Interesting to consider how this applies to yearly influenza. All the above things considered, would pro-lockdown people suggest yearly lockdowns until universal flu vaccines? It's unfortunate RNA viruses mutate so damn much.
What is the purpose of performing multiple high and sub-level analyses of changing definitions of what constitutes a case, what constitutes a hospitalization and what constitutes a death? First of all, more testing initially means a spike in cases. There is already a high false positive rate for testing regurgitating dead nucleotides and amplifying it many times just to get a match. Threshold sensitivities were modified for non-vaccinated vs vaccinated patients. Case counts were modified from 'clinical x-rays' to '# of symptoms' to 'if you had a positive test within 28 days, inclusive if you died from a ladder or car accident'. Testing was eliminated for those who were already vaccinated or partially vaccinated. Older patients were forcibly locked up together in elder care homes with positive cases, even though the # of co-morbidities for each case due to death is already high, and has an average age in the 80s... The cofounding incentives of diagnosing patients as positive or getting treatments, getting payoffs either by medical practitioners or hospitals. The ad nausea footage of the Chinese falling ill and locking up of doors with piling dead bodies when the elephant in the room is that countries like Russia/China and some states in the United States have been fully opened for more than one year yet the cognitive dissonance when none of this materializes in the West. The initialization of pandemic by case counts, not by death rates as changed per WHO's guidelines a decade ago. Moving targets, changing definitions, high compliance rates yet no difference whatsoever or strong correlations when compared to different nations that didn't even bother reacting. Flu cases mysteriously disappearing or causes attributable to other causes of death being removed, when people are denied services to hospitals for testing/treatments because of a focus solely on this .. illness. The alignment of recurring seasonality of influenza/flu season with spike in cases, also post-mortem death rates following 'variants' / high vaccination rates. There are a lot of confounding variables that make this whole point moot. Placebo groups are entirely vaccinated.. already or they weren't treated with a negative control but an alternative vaccine for measles. No baseline studies for animal mortality. Multiple stakeholders/shareholders in multiple corporations/media companies/fact checkers/social media platforms incestuously having a strong profit incentive for booster shots or stronger lockdowns.
I live in Wisconsin, a state that had a judicial fiat against lockdowns for most of the pandemic but is otherwise very similar to its neighbors Minnesota and Michigan, which had fairly significant lockdowns. I've been hollering to the wilderness that the pandemic really didn't seem that much worse, or the economy any better, than these natural comparisons. Nice to see someone do the work to confirm my suspicions.
Better HVAC could be a game changer. Maybe someone needs to invent a ceiling fan with a filter which is continuously irradiated by UV light, which draws all the droplets up to the ceiling and neutralizes them. If this already exists, let me know.
Hansonian hot take: lockdowns aren't about preventing COVID, they're about preventing dissatisfaction in conscientious distanced citizens, who want official validation that their non-distancing neighbors *should have* stayed indoors as much as them. In other words, staying at home causes lockdowns.
1) "This is an absolutely beautiful graph. It’s showing how lockdown strictness (as of May 5) correlates with death rate over time. We find that early in the epidemic, the stricter your lockdown, the worse you're doing. This is the endogeneity... Later in the epidemic, the stricter your lockdown, the better you're doing - probably because the strict lockdown is giving good results."
While the graph indeed looks quite nice, the meaning is much less clear than implied. Unfortunately (from the perspective of being able to do easy causal inference using the time series variation), consider the following two stylised facts:
i) There is substantial spatial correlation in lockdown intensity - e.g. the hardest lockdowns occurred in the northeast and the Pacific west, the loosest restrictions were in the South and plains states.
ii) The various waves of Covid have exhibited substantial amounts of spatial correlation in outbreak levels. The first wave hit the northeast hardest, the second wave the south, the third wave really kicked off in the plains states, and so forth. It doesn't take that creative a thinker to work out plausible climatic patterns that could give rise to this sort of seasonality.
Accordingly, just how sure are we that the picture of "over time, the lockdown state advantage became stronger" is causal? One easy thought experiment is to extend the time horizon of the graph. And indeed, in the short-lived fourth wave (when b.1.1.7 finally broke through, before the vaccines murdered it), something like 9 of the 10 states with worst outbreaks (as measured by weekly cases per capita at that point in time) were states with stricter than average lockdowns. They also happened to be clustered in the northeast and midwest. Of course, this doesn't mean that the stricter lockdowns caused the fourth wave. But it should reduce our confidence in inferring much from that graph, as well.
2) "There was a significant negative correlation (-0.55) between the lockdown stringency index as of January 1, and the number of post-first-wave cases a state had. This was robust to... using all cases instead of just post-first-wave cases (although some of these changes slightly diminished the magnitude of the effect)."
I find it difficult to justify excluding the first wave. Given how rare reinfections are (call it the YOCO constraint), doing so mechanically advantages places that were hit hard early. Which also turned out to be pretty correlated with lockdown propensity.
As you say, the result gets weaker using all cases. But here *cases* have a glaring problem - tests were much scarcer in the first wave than subsequently. So a higher proportion of infections were missed in the first wave than in subsequent waves. So including the first wave but looking at cases amounts to (relatively speaking) throwing out much, but not all, of the first wave. Since deaths were measured much more consistently (both in level terms, and across time), better to just look at deaths. Which almost certainly will shrink the correlation again. (For example, NY and FL have basically identical cases per capita. NY has dramatically higher deaths per capita, though).
I fail to see the value in separating voluntary quarantining(VQ) vs. mandatory lockdown(ML). If everyone is already staying home what are the negative effects of ML we should be concerned about?
Additionally, VQ is caused by fear/concern. Accordingly, we could have increased VQ by increasing media coverage of the negative consequences and risks associated with Covid. Would this have been in any way superior? It seems this actually has negative effects even absent positive effects(people staying home) where mandatory lockdowns do not.
"Most of the debate about whether lockdowns work centers on ideas within the Overton Windows of western countries, after the pandemic had started spreading - ie, given whatever level of lockdown your country had, is the marginal effect of more (or less) lockdown positive or negative?"
I feel this is missing the point. One need not appoint a president for life to implement lockdowns strict enough to actually work, and state of emergency laws are on the books in many Western countries that allow governments to implement lockdowns without violating various constitutions.
I would far rather spend a month or two in a China-style lockdown than a year plus in a Western one (or worse, if the Delta or some other variant spreads enough.) This strikes me as an area where Western governments had an absolutely massive policy failure with millions dead and their Overton window still isn't expanding wide enough to include "actually solving the problem".
Interesting that, on naive estimates at least, the dollar-life or dollar-QALY trade-off rate of Covid restrictions is within a factor of 2 of other such tradeoffs determined by government regulation. I wonder how much of the lockdown debate is just people projecting their political values onto a novel factual question-- i.e. you probably think COVID restrictions were a bad deal if-and-only-if you think EPA restrictions are too.
Editing note…I had to go back to see what a QALY was. It might be good to follow the original mention with the acronym, I would have seen it more quickly, maybe others too. It made it difficult for me to follow the conclusion section at first.
My apologies, this is my first comment but a few 'What if's' come to mind. What if 85% of the people under 50 had the SARS-Cov-2 virus infection by Nov. 2020..and it was so mild they never noticed? What if the PCR test is the wrong test , has massive false positives, picks random protein and old viruses, is dialed up to a 45 'magnification' instead of 28 as recommended? What if the virus is 1 micron in diameter and the average mask (sieve) is 500 microns? What if the vapor travels not 6 feet but 100 feet? What if staying indoors is exactly against all the viral transmission rules?
What if the 'lockdown success' in the first wave is actually attributable to Sunshine and Fresh Air (aka Spring)?
What if the 'vaccine success' is again vastly attributable to Sunshine and Fresh Air ( and the CDC dialing down the PCR test at vaccine launch)?
What if .. for every 1% increase in unemployment 37,000 Americans die (as one prepandemic study showed)?
What if the natural, cheap and off-patent solutions, Sunshine (Vit D), Zinc, Quercetin, Ivermectin, Corticosteroids, Melatoni, Iodine and dozens more EACH reduce the Absolute Risk(AR)
of hospitalization and death by 65-94% ? What if people think that vaccines 'effectiveness' is 95% when this citation is Relative Risk (RR) and vaccines Absolute Risk reduction hovers just over 1%? What if the Inventor if mRNA technology Dr. Robert Malone warned the FDA about the toxicity of the spike proteins (generated by the vaccine) a year ago and Dr. Byram Bridle found evidence in Pfizers Japan data and exModerna Dr. Luigi Warren says vaxxed people shed spike proteins and all 3 have been variously trashed, deleted, deplatformed and ghosted? What if mRNA Inventor Dr. Robert Malone
and his 16 patents have been scrubbed from Wikipedia? What if this unprecedented Orwellian fact of this pervasuve laundering is because Google and Jeff Skoll invested in GoF research starting in 2010? What if up is down and down is up, Alice - here in Wonderland? Scrubadubdub.
Friedrich Nietzsche said ,
"The strength of a person's spirit would then be measured
by how much 'truth' he could tolerate, or more precisely, to what extent he needs to have it diluted, disguised, sweetened, muted, falsified"
I live in New Zealand, and I feel this post is missing something without talking about us (or other countries that have pursued similar "Zero Covid" policies, like Australia).
With strict border controls and a strict lockdown (and probably significant assistance from our geography), we managed to eliminate Covid-19 in June 2020 and have mostly kept it eliminated since, with mandatory isolation of all arrivals, and a few short lockdowns when Covid managed to leak into the community. Australia's biggest wave (Victoria mid-2020) was eliminated after months of harsh lockdowns, and they've since had similar policies and outcomes. Our economies have also held up fairly well, helped by the ability to maintain minimal internal restrictions whenever Covid had been elmiminated.
I think there are good reasons (mainly geography) to think our experiences can't be just copy-and-pasted to the rest of the world. But I think the lesson specific to lockdowns is that there's a discontinuity when elimination is a plausible option. If e.g. Colorado had decided it was going to institute a seven-week-long harsh lockdown to try to eliminate Covid-19, it'd be at a great cost, but because Covid would be re-imported from another state so easily, the effect on Covid-19 deaths might not be that larger over the course of the pandemic. But in NZ's case, we were in a position where we could eliminate Covid-19 and remain that way.
That also changes the calculus on short "circuit-breaker lockdowns" whenever cases emerge in the community. NZ or Australian states locking down for 1 or 2 cases in a city may seem crazy to outsiders (and I do think there have a few overkill examples of this (looking at you, Western Australia)). But these can in fact have some of the highest benefit-to-cost ratios of all lockdowns. The reason is that they can be the difference between returning to a low restriction elimination state, or a phase transition to an endemic Covid state.
As such, I have a theory that optimal lockdown strategy may be bimodal. Lockdowns make little sense with zero cases, can be very good with a few cases (and strong border controls), may not make as much sense with a moderate amount of Covid, but may again start to make more sense with a healthcare-system threatening wave.
I've long thought there are way too many confounding variables to really be able to draw any strong conclusions about this sort of thing. Just looking at how wildly different the outcomes are in different countries, or in states that have similarly strong/weak lockdowns.
We have heard, for example, that the weather affects transmission. People who argued this accurately predicted changes in case numbers in many cases, most notably the big winter wave in the US and Europe, predicted months in advance. So ... how the hell do you account for that?
Given all that, I am inclined to just evaluate what policies work the best given our understanding of how the virus works and of human behavior. I know we all like this sort of empirical analysis, scientific method and all that, but on some level if it's this hard to measure you just end up measuring your own blind spots. "We can figure this out using empirical analysis" reminds me of the High Modernism thing - if you can't really figure out a good way to approach it scientifically, just kinda do something science-y.
A few other points:
<ul>
<li>An underrated part of lockdown politics is really about the financial assistance to laid off workers. For many people early on the understanding was that lockdowns lead to people losing jobs and so political support for unemployment benefits, etc. And that ending lockdowns would mean an earlier end to those benefits, so whatever people thought of the money stuff drove views on lockdowns.</li>
<li>I wonder how much the <i>public messaging</i> matters. In the US, it wasn't a particularly right-wing thing to be unconcerned about the virus, or left-wing to be concerned, at first. It only started that way after Trump and Fox News went around talking about how it's all overblown and how "this" is "the Democrats' new hoax" and all that. You mentioned how actual behavior is often loosely connected with government rules - it seems that it is more strongly correlated with the partisan messaging.</li>
<li>I think we got locked into a not-very-helpful pro- or anti-lockdown debate early on that prevented any discussion of <i>what are the best lockdown policies</i>. Early on there was discussion of centralized quarantine - people said NYC was hard hit because of overcrowding in small apartments, where a sick person would stay at home and infect everyone else - and widespread testing and tracing. None of which ever happened. At the same time, as far as I can tell "six feet apart" has been known for awhile to not have any basis in fact, and people still follow it. And restrictions on outside activity lasted a long time after it was clear that it was a way lower risk.</li>
<li>I think the medical establishment did a bad job of communicating at many times. Big examples include the initial anti-masking message, and the failure to give more realistic guidelines that people who don't follow the strictest guidelines might follow. To steal a point from someone, all non-COVID CDC advice is <i>also</i> super-strict rules that nobody follows (IIRC they recommend using a dental dam during cunnilingus. And 4 drinks in a day for a woman is "binge drinking").
And some political bullshit like saying it was OK to go to racial justice protests because it's a more important issue than COVID.</li>
<li>That said I'd be remiss if I didn't add that the medical establishment's bad job pales in comparison to the aggressively terrible job from the administration. People forget it now but before Fox News was against vaccines or lockdowns or masks, Trump was even against testing people, on the basis that it would increase the number of cases and make him look bad. He said this out loud on TV repeatedly! The main guiding principles seemed to be the stock market, and a mystical belief that nothing could stop the "Trump train". And people on his Coronavirus "task force" have alleged that they slow-walked the response because it was seen as a blue state problem.
All the arguments about calling it the "China Virus" or whatever came about because they needed new talking points to replace the "it's a media hoax" talking points once it became clear that it was, in fact, a big deal.</li>
<li>I think it's clear that earlier waves cause lockdowns (and voluntary lockdown-ish behavior). People in other parts of the country ask why everyone in NYC wore masks so long - probably because how bad it got in April of 2020.</li>
"Sweden had closed some public schools (other countries had closed all of them), restricted large gatherings (other countries had restricted all gatherings), “recommended” closing businesses and staying at home(other countries had mandated it), and closed public events and public transport. "
Actually public transport in Sweden never closed. At some point in late 2020 it was recommended that commuters wear a mask when using public transport during peak hours (which, anecdotally, not many did).
Thanks for the link about Belgium's death rate! I was very curious about that.
I hate to add yet another "theoretical concern" to your list, but shouldn't voluntary changes also effect the economic impact of any policy? If most people stop going out to eat voluntarily, then the associated reduction in R *and* the associated restaurants going out of business have little or nothing to do with the government policy.
For secondary effects, I think you missed a few that are potentially much larger than the ones listed. We had a lot fewer cars on the road, resulting in thousands of additional traffic deaths (yes, more, because the people left were driving faster--see https://www.nsc.org/newsroom/motor-vehicle-deaths-2020-estimated-to-be-highest); on the flip side, air quality may have improved substantially (https://www.cnn.com/2021/03/16/health/world-air-quality-report-intl-hnk-scn/index.html) and air pollution is actually a substantial health hazard, particularly in poor countries. Then there's the culture war and political effects: much-discussed increased politicization of science and policy, Trump would likely have coasted on incumbency effects and 4% unemployment to re-election, arguably growing inequality and the strength of stocks/big companies compared to small businesses and average peoples' salaries.
"We know this is possible in principle - some states tried things like closing parks and trails, which in retrospect probably wasn’t too useful since the virus doesn’t spread well outside."
Indeed, this particular intervention could even have been counterproductive. I saw an argument (probably on the SSC or Motte subreddits) that lockdowns past a certain point *increase* cases, because everyone is jammed together into the few places they can go, like grocery stores. I wasn't sure of that, but shutting down an outdoor space or preventing all but the largest and most densely-packed gatherings is likely to have 0 positive impact, and secondary effects like pushing people indoors or reducing physical activity very likely make it a net negative. I know that some outdoor areas like major national parks were and ski resorts (and still are) overwhelmed and probably couldn't have maintained standard services like ranger support without compromising employee safety, but local parks and most trails should have been kept open
"Maybe this was a dress rehearsal for a much worse pandemic later on, and the most important effect of our choices now will be setting the defaults and expectations for how we respond to that one."
And that's probably the most terrifying thing. There is no indication that the powers-that-be have realized any of their mistakes. The FDA is still going to ban tests early on. The CDC is going to be wrong about risk. The intelligentsia will sneer at the plebs for being scared, then sneer at them for being selfish, without a hint of self-reflection.
Talking about the US and comparing different states. My prior would be that red states would tend to lower the number of COVID deaths in the statistics, compared to blue states. Shouldn't we account for that? Also most of the big high density cities (aka places where virus spread should be the highest) are blue even in the red states. And they could have stricter local policies compared to the state.
The two plots of "cases in Sweden vs Europe" and "deaths in Sweden vs Europe", considered together, seem like very strong support for the arguments "lockdown cannot pass a cost-benefit test" and "the Swedish non-lockdown really wasn't a lockdown".
We see a gargantuan bubble in Swedish cases, unrepresented anywhere else, that doesn't show up in Swedish deaths *at all*. Swedish cases soar to new heights at the same time Swedish deaths maintain a steady downward trend.
That's a huge number of people falling sick for whom falling sick is the right outcome -- they get all the benefits of whatever they were doing with negligible downside -- but who were, in every other country, prevented from achieving this correct outcome.
Also missing: Taiwan, South Korea, Japan, Vietnam. (Despite what many people think, S.Korea and Japan citizenry have pretty low confidence in their governments - in Japan, people still remember the government mismanagement of the Fukushima nuclear reactors after the tsunami; for S.Korea: https://twitter.com/BluRoofPolitics/status/1399555956875296769)
There are two other factors to consider: how open the economy is to the outside world, and how quickly information is collated and disseminated. The UK is very open, and had a government that was until recently very long to close down borders or institute mandatory quarantines, which is why the delta variant is spreading like wildfire. On the data collection front, originally it took them 2 weeks to collect and tabulate data due to an unfit-for-purpose health IT infrastructure, which obviously makes it very difficult to control either the government or private-actor control loop. In one particularly embarrassing incident they discovered that because they used an old version of Excel with a 32K row limit, they were undercounting cases.
I work as an MD in Sweden and have thought a lot about COVID-lockdowns. Many things that governments in other countries made illegal Sweden only recommended i.e. limit social contacts, don't have private parties etc. But the stringency index counts these recommendations as if they were mandatory: https://twitter.com/TTBikeFit/status/1359913436981903361/photo/1 . This makes Sweden seem more stringent than it was, especially during second and third wave. For example according to ourworldindata stringency Sweden had higher stringency than France in January -21, this at a time when it was illegal to be outside in France after 8 or 9pm without valid reason. So in the stringency index it may look like Sweden was a pretty average European country during second and third wave I don't think that was the case. Anecdotally French and German people in Sweden also told me it was much more relaxed here.
