5 ms·

Some 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 rece

by Lazare 6y ago

Some 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 ago
If the movement restrictions cost lives, why are total fatalities down? (even including SARS deaths)
- rhn_mk1 6y ago
  Because total = increase - decrease. If the decrease is bigger than the increase, you will see the total drop.
- elcomet 6y ago
  Also, movement restrictions cause deaths in longer terms than the virus.
  - drapred7 6y ago
    How?
    - elcomet 6y ago
      Movement restrictions causes financial difficulties for companies, which cause job losses, which can cause depression. All this can take time.
- manigandham 6y ago
  These deaths aren't as acute. Deaths from economic depression will take longer to manifest than a sudden illness.
  - Gibbon1 6y ago
    That sounds like a call for a coherent policy rather than the do nothing that's being proposed here.
- TJSomething 6y ago
  The 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
- Lazare 6y ago
  They undoubtedly do cost lives but: 1) You're looking at net lives, and there's no particular reason to think we're net negative yet. Let's imagine a brief lockdown to avoid overwhelming the emergency rooms with people needing ventilators is very net positive. And let's imagine crippling the economy by fully locking down everything until a vaccine passes clinical trials in 18 months is very net negative. Even if you accept these as true, we might have weeks to go until the crossover point arrives...or we might have already passed it. 2) Which brings us to the next point - even if we're already in net negative territory, deaths from Covid-19 are (hopefully) front loaded; they're happening now. Deaths three years from now because the long term economic growth rate is 0.2% lower than it otherwise would have been are still in the future. I linked to some studies suggesting the GFC cost a fair chunk of lives in the end, but you wouldn't have been able to detect any of that the week after Lehman failed; the fallout had yet to land. And finally: 3) Coming back to the point in the linked article, there's more to life than strict maximising quality-adjusted life years. There's a lot of ways you could, in principle, save lives via a stroke of a pen. Boxing, white water rafting, surfing, diving, and mountain climbing are all shockingly dangerous sports. We could ban them! It'd straight up save lives. Should we? I, for one, would strongly argue no. But that cuts both ways. Even if we had inarguably correct data showing continuing the lockdowns was starting to cost lives, that's the starting point for the debate, not the conclusion. We don't (and shouldn't) just do the things that would save the most lives.
  - pmiller2 6y ago
    Regarding point 3, I think your examples, being individual sports that people choose to participate in, are kind of straw men. For one, relatively few people die doing them. For another, as I mentioned, they're activities that people participate in, knowing that there are some serious risks. A better example would be "let's end all farm subsidies for sugar and tobacco." You could arguably include corn here, as well. Go a little further, and you can start talking about national sugar and tobacco taxes. All these measures simply increase the price of sugar and tobacco, which has been proven to reduce consumption, and would certainly have the effect of reducing obesity and cancer. I find it a lot harder to argue against those things than to say we should ban surfing, boxing, or rafting, because a few people get injured or die every year doing them.
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 ago
  It 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 ago
The 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 ago
Haven't they also cost lives from hindered access to medical care for stuff unrelated to Covid-19?

by Lazare 6y ago

drapred7 6y ago

If the movement restrictions cost lives, why are total fatalities down? (even including SARS deaths)

rhn_mk1 6y ago
Because total = increase - decrease. If the decrease is bigger than the increase, you will see the total drop.
elcomet 6y ago
Also, movement restrictions cause deaths in longer terms than the virus.
- drapred7 6y ago
  How?
  - elcomet 6y ago
    Movement restrictions causes financial difficulties for companies, which cause job losses, which can cause depression. All this can take time.
manigandham 6y ago
These deaths aren't as acute. Deaths from economic depression will take longer to manifest than a sudden illness.
- Gibbon1 6y ago
  That sounds like a call for a coherent policy rather than the do nothing that's being proposed here.
TJSomething 6y ago
The 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
Lazare 6y ago
They undoubtedly do cost lives but: 1) You're looking at net lives, and there's no particular reason to think we're net negative yet. Let's imagine a brief lockdown to avoid overwhelming the emergency rooms with people needing ventilators is very net positive. And let's imagine crippling the economy by fully locking down everything until a vaccine passes clinical trials in 18 months is very net negative. Even if you accept these as true, we might have weeks to go until the crossover point arrives...or we might have already passed it. 2) Which brings us to the next point - even if we're already in net negative territory, deaths from Covid-19 are (hopefully) front loaded; they're happening now. Deaths three years from now because the long term economic growth rate is 0.2% lower than it otherwise would have been are still in the future. I linked to some studies suggesting the GFC cost a fair chunk of lives in the end, but you wouldn't have been able to detect any of that the week after Lehman failed; the fallout had yet to land. And finally: 3) Coming back to the point in the linked article, there's more to life than strict maximising quality-adjusted life years. There's a lot of ways you could, in principle, save lives via a stroke of a pen. Boxing, white water rafting, surfing, diving, and mountain climbing are all shockingly dangerous sports. We could ban them! It'd straight up save lives. Should we? I, for one, would strongly argue no. But that cuts both ways. Even if we had inarguably correct data showing continuing the lockdowns was starting to cost lives, that's the starting point for the debate, not the conclusion. We don't (and shouldn't) just do the things that would save the most lives.
- pmiller2 6y ago
  Regarding point 3, I think your examples, being individual sports that people choose to participate in, are kind of straw men. For one, relatively few people die doing them. For another, as I mentioned, they're activities that people participate in, knowing that there are some serious risks. A better example would be "let's end all farm subsidies for sugar and tobacco." You could arguably include corn here, as well. Go a little further, and you can start talking about national sugar and tobacco taxes. All these measures simply increase the price of sugar and tobacco, which has been proven to reduce consumption, and would certainly have the effect of reducing obesity and cancer. I find it a lot harder to argue against those things than to say we should ban surfing, boxing, or rafting, because a few people get injured or die every year doing them.

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 ago
It 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 ago

The 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 ago

Haven't they also cost lives from hindered access to medical care for stuff unrelated to Covid-19?