Reply
 
Thread Tools Display Modes
  #1  
Old 05-13-2020, 01:21 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402

Establishing criteria for dealing with pandemics


Experience in business and running shops has taught me to establish criteria to base my decisions on so as to minimize delays in making decisions. when it comes to human life it becomes much more difficult. I made up a few questions I would have to ask myself if I were in a position of authority making decisions that would affect peoples lives such as the shutdown.

Suppose we used a very bad flu season as a baseline for criteria. We used a number like 100,000 projected deaths life goes on like normal, 200,000 deaths we implement some social distancing recommendations, 300,000 deaths we tighten up a bit on social meetings etc.

How do we rate human lives at stake? Is everyone the same or do we prorate based on life expectancy of those at risk. Anything below 90% would be considered a full person. If a person 70 years old was expected to have 7 years left he would count as 1/10 of a person and 80 year old with 6 months to live he might count as 1/100 of a person etc.

How would we deal with extreme risk cases being primarily because of bad life choices? Smoking, obesity etc? Would this be a consideration or would that automatically lower the influence they had on decisions that would affect us all and our economy? Should they automatically be rated at a lower number say for example 1/5 of a person.

We do need a criteria here, how could we go about establishing that?
  #2  
Old 05-13-2020, 01:54 PM
nelliebly is offline
Guest
 
Join Date: Jul 2017
Location: Washington
Posts: 3,058
Quote:
Originally Posted by HoneyBadgerDC View Post
Experience in business and running shops has taught me to establish criteria to base my decisions on so as to minimize delays in making decisions. when it comes to human life it becomes much more difficult. I made up a few questions I would have to ask myself if I were in a position of authority making decisions that would affect peoples lives such as the shutdown.

Suppose we used a very bad flu season as a baseline for criteria. We used a number like 100,000 projected deaths life goes on like normal, 200,000 deaths we implement some social distancing recommendations, 300,000 deaths we tighten up a bit on social meetings etc.

How do we rate human lives at stake? Is everyone the same or do we prorate based on life expectancy of those at risk. Anything below 90% would be considered a full person. If a person 70 years old was expected to have 7 years left he would count as 1/10 of a person and 80 year old with 6 months to live he might count as 1/100 of a person etc.

How would we deal with extreme risk cases being primarily because of bad life choices? Smoking, obesity etc? Would this be a consideration or would that automatically lower the influence they had on decisions that would affect us all and our economy? Should they automatically be rated at a lower number say for example 1/5 of a person.

We do need a criteria here, how could we go about establishing that?
100,000, 200,000 where? In the US? The world? And are these deaths evenly distributed or clustered? The federal government can guide or make strong recommendations, but decisions re: shutting down are still up to the states, so who is "we"?

Finally, the idea of designating people as fractions of a person is not going to go well. We tried it once before with a segment of our population, and it was pretty awful.

I get what you're trying to do here. I just think you need more information and a different approach.
  #3  
Old 05-13-2020, 02:00 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by nelliebly View Post
100,000, 200,000 where? In the US? The world? And are these deaths evenly distributed or clustered? The federal government can guide or make strong recommendations, but decisions re: shutting down are still up to the states, so who is "we"?

Finally, the idea of designating people as fractions of a person is not going to go well. We tried it once before with a segment of our population, and it was pretty awful.

I get what you're trying to do here. I just think you need more information and a different approach.
I don't have any information, the post was just intended as an example to think about. Any numbers I proposed were strictly hypothetical.
  #4  
Old 05-13-2020, 02:18 PM
Telemark's Avatar
Telemark is online now
Charter Member
 
Join Date: Apr 2000
Location: Just outside of Titletown
Posts: 24,108
Quote:
Originally Posted by HoneyBadgerDC View Post
Any numbers I proposed were strictly hypothetical.
The problem isn't the proposed numbers; it's the system of counting some people as worth less than a whole person.
  #5  
Old 05-13-2020, 02:35 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by Telemark View Post
The problem isn't the proposed numbers; it's the system of counting some people as worth less than a whole person.
Suppose a situation where we have now where about 40% of the deaths are in skilled nursing homes and basically very close to the end of their natural lives. Another very large segment of the deaths could be attributed to bad life style choices. I think these circumstances need special consideration when deciding what to do with the general population.
  #6  
Old 05-13-2020, 02:38 PM
VOW is online now
Member
 
Join Date: Apr 2002
Location: NE AZ
Posts: 4,299
The key here is your sentence, "I don't have any information."

Scientists spend lifetimes studying diseases in populations. They use contact tracing to follow the disease spread, and collect mortality and morbidity figures to enable them to project outcomes. Further study allows them to model changes in behaviors to vary the outcomes.

Simply pulling numbers out of the air doesn't work too well. People who do that are called "novelists."


~VOW
__________________
Klaatu Barada Nikto
  #7  
Old 05-13-2020, 02:43 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by VOW View Post
The key here is your sentence, "I don't have any information."

Scientists spend lifetimes studying diseases in populations. They use contact tracing to follow the disease spread, and collect mortality and morbidity figures to enable them to project outcomes. Further study allows them to model changes in behaviors to vary the outcomes.

Simply pulling numbers out of the air doesn't work too well. People who do that are called "novelists."


~VOW
Not sure why you would say that. The only premise I am proposing is that we need to establish criteria based on something tangible. Forget the numbers they are hypothetical. We currently have a circle jerk going on. Decisions are being made based on emotional responses.
  #8  
Old 05-13-2020, 03:12 PM
Shalmanese is offline
Charter Member
 
Join Date: Feb 2001
Location: Shenzhen, China
Posts: 7,436
Yes, every government has left the successive government a pandemic preparedness playbook which was ignored. Here's Bill Clinton's, George W Bush's, Obama's.


Inside America’s 2-Decade Failure to Prepare for Coronavirus
for a detailed article about how every change in administration leads to a loss of institutional knowledge about how you need to treat pandemics seriously and a subsequent relearning of the same expensive lessons.
  #9  
Old 05-13-2020, 03:19 PM
Shalmanese is offline
Charter Member
 
Join Date: Feb 2001
Location: Shenzhen, China
Posts: 7,436
And here's the WHO version published for the first time on September, 2019.
  #10  
Old 05-13-2020, 03:35 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
A good discussion of how economists attach dollar values and how that applies to the current circumstance.
https://www.google.com/amp/s/www.for...lockdowns/amp/

Counting a likely 60 future years of disability free life as of different worth to invest in than a likely 2 of bed ridden, is pretty standard for medical intervention cost analysis, FWIW.

