Some Further Fatuities on the Response to The Contagion

(For previous fatuities, see https://cool-hot-center.blogspot.com/2020/03/a-few-fatuous-notes-from-congation.html)

I will here describe a way of thinking about the response to CV-19 that much smarter and more knowledgeable scientists, doctors, actuaries, economists, statisticians, and politicians – and, I suggest, philosophers – might at least be thinking about thinking.  (Not to distance myself too obviously from what follows.)

Assumption #1:  It is tragic when people die and more tragic when they die before they should actuarially be expected to – for example, from a novel virus for which there is no vaccine or cure.  The strain on the healthcare system itself risks deaths from other causes for which treatment is unavailable owing to the crush of CV-19 cases.

Assumption #2:  It is also tragic, and can lead to fatalities of its own, when the leading economic power in the world is thrown into an artificial depression with misery for millions and no real strategy in sight to lift it.  The deprivation and unrest are themselves horrors, and just as unjust.

Assignment:  What level of death can we tolerate to avoid economic catastrophe?*

*  I will assume for the time being that an illness not resulting in death in the usual case would not have produced the current lockdown, although given the media’s panicked reporting, I’m not entirely sure about that.  So I will focus on deaths while understanding that non-fatal infections also cause pain to victims and the healthcare system.

To ask the question may seem cold-blooded.  Assumption #2 contains the subassumption that the damage to the economy and the population at large from a near-full shutdown of indefinite duration, which is where we seem to be heading at this writing, would be catastrophic:  At a minimum a classic deep depression, this time around possibly accompanied by social unrest and even violence in a population unaccustomed to privation and full of confidence about its "rights."  Is this assumption correct?  If it is not, you may stop reading now.   There is at least the strong possibility that the currently contemplated measures would yield a national condition that is itself very bad, so bad that it is at least worth thinking about how it balances with the deaths to be expected from the contagion.  So let’s think about it.

As of today, the numbers provided by reputable websites (Johns Hopkins among them) yield about the same U.S. death rate:  2.7% (8,098/297,575).  For seasonal flu, it is much less than 1%.  Worldwide, the CV-19 death rate is about 5.4%, depending on what you think about the accuracy of foreign (e.g., Chinese) reporting.

The R0 (number of persons estimated to be infected by an infected person) is unknown with precision, but since it is certainly greater than 1, the disease can be expected to spread – it won’t die out naturally.  The number most recently seen is about 2.5, which is higher than regular flu.  The thing is highly infectious; it isn’t going to go away on its own, and it is more lethal than regular flu.

Current forecasts of deaths in the United States under these circumstances vary.  In February, the Centers for Disease Control ran a series of scenarios and came up with an unhelpful estimate of from 200,000 to 1.7 million deaths.*  The same article quotes another expert as estimating 480,000 deaths. 

*  https://www.nytimes.com/2020/03/13/us/coronavirus-deaths-estimate.html; March 13, 2020.

It is hard to know what to make of these estimates.  “At the outset of the H1N1 swine flu outbreak in 2009, President Obama’s Council of Advisors on Science and Technology predicted that the virus would result in 900,000 to 1.8 million hospitalizations and 30,000 to 90,000 deaths. Actual figures a year later were to be 274,000 hospitalizations and 12,000 deaths.”

*  https://thehill.com/opinion/healthcare/488494-estimating-coronaviruss-us-toll; March 19, 2020.  This article estimates far fewer deaths.  

Which is what makes essays like this fatuous.  I have no idea how many U.S. deaths to expect.  A lot.  And a crushing burden to the healthcare system.

It is no comfort to compare The Contagion to seasonal flu.  The sites I have visited estimate this year’s influenza A and B death toll to be anywhere from the low- to mid-five figures.  And the health system is already equipped to handle those.

At first blush, one might conclude:  Based on current estimates and our current understanding of the disease, CV-19 is much more deadly than seasonal flu and justifies the economy-depressing measures being taken.

But let’s come at this from a slightly different angle.  Consider the infection rates upon which the worst-case scenarios are based – the ones that have stopped us all down:  Those February CDC scenarios I cited above assume the infection of between 160 to 214 million people.  (Fatuity alert:  I don’t know if those numbers take any degree of any of the current preventive measures into account.)  The current population of the U.S. is 330 million.  The estimate assumes that half to about 65% of the citizenry will be infected.  According to an article posted a couple of days ago reporting on a late-March article from Lancet Infectious Diseases, the infection rate is about 50% (again, effects of prophylactic measures unknown).

