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Social distancing slowing not only Covid-19, but other diseases too (qz.com)
402 points by prostoalex 15 days ago | hide | past | web | 223 comments | favorite





There could be some selection bias here. It's based on thermometer readings from Kinsa. And the articles states:

Kinsa is receiving two to three times more thermometer readings per day than in previous flu seasons

Many more people may be taking thermometer reading that don't really need to, but are being cautious. That would cause the appearance of a proportional drop in high temp readings compared to prior years when really it's just that lots of not-so-sick people are taking their temp lots more.


> Due to the emergence of the coronavirus, Kinsa is receiving two to three times more thermometer readings per day than in previous flu seasons. Historically, Kinsa’s methods have been able to account for a sharp rise in the number of people taking tests, said Benjamin Dalziel, a professor at Oregon State University who studies infectious diseases. For his research, Dalziel has ensured that a spike in testing didn’t lead to inaccurate predictions, and so he believes the current decline in illness is a result of social distancing, and not a statistical anomaly. (Dalziel has had research funded by Kinsa in the past).

It seems to be accounted for.


That'll teach me to rush to comment when I see something "off" instead of reading the whole thing. I'm tempted to delete a post that isn't useful now, but I should leave it as a minor embarrassing lesson to myself. I wish people would stop upvoting me though... Each one makes me cringe: another person who didn't read very carefully.

> I wish people would stop upvoting me though... Each one makes me cringe: another person who didn't read very carefully.

I don't think upvotes mean something's correct, I think they mean that something (and the ensuing discussion) is worth reading.

Even though you were a little off base, it was a useful chain of discussion because presumably a large nonzero number of people would think the same thing. :)


I agree with your original point, even if you no longer stand by it.

>Historically, Kinsa’s methods have been able to account for a sharp rise in the number of people taking tests

What historical precedent is Kinsa referring to? There has never before been a pandemic of this magnitude, in a time and place where many people owned internet-connected thermometers.

Perhaps I am being uncharitable, but it seems that they are leaping to conclusions here. I'm sure that they have done their best to account for this, but the claim that "Dalziel has ensured that a spike in testing didn’t lead to inaccurate predictions" is one I find difficult to take at face value. Ensured?

You said that "there could be some selection bias here." Could. Sorry to cause you to cringe again, but +1.


I don't think this is uncharitable at all. I'm sure Kinsa has made a good effort at controlling for testing frequency, and I'm sure it's helped. But there's no reason to think the dynamics of COVID-motivated testing are the same as for flu-season, or new-buyer novelty, or anything else.

And more importantly, how could we know if it is? That's not just a Kinsa problem; we see this over and over again with peer-reviewed studies that "control for" certain factors like socioeconimics or health history. They're inherently limited to controlling for what they know about, and it's never perfect. Often, the entire effect is from an undiscovered variable. Take, say, the widely-promoted study finding that visiting a museum, opera, or concert just once a year is tied to a 14% decline in early death risk. The researchers tried to control for health and economic status, then concluded "over half the association is independent of all the factors we identified that could explain the link." [1]

Now, what seems more likely: that the unexplained half is from the profound, persistent social impact of dropping by a museum or concert once a year? Or that some of the explained factors like "civic engagement" can't be defined clearly, others are undercounted (e.g. mental health issues), and some were missed entirely?

I suspect Kinsa did much better than that, because they're not trying to control for such vague terms. But I think "even after controlling for" should basically never rule out asking "what if it's a confounder"?

[1] https://www.cnn.com/style/article/art-longevity-wellness/ind...


Yeah, I wish that science reporting would either a) mention specifics on methodology or b) link directly to papers.

Without this plus a stronger push for open-access publishing, readers often have absolutely no way to verify claims like this - and, moreover, have no way to learn how to apply similar methodologies to their own work. There's a lot of people in data science / analytics positions right now who could benefit from sharing knowledge around statistical tools to correct for highly unusual situations.


It’s a reasonable question, and the reply to your OP suggests it was accounted for but I don’t know enough about stats to say that it fully accounts for it. I would say it’s still very reasonable to be skeptical and ask if it is still biased, or still partially biased.

Eh, the response isn't exactly a slam dunk. There's a difference between saying "I thought of that, and it's not a problem" and whatever it is actually not being a problem.

The reply doesn't necessarily have to be a slam dunk or complete rebuke. Quoting the single sentence, without the next 5, impartially paints the story. It's imbalanced. It denies the reader the level of nuance necessary to pass fair judgment.

Even if you jumped to an incorrect conclusion in this case, it's still a useful one in other cases. And anyone who maybe would not have thought of that might learn something from your comment, even if it wasn't applicable in this specific instance.

It's good to be skeptical. You asked a fair question, and when presented with evidence you changed your position. Those are all positive things.

I think your parent, parent post should stay up. This discussion is valuable. So many show up in the comments when the first thing seems amiss before having a full understanding of what is linked. It's a cycle that repeatedly plays out. It's something I've done before, too. We could all collectively do better.

Doesn't really explain how it's accounted for

Please see their adjustment method here, https://bit.ly/39wW0yC.

It is just a linear interpolation and backward looking. I’m definitely not convinced how this would control for how more healthy people take temperatures more frequent after govt announced social distancing to stop COVID-19.

And their data contradicts CDC, https://gis.cdc.gov/grasp/fluview/fluportaldashboard.html

Also very misleading variable labeling. y is CDC ILI activity, % outpatient visits for flu-like symptom, not actual % population that are ill, https://academic.oup.com/ofid/article/6/11/ofz455/5610164


That's wishful thinking. We haven't had a pandemic in recent years.

