The Internal Contradictions of Segregating the Elderly

There are two problems, even internal contradictions, with segregating the elderly and letting others return to work. The first is fairly well known. When you run the numbers, as the British did, you find that a lot of young people would die. If we return to work too quickly it could easily happen that 20-40% of the US population gets COVID-19. Suppose 20% of the population gets it–that’s 66 million people. And let’s suppose the death rate is on the low end because healthy, young people get it rather than the elderly, say half of one percent, .005, then we have 330,000 deaths of healthy, young people.

Moreover, the numbers I just gave are conservative and don’t make a lot of sense because if 330,000 die then the hospital system is going to be overwhelmed and the death rate will be higher than .005. An internal contradiction.

The second internal contradiction is less well known. We probably can’t segregate the elderly because the more young people get COVID-19 the less realistic protecting a subset of the population becomes. In other words, the premise of the segregation argument is that we can protect the elderly but that premise becomes less plausible the more COVID-19 spreads but allowing it to spread is why we were locking down the elderly. An internal contradiction.

Are there some scenarios where all this works out? Probably but I wouldn’t bet on hitting the trifecta. The lesson of COVID-19 is that like it or not we are all in this together.

Comments

What?

Alex - a bit too much social distancing on a Saturday night?

the rate of increase of infections seems to have already peaked in the US according to the latest numbers. It seems like it’s getting under control now.

Let's hope so.

This comment didn’t age well did it?

'Peaked'? Isn't that just because testing has finally started and places like NYC are discovering the disaster that has been baked in over the past few weeks? The underlying rate hardly seems to have changed.

The CDC reports case fatality rates by age of 0% (Age 0-19), 0.1-0.2% (Age 20-44), 0.5-0.8 (Age 45-54), 1.4-2.6% (Age 55-64) [https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm#T1_down]. So, a 0.5% estimate is not on the "low end" for "young" people. I don't know what the blended rate for young and middle-aged people would be.

The table shows that death rates vary by two orders of magnitude (perhaps more depending on teen death rate) across age groups so maybe we should stop talking about "the" fatality rate. That's what also makes it hard to determine what is best for "society": crashing the entire economy vs. accepting risk of deaths. We do go to war when the casualty rate is reversed: high casualties among the young, near zero for middle-aged and seniors. (Btw, what we are doing now is not like a war, as some have suggested. It's like pacifism: accepting large societal losses to way of life and economy to avoid risk of casualties. That doesn't make it wrong either; it's actually a good argument for pacifism.)

We should keep all this in mind when we lambast young Spring Breakers. Our present policies are being determined almost completely from the perspective of seniors and the middle aged. I say this as a someone in the 45-54 age group. But, I recognize unacknowledged bias when I see it.

Also, when we say those with other health conditions are also at risk, how serious are those other health conditions? Would some of those people have died even without COVID-19 due to those other conditions, i.e., what is the *incremental* death rate? Even for seniors, what percentage of senior fatalities is due to age per se rather than higher prevalance of those other health conditions among seniors?

330,000 over 6-8 months would not overwhelm the system. Maybe 1,500,000 might. Esp since we could adjust along the way like building hospitals in Javits Center.

One thing I don't understand about the hospital system being overwhelmed. Social distancing is imposing trillions of dollars in costs, combining the $1.6T rescue package and order-$T loss in GDP. Without social distancing, the worst case fatality estimates are order-1M people. Order-$T savings from avoiding the worst social distancing means order-$1M per person available to treat the order-1M people that would otherwise die due to hospital overcrowding. Why is order-$1M not enough to create capacity to treat 1 additional patient? How much does it cost to treat one additional patient?

The worst case fatality estimates in an overwhelmed medical system are not 1M, but several times more (probably more like 3-5 million).
The reason you cannot increase capacity is because you cannot produce sufficient number of new doctors, nurses and ventilators in a week.
Granted, you can produce enough ventilators in 3-4 months but the former 2 - not a chance.

1% fatality rate in population of 325M is 3.25M. That's with 100% infection. Regardless, cost of social distancing is also several trillion not just $1T, so it's order-$1M per person either way.

I understand that if we treat with normal protocol, then we will run out of capacity. The question is whether $1M per patient of additional resources enables creative solutions including transporting someone from a crowded NYC hospital to a less crowded rural hospital, repurposing spaces, etc. Also, one does not necessarily need to maintain the same doctor-patient or nurse-patient ratio if a large fraction of the patients have the same condition. One could train personnel (medical students, paramedics, generally intelligent people) to treat that specific condition even if they are not qualified to treat the entire range of maladies that a doctor or nurse could.

If a multimillionaire was willing to spend $1M+ to find treatment for a loved one, do you think he would not be able to find it?

At the very least, it seems strange to be sending $1200 checks to every taxpayer instead of spending that on emergency treatment capacity if capacity is our limiting factor.

"...we are all in this together." +1

+1

This too shall pass.

Pull, together and we will beat it.

We crashed the economy to save the likes of you, Dick. You better be thankful because my 401k sure isn't.

Send Toilet Paper!

My portfolio is worth less than toilet paper.

Buy gold!

You can't take bonds, Federal Reserve Notes, stocks with you. They'll burn.

Silver Lining Department. The Wuhan Flu has brought together in true unity Dems and Repubs - Better Destitute Than Dead!

>we are all in this together.

Up yours, Alex. We got CNN and NYT and Bernie Bros openly rooting for the virus.

Really? Was it when Trump and Fox News were aiding and abetting the virus and pretending nothing was wrong? I really hope some heads roll after this all is over. We can not go back to business as usual. We can not forget.

Brooklyn,

Look on the bright side.

The Trump crash has reduced
Wealth disparity.

Trump 2020 - Keep America Great!

I did this to get your reaction. It's not really Trump's crash, it's a worldwide problem, but, consider how in our political discourse we tag politicians to events.

Sorry, Dick. There will be wealth effects and effects on wealth inequality. Perhaps that will lead to more understanding about the rung of what was once below you because you are now there yourself.

Thanks for your concern.

My biggest true problem: I couldn't go to Mass this morning. Watched it on YouTube.

My second biggest problem I need to pray for the moral courage and patience to bear my crosses without complaint and to not murder (with.my.bare.hands) the Warden.

We'll see what the Pope has to say about the choice between life or a more robust economy. Interesting right to life issue.

There are some additional ethical or legal issues that arise here as well.

Many states prohibit euthanasia. Will that change

What if an elderly person seeks elective surgery with the same risks as dying from covid; should society permit it if it creates an externality on the health care system.

What if an elderly wealthy person has enough assets to pass on to his kids and at the same time a single parent mother who has no assets but underage children asks for the same ventilator. Do we have economic triage: if you could support for your kids after death v. one who has dependents and could not.

Considerably more than 20-40% of all Americans (not to mention the entire world) are going to become infected with covid-19. The only question is the timing and growth of that percentage, not the percentage itself, which will be considerably higher.

The rate of increase in cases appears to have already peaked according to the latest numbers. I would expected far far less than 0.1% of the population ends up infected based on the latest trend.

Regardless of that good news, we are all going to the poor house.

Finally, Trump and the Dems have agreed on one thing: How To Wreck The Economy.

Well, no ... New York is clearly out of control. They just reported 12,000 cases for today alone

Maybe all those people who went out for St. Patrick’s day last week. It’s a one-off spike.

Our son's 18 year old friend dropped by yesterday, claimed that he gets tested every day.

His part time job is in a nursing home kitchen. So I guess that says something about "isolating the elderly," the work in doing that, and how tests are allocated.

(What's with all these people dropping by? People are really bad at social distancing.)

I work in nursing homes. Nobody is getting tested every day. He is a liar.

Someone suggested that he might just be getting checked out, temperature taken, and think he's "tested."

Or who knows. Maybe somebody is putting swabs in the mail and thinks that's doing good.

Or, he is 18 and is confusing being screened for fever with getting "tested".

As others have noted, he's absolutely not being tested. And given that young people are contagious without often having symptoms, the fact that he's working in a nursing home kitchen while also keeping up his social life, and his boss is relying on the unlikely possibility that he'll register a fever before they worry about him, is precisely the reason that this concept of isolating the elderly is silly.

Exactly how the best laid plans of mice and men...etc.

It's possibly dumb to think that this guy would not observe quarantine measures required to keep the people he cares for alive.

But if he's not, he's gonna obey lockdown? We talk of internal contradiction, that's fucking ridiculously internally contradiction. If quarantine of the old and testing is impossible because of low discipline and adherence, absolute lockdown, in a long term, is going to be waaaay more impossible.

Contradictions ?

explain the huge nation of India versus Covid-19.

India has done almost nothing to defend against Covid-19, yet its billion people are almost totally unaffected by this alleged existential worldwide pandemic.

India is right next to China, has large segment of its population in poverty, other diseases are rampant, severe shortages of health care, etc.
Why aren't millions of India residents already dead from Corona?

They've been lucky so far, but their luck won't hold out indefinitely? Seems pretty obvious at this juncture.

I have been wondering about that as well. Same for other densely populated countries, like Indonesia, Egypt and Brazil, which aren’t necessarily next to China, but otherwise have similar conditions. Is the explanation differences in climate?

Yes, according to researchers, the Covid19 virus does not survive or spread much in hot humid climates.

I wouldn't say India has done nothing or that it wasn't affected. The BSE Sensex crashed. A dozen states have declared an epidemic and at least 75 districts where coronavirus cases have been confirmed only allow essential services to operate. The whole country is operating under the Janata curfew. Schools, sports, temples, Indian Railways are shut down. Travel bans are in effect.

India lacks testing so it is difficult to know how effective they are so they are either just a few days behind everybody else or their actions worked. Hard to say. Iran which is closer to India than Hubei is a disaster.

https://en.wikipedia.org/wiki/Janata_Curfew
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_India

These are kids that used to go to out pretty much every night. I think we've convinced them to cut it down to three or four core friends.

Still it's hard, and from TV obviously not everyone is doing that.

Wow, I missed. Response to Kevin above.

Steve Sailer's jetsetters and international travelers as superspreaders phenomenon? Too poor to be in contact with such a person?

Hopefully it's the latitude though.

But if Sailer is right, maybe this should be called the Airport Virus.

If it really is the air travelers' virus, it is interesting that for example, in the wikipedia of Thailand's infection tracing with 599 cases there's no mention of flight attendants. Plenty of people caught it directly and indirectly from a kickboxing match on a particular night.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Thailand

If flight attendants seldom get the disease even with their duty to serve many people plus light bathroom tidying, it would seem that severely mitigating the spread isn't hopeless. Do Asian flight attendants wear N95 masks or something not quite as effective?

People were once saying the same thing about the U.S., Thailand and the Philippines. The main factors at play are when the country first reaches a critical mass of cases, probably somewhere between 50-100. From there, exponential growth takes over at the rate of doubling every 2 to 3 days (2 if no measures are taken at all, 3 if there is some level of public awareness).

The U.S. jumped from 100 cases to 19,000 in just 18 days. India just hit 100 four days ago -- I would not bet on them having slower growth than the U.S. Japan and Singapore are the only two countries that managed to flatten the curve quickly after reaching 100.

1. Caste system making any physical contact between upper castes who are likely to come in contact with Chinese business people, and lower castes, who are poor, impossible. I was in Delhi once, and saw an upper caste Indian teenager, hit a lower caste toddler in the head, knocking the child to the ground and concussing it, because the child touched him. There was a crowd of upper castes nearby, and nobody did anything about it. There is very minimal mixing going on.

