A Modest Proposal for "Phase 2" of Social Distancing

"Ash78, voting early and often" (ash78) 03/19/2020 at 15:50 • Filed to: None

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( TL;DR: High risk groups should remain distanced for longer, others should see restrictions lifted sooner for the benefit of all)

Despite the title, I’m not trying to be satirical here. I’m genuinely looking around at the world and seeing that what we’re doing right now may not be sustainable for much longer — economically, psychologically, or politically.

As the most susceptible to COVID-19 are age 60+ and/or those with pre-existing conditions, I think the time may come that we need to consider that younger, healthier, and able-bodied people should consider a return to work and school on a limited basis, including tight controls around health and sanitation.

This will undoubtedly increase the number of cases, but not necessarily cause a big jump in the number of deaths if we can properly distance the aforementioned group until it’s safer for them. In other words, I’m taking a “limited utilitarian” view of this where we might have to be a little more liberal about an acceptable amounts of casualties.

Just a few points I was brainstorming regarding our parents/grandparents’ age cohort:

They are the most reliant on the stock market of any group. Their future livelihood and retirement (including health) are being decimated right now.

Many functions or assistance they might need are being restricted right now.

Those who are already retired are currently experiencing the least disruption to their daily routine compared to most.

I think we owe it to society as a whole to better balance acute illnesses against overall societal well-being (including the notion that people will also suffer and maybe even die from COVID’s tangential effects, such as reduced wages or depression/suicide). At the moment I think the most pressing issue is not overwhelming the healthcare system, which would have a horrible impact.

I know this is all oversimplified, but I’m just trying to figure out what’s next...we place a very high value on human life in the modern first world, and I don’t envy anyone having to make decisions like this.

Open discussion, I’d love to hear thoughts, rants, ideas, or even some Fight Club references to how to calculate the value of a life....

Dr. Zoidberg - RIP Oppo > Ash78, voting early and often 03/19/2020 at 16:12

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The flaw is if younger able- bodied people start dying — even at a small mortality rate — people are going to correctly wonder why we all just didn’t stick to the plan of a total quarantine.

For Sweden > Ash78, voting early and often 03/19/2020 at 16:12

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Expand antibody testing. I bet a large number of people who had a mild cough a few months ago caught this and are now immune*

*absolutely not suggesting this disease is not serious.

Chuckles > Ash78, voting early and often 03/19/2020 at 16:15

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I wish that the current guidelines had been a little more stringent in the interest of being effective. In my state, the governor called for a voluntary closure of all non-essential businesses. But what is a non essential business? Here are examples:

My company doesn't fall into any of those categories. But we also aren't essential. We could shutdown for a few weeks and it would have no impact on society. So our company, along with many others who aren't technically on that list, have stayed open. So I expect things to get worse here in a few weeks when everyone is out sick because my company neglected to act. 

Ash78, voting early and often > Dr. Zoidberg - RIP Oppo 03/19/2020 at 16:19

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Yep. I just hope we’re not digging a 50-year economic hole for ourselves that will result in more suffering in the long run. Almost like trading a few big plane crashes for a lot of car crashes. The former gets investigated heavily, the latter is just part of life.

ranwhenparked > Ash78, voting early and often 03/19/2020 at 16:20

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Honestly, if this lasts longer than a few weeks, we’re probably going to have to do something like that just so society can function, we can’t keep 327 million people locked down for a year and a half. Quarantine the elderly and sick, let everyone else take their chances.

I know that was Britain’s original strategy, but they backed off because the casualty estimates were too high. Moving to that plan will still be signing the death warrants of a few hundred thousand people, because there are always going to be outliers. A certain number of young, healthy people will require hospitalization, because everyone’s body is different and will react differently, and because there are people walking around with undiagnosed illnesses (like that 20 year old surfing instructor who died of COVID19, and it was found that he had leukemia and didn’t know it).

I don’t think any politician wants to be responsible for making that call. Every death that results will become their responsibility, and does anyone really want to go on TV and start advocating for what they consider to be ”acceptable losses” ?

ranwhenparked > Ash78, voting early and often 03/19/2020 at 16:23

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We are definitely digging ourselves into a 50 year poverty hole that will result in more people suffering over the longer run, but the alternative is just something too callous to be seriously considered in a modern society.

