I think I need to make this case more clearly.
Consider three scenarios.
1. Back to normal. Everyone behaves the way they did before the virus hit.
2. Baseline scenario. Everyone makes individual decisions, except that government dictates wearing of masks in crowded public places, such as subways. I expect under this scenario that many of us would telework as much as possible, avoid travel, stay home a great deal, and practice social distancing. Those would be our choices.
3. Lockdowns. The government orders certain businesses and schools to close. It restricts people’s freedom to move.
For me, (1) is irrelevant. If you insist that the only alternative to (3) is (1), then I won’t pay attention to what you have to say.
The relevant margin is between (2) and (3). Under either of those scenarios, I expect much less virus spreading than under (1). By the same token, I expect a big drop in economic activity under either scenario.
Suppose that the lockdown produces a significantly lower spread rate than the baseline scenario. Does that mean a much lower death rate? That would only be true if we can do a better job of treating people later than now.
The cry of “Flatten the curve!” was based on the presumption that having enough hospital beds and ventilators was crucial to saving lives. Now that we have had a chance to observe the way that cases progress, this argument seems less compelling. It seems that survival chances depend a lot more on patient characteristics than on medical treatment. My impression is that if anything, we are putting too many patients on ventilators. Too often, ventilators constitute futile care, keeping patients alive for only a few weeks.
Our personal policies are as follows.
a) My wife and I will continue to stay at home by ourselves, except for very infrequent trips for groceries.
b) When we do go out, we will wear masks except if we are on walks (or bike rides, in my case)
c) If I get the disease, I only want to be put on a ventilator if there is a decent chance of a good outcome.
[UPDATE] d) I hope we that the two of us have had the virus already and that we are immune. If we find that to be the case, then of course we will be willing to go back to normal. Or if better treatments become available.
In what I call the baseline scenario, other people would be free to have different policies. I prefer that to the lockdown scenario.
Having worn a mask for several days now, I can see why they weren’t people’s first choice. They make it harder to breathe. They are hot and you breathe your own breath. So far, my glasses keep fogging outside–though I’m working on fixing that. Maybe if I’d been a scuba diver, I’d take this better.
Still (2) is way better than (3). I feel the need to move and get out at least once a day, and I now wear a mask whenever I go out–unless I’m biking. There’s kind of a fellowship of the masked as we smile, with our eyes, at each other.
When on walks or biking, you can wear a mask pulled down, and only put it up when you see you are going to pass in someone’s vicinity.
My observation is this is probably not very useful. If you are walking on a path, the danger isn’t so much from when you pass someone as from the fact that once you pass each other, you are walking through the path they just took.
That is, you’re breathing the air they just breathed and vice versa. Obviously this dissipates the further away you are based on wind and whatever, but the point is that we really don’t know. It’s some level of risk.
We basically need to expect some level of risk. The question is what’s an acceptable trade-off, and which of those decisions need to be imposed collectively.
Will the programs be in place for income support etc that would have been provided for 3, including not not being able to be fired or school progress penalized if you voluntarily self restrict like 3, but 2 is implemented? Otherwise you are forcing the vulnerable to behave closer to 1 even if they would have prefered 3, but the people with means can behave like 3 with minimal penalty.
Good comment. Noting – we’re all socialists now.
“The cry of “Flatten the curve!” was based on the presumption that having enough hospital beds and ventilators was crucial to saving lives. Now that we have had a chance to observe the way that cases progress, this argument seems less compelling. It seems that survival chances depend a lot more on patient characteristics than on medical treatment.”
Do you have a source for this? I’ve read similar statements recently, but not the data they’re based on. Thank you!
+1. The claim that the standard of care does not significantly affect outcomes is extraordinary, and requires extraordinary evidence.
One anecdotal piece of evidence against it are the stories (first from China, then Italy, and now New York) of medical staff weeping in hospital hallways because they can’t provide treatment to everyone. Clearly they believe the standard of care matters.
