life

Covid strategies for Australia: herd immunity or quarantine land?

Published by Anonymous (not verified) on Thu, 28/05/2020 - 9:20pm in

Let’s talk about some of the covid policy options facing Australia in the coming months and years. It seems to me we can either grasp the nettle and accept we will get a wave of highly visible covid-19 deaths before life returns to normal, or we can try and defend ourselves against any further wave and infections by quarantine rules, State border controls, immunity passports, tracer apps, and the like. The main cost of the latter is in the total collapse of several industries, as well as longer-term but less visible loss of life. The main political cost of the former is admitting we f*cked up first time round and needlessly damaged the economy and society for no benefit.

Let’s talk about the quarantine path first.

Stuck In Quarantine – Zombie Guide Magazine

If one only wanted to prevent a up flare of covid cases in Australia one should continue the current restrictions.

One would have strong quarantine rules regarding visitors from any country with a high number of active cases. Even with countries with few identified active cases, one would want a strict quarantine policy: there is a 2-week delay between the unseen spread of the virus via asymptomatic cases and visible deaths, so you don’t know whether a country is experiencing an unseen flare up of the virus. Hence even visitors from “clean” countries pose a risk. This means one should not expect too much of the idea of some large group of countries that declare themselves a covid-free zone and have free travel between them. One little wave of infections in one of them and such a system would already break down.

The economic costs of quarantine rules is that it kills off some of the tourism, a lot of the international student business, quite a bit of temporary migration, and most business travel. This is exactly why in the UK over 70 big travel operators and hotel businesses have called on the UK government to ditch its plans for quarantine rules. Those businesses are very afraid that the summer holiday season (mid June to August), in which they make a lot of their yearly revenue, is lost, so they are making a huge noise right now. It would mean the end of their business and hence the jobs they provide if the quarantine rules are kept in place. They claim to be close to 10% of the UK economy.

If you count all the ancillary business associated with tourism and business travel, like catering, this industry is somewhat similar in size in Australia. So quarantine rules come with a big economic impact, which is why right now the Gold Coast operators are strongly lobbying the Queensland government against border controls and quarantine rules. They claim 40,000 jobs are in danger. And the Gold Coast is just one small part of the Australian tourism and business travel industry.

And don’t forget, jobs and the economy are about lives. That’s why a job is called someone’s “livelihood”. Jobs support individuals and their families. As I have calculated before, a million jobs lost for just one year equates to over 100,000 life-years lost in terms of direct misery to the unemployed, and another couple of hundred thousand life-years via reduced public services and (health) consumption for the whole community.

Now, of course, things are not quite as bleak as saying quarantining arrivals from outside of Australia kills all tourism and hospitality: quarantine rules not only discourage foreign tourists from coming in, but they also discourage domestics from going out, meaning less foreign tourism but more domestic tourism. Australians do like to travel, with a million or so abroad at any moment in time and they’d do less of that if forced into quarantine every time they return from abroad. With the glut of Asian tourism in the last 10 years, Australia is probably a net winner in terms of the international tourism trade, but it clearly wont be true that its tourism industry will have no clients if the Asians and others are discouraged from coming via quarantine rules. Destinations popular with Australians might even see a net increase. It’s the internationally oriented tourism, travel, and hotel chains that will lose out most. So yes, jobs are on the line, but not quite as many as the whole of the industry.

That is unless one has lots of border controls within Australia that basically kill off most internal tourism as well! Lots of internal controls on movement are essentially equivalent to preventing lots of people from doing their jobs (ie, looking after interstate tourists and travelers), which is a straightforward reduction of total production in Australia. Its like a mandatory closure.

So there is an economic price tag on quarantines rules for foreign visitors and a separate but also big price tag on internal border controls.

Nevertheless, let us press on with describing what the continued suppression path could look like. Importantly, you wont keep this out completely with a quarantine regime, if only because of all those government and military people still flying around on official business. Also, you’ll get cases that fall through the cracks of any quarantine system, whether that is an infected visitor escaping from the quarantine hotel or some infected piece of clothing getting passed on from a docking freight ship. It’s just too contagious and hard to notice to keep out completely when you have a lot of activity in airports and freights (which you have even right this moment). So you cant only have a quarantine regime if you want to keep the virus repressed.

Another element in the suppression strategy is the notion of forced local lock downs connected to a track-and-trace system. They now announced such a system in the UK: anyone tested positive for covid will be asked to say whom they have been in contact with recently, and those others can be forced into an involuntary two week lock down to prevent further spread. The UK government is essentially copying the Chinese system of neighbourhood snitches for this, ie 25,000 busy-bodies whose job it will be to go and pester everyone about their health and their movements. Those 25,000 ‘contact tracers’ will be on the phone to all the friends of an identified case, as well as looking at the movements of a victim’s mobile phone, charged with looking at where an infected person might have gotten the virus from and whom he or she might have given it to.

To Tame Coronavirus, Mao-Style Social Control Blankets China - The ...One might call this a “low-tech” track-and-trace system, something that other countries try to do with apps but that China and Japan have done with an army of local busy-bodies checking on all others. Key in this system is that one can be forced to undergo a covid test if one the new busy-bodies think that is appropriate. One might thus call it the covid-police.

The Australian government first tried something like this with a mobile phone track-and-trace app, but that one now seems to be abandoned. Yet, it can try again with an updated app or copy China, Japan, and the UK, in setting up a covid-police to track and trace more manually.

Now, of course, the dangers for abuse in this system are horrendous. These contact tracers can threaten businesses with oblivion by calling for a local lock down of all the high-contact businesses in an area, and they can make life hell for any particular individual by calling all their friends and families, or forcing them into continuous tests. As a result, people will be very reluctant to have tests done!

Perhaps even more important is that “track-and-trace” creates its own demand when it is “successful”: by preventing local flare ups, such a system means the community never gets high infection levels and so perennially remains vulnerable to them. So one has to track and trace until there is a vaccine. And with a new virus or a new version of the covid-19 virus, one would have to have the track-and-trace system running again. The local Chinese busy-bodies also find some new threat to guarantee them an ongoing job, and the Australian covid-police would do so too. So its an ongoing cost and form of interference. Just like the Chinese system of social busy-bodies. It would turn the UK or Australia into a mini-China.

Successful continued repression in Australia comes with the irrelevance of immunity passports: those only make sense if you have had enough cases of people recovering from infections. That’s relevant for the UK, but not Australia.

Crowds - The opera house was deserted. The doors were closed. The ...Note also how difficult a track-and-trace system is to operate with lots of visitors and foreign tourists in a neighbourhood. A place like Buckingham Palace or the Sydney Opera House, with a continuous flow of buses full of foreign tourists feeding into cramped spaces, does not allow one to track and trace all the interactions between them and the locals.

So track-and-trace almost inevitably comes with further restrictions: no crowds in massed spaces and no mass tourism. The Opera House deserted.

What does a ban on mass gatherings kill off apart from certain forms of tourism? Well, it kills of all major sports, cultural, or even political events. No stadiums full of football fans or music lovers. No festivals. No Opera House performances with meaningful numbers of attendants. No sizeable political demonstrations. No election rallies. No park runs. No London or Sydney marathon. Probably no large full open office spaces.

So track-and-trace combined with bans on mass gatherings kills off a lot of joy and work. Again, this holds until there is a vaccine, and then applies again with the next version of the virus or some new threat.

Another policy meant to suppress the virus is social distancing and staying indoors. In Europe, we have basically woken up to its futility in preventing cases. Both the 1.5 metre ban and the pressure to stay indoors have now proven to be either largely useless (social distancing) or strongly counter-productive (staying inside). The Germans are thus leading the way in lifting the 1.5 metre ban, and governments are starting to realise they should encourage people to go outdoors.

The Australian government will be getting the same advice right about now.

