Policy for pandemic issues and how models shape it

[jim mcnamara]

TL;DR

Discusses the use of modeling, mostly for the Dutch decision makers, to determine Covid 19 control policy

https://www.sciencemag.org/news/202...ase-models-shape-national-shutdowns-and-other

This shows how policy can be informed about differing effects of control policies in different environments.

One of the bleak aspects of UK choices is shown as a graph. From the article:

One aspect which stands out is the longterm recurrence from residual infections, which is the result of periodic loosening and then tightening restrictions to limit the "size" of the surge of ICU patients.

 

[pinball1970]

Summary:: Discusses the use of modeling, mostly for the Dutch decision makers, to determine Covid 19 control policy

https://www.sciencemag.org/news/202...ase-models-shape-national-shutdowns-and-other

This shows how policy can be informed about differing effects of control policies in different environments.

One of the bleak aspects of UK choices is shown as a graph. From the article:

View attachment 259669
One aspect which stands out is the longterm recurrence from residual infections, which is the result of periodic loosening and then tightening restrictions to limit the "size" of the surge of ICU patients.

Huge push in the UK to make more ICU beds and ventilators available.
Formula one teams were mentioned in the news today supposedly assisting with new technologies.
The Imperial publication on worse case scenario was not pleasant reading.
81% infection with half a million deaths in the UK.

 

[Vanadium 50]

Point one: it doesn't seem to me that decision-makers are poring over these models. It seems to me that their guiding principle is Something Must Be Done.

Point two: these models are a little like the Drake Equation. Absolutely correct, given that we know the input parameters, which we don't.

2a: It is relatively easy to determine if someone died with coronavirus. It is difficult to determine if someone died from coronavirus. This is particularly troublesome in this case, where most of the deaths occur in patients with (multiple, usually) underlying conditions.

2b. The fatality rate varies by an order of magnitude or more even between countries at similar stages in the epidemiology. Independent of explanation, this is something which makes drawing conclusions from models difficult.

It is almost certain that the estimates of prevalence of infection are lower bounds and the estimates of case fatality rates are upper bounds. It's difficult to err in the other direction. That would suggest there is an element of closing the barn door after the horse has run off about current activities, and that it might be more effective to increase isolation of the most vulnerable. (My personal hobby horse is having free grocery delivery for the elderly, but apparently that's just crazy talk)

 

[pinball1970]

Point one: it doesn't seem to me that decision-makers are poring over these models. It seems to me that their guiding principle is Something Must Be Done.

Point two: these models are a little like the Drake Equation. Absolutely correct, given that we know the input parameters, which we don't.

2a: It is relatively easy to determine if someone died with coronavirus. It is difficult to determine if someone died from coronavirus. This is particularly troublesome in this case, where most of the deaths occur in patients with (multiple, usually) underlying conditions.

2b. The fatality rate varies by an order of magnitude or more even between countries at similar stages in the epidemiology. Independent of explanation, this is something which makes drawing conclusions from models difficult.

It is almost certain that the estimates of prevalence of infection are lower bounds and the estimates of case fatality rates are upper bounds. It's difficult to err in the other direction. That would suggest there is an element of closing the barn door after the horse has run off about current activities, and that it might be more effective to increase isolation of the most vulnerable. (My personal hobby horse is having free grocery delivery for the elderly, but apparently that's just crazy talk)

The commons science select committee met with with Professor Ferguson (via Skype) a few days after the publication. They hardly showed anything of the dialogue but what I did get from the meet was that the select committee was trying to ask if the government was taking adequate measures. Ferguson said policy was not his business that was up to the policy makers.
The press conferences have been quite good in terms of trying to explain what the numbers mean.

 

[jim mcnamara]

@Vanadium 50 - you are spot on.

Those comments are correct, and will likely always be true about pandemics and models without surveillance: late to the show, poor data collection. Then, when things are ramping up to bad, the modelers are able tune in usefully. And late, of course. Some of the time drag is politically motivated foot dragging and denial.

Timely and correct disease surveillance has to work. Or this current Covid 19 mess will happen over and over from different pathogens. We got somewhat lucky with Ebola, MERS, and SARS. Not so Covid 19.
What is required:
"Forecasting Disease Risk for Increased Epidemic Preparedness in Public Health"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196833/

 

[Ygggdrasil]

2a: It is relatively easy to determine if someone died with coronavirus. It is difficult to determine if someone died from coronavirus. This is particularly troublesome in this case, where most of the deaths occur in patients with (multiple, usually) underlying conditions.

