6 ms·

>>For economic indicators at least the data is available, and IMHO clearly shows Sweden was not unusual, e.g. Economic indicators over shorter time spans can't

>>For economic indicators at least the data is available, and IMHO clearly shows Sweden was not unusual, e.g. Economic indicators over shorter time spans can't reflect long-term harm. Tens of thousands of business closures, and elevated deficit spending to make up for the loss of private income, is going to show up in GDP statistics over a very long period of time. You're correct that sheltering and social distancing behavior manifests in a lockdown-free society as well, but it will be 1. less prevalent (if not, what was the point of the lockdown) and 2. more intelligently applied based on the diverse set of circumstances found in the population. With respect to point 2, a lockdown is a one size fits all solution that treats an elderly person and a young person the same, despite COVID posing a 1,000 times greater risk to the former than to the latter. A lockdown precludes creative ways of minimizing COVID risk, like having social gatherings in venues with better ventilation, or only with people in a low-risk demographics, because again, a one-size-fits-all solution cannot be adaptive/intelligent the way individuals can. A lockdown rule, being rigidly preset, can't know when a young person is facing drug abuse problems, and faces far greater risk from social isolation than from COVID. The US saw a massive spike in fentanyl overdose deaths in 2020, showing the steep cost of social isolation - which lockdowns exacerbate - for public health. People when left to their own devices are able to make judgments based on their individual circumstances, and this latitude is impeded by lockdowns. The potential harm from this is simply ignored by the authors.

ModernMech 5y ago
> People when left to their own devices are able to make judgments based on their individual circumstances The pandemic also revealed that when left to their own devices, people make judgements based on their own individual circumstances without any consideration whatsoever given to the circumstances of others. People were having COVID parties in an effort to intentionally spread the disease -- that should tell you everything you need to know about an individual's capacity to think in terms of public health. > like having social gatherings in venues with better ventilation, or only with people in a low-risk demographics, because again, a one-size-fits-all solution cannot be adaptive/intelligent the way individuals can. The idea that we can let young people do whatever they want while isolating and protecting the old and vulnerable has always been false in our society. Many vulnerable people died as a result. It's created paradoxes where we send kids to school because they are not vulnerable; meanwhile their teachers are in fact vulnerable and have predictably died at a frequency that has created teacher and substitute shortages. > The US saw a massive spike in fentanyl overdose deaths in 2020, showing the steep cost of social isolation - which lockdowns exacerbate - for public health. Fentanyl has been a problem long before the pandemic, and many of the places that are most affected by increased fentanyl deaths over the last 2 years have imposed the least restrictive lockdown measures [0]: Alaska – 385% Colorado – 382% Louisiana – 378% Mississippi – a 373% California – 370% Texas – 350% Oregon – 303% Kansas – 303% Idaho – 283% Alabama – 271% Florida, a state which advertises itself as the state of freedom, and whose governor has positioned himself as an anti-lockdown champion, has the worst fentanyl deaths in the entire nation. So I don't know how much you can say about the causation between lockdowns and fentanyl overdoses. One demographic that has seen the highest increase and absolute rates of fentanyl deaths has been African Americans, particularly young men and teens. If your contention is that fentanyl is a drug of despair, why are you assuming lockdowns are the source of that despair? During the summer of 2020, African Americans (and Americans of all backgrounds) highlighted one of the most pressing concerns in their community: police violence against black men and teens. Have you considered this despair as a possibility for the increase in overdose deaths (particularly considering many of the states hit hardest have very high black populations)? [0] https://www.route-fifty.com/health-human-services/2022/02/states-highest-fentanyl-deaths/361839/ https://www.route-fifty.com/health-human-services/2022/02/st...
- CryptoPunk 5y ago
  >>The pandemic also revealed that when left to their own devices, people make judgements based on their own individual circumstances without any consideration whatsoever given to the circumstances of others. Of course there are exceptions to every rule, but generally people adjusted their behavior based on rational risk benefit assessments: https://www.tandfonline.com/doi/abs/10.1080/13571516.2021.1976051 https://www.tandfonline.com/doi/abs/10.1080/13571516.2021.19... >>Atkeson (February 2021) then used the same model with a simple behavioral adjustment that allowed individuals to change behavior in light of the value of Rt . >>The new forecast of daily deaths is shown as the blue line in panel (b) of Figure 2. Adding the single behavioral response completely changed the model’s predictive power. The model now tracks the actual progression of the daily deaths very closely. In correspondence with Atkeson he provided the reason for this result: The intuition for this result is simple. If new infections and daily deaths from the disease grow too high, people take costly efforts to avoid interaction and thus slow disease spread. Likewise, if the prevalence of the disease falls toward zero, then the demand for costly disease prevention efforts also falls towards zero, and so the >>– >>disease will come back unless the population has already achieved herd immunity measured at pre-pandemic levels of behavior. Regarding this: >>The idea that we can let young people do whatever they want while isolating and protecting the old and vulnerable has always been false in our society. Many vulnerable people died as a result. It's created paradoxes where we send kids to school because they are not vulnerable; meanwhile their teachers are in fact vulnerable and have predictably died at a frequency that has created teacher and substitute shortages. Young people should take priority over the old. This is not acceptable: "Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020" https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm... Neither is this: "Covid-19: Children born during the pandemic score lower on cognitive tests, study finds" https://www.bmj.com/content/374/bmj.n2031 https://www.bmj.com/content/374/bmj.n2031 And for what? The lockdown proponents projected 96,000 COVID deaths by July 1st 2020 in Sweden without a lockdown. The real number was approximately 20 times lower, at 5,400, the vast majority the elderly. Is robbing a million young people of a year of their development worth maybe reducing this 5,400 death toll? I think clearly it's not. You need to consider the damage done by lockdowns, not just by COVID. Just this alone makes the whole exercise unacceptable: "30-40 percent of minority and low-income students weren’t learning during lockdowns" https://www.mckinsey.com/featured-insights/coronavirus-leading-through-the-crisis/charting-the-path-to-the-next-normal/30-to-40-percent-of-minority-and-low-income-students-werent-learning-during-lockdowns https://www.mckinsey.com/featured-insights/coronavirus-leadi... And the premise of your argument - that young people being able to live normally was such an unacceptably high risk to those older than them that it should have been forbidden - is very tenuous, with some findings suggesting that there was very little COVID spread through schools: "Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools " https://publications.aap.org/pediatrics/article/147/4/e2020048090/180871/Incidence-and-Secondary-Transmission-of-SARS-CoV-2 https://publications.aap.org/pediatrics/article/147/4/e20200... >>Fentanyl has been a problem long before the pandemic I never implied otherwise. My only comment was on the spike in deaths. >>and many of the places that are most affected by increased fentanyl deaths over the last 2 years have imposed the least restrictive lockdown measures [0]: Alaska had a stay-at-home order, and in any case would have been amongst the most affected by the lockdowns, as it severely impacted travel between Alaska and the continental US. I don't see anything in that list suggesting that less locked down states saw a bigger spike in fentanyl deaths. In your list, all had stay-at-home orders: https://www.nytimes.com/interactive/2020/us/coronavirus-stay-at-home-order.html https://www.nytimes.com/interactive/2020/us/coronavirus-stay... And all of them had restrictions that persisted long after the stay-at-home order was lifted. Which of those states didn't shut down in person schooling? >>Florida, a state which advertises itself as the state of freedom, and whose governor has positioned himself as an anti-lockdown champion, has the worst fentanyl deaths in the entire nation. So I don't know how much you can say about the causation between lockdowns and fentanyl overdoses. Completely irrelevant to my point, which again, is about the spike in fentanyl deaths. Yes Florida has for a long time a massive drug problem, probably due to being the largest gateway for drugs entering the US. Obviously this massive spike in fentanyl deaths is due to behavioral changes relating to the pandemic. And by far the behavioral change most likely to have contributed is social isolation, which is a known risk factor for drug use. You can't simultaneously argue that people are not risk averse enough to be left to their own devices, and thus we need lockdowns, while arguing that lockdowns did not contribute to the spike in fentanyl deaths through their impact on behavior. >>One demographic that has seen the highest increase and absolute rates of fentanyl deaths has been African Americans, particularly young men and teens. If your contention is that fentanyl is a drug of despair, why are you assuming lockdowns are the source of that despair? During the summer of 2020, African Americans (and Americans of all backgrounds) highlighted one of the most pressing concerns in their community: police violence against black men and teens. Have you considered this despair as a possibility for the increase in overdose deaths (particularly considering many of the states hit hardest have very high black populations)? The spike in fentanyl deaths was seen in all demographics. And to me it's common sense that being forced to stay home, and prevented from socially interacting, is going to be a far more likely source of despair, than some perception of police brutality stemming from the video of George Floyd's death. I don't see how you are so easily dismissing the damage that lockdowns/social-isolation can do to people. People being negatively affected by social isolation and economic decline is completely predictable. Social isolation in particular is known to massively increase mortality risk: "Social Isolation: A Predictor of Mortality Comparable to Traditional Clinical Risk Factors" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871270/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871270/ Even George Floyd had lost his job as a bouncer at a club due to the lockdowns before his attempt to use a fake $20 bill led to the deadly police interaction that killed him.
emn13 5y ago
Mass business closures would show up in GDP stats fairly quickly, i.e. be visible by now. Regardless, we need to compare to the appropriate counterfactual; you're still listing a bunch of bad things that happened, but implicitly comparing those to some world where the pandemic never happened - but it did happen, so that's not valid; you need to tease out how much of those downsides are due to "lockdowns" specifically. There's just not a lot of clearcut evidence showing lockdowns actually were worse than the alternative - self-imposed lockdowns, or pre-vaccination mass outbreaks. Some countries suffered more; others less; but I can't see a trend (maybe somebody can, but at least a few papers on the topic are clearly biased, which doesn't help). For instance When you ascribe Fentanyl overdose deaths to lockdowns, that's a mistake. Some of those are pandemic related, sure - but not necessarily the formal lockdown bits of it. Social distancing was going to happen no matter what; as was economic disruption and huge amounts of stress - and those factors may well increase the likelihood of overdose - but they would have applies with or without lockdowns. Furthermore, the huge number of ODs existed prior to the pandemic too - https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/... - lists the year ending in April 2021 as having 28.5% more deaths than the year ending in April 2020; and fentanyl OD deaths had been rising consistently for years up to that point too, i.e. it's not reasonable to assume they wouldn't have risen even without without covid and without lockdowns. Some of that rise was due to pre-existing trends, some of it due to covid - and perhaps very little due to lockdowns; especially if the alternative to lockdowns was even more deaths and social upheaval leading to "voluntary" economic shutdown. It's perfectly plausible lockdowns caused some of those deaths; yet it's also possible they prevented yet more OD deaths too. And if Fentanyl OD's were due to lockdowns, you might expect their timing to be correlated with them, or that states with more and stronger lockdowns have higher rates - but I can't find any evidence of that - can you? Furthermore, let's talk about that word "lockdown", which you describe as being rigidly present - well, 0% of the world's countries had rigid lockdowns for the duration of the pandemic. Some had long, very mild non-pharmaceutical interventions (including some in Sweden!). Some had occasional harsher measures, but with many long pauses in between. We might as well call these "policies", because that better represents just how diverse all these measures were, and because it doesn't prejudice the reader into thinking these measures were all particularly harsh. Is a mask-mandate for shops a lockdown? How about for public transport? How about a max-occupancy for, say, a theater? Or school closures for over 16s? How about vaccine requirements for restaurants? Or vaccine passports for large gatherings? Or non-binding work-from-home advice? ... even when in practice major firms enforce it? And even that belies practical complexities - I sure get the impression that most places, for most of the duration of the pandemic did not actually police many covid-restriction-violations very harshly. But that too will have differed from place to place, not to mention populations differ due to culture and habits and how any given restriction interacted with other restrictions. We can't just throw all these policies in one big huge box labelled "lockdowns", give it a good shake, and expect meaningful data to emerge: that's classic garbage in, garbage out. Some of the policies were surely more effective than others; and some more harmful. But which policies? If that weren't bad enough; clearly various countries had waves of differing intensities at different times, largely not due to anything the government was or was not doing. And governments deal with worse situations using the tools they have - including restrictions. But that raises the question of causality, too - in places that suffered more from social distancing and more from covid, which variable caused what change in which other variable? When we see "high death rate", what we _don't_ see is how high it _would_ have been with different policies (such as no restrictions). It's perfectly plausible that a country had excellent policy, including harsh lockdowns, real lock-down related damages, and high death rates - all at once! Because the alternative might have been much worse; and _that's_ hard to measure; we can't do randomized controlled trials on entire countries.

ModernMech 5y ago

> People when left to their own devices are able to make judgments based on their individual circumstances The pandemic also revealed that when left to their own devices, people make judgements based on their own individual circumstances without any consideration whatsoever given to the circumstances of others. People were having COVID parties in an effort to intentionally spread the disease -- that should tell you everything you need to know about an individual's capacity to think in terms of public health. > like having social gatherings in venues with better ventilation, or only with people in a low-risk demographics, because again, a one-size-fits-all solution cannot be adaptive/intelligent the way individuals can. The idea that we can let young people do whatever they want while isolating and protecting the old and vulnerable has always been false in our society. Many vulnerable people died as a result. It's created paradoxes where we send kids to school because they are not vulnerable; meanwhile their teachers are in fact vulnerable and have predictably died at a frequency that has created teacher and substitute shortages. > The US saw a massive spike in fentanyl overdose deaths in 2020, showing the steep cost of social isolation - which lockdowns exacerbate - for public health. Fentanyl has been a problem long before the pandemic, and many of the places that are most affected by increased fentanyl deaths over the last 2 years have imposed the least restrictive lockdown measures [0]: Alaska – 385% Colorado – 382% Louisiana – 378% Mississippi – a 373% California – 370% Texas – 350% Oregon – 303% Kansas – 303% Idaho – 283% Alabama – 271% Florida, a state which advertises itself as the state of freedom, and whose governor has positioned himself as an anti-lockdown champion, has the worst fentanyl deaths in the entire nation. So I don't know how much you can say about the causation between lockdowns and fentanyl overdoses. One demographic that has seen the highest increase and absolute rates of fentanyl deaths has been African Americans, particularly young men and teens. If your contention is that fentanyl is a drug of despair, why are you assuming lockdowns are the source of that despair? During the summer of 2020, African Americans (and Americans of all backgrounds) highlighted one of the most pressing concerns in their community: police violence against black men and teens. Have you considered this despair as a possibility for the increase in overdose deaths (particularly considering many of the states hit hardest have very high black populations)? [0] https://www.route-fifty.com/health-human-services/2022/02/states-highest-fentanyl-deaths/361839/ https://www.route-fifty.com/health-human-services/2022/02/st...

