What Is Dead May Never Die

I think the world is overreacting to nCov, and using a sledgehammer instead of a scalpel.

I should say that the most compelling reason to think this would be if you fully understood the science and incidence and preparations. I don’t. This is instead a different sort of argument: that my prior is the response makes no sense, and that the nature of the response makes me think that it was not designed rationally.

To be clear, I’m not confident I’m right here; it’s just my best guess. But it remains my best guess even after others have disagreed.  This post will also probably come across more strongly than I actually feel!  And to be clear, I do think that we should ramp up anti-nCov measures if/when its incidence grows, though only to a moderate extent.

Furthermore, I think our reaction as a society has done an order of magnitude more damage than nCov could.

I should also make it clear that for the purposes of this, I’m only talking about young healthy people who aren’t near Wuhan. If you are over 70, in poor health, or in Hubei province, you should ignore this.

———

My Prior

I guess I’ll start with my prior for why I’m not too worried about it right now, for healthy people.

Currently around 4,000 people have been reported dead of nCov. If that were distributed randomly, each person would be losing on average around 0.02 days of life from nCov–about the amount of time it’ll take to read this post.

Furthermore, the cases are not random. It seems like the old and sick are way more likely to die of nCov than healthy middle aged people. This probably takes another factor of 10 or so out of the death rate for the healthy–so maybe about 5 minutes of life each.

And I’m also going to assume that you’re not in Hubei. If you are, ignore this and keep safe. But if you’re not–well, about 80% of reported deaths are from near Wuhan, so that takes us down to my prior–that nCov is right now costing the average healthy person not in Wuhan roughly 1 minute of life in expected value.

On the other hand, what’s the cost of our reaction as a society?  Well, one place to look is stock markets, which are down around 20%.  You’ll get similar results if you look at US stocks, foreign stocks, oil, or basically anything else.  And to be clear, that’s not 20% of GDP; that’s 20% of the net present economic value of the entire future that we’ve burned to the ground fighting nCov.  Even if you think nCov will eventually spread to infect 10% of the world, given the age distributions of its impact and its mortality rate the cost of just letting is spread is likely to be around 0.1% of the world–more than two orders of magnitude lower than the cost we’re on track to pay fighting it.

That’s where my prior comes from.

What follows is a lot of attempts that I’ve seen to argue that no, we should still be freaking the fuck out, and my responses to them.

Arguments

Maybe Cases are Underreported

Yeah, they probably are! But how underreported?

Sure, maybe I’m off by a factor of 10–and my prior should instead be about 10 minutes (the time it takes you to read this piece). But it can’t be that much farther off.

I don’t know anyone who’s died of nCov. I don’t know anyone who’s gotten nCov, and in fact I think I only know one person who knows one person who’s gotten it. That would imply an incidence rate of roughly 0.01%, or something roughly seven times the officially reported rates. And, not surprisingly, that person recently came from central China.

And underreporting is a double-edged sword: cases are likely way more underreported than deaths (because only sicker people bother going to the hospital), and so the true death rate is likely below the reported one.

It’ll Spread

Yeah, it probably will spread.

The numbers are a bit all over the place but nCov still seems to be spreading globally, though it may have tailed off in China, at least according to some numbers.

The first thing I’ll say here is: if and when nCov does end up spreading a lot, it might then make more sense to take drastic action. It might very well be correct to ignore it now and then make extreme decisions in a month.

But this brings us back to the death rate. Currently the healthy death rate is estimated to be a fraction of a percent for people below 50, even before filtering for healthy people. My guess is that the true healthy person death rate right now is probably below 0.10%. Which means that, even if everyone got nCov, I’d probably still only loose about a month of life in expectation–meaning that I shouldn’t be spending a month of my life avoiding it!

And that’s if it maximally spreads. Almost nothing maximally spreads; the worst things generally affect ~⅓ of the population, and we don’t yet have evidence this is in that category. In expectation it’s probably more like 10% of the population, bringing the expected time lost to something like a few days.

