Policy for pandemic issues and how models shape it

[Evo]

Not really. Everybody needs to get it (naturally or by vaccination). If it is not by vaccination, for a few, hospital will be a consequence and, for even less, death. No matter how many people get sick, the goal should be that the health care system can care for all of them.

Without isolation, herd vaccination will happen quickly, but the health care system must be strong. We can achieve that by reorganizing our work force, resources and priorities. Not only society isn't on pause, it could be in overtime.

With isolation, herd vaccination is extremely slow (stagnant?), but there is no need for a strong health system. The isolation process shall last until a vaccine is found everybody is vaccinated. That is at least 1½-2 years. Can we stop living for at least 1½-2 years? (3 years? 4 years? How long is too long?)

It's always an individual choice. You choose to isolate yourself (freedom to do whatever you want) and/or you choose to isolate others (forcing your will on others). In any case, the length of the isolation period is based on your fear level, since you have no data to base your judgement on.

The funny thing is that if you only choose to isolate yourself, in less than a few months, herd vaccination will happen and you will be able to get out. If you force everybody to isolation, you have to wait for everyone to get vaccinated, i.e. a 2-year waiting period.

So what is the lockdown like in your country jack? I see that they just placed your area under lockdown a couple of weeks ago? One headline read that the death toll had jumped 50% in just one day. What is the healthcare scenario there? Here in the US it's mostly private hospitals, not Universal government healthcare, perhaps your country is better able to handle this crisis than the US.

 

[Mary Conrads Sanburn]

jack action A PF Ocean · From Québec, Canada

Government of Canada

Coronavirus disease (COVID-19): Symptoms and treatment

[ . . . ]

Treating coronavirus

Most people with mild Coronavirus illness will recover on their own.

If you are concerned about your symptoms, you should self-monitor and consult your health care provider. They may recommend steps you can take to relieve symptoms.

Vaccine

If you have received a flu vaccine, it will not protect against coronaviruses.

At this time, a vaccine or therapy to treat or prevent this disease has not yet been developed. However, the COVID-19 pandemic has resulted in a global review of therapies that may be used to treat or prevent the disease.

Health Canada is fast tracking the https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/covid-19.html.

[ . . . ]

###

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms.html

 

[jack action]

So what is the lockdown like in your country jack? I see that they just placed your area under lockdown a couple of weeks ago? One headline read that the death toll had jumped 50% in just one day. What is the healthcare scenario there? Here in the US it's mostly private hospitals, not Universal government healthcare, perhaps your country is better able to handle this crisis than the US.

It's panic mode. Some regions are isolated. Most people having the fear of their life, even though about 90% of them have nothing to worry about. I estimate that the governments have already spent directly 1000 $ per citizen that will need to be repaid by people who are now out of work.

All of this with only 7944 confirmed cases and 94 deaths for a population of 8 500 000. But apparently we have higher numbers for confirmed cases compared to other provinces (and countries) because we do more tests.

The health care system doesn't seem to be too overcharged right now, but the situation is watched closely.

The exponential increase is unavoidable. Even with the 'flattening the curve' philosophy. Here, the officials are honest and tell us the truth: this philosophy will not reduce the amount of confirmed cases, it will only spread them over time. But I don't think the general public is getting that message: They expect to see the numbers going down soon. But 'flattening the curve' means it will last longer. Even if the numbers would go down, loosening the restrictions will necessarily bring a second wave:

"For China, I think it's too premature to celebrate," said Benjamin Cowling, the head of the epidemiology department at the University of Hong Kong. "There will be a second wave; it's unavoidable."

You cannot come back to 'normal' until the Coronavirus is under control everywhere on Earth, at the same time. How long can we stop the world before everyone goes crazy?

So maybe we will have less deaths because the health care system will be more efficient. Maybe not. We don't know. But the price to pay is already guaranteed: Bigger money problems and mental issues coming afterward.

 

[Evo]

It's panic mode. Some regions are isolated. Most people having the fear of their life, even though about 90% of them have nothing to worry about. I estimate that the governments have already spent directly 1000 $ per citizen that will need to be repaid by people who are now out of work.

All of this with only 7944 confirmed cases and 94 deaths for a population of 8 500 000. But apparently we have higher numbers for confirmed cases compared to other provinces (and countries) because we do more tests.

