What Price Should We Pay to Fight COVID-19?

[Buffaloski Boris]

Very interesting article by Joshua Kennon

https://www.joshuakennon.com/what-price-should-we-pay-to-fight-covid-19/

Snippets:

We need to have a hard conversation.  These conversations are not natural, or even comfortable, for a lot of people but at this time, in this moment, it is necessary.  To that end, I am going to be candid.  I think it is important for us to be honest about what we are facing, the trade-off calculations that are going to have to be made sooner rather than later, and the political and social ramifications of those decisions.

Let’s start with a statement: The COVID-19 pandemic was a humanitarian disaster that could have been avoided.  Yet, we didn’t so here we are.  Now, it is becoming an economic disaster that was not, and is not, inevitable, but rather which flows from decisions politicians are making without considering the best interest of all their constituents.  For example, consider the probable worst-case scenario in the United States: Yes, it would have been traumatizing.  Yes, everyone who would have survived would have known, or known of, at least one person who passed away.  Yet, as far as historical pandemics go, this is nothing like the traumas our ancestors faced.  In strict numbers, assuming the most catastrophic probable outcome – 2,200,000 deaths from COVID-19 in the United States over the next year-and-a-half – the country would have been looking at our ordinary effective annual death rate of 2,800,000 people increasing to around 4,267,000 for eighteen months before returning to its previous level.  That is a horrific human cost.  The individual suffering would be unimaginable.  Yet, those numbers are not civilization-ending in a country of roughly 331,000,000 and which experiences significant new births each year as babies are welcomed into the world.  In all of the panic, in all of the chaos, this should be kept in mind.  This is nothing like the Black Death, which slaughtered so many people that it took 200 years for the population to recover; a pestilence which, in Europe alone, killed 30% to 60% of people.

This means that as a country, most of the fall-out we are, and will, experience, is the result of not the pandemic itself, but our reaction to the pandemic; how we chose to fight it and the total dearth and failure of leadership.
.......

My strongly, and passionately, held opinion is that given this particular set of trade-offs, to accept the genie’s deal or to vote for such an outcome at the ballot box would be profoundly immoral once a person understands what is truly at stake because what looks like compassion – saving a life now – would ultimately kill far more people due to second-order and third-order effects, as well as destroy life for nearly every person around the globe given that the United States is not only the world’s reserve currency, but that if we go down, nearly the entirely of Europe, Asia, and Africa go down with us.

A Great Depression is not about preserving a few points of GDP, it is a catastrophe on a scale that is unimaginable to people who are treating it as some sort of afterthought. To even consider entering into one is the equivalent of drinking cyanide in the desert because you are thirsty.  It doesn’t mean putting off a kitchen renovation for a year or two, or not buying a new car.  We’re talking about condemning nearly the entirety of the world to a generational black hole.  We’re talking about tens of millions of children being homeless.  Starvation.  Endemic poverty with the multi-generational scars that result including addiction, depression, anxiety, heart attack, and suicide.  The net harms, and ultimate deaths, are so much worse for humanity than what we are facing from COVID-19, to go down this route would be one of the greatest unforced errors in global history.  It would be unbridled madness.  The lives of your own children, grandchildren, great-grandchildren, nieces, nephews, friends, co-workers, and neighbors, will be destroyed.  This isn’t a decision about money or economics in the way that most people think about it, this is about prioritizing human life and reducing suffering.  The balance isn’t even close in this case.  There is no possible justification for ruination on that scale, especially given that nearly all of the people who would benefit from such a disaster being unleashed would not be alive long enough to live through the nightmare that had been brought down upon society’s head for their sake.
.........

H/T @rabbitarian

[runbikerun]

For someone who goes into such detail on the numbers, it's disappointing that the author takes it as a given that it would be possible to have a healthy and growing economy while the worst increase in mortality since the Black Death tears through society.

The numbers are well argued, but the assumption at the core of his case is absolutely indefensible.

[OtherJen]

So Mr. Kennon is volunteering as tribute? Great, he can come here and take my young cousin's place in the local ER. It's her first job since graduating from nursing school last December.

[Incandenza]

A few points:

Anyone making these points regarding death rates needs, for the sake of consistency, to acknowledge that terrorist attacks, which consume  acres of newsprint and spur trillions of dollars in military actions, not to mention incredible privacy sacrifices, also have no effect whatsoever on our overall death rate. The next time someone blows up a building or goes on a shooting rampage, all the mortality rate folks better be anti-war activists. 

Next, the primary argument here seems to be that the death projections are not "civilization ending."  Which is true.  But cold rationality is then immediately replaced with unbridled hysteria about the economic impacts, which will apparently destroy everything and everybody....including the lives of my great grandchildren?  This prediction, which has no historical precedent, is based entirely on emotion and hysteria. 