However, one should note that whilst being in close proximity to others outdoors is now known to carry very little risk of infection, it is of course not the case that there are no infections from close proximity outdoors. Also, close proximity outdoors makes track-and-trace virtually impossible to do. If each individual is in close proximity to a thousand others every day, such as via public transport or lots of close passes on the streets, then the covid-police is going to have to call millions of people every day to inform them they have been ‘in contact’ with someone who has the virus. That is quickly going to become laughable. So there is a tension between letting go of the “stay inside and keep distance” policy and track-and-trace, which is basically why much of continental Europe has abandoned the idea of track-and-trace.

Note also that, once again, preventing mass gatherings might create its own demand if it is successful: one prevents lots of people from catching the virus so one maintains total vulnerability in the population.

Then, the business of face-masks. These have now been found to have a particular use in crowded indoor places with low humidity and poor ventilation. They are thus made compulsory in many European countries for use in public transport (which is crowded, poorly ventilated and sometimes with low humidity). They seem quite important in reducing infection rates.

For those not yet in the loop on the medical reason for this: the issue is tiny “respiratory” droplets of water and saliva (snot!) in the air which contain the virus and which people breathe in. Infected people breathe out rather a lot of such droplets and those droplets can hang in the air for hours depending on circumstances. Those circumstances are humidity and ventilation: if a place is well ventilated, the droplets move away or fall to the ground, and if there is high humidity the droplets also fall down much quicker. On the ground, those droplets are not much of an infection hazard. And where is ventilation good? Outdoors. Where is it bad? Indoors.

So this has become the new wisdom on covid-19 infections: the main place lots of people get strongly infected is in crowded indoor places with poor ventilation, like the Sydney Opera House on a dry day. Sit in there with a few infected people for a few hours and the infection will have reached all areas of the lungs, a much worse form of infection than having only the nose infected by a chance meeting outside. The face masks stop most of the droplets.

So compulsory face-masks in public transport come with another strongly suggested policy, which is continued bans of large gatherings in poorly ventilated indoor places, or at least compulsory face masks in those. That includes lots of school sports. It includes parliament, though they’ll be fixing the ventilation there as soon as they can. It includes bus rides full of tourists. It includes ocean cruises and large boats generally. It includes lots of factory floors. It includes academic conferences, business retreats, and all those other mass-indoor events. For some, you can imagine everyone wearing face-masks for an hour so, but for many, like factory floors or indoor sports, wearing continuous face-masks seems pretty infeasible.

So it kills off an awful lot of industries and activities, at least in the face-masks-off form we used to know, until there is a vaccine, which might well be never. Considering how every year there are new versions of the flu, that it normally takes many years to develop and test a vaccine, and that there is still no vaccine for the previous covid-virus (SARS), one shouldn’t believe in a quick vaccine miracle too easily.

Realistically speaking, the package of quarantine, State border controls, track-and-trace, face-masks, and banned mass gatherings should be expected to have to stay in place for several years in a suppression strategy. Precisely if they work, they have to be kept up till a vaccine because the population never develops immunity. So one kills off large economic sectors indefinitely.

Now, particular aspects of the potential package are more socially and economically costly than others. It is hard to know with the data at present, but I think that compulsory face-masks are probably the least costly of the package, unless they are mandated for all offices and factory floors. They main cost is more indirect in keeping up the fear. Social distancing is probably the most economically and socially expensive item in the potential package as it kills off most of office life and regular work. If mass gatherings include office floors, then keeping them outlawed costs close to that of social distancing. Quarantine is quite expensive, particularly economically, whilst track-and-trace on its own is probably more socially expensive than economically expensive.

 

Let’s then talk about two different options for grasping the nettle, ie accepting some form of herd immunity is the way to go, which comes with accepting a second wave of infections and deaths with a full opening up of the economy.

 

Measles, journalism and herd immunity / Data news / News / Home ...The technically easiest thing to do is to simply lift all government-mandated restrictions (state and federal), have some measures in place for the most vulnerable (unhealthy old people in nursing and retirement homes), and otherwise just watch and see what happens as international tourists, business people, migrants, and students come flooding back in. Like in Sweden, one would let individuals and businesses make their own calculations and decisions on how afraid they would be of what, but the official line would have to be that the risks in hindsight were much smaller than initially feared and people should hence just get on with their life and not be so scared.

There would clearly be a wave of infections and deaths lasting a few months. That wave would be quite a bit larger than the first wave Australia had. How large is not known, but I would personally expect it to be inbetween Sweden, which looks like ending up with a death rate equivalent to 15,000 Australians, and Japan, which would mean a few thousand Australians. Hand on heart, I’d expect about 10,000 covid deaths in Australia if we fully open up and stop worrying about the virus.

The advantage is that the economy starts to recover and social life resumes. There would still be one hell of a recession and a leftover government debt, but at least one would be on the path upwards again rather than killing off more industries permanently.

What happens after that first wave? The experience in Sweden is still the most instructive: the virus keeps “burning its way through the population” to the degree that that is natural with the economic and social reality in that country. Large parts of the healthy population eventually get the virus. After 2 months, the Swedish virologists now think only about 20 to 25% of the population in the capital have had the virus (up from 7% in early April), and they thus still have a few more months of relatively high infections to go before so many (50%?) are immune that the number of new cases become negligible. Part of the reason the immunity is happening slower than expected is because of the high degree of voluntary isolation by a population afraid to gather in large numbers.

Australia would be on a similar trajectory, with probably lower eventual levels of the population having been infected because Australia is more spread out, more humid, and might be lucky in importing less virulent versions of the disease than Sweden.

So it would take maybe 4-6 months for the number of cases to drop to almost nothing, after which you’d get the occasional local flare-up but no major further waves as a large part of the population has become immune. If it turns out that people lose immunity, you’d get smaller waves in subsequent years, much like the flu comes around every season. Eventually the population shrugs it off as just another health risk among many other, more worrying ones, like smoking or obesity.

Now, for me this represents the politically easiest option as one does not have to do anything radical but simply talk down the risks of the virus and give in to the demands of business to lift restrictions.

The narrative writes itself: “we have to make a living”, “we cant hide away from the world”, “Australia must be open for business”, “The virus is not even 1/10th of the risk of smoking”, “Our children must have a future”, “our elderly must be allowed to mingle with their family and friends”, “we cannot police the whole population”, etc.

This is the politically easier option and thus the more likely one. Yet, if one is of a more pro-forward and maverick nature, like myself, one is interested in the question of the smartest option around. What would that look like?

I think the smartest option around is to have a designated period in which one tells the old and frail to stay away from the active part of the population, whilst one deliberately created herd immunity by letting the healthy who come most into contact with others get a mild infection in the nose. You’d literally give them nose-sprays with the virus, a technology we already have and could mass-produce quickly.

One would thus have an infection program to catch up with Sweden, but then with fewer deaths and less economic disruption. You’d want something like 30-40% of the population to get infected, and that of course should be the most active group that runs almost no risk of dying from the infection. That’s 18-60 year olds who travel around a lot, which includes public transport commutes.

So you have a second wave, but one that is created and managed rather than one that occurs naturally. One can repeat the exercise in future years if it turns out that people lose immunity. There would of course still be a sizeable number of deaths from this approach. Not so much among those deliberately infected, but among those infected by the deliberately infected. One would try to minimise this damage, but one cant prevent such a large group of people entirely from working or mingling during their infectious period and one should thus expect to fail to some degree in completely protecting the vulnerable population during this deliberately created second wave.

Is this the lowest risk option? I think on balance yes, but it is not without risk. One such risk is that one didn’t need to do it because of some as yet unknown advantage that Australia might have that would make the natural “herd immunity level” particularly low. In that case the “second wave one needs to have to get back to normal” could be much smaller than it seems at present. Just as the fatality of the virus was totally over-estimated, so might the level of the population needed to be immune to get herd immunity also be over-estimated.

One indication that this might be possible is that much of Asia and Africa simply has incredibly low infection and death rates of this virus, suggesting that “doing pretty much nothing” would not lead to much death or infection in those places anyway. Just like malaria does not exist in Europe because it is too cold, maybe covid-19 has a tougher time in Australia than you’d think from merely looking at the usual indicators (urban density, climate, health characteristics of the population, age structure, work habits, social habits, etc.). So the deliberate infection options comes with the risk of creating a larger second wave than you’d actually need.

