An important consideration is that the ‘thing that the US, UK and China have been doing, and what Sweden didn’t’, may not refer to anything. There are two meanings of ‘lockdowns have not been worth it’ - ‘allow the natural herd immunity to happen and carry on as normal, accepting the direct health damage while saving the economy’ or ‘we shouldn’t adopt legally mandatory measures to attempt to suppress the virus and instead adopt voluntary measures to attempt to suppress the virus’. The latter of these is the only correct way to interpret ‘thing Sweden did that the other countries didn’t’. The first of these is basically a thought-experiment, not a possible state of affairs, because people won’t carry on as usual. So it can’t be used for cost-benefit comparisons.
In terms of behaviour, there is far more similarity between what the US and Sweden ‘did’ than what the US and China ‘did’. Tyler Cowen has written several articles emphasising exactly this point. What Sweden ‘did’ was an uncoordinated, voluntary attempt at the same policy that China, Germany, the UK and the US attempted with varying levels of seriousness—social distancing to reduce the R effectively below 1, suppressing the epidemic. This thread summarizes the ‘voluntary suppression’ that countries like Sweden ended up with. Tyler Cowen writes an article attempting to ‘right the wrong question’:
“The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”
What exactly does the word “allow” mean in this context? Again the passivity is evident, as if humans should just line up in the proper order of virus exposure and submit to nature’s will. How about instead we channel our inner Ayn Rand and stress the role of human agency? Something like: “Herd immunity will come from a combination of exposure to the virus through natural infection and the widespread use of vaccines. Here are some ways to maximize the role of vaccines in that process.”
So, the question cannot be “should we allow the natural herd immunity to happen and carry on as normal, accepting the direct health damage while protecting the economy”—that is not actually a possible state of affairs given human behaviour. We can ask whether a better overall outcome is achieved with legally required measures to attempt suppression, rather than an uncoordinated attempt at suppression, but since people will not carry on as normal we can’t ask ‘has the economic/knock-on cost of lockdowns been worth the lives saved’ without being very clear that the counterfactual may not be all that different.
The most important considerations have to be,
How long do we expect to have to wait for a vaccine or much more effective treatment? If not long, then any weaker suppression is ‘akin to charging the hill and taking casualties two days before the end of World War I’. If a long time, then we must recognise that in e.g. the US given that a slow grind up to herd immunity through infection will eventually occur.
How does the economic and related damage vary for voluntary vs involuntary suppression? The example of Sweden compared to its neighbours is illustrative here.
How does the total number and spread of infections vary for voluntary vs involuntary suppression? You can’t rerun history for a given country with vs without legally mandated suppression measures.
To what degree do weaker legally mandated measures earlier spare us from stronger legally mandated measures (or greater economic damage from voluntary behaviour change) later?
Edit: Tyler Cowen released another article arguing for a new consideration that I didn’t list—what reference class to place Coronavirus in - ‘external attack on the nation’ or ‘regular cause of death’.Since, for fairly clear rule-utilitarian/deontological reasons, governments should care more about defending their citizens from e.g. wars and terrorist attacks compared to random accidents that kill similar numbers of people. I also think this is a key disagreement between pro/anti-‘lockdown’ positions.
To emphasise this last point, although it falls under ‘questioning the question’, the focus on Lockdowns can be counterproductive when there are vastly more cost-effective measures that could have been attempted by countries like the UK that had very low caseloads through the summer—like funding enforcement and support for isolation and better contact tracing, mask enforcement, and keeping events outdoors. These may fall under some people’s definition of ‘lockdown’ since some of them are legally mandatory social distancing, but their costs and benefits are wildly different from stay-at-home orders. Scepticism of ‘Lockdowns’ must be defined to be more specific.
How long do we expect to have to wait for a vaccine or much more effective treatment?
I can’t think of a better source on this than the Good Judgment project’s COVID-19 recovery dashboard.
How does the economic and related damage vary for voluntary vs involuntary suppression?
This is incredibly complicated and country-specific and dependent on all sorts of factors but maybe this graph from the Financial Times is a good place to start, it tells us how things have gone so far.
How does the total number and spread of infections vary for voluntary vs involuntary suppression?
