may simply replenish this supply of "those with the weakest heart".

However, even the middle part of assuming Covid kills "those with the weakest heart" within the heart disease group is not a sound argument. Other factors can easily dominate in selecting for death within the heart disease group.

Furthermore, a big determining factor for surviving a heart attack is time and place, and this is a completely independent variable to Covid; likewise, people may improve or deteriorate their lifestyle moving from this "weakest" category to "ok" or vice versa, or a really stressful life event has an acute impact on heart disease likelihood; failing to seek timely treatment etc.

Point being, even simply considering these future events that determine heart disease deaths, in other words make your "weakest heart" category not static but a dynamically changing group, significantly enlarges the category of "weakest heart"; i.e. Covid may kill someone who is in the "weakest" category now, but would otherwise have gone on to make life changing decisions and moved out of the weakest category, and so would not have appeared as a heart disease death in the short term.

So, you also have to deal with the dynamic nature of your "weakest" category, in addition to deal with the fact "weakest" is not a given and other factors may dominate who dies and who doesn't of Covid with a risk category. After solving these, there is the fact not enough people have gotten Covid for such an effect to be large, and the fact that if that does happen, Covid does kill off the "weakest", that those that survive may now have long term comorbidity effects due to Covid, thus replenishing this "weakest" group.

The question is: who are those people who are most likely to die of COVID? That's people who are elderly and have comorbidities. — fdrake

I'm not disagreeing that people with comobidities are more likely to die from Covid.

My argument is a counter-argument to the idea that Covid is shaving off a population from these risk groups that can be in some sense said to "about to die anyways"; I've been using a year as a baseline time frame for the meaning of "about to die".

Covid doesn't kill enough people to have an obvious and noticeable statistical effect of this kind, such as non-respiratory disease going forward making up for, or nearly making up for, Covid deaths and arriving at some equilibrium.

If Covid killed everyone who smoked, everyone with heart disease, and every cancer patient and all the old people, then it would have such a very noticeable effect, but the disease doesn't behave in this way and we cannot assume that "particularly unhealthy anyways" dominates in determining who in these risk groups actually dies from Covid; other factors could dominate the death selection process within these groups.

Now, maybe this effect of less respiratory disease deaths does actually happen, since the lockdowns we can easily expect to have a significant change to peoples relationship to pollution, to stress, and to influenza and other infections -- that we can assume are also depressed by the lockdowns. But these effects are due to the lockdowns, not due to Covid culling the "otherwise would have died anyway" group in a big way.

This is trivial compared to the disproportionate risk having heart disease, lung conditions or undergoing treatment for cancer has on your risk from dying of Covid-19. — Isaac

But these are the large groups I've been talking about.

Yes, heart disease is a big predictor of Covid outcome, but it's a large group and there's simply no reason to assume deaths from Covid overlap with some unknown "particularly unhealthy" sub-group of heart disease.

There are definitely known subgroups such as those already experience heart failure, or have had a heart transplant which is being rejected, which I would assume Covid is an even bigger risk. But there is no evidence that Covid is only affecting this known extreme risk subgroup.

Your argument is that we can assume Covid selects for the "particularly unhealthy" within these groups, but there is no reason to assume that is the case. We cannot expect heart attacks to lesson substantially after Covid because the "particular bad cases of heart disease" were culled from the heart disease risk group.

Now, maybe heart attacks do decrease due to systemic effects such as people de-stressing in lockdown, but this is totally different than a "cull effect".

And, even if there was a substantial cull effect, many survivors may have long term injury that simply replenishes the "particularly unhealthy" end of their risk group.

It isn't necessary that those within a risk group that at "least healthy" will die, it's just more likely. If you found any factor or variable which contributed to risk, and it wasn't aliased with * the risk group already, those in the sub group of that risk group that have the extra risk are more likely to die. — fdrake

This is simply not true, as I've explained above.

First of all, at this stage with a small percentage of the population that has gotten Covid, it just doesn't matter because 90-99% of these "least healthy" are still out there and will continue to die due to whatever they are at risk of.

Second of all, even of the people that die within a risk group, the factors determining death compared to one's peers could be otherwise benign. A particularly unhealthy smoker may survive Covid due to some completely benign genetic difference, such as exact shape of proteins on cells etc.

An example, it seems blood type O is particularly resistant to Covid, but blood type O does not provide a similar resistance to smoking. So O blood type's who smoke and survive Covid due to this genetic advantage, there's no reason to assume that they were a "particularly healthy" smoker.

It's an over simplistic assumption to postulate Covid deaths is selecting for "least healthy" within a risk group. It seems intuitively correct, but is not correct.

As I've also mentioned previously, the survivors of Covid, but with long term lung damage or treatment complications, may then replenish the "least healthy" category even if there was such a selector for "least healthy" to begin with.

No they don't, because if everyone is equally likely to be infected then the liklihood of infection can be removed from the equation. — Isaac

No it can't, if you're trying to support the idea that Covid kills the "particularly unhealthy". Lot's of "particularly unhealthy" simply don't get the disease, so there will remain lot's of these "particularly unhealthy" around since they didn't get infected.

Unless you're suggesting that there's some gene specific to the defense against Covid-19, then the only genetic component which might be relevant is one which affects the immune system in general. Such as defect would put you in the cohort from which the 300,000 yearly deaths are drawn. — Isaac

I'm saying there's no reason to assume the variation of death and survival within a risk group is due to being "particularly unhealthy" within that group. It could be some other mechanism such as otherwise benign genetic differences, or then simply random variation such as where exactly the virus begins replicating in the body, that then dominates chances of death within a risk group.