Problem still is poor inputs. What are the lives quality and dollar costs downstream from different actions? It’s unclear. That still does not mean that those who have the best tools to use to make those analyses shouldn’t be trying to rough it out under ranges of assumptions.
  #11  
Old 05-13-2020, 04:02 PM
VOW is online now
Member
 
Join Date: Apr 2002
Location: NE AZ
Posts: 4,299
I puke at the thought that some economists will determine my worth as a human being, and decide whether or not I qualify for life saving treatment.

I'm 67 and have several co-morbidities, so that means I'm standing at the edge of my grave until some bureaucrat gives me a good shove. The fact that I worked my entire adult life is meaningless, I guess.

Someone else had that idea. His name was Hitler.


~VOW
__________________
Klaatu Barada Nikto
  #12  
Old 05-13-2020, 04:09 PM
Stranger On A Train is offline
Guest
 
Join Date: May 2003
Location: Manor Farm
Posts: 19,868
Quote:
Originally Posted by HoneyBadgerDC View Post
Decisions are being made based on emotional responses.
Although you are correct that many decisions on how to deal with the COVID-19 pandemic are “being made based on emotional responses”, it is clear from your previous history that what you mean by this is that the decisions you disagree with, i.e. those recommending isolation and closure of non-essential business. In fact, it is the appeals to ‘reopen the economy’, being made by people who are arguing from ignorance that this is just an ‘old peoples’ disease’ that are making the emotional argument. The rational argument is that we should gather data and make cautious, well-monitored incremental efforts to relax isolation measures rather than just open everything up at once and let ‘nature’ takes its course.

The recommendations by epidemiologists and public health experts are based upon empirical science and experience with previous infectious epidemics. These recommendations are geared toward minimizing the loss of life from the pandemic which does have to be balanced against the economic and social impacts that those recommendations will have because the lost of employment, mobility, social contact, et cetera also has an effect on population morbidity and mortality. Because the SARS-CoV-2 virus is novel (never previously experienced in the human population, and thus, there is no acquired immunity, a poor understanding of the dynamics of this contagion, and no prior knowledge of pathogenesis of the virus or treatments for it) those experts have recommended very conservative infection control measures that are unprecedented in living memory. As we are learning more about the SARS-CoV-2 virus and the COVID-19 syndrome it causes, it is apparent that such caution is warranted, because what was originally believed to be ‘just’ a respiratory infection that only affected the elderly and those with severe co-morbidities has been discovered to affect healthy adults with no underlying conditions, attack the heart, kidneys, and other organs and extremities, and even severely impacting some children presenting a Kawasaki-like vasculitis via a mechanism that is not understood.

We currently do not have effective pharmacological prophylactic treatments or interventions that have been shown to be substantially effective in reducing mortality across any age group (although a few drugs have shown some degree of promise). The normal intervention of mechanical respiration for patients experiencing ARDS has had surprisingly low efficacy compared to normal influenza-like and pneumonia diseases, and the severe lack of reliable testing means that even several months after the start of this pandemic we do not have reliable numbers on the percentage of the population infected or the infection fatality rate, nor do we really understand the long term impacts of people with seemingly mild infections but persistent debilitating sequelae. We do not know when a vaccine will be available (the frequent promises of “in a year” are still at this point magical thinking until one of the candidates manages to get through a Phase II efficacy trial with success) and we don’t even know the degree of immunity conveyed by prior exposure or how long it may last.

As for the notion of making the response proportional to some kind of metric like financial loss due to isolation measures compared to the valuation of a hypothetical reference person at different stages in their life, this might have some ethical merit in a constrained sense if we actually knew what the end result would be of a free fire contagion versus the efficacy of various restrictions. Unfortunately, we have neither adequate knowledge of the effects of the virus in the long term nor a good way to make high confidence estimates of the efficacy of the graduation of isolation measures. Since the basic reproduction number and other figures of merit of the infectiousness have been repeatedly revised through the past couple of months, any kind of simulation of the efficacy of such measures would have to be revised repeatedly and the results interpreted with a statistically large uncertainty notwithstanding the variable compliance of the public with any stated measures.

If we had taken non-conservative measures we would have likely seen more incidence of the kind of outbreaks that were observed in New York City, Detroit, and New Orleans, and we may yet see those as measures are lifted to abruptly with no controls or any attempt to assess the effects on localized populations first. Since we do not have the information to make very accurate predictions of how a novel pathogen will spread and behave, trying to make any kind or opportunity cost estimates is fraught with the potential that a wrong decision could cost an order of magnitude more deaths that could potentially be savable not withstanding the inability to calculate the cost on the economy of a free running epidemic, which is a point all of the ‘damn the virus, America wants to be free’ populists either obtusely or willfully miss.

All of that being said, epidemiologists and public health experts are cognizant of the costs of keeping states or regions shut down to prevent epidemic spread, which again have real health and welfare consequences that can be estimated and measured. This is why the CDC put a lot of effort into developing criteria for when a state should consider opening up, how they might perform a gradual relaxation of measures, and what kind of testing and monitoring to perform to prevent flareups that would overwhelm health services. Unfortunately, the White House has tried to block these detailed recommendations and many state governors don’t seem to care about them, or even the less detailed measures the White House published when electing to relax or remove business and social restrictions. So, we’ll see how that goes. I’m guessing that spikes in mortality and ICU wards overflowing in the Midwest are not going to be too great for the economy.

Stranger
  #13  
Old 05-13-2020, 04:09 PM
Oredigger77 is offline
Guest
 
Join Date: Aug 2007
Location: Back at 5,280
Posts: 5,537
The metric you may be looking for is what is a life worth. Generally in the US we consider a life worth about $10mm. So it's worth spending $10mm to prevent a person from dying. This can be applied to pandemics in that each person we prevent from dying can cost the Country or State up to $10mm before the pain isn't worth it. Generally, that number isn't divided to make granny worth less than junior but you could probably come up with a metric that somewhat useful.

If we use the Imperial College London worst case/best case numbers we could save 1.1mm lives by taking preventative measures so it would be worth it for the governments in the US to spend $11T to prevent that loss of life or about $600B/month over the 18 months to develop a vaccine. How that $600B should be spent to maximize the results is a different question of course. Though preventing economic pain while locking everyone inside would have probably made the most sense. It would have worked out to a cash payment of $1,800/ month to every person in the country.

Last edited by Oredigger77; 05-13-2020 at 04:13 PM.
  #14  
Old 05-13-2020, 04:15 PM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by HoneyBadgerDC View Post
Suppose a situation where we have now where about 40% of the deaths are in skilled nursing homes and basically very close to the end of their natural lives. Another very large segment of the deaths could be attributed to bad life style choices. I think these circumstances need special consideration when deciding what to do with the general population.
Why are you only considering mortality?

Even if only a handful die, many more will be hospitalized, or will be off work for possibly extended periods due to illness, and some of them are going to have a very long road back, a road that for some is likely to detour through short- or long-term disability.

Then there are the knock-on effects of having a bunch of people off sick. For example, the meat processing plants are closing not because so many employees have died, but because so many are ill; most will recover, but in the meantime they're not able to work. At the state prison in northeast Kansas, illness and quarantine among staff are exacerbating their long-term staffing issues; it's bad enough that they have the National Guard taking inmates' temperatures and overseeing property distribution. "Only" two staff (plus three inmates) have died, and they've all been men aged 50+, but neither guard was decrepit: they were both at work as recently as mid-April. (Hearing about guards dying isn't likely to improve staff morale or aid staff recruitment efforts, either.)
  #15  
Old 05-13-2020, 04:40 PM
Chronos's Avatar
Chronos is offline
Charter Member
Moderator
 
Join Date: Jan 2000
Location: The Land of Cleves
Posts: 88,641
Quote:
Quoth VOW:

I puke at the thought that some economists will determine my worth as a human being, and decide whether or not I qualify for life saving treatment.

I'm 67 and have several co-morbidities, so that means I'm standing at the edge of my grave until some bureaucrat gives me a good shove. The fact that I worked my entire adult life is meaningless, I guess.

Someone else had that idea. His name was Hitler.
LOTS of someone elses had that idea. Every aspect of your life is affected by decisions made by people weighing lives against other considerations. People die in car accidents, too. Fewer people would die if we had a nationwide speed limit of 55 MPH, or 35. Why don't we have those lower speed limits? Because there are other costs to having speed limits that low, and those costs must be weighed against the cost of lives.
  #16  
Old 05-13-2020, 07:47 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
Quote:
Originally Posted by VOW View Post
I puke at the thought that some economists will determine my worth as a human being, and decide whether or not I qualify for life saving treatment. ...
There's medicine you can use for your hyperemesis, because whether you think about it or not it is done ALL THE TIME. Not your worth "as a human being" but how much should be spent to save a full "quality" year of life. It is something that is obviously true, even if it is not always done in consistently rational ways. People do it even valuing their own lives ... pay the extra thousand for the extra safety package on the car or not?

As the article I linked to discusses, on the medical side it is often referred to as Quality Adjusted Life Years (QALY), and the ranges that seem to get settled into are $100K to 150K/QALY. There are a variety of variations of it but on the medical side a public health intervention that say saves 10,000 eighteen year olds lives to likely live to average life expectancy might be funded at a cost of $50B while one that saves 10,000 eighty year olds to live to average life expectancy would probably not be funded at that cost.

Again though the bigger difficulty are the unknowns that such calculation would need.

The issue of net lives or QALYs saved directly from COVID by way of one or another intervention, as unknown as it is how effective each individual intervention is, is a relatively minor part of the calculation.

How many are disabled from the disease and how does that get valued? How many deaths do the harms of the interventions cause? Do you value the deaths caused in low income countries by the hunger pandemic and childhood vaccine preventable disease increases that will predictably occur the same as American lives? (I do but our society does clearly does not.) The actual costs of different course of action, assuming one can agree on how much to value which life, are guesswork.

The best we can do is recognize that some interventions are much more costly across various metrics (including non-COVID-19 deaths), and some that are less. Some that have solid reasons to believe they do a lot of good, and some that have little evidence for this specific germ. Ideally we the criteria includes easing off on the ones that are most costly for the least proven benefit first, and the interventions that provide the most benefit for the least costs get done well for the longest. That should be specific for each pandemic as the specifics of the germ and its behaviors are determined.
  #17  
Old 05-13-2020, 08:27 PM
nelliebly is offline
Guest
 
Join Date: Jul 2017
Location: Washington
Posts: 3,058
Quote:
Originally Posted by DSeid View Post
There's medicine you can use for your hyperemesis, because whether you think about it or not it is done ALL THE TIME. Not your worth "as a human being" but how much should be spent to save a full "quality" year of life. It is something that is obviously true, even if it is not always done in consistently rational ways. People do it even valuing their own lives ... pay the extra thousand for the extra safety package on the car or not?

As the article I linked to discusses, on the medical side it is often referred to as Quality Adjusted Life Years (QALY), and the ranges that seem to get settled into are $100K to 150K/QALY. There are a variety of variations of it but on the medical side a public health intervention that say saves 10,000 eighteen year olds lives to likely live to average life expectancy might be funded at a cost of $50B while one that saves 10,000 eighty year olds to live to average life expectancy would probably not be funded at that cost.

Again though the bigger difficulty are the unknowns that such calculation would need.

The issue of net lives or QALYs saved directly from COVID by way of one or another intervention, as unknown as it is how effective each individual intervention is, is a relatively minor part of the calculation.

How many are disabled from the disease and how does that get valued? How many deaths do the harms of the interventions cause? Do you value the deaths caused in low income countries by the hunger pandemic and childhood vaccine preventable disease increases that will predictably occur the same as American lives? (I do but our society does clearly does not.) The actual costs of different course of action, assuming one can agree on how much to value which life, are guesswork.

The best we can do is recognize that some interventions are much more costly across various metrics (including non-COVID-19 deaths), and some that are less. Some that have solid reasons to believe they do a lot of good, and some that have little evidence for this specific germ. Ideally we the criteria includes easing off on the ones that are most costly for the least proven benefit first, and the interventions that provide the most benefit for the least costs get done well for the longest. That should be specific for each pandemic as the specifics of the germ and its behaviors are determined.
Now please apply that reasoning to the OP, specifically:

HoneyBadgerDC: How do we rate human lives at stake? Is everyone the same or do we prorate based on life expectancy of those at risk. Anything below 90% would be considered a full person. If a person 70 years old was expected to have 7 years left he would count as 1/10 of a person and 80 year old with 6 months to live he might count as 1/100 of a person etc.

How would we deal with extreme risk cases being primarily because of bad life choices? Smoking, obesity etc? Would this be a consideration or would that automatically lower the influence they had on decisions that would affect us all and our economy? Should they automatically be rated at a lower number say for example 1/5 of a person.
  #18  
Old 05-13-2020, 10:21 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,293
Quote:
Originally Posted by HoneyBadgerDC View Post
We do need a criteria here, how could we go about establishing that?
I think we already have it. The concern is whether or not the health care system gets overwhelmed. So 100,000 evenly spread out over a year not as serious as 20,000 in 1 city in 3 months.
  #19  
Old 05-13-2020, 11:00 PM
Banksiaman is offline
Guest
 
Join Date: Apr 2012
Location: Straya
Posts: 1,370
Recognising that you may get to a point where you do have to make value-judgements about the relative worth of different lives, for example which of the 10 people you allocate to the 5 ICU beds and which 5 will likely die, and that this will be a severe, irreversible, morally challenging decision, surely the first question to ask is - What can I do to NOT get to that point, because any answer at that point cannot be satisfactory. This is completely missing in your pseudo-objective quantification process.

To me, the original post is couched to say the solution is a cost-benefit formula that absolves us from moral culpability in the outcome. We are probably already doing that far too much in the current situation, where doctors are being left at the pointy end to make decisions about whether people live or die, for which they are held responsible, so that society can avoid the psychological angst of having to be part of a morally invidious decision.

The answer is to be more proactive and intrusive in isolation early on, but from your commentary here and elsewhere you'd rather swallow your own tongue than entertain that.

Last edited by Banksiaman; 05-13-2020 at 11:05 PM.
  #20  
Old 05-14-2020, 10:25 AM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by Banksiaman View Post
Recognising that you may get to a point where you do have to make value-judgements about the relative worth of different lives, for example which of the 10 people you allocate to the 5 ICU beds and which 5 will likely die, and that this will be a severe, irreversible, morally challenging decision, surely the first question to ask is - What can I do to NOT get to that point, because any answer at that point cannot be satisfactory. This is completely missing in your pseudo-objective quantification process.

To me, the original post is couched to say the solution is a cost-benefit formula that absolves us from moral culpability in the outcome. We are probably already doing that far too much in the current situation, where doctors are being left at the pointy end to make decisions about whether people live or die, for which they are held responsible, so that society can avoid the psychological angst of having to be part of a morally invidious decision.

The answer is to be more proactive and intrusive in isolation early on, but from your commentary here and elsewhere you'd rather swallow your own tongue than entertain that.
My personal feeling about this virus is that it will be well above the 100,000 mark so does deserve special attention. I am not opposed to shutdowns to slow the virus. I do feel the shutdowns have slowed it a bit too much and in many states and was applied to soon. I realize that is a hard call because of the two week lag and not knowing how many were infected that will be hitting the hospitals in two weeks. Once we became aware of who was primarily at risk I didn't see much effort in educating the public and those at high risk about their true risk factors and things they could do to mitigate this. It seemed it was just stoking as much fear as possible to keep everyone in. I see lots of decisions being made on the fly.

I feel establishing more criteria would save lives in the long run and consider everything that was at stake. I believe we are still in the very early stages of this virus and learning more everyday. Hopefully we are establishing counter measures that will save lives and allow folks to get back to living as normal lives as possible.
  #21  
Old 05-14-2020, 10:32 AM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
Quote:
Originally Posted by nelliebly View Post
Now please apply that reasoning to the OP, specifically:

HoneyBadgerDC: How do we rate human lives at stake? Is everyone the same or do we prorate based on life expectancy of those at risk. Anything below 90% would be considered a full person. If a person 70 years old was expected to have 7 years left he would count as 1/10 of a person and 80 year old with 6 months to live he might count as 1/100 of a person etc.

How would we deal with extreme risk cases being primarily because of bad life choices? Smoking, obesity etc? Would this be a consideration or would that automatically lower the influence they had on decisions that would affect us all and our economy? Should they automatically be rated at a lower number say for example 1/5 of a person.
It is very difficult to apply it to his specifics; his specifics are more questions that have to do with end of life expenditures in general, and while as a society we do a not too inconsistent job of applying QALY and the statistical value of a life to population wide interventions, we throw it all out the window when faced with, well, a face.

None of the systems used explicitly value populations differently based on what the op seems to consider moral failings or poor choices made. We spend on smokers and drinkers, for example.

My only contribution here is that it is VERY ethical, really necessary, to consider the full range of near to longer term costs/benefits, inclusive of indirect but predictable impacts, to each element of ongoing interventions, and to use QALYs as part of that analysis, with full recognition of what is being assumed and what the evidence to support each option is. There are people with whole toolboxes to apply to those questions and they do not seem to be involved in the process very much.
  #22  
Old 05-14-2020, 11:22 AM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
The importance of being as sure as possible that our response to the disease is thoughtful, maximizing the benefits of controlling its spread and harmful impacts over the harms that the disruptions of the interventions cause are illustrated in this article.
Quote:
In weighing their options, policy makers must consider not only the immediate health effects of the pandemic but also the indirect effects of the pandemic and the response to it. An analysis of the 2014 outbreak of Ebola virus in west Africa showed that the indirect effects of the outbreak were more severe than the outbreak itself.4 Although mortality rates for COVID-19 appear to be low in children and in women of reproductive age,5 these groups might be disproportionately affected by the disruption of routine health services, particularly in low-income and middle-income countries (LMICs). With this in mind, we sought to quantify the potential indirect effects of the COVID-19 pandemic on maternal and child mortality. ...

... Our analysis shows that if the COVID-19 pandemic results in widespread disruption to health systems and reduced access to food, LMICs can expect to see large increases in maternal and child deaths. Under our first scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%), over 6 months there would be 253 500 additional child deaths and 12 200 additional maternal deaths. Under our third scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%), over 6 months there would be 1 157 000 additional child deaths and 56 700 additional maternal deaths. These deaths would represent a 9·8–44·7% increase in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. ...

... the choices that governments make in responding to the pandemic will have consequences for maternal and child health. There has been debate around the trade-off between establishing movement restrictions and minimising disruptions to business and economies. Our results show that the indirect effects of the pandemic are not merely economic. If the delivery of health care is disrupted, many women and children will die ...
Bolding mine.
  #23  
Old 05-14-2020, 11:45 AM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
[QUOTE=HoneyBadgerDC;22302304Once we became aware of who was primarily at risk ...[/QUOTE]

When did this happen?

We're still learning what the main risk factors are; we are having to make decisions on the fly because we simply don't have all of the information needed to make truly well-informed decisions.

For example, early on, it was thought that asthma was a major risk factor; now, not so much, with hypertension and obesity being apparently greater issues. Early on, we thought that kids weren't really at risk; the recent investigations of Kawasaki-like illness in kids is a warning that we don't know that for sure. Is this a really rare complication, or even something only obliquely associated, or is it just that the virus goes into stealth mode in kids, and six months or a year or five years down the road we're going to have a huge outbreak of COVID sequelae sickening and killing children? We can make some guesses, even educated guesses, but at this point, we are NOT "aware" of exactly what the risks are, and pretending we know for sure what's going on is not somehow an improvement on the current situation.