2. Chinese travelers are unlikely to travel or interact with low or middle class individuals due to the extremely high percentage of Chinese who travel in tour groups and stay in higher end accommodation.

3. Proximity is a poor measure of transfer, given Russian, Mongolian, and all of South East Asia's relatively low infection rate, especially considering, the latter is densely populated, and much more connected socially and financially to China.

One's concerns should be based on understanding, rather than wild conjecture. In this case one should have some concept of Indian societal arrangements and Chinese travel habits.

4. Due to the time period Covid hit, pre-Chinese new year, it would be extremely unlikely that the Chinese would travel to India before the New Year, and almost impossible to imagine they would go to a country notorious for it's poor medical care and lack of sanitation after the virus was known. Whereas Europe would have seemed an attractive option in terms of comfort and possible health care for those fleeing the virus, aka those wealthy enough to leave China. Why the hell would they go to India?

It's been up for several days, but I still find Nicholas Kristof's descriptions of the best case scenario and the worst case scenario helpful: https://www.nytimes.com/2020/03/20/opinion/sunday/coronavirus-outcomes.html

As of 22 March 2010, 330,000,000 Americans did not die from the Wuhan Flu.

Best case (for NYT et al) scenario: Trump loses election.

Corrected for Dick:

As of 22 March 2010, 330,000,000 Americans saw their retirement accounts die from the Wuhan Flu.

I have to say I've been mostly unimpressed by much of the economic punditry's speculation about this. This sounds like the wheel has just been invented again. Robin Hanson is another example (why don't we pay people to get it now so we get them out of the way first, ohhh wait we'll crash the medical system). My favorite, though, was when he asked on Saturday why he was being asked to contribute to a GoFundMe to help people make masks in central PA when the US is spending 18% of its GDP already on healthcare. Yes questions that seem very obvious now were just as obvious then.

Anyway what I don't see from economists putting out various oddball cases is any real look at costs. How exactly do you in less than 30 days isolate an entire demographic that is spread out throughout the population? I mean either way it fails. If there's one old person in every home, it will be very hard to keep the other people in the home far enough away to avoid spreading it to them. If you put all the old people together, then all it takes is one person to get infected and the virus now can hit the whole population at once. Regardless, though, how does a profession that cuts it teeth on demonstrations for why central planning doesn't work not see that you cannot shift society that much anyway on notice of less than two weeks.

BTW, two weeks ago I was still arguing with people saying "it's just the flu" and closing the schools was scare mongering. How much easier would it have been if we had instead argued for "let's just put all the older people on a giant Borg Cube and send it away for two weeks or so?".

Not to mention the people who didn't want to hear about washing their hands.

As the policy response. So far your policy response is “keep the borders open, keep your kids socializing, and wash your hands”

That was your line for literally months. Wuhan was locked down, and we heard “keep the flights coming, keep the borders open, just #washyourhands”

Now we have a global pandemic.

I never had those positions, you crazy person.

You just think because I never argued them as my theme, I must believe the opposite.

We've got the kid who used to party on a school night home in his room, and hanging with two or three friends. Not perfect, but a huge improvement.

We note that it would have been easier with his older brother, now moved out. He was the gamer who wouldn't leave his room.

You literally commented "Wash your hands" dozens of times and argued against other measures like closing the border

I argued for handwashing and social distancing, but I never complained about border closing or the rest of this stuff.

I did say that people who were going on about closing the China border *after* the disease was in Italy, and entering the US from that direction, were not staying on top of things.

That was stupid, to say that all we needed was closed borders even as we had community spread in the United States.

Listening to the voices in your head is rarely a good idea. At least in your case.

The actual policy response was to close the borders, and there was a pandemic anyway. In fact, countries that closed borders early seem to have had no better outcomes than neighboring countries that did not close borders early or at all (compare Canada vs. US or UK vs. Italy).

It was compounded by the fact that borders were "closed" while welcoming back citizens, and not putting them in quarantine.

Taiwan closed borders to PRC pretty much instantly. Worked better than any other strategy. (In meme form - https://twitter.com/Scholars_Stage/status/1241697894601760774)

Doesn't work if you're open to a bunch of countries that are open to China, because pax just do indirections.

But for small number of countries where China's was the main vector of Chinese entrants, travel bans to China obviously worked.

Or basically, the problem with travel ban is not demanding complete closure of "the West" to PRC Chinese through any vector, and closure to any vector that can bring PRC Chinese or people secondarily infected by PRC Chinese into the West. It's not the ineffectiveness of travel bans.

A travel would have been ridiculously light touch on the economy compared to what is now necessary. Think of that when you think about how you were advocating taking away border closing powers from the US government, out of a "Open borders at all costs" mentality.

Many other countries in Asia including Hong Kong and South Korea have had similarly good results without border closures.

And mandatory quarantines of inbound travelers are an even more effective method of stopping inbound infections without border closures that do not prevent critical travel. Indeed, that is what China is doing now. If countries weren't allowed to close borders, perhaps they would have mandatory quarantines and that would make them even more effective at stopping the virus. Indeed, US states cannot legally close their borders, and so Hawaii is now having mandatory quarantines.

Not as effective as Taiwan, not nearly.

A 14 day quarantine for every traveller is effectively a travel ban for the purposes of short term travel, so sure.

A travel ban for purposes of a short term travel is very different from a total travel ban. The people who will be harmed most by a travel ban are those who have long-term travel needs, such as people moving for jobs, school, or families. Some of these people's entire lives could be drastically changed if the window of opportunity for jobs closes or if family reunification visas expire and they have to get back in the line for years. If the only people harmed by a travel ban were short-term tourists, there would be no issue. But tourists aren't traveling anyway.

Sure, fine. Ban short term travel, quarantine and test longer term travel.

But those folks who are moving for jobs, school, families.... What the hell are they getting out of it in the current situation, where schools are closed, businesses are shuttered, people are advised to socially distance from family? Pretty marginal. Their lives are already disrupted by this thing, with the cost that everyone else is also affected.

It's not marginal at all. Visas for certain kinds of things can take years to get; the waiting line for some types of visas to the US from China, India, and Mexico is over ten years. If yours expires while travel bans are in effect, there is no telling when you will be able to get a new one. Jobs and schooling offers can also be time-sensitive and there is no telling when if at all you would be able to get it back. And of course this also affects the Americans who invited people from other countries in.

Read this forum: https://www.visajourney.com/forums/forum/173-coronavirus-covid-19/. There are a lot of horror stories. Lots of people facing expired visas, even for spouses, with no indication of if or when they could be renewed.

It's highly likely that they will re-extend any visas in future that will have lapsed due to a lack of travel. If not, oh well, some other equally deserving person will get that slot.

Not travelling, in any case, is better than travelling and then having the educational institution or job shut down, and then severe difficulties to return.

The US is run by people who have been using every possible pretext to keep out foreigners for years. I would not assume good faith on their part. Instead, it is more likely that they will say: the people who stayed tight and waited for the epidemic to end will have their visas cancelled because they could have traveled to a third country and from there to the US but didn't, while the people who traveled to a third country and from there to the US will have their visas canceled because they were trying to avoid travel restrictions.

C’mon man....the US is run by people that want the cheapest labor possible. They are utterly unconcerned where it comes from.

Anyway, I'll reiterate, I'm roughly as happy with:

- Short term travel totally banned, student visas deferred (because the schools are gonna shut anyway), any public facing work visa in a job that your boss isn't happy for to telecommute deferred (and if he's happy with that, why aren't you telecommuting from China?), and quarantine and testing of 14 days at least for anyone who does get through.

as with a total travel ban. Acceptance of the above seems very far from your original stances on what powers government should have to regulate movement during these crises though!

What do you mean? I've never opposed the power of the government to quarantine people. But for the reasons I've laid out, mandatory quarantines are extremely different from a ban on all travel. I don't believe the government should never do anything; I believe the government should always take the least restrictive course of action possible for fulfilling its objective. In this case, the least restrictive course of action would be individual testing, and if that is impossible, then it would be mandatory quarantines for all incoming travelers. The problem is that many governments immediately jumped to the most restrictive policy of banning travelers without any consideration of less restrictive ones.

Go back and read your own comments from the threads where we initially discussed this. At no point did you raise mandatory quarantines and banning of short term travel as an alternative.

Your argument that the entire "West" should have been closed is also contradicted by the fact that the outbreaks in the US and Italy did not start because of travelers from Western countries that kept travel open. To the contrary, it seems that many global cases were seeded from Italy, even though Italy was the first country in the "West" to ban travel from China.

A travel ban could not have been effective because there was already community spread in the US in mid-January and some doctors believe in Italy in December, long before the Chinese government closed down Wuhan or when the information known at the time could possibly have justified travel restrictions. If you disagree with this, then what date would you have suggested a travel ban on China, and could you justify that date based only on information known as of that date?

The virus obviously got to Italy from Chinese travellers from Schengen countries that kept travel to the PRC open. Think about it for a millisecond. If those Schengen countries had practiced closure, wouldn't have happened.

To add, even if you have early community spread, travel bans and entry quarantines still help, because you will avoid secondary infection vectors, and its easier to track, trace and shutdown. The essential point here is that these are absolutely vital tools; it is wrong to suggest they should not be in the hands of governments, and the WHO was wrong to suggest they should not be used.

Why couldn't the virus have entered Italy from before they imposed the travel ban? I have not seen any evidence that it entered Italy from other Schengen countries (and if it did enter Italy from another Schengen country, then that other Schengen country should be seeing a worse outbreak, but the worst outbreak is in Italy).

Travel is a drop in the bucket because of the math of exponential growth. Domestic cases are growing exponentially and travel cases are linear or nothing. The result is that even if the very first cases are travel-related, by the time you get domestic spread cases, travel cases are a miniscule part of the problem that only distracts from the larger problem. In the US for example, only about 2% of cases involve travel as of last Friday, and that number is only going to fall further: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Yet a disproportionate amount of energy has been spent on stopping the 2% or less travel cases, all the while the government has been encouraging people to be complacent about the 98%+ of domestic spread cases.

In the early stages when prevalence is at a higher level in a foreign jurisdiction, travel is *not* a drop in the bucket. Every separate instance travel by someone with the infection is a new vector to travel, arriving at a different place in your country.

No it is not necessarily the case that another country which a person would have entered Italy from would be seeing a worse outbreak, if they were not there for long, or if their behaviour were different while there. How else is it supposed to get to Italy if they've banned travel from China? Magic?

To add to this comment - https://www.aljazeera.com/news/2020/03/singapore-closes-borders-virus-bay-shutdown-200322061359901.html - A day after Singapore confirmed its first two coronavirus-related deaths, the country said it would close its borders to short-term visitors and some foreign labourers from 11:59pm (15:59 GMT) on Monday to help the limit the spread of the disease.

The new rules mean short-term visitors will no longer be allowed to enter or transit through Singapore, while semi-skilled workers on "work passes" will not be allowed to return to the island unless their job is in sectors that provide essential services such as healthcare and transport, the Ministry of Health (MOH) said in a statement.

They clearly think managing and limiting "imported cases" matters at the low bound.

Another point, maybe an early travel ban would still not have been enough for "the West", and Taiwan only got lucky with their travel ban by the good fortune of avoiding early infection.

But that's really a story about PRC Chinese cover-ups making travel bans hard, less about travel-bans being a bad idea even if you have advance notice and you have that advance notice because the country you're dealing with is honest and open. It's a point *against* high frequency travel with places where people eat bushmeat or otherwise poach wild population and public health is not so stringent and open at the start, not a point against travel bans.

How did PRC cover-ups make travel bans hard? The US and Italy had travel bans in place within one week of when China itself had a travel ban on Wuhan. Are you suggesting China or other countries should have banned travel from Wuhan even earlier? If so, what day would you propose, and why? Of course we have hindsight that this disease turned out to be extremely contagious, but at the time there was no reason to think that such drastic measures were necessary. Judging by the stock markets, most people did not expect such drastic impacts until the end of February. You can't fault the Chinese government for failing to take drastic measures to halt something that virtually all other governments also did not take drastic measures to halt. In fact, the US still has not banned travel out of New York City even though there are far more cases in New York City than there were in Wuhan when the Chinese government locked that city down.

Moreover, this disease was actually detected and reported to the world quite quickly. Compare this to the 2009 swine flu, which originated in Mexico. In the 2009 swine flu, the disease had already spread to the United States and from there to many other countries before it was even known to have originated in Mexico.

These travel bans are going to severely discourage the next country where an epidemic breaks out from reporting early though. If China had waited a few weeks to report maybe the first identified cases would have surfaced in Italy and everyone would be calling this the Italian virus.

Yeah, they absolutely should have banned it even earlier, and would have done, had China not tried to cover this thing up.

Again, give me a date, and make the case that it would have been reasonable to lock down regions based on what was known as of that date. China locked down Wuhan on January 23rd, when Wuhan had 800 cases. Why would it have been reasonable to lock down Wuhan earlier than that? By comparison, the US has not locked down New York City even though New York City now has 15,000 cases.

The world has had many, many would-be pandemics over the last twenty years: the original SARS, MERS, Ebola, avian flu, swine flu. None of these pandemics were as contagious as COVID. In January, nearly everyone in the world thought that this pandemic would be contained with similar measures to previous pandemics. It is completely unreasonable to judge the Chinese government's actions through the lens of what someone with perfect hindsight would have done. You should compare the Chinese government's response to the responses of other countries where new pandemics originated, such as Mexico's response to swine flu in 2009. By that standard, it is hard to think of a country that did a better job that China did this time. Sure, maybe Taiwan, Hong Kong, or South Korea would have done a better job than China did had this disease started there, but the typical Western country certainly would not have. In the US, in fact, we had all of February to prepare, yet the government did nothing productive, downplayed the risks to the public, and in fact did so while multiple senators (that we know of) were selling their stocks based on classified intelligence! Our government was not that much more transparent than the Chinese government, even though it had warning from China's experience about how contagious this disease could be while China had nothing to go on, so it's hard to take its criticism of China seriously.

Moreover, a lot of people who criticize China for failing to contain this disease also seem to believe that the costs of containing this disease are excessive (and some of your other comments appear to be in this vein as well). What's good for the goose is good for the gander--if Western countries are unwilling to take harsh and rapid measures to contain a disease that is now known to be extremely contagious, it is hard to fault China for failing to take those harsh and rapid measures in the fog of war.

https://foreignpolicy.com/2020/02/15/coronavirus-xi-jinping-chinas-incompetence-endangered-the-world/ -

The pneumonia death last week of China’s real epidemic hero, the ophthalmologist Li Wenliang, has revealed the ugliest side of the Chinese Communist Party (CCP) and its terrible effort to rewrite the history of a seemingly out-of-control epidemic. Li treated patients in December in Wuhan, where the outbreak originated, who looked like SARS cases, he told colleagues on Dec. 30 via a doctors’ social media chatroom. Days later, for the so-called crime of rumormongering, Li and seven other physicians were brought before China’s security police and compelled to sign a document admitting to “spreading lies.” For days, Wuhan authorities sought to stifle Li’s voice, but even after he caught the virus while treating his patients and was confined to an intensive care unit bed, he continued to sound epidemic alarms on the BBC World Service. On Feb. 6, the once-robust 34-year-old physician died. Li’s death opened the gates of political rage across China, sparking an unprecedented outpouring of grief and outrage, denouncing the government cover-up.

But you know this Zaua. And you know no liberal Western government, of the open stripe that you usually claim to admire (and you probably do admire, most of the time), would do anything of the like. They didn't during any kind of animal disease epidemic we've ever seen. They don't on a yearly basis when they monitor new infections in hospitals, etc. If you are not merely a PRC booster, and really do hold the liberal government beliefs that you seem to (and not merely out of expediency against nationalism in the West that you believe to be a threat to your ethnic group), you will at least privately acknowledge this.

One final point: Taiwan banned travel from Mainland China on February 5th, one week *after* the US and Italy banned travel from Mainland China: https://www.cdc.gov.tw/En/Bulletin/Detail/KMAEC24Yf_5cm94oNL4Jxg?typeid=158. So Taiwan's success cannot be attributed to an earlier travel ban than the US or Italy.

It worked because PRC Chinese virtually cannot enter China from a third country. That's the point. Everywhere should have closed ranks against the PRC, whether by a travel ban or mandatory quarantine for all PRCs, less important.

when the US is spending 18% of its GDP already on healthcare.

We're not. About 7.5% of gross output is attributable to the medical sector and 12% of gross value added. The medical sector, btw, includes long term care and miscellaneous 'social assistance' as well).

There is also a cost to the death of anyone in a work or social network.

If you have ever had a parent die, you know, as a middle aged person, how much work is involved in settling the estate, how much work is involved in moving a surviving parent. So, there are costs down the line born by the middle aged person.

Let's say the middle aged person dies and has a family, leaving one remaining spouse (hopefully) or let's say it is a single mother who dies with children. Who takes care of the kids. Can the family unit in the first instance above recover, educate the kids, support their education. Good luck.

Let's say you are a 20 year old: do you depend on financial support from your parents. Would you have to drop out of school or not get the advanced or professional degree because your parent would not be able to support you. Now, of course, you could move in with your remaining parent and live in the basement while you pursued your online education from Trump University.

All I'm trying to say is that people are not numbers. They fit in a social network. They provide support to each other in a family social network, and their value in that network is under appreciated until it is not there.

And, for the libertarians in the audience, just think: the likely replacement for the social or family network support will be the state. You will end up cherishing those government loans or student loans that you would never have had to take out had your parents been alive to assist you.

Spare us the bad faith argument. The left doesn't give a damn about preserving civil society's little platoons against encroachments by the state. It is a never ending process of needing more government in order to prevent even bigger government.

Who'd ever think
I would sound like
Gary Becker.

In this thread Bill once again confuses Somalia with classical liberalism.

Those are big words for you. Are you sure you understand them. There must be a youtube video out there for you to watch that would explain them.

Also, Skeptical, you seem afraid to answer questions I pose to you in previous threads.

Now you have resorted to
Silly talk.

I would suggest that anyone interacting with Skeptical simply ignore him.

Skeptical is one of the true delights of MR, just like Thiagio.

Poor guy doesn't realize he is a Thiago.

Straight to ad hominem. As per usual.

Stay classy, anonymous.

Prior, use your handle.

I take it back. Thiago at least is self-aware.

Also, notice how Skeptical doesn't address arguments.
Notice that his comments are one liners...probably being entered on his phone without much thought.
Notice that Skeptical likes people to respond, and that is what drives his conduct.

So, goodbye Skeptical.
I mean good bye
I don't hear or see you.
You are dead to me.

In this thread, prior_approval shows his autism and 30 year simmering anger at GMU for being fired, anonymous trolls an Econ website while he sends his kids to go out every night and spread the virus, and Bill once again confuses classical liberalism with Somalia.

Spoiler alert: Bill has no questions and never did

I have read that this former GMU employee was fired 30 years ago for either sexual harassment or sexual assault.

In the spirit of the metoo movement, I think that should be noted every single time you identify this person. Personal courage is important - people who have personally experienced sexual harassment or sexual assault, possibly including yourself in such a traumatic situation, need to be supported unconditionally.

Trolls have the same effect as an auto accident.
You look at the auto accident and slow down.
A troll gets you to look at what the troll was responding to.

A troll is like
Cowshit
To a gardener.

“So, goodbye Skeptical.
I mean good bye
I don't hear or see you.
You are dead to me.”

Now that’s social distancing!

A 0.5% mortality rate among the young (under 60) is 10X too high.

"A 0.5% mortality rate among the young (under 60) is 10X too high."

Isn't that the truth! Way too high!
But that's reality; gotta deal with it.

No, it's not the reality. It's a made up number.

In Germany, the fraction death/tested positive is 0.35%. Of course the number of tested positive is a vast underestimate of the number of people who have the coronavirus : many of them are note tested, because they have no symptoms or too small symptoms. The mortality rate is thus probably less than 0.1% -- for the whole population. For the population of people under 60 without comorbidity, it is obviously much less. Certainly less than 0.05%. So Alex is off by a factor ten, at least.

Stop the fear mongering. If you see a fault in this reasoning, argue with facts and numbers and logic, not with reports from newspaper telling us about some horrible death somewhere (I am thinking to Bill here).

To reconcile Germany's data which is different from France, Spain, and Italy's, we may have to consider factors unique to Germany, e.g. more widespread testing (maybe they're just earlier in their disease spread and have yet to see the sickest declare themselves), higher # of ICU beds (more patients being actively treated in hospitals not yet declared to be recovered or dead). It's premature to call their CFR the definitive gold standard.

It's certainly possible that when the dust settles, Germany and SK have the best overall CFR results, but that's with a lot of work! By no mean will that same result be replicable for all countries.

I work in ICUs. Here's a thought experiment. A respiratory illness runs through your population. You have a portion who recover without treatment, a portion who recover after hospital stay, and a portion who never recover to leave the hospital but can be kept alive forever on a ventilator.

It's possible to manipulate your CFR by keeping those people on the vent. They're technically dead but don't count for CFR as long as they're being vented. Their lungs have been so damaged they can never survive off the vent. They can be "trached" for long-term ventilation but is that really living? As soon as you take them off they'll die.

Oh, also how many hospital beds can you use up to keep these vented patients alive?

That will cause a long tail for some of the CFR data to shake out.

The prior talk of letting the young go out and work may not be doable after all.

Bloomberg today is reporting NY hospitals having half their patients be between 18-49 (https://www.bloomberg.com/news/articles/2020-03-21/-tipping-point-at-new-york-area-hospitals-as-virus-cases-mount).

Also CDC data for US admissions (again Bloomberg: https://www.bloomberg.com/news/articles/2020-03-19/coronavirus-in-young-people-is-it-dangerous-data-show-it-can-be) shows that for 20-44 year olds there is still a 14-20% hospitalization rate and 2-4.2% ICU admission rate even if the overall case fatality rate is only 0.1-0.2%. The rates for all 3 rise as you go up in age cohort.

It's the first two numbers that will get you, not the last one - patients (even young ones) sick for days in the hospital or ICU blocking a bed.

This is why we can simultaneously say that it's only as deadly as a bad flu
for young people (caveat being if they're properly treated in the hospital) but also will crash the health care system from sheer volume of moderately-severely sick.

I accept the disclaimer that we are not testing enough to discover the background rate of asymptomatic or minimally symptomatic such that they're not tested people. We'll see significant swings in CFR as a result of this. It may drop because of more testing, or rise as a result of previously hospitalized people dying, or rise because of hospital crowding. It's very hard to estimate a natural CFR untreated, or a natural CFR w treatment for the population as a whole without more testing.

If you claim to know for sure that the CFR is higher or lower than what the data is saying right now, you're displaying mood affiliation and justifying your priors.

I completely agree with @Rick Zhang above!

The Italian doctors are saying we mostly catch it in the emergency room. Plus we do not know the immune response well enough and hospitals may be re-infecting. The best solution, right now, it so treat it like the sever flu, go home and drink hot chicken soup, says the latest medical advice I read. They want you to phone in your symptoms and do not call for medical transport until the fever or breathing start to become depressed.

This is data we know, from Italy, backed up by two recognized epidemiologists.

one huge caveat with that data.

As of March 16, 4226 cases have been reported.

We only know the ages of 2449 of them.

We preamble know the ages of the 508 who were in a hospital. What we don't know is how serious a case that is.

In terms of ICU, only 12% of ICU people were 20-44.

That is roughly people 18-44 is about 36% of the US population, so the priors haven't changed -- young people are not coming down with this in great numbers.

John F. Bonamo, chief medical and quality officer for RWJBarnabas Health, the largest system in New Jersey, said his organization had purchased 500,000 masks from a vendor that’s not part of its typical supply chain -- for nine times the normal price.

yay capitalism

A lot of people are being hospitalized as a precaution, not because their cases are serious or critical.
Statistics here say only 2% of cases in the US are serious or critical. 708 as of yesterday. I doubt that's the total number of hospitalized cases.
https://www.worldometers.info/coronavirus/country/us/

AT: "And let’s suppose the death rate is on the low end because healthy, young people get it rather than the elderly, say half of one percent, .005, then we have 330,000 deaths of healthy, young people."

Half that again if we go by the Chinese numbers - https://www.cebm.net/global-covid-19-case-fatality-rates/

10 to 19, 20 to 49: 0.18%, 0.32%

and that's assuming they are actually counting everything. If they're off on how many they're testing by a factor of 2 due to mild or asymptomatic cases then you get down to 0.125% or 75000 excess deaths, or if they're off by a factor of 4 then 30000 excess deaths.

Again, need a random community sample to make these predictions.

Plus, all the above seems to be assuming continued spread by panmixia. This is an unrealistic assumption. Without panmixia you might not even get to 30% of <50s (something like 20% total pop?) before vaccination or effective anti-virals are achieved.

We need a wide sample. It may be that you can get down to totally acceptable excess death rates among the young, where by acceptable I mean "Relative to costs of lockdown".

You can also crash the death rate among the young further by selective quarantine of people who are already likely on medical disability, which is another factor excluded here. Co-morbidities are essential in this problem. That'll reduce the effective death rate in under 50s even further.

And on the last point, if we want to crash the death rate among the young and old?

Ban smoking today. This instant. Until the duration of the crisis is complete. Or at least jack up the tax to hell.

(And maybe you can add imposing a salt tax to try and kill hypertension to that).

The dangers of salt are much exaggerated.

I understand that insurance companies have good, quick, cheap ways to test whether someone is a smoker. Apply them at the hospital door: smokers will not be admitted for respiratory problems.

Does that lower the death rate or is this some septuagenarian Tory "smokers deserve to die" thing?

The major problem I see with this analysis is your assumed death rate. CFR under 50 in Italy and China seems to be pretty clearly .3 at the higher end. I make an assumption that seems obvious to me, but is certainly an assumption, that there is a sample bias in this data. Namely, that many people are not tested that have the virus. I have heard estimates that 1 in 10 of cases were tested, but let's say that it's 1 in 3. That would put the CFR at 0.1.

This is not an assumption, most of those deaths would come from those with serious illnesses. So you would need to isolate those people as well. Assuming, this works to some degree you get the death rate down to 0.05%. If your assumption of 20% infected, which seems a little high given that was the Diamond Princess's infection rate and no one is claiming basic social distancing should not continue, then you are down to 33,000 younger deaths.

Is that tragic? Absolutely. But so is what we are doing to the economy. Businesses going under, people with no idea of what they will do into the future, young people trying to find a job, depression and suicide, social fabric issues, etc. It seems pretty clear this cannot last long.

Your concern about the continued necessary interaction of at-risk people and younger people is valid. The 45 minute test is promising for that. This also remains a problem with a lockdown, and one of the reasons a lockdown does not make too much sense as we have it now.

No good choices, but isolation seems pretty clearly the better one.

You're basing CFR on incomplete data. Italy's data as of my posting is 53578 cases, 4825 deaths, 6072 recovered. That still leaves 42681 patients whose fate is to be determined. They're still being treated in the hospital. Some will die in a few days-weeks and add to your CFR.

I would go by Lombardy and Wuhan's data to simulate a worst case scenario (e.g. overwhelmed health care system). In Wuhan the central gov't was able to ameliorate things by rushing in personnel from other provinces and build hospitals in days. I doubt the US can or will do that. Lombardy or worse may be a better approximation of e.g. NYC CFR.

Of course I am, there is no complete data. I'm basing it on the most complete data there is. Not sure why Alex's 0.5% is better.

Well luckily for you you can see a sample of what NYC's data will look like 2-4 weeks from now.

Hopefully sooner than that. I am sure some countries that have been properly testing for longer will have fairly complete data soon enough.

Most definitely, but I don't want you to use the excuse of confounders like people have been doing questioning other countries' data.

e.g. China manipulates data, Italy reports deaths differently

It'll be hard to argue with NYC's data once they run out of capacity.

I'd also be interested to see a control group - a country that lets the virus run through its population without ever instituting increased distancing or lockdowns.

I would say your confounder concern over China is potentially valid. But Italy is still reporting very similar CFR for younger groups, despite the fact that they are clearly having many, many more deaths per case. If anything this strengthens the argument that younger people are not nearly as affected.

Sadly, it is quite possible that the oldest die first, and younger people who will never breathe on their own again are being kept alive on ventilators for now.

We will know considerably more in just 6 months - which is still longer than this particular virus has existed in humans.

If by possible you mean there is some tiny probability of that happening, then yes, that's possible.

But exceptionally unlikely. China has had 82,000+ cases recorded of which 72,000+ are recovered and 3,000+ are dead. All since December/January. So there is almost no chance that you are right.

Basically, the Chinese numbers are likely not precisely focused in the way that the Italian or German or American numbers will be in the next 6 months. And even using your own numbers, there are still 7000 people (that is, almost 10%) not listed as recovered yet, even as new cases have tailed off to essentially zero over the last week,

The problem with this line of thinking is that it assumes that waiting is costless. It is not, it is exceptionally costly. As in real life years, many of them, being lost every day we destroy our economy, impoverish people, and put people in real jeopardy of losing housing and food.

We have to work from incomplete data, and the incomplete data is all on my side so far.

This line of thinking most certainly assumes waiting is inevitable.

The U.S. has yet to reach German levels of covid-19 infection (taking into account just how truly poor the American data is), much less Italian or Spanish ones. If the U.S. does reach Italian levels (and sadly, there is absolutely no reason to think that will not happen in areas such as New York), will the data be complete enough for you then? No need to answer, since waiting will answer it regardless of what either of us thinks now, with incomplete data.

Shutting everything down is the last desperate attempt to stop a wave of deaths. Like the ones happening right now in Italy, Spain, Iran, and France, with Germany, Switzerland, the Netherlands, the UK about to enter the game. And Germany, at least, is fully aware of what has happened in Lombardy (which easily explains why Bavaria has reacted more strongly than any other German state), and is equally fully aware that it will happen in Germany too, even with a lock down. In comparison to Italy or Spain, the Germans are a touch earlier - and they are desperately hoping that will make some difference in the death toll from the first wave that everyone can see coming, compared to doing nothing.

Sometimes, people with incomplete data decide to do their best to keep as many people as alive as possible, if only out of hope and a sense of shared humanity.

At this point it is clear that testing is not catching even a majority of cases in most countries. In the places with extensive testing (Diamond Princess, SK, Singapore, Hong Kong, Germany) the death rate is AT LEAST 10x lower than those given by China.

The following two thoughts are speculation, but hardly leaps of logic.

1. In China, they indicate that 2.3% of cases died, 5% were critical (ICU), and 14% were severe (hospitalization required).

The argument to ignore these low death rates in high testing countries is that we don't know how many of those who recovered did so due to proper ICU care, which may be limited under high load. So the number we really want is the critical case rate. In China, the critical case rate appears to be 2x the death rate.

2. In China, the fatality rate by age is given as 0.2% in younger than 40, 0.4% up to 40-49, 1.3% up to 50-59, 3.6% 60-69, 8% 70-79, 14.8% 80+.

Using the 10x estimate this gives the true critical case rate as follows:

0.04% in younger than 40, 0.08% up to 40-49, 0.23% up to 50-59, 0.72% 60-69, 4% 70-79, 7.4% 80+.

I know this ignores the effect of age on asymptomatic/not, but the Diamond Princess numbers seem to back me up here. In any case, what we are arguing for isn't that we should let everyone get it, but rather than we should let young, healthy people get it.

As a result, here is my armchair playbook of what we ought to do:

1. end of Feb: Attempt containment at borders.
2 start of Mar: Implement social distancing measures.
3. mid Mar: lockdown

This is actually what most governments have done. The reason for this is that at this point, all of the above information is still unclear. Now that it's starting to become more clear, we should start seriously considering returning healthy young people back to work, either immediately or after first approval of an effective anti-viral.

4. mid-late April: return to work of healthy young people

I'm actually quite confident that this is what will happen, as the economy continues to suffer and the above figures will become more and more obvious.

As to whether effective quarantine of those with comorbidities and the old is possible, it seems like a spurious argument to claim that full lockdown is possible but that isolation of a subset is not. If they live in a house, dedicate a room or section of the house/apartment to them, if they live in a nursing home, limit visitation to video calls. If they require a caretaker, increase payments (possibly with government assistance) and have the caretaker also participate in quarantine measures. Certainly these are not great conditions and you may get ineffective implementation and/or refusal, but it ought to be possible to think of ways to improve the experience without compromising effectiveness.

I messed up some numbers above. It should be as follows:

Using the 10x estimate this gives the true critical case rate as follows:

0.04% in younger than 40, 0.08% up to 40-49, 0.23% up to 50-59, 0.72% 60-69, 1.6% 70-79, 2% 80+.

We can't be the society we were for very long.

News this morning is that Marriott is going to put thousands of workers on furlough, give them 20% wages, and say you can apply that to healthcare if you want.

I am a fairly capitalist guy, but I can see some truth in the criticism "the meritocracy is fake." Those Marriott workers were working hard and doing their jobs, now SOL.

Compare and contrast to Denmark which had the philosophy and infrastructure in place to put all laid-off workers on 70% salary.

You aren't serious. Denmark can afford to pay everyone for nto working a month at best.

Narratives don’t have to be true to be useful.

He has a goal in mind and is very willing to blatantly lie to achieve it.

Denmark has it's own currency.

What's the argument, that this type of deficit spending or monetization would be inflationary in this scenario?

Do you actually believe this is true?Remember, this is an Econ website.

Look up ERM maybe.

Or not, you can always go back to ad hominem and trolling.

That was a confrontational and non-enlightening answer.

If, and I realize this is an if, we end up doing 6 months of social isolation how much wealth destruction does that entail?

