The costs of not maximizing aggregate utility

Many people don’t like utilitarianism. They advocate alternative (often deontological) approaches to ethics. In 2020, we saw the immense costs of some of those misguided ethical systems.

Scott Aaronson has an excellent post that begins with a discussion of why he believes our response to Covid was inexcusably slow. He discusses challenge trials of vaccines, and also a WWII-style plan to build manufacturing capacity just in case the vaccines were successful.  But he also considers possible objections to his arguments, such as the fact that moving faster imposes risks:

Let me now respond to three counterarguments that would surely come up in the comments if I didn’t address them.

1.  The Argument from Actual Risk. Every time this subject arises, someone patiently explains to me that, since a vaccine gets administered to billions of healthy people, the standards for its safety and efficacy need to be even higher than they are for ordinary medicines. Of course that’s true, and it strikes me as an excellent reason not to inject people with a completely untested vaccine! All I ask is that the people who are, or could be, harmed by a faulty vaccine, be weighed on the same moral scale as the people harmed by covid itself. As an example, we know that the Phase III clinical trials were repeatedly halted for days or weeks because of a single participant developing strange symptoms—often a participant who’d received the placebo rather than the actual vaccine! That person matters. Any future vaccine recipient who might develop similar symptoms matters. But the 10,000 people who die of covid every single day we delay, along with the hundreds of millions more impoverished, kept out of school, etc., matter equally. If we threw them all onto the same utilitarian scale, would we be making the same tradeoffs that we are now? I feel like the question answers itself.

And it’s not just vaccine development; we’ve also prioritized “ethics” over saving lives in the distribution of the vaccine:

Update (Jan. 1, 2021): If you want a sense of the on-the-ground realities of administering the vaccine in the US, check out this long post by Zvi Mowshowitz. Briefly, it looks like in my post, I gave those in charge way too much benefit of the doubt (!!). The Trump administration pledged to administer 20 million vaccines by the end of 2020; instead it administered fewer than 3 million. Crucially, this is not because of any problem with manufacturing or supply, but just because of pure bureaucratic blank-facedness. Incredibly, even as the pandemic rages, most of the vaccines are sitting in storage, at severe risk of spoiling … and officials’ primary concern is not to administer the precious doses, but just to make sure no one gets a dose “out of turn.” In contrast to Israel, where they’re now administering vaccines 24/7, including on Shabbat, with the goal being to get through the entire population as quickly as possible, in the US they’re moving at a snail’s pace and took off for the holidays. In Wisconsin, a pharmacist intentionally spoiled hundreds of doses; in West Virginia, they mistakenly gave antibody treatments instead of vaccines. There are no longer any terms to understand what’s happening other than those of black comedy.

Everyone is entitled to choose their own preferred ethical system as a guide to their daily life.  But there is only one reliable ethical system to be used in public policy—maximizing aggregate utility.  As soon as you ignore that goal, you end up killing lots of people for no good reason.

In retrospect, none of this should have been a surprise (although I admit to being caught off guard.)  I had assumed that our disgraceful policy of banning kidney markets was a one-off exception.  Now I see that the same instinct that leads to tens of thousands of excess deaths of people with kidneys disease also pervades our entire public health system.

Aaronson understands that this failure goes well beyond one individual or even one country; it’s a broader failure of society:

Furthermore, I could easily believe that there’s no one agent—neither Pfizer nor BioNTech nor Moderna, neither the CDC nor FDA nor other health or regulatory agencies, neither Bill Gates nor Moncef Slaoui—who could’ve unilaterally sped things up very much. If one of them tried, they would’ve simply been ostracized by the other parts of the system, and they probably all understood that. It might have taken a whole different civilization, with different attitudes about utility and risk.

At the same time, I do believe that utilitarianism is gradually gaining ground.  But there’s still much more work to be done.

HT:  Matt Yglesias

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Nice vaccine; pity there’s no distribution mechanism

Many people are horrified by the prospects of introducing the profit motive into health care. Thus they oppose paying kidney donors, even though it would save tens of thousands of lives. They oppose price gouging on masks or vaccines, even though it would save many lives. They oppose challenge studies for vaccines, even though it would have brought us a vaccine much sooner, thus saving many lives.

Instead, we end up with a government controlled health care regime, where decisions are made by slow and cumbersome bureaucracies.

In a libertarian society, the pandemic might already be essentially over. That’s not to say that libertarianism is necessarily precisely “optimal”, as indeed there is a market failure aspect to pandemics, due to the external effects of infection. Yet despite the theoretical case for government intervention, in reality it does much more harm than good.

Critics of libertarianism make the following errors:

1. Ignoring the Lucas Critique: They assume that behavior in a highly regulated society is similar to what it would be in a libertarian society.  When interviewed, several Swedes indicated that they didn’t see any need for masks because the Swedish government told them they were not needed. People don’t behave like sheep in a libertarian society; they learn to be responsible for their own decisions. Before FDIC, people took an active interest in the safety of the banks where they deposited their hard earned money. Now nobody cares how recklessly their bank lends out their money—it’s all insured. And yet I see opponents of abolishing FDIC argue that people are not able to ascertain whether banks are safe.

2. People underestimate the pervasiveness of government regulation: Occasionally one encounters progressives describing America’s socialist health care system as a free market system, which is absurd.  Or they’ll say “There was nothing to prevent health care firm X from doing what you suggest.”  Yes there was; health care providers are so enmeshed in our over-regulated system that they have almost no ability to engage in creative problem solving.  Suppose a vaccine company pursues an ambitious plan to speed vaccine development.  They ask participants to sign as waver promising not to sue if things go bad.  How would that contract hold up in court?

3.  Externalities cut both ways: Progressives like to talk about externalities as a market failure. They also like to suggest that selling vaccines to the highest bidder is an abhorrent idea.  But you can’t have it both ways.  The externality aspect of pandemics means that a program that vaccinates people more rapidly also helps those who are not yet vaccinated.  In other words, when it comes to pandemics, “externality” is just another word for “trickle-down theory”.  A free market regime that uses the profit motive to vaccinate 20 million people in December is superior to a bureaucratic regime that vaccinates 5 million people in December, even if the free market allocation is in some sense “unfair”.

4.  Cultural norms also matter in a libertarian society: Just as people put up phony arguments against utilitarianism by positing abhorrent policies that supposedly increase aggregate utility but actually make society more unhappy, progressives make phony arguments against libertarianism by ignoring the fact that our ethical instincts would still exist in a libertarian society.  Bill Gates doesn’t stop donating tens of billions of dollars for the provision of health care to the world’s poor just because we deregulate.  Catholic hospitals don’t suddenly ignore ethical considerations just because we deregulate.  Society is still there, with all its instincts and norms.  We don’t all become Gordon Gekko; indeed people are “nicer” in capitalist countries than in communist countries.  What we get through deregulation is competition; if some of our institutions are creating roadblocks then other institutions (or even foreign countries) will provide services to those willing to pay. To attract progressives, maybe we should start calling competition “diversity”.

5. Bureaucrats use cost/benefit analysis, for themselves: Yes, bureaucrats weigh costs and benefits.  They consider the cost to their career in letting a bad product our prematurely and the cost to their career of a “better safe than sorry” long delay in testing a new product.  Unfortunately the outcome that is best for the individual bureaucrat is almost never the outcome that is optimal for society as a whole.

This twitter thread discusses how the US government botched the vaccine rollout.  And this Alex Tabarrok post discusses how the Canadians do it better.  (Tyler Cowen makes a similar point.)  Our government also botched testing, masks, challenge studies, etc.  And now tens of thousands are dying as a result.  Socialism kills.

HT:  Matt Yglesias

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The FDA’s Deadly Caution

The earliest Moderna probably would have sold the mRNA-1273 vaccine would have been after it began scaling up manufacturing. A company doesn’t begin manufacturing until it believes in a product. In the timeline above, that’s March 23. But manufacturing takes some time to get going. Let’s assume that by April 1, five weeks from the date the first batch was shipped, Moderna begins offering mRNA-1273 for sale.

Sales start slowly. Supplies are limited. Only the bold and brave get inoculated. The rest of us, and Moderna, get some early, albeit messy, safety and efficacy data. This data helps Moderna improve the vaccine, dose, and dosing schedule. Having a ready market and a steady source of revenue, Moderna scales up production faster than in the timeline above.

In this scenario, inoculations could have begun at least 8.5 months earlier and, perhaps, the pandemic would have ended 240 days and 240,000 lives earlier. There’s little talk of lockdowns and the economy remains resilient.

This is from Charles L. Hooper and David R. Henderson, “The FDA’s Deadly Caution,” AIER, December 16, 2020. In it, we consider various scenarios for what would have happened had we had a truly free market in pharmaceuticals.

The one above is the most optimistic.

Read the whole thing.

 

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Response to a Friend about Fear of Death

My friend Ross Levatter sent me a thoughtful email challenging some aspects of my posts (here and here) on the risks we should fear. He gave me permission to post the whole thing. I also shared it with co-author Charley Hooper, who emailed me his thoughts. I’ll answer, and give Charley’s answer, after his letter. Here’s Ross’s letter:

I briefly skimmed your posts on what people are frightened of, where you note that many are frightened about rare events rather than more common causes of death or injury. You write “What should we fear? What threats are most likely to kill us?” Your underlying assumption is that the answer to the latter should strongly inform us in answering the former. But I don’t think that’s right.

The fact is, most adults have made peace with the fact they’re going to die at some point. Most people are not scared of dying per se. They go through the 5 stages, ending with acceptance. You don’t find massive amounts of fear in hospices.

It seems your paper’s underlying assumption is that FEAR of death by X should track LIKELIHOOD of death by X. But I don’t think that’s correct.

What ARE people frightened about?

1. UNEXPECTED deaths. Cardiovascular disease kills lots of people. Cancer kills lots of people. Shark attacks DO NOT kill lots of people. One might be frightened to anticipate dying of something that hardly kills anyone.

2. PAINFUL deaths. Here’s an Anthony Jeselnik joke: “My grandmother died last year. Initially, we all thought she died in the best way possible. What’s the best way possible? Right, in her sleep. But then we had an autopsy and we found grandma died in the worst, most gruesome way possible. During an autopsy.” In fact, numerically, dying in one’s sleep is orders of magnitude more likely than dying during an autopsy (which I doubt has actually ever happened unless you count vivisection.) But it’s hopefully understandable why the thought of the latter is more frightening than the thought of the former.

3. SUDDEN deaths. The *novel* coronavirus infection is very unlikely to kill you, especially if you’re under 70. But unlike dying of cardiovascular disease, this is not a death you’ve given any thought to up until a year ago. So it’s more frightening. A *NEW* way to die.

4. UNFAIR deaths. The odds of dying of a terrorist attack are extremely low. But to most people it seems very UNFAIR to be a perfectly healthy, active individual with decades of life ahead of him in the morning and dead in the afternoon.

I’m sure if I gave it more than casual thought I could come up with other distinctions, but I hope my point is clear. The belief that fear of death from X should track likelihood of death from X is an assumption that is not obviously true—it needs at least to be argued for—and is most likely, IMHO, false.

I basically agree with most of what he said because Ross keyed in on our words “fear” and “afraid.” I think we should have focused not on fear but on what things it makes most sense for a person to invest in preventing. Terrorism? No. Shark attacks? No. Being killed by a policeman while unarmed? No. Living a life to avoid heart attacks or delay them by 5 years? Yes. Being cautious around social groups to avoid COVID-19? Yes.

Charley put it better. He wrote:

His [Ross’s] points are correct and we did use the word “fear,” but what we were getting at isn’t fear as much as being smart about risks. If you want to live a long life, what should you think about and do?

To summarize his points, if we make peace with a manner of death, we no longer fear it. We fear those deaths that are sudden, painful, and unexpected.

We could have used “being smart about fatal risks” instead of “what fatal risks to fear.” But at some point, we start sounding like Star Trek’s Spock.

Now back to me: Consider the hospice point. If you’re in a hospice, then, if it was a good decision for you to be there, you have exhausted the alternative ways of preventing, without great discomfort, the thing or things that you’ll die of. It makes sense both not to fear the thing that will kill you and also not to invest further in preventing it. The time to act would have been much earlier when possibly a change in life style could have given you a couple more years of good life.

Ross then added a short additional point:

BTW, here’s another (I think incorrect) implication of this line of reasoning. Assume “Dying in your sleep” and “Dying from shark attack” are statistically exactly equally likely. Does it then follow that one should be equally frightened at the two prospects? I suspect most people, told they are equally likely, would still more greatly fear dying of shark attack.

I answered Ross as follows:

Yes, I would much rather die in my sleep, as my grandfather did, rather than dying in sheer terror, as his passengers did.

But seriously, folks, it is true that if you  choose between two ways of dying that have equal probabilities, the one that is more painful is the one to avoid.

You could alter our analysis by scaling the numbers, though, and in many cases that won’t matter. For instance, imagine that you would hate being killed by a shark 1,000 times as much as dying in your sleep. The odds of being killed by a shark are still so low that it doesn’t make sense to take account of that in deciding whether to swim in the ocean.

 

 

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Death panels, euthanasia, and the conservative embrace of herd immunity

I don’t have an ax to grind here, but I’ve noticed an anomaly and wonder if commenters see the same issue.

I’ve always thought of the left as being vaguely “pro-life” on issues like pollution control and national health care. The right seems “pro-life” in its opposition to Medicare “death panels”, euthanasia, and of course abortion.

Conservative views are often informed by religion, and there’s a clear hostility to the cold utilitarian calculation embodied in death panels and euthanasia. The idea of viewing old people as disposable, or the idea of saying, “it’s not worth spending $X to save grandma” seem especially repugnant to conservatives. This group often criticizes countries in northwestern Europe that have a more “utilitarian” approach to death. To many conservatives, life is sacred.

Given these perceptions, I would not have expected so many conservatives to embrace the view that its OK to trade off the lives of a few hundred thousand mostly old people in exchange for a few trillion dollars more in GDP (and, in fairness, more freedom as well.) Note that this freedom argument could be called “pro-choice”. My partying may kill grandma, but “it’s my body, my choice”.

Just to be clear, I’m not arguing here that conservatives are right or wrong on any of these views. I’m not even sure that the views conflict. I’m also not sure that I fully understand the views of “conservatives” as a whole, a label that includes people as diverse as pro-life Catholic supporters of the welfare state and pro-choice libertarian atheists.

So maybe there is no contradiction here at all.

Another possibility is that conservatism is evolving in a new direction. We know that ideologies change all the time. Liberals have been on both sides of eugenics, free trade, free speech, and a host of other issues. Why shouldn’t conservatism evolve as well?

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Answer to a Reader on What We Should Fear

I received the following letter last week and the author gave me permission to quote without using his name.

Hi Dr. Henderson,

My name is X, I’m a fan of your writing, so I wanted to thank you for your work and insight that I’ve been able to enjoy…

I recently read your article “What should we fear most and what should we do about it” in the recent Regulation magazine, and while I generally agree with the policy prescriptions for the FDA I was somewhat confused about the discussion around people’s irrational reaction to different threats in life.  I’ve also heard other economists discuss irrational threat response behavior and honestly it strikes me as a bit misguided.  But I’m also not an economist or an academic so I may be missing something, and I’d be grateful to hear your thoughts on it..

One thing is that isn’t there a categorical mistake being made when comparing something like shark attacks to things like heart disease or cancer?  The latter two seem to be more or less results of aging (or long-term behaviors like excessive eating or smoking, for example).  In other words, aren’t illnesses or diseases that come with the territory of aging and dying categorically different than something like a shark attack?  I feel the same reasoning could be used to tell people not to worry about walking in a bad part of the city because your chances of dying from cancer are higher than getting shot.  It seems like a non-sequitur to me.  One way is a gruesome and sudden end to (hypothetically) a younger person’s life while the other is something that is more or less accepted by people as a very possible ending to their lives when they are older–illness and death at the end of life are accepted as part of the tragedy of the human condition.  This is not to say that I think people should be very worried about shark attacks, just that the statistical probability analysis comparing these events is missing something.

The second thing is the uncertainty of some risks as opposed to others.  I’d agree with the proposition that we shouldn’t go too far in restricting freedoms in order to prevent terrorism, but comparing it to illness or automobile accidents again seems misguided to me.  I think most people would have found it irrational to say, for example after the attack on Pearl Harbor, that people should be more worried about automobile safety and cancer than Japanese acts of war because their likelihood (at that point) of dying in an attack was much lower.  People worried about it because there was uncertainty about further attacks, a time sensitivity to stop aggression as early as possible, and the possible defeat of the US in a war.
Am I missing something here?  I appreciate your time and any thoughts you may have on this.  I look forward to reading more of your writings!

X was referring to this article by Charley Hooper and me.

Here’s my answer.

First, thanks for the compliment.

Second, let’s consider the shark versus heart disease/cancer point. They are different categories, but I don’t think there’s a category mistake. You’re right that the heart disease and cancer risk come with age whereas the shark attack is pretty much unrelated to age. They do come with the territory, but there’s a lot you can do about the territory. Just as you can avoid the almost infinitesimal risk of being killed by a shark by staying out of the ocean, you can substantially reduce a risk that’s a few orders of magnitude greater by, say, not smoking cigarettes, getting exercise, and eating in moderation. As someone who just turned 70, I don’t passively say, “Oh, that risk comes with the territory. I want to make it to 100 and I’m doing a number things will help me.” And I haven’t even mentioned medications that will help me as I age.

Regarding the point about walking in certain parts of town, if the risk is high enough, then it easily could be the case that you’re more at risk from dying in an hour from walking in that part of town than you are at risk from dying from a heart attack or cancer in an hour. The sensible way to think about risk is per unit time, whether it be an hour, a day, or a year. As I’m sure you noticed in our article, we normalized by having it be risk in a year.

You said that comparing terrorism to illness or automobile accidents seems misguided, but you didn’t say why. Why do think that?

Re Pearl Harbor you wrote:

I think most people would have found it irrational to say, for example after the attack on Pearl Harbor, that people should be more worried about automobile safety and cancer than Japanese acts of war because their likelihood (at that point) of dying in an attack was much lower.  People worried about it because there was uncertainty about further attacks, a time sensitivity to stop aggression as early as possible, and the possible defeat of the US in a war.

You make a good point. The way to compare risks there is not to see Pearl Harbor as a one-off event but to put it in context. What was the probability of further attacks? What was the chance the United States would have been defeated in war and what would have been the consequences of that?

What that basically says is that it makes sense to look at the whole thing, not just a piece. I would give you my views on the war with Japan because they are different from the views of almost everyone else I know, but that would take us too far away from the statistical issues you’ve raised.

I shared the letter with my co-author Charley Hooper, who answered as follows:

If we don’t want to die, or at least die at a young age, there are certain actions we can take. These actions have a cost and an expected benefit. That expected benefit is the probability times the benefit.

There’s a cost I incur if I avoid swimming in the ocean to reduce my risk of a shark attack. The expected benefit is minuscule because the probability is already so low that it’s difficult to lower it further. In other words, the expected benefit is negligible.

There’s a cost I incur if I exercise more, take a medication, practice meditation, or avoid eating certain foods. The expected benefit may be large because I only need to reduce the probability of dying from a heart attack or cancer a little bit to make a noticeable improvement. In other words, the expected benefit is large.

X is saying that we accept heart disease and cancer because they are a part of aging. If that’s the case, then why are so many drugs sold, so many procedures completed, and so much medical attention devoted to treating cancer and heart disease? Plus, if you could prevent a death from any source, you’ve still prevented a death. A heart attack can kill you just as certainly as can a shark.

We don’t act as if we accept heart attacks and cancer. And even if we did, we shouldn’t.

Regarding Pearl Harbor and WWII, again it comes to probabilities, actions, and outcomes. An individual might have a greater chance of dying in a car crash than dying in the war, but the risk of war is more than death: it’s having your house destroyed, your family killed, your government overthrown, your wealth destroyed, and your daughter raped. War is hell.

We shouldn’t worry about either car crashes or wars; we can worry about both and take the appropriate steps to reduce the risk of each.

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We Could Have Had the Vaccine in Early Spring at the Latest

You may be surprised to learn that of the trio of long-awaited coronavirus vaccines, the most promising, Moderna’s mRNA-1273, which reported a 94.5 percent efficacy rate on November 16, had been designed by January 13. This was just two days after the genetic sequence had been made public in an act of scientific and humanitarian generosity that resulted in China’s Yong-Zhen Zhang’s being temporarily forced out of his lab. In Massachusetts, the Moderna vaccine design took all of one weekend. It was completed before China had even acknowledged that the disease could be transmitted from human to human, more than a week before the first confirmed coronavirus case in the United States. By the time the first American death was announced a month later, the vaccine had already been manufactured and shipped to the National Institutes of Health for the beginning of its Phase I clinical trial. This is — as the country and the world are rightly celebrating — the fastest timeline of development in the history of vaccines. It also means that for the entire span of the pandemic in this country, which has already killed more than 250,000 Americans, we had the tools we needed to prevent it.

This is from David Wallace-Wells, “We Had the Vaccine the Whole Time,” New York, December 7, 2020.

HT to my Hoover colleague John Cochrane, who hits home run after home run, but this is one went out of the park.

If you do nothing else today, read his post.

Wallace-Wells writes:

To be clear, I don’t want to suggest that Moderna should have been allowed to roll out its vaccine in February or even in May.

To be clear, I want not only to suggest that but to advocate that.

John Cochrane explains why:

Even under operation Warp Speed — a truly commendable accomplishment of the Trump Administration that, maybe a year or so from now the TDS crowd might acknowledge — the only thing we have been waiting for is FDA certification: Randomized clinical trials to prove safety and efficacy, before anyone is allowed to take the vaccine.

What’s the free-market way? A drug company can sell a vaccine on January 14, and you can buy it, without fear of going to jail.

Sure, there is an FDA, and a Federal Trade Commission which monitors drug labeling. The vaccine has to say “this is totally untested, and has not been proven safe or effective in clinical trials” and offer a stack of paper about known risks. You sign a stack of consent forms. If you take it, you’re enrolled in our big national database — you just volunteered for the national non-random clinical trial. (We don’t collect much data on drugs that are out there).  The FDA rapidly collects information. At the same time, randomized clinical trials are going on. Drugs can give more and more hopeful labels as the results roll in. At some point after Phase III and FDA review, a drug can get the official FDA seal of approval. No, insurance and medicare don’t pay for non-approved stuff. This is free-market nirvana, you pay for unapproved medicines if you want them (see part 1). There is an FTC and a tort system. Drug companies that sell things they know are unsafe or ineffective pay billions.

Sunk costs are sunk, of course. But wouldn’t it be great if we took some learning from this so that we could be more prepared for the next pandemic and not shut down the economy and lose lives both from the pandemic and from the shutdown?

 

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Vaccines’ Last Hurdle: Central Planners

Urgently needed drugs developed under Operation Warp Speed are at the mercy of officials working at “bureaucrat speed.”

I rarely like the titles that editors choose for my op/eds and articles. But this title that my Hoover editor chose is way better than mine.

Here are the first three paragraphs of “Vaccines’ Last Hurdle: Central Planners,” Defining Ideas, December 4, 2020:

First, the good news. We now appear to have at least two viable vaccines with high efficacy in preventing the awful disease known as COVID-19. On November 9, Pfizer/BioNTech announced that the efficacy of its vaccine exceeds 90 percent. On November 16, Moderna announced that its vaccine’s efficacy exceeds 94.5 percent. Take that, Pfizer! Seriously, though, both announcements are great news. Let’s put those percentages in perspective. I get a flu vaccine every year without fail. Is that because the vaccine is 90 percent effective? No. At best, it’s 60 percent effective, and its effectiveness is often well below 50 percent.

There’s even more good news. Even when the vaccines don’t prevent COVID-19, they make it substantially less severe. For example, in a study of thirty thousand volunteers for the Moderna test, of the eleven cases in people who got the vaccine, no case was severe, versus thirty severe cases for people who received the placebo. It’s risky to generalize from a sample size of thirty thousand, but still, the numbers are extremely encouraging. There’s also good news for us elderly. I was talking with a healthy seventy-seven-year-old woman at pickleball last week who was delighted that she, as an elderly person, would be one of the first to get it. I just turned seventy and my wife is seventy-one, and so presumably we will be on the priority list.

But the bad news for people who live in California is that California’s state government will slow things down. This might happen in New York and in some other states also. Let’s start by focusing on California, the state I know best. California’s government will slow things down in two ways: one is intentional and the other is unintentional.

Read the whole thing.

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Life-Years Lost: The Quantity and The Quality

A few weeks ago, the NYT reported that “The Coronavirus Has Claimed 2.5 Million Years of Potential Life.” If you read the original study, you’ll discover one crucial caveat: The authors’s calculations assume that COVID victims would have had the standard life expectancy for Americans of their age.  They freely admit that this is unrealistic and inflates their estimate:

The SARS-CoV-2 virus is known to infect and replicate in many different tissues and exacerbates problems in several organ systems including the kidney, liver, heart, lungs and brain (Lu et al., 2020; Chandrashekar et al., 2020). Any individual with problems in these systems or the immune system is likely to be more vulnerable to SARS-CoV-2 infection and suffer more severe outcomes as has been demonstrated for immune deficiencies (Bastard et al., 2020). In addition, other health states qualifying as pre-existing conditions, such as obesity, hypertension, chronic kidney disease and diabetes are known comorbidity factors for COVID-19 (see CDC co-morbidity tables and references therein; https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html) and these cohorts of individuals have a shorter than average predicted life span. Deaths due to complications with pre-existing comorbid conditions would artificially increase the person-years lost in these calculations but are difficult to quantitate in this current analysis.

The authors argue that fixing this problem would only modestly cut their estimates.  I’m not convinced, but I’d rather focus on a much bigger issue: Taking quality of life into account, how many life-years has the reaction to COVID destroyed?  To see what I’m getting at, ask yourself: “Suppose you could either live a year of life in the COVID era, or X months under normal conditions.  What’s the value of X?”  Given the enormous social disruption and dire social isolation that most people have endured, X=10 months seems like a conservative estimate.  For what it’s worth, this Twitter poll agrees*:

So what?  Well, we’ve now endured 8 months of COVID life.  If that’s worth only 5/6ths as much as normal time, the average American has now lost 4/3rds of a month.  Multiplying that by the total American population of 330M, the total loss comes to about 37 million years of life.  That’s about 15 times the reported estimate of the direct cost of COVID.

Casual readers will be tempted to declare that the cure has been much worse than the disease.  The right cost-benefit comparison, however, is not to weigh the cost of prevention against the harm endured.  The right cost-benefit comparison is to weigh the cost of prevention against the harm prevented.  You have to ask yourself: If normal life had continued unabated since March, how many additional life-years would have been lost?  I can believe that the number would have been double what we observed, even though no country on Earth has done so poorly.  With effort, I can imagine that the number would have been triple what we observed.  There’s a tiny chance it could have been five times worse.  But fifteen times?  No way.

Upshot: The total cost of all COVID prevention has very likely exceeded the total benefit of all COVID prevention.

Before you panic, note these key caveats:

1. This does not imply that zero COVID prevention was optimal.  The lesson is merely that we went much too far.

2. Prevention includes both private and government efforts.  The main lesson of the data is not merely that government overreacted, but that people overreacted.

3. As I’ve argued before, the initial costs of government action were moderate, because private individuals reacted strongly on their own.  Over time, however, government’s share of the burden has increased because private individuals’ have a strong tendency to lose patience and return to normalcy.

4. If a vaccine suddenly became available today, my calculations for the story so far would still hold.  Behavioral changes prevent deaths day-by-day.  They also drain life of much of its meaning day-by-day.

 

At this point, you could protest, “Hey Bryan, I thought you weren’t a utilitarian.”  So what if the cost of COVID prevention greatly exceeds the value of life saved?  My answer, to repeat, is that I have a strong moral presumption in favor of human liberty.  So while I respect individuals’ rights to overreact to moderate risks, I oppose any act of government that does not pass a cost-benefit test with flying colors.

And no, I don’t think that an asymptomatic person who walks down the street unmasked is “aggressing” against passersby in any meaningful way.

* You could object that my Twitter followers are self-selected to regard COVID prevention costs as high.  In point of fact, they consider the personal costs markedly less serious than the average costs:

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Conspiracy theories can cost lives

In a recent post, I discussed the appeal of conspiracy theories. Some of these theories are probably harmless, as with the belief that the government is hiding evidence of alien contact from outer space. In other cases, however, the theories are quite costly.

I’d encourage people to read this twitter thread from a nurse in Texas. He’s a brief excerpt:

 

And a recent Yahoo article mentions a similar example from South Dakota:

I don’t know how many people share this view, and indeed it is unlikely that people fall neatly into one of two camps.  Thus one poll suggested widespread skepticism about Covid was increasing:

In February, a little more than a quarter of U.S. adults believed the coronavirus was being blown out of proportion. Now, that number has risen to nearly 40% of respondents.

However “blown out of proportion” can include both those who see a hoax, and those who correctly understand that the risk is fairly low for younger people.  There are degrees of skepticism.

Nonetheless, I’ve see quite a few press reports of people are open to some pretty extreme conspiracy theories about Covid:

The survey conducted earlier this month also asked voters how likely they are to believe that “vaccines for COVID-19 will be used to implant tracking chips in Americans,” another baseless theory that has spread on social media this year.

More than a quarter of voters in the poll, 27 percent, said they thought the statement might be true, while 73 percent said it was likely false.

(Yes, I’m just as frustrated by the vague wording as you are.  “Might be”?  “Likely”?)

I don’t have any solution to this problem, but I do believe that when issues become politicized the problem often gets worse.  On average, people will probably make better choices when we don’t protect them from the consequences of their actions.  Treat them like adults, and they are more likely to act like adults.

At the same time I understand that there are “externality” issues with a pandemic, so it’s unlikely that the issue will remain completely apolitical.

HT:  Razib Khan

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