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On COVID, NPIs, and “Human” Data Points

24 Tuesday Nov 2020

Posted by pnoetx in Lockdowns, Pandemic, Public Health

≈ 1 Comment

Tags

Alzheimer's, Anthony Fauci, Asymptomatic Carriers, Cancer, CDC, Centers for Disease Control, Covid-19, Dementia, Domestic Abuse, Education, HIV, Human Costs, Journal of the American Medical Association, Lancet, Lockdowns, Malaria, Malignant Neoplasms, Mandates, Masks, Public Health, Robert Redfield, SAAAD, SARS-CoV-2, Starvation, Suicide, The Ethical Skeptic, Tuberculoosis, Tyler Cowen, United Nations, Vitamin D

The other day a friend told me “your data points always seem to miss the people points.” He imagines a failure on my part to appreciate the human cost of the coronavirus. Evidently, he feels that I treat data on cases, hospitalizations, and deaths as mere accounting issues, all while emphasizing the negative aspects of government interventions.

This fellow reads my posts very selectively, hampered in part by his own mood affiliation. Indeed, he seems to lack an appreciation for the nuance and zeitgeist of my body of blogging on the topic… my oeuvre! This despite his past comments on the very things he claims I haven’t mentioned. His responses usually rely on anecdotes relayed to him by nurses or doctors he knows. Anecdotes can be important, of course. But I know nurses and doctors too, and they are not of the same mind as his nurses and doctors. Anecdotes! We’re talking about the determination of optimal policy here, and you know what Dr. Fauci says about relying on anecdotes!

Incremental Costs and Benefits

My friend must first understand that my views are based on an economic argument, one emphasizing the benefits and costs of particular actions, including human costs. COVID is dangerous, but primarily to the elderly, and no approach to managing the virus is free. Here are two rather disparate choices:

  1. Mandated minimization of economic and social interactions throughout society over some time interval in the hope of reducing the spread of the virus;
  2. Laissez faire for the general population while minimizing dangers to high-risk individuals, subject to free choice for mentally competent, high-risk individuals.

To be clear, #2 entails all voluntary actions taken by individuals to mitigate risks. Therefore, #1 implies a set of incremental binding restrictions on behavior beyond those voluntary actions. However, I also include in #1 the behavioral effects of scare mongering by public officials, who regularly issue pronouncements having no empirical basis.

The first option above entails so-called non-pharmaceutical interventions (NPIs) by government. These are the elements of so-called lockdowns, such as quarantines and other restrictions on mobility, business and consumer activity, social activities, health care activities, school closures, and mask mandates. NPIs carry costs that are increasing in the severity of constraints they impose on society.

And before I proceed, remember this: tallying all fatal COVID cases is really irrelevant to the policy exercise. Nothing we do, or could have done, would save all those lives. We should compare what lives can be saved from COVID via lockdowns, if any, with the cost of those lockdowns in terms of human life and human misery, including economic costs.

Economic Losses

NPIs involve a loss of economic output that can never be recovered… it is gone forever, and a loss is likely to continue for some time to come. That sounds so very anodyne, despite the tremendous magnitude of the loss involved. But let’s stay with it for just a second. The loss of U.S. output in 2020 due to COVID has been estimated at $2.5 trillion. As Don Boudreaux and Tyler Cowen have noted, what we normally spend on safety and precautionary measures (willingness-to-pay), together with the probabilities of losses, implies that we value our lives at less than $4 million on average. Let’s say the COVID death toll reaches 300,000 by year-end (that’s incremental in this case— but it might be a bit high). That equates to a total loss of $1.2 trillion in life-value if we ignore distinctions in life-years lost. Now ask this: if our $2.5 trillion output loss could have saved every one of those 300,000 lives, would it have been worth it? Not even close, and the truth is that the sacrifice will not have saved even a small fraction of those lives. I grant, however, that the economic losses are partly attributable to voluntary decisions, but goaded to a great extent by the alarmist commentary of public health officials.