Yes we do. It will (disproportionately) be the least healthy. Same as those most likely to die from Covid-19. — Isaac

As I've explained above, this is not a given assumption.

We cannot assume those that die from Covid are "least healthy" within their risk group.

Then where is the random mechanism? — Isaac

The random mechanism is that we don't know who within a risk group is actually going to die this year, so taking people out of the group by another mechanism, such as Covid, doesn't change significantly the expected pattern of death from the existing risk. The randomness is due to a lack of knowledge at this stage; but there's no reason to expect Covid targets "the particularly unhealthy members of a risk group".

No it isn't. Even within a risk group, the least healthy members of that risk group are more likely to die than the most healthy. — Isaac

This is not true.

For this to be true, the "less healthy members" within a risk group need to somehow be far more likely to get infected to begin with. That is certainly not the case so far.

Furthermore, it would need to be the case that being particularly at risk of Covid within a risk group, means being particularly at risk of whatever makes up your risk group. It could be random genetic differences that make a person in a risk group, such as smoking, particularly at risk of Covid.

In other words, one could be a on the "healthy side" of a risk group, but particularly vulnerable to Covid due to some genetic difference that has no bearing on one's underlying condition.

Covid-19 kills people either by the lungs filling with fluid as a result of a failure of the immune system (sometimes from comorbid bacterial infection) or by exacerbating the effects of other conditions, particularly heart disease. Every single one of those mechanisms relies on an underlying health problem. — Isaac

Nothing I have said contradicts this.

But it's not a pattern which has no causal mechanism to significantly overlap an existing pattern. — Isaac

No, there's no causal mechanism that will cause significant overlap, unless by significant you mean measurable.

I've repeatedly said I have no problem with your claim we'd see an effect of people dying in the "otherwise would have died" category, but it's not a big effect.

Most of the risk categories, including respiratory, will continue to suffer from whatever they are at risk of.

What would make a significant overlap with people who really would have otherwise died I have outlined:

1. Early days with low numbers and cause and effect is not clear, the disease could be simply correlated with the other comorbities but not causal.
2. A disease that has enormous bias towards killing the terminally ill, but essentially no one else -- such as a hospital disease.
3. A super high mortality rate and completely out of control epidemic that has large overlaps with other "would be causes of death" simply due to killing so many people. For instance, many people dying in an Ebola outbreak are genuinely people who would have died anyways in the short term; so there's lot's of overlap but the effect is now small because total deaths are so high anyways -- doesn't do much for lowering attribution of death to the disease. — boethius

Being in an at-risk group increases your risk of dying if you get Covid, but the progression of Covid, in itself, does not significantly alter the nature of those risk groups going forward, such as culling the people that would actually die soon, without some mechanism -- a mechanism which is simply not there. Risk groups of Covid are very large groups we'd expect to be vulnerable, such as elderly, obese, diabetics, smokers, and so on.

I am not arguing with the fact there are groups more likely to die of Covid if they get infected. I am arguing with the idea that there will be a significant decrease in smokers dying because Covid preemptively removed smokers that would have otherwise died soon.

No, and most people who get Covid-19 won't die this year either. That's not the point. The point is that of those people who will die, a disproportionate amount will be drawn from that small group of people who were going to die from respiratory illness or heart disease. — Isaac

Exactly where we disagree.

Yes, the people who would otherwise die of respiratory disease are a small group.

But no, people dying from Covid are not drawn from this small group, but very large risk groups of which this group of people who actually die, or would have actually died, this year is a small subset.

Smoking, obesity, being old, are very large groups. Covid killing some people in those groups is just as random as other causal mechanisms that make these risk groups exist. Since the probability of death due to being a smoker is fairly small for the average smoker and the probability of death of Covid is fairly small, then we can essentially ignore intersection of "smokers dying of general risks of smoking" and "smokers dying of Covid".

If Covid killed all smokers, then yes there would be complete intersection and we could look forward to having less deaths relating to smoking; this would be the ebola example.

If Covid only targeted smokers in the terminally ill phase of lung cancer then again there's an intersection; the hospital disease case.

Likewise, if Covid was not a cause of disease but something everyone already had just scientists didn't know it, then it could easily be a false alarm that there's a new terrible disease; this would be the corollary-causation mixup.

But we know we can rule these things out.

Again, not comparing like with like. If you're including (in your risk analysis) for Covid-19 potentially related deaths, then when comparing it to risks we know already, you have to do the same. — Isaac

That's why I clearly make the distinction of respiratory illness decreasing after Covid because those people were culled from risk groups, and respiratory illness going down after Covid due to less pollution or other second order affects of Covid.

Our response to Covid is a massive systematic causal change to all sorts of things. So, it is definitely true we might see less respiratory deaths because of massive systemic changes to society; but it's a mistake to attribute that decrease to "people who would have otherwise died, but Covid got to them first and so they were not available to die in the existing death patterns we see".

However, we also know that the disease can cause long term lung damage, so it could be that we see this effect dominating the less pollution effect.

Point being, we cannot assume anything about these second order effects on face value. We can list effects, but we can't conclude which trend we will see nor conclude that our list of effects is exhaustive without some detailed model justification -- i.e. the opposite of face value.

We can be confident less pollution is good for lungs, and more lung damage is bad, but we can't know which will be the bigger effect, especially in a scenario where we don't find any effective treatment and everyone gets the disease.

We should also not confuse second order effects with primary effects of changing the makeup of risk groups in absolute terms as direct consequence of the disease killing some people.

