Looking at Covid-19 death rate is like the old saying “An economist is someone who knows the price of everything and the value of nothing”?

by philg

A couple of mathematically sophisticated friends were debating Sweden’s policy with respect to Covid-19. One argued from the assumption that the death rate in Sweden was higher than in some nearby European countries (also true for Massachusetts and nearby states such as Vermont (photo below), New Hampshire, and Maine, despite similar policies).

Me:

How do you know how many people died in these respective countries? What if the shutdown in Finland and Norway, for example, made people depressed, fatter, out of shape (gyms closed), etc. and they’ll be more likely to die in the next few years from these ailments? A huge number of people in the U.S. will die from the shutdown of regular health care. Because we are obsessively focused on a single number (Covid-19 death rate) as a measure of the success of a society, we will probably never bother to add these up. (see NEJM)

You aren’t asking how many lives are lost when children can’t go to school and don’t get the education to which they were formerly entitled. People with less education tend not to live as long. Swedish children continued their education. Children in most European countries had a couple of months denied to them. Children in the U.S. are shut out of school for 6 months minimum!

Looking at this one number for a society is a lot like the way the American medical system evaluates itself. A patient who is on a ventilator for three years and is in a coma is considered a success. “We saved him,” the doctors will say. They look at one number: the heartbeat. They don’t look at the bigger picture of human health.

Math Expert:

Show me the math.

Me:

There is no “math” because nobody knows what will happen for the next few years. The countries that locked down created the ideal population for a coronaplague! If you make everyone in a society 5-10 lbs. fatter and in worse cardiovascular health because of 3 months of forced inactivity, you set them up for a massive wave of death from whatever virus comes along next (maybe just Wave #2 of coronaplague). My cardiologist friends mostly stopped working for months. Unless you think that cardiology is not important, you should expect plenty of extra deaths from heart disease over the next few years.

My friend’s 8th graders didn’t leave their suburban house for 3 months. That is not a normal life for a child. They are the subjects of an experiment that has never previously been tried. Maybe they will survive pretty well because my friends are well educated, the house is big/comfortable, and there is no domestic violence within their household. If you were to head into Newark and go to a public housing complex to find some 8th graders locked into a 2BR apartment the story might be different.

(The majority of my med school professor and physician friends, incidentally, believe that the shutdown was a mistake in terms of “saving lives”. They think that far more Americans will be killed from the shutdown of health care, from shutdown-induced obesity, and from shutdown-induced social ills than could have been saved by a shutdown (even if a shutdown had cut the number of Covid deaths to 0))

You are entitled to your opinion that the Swedes did the wrong thing in giving priority to children being able to go school, adults being able to socialize, work, and go to the gym. But you can’t prove that you’re right with “math”, any more than my med school professor and physician friends can prove that they’re right about Sweden having done the right thing.

Math expert:

It seems likely to me that the shutdowns bought enough time to save hundreds of thousands of lives, and if you can show me a real economic argument that indicates that the toll from the economic damage was comparable to that, go right ahead.

Me:

Maybe the effective Chinese shutdowns prevented a lot of Covid-19 deaths, at least until Wave #2 hits. But I don’t see how you can say that the U.S. shutdowns prevented a significant number of Covid-19 deaths given that the death rate from Covid-19 is pretty close to never-shut Sweden’s (maybe about the same if you adjust for urbanization; Sweden overall is more urbanized than the U.S.). The U.S. has experienced a death rate so far that is about 30% lower than Sweden’s [update: now forecast to be the same]. Is that worth all of the lives destroyed by shutdown, all of the education lost by children, and all of the cities destroyed by riots? Those aren’t questions that can be answered by a mathematician (even if we want to count up life-years lost we don’t have the data on how many we killed via our shutdown, as noted above).

After this discussion burned itself out (like the virus in NYC?), I realized that what I was trying to say was neatly summarized by the old expression: “An economist is someone who knows the price of everything and the value of nothing.” The Europeans who reopened their schools after a couple of months seem to understand this better than Americans do. A Covid-19 epidemiologist can tell you how many Covid-19 deaths your society has suffered and, perhaps, some things that you can do to reduce Covid-19 deaths going forward. But the Covid-19 epidemiologist can’t tell you whether Intervention A against Covid-19 is actually worth implementing because (a) the Covid-19 epidemiologist is ignoring deaths from all other causes, and (b) epidemiologists in general can’t tell us what human activities are worth accepting some risk of death. How many lives are we willing to sacrifice in order that our children can go to school? Obviously we are willing to sacrifice some, because all of the driving of children, teachers, and administrators to and from school causes some deaths. But the threshold number at which schools should be shut down is not something that any epidemiologist can give us.

