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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Wicked Swedes and Righteous-but-imperfect Americans forecast to have same coronaplague death rate

by philg

The wicked Swedes who refused to lock themselves down, refused to pull their children from schools, refused to follow WHO advice (the latest advice, that is, not the June 4 advice) to wear masks, and refused to stop going to work will suffer 5,754 deaths from/with Covid-19 through October 1, 2020, according to the prophets at IHME:

The infidels who refused to accept the true Church of Shutdown will lose 0.056 percent of their 2019 population of 10.23 million.

The latest (June 24) IMHE prophecy for the U.S. is that 179,106 residents will die from/with Covid-19 through October 1, 2020:

Compared to the 2019 U.S. population of 328.2 million, that’s a rate of 0.055 percent.

In other words, the U.S. and Sweden will have almost exactly the same death rate from coronaplague.

Yet for Americans believers in the Religion of Shutdown, Sweden remains the touchstone example of disastrous “experiment” and folly. (It is not an “experiment” to lock people into their apartments for three months in hopes of stopping a viral plague, nor to shut down K-12 schools nationwide for the first time in U.S. history. These are examples of wisdom and being “conservative”.)

An example from yesterday, by a Harvard Law School professor, “Is Digital Contact Tracing Over Before It Began?” (Medium, June 25):

The first scenario is roughly the same as Sweden’s approach: re-open all but the most high-spreading services and events; ask people to exercise social distancing where they can; have people wear cloth masks to minimize the spread of the moisture in their breath to others; and try to make available testing so that people who wish to know if they’re infected can find out and then self-isolate if they test positive or show worrisome symptoms. We might call this the YOLO scenario.

This approach risks lots of preventable misery, and death, should hospital capacity be exceeded, or the disease affect far more people than it would if we were able to mitigate spread before a vaccine or treatment is available. (The architect of Sweden’s YOLO plan has expressed some regrets over it, though the numbers appear to be attenuating at the moment.)

The author simply neglects to mention that the death rates in the U.S. and Sweden are on track to be within 3 percent of each other. For the American readers, this isn’t necessary because, to the extent that Americans die it will be because we are imperfect creatures. We try to follow the God of Shutdown, but sometimes we slip and need to ask forgiveness of Him/Her/Zir/Them.

(The article also shows the American faith that the God of Shutdown will protect the righteous and punish the wicked among us:

With the President resuming his campaign rallies, the line between partial re-opening and full re-opening may become quite blurred.

I.e., a Trump rally will spread coronaplague among the stupid/racist/sexist Deplorables, but the virtuous BLM protesters who gather in similar numbers will be protected by their faith.)

From across the river, a former Harvard Med School/School of Public Health professor writes “A Warning From Sweden’s Coronavirus Response” (Forbes, June 4):

Sweden now has among the highest per capita death rates from Covid-19 in the world. Why?

The answer is simple. Sweden was lax in its implementation of protective measures in the face of the outbreak, refusing to implement broad stay at home orders for residents, or to enforce recommendations to wear masks or social distancing measures.

Sweden’s story is a lesson for all of us around what happens when we pull back on social distancing and prudent epidemic control measures.

… one can’t help but wonder if perhaps the plan is to pin all hopes on a vaccine rather than use the public health tools we know can work to control the pandemic. If that is the case, we should be aware that our hope in a vaccine is far brighter than preliminary public data suggests it should be. The current generation of vaccines are likely to offer only partial protection, and likely only to some of us not all. With the new vaccines will come new risks, and unknown safety profiles.

The guy who looked at numbers for two decades at the School of Public Health can’t be bothered to compare the forecast death rates from Covid-19 for Sweden and the U.S., plus add to the U.S. numbers all of the deaths going forward from weight gain during lockdown, lack of exercise during lockdown, alcoholism and drug addiction acquired during lockdown, lack of education during lockdown, rioting as we emerged from lockdown, etc.

(He also sounds like an anti-vaxxer! “New risks” and “unknown safety profiles” from the rushed-to-market vaccines?!? So… if we aren’t going to have an effective or safe vaccine, doesn’t that make the Swedes ever smarter? Are we capable of staying shut down for 10 years?)

I still think that, 10 or 20 years from now when the U.S. has finally figured out how to deal with coronavirus (maybe just a psychological adjustment, as we’ve had to make for influenza, the common cold, and most other viruses), the most interesting writings on this period will be from scholars of comparative religion.

