U.S. to close..

[Lake-Effect]

Originally Posted by Dockhead

Another reason to be REALLY HAPPY about the progress with vaccines is that it is really unprecedented, to have developed effective vaccines to diseases in such a short period of time.

It's just the best thing I've heard all year.

Yup.

[Dockhead]

Originally Posted by Lake-Effect

. . . I am certain that overall, even with failed measures and some non-compliance, we still managed to reduce the impact and save many, many lives. It really is a noble achievement, and with the lessons learned we are that much better prepared to tackle (... or prevent) the next one.. .

Certainly COVID deaths have been saved, probably a lot of them.


But we don't know how many people we've killed, or whose lives we've ruined, with unnecessarily harsh or blunt measures. And we won't know for some years probably.


So I think it's early to congratulate ourselves.



Furthermore, we don't even know yet to what extent we're controlling the pandemic with whatever measures we have. It's far from over yet. The Spanish Flu later waves were much more deadly than the first one. It's not too late for the world to be whacked by a huge wave which dwarfs the first one, and at a time when many countries simply cannot afford radical measures. It's not over yet!!

[Dockhead]

20 million doses will be distributed in the U.S. already before the end of the year:

https://eu.usatoday.com/story/news/h...ia/6271794002/

[Lake-Effect]

Originally Posted by Dockhead

But we don't know how many people we've killed, or whose lives we've ruined, with unnecessarily harsh or blunt measures. And we won't know for some years probably.

I suspect that we already have a handle on collateral non-COVID deaths, and that they will turn out to be much lower than the COVID deaths prevented. Just a hunch, because if those deaths were happening in comparable numbers, it would already be well-publicized by the anti-lockdown movement.

Second, lives and livelihoods don't have to be ruined by lockdowns. We can choose otherwise.

As we find out more about the disease, its long-term effects are becoming more apparent, and lend strength to the importance of reducing its spread.

So I think it's early to congratulate ourselves.

I applaud your mental agility (and optimism)

[valhalla360]

Originally Posted by goboatingnow

This is the worst kind of fake fact , the underplaying of the seriousness of Covid , Firstly the disease can affect all ages and has a very long tail , even relatively minor versions can leave people with long term medical consequences, its not all about death

I'm debating which is the worst kind of "fake fact". UFO's or yours.

Reality is the disease is a real problem but you are taking the opposite extreme. Reality is for otherwise young and healthy individuals, it's not a big deal. It's specific portions of the population that are at risk.

Just saw an article that in the UK, the average age of death is 85. When you get under 60, those who don't have major underlying conditions have so few deaths as to be statistical anomalies. True it's not all about the death but hospitalizations and other major side effects follow pretty much the same pattern with the elderly and those with pre-existing conditions making up by far the vast majority of serious cases.

[valhalla360]

Originally Posted by Singularity

-So why spend an average of $150,000 on each of the 500,000 heart bypasses done per year? They are all old, sick people with at least 2 chronic health problems.
-Why spend $90,000 per year on a person with kidney failure...>25 billion per year in the US?

Actually, this is really questionable practice. I can't find the source but I recall something like 75% of all health care dollars are spent on average in the last year of a persons life.

And we are starting to see more of a move towards hospice rather than throwing the kitchen sink at someone on their way out with no real chance of recovery.

These big dollar responses really should have a focus on the quality and duration of life they are going to generate based on the patients condition...in fact when you get into expensive organ transplants, an elderly person with other health conditions winds up lower on the list when an organ is available.

Not suggesting it is an easy problem and doesn't have moral hazards to address but it's equally wrong not to consider the likely outcome and if the response is worth it.

So the idea that we should consider the age and health of people who contract corona is a valid and ethical approach.

[Dockhead]

Originally Posted by Lake-Effect

I suspect that we already have a handle on collateral non-COVID deaths, and that they will turn out to be much lower than the COVID deaths prevented. Just a hunch, because if those deaths were happening in comparable numbers, it would already be well-publicized by the anti-lockdown movement.