Also I did an estimate of the life years lost to COVID deaths in Sweden in 2020 a few months ago here: https://www.reddit.com/r/TheMotte/comments/msqqof/estimating_life_years_lost_due_to_covid_deaths_in/. Sweden had an excess mortality compared to previous years of 7.7 % and a 0.59 year decline in life expectancy. This translates to 63700 non QALY-adjusted life years lost to death or 6.37 years per COVID death or 2.32 days per person.
One complicating factor that doesn’t seem to be covered here is how many QALYs were lost due to things like:
1) Lack of exercise: gyms and parks were closed and group workout sessions were cancelled. Even when facilities were reopened, I didn’t use them because of restricted hours, fear of infection, and unwillingness to work out with a mask on. I’d guess many others didn’t either.
2) Increases in being sedentary: even if people managed to keep up their workout routine, people who worked from home just needed to move around less to do things compared to when they had a physical workplace to go to. Almost everyone I know with a step counter has reported a massive drop in their daily step count.
3) Delayed medical check ups and appointments. How many people will have cancers or other issues detected a year late or treatments delayed by a year? I know that me and many people I know delayed our appointments, figuring the odds are that we’d be fine. But a substantial number of people doing that means that many of us won’t be fine.
It’s possible it will take another year or more before this data is really available, but I’d be interested to know if we have any preliminary results or forecasted estimates on these. And if the strength of those results would overturn any of this post’s current conclusions.
"Finally, voluntary behavior change and mandates are hard to separate. If you hear the government is thinking of a mandate, that might make you scared and cause you to do things voluntarily (even things not included in the mandate). Or if the government knows that most people are staying at home, it might feel more comfortable issuing a stay-at-home order to mop up the last few holdouts, whereas if no one had been staying at home it might not be willing to do that."
One factor to consider here and which might further confound is that lockdowns almost certainly don't have effects just in the countries where they're implemented - you can't just treat countries as closed individual units in an open and connected world economy. Of course, an important factor is that if some country is in a bad phase of epidemic, it increases the chances the virus spreads elsewhere - usually, of course, this leads to travel restrictions, but the travel restriction patterns are not always optimal. Here in Finland, a major issue for these weeks has been the spread of virus from Russia to Finland via football fans who were watching the UEFA European Championships in Russia while Russia has been going through a fairly harsh wave, and of course if Russia hadn't been going through that wave, it would have also reduced considerably the chances of spreading to Finland.
However, another thing is that while people will adjust their thinking about how bad the virus is and what precautions to take according to government messaging and actions, government messaging and actions may also have effect in other countries. Throughout the pandemic, the Finnish media has paid a close attention to what other countries have been doing - particularly Sweden, usually presented as a negative example of what not to do. For instance, a bunch of countries enacting lockdowns around Europe has generally been considered a pretty good signal that extra measures will also be coming in Finland, and might lead to voluntary behavior changes even before the actual measures come. Now, the medias - and accordingly, a fair number of people, assuredly only a minority but still probably the minority that acts as the opinion-makers - are paying close attention to UK's policies regarding reopening, and which way they will go, as well as what the real relationship between the Delta variant, vaccines, reopening etc. is vis-a-vis case and death numbers. All such matters may end up having effects on public behavior without the Finnish government necessarily doing anything major.
Of course, this also leads to something of a freerider problem - it's perfectly possible that one of the reasons why Sweden was able to have lenient restrictions at the start of the pandemic without the situation getting really out of hand *was* that the other Nordic countries had stricter restrictions, not only lessening the spread of pandemic from those countries but also potentially contributing to voluntary behavior changes within the Swedish society.
Minor notes:
- "Stringency index" may also be confounding due to the policy of countries being considered according to the strictest subnational unit (https://ourworldindata.org/grapher/covid-stringency-index). At least in Finland, restrictions in the greater Helsinki region have mostly been stricter than in the rest of the country, but the majority of people still live outside of greater Helsinki.
- One of the functions of the lockdowns might not only be that they serve as a government signal for "things bad", but their end might also serve as a government signal that "things good, get on with your lives", potentially allowing for a faster reopening than whatever inchoate signaling the government is able to do *without* having a lockdown, in case the people still choose to voluntarily stay home.
- regarding masks, their spread in society - or people giving up on mask-using if they've gotten used to it - really probably happens in slower waves than what can be measured in, say, three weeks, unless there's a formal mandate with teeth. At least in Finland, where there was next to no mask-using until late Autumn 2020 when the government finally issued a recommendation (not a strong mandate; there has only been a mandate in some public transportation in trains and some cities, and even that is not really enforced too strongly) to use masks, it took *months* for anything close to a 80 % mask compliance to happen in places where it was recommended. (Still, it did happen without formal mandates, eventually, which also tells something about the Nordic society!)
- as the single-person household map shows, Estonia has a high percentage of households, and it still had a big COVID wave a few months ago, having the highest case rate in Europe per capita at one point, if I remember correctly. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Estonia
The former has daily national data, the latter daily US data by state and county. Both updated today.
While I agree with your analysis regarding "quasi-lockdowns" a la US and west Europe, I think you are missing the bigger picture with actual lockdowns a la China, east asia, oceania. I wrote about that on the reddit, but I see some people here covering similar points.
"Similarly, there was a really wide diversity of compliance levels with shelter-in-place orders. I know some people who didn’t see their closest friends for months, and others in the same cities who said “screw this” after a week or two and started having (small) parties again."
It's honestly difficult to say about how effective such measures are. The problems here in Ireland start after restrictions are eased, people come out in large numbers, and then we get a bump in the Covid cases. Part of that is economic, as businesses are pressuring government to relax restrictions (e.g. for Christmas as that is a major revenue generation period) and now for the summer - but we see that when restrictions are lifted, some people can't be sensible and then we get a spike once again in infection rates and then restrictions clamp down again.
Right now, where I live is one of the two areas in the country with the highest rates of Covid-19 (and we are not a large urban area). There was a spike in infections locally in the middle of June, and anecdotally that is alleged to be because in a local village, people who had been attending a match on the weekend went to the pub afterwards, where they mingled with people who were home from England for a funeral.
Given that the Delta variant was established in England at the time - well, there you go. This is also why many people are not happy with Boris Johnson and the relaxation of restrictions in Britain.
Just scanned the comments quickly, sorry if someone else has already pointed this out, but note that the same people who are likely to have high rates of voluntary behavior change are also likely to vote (or email their representatives, or...) for lockdowns. So if you check for the effects of lockdowns assuming nothing else is different between states that did/didn't implement them, you may be missing something.
My impression as a Bay Area Californian from listening to other people talk is that our voluntary measures, especially early on before the state took notice, were unusually extreme, our cooperation with the mask mandate once it did get instituted was unusually high, and the tendency for people to take precautions that weren't officially required (grocery delivery instead of shopping; washing groceries; refraining from taking walks, talking masked and distanced with one friend, or other activities that were explicit exemptions to mandates; etc.) was much more pronounced around here than many places. (Though take that with a grain of salt - the non-California part of the comparison is based on what people talk about, I wasn't actually in any other state until last week, and by that point differing mandates potentially affecting people's behavior had thoroughly confounded everything.) Still, I don't think the set of attitudes that get us the above set of behaviors are entirely unrelated to our state, and moreso our county, hitting the lockdowns early and hard. (At least, hard for a US State - anecdotally, compared to Chile or Spain or China we seem to have been quite mild.)
An effect not discussed (but which I don't know how you would handle)
In the UK the government said that lockdown was about avoiding hospital overload -- where overload is defined as a tipping point of serious cases per day the exceeds capacity and suddenly the standard of care drops and the mortality rate goes much higher.
I am interested in whether or not this turned out to be a thing? Early on, the consensus was that for serious cases a ventilator was required for recovery and countries were scrambling for ventilators; however, later on it the news told me that ventilators were irrelevant to recovery (that generally if you were put on a ventilator for covid, having it removed would kill you -- there was no recovery as such). So did it turn out that actually hospitals couldn't help you very much anyway if you had serious covid, which might make this capacity-issue not a thing. Just wondering because it's been a very long time since the UK government mentioned this issue -- nowadays they talk about balancing lives lost with keeping the economy running.
On the other hand, if the capacity issue does exist, then this changes the models above.
I do think a better pair of questions would be, "what is the optimum behaviour to respond to the pandemic?" and "what is the best way to get people to adopt that behaviour?". "Lockdown" confuses the two of these, and comparing lockdown vs voluntary measures is focussing on the second question at the expense of the first.
The part of your article I'm least convinced about is the attempt to model emotional impact. You summarise this as "52 months of stricter lockdown to save 1 month of healthy life", which does sound harsh, but it could also be phrased as "52 months of stricter lockdown instead of 52 months living through a pandemic with many voluntary limitations on behaviour", which is rather less harsh - albeit still not necessarily worthwhile. Also, some people may find it more emotionally traumatic to be living in a pandemic if the state and their fellow citizens behave in a non-optimal way. Early in the UK, there was a sense of collective pulling together in adversity that strongly mitigated against emotional impact. In other words, emotional impact is hard to measure.
On the other hand, you haven't mentioned the educational impact of disrupting children's education, which seems to be an important downside of the pandemic.
I'd love to see "Ivermectin: Much More Than You Wanted To Know," given the absolutely baffling lack of main stream media coverage (and suppression by Facebook, Google, etc) on the topic.
From what I can tell, it's probably better and safer than vaccinating teenagers and under-12 children. It might be capable of actually eradicating COVID-19, if its usage is widespread enough. It might even cure long-haul symptoms, although so far the accounts are anecdotal and there hasn't be a formal study.
I don't see any compelling evidence / arguments to *not* to the claims being made by the Front Line COVID-19 Critical Care Alliance, while there are a lot of people who very obviously have a literal vested interest in a cheap medication like Ivermectin not being the solution to COVID-19.
I respect Bret Weinstein enough to believe that his current take on this topic is probably accurate, but it would help tremendously if Scott could weigh in on it, too.
I take your point about total deaths being sensitive to how old the country is, but cases numbers before autumn 2020 are an outright mess. Some countries (UK) had a policy of "Don't get tested, just self-isolate for 14 days" until mid-April.
Now that we have granular data, I like "Deaths 50-69" and also the slightly more complex "Deaths per 100k people in each age bracket". Anyway, if you use these it pretty much confirms that Sweden did much worse than Europe in the first wave, and relatively the same as Europe in subsequent waves.
At the end of Preliminary Theoretical Issue 2 I thought "WTH??? That kind of thinking only makes sense near the Pareto frontier, and almost all western countries very clearly aren't anywhere remotely near it!!!" until the middle Actual Evidence 1.1.
im not sure i buy that US data is as nice as we'd like to be. in the US, red states are fairly strongly clustered in the south, and blue states are very strongly clustered in the north, which means red states got much milder winters, most deaths occurred during winter, and covid is pretty seasonal, so we should expect lower-lockdown states to get some sort of fairly significant advantage, but its not clear how much, which confuses everything
My impression is that both the deaths from COVID, and the costs of lockdowns tend to primarily fall upon poor people because they have higher rates of comorbidities, in person jobs, less access to healthcare, less savings, don’t own a home as often, etc. While the $150K/QALY figure for a first world country’s government might make sense to the government, since they have access to a tax base of people and companies who make a ton of money, it might be overpriced in this case.
Note that poorer countries tend to price QALY’s lower. My guess is that that’s because if most of your tax base was making $20K a year, paying 7 times the average annual income to keep someone alive for a year might be more costly and impose higher opportunity costs.
In the case of COVID lockdowns and deaths, most economic damages are going to be born directly by the poor as are deaths. So (without redistribution actions) it’s as though the deaths and monetary costs are born by a lower income country, and thus we should discount the cost of a QALY appropriately so we can better judge tradeoffs.
Of course, some countries (like the US) had pretty massive aid packages that helped make it so the whole population helped bear the costs, which would raise the QALY price back up to the national pricing.
Overall my point is that maybe you should be either more for redistribution during the pandemic (to raise QALY price to where it’s worth it) or more against lockdowns (since QALY price might be lower than your normal estimate).
Obvious disclaimer that QALY prices are for assessing tradeoffs and not for valuing the moral worth of a person’s life.
You seem to be missing the psychological cost of not locking down. Lots of people are frightened by the lack of lockdowns. This isn't just that they are voluntarily locking themselves down, but the emotional / psychological cost of perceiving everyone else as being a (potential) plague-carrier.
If there is non-economic suffering from an absence of lockdown, then that makes the calculation rather more balanced.
"So every 52 months of stricter lockdown in counterfactual Sweden would have saved one month of healthy life. You will have to decide whether you think this is worth it, but it seems pretty harsh to me.... Even if this is true, that just means it’s 21 months of stricter lockdown to save one month of healthy life. Again, seems pretty harsh."
It's very important to note that this isn't the cost of lockdown being compared to life lost, but the emotional cost of an involuntary vs voluntary lockdown. In other words, assuming the wild guesstimate is right, the Swedish locking down as their neighbors did would have been worth it as long as the difference in quality of life between them and their neighbors during the lockdown was no more than 4.8-1.9 %. Now, I didn't live in Sweden during the months of their lockdown, but I highly doubt that they had a great time there, and it's well worth remembering that we were all very far from the Pareto frontier and there weren't many big easy gains to be had. Maybe life was 5% worse or 1% worse in Sweden compared to Denmark during that time, maybe it was even 2% better if life was much scarier and more uncertain for them! But both are swamped by a giant shared hit to quality of life in both countries.
"And even if Sweden had decided to double down and weaken their lockdown despite high case levels, people would probably have voluntarily stayed home more because the pandemic was so bad - inflicting most of the same costs that a state-mandated lockdown would.... This argument seems less convincing in the US, where red states mostly just consistently had weaker lockdowns than blue states did, and never really got stricter to compensate. "
This seems like it was definitely true in Europe in general, and arguably it is less obviously true in the US, but one thing you discount is that maybe the emotional hit got bigger in the non-lockdown states even if measures were never reintroduced. Maybe voluntary behavior change goes higher instead if the red states never got stronger lockdowns to compensate, so the hit is still larger - your evidence is only about legal restrictions, not mobility data.
You say it seems kinda harsh to save one healthy month through 51 months of stricter lockdowns. I think you are overestimating the difference in life quality between softer and stricter lockdowns. For one, voluntary behavior change makes the lived reality in these scenarios not all that different for sensible folks, and for another, a lack of lockdown causes suffering too, both psychologically (feeling like a sacrifice to capitalism in the face of a global crisis) and in terms of being subjected to avoidable risk (having to come into the office where people don't wear masks for no good reason). But I might be biased because introversion causes me to avoid large gatherings anyway, so I barely lose quality of life (and gain some, as remote work and studies are much more to my taste).
Another effect the lockdowns had were in suggesting appropriate voluntary behavior changes. Hearing about possible lockdown measures worked to drive home the idea that these are the things that should be avoided, prohibited or not. Sure, recommendations were made throughout, but a lockdown drives home that really, everyone should do these, it's not one of these things the teacher suggests but the kids ignore.
Is there any known sensible estimate for a conversion of dollars into QALY, possibly assuming all the money to be subtracted directly from some specific healthcare budget or something like that?
Conclusion 2 is doesn't answer the question it's trying to. The headline is "Quantify Emotional Costs Vs. Benefits", but you're not testing the costs of lockdown vs no lockdown. Instead you're testing the marginal benefits and costs of Sweden being stricter like Denmark. I would definitely have liked to see the former, as it is more relevant to the political debates I've seen in the wild; they tend to be "lockdowns are good and we should do them again next pandemic" vs "lockdowns are bad and we shouldn't do them next pandemic".
Regarding the question you did try to answer. I think it's flawed by the lack of a serious attempt to define how much suffering is involved. 51 person-months in stricter lockdown per QAYL saved. If the extra strictness is moving from 100 people per gathering to 10 people per gathering, that seems doable. If it's no school, then it's not worth it.
It's also worth considering positive benefits from the lockdown too. If the cost of a lockdown is that you can't go to a cafe. But the benefit is the waiter isn't forced to choose between bankruptcy and going into work every day terrified you'll catch covid. I would call that a net positive.
This probably applies when comparing the marginal costs/benefits of moving from Sweden to Denmark. But it *definitely* applies when comparing no-lockdown to lockdown. The point you made earlier about "The moral of the story is that everything not forbidden is compulsory, so you can’t always substitute voluntary behavior change for government mandates." absolutely needs to be considered when quantifying emotional costs vs benefits. My working class girlfriend had such rants about how unsympathetic employers around her were when it comes to covid and her daily fear of it reaching the family (they have medical vulnerabilities). Only the lockdown let them isolate, meanwhile my tech company sent everyone home to work in our spacious home offices with gardens outside. Any attempt to measure the emotional costs/benefits of lockdown has to cover the emotional upsides.
> Preliminary Theoretical Issues 6: The Pandemic As A Control System
I think that a complicating factor here is that people don't observe R. They observe (media reports of) cases and deaths.
All other things being equal, a given set of behaviours will result in a particular R. The "pandemic as a control system" theory suggests that R will hover around 1, which implies equivalent behavioural sets under both lockdown and non-lockdown counterfactuals. The potential "win" of lockdowns, therefore, is to induce the "bad covid, therefore panic" set of behaviours earlier than would otherwise happen, so the same R-value (1) can be achieved with a lower overall case and death rate.
This feels like a very complicated problem, in large part because people respond differently to lockdown orders. After a moderate level of restriction, the marginal case might be found in an "essential" business like a logistics warehouse or in a wilfully ignorant member of the population, and imposing further mandatory orders might have little effect. That "resistant margin" may itself vary from time to time and from place to place.
In the scatter plot of stringency on Jan first vs deaths per million, the correlation seems disproportionately driven by six states in the lower right. The rest just look like a blob of noise. Now, %12 of the dataset is obviously too large to be dismissed as an outlier. But which states are they? Is there any particular policy or timing they have in common?
Have there been attempts to look at rates of all-cause mortality in locked down vs non-locked down areas? I could imagine this going either way. Hospital system collapse would increase all-cause mortality, which might not be accounted for by these studies, and in younger people.
IMO (for what it's worth) the critical issues for assessing the efficacy of NPIs are:
1) How do you control for precipitating conditions? In other words, the severity of the interventions was likely, in most cases, a function of the severity of the ongoing pandemic. The severity of the ongoing pandemic would be associated with the severity outcomes independently of the efficacy of the interventions, to some extent. Thus, reverse engineering from comparing outcomes across contexts, w/o controlling for the precipitating conditions, is of limited value.
2) Evaluating the efficacy of NPIs should necessarily address counterfactual assumptions about what would have happened absent the NPIs. You can't assess the differential effect of NPIs w/o addressing the issue of whether things might have been much, much worse if they weren't implemented - say if the pandemic raged more, whether more people would have stayed away from hospitals. That is the 300 lb. elephant in the "lockdown deaths" arguments.
3) Obviously, controlling for confounding variables and spurious associations when making comparisons across countries with vastly different conditions is VERY problematic. IMO, the data available is insufficient to do this. IMO, better is to look at patterns longitudinally in single countries. And even there, we don't really have a long-enough period to evaluate the effect of the NPIs - for example it may take years to really assess the impact of closing schools.
"Here, having US red states switch to a blue-state typical level of lockdown would save one month of healthy life per 51 person-months in stricter lockdown. Again, seems pretty harsh. Another way of looking at this is that each person who spent a month in slightly stricter lockdown would have saved someone else about 15 hours of healthy life"
Given most states had a period of strict early lockdown and then diverged in the pace of reopening how should I think about the hedonic delta between red-state a blue-state lockdown?