As an aside, I did a lot of looking for the source of the "roughly double your existing annual risk", and found it in a search engine cache, so I didn't dream it. It's from a BBC article posting a graph from Imperial College analysis, but seems to be removed from the original article, I imagine because it give the impression that the risk of death for all age groups is completely unchanged by the pandemic, rather than it simply overlaying risk of death from Covid, if you become a case, onto of your existing risk in relation to the single risk dimension of age. Anyways, I'll upload it as it's an interesting pattern, but it's not needed for my above arguments to work.

Where's this? Just on the face of it if this were true then we'd expect to see a doubling of the death rate in all age groups, yet we see absolutely no impact whatsoever in age groups below about 65 (decreasing in statistical significance of course, rather than a single cut-off point). — Isaac

I will track the source down. However, it's not really a premise to my argument concluding that collisions will be low; it just seemed the best predictor I have seen so far. There can be lot's of variations from one risk group to another, such as men and women (men being already in their own higher-risk group, so compatible with the predictor "doubles your risk of death compared to your risk group"). But I'll get back to this when I have the time.

As to, assuming it is true, doubling death rate to result in double the deaths, for that to happen based on the premise, everyone would need to get the disease, which hasn't happened yet.

500,000 people die every year - from which group do you think these deaths are drawn? If these groups do not form the ones who would have "died anyway", then from which group are the 500,000 people who do "die anyway" drawn? Are you suggesting that chance of death is essentially random and not related to underlying health conditions? — Isaac

Yes, there are risk groups along single metrics: age, diabetes, cancer stage, etc. and of course risk groups combining them. What is random is which individuals will create these patterns, but the patterns are nor random.

Introducing a new pattern that has no causal mechanism to significantly overlap (and thus displace) an existing pattern simply results in more deaths and no first-order reason to believe deaths will be lower when that pattern goes away.

I used the term "terminally ill" in my above analysis to refer to people we are "extremely sure will die in the short term".

If you look at risk groups such as "diabetes" this isn't a terminally ill disease where we'd expect death this year. Likewise, most people at risk of respiratory illness will also not die this year nor people suffering from heart disease. There's no reason to assume the Covid will overlap with the other causal mechanisms that make these risk groups what they are. People will continue to die of hear attacks for instance; there's no reason that Covid is killing people who really would die of a heart attack this year compared to people simply at risk of dying of a heart attack; since Covid doesn't kill enough people to change this risk group significantly in absolute terms, we should expect just as many heart attacks going forward. Likewise for respiratory illness, diabetes, cancer stages or survivor status.

In some cases there may very well be less deaths in the risk group, but this is due to our response to Covid (lowering pollution) changing the underlying causal mechanism impacting that risk group, not because Covid deaths overlapped with "expected deaths". And, as I mention, maybe other second-order effects increase causal death mechanism, such as lung injury.

That wasn't my intention. — fdrake

Sorry, should have clarified I wasn't attributing this to you; was really talking about lot's of people on the internet. The word comorbidity seems "really bad" if you don't know the definition, so a lot of people seemed to take it to mean on deaths door step.

I was just talking about whether partitioning the data based upon risk group removes the collider bias you mentioned, and giving some justifying statements that comorbidity complicates the attribution of the deaths to coronavirus, seeing as it also contributes to deaths from influenza. — fdrake

From what I understand, there's no other way to do it, as there's no way to "know" who really will die absent Covid. We can only put people into risk groups and then calculate the probability of death from Covid of people in their respective risk group.

Lot's of people at risk of respiratory disease, or death from any other cause, this year, of course won't actually

This applies especially if we're analysing only people who have died, will die, or would die, that group's going to have corona virus presence collided with other virus presence because it's already known that health outcome severity is influenced by comorbidity presence and severity. — fdrake

Yes, we're in agreement that disentangling is not clear-cut.

My point about overlap is perhaps best summarized as overlap is only significant, or potentially significant:

1. Early days with low numbers and cause and effect is not clear, the disease could be simply correlated with the other comorbities but not causal.
2. A disease that has enormous bias towards killing the terminally ill, but essentially no one else -- such as a hospital disease.
3. A super high mortality rate and completely out of control epidemic that has large overlaps with other "would be causes of death" simply due to killing so many people. For instance, many people dying in an Ebola outbreak are genuinely people who would have died anyways in the short term; so there's lot's of overlap but the effect is now small because total deaths are so high anyways -- doesn't do much for lowering attribution of death to the disease.

If a disease is in the Covid range where we now know it's not a correlation mixup, know it's not highly specific to terminally ill, and know it's not crazy high mortality, then expected overlap is low: most people dying of Covid are not people who would have died anyways; there is simply a large number of additional deaths from Covid and the risk profiles going forward remain constant, as far as we can expect at this time; it could be lower or it could be higher.

However, this expectation is not taking into affect social distancing. With social distancing deaths may go down due to people staying at home and relaxing; less air pollution, etc.. Apparently there are less deaths during a recession / depression. So these second order effects of our response to Covid can also add a layer of complication, and could swing the death count back the other way ... or world war III breaks out and we revise these estimates.

I think we're in agreement on all this -- and I'm not even sure I'm in disagreement with Isaac's original comment I was responding to, as if it's just "one effect" among many, and we'll see with time, then I have no qualms -- but I've rewritten this point for benefit of others or in case we do in fact disagree somewhere.

Basically, my purpose is to emphasize your point that these data sets will be analyzed for years and decades to come, we can only really speculate about subtler relations beyond "it bad" at this point.

The latter odds of the two coinciding likely depend on comorbidity to begin with though. I think if you stratified based on comorbidity the reasoning holds though. — fdrake

Yes, the reasoning is based on the empirical data that the virus seems to simply double your chances of death this year, whatever your risk group; that this is the best predictor for most people.

