Coronavirus

[samwise]

So the political decision is this: would you shutdown for 2 weeks (perhaps 4% of gdp hit) to save 1% of your population?

 

What if it was a 6% hit? What if the deaths were 4% of population? 0.1%? What if the deaths would be only among the old and sick who are not productive anymore? What if it could be either 0.1% or 4% and you didn’t know which?

 

There is also the fact that the competing “costs” will be borne by different groups. GDP loss affects the working people. The deaths seem to be focused on the retirees.

 

I don’t envy the decision makers here. They are implicitly coming up with the price for a life, under conditions of high uncertainty, in a one time (unhedgable, undiversifiable) decision where the “right” decision based on odds might not work. The right decision is about as clear as mud to me currently.

 

However incentives are more clear. Put yourself in the politician’s shoes.

 

Action 1: take strong action now, before people believe they are in danger.

Outcome 1a: turns out this was just the flu and you over reacted.

Outcome 1b: this was pretty bad, but you saved the nation.

Political outcome: 1a and 1b look the same to most observers. Most people never saw any danger, think you over reacted, they make jokes about the virus that never was and what a scaredy pants you are. You probably lose the next election, even if you are actually the hero here, because you are not perceived to be the hero.

 

Action 2: you wait until it’s obvious how dangerous it is

Outcome 2a: it becomes obvious there is not much danger.

Outcome 2b:  everyone sees the danger, probably in the news about deaths per day.

Political outcome: 2a you are the hero for saving people from panic. Big win.

2b: you are the idiot who didn’t take action in time. Big loss.

 

Action 3: between the above two choices. You wait until the majority of your base starts sensing some danger, but it’s not absolutely obvious. Now you ride to the rescue as the big saviour. Doesn’t matter what happens next, as you will be the wartime leader. Huge win possible here.

 

I think we see 3, just because of the incentives.

[samwise]

https://abcnews.go.com/Health/early-mortality-rates-covid-19-misleading-experts/story?id=69477312

 

Something to chew on, sure there will be counter factual articles but time will tell I guess.

 

Yes, this seems to make sense and I think the author is correct and overall mortality rate will come down. The mortality rate varies a lot from country to country. Korea’s mortality rate  is fairly low while Italy’s is surprisingly high. I guess age distribution and the detection/testing rate account for the difference.

 

The virus is also mutating, with possibly different mortality.

 

https://nextstrain.org/ncov?m=div&r=country

 

[Viking]

Here is an update from Washington State (Sunday).

 

Gov. Inslee considering ‘mandatory measures’ to combat coronavirus

- https://www.kiro7.com/news/local/gov-inslee-considering-mandatory-measures-combat-coronavirus/QO4YWHGEL5CDZGBYG7YOMUXSFI/

 

When asked if the next step was quarantine, Inslee responded, “Not necessarily quarantine, but reducing social activities that are going on, and we need to make decisions about that looking forward.”

 

Leading coronavirus researchers, like Samuel Scarpino at Northeastern University, said those measures worked wonders for China.

 

"Seattle is much earlier on in the outbreak than anywhere in China. However, because these pathogens can spread and grow very rapidly in terms of the number of cases, we need to be taking decisive action now to prevent a scenario where we end up having sizeable number of cases in the thousands in the Seattle area," Scarpino said in a Skype interview.

 

While the governor’s spokesperson said no final decision has been made about mandatory social distancing measures, Inslee said his team will be looking at models of future infection rate, which will factor into any future decisions on such measures.

[james22]

FWIW:

 

Do voters effectively hold elected officials accountable for policy decisions? Using data on natural disasters, government spending, and election returns, we show that voters reward the incumbent presidential party for delivering disaster relief spending, but not for investing in disaster preparedness spending.