Also, for what it's worth, recessions generally actually lower death rates, because people are driving less.

Which isn't to say that a conversation weighing consequences isn't smart.  This particular conversation just happens to be stupid.  A smarter conversation is based on determining relevant factors for re-opening the economy as soon as possible, which for me would include: 1) getting new cases down to a manageable level; 2) getting testing capacity to the point that anyone with symptoms could be tested, for free, and have results in 24 hours; 3) stockpiling medical supplies at sufficient levels for worse-case scenarios; 4) developing a treatment regime that at least somewhat decreases mortality; and 5) putting a developed system of contact tracing in place.  With the exception of (4), which is tough to predict, with sufficient resources these are all things we should be able to accomplish in the short to medium term.

   

 

[bacchi]

Starvation was not a problem during the Great Depression in the US. Infant mortality decreased and life expectancy increased throughout the 1930s, though suicides did increase as well.

This was, incidentally, partly because of government programs to feed the unemployed.

[Incandenza]

Reading through the whole thing, the argument is just that in about four months or so we should consider re-opening the economy to some extent, while taking as many precautions as we can.  Which for all the bluster and drama is probably not a particularly controversial statement.  I don't know if many people are reasonably arguing that we need need to keep the entire country shut down forever. 

We're just buying time.  With the right action now, there's a very good chance we're able to open up to some extent in the summer.     

[Much Fishing to Do]

I think it is an interesting question if looked at objectively, and I think it will inevitably be one we do look at.  But for the moment we have a short period of time we think that we can have a huge affect on the outcome.  We could obviously reduce deaths by forcing the wearing of seatbelts, which we did do in the 80s, and by forcing cars to spend the money on crash testing and airbags, we we then later did, and by not allowing vehicle travel at all, which we have not done.  Or reduce deaths by banning certain drugs which we have done or tobacco products which we have not.  So we do this line drawing all the time.  Out governments obviously make the decision every day to put X amount of dollars toward education or traveling to Mars versus fighting cancer, and though thats inevitable no one wants to look the actual parent of a child with cancer in the face when making that decision.

Here the total number of people who are infected that get sick...and then that eventually get hospitalized...and that then eventually die is not one that might be that huge big picture long term.  But the whole flattening of the curve thing to keep the hospitals from getting overwhelmed is a new variable we are not really used to factoring in.  Of course short term economic turmoil that will reduce the rate of those that die of the hospitalized/should be hospitalized makes sense at some point, we just aren't used to how to view it or calculate it.  And for now I think many are willing to overshoot caution on that as we're in that unknown period.  As time goes on we'll start getting used to it and it'll becaome a more calculated decision like all the others I mentioned before we already make.

[Telecaster]

The article missed a number of important points.  Namely, many businesses either shut down or went to WFH before they were required to.  Disneyland for example.  US airlines ended flights to China before travel restrictions were imposed.  Many restaurants closed because of WFH cut their business, not because they were required to.  On and on.

Saying "let's open up, older people be damned!" isn't enough to get many businesses to actually open up.  The only thing that will get them to open up is getting coronavirus under control.   People aren't going to start buying flights to NYC while they are using Central Park as a temporary morgue.  Will. Not. Happen. 

Another important point is that this isn't 1929.  The situations are not equivalent.  We understand a lot more about economics.   The Fed cut interest rates effectively to zero.  Congress just threw 10% of GDP at this problem.  We already have safety net programs, like UI, food stamps, Medicaid.   People aren't going to starve any more than they already do. 

Yes, there will be real and lasting damage from this.  No doubt there.  But it won't be the Great Depression.  And the country won't open back up until it is under control.  The path is clear.  Get on top of this, and then open up. 

[Captain FIRE]

It's not just older people that will die.  One very real concern is losing critical health care professionals, as they are on the front lines and at substantially higher risk of exposure as a result.  So if you let the virus rampage through the country unchecked, you can lose irreplaceable medical knowledge and skills, and will result in even more deaths immediately during this crisis and down the road.  And even if those people don't die, how many will have PTSD from being forced to make horrible choices such as who gets the scarce medical resources?  How many walk away from their profession in order to protect their family (considering we're not doing it with sufficient PPE, or providing say, alternative housing like dorm rooms for those who don't want to go home and infect their families)?

And then of course, there are also the younger people that are too cavalier or the immunocompromised who might die, with potentially greater impact to the economy.  I'm 8 months pregnant and there is still not good evidence regarding the affect on pregnant moms and newborns.  This plan may accidentally wipe out some of those kids/grandkids, making recovery again take longer with generational effects.

For what it's worth, I also think the article wildly underestimates the impact of all of those unchecked deaths - both financially and emotionally.

