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Deconfinement: The Price of Human Life
- Lazare 6y agoSome good points, although I'd toss another thought into the mix. The confinements and shutdowns and shelter in place orders also cost lives. We know that recessions cost lives. One study (published in The Lancet, so worth taking a second look at) suggested 500k excess cancer deaths from the global financial crisis[1], and another study (published in the BMJ) suggested that excess suicides in 2009 alone across the US and 53 other countries totalled some 5k[2]. I don't know of a single comprehensive effort, but we know recessions reduce the resources available at the margins for food, medicine and shelter, and increase the suicide rate. The net effect for something like the GFC seems likely to be on the order of tens of thousands of deaths (and perhaps significantly higher), and the recession caused in part by Covid-19 and in part by our reaction to Covid-19 seems to be within an order of magnitude of the GFC. Thus, it seems fairly obvious that at least some responses to Covid-19 would cost more lives than they saved. If you're evaluating a measure that, let's say, would save X lives from Covid-19, but would cause the resulting recession to go from, Y% as bad as the GFC to Z% as bad as the GFC, there are absolutely values for X, Y and Z which would make the measure net negative on lives. I'd be happier if that tradeoff got acknowledged a bit more often, even in a perfunctory "well, we're clearly MILES away from the break even point, so let's ignore it" sort of way. If you pretend that tradeoffs don't exist, you're unlikely to reach an optimal decision. [1]: https://www.telegraph.co.uk/news/2016/05/25/financial-crisis-caused-500000-extra-cancer-death-according-to-l/ https://www.telegraph.co.uk/news/2016/05/25/financial-crisis... [2]: https://www.bmj.com/content/347/bmj.f5239 https://www.bmj.com/content/347/bmj.f5239
- drapred7 6y agoIf the movement restrictions cost lives, why are total fatalities down? (even including SARS deaths)
- rhn_mk1 6y agoBecause total = increase - decrease. If the decrease is bigger than the increase, you will see the total drop.
- elcomet 6y agoAlso, movement restrictions cause deaths in longer terms than the virus.
- manigandham 6y agoThese deaths aren't as acute. Deaths from economic depression will take longer to manifest than a sudden illness.
- Gibbon1 6y agoThat sounds like a call for a coherent policy rather than the do nothing that's being proposed here.
- TJSomething 6y agoThe primary risk factors of economic recessions take years. Most cancers take years to kill people. The effect of unemployment on suicide peaks at around 2.5 years of unemployment [0]. I think that we're going to have an economic downturn with repercussions that will last long after a SARS-CoV-2 vaccine exists. I also think the ends currently justify the means, but that's just a gut feeling I've got. [0] Milner, Allison et al. “Long-term unemployment and suicide: a systematic review and meta-analysis.” PloS one vol. 8,1 (2013): e51333. doi:10.1371/journal.pone.0051333
- throwaway_pdp09 6y ago> but we know recessions reduce the resources available at the margins for food, medicine and shelter, and increase the suicide rate OK, agreed, because of hardship. But a lot of that hardship is due to enormous wealth inequality (I'm assuming you're a US person). How about you don't have titanic inequalities instead? Would that work?
- pmiller2 6y agoIt would. The fact that a science-based public health response to a public health crisis is causing extreme economic hardship for so many people right now indicates that our economic system is broken. The science behind reducing transmission of the virus is sound. What's going to get people killed in the near term is twofold: people undermining or protesting the quarantine orders; and people who need to go to work in order to support their families and not get evicted, who end up contracting the virus and either dying or spreading it to others. The former is either due to some kind of fucked up value system that interprets a temporary public health quarantine as some kind of intolerable infringement of rights. The latter is because the American form of capitalism leaves so many people so far behind that they can never get ahead.
- tonyedgecombe 6y agoThe confinements and shutdowns and shelter in place orders also cost lives. You have to remember the economic slowdowns started before the lockdowns were in place. Even without lockdown we were in for a lot of economic pain.
- js8 6y ago> We know that recessions cost lives. Interesting, I read a different view: https://www.theguardian.com/commentisfree/2020/apr/28/a-recession-devastates-peoples-lives-but-there-are-surprising-health-benefits-when-capitalism-stops-working https://www.theguardian.com/commentisfree/2020/apr/28/a-rece... I am not sure how to reconcile this.
- mirimir 6y agoHaven't they also cost lives from hindered access to medical care for stuff unrelated to Covid-19?
- Normal_gaussian 6y agoSomething that seems not to be considered by many observers is that if a disease is not eliminated, it will continuously either claim lives or reduce efficiency (which claims lives).
- luckylion 6y agoIs there reasonable hope for a virus like this to be completely eliminated? I figure if it's in that sweet spot of contagiousness, incubation time and mortality, it's hard to eradicate completely. And unless it's eradicated completely, we'll absolutely have to live with reduced efficiency in hyper-alert testing of anyone with symptoms, unless we find that it ceases to be a serious problem once humans have had contact with it.
- leereeves 6y agoIt probably depends on how long acquired immunity lasts, which we don't know yet. People remain immune to some diseases, like measles, for a lifetime after surviving the disease or being vaccinated. Immunity to other diseases, like influenza, disappears quickly (even immunity to the same strain lasts less than a year).[1] If COVID-19 is in the latter category, it will be difficult to control and we'll probably have to learn to live with it, as we have learned to live with the flu causing hundreds of thousands of deaths each year worldwide. 1: https://www.sciencemag.org/news/2019/04/how-long-do-vaccines-last-surprising-answers-may-help-protect-people-longer# https://www.sciencemag.org/news/2019/04/how-long-do-vaccines...
- drapred7 6y agoThat likely depends on how effective we are at eliminating it in the coming months. I doubt it will become endemic in Korea or Singapore. I wonder if even influenza could be erraticated in the coming years with mass testing and contact tracing. The lockdowns ended flu season early this year.
- leereeves 6y ago
- wrnr 6y agoC2 are really fun to drive if you are at the wheel, but the back seat is like a big beach chair. The ones with a piece of cloth suspended on a frame. Do you think in a world of autonomous driving cars, we can make the cars lighter again? I suspect that in the future, around 2100, there will probably be a lucrative industry around turning old-timers into self driving vehicle. Once a technology is commoditised it needs to be commercialised in another way. Maybe then driving will be fun again, like a big theme park.
- tonyedgecombe 6y agoA friend of mine had one which went up in flames. There was a lot of paper ducting around the engine that eventually got soaked in oil with inevitable results. It was interesting to drive, mostly I remember it would lean a long way over going round bends.
- ekianjo 6y ago> In the end, these determinations all place an unspoken price on human life We are already doing this by letting people drive with personal vehicles every year even they cost dozens of thousands of lives. There is no zero risk, but we decide (we, as in, the society at large, not individuals) what level of harm is "acceptable".
- MauranKilom 6y agoBut here the decision making is localized to individuals, and their decisions can formally be translated into pricing human life. I'd hate to be the one having to make these calls. I mean, various insurances price human lives already, so it's not exactly novel, but here the decisions directly cause these tradeoffs to play out (whereas e.g. a life insurance does not cause a death for monetary gain).
- thescriptkiddie 6y agoThe line between deciding that a particular level of harm is acceptable, and accepting it by default, is blurry. And yet allowing, through inaction, a human being to come to harm is not functionally or morally different than deliberately harming them. And so we wash our hands of responsibility by telling ourselves we didn't do anything. But who are we fooling?
- drapred7 6y agoIf that definition were taken, and people were moral, you could infinitely blackmail moral people by threatening harm.
- watwut 6y agoWe have incredible amount of regulations on what personal vehicles can do and how they can be made. We did not just accepted deaths from automobiles, we wrote driving rules, mandate seat bells, automobile makers have to prove their cars pass safety tests.
- ekianjo 6y ago
- Animats 6y agoThe "Get and keep America open" plan is really a "keep dying" plan, but this is something few want to admit. Someone else pointed out how deceptive the "flattening the curve" charts were. Most showed a symmetrical rise and fall. In reality, that plan just keeps the hospitalization rate and death rate down to what the medical system can handle. Both stay high for many months until either saturation ("herd immunity") is approached, or there's a vaccine. The "flat" part is probably a year long, somewhere around the current death rate, which is in the 1000-2000 deaths per day range. (That may be underestimated. See this Financial Times article, which is looking at "excess mortality", or the change in deaths from all causes.)[1] "Herd immunity" is a long way off.[2] That only happens when 70% or so of the population has had this virus. While there's not much data yet about how many people have cleared the virus and acquired antibodies, most figures are around 5% of the population, except a few cities, primarily New York, where it may be somewhere above 20%. So the dying is maybe 6-10% done, nationally. The CDC is now avoiding death forecasts beyond mid-June.[3] Previous longer-term projections have been so far off as to be useless.[4] Don't bunch up, and wear a real mask that protects you, not others. [1] https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac846c https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac8... [2] https://www.msn.com/en-us/health/medical/no-place-on-earth-is-anywhere-close-to-herd-immunity-for-the-coronavirus/ar-BB1466DN https://www.msn.com/en-us/health/medical/no-place-on-earth-i... [3] https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecas... [4] https://www.foxnews.com/politics/coronavirus-model-estimates-us-deaths-down https://www.foxnews.com/politics/coronavirus-model-estimates...