The deaths don't happen immediately. 30 million unemployed (say) will be surely 3 million or 6 million or more premature deaths. Not all immediately (though there will be some of those too), but lives shortened due to poverty, loss of health care, despair, hunger, whatever. Then people will die from other secondary causes -- reduced access to health care (thousands of deaths from this already in the UK; don't know about the U.S.), reduced vaccination from other diseases, etc. etc. etc.

I wouldn't be so confident that the lives saved will outweigh the lives lost, especially if you correctly count life-years rather than lives in absolute numbers. We shall see.

Originally Posted by Lake-Effect

. . . Second, lives and livelihoods don't have to be ruined by lockdowns. We can choose otherwise.

How do we choose otherwise? The U.S. has existed for 250 years, and has still not eliminated poverty or even hunger. We can't even provide decent healthcare to everyone. So where do we get the magic wand to do it now, in one stroke, and in a time of economic decline? This is a pure fantasy.

The bottom line is that we are hurting people, a lot of them, and hurting them badly. We can choose to mitigate the harm to these people, but at best we'll just take some dent out of it. We will never solve it. Even in Finland with a welfare state 100 years ahead of ours, it is considered IMPOSSIBLE to save people from economic collapse, which was the specific reason why moderate anti-pandemic measures were chosen -- welfare state would otherwise collapse, if economy collapses. And we don't even have the welfare state in the first place. So again -- pure fantasy, which has the harmful effect of deflecting your care and attention from the horrible fate of people thrown out of work because of theIpandemic measures. In my view, this is deeply wrong.

Originally Posted by Lake-Effect

. . .. As we find out more about the disease, its long-term effects are becoming more apparent, and lend strength to the importance of reducing its spread.

Don't be lazy and let yourself be swayed by anecdotes, talk yourself uncritically into your own prejudices. Long term effects are only significant in statistics, not in anecdotes. All diseases have a certain percentage of long term bad effects, including the flu. This needs a cold scientific eye.

Originally Posted by Lake-Effect

. . . I applaud your mental agility (and optimism)

Thanks, but I think no special agility required. We've been through a year of horror, and a lot of the horror is still ahead. It will likely get worse before it gets better. However -- through these tremendous breakthroughs with vaccines, we have a backstop to this -- the end is in sight. So there is simultaneously very bad news and very good news. Life is sometimes like that.

[capn_billl]

Originally Posted by Mike OReilly

The argument against assigning death to Covid-19 is like saying the airplane crash didn't really kill those 100 people because 1/2 of them had other underlying health issues. It's an overt attempt at obfuscation.

Lockdowns, and more specifically, population isolation, can stop this virus. But the cost is probably too high. So we need to be smart about how we employ the closure measures. And we need all the adults in the room to take some responsibility for their actions.

Unfortunately too many of us are focused on our rights, and not our responsibilities.

It's more like adding the 200 airplane deaths to underlying health issues because the pilot had high blood pressure.

[GordMay]

Originally Posted by valhalla360

Actually, this is really questionable practice. I can't find the source but I recall something like 75% of all health care dollars are spent on average in the last year of a persons life...

Not exactly correct, and definitely lacking context.
For some strange reason, we do end up spending more (medically) on the sick, and dying, than we do on the healthy.


“The Lifetime Distribution of Health Care Costs” ~ by Berhanu Alemayehu and Kenneth E Warner
Principal Findings
Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women's longer life expectancy.
Nearly one-third of lifetime expenditures is incurred during middle age, and nearly half during the senior years.
For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.
➥ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/

“Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey” ~ by Donald R Hoover et al
Principal Findings
From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years.
Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages.
Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.
➥ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/

“End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported” ~ by Eric B. French et al
We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.
➥ https://www.healthaffairs.org/doi/**...haff.2017.0174

[capn_billl]

Originally Posted by Lake-Effect

Classic misconceptions. A universal single-payer healthcare system puts more premium on maintaining good health than on heroic and expensive late-stage efforts to fix problems caused by health neglect. It eliminates the massive price inflation of a private system. And it COSTS LESS overall, and has better outcomes.