And as noted above, just because you tell people "ok you can go out now" doesn't mean that everyone will resume life immediately.  Most people near me are talking about choosing to remain isolated if they feel the official prohibitions are lifted too quickly.

I firmly believe more time will let us:
- Find better methods of treating those with COVID-19 even before a vaccination can be developed
- Ramp up production of medical equipment (PPE, ventilators, even hospital beds)
- Keep our medical professionals from being overwhelmed and dying/walking off the job

But sure, it does cause you to think about the value of a life.  I just happen to value it higher than the articles do, and disagree it'll lead to mass starvation.

[Jon Bon]

Yes, there will be real and lasting damage from this.  No doubt there. But it won't be the Great Depression.  And the country won't open back up until it is under control.  The path is clear.  Get on top of this, and then open up.

I don't think anyone knows the answer to those questions.

It does seam that according to the numbers I have seen cases are leveling off, and this exponential curve has not happened as of yet, or hopefully at all!

[partgypsy]

Jon Bon, what numbers are you looking at? Are you looking at the US or elsewhere? There is no leveling off going on in the US right now.

[Cassie]

People’s lives are more important than the economy.

[Jon Bon]

@partgypsy I pulled these off of worldometers. If that is a crap data website please let me know.

Maybe I slightly misspoke saying that they have leveled but the rate of increase has slowed and its nowhere near the 20-30% daily rate that I keep hearing. All this social distancing has to be accomplishing something right? Single digit growth is acceptable I feel at this point is it not? Probably too soon to be a trend but it is all the data we have for now.

Apologies for the formatting excel and MMM dont get along.

Date   Cases    % Change
14-Mar   696   
15-Mar   737    6%
16-Mar   983   33%
17-Mar   1748   78%
18-Mar   2848   63%
19-Mar   4530   59%
20-Mar   5594   23%
21-Mar   4824   -14%
22-Mar   9400   95%
23-Mar   10189   8%
24-Mar   11075   9%
25-Mar   13355   21%
26-Mar   17224   29%
27-Mar   18691   9%
28-Mar   19452   4%
29-Mar   19913   2%

[OtherJen]

@partgypsy I pulled these off of worldometers. If that is a crap data website please let me know.

Maybe I slightly misspoke saying that they have leveled but the rate of increase has slowed and its nowhere near the 20-30% daily rate that I keep hearing. All this social distancing has to be accomplishing something right? Single digit growth is acceptable I feel at this point is it not? Probably too soon to be a trend but it is all the data we have for now.

Apologies for the formatting excel and MMM dont get along.

Date   Cases    % Change
14-Mar   696   
15-Mar   737    6%
16-Mar   983   33%
17-Mar   1748   78%
18-Mar   2848   63%
19-Mar   4530   59%
20-Mar   5594   23%
21-Mar   4824   -14%
22-Mar   9400   95%
23-Mar   10189   8%
24-Mar   11075   9%
25-Mar   13355   21%
26-Mar   17224   29%
27-Mar   18691   9%
28-Mar   19452   4%
29-Mar   19913   2%

From what region were these pulled?

In Michigan, we're over 5000 cases and the authorities think we won't peak for a few weeks. https://www.google.com/amp/s/www.clickondetroit.com/health/2020/03/30/michigan-still-in-early-stages-of-coronavirus-spread-likely-several-weeks-from-peak/%3foutputType=amp

[erutio]

@partgypsy I pulled these off of worldometers. If that is a crap data website please let me know.

Maybe I slightly misspoke saying that they have leveled but the rate of increase has slowed and its nowhere near the 20-30% daily rate that I keep hearing. All this social distancing has to be accomplishing something right? Single digit growth is acceptable I feel at this point is it not? Probably too soon to be a trend but it is all the data we have for now.

Apologies for the formatting excel and MMM dont get along.

Date   Cases    % Change
14-Mar   696   
15-Mar   737    6%
16-Mar   983   33%
17-Mar   1748   78%
18-Mar   2848   63%
19-Mar   4530   59%
20-Mar   5594   23%
21-Mar   4824   -14%
22-Mar   9400   95%
23-Mar   10189   8%
24-Mar   11075   9%
25-Mar   13355   21%
26-Mar   17224   29%
27-Mar   18691   9%
28-Mar   19452   4%
29-Mar   19913   2%

That is US data and yes, ^ that is exponential growth.

The rate of growth may be leveling off, but the growth is exponential.

Mustachians, of all people, should know what exponential growth is.  If your stash grows 7% year over year, that's exponential growth.

Regarding the data points for march 28 and 29, those are weekend dates, and we get less reported cases on the weekends, because there are less hospital workers.

[Jon Bon]

Worldometer.com
https://www.worldometers.info/coronavirus/country/us/

These are daily new cases to be clear.