Ash78, voting early and often > ranwhenparked 03/19/2020 at 16:23

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Right. It’s like asking politicians to make decisions that military leaders have been making since the beginning of time.

Dr. Zoidberg - RIP Oppo > ranwhenparked 03/19/2020 at 16:24

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Basically: eugenics.

ranwhenparked > For Sweden 03/19/2020 at 16:24

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For many people, it really isn’t serious, for many others, its a death sentence.

ranwhenparked > Ash78, voting early and often 03/19/2020 at 16:27

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With comparatively small numbers of military personnel in a war setting, most or all of whom signed up with knowledge that they might be called upon for that sacrifice (yes, we’re had drafts, but still). Its easier to rationalize. Doing it to the civilians in the general public is a completely different situation.

WasGTIthenGTOthenNOVAnowbacktoGTI > Ash78, voting early and often 03/19/2020 at 16:27

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That is a great quote.

Just Jeepin' > Ash78, voting early and often 03/19/2020 at 16:28

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Unfortunately young adults are at high risk too: 

https://www.nytimes.com/2020/03/18/health/coronavirus-young-people.html?referringSource=articleShare

WasGTIthenGTOthenNOVAnowbacktoGTI > Ash78, voting early and often 03/19/2020 at 16:28

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Lesser of 2 weevils

Ash78, voting early and often > ranwhenparked 03/19/2020 at 16:28

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Yeah, the military example is p robably more apt for ancient Sparta or modern Israel :)

WasGTIthenGTOthenNOVAnowbacktoGTI > Ash78, voting early and often 03/19/2020 at 16:29

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Do you know what would be real fucking nice? being able to take a test to see who’ s infected and who isn’t. How in the actual hell is that not a thing yet? (outside of a vast minority in hospitals)

ranwhenparked > Dr. Zoidberg - RIP Oppo 03/19/2020 at 16:30

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Not intentionally , you’d still make an attempt to protect people you know to be vulnerable, the problem is we don’t know with certainty who all is in that category. So, it would turn into something close to unintentional or incidental eugenics, which is definitely not something we want as a socirty. Not now, anyway, 6 months from now, though, public opinion may well shift in ways that will frighten all of us.

VincentMalamute-Kim > Ash78, voting early and often 03/19/2020 at 16:30

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Interesting thoughts there. A counter-argument is that a strict campaign of tracking down and isolating cases and contacts was proven very effective by S. Korea. Italy shows what happens when you approach it the opposite way.

T he US has already dropped the bag so we’re probably going to be closer to Italy’s example. I can tell you from pe rsonal knowledge that we don’t have the medical resources and that people will die who otherwise would have lived if we don’t flatten the curve. More old people will die but young people will die too.

Young people get severe cases. They live because of ventilator support. Old people with severe cases die regardless. If we do as you suggest a lot more old and young people will die.

I don’t have much else for your big picture discussion but a nitpick:

As the most susceptible to COVID-19 are age 60+ and/or those with pre-existing conditions,

That really should read: “As the most susceptible to severe complications from COVID-19 are age 60+ and/or those with pre-existing condition”. Younger adults (apparently not so much children) are just as susceptible, I’m pretty sure .

Those who are already retired are currently experiencing the least disruption to their daily routine compared to most.

Very true with me. The most annoying thing are the hoarders making it difficult to buy certain items and the overwhelming news coverage which is starting to weigh on me psychologically.

Dr. Zoidberg - RIP Oppo > ranwhenparked 03/19/2020 at 16:38

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That’s the thing: who decides who is vulnerable? Age is good but not exhaustive. And supposed you’re young and healthy outside of maybe some poor lu ngs or previous illness. They’ll be expected to work unless they are exempt somehow. And will they be paid NOT to work? By their employer or government long term? I have my doubts.

Dr. Zoidberg - RIP Oppo > WasGTIthenGTOthenNOVAnowbacktoGTI 03/19/2020 at 16:40

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I agree in spirit, but w hat good will the test do if it can live on surfaces for X days, etc. etc. You’d literally have to test everyone daily to figure out if they should be allowed to leave their home — for just that day — to prevent spreading.

Highlander-Datsuns are Forever > Ash78, voting early and often 03/19/2020 at 16:41

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I suspect that the virus is already out there and spread around pretty well and the effort to quarantine especially in large urban areas is a bit late.

