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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
I think it is Northern Italy that is having the problem. Southern Italy is not; same country. That will happen here where the dense areas will see more cases, and I think is.
We have the most ventilators per capita in the world, our geographical area is as large as China, and other variables to take into consideration.
me too.
It warms my heart that the Governor is ensuring no abortions will ever again happen in the State of New York. Because its all about lives saved, after all.
Stad: I would have thought this virus would have wiped out the homeless in California by now.
In LA county, a county of roughly 15 million people, it is estimated that there are 59,000 homeless – the most by far in the state. As of this morning there were 292 confirmed Coronavirus cases with 2 deaths in LA County, which I believe puts the county, as I have been saying, on the very low end of infected per thousand in the country. ( 0.00194 percent of the population). So it is fairly safe to assume that the Homeless population here for whatever reason has not been infected too much yet, not to say that they couldn’t be. To put the numbers in perspective, there are likely at least 292 homeless under several freeway underpasses not far from where I live.
I think we need to refine the calculus at work.
If only 20% of those exposed get the bug (using the Diamond Princess population which was 83% virus-free despite close contact, infected food handlers, shared spaces and narrow hallways, and a belated diagnosis) and only 5% of those who get the bug require hospitalization (based on known stats and ignoring very tough issue of ICU use/availability but almost certainly too high) and if the whole USA has been exposed, then that would be a number almost three times higher than the number of existing beds. That is the worst case.
If it is possible to delay the spread with less costly precautions, to reduce the need for extensive care in many instances through availability of effective treatments, better weather and less mobility by the most vulnerable then the likely hospitalization curve flattens and we can project more manageable territory.
If we further suppose that the number of infections is already ten times higher than the official count due to limited testing and the fact that symptom-free individuals don’t present for treatment, then we are already approaching manageable projections and can reopen society rather soon with some prudent personal practices in place.
I agree with you. The slopes in the curves are similar. The slopes in the early part of the spread are eerily similar for all countries. I think it comes down to preventing the spread and having enough capacity to isolate those who come down with it. I was a critic, but I think the government is doing the right thing.
More info on California Homeless and Covid-19
San Francisco County has had 76 cases and is estimated to have 8,000 homeless. San Francisco is similar to NYC where it has a dense population where few have cars and so then people need to use public transportation and the place is almost always cold. A bad Covid-19 profile. Add to that a lot of Chinese and Homeless. So despite having a infestation profile not dissimilar to NYC, it has only had 76 cases. ( it is also in population about 1/20th of LA County so it has five time the rate of infection and 2 1/2 times the rate of homeless of LA .)
Santa Clara County ( Silicon Valley) has the largest number of cases in the Bay Area at 189. It has few homeless and is not dense or as cold as SF. There was a report though weeks ago that an infected Chinese had been wandering around Palo Alto for days infecting people before being treated.
Dr Bastiat:
The great Thomas Sowell observed, “There are no solutions, there are only trade-offs.”
Great quote and a great post.
The risk I keep being reminded of is Trump and Pence constantly standing next to each other at these news conferences. If both of them go down for the count, you-know-who becomes President. As if there’s not enough else to worry about.
I’ve been thinking that the homeless population actually wrote the book on social distancing. So this actually does not surprise me. It’s a bit on the sad side since it tells us a lot about how completely the social part of their life has disintegrated. But the homeless may not turn out to be the cauldron of infection it would seem to be.
If I were to join the language police to banish words and phrases, “If it saves just one life it will be worth it” would be near the top of my list. That type of thinking leads to some irrational decisions.
I suspect some hard (and maybe fortunate, for them) truth in there.
I think this is a very good point. It’s easy to stay in the house when the weather’s really cold or extremely wet – or both. It’s different when the weather’s beckoning you outside.
Not mine, but I don’t think the owner will mind.
Also, it assumes everyone is contained in cruise ship like conditions. And kind of old.
Flattening the curve is also becoming grating. Maybe it is just me.
We can back off soon and just figure a way to protect those who are vulnerable. If this got the attention of the young people and causes them to think beyond what they have been spoon-fed, we will have gotten some benefit.
Can I use it just once before the ban goes into effect? “If dropping a nuke on Albany NY will save just one life, it will be worth it.”
It may be that which drove Gov. Newsom to order everyone else to shelter in place. That is, Californians with apartments and homes are to be forcefully separated for two or more weeks from the large homeless populations. Or am I being far too dark here?
In the Navy, we used to say, “Don’t just do something, stand there!” Politicians are the worst when it comes to responding to a crisis, real or perceived . . .
Add the word “child’s” before “life” and there’s no argument against it unless you’re a monster . . .
They’re similar for a reason. They started looking for the virus, and found that it was more widespread than initially assumed.
That doesn’t, however, mean that the extrapolation is accurate – it’s just the timeframe in which the cases were identified. Meaning the virus itself doesn’t proliferate at the rate by which we identify the cases, but that’s the conclusion drawn in the most hyperbolic comments.
They’re two different things. And they vary, greatly, by demographics, countries, living situations, etc.
Which brings me back to the idea that the impact is hugely overblown, we don’t react like this when death tolls are much higher for annual flu seasons, and we don’t stop driving cars with tens of thousands of deaths, annually, nor change the speed limit to 5 MPH to “save just one life”.
IIRC, the automobile death toll decreased when the speed limits were raised back up from 55. The theory was that people who were speeding were now watching other cars on the road instead of scanning for cops to avoid tickets. Made sense to me . . .
I would be more inclined to credit the reduction in delta-V. That is, the difference in speed between slowest and fastest drivers. That is the most significant predictor of accident rates on highways, from what I understand.
I also heard some talk about drivers doing 55 being bored and not paying attention.
What does that say about the convention to class driving 15 mph over the speed limit as ‘reckless driving’ or ‘not giving your driving proper attention’ or whatever else TPTB can dream up with the insurance companies?
Yeah, it’s not so much that speed kills, it’s differential speed that kills.
Another good point.
This made me think of an incident here in Buffalo. There’s an expressway (Rt. 33) that cuts through a park. A lot of people never liked this.
A couple years back there was a tragic accident where a driver fell asleep, went off the road, and killed a child in the park. So instead of just putting in better guardrails, they dropped the speed limit on the expressway to 30 mph, even areas that are elevated and where there are no pedestrians. And speed had nothing to do with the original accident anyway.
So sometimes people do get carried away with “one life” and overreact.
Pulmonary emboli. Now that’s getting personal.
Hospitals are freaking complex and delicate enterprises and there are a lot of ways things that can go wrong. My mother nearly died 20 years ago when she was discharged from the hospital with pulmonary emboli after colon cancer surgery and a rough postop period.
She had fallen through the cracks in several ways:
In her postop care, I think she had the same nurse the next day only one or two times in a week and a half in the hospital. Most of the nurses were travelers, spending a few weeks to months at different hospitals in the big corporation. I was the only continuity, and was also overseeing the plumbers at her house who were fixing the broken sewer lateral in the pouring rain. Plumbers with a tweeker for a foreman, but I didn’t find that out until later.
And since her excellent PCP was out of the loop and her care was in the hands of teams of intensivists and then hospitalists, there were several handoffs at which the ball could be and was dropped.
When my mother finally was ambulatory, she reported shortness of breath but nobody put two and two together. And she was getting more short of breath, she made it home, took a shower (barely able to stand.) The new doc at her group was checking up on the hospital discharges on Christmas Eve, and caught her breathing problems and weakness over the phone. Off to the ER, and then the ICU.
My grandfather, A”H “owned” and rounded on all his hospitalized patients and was in essence their ombudsman. (On the other hand, he didn’t have enoxaparin, spiral CT and ventilators, and the tendency was not to ambulate postop patients as soon as possible. So there’s that. But he would have known there was something wrong.)
This little excursion was to point out that many internal and external circumstances (suboptimal staffing for any reason and poor communication are only two, a public health crisis is another) can really hurt people.
That’s what he said. This is what he was thinking: