There are a lot of comments here essentially saying this is not a problem an we are properly reaching herd immunity.
I am wondering if these commenters are discounting the possibility of a vaccine? There is a strong possibility that we will have a vaccine before we can safely reach herd immunity.
Natural herd immunity is a non-starter anyway. If we reach herd immunity before a vaccine arrives, the economic damage would be far worse than any shutdown. If the R0 is 5.7, you need 82.5% (4.7/5.7) of the population either immune or quarantined/locked-down. If everyone stops the lockdown, that means 82.5% of the population infected. No matter how much we want to argue down the IFR, that's catastrophic.
Semi-related note, I think we haven't properly socialized the basic numbers behind the disease. I hear that Covid-19 is more contagious than first thought, with a "natural" R0 of 5.7. I also hear that it has a doubling time of around three days, originally thought to be more like 5-6. I also hear that the contagion period is 8-10 days. These three numbers do not make sense together. The R0 number needs to be reached during the contagion period. The average contagion period is likely far longer, or, it's way more contagious than 5.7 (which would mean the herd immunity threshold goes higher).
Also, if the illness is more contagious than we first thought, it means that the lockdown was even more effective than we first thought.
Here's a fun mental exercise for whoever's reading this. Say that you have a bubble of 100 people, and released a disease that infected 50 people and killed all of them; 100% fatality. Then say you discovered that it actually infected all 100 people, but only 50% of them died. Is the disease less dangerous than you first thought?
>the economic damage would be far worse than any shutdown.
Any evidence for this? Singapore has 35k recovered and just 26 deaths, because the vast majority of infections are working-age migrants. A disease that kills less than 1/1000 working age people is not going to have a big effect on the economy.
The US is at 121K deaths atm. I made an estimate a while back assuming 60% of the population becomes infected and came up with 350K deaths. Bad, but not catastrophic. And I don't think we will get that high.
Even if the IFR isn't 1%, say it's half that, almost 1M deaths.
And if you think 350k surplus deaths isn't catastrophic, you must have been nodding your head while watching Chernobyl (3.6 Roentgen? Not great, not terrible).
60%/350k assumes an R0 of less than 2.5 (2.5 is to get to 60% herd immunity threshold, and then more infections continue to happen as it dies out), and also an IFR of less than 0.2%.
I think those are outside of the range of any recent estimates I've seen. Natural R0 is generally believed to be higher, and IFR is believed to be in the 0.5% - 1% range.
I also hope we won't hit 350k, but if we stay below that number, it will be because of a combination of continued lockdowns and finding an effective treatment/vaccine before we reach herd immunity.
The 1-1/R0 assumes a homogeneous and well-mixed population, and thus overestimates the fraction infected required for herd immunity. For real, people with lots of contacts will get infected and become immune first, with disproportionate benefit. That effect is hard to quantify, but it's near-certainly big, with many papers speculating that herd immunity may occur around 30% recovered:
This is before considering overshoot, which can occur just as in the homogeneous case (and is a reason to slow the spread as much as reasonable, even if you expect/fear that the end result will be herd immunity from recovered patients).
Reported IFRs are now calculated from serostudies testing for IgG. The best studies are on the high end of your 0.5-1%, but there's reason to suspect they're significant overestimates. Sensitivity for the blood tests was established from cases severe enough to seek medical help, and may be much lower for mild cases. There's also evidence of mucosal immunity in patients who test negative for IgG, and recently of T cell response in such patients too:
And the number of coronavirus deaths is greater than the actual number of excess deaths, since they're disproportionately elderly. All these second-order effects are uncertain, and difficult to incorporate into a final number; but they're real, and to ignore them completely risks a gross overestimate. Maybe people know that, and think of the overestimate as "conservative"; but considering the tremendous costs of both the coronavirus itself and society's response, I strongly disagree.
Finally, since you said "lockdowns"--if you credit lockdowns (which are always vaguely defined; but government-imposed restrictions on movement and assembly, broadly) with all of benefit to the USA, how do you explain Japan? They're sitting at 8 deaths per million, they never significantly locked down, and their contact tracers are missing ~80% of cases. Maybe it's the masks? Even in California, use is waning. No one seems to have the political appetite to enforce the order coercively; NYC just stopped enforcing theirs entirely after an incident.
Maybe it's the contact tracing anyways, since missing 80% of cases might be fine if you catch the 20% who are super-spreaders (which you will disproportionately, since each person they infect is a chance to find them tracing back)? I could imagine big public campaigns to explain the importance of cooperating with contact tracers, or websites to help people anonymously advise their contacts (which have been tried for STDs, which have at least as much stigma). But I've seen almost nothing.