 

https://marginalrevolution.com/marginalrevolution/2020/03/sunday-assorted-links-254.html

 

And Tyler's take:

 

https://www.bloomberg.com/opinion/articles/2020-03-09/america-s-coronavirus-response-has-started-slow-but-will-improve?utm_content=view&utm_medium=social&utm_campaign=socialflow-organic&utm_source=twitter&cmpid%3D=socialflow-twitter-view

 

Comments:

 

https://marginalrevolution.com/marginalrevolution/2020/03/america-is-historically-slow-to-mobilize-but-eventually-quite-effective.html#comments

[DocSnowball]

One more chilling healthcare worker thread from Italy - @Orthopa seems like there is a lull before the storm hits

https://twitter.com/silviast9/status/1236933818654896129?s=20

 

I agree with the above posts, it is a question of taking an economic loss for saving lives - you can always make money back, but can't bring back a life lost, and thank you for noting scenario 3 where decision makers come in as heroes to rescue the base (either economically or with quarantine measures).

 

WHO has broken outbreak status into 4 tiers: no cases, sporadic cases, clusters of cases, and community spread. I think the quarantine measures will be individualized to regions based on where they are in these tiers. In the US, CDC updated and expanded it's "guidance" on testing yesterday, now including anyone who wants to be tested while suggesting focusing on those with travel or exposure history, severe respiratory disease and high risk medical conditions. Turn around testing time is still 24-48 hours, rather than rapid testing. While this will guide clinical care for the sick and high risk, it will not be enough to stop transmission IMHO.

https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

 

One more excellent resource to add: Our world in data website - puts things into perspective and WHO map tracks new daily cases nicely if you're looking for what's going on as time elapses in each country that is affected. China, South Korea both show trends of declining numbers over 4-6 weeks whereas Italy does not (yet). I'm very curious and find it interesting to see fewer deaths in countries south of China and in Africa so far.

https://ourworldindata.org/coronavirus

 

[Read the Footnotes]

DocSnowball, James22, Viking, SamWise, and Meiroy: Thank you for your contributions. It definitely takes more time and effort to make thoughtful contributions like these to the board.

 

SamWise and Meiroy thank you for trying to quantify the complexities of trying to construct a more robust model for the likely path and outcomes of this situation. I think for some readers of this board it will be very instructive.

 

The real crux of the issue is what is being seen in Italy right now, which is the fact that the healthcare system can easily become overwhelmed if the curve is not flattened. Exponential growth in cases after tipping points are reached will cause case fatality rates to increase exponentially. At some point those presenting at hospital will be triaged and some will receive no treatment. In an absolute worst case the marginal patient presenting at hospital will be offered nothing and the fatality rates of a marginal case presenting will start to approach 100%.

 

In order to avoid this doomsday situation where hospitals in a region are non-functional, enormous costs will be incurred over a longer period of time than what most of society is considering at this point. Eventually our government and our private institutions will likely function very well. If there is tragedy in the USA it will be because they did not act fast enough and an ounce of prevention proved to be worth a pound of cure at a point when we did not even have a cure and only had supplemental oxygen and ventilation to offer.

[Gregmal]

Have yet to find a person not leaning towards selling the news on Donny’s big announcement. Little to do with the potential economic effects, and much more to do with his penchant for being a grand exaggerator and salesman.

[Liberty]

 

"Immigration judges have been putting up CDC coronavirus prevention posters in their courtrooms. The Trump administration just ordered them to take them down.

 

To be really really clear, these are government-issued posters on mitigating coronavirus transmission, produced by the CDC and put up voluntarily by immigration judges in their own work spaces. And the Trump DOJ has ORDERED that they be taken down nationwide."

 

https://www.miamiherald.com/news/local/immigration/article241046076.html

 

Also:

 

South Korea has conducted 190,000 tests thus far, capacity of 15,000 a day.

 

"If doctors suspect a COVID-19 case, they can proceed with testing without restriction. Of course, the testing is conducted free of charge."

[ERICOPOLY]

Have yet to find a person not leaning towards selling the news on Donny’s big announcement. Little to do with the potential economic effects, and much more to do with his penchant for being a grand exaggerator and salesman.

 

I'm not leaning towards selling it.

 

This isn't the Spanish flu which primarily targeted people in their 20s,30s,40s and largely left the children and elderly alone.  The level of panic will subside once the general public comes to understand this.

 

I am fearful for my parents who are in their 70s and 80s (my father has had pneumonia in the past 6 months) and I have two close social contacts with stage 4 cancer undergoing chemotherapy.  However, I don't fear for myself, my wife or my kids . (I remarried in January).

[rb]

Have yet to find a person not leaning towards selling the news on Donny’s big announcement. Little to do with the potential economic effects, and much more to do with his penchant for being a grand exaggerator and salesman.

 

I'm not leaning towards selling it.

 

This isn't the Spanish flu which primarily targeted people in their 20s,30s,40s and largely left the children and elderly alone.  The level of panic will subside once the general public comes to understand this.

 

I am fearful for my parents who are in their 70s and 80s (my father has had pneumonia in the past 6 months) and I have two close social contacts with stage 4 cancer undergoing chemotherapy.  However, I don't fear for myself, my wife or my kids . (I remarried in January).

I'm more in the selling the news camp. Metaphorically of course, cause I'm not selling anything. I don't think that this, whatever this is, is done yet. We normally don't get market activity like we've seen over the past x trading days and then all of a sudden we go back to normal and everyone forgets about it.

 

By the way, in my opinion, this is not about the coronavirus anymore but just good old fashion market dynamics where everyone is scared. If coronavirus cases and deaths spike we get more depressed market participants. If the corona thing abates though I don't think we see a big spike up in the market.

[Liberty]

(I remarried in January).

 

Congrats, mazel tov, shaadi ki badhai, felice matrimonio, tillykke, bednierebas gisurveb, meilleurs voeux!

[Gregmal]

I’m just referring you people’s ultimate level of let down with The Donalds plan. Seems to be a classic setup of over promise under deliver.

 

I also agree this is overblown. There’s dudes talking about extinction ROFLMAO

 

If you are really worried about extinction the last thing on your mind should be fucking around in the stock market...

[Read the Footnotes]

Have yet to find a person not leaning towards selling the news on Donny’s big announcement. Little to do with the potential economic effects, and much more to do with his penchant for being a grand exaggerator and salesman.

 

I'm not leaning towards selling it.

 

This isn't the Spanish flu which primarily targeted people in their 20s,30s,40s and largely left the children and elderly alone.  The level of panic will subside once the general public comes to understand this.

 

I am fearful for my parents who are in their 70s and 80s (my father has had pneumonia in the past 6 months) and I have two close social contacts with stage 4 cancer undergoing chemotherapy.  However, I don't fear for myself, my wife or my kids . (I remarried in January).

Best to you and your family.

 

It is also possible that the young are actually underestimating their risk. When hospitals have become overwhelmed, the triage has been to not even try to treat those with pre-existing conditions or over the age of 60-65. If they needed oxygen supplementation they won't get it and will decline more rapidly. If they can't get oxygen and they start to decline further, they certainly aren't getting ventilation. In these cases the mortality rates have likely increased to near 100%. So some over 65 hospitalized patients likely had good care and a low mortality rate and others had no care or were turned away or simply isolated and had no chance. The outcomes would not be dependent upon immune response, but the timing of when they presented to the hospital, which would be much less likely to be a factor in the under 60 crowd.

 

A well functioning modern healthcare system with adequate testing and early identification of symptoms should be able to keep the CFR well under 2%, but I think you can see from the points above how the risk to older people could be overstated and the risk to younger people could be understated. To some extent the outcomes are dependent upon the patient's ability to stage an immune response, but to some extent the data contain the artifact of denial of care to those over the age of 65.

[ERICOPOLY]

Here are mortality rates for any given age:

 

https://www.ssa.gov/oact/STATS/table4c6.html

 

Before accounting for COVID-19, an octogenarian was facing anywhere from a 4.2% - 11.6% chance of dying in any given year.

 

All I'm saying is I was already fearful for my father as it was.  The Chinese CDC is saying that COVID-19 is killing 14.8% of 80+ yr olds (and this number may be high). 

 

I am looking at this as basically knocking two years off of their life expectancy, and that might be exaggerated due to its propensity to kill the weakest.

[Read the Footnotes]

Here are mortality rates for any given age:

 

https://www.ssa.gov/oact/STATS/table4c6.html

 

Before accounting for COVID019, an octogenarian was facing anywhere from a 4.2% - 11.6% chance of dying in any given year.

 

All I'm saying is I was already fearful for my father as it was.  The Chinese CDC is saying that COVID-19 is killing 14.8% of 80+ yr olds (and this number may be high).

Your comments make me realize I could have expressed myself better. I really wanted to make two points regarding the scenarios outlined above.

 

1) In the limited examples where someone with commodities or over the age of 65 has severe enough symptoms to fall in the 15-20% who would normally be hospitalized and provided treatment, but the system fails and they are denied treatment, the situation becomes horrific. We should all try to prevent this from happening to loved ones and anyone else. This giant mobilization is about maintaining that capacity to treat and achieve better outcomes for anyone with severe cases.

 

2) The data contain an artifact that may cause healthier and younger people to underestimate the severity of risk that they face.

 

Hopefully this will all be better communicated to the American people soon as well as around the world.

 

Best of luck to you and your family, young and old.

[StubbleJumper]

Have yet to find a person not leaning towards selling the news on Donny’s big announcement. Little to do with the potential economic effects, and much more to do with his penchant for being a grand exaggerator and salesman.

 

I'm not leaning towards selling it.

 

This isn't the Spanish flu which primarily targeted people in their 20s,30s,40s and largely left the children and elderly alone.  The level of panic will subside once the general public comes to understand this.

 

I am fearful for my parents who are in their 70s and 80s (my father has had pneumonia in the past 6 months) and I have two close social contacts with stage 4 cancer undergoing chemotherapy.  However, I don't fear for myself, my wife or my kids . (I remarried in January).

 

 

Eric,

 

Congratulations for the new marriage.  I wish you all the happiness in the world with the new wife.

 

We have all seem to have lost our stiff upper lip.  Your take on this virus strikes me as being bang-on.  It is the 80+ year-old group who are being cleaned out by this.  But, people are really struggling to process what it all means.  I recommend that everyone take 15 minutes to pull up an actuarial life table like this one: https://www.ssa.gov/oact/STATS/table4c6.html 

 

If you are at all curious, you can look up what your probability of croaking was before Covid-19 came on the scene and compare it to what we think is the probability of croaking from Covid if you catch it.  Here's a rough collection of datapoints for men:

 

Age 20: Existing probability of death during a year: 0.001173  ==> Death rate if you catch covid: 0.002

Age 40: Existing probability of death during a year: 0.002420  ==> Death rate if you catch covid: 0.004

Age 60: Existing probability of death during a year: 0.011533  ==> Death rate if you catch covid: 0.036

Age 80: Existing probability of death during a year: 0.057712  ==> Death rate from covid: 0.148

 

Covid-19 is definitely bad news, but it does not appreciably increase your risk of dying in a year if you are young.  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

 

SJ

[Liberty]

Here are mortality rates for any given age:

 

https://www.ssa.gov/oact/STATS/table4c6.html

 

Before accounting for COVID-19, an octogenarian was facing anywhere from a 4.2% - 11.6% chance of dying in any given year.

 

All I'm saying is I was already fearful for my father as it was.  The Chinese CDC is saying that COVID-19 is killing 14.8% of 80+ yr olds (and this number may be high). 

 

I am looking at this as basically knocking two years off of their life expectancy, and that might be exaggerated due to its propensity to kill the weakest.

 

What's scary is that even if you don't die, it sounds like complications from lung fibrosis can have long-lasting/permanent deleterious effects in at-risk populations like the elderly.

[Liberty]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

[Liberty]

Paper that looks at potential seasonality:

 

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550308

 

PDF here

 

Also, what a competent response can do:

 

[StubbleJumper]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

 

 

No, I had intended to use a clinical tone to deal with that age cohort.  I have several family and friends who are in that cohort and I fully expect to lose more than a few from Covid.  When that happens, it will be sad for me and those around me.  But, when dealing with the aggregate question, you need to remain distant, clinical, and ideally, objective.

 

 

SJ

[Read the Footnotes]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

 

 

No, I had intended to use a clinical tone to deal with that age cohort.  I have several family and friends who are in that cohort and I fully expect to lose more than a few from Covid.  When that happens, it will be sad for me and those around me.  But, when dealing with the aggregate question, you need to remain distant, clinical, and ideally, objective.

 

 

SJ

What is sad is that if there is quick decisive action the financial costs can remain low. That unfortunately did not happen in China and this virus may now be with us indefinitely.

 

And it also did not happen in the USA, which may increase the ultimate costs. It's kind of like levering the heck out of a bunch of businesses and telling everybody everything is going to be great. The costs of the leverage will be minimal until they aren't.

[Liberty]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

 

 

No, I had intended to use a clinical tone to deal with that age cohort.  I have several family and friends who are in that cohort and I fully expect to lose more than a few from Covid.  When that happens, it will be sad for me and those around me.  But, when dealing with the aggregate question, you need to remain distant, clinical, and ideally, objective.

 

 

SJ

 

My bad, I didn't realize that "clean out" and "croak" were clinical terms.

[ERICOPOLY]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

 

 

No, I had intended to use a clinical tone to deal with that age cohort.  I have several family and friends who are in that cohort and I fully expect to lose more than a few from Covid.  When that happens, it will be sad for me and those around me.  But, when dealing with the aggregate question, you need to remain distant, clinical, and ideally, objective.

 

 

SJ

 

The 80+ yr old people that it is killing in that age group (the weakest) had a higher risk of dying this year (and the next year, and the next) than the actuarial table tells.  I believe we are talking about less than 2 years of life expectancy being lost for people 80+ who contract COVID-19. 

[StubbleJumper]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

 

 

No, I had intended to use a clinical tone to deal with that age cohort.  I have several family and friends who are in that cohort and I fully expect to lose more than a few from Covid.  When that happens, it will be sad for me and those around me.  But, when dealing with the aggregate question, you need to remain distant, clinical, and ideally, objective.

 

 

SJ

 

My bad, I didn't realize that "clean out" and "croak" were clinical terms.

 

 

No, but if you return to your psychology courses that you took from university, you would see that they are classical defence mechanisms:

 

https://www.simplypsychology.org/defense-mechanisms.html

 

 

The use of callous terms is designed to actually enable a clinical analysis.

 

 

SJ

[StubbleJumper]

  It will, however, clean out the 80+ year-old cohort (but 5.77% of them were destined to croak in 2020 from some other cause anyway).  Now, people might not like this comment, but I will make it anyway.  Is a family/community/nation/country economically worse off or better off when an 80 year-old dies?  The panic and lock-downs are what cause economic damage more than the morbidity and mortality.

 

I hope someday what happened to racism and sexism happens to ageism.

 

People are people, with inherent worth and dignity, they are not worth less because their bodies are sick and frail and they have had many birthdays.

 

Now I know you said "economically", but the tone still got to me. Maybe you didn't mean it to come across this callous with the lives of people who often already have tough lives.

 

 

No, I had intended to use a clinical tone to deal with that age cohort.  I have several family and friends who are in that cohort and I fully expect to lose more than a few from Covid.  When that happens, it will be sad for me and those around me.  But, when dealing with the aggregate question, you need to remain distant, clinical, and ideally, objective.

 

 

SJ

 

The 80+ yr old people that it is killing in that age group (the weakest) had a higher risk of dying this year (and the next year, and the next) than the actuarial table tells.  I believe we are talking about less than 2 years of life expectancy being lost for people 80+ who contract COVID-19.

 

 

Definitely that is true.  It is also likely the case that the covid-19 mortality rate will ultimately come in lower as time progresses, but we won't really know for quite some time.  But, if any 40 year-old is fussing about his own prospects of mortality, it's worth reflecting on the existing likelihood of death in the actuarial table before getting too worked up about a 0.2% chance of dying if you are part of the 60% or 70% who catch covid.

 

 

SJ