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Day 87: COVID-19 Return to the “Life We Aspire To”
The screengrab above is from the University of California San Francisco Department of Medicine “Grand Rounds” video of April 9 that @lockeon brought to my attention. This slide inspires the title of this post and the characterization of what it is that we most dearly want: to have a life like we had before the pandemic.
The debate rages on Ricochet on what price to pay in personal autonomy and public policy to contain and/or defeat the virus? Our members scan the data and come to various conclusions. Some feel the crisis is overblown as a means to enact controls on the people that progressives have been seeking for a long time, while others feel that the crisis is exactly as represented and personal liberties and the economy need to be sacrificed in the short term at least to preserve us all.
The truth is … elusive. Liberty is being sacrificed, but is it necessary for the common good? How long and in what ways must it continue to be sacrificed? It does not give one confidence to hear as New Jersey Governor Phil Murphy said to Tucker Carlson last night that the “bill of rights” was not part of his consideration in issuing his lockdown decrees. Maybe his statement was an inartful formulation of the balancing of interests he was doing. But it does not inspire confidence when a governor dismisses personal liberty so off-handedly.
The video linked above should be of interest to the Ricochet readers in a variety of ways as it gives us a look at one of our premier medical systems. It lends us the perspective from the inside. There is an expression that “when you are a hammer, everything is a nail.” UCSF is animated to defeat disease in all its forms. It is a research and teaching hospital/system. As you listen to the various presenters in the video, you come to realize that parts of UCSF have been in the game since early January. And much has changed in that time.
As you listen you will hear the biases that inform them: the primacy of the greater good, the comfort with the existing progressive political structure, the self-congratulation of enlightened Silicon Valley companies dispersing their workforces to home environments before the shelter-in-place orders were even considered by the politicians, the relative immunity from economic harm that is being suffered by “non-essential” workers and employers. That they have these biases does not make them wrong. It only makes them partially informed. Just as the biases that many of us may have that militate in the opposite direction: personal agency above community concerns, central planning and collective control inevitably leads to poverty and death, a perfect world is unattainable so risks must be accepted.
But I digress. The question is whether, when and how we get to the “life we aspire to?” When you look at the UCSF slide of April 9 and California Governor Newsom’s “re-opening” criteria of April 14, you see a lot of overlap:
1 Widespread testing that would allow the state to isolate people exposed to the virus and trace people with whom they have come in contact.
2 The ability for the state to care for older and medically vulnerable Californians, who are most at risk of suffering severe effects from the virus, as they continue to isolate at home.
3 The capacity for hospitals to handle a potential surge in patients, plus resume normal preventive and other medical care.
4 The identification of promising treatments.
5 The development of guidelines for businesses and schools to allow physical distancing even as they reopen.
6 The creation of a data-tracking system that provides an early warning if the state needs to reinstate a stay-at-home order.
Nowhere in the guidelines is there any consideration other than for the prevalence and risk of disease. This follows in the same pattern as policies for gun control: eliminating injury and death through limits on lawful access to guns, but no consideration of the value of citizen-owned guns as self-defense or a countervailing force to tyranny.
If this is the attitude of our leaders and influencers, there is no generally recognized return to the life we aspire to. There is only progression to the life our leaders aspire to for us.
[Note: Links to all my COVID-19 posts can be found here.]
Published in General
A major reason people like me have lost confidence in in the officials telling us we can’t live the lives we want is that the officials give the impression that they are looking at only one angle of the current situation – the viral disease angle – and that they have failed to consider any other issues, including other “medical” issues like treatment of other diseases and injuries, mental health, etc., let alone other issues like family wellbeing, personal fulfillment and life satisfaction, social cohesion, funding, and others. Statements like the one made by the governor of New Jersey, even if no more than an inartful formulation of his balancing of interests, is memorable to us because it fits with the impression we already have that he and other officials are not considering factors that are important to us.
As you note, infectious disease experts (hammer) see every matter that includes an infectious disease as primarily an infectious disease matter (nail). If government officials factor into their decisions only the views of the infectious disease experts, those government officials are missing a lot of factors that are important to us, the public that is supposed to be boss.
My point was not a recitation of libertarian preferences (you clobbered that straw man—whoever those lazy narcissists are I am sure they have been cowed by that thrashing) but that a single-minded focus on one set of risks and costs to the exclusion of all others is bad policy.
The reality is that given the fact that this bug features asymptomatic contagion with a very long lead time we simply cannot expect to wait it out with a porous shutdown. We have to work to minimize the risks while we have to assume them to continue to function as a society.
And the virus has not ‘grown more fearsome’ given that the specter of two million dead and all hospitals swamped proved to be wrong by magnitudes. The ugly reality is that probably tens of thousands more will die this year and that we have bought as much delay of the spread as we can afford without losing/destroying lives from other causes. We must be candid about the trade-offs we must choose.
This is at the nub of much of the discussion that I’ve read, here and elsewhere. I’ve seen generalized references to to the rate of suicides, drug use, etc, during economic downturns that I don’t necessarily doubt. But I remain uncomfortable with the assumption that we can accurately assess the trade-offs as the basis for nationwide policy.
The economic future, and its effect on the lives of those affected, is sufficiently uncertain that I’m not sure that it even deserves the label “speculative.” At least we have some broad-based idea of those whose lives are being compromised/ended by the virus in the present, and it’s not pretty. Additionally, there is no once-size fits all solution going forward (i.e., shutdowns v. economics). I agree that we do need to recognize that what’s going on in New York has little to do with what’s going on in Kansas. This is why, in a sense, the question of how to proceed is really 50 or more smaller decisions.
Sufficiently uncertain? As the unemployment rates continue to climb into the millions and the money Congress set aside for small businesses is not replenished (it ran out a day or two ago), how is the economic situation sufficiently uncertain to say that the lockdowns have started to cause economic suffering that’s only going to continue to worsen and grow if they continue for several more weeks – as many of the experts have called for. We have an example and therefore a broad-based idea of where things are currently headed on that front. It’s called the Great Depression; and from what I hear, it wasn’t very pretty.
That was well-stated.
A reasonable empirical argument could be made that economic crisis will increase suicides, drug overdoses, violent crime etc. But I think there is a more hard-nosed question about the dollars/per life saved cost of the policy. Blue Cross and Medicare do not cover every possible treatment in every instance for fiscal reasons. We do not mandate titanium alloy car frames and radar-equipped bumpers on every car even those that would save thousands of lives because we can’t afford it.
This economic hit (say, one trillion$ and counting) will likely save 10 or 20 thousand lives but not much more given the porousness of the shutdowns. And at a rate of $100,000,000 per life—can we afford it or should try to afford it we given that we do not spend anywhere near that rate to protect against any other equally lethal risks.
That is the real trade-off question and nobody wants to go there but we have to do so.
I don’t disagree with your comment. Perhaps I’m being overly contentious for wanting something more quantifiable in terms of the human consequences.
I don’t see it as a close enough call to warrant any need for me to see numbers in detail. Just my opinion. I’m staying home.
It’s hard to quantify human freedom and dignity, which is the alternative that I wish we were talking about. I am not very much in favor of making the issue to be this kind of deaths vs that kind of deaths.
Ah, but that’s the rub. The restrictions have been imposed with equally un-quantified speculation. (AKA models.) We know that economic hardship drives domestic violence, property crimes, suicides, and health problems due to declining dietary habits. I’m of the opinion that avoiding economic hardship must be the default, except in places where the impact unquestionably calls for continued restriction. I’d say that’s only NYC and its environs, at the moment.
At some point I would like to see some estimates of the percentages of essential versus non-essential functions and workers by location, maybe states and metropolitan areas. Population density might lose some favor (and promotion by centralized government) when facts are available and decentralization might gain more followers.
Most of the talk of re-opening vs not seems to ignore the people who for the last 45 days or so have been unable to work (mostly due to the shutdown of their workplaces and not having a job that is condusive to sitting at a computer) and will have used up their small amount of savings. I’m not sure they appreciate being told by people who have not suffered any economic cost that they will be forced to endure another month, two months, or year.
Not just declining dietary habits. For some, it’s due to a reduction in needed medications as well.
There seems to be this underlying assumption, when I see this topic discussed, that you can turn the economy on and off, like it’s some kind of machine. But that’s not the case.
I generally agree with the measured approach the president and his team laid out yesterday, and which most governors seem to be adopting. But we have to remember that the heart of the problem is the virus, not the stay-at-home orders. If the virus spreads unchecked, the economy will be wrecked anyway – regardless of what the government does. I think it is proper, therefore, for the various governments to focus on the virus and checking its spread.
There are two dangers: a) the virus, and b) control freaks.
I say re-open, I don’t need to see any numbers, people need a life. I guess I wasn’t clear on that. I’m still staying home.
There are two dangers: a) the virus, and b) control freaks.
One thing the latter are going to teach us is not to trust the public health officials, which is not going to be good for us.
Well said, but avoiding the economic hardships of crashing the health care system, especially in large cities, must be factored in.
At that point other political factors come into play.
We need hard data. Some is coming about how many people probably had SARS-CoV-2:
What this is: data that may help guide public policy that depends on knowing the infection fatality rate.
Dr. Bendavid is using a test he developed and which he hopes will be FDA approved, so he has a financial interest in promoting his work. NTTAWWT.
What this is not (or , perhaps, not yet:) Clinically useful.
The test does not so far have documented sensitivity or specificity, which means we don’t know how likely it is that the results for any individual’s test give a false positive or false negative. So right now, we cannot responsibly use this test to say “Yep, you’re immune (for now, anyway, because we don’t have that info either;) go and contage no more.”
This may be true, but it is not demonstrated. The public health emergency was not declared on economic grounds. It was declared with the belief that persons who are elderly or who had compromised immune systems were most at risk and the younger and healthier populations were substantially at less risk and…this is important…that the numbers of vulnerable persons becoming ill could overwhelm the health care system. And if the health care system was overwhelmed then death from all causes — trauma and disease would be incredible.
If this was purely an economic decision, then as soon as the health care system was assured of not breaking you would open up the economy. So we have made a choice to intentionally wreck the economy to save the largest amount of net lives from trauma and disease. That is the choice that was made, without considering whether a Depression would increase the net lives lost to flip the cost/benefit calculation. And that is because the public health establishment was focused on only one side of the equation and the Dems and media did their damnedest to make Trump and anyone else look bad who said you have to look at both sides of the equation.
Kimberly Strassel’s article in today’s WSJ is about moving the goalposts. If somebody with a subscription is willing to mail me a link via the mechanism the WSJ provides, I’ll be glad to provide my e-mail address.
I think this is called shameless begging.
PM me.
Flatten the curve so the hospital and medical system is not overwhelmed by virus cases. Wherever that has been done and can be sustained should try to get back to normal activity. There can still be guidelines for behaviors, individual and group. If laws are deemed necessary let state’s make them and defend them where required, if they can.
Here’s something to ponder. The re-opening is geared to restart an orderly productive society. I think it will be interesting to watch how the hard-hit metro areas do this. Watching inside the beltway should be fun too.
Federal employees were untouched. Federal contractors have taken some hits. Private businesses that cater to downtown offices have been hammered. DC will fare better than a lot of places because the core customer base is still solvent and employed so recovery is easily foreseeable for the local economy.
Yes, I agree. I did not mean to imply that the emergency was declared for economic reasons. That’s not my point.
This is what I disagree with. It was not an intentional choice to wreck the economy. The economy was going to take a major hit either way. I don’t doubt that the stay-at-home orders hurt it further, but we never had the option of having a great economy with an unpleasant side dish of coronavirus. With the stay-at-home orders we have now over 35,000 dead in a month. If we were looking at some multiple of that number because people didn’t take it seriously and kept going to restaurants, movies, hair salons or whatever, at some point people would have stopped doing that. Even young healthy people have friends and loved ones who are in vulnerable categories and would change their lifestyles to avoid passing the virus to those friends and loved ones.
The stay-at-home orders have been reasonable and necessary, and I think the plan to gradually lift them is reasonable and necessary as well.
Moderate major hit vs huge major hit.
I disagree. It was clearly a choice to wreck the economy. It was based on quite incomplete information, and our information still isn’t very good.
I know that it is unpleasant to face facts, but almost all of the dead are very old. If we’d kept working, and lost 3-4 times as many people, the economic effect would have been minimal. Say it was 110,000 dead, about 80% of them over 70. That’s about 1 in 3,000 Americans, and among those working, closer to 1 in 15,000. The economic effect would be barely noticeable.
It may have been worth it to wreck the economy to save lives, but I dissent from your suggestion that the economic hit would have been bad had we done nothing.
I estimated the age distribution in my prior comment, and overestimated slightly. Based on data from New York state, about 65% of COVID-19 deaths are 70 and over, and about 84% are 60 and over.
I still think that the economic effect of doing nothing would have been minimal. Say the Imperial College London estimate was accurate, and we were looking at 2.2 million deaths. About 75% would be retirement age. About 25% — 550,000 — would be working age. The labor force participation rate is probably around 70%, so that’s a loss of about 350,000-400,000 workers.
The labor force is around 165 million, so we would have lost approximately 0.2-0.25% of the work force (about 1 in every 450 workers or so).
I’m not advocating for any particular position here. I am simply pointing out that I don’t see any reason to expect that the “do nothing” approach would have caused an economic catastrophe, had we actually kept working. Now it is quite possible that people would have panicked and stopped working anyway, even without government orders. But that, too, is a choice.
I have been thinking something similar. The true cost to the economy is not the difference between our “regular” economy and the economy as we know it now. It is the difference between the latter and the economy as it would have been accounting for the virus and personal behavior even in the absence of compelled shutdowns. There may be principles at work relating to the shutdown orders, but, as a practical matter, I don’t buy that the businesses affected would be faring much better had they remained open. Large amounts of people would still be staying home, not heading out for a burger and a beer.
What do you think the medical care situation and activity would have looked like if nothing had been done other than vulnerable segregating themselves?
I can’t speak for others, but in my experience, people get pretty upset when their parents, grandparents, other family members, friends with diabetes, etc…die horrible deaths by suffocation and organ failure, helplessly alone in hospital beds. They are also pretty put-out when they themselves get sick and sometimes have to be hospitalized.
Point being, if hundreds of thousands are dying (which means millions of hospitalizations and people who get frighteningly close to death, hospitals overrun, and God knows what else), you can’t keep that a secret. And when word gets out that all this horrible suffering is caused by a virus that spreads by human contact – people will stop what they are doing anyway. They won’t go to work, they won’t go to restaurants, movies, or anywhere else. They will take extraordinary measures to keep that virus away from themselves and their loved ones. And, indeed, that’s exactly what they should do. This will happen even with no orders from the government. In fact, it is likely to be far more chaotic without some kind of government intervention. So – economy wrecked either way. Might as well try to save some lives.