To me total cases don't matter at all, at least when it comes to fighting the disease. If we are going to beat this back the daily new cases needs to start dropping. This is the actual curve that everyone wants to flatten that we keep hearing about.

Deaths also get a lot of attention(They also make for a good headline). However you can't die from something you don't catch. Which is why I am closely monitoring daily new infections.

[Jon Bon]

That is US data and yes, ^ that is exponential growth.

The rate of growth may be leveling off, but the growth is exponential.

Mustachians, of all people, should know what exponential growth is.  If your stash grows 7% year over year, that's exponential growth.

Regarding the data points for march 28 and 29, those are weekend dates, and we get less reported cases on the weekends, because there are less hospital workers.

Please explain, I was under the impression that was 20-30% growth per day, we are nowhere near that.

Compounding is different from exponential is it not?

Re Weekends: yeah I had thought about that too, hopefully it does not catch-up so to say today and tomorrow.

 

[sixwings]

Theres a lot of talk about the deaths from covid-19, but it also will lead to a general escalation in deaths. As ICU beds fill due to covid-19 there's no beds for other regular emergencies and as a result, issues that would have been fixable become a death sentence.

Like I hope you dont slip and fall or have birth complications in 3 weeks....

[erutio]

Please explain, I was under the impression that was 20-30% growth per day, we are nowhere near that.

Compounding is different from exponential is it not?

Re Weekends: yeah I had thought about that too, hopefully it does not catch-up so to say today and tomorrow.

Compounding (your interest in your account) is an example of exponential growth. 

[OtherJen]

Worldometer.com
https://www.worldometers.info/coronavirus/country/us/

These are daily new cases to be clear.

To me total cases don't matter at all, at least when it comes to fighting the disease. If we are going to beat this back the daily new cases needs to start dropping. This is the actual curve that everyone wants to flatten that we keep hearing about.

Deaths also get a lot of attention(They also make for a good headline). However you can't die from something you don't catch. Which is why I am closely monitoring daily new infections.

'Southeast Michigan is burning': Michigan's coronavirus case count doubles every 3 days

[Jon Bon]

Ok yes interest on the interest you have earned I get that.

Maybe we are splinting hairs, but a single digit growth rate feels a heck of a lot better then double digits!

I guess all I am saying is I keep hearing dooms day numbers of 20-30% per day growth throw out, which would be dire. An 8% or less growth rate would indeed flatten the curve.

[Jon Bon]

Worldometer.com
https://www.worldometers.info/coronavirus/country/us/

These are daily new cases to be clear.

To me total cases don't matter at all, at least when it comes to fighting the disease. If we are going to beat this back the daily new cases needs to start dropping. This is the actual curve that everyone wants to flatten that we keep hearing about.

Deaths also get a lot of attention(They also make for a good headline). However you can't die from something you don't catch. Which is why I am closely monitoring daily new infections.

'Southeast Michigan is burning': Michigan's coronavirus case count doubles every 3 days

Sure some states are having more success then others. But at the population level I find the slowing growth rate* encouraging.

*Pending weekend numbers of course

[Freedom2016]

Ok yes interest on the interest you have earned I get that.

Maybe we are splinting hairs, but a single digit growth rate feels a heck of a lot better then double digits!

I guess all I am saying is I keep hearing dooms day numbers of 20-30% per day growth throw out, which would be dire. An 8% or less growth rate would indeed flatten the curve.

That doesn't sound right. When the growth rate is positive the curve is still curving upward. A negative daily growth rate would start to flatten the curve.

[Hirondelle]

Ok yes interest on the interest you have earned I get that.

Maybe we are splinting hairs, but a single digit growth rate feels a heck of a lot better then double digits!

I guess all I am saying is I keep hearing dooms day numbers of 20-30% per day growth throw out, which would be dire. An 8% or less growth rate would indeed flatten the curve.

These are the growth rates reported of the new cases/total cases.

However, as testing is limited in most places, to get exponential growth of new cases you'd also need exponential growth of testing material. That's not available in most places.

Growth rate of hospitalization and deats is more reliable (although still not perfect as some people die before they get tested and most places don't 'waste' a test on someone postpartum).

[OtherJen]

Michigan reported increases in the number of confirmed cases by 836 on Sunday and 1012 by 10 am today.

[bluebelle]

Please explain, I was under the impression that was 20-30% growth per day, we are nowhere near that.

Compounding is different from exponential is it not?

Re Weekends: yeah I had thought about that too, hopefully it does not catch-up so to say today and tomorrow.