Consider some 85-year-olds in a retirement home. Their life expectancy is 6 years (SSA). Suppose that they have a 3 percent risk of dying from Covid-19 if infected. Is it better for them to stay locked down for two years, until an effective vaccine is developed (we hope!), or resume their ordinary lives, which will carry a higher risk of coronavirus infection? The lockdown will take away more than half of the things that they enjoy in life, thus surely robbing them of 16-33 percent of their remaining life. Covid-19 could rob them of all of their remaining life (by killing them), but the probability of that even is fairly low. Can an expert decide for these 85-year-olds which option is actually better? No! The answer depends on whether the 85-year-old mostly enjoys Internet and TV, in which case maybe the lockdown is preferable, or mostly enjoys socializing with other humans, in which case running the risk of Covid-19 is preferable.

Readers: Is asking an epidemiologist whether to keep schools and playgrounds open like asking your accountant whether you should buy a dog? Yes, the expert can give you a bit of insight (“my other clients with dogs spend $4,000 per year on vet, food, and grooming”), but not a life-optimizing answer.

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23 thoughts on “Looking at Covid-19 death rate is like the old saying “An economist is someone who knows the price of everything and the value of nothing”?”

  1. As usual fantastic arguments Philg, but I have to tell you I am greatly offended by your labeling your opponent “math expert”. I have self-identified as a math expert for a long time and can be totally confident that person is not on my team.

  2. Phil, again, really learning a lot from your thinking and discussion with “math experts”. One comment around nursing homes. I agree with you calculations :-), but not sure about the 3% probability of dying. Based on what we have seen the past 3-4 months, it seems like there is a MUCH higher chance of dying at that age due to COVID-19, but also haven’t nursing homes had some of the worst outbreaks? In Colorado, 76% of the deaths attributed to COVID-19 are in people ages 70-80+.

    I say this, but my wife’s father is in a nursing home and we can’t see him :-(. Facetime yes, and through a window, but it seems in many ways like a prison. I understand WHY, it’s just hard.

    • Paul: It could be 100% of Covid-19 deaths among people 70+ and that still wouldn’t necessarily imply a high risk of death for those 70+ because not that many people have actually died from/with Covid-19. I’m not sure that the 3% number is correct. It was just an example.

      https://www.statista.com/statistics/1105431/covid-case-fatality-rates-us-by-age-group/

      says that “case fatality rate” for an 85-year-old is 10.4%. So if you assume 2 folks with minimal symptoms from an infection for every person sick enough to be a “case” then we get to 3%. If you assume that every infected 85-year-old gets sick enough to be treated and tested then we have a 10.4% risk of death from infection (but, of course, not everyone who goes out into the scary world will actually be infected; even some New Yorkers and Bostonians escaped!).

    • Some numbers from the notorious Sweden., IFR by age:

      https://www.folkhalsomyndigheten.se/contentassets/53c0dc391be54f5d959ead9131edb771/infection-fatality-rate-covid-19-stockholm-technical-report.pdf

      Age 0–49 0.01% [0.00 0.02]
      Age 50–59 0.27% [0.15 0.50]
      Age 60-69 0.45% [0.25 0.88]
      Age 70-79 1.95% [1.16 3.40]
      Age 80-89 7.20% [4.54 12.84]
      Age 90+ 16.21% [10.11 29.50]

      The first group seems implausibly low for the 49’ers, although the average is about 0.6% which close to other sources (Iceland 0.55%).

    • I’m not sure if the ugly 17% number for “nursing homes” is representative of what an 85-year-old who is healthy and resides in an “independent living” retirement home. I think “nursing home” or “long-term care facility” may mean someone who needs medical intervention on a regular basis in order to stay alive. So it isn’t surprising that coronavirus can attack successfully.

  4. Epidemiologist around the world aren’t making the final decision so it doesn’t much matter. I am willing to speculate that those in power aren’t too concerned with lives (it would be a first) but are trying to prevent mass chaos (possibly for self-preservation). And an unabated pandemic left to run its course or an extended lockdown could each cause mass chaos. Due to cultural differences politicians from each country will have a different tool kit available and will have to take different approaches and, of course, many will get it entirely wrong with the tools they have available anyway. Comparing one country to another is a fools game.