It is likely most of the deaths of people with Coronavirus is largely due to Coronavirus infection. For example, the life expectancy for an 80-89 year olds in China is 6.58 years. Median time to death for fatal COVID-19 patients was observed to be about 20 days from the onset of symptoms, and for people over 80, the mortality rate was 14.8% in studies of the Chinese outbreak. I don't think 14.8% of all people >80 years of age are going to drop dead in the next three weeks. (There are 23 million 80+ year olds in China, so this would correspond to 3.4 million deaths over three weeks. You would only expect to see 0.56 million total deaths of all ages in China over three weeks.) Modeling survival as an exponential decay with a half-life of 6.58 years, we would only expect to see about 0.61% mortality among octogenerians over a three week span (even if you double the period to six weeks as 20 days is only the median time to death, you still only expect 1.2% of octogenerians to die of natural causes in that time span). Thus, COVID-19 may increase mortality among octogenerians by over an order of magnitude.

Does the 14.8% represent the proportion of the >80 year-olds that are worse off in health? The study of life expectancy among the elderly in China found that ~ 11.8% of octogenerians were disabled (they require assistance in the essential activities of daily living like bathing, dressing, eating, or going to the bathroom). Among disabled octogenerians, life expectancy is only 1.1 year. Still, you would only expect to see 3.6% of that population die over the course of three weeks, nowhere near the 14.8% mortality seem among all infected 80+ year olds (regardless of whether they have additional health problems). Even the 70-79 age group (mortality rate of 8%) has twice the expected death rate of disabled octogenerians.

The health conditions that pre-dispose COVID-19 patients to greater mortality do not come close to explaining the observed mortality of the disease.

(This text is largely copied from my previous post here.)

 

[BillTre]

(My personal hobby horse is having free grocery delivery for the elderly, but apparently that's just crazy talk)

Act locally.
You can deliver groceries for the elderly you know that live near you.

We got somewhat lucky with Ebola, MERS, and SARS. Not so Covid 19.

Bad luck, Strongly Aided by Extremely Poor Management Decisions (which have not yet entirely stopped).

 

[russ_watters]

Summary:: Discusses the use of modeling, mostly for the Dutch decision makers, to determine Covid 19 control policy

https://www.sciencemag.org/news/202...ase-models-shape-national-shutdowns-and-other

This shows how policy can be informed about differing effects of control policies in different environments.

One of the bleak aspects of UK choices is shown as a graph. From the article:

View attachment 259669
One aspect which stands out is the longterm recurrence from residual infections, which is the result of periodic loosening and then tightening restrictions to limit the "size" of the surge of ICU patients.

This graph and policy framework is indeed bleak, as it assumes that the Dutch will never successfully contain the virus. Maybe they won't, but IMO every country should be attempting to set up a framework for a future, after the first peak, where they can. This is - assuming one believes it - the current state of the virus control efforts in China. And South Korea never lost containment (only country I'm aware of with significant cases and no loss of containment). IMO, we should be learning from them and determining if what was done there can be repeated in the West or if Western law/political philosophy forbids it.

Also, IMO, if that's what is required for control, then we should abandon restrictive control policy after the first peak. The economies of most countries could not survive being partly shut down 80% of the time for the next 18 months.

 

[russ_watters]

The commons science select committee met with with Professor Ferguson (via Skype) a few days after the publication. They hardly showed anything of the dialogue but what I did get from the meet was that the select committee was trying to ask if the government was taking adequate measures. Ferguson said policy was not his business that was up to the policy makers.

That annoys me.
Scientists: "Politicians never listen to us."
Also Scientists: "Forming policy isn't my job."

This pandemic is multiple containment strategy experiments being performed in the real-world on people who didn't sign up for it. Nobody likes it. Nobody wants to be involved. But we all are, and we don't have a choice to opt-out. Scientists need to be all-in in the game, playing the role they are trained to play; they can't sit on the sidelines and complain that the game isn't going well or that they aren't really players/coaches.

 

[pinball1970]

That annoys me.
Scientists: "Politicians never listen to us."
Also Scientists: "Forming policy isn't my job."