Politically, the fast-track policy to herd immunity also seems a tough sell. It is super easy to criticise and you’d have a conga line of supposed experts warning of the dangers of doing this. Whilst there are the odd medics whispering in the corridors about such an option, there is not an open consensus on it, so one cant hide behind some recognised solidly large group of scientists. You’d get doctors grand-standing how deliberate infections violate their oaths, and lots of other forms of protest. That alone would seem to make it a political impossibility, even though it seems to me the smartest option on the table with the least net economic and social disruption. Its probably too toxic for politicians to even mention it.

 

Between A Rock And A Hard Place. Stock Photo, Picture And Royalty ...These are then the more politically realistic options: continue with suppression indefinitely at high social and economic cost until the miracle vaccine appears, or open up fully and take your chances. Whilst Australia is currently right on track with the suppression option, it seems inevitable to me it will end up with laisser-faire after a few months of pussy-footing and continued economic harm. It would be nice to visit Australia again without needing to spend 2 weeks in a hotel room alone.

On Corona/Covid-19, herd immunity and WELLBY tradeoffs: key predictions and numbers

Published by Anonymous (not verified) on Thu, 14/05/2020 - 10:46pm in

[in progress: will add more references, links and latest numbers when I get the time]

In this note, I want to deal with three related issues: the main lessons on the corona virus from the reported deaths across countries with different policies; the feasibility of different “end games” relevant to this pandemic, including vaccines and herd immunity; and some key WELLBY numbers relating to loneliness, unemployment, and how government expenditures link to lives saved. Armed with these numbers you can generate your own estimates for how various policy scenarios change the numbers of happy lives lived by the population.

The take-away message is that I think most European countries will end up with a “Sweden, perhaps on steroids” strategy, openly adopt a not-much-to-truly-fear narrative, and that the key wellbeing consideration for the next two years will be jobs and social closeness. We will then also hopefully acknowledge as Westerners what the awful and totally predictable costs have been in the rest of the world of our attitudes and policies in dealing with this virus.

The dangers of the corona virus: on New York, Sweden, South Korea, and herd immunity.

In February / March, when many key policy decisions had to be made, it was still possible for a reasonable person to think more than 1% of the whole world would die if one didn’t lock down the majority of the population. With the benefit of all the research and information of the last 2 months, we now know much better what the risks are and what matters in terms of policies. The key information that is new is how many victims the corona virus has made in different countries following different strategies and with different circumstances. Though there are huge statistical issues with this data, including the fact that some countries are more strict than others when counting a death as covid related, and the large differences in just what part of the population was exposed, we can nevertheless turn to this data to help see the main contours.

One clear lesson is that death tolls have been highest in dense urban areas, and very low in rural and (sub)tropical areas, particularly in countries where infectious diseases are a very normal cause of death. In the dense cities, transmission rates are much higher than in other areas, and so a much higher percentage of the population is infected until some kind of herd immunity is achieved (which is basically when residual transmission rates are low, ie the “rho<1”).

The worst affected large region in the world is thus New York, with a death toll of around 0.15%, which is easily ten times higher than that of rural areas in the US. Importantly, the US basically let the virus roam around unhindered for over a month, which was long enough to spread all over New York, pretty much a worst case scenario. The latest estimates suggest there are several neighborhoods in New York that have over 40% of the population with observed anti-bodies. Since it takes a few weeks after infection to get anti-bodies and the reported numbers always related to measurements of several weeks ago, this means many areas of New York must at this moment be pretty close to herd immunity levels.

We don’t quite know why (sub)tropical areas have such low death rates, but its probably a combination of weather (the virus doesn’t like the sun), natural circulation in houses preventing the aerosols that carry the virus from hanging around, high humidity that prevents the contagious aerosols from hanging around, population density, and perhaps the fact that in most (sub)tropical areas, infectious diseases are plentiful and a very prevalent health hazard. Rich populations have dry inside places where it is far easier to catch the virus, and perhaps are not so used to infectious diseases. So it is a rich man’s disease where, for once, slum dwellers in poor countries are at the advantage. Having said that, within rich countries, its the poor who are most at risk.

In places like Vietnam, Thailand, the Indian countryside, South Asia, Africa, and even Brazil, total death rates from corona are thus below 0.01%.

We now also have a much better idea “what it takes” to get natural herd immunity because of Sweden. The Swedish ambassador to the UN claimed Sweden is now close to herd immunity, with more than 30% of people in its capital already immune by late April. It has a current death toll of around 0.035% and should thus be expected to have achieved herd immunity for a finalised death toll of around 0.05% (their death rates are well on the way down now). These numbers are of course not uncontested, with later research suggesting only 20% immunity in Stockholm by late May, whilst yet others think the immunity levels are far higher because the main immunity tests miss groups of people who are immune by having had similar diseases in the past or some genetic disposition. Still, these lower-than expected number might mean Sweden will have a death toll of 0.1% before it reaches herd immunity level, half of what New York seems to be heading for to get that outcome.

Relevantly, Sweden has a population density still higher than Australia, also has cities with lots of space, inside dry places, and has in previous decades also marginalised most other infectious diseases. So its reasonable to expect that Australia too could achieve herd immunity with a loss no higher than 0.05% to 0.1% of the population, ie 10,000 to 20,000 people. Ditto for other Western countries: one in thousand seems the maximum one “has to suffer” to get herd immunity, probably quite a bit less.

There are a few other lessons one can draw from the experience of other countries, though one should bear in mind that the international statistics have to be read with caution as different countries have totally different rules on whom to count as a corona death, which can easily lead to a factor of 5 difference in claimed deaths.

One lesson is that lock downs have had remarkably little benefit in preventing deaths in Europe. Their main failing is that they didn’t manage to truly shield the elderly and vulnerable population, possibly even the opposite: the vulnerable elderly who rightly had something to fear were those with lots of other health problems and in retirement/nursing homes. Their continuing need for help brought them into contact with infected elderly and infected health workers, thus spreading the virus precisely among the vulnerable population.

Lock downs were quite probably worse than asking their families to take them in for a month, and probably worse also than having the virus spread quickly among the healthy population so that the health workers would much sooner be in a herd immunity situation. Paradoxically, the lock downs prevented herd immunity among large groups which meant more health workers kept being infected, with hospitals and retirement/nursing homes some of the worst places one could be.

Now of course, smart lock downs can prevent this. The UK in that sense is the shining example of the worst of all worlds: economic and social devastation due to the lock downs, whilst the truly vulnerable population was not protected at all. Sick elderly patients were sent back to their nursing/retirement homes and infected hospitals and health workers helped spread the virus among the very group that truly had something to fear.

So it is now clear that blanket lock downs are a terrible idea and prevent few deaths, probably even causing corona deaths depending on various policy particulars.

Another lesson is that one should not see a country as a single herd, but as being made up of lots of different communities that have their own infection rates, vulnerabilities, and thus threshold levels of infection before herd immunity is hit.

The most useful way to see the issue of herd immunity is to realise that our societies have both places where there is a lot more interaction, as well as people that do a lot more interacting. Cities have high interaction rates, but there are also groups of workers and individuals that do a lot of traveling and interacting. Nurses for instance do a lot of interacting with different groups, and are highly efficient carriers of viruses since they will often be non-symptomatic. Traveling salesmen, university students, and businesswomen are also “high contact groups” that are very prevalent carriers and spreaders of the corona virus.

This means two crucial things: since the healthy ones among these groups run negligible risks when they get exposed to this virus, you actually want them to be exposed as quick as possible to this virus so that they build up immunity and can no longer accidentally spread the virus; and once a certain percentage of the high contact groups have built up immunity, a whole locality or community basically has herd immunity. Put in a language we have now all gotten used to: the high-contact people are the ones with a rho>1. Get them to be immune and further spreads peter out without any special intervention.

