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Canadian doctor Joffe MD on the negative effects of covid-19 responses

Published by Anonymous (not verified) on Fri, 23/10/2020 - 8:01pm in

Dr. Joffe just posted a new article on the many negative effects of lockdowns in Canada and in the world as a whole. He really has put in a fantastic effort to source the evidence on the negative effects of the covid-related policies, digging up and critically evaluating nearly 200 international studies. Here is his Table 2 (out of 8).

Highly recommended as a summary document of the masses of evidence now rolling in on the unnecessary self-inflicted disaster that is befalling humanity. The link is https://www.preprints.org/manuscript/202010.0330/v1

After The Donald, The Deluge?

Published by Anonymous (not verified) on Wed, 14/10/2020 - 12:12am in

French Revolution Series Ordered at Netflix - ComingSoon.net

           Joe Biden enjoys a double-digit lead over the incumbent president because he promises a return to normalcy—not the platonic ideal of objective normalcy in a country that doesn’t torture or spy on its citizens or let them starve because their coding chops are a few years out of date. Americans desperately want to resume “normal” political life as Americans knew it before the last four years of manic presidential tweetstorms, authoritarian strongman antics and pandemic pandemonium. As Michigan voter Katybeth Davis told The Guardian, “I just want it [the Trump presidency] to be over with. I really do.”

            Be careful what you wish for. Things could get even crazier under Biden.

            Even though it’s only a few weeks away, I am hesitant to call the election. Biden has a huge lead in the polls but Trump has an ace in the hole: an unprecedented volume of mail-in ballots due to the COVID pandemic, which will run predominantly Democratic and provide attractive targets for Republican attorneys to drag out state vote counts past the December 14th electoral college certification deadline, which would trigger the obscure 12th Amendment scenario in which 50 states each get one vote for president in the next House of Representatives, in which case Trump wins even if Biden wins the popular vote by a lot.

            But let’s assume Biden prevails. Let’s say it’s a blue wave election and the Democrats expand their majority in the House and take control of the Senate. What happens next? Revolution, maybe.

            Revolution would certainly be likelier under Biden than under Trump.

            One of history’s least-discussed ironies is a counterintuitive pattern: it is not the vicious tyrants who are overthrown by angry mobs, but well-meaning liberal reformers who promise to fix a broken system and fall short of expectations.

            A Biden Administration will face several daunting existential challenges. Unlike Obama, whose high approval rating at inauguration prolonged his political honeymoon into his second year, Biden will enjoy little to no support from Republican voters or elected representatives. Progressives will pressure him from the left. Worse, Biden will inherit problems that have been neglected or exacerbated for so long that no solution will be able to come fast enough.

A president who will have achieved victory by campaigning against his predecessor’s mishandling of the coronavirus pandemic will be expected to quickly turn around the ongoing medical and economic disasters with lightning quick results. Like Obama, Biden has promised to add a “public option” to the Affordable Care Act; he’ll need to do that right away. That’s only the beginning: the ACA will collapse unless Congress vastly increases premium subsidies to middle-class patients and orders Medicaid expansion nationally.

The $600-a-week supplemental unemployment benefits that both parties allowed to expire during the summer will have to be replaced in some form. There will need to be meaningful broad-based relief for distressed renters and homeowners facing eviction or foreclosure; without an infusion of cash millions of people who formerly belonged to the middle and working classes will become homeless, adding to social and political instability. Billions will have to be pumped into the economy in the form of direct stimulus checks to every man, woman and child. The alternative is economic collapse.

The presidency, of course, is about more than policy. Many Americans who believed in exceptionalism a few years ago are wondering aloud whether the U.S. is literally over and done. During times of crisis, leaders are called upon to reassure citizens that a wise and steady hand is at the helm and that a team of intelligent and innovative advisors is running the show behind the scenes.

Can Biden deliver? On most fronts, probably not.

The Democratic Party is too beholden to its corporate donors to enact the FDR-style stimulus and social programs that are required to dig out of an economic hole filled with tens of millions of newly unemployed workers and where one out of five businesses have gone broke. Biden comes out of the Clinton/Obama/Democratic Leadership Council austerity wing of his party. His instinct will be to spend as little as possible in order to try to balance the budget.

“When we get in, the pantry is going to be bare,” says Ted Kaufman, who will run the transition office that will select Biden’s top personnel. “When you see what Trump’s done to the deficit…forget about COVID-19, all the deficits that he built with the incredible tax cuts. So we’re going to be limited.” Kaufman, a former Delaware senator, promises that Biden won’t significantly increase federal spending.

The streets are already seething. Austerity will bring things to a boil.