I would also point out, again, that dying isn't the only risk. For example, right now about a quarter of COVID-19 hospitalizations are in adults aged 18-49 (cite) and another 30% are adults 50-64 (i.e., still working age); that's not counting the people who are sick at home. With COVID-19, illnesses tend to be protracted, with recovery times typically ranging from two to six weeks. The people most likely to have been laid off in the recent shutdowns, such as retail clerks and restaurant workers, are also the people most likely to lack employer-paid health insurance and paid sick leave, which means that if they get sick, they're not getting a paycheck, they're not "available to work" so can't collect unemployment, AND they risk getting slammed with medical bills, so a trifecta of financial hurt.
  #24  
Old 05-14-2020, 01:07 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
Quote:
Originally Posted by slash2k View Post
... Early on, we thought that kids weren't really at risk; the recent investigations of Kawasaki-like illness in kids is a warning that we don't know that for sure. Is this a really rare complication, or even something only obliquely associated, or is it just that the virus goes into stealth mode in kids ...
I will be apparently saying this over and over again: we know as much as we have known for a while now that serious outcomes in kids occur ... very rarely. There is absolutely NOTHING that suggests other than that. It is clearly NOT “stealth mode” ... fear mongering about kids is NOT useful.
__________________
Oy.
  #25  
Old 05-14-2020, 01:10 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
To emphasize... it is clear that this germ is MUCH less dangerous than influenza in kids. Has been clear and still is so.
__________________
Oy.
  #26  
Old 05-14-2020, 01:28 PM
bump is offline
Guest
 
Join Date: Jun 2000
Location: Dallas, TX
Posts: 19,674
Quote:
Originally Posted by HoneyBadgerDC View Post
I do feel the shutdowns have slowed it a bit too much and in many states and was applied to soon.
I'm not so sure you understand how the shutdowns work if you're saying that.

Basically there's no such thing as "too soon". Hypothetically, had the President possessed the power and the desire to mandate that ALL states lock down in the last week of February, there's every chance that we'd have come out of the lockdown earlier AND have had less in the way of extreme situations like that of NYC.

Similarly, by unlocking early, it's entirely likely that those states are going to suffer larger, more intense outbreaks than had they just stayed locked down another few weeks.

Think of it like a fire; is there ever a point when you can put it out "too soon"? Or if it's still burning, to quit spraying water on it? This is very similar in concept.
  #27  
Old 05-14-2020, 01:44 PM
bump is offline
Guest
 
Join Date: Jun 2000
Location: Dallas, TX
Posts: 19,674
Quote:
Originally Posted by HoneyBadgerDC View Post
I do feel the shutdowns have slowed it a bit too much and in many states and was applied to soon.
I'm not so sure you understand how the shutdowns work if you're saying that.

Basically there's no such thing as "too soon". Hypothetically, had the President possessed the power and the desire to mandate that ALL states lock down in the last week of February, there's every chance that we'd have come out of the lockdown earlier AND have had less in the way of extreme situations like that of NYC.

Similarly, by unlocking early, it's entirely likely that those states are going to suffer larger, more intense outbreaks than had they just stayed locked down another few weeks.

Think of it like a fire; is there ever a point when you can put it out "too soon"? Or if it's still burning, to quit spraying water on it? This is very similar in concept.
  #28  
Old 05-14-2020, 01:49 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by bump View Post
I'm not so sure you understand how the shutdowns work if you're saying that.

Basically there's no such thing as "too soon". Hypothetically, had the President possessed the power and the desire to mandate that ALL states lock down in the last week of February, there's every chance that we'd have come out of the lockdown earlier AND have had less in the way of extreme situations like that of NYC.

Similarly, by unlocking early, it's entirely likely that those states are going to suffer larger, more intense outbreaks than had they just stayed locked down another few weeks.

Think of it like a fire; is there ever a point when you can put it out "too soon"? Or if it's still burning, to quit spraying water on it? This is very similar in concept.
That is exactly my point, I favor maximizing infections going for herd immunity. Once we get about 50% infected things should start slowing down.
  #29  
Old 05-14-2020, 02:10 PM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
Quote:
Originally Posted by DSeid View Post
I will be apparently saying this over and over again: we know as much as we have known for a while now that serious outcomes in kids occur ... very rarely. There is absolutely NOTHING that suggests other than that. It is clearly NOT “stealth mode” ... fear mongering about kids is NOT useful.
The recent reporting on the kids with Kawasaki-like illness suggests that it typically presents some weeks after the primary infection; Dr. Sunil Sood at Northwell Health in NYC (a pediatric infectious disease specialist) is quoted as saying about four weeks later. Most of the kids test positive to antibodies but not to the actual virus, indicating a post-infectious complication rather than something concurrent. Post-infectious inflammatory responses weeks or months (rarely, years) after the primary infection are known from other diseases; what about this disease says it cannot happen, or even happen commonly, with COVID-19?

At this point, nobody can say for sure even that the Kawasaki-like illnesses are related (except temporally) to COVID-19; perhaps it is mere coincidence that the illness has been reported so far only in kids testing positive to either the virus or the antibodies. Why is it "fear-mongering" to say that it might not be a coincidence? If some kids are getting sick four weeks after the illness, what stops others from getting sick six or eight or twelve weeks later? We know so little about how this virus actually attacks humans that I'm not sure it is accurate to say serious outcomes in children must and will always remain very rare. Making promises about the long-term consequences, good OR bad, of a disease identified less than six months ago is a bold step.
  #30  
Old 05-14-2020, 02:23 PM
slash2k is offline
Guest
 
Join Date: Feb 2014
Posts: 2,811
nm

Last edited by slash2k; 05-14-2020 at 02:28 PM. Reason: board hiccup = dup post
  #31  
Old 05-14-2020, 03:17 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
YES. The presumptive understanding is a post infectious response ... that is NOT the virus being in some weird stealth mode. It is occurring, it seems, in kids who have had great response to beating off the infection ... but in these very few the reaction goes too far.

It is fear mongering to portray this rare event as something that is anything other than rare. There is NOTHING about this that raises fear of more showing up in a more delayed manner to any of those who understand the pathophysiology. I for one am unaware of other established post infectious (not latent or prolonged) conditions that show up with onset much later than a month after the infection has been beat off.

Be afraid! This could be the one! Who knows?!! Sorry no.

All we can say is that serious disease resultant of SARS-CoV-2 including the KD -like syndrome is MUCH less common than serious disease from influenza among children. It is weird but true.
  #32  
Old 05-14-2020, 03:56 PM
crowmanyclouds's Avatar
crowmanyclouds is offline
Guest
 
Join Date: Sep 2005
Location: ... hiding in my room ...
Posts: 5,080
Quote:
Originally Posted by HoneyBadgerDC View Post
That is exactly my point, I favor maximizing infections going for herd immunity. Once we get about 50% infected things should start slowing down.
The pile of corpses required to get us there should just be happy to volunteer? Take one for the team, right?

CMC fnord!

Last edited by crowmanyclouds; 05-14-2020 at 03:58 PM.
  #33  
Old 05-14-2020, 04:04 PM
Stranger On A Train is offline
Guest
 
Join Date: May 2003
Location: Manor Farm
Posts: 19,868
Quote:
Originally Posted by HoneyBadgerDC View Post
That is exactly my point, I favor maximizing infections going for herd immunity. Once we get about 50% infected things should start slowing down.
I hesitate to go over this ground again but for anyone who is actually interested in understanding the issue, “herd immunity” is not a strategy but the (hopefully) end result of driving the contagion down to sub-epidemic levels. This can be achieved by vaccination (if we had a vaccine), variolation (measured exposure to the active virus), or unmeasured exposure by letting the contagion spread in either a controlled fashion (gradually loosening isolation measures) or uncontrolled (let the contagion run its course. If we do the last by “maximizing infections going for herd immunity” then what will happen is that we will achieve the maximum mortality as health systems are overwhelmed and people who could be saved with interventions instead die because of the lack of facilities, drugs, and medical personnel to care for them. Not a good plan.

As for “Once we get about 50% infected things should start slowing down,” this is incorrect. The R0 of the virus has been found by more recent and accurate test data to be between 3.8 to 8.9 with a mean of 5.7 (“High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2”, CDC Emerging Infectious Diseases, Volume 26, Number 7—July 2020 (early release)). This means the threshold infection level for herd immunity is between 74% and 89%. That means in the best case assuming an infection fatality rate of 0.5% we would be looking at 1.125M dead; however because so many people would be seriously ill at once, the fatality rate would climb as hospitals are unable to treat the seriously ill but potentially savable. Again, not a good plan.

Stranger
  #34  
Old 05-14-2020, 04:09 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by Stranger On A Train View Post
I hesitate to go over this ground again but for anyone who is actually interested in understanding the issue, “herd immunity” is not a strategy but the (hopefully) end result of driving the contagion down to sub-epidemic levels. This can be achieved by vaccination (if we had a vaccine), variolation (measured exposure to the active virus), or unmeasured exposure by letting the contagion spread in either a controlled fashion (gradually loosening isolation measures) or uncontrolled (let the contagion run its course. If we do the last by “maximizing infections going for herd immunity” then what will happen is that we will achieve the maximum mortality as health systems are overwhelmed and people who could be saved with interventions instead die because of the lack of facilities, drugs, and medical personnel to care for them. Not a good plan.

As for “Once we get about 50% infected things should start slowing down,” this is incorrect. The R0 of the virus has been found by more recent and accurate test data to be between 3.8 to 8.9 with a mean of 5.7 (“High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2”, CDC Emerging Infectious Diseases, Volume 26, Number 7—July 2020 (early release)). This means the threshold infection level for herd immunity is between 74% and 89%. That means in the best case assuming an infection fatality rate of 0.5% we would be looking at 1.125M dead; however because so many people would be seriously ill at once, the fatality rate would climb as hospitals are unable to treat the seriously ill but potentially savable. Again, not a good plan.

Stranger
I should have stated maximizing the infections that we could safely deal with.
  #35  
Old 05-14-2020, 04:37 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,293
Quote:
Originally Posted by bump View Post
Think of it like a fire; is there ever a point when you can put it out "too soon"? Or if it's still burning, to quit spraying water on it? This is very similar in concept.
Using your analogy, the fire kills very few people so to the effort should focus on the vulnerable in order to save the financial houses of everyone else.
  #36  
Old 05-14-2020, 05:53 PM
Stranger On A Train is offline
Guest
 
Join Date: May 2003
Location: Manor Farm
Posts: 19,868
Quote:
Originally Posted by HoneyBadgerDC View Post
I should have stated maximizing the infections that we could safely deal with.
No, that isn’t correct, either. Aiming to maximize infections that fall under the threshold of what the health care system can deal with (even if we had that kind of ability to fine-tune the extent of contagion, which we don’t) will just result in other casualties are people with chronic, traumatic, or unexpected serious medical needs fail to seek aid or are denied access because the care system is dealing with COVID-19 patients and people are fearful of going to hospitals because they may become infected. What the goal should be is to drive new infections down to a level where the effective replication number is below 1, develop and use antigen testing to track and trace new infections, develop antibody tests and determine the degree of immunity conveyed by previous exposure, and work on therapeutics and vaccine candidates. We also need to restructure industries and the economy to cope with long term isolation, distancing, hygiene, and epidemic surveillance measures not only to deal with SARS-CoV-2 but also future infectious pandemic pathogens so we aren’t caught flat-footed by the next and potentially more virulent contagion.

That isn’t the silver bullet that “rushing to herd immunity” might seem to be, but then, nobody uses actually uses silver bullets because it is a dumb idea. We don’t even know if we can achieve herd immunity with this virus without a vaccine (it was never achieved naturally with chickenpox despite nearly every person on the planet acquiring immune response in childhood, and waves of smallpox and other infectious plagues swept through Eurasia repeatedly despite nearly total levels of infection) and this idea of somehow controlling the spread of contagion just below the threshold of what the health system can cope with is, aside from the trauma that puts medical personnel and first responders through, is just not practicable given how little we still know about the spread and pathogenesis of the virus. The point of the ‘lockdown’ measures is to reduce the rate of spread such that we could relax isolation measures incrementally and measure the effects before proceeding with further relaxation. Just opening things up and hoping for the best—which is not even a fraction of a plan—essentially assures the worst case scenario, and we already have evidence of how that will go.

Stranger
  #37  
Old 05-14-2020, 07:46 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
Quote:
Originally Posted by bump View Post
... Think of it like a fire; is there ever a point when you can put it out "too soon"? Or if it's still burning, to quit spraying water on it? This is very similar in concept.
I'm not defending HoneyBadgerDC's position here but your analogy in this case if anything makes his point ... yes you do sometimes want smaller natural fires to occur, they tend to be of lower intensity, clearing out shrubs, and reduce the risk of huge conflagrations later. Too much suppression of them is a bad thing. There are also controlled burns that manage a forest by controlling the not only the where and the when of fires but the intensity of the events. Tricky business that.

And certainly there is a time to stop spraying water, when the water is causing more damage than benefit, even before a fire is completely out.

If forest fires are managed they don't need to be fought so hard and so often.

No one would advocate for letting a forest burn out of control, in a rush, just get it done. That position is even more untenable.

Does the analogy hold? Maybe.

There are cautions out there by experts against thinking that a vaccine is just around the corner bound to put this fire out. Mike Ryan of the WHO for example -
Quote:
Speaking during a virtual news conference from Geneva, Ryan said the world should prepare for the possibility that a vaccine for COVID-19 will not be found. Even if one eventually is developed, it would still take a “massive effort” to distribute it worldwide and control the virus — a “massive moonshot.”

