My father recently passed away. Ironically, despite being extremely at risk for COVID, when he finally got it the whole thing was a total non event. Didn't even feel very sick. He later died of the same health problems we knew would inevitably kill him.
There were two paths my fathers last two years could have taken.
One was to stay in that old folks home that my parents moved into for like a year beforehand. They had decided to leave and move in with us just before COVID as they hadn't really liked the old folks home before COVID. After COVID, the few things they did like went away. People were essentially locked in their apartments with food delivered every meal. All social events and activities were cancelled. People had to wear masks all the time whenever they rarely left their room. Visitors were either not allowed or highly restricted, and leaving to go outside was the same. Life consisted entirely of sitting in a room alone and watching TV all day.
This was in fact very safe, I imagine he wouldn't have caught COVID at all.
He still would have died at the same time, in fact probably sooner would be my guess.
Instead, he came to live with us. He played with his grandchildren every day. He made friends and engaged in activities. After vaccines he got to sing twice a week in his chorus. He was Santa Claus one year. His life was a joy, not a prison.
When it became obvious that having them watch the kids full time was a lot on them and that our kids were becoming shy and missing out of key social development of being around other kids, we discussed with him about sending them to daycare. We had found one that didn't do masks or social distancing or the rest despite threats from the state. It seemed best for the girls. My father said that if they brought home COVID and he died that was a risk he would take if it was best for the girls. This was just before vaccines came out when we didn't know if there would every be an effective vaccine.
When the end finally came he was in kidney failure at the hospital. He could do dialysis to try and stay alive, but he was having heart attacks every other time he did dialysis. They had revived him so many times that his ribs were cracked and bloody. I won't go into it all.
Instead of trying to drag things out a slight bit longer doing dialysis, he decided to come home. He got to spend a week with his family. He saw his grandkids. He sang with his signing groups when they came to the house. He sat on the porch on a beautiful day and talked to the neighbors. Members of the family visited. Friends called. He got to eat home cooking around a table with all of us. It was a great last week after a miserable time in the hospital.
I don't think my father would have traded the end of his life for any other. I honestly can't understand people whose idea of the correct way to live is to sit alone in a room watching TV and trying whatever they have to in order to exist on the earth slightly longer. The mindset it so foreign to me.
When that way of life was forced on the rest of us in the name of protecting such "life" it was evil.
I have been lightly following you for a while (we seem to read a lot of the same Substacks). I've been thinking of this for the last few weeks and this comment pushed me over the edge:
If you don't write somewhere, I STRONGLY encourage you to do so. I would sign up in a heartbeat.
Your comments are almost universally among the best ones that I read. They are thoughtful, insightful, and your points are articulated extremely well.
This beautiful story of your father deserves to be its own post somewhere - not just a random comment on Arnold's Substack (no disrespect intended to Arnold).
This is not an idle thought - I would be willing to bet a substantial amount of money that it be a big win for you (and for your readership, though that's harder to measure).
I'm just some random guy on the internet, but I believe that I'm right about this, and I encourage you to take the plunge.
I don't think a Substack would be right for me. I mostly think this is a bad habit I can't kick that I barely justify in the fact that I mostly post when my job is paying me to be "available" but I don't really have work to do. Even then I could probably make better use of my time, but this is more or less my only outlet. You can't talk to normies about this stuff.
Also, if I have a comparative advantage to everyone else its that I'm a true Anon. No bank account, no real name. Everyone else has to self censor to some extent because they are a real person who is traceable.
My answer might be different if I didn't have a wife and kids and better things to be doing. As a commenter I do what I want when I want. As a Substacker it would be kind of like a very low paid job with the potential to disrupt my real life at some point.
I think you are misunderstanding something when you write 'Would the immunity acquired from an exposure in 2003 not have worn off by 2019'? Immunity, in the general case, does not wear off at all. But the immunity is specific for a particular variant of a particular pathogen. And the pathogens mutate. If the current thing that is going around is sufficiently like what you have immunity to, then bingo you are immune. If it is sufficiently different, then your body may not mount any immune response at all based on the old thing you were infected with. From your immune system's point of view this is a whole new disease and it has to go about creating a new immune response to this one.