If I can save 15 hours of healthy life by wearing a mask, or going without in-person dining, for a month that's one thing. A month with the near total isolation of the early pandemic is another thing entirely.
It's also difficult to construct the hedonic wedge because of how voluntary the restrictions are. I'm young and healthy and aren't in contact with old people, so once most of my friends figured out that outdoor gatherings were okay my life was pretty normal post summer 2020. My uncle literally did not leave his house for any reason from April 2020 until he was vaccinated, but he's generally paranoid and risk averse. Would either of our experiences have changed under different state laws?
Excellent post, which mirrors a lot of my thinking about lockdowns. But I think this:
2: If Sweden had a stronger lockdown more like those of other European countries, it probably could have reduced its death rate by 50-80%, saving 2,500+ lives.
Cannot be squared with this:
3: On a very naïve comparison, US states with stricter lockdowns had about 20% lower death rates than states with weaker ones, and about 0.6% more GDP decline. There are high error bars on both those estimates.
Unless Sweden was extraordinarily more open than even the reddest of states, but it was not:
It looks like the biggest thing a lockdown does is to "give cover" for things that people want to do anyway.
My employer (in Ontario, Canada) sent everyone home that could work from home on March 17. Was thinking about working from home anyway (I do IT stuff relating to cloud, so it's not like I need to be in a cubicle), but this meant I could just do it instead of having to arrange things.
From what I hear, the "return to office" will be based on how much of one's work needs to be done in a cubicle, so I suspect that I will be in the last cohort to return.
One minor quibble about the SF Bay area Mobility Trends graph — people seem to forget that the SF Bay area counties were three weeks ahead of the rest of California in locking down. It's a mistake to say "It’s pretty evident from this graph that people were starting to decrease their mobility before any official government action." Mayor London Breed of San Francisco declared a state of emergency in SF on Feb 25th 2020, three weeks before Governor Newsom made his shelter in place announcement. Likewise, Santa Clara County asked employers to have their employees work from that last week February. And all the bay area counties coordinated their response to the early outbreak. I started tracking and graphing the case numbers between SF Bay area and LA, and the three-week head start that SF Bay area had made a big difference in the overall case loads between the two metro areas.
The premise behind lockdowns was not to reduce total infections, but rather to flatten the curve so that the hospitals were not overwhelmed. That appears to have succeeded in most places. If people are not vaccinated, lockdowns simply wont stop the spread of the virus since as soon as people are free, they will move about.
Different levels of lockdown had less of an effect on US states than European countries because there's no practical way to close a state's borders. While Norwegian customs officers could force foreign arrivals to quarantine at a hotel for ten days, there's no infrastructure stop someone from locked-down California from partying in Las Vegas for the weekend.
One potential confounding variable might be hospital availability. In a hypothetical country with an infinite number of hospital beds, we would expect the death toll to be significantly lower -- though obviously not zero; and thus the effect of lockdowns would be attenuated. In a place like NY or CA (to a lesser extent), where hospitals quickly got saturated, the opposite is the case.
Thanks for this. In regards to voluntary vs forced quarantine. I really liked the idea put forward by Po-Shen Loh (I heard on Lex Fridman https://lexfridman.com/po-shen-loh/) And explained some here. https://www.novid.org/ (though not a great web site.) The idea is to let you know when people 'near you' are getting infected and that allows you to decide when it's wise for you to voluntarily quarantine. The key idea to me is that this has all the right feedback.
There are significant "blue" populations in red states (particularly in major metro areas) and vice versa. Maybe "states" are just too broad a brush to paint with?
According to that New Yorker article, you really have to look at communities rather than the states to get a truer picture. If 40% of COVID deaths were nursing home-related, how those communities reacted to the virus would be a compelling variable.
If "blue" counties had higher compliance with lockdown procedures, there is still the variable of high minority populations who worked in industries such as food processing, nursing home care, and other essential industries AND who lived in extended family situations, which may have significantly skewed the "blue" county numbers up.
So, I'd love to see a breakdown of "blue" versus "red" counties. Also, possible to examine COVID-related deaths by political affiliation? That may broadly indicate who was taking lockdowns seriously versus not? Obesity was a significant variable in worse outcomes - could obesity rates by county be correlated?
The biggest problem here is the assumption that there aren't external natural causes for increases and declines in case rates. There are no lockdowns for the flu and it is quite seasonal and people aren't voluntarily changing behavior for a flu outbreak. The timing of the worst US covid outbreak is nearly coincidental with the flu season. People change their behavior by season but this would still need to be factored out for a fair comparison that was judging either personal change from fear or government mandate.
The seasonality of the flu is not well understood and one assumes parts of the increase and decrease of covid are also unrelated to behavior (perhaps temperature, humidity, etc.).
The deaths were a majority in old age homes that weren't able to cope. Something like 81% in Canada. Something like half in Sweden of all deaths were in old age homes. 42% in the US. Belgium 42%. 64% Norway. Spain 52% How the old were handled were likely the most important factor. How soon these were locked down and managed.
"If there had been looser lockdowns, more children would have had to go to school, which would have been either good or bad depending on how you feel about school."
This is a throwaway line in the essay and not the main point, but I think it undersells the likely importance of this decision.
The mainstream economic consensus is that each year of schooling increases lifetime income by 10%. In the United States this equates to an economic cost of ~100K (in net present value).
We have absolutely no idea how much worse virtual school is than in person education, but even a conservative estimate of 10% would equate to a cost of $700B. Dividing that in half (to only apply to the blue states) would mean that the costs of closing schools were more than 6 times higher than the direct economic impacts.
In your GDP vs lockdown analysis, what are the units for GDP? I know its decrease in GDP but is that a raw value or a percentage of GDP for some control day?
Pretty disappointed that you missed the most obvious confounder in all this discussion. Quote:
*** This is an absolutely beautiful graph. It’s showing how lockdown strictness (as of May 5) correlates with death rate over time. We find that early in the epidemic, the stricter your lockdown, the worse you're doing. This is the endogeneity - places (like NYC) that are doing really badly institute strict lockdowns to try to save themselves. Later in the epidemic, the stricter your lockdown, the better you're doing - probably because the strict lockdown is giving good results. ***
OR it could be that the states that got hit early had partial herd immunity because of getting hit early. This continually got missed by everyone all of 2020 and I'm sad you missed it today.
The biggest problem with this post is that the range is too limited. The post does not mention the most obvious lockdown failures: India (which had the strictest lockdown) and Peru (which had the highest COVID death rate). It also does not mention the fairly lockdown-light East Asian success stories.
"In the end, Sweden still ended out with a death rate about double the European average. Seems pretty bad."
Objection: there's no such thing as a European average pre-second wave because Eastern and Central Europe was spared. In the end, Sweden ended up having a lower COVID death rate than most Eastern Europe.
"The real question we should be asking is what set of policies countries should have implemented."
Bingo.
"Contra Lemoine’s picture where Sweden just has an earlier start but eventually does no worse than everywhere else, here Sweden has the same (or better) start as everyone else, but clearly does worse afterwards."
Agreed.
"If Sweden had a stronger lockdown more like those of other European countries, it probably could have reduced its death rate by 50-80%, saving 2,500+ lives."
This is a dubious conclusion; it's only true for the first wave, if it's true at all. But there is a difference between preventing deaths and delaying them; Bulgaria had hardly any Spring 2020 wave at all, after its winter and spring waves it has the second-highest COVID death rate in the world.
Any analysis of lockdowns need to tease out nursing home policy. Sweden was blasted over it, so were New York and Pennsylvania. In my PA county to this day, 64% of deaths were nursing home residents. No amount of lockdowns was going to salvage a policy of stuffing confirmed COVID-positive patients back into poorly ventilated nursing homes
> Nobody agrees on exactly what “Scandinavian/Nordic” is
There appears to be a consensus that "Nordic" means exactly the five countries you mentioned, and it's just "Scandinavia" that's ambiguous, with it most often referring to Sweden, Norway, and Denmark, but sometimes also excluding Denmark, or being used synonymously with Nordic countries, as you do here. At least, that's what wikipedia says, and the maps I find by searching those terms on google images seems to support it.
Excess fatality tells a different story still. Personally, I'm content in knowing that I'll never know the effectiveness of various measures. Can you ever really know? If the deaths had been really bad, who knows we might have freaked out enough to start taking vaccines, try vit. D/ivm, let people test themselves, etc.
It's been unfortunate to see the discussion framed in terms of data rather than principles. If government can do X if data is Y then moral hazard naturally increases greatly as the measurement error in Y increases. I'd much rather attempt to reach consensus on the moral/philosophical framework.
Can someone help me evaluate the Leech study on mask wearing? They detect a significant reduction in R from mask use, but they use a seemingly super-complex hierarchical bayesian model which always makes me suspicious. Does the data really support their conclusion or are they hacking their model somehow? I've seen other observational studies that don't correlate mask usage with R reduction, lab studies that show no reduction in viral cultures from mask wearers, and older data which indicate masks don't reduce influenza transmission. Can someone help me reconcile these data? I'm sure n95 masks help, but in my experience it doesn't seem like anyone wears those and I am highly skeptical that the average cloth mask worn by the average person could possibly do anything.
Your analysis of Sweden is flawed as you're using doctored stringency data. Go to an earlier version of the data and see how much they bumped Sweden's stringency index up by. They claimed they did this because of some vague guidance that was in place (rather than laws or mandates). Their data is silly as it suggests Norway and Finland were even less stringent than Sweden
Here is a theory of lockdown: lockdowns can help people co-ordinate. If the virus is in the community and I don't think people will keep R far enough below 1 to eliminate it, then I have no reason to take avoidance measures beyond protecting my own health. Because infection risk increases with disease prevalence, everyone taking "personal risk measures" will always be insufficient on average to drive R below 1 if the prevalence is low enough (though they may be sufficient once the prevalence rises a lot) and so the disease will persist with cyclic pattern that depends on how quickly people re-evaluate personal risk based on changes in community prevalence.
However, with a lockdown aimed at elimination I can believe that other people will keep R down enough for elimination and I can now weigh the risks I take against the costly possibilities of compromising elimination or extending the lockdown instead of the less costly possibility of personally dealing with getting sick. Thus, with a lockdown, even under my own evaluation I should accept a much lower risk of infection. There is still a prevalence below which I won't take many precautions - but it is much lower, possibly lower than 1 case in the entire country in which case I can take precautions until elimination is probably achieved.
This is a very different theory of lockdown to "disease burden management", though! Also contradicts the view I advocated early last year which was that 12 months of suppression is a reasonable aim.
> nobody responds to the virus in any way and it spreads uncontrollably until 70% of the population has been infected.
70% is the threshold for herd immunity in a naive SIR model with an R of 3.33, but due to the phenomenon of "overshoot", the virus would infect 96% of the population before petering out. The "herd immunity threshold" means the reproduction number of the virus goes down to one (not zero). When that threshold is crossed, there is still a very large population of infectious people, each of whom infects one other.
The equation for the proportion (p) of a population infected by a virus with reproductive number R at the end state of an epidemic satisfies p = 1 - e^(-p*r). So once overshoot is considered, and assuming no intervention, the R of the disease which infects 70% of the population before sputtering out is about 1.7.
I'm not sure what to make of the mobility data. The rest of the data seems to suggest that lockdowns make a difference beyond what people did on their own, but the mobility data suggests that the government was basically telling people to keep doing what they were already doing. Maybe things like "ban on large gatherings" don't show up in mobility data (not that many people are going to conventions), but make a big difference in the spread? Maybe making the lockdown involuntary prevents things like "your boss tells you to come in even if you're sick"?
Your link to "value of one life" per the EPA doesn't link to the EPA. It instead links to a Statista article on "Percent change in Real Gross Domestic Product (GDP) of the United States from preceding period in 2020, by state", which I presume is an error?
The data you looked at, how you looked at it and the various ways of interpreting the data, and, of course, the questions you asked were fascinating and helpful. I can now think of this subject in more enjoyable ways. It's truly a breeze not having all the answers while maintaining methods of attaining them someday. It must be truly stressful needing an answer.
I believe serology tests in NYC suggest the number there was about 15%, I'm not sure why this shouldn't be a big deal because (to simplify massively) if all your super-spreader types are in that 15% of your population, you now have no more super-spreading events to worry about.
>This is a victory for lockdowns insofar as the correlation is significant, but strong proponents might be surprised by how small the effect was.
It would be even smaller if you just drew the straight line through the main cluster instead of calculating a least squares fit. Also "correlation is significant" isn't really appropriate here, you can't just feed your data into something that then spits out the words "significant" or "not significant" and then expect it to mean something; "significant" and "not significant" is *always* tied to a statistical model which you do not have.
Would it be arbitrary and sill and not at all mathematical to just draw the straight line by hand? Yes. Would it be mathematically any worse than what you are doing now? No. If you're doing a least-squares fit on data like this you already statistically in a state of sin.
> US states mostly had stable and predictable responses based on their internal politics - a nice exogenous factor!
Which correlates with the amount of voluntary changes people make; what do you think would happen if you tried to control for those?
a) In the discussion about lockdowns vs voluntary behaviour change the two are considered to have a complicated relationship but still to some degree independent. I think there's also a possibility that voluntary behaviour changes *because* people can hear their government debate lockdowns and can see it might be needed. I.e. the political discussion about lockdowns is also part of the pressure on voluntary change.
b) The death rate calculation is only looking at people dying of Covid. In the UK we've also seen that hospitals full of covid patients have to move resources away from other activities. This gives rise to an ever-growing waiting list for other operations. So you have lower standards of daily life for hundreds of thousands of people and many more deaths. The full death toll, and the 'how many good years saved,' calculations really ought to include people waiting more than a year for gallbladder operations etc.
In summary point 3, shouldn't that be 0.6%pts more GDP decline, not 0.6%? If the latter then that's almost nothing, but I gather from the data and discussion earlier it's a 0.6% point difference in the change in GDP.
Small note: I think looking at excess deaths is much better than relying on self-reported stats. Eurostat has a tool where one can see excess deaths (easily found via searchsites). It would not change Sweden's general position as doing worst in the Nordics, but would increase the distance between itself and other Western European countries.
One should also make note of the fact that Sweden is by far the most diverse Nordic country, and deaths in all Western countries have been concentrated among immigrant-heavy populations, partly for cultural reasons (high prevalence of multi-generational homes) but also socioeconomic (disproportionately the poorest groups).
At least early on, I think the Swedish focus was clearly more on mitigation than suppression. It seems quite clear that there is a link between that strategy and the high number of covid fatalities in the first wave, as you point out. However, one could argue that the strategy was _partly_ vindicated if you consider the cumulative deaths over the _entire period_ up until now. While Sweden was 2x above EU average by August 2020 in terms of cumulative confirmed covid-19 deaths per million people (as you pointed out), by now it's actually <10% _below_ EU average. Does this mean that Swedish chose a smarter strategy for 2nd and 3rd wave? That there is a natural "reversion to the mean" over time, as most governments were unable to protect the most fragile people for more than a year until the vaccines arrived? I don't know, but it would be interesting to hear your thoughts on it.
In a sense the analysis here is for "we tried X, it mostly didn't work, was it still worth it?" But that doesn't seem like a fair analysis to answer the question "is X worth it"?
In my memory the trade-off at the time was between "can we flatten the curve or do we need a lockdown?" Where "flattening the curve" meant staying at home if you're sick, social distancing when you're out, not shaking hands, don't touch your face etc, it was seen as the more gentle, cheaper approach that could get us through without overwhelming the hospitals. The alternative was a "lockdown" where everyone stays at home and you close businesses, which was more expensive, but was going to give us similar results as in China, where you completely get the virus under control, at least enough to go back to contact tracing.
Importantly this means that we didn't get the benefits that we were promised. We got the costs of a lockdown with the benefits of "flattening the curve."
If these were different terms at some point ("lockdown" and "flatten the curve" got mixed together very quickly after lockdowns started, as if they used to not be competing opposite alternatives...) then the calculation is very different, because we didn't expect the outcome that we got. In hindsight it's easy to say "we didn't get the Chinese results in the US and Europe, so overall it's an expensive measure that didn't get us many benefits" but you couldn't have known that at the time.
Another example may be the collapsed apartment building in Florida recently. Imagine you're one of the people who just bought an apartment in there a few months ago. You bought an apartment, the building collapsed, so now you either don't have an apartment or you're dead. Does that mean that buying apartments is a bad idea? No, because at the time you didn't know that the building would collapse. You have to judge the decision based on what you knew at the time, and usually buying apartments is a good idea.
Of course once people started sabotaging the lockdowns, (most obviously Trump, but also Cuomo keeping construction going...) and once the goal shifted to "we're just trying to flatten the curve" you could have argued that that doesn't make sense any more. And I never heard a good justification for the later lockdowns in Europe.
But before the sabotage we could only make the decision based on the results we saw in China. And some countries got the same benefits as China.
In the next pandemic, if people argue for another lockdown, what will we decide based on? Will we decide based on how lockdowns went in countries that messed it up last time, or based on the countries where the lockdown worked last time? I predict it'll be the latter. People will say "we should do a lockdown, and we should do one that works, because it can rapidly end the pandemic." If that's true, and if people aren't interested in dragging the next pandemic out like we did this one, (see the strong reaction in Asia this time, who had the prior experience of SARS) then they won't consult the analysis in this blog post, because it's only looking at cases where the lockdown mostly didn't work.
> If we had let the virus spread more, it would have gotten more chances to mutate.
Is this so certain? I'm thinking that, given the same number of total people infected, flattening the curve and keeping R on average around one for a longer time is much much worse regarding giving the virus maximum selective pressure, and it probably more than makes up for the reduced total number of people infected.
Also, let's irresponsibly assume stuff. Let's say that, doing nothing, 2% of the population would have died within the first 6 months and then herd immunity. And that each death killed 10 years of life. So the pandemic ended within 6 months, reducing life expenctancy by 2% of 10 years = 70 days. As a citizen of Spain (life expectancy of 83.2 years), you would need >23 covid pandemics in your lifetime to turn your country into the US (life expectancy 78.5).
For US comparisons it would be nice to look only at what types of businesses are allowed to be open (also if we were able to know what fraction of eligible businesses were open as a measure of voluntary effect) since that's really the area the government has the most control over (since we did not use the police to break up house parties or give fines to individuals for walking outside etc)
I don't think Conclusion #2 (Quantifying Emotional Costs) gets enough attention. In my opinion, this is perhaps the most important trade-off. I lived in Idaho (with family in Spain) through this whole thing and I can't think of a better place to have been through it all... I sure was glad I didn't live like a prisoner as in Europe (for a whole year!); in rural parts you wouldn't know there was a virus even during the second wave in the winter.
And all this madness everywhere else just to save a few QALY (at the cost of sacrificing a bunch more QALY)? I think there is a lot more to live than avoiding death. And somehow, Idaho's deaths numbers are some of the better ones too!
The one aspect which only time will uncover: the economic ill effects from the lockdown are long term. Small businesses destroyed - the health and economic effects are decadal. Even people unemployed but on short term government subsidies - that impact is also decadal.
The entire economics analysis is contingent on a false assumption - that economic activity/growth is independent from one political entity to the next. If all but one country decide to lock down their borders and limit trade, how much of a difference does it make that the one holdout is still willing to play? If all your kid's friends tell him they won't play with him, you can't claim that he's outside "playing with friends" because he's still willing to get together. Economic activity isn't independent, and this assumption should place a giant red asterisk on the whole analysis.