So in hindsight it is now much clearer what the optimal social strategy towards herd immunity is: to have the healthy individuals among the high-contact groups mingle as much as possible with each other so that they all get exposed to the virus and they all built up immunity. That would give all locations herd immunity. In a dense city, where there are far more high-contact people, this means one would need a much larger percentage exposed to the virus to achieve herd immunity than in other places. In the countryside or (sub)tropical countries, the group you’d need to have immunity would probably be no larger than 5-10% of the whole population and you’d already have widespread herd immunity. Incidentally, children seem hardly able to get it or carry it for a long time, so they would not be in the group one would want to deliberately expose. They are somewhat “inert agents” anyway when it comes to this virus.

We didn’t know this before: before, based on the experience with vaccines, we thought one would need something like 70% of the whole population to contract the virus in order to have herd immunity. Now our understanding is more nuanced: you only need the high-contact makers to be immune for the residual infection rates to become low enough so that a local upflare dies down, ie “rho<1 locally”.

This is also partially why the South Korean approach has worked well to contain the virus, though at the cost of huge economic and social disruption: the South Koreans tested lots of people on the motorways and in transit between places, thus picking up the high contact makers who were infected and were spreading it. By tracing them so quickly they managed to get the infection rates down and thus suppress the outbreaks. Yet, that kind of targeted track-and-trace would have to kept up indefinitely, thus incurring an indefinite economic and social cost. The South Koreans for instance will not be able to have large groups of tourists roaming around freely, nor lots of new international students and others: because South Korea does not have local herd immunity, bringing in infected people from outside would lead to run-away virus outbreaks. This will not in general be true for Sweden though, particularly not because international students and tourists will primarily interact with high-contact Swedes who will largely already be immune.

Finally, we now have a lot of potential vaccines in the pipeline. Something like 100 or more, with a human trial in Oxford as the front runner, hopefully giving us good news in 2 months or so. Their vaccine worked well in macaques and they hope to learn how it will fare in humans. Still, the odds are actually quite high that their study will fail to be definitive even if their vaccine works. This is because too few healthy people around Oxford might get exposed to the virus to say with certainty that those with the vaccine were less likely to get a full-blown infection than those without the vaccine in their trial. Also, it already seems the Oxford vaccine does not prevent someone from spreading it, limiting its use. Similar problems go for a lot of the other trials: it is probably more realistic to expect another 12 months before there is a vaccine that is actually rolled out to whole populations. We all hope, me included, for an autumn miracle, but I am not counting on it and its quite possible we’ll not find a vaccine for the next 10 years.

 

End-games, basic options around the virus going forward, and death tolls.

 

There are many end-game scenarios doing the rounds, but I find the three most important ones to be: i) the open adoption and conscious move towards herd immunity for the whole population (Sweden), ii) limited social distancing plus targeted track-and-trace till a vaccine (South Korea), and iii) indefinite or seasonal lock downs (suggested in the UK).

Let’s quickly dismiss the last of these options. The economic and social devastation, as well as their likely health ineffectiveness, of lock downs is such that we should just openly dismiss them as ridiculous and ill-conceived, as I have argued for 2 months now. They cost at least 10 times as much as they potentially give. For face-keeping purposes many of the elites and “scientists” in Western countries are loathe to accept this, but I actually doubt any country will truly repeat the mistake of the last two months of lock downs. I am willing to bet against it occurring in Europe if anyone wants to seriously suggest otherwise!

Nearly all Western countries locked down are now openly embracing either herd-immunity or some notion of limited social distancing and track-and-trace. So let’s not even bother talking about continued lock downs.

With the South Korean style track-and-trace, as well as their continued habits of social distancing, it is clear the total death toll of covid is very very low. They claim their death toll is 5 per million, ie 0.0005%, basically a few hours of the normal death toll of a single day. A bad flu year is much worse. South Korea is particularly relevant for many European countries because it is also rich, quite urban, well organised, and also has bad flu years (unlike Australia where flu and pneumonia are much less of a problem than in colder rich countries anyway). So South Korea offers an appealing, relevant, and replicable example to follow.

If one maintains the South Korean effort, one should basically expect no more than an ongoing death toll of about 0.0002% per month, essentially till a vaccine or another strategy/treatment emerges, which is quite possibly only 12 months from now. That is why so many countries are dabbling with these corona apps.

It does mean one has to copy the South Korean institutions around this: a very large, mobile, and intrusive test regime that can force the mobile parts of the population to get tested, and then to track their prior movements via their mobile phones to see who else might have been infected. This takes a while to set up and the intrusiveness may be less acceptable to some European countries than it is to South Koreans.

Also, one should bear in mind that the South Korean economy is being hit just as badly as the Western countries. They too are looking at over 10% additional unemployment, a GDP hit of close to 20%, and the almost total crash of the hospitality, tourism, business travel, and cultural sectors. Since the SK model comes without herd immunity, it basically cannot “open up” these sectors to their full prior extent.

So with the SK model one also extends the economic and social pain into the future. As I will show later on, the costs of doing so, however you want to put it (lives, healthy years, or happy years), far outweigh the benefits.

Then the herd immunity route. As hinted at before, one can do “stupid herd immunity” and one can do “smart herd immunity”. Stupid herd immunity could for instance be achieved very quickly by deliberately infecting the 70% healthiest part of the whole population. This can be done quickly by giving lots of people a nasal spray, but would probably have a rather large death toll as not everyone who seems healthy actually is all that healthy, and infecting people deliberately involves more risks than mild infection levels, which are often good enough to get an immune response.

Smart herd immunity can be achieved by actively encouraging the healthy part of the “high contact” part of the population to mingle in large crowds with each other, such as basically happens naturally in dense cities anyway. People know themselves whether they are high-contact people, but you could also target particular professions. They include the frequent fliers, the salesmen, the politicians, the sales people, the nurses, the police, market sellers, international and national students, etc. You basically can expose them to normal levels of the virus so that they get an immune response and no longer can get it later on. As a reward you can offer them an immunity passport with which they could travel. During this “quick spread” period, you would want these high-contact people to of course stay away from the truly vulnerable and preferably mainly mingle with other high-contact people.

We don’t know perfectly how many “should get it to achieve herd immunity” as the answer will vary by type of city and country, but Sweden and other places are suggesting the answer in big cities is at least 50% and in other places no more than perhaps 10%. That at least is my current best guess.

The expected death toll among those encouraged to get it would be minimal, probably well below 0.01%, which is a number based on the low death rates among prime-aged groups in Sweden, Germany, and elsewhere who have been found to be immune, often unaware they even had the disease. A high number would simply be the 0.05% found in Sweden already.

The option I am sketching is basically a “Sweden on steroids” scenario, where one tries to mimic the basic strategy and end-game of Sweden, but much quicker and with much less economic disruption than Sweden suffered. Btw, on the issue of economic disruption one should of course acknowledge that much of it is due to the reactions of individuals themselves rather than government choices, and that there are large economic spillovers between countries such that a region only has limited agency over its economic fate. That is why an anti-fear campaign and international cooperation matter.

However, if a smart herd immunity program is done successfully, the country as a whole can then return to normal life. You’d have a local outbreak now and then, just as with any infectious disease, and one might want new large groups of high-contact makers coming into the country, such as a new glut of international students, to be deliberately exposed when they come in, but otherwise life is lived as before. The corona virus would join the long list of other infectious diseases that now and then flare up but don’t make a lot of victims.

Whilst I think countries will tinker first with what looks like the South Korea option, I think the ongoing economic and social devastation inherent in that option will basically make them gradually move towards the herd immunity scenario.

Incidentally, I actually expect the United States to end up in roughly this herd immunity scenario also, though more out of incompetence at doing anything else than by design. The US too looks to me like it will hit herd immunity in many states and cities with an overall death toll below 0.05%, higher in the highly urban areas like New York and much lower in the warm spread out areas down South.

Unless a vaccine comes along the next 4 months or so (which is possible but unlikely), I think this is the scenario that will de facto be chosen by most countries, who will then also adopt the anti-fear narratives that come with it, essentially openly admitting the corona virus is not so dangerous after all.