And note that the first counterargument–that maybe cases are underreported–works against this one. If it’s true then the death rate is probably another factor of 10 or so lower than claimed, the worst case scenario is a few days, and the expected time lost is like ten hours.

We Don’t Have It Because We’re Reacting

In some ways this is definitely true–we’re quarantining people who have it, which definitely makes sense.

But again I think there’s a limit to how far this goes. Two nights a week thousands of people descend on a three block stretch of Hong Kong, packing a hundred people each into tiny rooms where they breath on each other, sweat on each other, and make out; all just miles away from China. As far as I know, no one has gotten nCov from LKF.

And, realistically, what would happen at, for instance, a conference? If you think about the types of interactions people would have–especially given that people are likely to be washing hands instead of shaking hands–I’m guessing that there’s an expected value of a fraction of a single transmission; given mortality rates, probably something less than an hour of life lost per participant.  Which isn’t to say we definitely shouldn’t cancel conferences–the cost of doing so isn’t super high.

Hospitals Will Fill Up

The newest incarnation of fear from nCov is the following set of claims:

  1. Eventually, half the world’s population is going to get nCov.
  2. The death rate is currently ~0.50%
  3. (2) is only true because of hospitals. But in a month a billion people will have it and hospitals will be overflowing; and the healthy person death rate without a hospital is 10%.
  4. Thus, 5% of the world’s healthy population will die from nCov.

On its face this is plausible, though it makes a number of claims I weakly disagree with. I’m pretty sure it’s wrong. But even more strongly, I’m pretty sure that even the people making the claim don’t really, truly believe it. Not that they’re lying, so much as that it’s an expression of fear rather than a rational position that’s been fully thought out.

Why do I think this? Because a lot of these people are damn smart, and if they really did think the above was true, then it’s pretty clear what you should do.

See, we already have an nCov vaccine, if you’re willing to give enough for it. And if you really think the mortality rate is 0.50% now but will be 5% in a month, and that you’re fairly likely to get nCov, then you should be willing to. But whenever I suggest this it’s met with abject horror; not what you’d expect for a strategy that would save someone 4.5% of their life.  And even if you think actually trying to get nCov is too extreme, this really does imply that you shouldn’t be at all trying to avoid getting it for now.

The Fatality Rate Is Higher

Some claim that the fatality rate is really higher than is claimed. I think these claims all fall apart when you look into them more, at least for healthy people.

One often cited source uses the Diamond Princess cruise, a ship that had an nCov outbreak, as a data set. The abstract, which has been cited a lot, says:

Adjusting for delay from confirmation-to-death, we estimated case and infection fatality ratios (CFR, IFR) for COVID-19 on the Diamond Princess ship as 2.3% (0.75%–5.3%) and 1.2% (0.38–2.7%). Comparing deaths onboard with expected deaths based on naive CFR estimates using China data, we estimate IFR and CFR in China to be 0.5% (95% CI: 0.2–1.2%) and 1.1% (95% CI: 0.3–2.4%) respectively.

This was a bit higher than I had previously heard. Later in the article, they give estimated fatality rates by age:

Well that’s interesting; this source sometimes cited for high fatality rates still finds only 0.20% for people under 40. Or at least that’s what nCFR says, which is their attempt to estimate expected deaths from the data. What if we look at the raw data?

Oops.

There Are Long-Term Effects of Surviving nCov

Most of the claims that nCov lingers on in survivors looks at studies of SARS.  And I do think that this is a real worry!  But I find the presented data pretty uncompelling.

For one thing, SARS was about 10x as bad as nCov is per person; it’s going to be pretty hard to read into nCov long-term effects from that.  But for another, there are significant issues with the studies.  For instance this one pre-filters the list of SARS survivors for the 25% who reported long-term effects, and then compares them to the general population, finding that…. they have long-term effects.  The control group there really should be taking a sample of people, filtering for the 25% who report feeling the worst, and then just comparing to those 25%.