This pandemic is multiple containment strategy experiments being performed in the real-world on people who didn't sign up for it. Nobody likes it. Nobody wants to be involved. But we all are, and we don't have a choice to opt-out. Scientists need to be all-in in the game, playing the role they are trained to play; they can't sit on the sidelines and complain that the game isn't going well or that they aren't really players/coaches.

The select committee read the studies then talk to Imperial then forward this to the government.
I don't know the process but Boris is very smart. He went to Baliol.

 

[jim mcnamara]

@russ_watters
Actually I was more the messenger. V50, pinball, and yourself have kind of run with it. FWIW the graph I posted is for the UK. Not the Dutch model. It still is awful IMO. Bleak best describes it. The economy may survive in tatters, but people will be very unhappy and take it out on decision makers.

I did not post anything from another paper with a very dire model for the US:
no intervention no containment and no social isolation - 5.8 million - 10.2 million deaths by August 2020.
It no longer pertains. Thank heavens. <edit 19:56 MDT, typo>

That would completely cripple any country for years. Not to mention the economy. That model got leadership's attention, I would guess.

V50 is correct. Epidemiology has been mostly an 'a posteriori' science. We analyze what happened after some of it has already transpired. And. Data is not really forthcoming exactly for the reasons you mention. Primary reason: Policy makers may stave off or minimize scope of illness for people out there to placate those who might otherwise object to containment efforts. Decision makers may simply fail to get it as well. See Brazil. And then hope things work out.

And we cannot blame decision makers exclusively because no matter what they do or do not do some substantial portion of the population will react negatively.

With different approaches. leadership styles, and healthcare infrastructure

Some countries:
  failed miserably early on then got with the program late - Italy
  really got things under control from the getgo - South Korea.  
  came down somewhere in the middle between the two extremes - US
Where failure is measured in percent deaths.

And. With some few governments it is hard to tell precisely what the heck happened - China. It appears they took a draconian approach - for me anyway. And there may have been greater mortality than reported.
I do not know. Which is probably their main goal - obfuscation. 1918 pandemic saw the same kinds of under-reported mortality, apparently, when it was extant. For example see:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634693/

 

[jack action]

you still only expect 1.2% of octogenerians to die of natural causes in that time span

What is a natural cause of death of old people? Old people die because their body weakens. The process doesn't happen overnight. A one point something gives.

When a normal 20-, 30- or 40-year-old can fight a virus, bacteria or another type of pathogen and that a weaken body can't, I have difficulty saying the pathogen is responsible; Pointing to the weaker immune system seems to be more appropriate.

It is likely most of the deaths of people with Coronavirus is largely due to Coronavirus infection. For example, the life expectancy for an 80-89 year olds in China is 6.58 years. Median time to death for fatal COVID-19 patients was observed to be about 20 days from the onset of symptoms, and for people over 80, the mortality rate was 14.8% in studies of the Chinese outbreak. I don't think 14.8% of all people >80 years of age are going to drop dead in the next three weeks. (There are 23 million 80+ year olds in China, so this would correspond to 3.4 million deaths over three weeks. You would only expect to see 0.56 million total deaths of all ages in China over three weeks.)

But that also means that all octogenerians who could die represents the equivalent amount of less deaths in the next 6-7 years in China, with little to no impact on society. It will certainly have no impact on population growth.

The study of life expectancy among the elderly in China found that ~ 11.8% of octogenerians were disabled (they require assistance in the essential activities of daily living like bathing, dressing, eating, or going to the bathroom). Among disabled octogenerians, life expectancy is only 1.1 year.

That makes it even worse. 11.8% is pretty close to 14.8%. Let's assume that the former is entirely part of the latter. Now, we have people that have lived a full life, that cannot continue to do so for all sorts of reasons, and that are expected to die in the next year. Them dying will not even makes a difference in the yearly death rate. Can someone remind why we are not sending children to school?

I'm not saying that we shouldn't care for the weaker members of our society. But I think isolating them is a lot smarter than isolating the rest of the community - that can easily handle the pathogen - essentially putting living on hold. We can isolate them for as long as it is necessary, but how long can the majority stop living? And does isolating everyone will make that much of a difference on the death toll in the long run or just spread it over time?