The health care system doesn't seem to be too overcharged right now, but the situation is watched closely.

The exponential increase is unavoidable. Even with the 'flattening the curve' philosophy. Here, the officials are honest and tell us the truth: this philosophy will not reduce the amount of confirmed cases, it will only spread them over time. But I don't think the general public is getting that message: They expect to see the numbers going down soon. But 'flattening the curve' means it will last longer. Even if the numbers would go down, loosening the restrictions will necessarily bring a second wave:

You cannot come back to 'normal' until the Coronavirus is under control everywhere on Earth, at the same time. How long can we stop the world before everyone goes crazy?

So maybe we will have less deaths because the health care system will be more efficient. Maybe not. We don't know. But the price to pay is already guaranteed: Bigger money problems and mental issues coming afterward.

Is working at home an option for office workers there like it is here? Perhaps there are more people that do not work in an office in outlying areas, but maybe they are not as affected by the lockdown, or is it pretty much nationwide? Here it's been more local, city, county, then slowly state by state. Even though we have been in lockdown, aside from some non-essential businesses like bars and sports arenas, etc... closing, I've been surprised that traffic is pretty normal, the grocery store is fuller than normal, with less goods available, but people are polite and joking about the empty shelves, but it's just the BEGINNING. If the shelves continue to be empty, I'm afraid things could start to get ugly as people's nerves get worn down.

I know that Walmart has closed all entrances to their stores except one and is counting the number of people that they allow in. Not bad to stand outside if the weather is nice, but in the rain...

I think I am derailing the thread.

 

[jack action]

So when I woke this morning, I learned that we will be on lockdown for 3 more weeks. We are on lockdown since March 23rd and we were supposed to return to normal on April 13th. And now it has been pushed back until May 4th.

The reason behind it: We are still on an ascending slope. The Prime Minister said that it will not return to normal until numbers go down.

According to this article, we have masks & gloves for 13 days and surgical masks & gowns for 7 days.

How is it going here? This happened about 75 km where I live:

Quebec Walmart worker hit by driver allegedly angered by Coronavirus measures

A Walmart security guard from southern Quebec was fighting for his life on Sunday morning after being struck and dragged by a driver who was allegedly enraged by social distancing policies aimed to curb the spread of COVID-19, local police said.

Funny thing, when I say 'some people may died of COVID-19 and that is normal', I'm told that I'm insensitive and every life matters. But in this case, the Prime Minister says “Unfortunately, you have a few crazy people in our society, but I (haven’t) heard it’s happening much”. Apparently, fighting for his life because of a person going crazy over the isolation measures is more acceptable than fighting for his life because of COVID-19. Go figure.

 

[Laroxe]

Why not put the emphasis on increasing the health resources? I prefer a government ordering me to work for the health care system instead of whatever I do than ordering me to not get sick (which is non-sense).

There is a huge effort ongoing to improve the availability to the sort of intensive care needed to support the severely ill, if the disease is allowed to reach the point at which the system is overwhelmed this increases the death rate dramatically, and not just in the sufferers of Covid 19.
Health care workers are at particular risk from the infection, sending people to work in healthcare with none of the skills that would make them useful would be disastrous.

What is the definition of practical? How come it is not defined before applying the restrictions?

Its easy really to decide when it might be practical to reduce restrictions, that would be when its clear that transmission is at a level below what would overwhelm the health resources available. As there is a huge effort to increase these resources this level will change, no one could set a figure early in the epidemic, we need to know what is currently available.

They are are not denied care. You can't expect more from people than what they can do. Society has the health care system it deserves, based on decisions it made in the past, good or bad.

The concern that is frequently discussed is in whether medics will be forced into a decision to allocate scarce treatment resources based on simple criteria like age. If the epidemic is controlled and maintained at a level that don't overwhelm the available resources this shouldn't be an issue, these resources are not fixed and are rapidly being adapted to meet the current needs.

What about the value of healthy people and/or people who can handle the pathogen? Should they value a society that denies them the freedom to go about their day? Even helping the ones they care about, that the current health care system do not handle?

Virtually all countries have at their disposal laws that can be used to restrict personal freedom if that freedom puts other people at risk, it has been possible to restrict a persons freedom if they are carrying an infectious disease and refuse to comply with isolation measures for more than a century.