If the virus only tended to kill people about to die of a heart-attack, or who have late stage cancer, then the overlap with "people who are likely to die anyways" would be more significant.

I think "comorbidities" has given a lot of people on the internet the impression that most people who die from Covid are essentially on deaths doorstep and the virus was a, perhaps even in their minds a merciful, coup de grace. However, these underlying conditions that increase the probability of death are very large, fairly banal groups; people with heart disease, diabetics and cancer survivors that have relatively long life expectancies. Large groups where there's no reason to believe those that would die of some respiratory disease anyways, not to mention just any cause of death, are significantly more likely to get Covid fist.

Edit: also notice the transition between discussing death probability and infection probability. — fdrake

What do you mean by this?

If you reference my term "infection-fatality-rate", it is simply reference to the unknowns on asymptomatics. More asympotomatics makes the disease harder to control, but faster to process the whole population -- whether in a controlled or uncontrolled way.

Right now we only really have "okish" data on the cases, infections that manifest to the tracking system in some way. The factor of asymptomatics can be played with to radically decrease the true infection-fatality-rate. But from what I understand, based on the spread pattern it's not very plausible to postulate numbers much more than double symptomatic cases. Double is a lot, but it isn't so high as to be able to process the entire population anytime soon, and lot's of asymptotics is a double edge sword as they require more extreme social distancing to control the spread.

Not that I know or even have a better guess than the professional to any of these factors. But my point was subtle things like Isaac's point can be illusory, especially at these small number of cases and relatively small odds and the disease affects seeming to be well mixed in the population; and, we can also think of subtle factors that might go in the opposite direction of the effect, such as lung injury -- which then might be the confounding "comorbity" creating a new risk group of Covid survivors that keep the general risk-profile of society the same post-pandemic, or potentially even higher.

So many unknowns. Why not investing in containment such a crazy idea.

We're going to have to social distance until we get a vaccine. The virus is not going to put up the white flag and leave us alone. That shouldn't be news to anyone at this point. Lockdowns are just one form of enforced social distancing and they'll be ending well before social distancing does. I don't think anyone is arguing we should continue those indefinitely. — Baden

Though I agree with your points about social distancing going to be with us for a while, that "We're going to have to social distance until we get a vaccine" is not a certainty.

Vaccine science and technology is pretty bad in terms of rapidly developing and deploying a new vaccine as well as efficacy in general.

Certain diseases have had no successful vaccines despite decades of work and motivation on them, while other vaccines have really poor efficacy.

True, a lot of effort is going into vaccine for Coronavirus in a short period of time, but the sequential limitations to research and development is generally a trustworthy truism (the "a manager is one who believes nine pregnant women can produce a baby in one month" adage).

There is also serious concerns in the evolutionary community about vaccines with low efficacy. If the vaccine works for some, but simply doesn't work for others and the majority just get a mild form of the disease then (even with 100% compliance) a huge amount of people still get the disease as normal.

What can be much worse, is that a large group getting a milder form of the disease can apply evolutionary pressure to the virus to be "better replicator" and so then cause more severe disease in the people for whom the vaccine simply didn't work at all.

So, with an "imperfect vaccine" (the technical term) it may look good on paper but not actually change anything; it could result in 70% having a milder disease but 30% of people having a much worse disease. It is not a resolved issue of how good an imperfect vaccine needs to be to be worth it.

So, a magic bullet vaccine or magic bullet treatment is possible, but it is not guaranteed on a time frame relevant to us. Some diseases resist magic bullet solutions, some don't, and it's impossible to to know ahead of time.

The alternative to a magic bullet is simply muddling through (more-or-less chaotic social distancing) over about 1-3 years depending on the true infection-fatality-rate.

(1) No idea what that means or how it counters anything I said? The figures give are for week ending April 3. Clearly there is a spike in deaths. — I like sushi

Yes, my reading of these numbers is the same as yours, there's clearly a large increase in respiratory deaths. Of course, lot's of caveats can tweak things one way or another; I'm not sure Isaac is saying effects he's pointing too are significant or not.

What is clear, however, is that we have a phenomenon that can quickly overwhelm a heath system with (in any remotely plausible analysis) only a small fraction of people being affected by that phenomenon.

There are now 2 million official cases world-wide, and an economic depression has been triggered due to lock-downs needed to keep things remotely within health care capacity. We're 7 billion. So a short back of the envelope calculation of getting to heard immunity with current health capacity is easily dozens of months (even with super-duper high assumptions of asymptomatic; i.e. even if real cases right now are 200 million, is still months and months to process severe cases at that rate). This is what people are currently not understanding ... but they will soon.

3) 2000 cases from respiratory conditions is not far off normal. It's the amount of cases with underlying health problems being pushed over the edge that is the real problem here. The key thing there being that we don't know how many of them would have died anyway, nor will we until the year's figures are out. — Isaac

The statistical analysis of this general issue I've seen so far, is that getting the virus doubles your chances of death of the year compared to your risk group. Young healthy people have a low risk of yearly death, so absolute numbers are low but there are still young people dying.

The affect your talking about, if I understand you correctly, also only really kicks in with large numbers and even then the effect is low.

For instance, if there is a risk group with 10% chance of respiratory death this year, and getting the virus increases those chances by double, then there is a of collision between Covid deaths and other respiratory deaths. But if those diseases are distributed randomly the collision is not much. E.i. if this group is 100 people, then the odds that the 10 people expected to die from Covid would happen to be the 10 people expected to die from influenza, is extremely low.

So, even though people dying of Covid are in high-risk groups, it is a mistake to assume "they would likely, individually, go onto to die from respiratory illness anyways, or even any other illness".