This is even harder than the previous question. ‘All we can say for sure is “It was possible to get R<1 in Sweden in the spring with less stringent measures’. If you consider that Sweden suffered considerably more death than its comparable neighbours, then you can project that the initial surge in deaths in badly-hit locked down countries like the UK could have been much higher with voluntary measures, but how much higher is difficult to assess. I think that between-country comparisons are almost useless in these situations.
This is also where accounting for coronavirus deaths and debilitations comes into play. ‘Anti-lockdown’ arguments sometimes focus on the fact that even in badly-hit countries, the excess death figures have been in the rough range of +10%, (though with around 11 years of life lost). There are ways of describing this that make it seem ‘not so bad’ or ‘not worth shutting the country down for’, by e.g. comparing it to deaths from the other leading causes of death, like heart disease. This assumes there’s a direct tradeoff where we can ‘carry on as normal’ while accepting those deaths and avoid the economic damage, but there is no such tradeoff to be made. There’s just the choice as to which way you place the additional nudges of law and public messaging on top of a trajectory you’re largely committed to by individual behaviour changes.
And if you do try to make the impossible, hypothetical ‘tradeoff economy and lives’ comparison between ‘normal behaviour no matter what’ and virus suppression, then the number of excess deaths to use for comparison isn’t the number we in fact suffered, but far higher, given the IFR of 0.5-1%, it’s on the order of +100% excess deaths (600,000 in the UK and 2 million in the US).
But again, such a comparison isn’t useful, as it’s not a policy that could be enacted or adopted, in fact it would probably require huge state coercion to force people to return to ‘normal life’.
The basic point that it wouldn’t be worth sacrificing everything to reduce excess deaths by 10% and save a million life-years is true, but that point is turned into a motte-and-bailey, where the motte is that there exists a level of damage at which a particular suppression measure (full lockdowns) is no longer worth it, and the bailey is that in all the situations we are in now most suppression measures are not worth it.
To what degree do weaker legally mandated measures earlier spare us from stronger legally mandated measures (or greater economic damage from voluntary behaviour change) later?
This raises the difficult question of how much to take into account panic over overwhelmed hospitals and rising cases. Tyler Cowen:
In that sense, as things stand, there is no “normal” to be found. An attempt to pursue it would most likely lead to panic over the numbers of cases and hospitalizations, and would almost certainly make a second lockdown more likely.
An important consideration is that the ‘thing that the US, UK and China have been doing, and what Sweden didn’t’, may not refer to anything. There are two meanings of ‘lockdowns have not been worth it’ - ‘allow the natural herd immunity to happen and carry on as normal, accepting the direct health damage while saving the economy’ or ‘we shouldn’t adopt legally mandatory measures to attempt to suppress the virus and instead adopt voluntary measures to attempt to suppress the virus’. The latter of these is the only correct way to interpret ‘thing Sweden did that the other countries didn’t’. The first of these is basically a thought-experiment, not a possible state of affairs, because people won’t carry on as usual. So it can’t be used for cost-benefit comparisons.
In terms of behaviour, there is far more similarity between what the US and Sweden ‘did’ than what the US and China ‘did’. Tyler Cowen has written several articles emphasising exactly this point. What Sweden ‘did’ was an uncoordinated, voluntary attempt at the same policy that China, Germany, the UK and the US attempted with varying levels of seriousness—social distancing to reduce the R effectively below 1, suppressing the epidemic. This thread summarizes the ‘voluntary suppression’ that countries like Sweden ended up with. Tyler Cowen writes an article attempting to ‘right the wrong question’:
So, the question cannot be “should we allow the natural herd immunity to happen and carry on as normal, accepting the direct health damage while protecting the economy”—that is not actually a possible state of affairs given human behaviour. We can ask whether a better overall outcome is achieved with legally required measures to attempt suppression, rather than an uncoordinated attempt at suppression, but since people will not carry on as normal we can’t ask ‘has the economic/knock-on cost of lockdowns been worth the lives saved’ without being very clear that the counterfactual may not be all that different.