Then some key numbers important for tradeoff calculations.

Important tradeoff-numbers: public services and WELLBYs, loneliness from lock downs, and cost of unemployment.

For one, we now know that the number of healthy life years (QALYs) of those dying from corona are probably between 3 and 6. Some journos think it is still above 10 years, because that is how long healthy people would still have to go on average if they died at the ages of the corona virus victims, but because of the high prevalence of multiple co-morbidities among the victims, this is just not the case. Whereas my initial guess based on the Italian data was that the corona victims had another 3 good years left, I would now revise that upwards to 4 as the most reasonable guess for the world as a whole, because the Italian victims were particularly frail. My best guess for why that is, is that Italy seems to have had people dying of corona who would have died of the flu in previous years had they lived in a place like the UK.

One years of a healthy life (=1 QALY) is 6 WELLBYs because a healthy life is spent with a life satisfaction of 8 and the level at which people are indifferent between living on another year or not is probably around 2. So the corona victims on average had another 24 WELLBY left. that is the loss one would count in a WELLBY approach of a corona virus victim.

Then public services. Crucially, the UK public service itself claims that 15,000 pounds spent on the National Health Service buys 1 QALY, ie 6 WELLBY. That claim is based on research into how costly it is to save people from cancer and other illnesses via chemo, operations, and other health services. I might add to this that the found “productivity” of health services is often found to be far higher than this. The introduction of GP services in Turkey for instance was easily ten times more productive than this. The WELLBY productivity of Obamacare was similarly found to be much higher than this.

So 15,000 pounds productions costs of 6 WELLBYs via health expenditure is not a crazy number but the simple reflection of how necessary government services are for maintaining a population with high health. And government is much better at this than the private sector, which is why the UK has a life expectancy of close to 82 which the US has one closer to 78 whilst the UK spends less than half on health than the US per person: the UK has a cheap government-provided service whereas the US has an expensive privately-provided one that forces lots of services on patients that they don’t need (like useless tests).

Now, the question is of course whether other government services are equally productive. If government spending was rational and based on where it did most good, the answer would be “yes, at least as productive”.

Indeed, we know that people who are higher educated look after their health better and that state education thus also buys health. We know that better roads, sewage works, clean water, clean air, and many other things that non-NHS government services pay for also buy a lot of health.

Importantly, even if the non-health expenditures of government were to buy no health directly at all and were merely there to “keep the place running”, one should still assign them the same marginal productivity as health expenses: if the place is not kept running, then by implication GDP and other tax-revenue-generating activity would come to a halt, basically leading to collapsing health services. So unless one buys into some notion of the idea that anything not directly spent on health is a total waste, one should credit non-health expenditure with the same marginal health benefit as health expenses.

In my initial calculations I thus took the argument seriously that government spending is roughly rational and the marginal health productivity of the NHS should be applied to all government expenses. So I argued that 15,000 pounds in government expenses buy 6 WELLBY in all areas of government expenses.

One can reasonably argue for other numbers, such as the often used number that it costs 30,000 pounds to buy 1 QALY and thus 6 WELLBY via life-saving medicines provided by pharmaceutical commpanies. Or one can use consumer willingness-to-pay numbers for 6 WELLBYs, which is basically 60,000 pounds (see the Handbook for Wellbeing Policy for references and details). Yet if one uses consumer willingness to pay, one should then apply it to all incomes, not just government incomes.

These numbers are crucial for getting a handle on how many lives and WELLBYs are lost with an economic depression: they capture the long-run relation between economic development and the length of life via government services. They do not capture the short-run relation because government expenses are often kept up artificially during recessions and many government expenses have very long-run continuing payoffs that do not change during a recession (like sewage, innoculations, clean water). So the “health costs” of a recession will be smeared out over decades. Some poorly-trained commentators seem to miss this entirely and stare blindly at the Ruhm papers which are about short-run relations. More informed studies acknowledge that the long-run relation between government spending and health is strongly and causally positive.

What this means is that a reduction in government expenditure by 4*15,000 pounds will probably in the long run cost the equivalent of a corona virus death. That is 60,000 pounds. Since government spends 40% of GDP, roughly speaking, that means a reduction in GDP by about 150,000 pounds will lead to the equivalent health loss of a corona virus death. If one wants to be conservative and use consumer willingness to pay, one would say that 240,000 pounds less in economic activity would count as a corona virus death. That’s about 300,000 US dollars or 450,000 AUS. And that’s the conversion rate in rich countries. In poor countries, where the average income is three times lower, the same economic contraction would cause three times more health damage.

This is a crucial conversion number because it means, for instance, that 1 trillion pounds less economic activity with have the long-run effect of a minimum of 4 million corona deaths, or 100 million WELLBY. Given how the recession in 2020-2021 alone is now expected to reduce the world economy by over 6 trillion pounds, that immediately gets you huge numbers of implied victims that dwarf the actual death tolls of the corona virus. The lost economic damage over the next ten years is much higher again as the lost productivity and jobs take a while to return (the long-term loss is easily a factor 5 of the loss in the next year). Even 10% more economic damage, which is what you’d at the minimum must expect if we’d continue with fractional lock downs or closed borders between countries for another year, would then be equal to 12 million corona deaths, higher than the 0.05% of the world population I calculated would be at risk in a smart herd immunity scenario. That would be 4 million corona deaths, and even that is, if we’re honest, a ridiculous over-estimate of the additional number of victims from a smart herd immunity strategy.

Another crucial WELLBY number is the effect of social isolation due to lock downs, which comes with depression, loneliness, and a sense of futility. I initially guessed this effect to be 0.25 WELLBY per year of social isolation based on the literature on how important social interactions were for wellbeing. We now have actual studies.

A recent Fujiwara study put the effect of the lock downs on the average member of the public at 0.8 WELLBY, essentially by looking at how strongly life-satisfaction declined over time in the UK before and after the lock downs. Yet he had to glue two datasets together because his post lock down data was gathered by a different company, and that is always tricky when it comes to wellbeing. Nevertheless, it’s a very large effect in line with the found effects of unemployment or a mild depression.

An even better estimate comes from the “State of Life” people who follow lots of groups in the UK over time as part of their business, which is to help thousands of small charities measure their WELLBY effects on vulnerable populations. They thus have the same survey design and measurement methods before and after lock downs, finding that the average effect is 0.4 WELLBY per year of lock down. Their number is particularly believable because they could distinguish between groups that kept on working (the “crucial sector” employees) and groups that were forced to stop working. They found no life satisfaction decrease in the group that kept on working, as their routines and their self-esteem hence kept intact, whilst they found a much higher effect amongst the groups forced out of work and sitting at home. Exactly as one expects, but also showing that the effect is truly of the lock downs and not merely of some general anxiety in the whole population.

This too is a crucial number because it means that per 1 million inhabitants, a 70% lock down (which is the UK variety: roughly 30% kept on working) causes a loss of 400,000 WELLBY per year. Per 20 million, that is 8 million WELLBY, or 1.33 million happy years of life, or 333,000 coronavirus deaths. That is an equivalent of about 28,000 corona virus deaths per month.

Because it applies to the social isolation that is time and place dependent, this is thus a crucial number for any scenario to do with marginal lock downs or smart tracking: it tells you what you should count as the general reduction in quality of life due to the stress and loneliness caused by forcing people to stay at home and keep their distance from other humans. It should be clear that this effect is so large as to make a mockery of any claim that lock downs were worth it or that any significant fraction of a lock down will be worth it in the future.

Finally, I should simply reiterate that a year in unemployment has long been found to cost around 0.7 WELLBY. That number comes from hundreds of studies looking at plant closures, unexpected unemployment, recessions, etc. So 100 million people unemployed for another year is worth 70 million WELLBY. You can convert that into QALYs and corona deaths.

 

In conclusion, with the numbers above you can build your own basic tradeoff calculation based on what you expect to happen in various economic and health policy scenarios.

