Depends on what you mean by “pessimistic,” I guess. I think my model back in March was that basically everyone would dismiss COVID as being “like the flu”; tons of people would die; but no one would really pay much attention to it.
Instead, people actually freaked out about it and lots of people actually got overly into enforcing quarantine restrictions on each other. I was expecting that people would fail to even parse the small chance of death by COVID as sufficiently important to be worth worrying about, and that didn’t turn out to be true.
I agree that the real outcome is much worse than we could have done overall, with e.g. mass testing or challenge trials—though I don’t agree that this is clearly worse than runaway herd immunity. Back-of-the-envelope calculation: if 1% of the US population died of COVID, that’s around 3 million deaths, which in VSL terms is around $30T. The US’s GDP for one year is around $20T. My error bars on the validity of VSL at that scale are pretty large, as is my uncertainty about comparing GDP to VSL, and other non-GDP considerations of lockdown… but the two certainly seem comparable in magnitude, and I weakly think that lockdown is better in terms of total social utility.
(edit: of course we’re at ~300k deaths now, which changes the analysis by 10% or so; still seems like the calculation comes out about the same as of right now. The effect of another huge wave could change this calculation substantially.)
It is very unlikely that we would have gotten to 100% prevalence in any world, which would be necessary for 1% of the U.S. to die. With all the superspreader dynamics, you would likely reach heard immunity at something like 50% prevalence, maybe even less than that, and we are about 40% of the way there. This also completely ignores age-related effects. The average life-years lost per covid death is ~10-15, since the average person who dies of COVID is much older.
This all results in a VSL closer to 1/10th of the value you cited (~2 for only getting to 50% prevalence and a factor of 5 for age-related effects). Then, if you take into account that we aren’t actually on track to prevent most of the relevant deaths (we are already at 20% historical prevalence and are likely to reach 30%-40% before widespread vaccine adoption, suggesting that we are likely to end up with 60-70% of the relevant deaths, compared to the world with zero lockdowns), the numbers really aren’t looking good.
This makes the total calculation come out to more something like a counterfactual $1T in VSL terms. I think with that, it’s looking pretty unlikely to me that the lockdowns we had were worth it, even just taking into account the economic effect of this year (not to mention that the total impact and length of lockdowns is likely to extend substantially into 2021). I also think this year will have a large number of highly negative long-run effects on institutions, political tension and long-term health for lots of people that will make the overall cost of the lockdown greatly exceed the deaths that were prevented.
Back in March, there was a lot of concern that uncontrolled spread would overwhelm the medical system and some hope that delay would improve the standard of care. Do we have good estimates now of those two effects? They could influence IFR estimates by a fair amount.
Also, my understanding is that the number of infections could’ve shot way past herd immunity levels. Herd immunity is just the point at which the number of active infections starts declining rather than increasing, and if there are lots of active infections at that time then they can spread to much of the remaining people before dwindling.
Depends on what you mean by “pessimistic,” I guess. I think my model back in March was that basically everyone would dismiss COVID as being “like the flu”; tons of people would die; but no one would really pay much attention to it.
Instead, people actually freaked out about it and lots of people actually got overly into enforcing quarantine restrictions on each other. I was expecting that people would fail to even parse the small chance of death by COVID as sufficiently important to be worth worrying about, and that didn’t turn out to be true.
I agree that the real outcome is much worse than we could have done overall, with e.g. mass testing or challenge trials—though I don’t agree that this is clearly worse than runaway herd immunity. Back-of-the-envelope calculation: if 1% of the US population died of COVID, that’s around 3 million deaths, which in VSL terms is around $30T. The US’s GDP for one year is around $20T. My error bars on the validity of VSL at that scale are pretty large, as is my uncertainty about comparing GDP to VSL, and other non-GDP considerations of lockdown… but the two certainly seem comparable in magnitude, and I weakly think that lockdown is better in terms of total social utility.
(edit: of course we’re at ~300k deaths now, which changes the analysis by 10% or so; still seems like the calculation comes out about the same as of right now. The effect of another huge wave could change this calculation substantially.)
It is very unlikely that we would have gotten to 100% prevalence in any world, which would be necessary for 1% of the U.S. to die. With all the superspreader dynamics, you would likely reach heard immunity at something like 50% prevalence, maybe even less than that, and we are about 40% of the way there. This also completely ignores age-related effects. The average life-years lost per covid death is ~10-15, since the average person who dies of COVID is much older.
This all results in a VSL closer to 1/10th of the value you cited (~2 for only getting to 50% prevalence and a factor of 5 for age-related effects). Then, if you take into account that we aren’t actually on track to prevent most of the relevant deaths (we are already at 20% historical prevalence and are likely to reach 30%-40% before widespread vaccine adoption, suggesting that we are likely to end up with 60-70% of the relevant deaths, compared to the world with zero lockdowns), the numbers really aren’t looking good.
This makes the total calculation come out to more something like a counterfactual $1T in VSL terms. I think with that, it’s looking pretty unlikely to me that the lockdowns we had were worth it, even just taking into account the economic effect of this year (not to mention that the total impact and length of lockdowns is likely to extend substantially into 2021). I also think this year will have a large number of highly negative long-run effects on institutions, political tension and long-term health for lots of people that will make the overall cost of the lockdown greatly exceed the deaths that were prevented.
Back in March, there was a lot of concern that uncontrolled spread would overwhelm the medical system and some hope that delay would improve the standard of care. Do we have good estimates now of those two effects? They could influence IFR estimates by a fair amount.
Also, my understanding is that the number of infections could’ve shot way past herd immunity levels. Herd immunity is just the point at which the number of active infections starts declining rather than increasing, and if there are lots of active infections at that time then they can spread to much of the remaining people before dwindling.
I agree