The most important considerations have to be,
How long do we expect to have to wait for a vaccine or much more effective treatment? If not long, then any weaker suppression is ‘akin to charging the hill and taking casualties two days before the end of World War I’. If a long time, then we must recognise that in e.g. the US given that a slow grind up to herd immunity through infection will eventually occur.
How does the economic and related damage vary for voluntary vs involuntary suppression? The example of Sweden compared to its neighbours is illustrative here.
How does the total number and spread of infections vary for voluntary vs involuntary suppression? You can’t rerun history for a given country with vs without legally mandated suppression measures.
To what degree do weaker legally mandated measures earlier spare us from stronger legally mandated measures (or greater economic damage from voluntary behaviour change) later?
Edit: Tyler Cowen released another article arguing for a new consideration that I didn’t list—what reference class to place Coronavirus in - ‘external attack on the nation’ or ‘regular cause of death’. Since, for fairly clear rule-utilitarian/deontological reasons, governments should care more about defending their citizens from e.g. wars and terrorist attacks compared to random accidents that kill similar numbers of people. I also think this is a key disagreement between pro/anti-‘lockdown’ positions.
To emphasise this last point, although it falls under ‘questioning the question’, the focus on Lockdowns can be counterproductive when there are vastly more cost-effective measures that could have been attempted by countries like the UK that had very low caseloads through the summer—like funding enforcement and support for isolation and better contact tracing, mask enforcement, and keeping events outdoors. These may fall under some people’s definition of ‘lockdown’ since some of them are legally mandatory social distancing, but their costs and benefits are wildly different from stay-at-home orders. Scepticism of ‘Lockdowns’ must be defined to be more specific.
How long do we expect to have to wait for a vaccine or much more effective treatment?
I can’t think of a better source on this than the Good Judgment project’s COVID-19 recovery dashboard.
How does the economic and related damage vary for voluntary vs involuntary suppression?
This is incredibly complicated and country-specific and dependent on all sorts of factors but maybe this graph from the Financial Times is a good place to start, it tells us how things have gone so far.
How does the total number and spread of infections vary for voluntary vs involuntary suppression?
This is even harder than the previous question. ‘All we can say for sure is “It was possible to get R<1 in Sweden in the spring with less stringent measures’. If you consider that Sweden suffered considerably more death than its comparable neighbours, then you can project that the initial surge in deaths in badly-hit locked down countries like the UK could have been much higher with voluntary measures, but how much higher is difficult to assess. I think that between-country comparisons are almost useless in these situations.
This is also where accounting for coronavirus deaths and debilitations comes into play. ‘Anti-lockdown’ arguments sometimes focus on the fact that even in badly-hit countries, the excess death figures have been in the rough range of +10%, (though with around 11 years of life lost). There are ways of describing this that make it seem ‘not so bad’ or ‘not worth shutting the country down for’, by e.g. comparing it to deaths from the other leading causes of death, like heart disease. This assumes there’s a direct tradeoff where we can ‘carry on as normal’ while accepting those deaths and avoid the economic damage, but there is no such tradeoff to be made. There’s just the choice as to which way you place the additional nudges of law and public messaging on top of a trajectory you’re largely committed to by individual behaviour changes.
And if you do try to make the impossible, hypothetical ‘tradeoff economy and lives’ comparison between ‘normal behaviour no matter what’ and virus suppression, then the number of excess deaths to use for comparison isn’t the number we in fact suffered, but far higher, given the IFR of 0.5-1%, it’s on the order of +100% excess deaths (600,000 in the UK and 2 million in the US).
But again, such a comparison isn’t useful, as it’s not a policy that could be enacted or adopted, in fact it would probably require huge state coercion to force people to return to ‘normal life’.
The basic point that it wouldn’t be worth sacrificing everything to reduce excess deaths by 10% and save a million life-years is true, but that point is turned into a motte-and-bailey, where the motte is that there exists a level of damage at which a particular suppression measure (full lockdowns) is no longer worth it, and the bailey is that in all the situations we are in now most suppression measures are not worth it.
To what degree do weaker legally mandated measures earlier spare us from stronger legally mandated measures (or greater economic damage from voluntary behaviour change) later?
This raises the difficult question of how much to take into account panic over overwhelmed hospitals and rising cases. Tyler Cowen: