by Will Boisvert
Thanks to my knee-jerk anti-alarmism I wrote some egregiously wrong blog comments about the COVID-19-19 pandemic back in March. I guesstimated the infection-fatality rate at a flu-like 0.1 percent, rather than the roughly 0.3 to 1 percent (depending on the demographic mix) that’s now reckoned for various populations by antibody testing. I’ve apologized for those comments, and internalized the lesson on the perils of armchair epidemiology by rank laymen like myself.
But now it’s time to double down on the anti-alarmism with more (and, hopefully, better-informed) armchair epidemiology.
Because while COVID-19 is much worse than I thought it would be, it’s nowhere near as bad as government policy and media hysteria make it out to be. It’s not the flu, but, in scale, it is a flu: it’s likely comparable to the 1957-8 Asian Flu pandemic, which almost no one, then or afterwards, considered a major disaster. The mortality burden in years of life lost is light because the virus mainly kills very old and sick people who would have died soon anyway. Society-wide lockdowns are a drastic overreaction and not very effective. They haven’t worked well in many places that tried them, and weren’t used in many places that tamed their outbreaks, including the Scandinavian countries. Worse, the economic disruptions caused by lockdowns are exacerbating other health problems—drug overdoses, suicide, heart disease, poverty and underdevelopment—that pose greater risks than COVID-19 itself.
If lay epidemiology has its pitfalls, so too does the professional epidemiology that has dominated COVID-19 policy. On major questions from forecasts of the death toll to the usefulness of masks, expert opinion has been confused, divided, politicized and sometimes flat-out wrong. Yet this very conflicted science has driven cataclysmic economic policies that are unprecedented in peacetime, and an expansion of state power that would have been unthinkable a year ago. It has altered our concepts of individual rights and social morality, and steered politics in an illiberal and elitist direction.
With the climate movement using science to make similar demands for the reordering of society, the COVID-19 response is a harbinger of things to come. It’s time for laymen to think hard and skeptically about what the pandemic is teaching us.
Lesson 1: COVID-19 is not an especially lethal disease.
So far the pandemic has killed about 900,000 people worldwide (115 deaths per million population) and about 194,000 in the United States (584 dmp). [1] (Deaths per million population numbers cited here are as of September 7, 2020.) That’s a big toll, but still short of the per-capita toll of the 1957-58 Asian Flu pandemic, which killed 1.1 million people worldwide (379 dmp) [2] and 70,000-116,000 in the States (407-674 dmp) according to the CDC.
There are uncertainties in those numbers, of course. Excess mortality figures in many places are higher than COVID-19 fatalities, suggesting an undercount. The New York Times reports that excess mortality in the pandemic period now exceeds 200,000 deaths in America. [3] (Some of those excess deaths are likely from other ailments caused by economic and social disruptions caused from the lockdowns rather than from the virus. COVID-19 deaths are also likely being overcounted as well, because of a tendency to count every death after a positive COVID-19 test as a death from COVID-19, even if the victim died of something else.) Still, global deaths would have to significantly exceed three million, and US deaths 223,000, before COVID-19 would count as a much worse pandemic on a per-capita basis than the Asian Flu.
We’ll likely get there in the U. S., but we probably will not reach a dramatically higher death toll. The influential Imperial College study, which played a large role in justifying lockdowns, estimated 2.2 million deaths, or 6,646 dmp, [4] in the U.S. in the absence of official measures or voluntary social distancing, a forecast that looks far-fetched now under any realistic scenario. (Sweden’s outbreak with no lockdown has fizzled out at 577 dpm.) [1]
While the COVID-19 pandemic will likely be in the same mortality ball park as the 1957 flu, the policy response has been enormously larger. In 1957 and1958 there were few school and business closures, no stay-at-home orders, no mask mandates, no solemn heralding of a “new normal.” The pandemic never made anyone’s list of Top Ten Things that happened in 1957.
That non-response is typical of our habitual indifference to health risks. Smoking kills 480,000 Americans every year, yet we don’t ban cigarettes. Seasonal flu kills 30,000 to 60,000 every year, but we do nothing to stop it besides a half-hearted vaccination campaign and rare school closures.
It’s hard not to conclude that the panic and upheaval over COVID-19 are bizarrely disproportionate to the risk it poses.
[This first lesson hasn’t aged well. The pandemic has had a dramatically higher death toll than I anticipated. But see COVID: The View From On High – Progress and Peril for a reconsideration of the pandemic’s mortality and whether or not it warrants harsh lockdowns; I still say no.]–WB.
Lesson 2: COVID-19’s mortality burden in years of life lost is light.
As with seasonal flu but even more so, serious and fatal COVID-19-19 cases are heavily concentrated among the very old and sick. The U. S. CDC puts the median age of fatalities at 78 years, with 80 percent of fatal cases among those 65 years or older. [5] In Sweden, 67.6 percent of those who die are 80 years or older, and 89.2 percent are 70 years or older. [6] Those who die are usually so old and sick—most of them had serious pre-existing illnesses like diabetes, hypertension or cancer—that they would have died soon anyway of some other malady, so on average they are losing only a few years, often a few months, of life. Aggregate “years of life lost” is a key metric epidemiologists use to gauge the severity of a public health threat, and by that measure the mortality burden of COVID-19 is light.
There has recently been some pushback against this argument in the literature. A widely reported study from the Universities of Glasgow and Edinburgh modeled YLLs among COVID-19 fatalities and estimated them at 13 years on average for women and 11 years for men after taking into account comorbidities—a substantial YLL burden. [7]
But the Scottish study is flawed because it doesn’t account for a crucial feature of COVID-19 fatalities—namely the high proportion of nursing home residents, whose life expectancy is extraordinarily low. The New York Times reports that, as of August 13, 41 percent of American COVID-19 deaths have occurred in nursing homes and other long-term care facilities. [8] The figure for Europe is about 50 percent according to the Washington Post, [9] while press reports put the figure in Canada at 81 percent. [10] Those percentages are dramatically higher than the percentage of elderly people in long-term care: in 2016, only 4.5 percent of American seniors lived in nursing homes or assisted living facilities. [11]
The huge over-representation of nursing-home residents should skew average life expectancy for COVID-19 fatalities sharply downward. A typical 78-year-old American has a life expectancy of 9.4 years if a man, 10.9 years if a woman. [12] But nursing-home residents in long-term care are anything but typical: their life expectancy is more like one to three years. A 2010 study found that nursing home residents in the U. S. had an average “length of stay”—until death—of 13.7 months, and a median LOS of just 5 months, with 53 percent dying within six months after placement in the home. [13] A recent AARP fact sheet estimated slightly less dire life expectancies, with women in long-term nursing care lasting about 2.5 years, men 1.5 years. [14] A 2020 study of Belgium, England, Finland, Italy, Netherlands and Poland arrived at similar numbers, with an average length of stay of 126 weeks and a median of 73.4 weeks. [15]
Not everyone who goes into a nursing home dies there—about 38 percent of U. S. nursing-home admissions recover enough to be discharged to someplace other than the hospital or the graveyard [16]—and those in that category who die of COVID-19 might lose more years of life. But they are probably not typical of nursing-home fatalities. Even among nursing-home residents, only 17 percent of diagnosed COVID-19 cases end up being fatal, and that ratio leaves out many asymptomatic cases that aren’t counted. [8] It’s mainly the sickest and weakest of nursing home residents who are dying of COVID-19, and their life expectancies are likely even shorter than those of the general nursing-home population.
That’s likely true of other COVID-19 victims as well: even if they are not yet in the nursing home, their health is probably drastically worse than that of typical seniors. That debility goes beyond the usual comorbidities that scientists link to COVID-19 risk. The most important marker of short life expectancies among COVID-19 fatalities is simply that they died of COVID-19, which is a very hard thing to do unless you already have one foot in the grave. It’s a clear indicator that a victim was unusually susceptible to respiratory infections, including ordinary infections—flu, colds caused by other coronaviruses—that regularly cull the very old and sick and would likely have killed the victim anyway within a few months to a few years. The Scottish study did adjust for the shorter life expectancies of people with comorbidity diagnoses, but did not consider the over-representation of nursing-home residents with very short life expectancies in the COVID-19 death toll. Thus, it almost certainly overstated the average years of life lost by COVID-19 victims, and by a wide margin.
Even if we accept the study’s estimation of about twelve years of life lost on average, that still puts COVID-19 well within the range of other mortality burdens that we calmly accept. In 2019, 70,980 Americans died of drug overdoses, mainly from opiods, cocaine and methamphetamines. [17] Most of them were relatively young adults, with an average YLL for opioid overdoses of about 40 years. Assuming that figure holds for all overdoses, the aggregate mortality burden of the 2019 overdoses would be 2,839,000 aggregate years of life lost. At 12 years of life lost per COVID-19 death, it would take 236,000 coronavirus deaths to equal that YLL toll.
Again, COVID-19 mortality may well get to that point, but probably won’t dramatically exceed it. Yet in 2019 we didn’t spend trillions of dollars to fight drug overdoses; or ban opioid painkillers; or ban travel from China where illicit fentanyl is made; or close the Mexican border to prevent narcotics smuggling. We didn’t do much of anything to halt the overdose epidemic.
Beyond the YLL tally, one might argue that 236,000 bereaved families outweigh 70,980, but the qualitative and moral distinction between COVID-19 deaths and overdose deaths points the other way. The death of a 25-year-old overdose victim is a tragedy that will permanently shadow his family, and represents a wasted potential for a long and happy life. The death of an 85-year-old in a nursing home isn’t a tragedy; it’s just a sad inevitability—and often a release from incurable anguish.
We shouldn’t be indifferent to COVID-19 deaths. Indeed, we should have done more to protect the elderly and nursing-home residents from the infection. The policy of widespread lockdowns may have impeded that by diverting government attention, resources and testing away from the targeted protection of high-risk groups and into diffuse efforts to suppress the virus among the general population, most of whom face very little risk from the virus. An example of this is New York Governor Andrew Cuomo’s infamous order sending elderly COVID-19 patients into nursing homes for care, where they may have touched off outbreaks that killed thousands. Cuomo did that as he was instituting one of the harshest—and least effective—general lockdown regimes in the world.
Mistargeted policies like that flow from a persistent official denial of the virus’s demographic realities. To stoke the anti-COVID-19 effort and keep younger people enlisted in it, health experts have downplayed the age profile of COVID-19 fatalities and the light YLL toll. Instead, they emphasize that “anyone can get it” without discussing just how unlikely death is for those who aren’t elderly. Meanwhile, the media spotlight vanishingly rare fatalities among young adults and children, which distorts public perceptions of the disease and exaggerates its impact on human longevity and well-being.
By justifying ongoing shutdowns, that distorted message will continue to have serious health consequences. Drug overdoses are soaring along with suicidal thinking, especially among young people, as a result of the economic disruption and isolation caused by the COVID-19 lockdowns. Their legacy of bankruptcy, unemployment and poverty will cause many deaths of despair for years to come.
Lesson 3: Lockdowns don’t work very well.
The great question of the epidemic is whether the harsh lockdowns have actually succeeded in suppressing the virus. It seems like a no-brainer that they would, and that’s how these hugely disruptive measures have been sold. But the empirical evidence is muddled, and against it we have to set the extraordinary economic and social costs of the lockdowns.
Let’s start with Sweden’s experience with its famously lax COVID-19 restrictions. The Swedes relied almost entirely on voluntary social distancing, closed very few businesses or other activities, left schools open in grades K through 10 and have not mandated mask-wearing. Sweden also suffered one of the worst outbreaks in Europe, with 577 deaths per million. Moreover, Sweden’s death toll is many times higher than that of its Scandinavian neighbors Denmark (108 dpm), Finland (61) and Norway (49). [1] It thus seems obvious that its decision to forego a lockdown was a disaster.
But a closer look undermines that conclusion. Despite the lack of restrictions, Sweden’s outbreak has now died out, and at a death toll about ten times lower than the methodology of the alarmist Imperial College study would have predicted. While Sweden’s mortality rate is high, it’s lower than that of Italy, Spain and Britain, all of which instituted strict lockdowns. [1] It’s lower than the mortality rate in New York State, which imposed perhaps the harshest lockdown in the world with a stay-at-home order, bans on all non-essential workplaces and all gatherings of any size, and mandatory mask-wearing in public. Despite these measures, New York State’s mortality rate of 1701 dpm is almost three times higher than wide-open Sweden’s. And that’s not solely because of New York City’s vast mortality: leaving out New York City, the rest of the state suffered 577 deaths per million population, the same as Sweden despite the lockdown. [18]
Sweden’s stats show that voluntary social distancing without draconian lockdowns will eventually snuff out an epidemic and limit mortality about as well as strict lockdowns. They also accords with a growing body of research that suggests that T-cell immunity—either from mild COVID-19 infections or from cold infections caused by other coronaviruses—is widespread and that populations are therefore much less vulnerable than epidemiologists thought. [19] Moreover, while many other countries in Europe are now seeing a second wave of infections, Sweden is not. It’s plausible that, thanks to the absence of a lockdown, enough non-elderly, low-risk Swedes have caught the virus to establish herd immunity.
Even the comparison of Sweden with the rest of Scandinavia is less conclusive than it appears. Although they are held out as paragons, Sweden’s Scandinavian sister countries didn’t impose harsh lockdowns either. None of them imposed stay-at-home orders. Norway and Finland did not close non-essential shops and workplaces. None of them mandated mask-wearing (apart from recent orders to mask up on public transit), and mask-wearing rates in Scandinavia have stayed well under ten percent throughout the epidemic. Sweden is at the far end of the spectrum in both its relaxed measures and the unflappable stoicism of its chief epidemiologist Anders Tegnell. But while the other Nordic countries sounded a louder alarm about COVID-19, they followed a mild approach to COVID-19 restrictions and experienced mortality rates that were substantially lower than did countries with harsher measures.
