Over at Marginal Revolution this morning, Tyler Cowen writes:
For instance, some scientists have told me that at some point, if the virus is widespread enough, there is no choice but to let it burn its way through the population (not saying we are there yet, probably not according to the consensus of experts I am seeing).
I went to his link to see how many experts it took to establish a consensus. Are you ready for the number? It was one. That one is Tom Inglesby, Director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.
If all you have is one expert, you can’t conclude that there’s a consensus.
Moreover, since the whole point of Tyler’s post, which is titled “The Speed Premium in an exponentially growing pandemic world,” is that things are changing very fast, how could there be a consensus?
In fact, there’s not. Read “The Coronavirus mass panic is not justified,” by Professor Peter C. Gotzsche, March 24, to see a different view from that of Dr. Inglesby.
Here are two key paragraphs from that article, although the whole article is key:
The WHO has estimated that seasonal influenza may result in 290,000 to 650,000 deaths each year due to respiratory causes alone. We don’t know how reliable this estimate is, or how reliable estimates of Coronavirus deaths are, but so far, 4 months into the pandemic, the estimate is around 17,000 deaths. Why then the extreme panic, with non-evidence-based draconian measures in many countries restricting seriously people’s lives?
People tell me it is because the Coronavirus is much more contagious than the influenza virus but every time I have asked for the evidence, there was silence. The transmission rate seems to be very similar to the seasonal flu. I base this on Ioannidis information about the cruise ship where people have a high risk of getting infected because they crowd in bars, at buffets and when they dance, and on the information in Ginn’s paper. Furthermore, Ginn writes that out of the thousands of flights since November 2019, only a handful of airport and airline staff have tested positive.
HT2 Less Antman.
READER COMMENTS
Scott Sumner
Mar 25 2020 at 3:53pm
In my view, the debate over whether “we” should stop social distancing is the wrong debate. For the next few weeks at a minimum, there is no force on Earth that could stop social distancing, which is occurring mostly due to the voluntary decisions of hundreds of millions of people. People are terrified about what happened in Wuhan and Lombardy. The real issue, in my view, is what’s the best way to get the economy back up again as quickly as possible. What government policies would be most helpful? I lean toward deregulation.
David Henderson
Mar 25 2020 at 4:53pm
I agree. I was addressing Tyler’s point though. There’s no scientific consensus and Tyler is writing as if (1) one guy constitutes a scientific consensus and (2) there IS a scientific consensus. I challenge both assumptions.
Also, check out the twitter feed of the guy Tyler links to. He’s not just talking about social distancing, which my wife and I have been doing for over 2 weeks. He’s talking about why we need to keep “shelter at home” restrictions in place. And he simply goes exponential over weeks, with no hesitation about that. I criticized that approach in my Defining Ideas piece.
John Strong
Mar 25 2020 at 4:55pm
Thank you, Mr. Sumner! I see people worried about fatalities and I see people worried about the economy, but you are the first to suggest that concern about both things might suggest loosening regulation! You don’t say how, but seems obvious to me that the FDA is way, **way** to concerned about negative side-effects of vaccines. Without their obstructionism, we could have a vaccine in 6 months (judging by comments of Bill Gates) instead of 18 months.
nobody.really
Mar 25 2020 at 5:45pm
I’d be interested in seeing some study on this matter. Specifically, what should we strive to optimize?
Yes, we want medicines that are both safe and effective–and needless delay has an obvious cost. But we also want to manage public anxieties. If the FDA approves a drug, and it later proves to have undisclosed negative side-effects, people will become ever more reluctant to take medications–and that may ALSO have a cost. Thus, if the goal is maximizing public health, the FDA may rationally exercise greater caution regarding human medications than, say, medications for animals that have no choice about taking the meds.
(Then again, we might need to test my assumption that people’s anxieties about taking medications bear any relationship to actual risk. Allegedly people still think that vaccines cause autism, facts be damned. So another theory is that some percentage of the population will have anxiety about meds, regardless of facts, and we should not alter testing procedures in a futile effort to manage their concerns.)
Thaomas
Mar 25 2020 at 6:49pm
I lean toward NGDPL targeting. 🙂
Deregulation would help, but where to start? Immigration reform? Removal of trade barriers? Zoning and restrictions on residential and commercial development? Congestion taxation? Occupational licensing? Taxation of net CO2 and particulate emissions?
Matthias Goergens
Mar 26 2020 at 1:42am
All those are good ideas, but the first step might be to remove the recently introduce restrictions, like price controls. Just to get back to the status quo ante.
Stéphane Couvreur
Mar 26 2020 at 3:24am
Scott,
My 20yo son is afraid to get the virus and to give it to his mother who has a weak immune system. He came to my place not to infect her. That’s voluntary.
