I found this op-ed at the Wall Street Journal by T. J. Rogers interesting and timely:
Do quick shutdowns work to fight the spread of Covid-19? Joe Malchow, Yinon Weiss and I wanted to find out. We set out to quantify how many deaths were caused by delayed shutdown orders on a state-by-state basis.
To normalize for an unambiguous comparison of deaths between states at the midpoint of an epidemic, we counted deaths per million population for a fixed 21-day period, measured from when the death rate first hit 1 per million—e.g.,‒three deaths in Iowa or 19 in New York state. A state’s “days to shutdown†was the time after a state crossed the 1 per million threshold until it ordered businesses shut down.
We ran a simple one-variable correlation of deaths per million and days to shutdown, which ranged from minus-10 days (some states shut down before any sign of Covid-19) to 35 days for South Dakota, one of seven states with limited or no shutdown. The correlation coefficient was 5.5%—so low that the engineers I used to employ would have summarized it as “no correlation†and moved on to find the real cause of the problem. (The trendline sloped downward—states that delayed more tended to have lower death rates—but that’s also a meaningless result due to the low correlation coefficient.)
No conclusions can be drawn about the states that sheltered quickly, because their death rates ran the full gamut, from 20 per million in Oregon to 360 in New York. This wide variation means that other variables—like population density or subway use—were more important. Our correlation coefficient for per-capita death rates vs. the population density was 44%. That suggests New York City might have benefited from its shutdown—but blindly copying New York’s policies in places with low Covid-19 death rates, such as my native Wisconsin, doesn’t make sense.
I’ve highlighted the portion of the op-ed I think is most significant. The balance of the op-ed deals with Sweden and to my eye it contains a certain amount of handwaving so I have not quoted it. The fact remains that Sweden’s outcome has been worse than other, demographically, culturally, and geographically similar countries that adopted other strategies. That seems to me as close to a real world experiment as we’re likely to come.
It seems to me there are multiple questions worthy of consideration from a public policy standpoint. The first is whether putting “stay at home” directives in place early are effective? But that isn’t identical with the second question: how risky would it be to lift them? The final question is what should we be doing?
If you don’t like the op-ed, propose your own evaluation methodology. I’d be interested in seeing what you come up with.
1) This is one study. We shouldn’t decide stuff on one study.
2) NY was early? They closed on March 22. We closed March 16.
3) Why choose deaths as your metric? It takes people, on average, 2 weeks to die. If you wait until a given date to lockdown you will already many more future deaths in your hospital. Track it by hospitalizations, or do both. Track ICU admissions.
4) Maybe the places with fewer pts provided worse care. (Kind of a general truism in medicine.) OK, I am sleep deprived and too tired but I think that tilts the study in their favor if pts in those states die early.
5) Are all lockdowns the same? I doubt it. You pointed out that what is considered essential varies from state to state.
6) If you think the curves are being bent by better medical care then study that also. No need to look at only one possible explanation.
Finally, (OK, I just got tired) I dont really have much problem with different plans for different areas especially if we have adequate testing. That said, I think that people proposing that should have a plan or explain how we wont have people from areas of low population density traveling into areas of high density when they are infectious.
Steve
Chicago may have an ICU bed problem but it’s only indirectly related to COVID-19. I think it’s caused by gunshot victims from the shooting spree that’s been going on in Austin and a couple of other neighborhoods. The evidence suggests that letting prisoners out of Cook County is a substantial factor in the shooting spree.
Contrary to the NYT, it may well be that the better strategy is letting people in jail contract COVID-19 rather than releasing them into the neighborhoods. It may result in fewer lives lost as well as less stress on the system.
“Chicago may have an ICU bed problem but it’s only indirectly related to COVID-19.”
Should be easy to figure out since hospitals are tracking Covid pts separately.
Steve
‘The fact remains that Sweden’s outcome has been worse than other, demographically, culturally, and geographically similar countries that adopted other strategies.’
Only if you count COVID-19 deaths. As you have pointed out on earlier posts deaths as result of economic hardship aren’t quantified and likely can’t be (except perhaps suicides). By avoiding a countrywide shutdown Sweden’s economy not only didn’t take near the hit its neighbors did but will revv up faster once those neighbors end their lockdown. It sounds cold and cruel to factor the cost in kronors lost versus lives lost, but at the time the Swedes made their decision no one really WTH was going on. BTW, I think the Muslim component of Sweden got hit really hard, likely due to crowded living conditions and a culture that distrusts the host nation including its medical apparatus. Subtract their deaths and the native Swedes did better than their neighbors who didn’t have nearly the immigrant population that Sweden has.