Or they have absorbed the American social norm that you must care for everyone, no matter how futile. I’m not against that as a social norm, but it should not be confused with the ability to cure someone
If you have experienced how a patient with a DNR is treated by our healthcare system, you might be shocked at how that American social norm comes to a screeching halt — and this was in a time with plenty of capacity.
I find it odd that this topic has not been touched in media coverage. But, I can imagine, it wouldn’t play well on TV.
Let’s imagine these three.
#1 Economic Activity Level = 100%, Increased Illness = A%
#2 Economic Activity Level = X%, Increased Illness = B%
#3 Economic Activity Level = Y%, Increased Illness = C%
I say increased illness because people seem monotonously focused on the mortality rate. “Mild cases” seem to make people very sick for weeks, and “severe” cases often mean hospital stays and lung damage. So its not like if you avoid death this thing is no harm no foul.
I think your claims are:
1) X% is substantially higher than Y%.
2) B% isn’t that much different than C%.
Those are debatable in my mind. I can see B% and C% having a wide range and depending on the effectiveness of a lot of variables. I’m not particularly convinced X% is substantially greater than Y%. I just don’t see government as the reason for the downturn, legitimate fear of the disease is.
I can see how B% vs C% could effect X% vs Y% (since I see fear of the disease as the primary driver behind the economic downturn). I suspect the lockdowns simply moved forward the same concerns private individuals would have had on their own two weeks later when we turned into Milan. In many cases government was simply reacting to the actions taken by more ahead of the curve private institutions (the NBA locked down before the government did).
You also seem to be confusing X% vs Y% with stimulus efforts. I suspect such stimulus efforts would exist regardless of whether we do #2 or #3.
I see all of those things, with the addition that there isn’t evidence that medical care doesn’t help much, as the post says. Hospitals are releasing people. People on ventilators are getting off of them. They might not need as many ventilators if they find evidence that other treatments will work better. In addition, hospitals are where new treatments are frequently invented and tested — new treatments that may either be only able to be done in hospitals, or at home.
I do not see how we can go to scenario 2 without more testing, contact tracing, and more information about medical interventions.
A pandemic of a novel illness is not at all like a bad year of a known virus. Every moment of time is precious, to get the new treatments, the vaccine prepared, and so forth.
Scott Gottleib’s roadmap to ending the pandemic is the best way to get this done. And it means vastly increasing testing, making an app to trace contacts, and hiring a *lot* of people to do contact tracing. Look! Economic activity!
https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening/
I think the best way forward in any scenario is to focus on what steps will aid in either #2 or #3, and if we get enough of those in place it will be easier to ease into #2.
I think hyper focusing on switching from #3 to #2 is a waste of time, and if you do it too early without the right things in place and get a second wave you are going back to #3 like forever.
If you’ve done enough things to be worth of #2, it will happen on its own.
There vast majority of economic theory and evidence suggests X > Y, simply because Y is, in effect, central planning about what production is allowed and what isn’t.
To give an example, my car needs an oil change. So far, the average car repair shop doesn’t seem to have been deemed essential. But as cars start to go without maintenance and breakdown, that’s gonna have high costs.
There are a million things like that where the blanket rules imposed by a government are going to have trouble keeping up and impose significant cost on the economy over a situation where everyone is scared but also scared of their car breaking down.
It’s evident to me that at some level B >= C, simply because even the best precautions don’t seem to be as effective as avoiding an interaction entirely.
The danger, I think, is that we don’t have a good grasp at all on B vs. C. With the understanding that “Increased Illnesses” is basically a nuclear reactor. How much increase in heat can the reactor sustain before it starts to meltdown?
That’s really the critical piece of information. It’s obvious we want to allow as much freedom as possible without crossing that line.
Running a war is central planning, and yet no stateless army has ever won a total war.
I maintain my believe that the government followed private industry on the lockdowns, and that those private citizens that were behind the curve would have been in agreement after two more weeks of uncontrolled growth. I would go further. If the authorities had done nothing and we had turned into Milan, then Y > X.
I think it’s easier to make the case to allow car maintenance then rail vaguely against the lockdown. At first we thought all construction in some states was shutdown, but that’s just because at first all you have is the press release. Later we found most construction was exempt, and anything not automatically exempt could apply for an exemption. If you think something essential has mistakenly been deemed non-essential, lobby to change it.
This has almost nothing to do with economic theories. It has to do with a very simple question, and one that is unknowable in advance:
Can #2 contain the spread or not?
What Arnold’s post hasn’t considered is how many simultaneous infected can our society tolerate before the economics become even worse than it would be under lockdown.
Setting aside the risk of dying, if you have the virus, you can’t work. You have a 20% chance of getting quite ill, and what, a 10% chance of getting permanently damaged? How many simultaneous infections must occur before #2 is worse than #3 economically?
Ask Italy.
You can ask China, and I doubt you’d get the truth but actions speak louder then words.
If a person does something reckless and gets infected, and then passes that infection onto someone else (who is taking the best of precautions, but its virtually impossible with an airborne virus that is contagious in the asymptotic) is that person liable for the damage they have done to the other individual?
Obviously, one could never prove guilt of a single individual, but in theory?
If yes, why shouldn’t the government simply make illegal “reckless” behavior.
If your claim is that the government is currently classifying too many things as “reckless”, then make a case situation by situation. One of the states my wife was operating in briefly made some activity illegal, but quickly reverse within a week once it was brought to the states attention.
On a personal level, I have not observed a single activity that is “locked down” that I could see someone participating in without being “reckless”. Granted, I’m not all seeing and all knowing.
We start having 2) next month but a lot of interruptions of 3) here.
1) You are way underestimating the local Prisoner Dilemma here and everybody will cheat in some form or fashion. Most people can not follow your steps as easily the next 12 months.
2) Masks are not that effectively on helping the individual but even lower the catching the disease by 10% for everybody has impact the R rates a lot. (Surgical masks are going to be more effective to 20%)
3) The death data from New York and Italy are beyond scary here. A week of COVID-19 deaths officially are about equal to several years of murder deaths. And the number of people dieing at home has jumped in both locations.
As far as cheating goes, we tried the honor system here in MD for a week, and it didn’t especially work. People apparently only see things as important if it’s made illegal.
The Maryland governor’s spokesperson just released how much cheating there is going on out there, even during this shutdown:
“Enforcement update. As of yesterday afternoon, since March 24, police across Maryland have conducted 15,941 compliance checks, responded to 1,211 calls for service related to the Governor’s Executive Order and arrested/charged 23 people for violation of the order.”
“since March 24, police across Maryland have … arrested/charged 23 people”
That’s about two a day, far, far less than a rounding error in the scheme of things.
“15,941 compliance checks, responded to 1,211 calls for service”
That vast number of unnecessary interactions almost certainly transmitted orders of magnitude more virus than the 23 people, even if the police were wearing full isolation suits, which seems highly unlikely with the shortages. (Partly because people who don’t use suits or N95 masks or gloves regularly will tend to be transmitting virus on the outside of said garments, or past improperly-worn seals, during interactions of that sort.)
Essentially all of the “1,211 calls for service” are undoubtedly about neighborhood and other busybodies calling the police over essentially nothing. Those interactions will likely directly cost more lives than they save, too. And by inhibiting or eliminating social solidarity, they will likely indirectly cost many more lives.
No scheme is perfect – even under normal law-enforcement, crime is not zero. Tradeoffs, tradeoffs. I guess the hopelessly spoiled part of the public, including the bored busybodies, can’t understand that almost everything in life involves a tradeoff.
This is mostly about the modern USA virtue-signaling value, people stamping their feet like spoiled children and shouting “DO SOMETHING”, even when the “something” is probably at least useless and highly likely much worse than useless.
Thus I think I have to go with the original post and scenario (2) here.