The economic impact is just staggering, like I can’t even conceive in my little brain the impact. We need to get back to some kind of normal life and maybe just leave the sensitive groups isolated until the virus dies down in the summer.

ranwhenparked > Dr. Zoidberg - RIP Oppo 03/19/2020 at 16:43

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I think we have some decent enough data from South Korea and China to define some basic categories. But, the bottom line, it's not going to happen. We are going to have 100 million or so out of work, and we will not be able to make them whole, though.

Gone > Ash78, voting early and often 03/19/2020 at 16:47

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Rystad (energy analysis usually) did a high level i mpact study of this - sat in on the webinar yesterday. First half was energy demand + COVID-19 mitigation strategy r elated to world/local econo mics. The se cond half was level COVID-19 spread and energy demand   analysis. The webinar was much more detailed in how mitigation strategies related to economics but you’d have to pay for that analysis.  However, energy demand should correlate cl osely to the actual economic conditions. Second half PDF report is available via link.  

https://www.rystadenergy.com/newsevents/news/press-releases/rystad-energys-covid-19-report/

WasGTIthenGTOthenNOVAnowbacktoGTI > Dr. Zoidberg - RIP Oppo 03/19/2020 at 16:48

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True, but think if we had that capability!

Long_Voyager94 > Ash78, voting early and often 03/19/2020 at 16:50

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https://www.nytimes.com/2020/03/16/us/coronavirus-hype-overreaction-social-distancing.html

ranwhenparked > Just Jeepin' 03/19/2020 at 16:52

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Nearly 40% of hospitalizations under age 54, and 20% under age 44, but that will still knock o ut over half of patients needing care. And if recovery is faster, beds can be turned over. We've had about 500 hospitalizations so far, so that would still have been 300 less if we had focused more strongly on locking down and isolating people we knew full well were in the most danger.

Long_Voyager94 > For Sweden 03/19/2020 at 16:54

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Mild cough?

Oh you mean the severe flu-like respiratory infection that held on for 7 weeks in January resulting in me missing almost 2 weeks of work?

The same one that they called influenza despite the test coming back negative.

Ash78, voting early and often > Gone 03/19/2020 at 16:55

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Thanks, I love Rystad’s work — we use it in risk analysis pretty regularly (banking — with lots of Energy borrowers).

Oppo rarely HELP me with work instead of just distracting me :)

TheRealBicycleBuck > Long_Voyager94 03/19/2020 at 16:55

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We’ve found patient zero!

ZHP Sparky, the 5th > ranwhenparked 03/19/2020 at 16:55

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News reports today from US infection data showing something around 20% of folks being hospitalized with serious symptoms are members of the 20-40 year-old cohort. So certainly some risk there. Right now we’re limiting the movement of those groups - if we stop that and have them return to work, that group in itself might overwhelm the medical systems all over again. 

Snuze: Needs another Swede > Long_Voyager94 03/19/2020 at 16:58

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I think I just found patient 0!

ZHP Sparky, the 5th > VincentMalamute-Kim 03/19/2020 at 16:58

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Yes, we should have looked to South Korea, Singapore, Taiwan, Hong Kong. They aced this test. Unfortunately it’s too late for us now to get anything better than a D minus if we really really try, all told. 

Eric @ opposite-lock.com > Gone 03/19/2020 at 16:59

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I heard that they might exploit this to refill the strategic oil reserve...

Ash78, voting early and often > Long_Voyager94 03/19/2020 at 16:59

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This is a great read, thanks for sharing.

ranwhenparked > ZHP Sparky, the 5th 03/19/2020 at 17:00

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Again, in 18 months, I think people are going to kind of shrug and say, oh well?

Personally, if this is how we are going to have to live forever, I would rather not live. As I've told my family, that isn't me being suicidal, it's me being rational. 

This could be permanently endemic in society now, the same way flu is .

VincentMalamute-Kim > ZHP Sparky, the 5th 03/19/2020 at 17:01

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Do they grade on a curve?  Europe may drag the curve down.