There might be real things going on here but I also think there’s a bit of an isolated demand for rigor.  People aren’t looking at the negative effects of shutting down society for a few months–people losing their jobs, for instance–and asking whether there are long-term effects of that on health (I bet there are!).

 

What Do I think?

I don’t know exactly what I think! But my rough sense is some combination of the following.

How would I think about this?

I would probably take two different approaches here and compare them.

Shut Up and Multiply

If you just do a good-faith effort at estimating risk, what does that imply you should do?

Well, if you think the death rate is ~0.10% for healthy people then you should be willing to sacrifice about one month to go from 100% of getting nCov to 0%. That’s an upper bound.

Right now, your odds of getting it seem to be something around 0.01%, so you should be willing to sacrifice about an hour to prevent it. That means that it might make sense to wash your hands, and pretty much nothing else is worth bothering with.

Now, if the infection rate keeps going up, eventually you should be willing to sacrifice more. Realistically, if it starts spreading to a significant fraction of the population, you might be able to take moderately extreme actions to decrease your odds of getting it by 10% (e.g. from 15% to 5%). So that would make it worth a few days of your time. That makes it seem like, even if it spreads massively, it’s probably not worth avoiding the outdoors, but that washing your hands and trying to avoid touching your face are likely worth it. Wearing masks is probably worth it if it doesn’t bother you but nowhere close if it decreases your productivity at all.

Stocking up on food seems maybe worth it but just in case the rest of the world freaks out and makes it hard for you to later get food.

Anecdotes and Common Sense

Right now, I know one person who knows one person who got nCov from traveling to China, and is going to be fine. That makes me feel pretty good about my above estimates: washing my hands regularly seems like a fair price to pay for that amount of risk, and anything else seems like an overreaction.

If it massively spreads–getting the flu sucks! It happened to me this year, and I lost half my productivity for a week. So spending a few days to prevent that seems reasonable to me–worth changing your habits if it gets above 10% of the world infected but not worth e.g. working from home.

On the other hand, half the people I know’s lives are on hold right now because of nCov preparations.

Other Measures

Temperature checks seem pretty reasonable to me–they are a good way to decrease transmission without disrupting most peoples’ lives. Closing borders seems more questionable, though at least having temperature checks on the borders makes sense. Either masks are a scourge or I’m a wimp, or maybe both; I tried wearing one and it was clear my productivity was going to be in the gutter with it. Washing your hands seems low cost and generally effective. Working from home seems high cost and effective. Going to Wuhan seems like a bad idea, though I honestly think most of China is fine.

The Costs

I think the costs to the nCov preparations the world is making is really high.  Some examples:

  1. Markets are down about 20% on nCov.  That’s not 20% of GDP, it’s 20% of the net present value of the economic future of the world.  If you use a 5% annual economic time-decay that translates to losing roughly the next 4 years of economic production.  That’s probably more than the impact of nCov if we just let the entire world get it.
  2. This hits the whole population: yeah it’s primarily the rich losing the wealth, but it’s the worse-off who are probably hit the hardest: losing a few months of salary/school/etc. is really hard on a lot of people!
  3. My guess is that’s why China is slowly giving up on having the country shut down: not just because cases are starting to decrease there but because it quickly becomes clear that it’s just not sustainable to keep the world shut down for months.
  4. Shutting the world down for a month is much worse than just losing a months’ economic growth, because the world is still consuming during that month; similarly companies still have expenses but are losing all their profits, and families still have to eat but are losing their wages.

In fact I think this 20% estimate isn’t totally crazy.

If you shut the world down for a few months, a lot of business will go under.  A lot of people will lose their jobs, a lot of people will starve in poor countries, and we very well might see the kind of snowball effects we saw in the 2008 recession.  Betting markets are already implying a 57% chance of a recession in 2020, up from around 20% before nCov; that’s also in line with the market move.  If anything I think that small businesses not captured by public market indexes will do worse than large public ones because they have less runway, and that poor countries contributing to a low fraction of world GDP will do worse because they can less afford a few months’ isolation.