It is only true of people in risk categories such as "80% chance of dying next week" who get Covid and die this week; but these risk categories are very small in absolute numbers.

Of course, if Covid deaths are kept low due to extreme social distancing, then the deaths (in this first phase) are mostly sensitive to when the measures are put in place. If the virus is replicating along a pathway of a doubling time every 3 days, then a week delay in required measures will have dramatic effect; 2 week delay and the results are no longer really comparable.

(This is why Trump supporters are not angry about the delays and inventing excuses; they do not understand the basic math, as I'm sure you'd agree).

I'm not sure you're even arguing / implying something against what I emphasize above, or are just compiling all the statistical minutia of relations to consider.

In terms of adding to the list, a big one that can not only nullify the affect of high-risk groups decreasing in absolute size (due to dying), but actually reverse that tendency, is that the virus may cause long term lung damage.

So, if every 70 year old got the disease, all else being equal, we may expect that demographic cohort to have less deaths post-pandemic, simply due to their numbers being smaller or perhaps particularly weak breathers being culled from the heard. However, if long term injury increases the risk-of-death factor for survivors of Covid, then you may end up with more deaths in absolute terms next year due to lung injuries or other long term Covid treatment complications. (likewise for every other demographic cohort)

Long story short, some Covid deaths would have died anyways, but expected overlap is small (extreme bias towards this group getting Covid would be needed for a significant overlap), and long-term injury may compensate, even significantly over-compensate, this overlap by increasing the risk-of-death factor for these risk groups (indeed all risk groups).

2 days ago:

You're forgetting the key elements that the left is to blame for the shutdown (somehow the left is in charge and setting policy in the white house), that Trump has had essentially no agency through the entire ordeal, poor thing — boethius

Today:

If Trump doesn't have the power to reopen schools, businesses, state and local govt. offices, etc. then did he really have the power to close them down? If it is the power of the governors to reopen their states, then wasn't it their responsibility to close them? If so, then why are people blaming Trump for not closing things down sooner? — Harry Hindu

Amazing.

I really don't see how this answers my question, which is specifically how the delay in social distancing has resulting in a measurable loss of life, unless you can show that the treatment received under the current conditions has limited the healthcare received and that limitation can be specifically shown to matter. — Hanover

Mechanisms are pretty simple.

Without adequate protection not only to health care workers get sick at the peak, when they are needed most, but they also receive higher viral loads which are associated with worse outcomes.

As hospitals are overwhelmed people get less good care in several steps. It's not binary. First, doctors and nurses that aren't respiratory specialists find themselves caring for respiratory illness, this isn't optimum care. Second phase is that doctors and nurses simply have too many patients to adequately care for everyone. Third phase is triage where patients over a certain age, or certain prognosis, or have dementia and "no quality years left", aren't cared for at all. Fourth phase is that patients who need care, of varying degrees, for other things can't go to the hospital or don't get good care for above reasons even if they do. Fifth phase is health care system collapse.

The other reason for loss of life is that delaying the outbreak also allows more learning and treatments options explored about the illness. Maybe there is some straight-up cure, so this has a sort of "net-present-value" of the consequence of some probability spectrum of treatment improvements over time that buying more time provides. Treatment isn't static; as more experience and science accumulates, treatment gets better.

The virus isn't static either. Slowing the outbreak slows the rate of mutation (there are simply less viruses around to mutate).

These are all measurable affects. I didn't focus on them in my previous response because they aren't the biggest difference since "stop society" is a very effective measure that is not radically different than a "Stop, Think, Observe, Plan" preemptive approach, in terms of overall health outcomes. It's not like other disasters where there can be a point-of-no return that then locks in the worst outcome (discounting trying to actively make an even worse outcome, like dropping bombs on flood survivors or something).

The economic difference is much larger comparing these scenarios, and "exactly how many died due to inaction" is difficult to prove in the risk-analysis-is-taboo framework of modern discourse; whereas the economic consequences are larger and more obvious.

I've nor heard however that there have actually been a lack of ventilators and that people are dying who could have been treated. While many thought it would get that bad, it never actually did. What I'm hearing is: — Hanover

Ventilators is only one of many issues.

It's been a focus only because it's a simple metric, and more importantly something that can be acted upon.

The far bigger issue so far has been lack of masks and protection for health-care workers.

Overwhelming the system is also not simply an equipment issue in any case. Most severe cases have other medical problems, doctors need to continue to treat these problems as well as the virus, which takes knowledge and trained staff. So, killing doctors and nurses due to a lack of protection and lowering moral generally doesn't help, and there's simply a limit to how many patients doctors and nurses can treat concurrently.

The lack of equipment is more emblematic of how terrible the preparedness is and how the denial was really total; not even trying to stock up and organize logistics before there are shortages. If a doctor or nurse doesn't have the right equipment today and gets sick, that equipment showing up eventually doesn't help him or her.

Delaying outbreaks as much as possible through containment as well as preventing the outbreaks entirely in some regions, in this first phase at least, has massive equipment preparedness, human resource implications, and logistical optimization implications.

I've nor heard however that there have actually been a lack of ventilators and that people are dying who could have been treated. While many thought it would get that bad, it never actually did. What I'm hearing is: — Hanover

Although there's a lot to discuss here, even assuming it's true, the reason it's true is because of acute lock downs.

The major benefit for pro-active management is mostly economic.

For instance, had containment been pursued to radically slow and prevent where possible the spread of the virus around the globe due to plane travel (i.e. a flying freeze and serious quarantine and testing of all plane travelers) then most of the globe can continue mostly as normal at any given time. The current experiment of "what if we shutdown most economic activity on the planet at the same time" doesn't need to be run; the problem moves around, we learn what outbreaks look like and how best to deal with it, it's a problem but essentially just a nuisance compared to this scenario.