Gone > Eric @ opposite-lock.com 03/19/2020 at 17:17

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Based on est oversupply (~3MMbbl/day, which is prob under actual currently) and total remaining SPR capacity ( ~78MMbbl) , that’s only a bout 25-29 days, API gravity dependent. Most shale is light (getting lighter even) though, so it can be p umped in to SPR. They may not accept that much oil/day as you have to be careful not damage the salt domes. Pushing brine i n/out degrades them over time. Longer that KSA is WOT, quicker everyone runs out of storage capa city. Shell is starting to rent ocean tankers already.

facw > Ash78, voting early and often 03/19/2020 at 17:22

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Bad idea . This is what the Brits were hoping to do, and they were rightly excoriated for it. Reasons:

COVID-19 kills mainly old people. However, that doesn’t mean it doesn’t kill anyone else. Even among young healthy people it kills more than is acceptable.

Even among people who don’t die, many need to be hospitalized. A young person who recovers but takes up a hospital bed is still absorbing precious resources we can’t afford to spare. In China the death rate was like 5.5.% in Wuhan and 0.7% elsewhere. This is a strong indication that what causes the most deaths is overwhelming the hospital system, which will still happen if you let the virus spread happily

We can’t just cut old people off from society. Most crucially, they require services provided by younger people, so either you are going to let them get sick, or you have ever expanding quarantines anyway.

Asymptomatic transmission appears to be happening, which means just saying “stay home if you’re sick won’t work”

We know how to contain this without huge long-term disruptions. Other countries have done so, and we just need to do that as well. What does that mean? It means we need to test heavily. Not just suspected cases, but also anyone they’ve interacted with. And then the same for everyone anyone who tests positive has interacted with. Add in some random testing as well. And isolate all those people. Once you believe you know who’s sick, then you can isolate those people specifically and not have to isolate everyone. That should be doable in the span of a month or two. Had this administration not proven astoundingly incompetent , we’d be there now.

Now it may be possible to reverse some of the tightest restrictions before that point. If we are smart and careful, we shouldn’t need to shut down the entire retail sector. It’s enough to not have people in close proximity. You might even be able to reopen restaurants at 1/4 capacity (I don’t know if that would be desirable for them). Businesses that need people there in person can continue to operate if there is adequate spacing. Mandatory paid sick leave for everyone helps with this as well.

Ultimately though, pretending the virus doesn’t exist doesn’t make it go away, so just trying to return to normal won’t fix things health wise or economy wise.

Gone > Ash78, voting early and often 03/19/2020 at 17:31

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It wasn’t supposed to turn into work! :) The w ife and I are both in the sector . We know energy ™. lol

I like Rystad but I feel with shale they fly too close to the sun, if that makes sense. I’m historically very hard on shale however .

SilentButNotReallyDeadly...killed by G/O Media > Ash78, voting early and often 03/19/2020 at 17:35

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The problem as I see it with your proposal is that you are assuming that those of a working age who are infected won’t die. They probably won’t but you are perhaps not considering that a significant proportion of them will in fact become monumentally ill and will require hospitalisation. This will stretch your health system just a badly as if only the old timers got it.

Death in this case is the least of most people's problems. It's just the most visible statistic

For Sweden > Long_Voyager94 03/19/2020 at 17:35

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Congrats on your new superpower.  Can you get some groceries for me?

ZHP Sparky, the 5th > ranwhenparked 03/19/2020 at 17:58

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True - so in the meantime until we get medication and vaccines figured out for this, like we do for the flu - let’s do our best to not further overwhelm the medical system. If anything, to prevent unnecessary suffering and death, that could be avoided if we spread out cases over a longer time period. 

ranwhenparked > ZHP Sparky, the 5th 03/19/2020 at 18:20

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If that’s the answer, I am going to kill myself.

That isn’t being dramatic, there’s been a couple of times already where, if a doctor had put a button in my hand, I might have done it. I’m not there right now, it goes in and out, but I’m not going to live through being homeless, I can tell you that. The biggest argument I can come up with against it is that I don’t want my parents to have to deal with it, but they’re 70 and 62, if this takes them, that gets rid of that.

Everything I enjoy in life is already gone, if it doesn’t come back, I don’t see breathing oxygen, eating, and sometimes sleeping and defecating as compelling reasons to keep waking up every morning. I know its only been a week, I’m fine if its a couple of weeks, its the fact that it isn’t going to be a couple weeks that’s the problem. This could be permanent, or close enough to permanent that it makes no difference.