To be sure, COVID-19 restrictions were tighter in the other Scandinavian countries than in Sweden. [20] They all closed their schools and universities entirely, along with many sports facilities and cultural institutions like movie theaters. Some government offices were closed, non-essential government workers were sent home and gatherings of more than 10 people were banned. (Sweden banned gatherings of 50 or more.) Norway and Denmark shuttered the close-contact sector of barbers, tattoo parlors, dentists, massage parlors and the like, but Finland did not. As for the critical restaurant and bar sector, Denmark and Finland closed it but Norway did not: it allowed restaurants and bars to stay open if they served food and maintained a one-to-two-meter physical distance between patrons—the same policy as Sweden’s. Aside from a few targeted, high-risk sectors, Norway and Finland stayed pretty open. Factories stayed open, offices stayed open, most shops stayed open, and in Norway restaurants stayed open if they complied with the physical distancing. Almost everyone went almost everywhere mask-free.
Scandinavian countries also lifted their restrictions quite early. Denmark and Norway reopened elementary schools and the close-contact sector in April. Norway opened all schools in May, opened all amusement parks and bars without food service on June 1, and raised the ceiling on public gatherings to 200 on June 15, when most COVID-19 restrictions were lifted. For most of the pandemic period Norway has been as open as Sweden, and more open than most red states in America. Even Norway’s loose regime was probably too strict according to Prime Minister Erna Solberg, who said in May that some of the restrictions, like school closures, were probably unnecessary. [21]
It’s possible that tighter restrictions early in the pandemic helped restrain death rates. But the evidence on that is shaky as well.
To get a quantitative sense of this, we can look at cell-phone data published by the University of Washington’s Institute for Health Metrics and Evaluation, which measures increases in social distancing by declines in cell-phone mobility. [22] The data do show that, while Sweden’s social distancing started at about the same time as its neighbors, the level it reached was markedly lower. At its minimum, Swedish cell-phone mobility declined 35 percent from normal, compared to 51 percent in Finland, 59 percent in Norway and 61 percent in Denmark. Those numbers are consistent with the argument that increased social distancing (decreased cell-phone mobility) leads to less COVID-19 mortality.
But in other respects, and with more extreme lockdowns, that correlation seems to break down. Belgium’s very strict lockdown is an example. Thanks to a stay-at-home order and closure of all non-essential shops, Belgium’s social distancing was even more complete, with cell-phone mobility down 78 percent on March 25. [22] But Belgium has suffered the worst mortality of any country in Europe, with 854 deaths per million population. [1] Right next door, the Netherlands, with lighter restrictions, also reached minimum cell-phone mobility (maximum social distancing) on March 25 with a decline of only 54 percent, [22] but its outbreak was less than half as severe at 364 dpm. [1] Finland’s social distancing was much slower and less complete than Belgium’s—a maximum cell-phone decline of 51 percent on April 15—but it had an outbreak of just 61 dpm. [1] And, of course, Sweden had a substantially lower mortality rate than Belgium despite social distancing that was slower and less than half as effective, with minimum cell-phone mobility on April 9. Face-mask use was also much more common in Belgium than in the Netherlands or Scandinavia. [22]
It’s not just Belgium that sticks out. Scandinavia as a whole, with lax restrictions and virtually no masking, had dramatically lower mortality than Italy, Spain, France and Great Britain with their strict lockdowns and high masking rates.
We see a similar story if we compare different states in America. California, for example, was lauded for its early lockdown measures, which were credited with forestalling a large outbreak during the first wave of the epidemic in March through May. But IHME’s cell-phone mobility data call that narrative into question.
For one thing, the data show that California was already engaging in extensive voluntary social distancing before the lockdown. (This is an important point—informal social distancing accomplishes a lot while avoiding the disruptions of draconian lockdowns.) Moreover, the data show that social distancing in California was slower and less complete than in states with much higher mortality.
On March 19, when Governor Gavin Newsom announced California’s lockdown, cell-phone mobility in the state had already declined by 36 percent. But in New Jersey, the worst-hit state in the country (and the world), cell-phone mobility had declined even more, 44 percent, by that date. In New York State cell-phone mobility was down by 45 percent. Maximum social distancing was also less complete in California than in New Jersey and New York. California reached minimum cell-phone mobility, down 55 percent, on April 7, while New Jersey’s was down 63 percent on April 9 and New York’s was down 66 percent on March 27.
One can argue that the disease environment in high-density, hyper-urban New Jersey and New York is different from California’s, but what about low-density, sprawling Michigan? Michigan had a huge first-wave outbreak, with 682 dpm versus California’s current 348, [1] but it far outpaced California on lockdowns. On March 19 Michigan’s cell-phone mobility was down 43 percent compared to California’s 36 percent, and it reached its minimum, down 67 percent, on March 27, a full eleven days before California bottomed out at 55 percent. Meanwhile, South Dakota, with virtually no COVID-19 restrictions and a modest decline in cell-phone mobility of only 35 percent, [22] has had a relatively mild outbreak with 196 dpm. [1]
Evidence from the second-wave states—Arizona, Florida and Texas—gives us more reason to question whether lockdowns are a key factor in suppressing outbreaks. These states had large outbreaks in June, July and August with high mortality that prompted tightened restrictions and mask mandates; their outbreaks have now peaked and sharply receded. But IHME cell-phone date make it hard to attribute the abatement of these outbreaks to stricter social distancing from renewed restrictions, because social distancing changed very little over the period. In Arizona cell-phone mobility from June 1 to August 18 fluctuated between -27 percent and -34 percent, in Florida between -25 percent and -33 percent, and in Texas between -20 percent and -27 percent. (There was, however a consistent increase in masking, up from 16 percent to 65 percent in Arizona, 43 percent to 62 percent in Florida and 42 percent to 55 percent in Texas.) [22]
Maybe premature reopenings did spark these outbreaks, since social distancing metrics had waned substantially from their April peaks in these states. But it’s not clear that increased social distancing from renewed restriction played any role in flattening the second wave. Mask mandates may have helped (and have the advantage of not causing mass unemployment). On the other hand, with all these states now approaching Sweden’s mortality rates, it’s possible that the outbreaks subsided from growing immunity. [1]
So while lockdowns don’t exacerbate outbreaks, it seems likely that they usually don’t have much influence on them. They are lagging indicators of an outbreak, kicking in after it grows large enough to force politicians to do something, but their role in eliminating large outbreaks seems weak at best.
What does account for wildly different mortality in neighboring areas? One crucial factor is probably the extent of testing: lots of testing while an outbreak is small can snuff it out. We can get a crude measure of this from IHME estimates of daily infections and testing. [22] IHME doesn’t have data on Swedish testing, but testing in Belgium and the Netherlands was clearly inadequate for their large outbreaks. On March 26, the day IHME estimates Belgium had its peak number of new infections, 17,480, it only did 3,792 tests; on its peak infection day the Netherlands had 11,736 new infections against 2,987 tests performed. These countries were suffering four infections for every test, so they had little hope of finding and quarantining most infections. On Norway’s peak infection day, by contrast, it suffered 725 infections but conducted 3,917 tests, more than five times as many tests as infections, which helped authorities find and isolate cases before they spread.
Epidemiologist put great store in early testing and quarantining to smother an epidemic before it starts. But once it takes off, testing can’t keep up. That’s why China’s success in halting the Wuhan outbreak with a lockdown came as such a revelation. Suddenly epidemiologists could envision something that was never tried before: quarantining whole nations until mass outbreaks subside enough to be strangled by testing. When Italy followed China’s lead the new epidemiological paradigm of lockdown came into its own as a policy for liberal democracies as well as tyrannical police states. But the lockdown model hasn’t worked well anywhere outside of China.
Why the lackluster results? The reason might be that lockdowns target the wrong things without blocking crucial avenues of infection. A number of studies indicate that schools aren’t major spreaders of COVID-19 infections, so closing them likely does little to stop the virus. [23] Nor will lockdowns protect nursing homes if infected patients are sent into them, as in New York.
Locking down the non-essential economy may not help much if transmission proceeds in the essential economy. Closing a lightly staffed manufacturing plant or office may not stop contagion from spreading in a densely staffed, essential meat-packing plant, and closing smaller non-essential shops may not stop the virus from spreading in the few essential supermarkets that everyone has to crowd into. The essential economy may pose a markedly greater health risk because it’s disproportionately staffed by immigrant and minority workers with poorer health and health care, who are more likely to live in multi-generational households where they spread infections to the elderly.
There’s a limit to the state’s ability to abolish social interaction, and banning some aspects of it won’t help if it continues in even more infectious contexts. Near my apartment in Manhattan I’ve noticed quite a few informal bong parties going on since the weather warmed up in May, with groups of up to thirty young-to-middle-aged adults passing the bong tube from mouth to mouth. I’ve seen them in the courtyard behind my building, on the sidewalk, in parks and even at outdoor restaurants. They are not much of a risk anymore because New York City seems to have substantial herd immunity to COVID-19 now that the colossal outbreak here has burned itself out. But indoors bottle-and-bong parties in March and April may have played a substantial role in spreading the virus.
Despite bans, stay-at-home orders, constant scolding by officials and occasional arrests, similarly dense and infectious gatherings have been reported everywhere—at Hasidic funerals in Brooklyn, street parties on Chicago’s South Side, house parties in the Hollywood Hills, and frat parties everywhere. Bans on indoor restaurant dining, where there is at least some enforcement of distancing, won’t stop clandestine gatherings where germs spread more freely.
So it’s hard to make a convincing case that lockdowns that force working-age people and children to stay home have a reliable effect on suppressing an epidemic or protecting the vulnerable. They don’t stop people from crowding into meat-packing plants or Wal-Mart’s with recirculated air conditioning, or close off the pipeline carrying COVID-19 from essential workers and clandestine partiers through multi-generational households to frail old people.
Perhaps that’s why lockdowns seem to have been largely irrelevant in so many places. Michigan Governor Gretchen Whitmer imposed an early and ferocious lockdown, with draconian stay-at-home orders and a ban on all non-essential work including outdoor lawn work. None of that helped Detroit, which suffered an enormous outbreak with a mortality of 2,406 dpm, [24] almost as high as New York City’s. Banning non-essential work didn’t stop Detroit’s essential workers from going to their jobs and being exposed to the virus, because essential workers are essential. Stay-at-home orders probably didn’t stop young people from holding bottle-and-bong parties. (Whitmer let liquor stores and marijuana dispensaries stay open as “essential services” to keep up the flow of state tax revenue.) [25] There was no attempt to help old people in multigenerational households isolate from younger relatives, or to build a wall of testing around nursing homes to keep the virus out. Whitmer’s crusade to close down rural barber shops a hundred miles from Detroit probably achieved nothing except to help spike the state’s unemployment rate to 24 percent [26] and give more people reason—and time on their hands—to get drunk and stoned.
Weighing heavily against the uncertain usefulness of lockdowns are their enormous costs. The unevenly locked-down U. S. economy contracted by 9.5 percent in the first half of 2020. Things were worse in Europe. The Eurozone economy shrank 15.9 percent in the first two quarters of the year; France’s shrank by 18.9 percent, Britain’s by 22.1 percent and Spain’s by 22.7 percent. (Sweden did about as well as its Scandinavian neighbors, and as a whole the Nordic laxity zone did far better than the European lockdown economies, with Sweden’s economy shrinking 8.2 percent, Denmark’s 9.5 percent, Finland’s 5.8 percent, and Norway’s about 7.1 percent.) [27]
Those economic losses make the lockdowns themselves the cause of much suffering and death. In the U. S., they have caused drug overdoses [28] and suicidal thinking [29] to soar. COVID-19 alarmism has prompted bans on “non-essential” medical procedures and stoked germ-phobia that keeps people from going to the hospital when they have other life-threatening conditions, leading to a rise in heart-attack deaths. [30]
The effects of lockdowns are much worse in poor countries where many people live hand-to-mouth and go hungry if they miss a day of work or begging. Despite UN forecasts of a record-breaking global harvest, [31] Oxfam warns that more people could die from hunger caused by economic disruptions than from the virus. [32] Brazilian President Jair Bolsonaro has been castigated for making light of the virus threat in a Trumpian vein, but Mexico’s left-leaning President Andrés Manuel Lopéz Obrador has done the same because a panicky shutdown would have devastated Mexico. Indeed, all developing countries have vacillated on COVID-19 restrictions to prevent economic collapse.
The “premature” reopenings that may have sparked second COVID-19 waves were therefore inevitable. No country has been able to maintain peak social distancing for more than a few weeks, because no government can impose that level of economic devastation and social isolation for long without sparking mass protest and mass noncompliance that negates the lockdown’s effectiveness.
Lesson 4: The dictatorship of the professoriate.
It was also inevitable that COVID-19 would become a political issue. In the United States lockdowns—and especially mask-wearing—have become a vitriolic controversy pitting a don’t-tread-on-me right that decries business bankruptcies and social controls and a left that venerates lockdown and masks as the triumph of solidarity over selfish individualism.
But these ideological associations are also muddled. The American left has been as eager as the right to defy social-distancing strictures and stay-at-home orders when it’s a matter of mass demonstrations against police brutality, and has done so with the blessing of the same public-health experts, politicians and media commentators who decried right-wing lockdown protests. In Scandinavia, lockdowns have been eschewed by both the center-right and the center-left. For all President Trump’s erratic, self-centered leadership and crazy tweets, on the substance of his COVID-19 policy he’s indistinguishable from a Swedish Social Democrat.
So there’s tacit agreement across the political spectrum that COVID-19 is just not worrisome enough to outweigh other priorities like protesting or partying. Given the small health risk the virus poses to most people, and its light mortality burden, their relaxed view of the disease makes sense—more sense than the fear-mongering and emergency strictures of officials.
All of this makes the COVID-19 pandemic a textbook example of an elite panic, a hysteria promoted by privileged factions to impose their worldview and strengthen their control over society, and especially the government. Just as the September 11 attacks served as an excuse to radically expand the surveillance state in the name of security, COVID-19 furnishes a rationale for radically expanding the power of the nanny state, giving it unprecedented authority to reorder society in the name of health.
That revolution has a vanguard in the public health establishment and the professorial class from which it is drawn. The real political story now isn’t left populism vs. right populism or Trump vs. all that is sacred, but the new and extraordinary ascendancy of academic experts. All sides of the issue look to epidemiologists for guidance or endorsement of their preferred policies. Their pronouncements are instigating unprecedented forms of economic austerity and social reengineering, with tens of millions of people seeing their livelihoods casually discarded as “non-essential.”
So unquestionable has the epidemiologists’ authority become that politicians are ready to give them dictatorial power. So said Joe Biden in a recent interview with ABC’s David Muir [33]:
Muir: If you’re sworn in come January, and we have the coronavirus and the flu combining, which many scientists have said is a real possibility, would you be prepared to shut this country down again?
Biden: I would be prepared to do whatever it takes to save lives. Because we cannot get the country moving until we control the virus. That is the fundamental flaw of this Administration’s thinking to begin with. In order to keep the country running and moving and the economy growing and people employed you have to fix the virus. You have to deal with the virus.
Muir: “So if the scientists say, ‘Shut it down?’”
Biden: I would shut it down. I would listen to the scientists.
With professorial expertise enshrined as the sole legitimate basis for deciding policies that turn society into a prison, as Biden suggests, it’s hard to see what’s left of democracy and individual freedom.
Millions of Americans, perhaps most of them, would agree with Biden’s formulation. But as reassuring as it sounds in the midst of a pandemic, “all power to the scientists” is a spectacularly bad governing philosophy.
For one thing, which scientists do we listen to? COVID-19 policy has been controversial even within the epidemiological community. There’s no unanimity on basic issues like mask-wearing. Many eminent epidemiologists dissented from the early alarmist forecasts of the Imperial College study and opposed “shut it down” measures on precisely the grounds that I’ve cribbed from them here: the pandemic is not terrifying in scale, the lockdowns aren’t very effective and their health and social effects can rival those of the virus. None of the experts calling for lockdowns have seriously addressed these tradeoffs in health and life-expectancy, even in strictly epidemiological terms of lives and years of life lost.
That’s because they can’t. Health risks are complex and many-faceted, and scientists often don’t know how to assess and parse them. The notion that “doing whatever it takes to save lives” constitutes a clear program that scientists can calculate with certainty is a myth, since many scientists believe, with good reason, that lockdowns may kill more people than they save.
On a deeper level, even if we knew how to do whatever it takes to save lives, it still wouldn’t be morally coherent to do so. Mortality risks have to be balanced against other concerns. Epidemiologists can’t tell us whether extending the life of a nursing-home resident by a year is worth bankrupting a business and throwing a young family into poverty, nor can democratic politics fully settle the matter. We have a collective responsibility to safeguard the old and the vulnerable, but not to sacrifice everything to that goal. The young and healthy have a right to live their lives without having their careers and educations derailed. If the government pursues collective goals that get too far out of alignment with citizens’ individual interests, it loses legitimacy. With tens of millions of people losing their jobs because of a virus that poses no more than flu-level risk to them, we have reached that point.
COVID-19 seems to have made us forget basic principles of morality and freedom, but the groundwork for that was already laid by climate-change dogma. Climate ideology demands that politics be organized around the collective purpose of saving lives—infinite numbers of future lives, since the planet’s survival is at stake—with every individual interest paling into insignificance beside the morally transcendent goal of decarbonization. It calls for austerity and social reengineering to eliminate the non-essential economy for the sake of sustainability. Above all, it makes scientific expertise the sole legitimate arbiter of policy, marking out a perfectly clear path to salvation with no uncertainties or trade-offs worth debating.
The COVID-19 pandemic has shown just how badly that style of politics can go awry, how economically disastrous and socially divisive it can be and how blinkered and obtuse it is, both scientifically and morally, as it fixates on a few ideologically charged risks while dismissing all countervailing interests as a threat to collective survival. If COVID-19 policy is an indicator of how that politics will develop, the cure may be worse than any disease it confronts.
Sources:
[1] https://www.worldometers.info/coronavirus/
[2] 70,000 deaths in the U. S. in 1957-1958 flu pandemic https://www.cdc.gov/publications/panflu/stories/1957.html ; 116,000 deaths in the U. S. and 1.1 million deaths worldwide https://www.cdc.gov/flu/pandemic-resources/1957-1958-pandemic.html
[5] https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e1.htm
[6] https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa on July 25
[7] https://wellcomeopenresearch.org/articles/5-75
[8] https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html
[10] https://www.vox.com/future-perfect/2020/7/7/21300521/canada-COVID-19-19-nursing-homes-long-term-care https://www.cihi.ca/sites/default/files/document/COVID-19-19-rapid-response-long-term-care-snapshot-en.pdf?emktg_lang=en&emktg_order=1
[11] https://www.cdc.gov/nchs/data/series/sr_03/sr03_43-508.pdf
[12] https://www.ssa.gov/oact/STATS/table4c6.html
[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945440/pdf/nihms216108.pdf
[15] https://bmjopen.bmj.com/content/10/3/e033881
[16] https://www.longtermcarelink.net/eldercare/nursing_home.htm
[17] https://www.advisory.com/daily-briefing/2020/07/17/overdose
[20] Norway: https://www.regjeringen.no/en/aktuelt/coronavirus-measures-to-continue/id2694682/ https://www.regjeringen.no/en/dokumenter/long-term-strategy-and-plan-for-handling-the-COVID-19-19-pandemic-and-adjustment-of-measures/id2701518/ https://www.forbes.com/sites/davidnikel/2020/04/07/norway-pm-relaxes-coronavirus-restrictions-but-event-ban-continues/#505c4c50298e Denmark https://progressive-alliance.info/2020/04/25/the-COVID-19-19-response-in-denmark/ . https://www.reuters.com/article/us-health-coronavirus-denmark/fast-in-first-out-denmark-leads-lockdown-exit-idUSKBN22U1TC https://politi.dk/en/coronavirus-in-denmark/controlled-reopening-of-denmark https://politi.dk/en/-/media/mediefiler/corona/genaabning/face-masks-or-shields-required-on-all-forms-of-public-transport-from-22-august-2020.pdf?la=en&hash=3438F39C3B8F72E5FA2BE5BC514308FF091C910C Finland https://valtioneuvosto.fi/en/-/10616/hallitus-totesi-suomen-olevan-poikkeusoloissa-koronavirustilanteen-vuoksi https://valtioneuvosto.fi/en/-/10616/ravitsemisliikkeiden-toimintaa-rajoitetaan-ja-valmiuslain-mukaisia-toimivaltuuksia-jatketaan https://valtioneuvosto.fi/en/-/10616/hallitus-paatti-varhaiskasvatuksen-ja-perusopetuksen-rajoitteiden-purkamisesta https://valtioneuvosto.fi/en/-/10616/hallitus-linjasi-suunnitelmasta-koronakriisin-hallinnan-hybridistrategiaksi-ja-rajoitusten-vaiheittaisesta-purkamisesta https://valtioneuvosto.fi/en/-/10616/korjaus-hallitus-linjasi-neuvottelussaan-kasvosuojuksista-ja-keskusteli-rajaliikenteesta https://valtioneuvosto.fi/en/-/10616/restrictions-imposed-due-to-COVID-19-19-to-change-as-of-1-august https://valtioneuvosto.fi/en/-/10616/government-resolutions-on-recommendations-for-wearing-face-coverings-and-face-masks-and-for-remote-work
[22] https://COVID-1919.healthdata.org/united-states-of-america
[23] https://www.reuters.com/article/us-health-coronavirus-sweden-schools/swedens-health-agency-says-open-schools-did-not-spur-pandemic-spread-among-children-idUSKCN24G2IS https://www.bloomberg.com/news/articles/2020-07-19/COVID-19-s-spread-in-schools-is-questioned-in-latest-nordic-study https://www.bloomberg.com/news/articles/2020-06-23/school-children-don-t-spread-coronavirus-french-study-shows
[24] COVID-19 deaths in Detroit are 1612 https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173—,00.html in a population of 670,031 in 2019.