Let's do a counterfactual reasonableness analysis. Let's say nobody knew about COVID-19, because we hadn't invented the technology to test for it, and hospitals just treated it like a particularly bad cold. Cumulative US deaths from COVID-19 for >1year currently stand at <0.2% of the population. Cumulative infections at close to 10%. Is it reasonable to attribute massive GDP changes to the virus alone? (Because <0.2% of people died and <10% got sick for two weeks?)
What if next year a bad variant of H2N3 flu started spreading across the US, but nobody was focused on it because we were too busy watching for more COVID-19. Say 10% of people got sick from it for 2 weeks, but nobody got scared because everyone who got tested showed they were negative for COVID-19. Of those infected, around 600k people died (out of a population of >350million), but they were mostly elderly, so nobody thought it was out of the ordinary. How likely is it that a drop in GDP would have even been measurable under those circumstances?
Now, maybe that thought experiment doesn't exactly encapsulate the difference between voluntary behavior and lockdowns. But it seems clear to me that nearly all of the economic impact from COVID-19 is downstream of behavior, not due to the virus itself.
I think this analysis missed out on the fact that increasing voluntary quarantining decreases the cost of mandatory quarantining.
This is maybe impossible to measure, but I think it would dramatically affect the cost calculations when looking at red vs blue states, as my assumption is that blue states had much higher rates of voluntary quarantining, and so stricter lockdowns were less costly there than they would have been in red states.
I played and earned Czechia probably $10B by killing all the old people who were going to use healthcare, draw from retirement, etc. Not to say that makes much sense, but neither does estimating the "economic costs" while ignoring the largest factor.
A very well written, sober and judicious piece. Nicely done indeed.
I have on quibble, which is with your conclusion #5, in which you compare the cost of emotional suffering by those who endured lockdowns with the benefit of the QUALMs gained by people who don't die of COVID.
I think if you are going to count the *emotional* suffering of those who endure lockdowns on the "cost" side of the ledger, then you have to count the (averted) *emotional* suffering of the friends and family of those who would have died on the "benefit" side.
The emotional cost of a death is not just, and perhaps ultimately not even mostly, borne by the person himself dying -- a death has savage emotional (and even practical, financial, childrearing et cetera) repercussions among the family of the deceased, and these go on for a long time, years often.
One point I'd make is that decisions by politicians have ramifications even where the leader's writ doesn't run. For example, on March 15, 2020, the mayor of Los Angeles shut all the movie theaters in Los Angeles, the movie capital of the world. I suspect that had impact around the world because you'd expect the mayor of Los Angeles to be in favor of people thinking of going to the movies as a fun and safe thing to do for the whole family, kind of like how the mayor of Amityville in "Jaws" is pro-going-to-the-beach. But suddenly Mayor Garcetti was announcing, in effect, that going to the movies could KILL you, so do not, by order of law, partake of Los Angeles' most famous product.
In contrast, the prime minister of Sweden did not shut Sweden's movie theaters. But very rapidly, nobody was going to Sweden's movie theaters so they shut themselves down for lack of business.
Ironically, the payoff from lockdowns in America is mostly due to the almost miraculously effective mRNA vaccines riding to the rescue faster than just about anybody other than the ever-optimistic Mr. Trump imagined. If instead we got, say, some 75% efficacy vaccines in late 2021 with supply chain problems keeping everybody who wanted a vaccine from getting one before 2023, then we in the US would have likely gone through 7 or 8 waves infecting maybe 75% of the population before the vaccines finally kicked in.
Under that scenario it's hard to see much point in kicking the can down the road with lockdowns other than to avoid overloading the hospitals (and hospital administrators proved pretty good at stretching the capacity of their hospitals in the pinch).
Of course, under that scenario, lots of people would have voluntarily locked themselves down: e.g., as I pointed out 15 months ago, movie theaters were legally free to be open in Sweden, but their owners shut them down anyway because everybody had stopped going to the movies. (I cite movie theater data a lot because it's easy to find only at BoxOfficeMojo.com.)
But because of the remarkable efficacy and speed of development of vaccines (which, amusingly, Biden and Harris were spreading Fear, Uncertainty, and Doubt about during their debates last fall), blue state policies come out looking pretty good.
Back on March 18, 2020, I wrote:
"The [British] forecasters argue that suppression would need to be practiced for the majority of the next eighteen months, at which point they hope a vaccine would be ready.
"Even worse, I’d point out, it’s possible that no vaccine will be found: Coronaviruses are hard to vaccinate against. They tend to mutate rapidly.
"On the other hand, kicking the can down the road for seven months or so on the prospect of mass death might possibly pay off in multiple ways, not all of which can be specifically anticipated at present.
"For instance, it seems possible for the English-speaking countries to have a South Korean-style testing regimen working by fall that could put out flare-ups before they turn into the apocalypse.
"There are many different methods to create a vaccine. Well-funded crash programs might get lucky.
"They could speed things up somewhat by cutting corners on safety. Today’s vaccine researchers are not used to taking heroic steps to rush because they typically work on the fairly obscure infectious diseases that still lack vaccines, so there isn’t much excuse for risking nasty side effects lately.
"Medical treatment of the infected ought to improve with time. Testing will certainly get better than it has been. (In America, it can’t get worse.)"
Apologies I only had time to skim this for now, although it all looks reasonable and I'll try to read it more closely when I have time. Apologies for the usual academic self-promotion, but I did want to mention that I just published a paper on this topic in Health Services Research:
The disadvantage compared to many of the ones discussed here is that ours is [much] less sophisticated modeling. The advantage is that by the same token we require [many] fewer assumptions.
What's the explanation for the Sweeden's huge peak around Jun 9-29 in infections not translating into analogous peak in covid deaths (which seem to continue to decline in this period)?
Is it that the first wave killed all voulnerable targets? Or perhaps voulnerable people stayed at home during the second wave? Or did something change in medical capacity or reporting? What's the official story?
My take: if this much analysis can only find a possible, small effect, then all but the most comically inadequate utilitarian (plausible) moral theory must condemn lockdowns vehemently.
By the way, since there's been people suggesting similar threads for masks, vaccines etc., can I suggest another Much More Than You Want To Know COVID thread for a topic that's interested me for quite a bit but which I can't really make heads or tails out of: Long COVID? How much is it a real physical thing, how much a psychological thing, and how much other conditions lumped with one moniker when they randomly crop up or flare out after COVID? What are the actual numbers of sufferers - and how many of the cases are serious, or have lasted more than a few months? There really is little "official" information of any kind on these.
It’s good that you made an effort to assess actions in a comprehensive way and the additional debate and discussion is also useful. The discussion HAS to begin somewhere. The mental health aspects of the lockdowns remain largely unrecognized and unreported. Anecdotally, therapists were nowhere to be found in the US after the child depression epidemic spiked. Appointments were available one year out in the Seattle area for example. Hopefully some best practices around how to handle a pandemic will emerge. Lessons of the Spanish Flu didn’t seem to provide much guidance except that children remained in school and didn’t have screens so they were already outdoors, which probably helped a great deal.
I'm not sure I absorbed all of the statistical analysis, every time I try to consider more than a few simple factors, my head spins. However, just to throw *more* info into your pile, here's some potentially interesting information that is not usually discussed when going over the Swedish infection rates/death rates and course of the pandemic in 2020.
A lot of what happened initially in the pandemic (ie Feb-Mar 2020) was the result of a ‘perfect storm’ of setup and subsequent events. The longest prior situational setup was that, prior to 8 years ago, there was a gap in the Social Democratic dominance of parliament for two terms, where “Moderates” (considered right-ish here, more like Obama-style democracy/neo-liberalism) had a coalition with the Liberals (market libertarians) and other right-leaning parties. Several waves of privatization and deregulation happened in this government, eg they sold the post office to the Danish company Postnord (who promptly shut down 2/3 of processing stations to function economically, you can imagine how the mail is now), most of the health clinics were sold to Capio (a CAPital Investment Organization who runs health care in France, yup, health clinics have immense wait times now and are understaffed )and more that lovely old Social Democratic Sweden will never recover from…
Now, old peoples’ homes used to be run by the state, but many had been farmed out to private organizations who either cited some obscure regulation (not enough space between a door and a window type of thing) to kick all the old folks out and then rent the places out to refugees/asylum seekers, charging the state massive rent as Sweden received more and more people fleeing war and famine etc in Iraq, Syria, Eritrea, Afghanistan, etc. Or they continued to run them as old-folks' homes, just more cheaply.
The remaining now-private old peoples’ homes were additionally no longer regulated with regard to what was legal or necessary training for the workers—nor pay levels for workers—so the äldreboende ended up losing all their previous staff who simply would not work for minimum wage, and hiring, yes, off-the-boat immigrants at low pay, and no training.
Ok, so, next step. Stockholm, being the “Capitol of Scandinavia” is a very wealthy city, by which I mean: it’s extremely bourgeois. One of the yearly parts of people’s lives is Sportlov, a “sporting vacation” that happens in late February, where everybody goes skiing! Except, if you’re rich and from Stockholm, you don’t go skiing in Sweden, it’s too flat, so you go to Northern Italy. Only the middle class skis within Sweden.
(personal note, I was playing music on tour in the US in Dec2019-Jan2020, we all got incredibly sick directly after shows on the west coast after Christmas, continued with shows on the East Coast with the aid of University sports doctors applying “Z-pacs” of steroids and antibiotics, so we were probably super spreaders of an as-yet-unknown virus! I got back to Stockholm at the beginning of Feb, had two more shows in Finland mid-Feb, but by then Covid-19 had been identified and the start of pandemic prep had begun. Not that my family goes anywhere for Sportlov anyway, we’re not that class of citizens, being musicians and schoolteachers.)
So. Rich people flying to Northern Italy in February 2020. Who drives them to and from the airports? Taxis. The cab drivers are, yup, mostly recent immigrants from the aforementioned war-torn regions, who, having escaped with families, often live in multi-generational households. Viral transmission begins in earnest, apparently a lot from London and to a lesser extent from Northern Italy. The taxi drivers are a big vector. This combines with in-country skiers flying up north to ski in Sweden.
In many of these households it is/was common to sit by the bedside of a person who is sick, and you can imagine the health and safety warnings not exactly reaching through the language barriers (honestly, even getting info through to me in English was not top notch, and I saw nothing in Arabic or Somalian/Eritrean at that time, and I live across the street from an asyl-boende, where they house teenage asylum seekers with no families.) Older people started getting Covid, the families sat with them, then the men go back to work driving the taxis, the women off to the old peoples’ homes, where viral transmission starts to take hold of the elder population in a big way. And the people working in the old peoples’ homes did not know how to deal with it due to a) no actual medical or assistance training and b) language barriers. The bulk of Covid infection in Stockholm, the bulk of the deaths in March and April 2020 were caused by these vectors, minimum wage jobs held by recent immigrants carrying the virus home from rich people traveling the world, to their families and then out to their jobs. So the thing is, there *are* a lot of multi-generational households here, they just aren’t the rich white peoples’ households.
It took most of April and into May before they figured that out. Regardless, I don’t think any regulation has yet been put in place regarding training for hospice workers—it takes a long time to get anything done in this sort of bureaucracy. At least this year (2021) I’ve seen vaccination posters and info in nearly every language available all over the place. I think there are people *not* getting vaccinated, still (I believe it’s just gotten to the under-30 year olds this month) because, yes people are idiots and especially in extremely entitled societies there will be people who think that nothing can harm them. With the lack of any real lockdown, most people (in Stockholm anyway, I didn’t go anywhere to observe anybody else this past year) ignore anything not explicitly mandatory—mask usage on the subways was like 5% max any time during the past year+. People just don’t pay attention, think “won’t happen to me!” etc. So you could consider 'entitlement' a possible factor as well.
At least that's where you have to look as well, if you see such a huge difference, but I guess you have to know say italians and scandinavians personally, otherwise it might not be a common knowledge.
Curious where these numbers come from, given that they are not at the link ...
> For example, when the EPA is determining how worth-it environmental regulations are, they value one life at $9.1 million; when the Department of Transportation is determining how worth-it road safety regulations are, they value a life at $9.6 million
Thank you, great analysis, for me the crucial point: "It's harder to justify strict lockdowns in terms of the non-economic suffering produced. Even assumptions skewed to be maximally pro-strict-lockdown, eg where strict lockdowns would have prevented every single coronavirus case, suggest that it would have taken dozens of months of somewhat stricter lockdown to save one month of healthy life."
and I would add that what you missed - you didn't address at all - is who is threatened by the disease and who is threatened by the restrictions, that here we are clearly shifting the burden from the sick and elderly to the children, that they are hardly threatened by the virus at all, but by the restrictions quite fundamentally, and again it is up for debate how such a manufactured shift is moral
and the second point, that you does not address at all that restrictions can still hurt after they have ended, as explained here:
Brilliant pondering. My take is the population that continues to wear masks and vaccinate will be generally fine as the variant breaks through the vaccinated. Those who don’t continue to wear masks or eschew vaccination will have a much higher viral load, and thus a tougher fight for recovery. For children under 12, they need to be isolated until a vaccination is available to them.
I remember people talking about non-official signals of seriousness as drivers of individual behavior; that there was a major uptick in taking the pandemic seriously when large organizations (e.g. the NCAA and NBA) started taking it seriously even though it lost them a lot of money and a major downtick when leaders (California, Britain, etc) were caught hypocritically flouting their own lockdowns.
Even if the confounding factors could all be untangled, isn't all of this granular analysis basically pointless because: (1) the "new infection" data are kinda garbage due to positive test rates being highly unreliable and, in any event, testing is not conducted on a randomized basis; and (2) the "covid deaths" data are also kinda garbage because they don't distinguish "died with" and "died from" covid.
I didn't see where you dealt with the problem of risk. Unlike plague, dengue or cholera, COVID was a novel disease. We now know all kinds of stuff we didn't in early 2020. For example, we know roughly how dangerous and how contagious it is. We know how likely it is to kill someone, how long a typical infection will last, something about how to treat the disease, how quickly it mutates and so on. A lot of our knowledge is still sketchy. No one has had COVID and lived for even two years.
When dealing with a novel risk, it can make sense to be more cautious than when dealing with a well understood risk. Doing a retrospective analysis ignores this. It's called Monday morning quarterbacking in certain circles. Suppose COVID had been more deadly, less amenable to such treatment as we now have, more infectious, more likely to become more dangerous adn so on. Similarly, it could, as our president at the time suggested, have simply gone away on its own.
If you are a politician, you have to deal with risk. Sometimes they overreact. After 9/11 the political assumption was that the world was full of terrorists plotting new, similar attacks, and that it made sense to invade Afghanistan and Iraq, if only to send a message that the US was serious about fighting terrorism. Anyone who suggested that this was overreacting, perhaps arguing that it made sense to invade Afghanistan where the attack was organized but not Iraq which had nothing to do with it, they were noisily and sometimes viciously shouted down and sidelined. One politician argued that overreaction was proper in the face of "unknown unknowns".
Of course, it was much easier to understand and deal with 9/11 style terrorism. We had a lot of knowledge about how terrorist attacks could work, what was needed to make them less likely, conditions and potentials in the Mideast and existing terrorist organizations. It's not as if the intelligence community knew nothing about Al Qaeda and friends.
In contrast, COVID was something no one had ever seen before. The closest models were SARS and MERS which were much less infectious and could be stopped with conventional contact tracing. COVID was clearly more dangerous and much less well known. The only way to find out what the threat was was to let the threat play out and try to stay ahead of it. Needless to say, this did not work very well in Italy, NYC or elsewhere. It only worked in China because of massive reaction, shutting down entire cities, complete lockdowns that would have been impossible in less regulated nations.
Looking back and saying that we should have traded so many dollars for so many lives or illnesses or perhaps traded so many lives or illnesses for dollars is rather pointless.
As mentioned: Belgium covid high death rate partly explained by an unusual counting method. I'm surprised this analysis did not include excess death rate trends. Data for 2020 has come out, for example, here. This table is "age adjusted"; I'm not clear how that works exactly). Note that Sweden comes out lower/"better" than Germany by this metric. https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/ )
I'm missing your ethical assumptions in this piece when you talk about what does and doesn't justify a lockdown. You seem to be implying in some parts that governments ought to act according to some utilitarian sum, but why shouldn't they (for example) maximize freedoms of the individual? Actually I don't think 'objective ethical theories' can be grounded at all and then government are just the results of complicated social contracts between citizens that act out of their (ir)rational self-interest, and from that perspective why be in favour of a lockdown if it doesn't benefit you more than not having a lockdown?
Late response here, but the Branch Covidians are plunging us into a dark age from which we may never recover. If you think this was about giving boomers 1-2 years of extra life, or saving fat people, this is very naive.
Humans aren’t meant to do lockdowns, better to have no humans left than a world where we are tightly controlled in this way.
I’d rather DIE than live in China, and am starting to think that everyone should rather than anyine live in such a subhuman state where you can be welded into your dwelling, removed into camps, injected involuntarily and be rendered nonessential
As a psychiatrist, if you don’t recognize the catastrophic effect of this on mental health, I suggest a new profession
No mention of Australia or New Zealand?
Interesting to consider how this applies to yearly influenza. All the above things considered, would pro-lockdown people suggest yearly lockdowns until universal flu vaccines? It's unfortunate RNA viruses mutate so damn much.
What is the purpose of performing multiple high and sub-level analyses of changing definitions of what constitutes a case, what constitutes a hospitalization and what constitutes a death? First of all, more testing initially means a spike in cases. There is already a high false positive rate for testing regurgitating dead nucleotides and amplifying it many times just to get a match. Threshold sensitivities were modified for non-vaccinated vs vaccinated patients. Case counts were modified from 'clinical x-rays' to '# of symptoms' to 'if you had a positive test within 28 days, inclusive if you died from a ladder or car accident'. Testing was eliminated for those who were already vaccinated or partially vaccinated. Older patients were forcibly locked up together in elder care homes with positive cases, even though the # of co-morbidities for each case due to death is already high, and has an average age in the 80s... The cofounding incentives of diagnosing patients as positive or getting treatments, getting payoffs either by medical practitioners or hospitals. The ad nausea footage of the Chinese falling ill and locking up of doors with piling dead bodies when the elephant in the room is that countries like Russia/China and some states in the United States have been fully opened for more than one year yet the cognitive dissonance when none of this materializes in the West. The initialization of pandemic by case counts, not by death rates as changed per WHO's guidelines a decade ago. Moving targets, changing definitions, high compliance rates yet no difference whatsoever or strong correlations when compared to different nations that didn't even bother reacting. Flu cases mysteriously disappearing or causes attributable to other causes of death being removed, when people are denied services to hospitals for testing/treatments because of a focus solely on this .. illness. The alignment of recurring seasonality of influenza/flu season with spike in cases, also post-mortem death rates following 'variants' / high vaccination rates. There are a lot of confounding variables that make this whole point moot. Placebo groups are entirely vaccinated.. already or they weren't treated with a negative control but an alternative vaccine for measles. No baseline studies for animal mortality. Multiple stakeholders/shareholders in multiple corporations/media companies/fact checkers/social media platforms incestuously having a strong profit incentive for booster shots or stronger lockdowns.