Chuckles > Chuckles 03/19/2020 at 18:25

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Ask, and ye shall receive

https://www.wfmz.com/health/coronavirus/gov-wolf-orders-non-life-sustaining-businesses-to-close/article_68d9b5f6-6a24-11ea-9799-f7e712b56fc4.html

DipodomysDeserti > Ash78, voting early and often 03/19/2020 at 18:30

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My sister is a nurse and doctoral student, and she’s starting to wonder if there’s something they suspect about people’s ability to develop immunity to this thing, and that’s why such drastic steps are being taken.

But there’s always the chance it’s just a complete (but justifiable)  freak out.

Thomas Donohue > Ash78, voting early and often 03/19/2020 at 18:34

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The biggest issue with that is the ‘unknown’ of who will require hospitalization, and how quickly they will overwhelm our medical resources. The ‘acceptable losses’ start to include everyday injuries and illnesses that are normally survivable , but result in death to a lack of resources.

Testing is the answer to a lot of this....the more people that are tested (and quarantined) lets the rest of us go on with life.

IMO, t he lack of testing has been our biggest issue so far. Example: My cousin and her 1 year old son, both sick and negative for standard flu , finally got tested last Saturday after three days . However, STILL no results as of Thu/ today . That’s how bad it is. They are opening another drive-thru center for testing in NJ, but it’s just for the swabs....actual testing is still behind the curve.

ZHP Sparky, the 5th > ranwhenparked 03/19/2020 at 18:43

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This is not permanent, and things you enjoy in life will be back. Look at other countries - China had zero new cases yesterday. We are a few months behind them, with the proper level of serious action against this virus. There are many, many reasons to stick around - family being the first of them. I have a 22 month old daughter - this sure isn’t the new normal I want her to grow up in, or everything being downhill from here. It won’t be, and we won’t let it.

The main way to stop that from happening is for everyone to take this seriously for a few weeks. The disease needs social interaction to spread. We know that people can be asymptomatic for weeks. Don’t give it that opportunity to keep spreading, and we’ll be able to actively fight it.

Everything we still love will still be there on the other side after that, the economy will come roaring back to life. In the meantime enjoy the simple things in life, get stuff done around the house, just be with your family. It’s all worth it even just as is. 

VincentMalamute-Kim > Ash78, voting early and often 03/19/2020 at 19:09

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Current info on young adults: 

https://www.medscape.com/viewarticle/927202?nlid=134571_3901&src=wnl_newsalrt_200319_MSCPEDIT&uac=69126AK&impID=2317435&faf=1

ranwhenparked > ZHP Sparky, the 5th 03/19/2020 at 19:09

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China is a different story, they contained it to a confined geographic area, this is in all 50 states. Plus, they have a totalitarian government with extreme social controls under normal circumstances, so it was easier for them to lock everything down. Also, there’s no guarantee it won’t come back as soon as they start relaxing controls, and if it doesn’t, they’re back immediately. ations before we’d have an appetite for that, which is probably impossible

Plus, they lied about this virus from the start, we don’t know that they’re telling the truth now (destroying blood samples from early patients, prohibiting doctors and nurses from discussing it with each other, permitting large scale public events to continue, disappearing a few doctors who questioned the response, not admitting it could spread person to person until 3 weeks after their labs confirmed it could, etc). When South Korea reports zero infections, then we can celebrate progress.

North Korea is also saying they have less than 200 cases, and that the several large new hospitals they just started building are part of a pre-planned, but previously unannounced, upgrade to normal healthcare capacity. 

Thisismydisplayname > Dr. Zoidberg - RIP Oppo 03/19/2020 at 20:42

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But if you can be tested and it’s positive, then you know and can stay away from people or get treatment, or at least be able to retrace what places and people you had contact with to keep track of the spread.  Knowledge is power in this situation.

facw > ZHP Sparky, the 5th 03/19/2020 at 20:51

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Not a reason for us to just say fuck it and get an F. That approach is still the way forward.

Jason Spears > Ash78, voting early and often 03/19/2020 at 21:12

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The immediate and near future concern is not just protecting the known vulnerable populations.

https://newsnetwork.mayoclinic.org/discussion/covid-19-flattening-the-curve/

Long_Voyager94 > Snuze: Needs another Swede 03/20/2020 at 06:53

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Doubtful. It had been going around for a month or so already when we got it.

Long_Voyager94 > For Sweden 03/20/2020 at 06:54

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Sure, what do you need?

ZHP Sparky, the 5th > facw 03/20/2020 at 13:03

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Absolutely, didn’t mean to imply otherwise. We don’t have an alternative choice.