Mary Mallon an asymptomatic carrier of Typhoid who continued to work as a cook against advice at the turn of the 20th century was forcibly isolated twice, ultimately spending some 3 decades in isolation. An individuals freedom, does not give them the right to put others lives at risk, this is a general legal principle, so we have speed limits, drink driving laws etc.

How can you be sure? They are no guidelines. What defines the point where it is OK to return to 'normal'?

The problem I have with all of this is that one rules the others based on its own fear. That is not what liberty is about.

You have the right to be afraid and act accordingly. But another person who doesn't share your fear, shouldn't be forced to act the same way as you. You fear a pathogen? You have the right to isolate yourself. It doesn't matter if others think your fear is legit or not. As a member of our society, I'm even willing to support you during your isolation time, because your fear is either real or you are in mental distress. But why should I be forced to isolate myself if I don't share your fear? Controlling others should never be the answer to your fears. That is in total opposition with freedom and it is not a case of the saying «One persons freedom ends where another persons freedom begins». You are free to act as you wish, not to force others to act as you wish.

I think there are all sorts of reasons to believe that the epidemic will change over time, there are a large number of initiatives which will likely have some effect, however even without these, there will be a steady increase in the number of people who recover which will effect transmissivity and the disease itself is likely to change as it further adapts to its new human hosts. Its generally a bad idea for a pathogen to kill its host and it increases its fitness by having a longer period in which it can spread. Many diseases over time become less sever while running a longer course, in fact it was human behaviour that actually reversed this process during the 1918 flu pandemic, which became more sever.
We continue to manage this disease based on very little accurate data and it may very well be that as we become aware of the true level of immunity at the population level and establish the true mortality rate that things will change. However at the moment, failure to take action to at least martial our health care resources would risk a humanitarian tragedy while providing no real advantage.
It is unfortunately the nature of risk management that decisions are often made based on inadequate data and that the balance of risks changes over time. It may be that the economic risks become so sever that this would force a change and its clear the situation can't stay as it is, so it will change its just difficult to know how without being able to predict the future.

 

[PAllen]

People find it uncomfortable to try and put a value on a life. That's why people say things like "whatever it takes to save just one life" but are willing to tolerate 38,000 car deaths. What one is willing to tolerate is set by what feels right, and that's why we require flying to be two orders of magnitude safer than driving and nuclear power to be three or four orders of magnitude safer than fossil.

Even the metric "lives saved" has an implicit value judgement. We could have instead used "years of life saved" and that would result in different policies.

One can certainly do a calculation like you suggest, but I doubt people would - or even should - act on the outcome. We know that each factor of 2 in GDP per capita corresponds to about 10 years life expectancy. If Covid-19 infects 20% of the population, it will reduce mean life expectancy by maybe 0.04 years. That suggests that 5 or 6 billion should be spent to fight it - assuming maximizing life expectancy is your goal, which I am not advocating. Any more and you're better off letting Covid-19 run its course and using the money to build pediatric hospitals.

Just because the calculation gives an answer doesn't mean you have an answer.

Different metrics, of course, yield completely different answers. Insurance economists often use a figure of 9 million dollars for the value of an average life in the US. Then, if you can reduce 2.2 million deaths to 200,000, that is worth 18 trillion dollars. That is close to a year of US GDP.

 

[Vanadium 50]

Yes, that's true. Common numbers are $9M for a life and $130K for a year of life. If you want to maximize life expectancy you get one number, lives saved this year you get another number, lives saved 5 years down the road you get another number, and so on.

However, I do take issue with the 2.2M number. We know now that was never going to happen.

 

[Vanadium 50]

Expanding on my last post, I predict that when this is over we will see a flood of calculations of the sort "we saved N lives" by taking some counterfactual, and subtracting the actual number from it. I suspect what we will not see is as many well-conducted studies comparing the success of different interventions. We can see that now with Sweden. If the Swedish plan fails, well, we knew it would all along. If it succeeds, we'll you can't tell anything from one country especially Sweden.