The interesting question is 'what happens when a new pathogen is different, but not a whole lot different from something that you have before'. Your body starts trying the thing that worked before. If it works, great. If it doesn't work, then it switches to making a new thing. But this is seriously age dependent. Young children, with robust immune systems, very quickly move to 'make a new thing'. Very old people don't, and rely entirely on making things they have seen before. If you look at their antibody production for flu in flu season you will find they are busy making antibodies for 'flu I caught in 1968' and 'flu I caught in 1983' and so on and so forth. When making antibodies, at whatever age, 'things you caught in childhood', and 'last year' seem to be preferred. It's quite expensive to find the antibodies and then test them against past pathogens, (so this is not something we can expect to do at home) but people who study aging immune systems have done so. Sometimes the old ones are effective, too -- it is not as if flu viruses are 'progressing' in a particular direction with an end goal.
My understanding was that SARS 1 was not widely spread enough to confer immunity on large swaths of the population. I do not know if this is actually true. Regardless immunity can last essentially a lifetime. Cowpox can give you lifetime protection against Smallpox.
And I remember one postulation the Swine Flu pandemic was not much worse was because there was a close enough Swine flu that had spread in the 1970's and conferred immunity or partial immunity to many.
Millions of Americans die each year, most of them are 65 years or older.
Sweden famously resisted lockdowns and compulsory masking. They kept schools open, they did not close shops. You find pictures of the prime minister with other officials in a train without mask, while nearly every American politician would not be seen unmasked. At the time, it was predicted that Sweden was headed for a catastrophic outcome. Sweden had its second lowest per capita death rate on record in 2020-2021. It had its lowest mortality rate the year before the pandemic.
The USA has various states that used different approaches. Florida was relatively close to Sweden, yet their age-ajusted mortality rate during the pandemic is better than the American average, for all age groups.
If you accept the numbers you quote, then you must accept that covid is far less deadly than the flu for the young and comparable to the flu for the elderly. They differ also drastically from the WHO numbers: 3.4% infection fatality rate (March 2020) for the general population.
Covid hysteria was greatly elevated by the anecdotal "close to home" death of a neighbor or relative. I heard many versions of this story. Yet my story of not knowing anyone, including my 90+ old parents or 75+ in-laws having a bad Covid encounter doesn't count.
The most salient truth of Covid is it was widespread and people would have multiple exposures. And by those exposures a person may eventually become sick. And some of those who became sick would die.
If people undersood that they could not hide from a respiration virus and that trying to hide would destroy their way of life and cause great social harms, would they have supported lockdowns & shutdowns & masking and other Covid security theater measures?
A majority of people seem to understand that now. I expect we won't see a repeat of Covidmania for another generation or two.
Re: "But the idea that the optimal policy regarding COVID was to blow it off will not get my endorsement."
The main policy contenders were broad restrictions (e.g., closures and mask mandates) and "focussed protection" (special policies to reduce probability of transmission to older persons and persons with relevant co-morbidities).
There was also contention about the balance of government response and private adaptation. The latter allows more flexibility and room for people's different motivations (e.g., risk-taking, values) and circumstances (e.g., demographic circles, workplace structure).
Those who favored private adaptation made a case that a crucial role of public-health agencies is to provide timely information to a high standard. Alas, the information function was stymied by norms against experiments about transmission; and was heavily distorted by political strife exacerbated by the election year.
Did many people argue that the best COVID policy would be to blow it off?
Young people face essentially zero risk from Covid. Is it rational to have young people modify their behavior for a negligible risk? The rational response for schools and universities would seem to be to "blow it off" while providing options to teachers and staff of elevated age.
The statistics for the over 80 crowd does look grim. We just use our PPE (personal protection equipment) and still went out every day. I looked at the thermodynamics of thermal inactivation of all corona virus and SAR-CoV-2 in particular (data available in Feb - March 2020)and putting our external garments through our gas dryer on high for 30 minutes and the N-95 masks through our oven at 170ºF for 20 minutes. Calculations show that would inactivate this virus by 4 to 5 log reduction (99.99+% inactivation is good enough to prevent transmission). One box of N-95's and several old shirts, pants, and head coverings lasted until we could get vaccinated. As surface transmission appeared less relevant, we shifted to just N-95 masks only.
So much energy had to go into fending off kooky ideas -- outdoor masking and antivaxxers -- that little was left over for improved ventilation and test to stay regimes to avoid closing offices and schools.
Usually regulation according to hunches and popular perceptions just leads to a bit of inefficiency (serious in the aggregate but each one is small). With COVID the spectacular failure of FDA to approve vaccines and asymptomatic testing using cost benefit analysis (i.e., much more rapidly) and the CDC to provide information and guidance to individuals and policy makers about how to make cost benefit guided decisions about masking, venue closings, social distancing, surface hygiene, indoor ventilation, and even vaccination led to massive losses of life and incomes. And there is little evidence that the systemic cause of the failure has been recognized.