And why are we hearing about all of these pessimistic models about death toll and we have none about the impacts on the economy or the mental health of the population? It is difficult to make an informed decision when we are not told on the price to pay from all sides.

Below is an image that goes around on Facebook and is meant to convince people to stay home:

The text reads: «15 days at home was too long! Now I have all the time in the world.»

This represents well the feeling of people around me: If you get COVID-19, you die. That is madness. Most people won't die of COVID-19. Many will not even know they have it. The measures taken right now do not represent that fact.

All of these pessimistic models about death tolls - mostly based on unknown inputs - are not scientific facts, just mere observations to develop future scientific models. I really hope the masses won't realize they were not given scientific facts after the crisis, because we all know it will be another argument for the flat-Earthers.

 

[Ygggdrasil]

What is a natural cause of death of old people? Old people die because their body weakens. The process doesn't happen overnight. A one point something gives.

When a normal 20-, 30- or 40-year-old can fight a virus, bacteria or another type of pathogen and that a weaken body can't, I have difficulty saying the pathogen is responsible; Pointing to the weaker immune system seems to be more appropriate.

The expected mortality rate in octogenerians in the absence of the disease is more than ten time lower than the mortality rate of octogenerians infected with the disease.

But that also means that all octogenerians who could die represents the equivalent amount of less deaths in the next 6-7 years in China, with little to no impact on society. It will certainly have no impact on population growth.

The value of the lives of octogenerians versus the health of the economy is a value judgement that is outside of the scope of scientific discussion. However, based on reactions to the Lt. Governor of Texas's suggestion that the elderly to sacrifice themselves for the good of the economy, many would disagree with you.

That makes it even worse. 11.8% is pretty close to 14.8%. Let's assume that the former is entirely part of the latter. Now, we have people that have lived a full life, that cannot continue to do so for all sorts of reasons, and that are expected to die in the next year. Them dying will not even makes a difference in the yearly death rate.

There is no evidence that the octogenerians that are infected are solely those with comorbidities. In a study of 1590 cases in China, 30% of deaths occurred in people with no comorbidities.

I'm not saying that we shouldn't care for the weaker members of our society. But I think isolating them is far more smarter than isolating the rest of the community - that can easily handle the pathogen - essentially putting living on hold. We can isolate them for as long as it is necessary, but how long can the majority stop living? And does isolating everyone will make that much of a difference on the death toll in the long run or just spread it over time?

Researchers at the MRC Centre for Global Infectious Disease Analysis (who produced the analysis leading to image in the OP) produced a report looking at this scenario:

Without social distancing of the whole population, they found, even the best mitigation strategy—which means isolation or quarantine of the sick, the old, and those who have been exposed, plus school closures—would still lead to a surge of critically ill people eight times bigger than the US or UK system can cope with. (That’s the lowest, blue curve in the graph below; the flat red line is the current number of ICU beds.)

https://www.technologyreview.com/s/615370/coronavirus-pandemic-social-distancing-18-months/

There is evidence that when hospitals are overwhelmed, mortality rates from the disease can increase by a factor of ten. Furthermore, when hospitals are overwhelmed, they lack capacity to treat other emergencies (heart attacks, car accidents, appendicitis), so mortality from all causes would be expected to increase under such a scenario as well.

 

[jack action]

That is another thing when we are presented with the capacity of the health care system.

From the beginning of this crisis, we've been told that we are at war. I can agree with that. But we are also told that the best thing we can do is to sit at home and do nothing. That is the weirdest statement I ever heard about a war strategy.

In WWII, when they said we were at war, companies were forced to halt production and work for armament. All men were on the front and no one left to work on the production lines? We got the women out of their kitchen, even if at the time they were not considered as 'good workers'. No war ever had a negative impact on the economy, it is most likely the opposite that happens.

In light of that, I think it would be more logical to isolate the weaks and steer the work force toward increasing the health care system capacity. Build a 1000-bed hospital in 10 days. Stop manufacturing snowmobiles and hammers, and build ventilators and masks. It's a war, it is not a time to sit at home.

 

[Tom.G]

And why are we hearing about all of these pessimistic models about death toll and we have none about the impacts on the economy or the mental health of the population?

Which of those three impacts are reversible?

It seems to come down to what value system is in use.

The current "western," or "advanced," societies put a very high value on life itself.