The folks at TWIV (This Week In Virology) noted that regular influenza numbers were sharply down in Japan as a result of people's changing hygiene behaviors.

Exactly what we'd expect. It's a silver lining on this whole mess.


(Removed)

This line:

>Recent data clearly show the spread of Covid-19. On March 19, the share of Americans with temperatures indicating they had flu-like symptoms was about 4.9% when it typically would be expected to be about 4.0%. This was likely a result of the spread of Covid-19, according to Kinsa’s researchers.

... means that 1 week ago 2,964,898 Americans (0.9%) had Covid-19. Today there are 65,950 recorded cases in the United States: https://www.worldometers.info/coronavirus/


Given that US COVID19 fatalities are 1,031 today.

Assuming 0.5% death rate after 3 weeks, then 3 weeks ago there were 200000 infected.

Assuming cases double every 5 days, then multiply that by 2^4, therefore:

The US has 3.2 million infected.


How did you come to the .5% death rate after 3 weeks assumption?

It's roughly consistent with the data from South Korea which was quite liberal with testing potential cases based on contact tracing (so they have records of also the infected but asymptomatic or very mild symptomatic carriers) and they got 0.6%-0.7% case fatality rate, and the median time from infection to death is something like 3 weeks.

You get a much higher fatality rate if you're testing only people with severe symptoms or those who get hospitalized, which is what many countries are doing. For example, if you have mild symptoms, UK health service will tell you to isolate at home and call them for hospitalizatin if you get worse, and you'll get tested only if that happens. You also get a much higher fatality rate if hospitals are overloaded and people can't get proper lifesaving treatment, which wasn't the case yet in USA, so an estimate based on these numbers seems reasonable now.


Pick whatever numbers you think are reasonable based on the data you have read - I think you will end up with a worrying result.

I use this analysis because the number of deaths is hard to fudge, and the fatality rate after x days, and the infection rate are somewhat measurable (I believe there are statistically valid measurements of those numbers).

Any analysis based upon detected cases is deeply flawed IMHO, because detected cases can be anything (look at different countries with wildly different values with no basis in reality).


It is not an assumption just arithmetic. Median time to first symptom is 6 days. Median time from first symptom to hospitalization is 5-7 days. Median time to death is about 7 days. Add them up and the median time from contact to death is about 3 weeks.

Wow that’s pretty amazing. Really makes you wonder.

And that would just be the people with symptoms right now. It wouldn’t include recovered, asymptomatic, nor people in the incubation period.


Or the data is invalid. We'll find out soon enough, there are millions of test kits being made available soon.

I dont understand what millions of millions of test kits will do. I’m not going to get tested because I have no symptoms. If I had symptoms I would stay in lockdown until it got worse. I don’t see rationale for anyone going to get tested just because (and based on some of the photos from drive through testing, a very easy way to contract COVID yourself)

The error bars on that 4% number are huge, I imagine. Like 4% - 2% or +15%. It's entirely possible you could get 4.9% with zero Covid-19 infections, just from normal variation. Not only possible but I'm sure there's a month in the past decade which had more.

Why would the error range be that high? We'd know about huge spikes like that through hospital data, insurance claims, and the sales of drugs, and there aren't spikes like that. The number of people who are ill is relatively stable year-on-year.

I'm not sure what you're basing your assertion on, but the estimated number of symptomatic flu illnesses ranges from 9.3 million to 45 million annually over the past decade, which as I said is roughly from between 3 and 15% of the US population.

https://www.cdc.gov/flu/about/burden/past-seasons.html


There is probably some selection bias - it’s 4.9% of people using the thermometers, which would skew towards people that are thinking they have a fever.

I am definitely buying one of these to support the company.

It's fascinating data, and I'm glad it's being taken, but...I am a bit skeptical that we can draw any reasonable conclusions from it without limiting the data to long-term users.

It seems implausible that there has not been a significant change in the health-consciousness of the typical purchaser in the last month or two, vs. prior to that. I can't tell you what the change would be, but I find it highly implausible that it would be not at all different, given the biggest spike in public awareness of a health issue in several decades.

It's nice to see that Dalziel has thought of the issue, but the article doesn't tell us much about _how_ he accounted for that. I could think of ways, but I could also think of ways to screw it up, and it doesn't say in this article how he "ensured" that the effect is real.


There has also been a decrease in traffic accidents and violent crime. This is data from hospital casualty units in South Africa

I’m purely guessing, but maybe the traffic deaths have decreased linearly with traffic, and violent crime in some porportion to gathering size.

That is to say, that it’s due to less activity and not a changed mindset.


I doubt traffic accidents and traffic have a linear correlation. I would assume it looks very different depending on the density of the traffic, i.e. not linear at all.

Maybe it's not due social distancing, but the economic uncertainty.

Agreed, but this study can certainly be used as part of a larger triangulation. A guy I worked with pointed out that this was happening in Japan about a month ago: https://www.japantimes.co.jp/news/2020/02/21/national/influe...

But who is going to go to a doctor/hospital for the flu when they are scared of catching sars2 there?

Randall Munroe did a small section on eradicating the common cold in his What-if book, the basic idea is if that all of humanity stayed away from each other for a week or two then the common cold would die out as it can't survive outside of the human body for more than a week and normally survives by continuously hopping from host to host.