When was the last time the US had to recover from that kind of destruction?

Pandemics are not wars - no factories are being bombed, no cargo ships are being torpedoed, no cities are being fire bombed.

Isn't this a website that too often reasons from stock prices?

I think falling stock prices are mainly a prediction that many government restrictions put in place for the coronavirus are going to stay in place and dampen the economy for years. But this is not inevitable like a physical factory being destroyed and needing to be replaced--it can easily be prevented by not having those restrictions.

If a factory is closed and it's contents auctioned, has any wealth been lost?

Considering how many factories were basically dismantled and sent to Mexico or China, that seems to be a question that can at least be answered.

My preference is redistributed, more or less, with the only clear winners being the owners.

It depends. Who is buying the contents of the factory, and what are they doing with it? It could be that wealth is even gained if the contents are being moved to a higher-value use (as is likely by the fact that the buyers of the contents are willing to pay more than the seller of the contents are willing to give them up for).

When a small minority of factories close their contents may be purchased by people with the equivalent human capital and institutional knowledge.

Put you reach a threshold and that ain't true anymore, good machines start going to scrap.

It's probably not going to be inflationary right away because people are stuck at home and aren't spending money, but printing money and giving it to lots of people seems likely to create significant inflation once lockdowns end and people start spending the money that was printed before (particularly if aggregate supply takes longer to recover).

I'm not sure that is really the lesson of the last 20 years.

The Japanese are finally managed to hit 1.3% inflation?

And of course the MMTers are right, that money can be removed from the system.

Some amount of money printing will lead to inflation. Lots of countries like Argentina, Turkey, Venezuela, and Zimbabwe have had hyperinflation in the last few years. Inflation isn't dead; most developed countries just haven't gotten there yet. But none of them have printed the scale of money now being thrown around either.

I am not an economist and I'm not going to pretend to be one here, but I think that is a serious question for the people with fed level experience:

Have we underestimated the gray area between inflation and hyperinflation?

Given the radical differences between countries that have experienced each in recent times, perhaps there is more separation and less danger than is commonly feared.

There's a lot of gray area. I'd say the 10%-ish inflation the US experienced in the late 70s counts as a gray area, as are the double-digit rates of inflation experienced by Turkey, Russia, Iran recently; even Argentina would arguably on the cusp of it. Hyperinflation of the Venezuelan and Zimbabwean type is pretty rare, but even 10% inflation would be very damaging to the US (as it was in the 70s).

Right, but I think in retrospect that more of the '70s was oil shock than monetary inflation. We just had to treat it like inflation because too much was indexed indirectly to oil prices.

Oil prices went up by even more in the 2000s than it did in the 70s (https://www.macrotrends.net/1369/crude-oil-price-history-chart) yet did not create broader inflation.

Except in extreme cases where your country's productive capacity has been entirely destroyed, inflation is a monetary phenomenon.

It is kind of ingrained that governments should never print money, but surely there is a point where wealth destruction is so extreme ..

Speaking of going to war with the army we have:

"BREAKING: U.S. hospitals are warning that they are so strapped for cash that without some financial relief, they will be unable to meet their payrolls in a matter of weeks and some could be forced to close just as coronavirus cases are surging."

https://www.washingtonpost.com/national/health-science/hospitals-warn-of-shortages-closures-without-emergency-aid/2020/03/21/6ba3e9d8-6b90-11ea-9923-57073adce27c_story.html

A cruise is a different situation from regular society. For one you are on a boat mostly of strangers so social distancing is part of the routine whereas in society you tend to be more social with people you know (work, school, cafe, gym, friends, family, etc.). On Diamond Princess, they diagnosed early and began immediate enforcement of quarantine. A quarantine on a boat is more easily enforced than a city or state wide quarantine.

So I would treat the Diamond Princess as an exception and not the rule for the reasons listed above.

The quarantine was clearly not particularly effective, nevertheless I take your point.

The counter to that is that a cruise skews much, much older than the population at large. And even without complete data it is obvious that older people are much more susceptible to this virus.

About 11% of the passengers were symptomatic and tested positive for the virus. That amounted to roughly 240 people over 60. There have been 8 deaths so far and there are 15 people who've been in bad shape and are not yet cleared.

A cruise ship has close quarters, common dining rooms, a common ventilation system, and staff interacting with patients. I'm puzzled that he fancies that you're less likely to be infected in that environment than out and about.

He gave his reasons and they make sense. Your reasons make sense too but my hotel room is in much closer quarters than a cruise ship, there's common dining rooms, and a common ventilation system but since I never interact with my neighbors there's close to no chance of me getting anything.

Clearly not, at least on a cruise ship. Once the quarantine began, if effective, then that is true.

But before the quarantine began, and if it was not effective then a cruise ship is pretty disastrous for this. No one wants to stay in their rooms, they are tiny. Considering the long period before infection is known, many were likely infected before any quarantine due to this and all of those mentioned vectors.

We do not know the case fatality rates for young people, because we haven't been able to test systematically enough to properly know the denominator. So far in Italy, 9 people under 40 and nobody under 30 has died from the virus.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy#Statistics

If you compare this to the 53k confirmed cases, since the median Italian age is 45, so even if another 31 patients under 30 die, that's a mortality rate of around 0.16% for under 40s, assuming the case demographics match their population (in Korea I remember seeing more cases in 20-30, but can't find it at the moment).

Suppose Italy has only confirmed 1/20 cases, and there are actually 1m Italians with Ncov, compared to the 50k which have been diagnosed. If again slightly less than 1/2 are under 40 and again an extra 31 deaths occur as cases develop, we now have a fatality 40/ 400k = 0.01% for this age group, nearly 2 orders of magnitude less than the figure that you cite.

If you want encouragement, the cases that have excessively tested (actually much more per case than South Korea), Germany, Canada and Australia currently have the following case to death ratios:

Germany: 0.4%
Australia: 0.5%
Canada: 1.5%

(Worldometer again)

Italy's case to death rate has consistently been closer to 10%, even before they started reported that their hospitals were under severe strain.

https://ourworldindata.org/coronavirus

(testing section)

If you take the Diamond Princess passengers and crus, mostly everyone was tested, and most of the cases are now resolved. Just over 1% have died died, but the demographics skewed very old, with 60% passengers above 60. It maps to death rates of less than 0.5% for the typical Western demographic patterns.

https://cmmid.github.io/topics/covid19/severity/diamond_cruise_cfr_estimates.html

Over the coming weeks, we need to find out what the true mortality rate is, including asymptomatic/mild cases! Before then, there is a lot of uncertainty.

"So far in Italy, 9 people under 40 [have] died from the virus."

How do we know that? The UK numbers are reported as deaths of people who have tested positive for the virus. Are the Italians just assuming deaths are caused by the virus? Are the Germans just assuming the opposite?

This anecdote may be out of date but a retired epidemiologist friend has told me of the trouble he had with Italian cause of death data until he learned who in Italy recorded the cause of death. Doctor, or nurse, or the family of the bereaved, that's who. Has this changed in recent decades?

Oops. "family of the deceased".

I've link again to the table. These are the mortality figures, that, as far as I know, Italy is reporting using reasonably consistent methodology.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy#Statistics

Agree that there are some issues with people dying who incidentally had the disease, but it doesn't change my view that mortality risk for Ncov has a crazy age skew. We need better data, I agree, but I don't this we can be sure that this disease is particularly risky for young people.

We don't know the true value, but Alex's numbers don't seem 'conservative' to me.

But here are some highlights - "One likely explanation for the discrepancy in figures, Addo suggested, was that while northern Italy’s hospitals are being overrun with new patients, Germany’s are not yet at full capacity and have had more time to clear beds, stock up on equipment and redistribute personnel.

“One advantage Germany has is that we started doing professional contact tracing when the first cases were reported,” Addo said. “It bought us some time to prepare our clinics for the coming storm”.

Crucially, Germany started testing people even with milder symptoms relatively early on, meaning the total number of confirmed cases may give a more accurate picture of the virus’s spread than in other states."
*****
The age profile of those affected in the first few weeks has also been younger than in other countries, many of them fit and healthy people returning from skiing resorts in Austria or Italy, which would also help explain the low mortality rate.

“I assume that many young Italians are or were infected without ever being detected,” Christian Drosten, a virologist at Berlin’s Charité hospital, told the newspaper Die Zeit. “This also explains the virus’s supposedly higher mortality rate there.”

Drosten, who has been advising the German health ministry, has also warned that Germany’s mortality rate is likely to rise in the coming weeks as high-risk areas become harder to identify and testing capacity becomes stretched.
*****
Unlike in Italy, there is currently no widespread postmortem testing for the novel coronavirus in Germany. The RKI says those who were not tested for Covid-19 in their lifetime but are suspected to have been infected with the virus “can” be tested after death, but in Germany’s decentralised health system this is not yet a routine practice.

As a result, it is theoretically possible that there could be people who may have died in their homes before being tested and who do not show up in the statistics.

Practising medical specialists such as Addo do not believe this number of unreported cases to be statistically significant. “I have yet to see any data that would suggest a large number of untested corona-related deaths that don’t show up in the statistics,” she said.

“Clinics dealing with respiratory illnesses have been on high alert about the virus for weeks, so I would be very surprised if there was a significant figure of uncharted deaths.”
“It will appear that the virus has become more dangerous, but this will be a statistical artefact, a distortion. It will simply reflect what’s already starting to happen: we’re missing more and more infections.”

This seems interesting. what is the source?

The source is the Guardian online front page, and the article is called Germany's low coronavirus mortality rate puzzles experts

Key words here: "so far"
Deaths lag cases; cases are just now ramping up. No conclusions about death rates can be validly drawn in this circumstance.

China is supposedly not ramping up and should be well beyond lag, and that is where a death rate of half what Alex mentions comes from. (At this point high counters leap on scene to explain that this is due to the heroic hospital building efforts etc.)

Yeah that's my point, we don't know!

With case-level data it's actually possible to adjust for the death lagging cases effect you are talking about, the one that you can't resolve is the mild/undiagnosed issue.

From my perspective could be anywhere from 2x to 20x. Ability to know this crucial!

Dude, it's just a flu! This isn't worth shutting down society for! I must be the last independent freethinker!

"And let’s suppose the death rate is on the low end because healthy, young people get it rather than the elderly, say half of one percent, .005, then we have 330,000 deaths of healthy, young people."

The number of people the US lost in WWII was about 420,000. The idea that we are going to see WWII levels of people getting killed over the next six months is mind blowing.

"And let’s suppose the death rate is on the low end because healthy, young people get it rather than the elderly, say half of one percent, .005, then we have 330,000 deaths of healthy, young people."

This virus has been around not even 6 months. We don't really know anywhere near what we need to know about it. One estimate is that 20% of people who get it need hospitalization. Needing to be on a ventilator for weeks is a major medical crises and we have no idea what the effects will be in the long term for the people that recover after that. For that matter we don't even know the long term effects on the people who pass the virus without apparent symptoms.

I find Nassim Taleb grating, pretentious and annoying but his ideas are having their moment in the sun. Anyone toying with ideas like "well let's just let everyone under 60 get it" is acting like they understand what is on the left side of the curve when they are just speculating.

Yeah I'm really scared of the worst-case scenarios...

I find Nassim Taleb grating, pretentious and annoying but his ideas are having their moment in the sun.

He thought in 2009 that Nouriel Roubini was 'too optimistic' in predicting a contraction of 10% in output over a year and predicted that banks would be reduced to cash dispensing services, and should have no other role in the economy. Stop listening, and maybe the media quite booking him.

A lot of doomsday-type thinkers are looking quite prophetic today. But it's important to look at everything they've written before. This is especially true on YouTube: there are many "prepper" channels that looks like they got this whole crisis right, but they have years of videos where they have been predicting that this event or other would lead to social collapse and all of those ended up being nothingburgers. If someone's been consistently wrong for ten or twenty years, just because they got this one right doesn't mean that they have some special insight.

I'm not basing my concern on doomsday prepper Youtube channels. I'm basing it on the mathematics of the disease. It spreads to many people and even if the mortality rate is much lower than 3%, we are going to have a lot of dead people. I'd be very happy if unexpected things cause it to not be as serious but the downside here is very deep.

I won't defend a lot of what Taleb says but where he is indisputably correct is in mocking the whole industry of prediction in areas of life ruled by black swan events.

Right now, we don't know exactly what rates of hospitalization, ICU admission and death (under ideal treatment scenarios) are by age group. We have worrying estimates and people seek to downplay these estimates on the unproven assumption that there are millions of younger people out there who are infected and asymptomatic. That's a hell of an assumption to make considering the downside if the assumption is incorrect.

"...say half of one percent, .005, then we have 330,000 deaths of healthy, young people."

This quote, and many of comments here, focus on the CFR for young healthy people. Somehow, if we can imagine that it's super low, we can justify some scheme to speed this process up and get back to a healthy economy, right.

First, the fatality rate rises about 4% for each year of age over the age of 20. So the CFR may be tiny for a 21 year old, appreciable for a 30 y/o, and pretty damned high for a 45 y/o. Add it the wide variety of prevalent risk factors, and the numbers go up higher (i.e., there aren't as many "young, healthy people" as you think).

Second, and even more damning for this foolish thought experiment, is that we have very good data for the rate of serious and of severe illness due to the virus, and for young people it's dramatically higher than the death rate. If you have a rate of infection that, your best case (i.e., the health care system magically scales up 20 fold at least), is that it kills 330,00 young healthy people. With that level of infection you'd have millions of young people with serious/severe illness requiring extended hospitalization, many of whom would be left with permanent disabilities. This is a great scheme to turn a lot of young, healthy people into young, disabled people

To all the newly-minted epidemiologists, the ones who just learned about the Spanish Flu about a month ago, here's some homework (this is for you, too, Alex, though I'm sure you knew about the Spanish Flu before): look up what percentage of the population were left with permanent damage and disability from the Spanish Flu. The Spanish Flu didn't cause it's own pneumonia, like COVID-19, so take the Spanish Flu numbers and multiply them up. Then you'll get some idea of what is really being advocated. There is no "trifecta" scenario of letting this virus run rampant though the young and healthy and have it be a good outcome. We have to delay infection as much as possible while medicines and vaccines are developed.

And if no successful vaccine is developed?

Hail Bentham! You die for the good of the collective.

Then hope that the hospitalization rates are nicely stretched out over the rest of the year so as not to overwhelm like in Wuhan which had to construct more buildings or Lombardy which is running above capacity and had to turn to the military for logistics, pull doctors out of retirement and fast track nursing students. This gives the greatest chance for survival and burdens the hospitals the least.

This, plus more widespread use of medications that are showing promise (there are several, and the clinical trials are moving rapidly in many parts of the world). And I think there are some signs that this virus doesn't spread as readily when the weather is warm (good for most of the places hard hit now, not good for the southern hemisphere, but then they'll have the advantage of applying the hard-won lessons of Asia, the US, and Europe). And I'm growing more confident that we will have a vaccine, more likely several vaccines. Perhaps none will be ideal and perfect, but they will make a difference.

"We have to delay infection as much as possible while medicines and vaccines are developed."
Which is how long? Possibly never. There is still no vaccine for SARS or MERS.

Ted,

Did you say that not knowing that the SARS vaccine work was discontinued. What would you say if you knew the SARS vaccine work was discontinued. https://fortune.com/2020/02/18/coronavirus-sars-vaccine-development/ and now SARS work is being used for a covid virus: http://www.pharmatimes.com/news/sanofi_to_repurpose_sars_vaccine_candidate_for_coronavirus_1326473

Knowing this, do you wish to revise your comment.

Yes, I do. There was no definitive vaccine for either of these diseases. It's possible that discontinued work and faster genome sequencing will speed up the process. But that process could still take up to two years. Are we seriously going to close up shop for that long?

You phrase it as closing shop, nice words, but that's not what it is. Unless you specify what you mean, it's just word pudding. And, if the economy shuts down as it did in Italy, you are no worse off if you could have saved lives.

The problem lies in specification: what is the alternative one would measure the economy against if you did nothing.

What are the plans you would implement to minimize death while maintaining an economy.

And, finally, recognize there is an interaction effect between death rates and the economy and economic efficiency. If there aren't any doctors after this over, if there aren't many plumbers, or some skilled persons, you can't wish them to appear after they died.

Bottom line: Specify terms, specify interaction effects, specify alternatives from which you make comparisons.

Specify an endgame, Bill. Do you support waiting until there is a medical solution? How long will that take? Realistically. Expert estimates for a vaccine are 18 months, if it works. So we shelter in place for 18 months? And then how do we restart the economy? There are no easy answers, although you seem to think there are. Yes, death is an economic drain, to an extent. If you were being cold, you could also say there are some benefits. Could pension systems be in better shape after this? I see three likely outcomes:
1. We shelter in place, waiting for a medical solution. That might take until the end of 2021.
2. We accept death. Don't be foolish, but prepare for the worst. Prior to the 20th Century, this was normal.
3. Improved hygiene and higher humidity greatly reduce the outbreak. This seems to be what happened with SARS.
By the way, "word pudding" is a cute was to dismiss someone. Can I have your recipe? Because you seem a master chef.

I am still waiting for you to specify the alternatives listed in my reply. Use numbers as to the economy and deaths for each alternative. Provide links and show your work.

"what is the alternative one would measure the economy against if you did nothing."
I don't know. Neither do you. I do know the fragile state of most businesses and consumers.
"What are the plans you would implement to minimize death while maintaining an economy."
I have no such plans. "Accept death" means just that.
Finally, yes the economy will experience some inefficiency. It might also experience more.
As I said, no option is great and nobody really knows.

As Bill pointed out, SARS/MERS didn't get vaccines because they didn't persist. I'm reading preprints daily, and I'm becoming optimistic that vaccine will come sooner than the usual 18 months. There is literally a vaccine that has just started human trials, and others scheduled to start in the coming weeks. This is a speed that hasn't been achieved before.

Here's another thought that smart people trying to figure out the optimal "speed up the infection rate in young people" scenario. The whole goal is to preserve the economy and minimize long term disruption to civilization, right? Get it over with and move on? Well, what happens in those societies where the leaders implement this policy, 'for the good of the nation,' and (depending on the size of the nation) hundreds of thousands die, and millions are disabled. No family will be untouched. The economy will still be in shambles, lots of wealth destroyed, and on top of it a government mandated policy to speed of the infection. How is the populace going to react? What will they think of those wise leaders who mandated that death and destruction, while privately talking about decreased burdens on pension funds? Maybe, just maybe, the plan was slightly better than the delay and mitigate and isolate strategy we're mostly doing now, but that will be a theoretical comparison, because once you implement this "speed it up" policy, you can't go back.

I suspect the governments and the smart clueless fools who advocated and instituted such policies would be, at best, run out of office and run out of town. At worst, some of them would end up the way Mussolini did.

"SARS/MERS didn't get vaccines because they didn't persist."
That's somewhat true. But there were clinical trials for a SARS vaccine. But they took place 18 months after the outbreak started. Work continued for the next decade and there was still no definitive vaccine.
" I'm becoming optimistic thatvaccine will come sooner than the usual 18 months."
That's great and you seem to have a relevant background. Others are less optimistic. How soon is sooner? If, say, the Seattle trial seems promising, we'll know at the end of April. How soon after that? Legitimate progress will change a lot.
Just to be clear, I'm not advocating "speed up the infection rate in young people," so spare me your Mussolini comparisons. I'm saying that no decision at this time is optimal.

Higher on the page you said "millions of young people with serious/severe illness requiring extended hospitalization, many of whom would be left with permanent disabilities". Now you say "hundreds of thousands die, and millions are disabled".

So to be clear you are not saying there will be millions of young people in the U.S. with permanent disabilities because in the first comment they are "many and young" and the second those disabled by the strategy to infect the young are in the millions but not necessarily young?

Just checking.

"And let’s suppose the death rate is on the low end because healthy, young people get it rather than the elderly, say half of one percent, .005, then we have 330,000 deaths of healthy, young people."--Tyler Cowen

Is this intentional fear-mongering?

Korea has reported zero deaths among people under 30 years of age. Zero.

Not one of 1,110 crew members of the Diamond Princess died----a sample of middling healthy, non-elderly adults who lived and ate in common quarters for weeks, under lockdown. Probably 100% infection rate.

There may be some young people, sadly, with compromised immune systems, or co-morbidities. But probably down in the one per several thousand range.

What can explain Tyler Cowen writing such a sentence? Fatigue?

Sorry, I meant Alex T.

"Is this intentional fear-mongering? "

You react too strongly to Alex's spit-balling. We don't have perfect information here so the napkin math is completely within reason given what we do know. FYI, Diamond Princess had a 20% infection rate.

Anthony Fauci puts the expected CFR at 1%. I'd say Alex is being generously optimistic when he didn't have to be. It's the opposite of fear mongering.

Young, not total population.

Not for young healthy adults, he doesn't.

We can also check up in a month and see if on DP and other decent scale large samples of young people to see if there is long term damage visible.

I'm guessing no (suggestions that even 5-10% or something like this of even identified cases, like you'd need to get millions of disabled Americans, likely to have long term health issues seem likely to prove laughably disproportionate).

But if lockdown's going on for a few months, we can see and then make decisions then.

>Is this intentional fear-mongering?

Why yes. Yes it is. Welcome to MR!

Because the sentence was written by Alex.

Fatigue?

Epidemiologists repeatedly point out that isolation will probably NOT reduce the number of cases, only stretch them out over a longer time period.

Yes, the choice is a lot of people dying quickly, or slightly fewer people dying over a longer period of time, with more collateral economic damage.

Great choices overall. No wonder there's hand wringing over the right course of action.

In fact it probably does reduce the the total number of cases. More importantly, it reduces the percentage of cases that die, that suffer serious illness and disability, and it reduced the number of health care professionals in both of those categories. The right course of action is overwhelmingly clear.

I suggest we adjust our way of thinking about these problems. Four the past 40+ years we have developed an activist's method of presenting and reacting to problems: If *auntie, Johnny, mom* could have known 5 seconds sooner, they could have gotten out their house quicker, and not succumbed to flames and smoke. Result: 15 smoke detectors in a 3500 sq foot home. –Please excuse the slight, yet not that slight, hyperbole.
We tolerate mortality rates every single day, on our roads, on our sidewalks, in our food distribution, in our work places. But if an activist wants to get a change through, a horrible exception is personalized, photographed and put on display. In difficult times we need big group choices.
What I take issue with in Alex’s segment: aggrandizing mortalities by magnifying numbers over the (large) US population. Assuming that if everyone shelters there will be no mortalities. Not subtracting deaths that would occur in any year due to a variety of other issues already present. Not considering that we have some advanced noticed to prepare for additional patients—ex cancelling elective surgeries etc.
It seems, as well, that isolating 62+ demographics from any interaction, even going to the grocery stores, is bound to results in some gains.
Finally, at least in MN, I think this re-sorting of living situations is very doable. I don’t have the statistics, but occupation rates per living unit is probable averaging between 2-3 people. Sorting out the few larger households could also be assisted by the state in, say, motel settings, a dorm room building. Some homeless people have already been moved into a motel.
Now someone will write in one example of 63-year-old parents who have to be separated from their children and there will actually be time spent on this one exception. Please stop thinking like activists!

It turns out being something of a recluse is no free lunch* in this context. I began to have cabin fever last night and whined to my husband just what AT facetiously proposes - quarantining the elderly only. It seems so much easier - to maintain, for longer. I don't think America can do this more than another week. But y'all's comments have properly shamed me. One thing bugs me, though. I've noticed that at the same time the media have started reminding us as a PSA that everyone can get/die from the coronavirus, not just the elderly - they've also, locally, quit telling us the age of the victims. My state's first death, a week ago or so, was a man in his "late nineties." We've had four since, as of last night - no details. I'm wondering if they've been asked to withhold their ages, lest we grow cavalier.

*Literally - my suspicion that a husband and wife were not meant to eat lunch together every day, grows apace.

Look at this 20 seconds video:
https://twitter.com/karimbitar/status/1241464190650417152?s=20

Right back atcha, Karim!

Door A: crush the healthcare system.

Door B: crush the economy, which crushes the healthcare system.

Door C: Crush the health care system, then do everything possible to keep the death toll as low as possible as long as possible

China, Italy, and Spain chose Door C. And it is possible that the only actual door you can open is Door C anyways.

Door USA: crush the economy, do nothing to help the medical care system, pass a corporate tax break.

The USA has always been exceptional.

For Door A, when you crush the healthcare system, you crush the economy too because your market now has less supply and demand.

Then model it. There are a zillion models for Door A.

Now model Door B.

Another point,

AT: Moreover, the numbers I just gave are conservative and don’t make a lot of sense because if 330,000 die then the hospital system is going to be overwhelmed and the death rate will be higher than .005.
An internal contradiction.

Let's do a sense check of this.

Iceland has the closest thing to population representative sampling at the moment (highest test count per capita).

On 15/03, hospitalization level was 3 tested, out of total cases of 180. That's about 1.6%.

(How you get a whole population fatality rate of 4% of infection out of something with that apparent kind of hospitalization rate for infection, I don't know. But I don't trust hospitalization rates from other sources much less because of sampling issues, despite Iceland's small sample size and the emerging nature of the problem.)

Apply that to 66 million infected under AT's model; 1,056,000 will require hospitalization. Assume that's spread over a year, due to natural slowing of exponential growth from less than perfect panmixia, plus some residual social distancing (limited opening for bars and restaurants, etc.).

The question then is what is most realistic about how you spread that over a year. I would guess (as a simple, broad scale guess) that if you assume each patient has a two-week stay in hospital, then you would need capacity for about 40,000 extra places in hospital, spread across the USA's population. Assume you need ICU for about a third of those, and then that's about 10,000 across the US, distributed proportionate to population. Will that really prove overwhelming?
Something like 12 extra hospital places per million.

Now, this can all be sense checked and will need to be sense checked as data emerge (the above is on pathetically small samples, even though they are closest to representative and thus why I use them), but it shows the need to look at large, population samples to actually understand this thing.

+ Do not model one, and not the other.

We don't even have 1,000 deaths. The flu kills more people. This is a Democratic hoax because they failed to impeach Trump.

Could the elderly be protected for a trillion dollars? How about 2 trillion? Excluding the bailout, which is already a trill and change, I think the economic harm from shutdown is running a trill a month already. So, at some point, even beyond utilitarianism (and I'm not that), you have to roll the dice.

We are going to need a new unit, perhaps petabuck, or whatever comes next.

Is there a math whiz who can crunch this number for me please? I decided to honor the Sabbath.

What are the odds you will know someone who dies from Covid ,under various CFR assumptions? I read that the average person knows 600 people.

Confinement won’t work. The virus is already widespread and we're not doing a Wuhan style lockdown. It's too porous. The virus will keep spreading
Italy is now realizing treating people in hospitals doesn’t work well. Hospitals create more infections than they fix.
https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080

Prosperity is important. Losing your job and your future is very stressful. I doubt this stress will increase life expectancy. It will have a lot of secondary effects on people’s lives like depression and crime and homelessness and domestic abuse. It will have effects on the fetuses of stressed pregnant women. Nobody has bothered to tally the costs. Nobody seems to care. They act like some “ stimulus” can always fix things.
There’s no paper out there that claims permanent effects from this virus if one recovers. There might be some in the very old. They’re frail. It doesn’t take much. They’re vulnerable to many things. Covid is just one if them.
Young people are killed in car accidents (2500 per year in the 15-20 age brackets),old people too.
We don’t give it a second thought. We accept it.
We accept deaths from many sources. We don’t declare they must be stopped no matter the cost. No life is infinitely valuable.
The death rate from this is almost certainly overstated. It’s the flu for the <20 , probably less than 0.1% for the 20-40 with the majority of deaths having other health problems The number of people infected who never showed symptoms is not known. Iceland now seems to show it could be 50%.
The disease doesn’t do well in warmer temperatures. Thailand is not overwhelmed. Virus droplets don’t last as long In warmer air. .In cold and dry air, the thin layers of liquid that coat our lungs and airways become even thinner, and the beating hairs that rest in those layers struggle to evict viruses and other foreign particles . All Coronaviruses to date have this characteristic along with the flu. This is most likely seasonal
We can wear masks and go back to normal. It’s pathetic that these effective simple and cheap expedients are too hard for the US to deploy . We can’t stop this virus from spreading anyway, not the way we're doing it. Let’s treat the sick mostly at home with few exceptions for the very sick.This won't overwhelm the hospitals.
Hospitals are full of bugs. They kill 100 k people a year and infect 1.7M from hospital acquired infections in the US according to the CDC. Most of the people who died in Italy had several infections but not when they came in but somehow we want to cram the elderly there ?. Treat most of them at home
Give all the young people already laid off by this a chance to work for a health corps. They can be screened by a serological test which we need to deploy. Probably enough of them are already immune.

We don’t need to bring the Great Depression. It will last a long time and create a lot of resentment. It will have dire consequences

This is utterly wrong, when using Germany as an example - "Hospitals create more infections than they fix." The hospitals are fixing nothing, they are just keeping people (hopefully) from drowning in their own lung fluid long enough to get healthier.

You’re the one wrong. Didn’t you read the article. “Hospitals are highly contaminated “ Germany is not overwhelmed yet. And it’s a fact people acquire a lot of infections in hospitals. MRSA, Candida albicans, bacterial pneumonia. They’re all there.

That hospitals are highly contaminated has been a trite truism for centuries. They are also the place where the ventilators are located, with the trained staff to run them. If you are drowning in your own lung fluids, it is irrelevant how contaminated the hospital may be.

However, this is also where testing and quarantine is important, something Germany started very, very early. Keeping people with covid-19 out of a public setting, and using stringent isolation measures for those who have indications of/have been tested for covid-19 is the best way to keep the spread as slow as possible.

The Italians basically got very unlucky by being the first mass case - and the Germans got very lucky by having the first isolated case.

Only a very small fraction need to go to hospitals. The rest can be treated somewhere else. The Koreans put less sick people in dormitories.
“South Ko­rea di­vided con­firmed pa­tients into four cat­e­gories. Only the sick­est and el­derly went to hos­pi­tals. The young and asymp­tomatic went to dor­mi­to­ries, which were lent by Sam­sung Life In­sur­ance Co., LG Dis­play Co. and oth­ers, equipped with lit­tle more than beds, Wi-Fi and the oc­ca­sional tele­vi­sion.”
It’s also a truism that masks are effective and cheap. Somehow we don’t have them. If it’s a truism that hospitals are a source of infection then it’s just too stupid to cram people there.

The Germans have not been sending most people who have covid-19 to hospitals. Why would they?

We may not be talking about the same thing in the end. Germany placed an extremely high value on quarantining and testing from the start, so as to avoid people using hospitals without needing to.

If you are young and married, and want to start a family, you will likely not want to conceive a child during a pandemic crisis. If you are pregnant, you and your husband will be worrying about you and your child and your early trip to the hospital to deliver a premature baby if you get infected.

If you are a single young mother with children, you will think of their life without you.

When you protect the herd, you protect yourself.

Alex, thank you for looking into the scenario of dealing with the coronavirus threat holistically. We should be treating both the health of the people and the health of the economy together, as they are tightly linked and we should be optimizing for minimum total misery, and not bias toward one or the other. Right now we are strongly biased toward the health issue while wreaking havoc on the economic well being of a nation.

As the UK has just announced, we can and should be focusing on quarantining the truly at risk (over 70 and those with one of a dozen serious conditions). Much higher testing rates are needed to find those of all ages who have the virus and need to be quarantined. Those outside the high-risk group have a role in minimizing what I'd call "net misery" by keeping businesses functioning and supporting those who are quarantined.

I fear we are optimizing only for minimum deaths, and frankly with little data to know with conviction that our choices are optimal. This is noble and the natural human response, but focusing myopically on just saving lives at any cost while the "cure" kills the economic livelihood of 330M people seems grossly irresponsible.

For all the irrational doomers,
Costco will not
Take back
Water, rice or
Toilet paper.

Costco is smarter than you are.

Ca-Ching.

I am waiting for a run on hand lotion
For all those people
Washing their hands
With anti-bacterial soap.

Worse than the lotion shortage, what if all the antibacterial hand washing just makes antibiotic resistance worse? Yikes.

What you describe are not "internal contradictions" which would be logical inconsistencies (i.e. there is no circular reasoning etc.). It would be more accurate to say their argument is weak based on your analysis, and the spread of the virus. But, as some other comments have pointed out statistics are changing and not very accurate yet with Coronavirus. However, to deride an argument by saying that the people that argue this are only rich and have healthy grandparents is to attack the people rather than the argument, which is a logical fallacy (i.e. ad hominem).

Edit: it appears Alex has removed his comments about the only people using this argument are rich and have healthy grandparents...

I never made that argument or used those words or removed any comments.

My bad, you're correct, that was a comment from the tweet where I found this. You can find it here, https://twitter.com/asymmetricinfo/status/1241705233815830528
Although what I said about internal inconsistencies is correct.

oops, *internal contradictions

How is it conservative to assume that 20-40% would get it?

"And let’s suppose the death rate is on the low end because healthy, young people get it rather than the elderly, say half of one percent, .005, then we have 330,000 deaths of healthy, young people."

Are all of you at GMU dumb ? We have about 13,000 deaths worldwide over the past two months from this. We're going to end up with almost 25 times the number of world cases in the U.S. if we go back to work like the Koreans? Do you, Tyler, Russ, etc., have any sense of the data. This is madness.

Singapore is open for business again. All of the restaurants and bars and what not are open again and everyone is back at work. We should do whatever Singapore did rather than shutting down our economy and destroying everyone's' livelihood.

Well, apart from Singapore closing its borders completely to any and all transit. "A day after Singapore confirmed its first two coronavirus-related deaths, the country said it would close its borders to short-term visitors and some foreign labourers from 11:59pm (15:59 GMT) on Monday to help the limit the spread of the disease.

The new rules mean short-term visitors will no longer be allowed to enter or transit through Singapore, while semi-skilled workers on "work passes" will not be allowed to return to the island unless their job is in sectors that provide essential services such as healthcare and transport, the Ministry of Health (MOH) said in a statement."

Further, Singapore seems fully aware this will come with a certain cost - "Singapore’s development minister, Lawrence Wong, told reporters Sunday that officials deliberated over the measure and its economic impact on the city, which serves as a base for Asia operations for many multinational corporations.

“These are very significant moves, especially for a small open economy like Singapore that has always been connected to the world,” Wong was quoted by Channel News Asia as saying. “This is an unprecedented crisis, so we have deliberated over this carefully.”

Singapore is not open for international business, and they decided it was for the best anyways.

Singapore's decision was pragmatic and based on the fact that the vast majority of recent new covid-19 cases in the country could be traced to international travel. Before it placed the ban on visitors, it was telling them they had to self-quarantine for 14 days immediately upon arrival. This being Singapore, they meant what they said and found it was consuming resources to monitor people in self-quarantine.

This is positive news, as is China's news that most of their new cases are now imported. Sensible, non-draconian public health measures combined with travel restrictions that may have to be in place for a few months is something most people would gladly accept at this point.

If this was a REAL plague, like the human transmission bird flu in the John Ringo novel (The Last Canturion), we wouldn't be having discussions about the need for nation-wide shutdown and the like. Everyone would be hunkering down and the economy would fly apart like a disintegrating turbine on its own independent of the actions of politicians. Our current reality is not like this at all. This alone should make you think about the nature of whats going on.

Lots of reports today that there are a lot of asymptomatic stealth infections ( no symptoms ever ).

in the range of 30 to 50% . This is generally thought of as bad because it spreads the infection but it’s a good thing I think.
It means many people have natural immunity

Welcome to four days ago... ;0

In Italy the disease was spreading from crowded emergency rooms. Any clue?

Let us apply abstract tree. medical services are a value added chain, and the delivery channel must be a round tree trunk, optimally congested. The end of distribution has a bandwidth determined by home triage, the ability of the household to partially treat, and eliminate or schedule the proper medical visit. Home triage should be the first of a compound structured queue in this value added chain. It got eliminated with medicare for all which in Italy means go to the clinic and catch the virus.
Under no circumstance, short of acute stress should anyone go to a crowded clinic at this time.

If you are flu like, go home, read Web MD on flu treatment and be prepared for an emergency trip only when acute stress arrives.

So, the theory of value added chain can save lives here. Over congestion spreads the disease, we now got math for that, one Nobel Banana to the mathematicians of the world.

but couldn't we combine such a measure with more widespread testing, better hygiene, excess hospital capacity, normalizing mask wearing in crowds, more careful about staying home when sick (and perhaps better sick pay for workers), some use of existing anti-virals, and hope warmer weather curbs the spread. it would be the combination that could work and not destroy the economy.

Ok but we are talking about a 2 Trillion Dollar bailout, right? There is an entirely reasonable argument that, say, we should act normally economically and socially except throw two trillion at emergency quarantine old folks homes and hospitals/treatment/financial aid for the younger infected. I mean, seriously, why is that any crazier than what we are doing now?

Bad math. Its 20% of the < say 55 population. Also, a CFR of 0.005 for this population is absurdly high. Separately, there's no reason why the vulnerable can't be safely protected even if the rest of the population has the virus.

Yes and No. Roughly 1/3 of Americans are over 55 yrs old, so let's say the population base for "young" people is 222 million. 20% of that is 44 million.

CFR of 0.005 is indeed high, most numbers I've read indicate its more along the 0.001 to 0.003 range, so we will say it's 0.002. Which gives us ~88,000 death of young/healthy people.

This number might look small but I suspect it's still going to overwhelm the system because the total number of people requiring ICU will likely be 2x or 3x+ of this 88,000. So my conclusion is still in line with AT's, even though the numbers are different.

That's assuming every young person gets the disease with those percentages, which no one is claiming.

No, it's not assuming that at all.

We need to know the true hospitalization rate of infected to make that calculation. Italy seems to think it's about 50%, and China about 15%, which vary *wildly*, but both have dubious testing coverage of how much of the population they really hit.

Iceland has large population samples and hits about 1.5-1.7% hospitalization in discovered Covid19 - https://cleantechnica.com/2020/03/21/iceland-is-doing-science-50-of-people-with-covid-19-not-showing-symptoms-50-have-very-moderate-cold-symptoms/. Sampled about 1% of their population. (10,405 per million is essentially 1%).

Government of Iceland: “A total of 409 cases have been identified in Iceland since the first case on February 28th. One person with COVID-19 has died. Six individuals with COVID-19 are hospitalized, one in intensive care.” (1.46% is you count the six, 1.7% if you count the seventh who was an imported Australian case who essentially died before they recognized him).

And this is whole population, not the young alone. The young would probably have a lower hospitalization ratio than that.

Let's see if this proves to be a meaningful estimate.

Btw, South Korea has about the second most comprehensive test coverage after Iceland (a mere factor of two less), so I would welcome any link to their hospitalization rates, which seem not as easy for me to find as for Iceland.

South Korean hospitalization rate - https://www.worldometers.info/coronavirus/ - "critical is hospitalized" - critical cases = 59, Active cases = 5,884.

So again, just like Iceland, whole population hospitalization is about 1% of cases.

Let's say hospitalization for cases among people <50 is about 0.5% of that, which is a high estimate given the slope of severity we know about (I'd guess about 0.3% is more likely). Then let's say 2/3 of that needs ICU (again a high estimate). About 0.3% of <50 cases? 132,000. Maybe about half of your 264,000ish ("2x or 3x+ of this 88,000").

Spread that over a year, and across the entire United States and seems like maybe you need 10 more ICU per million or something like that? Seems totally doable if you can avoid spikes.

Agree, key is to avoid spikes and spread that over a period of time. How can we do that with certainty if we only segregate the elderly and let the < 50 crowd do as they please?

You don't allow them to do as they please but you also allow them to work and make occasional social contacts, encouraging them to keep distancing. Test people a bunch. Keep R0 as you low as you can keep it.

Half of one percent is not a conservative estimate of deaths among young people, it's almost certainly absurdly high. The overall US death rate is currently at about 1%, including old people.

The CDC report that the Post and other outlets were using to hype the idea that young people were still in danger from this thing showed a case fatality rate of .1 to .2 percent.

And obviously we're been vastly under counting the non-symptomatic and mild cases and there are arguments that the real death rate among young people will be something like a hundredth or a thousandth of a percent.

The same CDC report also showed that only 2 to 4% of young people even needed an ICU admission. Again, this is an overestimate since we're under counting the mild cases. And young people is in quotes

But yes, isolating old people won't work because young people care for them and bring them things. The better option is to get an experimental vaccine working and give that to old people and let young people wait out the full testing cycle.

Accidentally submitted in the middle of editing but I had some cranky complaint in the 4th paragraph about how 44 year olds shouldn't be counted as young people.

More useful data:
https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says?fbclid=IwAR1RBw1EuSIlsGRYDtctZ3vSYDnBjbB_UCuOuxo1eOCQldYTGvkVp3kd12A

The Rome-based institute has examined medical records of about 18% of the country’s coronavirus fatalities, finding that just three victims, or 0.8% of the total, had no previous pathology. Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions.

More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.

The median age of the infected is 63 but most of those who die are older
The average age of those who’ve died from the virus in Italy is 79.5. As of March 17, 17 people under 50 had died from the disease. All of Italy’s victims under 40 have been males with serious existing medical conditions.

People talk this ("Almost all the death were in people with other diseases") if it means that only a very few people could die, and probably people already in the deathbed.

But hypertension and diabetes are very common conditions (I bet that more that 1/3 of the population has one of them), and, in normal situations and if you take the correct medication, rarely life-threatening.

Fair point. Although apparently 50% of the dead had all three of those. Or three of a longer list including cancer, liver disease, and renal failure.
Here' the actual report, in Italian: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf

Hypertension was the most common comobidity among the age group, but that's probably reflective of it being very common in the overall population. It's not necessarily indicative of it being the most correlated with dying due to COVID-19.

Here is a choice issue that relates to the elderly.

Say a 75 year old elects to take elective surgery with the same risk profile as getting covid and dying.

Should he or she be allowed to get the elective surgery if it places stress on the hospital.

This seems to ignore the fact that the vast majority of the young who pass have pre-existing conditions. If they segregated to it seems that the fatality rate would be much less than 0.5% of the young. Also, the effect of herd immunity on the infection rate.

This seems to ignore the fact that these pre-existing conditions, like hypertension and diabetes, are relatively common conditions - if you isolate all people > 60 y.o., plus all people with hypertension and diabetes, perhaps you will end up with a little more than the millenials.

Glad to see a rising tide of "wait! hold the phone!" op-ed posts on the group-think that blanket quarantines are going to do massive damage.

https://www.nytimes.com/2020/03/22/opinion/coronavirus-economy.html

https://www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.html

One of the most dangerous aspect of the boomers sheltering in place is the mental health affects of the amount of MSNBC and CNN they are consuming now.

This is another flu.. Nothing more.. The elderly and those with existing health concerns are at greatest risk for death.. As they always are during flu season.. The healthy are not dying..

The 2017-2018 Flu season caused over 600,000 deaths worldwide and 80,000 deaths in the US.. Where was the panic then? To date 247 Americans have died.. All with pre-existing health conditions..

If groups of people all claim to see something, but it doesn't exist or didn't happen, they call it mass hallucination.. What do you call a situation where many people believe they're going to die of an influenza strain that is no more lethal than any of the others in existence?

What do you call the dangerous delusion that all the experts can be ignored because only you are bold enough to have an independent opinion and therefore form the correct one?

It's not clear to me that, once you have the true total cases or well estimated known, it is much more lethal than flu (as in the orders of magnitude that are going about) or even has any more long term health damage.

But even if it is not, it's a novel virus that we have no existing defense for, unlike flu.

There's a reason death rates are up among the old across Italy, even the virus is an order of magnitude closer to going sigmoid and stopping growing, and even if these fatalities are a far smaller proportion of the true cases than many think they are.

Compared to 20% unemployment, you have a lot of workers available to protect the elderly. How many of them are infectious at a given time?

I though economists were supposed to be good at math and stats. This is embarrassingly bad for a professional. Numbers for those under 50 are all less than .5% and, for some groups, as low as a 0% risk and typically about .1% risk. You need to lower your estimates by a factor of 5 to 10.

David Katz has impressive plan to segregate the elderly and get economy moving again. https://www-nytimes-com.cdn.ampproject.org/c/s/www.nytimes.com/2020/03/20/opinion/coronavirus-pandemic-social-distancing.amp.html

He also has a comprehensive and sensible plan. https://www.linkedin.com/pulse/proposed-framework-risk-based-interdiction-david

There are other risk groups, like the obese and morbidly obese, who may be at as much risk as the "elderly". Many non obese people in their 70s who never smoked might do better than an obese or morbidly obese person at any age.

Should we separate the morbidly obese, too? (Personally, I'd love to!)

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