The full depth of losses is far worse than the dollars and cents comparison above might sound. Output losses are always matched by (and, in value, are exactly the same as) income losses. That involves lost jobs, lost hours, failed businesses, and destroyed careers. Ah, now we’re getting a bit more “human”, aren’t we! It’s nothing short of callous to discount these costs. Unfortunately, the burden falls disproportionately on low-income workers. Our elites can mostly stay home and do their jobs remotely, and earn handsome incomes. The working poor spend their time in line at food banks.

Yes, government checks can help those with a loss of income compete with elites for the available supply of goods, but of course that doesn’t replace the lost supply of goods! Government aid of this kind is a palliative measure; it doesn’t offset the real losses during a suspension of economic activity.

Decimated Public Health

The strain of the losses has been massive in the U.S. and nearly everywhere in the world. People are struggling financially, making do with less on the table, depleting their savings, and seeking forbearance on debts. The emotional strains are no less real. Anxiety is rampant, drug overdoses have increased, calls to suicide hotlines have exploded, and the permanence of the economic losses may add to suicide rates for some time to come. Dr. Robert Redfield of the CDC says more teenagers will commit suicide this year than will die from COVID (also see here). There’s also been a terrifying escalation in domestic abuse during the pandemic, including domestic homicide. The despair caused by economic losses is all too real and should be viewed as a multiplier on the total cost of severe NPIs.

More on human costs: a health care disaster has befallen locked-down populations, including avoidance of care on account of panic fomented by so-called public health experts, the media, and government. Some of the consequences are listed here. But to name just a few, we have huge numbers of delayed cancer diagnoses, which sharply decrease survival time; mass avoidance of emergency room visits, including undiagnosed heart attacks and strokes; and unacceptable delays in cardiac treatments. Moreover, lockdowns worldwide have severely damaged efforts to deal with scourges like HIV, tuberculosis, and malaria.

The CDC reports that excess mortality among 25-44 year-olds this year was up more than 26%, and the vast bulk of these were non-COVID deaths. A Lancet study indicates that a measles outbreak is likely in 2021 due to skipped vaccinations caused by lockdowns. The WHO estimates that 130,000,000 people are starving worldwide due to lockdowns. That is roughly the population of the U.S. east coast. Again, the callousness with which people willfully ignore these repercussions is stunning, selfish and inhumane, or just stupid.

Excess Deaths

Can we quantify all this? Yes we can, as a matter of fact. I’ve offered estimates in the past, and I already mentioned that excess deaths, COVID and non-COVID, are reported on the CDC’s web site. The Ethical Skeptic (TES) does a good job of summarizing these statistics, though the last full set of estimates was from October 31. Here is the graphic from the TES Twitter feed:

Note particularly the huge number of excess deaths attributable to SAAAD (Suicide, Addiction Abandonment, Abuse and Despair): over 50,000! The estimate of life-years lost due to non-COVID excess deaths is almost double that of COVID deaths because of the difference in the age distributions of those deaths.

Here are a few supporting charts on selected categories of excess deaths, though they are a week behind the counts from above. The first is all non-COVID, natural-cause excess deaths (the vertical gap between the two lines), followed by excess deaths from Alzheimer’s and dementia, other respiratory diseases, and malignant neoplasms (cancer):

The clearest visual gap in these charts is the excess Alzheimer’s and dementia deaths. Note the increase corresponding to the start of the pandemic, when these patients were suddenly shut off from loved ones and the company of other patients. I also believe some of these deaths were (and are) due to overwhelmed staff at care homes struck by COVID, but even discounting this category of excess deaths leaves us with a huge number of non-COVD deaths that could have been avoided without lockdowns. This represents a human cost over and above those tied to the economic losses discussed earlier.

Degraded Education and Health

Lockdowns have also been destructive to the education of children. The United Nations has estimated that 24 million children may drop out of school permanently as a result of lockdowns and school closures. This a burden that falls disproportionately on impoverished children. This article in the Journal of the American Medical Association Network notes the destructive impact of primary school closures on educational attainment. Its conclusions should make advocates of school closures reconsider their position, but it won’t:

“… missed instruction during 2020 could be associated with an estimated 5.53 million years of life lost. This loss in life expectancy was likely to be greater than would have been observed if leaving primary schools open had led to an expansion of the first wave of the pandemic.“

Lockdown Inefficacy

Lockdowns just don’t work. There was never any scientific evidence that they did. For one thing, they are difficult to enforce and compliance is not a given. Of course, Sweden offers a prime example that draconian lockdowns are unnecessary, and deaths remain low there. This Lancet study, published in July, found no association between lockdowns and country mortality, though early border closures were associated with lower COVID caseloads. A French research paper concludes that public decisions had no impact on COVID mortality across 188 countries, U.S. states, and Chinese states. A paper by a group of Irish physicians and scientists stated the following:

“Lockdown has not previously been employed as a strategy in pandemic management, in fact it was ruled out in 2019 WHO and Irish pandemic guidelines, and as expected, it has proven a poor mitigator of morbidity and mortality.”

One of the chief arguments in favor of lockdowns is the fear that asymptomatic individuals circulating in the community (and there are many) would spread the virus. However, there is no evidence that they do. In part, that’s because the window during which an individual with the virus is infectious is narrow, but tests may detect tiny fragments of the virus over a much longer span of time. And there is even some evidence that lockdown measures may increase the spread of the virus!

Lockdown decisions are invariably arbitrary in their impact as well. The crackdown on gyms is one noteworthy example, but gyms are safe. Restaurants don’t turn up in many contact traces either, and yet restaurants have been repeatedly implicated as danger zones. And think of the many small retailers shut down by government, while giant competitors like Wal-Mart continue to operate with little restriction. This is manifest corporatism!

Then there is the matter of mask mandates. As readers of this blog know, I think masks probably help reduce transmission from droplets issued by a carrier, that is, at close range. However, this recent Danish study in the Annals of Internal Medicine found that cloth masks are ineffective in protecting the wearer. They do not stop aerosols, which seem to be the primary source of transmission. They might reduce viral loads, at least if worn properly and either cleaned often or replaced. Those are big “ifs”.

To the extent that masks offer any protection, I’m happy to wear them within indoor public accommodations, at least for the time being. To the extent that people are “scared”, I’m happy to observe the courtesy of wearing a mask, but not outside in uncrowded conditions. To the extent that masks are required under private “house rules”, of course I comply. Public mask mandates outside of government buildings are over the line, however. The evidence that those mandates work is too tenuous and our liberties are too precious too allow that kind of coercion. And private facilities should be subject to private rules only.

QED

So my poor friend is quite correct that COVID is especially deadly to certain cohorts and challenging for the health care community. But he must come to grips with a few realities:

  • The virus won’t be defeated with NPIs; they don’t work!
  • NPIs inflict massive harm to human well-being.
  • Lockdowns or NPIs are little or no gain, high-pain propositions.

The rejection of NPI’s, or lockdowns, is based on compelling “human” data points. As Don Boudreaux says:

“The lockdowns and other restrictions on economic and social activities are astronomically costly – in a direct economic sense, in an emotional and spiritual sense, and in a ‘what-the-hell-do-these-arbitrary-diktats-portend-for-our-freedom?’ sense.” 

This doctor has a message for the those denizens of social media with an honest wish to dispense helpful public health advice:

“Americans have admitted that they will meet for Thanksgiving. Scolding and shaming them for wanting this is unlikely to slow the spread of SARS-CoV-2, though it may earn you likes and retweets. Starting with compassion, and thinking of ways they can meet, but as safely as possible, is the task of real public health. Now is the time to save public health from social media.”

And take some Vitamin D!

“Recycling Is Largely Fake”

30 Friday Aug 2019

Posted by pnoetx in Recyclng, Social Costs

≈ Leave a comment

Tags

Aluminum, Chinese Plastics Ban, Exporting Trash, External Costs, Glass Bottles, Landfills, Mandates, Michael Munger, NIMBY, Plastics, Recycling, Scrap Metal, Social Costs

The quotation headlined above is from Duke University economist Michael Munger, and it’s essentially what I’ve contended for years (see “When Is Recycling Not Wasteful?“). Munger’s latest essay on this subject is entitled, “For Most Things, Recycling Harms the Environment“. The reasons are very basic: resource costs. As Munger says, the degree of economic and environmental justification for recycling varies, depending on the item, but few supporters of recycling ever bother to look into the details.

First, a very basic economic point: resource conservation is beneficial for the environment. Sometimes there are technological trade-offs between conservation of different resources, but costs are always a matter of resource use: less use, lower total costs. Resource conservation is synonymous with lower costs. Indeed, that is why we are told to recycle, and that is what most people think they’re doing when they recycle.

But while recycling always conserves some resource more or less directly, the mere process of recycling uses other resources. This includes the costs of rolling trucks to collect the items, including fuel, labor, machinery and labor for sorting, water, chemicals, more distant shipping, and separate processes to convert the items into usable goods. In its entirety, then, recycling often does not conserve resources.

Voluntary consumer-recyclers seldom face the marginal costs of recycling directly. This highlights the general nature of environmental problems that arise in any society: external costs are often borne by parties external to the activity in question. And here is where the story of recycling’s poor economics gets interesting. Recycling advocates would have us believe that our private use of products, for which we generally pay full cost, imposes external or social costs on others unless we recycle all recyclable components of the product and it’s packaging. In fact, the opposite is often true!

Therefore, governments, fully on-board with popular recycling myths, often mandate recycling, which is another way of saying that you are not free to make your own decision based on costs and benefits. So the costs of recycling are on you, but you are unimpacted at any margin along which you can make decisions. You are forced to internalize some part of the costs that are presumptively avoided via recycling according to the myth. You pay taxes to fund the collection of materials at the curb, but governments often require citizens to clean and sort those materials. That carries significant costs that governments prefer to remain implicit.

This is to say nothing of the actual net value of the recycled materials, which is often negative. Certain items require so much processing and produce materials of such low quality that no one wants them. Virgin materials are often cheaper than fully processed recycled material, and usually yield better quality, or both. Far better, then, to pay the cost of transporting these kinds of discards to landfills and paying for the low-cost landfill space, which is plentiful, contrary to greenist propaganda.

Munger provides examples of such wasteful-to-recycle materials. For instance, attempts to recycle glass bottles are often completely non-productive relative to landfilling. That’s due to cost factors, lousy quality after processing, and weak market prices for recycled glass. Plastics are of questionable value as recyclables as well: huge quantities had been shipped to the Far East, but the volume was too much for the Chinese (and too dirty, they claimed), so it often ended-up in landfills anyway. Last year, the Chinese banned imports of recyclable plastics from several countries, which means that our plastic materials are probably headed for our own landfills. Yet we still go to the trouble of preparing and collecting them for recycling.

According to Munger, aluminum cans are worthwhile to recycle relative to landfilling. So are certain types of cardboard (though the Chinese don’t want some of those either). Also, scrap metals are privately recycled via active markets for the materials.

Private parties who can internalize costs in their voluntary decisions are wise to abide by the following:

“I have sometimes suggested a test for whether something is garbage or a valuable commodity. Hold it in your hand, or hold a cup of it, or tank, or however you can handle it. Consider: Will someone pay me for this? If the answer is yes, it’s a commodity, a valuable resource. If the answer is no, meaning you have to pay them to take it, then it’s garbage.”

Of course, society as a whole must internalize costs. There’s no way around it. Therefore, governments should behave as if they internalize costs as well, though they hardly ever do. They would sooner mandate recycling when they know full well that the simple economics outlined above don’t support it. That means an unnecessary consumption of resources is attributable to the recycling charade, which is environmentally unsound by the strictest of Green standards.

I am not quite so hard on government recycling mandates when there exist significant external costs associated with sending uneconomic trash to landfills, or when there are real efficiencies associated with recycling. Landfills must price their space efficiently, collecting sufficient fees from users to pay for environmental mitigation as well as the payoffs necessary to mollify those nearby who might happen to harbor NIMBY-ism. But recycling mandates offer strong evidence that the economics of recycling are not worthwhile. So please, whenever you are told that recycling is virtuous, be suspicious. As Munger says, it’s largely a fraud.

Obamacare Shills Try Heroic Measures

01 Saturday Nov 2014

Posted by pnoetx in Uncategorized

≈ 1 Comment

Tags

ACA, Business Week, CHIP, Cronyism, Death Spiral, Employer Sponsored Plans, Forbes, Government Failure, Health Care Exchanges, Mandates, Medicaid, Obamacare, USA Today, Welfare Programs

obama-health-care

Die-hard Obamacare supporters are in full denial over the lousy results of the health care plan in its first year. They’re tone deaf, living a delusion. This piece from Forbes.com notes that the Affordable Care Act (ACA) has been an abject failure thus far on six of seven major counts, and even the one “success” is terribly blemished. Close to 90% of the increase in the number of insured is due to expansion in the Medicaid and state Children’s Health Insurance Program roles. Both of those welfare programs predate the ACA and certainly could have been expanded without Obamacare and its collateral damage to existing health plans and the health care industry. In fact, according to Business Week, less than half of physicians now accept Medicaid, so it’s not always easy for those “newly insured” individuals to gain access to actual care.

In fact, Medicaid patients are not the only ones with access problems. This USA Today article linked by Forbes notes that physicians are limiting the number of Obamacare exchange-covered patients they’ll accept. After the disastrous unraveling of the “if-you-like-your-plan-you-can-keep-it” fiction, it was revealed that many of the policies foisted upon the “previously-insured-but-no-longer” group through Obamacare exchanges offered severely limited provider networks. If you liked your doctor, you might well have lost your doctor.

For the majority who do not qualify for taxpayer subsidies under Obamacare, the health insurance premia on policies acquired on the exchanges have risen drastically. This problem is covered in the Forbes article. Far less expensive short-term plans are being offered by insurers as an alternative to Obamacare, but they are only renewable if the insured remains healthy. It is precisely these kinds of circumstances that might devolve into a death spiral for Obamacare: an increasingly sick risk pool and universal rating may lead to accelerating premium hikes for the exchange policies.

So, prospects for improvement under the ACA are quite bleak. We’ve seen a botched rollout of the Obamacare website, the chief enrollment vehicle, which is still problematic; a wrecked individual market with policies cancelled and replaced by coverage with limited provider networks; a medical device industry battered by new taxes; a negative impact on full-time employment as firms reduce hours to avoid coverage requirements; expanded welfare programs with a concomitant burden on taxpayers; increased emergency room utilization; physicians opting out due to inadequate reimbursement and high compliance costs; healthy individuals opting out and sick individuals opting in; higher premia with more increases on the way and the prospect of an insurance death spiral; and we’ve seen arbitrary exemptions carved out for various cronies of the Obama administration all along the way. Oh, and we’ve seen lies, delays, and every effort to back-load costs and front-load benefits, an implementation governed by political considerations rather than improving health care. The next shoe to drop is likely to be widespread cancellation of employer-sponsored coverage as the ACA coverage mandate hits employers in 2015.

Desperate propaganda continues to flow, but that can’t change the fact that Obamacare is terrible policy with results to prove it. Here is government failure.

Physician: Why Take Insurance?

30 Wednesday Apr 2014

Posted by pnoetx in Uncategorized

≈ Leave a comment

Tags

Mandates, Obamacare, Price Controls

Image

Bravo to Daniel Craviotto for penning A Doctor’s Declaration of Independence, appearing today on wsj.com. It’s a condemnation of Obamacare from a man who understands sound medicine. Like many physicians, he’s had it with mindless regulations that take time away from patients and and interfere with the application of medical expertise. And he’s had it with the distortions that are typical of price regulation. “So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?”

 

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