“It is important to put this on the table: This virus may become just another endemic virus in our communities, and this virus may never go away,” he said. “I think it is important we are realistic and I don’t think anyone can predict when this disease will disappear. I think there are no promises in this and there are no dates. This disease may settle into a long problem, or it may not be.”

Ryan said that one way or another, humanity may have to learn to cope with COVID-19.
Keeping the brakes fully applied until and if there is a vaccine is not a good plan. Depending on a vaccine as the only path is not a good plan. It is a great hope, but not a plan.

Rushing to herd immunity is not a good plan.

Cautiously finding the moving point that maximally reduces the damages of the interventions while controlling the intensity of disease within the population within some, to be determined, acceptable parameters, hoping for a vaccine but meanwhile trying to advance to a path forward that lives with the disease if that is what the future requires ... is not a good plan. It is however the least poor one. And that parameter won't be zero any more than it will be just below healthcare system capacity.

The controlled burn fire analogy may in fact be apt.
  #38  
Old 05-14-2020, 08:17 PM
Stranger On A Train is offline
Guest
 
Join Date: May 2003
Location: Manor Farm
Posts: 19,868
Quote:
Originally Posted by DSeid View Post
There are cautions out there by experts against thinking that a vaccine is just around the corner bound to put this fire out. Mike Ryan of the WHO for example -

Keeping the brakes fully applied until and if there is a vaccine is not a good plan. Depending on a vaccine as the only path is not a good plan. It is a great hope, but not a plan.

Rushing to herd immunity is not a good plan.
If we could determine why some people are susceptible to the blood clot development, severe vasculitis, and other multi-organ failures from SARS-CoV-2 AND demonstrate that exposure produces long lasting immunity, variolation of non-sensitive people might be an option, especially if we can determine that certain infection titers or routes produce minimal impacts; essentially, vaccination with the unattenuated vaccine in a controlled measure. But those are big ifs which still require effective tracking and tracing to protect vulnerable populations. Until we have better data, keeping the contagion under control by limiting public gatherings and contact is the only practicable way of assuring that inevitable outbreaks do not grow to epidemic proportions.

Stranger
  #39  
Old 05-14-2020, 08:22 PM
HoneyBadgerDC is offline
Member
 
Join Date: Jul 2012
Location: Torrance Ca
Posts: 8,402
Quote:
Originally Posted by Stranger On A Train View Post
No, that isn’t correct, either. Aiming to maximize infections that fall under the threshold of what the health care system can deal with (even if we had that kind of ability to fine-tune the extent of contagion, which we don’t) will just result in other casualties are people with chronic, traumatic, or unexpected serious medical needs fail to seek aid or are denied access because the care system is dealing with COVID-19 patients and people are fearful of going to hospitals because they may become infected. What the goal should be is to drive new infections down to a level where the effective replication number is below 1, develop and use antigen testing to track and trace new infections, develop antibody tests and determine the degree of immunity conveyed by previous exposure, and work on therapeutics and vaccine candidates. We also need to restructure industries and the economy to cope with long term isolation, distancing, hygiene, and epidemic surveillance measures not only to deal with SARS-CoV-2 but also future infectious pandemic pathogens so we aren’t caught flat-footed by the next and potentially more virulent contagion.

That isn’t the silver bullet that “rushing to herd immunity” might seem to be, but then, nobody uses actually uses silver bullets because it is a dumb idea. We don’t even know if we can achieve herd immunity with this virus without a vaccine (it was never achieved naturally with chickenpox despite nearly every person on the planet acquiring immune response in childhood, and waves of smallpox and other infectious plagues swept through Eurasia repeatedly despite nearly total levels of infection) and this idea of somehow controlling the spread of contagion just below the threshold of what the health system can cope with is, aside from the trauma that puts medical personnel and first responders through, is just not practicable given how little we still know about the spread and pathogenesis of the virus. The point of the ‘lockdown’ measures is to reduce the rate of spread such that we could relax isolation measures incrementally and measure the effects before proceeding with further relaxation. Just opening things up and hoping for the best—which is not even a fraction of a plan—essentially assures the worst case scenario, and we already have evidence of how that will go.

Stranger
I think we are dealing with a virus that will be around for a long time. Most of the outbreaks once past a base level for herd immunity will likely take place in children whop show little ill effects from it. No matter what we would like to think we have limited resources, we have been operating in a deficit and cannot continue very long at all like this. The economy will have to certainly open up and soon or face financial suicide. I see no benefits to anything besides just slowing it down to manageable levels.
  #40  
Old 05-14-2020, 08:55 PM
Monty's Avatar
Monty is offline
Straight Dope Science Advisory Board
 
Join Date: Feb 1999
Location: Beijing, China
Posts: 24,685
Quote:
Originally Posted by Magiver View Post
Using your analogy, the fire kills very few people so to the effort should focus on the vulnerable in order to save the financial houses of everyone else.

Nope. A human life is worth more than property. Financial losses during a pandemic are secondary to the loss of human lives.
  #41  
Old 05-14-2020, 10:49 PM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
Quote:
Originally Posted by Stranger On A Train View Post
If we could determine why some people are susceptible to the blood clot development, severe vasculitis, and other multi-organ failures from SARS-CoV-2 AND demonstrate that exposure produces long lasting immunity, variolation of non-sensitive people might be an option, especially if we can determine that certain infection titers or routes produce minimal impacts; essentially, vaccination with the unattenuated vaccine in a controlled measure. But those are big ifs which still require effective tracking and tracing to protect vulnerable populations. Until we have better data, keeping the contagion under control by limiting public gatherings and contact is the only practicable way of assuring that inevitable outbreaks do not grow to epidemic proportions.

Stranger
The more granular we can get with risk assessment the better obviously, but meaningful population based decisions can, in fact will always, be made without such being so certain. Broad categories of relative risk is the best that can ever be hoped for, with the best efforts possible made to make them a bit less broad as more is known. Certain? Certainly not.

Let's go with the idea of "limiting public gatherings and contact" ... you I am sure appreciate that that is not a yes/no thing. Which sorts of gatherings by which populations of what size, and what sort of contacts are riskiest? Which ones least risky? Which ones restricted in which ways cause the most harms by limiting and which ones fairly little?



Start at one end - adequate PPE with adequate training and oversight for HCWs in nursing homes, frequent testing of those providers, and other high attention to protecting that population in ways that allow for some safe social contacts, is relatively low cost and big pay-off. Providing strict guidance for known super spreader event type activities (crowded social circumstances inclusive of funerals, weddings, bars, religious services) ... a significant spiritual and maybe to some degree quality of life cost but not as huge of an economic cost and a big benefit to reducing spread.