Yesterday, he got a 135€ fine because he was roller skating around the block – alone – to get some air. That’s involuntary confinement.
It is important to make the difference before deciding that one justifies the other, and which of the two above is useful or not.
Best regards,
Stéphane
Aleksander
Mar 25 2020 at 9:34pm
Because 700 Italians don’t die from influenza every day, and their hospitals aren’t usually overwhelmed by influenza patients with desperate breathing problems.
Almost every infected country on earth has first reacted with ambivalence: “What are we supposed to do? Stop our entire economy? It’s basically just another flu…”. Then, people start dying, more and more every day, and hospitals get overrun by patients in need of oxygen. Then the government, no matter what its stance has been so far, finally cracks, and closes down everything.
Whether COVID-19 actually warrants shutting down the economy is an open question. But there are clearly good reasons to panic.
Weir
Mar 25 2020 at 9:58pm
Good reasons not to panic: Because panic condemns us to decades of new debts and taxes. Because panic makes us less trusting of each other, less willing to take risks, less open to competition and innovation. Because panic destroys people’s livelihoods and throws them out of work. It cuts them off from society and leaves them at the mercy of the state instead. Because politicians see panic and celebrate “a tremendous opportunity to restructure things to fit our vision” (Jim Clyburn.) Because we will have to pay for this panic in centralization, regulation, authoritarianism.
Aleksander
Mar 27 2020 at 3:56am
Yes, the are good reasons not to panic. But this isn’t the flu.
Mark Bahner
Mar 26 2020 at 1:42pm
Have you ever seen the movie, Groundhog Day? Do you know about the sequences with the homeless old man? If you have never seen the movie, do NOT watch this video. Instead, see the movie, because it’s terrific. But if you have seen the movie, here’s the complete set of all sequences:
Spoiler alert! Anyone who hasn’t seen the movie Groundhog Day, don’t watch this!
Aleksander
Mar 27 2020 at 3:55am
Thanks, I’ve seen the movie before.
Mark Bahner
Mar 27 2020 at 11:52am
Hi Alexsander,
OK, good. (SPOILER ALERT! For those who have not seen Groundhog Day, don’t read further!)
Here’s how I view that sequence, which I think it excellent. No matter what Phil (Bill Murray) does to help that homeless old man, the old man dies that night.
That’s exactly how I view the deaths of the “700 Italians” dying from COVID-19 “every day.” The people in Italy who are dying of COVID-19 are generally extremely old. And the also almost always have one or more “co-morbidities.”
A review of 2003 deaths from COVID-19 showed that only 4 percent were under 60 years old. In contrast, 10% were more than 90 years old, another 42 percent were 80-89, and 35% were 70-79. Further, the overwhelming majority of the decedents had one or more co-morbidties.
The Italian Connection – WUWT
So yes, “700 a day” died. (But note that the death rate is far lower than that in recent days and today.) But of those 700 who died, a very large percentage of them were going to die soon anyway. Maybe not in the next week or two after they died, but probably in the next year or two, or three.
P.S. I’m not trying to minimize anyone’s death. The people under 60 possibly had many long years left, and even the 70-79 people a decade left. But we’re all going to die. And who are 80-89 or 90+, especially with one or more co-morbidites, are going to die soon. So what that really means is that the “700 Italians” who died “every day” in the period to which you were referring means that they won’t be dying next year or the year after. So they death rate will be lower next year or the year after.
P.S. I’m in my 60s, and assisting my parents who live next door to me, who are approaching their 90s. I certainly don’t want them to get COVID-19, which would almost certainly kill them both. Because whichever one was able would be at the bedside, hold the hand of the one who was sick. And there would never be any respirator or gloves involved. But regardless of whether they get COVID-19 it’s a simple fact that people approaching or in the 90s almost always don’t have very long to live. As the nurse said, “He was just old. It was his time.”
Aleksander
Mar 28 2020 at 6:32pm
Maybe, but then it’s not comparable to the flu, which is what I objected to. Or do 700 Italians die from the flu every day? Then the numbers given in the article are wrong.
Weir
Mar 25 2020 at 9:35pm
If you look up the word ambition in the Dictionary of Received Ideas, it’s always insane except when it’s noble.
Likewise wit is always sparkling, and a traveller is always intrepid.
An accident, Flaubert said, is always deplorable or unfortunate.
I think that’s what happened here. People can’t talk about experts now without adding the words “consensus of.”
Fred_in_PA
Mar 26 2020 at 12:32pm
Weir;
Your comment has an admirably light tone to it.
But your’s may be a hard/gritty observation about the mind’s workings. Following Kahneman, our System 1’s may be inherently associational: With one triggering concept causing a host of “nearby” concepts to resonate. (Holographic memories?) And the paired words naturally streaming out together.