  5. > It seems likely to me that the shutdowns bought enough time to save hundreds of thousands of lives

    The irony, of course, is that it looks like that current facts indicate that shutdown only delayed these deaths, not eliminated them. Looks like virus is not going away, effective vaccine is not found, treatments improved only slightly. So susceptible people will die anyway. Time to accept the facts and move on.

  6. In both Britain and the US the leaders, Johnson and Trump, wanted business as usual but were unable to pull it off politically because the public was too fearful and demanded a lock up, presumably because the public had been egged on by the so-called experts and their media echos. So Trump could then hide behind Anthony Fauci and Johnson behind Ferguson — and in so doing cede power to these unelected people. Why Sweden was able maintain business as usual while the US and Britain were not is an interesting question. And then there was the post hoc hysteria about what should have been a scientific question that morphed into an incoherent political issue — i.e., the Facebook back and forth Phil cites.

    • This is bullshit. “Business as usual” was going to continue in the US until New York got absolutely hammered. Then we decided that wasn’t enough, so we’re letting the rest of the country get hammered too now. I think we’re trying to go for about 800,000 deaths. We will be the laughingstock of the world and it will lead to the collapse of our nation (perhaps not immediately, but definitely over the long term).

  7. Here is an anecdotal story that persuades me and my wife to shelter for now at ages 82 and 79, with good health:
    https://www.yahoo.com/lifestyle/took-one-person-one-errand-050138571.html?soc_src=newsroom&soc_trk=com.apple.UIKit.activity.PostToFacebook&.tsrc=newsroom
    We are willing to wait out 2020 in hope for a vaccine, beyond that may be too far, and we may run out of patience but that’s our plan. We go to the beach and visit family at a distance.
    Although it shouldn’t matter, politically I’m registered no-party, ex-Republican and Never Trump.

  10. i think the press exaggerate and therefore create confusion. Sweden is an example. the press have emphasized they are not locking down and are engaging in risky behavior. if you look at their deaths vs time curve, you see them climb the mountain, peak on April 1, and then come down (with 6k deaths). What happened April 1? Mitigation, to the extent needed to bend their curve. they closed schools, told old people to not go out, told people to work from home if they can, and told people to socially distance. their people have been working to suppress the virus and they have done reasonably well.

  11. I think the schools should have stayed open but I don’t see how anyone could have done it in New York, NJ, CT, etc. Their leadership was so adamant and unified about school closures that I don’t think they could have been overcome or persuaded. Unfortunately I also don’t think the lockdowns were effective enough in the parts of the country now flaring back up, so they’re all going to lock down again, and now we’re in the beginning of the second crash into the wall.

    I think we’re truly getting the worst of all worlds. We’re not stopping the virus, it looks like we’re doing the lockdown dance all over again, and we’re going to suffer the economic and social pain with all the retributive finger pointing and calamities it entails. And the President is a head case, so we can’t count on his steady, calm leadership, either.

    • @GB: I try to watch as little TV as possible, especially where it concerns the President. The man is a self-perpetuating disaster. Here’s what’s going to be on TV all night tonight: https://www.cnn.com/2020/06/28/politics/trump-tweet-supporters-man-chants-white-power/index.html

      His Twitter account is a self-destruction mechanism, and that’s why Jack Dorsey won’t ban him. Why should he? The President uses it to create the attack ads against himself.

      Look, I know it’s not in the same echelon but in a past life I spent a lot of time working to protect someone in a position of power who was hell bent on wrecking their own life and career, which would have very serious repercussions for the institution they were leading. The first thing you have to do is intercept and review their electronic communications. You have to treat them like children because they can’t protect themselves, so you stand between them hitting “send” or “post” and review what they’re doing before they send it. Otherwise they get up at 2:00 in the morning and send crazy things that can’t be retracted to people all around the country. It’s sad to watch and even tougher to have to do it.

      This President won’t let anyone do that effectively, and we keep seeing the results, over and over again. He’s reckless, and someone should stop him from doing it.

  13. “It seems likely to me that the shutdowns bought enough time to save hundreds of thousands of lives”

    I’d love to have seen you reply “show me the math”.

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