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Norwegian TV series for the Age of Corona: Occupied

by philg

A (tenured professor) friend recommended Occupied, a 2015 Norwegian TV show on Netflix that is surprisingly timely. In the first episode, the prime minister has to decide whether it is better to die on one’s feet or live on one’s knees. Citing the priceless nature of even a single human life, he decides that Norwegians must accept subjugation by the EU and Russia.

(The initial plot premise doesn’t make obvious sense. Norway shuts down its oil and gas production in a noble effort to save Spaceship Earth from climate destruction. The EU wants Norwegian oil and gas and brings in the Russians to force Norway to turn it all back on. But since the Russians compete with Norway in oil and gas production, why would the Russians want to pressure Norway? Wouldn’t the Russians be better off just selling EU its own production at a higher price? This is never explained, but if you can suspend your disbelief on this one point, the rest of the series makes sense.)

As the episodes unfold, Norwegians gradually surrender what had been their rights. Just like Americans facing the threat of coronaplague, about half of the people simply assert that their rights have not been eliminated, just slightly adjusted (e.g., children who get a weekly email from a teacher and two hours/week of Google Classroom hangout are still receiving their right to an education) while a clandestine resistance emerges of people who want their former constitutional rights as they were previously understood.

I’ll be interested to hear what readers think about whether this movie captures the mindset of government leaders around the world today when it comes to dealing with the threat of coronaplague!

(My Dutch friend: “All of the rights that Americans fought and died in multiple wars to defend, they gave up in one governor’s press conference.” The screenwriters thought it would take a war for people in a Democracy to lose their rights, but a respiratory virus turned out to be sufficient to erase liberty!)

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Swedes are too polite to call us stupid…

by philg

… instead they call us crazy.

The leader of the Swedish government’s epidemiology team is interviewed in “Sweden’s Covid Expert Says ‘World Went Mad’ With Lockdowns” (Bloomberg):

The man behind Sweden’s controversial Covid-19 strategy has characterized lockdowns imposed across much of the globe as a form of “madness” that flies in the face of what is known about handling viral outbreaks.

Anders Tegnell, Sweden’s state epidemiologist, said he advised against such restrictions on movement because of the detrimental side effects they often entail.

“It was as if the world had gone mad, and everything we had discussed was forgotten,” Tegnell said in a podcast with Swedish Radio on Wednesday. “The cases became too many and the political pressure got too strong. And then Sweden stood there rather alone.”

Tegnell admits he misjudged the deadly potential of the coronavirus in its early stages, but has refused to consider abandoning his strategy. He says restricting movement to the radical extent seen across much of the globe can create other problems, including increased domestic abuse, loneliness and mass unemployment.

“In the same way that all drugs have side effects, measures against a pandemic also have negative effects,” he said. “At an authority like ours, which works with a broad spectrum of public health issues, it is natural to take these aspects into account.”

What would he think of Maskachusetts? Our kids might not have learned anything for the past three months and maybe won’t get to return to school in September, either, and they may have gained weight and lost muscle tone as they go into Month 4 of shutdown, but at least they are masked!

Tegnell also advised against using face masks, arguing there’s little scientific evidence they work. And he says it’s clear that closing down schools was an unnecessary response to the pandemic, a notion that’s actually supported in a recent French study.

Have you enjoyed being shut down and throwing rocks at the reckless Swedes? Dr. Tegnell says you’ll probably get to do it every year for the next few decades:

Tegnell’s underlying argument is that Covid-19 isn’t going away any time soon, meaning sudden, severe lockdowns will ultimately prove ineffective in addressing the longer-term threat. Meanwhile, the virus has recently resurfaced in a number of places where authorities thought they’d brought it under control, including Beijing.

The article is a good illustration of American journalism. Because Tegnell is a infidel relative to the Church of Shutdown, his credentials are left out. He is just some guy who works for the Swedish government, not a Scientist (Wikipedia by contrast: “Tegnell obtained a PhD in Medicine from Linköping University in 2003 and a MSc in Epidemiology from the London School of Hygiene and Tropical Medicine in 2004”).

The section in which the article appears is “Sweden’s Coronavirus Experiment”. In other words, it is not the U.S. that is conducting an “experiment” by trying something that has never been tried before (i.e., shutting down a modern society/economy and health care system). It is Sweden that is engaging in a wild “experiment” by doing what humans have always done when confronting a new virus.