However, once hospitals start to be overwhelmed then governments do "whatever it takes" to slow the virus down, so those worst case scenarios of unmitigated spread don't happen. However, getting to that overwhelmed point and then doing "whatever it takes" is insanely disruptive. Pursuing containment since November (when US intelligence first identified this virus as potentially cataclysmic) would have mostly been an economic benefit (disproportionately to the US ruling elite, but normal citizens around the globe too in this case).

Waiting, and then doing a hard and sudden social distancing is not orders of magnitude worse than containment, preparing, having well thought out plan at each step, in terms of lives. You can make up for lost time by having everyone stay at home and shutting down the economy. Foresight and a well thought out plan is mostly a difference in economic and general social disruption. Waiting for things to go out of control is still incredibly harsh on medical systems and does quantitatively result in more deaths and injuries, but the emergency break on all of society does work, so the difference is in factors and not orders of magnitude.

However, looking at the unemployment numbers, we do see order of magnitude difference compared to a scenario only affecting certain regions at certain times and policies being put in place and logistical problems solved to avoid the emergency social stop. This is what South Korea did, restaurants are still open for instance.

I'm not a Republican. — frank

You don't need to be a Republican to drink and parrot the Republican coolaid.

The fountain of lies quenches the thirst of all who seek it.

If people would learn from past mistakes, this would likely happen after this pandemic. People would be ready for the next one and likely contain it before the pandemic phase. — ssu

Ah yes, foresight is some sort of mystical quality that can't be expected.

It does make a certain kind of sense though. The right spends their time denying science and then when science based predictions come true: Magic! Demons!

Yet, you live in Finland, enjoying the fruits of foresight based politics and institutional design, quite comfortable during this crisis without any fear of social dysfunction, and instead of explaining how and why these institutions work, based on ideas worth considering, you prefer to coddle American conservatives (with whom you share only a couple of policy concerns) and help lull them back to sleep and protect them from too many terrifying facts at once.

Earlier the US would have created a great effective system to stop pandemics and both parties would take it as seriously as stopping Al Qaeda. The US would be a leader that others would follow. Now when I think of it, I'm not so sure about that. — ssu

The US had such a team! This has been one of the main subjects of debate. Ok, maybe the pandemic team wouldn't have prevented completely the pandemic, but there's just no reasonable argument to make that they wouldn't have been more effective.

But you misunderstand my argument. The US elite were previously concerned about pandemics, not because it's a threat to the American citizens, but because it's a threat to themselves and their "government can't help you, only money for army" ideology.

You see, it's not Eisenhower's era anymore where a Republican administration would invest in huge infrastructure projects like the Interstate Highway System or start a large vaccination program against polio. This isn't just about Trump ineptness, it's more about how broken the system is and how people distrust the government. — ssu

Yes, it is about Trump ineptness. It's also about the general corrupting trend, but obviously that trend resulting in the stupendous Trumpian ineptness is completely relevant.

Also, pandemic prevention is not a huge infrastructure, it's a small investment that has massive cost-benefits, as we're witnessing in real time.

"The system is corrupt and inept ... but don't look at the leader as exemplifying these qualities," is a terrible argument.

You think that all people are willing to take a corona vaccination when it comes in 2021-2022? Will they want to upload the apps now worked on to track the pandemic? I don't think so. It's big brother with it's sinister plans scheming behind the innocent sounding agenda of "stopping the pandemic". — ssu

Is this point relating to my position in some way?

Is it the big bad leftist big brother coming for them from the heart of Trump's white house, pushing the limits of double think. Or are you saying these people are going to be criticizing Trump and Republicans for big brother policies?

And then there's the economic recession (depression). Putting then money anywhere else than something that the people can immediately benefit from won't be popular. That will severely hinder the future responses and likely, at least after a decade, the guard will be down again. — ssu

So you agree that the American elite have lost the thread, are incapable now of making reasonable decisions even to protect the Empire and their own class interests, and we are witnessing the free fall of the American Empire?

Or will they somehow succeed despite such incompetence?

It's not exactly Mad Max, but we are getting more young ones than I expected. — frank

You do realize we already had this conversation, that I already explained over a month ago:

Yes, I do care about the old and would rather anyone, old or young, get the care appropriate to the disease.

The disease affects young people less, yes, but many still need critical care and some still die, all at once it is not logistically possible to provide that care. — boethius

There was zero reason to be surprised about "we are getting more young ones than I expected". The information was available to expect exactly what we are seeing, and the sooner actions are taken the less doubling times happen: and every doubling time you let happen due to inaction doubles the problem!

You were happily drinking the Republican cool-aid a month ago, smugly comfortable that whatever consequences for believing such propaganda are safely in the future, certainly secretly assuming things "won't be so bad" and you'll be able to pop out with this sentiment with the entire right-wing echo chamber roaring to the rescue.

That's not the timeline we're in though. Pretending this is more-or-less what you expected all along, with a few little details missed, is just pathetic trolling at this point. But, I am not calling you a troll like the beer guy; I think you're a genuine believer in this propaganda; even as it falls off the rails and plunges into the abyss, you're a happy passenger. Indeed, sailing has gotten noticeably smoother with a total lack of contact with the ground.

So what happened? How did NYC end up locking down and weathering the crisis fairly well in the face of no cure and no vaccine? — frank

You do realize we can read your previous comments?

The position you started at was:

Many elderly or terminally ill people won't go to the hospital at all. Hospice comes to them at home. Medicaid pays again.