6 post-Corona Institutional questions

Published by Anonymous (not verified) on Thu, 26/03/2020 - 11:34pm in

The mass hysteria of the corona crisis is raging, with the resulting self-isolation of whole economies and populations. The loss seems greater with every new forecast on the economic collapse than I initially thought, and the benefit of imprisoning and terrorizing the population smaller than I initially thought, leading courageous little Sweden to forego these options. High-level media and calm commentators are waking up to the longer-term implications, though the population is still too overcome by fear.

I want to share 6 areas where we should think of international institutional reform to prevent another hysteria like the one we are going through now. I don’t want to presume any answers but simply want to hear your thoughts and suggestions, so am merely laying out the challenges.

They are: i) How to diminish the normality of apocalyptic thinking, ii) How to read China better, iii) How to prevent international contagion of panic through social and regular media better, iv) How to reduce the fragility of international supply chains, v) How to foster better cooperation between countries in the EU, and vi) How to regain our lost freedom and reason.

Over the fold I explain them in more detail.

 

  1. The cult of the apocalypse. This crisis laid bare that large parts of the population and the scientific community, not just epidemiologists, have really bought into some notion of extreme emergencies for which a totalitarian response is needed. Via petitions and the media have these people loudly called for draconian measures, based on little evidence that this would work or no evidence that it would do more good than bad. The world has up till now shrugged its shoulders over the various doom scenarios dreamed up by scientists, including “extinction due to climate change”, “killer asteroids”, “nuclear devastation”, “run-away robots”, and a whole host of other scenarios you might recognise from disaster movies. This time the population went along with one such story, leading to devastating losses as the ‘cure’ turned out to be far more deadly and destructive than ‘the problem’. How do we reduce the prevalence and growth of these doomsday cults?
  2. Understanding China. The Chinese government showed the world the example of how to be totalitarian about a disease, and their example proved infectious. Understanding in the West as to why the Chinese did this was extremely limited, but we looked up to them anyway and several governments simply followed their example. We need to learn how China truly operates and stop imagining they are like us. The Chinese have a long history of disastrous totalitarian projects, like the Great Leap Forward or the Cultural Revolution, and we should learn why they do this, in order to avoid following their example, not copy them.
  3. Contagion of panics via social media and the regular media. This was first and foremost the biggest mass hysteria event in history, fed by a connected media. Even in India, which is far too warm for this virus to do much damage and where there are hence almost no recorded cases, the population has become scared enough to loudly call for draconian measures, leading to the madness of locking down hundreds of millions of extremely poor people who have no savings and no income to buy food. We need to think hard about how to make contagion of these panics harder and slower, not just for pandemics but also the many other global fears (financial, military, ethnic, religious). This will require thinking about the architecture of media, the internet, mobile telephony, etc. It is not easy to see what can be done.
  4. The fragility of international supply chains. The huge recessions of 1929 in the West, and 1990 in Eastern Europe taught us that broken supply chains are very hard to rebuild in a hurry. Companies and industries make very particular investments that form a link, and if some of the pieces in the chain break, the whole chain cannot function, disbands, and very quickly loses the knowledge to re-form as parts go their separate ways[1]. We should think of what we could do to make the supply chains less fragile to disruption: how do we build more slack into the system?
  5. International cooperation. As Harari pointed out in the Financial Times, international cooperation has broken down during this crisis. Even in the EU, countries went their own way, not caring about the disruption to partners of their own actions. This is also what happened in 1929 and in Eastern Europe in 1990, to the loss of all. We have learned again that only nation states remain cohesive and take collective decisions. What to do about it?
  6. How to regain respect for freedom, privacy, own reason, the fallability of expert advice, etc.? This hysteria has cost the West, which is the audience we on this blog overwhelmingly belong to, much of the best we had to offer the world. For the sake of fear have we loudly demanded totalitarianism, invasive top-down monitoring, top-down rules on who is important and who should do what, and adopted the fantasies of experts who had no more idea about the balance of the effects of what they proposed than anyone else. How to regain and more stringently hold on to our ideals and our reason?

I have preliminary suggestions on these but want to hear your thoughts. Also importantly, what other international institutional challenges do you see needing to be addressed once this hysteria passes and the West wakes up to the loss it has inflicted on itself?

[1Because this stuff is too hard to put in an easy macro-model (though you can do it in micro models, see here), mainstream economics hasnt managed to incorporate these lessons into its canon and has thus once again missed the importance of this when the crisis hit.]

It is 1984. A message from London.

Published by Anonymous (not verified) on Wed, 25/03/2020 - 12:01am in

People shuffling in the street, afraid to look others in the eye, get close, and be accused.

Fear as a silent ghost hovering above the city, watching us, like drones.

The panic in the eye of the mother as her little toddler cycles by an older woman on the street, too close.

The glee of the neighbourhood bully as she shouts at a couple embracing in the park, taking pictures with her phone.

The stern voice of the expert on the news who has discovered yet 5 more reason for why he was right last week.

The bombast of the politician who sheepishly looks through our screens, almost apologetic at introducing more restrictions and for what his experts are urging. Fines. GPS tracking. A gulag for the unwilling.

The desperation of the black teenager shouting abuse at himself on the street, echoing the words shouted at him at home where they are cooped up with 10 in a small apartment.

The shame in the eyes of the men who have no jobs and little savings.

The gratitude in the eye of the middle aged woman as someone returns her smile on the street, acknowledging she exists.

A beautiful day in which the first stirrings of spring can be seen: cherry blossoms.

The Corona Dilemma.

Published by Anonymous (not verified) on Sun, 22/03/2020 - 1:31am in

Consider the shown picture where you are the decision maker who can pull the lever of the train tracks to avoid the coming train from going straight. If you do not divert the train, one person, John, will get run over. He is elderly and suffering from many diseases. You know him personally and all his friends and family are watching you. They are all shouting at you to divert the train, claiming it is the moral and safe thing to do. You know that if you do not pull the lever, your life in the society you live in is over.

If you pull the lever, the diverted train will run over 50 random people from all over the world as the train drives through them, including people in your own country. Yet these people and their friends won’t know where the train came from that hit them.

What do you do?

And more importantly, because it is obvious what anyone with a modicum of self-preservation would do, what institutions can you think of that would lead to a different choice?

Over the fold I enumerate why I think this is roughly the tradeoff that has faced humanity over the coronavirus, where the options represent letting the virus rage unchecked (the train drives streight) or put whole countries into isolation, destroying many international industries and thus affecting the livelihoods of billions, which through reduced government services and general prosperity will cost tens of millions of lives (the diverted train).

If you don’t like my back-of-the-envelope numbers please provide an honest alternative numerical assessment: anyone can quibble with numbers of others but it only becomes a discussion if you give a reasonable counter-estimate.

Many believe we are currently saving tens of millions of lives via our response relative to taking no drastic actions. When pressed, some say the fatality rate of “letting it rage” could be 5%, which is then used to say we are saving 200 million people. Some even claim that the deaths from coronavirus would seriously disrupt the workforce and thereby the economy.

Let’s take the last issue before we address the question of death rates.

The fact that deaths in the working age population from a pandemic can have effects on the economy is well-established. The Spanish Influenza that wiped out maybe 50 million people in 1918-1920 had a large effect on the world economy because it took out so many healthy people aged 18-40.

What do we know about the fatalities from the corona virus?

The Italian statistics just released are probably the most comprehensive to date. As a new report of March 17th (https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf) showed, some 99% of the younger cases of coronavirus deaths were among people with pre-existing serious conditions. Furthermore, the average age of those who died was about 80.

It should be clear that people aged 80 with other serious conditions are not a significant fraction of the workforce.

Then the death toll of the virus in a “do nothing” scenario. Some use the figure of 5% death rates as the high-end estimate, for which one could cite World Health Organisation numbers.

The 5%  is just highly misleading. None of the modelling experts expects anything like that.