System 2, which might have questioned the pairing, never diverted its attentions to this. Probably off somewhere trying to remember Marjorie’s phone number.
Rebes
Mar 25 2020 at 10:43pm
“What government policies would be most helpful?”
A Federal law that protects businesses and educational institutions against liability for regular transmissions of the virus on their premises.
Matthias Goergens
Mar 26 2020 at 1:45am
If they can show to have taken reasonable precautions, I guess?
In theory, the insurance market should be able to supply such a product for a reasonable price. It might be useful to fix whatever impediments there are in the insurance market and general liability laws that might prevent such insurance and work on those, instead of special casing the current pandemic?
Mark Z
Mar 26 2020 at 4:01am
Actually, I’m going to suggest maybe the opposite would be the best policy. If businesses (or other institutions) were held financially responsible for spreading the virus, they would have incentives to prevent its spread on their own, to disinfect everything, to ban sick people from their premises, etc. and we would not need a government shut down. Maybe in free market AnCap utopia, you wouldn’t be able to get into a restaurant or bar without showing proof of a recent negative test result; and no one would got to establishments that doesn’t discriminate against infected people. Economic incentives would strongly pressure sick people to quarantine.
Looking at this through a Coasean lens, the problem may be a lack of liability rather than the current threat of liability (have any private businesses or universities actually been held liable for spreading the disease yet?), or at least the lack of clarity over who’s liable. If we assigned private parties liability for spreading the virus, it would create private incentives to stop the spread and mitigate the externality problem, and perhaps reduce the need for government action.
JFA
Mar 26 2020 at 7:04am
I don’t know who this guy is talking to, but there is plenty of evidence that the reproduction rate is much higher than seasonal flu: most of the estimates from Chinese data I saw were around the 2.2 – 2.6 range, here’s a estimate from the Diamond Princess of 2.28 (https://www.ncbi.nlm.nih.gov/pubmed/32097725), here’s an estimate of around 4 for Italy (https://www.medrxiv.org/content/10.1101/2020.03.17.20037689v1). The seasonal flu’s reproduction rate is around 1.2-1.3. Now I don’t know how valid/accurate those analyses are, but when I hear person X say “every time I have asked for the evidence, there was silence” but there is a ton of evidence supporting the exact thing that person X is arguing against, I am extremely skeptical that person X can be trusted in his/her opinion or motives.
Stan Kwiatkowski
Mar 26 2020 at 12:21pm
THANK YOU – I despise people making such bold statements that sound like they got something, while the only thing they “got” is an inability to google.
Anything above 2 is MASSIVELY higher than infuenza.
Tyler Wells
Mar 26 2020 at 4:06pm
So wouldn’t that reproduction rate of 4.0 imply vastly lower mortality rates than what the experts are telling us? I don’t understand what they mean by “”effective” per-day mortality rate was found to be 0.0173 (90% CI: 0.0154-0.0192)”.
Jfa
Mar 26 2020 at 8:38pm
I don’t really know. I’m not an epidemiologists. From what I gather, Gotzsche isn’t either (though I could be mistaken). The point is that I just wouldn’t trust/expect someone who can’t use google scholar to be able to provide informative pontificating on much of anything.
Fred_in_PA
Mar 26 2020 at 9:36pm
Isn’t this an exchange about “how high is up?”
It refers to Professor Gotzsche’s statement that, “People tell me it is because the Coronavirus is much more contagious than the influenza virus but every time I have asked for the evidence, there was silence.”
You cite Chinese and Diamond Princess data that both imply the R0 is about double the R0 for the seasonal flu (2.2-2.6 vs. 1.2-1.3). And your stance is that this is “much more“.
Stan Kwiatkowski agrees, saying “Anything above 2 is MASSIVELY higher . . . .”
Aren’t we going to need bigger superlatives? The R0’s for Smallpox is about 3.5 – 6, for Mumps is 4 – 7, and for Rubella is 5 – 7; These are double to triple CoViD-19’s R0. The “champ”, of course, is measles, whose R0 is variously estimated to be between 12 & 18.
Wikipedia’s numbers for Influenza run from 0.9 (sic) to 2.8, depending on whether we’re talking about “seasonal” or “2009 pandemic” or “1918 pandemic” strains. (I don’t understand how a bug with an R0 below 1.0 can blossom every winter, but . . . .)
Gotzsche’s “silence” quip was probably unwise. He would have been on safer ground saying that the counterclaim was “unconvincing” or such.
But the claim that CoVid-19 is “much more” contagious than influenza raises the question, “Compared to what?”