Go to the other - prohibiting small group daycare with a consistent set of children and providers, preventing in person education for elementary students also in cohorted (limited exposure) classes, are both a big cost, to the children, to their parents, and to the economy, with risk reduction avoided not demonstrated to be bigger than a regular winter infectious disease season entails. Stores and manufacturing open with rules on social distancing and capacity as the risks of the space require - huge benefit to opening up with relatively low risk. Perhaps more frequent targeted testing of front facing staff?

Surveillance in general sufficient to identify increases if rates before they show up as hospital rates increasing dramatically. Again, exact parameters to be decided but keeping well below capacity for hospital and ICU beds, enough that regular hospital business can be done and still have room to flex for a surge, but accepting that the zero is not the goal.
  #42  
Old 05-14-2020, 11:29 PM
Magiver is offline
Guest
 
Join Date: Apr 2003
Location: Dayton Ohio USA
Posts: 29,293
Quote:
Originally Posted by Monty View Post
Nope. A human life is worth more than property. Financial losses during a pandemic are secondary to the loss of human lives.
There's a simple test for this. Do we shut the country down every year for the flu season? The answer is no. Just wave goodbye to 60,000 people who died needlessly because we didn't shelter in place at the expense of other people's livelihood.
  #43  
Old 05-16-2020, 07:55 PM
Banksiaman is offline
Guest
 
Join Date: Apr 2012
Location: Straya
Posts: 1,370
Readers of this thread, and particularly the Original Poster, might find this article interesting -

It looks at the cost-benefit calculations for the pandemic. Its based on Australia, so not sure exactly how it would scale up for the US, but the broad structure of the cost-benefit calculation should be directly applicable between a hard lock-down versus a vague herd immunity approach.

As presented, it calculates the cost of the shut down to Australia, which went relatively early and hard as about AU$90 Billion nett costs. Like other places we are starting to emerge from lock-down but are, I suspect, in a much better place with a solid testing and contact tracing system operating and only 98 deaths to date, than many other countries which seem to be doing a Trumpian 'maybe it will just go away' and hope for the best response.

The cost of not having done this, and hoping that herd immunity would develop through broad infection, as an alternative was calculated at AU$1.1 Trillion, mainly composed of the cost of deaths within the population.

One thing to note is that its based on an actuarial cost per life as AU$4.9M (this is roughly U$3.15M). The figure used in the US is three times as much [US$10M], and an explanatory link is provided for info on that.

While this is a comparison between actual hard-early response and a do nothing much alternative, I think the cost progression is not linear and even. Once you miss or dilute the early lock-down, the costs rapidly rise towards the full amount, while also having the financial subsidy and lost production component included. If you lived somewhere like Michigan, you'd have to add a component for reduced economic activity due to continued uncertainty and risk of flare-ups because the virus was not properly suppressed (you may ask why socialismophobic armed morons seem happy to socialise the costs of their stupidity among the community).

Last edited by Banksiaman; 05-16-2020 at 07:57 PM.
  #44  
Old 05-17-2020, 02:33 PM
Dr_Paprika is offline
Member
 
Join Date: Oct 2000
Location: South of Toronto, Canada
Posts: 4,521
I took a university class in mathematical modelling years ago. Some of the variables can be fuzzy - limited to a defined range. But if there are a lot of fuzzy variables, the model is not worth much.

There are lots of ways to look at life, and I was going to discuss QALYs and insurance statistics. But this does not solve the problem of bad data. The estimates of problems by age cohort may not apply to future pandemics - they are different. And it isn’t clear that things for the same bug will remain the same, or be the same in different countries or places. So well you could come up with a system, it may be less useful than you think.
__________________
"A noble spirit embiggens the smallest man"
  #45  
Old 05-18-2020, 12:37 AM
nelliebly is offline
Guest
 
Join Date: Jul 2017
Location: Washington
Posts: 3,058
Quote:
Originally Posted by HoneyBadgerDC View Post
I think we are dealing with a virus that will be around for a long time. Most of the outbreaks once past a base level for herd immunity will likely take place in children whop show little ill effects from it. No matter what we would like to think we have limited resources, we have been operating in a deficit and cannot continue very long at all like this. The economy will have to certainly open up and soon or face financial suicide. I see no benefits to anything besides just slowing it down to manageable levels.
What makes you think "Most of the outbreaks once past a base level for herd immunity will likely take place in children whop show little ill effects from it"? Do you have a cite for that? If not, please explain the scientific basis for this assumption.

As for our limited resources, we're all aware of that. What I'm not sure you grasp is that the inescapably horrible economic consequences are WORSE if we open too early.

Quote:
Statewide lockdowns have sent the economy buckling to its knees.

But an extended pandemic would further the economic pain, according to a new report by Deutsche Bank. In a worst-case scenario, the US could see its debt-to-GDP ratio hitting 130% halfway through the next decade and nearing 150% by 2030, the bank found.

Even the base-case scenario sees debt-to-GDP close to 125% by 2030.

Either way, the outlook isn't good — these are levels not seen since the mid-1940s, when the debt-to-GDP ratio was 121.7% at the end of World War II. The ratio is already likely to rise from 79% in 2019 to 100% in 2020, according to the report, with debt ballooning to more than $4 trillion in the 2020 fiscal year.


Both scenarios for 2030 mean that America's debt load could outweigh its revenue. But states reopening early could send the country toward the worst-case scenario, potentially costing taxpayers trillions more in expenditures as the government shoulders a heavy burden to prop up the economy.
TL;DR: You want to limit the economic devastation? DON'T push for reopening so soon.
  #46  
Old 05-18-2020, 06:43 AM
DSeid's Avatar
DSeid is online now
Guest
 
Join Date: Sep 2001
Location: Chicago, IL
Posts: 23,972
A minor comment nelliebly - no one is out there arguing to open up things "too soon." It is a question of who is convinced what is "too soon" (and/or "too much") and a pushback against the mindset in some quarters that anything other than all standing completely still is too soon coupled with an apparent denial of the global harms (many deaths included) caused by going "too slow".

Of course the problem is that no one knows what the Goldilockian "just right" is, and there is not even broad agreement over what it would look like. There was broad consensus regarding "flatten the curve" with even some understanding by many what that meant (not eradication but stretching the curve out over time so that systems were not overwhelmed). The consensus breaks down when the goal becomes eradication or bust coupled with no appreciation of what that "bust" really means.

So agreed by all: each state and locality should open up "just right."

Last edited by DSeid; 05-18-2020 at 06:44 AM.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 12:48 PM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2020, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright © 2019 STM Reader, LLC.

 
Copyright © 2017