Let's back up a bit to talk about the two strategies.
(1) Containment lets you indefinitely avoid COVID-19-induced mortality in the short-medium term, at the expense of ongoing, mounting costs to wellbeing and the economy. These costs are certainly non-linear, for example businesses can generally only survive a given number of days/weeks based off their capital expenditure and thus it's not quite as simple as a linear relation. But for our purposes, it's easiest to think of the wellbeing and economic cost as being in direct proportion to how long we spend in containment.
The postponement of mortality only becomes the true avoidance of mortality when we get a "game-changer": a vaccine or a highly effective treatment that seriously improves outcomes.
Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment.
(2) My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. These groups are encouraged to shelter at home and are supported in doing so.
Bans on freedom of movement, transaction, etc are lifted. Non-at-risk individuals are encouraged to return to work. Given that we inflicted psychological harm on millions of individuals, we also would probably want a policy where someone is allowed to not work, but they must formally quit their job in order to be allowed to collect unemployment for up to a year (we likely also need to adjust unemployment because it's just way too high relative to wage earners right now). What we need to avoid is a case where someone "chooses" (in scare quotes because we have done true psychological damage to people) not to work for a year but their company can't let them go, since otherwise the company cannot replace them with a working employee.
So in short, we let people do what they want, we strongly encourage the at-risk to shelter at home and put out appropriate public health messaging in proportion to the real risk (which means overall WAY less fearmongering since we're so out of whack currently).
The uncertainty benefit is something we should implicitly factor in as well. The ultimate end state of my proposal is much more "known" than with containment (because we have no bound on containment worst-case scenario but we can use Ferguson to get a decent bound for mitigation). We're not sure how much mortality we will see, but with a 0.9% IFR and 82% of the population being infected we get about 2.2 million deaths per Ferguson (https://www.imperial.ac.uk/media/imperial-college/medicine/s...). I think that's a great upper bound to use.
BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO.
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The last thing I want to say is that I actually think in terms of wellbeing-years or quality-adjusted-life-years, and not just "lives". My belief is that the life of a healthy 12 year old is several times more valuable than the life of an 80 year old with heart disease, to use an example.
So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.
>that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.
Absolutely wrong. And you are missing:
- lockdown reduction in suffering, due both to the acute phase of the disease and after effects
- No-lockdown-externalities, including damage to the economy if the disease is allowed to spread through the entire population
And perhaps most importantly:
- the risk that a huge reservoir of infected people will lead to repeat waves caused by mutations, and even worse that cross-species infection occurs (we already know cats and dogs can be infected - pigs and poultry could be next); then we risk flu-like antigenic shifts.
Put all this into the equation and I think the only thing we should be contemplating is how to eradicate the virus as soon as possible.
> the only thing we should be contemplating is how to eradicate the virus as soon as possible.
Do you think that eradication is actually a possibility? Or are you using it as a metaphor for "contain it super well"?
There are a number of reasons why eradication is completely infeasible. In short, COVID-19 is a highly infectious respiratory disease and it came from a zoonotic origin. We know there are animal reservoirs at this moment.
Therefore eradication is impossible. We've only ever eradicated two diseases in all of human history.
> So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.
This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd.
> BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO.
Are you accounting for the other side effects of Covid? Life long lung capacity loss due to pneumonia side effects, weird not well understood side effects like strokes in young people etc? Most of the people I see minimizing the risk and saying we should reopen seem to entirely ignore those dangers.
> Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment.
This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years).
> My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society.
You realize that this is what's being done now, essentially, its just that tests are so severely limited that that isn't useful. We can't, for example, consistently test employees at nursing homes to make sure that they aren't infectious. Until we can do that, returning to normal is asking nursing home employees to shelter even more tightly than individuals are now, or it's sacrificing lives.
It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought.
> This seems like a very strange take. This is a utilitarian perspective, but with a floor of 20 million years of utility before we take any action. Why shouldn't we take action if the mortality reduction years > lockdown externalities? You're essentially saying "we should take no action to prevent a disease from costing us 20 million wellbeing-years", which seems odd.
You're right, that was my mistake. I got a rough 20 million life-years by taking Ferguson's worst-case scenario and then applying the "COVID-19 takes average 10 years of lives" claim (which is a false claim). Thus arriving at the implied scenario that lockdown proponents say could happen but that I think is an impossible to reach number.
(For context I use Ferguson's 2.2 million as an upper bound, but that 2.2 million scenario involves an overwhelming portion of the deaths being people who were already at death's door. Thus I think 2.2 million is possible but highly unlikely due to the other factors I mentioned, whereas the 20 million life-years figure I view as basically impossible to hit because it implies that same worst-case scenario but with the wrong distribution of age)
At that point I thought to myself "wait, I forgot to account for the negative externalities". But as you indicated, that logic was wrong.