The 5% is the high-end estimate of the death rate among individuals diagnosed with the virus. Yet, in most places, including the UK, only the very serious cases get diagnosed at all. Moreover, there are “silent spreaders”: people running around who have or had the virus without knowing it, having very mild symptoms or none. That number is very hard to know as our only estimates are model derived, but for every diagnosed case there could easily be 5 or 10 people running around who have it and never will know they had it (unless randomly tested). Researchers are trying to find this number now by looking at how many people have antibodies rather than whether someone is ill.

So my own best-guess for the total fatality rate for the coronavirus should the whole population get exposed is 0.2%. That corresponds to the death rate on the “Diamond Princess”, a cruise ship with over 3700 people on it that got quarantined in Japan for a month when cases were found. All on board were probably exposed, a bit over 700 on that ship were found to be infected, and only 8 died. This suggests only 1 in 5 have it long enough to be detected and even among those detected via frequent testing (which will give you a much higher number of cases than in one-off random testing) only a little over 1% dies. *

One might object that a cruiseship like the Diamond Princess wont have the most unhealthy people on it, but then one should also say its passengers will be much older on average.  Since every year 1-2% of the population die, 0.2% is basically the death toll of 2 months.

These reasons are also why the measured death rate differs so much between countries: in South Korea, where they did a lot of random testing and hence picked up more of the very mild cases, the death rate was 1%. The current death rate in Germany is only 0.3%, again probably due to huge random testing. In Italy and Spain, where only the more serious cases ever made it to a test, the rate is 5% or over. Other differences are the structure of the population, with more old individuals in Italy than in, say, Wuhan. And of course, it is the case that good medical care reduces fatalities, or should we say, postpones fatalities to a later date.

Indeed, it has also been reported that in Italy only 12% of the death certificates claim direct causation by coronavirus (rather than being “one of the causes”). So even in Italy on closer inspection the fatality rate among identified cases is probably not much higher than 1%.

This is probably also why the actual numbers of deaths are so low relative to other major diseases or natural causes. Every day in the world, 3,000 people die of traffic accidents and maybe half a million people die from old age and other causes. The worldwide death toll of corona is even now no higher than a thousand per day, or 0.2% of the usual human death toll per day.[1] Even in Italy, the corona virus fatalities (when properly measured) are dwarfed by the 2,000 or so “normal deaths” per day.

Failing to put corona deaths in such a context is part of the cause of the panic. Not just newspapers are guilty of this, also many health advisers and professionals who are not keeping a cool head. One needs to give reasonable middle-of-the-road estimates for how many people would die. People who claim 200 million might die from the virus choose the route of hyperbole. Not helpful, not safe, and not based on evidence.

Even reasonable death tolls from the virus are misleading because of the fact that the corona virus deaths are so heavily concentrated among individuals with very little remaining life left. Like the UK health system, that openly adopts QALYs (Quality adjusted life years) as the thing it cares about, we should look at “whole lives lost”, or “years of life lost”.

You’d need a good model to do this properly, but I can make a reasoned guess. Since life expectancy in Italy is 83 and the average age of death is 80, a simple rule of thumb would have it those who died had 3 more years left on average. This is obviously not a proper calculation[1], but I don’t think it will be far off given how even among the old, it’s the relatively unhealthy that died. Indeed, if we’d adjust for the quality of life, 3 more normal years is a generous assumption.

So with these basic numbers in mind, let’s work out the likely tradeoffs being made on the corona virus, where the scenarios would be “no containment response whatsoever” (let the train roll) versus the reaction we have had.

Even if no containment would mean there are 200 million deaths from this virus, that would cost the average world citizen 0.08 years of life, which is 600 million years of life lost divided by the world population of 7.7 billion people.

If the economic damage from the panic and disruption caused by taking this virus so seriously via economic self-isolation costs 50 million whole lives, the average of the world under that scenario loses 0.5 year of life (6 months). Under a more reasonable estimate of 0.2% total mortality rate of “do nothing”, we’d be talking about 15 million death, or 0.007 years of life of the average human.

So if I compare my best-guess estimates, then the loss of life of “do nothing” would have been 0.007 (2 and a half days per human) and the cost of our actual response equals 0.5 (6 months). That is a ratio of 1:70 in terms of length of life. Diverting the train to save John costs a whole village.

But even taking the wilder estimates around of the loss of do-nothing, the expected loss of life from the economic panic dwarfs the loss of life in the worst-case-scenario.

This really does raise the question what else we could have done and how to do things next time. I understand the extreme stress of doing nothing as the train hurtles towards a loved one, but for humanity as I whole I believe our panicked response has been disastrous. We have lost perspective on the damage we are doing whilst staring at something closer by.

So the issue is whether there was a middle way and what structures we need to make it politically feasible next time around to take that middle way.

 

[*] Update 21/4 Of course more passengers died since, as you’d expect from a boat with 3700 old people, muddying the water on what can be learned with later data from that ship. However, there is more research coming in on the likely death rate if the whole population were exposed. A recent German paper put the death rate at 0.37% based on finding that for every positively tested person there were 7 times more with antibodies. Yet, given how the more frail are probably also more exposed (see the Ionnanidis video John Walker linked to in the comments), and that there seem to be people who are not “infectable” anyway (the very young), the 0.37% is still an overestimate. Relevantly, a recent Standford study puts the death rate between 0.12% and 0.2%, essentially based on antibody findings in random samples in the US. So 0.2% is still looking like the right middle-of-the-road estimate of the more contemplative studies].

[1] Yes, there is a difference between life expectancy at birth and conditional on being a certain age, so I am taking an extreme short-cut to a much more complicated modelling issue (I have estimated duration models on mortality and taught them to PhDs). Still, the implicit argument that those who died had another 3 years to live on average seems rather generous if you look at the Italian data. [UPDATE 21/04: Andrew Briggs kindly provided a simple excel tool based on UK life tables to calculate the average number of lost QALYs if one knows the age and comorbidity distribution of the victims (which he doesnt quite have: he has the age distribution). He shows the QALY loss given the current age distribution of victims in the UK is between 2.25 (if there are strong co-morbidities) and 4.90 (few comorbidities). Given the high prevalence of co-morbidities, my initial eye-balled guess of 3 QALY loss per death is still looking reasonable.]

 

Independent Bookstores and Local Shops

Published by Anonymous (not verified) on Fri, 20/03/2020 - 1:17am in

Tags 

Books, Books, life

Worried about your local independent bookstore surviving the shelter-in-place orders, curfews, and social distancing of the COVID-19 pandemic?


[art by Jonathan Wolstenholme]

David Velleman (Johns Hopkins) suggests that people consider buying books from—and listing their own books on— Bookshop.org. He writes:

This site enables independent bookstores to set up their own sites within the bookshop.org domain, with all fulfillment functions performed by a third party; and in addition to the returns the bookstores earn from their bookshop.org sites, they share in a pool of returns earned by the central site. If your book its not yet available on bookshop.org, you can become an affiliate and list the book on your own sales site. You will then earn a share of the sales, but if you already link to your books on Amazon from your personal home page, you can switch those links to bookshop.org and format them in such a way that the earnings will go to your local independent bookstore instead, if they are also affiliates. (The format is https://bookshop.org/a/xxxx/yyyyyyyyyyyyy where xxxx is the bookshop.org affiliate number of the store and yyyyyyyyyyyyy is the ISBN-13 number of the book.)

As for other shops and restaurants, in addition to patronizing them now in their modified forms—many restaurants have switched to takeout only, and many shops are offering at least curbside (drive-up) service—one suggestion is to purchase gift certificates now for use later. If you can’t get in touch with the shops or restaurants directly about this, they may be making use of Kabbage, a service through which businesses can sell gift certificates online and anyone can purchase them.

I understand how it can seem silly to worry about the possible permanent closure of your favorite local shops and restaurants owing to a disease that may kill millions, but keep in mind that if these businesses close for good, that means employers and owners lose their livelihoods, and people become more vulnerable.

The post Independent Bookstores and Local Shops appeared first on Daily Nous.