Political suicide by fiscal means.

The Soviet Union didn’t collapse under Josef Stalin. It couldn’t have. He would have ruthlessly crushed any meaningful opposition. Nikita Khrushchev and Leonid Brezhnev presided over graduated liberalization but it was under Mikhail Gorbachev, architect of perestroika, that the USSR went out of business. Gorbachev, arguably the best, brightest and most decent premier the Soviet system could allow to come to power and the best the Russian people could hope for, failed to deliver the improvements in living standards and personal freedoms people wanted and needed. It was precisely the fact that he was so excellent, yet couldn’t deliver, that exposed the corruption and incompetence inherent to the system.

Neither Khrushchev nor Brezhnev nor Gorbachev were the problem. The system itself was. It had to go.

Similarly, the French Revolution couldn’t have succeeded under Louis XIV; the Sun King was too brutal and autocratic. Louis XVI attempted numerous reforms to make life better for the French, including the free distribution of grain, slashing the royal budget and the abolition of torture and servitude. He granted equal rights to Jews and Protestants, tried to tax the nobility (they refused) and began a transition toward parliamentary monarchy as in Great Britain. But the reforms were insufficient, internal forces were intransigent and resentments had built up for too long. The French were hungry and angry so Louis XVI lost his head to the guillotine.

So it went in Russia. Although Czar Nicholas II was a bit of a clueless dolt, he recognized the crisis and desperately tried to save a collapsing system. He introduced civil liberties, worked to increase literacy, granted representation to local districts throughout the country and modernized the empire’s infrastructure. Again, it wasn’t enough. He destroyed the economy by squandering the treasury on wars of choice, refused to consider democratization and ultimately succumbed to the resistance of shortsighted Russian aristocrats. Lenin and the Bolsheviks had long argued that the Russian government was corrupt and unwilling to provide for the needs of the people. Only when Nicholas II’s reforms proved to be too little too late did they agree and rise up.

Like Gorbachev, Louis XVI and Nicholas II, President Biden will disappoint at the worst possible time.

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Political Suicide: The Fight for the Soul of the Democratic Party.” You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

 

 

The post After The Donald, The Deluge? first appeared on Ted Rall's Rallblog.

The Great Barrington Declaration?

Published by Anonymous (not verified) on Wed, 07/10/2020 - 2:14am in

A group of senior medical scientists have gotten together to pen an open petition to governments and society, calling for a herd immunity approach to the coronavirus. Signatories already include over 3000 “Medical & Public Health Scientists”, 4000 “Medical Practitioners”, and 60,000 others not in those categories. That’s pretty good in these times of strong adverse media headwinds.

As I too have been here on Troppo, the organisers of that petition are deeply worried about the damage that the lockdowns and other anti-social measures are doing to children, students, the poor, the developing world, the elderly, and everyone else. Their key quotes on policy are

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.

where I want to heartily cheer the phrase “most compassionate approach”. It is exactly that. This approach means

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.

which is pretty much what many Australian residents called for in our June letter to governments. There are small things I do not agree with in the letter, but on the general message I am in agreement so have signed it. The strong should accept the burden of gaining high degrees of immunity so that the vulnerable run less risk when leading a normal life. We should indeed encourage and celebrate high covid infection rates among the young and healthy.

Do sign the petition to show your support.

Back to Normal

Published by Anonymous (not verified) on Wed, 30/09/2020 - 4:28pm in

One of the more persuasive arguments in favor of supporting Joe Biden is that things would go back to normal after Donald Trump leaves office. For those of us who remember what normal was, and is, that’s not necessarily appealing.

Professor Foster’s cost-benefit analysis for the Victorian parliament.

Published by Anonymous (not verified) on Thu, 20/08/2020 - 9:15pm in

[below the exact text (with different font/highlight) as Gigi Foster’s submission to the Victorian parliamentary library in mid-August here. To see her health-related notes, including on topics like non-linearities and Sweden, see here, and to see all documents of that inquiry, see here. I helped write some of this and largely agree. So this is the place you can raise objections and suggest additions.]

Cost-Benefit Analysis Executive Summary.

NOTE: The analysis presented here is based on only a partial accounting of the costs of lockdowns. A comprehensive cost-benefit analysis should factor in many additional costs, as detailed below (see “Other costs not tabulated explicitly here, but that should count in the government’s calculus”).

