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Avoiding Risk Is Risky
The great Thomas Sowell observed, “There are no solutions, there are only trade-offs.” Thus, when I hear someone say, “You just can’t be too careful.” I generally respond, “Oh yes you can…” For example, here in Hilton Head, when they evacuate for a possible hurricane, that involves evacuating our local hospital as well. And I point out that you simply cannot take a hospital full of very sick people, transport them all hundreds of miles over crowded interstates, move them into another hospital which is suddenly overcrowded and understaffed, then transport all those very sick people right back to where they started from, without killing at least some people. Not to mention traffic accidents on packed highways, COPD patients trying to get their home O2 to work in hotel rooms, people who evacuate and forget their heart meds, and so on. Hard to say who, or how many, but when you evacuate, you know you’re killing some people.
The idea, of course, is that you’re saving the lives of other people. Hopefully, a lot more people are saved than killed, of course. But the number of people saved is uncertain – it depends on if a catastrophic hurricane actually hits or not. So you never know. But you do know that you’re killing at least some people. That’s a given, and it must be considered in making decisions like this. So the risk-reward calculation has a built-in risk, but only a possible reward. And I’m starting to suspect that, as a society, we are having more and more trouble considering such risk-reward decisions.
As we become more wealthy, we predictably become more concerned with security. Those who are well-off naturally become more risk-averse. They fear any disturbance in the status quo. This is not a criticism. It’s only natural.
But now, rather than thinking, “I think this small risk is worth the large benefit,” we now say, “You just can’t be too careful.” And before you know it, we respond to a respiratory virus by buying toilet paper.
I’m not criticizing our government’s response to the Coronavirus. These are difficult decisions, with lots of unknowns. Hard to know what to proper course of action is. I don’t envy those who are making these decisions.
But I think they may be trying so hard to avoid risk, and taking such draconian steps to mitigate possible future events, that they are causing enormous damage now. By essentially quarantining the entire country, the damage they are causing is real, obvious, enormous, and unavoidable.
This quarantine is undoubtedly killing people. For example, I have an 82-year-old diabetic patient who had some burning with urination last week, but didn’t call in because she was afraid to come to my office. Her urinary tract infection went untreated, got worse, and now she is in the ICU with urosepsis. A couple of days ago, I was pretty sure she was going to die. Then she got a little better. But this morning she had a pulmonary embolus (not an unusual complication in a hospital). And now she’s in renal failure. So she’s in dire straits again. Will she survive? I’m not sure. But this could have been treated with $5 worth of antibiotics last week.
If she dies, it will be the Coronavirus that killed her. Or rather, it will be our response to the Coronavirus that killed her. As Thomas Sowell might say, our effort to avoid risk was not without risk.
But her death won’t show up in the Coronavirus statistics. Because she died of urosepsis.
My Uncle Fred might describe this as the seen vs. the unseen.
She could have called in for a prescription, but she didn’t. She could have made it out of the hospital without a pulmonary embolus or renal failure, but that’s not how it worked out.
Again, though, none of this would have happened without the terrifying news coverage and the widespread closures of just about everything. She acted appropriately, she thought, under the circumstances. But her actions may prove fatal.
And that’s just one lady in South Carolina. This sort of thing is undoubtedly happening all over the country. People are losing their livelihoods and losing their lives.
Which may be acceptable, of course, if there is an upside to our response to this virus.
But there had better be an upside. And the worse things get, one can’t help but think that there had better be an absolutely enormous upside.
And there may be.
But we’re talking about a virus which has been spreading across the world for the past four months and has killed around 11,000 people so far. On a planet of 7.5 billion people, there have been 11,000 deaths. Mostly in countries whose response was much less robust than ours. Remember, we have around 35,000 deaths a year from influenza in the United States. And Coronavirus has killed less than a third of that so far, on the entire planet.
So far, we’ve had 235 deaths from the Coronavirus in the United States. How many more deaths would we have had if our response had been less robust? Probably some. It’s impossible to say, of course. And perhaps the benefit over the next month or two could be even greater. Perhaps. I’m not sure.
But how many people have we killed in the meantime, to get that possible benefit? I’m not sure. But probably a lot more than you might expect. And they won’t show up on the lists of deaths from Coronavirus, because they died of urosepsis or something. But they are definitely dead. And the possible benefit is, well, it’s possible. We’ll see.
Not to mention the human costs. Missing weddings and funerals, missing basketball tournaments, missing college graduations, plus all the bankruptcies and other agonies being suffered by those whose finances are being gradually or rapidly destroyed. All that counts. Or at least, it should.
Remember that this is a virus with several treatments that seem to be working well. Tuberculosis drugs, malaria drugs, immunosuppressive drugs, and even Z-packs seem to work to one degree or another. We have several vaccines in development that seem to work well.
Again, there may be a large potential reward for our response to this virus. But in our desperate attempts to avoid risk, we have done real damage which is so huge it’s essentially impossible to calculate. So now, the worse the damage gets, day by day, it would seem that the benefit had better be absolutely enormous.
And from what we’ve seen so far, um, I don’t know…
Published in General
Thanks for putting into words much of what many of us have been thinking, but didn’t have the knowledge or experiences to adequately express it.
And their minds.
Thank you for this thoughtful, knowledgeable and insightful discussion. We here fear that the benign (more or less) impetus for all this breathless action (to what actual avail?) is some underlying sense that no one should become uncomfortable or ill or inconvenienced at all anymore. The less benign view is that a non-crisis is being inflated to a CRISIS which is being driven helter skelter toward chaos all summer and with the sole aim of defeating the President for re-election in November. His upbeat and exciting rallies have been stopped, his economy has been kneecapped and extremely radical propositions are being considered for social and political changes long sought by leftists.
No one can accuse the left of not being nimble. I don’t think they connived with China to let loose one of their spare germ sets but I sure do think they saw a crisis and know how to make mischief with it. the more the radicals agree with the President’s proposals the farther left they go. Telling Americans they can’t leave their homes? That they can’t go to their places of work? That businesses can’t manage their employees? That families can’t asses their own health affairs?
We have been talking about this a lot. We are not happy. And we don’t even see the more remote ripples of people living their fears to ill effect as you do. We just have otherwise healthy adults questioning whether it’s “safe” to come into an otherwise mostly empty office – by themselves – once a week while “working from home.” While otherwise intelligent adults may disagree bit many things, none of this makes sense to me.
Great post.
If these extreme measures persist, you can multiply all of those costs that you mention by 100, at least.
It won’t take very long before people won’t stand for it.
I hope you’re right.
This is a most welcome post. Thank you.
So true. I wish some politician would have the guts to say this, but I think it’s a step beyond even what politically-incorrect Trump would say.
It’s the problem of what’s easier to count – deaths by the virus are easy to count, but the collateral damage of all the quarantines is not.
And now even Fox News has a %$5#$%7$# counter on their screen.
I am reminded of the time the wife of one my grad school friends defended her dissertation in the Econ Department. I ran into my friend and asked how his wife’s defense went, thinking that it should have been no problem. He said her chairman stopped the defense after the first question, and re-scheduled it for the next week. I thought that must have been some kind of question, and maybe it was. She was a good Scandinavian social democrat, and thought herself well above the American politics of the day. The first gulf war had ended, but the US was enforcing no-fly zones in Iraq, and occasionally bombing airfields and military bases to enforce the policy. The offending question was “When should the US stop bombing Iraq?” I looked at my friend, and said “When the marginal cost of dropping the last bomb equals the marginal benefit from dropping that bomb,” like it was obvious. My friend nodded, and said that unfortunately she freaked out, and couldn’t come up with any answer, all of the options being well beyond distasteful, at least for a polite academic discussion. He tried to argue that the question was unfair and it should not have been asked in that way because the answer involved someone dying.
My staff (at least those few of us that are still allowed in the office) and I have been thinking about this all week. I’ve concluded that the approach taken at all levels is a political decision, not an economic one. It’s political because the chief executives–from the President, 50 Governors, and a multitude of mayors–weighed the political backlash of being accused of “allowing” a single death as greater than the sum of the costs of lives disrupted, lost income, lost businesses, and lost educational opportunities, etc. I don’t really fault the decisions made so far. They may turn out to be the correct decision when all the facts are known. But I am sure that whatever marginal cost/marginal benefit calculation was weighted very heavily in favor of minimizing deaths to the virus, rather than on the well being of the rest of society.
Despite what anyone says, society puts a dollar value on human life every day, we do it obviously in wrongful death settlements and insurance payouts, and less obviously in setting speed limits and clean water and air standards. Weighing out the costs and benefits is hard, especially when some costs are unseen like the patients who don’t get care, or the students who don’t get educated. But we will start to see the costs soon enough, when unemployment claims pour in and businesses close for good. These costs are too large to dismiss without a debate. It would be nice to have a civil debate without one side immediately defaulting to accusing the other of “killing grandma.”
This problem arises in lots of areas. One is safety of commercial air travel. If one looks only at deaths in commercial airliner crashes, almost any safety improvement is worth the cost, no matter how high. The deaths on the airliner are seen. But, if the safety improvement increases costs so that families choose to drive cars instead of flying, a certain number of those families will be involved in road crashes that result in death. But those deaths are unseen in airline safety statistics.
Things look dark at this moment, but I believe in two or three weeks, we’ll be seeing a break in the clouds, and there will be preventive strategies that actually work and treatments that can be completed at home, and I think the business world will get back to normal. In fact, there will be a great joy in the world in celebrating the lives we saved, and that will stimulate more business. :-)
I’ve said in hundreds of discussions over the years that our inordinate fear of death is going to destroy us. I’ve seen nothing in this current crisis to make me change my views.
I think federal guidelines should change very soon, certainly by the end of March. But look where the guidelines are being implemented and mandated by Governors. The lockdown will have it biggest negative economic effects on the three largest Democrat dominated states. I’m trying to figure out what effect 2020 election politics will have on these lockdown actions.
A few hours after I posted the above essay, John Hinderaker at Powerline posted an article with a similar perspective, which began as follows:
Great…. in several years of coaching I (and many others I know) lost more games “playing not to lose” when we should have been playing to win – being too careful which always means abandoning to some extent who you are, what you are about and what you believe in
Fine job
If I can tear myself away from playing Fallout 4 long enough, I’ll make a post about Probabilistic Risk Assessments.
Update:
No need to. The Wiki entry is reasonably good (I always double-check Wiki when looking up info):
https://en.wikipedia.org/wiki/Probabilistic_risk_assessment
One of my first tasks at DOE was to be the technical person assigned to the K-Reactor EIS. I was also assigned to the PRA for K-Reactor because of my background (BS in Physics, MS in Nuclear Engineering, Navy Nuke officer). The lead engineer for the PRA was also an NC State grad, so we got along great. In both areas (EIS and PRA), I started off knowing little to nothing about them, but ended up being knowledgeable on both subjects.
The PRA was particularly interesting because it showed me how a systematic, mathematical approach could be used to make a design (new or existing) safer. A PRA can also be used to show the cost/benefit of a suggested modification, something anti-nukes like to do. For example, let’s say you have triple redundancy nbuilt into your emergency cooling system. The antis will demand a fourth subsystem be added. If you can show adding another subsystem will cost $100M but only reduce risk from 5 x 10-7 to 2.5 x 10-7, then their suggestion looses credibility, which will help you if they take you to court.
A PRA can also reveal vulnerabilities in your design. Fukushima was a disaster on many levels, most notably a failure to recognize a common mode failure involving two beyond-design-basis events – an earthquake followed by a tsunami. There were other design flaws a PRA would likely have uncovered.
I think I’ll shut up now. I can hear snoring . . .
Yes I agree with your risk/benefit analysis but we have the sight of seeing what happened in Italy. The risk in the case of contagious viruses has to be looked at in exponential extrapolation. It’s not linear. One person you prevent from getting the virus could be ten people who did not catch it from him. Is what we’re doing over board? I don’t know. But for a few weeks I can see doing this. I can’t see it doing it for months.
Is what we’re doing even working? Too soon to tell?
I look at the numbers and seem to be going up in the USA just as fast as all the other countries. The curve hasn’t flattened yet.
Italy suffered because of their close ties to China via Chinese workers traveling to and from the mother country. Throw in the fact you have an older population on average, and it’s no wonder there’s an opera shortage as well . . .
I’ll argue that our fatalities will bear similar attributes as Italy’s, despite a vastly superior medical system – they will be found in defined populations. However, instead of a high proportion of deaths among the elderly, we will have a high proportion of deaths among the homeless drug abusers, other drug abusers, the heavy smokers, the obese, the diabetic, those with autoimmune diseases (genetic or life style) and the illegal with poor medical conditions upon moving into the country. I’ll further argue that none of those attributes will be identified and analyzed and made public.
I’ve been wondering about this from a virus containment point of view. I remember the skin tests we and then my kids used to have to detect the presence of TB. It looked like the allergy tests in some ways. It was a four-pronged something that nurses put against the skin and circled with a pen so they could see how the spot reacted four days later.
And the comparison of the immune system response to Covid-19 to an allergy–in some people the body overreacts to the stimulus of the virus and overproduces mucus, which settles in the lower lungs, from what I’ve read–it strikes me that some version of the TB test might help us identify an immune group of people. (I’m unclear as to whether it should show people who were naturally immune or who had the needed antibodies due to a mild exposure.) Finding out who is immune is as important a part of the equation as finding out who is sick.
I have hopes that the meds that are proving to work will turn the tide – both medically and emotionally. And make no mistake, many of the current shut-down policies are as much about emotions as facts.
This is the massive collateral damage I predict from this war on Covid-19. The people we are trying to protect with these makeshift quarantine measures are at risk from the very steps being taken to protect them. I don’t blame anyone for this problem. It couldn’t be avoided. The fire is raging, and everyone is doing what he or she thinks is best. But it is unfortunate.
I hope local clinics and hospitals throughout the country are stepping up their telemedicine efforts because elderly people aren’t going to head to the hospital or doctor’s office right now for any reason unless someone drags them there because they are unconscious. :-) Why would they go into the chaos and the likelihood of getting an infection? And frankly, most elderly people that I know don’t want to add to the hospital’s high case numbers.
I would have thought this virus would have wiped out the homeless in California by now. Makes me wonder if it’s not as contagious as advertised, and what we are seeing isn’t a rapid spread, but testing revealing an already existing population of people with the disease.
I’ve wondered about that, too. Is it the warmer temperature there?
Remember the homeless are transient- they could be anywhere by now. But I think it’s also notable and purposeful that there is no news about how that population is being managed while sheltering goes on in someplace. Lots of might do’s and could do’s but Newsom is just telling people what to do but there’s no media coverage of any homeless impact in any city. Austin had lost and lots of news about problem homeless, but the streets are now clear and who knows where they went? Probably somewhere with no restrictions. Kerrville isn’t far. But also take a look at the pictures of those in line in NYC seeking testing – seems a group of the usual suspects. I’m doubtful that these are people with symptoms and unable to manage. Yup, I’m deeply cynical.
They used to be transient, but now they appear to have selected major cities out west because the authorities can’t or won’t do anything to them.
How many times have we heard people defend bad reactionary political plans by saying, “Well, we had to do something!” Politicians are more likely to react to the news cycle than to anything else.
Yes, but those will be non-essential people dying so . . . I think governors are enjoying the power trip this virus is allowing them to go on (daily news conferences with new policies everyday). My mom talks about all the things she had to avoid as a kid because of polio, but they didn’t shut the country down.
I cannot imagine the shut downs being able to be enforced for as long as they are stated. 2 weeks is a long time to miss a paycheck. I know there is unemployment, but some small employers are not just laying off, but letting go because they are not sure they can survive to reopen themselves. A person I know lost both part time bartending jobs this past week. Not laid off, let go.
I don’t know the percent now, but the detroit news had Michigan at 550% increase in unemployment.
People have brought up the lack of similar reaction 11 years ago under Obama to H1N1, but the true test will be going forward, where society has accepted over the centuries that people are going to die from the flu. If the new metric — at least under this president — is going to be we have to do virtually everything possible to keep anyone from dying from the flu, that’s just not going to last as warmer weather arrives, unless a lot of people outside of the high-risk demographics start dying of the flu.
And that’s going to include demographics currently inclined to support the left, like millennials and GenZ-ers. How much do they want to give up their spring and summers to hold up inside their homes, if most of the COVID-19 cases are not severe — Tom Hanks has to die, not just have the blahs from the virus — in order to adhere to The Narrative is questionable.
I just don’t see how you get past mid-April, with more and more places starting to see 70 and 80 degree temperatures, and maintain the current shutdowns if we’re only talking about contamination from a virus that is virulent among limited segments of the population, but just an annoyance to the vast majority of the public. If that’s the new normal, worldwide economic shutdowns are going become semi-annual occurrences (unless the left goes back into 2009 “What Pandemic?” mode if Biden’s in the White House).