13 ms·

What makes you think we ever had the option to? Singapore's response was certainly better than the USA's, and the American equivalent of that would near-certain

What makes you think we ever had the option to? Singapore's response was certainly better than the USA's, and the American equivalent of that would near-certainly have resulted in fewer deaths; but why do you think that explains most of the difference between the two countries' death rates? In particular, how do you explain Japan? They barely locked down, and they're missing most of their cases so the contact tracing is at best reducing Reff by ~20% (per below). I personally suspect that Japan has benefited from some combination of masks, a culture of hygiene and distance, and the weather; but I'm far from confident, and disappointed to see others behaving with such apparent confidence in the face of all we don't know.

matthewdgreen 6y ago
I don't know what makes this virus spread or not spread. All I know is that as long as another Wuhan/Lombardy/NYC is still possible, we should be doing every damned thing we can do to control this epidemic as though it's deadly everywhere. Hopefully scientists will figure out that chrysanthemum pollen or TB vaccinations reduce the severity, and then we can deploy that tool here. Until that happens: we have to act like this disease is going to explode. That isn't confidence, it's just common sense.
- tripletao 6y ago
  That doesn't seem like a useful attitude to me. Even if we neglect the economy except to the extent it keeps sick people alive, the USA spends about 20% of GDP on health care, and considers treatments cost-effective around $100k/QALY (quality-adjusted life year). Assuming that percentage stays constant, a 10% drop in GDP is about $2T, of which about $400B would have gone to health care. That's 4M QALY, or the equivalent of 300k dead 75-year-olds (assuming perfect quality, using SSI tables for life expectancy, male and female average). So if whatever you do causes a 10% drop in GDP and saves fewer QALY than that, then in a meaningful statistical sense, you've killed people. The cost of the coronavirus in mortality is massive, but the cost of the reaction is too, even just in lives as above. Some measures seem clearly cost-effective to me (masks, not standing too close, keeping kids in stable groups, etc.), but others (closing schools completely) do not. It's not hard for me at all to imagine a response that causes more societal harm than the virus itself.
  - matthewdgreen 6y ago
    You're assuming that you can let the virus burn out of control without it having any negative effects on the economy. I'm going to be polite, so I'll just say that assumption is unrealistic. Imagine that the virus did what it did in NYC or Lombardy, but did it in every city in the US. Given our understanding of the virus, this is very possible. Now forget the statistics: just think viscerally about what that would mean for schools, office jobs, retail businesses, hospitals. You'd get all those deaths plus the economic damage of a lockdown. This isn't an either/or. Basically: if we're not going to control this thoughtfully, we'd better pray that some as-yet-unknown effect stops the spread most places, or that people naturally socially-distance enough to stop it. I hope one of those happens, maybe it will happen, but I have zero reason to believe it will right now.
    - tripletao 6y ago
      I'm not sure what makes you think I'm advocating "letting the virus burn out of control"? I specifically listed control measures that I advocated (masks, distance), and those alone seem to be mostly working for Japan without further restrictions--though I fully agree yet-unknown factors may mean those alone won't work in some other places. And I certainly agree the virus alone has economic impact, even if the government (recklessly) took no steps to control it. So do the math with the incremental cost in GDP for whatever intervention you favor, but remember that every extra percent of lost GDP is ~30k dead 75-year-olds in lost health care spending under the model above, even before considering any other economic impact. There is no safe path here, just different and uncertain tradeoffs.

matthewdgreen 6y ago

I don't know what makes this virus spread or not spread. All I know is that as long as another Wuhan/Lombardy/NYC is still possible, we should be doing every damned thing we can do to control this epidemic as though it's deadly everywhere. Hopefully scientists will figure out that chrysanthemum pollen or TB vaccinations reduce the severity, and then we can deploy that tool here. Until that happens: we have to act like this disease is going to explode. That isn't confidence, it's just common sense.

tripletao 6y ago
That doesn't seem like a useful attitude to me. Even if we neglect the economy except to the extent it keeps sick people alive, the USA spends about 20% of GDP on health care, and considers treatments cost-effective around $100k/QALY (quality-adjusted life year). Assuming that percentage stays constant, a 10% drop in GDP is about $2T, of which about $400B would have gone to health care. That's 4M QALY, or the equivalent of 300k dead 75-year-olds (assuming perfect quality, using SSI tables for life expectancy, male and female average). So if whatever you do causes a 10% drop in GDP and saves fewer QALY than that, then in a meaningful statistical sense, you've killed people. The cost of the coronavirus in mortality is massive, but the cost of the reaction is too, even just in lives as above. Some measures seem clearly cost-effective to me (masks, not standing too close, keeping kids in stable groups, etc.), but others (closing schools completely) do not. It's not hard for me at all to imagine a response that causes more societal harm than the virus itself.
- matthewdgreen 6y ago
  You're assuming that you can let the virus burn out of control without it having any negative effects on the economy. I'm going to be polite, so I'll just say that assumption is unrealistic. Imagine that the virus did what it did in NYC or Lombardy, but did it in every city in the US. Given our understanding of the virus, this is very possible. Now forget the statistics: just think viscerally about what that would mean for schools, office jobs, retail businesses, hospitals. You'd get all those deaths plus the economic damage of a lockdown. This isn't an either/or. Basically: if we're not going to control this thoughtfully, we'd better pray that some as-yet-unknown effect stops the spread most places, or that people naturally socially-distance enough to stop it. I hope one of those happens, maybe it will happen, but I have zero reason to believe it will right now.
  - tripletao 6y ago
    I'm not sure what makes you think I'm advocating "letting the virus burn out of control"? I specifically listed control measures that I advocated (masks, distance), and those alone seem to be mostly working for Japan without further restrictions--though I fully agree yet-unknown factors may mean those alone won't work in some other places. And I certainly agree the virus alone has economic impact, even if the government (recklessly) took no steps to control it. So do the math with the incremental cost in GDP for whatever intervention you favor, but remember that every extra percent of lost GDP is ~30k dead 75-year-olds in lost health care spending under the model above, even before considering any other economic impact. There is no safe path here, just different and uncertain tradeoffs.