I live in Wisconsin, a state that had a judicial fiat against lockdowns for most of the pandemic but is otherwise very similar to its neighbors Minnesota and Michigan, which had fairly significant lockdowns. I've been hollering to the wilderness that the pandemic really didn't seem that much worse, or the economy any better, than these natural comparisons. Nice to see someone do the work to confirm my suspicions.
Better HVAC could be a game changer. Maybe someone needs to invent a ceiling fan with a filter which is continuously irradiated by UV light, which draws all the droplets up to the ceiling and neutralizes them. If this already exists, let me know.
Hansonian hot take: lockdowns aren't about preventing COVID, they're about preventing dissatisfaction in conscientious distanced citizens, who want official validation that their non-distancing neighbors *should have* stayed indoors as much as them. In other words, staying at home causes lockdowns.
A few points, at the risk of repeating myself:
1) "This is an absolutely beautiful graph. It’s showing how lockdown strictness (as of May 5) correlates with death rate over time. We find that early in the epidemic, the stricter your lockdown, the worse you're doing. This is the endogeneity... Later in the epidemic, the stricter your lockdown, the better you're doing - probably because the strict lockdown is giving good results."
While the graph indeed looks quite nice, the meaning is much less clear than implied. Unfortunately (from the perspective of being able to do easy causal inference using the time series variation), consider the following two stylised facts:
i) There is substantial spatial correlation in lockdown intensity - e.g. the hardest lockdowns occurred in the northeast and the Pacific west, the loosest restrictions were in the South and plains states.
ii) The various waves of Covid have exhibited substantial amounts of spatial correlation in outbreak levels. The first wave hit the northeast hardest, the second wave the south, the third wave really kicked off in the plains states, and so forth. It doesn't take that creative a thinker to work out plausible climatic patterns that could give rise to this sort of seasonality.
Accordingly, just how sure are we that the picture of "over time, the lockdown state advantage became stronger" is causal? One easy thought experiment is to extend the time horizon of the graph. And indeed, in the short-lived fourth wave (when b.1.1.7 finally broke through, before the vaccines murdered it), something like 9 of the 10 states with worst outbreaks (as measured by weekly cases per capita at that point in time) were states with stricter than average lockdowns. They also happened to be clustered in the northeast and midwest. Of course, this doesn't mean that the stricter lockdowns caused the fourth wave. But it should reduce our confidence in inferring much from that graph, as well.
2) "There was a significant negative correlation (-0.55) between the lockdown stringency index as of January 1, and the number of post-first-wave cases a state had. This was robust to... using all cases instead of just post-first-wave cases (although some of these changes slightly diminished the magnitude of the effect)."
I find it difficult to justify excluding the first wave. Given how rare reinfections are (call it the YOCO constraint), doing so mechanically advantages places that were hit hard early. Which also turned out to be pretty correlated with lockdown propensity.
As you say, the result gets weaker using all cases. But here *cases* have a glaring problem - tests were much scarcer in the first wave than subsequently. So a higher proportion of infections were missed in the first wave than in subsequent waves. So including the first wave but looking at cases amounts to (relatively speaking) throwing out much, but not all, of the first wave. Since deaths were measured much more consistently (both in level terms, and across time), better to just look at deaths. Which almost certainly will shrink the correlation again. (For example, NY and FL have basically identical cases per capita. NY has dramatically higher deaths per capita, though).
I fail to see the value in separating voluntary quarantining(VQ) vs. mandatory lockdown(ML). If everyone is already staying home what are the negative effects of ML we should be concerned about?
Additionally, VQ is caused by fear/concern. Accordingly, we could have increased VQ by increasing media coverage of the negative consequences and risks associated with Covid. Would this have been in any way superior? It seems this actually has negative effects even absent positive effects(people staying home) where mandatory lockdowns do not.
"Most of the debate about whether lockdowns work centers on ideas within the Overton Windows of western countries, after the pandemic had started spreading - ie, given whatever level of lockdown your country had, is the marginal effect of more (or less) lockdown positive or negative?"
I feel this is missing the point. One need not appoint a president for life to implement lockdowns strict enough to actually work, and state of emergency laws are on the books in many Western countries that allow governments to implement lockdowns without violating various constitutions.
I would far rather spend a month or two in a China-style lockdown than a year plus in a Western one (or worse, if the Delta or some other variant spreads enough.) This strikes me as an area where Western governments had an absolutely massive policy failure with millions dead and their Overton window still isn't expanding wide enough to include "actually solving the problem".
Interesting that, on naive estimates at least, the dollar-life or dollar-QALY trade-off rate of Covid restrictions is within a factor of 2 of other such tradeoffs determined by government regulation. I wonder how much of the lockdown debate is just people projecting their political values onto a novel factual question-- i.e. you probably think COVID restrictions were a bad deal if-and-only-if you think EPA restrictions are too.
Editing note…I had to go back to see what a QALY was. It might be good to follow the original mention with the acronym, I would have seen it more quickly, maybe others too. It made it difficult for me to follow the conclusion section at first.
My apologies, this is my first comment but a few 'What if's' come to mind. What if 85% of the people under 50 had the SARS-Cov-2 virus infection by Nov. 2020..and it was so mild they never noticed? What if the PCR test is the wrong test , has massive false positives, picks random protein and old viruses, is dialed up to a 45 'magnification' instead of 28 as recommended? What if the virus is 1 micron in diameter and the average mask (sieve) is 500 microns? What if the vapor travels not 6 feet but 100 feet? What if staying indoors is exactly against all the viral transmission rules?
What if the 'lockdown success' in the first wave is actually attributable to Sunshine and Fresh Air (aka Spring)?
What if the 'vaccine success' is again vastly attributable to Sunshine and Fresh Air ( and the CDC dialing down the PCR test at vaccine launch)?
What if .. for every 1% increase in unemployment 37,000 Americans die (as one prepandemic study showed)?
What if the natural, cheap and off-patent solutions, Sunshine (Vit D), Zinc, Quercetin, Ivermectin, Corticosteroids, Melatoni, Iodine and dozens more EACH reduce the Absolute Risk(AR)
of hospitalization and death by 65-94% ? What if people think that vaccines 'effectiveness' is 95% when this citation is Relative Risk (RR) and vaccines Absolute Risk reduction hovers just over 1%? What if the Inventor if mRNA technology Dr. Robert Malone warned the FDA about the toxicity of the spike proteins (generated by the vaccine) a year ago and Dr. Byram Bridle found evidence in Pfizers Japan data and exModerna Dr. Luigi Warren says vaxxed people shed spike proteins and all 3 have been variously trashed, deleted, deplatformed and ghosted? What if mRNA Inventor Dr. Robert Malone
and his 16 patents have been scrubbed from Wikipedia? What if this unprecedented Orwellian fact of this pervasuve laundering is because Google and Jeff Skoll invested in GoF research starting in 2010? What if up is down and down is up, Alice - here in Wonderland? Scrubadubdub.
Friedrich Nietzsche said ,
"The strength of a person's spirit would then be measured
by how much 'truth' he could tolerate, or more precisely, to what extent he needs to have it diluted, disguised, sweetened, muted, falsified"
I live in New Zealand, and I feel this post is missing something without talking about us (or other countries that have pursued similar "Zero Covid" policies, like Australia).
With strict border controls and a strict lockdown (and probably significant assistance from our geography), we managed to eliminate Covid-19 in June 2020 and have mostly kept it eliminated since, with mandatory isolation of all arrivals, and a few short lockdowns when Covid managed to leak into the community. Australia's biggest wave (Victoria mid-2020) was eliminated after months of harsh lockdowns, and they've since had similar policies and outcomes. Our economies have also held up fairly well, helped by the ability to maintain minimal internal restrictions whenever Covid had been elmiminated.
I think there are good reasons (mainly geography) to think our experiences can't be just copy-and-pasted to the rest of the world. But I think the lesson specific to lockdowns is that there's a discontinuity when elimination is a plausible option. If e.g. Colorado had decided it was going to institute a seven-week-long harsh lockdown to try to eliminate Covid-19, it'd be at a great cost, but because Covid would be re-imported from another state so easily, the effect on Covid-19 deaths might not be that larger over the course of the pandemic. But in NZ's case, we were in a position where we could eliminate Covid-19 and remain that way.
That also changes the calculus on short "circuit-breaker lockdowns" whenever cases emerge in the community. NZ or Australian states locking down for 1 or 2 cases in a city may seem crazy to outsiders (and I do think there have a few overkill examples of this (looking at you, Western Australia)). But these can in fact have some of the highest benefit-to-cost ratios of all lockdowns. The reason is that they can be the difference between returning to a low restriction elimination state, or a phase transition to an endemic Covid state.
As such, I have a theory that optimal lockdown strategy may be bimodal. Lockdowns make little sense with zero cases, can be very good with a few cases (and strong border controls), may not make as much sense with a moderate amount of Covid, but may again start to make more sense with a healthcare-system threatening wave.
I've long thought there are way too many confounding variables to really be able to draw any strong conclusions about this sort of thing. Just looking at how wildly different the outcomes are in different countries, or in states that have similarly strong/weak lockdowns.
We have heard, for example, that the weather affects transmission. People who argued this accurately predicted changes in case numbers in many cases, most notably the big winter wave in the US and Europe, predicted months in advance. So ... how the hell do you account for that?
Given all that, I am inclined to just evaluate what policies work the best given our understanding of how the virus works and of human behavior. I know we all like this sort of empirical analysis, scientific method and all that, but on some level if it's this hard to measure you just end up measuring your own blind spots. "We can figure this out using empirical analysis" reminds me of the High Modernism thing - if you can't really figure out a good way to approach it scientifically, just kinda do something science-y.
A few other points:
<ul>
<li>An underrated part of lockdown politics is really about the financial assistance to laid off workers. For many people early on the understanding was that lockdowns lead to people losing jobs and so political support for unemployment benefits, etc. And that ending lockdowns would mean an earlier end to those benefits, so whatever people thought of the money stuff drove views on lockdowns.</li>
<li>I wonder how much the <i>public messaging</i> matters. In the US, it wasn't a particularly right-wing thing to be unconcerned about the virus, or left-wing to be concerned, at first. It only started that way after Trump and Fox News went around talking about how it's all overblown and how "this" is "the Democrats' new hoax" and all that. You mentioned how actual behavior is often loosely connected with government rules - it seems that it is more strongly correlated with the partisan messaging.</li>
<li>I think we got locked into a not-very-helpful pro- or anti-lockdown debate early on that prevented any discussion of <i>what are the best lockdown policies</i>. Early on there was discussion of centralized quarantine - people said NYC was hard hit because of overcrowding in small apartments, where a sick person would stay at home and infect everyone else - and widespread testing and tracing. None of which ever happened. At the same time, as far as I can tell "six feet apart" has been known for awhile to not have any basis in fact, and people still follow it. And restrictions on outside activity lasted a long time after it was clear that it was a way lower risk.</li>
<li>I think the medical establishment did a bad job of communicating at many times. Big examples include the initial anti-masking message, and the failure to give more realistic guidelines that people who don't follow the strictest guidelines might follow. To steal a point from someone, all non-COVID CDC advice is <i>also</i> super-strict rules that nobody follows (IIRC they recommend using a dental dam during cunnilingus. And 4 drinks in a day for a woman is "binge drinking").
And some political bullshit like saying it was OK to go to racial justice protests because it's a more important issue than COVID.</li>
<li>That said I'd be remiss if I didn't add that the medical establishment's bad job pales in comparison to the aggressively terrible job from the administration. People forget it now but before Fox News was against vaccines or lockdowns or masks, Trump was even against testing people, on the basis that it would increase the number of cases and make him look bad. He said this out loud on TV repeatedly! The main guiding principles seemed to be the stock market, and a mystical belief that nothing could stop the "Trump train". And people on his Coronavirus "task force" have alleged that they slow-walked the response because it was seen as a blue state problem.
All the arguments about calling it the "China Virus" or whatever came about because they needed new talking points to replace the "it's a media hoax" talking points once it became clear that it was, in fact, a big deal.</li>
<li>I think it's clear that earlier waves cause lockdowns (and voluntary lockdown-ish behavior). People in other parts of the country ask why everyone in NYC wore masks so long - probably because how bad it got in April of 2020.</li>
</ul>
"Sweden had closed some public schools (other countries had closed all of them), restricted large gatherings (other countries had restricted all gatherings), “recommended” closing businesses and staying at home(other countries had mandated it), and closed public events and public transport. "
Actually public transport in Sweden never closed. At some point in late 2020 it was recommended that commuters wear a mask when using public transport during peak hours (which, anecdotally, not many did).
Thanks for the link about Belgium's death rate! I was very curious about that.
I hate to add yet another "theoretical concern" to your list, but shouldn't voluntary changes also effect the economic impact of any policy? If most people stop going out to eat voluntarily, then the associated reduction in R *and* the associated restaurants going out of business have little or nothing to do with the government policy.
For secondary effects, I think you missed a few that are potentially much larger than the ones listed. We had a lot fewer cars on the road, resulting in thousands of additional traffic deaths (yes, more, because the people left were driving faster--see https://www.nsc.org/newsroom/motor-vehicle-deaths-2020-estimated-to-be-highest); on the flip side, air quality may have improved substantially (https://www.cnn.com/2021/03/16/health/world-air-quality-report-intl-hnk-scn/index.html) and air pollution is actually a substantial health hazard, particularly in poor countries. Then there's the culture war and political effects: much-discussed increased politicization of science and policy, Trump would likely have coasted on incumbency effects and 4% unemployment to re-election, arguably growing inequality and the strength of stocks/big companies compared to small businesses and average peoples' salaries.
"We know this is possible in principle - some states tried things like closing parks and trails, which in retrospect probably wasn’t too useful since the virus doesn’t spread well outside."
Indeed, this particular intervention could even have been counterproductive. I saw an argument (probably on the SSC or Motte subreddits) that lockdowns past a certain point *increase* cases, because everyone is jammed together into the few places they can go, like grocery stores. I wasn't sure of that, but shutting down an outdoor space or preventing all but the largest and most densely-packed gatherings is likely to have 0 positive impact, and secondary effects like pushing people indoors or reducing physical activity very likely make it a net negative. I know that some outdoor areas like major national parks were and ski resorts (and still are) overwhelmed and probably couldn't have maintained standard services like ranger support without compromising employee safety, but local parks and most trails should have been kept open
"Maybe this was a dress rehearsal for a much worse pandemic later on, and the most important effect of our choices now will be setting the defaults and expectations for how we respond to that one."
And that's probably the most terrifying thing. There is no indication that the powers-that-be have realized any of their mistakes. The FDA is still going to ban tests early on. The CDC is going to be wrong about risk. The intelligentsia will sneer at the plebs for being scared, then sneer at them for being selfish, without a hint of self-reflection.
Talking about the US and comparing different states. My prior would be that red states would tend to lower the number of COVID deaths in the statistics, compared to blue states. Shouldn't we account for that? Also most of the big high density cities (aka places where virus spread should be the highest) are blue even in the red states. And they could have stricter local policies compared to the state.
The two plots of "cases in Sweden vs Europe" and "deaths in Sweden vs Europe", considered together, seem like very strong support for the arguments "lockdown cannot pass a cost-benefit test" and "the Swedish non-lockdown really wasn't a lockdown".
We see a gargantuan bubble in Swedish cases, unrepresented anywhere else, that doesn't show up in Swedish deaths *at all*. Swedish cases soar to new heights at the same time Swedish deaths maintain a steady downward trend.
That's a huge number of people falling sick for whom falling sick is the right outcome -- they get all the benefits of whatever they were doing with negligible downside -- but who were, in every other country, prevented from achieving this correct outcome.
Also missing: Taiwan, South Korea, Japan, Vietnam. (Despite what many people think, S.Korea and Japan citizenry have pretty low confidence in their governments - in Japan, people still remember the government mismanagement of the Fukushima nuclear reactors after the tsunami; for S.Korea: https://twitter.com/BluRoofPolitics/status/1399555956875296769)
I'm waiting for "Climate Change: Much More Than You Wanted To Know"
There are two other factors to consider: how open the economy is to the outside world, and how quickly information is collated and disseminated. The UK is very open, and had a government that was until recently very long to close down borders or institute mandatory quarantines, which is why the delta variant is spreading like wildfire. On the data collection front, originally it took them 2 weeks to collect and tabulate data due to an unfit-for-purpose health IT infrastructure, which obviously makes it very difficult to control either the government or private-actor control loop. In one particularly embarrassing incident they discovered that because they used an old version of Excel with a 32K row limit, they were undercounting cases.
I work as an MD in Sweden and have thought a lot about COVID-lockdowns. Many things that governments in other countries made illegal Sweden only recommended i.e. limit social contacts, don't have private parties etc. But the stringency index counts these recommendations as if they were mandatory: https://twitter.com/TTBikeFit/status/1359913436981903361/photo/1 . This makes Sweden seem more stringent than it was, especially during second and third wave. For example according to ourworldindata stringency Sweden had higher stringency than France in January -21, this at a time when it was illegal to be outside in France after 8 or 9pm without valid reason. So in the stringency index it may look like Sweden was a pretty average European country during second and third wave I don't think that was the case. Anecdotally French and German people in Sweden also told me it was much more relaxed here.
Also I did an estimate of the life years lost to COVID deaths in Sweden in 2020 a few months ago here: https://www.reddit.com/r/TheMotte/comments/msqqof/estimating_life_years_lost_due_to_covid_deaths_in/. Sweden had an excess mortality compared to previous years of 7.7 % and a 0.59 year decline in life expectancy. This translates to 63700 non QALY-adjusted life years lost to death or 6.37 years per COVID death or 2.32 days per person.
One complicating factor that doesn’t seem to be covered here is how many QALYs were lost due to things like:
1) Lack of exercise: gyms and parks were closed and group workout sessions were cancelled. Even when facilities were reopened, I didn’t use them because of restricted hours, fear of infection, and unwillingness to work out with a mask on. I’d guess many others didn’t either.
2) Increases in being sedentary: even if people managed to keep up their workout routine, people who worked from home just needed to move around less to do things compared to when they had a physical workplace to go to. Almost everyone I know with a step counter has reported a massive drop in their daily step count.
3) Delayed medical check ups and appointments. How many people will have cancers or other issues detected a year late or treatments delayed by a year? I know that me and many people I know delayed our appointments, figuring the odds are that we’d be fine. But a substantial number of people doing that means that many of us won’t be fine.
It’s possible it will take another year or more before this data is really available, but I’d be interested to know if we have any preliminary results or forecasted estimates on these. And if the strength of those results would overturn any of this post’s current conclusions.
"Finally, voluntary behavior change and mandates are hard to separate. If you hear the government is thinking of a mandate, that might make you scared and cause you to do things voluntarily (even things not included in the mandate). Or if the government knows that most people are staying at home, it might feel more comfortable issuing a stay-at-home order to mop up the last few holdouts, whereas if no one had been staying at home it might not be willing to do that."
One factor to consider here and which might further confound is that lockdowns almost certainly don't have effects just in the countries where they're implemented - you can't just treat countries as closed individual units in an open and connected world economy. Of course, an important factor is that if some country is in a bad phase of epidemic, it increases the chances the virus spreads elsewhere - usually, of course, this leads to travel restrictions, but the travel restriction patterns are not always optimal. Here in Finland, a major issue for these weeks has been the spread of virus from Russia to Finland via football fans who were watching the UEFA European Championships in Russia while Russia has been going through a fairly harsh wave, and of course if Russia hadn't been going through that wave, it would have also reduced considerably the chances of spreading to Finland.