I know it's long, but I just don't think it's possible to present all the data in favor of that hypothesis in a more succinct manner. In fact I didn't publish everything I had collected.
I'm sorry to make a reply to my own comment, but I forgot to mention that since I haven't read the Bhattacharya, Magness and Kulldorff paper yet my articles are not to be taken as criticism of their paper. I just collected a lot of data to support that hypothesis and I hope that some of that data might be of use to anyone else interested in that hypothesis.
About ventilators, I agree that higher spending in general might have meant higher spending in some particular treatment(s)/therapy that worsened outcomes, and ventilators are one posibility. And I don't have any data on ventilator use by country during the pandemic that would allow to check for correlation between ventilator use and deaths by Covid. That being said, you first had to be hospitalized before being connected to a ventilator, so ventilators could explain the exceptionalism of East Asia with respect to deaths but not with respect to hospitalizations. I'll check the data on hospitalizations (it's been a while I don't remember if it was available) to see whether the exceptionalism of East Asia disappears or stays the same.
About the correlation between healthcare spending and physician efficacy, this should be easy to check if we agree that some indicators are objective measures for physician efficacy or healthcare system efficacy in general. The most common that I can think of is life expectancy and healthy life expectancy.
"Suppose that the infection fatality rate for age 60-69 is the median of 0.5 percent.., then 175,000 would have died."
How do we put those 175,000 in perspective when each person is important?
175,000 is roughly the number of people who die each year in the US from accidents of all types. Given the revealed policies wrt covid, is enough done to prevent accidents?
My father recently passed away. Ironically, despite being extremely at risk for COVID, when he finally got it the whole thing was a total non event. Didn't even feel very sick. He later died of the same health problems we knew would inevitably kill him.
There were two paths my fathers last two years could have taken.
One was to stay in that old folks home that my parents moved into for like a year beforehand. They had decided to leave and move in with us just before COVID as they hadn't really liked the old folks home before COVID. After COVID, the few things they did like went away. People were essentially locked in their apartments with food delivered every meal. All social events and activities were cancelled. People had to wear masks all the time whenever they rarely left their room. Visitors were either not allowed or highly restricted, and leaving to go outside was the same. Life consisted entirely of sitting in a room alone and watching TV all day.
This was in fact very safe, I imagine he wouldn't have caught COVID at all.
He still would have died at the same time, in fact probably sooner would be my guess.
Instead, he came to live with us. He played with his grandchildren every day. He made friends and engaged in activities. After vaccines he got to sing twice a week in his chorus. He was Santa Claus one year. His life was a joy, not a prison.
When it became obvious that having them watch the kids full time was a lot on them and that our kids were becoming shy and missing out of key social development of being around other kids, we discussed with him about sending them to daycare. We had found one that didn't do masks or social distancing or the rest despite threats from the state. It seemed best for the girls. My father said that if they brought home COVID and he died that was a risk he would take if it was best for the girls. This was just before vaccines came out when we didn't know if there would every be an effective vaccine.
When the end finally came he was in kidney failure at the hospital. He could do dialysis to try and stay alive, but he was having heart attacks every other time he did dialysis. They had revived him so many times that his ribs were cracked and bloody. I won't go into it all.
Instead of trying to drag things out a slight bit longer doing dialysis, he decided to come home. He got to spend a week with his family. He saw his grandkids. He sang with his signing groups when they came to the house. He sat on the porch on a beautiful day and talked to the neighbors. Members of the family visited. Friends called. He got to eat home cooking around a table with all of us. It was a great last week after a miserable time in the hospital.
I don't think my father would have traded the end of his life for any other. I honestly can't understand people whose idea of the correct way to live is to sit alone in a room watching TV and trying whatever they have to in order to exist on the earth slightly longer. The mindset it so foreign to me.
When that way of life was forced on the rest of us in the name of protecting such "life" it was evil.
I have been lightly following you for a while (we seem to read a lot of the same Substacks). I've been thinking of this for the last few weeks and this comment pushed me over the edge:
If you don't write somewhere, I STRONGLY encourage you to do so. I would sign up in a heartbeat.
Your comments are almost universally among the best ones that I read. They are thoughtful, insightful, and your points are articulated extremely well.
This beautiful story of your father deserves to be its own post somewhere - not just a random comment on Arnold's Substack (no disrespect intended to Arnold).
This is not an idle thought - I would be willing to bet a substantial amount of money that it be a big win for you (and for your readership, though that's harder to measure).
I'm just some random guy on the internet, but I believe that I'm right about this, and I encourage you to take the plunge.
Thank you for your consideration.
Thank you for the kind words.
I don't think a Substack would be right for me. I mostly think this is a bad habit I can't kick that I barely justify in the fact that I mostly post when my job is paying me to be "available" but I don't really have work to do. Even then I could probably make better use of my time, but this is more or less my only outlet. You can't talk to normies about this stuff.
Also, if I have a comparative advantage to everyone else its that I'm a true Anon. No bank account, no real name. Everyone else has to self censor to some extent because they are a real person who is traceable.
My answer might be different if I didn't have a wife and kids and better things to be doing. As a commenter I do what I want when I want. As a Substacker it would be kind of like a very low paid job with the potential to disrupt my real life at some point.
I think you are misunderstanding something when you write 'Would the immunity acquired from an exposure in 2003 not have worn off by 2019'? Immunity, in the general case, does not wear off at all. But the immunity is specific for a particular variant of a particular pathogen. And the pathogens mutate. If the current thing that is going around is sufficiently like what you have immunity to, then bingo you are immune. If it is sufficiently different, then your body may not mount any immune response at all based on the old thing you were infected with. From your immune system's point of view this is a whole new disease and it has to go about creating a new immune response to this one.
The interesting question is 'what happens when a new pathogen is different, but not a whole lot different from something that you have before'. Your body starts trying the thing that worked before. If it works, great. If it doesn't work, then it switches to making a new thing. But this is seriously age dependent. Young children, with robust immune systems, very quickly move to 'make a new thing'. Very old people don't, and rely entirely on making things they have seen before. If you look at their antibody production for flu in flu season you will find they are busy making antibodies for 'flu I caught in 1968' and 'flu I caught in 1983' and so on and so forth. When making antibodies, at whatever age, 'things you caught in childhood', and 'last year' seem to be preferred. It's quite expensive to find the antibodies and then test them against past pathogens, (so this is not something we can expect to do at home) but people who study aging immune systems have done so. Sometimes the old ones are effective, too -- it is not as if flu viruses are 'progressing' in a particular direction with an end goal.
My understanding was that SARS 1 was not widely spread enough to confer immunity on large swaths of the population. I do not know if this is actually true. Regardless immunity can last essentially a lifetime. Cowpox can give you lifetime protection against Smallpox.
And I remember one postulation the Swine Flu pandemic was not much worse was because there was a close enough Swine flu that had spread in the 1970's and conferred immunity or partial immunity to many.
https://www.nature.com/articles/nm917
Millions of Americans die each year, most of them are 65 years or older.
Sweden famously resisted lockdowns and compulsory masking. They kept schools open, they did not close shops. You find pictures of the prime minister with other officials in a train without mask, while nearly every American politician would not be seen unmasked. At the time, it was predicted that Sweden was headed for a catastrophic outcome. Sweden had its second lowest per capita death rate on record in 2020-2021. It had its lowest mortality rate the year before the pandemic.
The USA has various states that used different approaches. Florida was relatively close to Sweden, yet their age-ajusted mortality rate during the pandemic is better than the American average, for all age groups.
If you accept the numbers you quote, then you must accept that covid is far less deadly than the flu for the young and comparable to the flu for the elderly. They differ also drastically from the WHO numbers: 3.4% infection fatality rate (March 2020) for the general population.
Covid hysteria was greatly elevated by the anecdotal "close to home" death of a neighbor or relative. I heard many versions of this story. Yet my story of not knowing anyone, including my 90+ old parents or 75+ in-laws having a bad Covid encounter doesn't count.
The most salient truth of Covid is it was widespread and people would have multiple exposures. And by those exposures a person may eventually become sick. And some of those who became sick would die.
If people undersood that they could not hide from a respiration virus and that trying to hide would destroy their way of life and cause great social harms, would they have supported lockdowns & shutdowns & masking and other Covid security theater measures?
A majority of people seem to understand that now. I expect we won't see a repeat of Covidmania for another generation or two.
But Covidmania was a boon to many bureaucrats, and it became a political cause for those on the left. I would not rule out a repeat.
Re: "But the idea that the optimal policy regarding COVID was to blow it off will not get my endorsement."
The main policy contenders were broad restrictions (e.g., closures and mask mandates) and "focussed protection" (special policies to reduce probability of transmission to older persons and persons with relevant co-morbidities).
There was also contention about the balance of government response and private adaptation. The latter allows more flexibility and room for people's different motivations (e.g., risk-taking, values) and circumstances (e.g., demographic circles, workplace structure).
Those who favored private adaptation made a case that a crucial role of public-health agencies is to provide timely information to a high standard. Alas, the information function was stymied by norms against experiments about transmission; and was heavily distorted by political strife exacerbated by the election year.
Did many people argue that the best COVID policy would be to blow it off?
Internet pundits referred to it as the Wunan flu, or "Wu-flu," which to me suggests blowing it off.
"Did many people argue that the best COVID policy would be to blow it off?"
No, but a fair number of people are arguing that now.
It's not clear what "blowing it off" means here. Certainly, government should have blown it off. Many institutions should have too.
To what extend individuals should have "blown it off" depends on each individual.
Young people face essentially zero risk from Covid. Is it rational to have young people modify their behavior for a negligible risk? The rational response for schools and universities would seem to be to "blow it off" while providing options to teachers and staff of elevated age.
The statistics for the over 80 crowd does look grim. We just use our PPE (personal protection equipment) and still went out every day. I looked at the thermodynamics of thermal inactivation of all corona virus and SAR-CoV-2 in particular (data available in Feb - March 2020)and putting our external garments through our gas dryer on high for 30 minutes and the N-95 masks through our oven at 170ºF for 20 minutes. Calculations show that would inactivate this virus by 4 to 5 log reduction (99.99+% inactivation is good enough to prevent transmission). One box of N-95's and several old shirts, pants, and head coverings lasted until we could get vaccinated. As surface transmission appeared less relevant, we shifted to just N-95 masks only.
So much energy had to go into fending off kooky ideas -- outdoor masking and antivaxxers -- that little was left over for improved ventilation and test to stay regimes to avoid closing offices and schools.
Usually regulation according to hunches and popular perceptions just leads to a bit of inefficiency (serious in the aggregate but each one is small). With COVID the spectacular failure of FDA to approve vaccines and asymptomatic testing using cost benefit analysis (i.e., much more rapidly) and the CDC to provide information and guidance to individuals and policy makers about how to make cost benefit guided decisions about masking, venue closings, social distancing, surface hygiene, indoor ventilation, and even vaccination led to massive losses of life and incomes. And there is little evidence that the systemic cause of the failure has been recognized.
I'll try to read the paper later today in order to make a more informed comment, but for now I would like to point you to this:
https://medium.com/p/ba2ae7b10062
https://medium.com/analytics-vidhya/alternative-covid-19-hypotheses-part-1-18fec0f95a1f
I know it's long, but I just don't think it's possible to present all the data in favor of that hypothesis in a more succinct manner. In fact I didn't publish everything I had collected.
Opinions and criticisms are welcome.
I'm sorry to make a reply to my own comment, but I forgot to mention that since I haven't read the Bhattacharya, Magness and Kulldorff paper yet my articles are not to be taken as criticism of their paper. I just collected a lot of data to support that hypothesis and I hope that some of that data might be of use to anyone else interested in that hypothesis.
About ventilators, I agree that higher spending in general might have meant higher spending in some particular treatment(s)/therapy that worsened outcomes, and ventilators are one posibility. And I don't have any data on ventilator use by country during the pandemic that would allow to check for correlation between ventilator use and deaths by Covid. That being said, you first had to be hospitalized before being connected to a ventilator, so ventilators could explain the exceptionalism of East Asia with respect to deaths but not with respect to hospitalizations. I'll check the data on hospitalizations (it's been a while I don't remember if it was available) to see whether the exceptionalism of East Asia disappears or stays the same.
About the correlation between healthcare spending and physician efficacy, this should be easy to check if we agree that some indicators are objective measures for physician efficacy or healthcare system efficacy in general. The most common that I can think of is life expectancy and healthy life expectancy.
"Suppose that the infection fatality rate for age 60-69 is the median of 0.5 percent.., then 175,000 would have died."
How do we put those 175,000 in perspective when each person is important?
175,000 is roughly the number of people who die each year in the US from accidents of all types. Given the revealed policies wrt covid, is enough done to prevent accidents?
CDC causes of death 2018-9: https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-09-508.pdf
Fetal abortion deaths: https://www.pewresearch.org/fact-tank/2022/06/24/what-the-data-says-about-abortion-in-the-u-s-2/