[26] https://www.bls.gov/eag/eag.mi.htm
[27] US https://www.bea.gov/sites/default/files/2020-07/gdp2q20_adv_0.pdf Britain, Spain, France https://www.ons.gov.uk/economy/grossdomesticproductgdp/bulletins/gdpfirstquarterlyestimateuk/apriltojune2020 Eurozone https://www.cnbc.com/2020/07/31/euro-zone-gdp-q2-2020-as-coronavirus-crisis-hits.html q1 https://ec.europa.eu/eurostat/documents/2995521/10294864/2-15052020-AP-EN.pdf/5a7ea909-e708-f3d3-8375-e2510298e1b8 Sweden https://www.cnbc.com/2020/08/05/sweden-coronavirus-record-gdp-fall-still-outperformed-some-in-europe.html https://ec.europa.eu/eurostat/documents/2995521/10294864/2-15052020-AP-EN.pdf/5a7ea909-e708-f3d3-8375-e2510298e1b8
Denmark https://www.businessinsider.com/coronavirus-sweden-gdp-falls-8pc-in-q2-worse-nordic-neighbors-2020-8 https://www.focus-economics.com/countries/denmark/news/gdp/economy-contracts-in-q1-worse-to-come-in-q2 Finland https://yle.fi/uutiset/osasto/news/finlands_gdp_drops_nearly_5_in_q2/11494389 https://www.reuters.com/article/finland-economy/finland-in-recession-after-q1-gdp-shrinks-09-q-q-statistics-finland-idUSL8N2DB1C3 Norway https://www.businessinsider.com/coronavirus-sweden-gdp-falls-8pc-in-q2-worse-nordic-neighbors-2020-8
[28] https://www.ama-assn.org/system/files/2020-08/issue-brief-increases-in-opioid-related-overdose.pdf
[29] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
[30] https://www.bidmc.org/about-bidmc/news/2020/05/kazi-emergency-care-COVID-19-19
This is an incredibly fascinating and thorough overview. The only tiny quibble I have — and who am I to quibble? — is with this concept: “Excess mortality figures in many places are higher than COVID-19 fatalities, suggesting an undercount.” This idea — that if 1000 people died in city X in April last year and 1200 died this year, that Covid killed 200 people. Seems sound enough, until one recalls the total lunacy of the way Americans were encouraged, and sometimes forced, to respond to this disease. Elsewhere in the story you note “drug overdoses, suicide, heart disease, poverty and underdevelopment” are all worsened by the pandemic. Could have easily added a hundred other ailments that were made demonstrably worse by the reaction to the pandemic, including people skipping cancer treatments, let alone opportunities to diagnose, because of extreme fear of hospitals and worries about hospital capacity shortages that mostly never materialized.
Good points all!
It’s possible for COVID-19 to be both undercounted (in the sense that we are missing people who died of the virus at home without benefit of testing) and overcounted (in the sense that some people who died with COVID-19 did not die of it, including some who died in falls or traffic accidents but were listed as COVID fatalities.
And yes, a substantial amount of the excess all-cause mortality we’re seeing is undoubtedly from the effects of lockdowns and “non-essential” medical shutdowns and hospital-phobia rather than the virus—deaths of despair, untreated heart attacks and strokes, untreated or undiagnosed cancers, etc.
That said, probably the bulk of excess all-cause mortality is from COVID the virus rather than COVID the panic. It will take years of epidmiological studies to quantify the proportion, and even then there will be big error bars, +/- 20 percent is probably the closest we can get to the “true” figure. (Note how wide the range of mortality estimates is for the 1957-1958 Asian Flu.)
Hi, Bill,
Your usual thorough argument, in most respects. Just a few thoughts off the top of my head.
1. The deaths from the virus didn’t even get going until mid-March. The annual rate of US dpm from, say, April 1, 2020 to April 1, 2021, is aiming at (and likely to achieve) ~400,000. More with the undercount. So the US annual rate will likely end up ~ twice as high as it is now. Winter will be worse than summer, every college that has started recently had big outbreaks… Perhaps a vaccine can help…or not…but when?
But you admit that even 223K US deaths will make covid “much worse than the Asian flu” per capita Yet a few sentences later, you still say the “COVID-19 pandemic will likely be in the same mortality ball park as the 1957 flu.”
“Much worse” isn’t “in the same ballpark”, as I understand those phrases. 400K annually will be…much worse than much worse!
Globally, the virus is still growing steadily in most of the highly populated countries, and there is at least a 30% to 40% undercount in many 3rd world countries–India, for example, reports an official, attributed cause of death in only 10% of its deaths in NORMAL (pre-covid) times. The annual global dpm rate, if counted/estimated correctly, will likely be tripleor more the current nominal value by April 1, 2021.
2. You don’t want to ‘obey’ the academics. But what about those countries that have achieved tiny dpm rates compared to the US? New Zealand, Australia, South Korea, Vietam, Japan, China, etc. How did they achieve those? It seems to me they “obeyed their academics”–how else did they know what to do? Did they consult shoe salespeople and cab drivers about the best policies to (successfully, in their cases) crush the virus? I sense inconsistency here…
3. And how should we decide which vaccine(s) to use, and when they are ready to use, and safe–should we follow consensus academic advice, or take a poll of shoe salespeople and cabdrivers on that one too?
4. What does explain why Sweden was so much worse than its fellow Scandianvian countries? They are imilar countries in many factors; Belgium is not a peer of Sweden.
5. Your conclusions on efficacy of lockdowns still have a lot of “mays” and “mights” in them. Which is of course good, you’re being cautious (and perhaps you have in the back of your mind the countries where lockdowns DID work so very well), but you ignore one of the main fears at the time–that hospitals would be overwhelmed without mitigation of the skyrocketing case rate. When a course of action has a lot of “mays and might” in it (and you still have them after the fact–it was far more uncertain then, before the fact), doesn’t it make sense to err on the side of caution, i.e., on the side of avoiding mass death from a systemic failure of the health care system?
5. Most of the effects of the job losses in the developed world could have been largely mitigated (and were, in the first round) by helicopter payments to the unemployed. The fact that DC is currently unable to agree on a second round, and will do so inadequately if ever, is the usual travesty. Just pay inemployed people so they can buy food and pay rent and utilities, and most of the hardships go away…
6. While some climate opiners do want less (useless, wasteful) economic activity overall, they have no power. Even the still marginalized AOCistas want a “Green New Deal”, envisioning LOTS of GROWTH and JOBS to fuel CONSUMPTION–business as usual, just a different kind of (less carbonic) business (like car-makers were a different kind of business back in the day, instead of horse-shoers and stablers and buggy-makers.) Let alone the mainstream Dem’s, who barely acknowledge the urgency climate change–most don’t even support a simple, refundable carbon tax– and let really alone the Republicans, who want to burn every last bit of carbon in the earth, then hope for an early ice age to bring down the temps…
1. “But you admit that even 223K US deaths will make covid “much worse than the Asian flu” per capita Yet a few sentences later, you still say the “COVID-19 pandemic will likely be in the same mortality ball park as the 1957 flu. “Much worse” isn’t “in the same ballpark”, as I understand those phrases. 400K annually will be…much worse than much worse!””
Sorry, I should have made this point clearer. When US deaths hit 223k the COVID-19 outbreak will be exactly as “bad” as the high-end estimate of the 1957-1958 Asian Flu, and no worse. At 223,001 it will be “worse” but only trivially so. It will have to get “significantly” worse than 223,001 for it to be “much worse” than 1957-8 in my book. You can decide what figure counts as “much worse” in your book. I think your guesstimate of 400,000 is high, but for me, 223,000 to 400,000 could still be “the same ballpark” as 1957-8 since that phrase denotes a rough subjective comparability rather than precise equality. Note that a routine flu season is anywhere from 30,000 to 60,000 deaths per year, so a two-fold difference doesn’t necessarily constitute a different ballpark for flu.
That may sound squishy, but the question of subjective comparability, and proportionality, is at the heart of the COVID controversy.
Since we did virtually nothing in 1957 for a death toll of 674 dpm, what is the right proportionate response now to your prospective toll of 1223 dpm (400k)? Does it seem right to our sense of proportionality to leap from doing nothing at 674 dpm to locking down for 9 months or longer for 1223 dpm? Does that feel like the same ballpark? How about when we reckon the countervailing mortality and poverty, and the simple loss of liberty, that results from a lockdown?
Is it comparable and proportionate to our non-response to other health risks besides the flu? Cigarettes kill more Americans every year than COVID will, but we don’t ban them. We don’t spend $5 trillion per year, or even 10 percent of that, to end global contagions like malaria (400,000 deaths per year), AIDS (690,000 deaths) or infant diarrhea (480,000 kids killed per year) or tuberculosis (1.5 million deaths, including 200,000 children).
Any way you slice it the COVID upheaval is wildly disproportionate to how we deal with other comparable health risks.
“The annual global dpm rate, if counted/estimated correctly, will likely be triple or more the current nominal value by April 1, 2021.”
Could happen—let’s hope the vaccines kick in before then!—but that would bring the death toll up to 351 dpm, still a bit below the 379 dpm in mid-range estimates of the global toll in the 1957 pandemic.
Do you think we should keep everything locked down until next April?
“You don’t want to ‘obey’ the academics. But what about those countries that have achieved tiny dpm rates compared to the US? New Zealand, Australia, South Korea, Vietam, Japan, China, etc. How did they achieve those? It seems to me they “obeyed their academics”–how else did they know what to do? Did they consult shoe salespeople and cab drivers about the best policies to (successfully, in their cases) crush the virus?… perhaps you have in the back of your mind the countries where lockdowns DID work so very well)”
Which academics do we obey? Many eminent academics advise against lockdowns. In the end, the professors can’t lift from us poor shoe salesmen and cab drivers the burden of making our own decisions.
In the Asian countries you cite the academics did not recommend lockdowns. COVID restrictions there were laxer than in Scandinavia. They relied on quarantining travelers from abroad along with lavish testing and tracing to suppress their outbreaks, not draconian social distancing.
We can get a quantitative sense of this from IHME’s data on social distancing and testing, particularly on estimated peak days of infection.
The peak infection day is also the day that the outbreak turns the corner and starts to subside, with fewer infections on every subsequent day. If social distancing is responsible for the turnaround, we should see lots of social distancing on PID; if testing is the main factor, we should see lots of testing. And the data from these Asian countries is pretty clear: on peak infection days testing is huge while social distancing is modest. (As always, IHME measures increases in social distancing as declines in cell-phone mobility.)
Japan, for example, reached a maximum cell-phone mobility decline of 50 percent on March 3, but then sharply rebounded. On its peak infection day of April 12 cell mobility was down only 34 percent, which is Swedish territory. Its testing ratio, though, was adequate: 7,228 tests compared to 3,069 infections. South Korea shows the same pattern more clearly. On PID its cell mobility was down just 27 percent, but it conducted 10,464 tests against only 542 new infections.
In Australia there have been two waves, in March and July. The PID on March 23 saw cell mobility down only 22 percent but the country conducted 8,016 tests against 241 new infections, a 33-fold ratio of tests to infections. On July 27’s PID cell mobility was again down just 22 percent, but there were 1, 354 new infections against 63,923 tests.
New Zealand’s stats are consistent with lockdown snuffing out an outbreak. On its March 31 PID cell mobility was down a whopping 80 percent—a skyhigh level of social distancing. However, its testing ratio was also massive that day, with 2,447 tests performed compared to 138 new infections. So it’s plausible that testing, not lockdown, snuffed the virus.
I couldn’t find data for Vietnam, but Taiwan makes for an especially striking comparison. Taiwan was very successful in suppressing the virus, but its cell mobility has never dropped below 14 percent—and on peak infection day, March 12, it was down all of 4 percent. Fortunately, its test ratio was high: 507 tests to 68 infections.
Several of these countries had very high masking rates throughout—but not Australia, where masking rates stayed well below 10 percent, or NZ, where they peaked at 14 percent.