My parents left their senior living facility and moved into a hotel to hold over until our house is built. In the last couple of weeks that hotel has been flooded with lower class people that are having beer parties, staying up all ours of the night, and not observing even mild forms of hygiene and social distancing, even when asked. We got them out into an apartment we found this week.
Middle class + people follow the rules. Others do not unless it’s beaten into them.
It’s even worse than that. Conspicuously breaking rules for selfish gain signals privilege, power, and social status, which is why some people respond favorably to “rebels” and “bad boys” and “jerks”. See, e.g., Breaking the Rules to Rise to Power: How Norm Violators Gain Power in the Eyes of Others
If you do a search for “flouting” right now, you will get all kinds of hits for people complaining (even reporting, snitching) about other people doing irresponsible things that tend to spread the virus around, despite fairly strict state prohibitions.
A lot of the complaints are about kids and teens, and unless they are literally locked down and imprisoned, it is already hard enough to get them to avoid getting together, especially since they now know they have a negligible risk of dying, and low risk of even getting very sick. Without state prohibitions and at least some fear of enforcement, well, good luck.
As John Hinderaker writes, the jury is still out on 2 versus 3. But he observed that we will have a natural experiment to consider when a hard-lockdown country like Norway, relaxes its shutdown: https://www.powerlineblog.com/archives/2020/04/norway-and-sweden-conduct-an-experiment.php. A spike in cases would undermine the lockdown option.
But we can learn a lot from other countries and the wide variations in policies. States might make their empty college dormitories available for infected individuals who volunteer to isolate away from their families and thereby avoid the Italian tragedy. Keeping the state college campuses closed to make the dormitories available for this purpose would be a cost-saving, high reward low-hanging fruit solution. Another low cost, high reward option would be more widespread temperature scanning. No-touch infrared thermometers are cheap and could be installed at grocery stores and elsewhere so that customers would automatically be checked before being allowed in. No personnel even need be necessary: just set the thermometer up at the entrance and hook it up to a red/green light, Mark where the customer stands, they press a button and get there temperature read. That should not be so difficult to implement.
Waiting for the vaccine may not be necessary if sufficient easier satisficing can be deployed quickly.
https://www.bloomberg.com/news/articles/2020-04-09/nyc-reports-record-824-deaths-from-coronavirus-in-24-hours?srnd=premium
The latest spike in deaths, which lag as an indicator of the virus’s spread, comes as the rate of hospitalizations in the city and state is dropping. At his daily virus briefing on Thursday, Governor Andrew Cuomo said there had been only 200 net new hospitalizations over 24 hours, the lowest number since the crisis broke out. That number had been as high as 1,400.
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Deaths are up, however.
“The cry of “Flatten the curve!” was based on the presumption that having enough hospital beds and ventilators was crucial to saving lives.”
A lot of people were saying things like that and thinking that way. But it was incomplete. The better argument was that slowing things down a lot buys valuable time. And that time means:
1. Preventing supply-inelastic health care resources – of unknown but possibly high utility – from getting maxed out and overwhelmed (the original argument).
2. Opportunity to ramp up production and administration of tests, for the virus and for antibodies
3. Opportunity to study and learn as much as possible about the disease
4. Opportunity to think about optimal courses of action, or enforceable protocols which balance competing interests,
5. Opportunity to experiment, study, discover, develop, and then deploy cures, treatments, vaccines, etc. The latest vaccine tech is really, really fast at making lots of safe antigen to confer immunity – it’s the clinical trials and approvals which are slow, and
6. Insurance, in case another mutation quickly arises that makes the pandemic much worse, because, after all, it’s still only a 2 or 3 out of 10 on the plague scale. If the fatality rate was like ebola and the reproduction rate like measles, then it would be martial law, confinement to quarters, welded doors, and lots of shooting on sight. And justifiably so.
Some people can work from home and get all their work done from home, as they are doing now during lockdowns, but their bosses only allow it if there are government orders to do so. Otherwise the bosses say “well, we just follow the rules, and the government say it’s fine, so come back in to the office or you’re fired”. That issue will be need to be addressed so people can actually choose to work from home.