For all of Australia, the minimum cost of a month’s worth of wholesale lockdown is estimated at 110,495 QALYs. This includes:

83,333 QALYs lost due to reduced wellbeing in the immediate term [2 million QALYs lost per year divided by 12 (to recover QALYs lost per month) divided by 2 (to attribute only half of this reduction to lockdowns per se)]

25,812 QALYs lost due to reductions in economic activity directly attributable to government restrictions

600 QALYs lost due to increased suicides during lockdowns

750 QALYs lost in the form of foregone wages of children suffering disrupted schooling during lockdowns.

For all of Australia, the estimated benefit of locking down “ad infinitum” (not only per month) is 50,000 QALYs.

Hence the minimum cost *per six weeks* of wholesale lockdown is at least three times greater than the benefit in terms of Covid-related welfare that could potentially be saved *in total* by wholesale lockdown. For Victoria alone, simply multiply both costs and benefits by the fraction of the Australian population resident in Victoria.

Costs

Mental stress. Mental stress associated with being locked away from the broader social sphere captures one dimension of the impact of increased domestic violence risk, anxiety about the future, loss of contact with friends and family, concerns about financial and health security, increased unemployment, loneliness and so on that are either caused directly by or further fuelled by wholesale lockdowns.

Assume that life satisfaction of Australians is 0.5 points (on the typical 0-to-10-point scale) lower than usual on average during wholesale lockdown (sources: Clark et al 2018, UK Office of National Statistics).

0.5 multiplied by the Australian population (25 million) = 12,500,000 WELLBYs sacrificed per year of lockdown.

One year of average healthy life in Australia equates to approximately 6 WELLBYs (6 WELLBYs equals one QALY), so the human cost of this increased mental stress is equivalent to the sacrifice of 12,500,000/6 = slightly over 2 million average healthy life-years (QALYs) sacrificed per year of lockdown.

How many full lives is this worth? A full life is assumed to be 80 years of average healthy life, hence 2,000,000/80 = 26,000 full lives lost per year of lockdown.

This translates to 26,000/12 = 2,170 full lives lost in each month of wholesale lockdown due to declines in wellbeing. Recognising that an average Covid death represents a sacrifice of 5 remaining healthy life-years (QALYs) (equivalent to 30 WELLBYs), 173,000 healthy life years represents the equivalent of approximately 34,600 Covid deaths sacrificed in each month of wholesale lockdown due to declines in wellbeing.

If we assume conservatively that only half of this figure is attributable to the lockdowns per se, then each month of wholesale lockdown causes the destruction of 17,300 lives of the type typically lostdue to Covid.

Reductions in GDP. Falls in GDP mean falls in both public and private spending that would have translated into more human welfare this year, and continued lagging of GDP in future years, until we catch up to where we would have been in the absence of Covid.

Assume that half the projected loss to Australian GDP is due to the lockdowns per se (see Appendix for full argument). Present projections of GDP falls, coupled with a conservative assumption that only government expenditure, not private expenditure, buys welfare, the minimum projected loss per month of lockdowns is estimated at 25,812 QALYs, or 5,162 lives of the type typically lost due to Covid.

Violence. When mental stress becomes extreme, suicides and domestic violence can be the result.

Lifeline (https://www.lifeline.org.au/resources/data-and-statistics/) reports that there are 8 suicides per day on average in normal times. Professor Ian Hickie, co-director of the Brain and Mind Centre at the University of Sydney, says suicides are expected to rise 25% over the next five years (https://www.news.com.au/lifestyle/health/health-problems/the-silent-deat...).

Assuming that the increase in suicides due to wholesale lockdowns per se is only 10% from the baseline level of 8 per day, this translates to an additional 24 suicides per month directly attributable to lockdown. Suicide typically claims people far younger (average age 44) than those claimed by Covid-19. Assuming that the average person lost to suicide has 25 healthy life years remaining (as compared to 5 healthy life years for an average person lost to Covid), each month of wholesale lockdown is estimated to produce (24 x 25)/5 =)120 lives lost of the type typically lost to Covid, from suicide. This equates to 120x 5 = 600 QALYs lost per month.

Further studies about the link between the Covid crisis and suicide are available here: https://lifeinmind.org.au/research/australian-covid-19-suicide-research/...

Losses due to schooling disruptions. When children stay home from school, their learning suffers and their parents’ productivity suffers.

Looking only at the cost of children’s online rather than face-to-face learning in terms of foregone wages, I have estimated a conservative future cost of $75 million in a peer-reviewed paper recently accepted to the Australian Journal of Labour Economics. Assuming a high willingness-to-pay of $100,000 per QALY, this cost represents the cost of saving 750 QALYs, or (recalling that a Covid death on average represents a sacrifice of 5 QALYs) 150 lives lost of the type typically lost to Covid, in the form of foregone wages of children who have suffered disrupted schooling during lockdowns.