So the pattern is clear. Except for China, Asian countries succeeded by smothering small outbreaks with early travel restrictions, quarantine, and massive testing and tracing. Lockdowns played little to no role and masking also probably played little role.
(For people rightly incensed by my half-assed treatment of testing data, yes I should be comparing new infections with tests several days later to account for incubation periods, etc etc, but I’ll leave that to real epidemiologists. I stand by testing/infection ratios on PID as a reasonable though very approximate indicator of the general sufficiency or insufficiency of testing.)
>Which academics do we obey? Many eminent academics advise against lockdowns. In the end, the professors can’t lift from us poor shoe salesmen and cab drivers the burden of making our own decisions.
In the Asian countries you cite the academics did not recommend lockdowns.>
Right–so again, those Asian countries DID obey their academics. You’re not against obeying academics, just against obeying (some of) them when you personally disagree with them. How does that constitute a systemic problem with academics–had the US not locked down it would have been “obeying” those academics who didn’t want the lockdown.
“4. What does explain why Sweden was so much worse than its fellow Scandianvian countries?”
Swedes didn’t get out ahead of the outbreak when it was small with testing and tracing, as neighboring countries did. They also by their own admission did a bad job protecting nursing homes. They talk about having a substantial immigrant population in multigenerational households, a big risk factor. There’s no reason to believe lockdowns would have changed things, just as they didn’t in Belgium, New York, Britain or Michigan.
“Belgium is not a peer of Sweden.”
Hard to say.
Malmo to Helsinki: 539 miles.
Malmo to Brussels: 487 miles.
“5. Most of the effects of the job losses in the developed world could have been largely mitigated (and were, in the first round) by helicopter payments to the unemployed. The fact that DC is currently unable to agree on a second round, and will do so inadequately if ever, is the usual travesty. Just pay inemployed people so they can buy food and pay rent and utilities, and most of the hardships go away…”
Overdose deaths, mental health problems, heart-attack deaths, missed cancer appointments were all rising sharply early in the lockdown before the Federal unemployment benefits ran out. A lot of businesses have gone bankrupt permanently because they have no customers since the lockdown, can’t service debt, pay mortgages, etc, those jobs won’t be there for workers to come back to.
There’s real hardship out there.
“3. And how should we decide which vaccine(s) to use, and when they are ready to use, and safe–should we follow consensus academic advice, or take a poll of shoe salespeople and cabdrivers on that one too?”
That’s actually a complicated question, but the crux of the COVID issue isn’t scientific, it’s moral and political.
The relevant scientific facts were known very early in the pandemic, and they are pretty simple: old people face a substantial risk, but most of them can avoid infection on their own through voluntary self-isolation. The vast majority of people, children and adults, face no more than flu-level risk.
Given those facts, the question is: what policy should the government follow? Should it let the vast majority of low-risk people go about their lives and focus on helping old people to isolate? Should it lock down the economy? What’s the right balance to strike between the risks to old people and the serious and sometimes fatal hardships befalling younger people when their lives are derailed by COVID restrictions?
Scientists have no special insight into those questions. Shoe salesmen and cab drivers get a say too. #democracy #freedom #equality.
“You ignore one of the main fears at the time–that hospitals would be overwhelmed without mitigation of the skyrocketing case rate. When a course of action has a lot of “mays and might” in it (and you still have them after the fact–it was far more uncertain then, before the fact), doesn’t it make sense to err on the side of caution, i.e., on the side of avoiding mass death from a systemic failure of the health care system?”
The anxiety about ICUs and ventilators being overwhelmed by COVID patients was pretty much all caused by the spectacle of Italy. There was no shortage of capacity anywhere else in the developed world. Not in the US, not even in NYC.
This is one prediction that I actually got right back in March, because I just looked at the stats on ICU and critical-care beds: over twice as many per capita in the US as In Italy. One virtue of America’s super-expensive health care system is that it’s really loaded up with high-tech hospital beds and staff, just what you need in a pandemic.
The other factor in the ICU doomsday scenario was, naturally, Neil Ferguson’s Imperial College study, which harped on that possibility and made “flattening the curve” and “saving the NHS” the rationale for temporary lockdowns. But when no ICU crunch materialized and the curve duly flattened, lockdowns kept going…
It didn’t have to be this way. Lots of people, like the Swedes, correctly predicted that hospitals would be able to ride out the curve without lockdowns.
Please think harder about accepting “the precautionary principle” as an unquestionable guide to action. It just means that any activist with a scare story about “mass deaths” gets to dictate emergency mobilizations to the rest of us, while every skeptic is tarred as a callous lunatic who wants to see the world end.
It’s exactly the logic that Dick Cheney used to railroad us into the Iraq War: if there’s even a 1 percent chance that Saddam has WMDs, we have to invade and overthrow him to preserve our safety. We need to take a hard look at that kind of safety absolutism, whether it’s used to justify a war or a lockdown.
In several instances (Chicago was one of them) we came very close to having no unoccupied icu beds. They were so afraid of this they built a huge “hospital wing” in McCormick Center to take “less serious” cases out of hospitals.
Yes, we barely avoided that limit in the US after all–but that was because the lockdown DID drastically reduce the case (and hence icu bed use) growth rate. Had the lockdown not occurred, there is no reason to believe that the case growth rate wouldn’t have continued its exponential growth far past the icu bed limits.
1. “In several instances (Chicago was one of them) we came very close to having no unoccupied icu beds. They were so afraid of this they built a huge “hospital wing” in McCormick Center to take “less serious” cases out of hospitals.”
The McCormick Center emergency hospital took very few cases. It mostly sat empty. Chicago hospitals never came close to being overwhelmed because there was large reserve capacity in the unused McCormick Center hospital and elsewhere.
The same was true in NYC—the Javitz Convention Center field hospital, the Navy hospital ship and other temporary hospitals all went mainly unused. NYC always had ample reserve capacity of hundreds of empty ICU beds in the temp hospitals. The same was true in London and everywhere in the West with the exception of Italy. Unfortunately, the Italian outlier set the template for panicky forecasts of overwhelmed ICU units.
2. “Yes, we barely avoided that limit in the US after all–but that was because the lockdown DID drastically reduce the case (and hence icu bed use) growth rate. Had the lockdown not occurred, there is no reason to believe that the case growth rate wouldn’t have continued its exponential growth far past the icu bed limits.”
As I argued in the OP, there’s no good evidence that lockdowns tame large outbreaks or save the hospitals. NYC, for example had one of the harshest lockdowns in the world, and just about the highest mortality rate as well. (The outbreak likely subsided because of spreading immunity. Stockholm’s outbreak subsided at less than half NYC’s dpm without any lockdown, thanks to immunity and voluntary social distancing by the vulnerable.)
Even so, NYC didn’t run out of ICU capacity or ventilators. In literally the world’s worst COVID outbreak, ICU capacity held up and didn’t even need the substantial emergency capacity that was held in reserve.
The narrative that we needed lockdowns to save the hospitals is clearly wrong, time to drop it.
The epidemic isn’t over yet.