Compounding (your interest in your account) is an example of exponential growth.

apparently, I didn't understand what exponential growth is.....I did not think constant interest at 7% would be exponential (based on the rule of 72), I always thought of exponential to be in more immediate terms, like covid-19 cases doubling ever 4 days....not my money doubling in 10 years
but, according to wikopedia (so it must be true):
Compound interest at a constant interest rate provides exponential growth of the capital. See also rule of 72.

[runbikerun]

There is a broader question to be asked about what price we should pay, once this is behind us, to prevent a recurrence.

There are a lot of people who will not like the answer, because it demands a political position anathema to their beliefs.

[bendixso123]

I suspect that the economic damage has already been done. Before the government intervened, people were already changing their behavior. I certainly was. So even when the government says "hey everything's okay" people are still going to be leery of going out to eat and doing all of the things we did before this public health crisis.

I think it's a fallacy to assume we're just going to go back to normal life after this or that we're all just waiting for the government to "reopen the economy". Many of us will change our behavior in the longterm, and that's going to have an effect.

In my view, many of the ways we've tried to solve the problem haven't directly addressed the issue. People can't stay at home forever. We need to find a way to employ them from home or in some capacity where they are properly distanced from other workers.

Restaurants probably aren't coming back, at least not in the next six months. People are justifiably leery about the sanitary situation.

Other activities will come back, but in parts and only when the public feels like they're safe to do. Next year, I'll go snowboarding but I probably won't ride the bus to the resort. I'll be a little more cautious waiting in lift lines. I'll keep my mask up.

Government comes in and tries to justify its existence with bailouts but that's just pissing on a forest fire. Damage is done. The public will decide and at its own pace. The economy *has* to change, and it will only improve when we fully adapt to this new lifestyle.

[HPstache]

People’s lives are more important than the economy.

I agree.  But where do we draw the line?  Lock down every cold and flu season from here on out?

[runbikerun]

People’s lives are more important than the economy.

I agree.  But where do we draw the line?  Lock down every cold and flu season from here on out?

Oh, for the love of God. How many times are people going to repeat this ridiculous comparison?

[HPstache]

People’s lives are more important than the economy.

I agree.  But where do we draw the line?  Lock down every cold and flu season from here on out?

Oh, for the love of God. How many times are people going to repeat this ridiculous comparison?

It's a real question.  YES.  Everyone knows that COVID-19 is not the flu, and that it is much more deadly and contagious than the flu.  The statement made above is that lives are more important than the economy, my response is how do we draw the line?  It's an absolutely fair comparison.  how do we determine if we need to shut down for COVID-20 or COVID-21 when we might have a vaccine that not everyone feels like taking or a drug like Chloroquine that reduces death rate to 0.2%?

[bendixso123]

People’s lives are more important than the economy.

I agree.  But where do we draw the line?  Lock down every cold and flu season from here on out?

Certainly not. The cold and flu have already evolved and "discovered" their ecological niche as parasites on humanity. The goal of any organism is to get its genetic material into the next generation, and the "strategy" they employ involves giving most people symptoms but not so many symptoms too many people die and we enact the same harsh measure we are enacting on the novel Coronavirus.

Sars 2 really is different. For a time, it was endemic to bats, and it has just now begun to infect humans. The first wave is bound to be more deadly because it hasn't evolved and found a niche in humans. At the moment, it's too deadly, and that's not a good "strategy" if it's "trying" to get other people to spread it. The virus will die before it gets a chance to leave its host.

Over time, the virus will likely evolve to be less deadly. It will become more like the common cold or flu. If it doesn't, it will die out because it kills too many of its hosts.

Airborne infections tend to work this way. They're harder to spread than blood born or water born infections, so they tend to evolve to be less deadly over time because they need their host to be alive longer in order to spread. Ebola spreads instantly on contact with its host's blood, which gives it more of a license to kill because it can spread so effectively.

But even then, one of the "challenges" Ebola has always faced is the fact that it tends to kill whole villages and stamp itself out naturally.

Humanity made huge leaps when we figured out how to properly treat sewage because it removed many of the most dangerous bugs from contact with humans.

But right now we are very much in a "first contact" situation with SARS2. Epidemiologists get very concerned whenever a virus moves from one species to another precisely because it hasn't evolved to fit the new species (a.k.a us humans) and will likely "overshoot" by being too deadly, at least for a time.

Things will get back to normal. They always do. But we need to allow time for evolution to happen.

[Buffaloski Boris]

IMHO, The decision has already been made. We’ve already decided that we’re going to trade the economy for lives. Speaking for myself I think that it’s the right decision. Obviously there is a point where we cannot sustain a shut down from an economic perspective. But I think the more immediate issue is actually the medical one. While we talk a lot about ventilators, what we seem to be forgetting is that you need people to run them. How many weeks of death and misery do we think doctors and nurses and other medical professionals are going to endure?  This isn’t slavery, we don’t have a draft, and the working conditions these people are facing are likely to be beyond horrifying. Then there is the issue of a cooped up public. How long do we think people are going to quietly tolerate no jobs and de facto house arrest?