This current situation had me wondering how hard it would be to coordinate a regular -- maybe not yearly -- global self-isolation for say 2-3 weeks at a time.

Aside from the difficulties of getting everyone in the world to agree that the first three weeks of February during a leap year are observed through social distance, it doesn't seem like it would be as bad on a recurring basis as it is during an emergency like this. You could plan for your self-isolation in advance, so there wouldn't be a rush for supplies the way there is now; you would already know not to schedule anything for February; you'd probably still have to solve some money problems for a large number of people, since being able to WFH probably anti-correlates with living paycheck to paycheck.

If you could actually eliminate -- or at least, dramatically reduce the incidence of -- common colds and seasonal flu through such a scheme, it would probably be worth both from a QoL standpoint for the everyone in the world (would you trade 3 weeks of cabin fever every four years for never having another actual fever?) and from an economic standpoint (three weeks of predictable low productivity is almost certainly better than the unpredictable constant costs associated with illness and death).


I've theorized this about sexually transmitted diseases, too. It's even less realistic to imagine compliance, but suppose everyone only had sex with people who were born the same year as them. Any given disease would lose the ability to spread into younger people, and simply fall off the end of the age conveyor-belt.

It’s pretty easy to stop STDs just by only ever having sex with 1 person, or more liberally, 1 person at a time and both getting tested before then. Having to go with the “same year” rule is probably harder than that.

Small reminder that STIs are not just transmitted by 'sex', but also through other intimate acts like kissing.

The only suggestion that seems remotely plausible is 'all participants getting tested first'. There are still issues with getting tested, as there are false negatives and it can be hard to get tested for all diseases, but this would dramatically reduce incident of STIs.


Or hey, let's try this radical idea to just have protected sex unless we have both been tested.

I don't like embracing Big Brother

You will learn to love him eventually >:)

[Off topic]

I recently picked up 1984 again and finally managed to complete it this time. I read the last line with a mixture of relief and a tinge of disappointment. Until the very end, I was hoping for a Hollywood-style turnaround in the political situation.


In an ideal world you wouldn't even have to go that far. Just say that anyone born before 2020 is not allowed to have sex with anyone born in 2020 or later

I have a feeling that a lot of people will have happy memories from this time, except for those that have lost loved ones or facing the hell of trying to save those that are infected. I was talking about this today on a midday walk with my wife (which would have never been possible in other circumstances). With enough fond memories and fears of a repeat, an annual social distancing tradition may actually have the possibility of traction.

Most people won't. Many average people are going to lose their jobs or business and go broke, or be cooped up in a tiny apartment for weeks and months.

Some of us are lucky enough to be able to weather this without severe downsides. But we're in the minority.


I am on vacation and am having a great time.

I have been cooped up in my apartment for three weeks and only left it four times to go to the grocery store. Finally I have some time to spend on my oss projects


> This current situation had me wondering how hard it would be to coordinate a regular -- maybe not yearly -- global self-isolation for say 2-3 weeks at a time.

Very hard. We can’t even properly do it in the face of this pandemic.


Economically you need to take into account that a lot of people barely get sick from flu. Certainly not two weeks a year.

I mean, even if most people don't get sick enough to miss work for 2 weeks a year, 10 sick days a year is a pretty common number to give an employee, either by statute or as part of the benefits package. Even if they don't get used completely every year, most businesses are budgeting for their employees to be non-productive due to illness for two weeks each year.

And obviously colds and flu aren't the only way people get sick and miss work, but if you could cut those two weeks per year to one week per year by having three weeks of quarantine every four years, that's a productivity win before you include the more predictable "nothing happens in February this year", the economic value of the lives saved, and the savings on healthcare spending on the people who don't get sick.


The difficulty of getting compliance even in the face of a scary new threat should give a good deal of indication of how hard it'd be.

And the speed with which it spreads in a population that has little immunity against the current strain should be a good indication of how little you'd save.


Eh, there may be a certain amount of truth to that, but personally I think it's one of the many fears that sci-fi has overplayed.

Part of the problem we have in our war against infectious diseases is that they mutate in endless variety. The cold you catch tomorrow is slightly different than the cold you had last week; the variety of the seasonal flu spreading this year is different than the variety of last year.

But these endless varieties are generated at a rate proportional to the available hosts. If we can successfully reduce the number of hosts available, we would also reduce the number varieties of colds and flu we have to contend with, and the rate at which new ones appear. Everyone not getting a little sick all the time might conceptually weaken our immune systems, but it would also weaken the diseases against we're fighting, and we would still have our other tools we use to fight them.


Do we know for sure that it* doesn't have an animal reservoir?

[*] The common cold is a half dozen distinct viruses.


> The common cold is a half dozen distinct viruses.

Some of them coronaviruses. It makes sense, but it's funny that we classify the common cold by symptoms, ignoring that the viruses are in different families.


True. Maybe something like chickens or pigs could be an animal vector. Then a very minor mutation could make it infectious to humans.

Doesn't even need the mutation. It may be that it is infectious with R0>1 to some other animals as is, but with few health effects so we don't notice it.

If so, it'll just immediately get reintroduced to humans even if we distance it out of our population successfully.

No mutations required.


I've noticed this anecdotally. My son usually goes to preschool (and Sunday school and playdates and museums and parks). He has had an almost constant runny nose for a while... as soon as one virus is fought off, another takes its place. Nothing major, but clearly annoying to him (cheek red due to him wiping his nose, in spite of our efforts to keep his face clean). A few days to a week after soft-quarantine (school and church cancelled), his runny nose is gone and hasn't come back.

Have you verified that it's a virus and not actually allergies? Runny nose can be confused for allergies, school might e.g. have mold or dust which your son is reacting badly to.

Unlikely. The symptoms were worse at night.

This also means your little one is not getting that community immunity. You want your little one to get sick at a young age to ward of invaders as they get older.

Anecdote: my niece gets sick badly and passes it on to everyone in her house at least every other month. She does not got to daycare. My LO does go to daycare and comes home with a new mild sickness once every third week and is fine a few days later. I’m interested to see how he fairs when school opens up again


I could say the opposite. My son was sick 3 times prior to entering school, we took care of him at home until age 5. Each resolved in a day or so. Upon attending school, he’s got his share of colds and a fever or two, and clears them out quickly.

Childrens immune systems are challenged quite effectively with normal everyday exposure. You don’t need to feel symptoms to build immunity.

Here is a reason to believe that the data is biased. If you look at any county in California - you’d see a large drop on the exact date that the statewide shelter in place was ordered. This is obviously before any of the effects of isolation would manifest themselves.

The reason is likely due to larger amount of testing done due to the panic, that is not properly accounted for in their algorithm.


For what it's worth, some populations began isolating before the shelter in place order. I went to Ranch 99 on 2/28 and panic buying was already in full swing. Lots of masks. I think the Chinese community was very proactive and took action early. It left an impression on me and I started WFH full time. I think that was the day they announced the second community infection in Santa Clara county.

I whole heartedly agree. Kinsa’s data immediately shouts out that there’s a non-intuitive behavior being demonstrated.

I would also make an argument that individuals who invest in smart thermometers would be more concerned about illness than the typical population and thus highly responsive to governmental declarations of states emergency.

I think it’s really hard and misleading to look at this data and make any larger conclusions.


People started staying at home well before that.

It's certainly biased. The question is if it is still useful after accounting for bias.

People that use these thermometers probably skew towards being more worried about the virus. They probably isolated and were more careful days before the shelter in place was ordered.


I’ve heard there are 200 different cold viruses. It’s conceivable at least a few of them become eradicated after this.

Anything with a low r0 is going to have a lot of trouble surviving right now.


Influenza only has an R0 of 1.3. I really wonder if we’ve managed to push it below 1.0 world wide. Pretty wild to think about.

1.3 really isn’t that much. What if all the new people who’ve started washing their hands keeps it below 1.0?


It should be noted that R0 won't be constant - the more people have it the lower the R0 since more people will have immunity and more of the extroverts / travelers (who are high R0) will have spread it around to each other already.

Also, of course, the R0 always goes below 1 in summer...


Sadly, as long as there's a large enough region where it has R0 > 1, then when we lift restrictions we'll be back to normal.

Or a species. Viruses aren’t just for humans.

You have to distinguish between viruses in abstract and a concrete disease. Many viral diseases we are fighting with are human only. So if we erradicate it in humanity, it is gone. This is how smallpox went away. We vaccinated enough people to make it go away once and for ever. Measels have no animal host either, as far as I am aware, so we could have a good chance to erradicate it too.

The corona virus sars-cov-2, as well as the first sars virus jumped from animals to humans. There are several animal species which carry variations of the sars virus, but fortunately, they don't make the transition to humans regularly. If we managed to prevent further transmissions of sars-cov-2 between people, there is a good chance, this virus could go away entirely, unless it manages to jump to some common animal.


And then we would get an pandemic of another influenza type virus rushing through the population like wildfire because nobody is immune. It's very difficult to completely eliminate infections (even polio is still around despite extensive immunisation), especially if it mutates as much as influenza.

A little known fact btw, most of the influenza virii are descendents of the Spanish flu which have mutated to be less deadly.


> It's very difficult to completely eliminate infections (even polio is still around despite extensive immunisation),

This is only the case because some people are refusing vaccinations, or not able to get them.


Couldn't we just vaccinate people with all the known flu vaccines we have now to get the same result?

If that's the case, few generations from now people won't have immunity to as many common cold viruses as we do. I wonder if that could be detrimental.

"Historically, Kinsa’s methods have been able to account for a sharp rise in the number of people taking tests, said Benjamin Dalziel, a professor at Oregon State University who studies infectious diseases. For his research, Dalziel has ensured that a spike in testing didn’t lead to inaccurate predictions, and so he believes the current decline in illness is a result of social distancing, and not a statistical anomaly. (Dalziel has had research funded by Kinsa in the past)."

Huh, I was expecting the opposite of this. The previous data could be slightly off because of smaller sample size and now that it has exploded they have a better estimate to reality.


The problem is the sample isn't random.

Well their error bars may be smaller this year but they're comparing to past years.

Does anyone know if they account for their user base presumably being mismatched with actual demographics?

ie. I assume their users are going to correlate with tech-savvy people, in turn correlating with people able to work from home, giving a severely skewed sample


Well, the ultimate example of "social distancing" were tiny island nations. They got visited by Europeans, caught whatever bugs they brought and now they're all dead.

If you do not train your immune system it'll fail you. When we have some major epidemic with an ugly consequences coming then sure social distancing can help. However taking social distancing as a generic strategy for out future lives I think will lead to a major f.. up.


Social distancing is pretty great.

My company temporarily banned meetings with more than 6 people; this should be permanent.


What about selection bias? I'd think that people are more likely to use a thermometer even if they don't feel like they have a fever now than they would have previously. That could account for numbers going down.

They think they have been able to correct for that.

> Due to the emergence of the coronavirus, Kinsa is receiving two to three times more thermometer readings per day than in previous flu seasons. Historically, Kinsa’s methods have been able to account for a sharp rise in the number of people taking tests, said Benjamin Dalziel, a professor at Oregon State University who studies infectious diseases. For his research, Dalziel has ensured that a spike in testing didn’t lead to inaccurate predictions, and so he believes the current decline in illness is a result of social distancing, and not a statistical anomaly. (Dalziel has had research funded by Kinsa in the past).


I was hoping for this, lets do social distancing a tradition for every winter

Do you really think we're going to come out of this period causing people to lose their jobs, lose their savings, lose their loved ones, not see their friends, stop going to sports and social events… and everyone's going to be like "Hey, that was fun, let's do it again next year"?

Some countries have week-long holidays where most people go home/travel/don't work. Their economies aren't dead.

Make it a tradition where everyone with non-essential work stays home at least one week a year, all at the same time. More time is better, but even a little bit would likely cut back on disease. Governments already define Christmas/New Years/etc as a holidays and huge numbers of people aren't working on those days and economies don't die. It wouldn't be hard for companies to promote "Pre-Stay Home Week Extravaganza" sales and make people actually look forward to staying home, eating and watching movies/playing games/whatever.


> Governments already define Christmas/New Years/etc as a holidays

Just doing the days between those two holidays would probably be a welcome reprieve for a lot of people.


In Europe this is called "August".

In Europe this is called "August".

But without the social distancing aspect.


Do you personally know many people who has lost a loved one or their job to COVID? 2nd, could be painted as a lets do this preemptively every year or in memory... Don't need to close everything, could be as simple as work from home if you can don't do gatherings/go out unnecessarily for a week or two.

Social distancing isn't the same as lockdown. You can habitually keep your distance without being laid off, etc.

Maybe a brief version, like a Passover commemorating COVID-19 instead. Passover isn't exactly a fun party kind of holiday.

Maybe if they get enough cash transfers.

I’m just trying to get my head around this...

I wonder if people are just ignorant of the widespread devastation caused by the lockdown, if they feel like people devastated by the lockdown did not “do enough to prepare” and so somehow deserve it, if they somehow believe people will be made whole by trillion dollar handouts, or what?

I personally know two family businesses which have laid off all their employees and may never start up again, and another which if it doesn’t see bailout funds before next month who won’t be able to make payroll.

To say nothing of the kids missing their friends, their educations, their graduations, the weddings canceled, even funerals, etc.

Yeah let’s totally do this every year. This is so out of touch with reality it’s bizarre.


Whatever happened to moderation. Extremely all or nothing ideology is how we got in this mess in the first place.

If people's take away from this all is to wash their hands,stay home when sick, and cough into their arms, tens of thousands of lives will be saved


Besides that I consider this discussion mostly theoretical as I doubt that one would get large enough parts of the population to agree - they are not even agreeing to erradicate diseases we could easily erradicate, like the measels - a planned limited shut down wouldn't be very disruptive.

Here it Europe, it is quite common for businesses to shut entirely down for a few weeks every year. The reason is managing employee vacations. It is easier managing this by shutting down entirely. Even the big car companies have two weeks every year, where the production is mostly shut down. And even many US companies have mandatory shut-downs on thanksgiving or christmas.


A coordinated reduction of time spent in groups doesn't have to be extreme to have a pretty big impact on infection transmission.

Like state health departments could declare that influenza is trending in the state and businesses could have less face to face meetings, and maybe churches cancel some of their non-worship gatherings, and so on.

For example, the orange scenario on https://covidactnow.org/state/MI includes possibly closing schools. States are doing the ones down at the bottom of the graph, social distancing is less severe and less effective, but still compares favorably to not adjusting behavior.

School closures in response to infections could probably be done more aggressively than we usually do now, but doing it on a statewide basis also probably doesn't make sense.


Dr Katz wrote in the NYT;

“I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.”

Let’s not do social distancing, or even “social distancing lite” at all please. It’s disastrously damaging to public health.


That paragraph doesn't describe social distancing, it describes the government ordering everything closed.

But whatever, we can call the thing where we take simple, effective public health measures that do not have grave economic impacts something else.

(the irony to me is that reducing the spread of things like flu would have economic benefits, many of which would be concentrated with those that are economically vulnerable)


Yeah, I'm seeing layoffs in sectors that I never would have expected to see layoffs. Its amazingly bad for everyone.

But don't worry, the government is here to save everyone! /s

We're definitely not volunteering for this every year.


Even easier and also reliable, normalize wearing surgical masks. Outside of Asia, wearing a surgical mask before the outbreak might invite some funny looks.

Why? I mean, sounds good if you are sick, but rather you stay home.

Lots of people, for lots of illnesses, are infectious without really having any symptoms.

Plus most people still go to work when sick. They will just dose up on whatever drugs they have to hide the symptoms and make them feel better, then go to work anyway. Even here in Europe where the government pays sick leave that happens.

And before this pandemic that was generally considered a virtuous habit. I wonder if that will change when this is all over

As we have observed in the Covid-19 pandemic, It could be the case that you were just only lightly sick but also contagious. Not to mention also a few things are difficult to pass, for example, University lectures (skipping one can make it difficult to follow the next) and again lecture halls are cramped so you can easily infect somebody.