You seem to be concerned with all the young healthy people. Most of them will either have no symptoms, mild symptoms, or they'll feel like shit for a couple of weeks. They won't burden the system too much more than all the other viruses are already doing.

I'd be happy to join you in talking about triaging hundreds of people in one day, rounding them up in convention centers, etc. That's almost a philosophical issue (not quite.) There just isn't any reason at all to think that we'll need to do that. None. — frank

For instance, your idea now that things are "progressing nicely" and you're the calm and steady hand among us doomsayers I already addressed a month ago (how I already explained it before even that):

It's going to be just like Mad Max. I'm telling you. Total disaster.
— frank

I've already explained it cannot get to a madmax outcome since 85-90% of cases recover easily. So letting it just go out of control and killing whomever it can as quickly as possible, wouldn't collapse society. The 90 - 95% (as not all people become cases) of people that survive can easily just carry on.

So, even if society chose to maximize deaths by doing absolutely nothing to slow infection, it's still not a mad max scenario.

Stop wagging your finger at that straw man.

However, just straight up letting 5% of people die without any attempt to help them is obviously not politically feasible.

Even 5000 isn't politically desirable as ssu notes. — boethius

You're just going in delusional circles now; you're just imagining you've been right all this time by adopting our previous positions and thinking we were predicting some even more extreme apocalypse.

When I was arguing for competent containment it was to avoid this as a worst case scenario of shutting down the major economies all at once (which means stressing the worlds resources to deal with pandemic all at once, and the obvious economic depression level implications). Now that we're here, yes, things can get even worse which merits discussion; martial law, out-of-control inflation, geopolitical dislocations. But considering your haughty dismissal of the risk of getting to this point, and the obvious advantages that would have been reaped if the US administration wasn't in denial about getting to this point, maybe it's time to review your analytical capabilities before jumping in again with your Apocalypse straw-manning and trying to portray the US response as competent with as little research as you did a month ago.

It's not just bad faith, but ridiculously and transparently so (since we can read your previous comments! just like we can watch Trump claiming the problem will magically go away and that he doesn't feel responsible anyway) to pretend the current situation was your "a ok, everything on track scenario". It's bizarre fantasy.

Of course the fine details of the computer models do not match the actual events, but everything in general about this was predicted and all the possible responses pre-evaluated. — unenlightened

Though this is true, the media (due to corrupt incompetence when it comes to science literacy to protect corporate interests) insists on presenting computer modelling as predictive and simplifying assumptions and error bars as some sort of problem where we need to wait and see (we see this in the global warming debate).

People making these models are not even attempting to predict actual events, they are trying to evaluate risk and cost bounds of different scenarios and identify the actions that have the highest cost-reward (for both informational and containment/mitigation purposes).

One of the previous health experts that's been on the TV a bunch (I'll try to track him down) was continuously making this point: the price is high in any scenario, but investing upfront can radically reduce costs on the back-end. All epidemic models easily show why this health expert is correct. As even in diseases that end up being not so bad (like swine flu), the local costs invested in containment as best as possible are anyways insignificant compared to the global costs if you underestimate the threat.

Ironically, the media was correct that swine flu was a big issue, but because risk analysis is taboo on mainstream television (otherwise you end up teaching people global warming is an irrational risk to take, giving the benefit of the doubt to chemicals is stupid, tolerating systemic fragility with just-in-time supply chains is moronic, outsourcing critical production is self-defeating, etc.), created a sort of "boy who cried wolf" effect and people were desensitized to this pandemic. Had they had scientifically literate people allowed to speak, then the risk framework (and what numbers ultimately drive the consequences and response level) would have been easy to point to: "see, swine flu ended up having these numbers, why it didn't shut down the global economy, but we now have 95% confidence level Coronavirus has these way high numbers that will shut down the global economy if containment isn't serious and disruptive to a lot of flyers, and yes Boeing stock too, which is a big kick while their down from the Max fiasco, but it's not society's job to run cover of a systemic risk to make mental life comfortable for a few Boeing executives ... a few weeks anyways".

The models end up having pretty good predictive accuracy anyways in this case because the phenomena of epidemics is really well understood and repetitive both throughout human history and other species. But this isn't really relevant for the purposes of decision making, it just makes decision making even easier if the goal is containment/mitigation (which it wasn't; stock market was the goal but epidemiologists didn't have a model to explain how the pandemic might interact with the stock market to Western leadership).

Yes, and this is one reason a Dem probably wouldn't have done things hugely differently in the current crisis. It would still have been a case of putting "the economy", i.e. the interests of the aristocracy, first too. — Baden

In broad outlines, yes.

But I disagree strongly in this particular situation.

The Democratic aristocracy are competent custodians of Empire; stabilizing the Empire is what Obama achieved. Hillary would have done mostly the same, just being slightly more aggressive with respect to Russia (and unknown vengeance factor against Republicans for humiliating her with the blow job).

In the case of the pandemic, the Democrats (and even Republicans before Trump) understood that a true pandemic like we're seeing is an incredible threat to both US imperial security and the aristocracy. There's simply no way to competently respond in a for-profit system nor social safety net to deal with the economic disruption.

This is why the US had the pandemic response team and the CDC would lead pandemic response anywhere in the world. I believe there's an answer Obama gave about "why are we spending money to stop Ebola in West Africa" which was basically "hey! this is in our interests too! Idiots!".

The great irony in the modern US political epoch is that it's Democrats trying to diligently preserve the empire that the Republican base loves so much. Clinton consolidated American soft power dominance post Soviet Union. Bush put the empire into free fall, Obama saved it. Trump has done severe damage to the Empire already before the crisis: purging the entire "soft power" diplomatic corp, making a mockery of the office of the president, embracing dictators, disregarding treaties, creating a trillion dollar deficit, having no coherent Imperial foreign policy, appointing corrupt sycophants to run everything (or then not appointing anyone at all!).