[Cassie]

My adult kids are suffering economically but they would rather be broke than dead. One will have to move in with us and my other son and his wife won’t have to. 

[nawhite]

People are willing to pay $544,000/life saved out of their own pocket for safety improvements to cars. The NHTSA is willing to spend $3 million per life saved in traffic safety measures: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/809835. EPA puts the number at $10 million: https://www.bloomberg.com/graphics/2017-value-of-life/.

Estimates I've seen showed if we did nothing we'd have around 2.2 million deaths and with all of the changes we're implementing, we'll probably be somewhere around 200k deaths.

So 2 million deaths times $544k is just over $1 trillion. If we use $3 million per life saved, that's $6 trillion. If we use the EPA's $10 million / life, thats a total cost of $20 trillion.

I think I've found upper and lower bounds for this question. That said, I think the closest comparison would be how much we paid 9-11 victims families. The federal government paid on average $1.7 million/death in the 9-11 attacks. That would put us as society willing to pay $3.4 trillion to prevent 2 million COVID-19 deaths from happening.

[Abe]

Thanks for the analysis, @nawhite. Question answered!

I'd also like to point out that of the 3 million people who got laid off, the majority of them were laid off within 1-2 weeks of the lockdown measures. That just tells me that companies are ready to jettison employees to preserve their bottom lines without concern for the employees' well-being (shocking, I know). Remember not to lay this at the government's (or public health personnel's) feet alone. Other countries are going through lockdowns without hitting the Eject button on its lowest-rung members.

[Paper Chaser]

People are willing to pay $544,000/life saved out of their own pocket for safety improvements to cars. The NHTSA is willing to spend $3 million per life saved in traffic safety measures: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/809835. EPA puts the number at $10 million: https://www.bloomberg.com/graphics/2017-value-of-life/.

Estimates I've seen showed if we did nothing we'd have around 2.2 million deaths and with all of the changes we're implementing, we'll probably be somewhere around 200k deaths.

So 2 million deaths times $544k is just over $1 trillion. If we use $3 million per life saved, that's $6 trillion. If we use the EPA's $10 million / life, thats a total cost of $20 trillion.

I think I've found upper and lower bounds for this question. That said, I think the closest comparison would be how much we paid 9-11 victims families. The federal government paid on average $1.7 million/death in the 9-11 attacks. That would put us as society willing to pay $3.4 trillion to prevent 2 million COVID-19 deaths from happening.

Not every life saved is equal. Saving a young, healthy person has more value than saving an elderly person with other health issues because the young person is more likely to have more years and a higher quality of life during those years. I'm not sure that insurance payouts or mandated car safety tech are better cost barometers than what's used in the medical field specifically for this sort of thing.
The medical and pharmaceutical industries have a formula for this, known as Quality Adjusted Life Years or QALY:

https://www.celforpharma.com/insight/do-you-know-what-qaly-and-how-calculate-it

The World Health Organization has a guideline for thresholds of cost effectiveness on a national health initiative level that suggests 1-3 X GDP per capita (per QALY saved) is about the upper limit of cost effectiveness:

https://www.who.int/bulletin/volumes/94/12/15-164418/en/

US GDP per capita was $63k in 2018, so according to the traditional WHO QALY metric, spending more than about $190k per QALY isn't advisable from an economic perspective.

The question then becomes, how many QALY are being saved by current practices/policies? Since this virus seems to impact older people more severely (especiallly those with pre-existing medical issues) the total QALY is likely to be on the low side.

A $1 Trillion stimulus package would likely have a cost per QALY of $75k-650k according to this analysis:

https://theincidentaleconomist.com/wordpress/economic-cost-of-flattening-the-curve/

That means that the $2 Trillion stimulus that was passed could be a cost per QALY of $150k-1.3 million. So, if the cost per QALY is on the low end of that estimate, then it would fit into the WHO's metric of cost effectiveness. But if the cost per QALY ends up on the high end of that estimate, then it's 6 times the upper limit of the WHO's metric for cost effectiveness.

[fasteddie911]

It's not just economic costs but other health costs. If you don't have money and can't afford your meds or to receive necessary care. Lots of patient procedures and visits are being put on hold for now. Hospitals are trying to keep clear to make space for covid patients or to avoid infecting non-covid.  I'm sure patients are foregoing care to avoid getting sick. And so on.  Who knows what these long term effects will be.  Right now is not a great time to be sick.

[Freedom2016]

Thanks for the analysis, @nawhite. Question answered!