Just you and me? That's not going to do much. Organizing action in the scale of the billions is a lot harder than having the idea. I'm not sure if there's any precedent for what's happening now.

Please do not. Social distancing has a high health cost, mainly wrt. mental health. It bad for depressed people, people with "home" problems like violent partners or parent, people which have problems socializing, children (in general, or at lest for most children it's bad if kept up).

It's fine if done once due to a bigger health emergency but it only should be a last effort if we have no better way to handle it.

Instead I would prefer:

1. Better wide spread education about all kind of disease and related thinks, especially de-stickmatization. But this would need major changes like proper sexed (required for proper education about STD's).

2. Wide spread vaccination where applicable. (maybe even required, e.g. for children when entering school).

3. Good health system so that people can always get help to fight illnesses, at least infectious ones.


Others told about the health risks, but also consider we have 2 hemispheres :)

Apparently, the new term is "physical distancing," because it's not like people are mass unfriending people or calling them Mr./Mrs. SoAndSo.

Funny thing is, term "physical distancing" doesn't make sense without mentioning "social distancing", because without that context and by itself it might mean different things.

“What if we made a better world...and it was all for nothing”

I am betting also driving and particularly drunk driving related accidents and deaths will also drop during this quarantine.

..And suicides will likely go way up.

Probably a lot of other issues as well that may be more difficult to track. Mental health crisis, domestic violence, etc.


As you hint at, unemployment numbers are directly proportional to suicide rates. The effects of shutting down the world are much higher than just missed paychecks and business bankruptcies. You list a few of them.

There must be a cost-benefit analysis done where we find the breakeven point between lives saved by quarantine vs. lives damaged by quarantine side effects.


The entire world is going on with it this time because the cost-benefit analysis is quite trivial. The entire world also doesn't go with it every few years to stop the flu because the cost-benefit analysis is quite trivial.

There has got to be something in between, but on the land of exponential growth and slow-down, that line is very thin. This one pandemic will cross the line at some point, but I bet we will resume business as usual even before that.


I was thinking if we go all in on this stay-in-place and we get it working around the world, could we eliminate measles? Chicken pox? Any other human-virus disease that relies on human-to-human contact to spread?

You're thinking of Solaria[1], from Isaac Asimov's Robot series. It's not a great society, all things considered.

We already have measles and chicken pox pretty well licked with vaccines. Smallpox was eliminated in the wild, polio is nearly there. There's no need to change our entire way of life permanently just for diseases we can easily vaccinate against.

1. https://asimov.fandom.com/wiki/Solaria


Unfortunate, stuff like the flue is believed to live in some/few/enough humans which do not show symptoms but are able to spread it.

It would be interesting to see a list or to survive it to see a documentary about its effects.


In theory yes, but in practical terms probably not, as it is unlikely that we get the whole humanity in a lockdown and of course there are still human-human contacts. This is the reason, it is unlikely that we get rid of sars-cov-2 entirely once the global spread was beyond a certain threashold. But in practical terms one could espect a lot of infectious diseases to be drastically reduced in case numbers.

Unfortunately, I think a more significant cause of the continued existence of these diseases is failure to vaccinate, either by choice (anti-vax) or due to circumstance (cost of vaccination, access to health care, etc).

There are several diseases that society could eradicate that we simply choose not to.

Even wealthy tech people are affected by this; I was just told my very good insurance doesn't cover a vaccine that my doctor prescribed. It would cost $400, so I need to weigh my actual risk of getting the disease against cost of vaccination. I'd think the long-term return on investment for society would justify making just about every vaccine free to all.

edit: consider how much easier it is to just get a few shots, compared to never going to a bar, restaurant, sporting event, public transit or shared workspace ever again. Going all-in on social isolation is a nonstarter, even discounting the people who won't comply (there are many) or the toxic political environment that has pitted half the US against science and expertise.


Not sure why you got down voted, I can only agree.

Social distancing only slows distribution it doesn't prevent it reliably also some disease are spread by animals which are not at all affected by social distancing.

And then vaccines are also not enough as it had shown for some disease where we did try to eliminate them by handing out free vaccines in affected countries.

Lastly social distancing has a super high cost if continued. Not only economically but a super high health cost. Humans are not meant to live permanently social distanced they are inherently social animals and the internet can't really replace it. E.g. for people fighting depression social distancing can be like poison. It prevents them or at least restrict them from doing many the thinks which can help fighting depression and causes "physical" isolation (Internet is helping but has limits, it's not helping enough to counter it). Another group most likely majorly negatively affected are people with "home" problems, like violent partners or parents (or just to controlling partners or parents). To just name some example.


> they may not have realized that they were also combatting other infectious diseases, such as the seasonal flu.

No, they fully realise. We have to also reduce the flu. It also takes up many ICU beds. This is vital. Any plan knows this.

Whether they are implementing measure like free Flu shots and are ramping up supply of Flu shots using the military if they have to, I doubt, because no one wants to think ahead more than a day.


India is practicing Untouchability for 2700 years https://en.wikipedia.org/wiki/Rigveda

Social Distancing is not different/difficult for them; http://archive.vn/bEMTt


"Social distancing" is such a weird and ambiguous phrase. Are we not socializing right now over the Internet while maintaining physical distance? Arguably, we're socially closer than before because of this crisis.

Which is why the WHO changed their recommended terminology to "physical distancing". Previous HN discussion:

https://news.ycombinator.com/item?id=22665506


Difficult to replace a phrase that's already caught on. Good to know, though.