*  https://reason.com/2020/04/03/what-percentage-of-covid-19-patients-are-likely-to-die/; April 3, 2020.

Which would lead me to ask the experts I assembled in the first paragraph of this essay the following question:  How would the infection rate differ if we (1) had no restrictions of any kind in place, or (2) allowed a substantial but not total resumption of normal economic activity?  Would it be a whole lot worse than 50-65%?  

The question is:  Would it be so much worse that the increase in deaths justifies the shutdown of the American economy with its attendant miseries, including health-related problems, possible civil unrest, and, quite probably, an increase in non-CV-19 deaths?*

*  I won’t get into the question of who is most at risk here – who is more likely to die.  I’m assuming that the lives of elderly and health-compromised persons who are at greater risk are of equal value to those of younger or healthy persons (who are at some risk themselves).

The revival of the economy would not have to be total.  Here’s a suggested half-measure program:

• Keep schools closed.
• Maintain the moratorium on organized sporting activities, including professional sports.
• Maintain a moratorium on stadium-auditorium-theater entertainment.
• Permit all other economic activity, including restaurants, and all retail, all manufacturing, supply, and service activity; that is, it is voluntary.
• Where feasible, require social distancing as many grocery stores are now doing.
• Require masking for certain activities, perhaps most activities; perhaps something close to all-mask-all-the-time when one leaves one’s residence  for any purpose (you can unmask to eat), including employment.
• Pass laws necessary to assure that all persons who do not self-quarantine, and all persons choosing to work for employers that choose to do business, assume the risk of infection; that is, all civil liability for transmitting the disease is eliminated except for intentional transmission.  I would also protect employers and merchants from civil rights suits for excluding symptomatic persons from the workplace or establishments (unless pretextual to disguise forbidden discrimination).
  

The analysis becomes, crudely: 

Projected infection rate from liberalization of economic activity minus current infection rate, times 330 million, times 2.5% = estimated number of additional deaths.  Crudely, because, among many other imponderables, that 2.5% might go up as the strain on the healthcare system increases.

But you’re not done, because you have to assume that the vast depression that would result from the full-measure shutdown would cause a certain number of deaths that will now be avoided.

But you’re still not done, because the revival of the economy (to the extent permitted with the foregoing half-measure proposal) will bring with it other benefits:  economical, psychological, governmental, hedonic, maybe even spiritual, while we all take a deep breath and gut out the higher mortality rate from CV-19 during the half-measure phase. (And don't forget that we need to check the assumption that a shutdown would be the disaster I'm assuming.)*

*  Remember:  all models are suspect.  Dr. Fauci:  "There are things called models, and when someone creates a model, they put in various assumptions. And the model is only as good and as accurate as your assumptions," he said. "And whenever the modelers come in, they give a worst-case scenario and a best-case scenario. Generally, the reality is somewhere in the middle. I've never seen a model of the diseases that I've dealt with where the worst-case scenario actually came out. They always overshoot."

So if you are thinking carefully about the full shutdown that seems to be approaching, you are comparing:

a numerically large, percentage-wise small, number of human lives

     with

certain hardship, sometimes severe, sometimes fatal, for close to 100% of millions that will likely outlast the pandemic. 

I state that prejudicially, but I acknowledge that it is a very hard choice because human life is very, very valuable.  But the choice should be considered.  As noted, people much smarter and better-informed and devoted than I sitting in my compression shorts and rash shirt for a few hours on a Saturday afternoon might usefully do the arithmetic and sound much less fatuous reporting on it.    

And, by the way, if my numbers are wrong -- what are the right ones?  If the current projections are not as dire as reported, then how less dire are they, and how does that change the lockdown analysis?  If the infection rate is more dire, doesn't that shift the analysis toward easing, rather than intensifying, the lockdown?  Whatever the numbers are, the question remains the same:  Is the death-delta from coercive-lockdown versus something-considerably-less-than-coercive-lockdown an acceptable price for the potentially huge damage to the economy and social order?

Too cold-blooded for you?   Come see me in a month.  If you can find a sitter.

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