The rest of the world has figured this out. The US will come around eventually.

How do you figure?

"Socialized medicine puts a premium on maintaining good health"

Yes, because the either the government mandates every detail of your life, and what you are allowed to eat, or refuses to pay.

SO you better keep your health up, because God help you if you get sick, and need to stand in line for up to a year at the government hospital.

[valhalla360]

Originally Posted by GordMay

Not exactly correct, and definitely lacking context.
For some strange reason, we do end up spending more (medically) on the sick, and dying, than we do on the healthy.


“The Lifetime Distribution of Health Care Costs” ~ by Berhanu Alemayehu and Kenneth E Warner
Principal Findings
Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women's longer life expectancy.
Nearly one-third of lifetime expenditures is incurred during middle age, and nearly half during the senior years.
For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.
➥ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/

“Medical Expenditures during the Last Year of Life: Findings from the 1992–1996 Medicare Current Beneficiary Survey” ~ by Donald R Hoover et al
Principal Findings
From 1992 to 1996, mean annual medical expenditures (1996 dollars) for persons aged 65 and older were $37,581 during the last year of life versus $7,365 for nonterminal years.
Mean total last-year-of-life expenditures did not differ greatly by age at death. However, non-Medicare last-year-of-life expenditures were higher and Medicare last-year-of-life expenditures were lower for those dying at older ages.
Last-year-of-life expenses constituted 22 percent of all medical, 26 percent of Medicare, 18 percent of all non-Medicare expenditures, and 25 percent of Medicaid expenditures.
➥ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/

“End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported” ~ by Eric B. French et al
We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.
➥ https://www.healthaffairs.org/doi/**...haff.2017.0174

So the percentage was off (I said I couldn't find the source) but the underlying principal is true...that drastically more is spent in the end stages...more often than not when there is little chance of a long term cure/recovery. Also, you have to figure in long term nursing home care which doesn't show up in some of these studies.

Also, some of your links are to countries that are further along the move towards hospice, so it's already showing some benefits.

Not suggesting for a second that we should implement death panels but throwing the kitchen sink at someone who has no realistic chance of recovery is a waste of limited resources.

[valhalla360]

Originally Posted by Mike OReilly

The argument against assigning death to Covid-19 is like saying the airplane crash didn't really kill those 100 people because 1/2 of them had other underlying health issues. It's an overt attempt at obfuscation.

A more like an old person with a heart problem dying from fright during turbulence and blaming it on turbulence.

If they are scarping your body off a mountain side, there's really no question what got you. That's not comparable to what we are seeing with corona.

[sv_pelagia]

Originally Posted by capn_billl

How do you figure?

"Socialized medicine puts a premium on maintaining good health"

Yes, because the either the government mandates every detail of your life, and what you are allowed to eat, or refuses to pay.

SO you better keep your health up, because God help you if you get sick, and need to stand in line for up to a year at the government hospital.

Certainly opposite to our (excellent) experience with our "govt run" health system here in British Columbia, Canada!

[Singularity]

Originally Posted by valhalla360

I'm debating which is the worst kind of "fake fact". UFO's or yours....
...Reality is for otherwise young and healthy individuals, it's not a big deal. It's specific portions of the population that are at risk...
...those with pre-existing conditions making up by far the vast majority of serious cases.

Below is simply one organ system, but you need to read up on the consequences to young people, people without pre-existing conditions, working age people, whatever. I strongly encourage considering, if not naturally apparent, that when you see what appears to be small numbers effecting younger people, the the aggregate effects routinely snowball...not just disease and healthcare costs, but across the board.

I've posted this before at least once...people tend to not read details and instead offer generalizations neglecting to synthesize the data into the perspective.