Hypothesis: people who are stuck at home have more time and inclination to check their temperatures, even when they don't feel sick.

That wouldn't generate an unusual number of 'fever' readings, and then a pretty simple model would do some accounting for repeated use of each thermometer (so 'extra' normal readings shouldn't be reducing the expected number of 'fever' readings).

Agreed, but it could easily generate an unusual number of "not a fever" readings, which would make it look as if there were a smaller than normal number of people getting sick with the flu. Or, maybe it doesn't do that. I don't see how you can say for certain which way it would shift, but I find it implausible that it would stay the same.

That's what I mean by a simple model.

Like a dead stupid one would be to compare to historical data for fevers/week per thermometer.

That is barely a model at all and it manages to ignore how many readings are done and accounts for multiple readings during a period of illness and readings for multiple sick members of a household and so on.


Sounds more like more people are taking their temperature despite not feeling sick. Hence the sudden increase in readings they receive. So a pronounced decline in the percentage of high temperature readings should be expected.

Wish I had seen this hours ago.

Their data is visualized at https://healthweather.us/

I’ve been checking this daily for the last week or so.


I expect norovirus and rotovirus D&V will decline but salmonella will rise. Maybe even accidental mushroom poisoning, ptomaine? (Foraging, tinned meat) and bad salami caused an outbreak of life threatening kidney and other problems in South Australia some years back, so people going into cured meats be warned.

Alcohol poisoning from home stills is a constant.


I'm not too worried about alcohol poisoning RE: home stills. It's people who don't toss the heads and tails that have a bad time: methanol poisoning sucks, and is the cause of most home distilling dangers (blindness, kidney failure, etc).

This is what I suspect most people will miss. Worldwide I think alcohol poisoning is adulteration of spirits with industrial alcohol but the heads and tails are not just methanol, it can have metal and chemical residues as well.

A worldwide fast through slow

I wonder if viruses will adapt to this hostile social distancing climate.

I prefer to call it physical distancing. Social distancing is when the Internet goes off.

I was just wondering about this yesterday. Neat, thanks for sharing.

I image new cases of the clap are going to tumble precipitously.

TLDR: Social distancing is also slowing the normal flu

Just imagine how many fewer people would fall ill each year with the flu if we didn’t shake hands as our default greeting?

Yep, I never liked hand shaking because of that. Where I am currently (PT) and where I lived mostly before (ES) kissing is almost mandatory, even often with people you meet for the first time and will never meet again. I think it is the same in Italy & Greece.

I think the future might be better with a polite nod instead. But that is because I do not like this contact with just anyone (I did a lot of business travel and it is scary to see how few people wash their hands after doing whatever on the toilet). Obviously with friends/people you know well things are different; I am referring to contact with just anyone you meet.

Is there any research about infectious diseases and greetings? Especially handshaking, hugging (another one I could do without unless close friends) and kissing.


This will be a very good silver lining. Bows, elbow bumps. Not sure what the standard greeting will be, but getting away from handshakes and cheek kissing will make all of us healthier.

Something strikes me as so cowardly about that line of thinking.

Handshaking came about because kissing on the cheek was what transmitted plagues in the past...

Some cultures bow.

It's time we start greeting everyone with a kiss on the cheek.

I don't think so; just speech is OK, or else bow is OK.

Demolition Man was prescient.

I’d be curious to see any research like that.

I really hope this helps kill the concept of handshaking entirely.

Unfortunately, there's still a large segment of dirty-handed people who think you can judge a person based on their handshake.


There's a lot of hidden value in physical contact. I don't think it should be disregarded so easily considering society as a whole became much more distant in recent years.

It's not even hidden value, it's very measurable -- when you touch someone else, your heart rates will trend towards each other and you'll gain a level of empathy that you wouldn't have had without physical touch.

Potentially. But I find there to be zero value in touching the hands of someone I only just learned the name of. Especially considering I don't even know whether they're the type to cough in their hands, or the type to not wash after using the toilet.

Bro hug with a friend I haven't seen in a while? Okay. Sweaty hand contact with a stranger? Never.


The danger is higher - that's exactly why we do it. It's an easy way to create intimacy with a stranger quickly. There's a reason politicians shake hands and kiss babies.

Handshakes far predate modern germ theory of disease. The "danger" doesn't really help with intimacy in any way. It's completely unnecessary danger. We'd find sharing tissues with strangers to be disgusting if it were introduced as a greeting today, but touching the hands of someone right after they've sneezed and coughed into them--after which we often unknowingly touch our own face--is regarded as a sign of intimacy or respect.


A handshake is symbolic and can be easily replaced with a different symbol.

Is there any evidence that people who prefer handshakes have dirtier hands on average? What a bizarre stereotype.

They touch other people's hands more often?

This is just temporary but effective way to lessen the spread of contagious disease. No other country wants to be the next Italy.

the title should really be "other INFECTIOUS diseases"

Reduced air pollution reduces non-infectious disease too.

Can you please explain me how is air pollution affected by social distancing?

And also article is not discussing air pollution at all, they talk about less fevers detected on smart thermometers. Those are caused by seasonal flu and other viral seasonal colds, obviously because people now take more care, so those other infectious diseases are blocked from spreading too.


Physical distancing prohibits all non-essential travel, much of which would have happened by motor vehicle.

The lockdown of non-essential businesses has essentially reduced traffic accidents here to zero when usually there'd be a over a hundred deaths and few thousand injuries per week. By comparison there's only been 20 deaths from covid-19 over the space of 3 months, nearly all of them elderly people with pre-existing conditions.

Yet people are emotional creatures and not all deaths are equal.


The "car accidents" fallacy.

1. "New thing X puts us at risk of losing Y lives every day."

2. "We lose Y lives to car accidents every day".

3. "Ergo, X is harmless!"

Except you now have 2Y lives lost every day.

Furthermore, car accidents kill an insane amount of people, and cars suck. This is not the bar.


Once covid-19/sars-cov-2 is over would you support the same levels of lockdown for car accidents and flu/viral pneumonia? Many more lives could be saved with the same political will and public support you find on this issue.

These lockdowns can clearly prevent the spread of existing diseases and save magnitudes more lives as presented by the article along with the inevitable traffic statistics to come out showing the effects.

I'm wondering how someone here supporting lockdowns can justify not repeating it once this pandemic is over? Is ten young healthy lives taken by cars not worth one old ill one taken by a disease?


I wouldn't justify a lockdown for cars because there are other ways to beat cars than locking everyone in their homes.

Point: I don't have a car, yet I'm locked in my home right now. Hmmmmm.

And yes, I would support forbidding cars altogether for most things they're used for today that can be done with different vehicles.


Would you support forbidding cars in neighborhoods designed around the car, e.g., most American suburbs planned after 1950, or would you limit the ban to neighborhoods planned after the start of the ban?

Is my opinion on the exact details of the implementation of a non-existant car ban really that relevant?

the fallacy is couching it that way. no one says “it’s harmless!”, but rather, they ask “is this more or less dangerous, and is it more or less costly?” so it’s absolutely a credible gauge of risk, or more colloquially, a bar. that’s how we figure out an appropriate response, by looking at what we’ve done in similar situations.

and yes, it absolutely sucks that we accept a million deaths a year worldwide due to cars. same for the flu. we should absolutely try to raise that bar.


I completely agree. I often use the car accidents as a statistical bar. Its really a big part of what made me realize how serious covid19 would be if we didn't adjust pretty aggressively. The numbers really could have eclipsed car deaths and that is already a huge number.

I don't think that is going to happen now, though, thankfully.


I don't think it's a good gauge, because established variables are never evaluated the same way as new variables.

This is true in many fields. For example, if you said 30 years ago that everyone should carry all the counter-privacy implications of a smartphone in their pockets at all times, how do you think people would react?

Is it reasonable to expect people to freak out en masse about it today? No it's not. Why is a bigger question but i suspect you instinctively know that I'm correct here.

Does that mean smartphones are a net good on privacy? No. The negatives still exist even if people accept them.

Does that mean the negatives outweigh the good, and we should all throw away our smartphones? No, I don't think so either. The positives are massive. But introducing them today would give us the opportunity to address the privacy issues ahead of time.


"How many people died of this" is only the tiniest factor to consider when trying to evaluate how dangerous a problem is. Consider the death of half a dozen unrelated people in city A, and the deaths of half a dozen separately unrelated people in city B. Who cares, right? That many people die every three seconds or something. Now add the information that the 6 people in city A died of smallpox. The 6 people in city B were all pedestrians hit by cars.

Should both cities react the same way?


Traffic accidents also aren't contagious

Allot of people do get them from someone else, but your point still holds as they tend to fall off not grow beyond first contacts.

As of right now, covid-19 is killing about 2,200 people/day, compared to about 3,300 people/day for car accidents. So it hasn't caught up yet, but it's still on an exponential climb and will probably get there in another week or so, and then keep right on climbing.

This whole "the flu/cars/heart disease is way worse" shtick people are leaning on has got to stop. It's true until exponential growth suddenly means it's not.

EDIT: And those are the worldwide numbers. In the US specifically, covid-19 is killing about 200 people/day, compared to 100 people/day for car accidents, and is of course going to go way up from here.


I still think the comparison is useful. Cars and their (horrible) rate of serious injury and death seem to be the worst thing that people readily accept. Showing that covid-19 can be worse than that can be enlightening. And it obviously becomes exponentially worse if the hospital system overloads.

Wouldn’t the number of people the virus will kill will reach a maximum and then decline rapidly as the remaining population will be immune to it?

Yes, but not so soon: at the moment in most of the places it grows exponentially, the numbers doubling every three to four days.

So "and will probably get there in another week or so" is probably too slow. If it's really 2000 deaths per day now, I can safely estimate 4000 deaths per day in just three to four days. Then in next 4 days it will be 8000. Save this estimate and compare.

In order for the effect you describe to happen (the maximum to be reached) the most popular estimate is that the number of infected has to reach around 70% of the population. Until that point the doubling of deaths every few days, without the measures to prevent that, would continue, deaths happening in always bigger amounts, but concentrated in the few weeks.


The maximum, absent strong measures, will be immense due to the fact that some significant percentage of patients require intensive care/ventilation for weeks.

Imagine 5% of the world’s population requiring hospitalization all at roughly the same time. We don’t have 350,000,000 ventilators and hospital beds and health care professionals to take care of them, so the death toll and general suffering would be unimaginable.


Yes, but this statement is trivially true for any exponential spread constrained by a maximum population - even if the virus kills everybody.

Not all diseases cause reliable immunity.

13 people died just yesterday in one hospital in NYC.

https://www.nytimes.com/2020/03/25/nyregion/nyc-coronavirus-...

You want a lockdown before your city turns into a medical disaster zone. Celebrate the fact that it's being done early.




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