These costs could probably be lessened with a well-targeted economic stimulus package.  But we’re probably on pace to lose around $20T of GDP in 2020 from nCOV; a stimulus of that size would be about 30 times the size of the 2009 US stimulus package.  I think the would probably could do it but debts would balloon globally, and realistically I don’t think governments are going to do anything nearly that big.

The Tradeoff

Putting two of these together:

Right now the benefit to worrying about nCov is close to 0.  But if it does spread a lot, then eventually you might have a 10% chance of avoiding it when you otherwise would have gotten it.  So these preparations might save the world something like 0.05% of the population’s DALYs.

On the other hand, the cost of the preparations is huge.  Markets are estimating it to be something like 20% of the net present value of the economic future of the world.  This is going to flow through not just to economics but to people; the 2008 recession wrought massive damage to everyone’s lives, and to our potential as a civilization.  So that would imply a cost of about 40 times the benefit, and the world is in fact freaking out way too much right now.

 

What’s Going On With The World?

In my worldview, everyone else is crazy. I basically do think that.

I basically think the world only has two settings–laughing it off, or freaking the fuck out. As soon as nCov spread outside of China, the rest of the world decided it was time for door number two.

It’s not shocking, but it’s also not productive. People’s attempts to think about how to nCov seem really, really bad to me. The best of them try to find out what the expected mortality is, but never even bother tracing that through to the cost of interventions and what’s worth it before deciding that it’s Freak Out Time. The worst of them just say “something is worse than someone thought, fuck everyone who isn’t freaking the fuck out”. The median confuses GDP with stock market moves without realizing there’s a factor of ~20 difference between them. I haven’t seen a single attempt to go through the fermi estimates I did above of the expected costs of nCov, the impact of interventions, and the cost of interventions. Maybe they’re happening somewhere–but my non-work interactions with people, online and in real life, have been roughly 90% nCov for the last month. I have to scroll for pages on Facebook to see a post about anything else! Every conference I know of has been canceled, and the first question anyone asks me when they realize I’m in Hong Kong is how bad things are. (Fun fact–Hong Kong got its freaking out of its system a few weeks ago, got bored of it, and is slowly starting to get back to work. Also basically no one here has nCov.)

And generally it’s pretty clear from talking to people about this that the first thing they do is decide it’s Really Bad and they should start Freaking Out, way before they’ve even considered doing some fermi estimates. And by the time they do start looking at data, they already know what conclusion they’re going to come to; by then they have too much ego on the line to seriously consider the possibility that it’s not that big of a deal, all things considered.

And this is all really sad, because as a society we’ll face potential obstacles time after time, and we have to be able to respond proportionately. If we have only two modes, we’ll end up Freaking The Fuck Out every year and then when it finally does matter–when the fate of the world really is at stake–we’ll just see yet another round of Think Pieces and santimonious I-told-you-so’s.

An EA Addendum

I think there’s one more piece of this that bothers me.

The advantage of freaking out is clear–it probably has some small chance of saving your life. What’s the cost?

Well, the cost is that the world descends a little bit further into chaos. GDP crashes, the odds of a global depression increase, xenophobia rises as people become terrified of those foreigners and their germs, jobs are lost which will have a permanent negative impact on productivity, and the world resigns itself to treating future incidents with a sledgehammer rather than a scalpel.

I think the flow through effects to the future generally penalize overreacting here, and so there’s a bit of a potential conflict between self and utility, with freaking out being more selfish. I would have hoped that EA would see through that.

But on top of that, I think that freaking out probably does a better job of saving your life than it does of saving your utility or impact. The negative impacts of freaking out probably won’t kill you, even if they do turn out to be large. Instead they’ll just disrupt your life, potentially permanently; not all of the jobs and friendships and mental fortitude lost to the nCov response are coming back.

Every day some people’s lives end, even if they won’t actually die for decades. I think it’s easy to end up sacrificing what matters about your life–your happiness, and your impact–in order to stave off death; sacrificing upside for certainty. I think people generally err too far in that direction, but for us it’s not close, because it’s likely that all of our impact is in the tails.

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