I'd also like to point out that of the 3 million people who got laid off, the majority of them were laid off within 1-2 weeks of the lockdown measures. That just tells me that companies are ready to jettison employees to preserve their bottom lines without concern for the employees' well-being (shocking, I know). Remember not to lay this at the government's (or public health personnel's) feet alone. Other countries are going through lockdowns without hitting the Eject button on its lowest-rung members.

I haven't followed the details on this, but who is doing the laying off? If you're talking about large corporations that have large cash reserves that are letting people go, I follow your logic. But if small businesses are the ones doing the laying off, your bolded comment seems way off the mark. I own a small business. Right now I'm the only employee, but I can tell you that if I had any other employees, I would be out of cash in about 2 months given how my own client work has fallen off a cliff, and I simply wouldn't have any money left to keep paying them, despite being concerned for their well-being.

[Abe]

You’re right, that is a big caveat to my statement I should’ve mentioned. I haven’t seen any statistics on company size so far, and may stand corrected if it’s mostly small businesses.

[marty998]

@partgypsy I pulled these off of worldometers. If that is a crap data website please let me know.

Maybe I slightly misspoke saying that they have leveled but the rate of increase has slowed and its nowhere near the 20-30% daily rate that I keep hearing. All this social distancing has to be accomplishing something right? Single digit growth is acceptable I feel at this point is it not? Probably too soon to be a trend but it is all the data we have for now.

Apologies for the formatting excel and MMM dont get along.

Date   Cases    % Change
14-Mar   696   
15-Mar   737    6%
16-Mar   983   33%
17-Mar   1748   78%
18-Mar   2848   63%
19-Mar   4530   59%
20-Mar   5594   23%
21-Mar   4824   -14%
22-Mar   9400   95%
23-Mar   10189   8%
24-Mar   11075   9%
25-Mar   13355   21%
26-Mar   17224   29%
27-Mar   18691   9%
28-Mar   19452   4%
29-Mar   19913   2%

That is US data and yes, ^ that is exponential growth.

The rate of growth may be leveling off, but the growth is exponential.

Mustachians, of all people, should know what exponential growth is.  If your stash grows 7% year over year, that's exponential growth.

Regarding the data points for march 28 and 29, those are weekend dates, and we get less reported cases on the weekends, because there are less hospital workers.

The problem is we are not talking about percents per year. We are talking about percents PER DAY

A growth rate of 3% per day for six months turns 100 cases on day 1 into 20,450 cases per day on day 180.

The bickering over exponentials is semantic. Any growth grate above zero % in the number of new cases per day is a problem.

[Davnasty]

People are willing to pay $544,000/life saved out of their own pocket for safety improvements to cars. The NHTSA is willing to spend $3 million per life saved in traffic safety measures: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/809835. EPA puts the number at $10 million: https://www.bloomberg.com/graphics/2017-value-of-life/.

Estimates I've seen showed if we did nothing we'd have around 2.2 million deaths and with all of the changes we're implementing, we'll probably be somewhere around 200k deaths.

So 2 million deaths times $544k is just over $1 trillion. If we use $3 million per life saved, that's $6 trillion. If we use the EPA's $10 million / life, thats a total cost of $20 trillion.

I think I've found upper and lower bounds for this question. That said, I think the closest comparison would be how much we paid 9-11 victims families. The federal government paid on average $1.7 million/death in the 9-11 attacks. That would put us as society willing to pay $3.4 trillion to prevent 2 million COVID-19 deaths from happening.

Not every life saved is equal. Saving a young, healthy person has more value than saving an elderly person with other health issues because the young person is more likely to have more years and a higher quality of life during those years. I'm not sure that insurance payouts or mandated car safety tech are better cost barometers than what's used in the medical field specifically for this sort of thing.
The medical and pharmaceutical industries have a formula for this, known as Quality Adjusted Life Years or QALY:

https://www.celforpharma.com/insight/do-you-know-what-qaly-and-how-calculate-it

The World Health Organization has a guideline for thresholds of cost effectiveness on a national health initiative level that suggests 1-3 X GDP per capita (per QALY saved) is about the upper limit of cost effectiveness:

https://www.who.int/bulletin/volumes/94/12/15-164418/en/

US GDP per capita was $63k in 2018, so according to the traditional WHO QALY metric, spending more than about $190k per QALY isn't advisable from an economic perspective.

The question then becomes, how many QALY are being saved by current practices/policies? Since this virus seems to impact older people more severely (especiallly those with pre-existing medical issues) the total QALY is likely to be on the low side.