-------------------

JAMA Cardiology
July 27, 2020
https://jamanetwork.com/journals/jam...rticle/2768916
Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)
100 patients recently recovered from COVID-19...mean (SD) age was 49 (14) years....
78 patients recently recovered from COVID-19 had abnormal CMR findings
67 recovered at home, 33 required hospitalization
hsTnT was detectable (greater than 3 pg/mL) in 71, significantly elevated (greater than 13.9 pg/mL) in 5 patients
Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation
Compared with healthy controls and risk factor–matched controls, patients recently recovered from COVID-19 had lower left
ventricular ejection fraction, higher left ventricle volumes, and raised native T1 and T2.
32 with elevated late gadolinium enhancement (~inflammation vs scar)

JAMA Cardiology
Sept 11
https://jamanetwork.com/journals/jam...rdio.2020.4916
Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection
CMR imaging in 26 competitive college athletes mean [SD] age, 19.5 [1.5]
twelve athletes reported mild symptoms during the short-term infection (sore throat, shortness of breath, myalgias, fever), while others were asymptomatic.
no ST/T wave changes and ventricular volumes and function were within the normal range in all athletes by echocardiogram and CMR imaging. No elevated troponin
Four athletes had CMR findings consistent with myocarditis
Two of these 4 athletes with evidence of myocardial inflammation had mild symptoms (shortness of breath), while the other 2 were asymptomatic.
Pericardial effusion was present in 2 athletes with CMR evidence of myocarditis
Twelve athletes (46%) had LGE/[evidence of ~inflammatory process], of whom 8 (30.8%) had LGE without concomitant T2 elevation
the rate of LGE (42%) is higher than in previously described normative populations

Prognostic Value of Cardiac Magnetic Resonance Tissue Characterization in Risk Stratifying Patients With Suspected Myocarditis
Oct 2017, Journal American College Cardiology
https://reader.elsevier.com/reader/s...B593F445044C34
670 patients (without coronary artery disease) with evidence of myocarditis on MR
age 47.8 +/- 16
followed mean 4.7 years
looking for major adverse cardiac events (MACE)
Annual rate MACE no LGE=2.1%, with LGE=4.8%
Annual rate death no LGE=0.9%, with LGE=1.7%

[Lake-Effect]

Originally Posted by Dockhead

The deaths don't happen immediately. 30 million unemployed (say) will be surely 3 million or 6 million or more premature deaths. Not all immediately (though there will be some of those too), but lives shortened due to poverty, loss of health care, despair, hunger, whatever. Then people will die from other secondary causes -- reduced access to health care (thousands of deaths from this already in the UK; don't know about the U.S.), reduced vaccination from other diseases, etc. etc. etc.

I wouldn't be so confident that the lives saved will outweigh the lives lost, especially if you correctly count life-years rather than lives in absolute numbers. We shall see.

... The U.S. has existed for 250 years, and has still not eliminated poverty or even hunger. We can't even provide decent healthcare to everyone. So where do we get the magic wand to do it now, in one stroke, and in a time of economic decline? This is a pure fantasy.

Fantasy is pretending that supporting those economically hurt by COVID measures is unthinkable. In fact, it's already happened to a great degree, and is likely to continue. And just about all economists are applauding this and encouraging more of it. Aggressive support now will greatly reduce the harms you're concerned about, and make for a faster recovery. Markets seem to applaud the actions taken to date, including the vaccine progress. So the only variable between our two positions is the extent of supports provided.

Yay to Finland for seeming to have chosen a minimally harmful path that was also effective. I don't think that what worked in Finland would have been as possible or equally effective in most other countries. But it's not something I hope to see tested again any time soon.

All diseases have a certain percentage of long term bad effects, including the flu. This needs a cold scientific eye.

...and likewise, you need to consider the potential damage, economic and otherwise, from increased COVID spread, from long-term effects, including mental illness (1 in 5, according to recent study), and from allowing some groups to suffer (on all fronts), while others are untouched and even profiting from the others' hardships.