So, allow me to retroactively change my answer to just 20 million life-years period.
Thanks for pointing that out.
> It feels like you haven't looked deeply into the criteria that many metro areas (NYC, WA, and the Bay to name a few) have to reopen. They're specific and clear, and backed by reasonable thought.
No, I understand their criteria but fundamentally disagree with the entire approach of containment, as I explained in the GP comment you replied to.
> This isn't at all true. Look at China, Taiwan, and South Korea, which have all begun reopening, but with infrastructure in place to track and keep outbreaks contained even as they reopen. Some parts of the US are on track to do the same relatively soon (weeks, not months or years).
I don't believe that the US can use the same strategy that China, South Korea, or Taiwan has been using. They have much better control of their borders and are a much more homogenous and compliant population.
> The postponement of mortality only becomes the true avoidance of mortality when we get a "game-changer": a vaccine or a highly effective treatment that seriously improves outcomes.
I don't think this is correct. Every day that passes by, we learn a little bit more about this virus and get a little better at treating it. For example, in the past few weeks doctors have discovered better ventilator protocols [1] and potential benefits of anticoagulants [2] in treating Covid-19 patients.
None of these are "game-changers" but they incrementally improve patient outcomes and that's a good thing. The more time we buy to make discoveries like these, the better off we will be.
Put another way: would you rather have been of the first few patients in Wuhan when doctors had no idea what this virus was or how to treat it, or would you rather have it now? What about a few months from now?
So I totally agree that we over time will get slightly better treatment outcomes. But I think the negative effects of containment far exceed those marginally improved outcomes, therefore we still need the "game-changer" that I've been referencing in order for containment to have been worth it.
(1) Containment lets you indefinitely avoid COVID-19-induced mortality in the short-medium term, at the expense of ongoing, mounting costs to wellbeing and the economy. These costs are certainly non-linear, for example businesses can generally only survive a given number of days/weeks based off their capital expenditure and thus it's not quite as simple as a linear relation. But for our purposes, it's easiest to think of the wellbeing and economic cost as being in direct proportion to how long we spend in containment.
The postponement of mortality only becomes the true avoidance of mortality when we get a "game-changer": a vaccine or a highly effective treatment that seriously improves outcomes.
Given that we must practice indefinite containment until we develop the "game-changer", we are executing a strategy which is based off a temporally unbounded future event. Therefore the potential drawbacks are unbounded given that the strategy involves waiting for a miraculous leap forward in COVID-19 vaccination or treatment.
(2) My proposal is an approach where we try to direct testing resources and governmental assistance to protecting the most at-risk members of society. These groups are encouraged to shelter at home and are supported in doing so.
Bans on freedom of movement, transaction, etc are lifted. Non-at-risk individuals are encouraged to return to work. Given that we inflicted psychological harm on millions of individuals, we also would probably want a policy where someone is allowed to not work, but they must formally quit their job in order to be allowed to collect unemployment for up to a year (we likely also need to adjust unemployment because it's just way too high relative to wage earners right now). What we need to avoid is a case where someone "chooses" (in scare quotes because we have done true psychological damage to people) not to work for a year but their company can't let them go, since otherwise the company cannot replace them with a working employee.
So in short, we let people do what they want, we strongly encourage the at-risk to shelter at home and put out appropriate public health messaging in proportion to the real risk (which means overall WAY less fearmongering since we're so out of whack currently).
The uncertainty benefit is something we should implicitly factor in as well. The ultimate end state of my proposal is much more "known" than with containment (because we have no bound on containment worst-case scenario but we can use Ferguson to get a decent bound for mitigation). We're not sure how much mortality we will see, but with a 0.9% IFR and 82% of the population being infected we get about 2.2 million deaths per Ferguson (https://www.imperial.ac.uk/media/imperial-college/medicine/s...). I think that's a great upper bound to use.
BTW I think once accounting for vector exhaustion (not everyone has the same risk of infection) and what I feel is a more realistic IFR, we'd be closer to 600,000 deaths in the "realistic" scenario IMO.
---
The last thing I want to say is that I actually think in terms of wellbeing-years or quality-adjusted-life-years, and not just "lives". My belief is that the life of a healthy 12 year old is several times more valuable than the life of an 80 year old with heart disease, to use an example.
So, while it's hard for me to give you a "real" number, I'd say if we could save 20 million wellbeing-years, then lockdown was probably worth it. But keep in mind that means that LOCKDOWN_COVID19_MORTALITY_REDUCTION - LOCKDOWN_EXTERNALITIES >= 20 million wellbeing-years.