To be clear, I agree that restrictions on movement and assembly were and are a good idea in some cases, and New York and Lombardy surely wish they'd locked down earlier. I just don't like seeing them discussed as if they're responsible for all the difference between our current situation and a first-order model that we know is significantly wrong.
Therefore what? Are you arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us? Because that's what I'm arguing against. I feel like I just read a template.
In my last paragraph, I said explicitly that I supported lockdown-type interventions in some cases. Further, even if the end result is herd immunity from recovered cases, slowing the spread will limit overshoot--so support for lockdowns and expectation the pandemic will end in herd immunity from recovered cases are not mutually exclusive.
So my suspicion is that you've skimmed my (long) comment, assigned it to some "template" that you've seen before, and made quick and inaccurate assumptions about my beliefs instead of reading what I wrote. I don't see how you could otherwise believe in good faith that I was "arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us".
To start, I'm arguing that the first-order death calculations using 1-1/R0 and IFR from IgG are probably significant overestimates. Do you disagree? If yes, why do you think heterogeneity and evidence other than IgG of prior infection are negligible?
And again, how do you explain Japan? They found a way to continue mostly operating society, while American schoolchildren without attentive parents fall behind their classmates a day at a time. Wouldn't we be better off trying to understand and emulate their success instead of arguing about "lockdowns"?
I don't believe you are "arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us". My point is, if you aren't, then why are you acting like you are disagreeing with me?
I've seen you ask about Japan in other threads, using much of the same words, without the various counterpoints seeming to register to you, and now you're making the same points here. It just seems weird. Why are you bringing Japan up as if it's some sort of counterpoint, when it's a counterpoint to something that you apparently believe in? Why are you bringing it up if you aren't in favor of ending mitigation and aren't in favor of acting more like... Japan? I don't care if (R0-1)/R0 is off by some negligible percentage - it would still mean there's a huge difference in death depending on whether we do or don't stop mitigation. I'm arguing against the people that don't even seem to have a rough mathematical sense about this, and also the people that seem content to be like Thanos and shrug their shoulders at a million, 350k, or 200k people in the US dying as long as it's not their friends.
I mean, back to your first comment, if you think herd immunity maxes out at 30%, and that IFR of 0.5 - 1% is a "significant overestimate", then you're pretty close to projecting our current death toll anyway. 0.25% IFR at 30% would be like 250k in the US, which we'll probably hit with our half-hearted mitigation. But since you're in favor of mitigation efforts, you clearly don't believe the estimates to be that low. So... again, what is the relevance of what you're saying? Are you just being sophist? What's the syllogistic connective tissue in your points? What's your therefore? You believe the R0 and IFR estimates are overestimates; therefore what?
Why do I need to explain Japan? I mean obviously something must be happening in Japan that is consistent with what is happening elsewhere, it's not like they are an alternate universe. It's not like Japan is a counterpoint to NYC or Lombardy; they're in the same reality somehow. How do you explain Japan? It's probably some mixture of culture and bad stats in a way that doesn't really have any bearing on what we should do - we already have sufficient data to know that mitigation saves lives, and we're stupid enough that we're about to learn it all over again for the first time over the next six weeks.
1-1/R0 may be off by a factor of two or more due to heterogeneity, which I don't consider negligible. I listed that and other effects because I believe they are real and significant, and not because they fit cleanly into any argument for a preconceived position. I agree that a horrifying number of people have died (and will die) of coronavirus. I also believe that the societal costs of the lockdowns will be huge, and will be paid for years to come. Ten years from now, will social scientists find a significant and permanent divergence in educational attainment between rich and poor schoolchildren starting from the school closures? I don't know, but from other studies of interruptions in education I fear yes.
Both harms seem tremendous to me, neither so obviously larger than the other that we should disregard information that helps make the best estimate possible. Do you disagree? If yes, how did you convince yourself that the costs of the lockdowns were definitely smaller? I agree that some of the people arguing against lockdowns are ignorant of the likely death toll, or indifferent to human life; but some of them just think you're underestimating the cost of the lockdowns, just as you think they're underestimating the cost in human life.
In any case, we certainly both agree that the government should take actions to mitigate the coronavirus. In your reply above, you've switched freely between "lockdown" and "mitigation", when the latter is a broader category. Japan is surely undercounting some (like everywhere), but you can't miss NYC-scale mortality. I see basically no question that Japan has many fewer deaths, despite the near-absence of lockdown-type mitigations there. As you say, the Japanese aren't aliens--so if something in their culture is saving them, why can't we find out what and adopt it? Whatever they're doing, compared to the USA, it let them operate their society almost uninterrupted and avoided about 46,000 deaths. How can you dismiss whatever they did as non-actionable, when we don't even know what it was?