Churchill’s children: the rise of the privileged Marketeers in Anglo-Land

Published by Anonymous (not verified) on Wed, 18/12/2019 - 2:08am in

For almost a century the royal road to becoming a top politician in Anglo-Land was to study law and/or a bit of economics. In Australia that was the ticket for Keating, Hawke, Gillard, Howard, and Turnbull. In the US, that mold fit Obama (law), Clinton (law), and both GHW and GH Bush (one studied economics, the other business). In the UK, the royal road is recognised to be the PPE (Philosophy, Politics and Economics) study in Oxford, which for instance begat Cameron and several other prime-ministers since WWII.

Yet, currently, we have marketeers in charge of the most populous Anglo-countries. They are invariably men who have spent their working lives engaged in selling ideas and themselves to the general public. In Australia we have Scott Morrison, a marketing man, and before him Tony Abbott, a journo. In the US we of course have Trump, who spent decades in showbiz. I include Justin Trudeau of Canada in this list because I regard him as a born marketeer. And in the UK we now have Bojo, a journo for many years who is also, like Trudeau, a lifelong and natural self-promoter.

This is a bit much for coincidence. Politicians have always had to sell themselves, but in previous decades it was the marketing departments of political parties that helped them do it. Margaret Thatcher was famously re-dressed and re-branded to make her electable, and the Bushes had a lot of professional help in selling them. What is interesting is that now the top people themselves are marketeers. Any other skill or interest other than how to sell stuff seems a burden when it comes to reaching the top of the political tree.

Can we say the same for top politicians outside of Anglo-Land? Not really. One might at a stretch include Berlusconi, who is in many ways Trump’s predecessor but with more panache. Yet, if you look closely you will find that all the major countries are run by the usual types: Macron of France studied public administration and was in charge of a ministry; Merkel of Germany is an engineer-administrator with a similar trajectory as Thatcher; Modi of India did political science and then became a professional pollie; Jiping of China is the usual engineer-administrator normal for Chinese leaders; Putin is the usual for Russia (secret service); and Bolsonaro of Brasil is the usual for that region (military). Even Berlusconi turns out to have started with a degree in Law, the usual for Italian politicians before and after him.

So no, the non-Anglo countries do not get their politicians from the world of marketing, not even in those places we associate with populism or right-wing nationalist politics. In the rest of the world, politicians still come from the same place they came from 20 or 50 years ago. Anglo-Land has changed with the rise of the marketeers.

What is equally interesting is that really, tree of these seem to have had to reform the way politics was done in their own party and have pushed policies their parties disliked: they were resisted internally and had to force their parties into new ways. This makes their rise to power even more impressive because they will have been told constantly how wrong they were and how obviously their attempts at gaining power would fail.

Trump’s constant critics in the media and within the Republican Party are famous. Bojo argued for Brexit against the top of his own party, then once in charge kicked out his rivals from within the party, notably alienated his own brother, and was famously unpopular and disliked by the vast majority of his own parliamentary party when he was voted in by his MPs. Morrison had to battle Dutton and others for supremacy within, and was then written-off by the Labour supporters and their friends in the media till his stunning single-handed victory. In all three cases did their party insiders only grudgingly accept them as leaders in the belief they had to in order to have a chance of retaining power.

They also had professional or political careers outside of the center of their party: Boris was first major of London and then had to work his way up in the parliamentary party; Morrison was a tourism manager for many years; and we all know the stories of what the Donald was up to before politics, even trying to get into the other party first.

What is it about Anglo-Land currently that makes marketing men so electable now and not before, to the extent that these characters can make it even against the wishes of their own party? Maybe we should have a look for clues in history and find someone similar who rose to power, looking at the characteristics of that time.

I think it is not coincidental that Boris Johnson is such an admirer of Churchill, because really, all four of these men are children of Winston Churchill. Their previous careers, rise to power, and even their alleged inadequacies are close copies of Churchill.

Churchill was also a journo, a child from the elites with huge charisma who milked his journalistic experiences in the Boer War in South Africa in 1899 to great effect in order to get into parliament. There, he made sure he was constantly in the news, even switching political parties when it was convenient to him. Twice no less, earning him a lifelong reputation as a ‘rat’, a disloyal liar!

He was also a famous womaniser and drug addict, playing with the institutions of his country with total disregard for expertise or loss of life to others. Sound familiar? By the standards of today you would have to call Churchill corrupt, racist, and a war-mongerer (see here: https://www.bbc.co.uk/news/magazine-29701767). Again, sound familiar? Amongs the policy disasters that have been laid at the feet of Churchill one can include the disastrous campaign of the Dardanelles and even the loss of the British Empire, though of course people disagree about this and this is not the place to argue either way.

My own English grandparents, who were conservatives their whole lives, thought Churchill was one of the biggest idiots in British political history (a title for which there is stiff competition!) and the biggest disaster to its standing in the world. They had to bite their tongue for decades as their country decided Winston was a hero, not an unmitigated disaster. But even my grandparents recognised he was someone who had the gift of projecting authenticity: a wonderful speech writer, quick witted and charismatic. He was a gifted marketeer and a magnet for romantic nationalists, just like Trump, Boris, Scott, and arguably even Trudeau.

So really, we are seeing the return of Churchill. It is almost as if the spirit of Churchill has infested four different men of different ages in Anglo-Land, each managing to grab power at almost the same time. Each has a bit more of this talent  and a bit less of that talent than Churchill, but with essentially similar skills.

It is tempting to conjecture that our times, at least in Anglo-Land, must resemble the time and place in which Winston rose, which was the UK of 1900-1910.

What are the similarities between 1900-1910 UK and Anglo-Land now? In 1900-1910 the UK was at the height of its colonial powers, a period of rising nationalism. It was also the time of impending loss of power as the UK was economically already overtaken by the US and, arguably, Germany, with Russia well on its way too. It was a period of immense inequality, with previous elites (the aristocracy that controlled land) feeling the hot breath of new ones in their neck (industrialists that controlled labour). It was an era used to violence and used to solving international problems with gunships.

Is our time really like this? Some bits seem similar, some not. The times are not violent at all now and the indicators we have of support levels of nationalism have been very stable for decades. What is true is that geopolitical power is being challenged by the newcomers, China and India. Inequality has also increased, though the big increase already dates back well over a decade now.

Still, then the UK was shoring up ties with France, not breaking up with France as the UK is doing now. The Labour movement challenging wealth then was up and coming, whereas now it is weak and waning.

Conversely, the 1900-1910 period in the UK had no Murdoch media, no social media, no analogue migration issues, and an even less educated and informed voting public.

The analogy with the 1930s is similarly poor, not merely because the usual politicians were in charge then of Anglo-Land (with Churchill somewhat sidelined, only to be dug up after the outbreak of the War). We are now not in the aftermath of a huge recession, but enjoying record levels of low unemployment in the UK and Australia. There are no colonial empires to lose. And there is no obvious ‘embedded elite’ that is fighting a battle with rising socialism, certainly not in Australia or Canada.

So what is going on? Why are the marketeers now again so in vogue? And why only in Anglo-Land? What are their skills that were undervalued by the existing party machineries and why are those skills so much more important now than before? Essentially: why has Churchill returned?

I have many ideas, but none that really convince me. It’s a puzzle. Maybe it’s just a coincidence and the analogy is less good than it seems. Maybe Churchill was a one-off marketing genius who was going to make it in politics in any era and we should not look at his career for clues why we currently have so many lookalikes in Anglo-Land. Any good ideas?

FRIGHT Friday - Stretched to Breaking Point

Published by Anonymous (not verified) on Tue, 13/12/2016 - 1:20am in

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Dan Holloway gives a talk for the FRIGHT Friday series of talks, held in the Ashmolean Museum on 25th November 2016.

FRIGHT Friday - Parenting, Fear, Hope and Salvation

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Dr Joshua Hordern gives a talk for the FRIGHT Friday series of talks, held in the Ashmolean Museum on 25th November 2016.

FRIGHT Friday - Embodying Life and Death

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Professor Cathy Morgan gives a talk for the FRIGHT Friday series of talks, held in the Ashmolean Museum on 25th November 2016.