CryptoPunk 5y ago
>>The pandemic also revealed that when left to their own devices, people make judgements based on their own individual circumstances without any consideration whatsoever given to the circumstances of others. Of course there are exceptions to every rule, but generally people adjusted their behavior based on rational risk benefit assessments: https://www.tandfonline.com/doi/abs/10.1080/13571516.2021.1976051 https://www.tandfonline.com/doi/abs/10.1080/13571516.2021.19... >>Atkeson (February 2021) then used the same model with a simple behavioral adjustment that allowed individuals to change behavior in light of the value of Rt . >>The new forecast of daily deaths is shown as the blue line in panel (b) of Figure 2. Adding the single behavioral response completely changed the model’s predictive power. The model now tracks the actual progression of the daily deaths very closely. In correspondence with Atkeson he provided the reason for this result: The intuition for this result is simple. If new infections and daily deaths from the disease grow too high, people take costly efforts to avoid interaction and thus slow disease spread. Likewise, if the prevalence of the disease falls toward zero, then the demand for costly disease prevention efforts also falls towards zero, and so the >>– >>disease will come back unless the population has already achieved herd immunity measured at pre-pandemic levels of behavior. Regarding this: >>The idea that we can let young people do whatever they want while isolating and protecting the old and vulnerable has always been false in our society. Many vulnerable people died as a result. It's created paradoxes where we send kids to school because they are not vulnerable; meanwhile their teachers are in fact vulnerable and have predictably died at a frequency that has created teacher and substitute shortages. Young people should take priority over the old. This is not acceptable: "Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020" https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm... Neither is this: "Covid-19: Children born during the pandemic score lower on cognitive tests, study finds" https://www.bmj.com/content/374/bmj.n2031 https://www.bmj.com/content/374/bmj.n2031 And for what? The lockdown proponents projected 96,000 COVID deaths by July 1st 2020 in Sweden without a lockdown. The real number was approximately 20 times lower, at 5,400, the vast majority the elderly. Is robbing a million young people of a year of their development worth maybe reducing this 5,400 death toll? I think clearly it's not. You need to consider the damage done by lockdowns, not just by COVID. Just this alone makes the whole exercise unacceptable: "30-40 percent of minority and low-income students weren’t learning during lockdowns" https://www.mckinsey.com/featured-insights/coronavirus-leading-through-the-crisis/charting-the-path-to-the-next-normal/30-to-40-percent-of-minority-and-low-income-students-werent-learning-during-lockdowns https://www.mckinsey.com/featured-insights/coronavirus-leadi... And the premise of your argument - that young people being able to live normally was such an unacceptably high risk to those older than them that it should have been forbidden - is very tenuous, with some findings suggesting that there was very little COVID spread through schools: "Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools " https://publications.aap.org/pediatrics/article/147/4/e2020048090/180871/Incidence-and-Secondary-Transmission-of-SARS-CoV-2 https://publications.aap.org/pediatrics/article/147/4/e20200... >>Fentanyl has been a problem long before the pandemic I never implied otherwise. My only comment was on the spike in deaths. >>and many of the places that are most affected by increased fentanyl deaths over the last 2 years have imposed the least restrictive lockdown measures [0]: Alaska had a stay-at-home order, and in any case would have been amongst the most affected by the lockdowns, as it severely impacted travel between Alaska and the continental US. I don't see anything in that list suggesting that less locked down states saw a bigger spike in fentanyl deaths. In your list, all had stay-at-home orders: https://www.nytimes.com/interactive/2020/us/coronavirus-stay-at-home-order.html https://www.nytimes.com/interactive/2020/us/coronavirus-stay... And all of them had restrictions that persisted long after the stay-at-home order was lifted. Which of those states didn't shut down in person schooling? >>Florida, a state which advertises itself as the state of freedom, and whose governor has positioned himself as an anti-lockdown champion, has the worst fentanyl deaths in the entire nation. So I don't know how much you can say about the causation between lockdowns and fentanyl overdoses. Completely irrelevant to my point, which again, is about the spike in fentanyl deaths. Yes Florida has for a long time a massive drug problem, probably due to being the largest gateway for drugs entering the US. Obviously this massive spike in fentanyl deaths is due to behavioral changes relating to the pandemic. And by far the behavioral change most likely to have contributed is social isolation, which is a known risk factor for drug use. You can't simultaneously argue that people are not risk averse enough to be left to their own devices, and thus we need lockdowns, while arguing that lockdowns did not contribute to the spike in fentanyl deaths through their impact on behavior. >>One demographic that has seen the highest increase and absolute rates of fentanyl deaths has been African Americans, particularly young men and teens. If your contention is that fentanyl is a drug of despair, why are you assuming lockdowns are the source of that despair? During the summer of 2020, African Americans (and Americans of all backgrounds) highlighted one of the most pressing concerns in their community: police violence against black men and teens. Have you considered this despair as a possibility for the increase in overdose deaths (particularly considering many of the states hit hardest have very high black populations)? The spike in fentanyl deaths was seen in all demographics. And to me it's common sense that being forced to stay home, and prevented from socially interacting, is going to be a far more likely source of despair, than some perception of police brutality stemming from the video of George Floyd's death. I don't see how you are so easily dismissing the damage that lockdowns/social-isolation can do to people. People being negatively affected by social isolation and economic decline is completely predictable. Social isolation in particular is known to massively increase mortality risk: "Social Isolation: A Predictor of Mortality Comparable to Traditional Clinical Risk Factors" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871270/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871270/ Even George Floyd had lost his job as a bouncer at a club due to the lockdowns before his attempt to use a fake $20 bill led to the deadly police interaction that killed him.