Was it all the masks? I don't know, but maybe. So why haven't we tried actually enforcing their use, and a big public education campaign on how to wear them properly? How many Americans have dismissed masks because they tried a fabric mask made from too many layers of high-thread-count fabric and found it hard to breathe through? Masks made from meltblown material are easier, and back close to normal prices. Do Americans know that? I didn't until recently.
Or maybe it's the contact tracing? I doubted that before because Japan is missing most of its cases, but I read a paper observing that heterogeneity meant the most important cases (super-spreaders) would be found preferentially. So maybe it's their cooperation with contact tracers? You could spend more than Coca Cola does in a year advertising the importance of that, and it would cost less than a day of strict lockdown. Why haven't we tried that? Or hygiene in general? Are Americans just bad at washing their hands? Major ad campaigns for basic public health measures have been successful in Africa. Why couldn't they here?
Or maybe it really is something non-replicable? I liked the humidity theory, though the trend in Florida goes against that (though Japan also tends to run the air conditioning hotter and more humid than American tastes; should we advise people to do that?). Something genetic? But even if it's not replicable, I'm amazed by the incuriosity most people--on either side of the "lockdown" debate--show at this massive unexplained difference.
I'm afraid you're trying to interpret my comments as supporting or opposing a small number of well-known, hardened, binary political positions. The result is confusing, because reality is a poor fit for either side of those positions. To the extent I have any goal in writing this beyond procrastinating, it's to show that, and to encourage people to spend their time exploring all the (messy, uncertain, self-contradictory) information available, instead of just arguing a position.
I don't really want to engage with most of this. I think you need to appreciate that there is very little daylight between your kind of points, which might very well be in good faith, and the approach of someone who just engages in what-about-isms with an intent to occlude debate and distract people from the urgency of implementing blunt solutions that do a lot of good. The latter is a particularly cowardly form of debate, where people suggest various forms of possible counterpoints and allude to certain controversial conclusions that they just never quite say out loud.
Just to highlight one point that I think is often missed. Comparing the "additional cost of covid if lockdown is ended" to the "cost of lockdown" is a frequently abused argument - partly because of bad faith, but in other cases because people legitimately miss that "ending the lockdown" doesn't mean that people will all of a sudden leave home. There is a portion of economic cost, and I won't engage in trying to size it right now, because I tire of this, that will remain just from people being rational self-actors. Restaurants will still close, schools will be reduced attended, etc. Because of the virus. So the comparison is to compare "additional cost of covid if lockdown is ended" (and we know there are sufficient idiots out there to drive spread in this case; it doesn't take a lot to have large effects) to "saved marginal cost if lockdown ends".
I understand the impulse to reveal truths selectively in order to guide people to the correct short-term action. I think it's incredibly dangerous, though. That's basically what policymakers did early in the pandemic when they advised Americans that masks were ineffective. Perhaps they got their short-term action, conserving scarce masks for medical workers; but now the shortage is over, and people (a) still aren't wearing masks, and (b) have lost considerable faith in the public health authorities in general. Hard to judge, but I suspect their noble lie saved hundreds of medical workers or patients at most, and will kill tens of thousands of Americans over the next year.
Those policymakers were trained professionals, so I doubt I'm any better at picking and choosing what truths should be spoken. So especially in a forum of moderately sophisticated readers, I'm not inclined to limit myself. I understand that may sometimes superficially look like things people often say in bad faith, but I hope readers expend the effort to distinguish.
In any case, I certainly agree that the coronavirus has tremendous societal and economic cost independent of the mitigations. That doesn't mean we still can't make it worse, though. I'm perhaps more optimistic than you are that Americans can do the right thing after exhausting all other possibilities, and actually wear masks properly and cooperate with other mitigations short of lockdown, with the right (perhaps coercive) guidance. I hope you weren't too close to the earthquake, continuing the apocalypse bingo.
The timing and effectiveness of a potential vaccine are still unknown. Hopefully some of the vaccines being tested now will work, but it's quite possible that all will prove to be ineffective or unsafe. So from a public policy standpoint we have to proceed on the assumption that a vaccine isn't going to save us.
I am wondering if these commenters are discounting the possibility of a vaccine? There is a strong possibility that we will have a vaccine before we can safely reach herd immunity.