And Trump's biggest mistake in managing the crisis was firing the pandemic team. Yes, China covered it up, but, knowing they might do this, the US previously had people on the ground to not rely on China's honesty (and it seems US intelligence agencies were on top of this issue to fill the civilian side anyways; just now must embarrassingly admit to intelligence capacity rather than rely on either the correct functioning or then the plausible deniability provided by a civilian team with boots on the ground, given the scale of the F-up, US intelligence agencies can't contain these infos even if they wanted to). So, the whole "blame China" thing is basically akin to leaving a kleptomaniac alone in your house and then working oneself into a righteous fury when things are stolen.

The mitigating affect of public health care and a social safety net is also why the EU simply delegated pandemic policing to the US. It's their Empire, it's them without public health system, it's them with most to lose, let them police pandemics; not as a conscious policy, just that risk analysis puts pandemic much lower down for Europe, and then the US has a big investment already, so the result is such a policy effect; hence, pandemic preparedness is just a bureaucratic health system issue rather than a potential existential European issue.

Of course, if you don't want US empire, then Trump and the absurd levels of corruption and propaganda of the Republicans is a good thing, in a sense; not good in itself, but the lesser of two evils (better to have a bumbling crime boss who makes a mess of things, than some genius Machiavellian psychopath).

The reason why the Democratic elites are legitimately "closer to the facts" and constantly virtue signal this belief, is because facts are genuinely needed to competently run an empire, whether for corrupt purposes or some laudable transcendent goal. Why the neo-cons were called "the crazies" by their more liberal, but equally devoted to Imperial maintenance, counter-parts. However, like all aristocratic systems, this goal of facts and competency, and being "long term greedy", is simply not maintainable; corruption and fantasy narratives always become endemic in any aristocratic system (Troy, Egypt, Athens, Sparta, Rome, Carthage, First Temple, Second Temple, Rajah's, China dynasties, the Khans, British Empire, French Empire, the Confederacy, Bismark, Ottoman's, the Tsarists, the Japanese, Nazis, the Soviets); the pattern is always the same, just more or less quick depending on various cultural and stabilizing external threat factors (threats large enough to force meritocratic processes within the elite and society at large, but not so big threats as to just show up and win).

Lamenting the cultural infantilization of Americans. - It appears to me we become merely annoying, but have lost the mantle of dangerousness that might have been our greatest protection. The spirit of the 2d amendment as that a citizenry could at need defend itself, the capacity alone usually sufficient, and the fact and practice when it wasn't. Now it's just deluded individuals who "need" their guns to "protect themselves and their families." So much for arms. — tim wood

We're in agreement here, in principle at least. However, I think we would also agree that violence of this kind is a last resort, and it must be first established that not only are democratic processes broken in the US (which I think we'd agree on that) but broken to a point that the effort to overwhelm those democratic processes to reestablish democracy is greater than some violent revolution.

But yes, I agree at some fundamental level, if the state derives justification by representing the general will of the people and state violence is morally speaking the people's violence in any case, then if the state no longer effectively performs that function and has lost legitimacy, re-appropriating the use of violence that was delegated to the state encounters no problem in principle. The problems are entirely practical, in that violence rarely accomplishes anything; discussion and argument have been far more powerful forces in history.

However, the reality of the situation at the moment, as you say, is infantilization and just deluded individuals, the loss of community, generally speaking, to do anything relevant at all. It makes no sense to call for armed revolution, if, for instance, general strikes have not been tried.

That is, a corruption of our national character and loss of moral compass. Trump, I think we shall find, is a no one, a nothing-at-all, the evil of him being that he occupies places where there needs to be a something/someone. And as a nothing he's undeposable. — tim wood

If you basically mean Trump is the symptom and not structurally relevant nor intelligent enough to create some sort of despotism, then we agree.

The cartoonist creator of Pogo, Al Capp, is the author of he quote, "We have met the enemy and he is us." Turns out he knew a thing or two. And the founding fathers knew we might make a mistake - it's not well understood that the electoral college was supposed to be a protection against such mistakes - and argued that the election was the curative. And now we have the 25th amendment, but without the common sense to use it. — tim wood

Here we disagree. The American founding fathers were quite self-conscious of making a system where only the wealthy could wield power; the rabble needed to be kept out. As such, Trump is entirely consistent with the system. Trump is the best proof of the advantages wealth has in the US system, and Bernie is the best proof of the disadvantages of "regular person". So, in this sense, Trump beating Bernie (because Bernie can't even get to the general, the system works so well) is demonstration of the system working exactly as intended. What the founding fathers didn't consider seriously enough is that the wealthy class, having such an electoral advantage, can systemically corrupt the whole system. In other words, the American system is simply "Aristocracy light" and the time frame from going from a "true educated and courageous elite" of the founding fathers to what we see now, is not even a good performance for an aristocratic systems.

The solution to insufficient democracy is always more democracy. Countries that have fixed feelings of disenfranchisement due to clearly unfair electoral processes, do well in maintaining a civil and coherent public discussion; countries that stagnate in this regard all up in both extreme polarization of the political discourse while simultaneously in a general political apathy of most people giving up on politics because their views aren't represented fairly.

Switzerland has, at the moment, the most fair democratic system and innovations such as "7 person presidency" so that one person cannot have too much power under any circumstances. They also have not only universal conscription but each conscript then keeping an assault riffle at home, precisely because the government really is the people and the people have no reason to fear themselves.