Policy for pandemic issues and how models shape it

[Vanadium 50]

I guess "I'm a doctor, not a [fill in the blank]"

 

[BillTre]

Right Bones.

 

[PAllen]

Yes, that's true. Common numbers are $9M for a life and $130K for a year of life. If you want to maximize life expectancy you get one number, lives saved this year you get another number, lives saved 5 years down the road you get another number, and so on.

However, I do take issue with the 2.2M number. We know now that was never going to happen.

We may 'know' (really, we don't for sure, but it certainly is looking like a major overestimate) now, but at the time US measures were initiated, it was one of the most reputable estimates out there, from Imperial College.

Unfortunately, in the case of still extremely incomplete information on transmission modes, and their relative likelihood in different environments, (and that there is still large uncertainty in infection fatality rate), the only option is to make policies that are basically experiments to see what happens. Over time, as different experiments (countries) play out, knowledge will increase and hopefully policies become more informed.

 

[PAllen]

We may 'know' (really, we don't for sure, but it certainly is looking like a major overestimate) now, but at the time US measures were initiated, it was one of the most reputable estimates out there, from Imperial College.

Unfortunately, in the case of still extremely incomplete information on transmission modes, and their relative likelihood in different environments, (and that there is still large uncertainty in infection fatality rate), the only option is to make policies that are basically experiments to see what happens. Over time, as different experiments (countries) play out, knowledge will increase and hopefully policies become more informed.

One additional point is that while 2.2 million now seems implausible, it is not order of magnitude off for estimate for minimal counter measures. Using data from here:
https://ourworldindata.org/coronavirus
one finds that, while infection fatality rate remains largely unknown, many of the countries who have had it a while, are stabilizing around 2% CFR. This compares to CFR (NOT IFR) of .15% for seasonal flu (that link has a table of CFR for various diseases). Assuming corona is similarly as infectious as the flu, and the seasonal flu has typically 40,000 deaths in the US, that leads to 550,000 deaths in the US for measures that are no more effective than the flu vaccine is for the flu.

 

[atyy]

One additional point is that while 2.2 million now seems implausible, it is not order of magnitude off for estimate for minimal counter measures. Using data from here:
https://ourworldindata.org/coronavirus
one finds that, while infection fatality rate remains largely unknown, many of the countries who have had it a while, are stabilizing around 2% CFR. This compares to CFR (NOT IFR) of .15% for seasonal flu (that link has a table of CFR for various diseases). Assuming corona is similarly as infectious as the flu, and the seasonal flu has typically 40,000 deaths in the US, that leads to 550,000 deaths in the US for measures that are no more effective than the flu vaccine is for the flu.

Indeed, others had made sensible estimates similar to yours.

nanoscale views
Exponentials, extrapolation, and prudence
http://nanoscale.blogspot.com/2020/03/exponentials-extrapolation-and-prudence.html

condensed concepts
Exponential growth: living and dying by it
https://condensedconcepts.blogspot.com/2020/03/exponential-growth-living-and-dying-by.html

 

[Ygggdrasil]

Expanding on my last post, I predict that when this is over we will see a flood of calculations of the sort "we saved N lives" by taking some counterfactual, and subtracting the actual number from it. I suspect what we will not see is as many well-conducted studies comparing the success of different interventions. We can see that now with Sweden. If the Swedish plan fails, well, we knew it would all along. If it succeeds, we'll you can't tell anything from one country especially Sweden.

While it will be a while before we have any studies to compare effectiveness of different strategies to combat the COVID-19 pandemic, we do have studies of past pandemics to help guide our current policymaking. For example, a (non-peer reviewed) working paper from economists at MIT suggests that stronger and earlier implementation of social distancing and other public health interventions were correlated with slightly improved economic recovery after the pandemic:

The study, using data from the flu pandemic that swept the U.S. in 1918-1919, finds cities that acted more emphatically to limit social and civic interactions had more economic growth following the period of restrictions.

Indeed, cities that implemented social-distancing and other public health interventions just 10 days earlier than their counterparts saw a 5 percent relative increase in manufacturing employment after the pandemic ended, through 1923. Similarly, an extra 50 days of social distancing was worth a 6.5 percent increase in manufacturing employment, in a given city.

“We find no evidence that cities that acted more aggressively in public health terms performed worse in economic terms,” says Emil Verner, an assistant professor in the MIT Sloan School of Management and co-author of a new paper detailing the findings. “If anything, the cities that acted more aggressively performed better.”

http://news.mit.edu/2020/pandemic-health-response-economic-recovery-0401

Of course, the differences are very modest and correlation is not causation, so other factors could be involved (e.g. maybe areas that have stronger, more effective leadership were able to both implement social distancing earlier and better coordinate the post-pandemic economic recovery). Also, it is unclear how applicable data from over a century ago are to today's circumstances.

However, the data are consistent with the view that the economy is a very interconnected entity and (as with public health), we are all in this together. Whether or not one country decides to trade off potentially greater risks to its population against lesser damage to its economy, the overall effect on the global economy would be enough to flatten out the effects across the entire world.

Here's a link to the working paper for those interested: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561560

Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu

Abstract: What are the economic consequences of an influenza pandemic? And given the pandemic, what are the economic costs and benefits of non-pharmaceutical interventions (NPI)? Using geographic variation in mortality during the 1918 Flu Pandemic in the U.S., we find that more exposed areas experience a sharp and persistent decline in economic activity. The estimates imply that the pandemic reduced manufacturing output by 18%. The downturn is driven by both supply and demand-side channels. Further, building on findings from the epidemiology literature establishing that NPIs decrease influenza mortality, we use variation in the timing and intensity of NPIs across U.S. cities to study their economic effects. We find that cities that intervened earlier and more aggressively do not perform worse and, if anything, grow faster after the pandemic is over. Our findings thus indicate that NPIs not only lower mortality; they also mitigate the adverse economic consequences of a pandemic.

(note: I am a biologist, no an economist, so I am in no way qualified to evaluate the working paper)

 

[Vanadium 50]

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.

There are some attempts at this: https://www.reuters.com/investigates/special-report/health-coronavirus-usa-cost/ It's broad but not very deep.

There is also this: https://www.realclearpolitics.com/articles/2020/04/13/shutdown_could_kill_more_americans_than_covid-19_142934.html I don't think she's making the correct comparisons, but at least it's an attempt to quantify,

One problem with "deaths of despair" is that it's difficult to look at a person and say "the single reason why they are dead is X". At best, one can look statistically. It's even worse for lives saved due to reduced accidents. How do you point at someone and say "her life was saved"? We can see this effect in European mortality statistics - in years with bad flu seasons, the spike in deaths exceeds the number of attributed flu deaths by a factor of 2-5.

 

[jack action]

For whom are interested, the UN is now evaluating confinement consequences in children's death:

Hundreds of thousands of children could die this year due to the global economic downturn sparked by the Coronavirus pandemic and tens of millions more could fall into extreme poverty as a result of the crisis, the United Nations warned on Thursday.