JFA
Mar 27 2020 at 7:05am
I don’t really get your point. Yes, there are some viruses that spread more quickly that other diseases. Comparing R0 values, cases of C19 double twice as quickly as seasonal flu (which is what everyone is comparing this too and the difference really comes in when you consider the R0 with the higher mortality). When Gotzsche is saying there is no evidence for a much higher transmission rate, he is saying that he thinks the transmission of C19 is the same as seasonal flu (“The transmission rate seems to be very similar to the seasonal flu.”).
As an economist, if someone told me that a 2.5% annual growth rate (doubling GDP in ~28) was not that different from a 1.3% growth rate (doubling GDP in ~53 years), I would know for certain that this person either has no knowledge of the subject area or that they have other motives to downplay the difference.
Guy Meunier
Mar 26 2020 at 10:31am
You might be interested by superforecasters’ predictions :
https://goodjudgment.io/covid/dashboard/s
Mark Bahner
Mar 26 2020 at 12:27pm
Hi,
This whole COVID-19 exercise, in the U.S. and globally, is going to be one for the record books, in terms of the “cure” being much worse than the disease (literally).
Hopefully, humanity will learn from this hopefully temporary insanity. The Beatles’ great lyric comes to mind:
🙁
Mark
Mark
Mar 26 2020 at 12:39pm
You cite Gotzche as proof of lack of consensus among experts. From his article
“I have learned a lot from discussions on email lists; from publications by my good friend, Professor John Ioannidis from Stanford and Silicon Valley technologist Aaron Ginn; from a teleconference with another good friend, the founder of CrossFit, Greg Glasman, and nine others; and from discussions with my best friend, my wife, Professor of Clinical Microbiology Helle Krogh Johansen.”
It doesn’t sound like he is much of an expert on epidemiology and is basing his view mostly on what his friends have told him. Gotzche undoubtably knows more about such matters than most people, certainly including myself, but he isn’t an epidemiologist. Is this really the best you can do in finding a counter-example to expert consensus?
Tyler Wells
Mar 26 2020 at 4:29pm
What I find fascinating is that no one discusses the alignment of interests of the “experts” in the medical field who are advising.
WHO, CDC, etc. have a vested interest in presenting the worst possible scenario to the public. It is unlikely that no measures will be taken, and if measures are taken and the death toll is much lower than they forecast then they can simply say, “good thing something was done, or millions would have died!” Plus, they probably should be conservative anyway, you don’t want to be the person who said 50k dead and it is 300k.
The hospitals will take an enormous financial hit from this. Yes, there will be some money from treatments but other, more lucrative, operations have to be put on hold. They really aren’t set up for this and the staff will suffer. It is in their interest to delay this as long as possible.
Pharmaceutical and hospital supply companies stand to make a fortune from this. I have heard that the price of ventilators has tripled, not to mention facemasks, testing kits, and drugs for treating the symptoms of the ill. They really want this last as long as possible.
Really, any medical expert who is associated with any of the above is best served by the “hold and wait” policy. Therefore, I would put the greatest weight on university researchers and anyone outside this field. Am I being cynical? Alas, I have had too much experience with the medical field to think that they aren’t governed by the same self-interests that all others have.
Fred_in_PA
Mar 27 2020 at 12:52am
Tyler Wells;
As an old operations instructor, I suspect your view is too simplistic.
It is hard to make money. (If it were easy, more of us would do it.) And competitive markets tend to wring out any excess profits beyond the cost-of-capital. Most of the organizations you’re referring to here are delicately balanced houses-of-cards; typically with thin margins and little control of their situations.
When external events (and governments) roil the waters, some of these boats are likely to sink. And the survivors are all likely to be green-in-the-face and bailing water.
Pharma and hospital-supply companies are all going to suffer ugly surge forces and sickening plunges into dried-up demand. (Consider the surge in demand for ventilators followed by next year, when everybody discovers that they have three times as many of these things as they will need for any foreseeable future. If you make ventilators, you’d better be able to survive for years without a sale.) And trying to meet surges in demand while protecting your employees, dealing with broken supply chains, and crumbling financial options is going to be rough. And putting on extra shifts requires finding and training the workers, paying time-and-a-half for night shifts and overtime, buying scarce supplies at high spot-market prices (if you can find them at all), all while your credit lines dry up and state’s attorneys general threaten to send you to prison for charging anything above last year’s prices.
You seem to recognize the hostility of this environment for the hospitals. I think it is easy to prove it to yourself for the others: Simply consider that their profits (if any) belong to their owners, that is, their stockholders. If you sincerely believe some will reap windfall profits, you can cut yourself in on that deal by becoming one of those stockholders. If you can’t find any where reasonably sure profits would outweigh the risk to yourself — that is, the risk of having your life savings wiped out, then . . . . Maybe they’re hard to find because they don’t exist.
Comments are closed.