And there comes a point where it’s fair to ask how much a life (and the quality of that life) is worth. A million? Ten million? A billion? I know my life ain’t worth all that much except to a few loved ones. It’s not fair to keep everyone in jail because freeing them might cause a death. If that was the case, they shouldn’t have released criminals on the chance they might catch Wuhan flu. It’s the same reasoning that was behind emptying the mental hospitals so that everyone, not just the staff, could abuse the ex-patients.
I think we should do more of a “all of the above approach”
Try
(a) contact tracing
(b) centralized quarantine
(c) raising indoor temperature
(d) universal masks,
(e) mass sanitization of public spaces
(f) lockdowns where necessary
(g) encourage people to seek treatment early (in a centralized quarantine facility)
I like to speed up decision making — for every measure, there should be a benchmark to signal whether it is effective in limiting spread. The benchmark should be “real time” and reviewed for effectiveness every week.
“By avoiding a countrywide shutdown Sweden’s economy not only didn’t take near the hit its neighbors did”
The AEI article I cited here recently said that their economic hit has been just as large.
Steve
What Have the Lockdowns Accomplished?
Like Smokey the Bear, putting out the fires while leaving the dry tinder in the forest. (that’s us). We make firebreaks by putting barriers and distance between us. It’s sad but these are the same tactics used 100 years ago, with the same sporadic compliance and results. Once patients are sick enough to go to the ER, we have precious little more to offer them now than then. I always hope, but I’m not too optimistic at this point.
Another thought, we should simply use death rates from all causes and compare it to recent averages to look for Covid increase.
Co-morbidity confusion has fouled up the count.
Belgium has the worst per capita death rate in Europe. It’s because of (intentional) miscounting and failure to address the nursing homes.
Gee, bad data and not focusing on the most vulnerable. Where have I heard that before.
Belgium is the one country probably being honest and they get accused of miscounting by right wing idiots. Where have we seen that before?
“not focusing on the most vulnerable”
I actually live this. As I said before, I think some nursing homes did not take adequate precautions, but a lot of that was just lack of money. They didnt have the staff or supplies to adequately protect people. However, there were lots of other nursing homes that were better off financially and prepared extensively, and still had outbreaks. We dont really know how to make nursing homes completely safe (using realistic methods and resources). Since the disease can be spread by asymptomatic people I dont know how you stop it in nursing homes.
Let me give you an update from the real world, not conservative bubble land. What we have found is the same thing nursing homes have found. Old, demented people in nursing homes, or the hospital, will not keep a mask on. They just wont. You have to bathe them, dress them and for the bad ones turn them in bed. All very intimate contact. There is no maintaining a 6 foot rule. One of the doctors we had test positive was caring for a nursing home pt who was asymptomatic who suddenly took off her mask in the middle of a procedure.
Steve
(g) encourage people to seek treatment early (in a centralized quarantine facility)
Curious: Call them terminal quarantine facilities. Would you go?
Treatment is palliative.
Grey, centralized quarantine is NOT for terminal cases.
The point of centralized quarantine is to bring (1) mild cases (2) potential cases (3) recovering patients but still infectious into medical facilities where they can get medical monitoring and most importantly, so they cannot infect the people the live with.
Home transmission accounts for a substantial, perhaps the majority of cases. If I get a mild case — it is really hard to avoid spreading it to my family over the 3 weeks I am contagious. But if I can stay in a hotel room for 2 of those 3 weeks, that cuts the time my family is “at risk” by 2/3.
In East Asia, mild cases go to College dorms, hotels, and a doctor checks up 2x a day. If you get worse, you get sent to a hospital.
It is better for patients as well because a medical professional is onsite to quickly react to any deterioration.
I’m not asking to force people to do this. The American way must be voluntary — but let’s incentivize people by paying $100 a day they do this (but only pay if they stay as long as doctors think they are infectious).
Centralized quarantine was more effective than the lockdown in Wuhan.
Well that could have worked two months ago but now it’s far too many people.
It is not too late.
Even now, limiting spread by 50% will save > 10000 lives. Also, it gets the outbreaks under control must faster — which we need if we want to keep economy from going into depression.
I’ll mention that to Trump. Got to figure out how to make it seem like his idea.