 

[atyy]

Expanding on my last post, I predict that when this is over we will see a flood of calculations of the sort "we saved N lives" by taking some counterfactual, and subtracting the actual number from it. I suspect what we will not see is as many well-conducted studies comparing the success of different interventions. We can see that now with Sweden. If the Swedish plan fails, well, we knew it would all along. If it succeeds, we'll you can't tell anything from one country especially Sweden.

And what do you predict if China's economy recovers very well?

 

[Vanadium 50]

Well, I'm not a psychic. Historically, China has not been very transparent, so I expect people to take (e.g.) Swedish and Danish data more seriously.

 

[atyy]

Well, I'm not a psychic. Historically, China has not been very transparent, so I expect people to take (e.g.) Swedish and Danish data more seriously.

And how would the South Korea data fit in with people's biases?

 

[jack action]

The economy will recover very well no matter what. People either work (good economy) or they don't (bad economy). It's a choice. People are not working now by choice (maybe someone else's choice, but still a choice). But it's not because the economy will go well in the future, that people are not suffering now from the isolation.

The question is how many deaths are acceptable for the current suffering (or vice versa)? The problem is that measuring suffering is very personal and cannot be done by any standard.

 

[Vanadium 50]

And how would the South Korea data fit in with people's biases?

I'm not a social psychologist either. Presumably it's a data point like any other.

 

[berkeman]

Well, I'm not a psychic.

I'm not a social psychologist either.

Well, it's a good thing you're really good at physics, because that's about the only phy... job left, it would seem.

 

[Vanadium 50]

I guess "I'm a doctor, not a [fill in the blank]"

 

[BillTre]

Right Bones.

 

[PAllen]

Yes, that's true. Common numbers are $9M for a life and $130K for a year of life. If you want to maximize life expectancy you get one number, lives saved this year you get another number, lives saved 5 years down the road you get another number, and so on.

However, I do take issue with the 2.2M number. We know now that was never going to happen.

We may 'know' (really, we don't for sure, but it certainly is looking like a major overestimate) now, but at the time US measures were initiated, it was one of the most reputable estimates out there, from Imperial College.

Unfortunately, in the case of still extremely incomplete information on transmission modes, and their relative likelihood in different environments, (and that there is still large uncertainty in infection fatality rate), the only option is to make policies that are basically experiments to see what happens. Over time, as different experiments (countries) play out, knowledge will increase and hopefully policies become more informed.

 

[PAllen]

We may 'know' (really, we don't for sure, but it certainly is looking like a major overestimate) now, but at the time US measures were initiated, it was one of the most reputable estimates out there, from Imperial College.

Unfortunately, in the case of still extremely incomplete information on transmission modes, and their relative likelihood in different environments, (and that there is still large uncertainty in infection fatality rate), the only option is to make policies that are basically experiments to see what happens. Over time, as different experiments (countries) play out, knowledge will increase and hopefully policies become more informed.

One additional point is that while 2.2 million now seems implausible, it is not order of magnitude off for estimate for minimal counter measures. Using data from here:
https://ourworldindata.org/coronavirus
one finds that, while infection fatality rate remains largely unknown, many of the countries who have had it a while, are stabilizing around 2% CFR. This compares to CFR (NOT IFR) of .15% for seasonal flu (that link has a table of CFR for various diseases). Assuming corona is similarly as infectious as the flu, and the seasonal flu has typically 40,000 deaths in the US, that leads to 550,000 deaths in the US for measures that are no more effective than the flu vaccine is for the flu.

 

[atyy]

One additional point is that while 2.2 million now seems implausible, it is not order of magnitude off for estimate for minimal counter measures. Using data from here:
https://ourworldindata.org/coronavirus
one finds that, while infection fatality rate remains largely unknown, many of the countries who have had it a while, are stabilizing around 2% CFR. This compares to CFR (NOT IFR) of .15% for seasonal flu (that link has a table of CFR for various diseases). Assuming corona is similarly as infectious as the flu, and the seasonal flu has typically 40,000 deaths in the US, that leads to 550,000 deaths in the US for measures that are no more effective than the flu vaccine is for the flu.

Indeed, others had made sensible estimates similar to yours.

nanoscale views
Exponentials, extrapolation, and prudence
http://nanoscale.blogspot.com/2020/03/exponentials-extrapolation-and-prudence.html

condensed concepts
Exponential growth: living and dying by it
https://condensedconcepts.blogspot.com/2020/03/exponential-growth-living-and-dying-by.html

 

[Ygggdrasil]

Expanding on my last post, I predict that when this is over we will see a flood of calculations of the sort "we saved N lives" by taking some counterfactual, and subtracting the actual number from it. I suspect what we will not see is as many well-conducted studies comparing the success of different interventions. We can see that now with Sweden. If the Swedish plan fails, well, we knew it would all along. If it succeeds, we'll you can't tell anything from one country especially Sweden.

While it will be a while before we have any studies to compare effectiveness of different strategies to combat the COVID-19 pandemic, we do have studies of past pandemics to help guide our current policymaking. For example, a (non-peer reviewed) working paper from economists at MIT suggests that stronger and earlier implementation of social distancing and other public health interventions were correlated with slightly improved economic recovery after the pandemic:

The study, using data from the flu pandemic that swept the U.S. in 1918-1919, finds cities that acted more emphatically to limit social and civic interactions had more economic growth following the period of restrictions.

Indeed, cities that implemented social-distancing and other public health interventions just 10 days earlier than their counterparts saw a 5 percent relative increase in manufacturing employment after the pandemic ended, through 1923. Similarly, an extra 50 days of social distancing was worth a 6.5 percent increase in manufacturing employment, in a given city.

“We find no evidence that cities that acted more aggressively in public health terms performed worse in economic terms,” says Emil Verner, an assistant professor in the MIT Sloan School of Management and co-author of a new paper detailing the findings. “If anything, the cities that acted more aggressively performed better.”

http://news.mit.edu/2020/pandemic-health-response-economic-recovery-0401

Of course, the differences are very modest and correlation is not causation, so other factors could be involved (e.g. maybe areas that have stronger, more effective leadership were able to both implement social distancing earlier and better coordinate the post-pandemic economic recovery). Also, it is unclear how applicable data from over a century ago are to today's circumstances.

However, the data are consistent with the view that the economy is a very interconnected entity and (as with public health), we are all in this together. Whether or not one country decides to trade off potentially greater risks to its population against lesser damage to its economy, the overall effect on the global economy would be enough to flatten out the effects across the entire world.

Here's a link to the working paper for those interested: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561560

Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu

Abstract: What are the economic consequences of an influenza pandemic? And given the pandemic, what are the economic costs and benefits of non-pharmaceutical interventions (NPI)? Using geographic variation in mortality during the 1918 Flu Pandemic in the U.S., we find that more exposed areas experience a sharp and persistent decline in economic activity. The estimates imply that the pandemic reduced manufacturing output by 18%. The downturn is driven by both supply and demand-side channels. Further, building on findings from the epidemiology literature establishing that NPIs decrease influenza mortality, we use variation in the timing and intensity of NPIs across U.S. cities to study their economic effects. We find that cities that intervened earlier and more aggressively do not perform worse and, if anything, grow faster after the pandemic is over. Our findings thus indicate that NPIs not only lower mortality; they also mitigate the adverse economic consequences of a pandemic.

(note: I am a biologist, no an economist, so I am in no way qualified to evaluate the working paper)

 

[Vanadium 50]

It's also worth noting that the containment efforts themselves will kill people and also save people unrelated to the disease itself. Those deaths need to be quantified and considered in the analysis.

There are some attempts at this: https://www.reuters.com/investigates/special-report/health-coronavirus-usa-cost/ It's broad but not very deep.

There is also this: https://www.realclearpolitics.com/articles/2020/04/13/shutdown_could_kill_more_americans_than_covid-19_142934.html I don't think she's making the correct comparisons, but at least it's an attempt to quantify,

One problem with "deaths of despair" is that it's difficult to look at a person and say "the single reason why they are dead is X". At best, one can look statistically. It's even worse for lives saved due to reduced accidents. How do you point at someone and say "her life was saved"? We can see this effect in European mortality statistics - in years with bad flu seasons, the spike in deaths exceeds the number of attributed flu deaths by a factor of 2-5.

 

[jack action]

For whom are interested, the UN is now evaluating confinement consequences in children's death:

Hundreds of thousands of children could die this year due to the global economic downturn sparked by the Coronavirus pandemic and tens of millions more could fall into extreme poverty as a result of the crisis, the United Nations warned on Thursday.