Before there was "advanced medicine," say 500 or more years ago, death seemed to be just a part of the natural order.

I'm not necessarily disagreeing with you, just trying to inject a wider perspective.

Cheers,
Tom

 

[jim mcnamara]

I'm not going to work this point too hard: transmissivity of a pathogen

@jack action do you understand transmissivity? Covid 19 in the wild has a transmissivity well above 2, circa 2.2 The flu is rated at about 1.1 These numbers are for humans in everyday contact (in the wild). So Covid 19 is a lot more contagious. At least twice as easy for us humans to act a disease vector.

Are we okay with this concept so far?

Humans are the vectors for both diseases. We transmit virus. Period. -- bodily fluids, contaminated surfaces from touch, handshakes, sneezes, contaminated body surfaces, etc.

Suppose you want to slow down the spread of the disease? Stop people from getting sick? Sounds good to me.

Okay? How to do it?

If you keep uninfected people out of contact with infected people you reduce transmissivity. If transmissivity goes below 1.0, the disease stops spreading. Down close to zero and the disease comes to a screeching halt. No new cases. So in 14 days no more deaths.

So what does cooling your heels inside rather than out and about with your buddies accomplish? You tell me what it does to transmissivity when everyone spends lots of time inside.

So, is it a social responsibility?

You have several other bits of less than correct information. Mortality is now showing up across the entire age spectrum. A lot. 42% of new cases in hospital, in New York City, are under the age of 44. (as of two days ago). Many of this younger population have no pre-existing conditions (no comorbidity) . These are ICU patients - already on ventilators, waiting for ventilators, and some lucky few are in rocking beds for severe ARDS. Just to be clear.

Let's stop here. This is likely not helpful to you. Thanks for reading.

 

[Vanadium 50]

@atyy , you tagged my post with "skeptical". What exactly are you skeptical about?

 

[atyy]

@atyy , you tagged my post with "skeptical". What exactly are you skeptical about?

The whole post seems to read as if the uncertainties are so large and that public policy is largely overreacting.

 

[jack action]

Are we okay with this concept so far?

Yes.

Suppose you want to slow down the spread of the disease? Stop people from getting sick?

Okay? How to do it?

Your suggestion sounds good on paper. But this thread is all about how the models you are basing your solution on are full of unknowns and not too reliable. You are talking of 14 days. Sounds easy enough. But where I live , we started already with 3 weeks. After that? Depends, it might be longer. How long? Nobody knows. Cooling your heels inside? Well, when I turn on the news, all I see are terrified people. That is with 31 deaths and 4162 infected (0.05% of the population) where I live. And it's been only 1 week. They're are not only scared of the disease, but of how the price of your solution will affect them in the future.

But the problem that has been put in front of me is not that people are getting sick. They've always been, they always will be. The actual problem is that the current health care system is unable to take all the sick people.

Your solution is all about not getting sick, which I find utopian. It is all about putting life on pause, which I found unrealistic. In real life, Nature develops defense mechanisms to achieve survival. My solution is about increasing the health care system capacity, which do not put life on pause. It actually gives purpose to one's work. It helps people calming down instead of worrying.

I'm not the enemy. I don't wish for people to get sick.

 

[Vanadium 50]

The whole post seems to read as if the uncertainties are so large and that public policy is largely overreacting.

That's two parts. I hold that the uncertainties are large, and as evidence I gave the wide variation in statistics. I never claimed that policy was overreacting. I think I would claim that it is mis-reacting. If someone proposed ahead of time that the plan is to let the infected and uninfected mingle for two weeks and once things are good and spread and the symptoms start appearing, then we lock everything down, I don't think we'd all be cheering this on as a great idea.

 

[atyy]

That's two parts. I hold that the uncertainties are large, and as evidence I gave the wide variation in statistics. I never claimed that policy was overreacting. I think I would claim that it is mis-reacting. If someone proposed ahead of time that the plan is to let the infected and uninfected mingle for two weeks and once things are good and spread and the symptoms start appearing, then we lock everything down, I don't think we'd all be cheering this on as a great idea.

I see, so the uncertainties are not related to your policy complaint? I agree the uncertainties are large, but they are not so large as to affect public policy, ie. even if there were a lot of unreported infections, and the true infection fatality rate were 0.5%, we know this already overwhelms health care systems if allowed to grow unchecked.

Yes, certainly it is mis-reacting (at least in the US, and reading about it from outside the country), but I guess the part about letting people mingle then locking down is not so much policy, as initial absence of policy (plus the lack of testing and the overly-narrow definition of a suspected case). The "horse out of the barn" part of your post did make some sense, as it could mean that the early failures is why drastic partial-lockdown-like measures had to be implemented later (to get the horse back into the barn) - though I'm not sure that's the sense in which you meant it.

 

[Ygggdrasil]

Large uncertainties can work in both directions, however. For example, below is data from a survey of experts conducted by UMass Amherst on Mar 16-17 to see whether they could predict the total number of US COVID-19 cases reported by the CDC on Mar 29:

https://fivethirtyeight.com/feature...w-bad-the-coronavirus-is-going-to-get-either/

The actual number reported by the CDC on Mar 29: 140,904.

So, if anything, the uncertainty is causing experts to underestimate the scope of the outbreak.

 

[russ_watters]

Which of those three impacts are reversible?

None of them.

While it may be theoretically true that it is possible to recover financial losses, the reality is that people won't. A lifetime and one's earning years during that lifetime are finite and when you lose that time, you don't get it back - whether you died or just had to sit at home doing nothing for 2 or 12 months. This is a well-documented phenomena from past turmoils, such as the most recent Great Recession having a permanent impact on millenials:
https://www.stlouisfed.org/~/media/files/pdfs/hfs/essays/hfs_essay_2_2018.pdf?la=en
https://www.businessinsider.com/gre...g-cap-on-millennials-earning-potential-2017-7
https://www.marketwatch.com/story/h...-cost-you-70000-in-lifetime-income-2018-08-13

The third link presents a good factoid: the average American is predicted to have lost-out on $70,000 in lifetime earnings due to the Great Recession. For millenials it will be much worse.

The current "western," or "advanced," societies put a very high value on life itself.

We do -- and we also put a high value on personal freedom, which in this case interferes with the value on life. I see three necessary driving factors to policy: life, freedom, economics.

It's also worth noting that the containment efforts themselves will kill people and also save people unrelated to the disease itself. Those deaths need to be quantified and considered in the analysis.

 

[russ_watters]

The value of the lives of octogenerians versus the health of the economy is a value judgement that is outside of the scope of scientific discussion.

While that's true, we need good data and analysis of it from scientists in order to make informed value judgement. Often, the choice of what data to pursue/forward itself reflects a value judgement, even if unconscious.

It is likely most of the deaths of people with Coronavirus is largely due to Coronavirus infection. For example, the life expectancy for an 80-89 year olds in China is 6.58 years. Median time to death for fatal COVID-19 patients was observed to be about 20 days from the onset of symptoms, and for people over 80, the mortality rate was 14.8% in studies of the Chinese outbreak. I don't think 14.8% of all people >80 years of age are going to drop dead in the next three weeks. (There are 23 million 80+ year olds in China, so this would correspond to 3.4 million deaths over three weeks. You would only expect to see 0.56 million total deaths of all ages in China over three weeks.) Modeling survival as an exponential decay with a half-life of 6.58 years, we would only expect to see about 0.61% mortality among octogenerians over a three week span (even if you double the period to six weeks as 20 days is only the median time to death, you still only expect 1.2% of octogenerians to die of natural causes in that time span). Thus, COVID-19 may increase mortality among octogenerians by over an order of magnitude.

Does the 14.8% represent the proportion of the >80 year-olds that are worse off in health? The study of life expectancy among the elderly in China found that ~ 11.8% of octogenerians were disabled (they require assistance in the essential activities of daily living like bathing, dressing, eating, or going to the bathroom). Among disabled octogenerians, life expectancy is only 1.1 year. Still, you would only expect to see 3.6% of that population die over the course of three weeks, nowhere near the 14.8% mortality seem among all infected 80+ year olds (regardless of whether they have additional health problems). Even the 70-79 age group (mortality rate of 8%) has twice the expected death rate of disabled octogenerians.

The health conditions that pre-dispose COVID-19 patients to greater mortality do not come close to explaining the observed mortality of the disease.