- boomboomsubban 6y ago>The Hong Kong Flu caused more deaths than are projected for this current pandemic and yet, at the time, no one thought of bringing entire economies to a halt. The other way to look at it, even with the quarentine this pandemic will kill a similar number of people. If the reports were true that "half the workers were in bed," that would mean there were millions of cases, yet only ~50k deaths. Compare that to the current pandemic, where France has 25k deaths in ~150k cases.
- sigotirandolas 6y agoThere have been many, many more cases than the official confirmed (=medically tested/diagnosed positive) cases. For example data in Spain points to 5% prevalence (~2M infected) with ~25k deaths (official number, may be higher due to unverified and side cases).
- lbeltrame 6y agoDo you know if the serological data in Spain has also per-city estimates? I doubt the 5% is evenly distributed across the population, I'm expecting higher percentages in Madrid, for example.
- sigotirandolas 6y agoIf I remember correctly the data from Spain is also available itemized by region (autonomous community), and indeed the most population-dense regions have a higher prevalence. I believe the data isn't broken down by city, but it should be obvious that they're going to have a higher prevalence as well.
- thepete2 6y agoI can't follow the argument. The Hong Kong Flu caused more deaths without the economy shutting down than this epidemic with the economy shutting down, therefore what?
- boomboomsubban 6y ago
- pmiller2 6y agoRegarding sending people to the moon, I don't believe we've changed how we calculate the value of human life in this scenario at all. Remember, astronauts volunteer to strap themselves to gigantic tanks of explosives, all for the chance to experience the universe personally in a way very few humans ever have. Rather, I think the issues here are: * America literally watched 14 people die on national TV. * At the time of the Columbia disaster in 2003, the Space Shuttle was already a 30 year old vehicle (Columbia itself was 22 years old when it was lost), based on 40 year old designs. * We realized we just don't need humans on the moon. Compared with robots, we're terribly fragile, inefficient, and largely superfluous on the surface of the Moon in a lunar exploration mission.
- WalterBright 6y ago> We realized we just don't need humans on the moon. Compared with robots, we're terribly fragile, inefficient, and largely superfluous on the surface of the Moon in a lunar exploration mission. Robots are inflexible. There's nothing like human eyes and hands.
- pmiller2 6y agoEven if I agreed with you in this context (I don't -- hands inside space suits are clumsy, and eyes limited in what they can perceive compared to instruments), we can keep the people here on Earth operating the robots with ~1 second latency, and it will be fine. We even operate rovers on Mars with ~20 minute latency, and they've worked out well.
- WalterBright 6y agoThey've worked out well considering the extremely limited scope of what they can do. They can't, for example, brush the dust off their solar panels. Or even the simplest repair. Or dig a hole with a pickaxe.
- js8 6y agoI find the complaint that it is harder to do something today, for safety reasons, a bit odd. Isn't the attempt to eliminate more and more human suffering a sign of moral progress? It seems to me that inevitably, if you attempt to save marginally more lives, the technology to do so will become more complex. But conversely, why have all the associated complexity of technology, if the human suffering is not reduced? What is the goal then?
- Fradow 6y agoI am under the impression the author is missing the point of the lockdown. The main point is not about "saving lives" / "avoiding deaths". Lockdown is about (1) keeping hospitals under capacity and (2) hopefully slowing the virus to the point it's not an epidemic anymore. If you don't keep hospitals under capacity, people who can be cured have to be either moved somewhere else at great cost (this happened, there have been people moved from France to Germany) or left to die because they cannot be taken care of (I am pretty sure this happened too). Please note people who have another issue than the Coronavirus are also affected. That's what everyone REALLY wants to avoid. Needless to say, letting the virus run its course and overwhelm hospitals would have an order of magnitude more deaths. The hard issue is about how to re-open without letting the virus rampage again. It's a lot of difficult decisions, and no one have conclusive data on what works and what does not. It's going to be a lot of trial and error, as shown by the fact that no 2 countries have the same rules to reopen.