However, another thing is that while people will adjust their thinking about how bad the virus is and what precautions to take according to government messaging and actions, government messaging and actions may also have effect in other countries. Throughout the pandemic, the Finnish media has paid a close attention to what other countries have been doing - particularly Sweden, usually presented as a negative example of what not to do. For instance, a bunch of countries enacting lockdowns around Europe has generally been considered a pretty good signal that extra measures will also be coming in Finland, and might lead to voluntary behavior changes even before the actual measures come. Now, the medias - and accordingly, a fair number of people, assuredly only a minority but still probably the minority that acts as the opinion-makers - are paying close attention to UK's policies regarding reopening, and which way they will go, as well as what the real relationship between the Delta variant, vaccines, reopening etc. is vis-a-vis case and death numbers. All such matters may end up having effects on public behavior without the Finnish government necessarily doing anything major.
Of course, this also leads to something of a freerider problem - it's perfectly possible that one of the reasons why Sweden was able to have lenient restrictions at the start of the pandemic without the situation getting really out of hand *was* that the other Nordic countries had stricter restrictions, not only lessening the spread of pandemic from those countries but also potentially contributing to voluntary behavior changes within the Swedish society.
Minor notes:
- "Stringency index" may also be confounding due to the policy of countries being considered according to the strictest subnational unit (https://ourworldindata.org/grapher/covid-stringency-index). At least in Finland, restrictions in the greater Helsinki region have mostly been stricter than in the rest of the country, but the majority of people still live outside of greater Helsinki.
- One of the functions of the lockdowns might not only be that they serve as a government signal for "things bad", but their end might also serve as a government signal that "things good, get on with your lives", potentially allowing for a faster reopening than whatever inchoate signaling the government is able to do *without* having a lockdown, in case the people still choose to voluntarily stay home.
- regarding masks, their spread in society - or people giving up on mask-using if they've gotten used to it - really probably happens in slower waves than what can be measured in, say, three weeks, unless there's a formal mandate with teeth. At least in Finland, where there was next to no mask-using until late Autumn 2020 when the government finally issued a recommendation (not a strong mandate; there has only been a mandate in some public transportation in trains and some cities, and even that is not really enforced too strongly) to use masks, it took *months* for anything close to a 80 % mask compliance to happen in places where it was recommended. (Still, it did happen without formal mandates, eventually, which also tells something about the Nordic society!)
- as the single-person household map shows, Estonia has a high percentage of households, and it still had a big COVID wave a few months ago, having the highest case rate in Europe per capita at one point, if I remember correctly. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Estonia
"My data source didn’t have the past few months, but if someone does, let me know."
Not sure if you read the reddit, I left some links there. These are the sources I have been using:
https://github.com/owid/covid-19-data/tree/master/public/data
https://github.com/nytimes/covid-19-data
The former has daily national data, the latter daily US data by state and county. Both updated today.
While I agree with your analysis regarding "quasi-lockdowns" a la US and west Europe, I think you are missing the bigger picture with actual lockdowns a la China, east asia, oceania. I wrote about that on the reddit, but I see some people here covering similar points.
"Similarly, there was a really wide diversity of compliance levels with shelter-in-place orders. I know some people who didn’t see their closest friends for months, and others in the same cities who said “screw this” after a week or two and started having (small) parties again."
It's honestly difficult to say about how effective such measures are. The problems here in Ireland start after restrictions are eased, people come out in large numbers, and then we get a bump in the Covid cases. Part of that is economic, as businesses are pressuring government to relax restrictions (e.g. for Christmas as that is a major revenue generation period) and now for the summer - but we see that when restrictions are lifted, some people can't be sensible and then we get a spike once again in infection rates and then restrictions clamp down again.
Right now, where I live is one of the two areas in the country with the highest rates of Covid-19 (and we are not a large urban area). There was a spike in infections locally in the middle of June, and anecdotally that is alleged to be because in a local village, people who had been attending a match on the weekend went to the pub afterwards, where they mingled with people who were home from England for a funeral.
Given that the Delta variant was established in England at the time - well, there you go. This is also why many people are not happy with Boris Johnson and the relaxation of restrictions in Britain.
Just scanned the comments quickly, sorry if someone else has already pointed this out, but note that the same people who are likely to have high rates of voluntary behavior change are also likely to vote (or email their representatives, or...) for lockdowns. So if you check for the effects of lockdowns assuming nothing else is different between states that did/didn't implement them, you may be missing something.
My impression as a Bay Area Californian from listening to other people talk is that our voluntary measures, especially early on before the state took notice, were unusually extreme, our cooperation with the mask mandate once it did get instituted was unusually high, and the tendency for people to take precautions that weren't officially required (grocery delivery instead of shopping; washing groceries; refraining from taking walks, talking masked and distanced with one friend, or other activities that were explicit exemptions to mandates; etc.) was much more pronounced around here than many places. (Though take that with a grain of salt - the non-California part of the comparison is based on what people talk about, I wasn't actually in any other state until last week, and by that point differing mandates potentially affecting people's behavior had thoroughly confounded everything.) Still, I don't think the set of attitudes that get us the above set of behaviors are entirely unrelated to our state, and moreso our county, hitting the lockdowns early and hard. (At least, hard for a US State - anecdotally, compared to Chile or Spain or China we seem to have been quite mild.)
An effect not discussed (but which I don't know how you would handle)
In the UK the government said that lockdown was about avoiding hospital overload -- where overload is defined as a tipping point of serious cases per day the exceeds capacity and suddenly the standard of care drops and the mortality rate goes much higher.
I am interested in whether or not this turned out to be a thing? Early on, the consensus was that for serious cases a ventilator was required for recovery and countries were scrambling for ventilators; however, later on it the news told me that ventilators were irrelevant to recovery (that generally if you were put on a ventilator for covid, having it removed would kill you -- there was no recovery as such). So did it turn out that actually hospitals couldn't help you very much anyway if you had serious covid, which might make this capacity-issue not a thing. Just wondering because it's been a very long time since the UK government mentioned this issue -- nowadays they talk about balancing lives lost with keeping the economy running.
On the other hand, if the capacity issue does exist, then this changes the models above.
Thank you for undertaking this detailed analysis.
I do think a better pair of questions would be, "what is the optimum behaviour to respond to the pandemic?" and "what is the best way to get people to adopt that behaviour?". "Lockdown" confuses the two of these, and comparing lockdown vs voluntary measures is focussing on the second question at the expense of the first.
The part of your article I'm least convinced about is the attempt to model emotional impact. You summarise this as "52 months of stricter lockdown to save 1 month of healthy life", which does sound harsh, but it could also be phrased as "52 months of stricter lockdown instead of 52 months living through a pandemic with many voluntary limitations on behaviour", which is rather less harsh - albeit still not necessarily worthwhile. Also, some people may find it more emotionally traumatic to be living in a pandemic if the state and their fellow citizens behave in a non-optimal way. Early in the UK, there was a sense of collective pulling together in adversity that strongly mitigated against emotional impact. In other words, emotional impact is hard to measure.
On the other hand, you haven't mentioned the educational impact of disrupting children's education, which seems to be an important downside of the pandemic.
The Sweden discussion should really consider the effect of its uniquely high immigrant population. Swedish virologists claim this is a huge factor.
I'd love to see "Ivermectin: Much More Than You Wanted To Know," given the absolutely baffling lack of main stream media coverage (and suppression by Facebook, Google, etc) on the topic.
From what I can tell, it's probably better and safer than vaccinating teenagers and under-12 children. It might be capable of actually eradicating COVID-19, if its usage is widespread enough. It might even cure long-haul symptoms, although so far the accounts are anecdotal and there hasn't be a formal study.
(https://covid19criticalcare.com/ivermectin-in-covid-19/)
I don't see any compelling evidence / arguments to *not* to the claims being made by the Front Line COVID-19 Critical Care Alliance, while there are a lot of people who very obviously have a literal vested interest in a cheap medication like Ivermectin not being the solution to COVID-19.
I respect Bret Weinstein enough to believe that his current take on this topic is probably accurate, but it would help tremendously if Scott could weigh in on it, too.
I take your point about total deaths being sensitive to how old the country is, but cases numbers before autumn 2020 are an outright mess. Some countries (UK) had a policy of "Don't get tested, just self-isolate for 14 days" until mid-April.
Now that we have granular data, I like "Deaths 50-69" and also the slightly more complex "Deaths per 100k people in each age bracket". Anyway, if you use these it pretty much confirms that Sweden did much worse than Europe in the first wave, and relatively the same as Europe in subsequent waves.
At the end of Preliminary Theoretical Issue 2 I thought "WTH??? That kind of thinking only makes sense near the Pareto frontier, and almost all western countries very clearly aren't anywhere remotely near it!!!" until the middle Actual Evidence 1.1.
im not sure i buy that US data is as nice as we'd like to be. in the US, red states are fairly strongly clustered in the south, and blue states are very strongly clustered in the north, which means red states got much milder winters, most deaths occurred during winter, and covid is pretty seasonal, so we should expect lower-lockdown states to get some sort of fairly significant advantage, but its not clear how much, which confuses everything
Just in terms of Scandinavia, Youyang Gu finds in the US that income inequality (measured by Gini coefficient) is the best predictor of deaths from covid: https://twitter.com/youyanggu/status/1407418434955005955
In that thread he cites a paper that finds this also for countries: https://link.springer.com/article/10.1007/s10198-021-01266-4
My impression is that both the deaths from COVID, and the costs of lockdowns tend to primarily fall upon poor people because they have higher rates of comorbidities, in person jobs, less access to healthcare, less savings, don’t own a home as often, etc. While the $150K/QALY figure for a first world country’s government might make sense to the government, since they have access to a tax base of people and companies who make a ton of money, it might be overpriced in this case.
Note that poorer countries tend to price QALY’s lower. My guess is that that’s because if most of your tax base was making $20K a year, paying 7 times the average annual income to keep someone alive for a year might be more costly and impose higher opportunity costs.
In the case of COVID lockdowns and deaths, most economic damages are going to be born directly by the poor as are deaths. So (without redistribution actions) it’s as though the deaths and monetary costs are born by a lower income country, and thus we should discount the cost of a QALY appropriately so we can better judge tradeoffs.
Of course, some countries (like the US) had pretty massive aid packages that helped make it so the whole population helped bear the costs, which would raise the QALY price back up to the national pricing.
Overall my point is that maybe you should be either more for redistribution during the pandemic (to raise QALY price to where it’s worth it) or more against lockdowns (since QALY price might be lower than your normal estimate).
Obvious disclaimer that QALY prices are for assessing tradeoffs and not for valuing the moral worth of a person’s life.
You seem to be missing the psychological cost of not locking down. Lots of people are frightened by the lack of lockdowns. This isn't just that they are voluntarily locking themselves down, but the emotional / psychological cost of perceiving everyone else as being a (potential) plague-carrier.
If there is non-economic suffering from an absence of lockdown, then that makes the calculation rather more balanced.
"So every 52 months of stricter lockdown in counterfactual Sweden would have saved one month of healthy life. You will have to decide whether you think this is worth it, but it seems pretty harsh to me.... Even if this is true, that just means it’s 21 months of stricter lockdown to save one month of healthy life. Again, seems pretty harsh."
It's very important to note that this isn't the cost of lockdown being compared to life lost, but the emotional cost of an involuntary vs voluntary lockdown. In other words, assuming the wild guesstimate is right, the Swedish locking down as their neighbors did would have been worth it as long as the difference in quality of life between them and their neighbors during the lockdown was no more than 4.8-1.9 %. Now, I didn't live in Sweden during the months of their lockdown, but I highly doubt that they had a great time there, and it's well worth remembering that we were all very far from the Pareto frontier and there weren't many big easy gains to be had. Maybe life was 5% worse or 1% worse in Sweden compared to Denmark during that time, maybe it was even 2% better if life was much scarier and more uncertain for them! But both are swamped by a giant shared hit to quality of life in both countries.
"And even if Sweden had decided to double down and weaken their lockdown despite high case levels, people would probably have voluntarily stayed home more because the pandemic was so bad - inflicting most of the same costs that a state-mandated lockdown would.... This argument seems less convincing in the US, where red states mostly just consistently had weaker lockdowns than blue states did, and never really got stricter to compensate. "
This seems like it was definitely true in Europe in general, and arguably it is less obviously true in the US, but one thing you discount is that maybe the emotional hit got bigger in the non-lockdown states even if measures were never reintroduced. Maybe voluntary behavior change goes higher instead if the red states never got stronger lockdowns to compensate, so the hit is still larger - your evidence is only about legal restrictions, not mobility data.
You say it seems kinda harsh to save one healthy month through 51 months of stricter lockdowns. I think you are overestimating the difference in life quality between softer and stricter lockdowns. For one, voluntary behavior change makes the lived reality in these scenarios not all that different for sensible folks, and for another, a lack of lockdown causes suffering too, both psychologically (feeling like a sacrifice to capitalism in the face of a global crisis) and in terms of being subjected to avoidable risk (having to come into the office where people don't wear masks for no good reason). But I might be biased because introversion causes me to avoid large gatherings anyway, so I barely lose quality of life (and gain some, as remote work and studies are much more to my taste).
Another effect the lockdowns had were in suggesting appropriate voluntary behavior changes. Hearing about possible lockdown measures worked to drive home the idea that these are the things that should be avoided, prohibited or not. Sure, recommendations were made throughout, but a lockdown drives home that really, everyone should do these, it's not one of these things the teacher suggests but the kids ignore.
Is there any known sensible estimate for a conversion of dollars into QALY, possibly assuming all the money to be subtracted directly from some specific healthcare budget or something like that?
https://thefatemperor.com/published-papers-and-data-on-lockdown-weak-efficacy-and-lockdown-huge-harms/
Conclusion 2 is doesn't answer the question it's trying to. The headline is "Quantify Emotional Costs Vs. Benefits", but you're not testing the costs of lockdown vs no lockdown. Instead you're testing the marginal benefits and costs of Sweden being stricter like Denmark. I would definitely have liked to see the former, as it is more relevant to the political debates I've seen in the wild; they tend to be "lockdowns are good and we should do them again next pandemic" vs "lockdowns are bad and we shouldn't do them next pandemic".
Regarding the question you did try to answer. I think it's flawed by the lack of a serious attempt to define how much suffering is involved. 51 person-months in stricter lockdown per QAYL saved. If the extra strictness is moving from 100 people per gathering to 10 people per gathering, that seems doable. If it's no school, then it's not worth it.
It's also worth considering positive benefits from the lockdown too. If the cost of a lockdown is that you can't go to a cafe. But the benefit is the waiter isn't forced to choose between bankruptcy and going into work every day terrified you'll catch covid. I would call that a net positive.
This probably applies when comparing the marginal costs/benefits of moving from Sweden to Denmark. But it *definitely* applies when comparing no-lockdown to lockdown. The point you made earlier about "The moral of the story is that everything not forbidden is compulsory, so you can’t always substitute voluntary behavior change for government mandates." absolutely needs to be considered when quantifying emotional costs vs benefits. My working class girlfriend had such rants about how unsympathetic employers around her were when it comes to covid and her daily fear of it reaching the family (they have medical vulnerabilities). Only the lockdown let them isolate, meanwhile my tech company sent everyone home to work in our spacious home offices with gardens outside. Any attempt to measure the emotional costs/benefits of lockdown has to cover the emotional upsides.
> Preliminary Theoretical Issues 6: The Pandemic As A Control System
I think that a complicating factor here is that people don't observe R. They observe (media reports of) cases and deaths.
All other things being equal, a given set of behaviours will result in a particular R. The "pandemic as a control system" theory suggests that R will hover around 1, which implies equivalent behavioural sets under both lockdown and non-lockdown counterfactuals. The potential "win" of lockdowns, therefore, is to induce the "bad covid, therefore panic" set of behaviours earlier than would otherwise happen, so the same R-value (1) can be achieved with a lower overall case and death rate.
This feels like a very complicated problem, in large part because people respond differently to lockdown orders. After a moderate level of restriction, the marginal case might be found in an "essential" business like a logistics warehouse or in a wilfully ignorant member of the population, and imposing further mandatory orders might have little effect. That "resistant margin" may itself vary from time to time and from place to place.
In the scatter plot of stringency on Jan first vs deaths per million, the correlation seems disproportionately driven by six states in the lower right. The rest just look like a blob of noise. Now, %12 of the dataset is obviously too large to be dismissed as an outlier. But which states are they? Is there any particular policy or timing they have in common?
Have there been attempts to look at rates of all-cause mortality in locked down vs non-locked down areas? I could imagine this going either way. Hospital system collapse would increase all-cause mortality, which might not be accounted for by these studies, and in younger people.
IMO (for what it's worth) the critical issues for assessing the efficacy of NPIs are:
1) How do you control for precipitating conditions? In other words, the severity of the interventions was likely, in most cases, a function of the severity of the ongoing pandemic. The severity of the ongoing pandemic would be associated with the severity outcomes independently of the efficacy of the interventions, to some extent. Thus, reverse engineering from comparing outcomes across contexts, w/o controlling for the precipitating conditions, is of limited value.
2) Evaluating the efficacy of NPIs should necessarily address counterfactual assumptions about what would have happened absent the NPIs. You can't assess the differential effect of NPIs w/o addressing the issue of whether things might have been much, much worse if they weren't implemented - say if the pandemic raged more, whether more people would have stayed away from hospitals. That is the 300 lb. elephant in the "lockdown deaths" arguments.
3) Obviously, controlling for confounding variables and spurious associations when making comparisons across countries with vastly different conditions is VERY problematic. IMO, the data available is insufficient to do this. IMO, better is to look at patterns longitudinally in single countries. And even there, we don't really have a long-enough period to evaluate the effect of the NPIs - for example it may take years to really assess the impact of closing schools.
"Here, having US red states switch to a blue-state typical level of lockdown would save one month of healthy life per 51 person-months in stricter lockdown. Again, seems pretty harsh. Another way of looking at this is that each person who spent a month in slightly stricter lockdown would have saved someone else about 15 hours of healthy life"
Given most states had a period of strict early lockdown and then diverged in the pace of reopening how should I think about the hedonic delta between red-state a blue-state lockdown?
If I can save 15 hours of healthy life by wearing a mask, or going without in-person dining, for a month that's one thing. A month with the near total isolation of the early pandemic is another thing entirely.
It's also difficult to construct the hedonic wedge because of how voluntary the restrictions are. I'm young and healthy and aren't in contact with old people, so once most of my friends figured out that outdoor gatherings were okay my life was pretty normal post summer 2020. My uncle literally did not leave his house for any reason from April 2020 until he was vaccinated, but he's generally paranoid and risk averse. Would either of our experiences have changed under different state laws?
Excellent post, which mirrors a lot of my thinking about lockdowns. But I think this:
2: If Sweden had a stronger lockdown more like those of other European countries, it probably could have reduced its death rate by 50-80%, saving 2,500+ lives.
Cannot be squared with this:
3: On a very naïve comparison, US states with stricter lockdowns had about 20% lower death rates than states with weaker ones, and about 0.6% more GDP decline. There are high error bars on both those estimates.
Unless Sweden was extraordinarily more open than even the reddest of states, but it was not:
https://cdn.substack.com/image/fetch/f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F72c14dca-59a1-4dfe-acff-66dbab0522b2_1157x787.png
(Unless even the bluest of states looked far more lax than Denmark or the UK.)
It looks like the biggest thing a lockdown does is to "give cover" for things that people want to do anyway.
My employer (in Ontario, Canada) sent everyone home that could work from home on March 17. Was thinking about working from home anyway (I do IT stuff relating to cloud, so it's not like I need to be in a cubicle), but this meant I could just do it instead of having to arrange things.
From what I hear, the "return to office" will be based on how much of one's work needs to be done in a cubicle, so I suspect that I will be in the last cohort to return.
That bat is seriously cute.
One minor quibble about the SF Bay area Mobility Trends graph — people seem to forget that the SF Bay area counties were three weeks ahead of the rest of California in locking down. It's a mistake to say "It’s pretty evident from this graph that people were starting to decrease their mobility before any official government action." Mayor London Breed of San Francisco declared a state of emergency in SF on Feb 25th 2020, three weeks before Governor Newsom made his shelter in place announcement. Likewise, Santa Clara County asked employers to have their employees work from that last week February. And all the bay area counties coordinated their response to the early outbreak. I started tracking and graphing the case numbers between SF Bay area and LA, and the three-week head start that SF Bay area had made a big difference in the overall case loads between the two metro areas.
The premise behind lockdowns was not to reduce total infections, but rather to flatten the curve so that the hospitals were not overwhelmed. That appears to have succeeded in most places. If people are not vaccinated, lockdowns simply wont stop the spread of the virus since as soon as people are free, they will move about.
Different levels of lockdown had less of an effect on US states than European countries because there's no practical way to close a state's borders. While Norwegian customs officers could force foreign arrivals to quarantine at a hotel for ten days, there's no infrastructure stop someone from locked-down California from partying in Las Vegas for the weekend.
One potential confounding variable might be hospital availability. In a hypothetical country with an infinite number of hospital beds, we would expect the death toll to be significantly lower -- though obviously not zero; and thus the effect of lockdowns would be attenuated. In a place like NY or CA (to a lesser extent), where hospitals quickly got saturated, the opposite is the case.
Thanks for this. In regards to voluntary vs forced quarantine. I really liked the idea put forward by Po-Shen Loh (I heard on Lex Fridman https://lexfridman.com/po-shen-loh/) And explained some here. https://www.novid.org/ (though not a great web site.) The idea is to let you know when people 'near you' are getting infected and that allows you to decide when it's wise for you to voluntarily quarantine. The key idea to me is that this has all the right feedback.
There are significant "blue" populations in red states (particularly in major metro areas) and vice versa. Maybe "states" are just too broad a brush to paint with?
https://www.newyorker.com/news/california-chronicles/what-the-san-francisco-bay-area-can-teach-us-about-fighting-a-pandemic
According to that New Yorker article, you really have to look at communities rather than the states to get a truer picture. If 40% of COVID deaths were nursing home-related, how those communities reacted to the virus would be a compelling variable.
If "blue" counties had higher compliance with lockdown procedures, there is still the variable of high minority populations who worked in industries such as food processing, nursing home care, and other essential industries AND who lived in extended family situations, which may have significantly skewed the "blue" county numbers up.
So, I'd love to see a breakdown of "blue" versus "red" counties. Also, possible to examine COVID-related deaths by political affiliation? That may broadly indicate who was taking lockdowns seriously versus not? Obesity was a significant variable in worse outcomes - could obesity rates by county be correlated?
The birthday paper seems relevant. https://twitter.com/sangerkatz/status/1412426320835973132
"at the height of the pandemic, there were not very big differences in private behavior according to party, even if public behavior was different."
The biggest problem here is the assumption that there aren't external natural causes for increases and declines in case rates. There are no lockdowns for the flu and it is quite seasonal and people aren't voluntarily changing behavior for a flu outbreak. The timing of the worst US covid outbreak is nearly coincidental with the flu season. People change their behavior by season but this would still need to be factored out for a fair comparison that was judging either personal change from fear or government mandate.
The seasonality of the flu is not well understood and one assumes parts of the increase and decrease of covid are also unrelated to behavior (perhaps temperature, humidity, etc.).
The deaths were a majority in old age homes that weren't able to cope. Something like 81% in Canada. Something like half in Sweden of all deaths were in old age homes. 42% in the US. Belgium 42%. 64% Norway. Spain 52% How the old were handled were likely the most important factor. How soon these were locked down and managed.
"If there had been looser lockdowns, more children would have had to go to school, which would have been either good or bad depending on how you feel about school."
This is a throwaway line in the essay and not the main point, but I think it undersells the likely importance of this decision.
The mainstream economic consensus is that each year of schooling increases lifetime income by 10%. In the United States this equates to an economic cost of ~100K (in net present value).
We have absolutely no idea how much worse virtual school is than in person education, but even a conservative estimate of 10% would equate to a cost of $700B. Dividing that in half (to only apply to the blue states) would mean that the costs of closing schools were more than 6 times higher than the direct economic impacts.
In your GDP vs lockdown analysis, what are the units for GDP? I know its decrease in GDP but is that a raw value or a percentage of GDP for some control day?
Pretty disappointed that you missed the most obvious confounder in all this discussion. Quote:
*** This is an absolutely beautiful graph. It’s showing how lockdown strictness (as of May 5) correlates with death rate over time. We find that early in the epidemic, the stricter your lockdown, the worse you're doing. This is the endogeneity - places (like NYC) that are doing really badly institute strict lockdowns to try to save themselves. Later in the epidemic, the stricter your lockdown, the better you're doing - probably because the strict lockdown is giving good results. ***
OR it could be that the states that got hit early had partial herd immunity because of getting hit early. This continually got missed by everyone all of 2020 and I'm sad you missed it today.
The biggest problem with this post is that the range is too limited. The post does not mention the most obvious lockdown failures: India (which had the strictest lockdown) and Peru (which had the highest COVID death rate). It also does not mention the fairly lockdown-light East Asian success stories.
"In the end, Sweden still ended out with a death rate about double the European average. Seems pretty bad."
Objection: there's no such thing as a European average pre-second wave because Eastern and Central Europe was spared. In the end, Sweden ended up having a lower COVID death rate than most Eastern Europe.
"The real question we should be asking is what set of policies countries should have implemented."
Bingo.
"Contra Lemoine’s picture where Sweden just has an earlier start but eventually does no worse than everywhere else, here Sweden has the same (or better) start as everyone else, but clearly does worse afterwards."
Agreed.
"If Sweden had a stronger lockdown more like those of other European countries, it probably could have reduced its death rate by 50-80%, saving 2,500+ lives."
This is a dubious conclusion; it's only true for the first wave, if it's true at all. But there is a difference between preventing deaths and delaying them; Bulgaria had hardly any Spring 2020 wave at all, after its winter and spring waves it has the second-highest COVID death rate in the world.
Any analysis of lockdowns need to tease out nursing home policy. Sweden was blasted over it, so were New York and Pennsylvania. In my PA county to this day, 64% of deaths were nursing home residents. No amount of lockdowns was going to salvage a policy of stuffing confirmed COVID-positive patients back into poorly ventilated nursing homes
> Nobody agrees on exactly what “Scandinavian/Nordic” is
There appears to be a consensus that "Nordic" means exactly the five countries you mentioned, and it's just "Scandinavia" that's ambiguous, with it most often referring to Sweden, Norway, and Denmark, but sometimes also excluding Denmark, or being used synonymously with Nordic countries, as you do here. At least, that's what wikipedia says, and the maps I find by searching those terms on google images seems to support it.
Thanks for article!
Extremely minor point: DOT currently uses $11.6 million as the value of a statistical life, not $9.6 million. https://www.transportation.gov/office-policy/transportation-policy/revised-departmental-guidance-on-valuation-of-a-statistical-life-in-economic-analysis
Excess fatality tells a different story still. Personally, I'm content in knowing that I'll never know the effectiveness of various measures. Can you ever really know? If the deaths had been really bad, who knows we might have freaked out enough to start taking vaccines, try vit. D/ivm, let people test themselves, etc.
It's been unfortunate to see the discussion framed in terms of data rather than principles. If government can do X if data is Y then moral hazard naturally increases greatly as the measurement error in Y increases. I'd much rather attempt to reach consensus on the moral/philosophical framework.
" Sweden... could have reduced its death rate by 50-80%, saving 2,500+ lives."
How many of those lives were not of folks w/ one foot already in the grave, e.g. w/ major co-morbidities?
Can someone help me evaluate the Leech study on mask wearing? They detect a significant reduction in R from mask use, but they use a seemingly super-complex hierarchical bayesian model which always makes me suspicious. Does the data really support their conclusion or are they hacking their model somehow? I've seen other observational studies that don't correlate mask usage with R reduction, lab studies that show no reduction in viral cultures from mask wearers, and older data which indicate masks don't reduce influenza transmission. Can someone help me reconcile these data? I'm sure n95 masks help, but in my experience it doesn't seem like anyone wears those and I am highly skeptical that the average cloth mask worn by the average person could possibly do anything.
Your analysis of Sweden is flawed as you're using doctored stringency data. Go to an earlier version of the data and see how much they bumped Sweden's stringency index up by. They claimed they did this because of some vague guidance that was in place (rather than laws or mandates). Their data is silly as it suggests Norway and Finland were even less stringent than Sweden
Here is a theory of lockdown: lockdowns can help people co-ordinate. If the virus is in the community and I don't think people will keep R far enough below 1 to eliminate it, then I have no reason to take avoidance measures beyond protecting my own health. Because infection risk increases with disease prevalence, everyone taking "personal risk measures" will always be insufficient on average to drive R below 1 if the prevalence is low enough (though they may be sufficient once the prevalence rises a lot) and so the disease will persist with cyclic pattern that depends on how quickly people re-evaluate personal risk based on changes in community prevalence.
However, with a lockdown aimed at elimination I can believe that other people will keep R down enough for elimination and I can now weigh the risks I take against the costly possibilities of compromising elimination or extending the lockdown instead of the less costly possibility of personally dealing with getting sick. Thus, with a lockdown, even under my own evaluation I should accept a much lower risk of infection. There is still a prevalence below which I won't take many precautions - but it is much lower, possibly lower than 1 case in the entire country in which case I can take precautions until elimination is probably achieved.
This is a very different theory of lockdown to "disease burden management", though! Also contradicts the view I advocated early last year which was that 12 months of suppression is a reasonable aim.
> nobody responds to the virus in any way and it spreads uncontrollably until 70% of the population has been infected.
70% is the threshold for herd immunity in a naive SIR model with an R of 3.33, but due to the phenomenon of "overshoot", the virus would infect 96% of the population before petering out. The "herd immunity threshold" means the reproduction number of the virus goes down to one (not zero). When that threshold is crossed, there is still a very large population of infectious people, each of whom infects one other.
The equation for the proportion (p) of a population infected by a virus with reproductive number R at the end state of an epidemic satisfies p = 1 - e^(-p*r). So once overshoot is considered, and assuming no intervention, the R of the disease which infects 70% of the population before sputtering out is about 1.7.
Source (with useful graph): https://twitter.com/CT_Bergstrom/status/1252008428542681088
Corona Game author here. I recommend using URL https://covidgame.info/ that loads the game in English by default. BTW for some more context, I commented on: https://news.ycombinator.com/item?id=27763873
I'm not sure what to make of the mobility data. The rest of the data seems to suggest that lockdowns make a difference beyond what people did on their own, but the mobility data suggests that the government was basically telling people to keep doing what they were already doing. Maybe things like "ban on large gatherings" don't show up in mobility data (not that many people are going to conventions), but make a big difference in the spread? Maybe making the lockdown involuntary prevents things like "your boss tells you to come in even if you're sick"?
Woohoo, I made the Pareto frontier! 1.8k deaths, 399B Kč: https://i.imgur.com/9DmHRuY.png
Strategy spoilers:
- Max 10 & masks/distancing stay on the whole time
- Never pay compensation
- Close high risk services & universities until the first summer
- Once summer comes, reopen services / schools
- When summer ends, close high risk services and universities again
- Once it's winter again, close all schools
- DO NOT reopen ski resorts
- Punish the anti-mask celebrity
- Don't invest in vaccination campaigns
- Do the cover up ¯\_(ツ)_/¯
Your link to "value of one life" per the EPA doesn't link to the EPA. It instead links to a Statista article on "Percent change in Real Gross Domestic Product (GDP) of the United States from preceding period in 2020, by state", which I presume is an error?
The data you looked at, how you looked at it and the various ways of interpreting the data, and, of course, the questions you asked were fascinating and helpful. I can now think of this subject in more enjoyable ways. It's truly a breeze not having all the answers while maintaining methods of attaining them someday. It must be truly stressful needing an answer.
>and even the worst states only about 10%
I believe serology tests in NYC suggest the number there was about 15%, I'm not sure why this shouldn't be a big deal because (to simplify massively) if all your super-spreader types are in that 15% of your population, you now have no more super-spreading events to worry about.
>This is a victory for lockdowns insofar as the correlation is significant, but strong proponents might be surprised by how small the effect was.
It would be even smaller if you just drew the straight line through the main cluster instead of calculating a least squares fit. Also "correlation is significant" isn't really appropriate here, you can't just feed your data into something that then spits out the words "significant" or "not significant" and then expect it to mean something; "significant" and "not significant" is *always* tied to a statistical model which you do not have.
Would it be arbitrary and sill and not at all mathematical to just draw the straight line by hand? Yes. Would it be mathematically any worse than what you are doing now? No. If you're doing a least-squares fit on data like this you already statistically in a state of sin.
> US states mostly had stable and predictable responses based on their internal politics - a nice exogenous factor!
Which correlates with the amount of voluntary changes people make; what do you think would happen if you tried to control for those?
A couple of thoughts:
a) In the discussion about lockdowns vs voluntary behaviour change the two are considered to have a complicated relationship but still to some degree independent. I think there's also a possibility that voluntary behaviour changes *because* people can hear their government debate lockdowns and can see it might be needed. I.e. the political discussion about lockdowns is also part of the pressure on voluntary change.
b) The death rate calculation is only looking at people dying of Covid. In the UK we've also seen that hospitals full of covid patients have to move resources away from other activities. This gives rise to an ever-growing waiting list for other operations. So you have lower standards of daily life for hundreds of thousands of people and many more deaths. The full death toll, and the 'how many good years saved,' calculations really ought to include people waiting more than a year for gallbladder operations etc.
In summary point 3, shouldn't that be 0.6%pts more GDP decline, not 0.6%? If the latter then that's almost nothing, but I gather from the data and discussion earlier it's a 0.6% point difference in the change in GDP.
Small note: I think looking at excess deaths is much better than relying on self-reported stats. Eurostat has a tool where one can see excess deaths (easily found via searchsites). It would not change Sweden's general position as doing worst in the Nordics, but would increase the distance between itself and other Western European countries.
One should also make note of the fact that Sweden is by far the most diverse Nordic country, and deaths in all Western countries have been concentrated among immigrant-heavy populations, partly for cultural reasons (high prevalence of multi-generational homes) but also socioeconomic (disproportionately the poorest groups).
At least early on, I think the Swedish focus was clearly more on mitigation than suppression. It seems quite clear that there is a link between that strategy and the high number of covid fatalities in the first wave, as you point out. However, one could argue that the strategy was _partly_ vindicated if you consider the cumulative deaths over the _entire period_ up until now. While Sweden was 2x above EU average by August 2020 in terms of cumulative confirmed covid-19 deaths per million people (as you pointed out), by now it's actually <10% _below_ EU average. Does this mean that Swedish chose a smarter strategy for 2nd and 3rd wave? That there is a natural "reversion to the mean" over time, as most governments were unable to protect the most fragile people for more than a year until the vaccines arrived? I don't know, but it would be interesting to hear your thoughts on it.
https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=USA~SWE~GBR~European+Union
Disclaimer: I'm Swedish ;)
In a sense the analysis here is for "we tried X, it mostly didn't work, was it still worth it?" But that doesn't seem like a fair analysis to answer the question "is X worth it"?
In my memory the trade-off at the time was between "can we flatten the curve or do we need a lockdown?" Where "flattening the curve" meant staying at home if you're sick, social distancing when you're out, not shaking hands, don't touch your face etc, it was seen as the more gentle, cheaper approach that could get us through without overwhelming the hospitals. The alternative was a "lockdown" where everyone stays at home and you close businesses, which was more expensive, but was going to give us similar results as in China, where you completely get the virus under control, at least enough to go back to contact tracing.
Importantly this means that we didn't get the benefits that we were promised. We got the costs of a lockdown with the benefits of "flattening the curve."
If these were different terms at some point ("lockdown" and "flatten the curve" got mixed together very quickly after lockdowns started, as if they used to not be competing opposite alternatives...) then the calculation is very different, because we didn't expect the outcome that we got. In hindsight it's easy to say "we didn't get the Chinese results in the US and Europe, so overall it's an expensive measure that didn't get us many benefits" but you couldn't have known that at the time.
Another example may be the collapsed apartment building in Florida recently. Imagine you're one of the people who just bought an apartment in there a few months ago. You bought an apartment, the building collapsed, so now you either don't have an apartment or you're dead. Does that mean that buying apartments is a bad idea? No, because at the time you didn't know that the building would collapse. You have to judge the decision based on what you knew at the time, and usually buying apartments is a good idea.
Of course once people started sabotaging the lockdowns, (most obviously Trump, but also Cuomo keeping construction going...) and once the goal shifted to "we're just trying to flatten the curve" you could have argued that that doesn't make sense any more. And I never heard a good justification for the later lockdowns in Europe.
But before the sabotage we could only make the decision based on the results we saw in China. And some countries got the same benefits as China.
In the next pandemic, if people argue for another lockdown, what will we decide based on? Will we decide based on how lockdowns went in countries that messed it up last time, or based on the countries where the lockdown worked last time? I predict it'll be the latter. People will say "we should do a lockdown, and we should do one that works, because it can rapidly end the pandemic." If that's true, and if people aren't interested in dragging the next pandemic out like we did this one, (see the strong reaction in Asia this time, who had the prior experience of SARS) then they won't consult the analysis in this blog post, because it's only looking at cases where the lockdown mostly didn't work.
> If we had let the virus spread more, it would have gotten more chances to mutate.
Is this so certain? I'm thinking that, given the same number of total people infected, flattening the curve and keeping R on average around one for a longer time is much much worse regarding giving the virus maximum selective pressure, and it probably more than makes up for the reduced total number of people infected.
Also, let's irresponsibly assume stuff. Let's say that, doing nothing, 2% of the population would have died within the first 6 months and then herd immunity. And that each death killed 10 years of life. So the pandemic ended within 6 months, reducing life expenctancy by 2% of 10 years = 70 days. As a citizen of Spain (life expectancy of 83.2 years), you would need >23 covid pandemics in your lifetime to turn your country into the US (life expectancy 78.5).
For US comparisons it would be nice to look only at what types of businesses are allowed to be open (also if we were able to know what fraction of eligible businesses were open as a measure of voluntary effect) since that's really the area the government has the most control over (since we did not use the police to break up house parties or give fines to individuals for walking outside etc)
Truly much more than I wanted to know. I lost interest midway through article and that doesn't happen often to me on ACT
I don't think Conclusion #2 (Quantifying Emotional Costs) gets enough attention. In my opinion, this is perhaps the most important trade-off. I lived in Idaho (with family in Spain) through this whole thing and I can't think of a better place to have been through it all... I sure was glad I didn't live like a prisoner as in Europe (for a whole year!); in rural parts you wouldn't know there was a virus even during the second wave in the winter.
And all this madness everywhere else just to save a few QALY (at the cost of sacrificing a bunch more QALY)? I think there is a lot more to live than avoiding death. And somehow, Idaho's deaths numbers are some of the better ones too!
Very respectiable stab at looking at the data.
The one aspect which only time will uncover: the economic ill effects from the lockdown are long term. Small businesses destroyed - the health and economic effects are decadal. Even people unemployed but on short term government subsidies - that impact is also decadal.
The entire economics analysis is contingent on a false assumption - that economic activity/growth is independent from one political entity to the next. If all but one country decide to lock down their borders and limit trade, how much of a difference does it make that the one holdout is still willing to play? If all your kid's friends tell him they won't play with him, you can't claim that he's outside "playing with friends" because he's still willing to get together. Economic activity isn't independent, and this assumption should place a giant red asterisk on the whole analysis.
Let's do a counterfactual reasonableness analysis. Let's say nobody knew about COVID-19, because we hadn't invented the technology to test for it, and hospitals just treated it like a particularly bad cold. Cumulative US deaths from COVID-19 for >1year currently stand at <0.2% of the population. Cumulative infections at close to 10%. Is it reasonable to attribute massive GDP changes to the virus alone? (Because <0.2% of people died and <10% got sick for two weeks?)
What if next year a bad variant of H2N3 flu started spreading across the US, but nobody was focused on it because we were too busy watching for more COVID-19. Say 10% of people got sick from it for 2 weeks, but nobody got scared because everyone who got tested showed they were negative for COVID-19. Of those infected, around 600k people died (out of a population of >350million), but they were mostly elderly, so nobody thought it was out of the ordinary. How likely is it that a drop in GDP would have even been measurable under those circumstances?
Now, maybe that thought experiment doesn't exactly encapsulate the difference between voluntary behavior and lockdowns. But it seems clear to me that nearly all of the economic impact from COVID-19 is downstream of behavior, not due to the virus itself.
Great post
I think this analysis missed out on the fact that increasing voluntary quarantining decreases the cost of mandatory quarantining.
This is maybe impossible to measure, but I think it would dramatically affect the cost calculations when looking at red vs blue states, as my assumption is that blue states had much higher rates of voluntary quarantining, and so stricter lockdowns were less costly there than they would have been in red states.
I played and earned Czechia probably $10B by killing all the old people who were going to use healthcare, draw from retirement, etc. Not to say that makes much sense, but neither does estimating the "economic costs" while ignoring the largest factor.
A very well written, sober and judicious piece. Nicely done indeed.
I have on quibble, which is with your conclusion #5, in which you compare the cost of emotional suffering by those who endured lockdowns with the benefit of the QUALMs gained by people who don't die of COVID.
I think if you are going to count the *emotional* suffering of those who endure lockdowns on the "cost" side of the ledger, then you have to count the (averted) *emotional* suffering of the friends and family of those who would have died on the "benefit" side.
The emotional cost of a death is not just, and perhaps ultimately not even mostly, borne by the person himself dying -- a death has savage emotional (and even practical, financial, childrearing et cetera) repercussions among the family of the deceased, and these go on for a long time, years often.
One point I'd make is that decisions by politicians have ramifications even where the leader's writ doesn't run. For example, on March 15, 2020, the mayor of Los Angeles shut all the movie theaters in Los Angeles, the movie capital of the world. I suspect that had impact around the world because you'd expect the mayor of Los Angeles to be in favor of people thinking of going to the movies as a fun and safe thing to do for the whole family, kind of like how the mayor of Amityville in "Jaws" is pro-going-to-the-beach. But suddenly Mayor Garcetti was announcing, in effect, that going to the movies could KILL you, so do not, by order of law, partake of Los Angeles' most famous product.
In contrast, the prime minister of Sweden did not shut Sweden's movie theaters. But very rapidly, nobody was going to Sweden's movie theaters so they shut themselves down for lack of business.
Ironically, the payoff from lockdowns in America is mostly due to the almost miraculously effective mRNA vaccines riding to the rescue faster than just about anybody other than the ever-optimistic Mr. Trump imagined. If instead we got, say, some 75% efficacy vaccines in late 2021 with supply chain problems keeping everybody who wanted a vaccine from getting one before 2023, then we in the US would have likely gone through 7 or 8 waves infecting maybe 75% of the population before the vaccines finally kicked in.
Under that scenario it's hard to see much point in kicking the can down the road with lockdowns other than to avoid overloading the hospitals (and hospital administrators proved pretty good at stretching the capacity of their hospitals in the pinch).
Of course, under that scenario, lots of people would have voluntarily locked themselves down: e.g., as I pointed out 15 months ago, movie theaters were legally free to be open in Sweden, but their owners shut them down anyway because everybody had stopped going to the movies. (I cite movie theater data a lot because it's easy to find only at BoxOfficeMojo.com.)
But because of the remarkable efficacy and speed of development of vaccines (which, amusingly, Biden and Harris were spreading Fear, Uncertainty, and Doubt about during their debates last fall), blue state policies come out looking pretty good.
Back on March 18, 2020, I wrote:
"The [British] forecasters argue that suppression would need to be practiced for the majority of the next eighteen months, at which point they hope a vaccine would be ready.
"Even worse, I’d point out, it’s possible that no vaccine will be found: Coronaviruses are hard to vaccinate against. They tend to mutate rapidly.
"On the other hand, kicking the can down the road for seven months or so on the prospect of mass death might possibly pay off in multiple ways, not all of which can be specifically anticipated at present.
"For instance, it seems possible for the English-speaking countries to have a South Korean-style testing regimen working by fall that could put out flare-ups before they turn into the apocalypse.
"There are many different methods to create a vaccine. Well-funded crash programs might get lucky.
"They could speed things up somewhat by cutting corners on safety. Today’s vaccine researchers are not used to taking heroic steps to rush because they typically work on the fairly obscure infectious diseases that still lack vaccines, so there isn’t much excuse for risking nasty side effects lately.
"Medical treatment of the infected ought to improve with time. Testing will certainly get better than it has been. (In America, it can’t get worse.)"
My biggest takeaway from all this data is that I kept trying to move the sliders on each new image, and felt an increasing amount of shame each time.
Apologies I only had time to skim this for now, although it all looks reasonable and I'll try to read it more closely when I have time. Apologies for the usual academic self-promotion, but I did want to mention that I just published a paper on this topic in Health Services Research:
https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.13688
The disadvantage compared to many of the ones discussed here is that ours is [much] less sophisticated modeling. The advantage is that by the same token we require [many] fewer assumptions.
-julian
What's the explanation for the Sweeden's huge peak around Jun 9-29 in infections not translating into analogous peak in covid deaths (which seem to continue to decline in this period)?
Is it that the first wave killed all voulnerable targets? Or perhaps voulnerable people stayed at home during the second wave? Or did something change in medical capacity or reporting? What's the official story?
My take: if this much analysis can only find a possible, small effect, then all but the most comically inadequate utilitarian (plausible) moral theory must condemn lockdowns vehemently.
Acts 16:31, 1 Corinthians 15:1-8, 1 Peter 1:17-21, Revelation 22:18-19
By the way, since there's been people suggesting similar threads for masks, vaccines etc., can I suggest another Much More Than You Want To Know COVID thread for a topic that's interested me for quite a bit but which I can't really make heads or tails out of: Long COVID? How much is it a real physical thing, how much a psychological thing, and how much other conditions lumped with one moniker when they randomly crop up or flare out after COVID? What are the actual numbers of sufferers - and how many of the cases are serious, or have lasted more than a few months? There really is little "official" information of any kind on these.
It’s good that you made an effort to assess actions in a comprehensive way and the additional debate and discussion is also useful. The discussion HAS to begin somewhere. The mental health aspects of the lockdowns remain largely unrecognized and unreported. Anecdotally, therapists were nowhere to be found in the US after the child depression epidemic spiked. Appointments were available one year out in the Seattle area for example. Hopefully some best practices around how to handle a pandemic will emerge. Lessons of the Spanish Flu didn’t seem to provide much guidance except that children remained in school and didn’t have screens so they were already outdoors, which probably helped a great deal.
I'm not sure I absorbed all of the statistical analysis, every time I try to consider more than a few simple factors, my head spins. However, just to throw *more* info into your pile, here's some potentially interesting information that is not usually discussed when going over the Swedish infection rates/death rates and course of the pandemic in 2020.
A lot of what happened initially in the pandemic (ie Feb-Mar 2020) was the result of a ‘perfect storm’ of setup and subsequent events. The longest prior situational setup was that, prior to 8 years ago, there was a gap in the Social Democratic dominance of parliament for two terms, where “Moderates” (considered right-ish here, more like Obama-style democracy/neo-liberalism) had a coalition with the Liberals (market libertarians) and other right-leaning parties. Several waves of privatization and deregulation happened in this government, eg they sold the post office to the Danish company Postnord (who promptly shut down 2/3 of processing stations to function economically, you can imagine how the mail is now), most of the health clinics were sold to Capio (a CAPital Investment Organization who runs health care in France, yup, health clinics have immense wait times now and are understaffed )and more that lovely old Social Democratic Sweden will never recover from…
Now, old peoples’ homes used to be run by the state, but many had been farmed out to private organizations who either cited some obscure regulation (not enough space between a door and a window type of thing) to kick all the old folks out and then rent the places out to refugees/asylum seekers, charging the state massive rent as Sweden received more and more people fleeing war and famine etc in Iraq, Syria, Eritrea, Afghanistan, etc. Or they continued to run them as old-folks' homes, just more cheaply.
The remaining now-private old peoples’ homes were additionally no longer regulated with regard to what was legal or necessary training for the workers—nor pay levels for workers—so the äldreboende ended up losing all their previous staff who simply would not work for minimum wage, and hiring, yes, off-the-boat immigrants at low pay, and no training.
Ok, so, next step. Stockholm, being the “Capitol of Scandinavia” is a very wealthy city, by which I mean: it’s extremely bourgeois. One of the yearly parts of people’s lives is Sportlov, a “sporting vacation” that happens in late February, where everybody goes skiing! Except, if you’re rich and from Stockholm, you don’t go skiing in Sweden, it’s too flat, so you go to Northern Italy. Only the middle class skis within Sweden.
(personal note, I was playing music on tour in the US in Dec2019-Jan2020, we all got incredibly sick directly after shows on the west coast after Christmas, continued with shows on the East Coast with the aid of University sports doctors applying “Z-pacs” of steroids and antibiotics, so we were probably super spreaders of an as-yet-unknown virus! I got back to Stockholm at the beginning of Feb, had two more shows in Finland mid-Feb, but by then Covid-19 had been identified and the start of pandemic prep had begun. Not that my family goes anywhere for Sportlov anyway, we’re not that class of citizens, being musicians and schoolteachers.)
So. Rich people flying to Northern Italy in February 2020. Who drives them to and from the airports? Taxis. The cab drivers are, yup, mostly recent immigrants from the aforementioned war-torn regions, who, having escaped with families, often live in multi-generational households. Viral transmission begins in earnest, apparently a lot from London and to a lesser extent from Northern Italy. The taxi drivers are a big vector. This combines with in-country skiers flying up north to ski in Sweden.
In many of these households it is/was common to sit by the bedside of a person who is sick, and you can imagine the health and safety warnings not exactly reaching through the language barriers (honestly, even getting info through to me in English was not top notch, and I saw nothing in Arabic or Somalian/Eritrean at that time, and I live across the street from an asyl-boende, where they house teenage asylum seekers with no families.) Older people started getting Covid, the families sat with them, then the men go back to work driving the taxis, the women off to the old peoples’ homes, where viral transmission starts to take hold of the elder population in a big way. And the people working in the old peoples’ homes did not know how to deal with it due to a) no actual medical or assistance training and b) language barriers. The bulk of Covid infection in Stockholm, the bulk of the deaths in March and April 2020 were caused by these vectors, minimum wage jobs held by recent immigrants carrying the virus home from rich people traveling the world, to their families and then out to their jobs. So the thing is, there *are* a lot of multi-generational households here, they just aren’t the rich white peoples’ households.
It took most of April and into May before they figured that out. Regardless, I don’t think any regulation has yet been put in place regarding training for hospice workers—it takes a long time to get anything done in this sort of bureaucracy. At least this year (2021) I’ve seen vaccination posters and info in nearly every language available all over the place. I think there are people *not* getting vaccinated, still (I believe it’s just gotten to the under-30 year olds this month) because, yes people are idiots and especially in extremely entitled societies there will be people who think that nothing can harm them. With the lack of any real lockdown, most people (in Stockholm anyway, I didn’t go anywhere to observe anybody else this past year) ignore anything not explicitly mandatory—mask usage on the subways was like 5% max any time during the past year+. People just don’t pay attention, think “won’t happen to me!” etc. So you could consider 'entitlement' a possible factor as well.
I cannot find anyone in comments interested in why Scandinavia did so well, so sorry if I'm repeating someone. Compare this: https://apnews.com/article/milan-health-ap-top-news-emmanuel-macron-virus-outbreak-b76b7e97cc6b3da0d2fa40a2e2b49503 to this: https://www.reddit.com/r/funny/comments/5blfam/finnish_bus_queue_personal_space_is_important/
At least that's where you have to look as well, if you see such a huge difference, but I guess you have to know say italians and scandinavians personally, otherwise it might not be a common knowledge.
Curious where these numbers come from, given that they are not at the link ...
> For example, when the EPA is determining how worth-it environmental regulations are, they value one life at $9.1 million; when the Department of Transportation is determining how worth-it road safety regulations are, they value a life at $9.6 million
Thank you, great analysis, for me the crucial point: "It's harder to justify strict lockdowns in terms of the non-economic suffering produced. Even assumptions skewed to be maximally pro-strict-lockdown, eg where strict lockdowns would have prevented every single coronavirus case, suggest that it would have taken dozens of months of somewhat stricter lockdown to save one month of healthy life."
and I would add that what you missed - you didn't address at all - is who is threatened by the disease and who is threatened by the restrictions, that here we are clearly shifting the burden from the sick and elderly to the children, that they are hardly threatened by the virus at all, but by the restrictions quite fundamentally, and again it is up for debate how such a manufactured shift is moral
and the second point, that you does not address at all that restrictions can still hurt after they have ended, as explained here:
Self-harm, suicide attempts, depression, eating disorders. Teenagers have filled the psychiatric wards of hospitals. It's like another epidemic has arrived - this time a wave of mental health problems. There was no relief for the kids as the lockdown ended. https://www.heroine.cz/rodina-a-vychova/5173-tezky-skolni-rok-je-za-nami-uleva-pro-teenagery-ale-neprichazi-co-ted-od-nas-potrebuji-ze-vseho-nejvic
The WHO's definition of health, includes well-being, was destroyed by the restrictions and again almost impossible to calculate.
Brilliant pondering. My take is the population that continues to wear masks and vaccinate will be generally fine as the variant breaks through the vaccinated. Those who don’t continue to wear masks or eschew vaccination will have a much higher viral load, and thus a tougher fight for recovery. For children under 12, they need to be isolated until a vaccination is available to them.
I remember people talking about non-official signals of seriousness as drivers of individual behavior; that there was a major uptick in taking the pandemic seriously when large organizations (e.g. the NCAA and NBA) started taking it seriously even though it lost them a lot of money and a major downtick when leaders (California, Britain, etc) were caught hypocritically flouting their own lockdowns.
Did that show up in the data?
Even if the confounding factors could all be untangled, isn't all of this granular analysis basically pointless because: (1) the "new infection" data are kinda garbage due to positive test rates being highly unreliable and, in any event, testing is not conducted on a randomized basis; and (2) the "covid deaths" data are also kinda garbage because they don't distinguish "died with" and "died from" covid.
I didn't see where you dealt with the problem of risk. Unlike plague, dengue or cholera, COVID was a novel disease. We now know all kinds of stuff we didn't in early 2020. For example, we know roughly how dangerous and how contagious it is. We know how likely it is to kill someone, how long a typical infection will last, something about how to treat the disease, how quickly it mutates and so on. A lot of our knowledge is still sketchy. No one has had COVID and lived for even two years.
When dealing with a novel risk, it can make sense to be more cautious than when dealing with a well understood risk. Doing a retrospective analysis ignores this. It's called Monday morning quarterbacking in certain circles. Suppose COVID had been more deadly, less amenable to such treatment as we now have, more infectious, more likely to become more dangerous adn so on. Similarly, it could, as our president at the time suggested, have simply gone away on its own.
If you are a politician, you have to deal with risk. Sometimes they overreact. After 9/11 the political assumption was that the world was full of terrorists plotting new, similar attacks, and that it made sense to invade Afghanistan and Iraq, if only to send a message that the US was serious about fighting terrorism. Anyone who suggested that this was overreacting, perhaps arguing that it made sense to invade Afghanistan where the attack was organized but not Iraq which had nothing to do with it, they were noisily and sometimes viciously shouted down and sidelined. One politician argued that overreaction was proper in the face of "unknown unknowns".
Of course, it was much easier to understand and deal with 9/11 style terrorism. We had a lot of knowledge about how terrorist attacks could work, what was needed to make them less likely, conditions and potentials in the Mideast and existing terrorist organizations. It's not as if the intelligence community knew nothing about Al Qaeda and friends.
In contrast, COVID was something no one had ever seen before. The closest models were SARS and MERS which were much less infectious and could be stopped with conventional contact tracing. COVID was clearly more dangerous and much less well known. The only way to find out what the threat was was to let the threat play out and try to stay ahead of it. Needless to say, this did not work very well in Italy, NYC or elsewhere. It only worked in China because of massive reaction, shutting down entire cities, complete lockdowns that would have been impossible in less regulated nations.
Looking back and saying that we should have traded so many dollars for so many lives or illnesses or perhaps traded so many lives or illnesses for dollars is rather pointless.
As mentioned: Belgium covid high death rate partly explained by an unusual counting method. I'm surprised this analysis did not include excess death rate trends. Data for 2020 has come out, for example, here. This table is "age adjusted"; I'm not clear how that works exactly). Note that Sweden comes out lower/"better" than Germany by this metric. https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/ )
I'm missing your ethical assumptions in this piece when you talk about what does and doesn't justify a lockdown. You seem to be implying in some parts that governments ought to act according to some utilitarian sum, but why shouldn't they (for example) maximize freedoms of the individual? Actually I don't think 'objective ethical theories' can be grounded at all and then government are just the results of complicated social contracts between citizens that act out of their (ir)rational self-interest, and from that perspective why be in favour of a lockdown if it doesn't benefit you more than not having a lockdown?
It was painful reading this.
Late response here, but the Branch Covidians are plunging us into a dark age from which we may never recover. If you think this was about giving boomers 1-2 years of extra life, or saving fat people, this is very naive.
Humans aren’t meant to do lockdowns, better to have no humans left than a world where we are tightly controlled in this way.
I’d rather DIE than live in China, and am starting to think that everyone should rather than anyine live in such a subhuman state where you can be welded into your dwelling, removed into camps, injected involuntarily and be rendered nonessential
As a psychiatrist, if you don’t recognize the catastrophic effect of this on mental health, I suggest a new profession