That's a good analysis, but it is (intentional or not) based on the assumption that all saved lives are equal; that the life of a disabled octogenarian with an expected lifespan of 1.1 years is equal in value to that of an average 25-year old, with an expected lifespan of about 75 years. In my opinion that difference matters a lot, so statistics like that need to be on the table for consideration.

In addition, if the high risk groups can be statistically and then physically isolated, that changes the rest of the numbers as well. In other words, it may be possible to quarantine retirement/nursing homes and individuals of other ages at high risk, leaving the rest of the population at a low enough combined risk that it could be acceptable to let the virus run through that population.

However, based on reactions to the Lt. Governor of Texas's suggestion that the elderly to sacrifice themselves for the good of the economy, many would disagree with you.

When it comes to life and death issues, people tend not to react rationally. In a great many cases, the default reaction is "save a life at all costs", and it's just plain wrong as a factual reality. All people make decisions - consciously or unconsciously - on a daily basis that weigh risk of injury/death vs money, happiness, convenience, boredom, and scores of other factors. I think most people build a wall of cognitive dissonance so they don't have to think about those decisions because it seems to cause most people's thought processes to short-circuit.

 

[Vanadium 50]

However, based on reactions to the Lt. Governor of Texas's suggestion that the elderly to sacrifice themselves for the good of the economy

That's not what he said. Read the link.
I don't agree with what he said either, but that's not it.

 

[Vanadium 50]

the default reaction is "save a life at all costs", and it's just plain wrong

I agree with that. To take an extreme example, we could save tens of thousands of lives per year by making it illegal to sell a car capable of moving faster than 5 or 10 mph. We don't.

I think we also haven't completely worked out the definition of "essential". Ventilators are essential. Are the wires in them essential? What about the copper mining to make the wire? What about the excavator to mine the copper? The oil filter on the excavator? The oil filter wholesaler? The guy who drives the truck from manufacturer to the wholesaler? The sports team who the truck driver wants to see, so is willing to work overtime to get the money to buy tickets? Where do you draw the line?

 

[russ_watters]

I agree with that. To take an extreme example, we could save tens of thousands of lives per year by making it illegal to sell a car capable of moving faster than 5 or 10 mph. We don't.

That's an odd and cumbersome approach. It would be much more straightforward to simply ban the use of cars and force people to stay home...er...wait...right.

Seriously, though, the Coronavirus response will have unintended consequences that save lives. I suppose it is reasonable to add these to the "lives saved" column along with the disease lives saved, but doing so will also highlight the pitfall of the "saving lives = better" philosophy. 38,000 people die from car accidents in the US every year. Assuming we only have a 2-month shutdown and the rate drops by half, it will save 3,100 lives. It could be more, since a large fraction of those deaths are due to drunk driving and I expect drunk driving will all but disappear due to bars and large event venues being closed during the shutdown. But if "saving lives = better", then clearly we should just ban cars altogether and be done with it.

So the question is: how many lives do you need to save for it to be worth it to crash the economy and permanently damage the standard of living of most of those who survive?

 

[BillTre]

So the question is: how many lives do you need to save for it to be worth it to crash the economy and permanently damage the standard of living of most of those who survive?

I'll define the extreme limits on that for you:

• more than one
• less than everyone

 

[Vanadium 50]

People find it uncomfortable to try and put a value on a life. That's why people say things like "whatever it takes to save just one life" but are willing to tolerate 38,000 car deaths. What one is willing to tolerate is set by what feels right, and that's why we require flying to be two orders of magnitude safer than driving and nuclear power to be three or four orders of magnitude safer than fossil.

Even the metric "lives saved" has an implicit value judgement. We could have instead used "years of life saved" and that would result in different policies.

One can certainly do a calculation like you suggest, but I doubt people would - or even should - act on the outcome. We know that each factor of 2 in GDP per capita corresponds to about 10 years life expectancy. If Covid-19 infects 20% of the population, it will reduce mean life expectancy by maybe 0.04 years. That suggests that 5 or 6 billion should be spent to fight it - assuming maximizing life expectancy is your goal, which I am not advocating. Any more and you're better off letting Covid-19 run its course and using the money to build pediatric hospitals.

Just because the calculation gives an answer doesn't mean you have an answer.

 

[atyy]

Some tiny, but positive, economic news from China
https://www.scmp.com/economy/china-...chinas-small-factories-stabilised-march-after