My stab at your query after 35 years of hospital practice: 1) Restricting visitors would increase mortality substantially because the most powerful brake on medical malpractice is the threat of lawsuits by family members against doctors and hospitals who treated the deceased. The visitor is the patient's most crucial witness and advocate in the course of any hospital episode. 2) Masks might marginally worsen mortality because they (like flu shots) have no effect on nosocomial viral transmission. They are a physical encumbrance, a distracting and time consuming ritual, and an impediment to communication between all participants in patient care. 3)Authorizing physician trainees to function without senior supervision would clearly kill many patients. Seasoned attendings while not infallible are certainly more experienced and skilled, and are more conscious of the professional liability risks inherent in their responsible position. 4) Double the case load = double the fatigue, stress, inattention and mistakes. It's beyond obvious to me that lockdown killed many people, especially in acute and chronic care facility settings.
Mortality would go up. Skewing the inpt population to older-sicker, inexperienced decision makers=more errors, and disallowing pt advocates(visitors)=more errors.
In the second scenario, the huge increase of patients incoming from nursing homes would be enough to significantly increase hospital mortality. Many people would be dying, not at the home or in a hospice, but at a hospital.
Also, I have to think that disallowing visitors means patients die faster, rather than lingering in a twilight state for potentially weeks.
People needing available treatments potentially not receiving them because they're isolated with zero advocates speaking on their behalf. DPA ventilators 1 wrench to cure them all... oops.
Influenza did not disappear. We were experiencing one of the worst flu seasons heading into the "pandemic."
..is it possible something we resurrected/created/spliced together got loose somehow and they're cleaning it up running cover in other "novel" ways? I have no idea, i know what they're telling us is bullshit.
increase % of very sick people in hospitals. Increase stress on said people and workers.
Decrease medical staff able / willing to work.
Likely some additional care mistakes but consequences may be limited due to short duration.
Decrease non emergency procedures / fewer "less" sick people.
Fewer people there from accidents.
At 2 weeks likely not have too many that pushed off going to hospital when they should have.
In patient mortality % would go up but raw numbers go down. The longer the duration, the worse it would get due to societal unrest and shutdown of support mechanisms.
I’ll add a funky twist to your scenario and up the theory of question.
Let’s say all virus never existed, only bacteria that pollutes one’s immune system so the need of antibiotics remains the same for population. But for whatever weird reason in 2018-19 it goes up but we won’t get into that. But let’s add all your new protocols and let’s add completely withholding OTHER medical interventions that’s extremely easy to tackle when applying right but extremely deadly if not. Let’s add withholding ABT for this new protocol and let admit this is a real bummer now because for whatever reason there’s an increase bacteria infection cases, much more than previous years. What do you think the end results would be when all that’s added?
Interesting post thanks, I work in the medical field, I think we are seeing this again, with the shotz, from anecdotal evidence, 'carers' feel betrayed for following the narrative, they’re afraid for their careers and also are scared to death that their bodies are ticking time bombs. It’s easier to ignore than to acknowledge. Morale is VERY low, how does this effect the standard of care?
Surely there is an example somewhere from history where scenario 1 happened. Like WWII London or Berlin prepping for air raids or Shanghai 2022 during full lockdowns. Or Israel during 6 Day War. Or American South during Civil War (New Orleans? Atlanta?).
If you restrict it to large metropolises, maybe not 8 million people but at least a couple million, there's St. Petersburg and Moscow early in the Nazi invasion, when the Germans were getting close to those cities.
But if you limit it to a suddenly developing enemy scare hitting a large 2+ million metropolis, maybe there isn't a precedent.
In terms of how things felt, the emotion of the situation, I think the only parallel we've gone through was the 4 days or so after the 9/11 attacks.
There is a flaw in my original suggestion, too, I think. Life expectancy has gone up significantly since many of those historic events. And it is possible that, prior to Covid, had gone up "too high." A sudden change in health care for millions of people would have leveled those who were frail and considered dry tinder or those entirely propped up by medical interventions. And 100 years ago maybe none of those dry tinder would have been alive anyway. So a sudden change to health care 100 years ago would have less of an effect on mortality.
I was going to suggest something like that, along the lines of, “did we have this many people in care homes and dependent on the healthcare system decades ago?”
When people remove a virus from the equation and think about the potential impact on mortality of even modest policy changes, let alone significant ones, maybe they will understand how insanely implausible NYC and Lombardy really are.
As I argued in an early Medium post (before being de-platformed with like 9 readers for writing a personal account of my decision not to inject unproven, and unneeded, medical tech into my body) - all now available on Substack - 2 weeks to slow the spread, if implemented by competent people with the goal of knowledge accumulation, was not unreasonable.
Now, I argued against it from the drop because it was never about knowledge and these aren't competent people, but if you wanted 2 weeks to do a ton of sample testing, understand actual infection spread (antibody tests) and true IFR, define risk profiles, assess corresponding risks (age, co-morbidities, etc...) in order to provide the best guidance possible (GUIDANCE ONLY), I could listen to a rational argument. you can't close churches but ensure liquor and cigarette sales continue, but if you wanted to close schools and reduce hospital load and ask people not to travel or congregate unless absolutely necessary while the testing was completed, I could have heard you out. And it's very likely all-cause mortality wouldn't have changed at all. Humans can handle two weeks of pretty much anything, as long as it's communicated rationally and approached rationally.
The harm done by our "two weeks" (now more than 1,000 days) was that it was implemented specifically with panic, and panic, in any and all forms, will always increase all-cause mortality because, with a population north of 330M, there will always be literally tens, if not hundreds of thousands of people a strong breeze away from death. That's just the cold hard reality of the situation. So I don't think the thought experiment can stop at what was implemented, it's the how that matters more than anything when you're talking about such a small and finite window. At least, that's my take on the situation...
I think my answer would be the same as MDskeptic below... any restrictions on visitors to hospitals and/or the definition of "emergency" would cause an all-cause increase.
The magnitude of this is very hard to determine because these trends are less consistent than we pretend. If it was spring/fall and two weeks of restrictions were placed in a VERY healthy year like 2019, you'd see increases, for sure, but they may be small enough to be immaterial. If it was a year with tons of dry kindling (like 2020), where, for some reason, many people that would have died normally didn't die in the previous two respiratory viral cycles, it would likely be much higher. Add panic on top of it and we're talking about a very material change (just as we saw).
Any panic, for any period of time, and any restrictions on hospital/nursing home admittance, where time with family/loved ones is one of the dominant determining factors in life expectancy, is likely to cause an increase of very varying (from statistically irrelevant to very statistically relevant) degrees.
We have something of a natural experiment in this regard in the US in 2020, when there were no vaccines administered, at least 42% of excess deaths were *not* due to Covid. Please see my article at Brownstone Institute at
In short, the damage is massive. And that's only the "instantaneous" effect. Tr.auma causes long-lasting problems.
To your problem using the numbers in my article for a SWAG: the 2020 lockdown deaths at ~200k were 0.000606061 of a US population of ~330m in 2020. Dividing this by 12 to get a monthly population rate gives 0.000050505 or 0.0050505% which would produce 404 deaths in a city of 8 million. Using US average deaths per 1m per year and dividing by 12 (10270/12*8 = 6847) yields an excess count of 404/6847 = 5.9%. Again, this is only the "instantaneous" effect.
For comparison, NYC say 433 homicides in 2022. So the estimate is in the range of numbers of concern, even though a small percentage of the population.
We have real world evidence of this. Look at Hawaii (lowest excess in the USA, one of strictest lockdowns) or New Zealand (NEGATIVE excess in 2020 when under one of the strictest lockdowns in the world. At one point you could be arrested for returning a ball that fell into your yard from the neighbor. Their mortality went DOWN during this year.)
Lockdowns alone don't cause mortality (they actually would decrease it in most scenarios.) You need something else to create excess deaths. Like...a raging pandemic maybe?
I’m actually confused about the scenarios. If there is no pathogen to restrict caregivers from coming in and caring for the vulnerable, that component of all cause mortality would not change. Also increasing the influx from nursing homes without a cause seems strange? Either way they come in as needed no? I could take your allowing resident doctors to make decisions as a counter to top down maltreatment protocols, though that may require a virus.
First I’m taking as a city-wide change, the second city is normal, but hospitals only.
#1 if indeed short term — 4 weeks, would expect all cause to short term go down due to lack of activity, fewer accidents. This is in the young predominantly. It would go up in older… fewer check-ins on less mobile. Without a virus and corresponding maltreatment recommendations might be a wash in terms of overall all cause, maybe lower in young cancelling higher in old. Without travel restrictions I would expect most to just leave actually. Maybe more mortality from old, immobile as people escape.
#2 Outside world as normal, hospitals change. You lose the visitors counter to bad medical decisions. You gain ability of staff and residents to counter bad medical decisions. You risk inexperience countering good nonintuitive medical decisions from people who know the patient. No idea how the scales of each compare…
Sure, but I think one needs the excuse of the virus to do most of the damage. To get care givers to be sufficiently afraid of being in public or of giving something to their charges to stay home instead of keep the elderly alive. Yes you don’t need the virus itself to do it but I think you need the virus narrative as a powerful excuse…
I think what John Beaudoin has found in MA death certificates is important. Maltreatment as an amplifier of preexisting/circulating respiratory disease, that lockdowns left many elderly to die — if people of a certain age are not helped to get up and moving regularly they develop life threatening pneumonia. Add to that the apparent recommendation to no longer prescribe antibiotics that Jikky has been pointing out. And then there could have been an actual bioweapon infectious clone release to seed the whole mess. NY would be a prime target for such a thing. If anything the natural spread of some former bat virus is the hardest scenario to make fit
If NYC per se was a target for a bio weapon, we would have to explain when the weapon was released and why it waited for Andrew Cuomo to give a stay-home order to create excess death
Bomb scenario 1 - My knee jerk response is ‘decrease’. Less activity = less death, right? But my practical experiences have shown that people die at home. Far fewer seem to die at work or moving about on an average day. There seems to be some sort of ‘sundowners’ effect of being home.
Your second scenario is harder for me to puzzle out but this is what I came to.
Mortality would go up. Only the truly sick would visit hospitals, therefore more would die simply because they are the ones that die.
My stab at your query after 35 years of hospital practice: 1) Restricting visitors would increase mortality substantially because the most powerful brake on medical malpractice is the threat of lawsuits by family members against doctors and hospitals who treated the deceased. The visitor is the patient's most crucial witness and advocate in the course of any hospital episode. 2) Masks might marginally worsen mortality because they (like flu shots) have no effect on nosocomial viral transmission. They are a physical encumbrance, a distracting and time consuming ritual, and an impediment to communication between all participants in patient care. 3)Authorizing physician trainees to function without senior supervision would clearly kill many patients. Seasoned attendings while not infallible are certainly more experienced and skilled, and are more conscious of the professional liability risks inherent in their responsible position. 4) Double the case load = double the fatigue, stress, inattention and mistakes. It's beyond obvious to me that lockdown killed many people, especially in acute and chronic care facility settings.
Mortality would go up. Skewing the inpt population to older-sicker, inexperienced decision makers=more errors, and disallowing pt advocates(visitors)=more errors.
In the second scenario, the huge increase of patients incoming from nursing homes would be enough to significantly increase hospital mortality. Many people would be dying, not at the home or in a hospice, but at a hospital.
Also, I have to think that disallowing visitors means patients die faster, rather than lingering in a twilight state for potentially weeks.
Exactly right
People needing available treatments potentially not receiving them because they're isolated with zero advocates speaking on their behalf. DPA ventilators 1 wrench to cure them all... oops.
Influenza did not disappear. We were experiencing one of the worst flu seasons heading into the "pandemic."
sidenote: "The decision to reconstruct the deadliest pandemic flu virus of the 20th century was made with considerable care and attention to safety." https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html
..is it possible something we resurrected/created/spliced together got loose somehow and they're cleaning it up running cover in other "novel" ways? I have no idea, i know what they're telling us is bullshit.
Would likely:
increase % of very sick people in hospitals. Increase stress on said people and workers.
Decrease medical staff able / willing to work.
Likely some additional care mistakes but consequences may be limited due to short duration.
Decrease non emergency procedures / fewer "less" sick people.
Fewer people there from accidents.
At 2 weeks likely not have too many that pushed off going to hospital when they should have.
In patient mortality % would go up but raw numbers go down. The longer the duration, the worse it would get due to societal unrest and shutdown of support mechanisms.
I’ll add a funky twist to your scenario and up the theory of question.
Let’s say all virus never existed, only bacteria that pollutes one’s immune system so the need of antibiotics remains the same for population. But for whatever weird reason in 2018-19 it goes up but we won’t get into that. But let’s add all your new protocols and let’s add completely withholding OTHER medical interventions that’s extremely easy to tackle when applying right but extremely deadly if not. Let’s add withholding ABT for this new protocol and let admit this is a real bummer now because for whatever reason there’s an increase bacteria infection cases, much more than previous years. What do you think the end results would be when all that’s added?
Interesting post thanks, I work in the medical field, I think we are seeing this again, with the shotz, from anecdotal evidence, 'carers' feel betrayed for following the narrative, they’re afraid for their careers and also are scared to death that their bodies are ticking time bombs. It’s easier to ignore than to acknowledge. Morale is VERY low, how does this effect the standard of care?
Surely there is an example somewhere from history where scenario 1 happened. Like WWII London or Berlin prepping for air raids or Shanghai 2022 during full lockdowns. Or Israel during 6 Day War. Or American South during Civil War (New Orleans? Atlanta?).
If you restrict it to large metropolises, maybe not 8 million people but at least a couple million, there's St. Petersburg and Moscow early in the Nazi invasion, when the Germans were getting close to those cities.
But if you limit it to a suddenly developing enemy scare hitting a large 2+ million metropolis, maybe there isn't a precedent.
In terms of how things felt, the emotion of the situation, I think the only parallel we've gone through was the 4 days or so after the 9/11 attacks.
There is a flaw in my original suggestion, too, I think. Life expectancy has gone up significantly since many of those historic events. And it is possible that, prior to Covid, had gone up "too high." A sudden change in health care for millions of people would have leveled those who were frail and considered dry tinder or those entirely propped up by medical interventions. And 100 years ago maybe none of those dry tinder would have been alive anyway. So a sudden change to health care 100 years ago would have less of an effect on mortality.
I was going to suggest something like that, along the lines of, “did we have this many people in care homes and dependent on the healthcare system decades ago?”
Yes, age adjusted mortality has been going down considerably for decades https://georgiedonny.substack.com/p/deaths-england-and-wales-2020-2022
Jo
🐒
Your non-Shanghai examples...where people were ordered to stay home and away from all those places for 4 weeks? Maybe.
Echoes of the point I made here:
https://pandauncut.substack.com/p/were-the-unprecedented-excess-deaths?sd=pf
Yes, indeed! We are on the same train.
When people remove a virus from the equation and think about the potential impact on mortality of even modest policy changes, let alone significant ones, maybe they will understand how insanely implausible NYC and Lombardy really are.
Both are exceptions that prove the rule, sadly.
As I argued in an early Medium post (before being de-platformed with like 9 readers for writing a personal account of my decision not to inject unproven, and unneeded, medical tech into my body) - all now available on Substack - 2 weeks to slow the spread, if implemented by competent people with the goal of knowledge accumulation, was not unreasonable.
Now, I argued against it from the drop because it was never about knowledge and these aren't competent people, but if you wanted 2 weeks to do a ton of sample testing, understand actual infection spread (antibody tests) and true IFR, define risk profiles, assess corresponding risks (age, co-morbidities, etc...) in order to provide the best guidance possible (GUIDANCE ONLY), I could listen to a rational argument. you can't close churches but ensure liquor and cigarette sales continue, but if you wanted to close schools and reduce hospital load and ask people not to travel or congregate unless absolutely necessary while the testing was completed, I could have heard you out. And it's very likely all-cause mortality wouldn't have changed at all. Humans can handle two weeks of pretty much anything, as long as it's communicated rationally and approached rationally.
The harm done by our "two weeks" (now more than 1,000 days) was that it was implemented specifically with panic, and panic, in any and all forms, will always increase all-cause mortality because, with a population north of 330M, there will always be literally tens, if not hundreds of thousands of people a strong breeze away from death. That's just the cold hard reality of the situation. So I don't think the thought experiment can stop at what was implemented, it's the how that matters more than anything when you're talking about such a small and finite window. At least, that's my take on the situation...
Limit it to two weeks.
Would mortality rise under the conditions in my scenarios?
I think my answer would be the same as MDskeptic below... any restrictions on visitors to hospitals and/or the definition of "emergency" would cause an all-cause increase.
The magnitude of this is very hard to determine because these trends are less consistent than we pretend. If it was spring/fall and two weeks of restrictions were placed in a VERY healthy year like 2019, you'd see increases, for sure, but they may be small enough to be immaterial. If it was a year with tons of dry kindling (like 2020), where, for some reason, many people that would have died normally didn't die in the previous two respiratory viral cycles, it would likely be much higher. Add panic on top of it and we're talking about a very material change (just as we saw).
Any panic, for any period of time, and any restrictions on hospital/nursing home admittance, where time with family/loved ones is one of the dominant determining factors in life expectancy, is likely to cause an increase of very varying (from statistically irrelevant to very statistically relevant) degrees.
We have something of a natural experiment in this regard in the US in 2020, when there were no vaccines administered, at least 42% of excess deaths were *not* due to Covid. Please see my article at Brownstone Institute at
https://brownstone.org/articles/lockdowns-deaths-2020-42-percent-excess-deaths/
for background.
In short, the damage is massive. And that's only the "instantaneous" effect. Tr.auma causes long-lasting problems.
To your problem using the numbers in my article for a SWAG: the 2020 lockdown deaths at ~200k were 0.000606061 of a US population of ~330m in 2020. Dividing this by 12 to get a monthly population rate gives 0.000050505 or 0.0050505% which would produce 404 deaths in a city of 8 million. Using US average deaths per 1m per year and dividing by 12 (10270/12*8 = 6847) yields an excess count of 404/6847 = 5.9%. Again, this is only the "instantaneous" effect.