From my Sweden pictures:

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New hate speech phrase: “Thank You ALL Workers”

by philg

Like righteous Lexington, Massachusetts, our white heterosexual suburb loves to hang banners celebrating Black Lives Matter and a rainbow of LGBTQIA+ victimhood (see “Our faith calls us to affirm Black Lives Matter…”).

To these, neighbors have recently added “Thank you essential workers,” “Thank you frontline workers,” and “Thank you first responders” signs.

Driving west on Rt. 117 to some suburbs that contain at least a few authentic working-class people, if not a significant number of black or LGBTQIA+ people, there is a glaring exception: a house sporting a “Thank You All Workers” sign.

Is this sloppiness? Or hate speech along the lines of “All Lives Matter”?

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Biden, Warren, and Sanders are Beardstown Ladies?

by philg

Today was supposed to be the last Democratic Presidential primary. We’ve heard primarily from three candidates: Joe Biden, Bernie Sanders, and Elizabeth Warren (though this article says that all of them are essentially just repeating things that Bernie Sanders said in 2016).

All of these Democrats have said that, through the magic of higher tax rates on the rich, the Federal government will be showered in tax revenue, breaking out of Hauser’s Law that found revenue to be limited to about 20 percent of GDP, independent of the headline rates (1945-2015). In the page pandering to Catholic voters, for example, Biden promises to “get rid of the capital gains loophole for multi-millionaires.” So a multi-millionaire would have to pay a 50% ordinary income tax rate, federal plus state, on capital gains but wouldn’t be able to move to Puerto Rico for 183 days/year and pay 4% instead under Act 22 (and that would be to Puerto Rico, so the Federal Government would get 0%).

I wonder if this kind of magical thinking about the possibilities of a high return on an investment of tax rates is partly due to the politicians’ age. They’re all senior citizens and senior citizens can be prone to mistaken estimates. One of the most famous examples of this is an investment group of women in their 70s known as the Beardstown Ladies, They believed that they’d achieved a 23 percent annual return on investment, beating the S&P 500. When younger people analyzed their returns, the conclusion was that the return had been 9 percent annually, underperforming the S&P 500.

[Some more fun stuff… All of the Democrats told us that immigration will make existing residents of the U.S. better off. It doesn’t matter how low the skill level of the immigrant nor how much in the way of government-provided services the immigrant needs. A 75-year-old migrant who does not speak English and who needs $2 million in health care will make every existing American slightly richer. Admitting several million elderly disabled non-English-speaking immigrants would make us crazy rich.

Joe Biden will deny that there is anything special about having been born with a physician-identified biological female sex at birth (“LGBTQ+ Equality”; what about LGBTQIA+?), but the rest of his policy pages refer to “women” as though it were a persistent well-defined category of humans.]

Readers: What do you think? Are the leading Democrats examples of the elderly being bad at arithmetic? Should we all make sure that we have a durable power of attorney set up for the day that we turn 70 and can’t trust ourselves to make a stock trade?

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Father’s Day reflections: How not to get a job at Hallmark

by philg

Some epic tweets regarding yesterday’s Hallmark Holiday of Father’s Day:

The author is “Feminist, socialist, part of the 99% and proud.” Can we agree that she would have a tough time getting a job at Hallmark, makers of cards for the 100%?

Separately, circulating in some (apparently deplorable) aviation groups: “Your dad’s not a pilot? Well, Happy Mother’s Day to your dad.”

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How can ordinary people buy the statues that are being pulled down?

by philg

“Roosevelt Statue to Be Removed From Museum of Natural History” (NYT): “The equestrian memorial to Theodore Roosevelt has long prompted objections as a symbol of colonialism and racism.”

I celebrate this decision because I would love to see this statue replaced with one of Donald Trump on a golf cart (and also to see Donald Trump’s image carved into Mt. Rushmore, either to join Teddy Roosevelt or to replace him; photo I took from a friend’s Mooney in 2002 shows that there is plenty of room; the lower photo shows that there is already a venue there architecturally suitable for a fascist rally).

As a practical matter, though, where can people buy these discarded works of art? Our neighbors, for example, all have enough room for such a statue, thanks to our two-acre zoning minimum (ensures that none of the low-income black Americans whose lives matter to us (judging by the hundreds of Black Lives Matter signs in our town) can afford to move in). But will they be on eBay or what?

(What did TR actually say about Black Lives Matter? “Teddy Roosevelt discusses America’s race problem” describes a 1905 speech:

In his argument for racial equality, Roosevelt used the rising tide raises all ships metaphor, stating that if morality and thrift among the colored men can be raised then those same virtues among whites, already assumed to be more advanced, would rise to an even higher degree. At the same time, he warned that the debasement of the blacks will in the end carry with it [the] debasement of the whites.

Roosevelt’s solution to the race problem in 1905 was to proceed slowly toward social and economic equality. He cautioned against imposing radical changes in government policy and instead suggested a gradual adjustment in the attitudes of whites toward ethnic minorities. He referred to white Americans as the forward race, whose responsibility it was to raise the status of minorities through training the backward race[s] in industrial efficiency, political capacity and domestic morality. Thus, he claimed whites bore the burden of preserving the high civilization wrought out by its forefathers.

I wonder what he would say if he could see the “forward race” of white Americans consuming millions of taxpayer-funded opioid pills!)

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How is Sweden doing with coronaplague?

by philg

I like to check in on forecasts versus reality at three-week intervals. Maybe prophets are getting better!

Previous posts:

From the first of those…

What’s the latest from the prophets at IHME? As of a May 20 update to the forecast, Sweden will have a gradually declining daily number of deaths, in more or less the same shape as still-shut-down Massachusetts. A total of 5,129 Swedes will die from/with Covid-19 (roughly one third the previous forecast). The virus will simply burn itself out, apparently, despite Sweden’s lack of shutdown. (But in other countries, the same shape decline will be attributed to a multi-month shutdown?)

That forecast for Swedish death was down from the 13,529 number in the early April forecast. As of June 5, 2020, the IHME model forecast 8,534 deaths for Sweden and the deaths will come in a Bactrian camel shape:

The forecast from June 5 predicts 60-70 deaths per day right around now. What are we seeing? Europeans refuse to work on weekends, so the reported deaths are zero for Saturday and Sunday. Even today’s report shows 0 deaths (so maybe tomorrow’s report will actually reflect three days of deaths?). The Friday report shows 12 new deaths reported in Sweden.

[Update: The Tuesday report included 69 new deaths. So that’s 81 new deaths spread over 5 days of reports (12+0+0+0+69) or 16 deaths per day compared to the forecast 60-70. In other words, the forecast was wrong by 4X.]

(Also from the Tuesday reports: Sweden has suffered 5,122 deaths from its population of 10 million. Massachusetts has lost 7,890 from its population of 7 million. In Month 4 of Shutdown, the Massachusetts rate is 2.2X Sweden’s.)

What about the former chief scientist of the European CDC who, when put on the spot, tossed out that coronaplague wouldn’t be worse than a bad flu season in terms of death? (note that assumptions regarding population fatality rate were not important for the Swedish plan; assumptions regarding the practicality of a non-Chinese country significantly changing the trajectory of infections were)

A bad season indeed was 1957-8, in which up to 116,000 Americans died out of a population of 172 million (compare to 330 million today). Applying that rate to Sweden’s 10 million people, 6,744 Swedes would succumb to Covid-19.

I don’t think economic arguments are highly relevant in a world where people seemingly care only about clinging to life. Nonetheless, since poverty often determines health outcomes: https://www.bloomberg.com/amp/news/articles/2020-06-16/one-economy-stands-out-as-crisis-reveals-striking-differences? (see “Most gunshot wounds are self-inflicted, coronaconomy edition”)

Readers: What’s your best guess on Sweden? How will the death rate from/with Covid-19 compare to the U.S. rate by early 2021? (right now the U.S. has roughly 71 percent of the death rate compared to Sweden, so the U.S. is better if we measure only by this one number)

[Update 6/24: the IHME prophets have released a new projection.

Instead of the Bactrian camel, Sweden is now on the dromedary shape. There is a new “what if?” capability in this model. For example, if only 10 million Swedes would put on masks, 2 lives would be saved on September 1. (but how many would be killed in car-pedestrian accidents due to fogged-up eyeglasses from the masks?). 5,754 Swedes will meet their end due to Covid-19 through October 1, 2020, a population fatality rate of nearly 0.06 percent.]

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