emn13 5y ago

Mass business closures would show up in GDP stats fairly quickly, i.e. be visible by now. Regardless, we need to compare to the appropriate counterfactual; you're still listing a bunch of bad things that happened, but implicitly comparing those to some world where the pandemic never happened - but it did happen, so that's not valid; you need to tease out how much of those downsides are due to "lockdowns" specifically. There's just not a lot of clearcut evidence showing lockdowns actually were worse than the alternative - self-imposed lockdowns, or pre-vaccination mass outbreaks. Some countries suffered more; others less; but I can't see a trend (maybe somebody can, but at least a few papers on the topic are clearly biased, which doesn't help). For instance When you ascribe Fentanyl overdose deaths to lockdowns, that's a mistake. Some of those are pandemic related, sure - but not necessarily the formal lockdown bits of it. Social distancing was going to happen no matter what; as was economic disruption and huge amounts of stress - and those factors may well increase the likelihood of overdose - but they would have applies with or without lockdowns. Furthermore, the huge number of ODs existed prior to the pandemic too - https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/... - lists the year ending in April 2021 as having 28.5% more deaths than the year ending in April 2020; and fentanyl OD deaths had been rising consistently for years up to that point too, i.e. it's not reasonable to assume they wouldn't have risen even without without covid and without lockdowns. Some of that rise was due to pre-existing trends, some of it due to covid - and perhaps very little due to lockdowns; especially if the alternative to lockdowns was even more deaths and social upheaval leading to "voluntary" economic shutdown. It's perfectly plausible lockdowns caused some of those deaths; yet it's also possible they prevented yet more OD deaths too. And if Fentanyl OD's were due to lockdowns, you might expect their timing to be correlated with them, or that states with more and stronger lockdowns have higher rates - but I can't find any evidence of that - can you? Furthermore, let's talk about that word "lockdown", which you describe as being rigidly present - well, 0% of the world's countries had rigid lockdowns for the duration of the pandemic. Some had long, very mild non-pharmaceutical interventions (including some in Sweden!). Some had occasional harsher measures, but with many long pauses in between. We might as well call these "policies", because that better represents just how diverse all these measures were, and because it doesn't prejudice the reader into thinking these measures were all particularly harsh. Is a mask-mandate for shops a lockdown? How about for public transport? How about a max-occupancy for, say, a theater? Or school closures for over 16s? How about vaccine requirements for restaurants? Or vaccine passports for large gatherings? Or non-binding work-from-home advice? ... even when in practice major firms enforce it? And even that belies practical complexities - I sure get the impression that most places, for most of the duration of the pandemic did not actually police many covid-restriction-violations very harshly. But that too will have differed from place to place, not to mention populations differ due to culture and habits and how any given restriction interacted with other restrictions. We can't just throw all these policies in one big huge box labelled "lockdowns", give it a good shake, and expect meaningful data to emerge: that's classic garbage in, garbage out. Some of the policies were surely more effective than others; and some more harmful. But which policies? If that weren't bad enough; clearly various countries had waves of differing intensities at different times, largely not due to anything the government was or was not doing. And governments deal with worse situations using the tools they have - including restrictions. But that raises the question of causality, too - in places that suffered more from social distancing and more from covid, which variable caused what change in which other variable? When we see "high death rate", what we _don't_ see is how high it _would_ have been with different policies (such as no restrictions). It's perfectly plausible that a country had excellent policy, including harsh lockdowns, real lock-down related damages, and high death rates - all at once! Because the alternative might have been much worse; and _that's_ hard to measure; we can't do randomized controlled trials on entire countries.