For comparison, NYC say 433 homicides in 2022. So the estimate is in the range of numbers of concern, even though a small percentage of the population.
We have real world evidence of this. Look at Hawaii (lowest excess in the USA, one of strictest lockdowns) or New Zealand (NEGATIVE excess in 2020 when under one of the strictest lockdowns in the world. At one point you could be arrested for returning a ball that fell into your yard from the neighbor. Their mortality went DOWN during this year.)
Lockdowns alone don't cause mortality (they actually would decrease it in most scenarios.) You need something else to create excess deaths. Like...a raging pandemic maybe?
What do you mean by “lockdown”?
I gave very specific measures in my scenarios and posed a question about whether those things would themselves increase mortality.
Are you saying no?
I’m actually confused about the scenarios. If there is no pathogen to restrict caregivers from coming in and caring for the vulnerable, that component of all cause mortality would not change. Also increasing the influx from nursing homes without a cause seems strange? Either way they come in as needed no? I could take your allowing resident doctors to make decisions as a counter to top down maltreatment protocols, though that may require a virus.
First I’m taking as a city-wide change, the second city is normal, but hospitals only.
#1 if indeed short term — 4 weeks, would expect all cause to short term go down due to lack of activity, fewer accidents. This is in the young predominantly. It would go up in older… fewer check-ins on less mobile. Without a virus and corresponding maltreatment recommendations might be a wash in terms of overall all cause, maybe lower in young cancelling higher in old. Without travel restrictions I would expect most to just leave actually. Maybe more mortality from old, immobile as people escape.
#2 Outside world as normal, hospitals change. You lose the visitors counter to bad medical decisions. You gain ability of staff and residents to counter bad medical decisions. You risk inexperience countering good nonintuitive medical decisions from people who know the patient. No idea how the scales of each compare…
I admit it's contrived, but I'm sure you get the point.
reality was worse, and not because of the virus itself. https://web.archive.org/web/20200324104921/https://www.governor.ny.gov/news/no-20210-continuing-temporary-suspension-and-modification-laws-relating-disaster-emergency
Sure, but I think one needs the excuse of the virus to do most of the damage. To get care givers to be sufficiently afraid of being in public or of giving something to their charges to stay home instead of keep the elderly alive. Yes you don’t need the virus itself to do it but I think you need the virus narrative as a powerful excuse…
Yes, we are on the same wavelength there.
My point is to get people to consider what even the things I listed would do to mortality, even were there no virus the mix
Remember, NYC hospitals experienced a massive 15K+ increase in inpatient deaths in a 12-week, over 100% of which have covid on the DC.
I’m sure you understand what they’re trying to imply, and how insane that is.
They think we’re stupid, and threw a bone with “Cuomo’s nursing home order was bad,” but that is a distraction from where the chief problem lay.
I think what John Beaudoin has found in MA death certificates is important. Maltreatment as an amplifier of preexisting/circulating respiratory disease, that lockdowns left many elderly to die — if people of a certain age are not helped to get up and moving regularly they develop life threatening pneumonia. Add to that the apparent recommendation to no longer prescribe antibiotics that Jikky has been pointing out. And then there could have been an actual bioweapon infectious clone release to seed the whole mess. NY would be a prime target for such a thing. If anything the natural spread of some former bat virus is the hardest scenario to make fit
If NYC per se was a target for a bio weapon, we would have to explain when the weapon was released and why it waited for Andrew Cuomo to give a stay-home order to create excess death
Otherwise I agree
Bomb scenario 1 - My knee jerk response is ‘decrease’. Less activity = less death, right? But my practical experiences have shown that people die at home. Far fewer seem to die at work or moving about on an average day. There seems to be some sort of ‘sundowners’ effect of being home.
Your second scenario is harder for me to puzzle out but this is what I came to.
Mortality would go up. Only the truly sick would visit hospitals, therefore more would die simply because they are the ones that die.
Keep the ‘well’ away and what are you left with?
Would only the very sick, on-the-edge of life people going to hospitals impact the perception of the staff in any way?
Definitely. “Everyone is sick”. This can be looked at as “everyone has Covid”. Well duh, you told everyone else to stay away.
We should be just as shocked at the remarkable stat that most women in the OB ward are pregnant. In other words, we shouldn’t.
Now tell the hospital staff that every person who is transferred in from a nursing home might have covid and/or has tested positive for covid.
Then tell them that those people should be on a ventilator.