Other costs not tabulated explicitly here, but that should count in the government’s calculus

Increased non-lethal self-harm during lockdowns

Increased (lethal and non-lethal) domestic violence during lockdowns

Reduced worker productivity during lockdowns

Crowded-out healthcare during lockdowns (missed cancer screenings, stroke treatments, surgeries, etc) resulting in more deaths and suffering of non-Covid causes

IVF babies not born due to the inability to attend fertility treatments during lockdown, and age-based expiration of fertility opportunities during the wait

The negative effects now and in future years of bad habits inculcated during lockdowns in both children (less play, less outside time, less sociability, less health, more fear) and workers (less productivity, less health,and less motivation)

Increased mental stress, self-harm, and violence in future months when people face higher unemployment created by the lockdowns (https://www.bloomberg.com/news/articles/2020-07-13/australia-s-effective..., Clark et al 2018), including the decade-long “scarring effect” of entering a job market in the midst of a recession

Benefits (again using conservative assumptions, biased in favour of lockdowns):

An average “Covid death” (given people who die of Covidare on average older and with co-morbidities) represents a loss of five QALYs. Assume that the equivalent of 10,000 Covid deaths in Australia –0.04% of the country’s entire population –were avoided directly by wholesale lockdowns per se. This assumes that the vast majority of the difference between our recorded per-capita deaths to date and those recorded in Sweden –deaths which totalled .056% of their population –would occur in the absence of wholesale lockdowns, which is an assumption extremely biased in favour of wholesale lockdowns saving lives on net relative to the alternative of targeted protection of the vulnerable, in spite of the lack of solid evidence for this assumption.

This assumption of 10,000 deaths can alternatively be thought of as an aggregate figure that includes not only actual deaths, but also the “death equivalent” of aggregated lower quality of life in the short run for those who become symptomatic but do not die, and for those suffering longer-run damage from the virus.

This translates to a maximum of 50,000 QALYs saved in total by wholesale lockdowns.

Given that one QALY equates to about 6 WELLBYs in Australia, this translates to an estimate of 300,000 WELLBYs saved directly by wholesale lockdowns.

What would society usually be willing to pay to save 50,000 QALYs? At a very high rate of $100,000 per QALY, saving this amount of human welfare would be worth paying $5 billion –equivalent to 0.34% of GDP.

APPENDIX

What fraction of the current and future economic contraction is directly attributable to lockdowns per se?

The Imperial College study of Miles et al (2020) into the costs and benefits of lockdowns in the UK finds the direct effect of lockdowns on economic activity to be direct and large:

Deb et al (2020) found that lockdowns reduced economic activity in the UK by 15% in the 30 days after they were adopted. They find that stay-at-home requirements and workplace closures are the costliest in economic terms. Preliminary estimates from the UK Office for National Statistics showed a slightly more than 20% fall in GDP in April 2020, the first full month after the lockdown. Tracking the immediate effects of policies (and not the external environment) across countries, Bonadio et al (2020) put the impact on output and incomes (i.e. GDP) of policies to counter the spread of the infection on GDP averaged across 64 countries even higher, at around 30%.

Aum et al (2020) estimate that around one-half of all job losses in the UK and US can be attributed to lockdowns. Coibion et al (2020a) estimate that there were 20 million lost jobs in the US by April 8th triggered overwhelmingly by government restrictions. In a follow-up paper the same authors undertake surveys of behaviour and economic outcomes across US regions with different degrees of restrictions. They conclude:

“We observe a dramatic decline in employment and consumer spending as well as a bleak outlook for the next few years. Our estimates suggest that this economic catastrophe can be largely accounted by lockdowns.”

This is now also the consensus in the economic forecasting literature. Economic pain like unemployment and GDP contraction remain while restrictive policies remain, with strong recovery only coming after that, and stalling if restrictions are reimposed. The main Bank of England scenarios, for example, depict economic recovery as being dependent on the lifting of restrictions (Table 1A, Bank of England May Monetary Policy Report).

In Australia too, the consensus is that restrictions and economic decline are causally linked. The Reserve Bank of Australia says in its projections that “The initial phase of the recovery is likely to be primarily driven by the easing in restrictions, which will lead to an improvement in employment outcomes as businesses re-open, as well as a pick-up in household spending.”

The RBA’s most recent forecasts indicate that the Australian economy is losing 6% GDP on an annualised basis in the months of lockdowns. Taking the very conservative view that further lockdowns do not mean the eventual recovery will take any longer, we can then attribute a 6/12% GDP loss to an additional month of lockdown. That 0.5% of GDP is just over $7 billion, implying$2.5 billion in reduced future government spending using the rule of thumb that government expenditure equates to 36% of GDP.

Ignoring all welfare lost due to reduced private expenditure, and using the conservative estimate of $100,000 as the value for a statistical life year, the reductions in future government services alone will imply a loss of approximately 25,812 QALYs per month of lockdowns.

References

Clark, A. E., Flèche, S., Layard, R., Powdthavee, N., & Ward, G. (2018). The Origins of Happiness: The Science of Well-Being Over the Life Course, Princeton, NJ: Princeton University Press.

Pragyan Deb, Davide Furceri, Jonathan D. Ostry and Nour Tawk (2020), “The economic effects of Covid-19 containment measures”. COVID Economics, CEPR, vol 24. May 2020.

Barthélémy Bonadio, Zhen Huo, Andrei A. Levchenko, Nitya Pandalai-Nayar(2020), “Global Supply Chains in the Pandemic”, NBER Working Paper 27224, May 2020.

Sangmin Aum, Sang Yoon (Tim) Lee, Yongseok Shin (2020), “Doesn’t Need Lockdowns to Destroy Jobs: The Effect of Local Outbreaks in Korea”, CEPR Discussion Paper 14822.

Olivier Coibion, Yuriy Gorodnichenko and Michael Weber (2020a), “Labor markets during the Covid-19 crisis: A preliminary view”, COVID Economics, vol 21,May 2020.

Olivier Coibion, Yuriy Gorodnichenko and Michael Weber (2020b), “The cost of the COVID-19 crisis: Lockdowns, macroeconomic expectations, and consumer spending”, COVID Economics, vol 20, May 2020.

https://www.bankofengland.co.uk/-/media/boe/files/monetary-policy-report...

https://www.rba.gov.au/publications/smp/2020/may/economic-outlook.html

Miles et al (2020): https://journal.sketchingscience.org/users/333926/articles/460021-living...

UK wellbeing reports: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing

“Living with Covid” Interesting paper on tradeoffs

Published by Anonymous (not verified) on Fri, 26/06/2020 - 6:05pm in

Here is a new paper from Imperial College, this time by a team with David Miles, Mike Stedman, and Adrian Heald, looking into the implicit cost per QALY that the UK spent via lock downs and other repression policies. They use a somewhat different methodology from mine, estimating marginal effects of policies from cross-country variation rather than with some notion of the previous status quo, but they end up with almost the exact same answer that “The lowest estimate for lockdown costs incurred was 50% higher than highest benefits from avoiding the worst mortality case scenario at full life expectancy tariff and in more realistic estimation they were over 50 times higher“. In other words, they estimate that for every life-year saved by restrictions, an estimated 50 will be lost down the line whom we can no longer afford to save. And that’s just solely within the UK. They hence say it was all a huge mistake that we should undo as fast as possible. Here’s their full abstract:

The COVID-19 pandemic has transformed lives across the world. In the UK there has been a public health driven policy of population ‘lockdown’ that had enormous personal and economic impact. We compare UK response/outcomes including excess deaths with European countries with similar levels of income/healthcare resources. We calibrate estimates of the economic costs as different %loss in GDP against possible benefits of avoiding life years lost, for different scenarios where local COVID-19 mortality/comorbidity rates were used to calculate the loss in life expectancy. We apply quality-adjusted life years (QALY) value of £30,000 (maximum under NICE guidelines). The implications for future lockdown easing policy in the UK are also evaluated. The spread of cases across European countries was extremely rapid. There was significant variation both in severity and timing of both implementation and subsequent reductions in social restrictions. There was less variation in the trajectory of mortality rates and excess deaths, which have fallen across all countries during May/June 2020. The average age at death and life expectancy loss for non-COVID-19 was 79.1 and 11.4years respectively while COVID-19 were 80.4 and 10.1years; including for life-shortening comorbidities and quality of life reduced this to 5QALY for each COVID-19 death. The lowest estimate for lockdown costs incurred was 50% higher than highest benefits from avoiding the worst mortality case scenario at full life expectancy tariff and in more realistic estimation they were over 50 times higher. Application to potential future scenarios showed in the best case a QALY value of £220k (7xNICE guideline) and in the worst-case £3.7m (125xNICE guideline) was needed to justify the continuation of the lockdown. The evidence suggests that the costs of continuing severe restrictions in the UK are so great relative to likely benefits in numbers of lives saved so that a substantial easing in restrictions is now warranted.

 

Revised GP Co-Payment Still Bad Policy: ACOSS

Published by Anonymous (not verified) on Thu, 11/12/2014 - 9:20am in