A $1 Trillion stimulus package would likely have a cost per QALY of $75k-650k according to this analysis:

https://theincidentaleconomist.com/wordpress/economic-cost-of-flattening-the-curve/

That means that the $2 Trillion stimulus that was passed could be a cost per QALY of $150k-1.3 million. So, if the cost per QALY is on the low end of that estimate, then it would fit into the WHO's metric of cost effectiveness. But if the cost per QALY ends up on the high end of that estimate, then it's 6 times the upper limit of the WHO's metric for cost effectiveness.

Their entire premise rests on the assumption that the stimulus package is only necessary due to the forced shutdown.

In reality businesses and events were closing before they were forced to. Some would have remained open until the increasing rate of infection scared their customers away. In addition there would be other economic costs to not shutting down that they ignore.

[2Cent]

[partgypsy]

I do feel that we will need to start opening things up, having more semi essential businesses open, things that are not as needed staying closed or having distancing measures put in. As others have stated, not just economically but emotionally and psychologically the stay at home orders takes a toll.

The thing I don't get, is the people who are most agitating for things to re-open, are the same people who don't want to wear a mask in public businesses. Or have rallies where they are not practising social distancing. If they understood that minor inconveniences such as mask wearing and social distancing will allow more of the US to open, I would think they would be pushing for us all to be on the same page. I have a stake in this. My boss and many colleagues in my department, given they are doctors, need to work shifts. My cousin is a nurse. A friend and collegue of hers died of COVID, doing her job. I just wish the people who don't want to social distance or wear a mask understood, it's not just about them.

[OtherJen]

I do feel that we will need to start opening things up, having more semi essential businesses open, things that are not as needed staying closed or having distancing measures put in. As others have stated, not just economically but emotionally and psychologically the stay at home orders takes a toll.

The thing I don't get, is the people who are most agitating for things to re-open, are the same people who don't want to wear a mask in public businesses. Or have rallies where they are not practising social distancing. If they understood that minor inconveniences such as mask wearing and social distancing will allow more of the US to open, I would think they would be pushing for us all to be on the same page. I have a stake in this. My boss and many colleagues in my department, given they are doctors, need to work shifts. My cousin is a nurse. A friend and collegue of hers died of COVID, doing her job. I just wish the people who don't want to social distance or wear a mask understood, it's not just about them.

Exactly this. I hear a lot about “I want” and “my rights” from libertarian virtue signalers and pseudo-patriots. Sure, we all want things to open back up so that people can go back to work.  Refusing (without a medical reason) to wear a mask to allow this to happen more safely seems like the height of selfishness. I’m so sick of people claiming that their essential rights are being infringed upon, when what they really mean is “I want to do whatever I want, whenever I want, with no restrictions or consequences.” Well, I want to buy groceries without worrying that some jerk without a mask is going to be allowed to cough viral particles all over me with no restrictions or liabilities. Whose rights are being impacted here?

[MrThatsDifferent]

So far, the price being paid is 100,000 dead and counting, with no end in sight.

I love the trolley problem picture above, except it needs a third track: freedom. You can save two I believe but not all 3. People can be saved, and the economy restarted but people will have to sacrifice a bit of freedom to get there. Here’s how:
—mandate testing of everyone: it’s too big now in the US, too many asymptomatic people spreading this. Test, isolate and quarantine the infected.
—mandate masks: they reduce the spread by infected people
—mandate social distancing: people need to adjust behaviors until things get under control
—re-think business with these ideas in mind
—continue government support until we get through this
—border controls for people entering and exiting the country, testing before leaving and upon arrival

Implement all of that and then open things up.

[MudPuppy]

Have any of you been present and heard a covid patient struggle for air as they die? If not please don’t insult those of us who have with these hypotheticals.

[Wrenchturner]

We won't know the price of our choices except retroactively, unfortunately.  I don't think there's a lot of accuracy in any predictive efforts at this time.  Too little data, too many second order impacts.  What I do know is that we are in the thick of it now, and India and Brazil are taking off with regard to infection rates.  The US rates are still in slight decline but I think this virus can out-wait any short term efforts to curb transmission.  Plus, you know, social apes on a rock...  As I said previously, the economy can't hemorrhage money forever, but this virus can keep hanging around.  COVID wins on attrition eventually.

Now we get to watch our governments make the tough decisions.

[stoaX]

Am I seeing this right - no matter which way government throws the switch, both of them, the people and the economy, get run over when the trolley loops back around? 

[Mr. Green]

It doesn't matter what the government does if the public don't have confidence that it is safe to eat out or get on a plane. The best thing the Feds could have done is roll out a cohesive plan that will create that confidence as things reopen. They botched that and major banks are already downgrading the GDP recovery because, despite the vocal minority you see, most people are intelligent to understand that just because things are reopening does not mean certain activities are any safer than they were four weeks ago. The government can't force people to eat out or travel and they're going to realize the screw up in the coming months when small businesses start failing because their revenue never recovers to the point of profitability.