We need to stop the lockdowns

published

2020-03-24

The CDC says "In the coming months, most of the U.S. population will be exposed to this virus" (https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html). "A panel of experts at the University of California, San Francisco, predicted that between 40 and 70% of Americans could become infected within the next 18 months" (https://www.businessinsider.com/coronavirus-150-million-americans-may-get-infected-2020-3?op=1). The lockdowns are not going to stop or contain the virus, they are only slowing it down. Slowing it down increases the chance that we'll have better drug treatments, gives us some time to increase hospital capacity, and spreads the load on hospitals over a longer period of time, preventing them from becoming overwhelmed. This last benefit is known as flattening the curve, and this is the primary justification for the lockdowns, the other two are not assumed to be as significant.

You've probably seen the cartoon diagram of how flattening the curve works. This diagram doesn't show how long the curve would have to be flattened to stay under hospital capacity. Researcher say it would require "roughly two months on and one month off—until a vaccine is available, which will take at least 18 months (if it works at all)" (https://www.technologyreview.com/s/615370/coronavirus-pandemic-social-distancing-18-months/).

How many lives can we potentially save during this 18 month period? There are many variables that we don't yet know accurately, so it's hard to say precisely, but we can try to estimate it. On March 5th, the assistant secretary for health at HHS said "The best estimates now of the overall mortality rate for COVID-19 is somewhere between 0.1% and 1%" (https://www.youtube.com/watch?v=ElDa--a_hso). This is called the infection fatality rate (IFR), which is significantly lower than the case fatality rate (CFR) because many infections go undetected and don't become cases. Since this estimate is based on current figures, it is likely to go up if hospitals are overwhelmed. To estimate how much, we use the fact that about half of critical patients in China died, which means it's likely that hospital care saved the other half (http://www.cidrap.umn.edu/news-perspective/2020/02/study-72000-covid-19-patients-finds-23-death-rate). So without any hospital care, we can estimate that the IFR would rise to 0.2% to 2%. Therefore, the approximate difference between no hospital care and optimal hospital care is about the same as the IFR: 0.1% to 1%. Given that about half of the population is expected to be infected, the difference would be between 0.05% and 0.5%. These numbers are rough, but I think something rough is better than nothing at all for wrapping our heads around this.

The difference in mortality with a lockdown and without a lockdown is smaller than this because hospitals will still operate even without a lockdown and even with a lockdown, we might still see hospital overload. Furthermore, this will skew lower if high risk individuals are more careful and isolated so that they end up in the half of the population that doesn't get infected until after we have a vaccine. Also, voluntary self-isolation will naturally increase as infections rise, which will flatten the curve even without lockdowns. I don't think anyone knows how to accurately quantify these factors, but it looks like a small fraction of a percent of the population potentially being saved by lockdowns.

To put this in perspective, about 0.77% of the world's population would have died this year even without the coronavirus (https://en.wikipedia.org/wiki/Mortality_rate). Given that the coronavirus heavily skews towards the elderly and those with pre-existing conditions, statistically we aren't going to be saving many years of life. This is not to diminish the importance of saving lives, but it's important to consider when we have to weigh this against seriously harming the lives of others.

On the Diamond Princess, out of 3711 on board, 705 tested positive, and 8 died, all over 70 years old (https://abcnews.go.com/Health/early-mortality-rates-covid-19-misleading-experts/story?id=69477312). "More than 99% of Italy’s coronavirus fatalities were people who suffered from previous medical conditions" and "All of Italy’s victims under 40 have been males with serious existing medical conditions" (https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says).

Is this worth the cost of shutting down the world? How can we even attempt to quantify the harm caused by isolating billions of people and stopping huge fractions of the global economy?

Nobody has ever done an experiment like this with a complex global economy. Perhaps the closest thing to a test of shutting down whole economies was the attempt at communism in China, which led to the starvation of tens of millions (https://en.wikipedia.org/wiki/Great_Chinese_Famine). Nobody is qualified to predict what the consequences will be.

Consider that most people don't even donate to charities that can save a life for about $3000 worth of mosquito nets (https://www.businessinsider.com/the-worlds-best-charity-can-save-a-life-for-333706-and-thats-a-steal-2015-7?op=1). At that rate, the stock market losses from the economic shutdown have already cost billions of lives, which just illustrates how inconsistent the reaction is with our usual attitudes towards saving lives. Anyone who thinks they are saving lives by shutting down the economy would be better off going back to work and donating their earnings to charity.

And the personal consequences are even harder to fathom. This situation affects different people very differently. Some people have much higher risk from the virus than others. Some people are terrified of dying while others are ready to die. Some people can work from home while others have been made unemployed. Some people live with their loved ones while others live alone and are effectively being put into solitary confinement. Some people live in huge comfortable homes while others live in a cramped van. If you're lucky, a lockdown might just be a minor inconvenience, but for others it might be life destroying.

Lockdowns and economic devastation could cause an increase in suicides, and the increase could last long after the pandemic if there is a major global depression. How many elderly lives would we have to save to justify each additional suicide of a young person? It's not clear if we would be saving net life-years in the long term. Even if we could be sure that we were, that's not all that we care about.

The movie "I, Robot" illustrates what happens when you value saving lives above all else. In the story, humans create a superintelligent computer and program it with Asimov's three laws of robotics, the first of which reads "A robot may not injure a human being or, through inaction, allow a human being to come to harm." The inevitable logical conclusion was that a massive fleet of robot police must permanently confine all humans to their homes because leaving their homes exposed them to risk of harm. Sound familiar?

Even without a pandemic, every time we leave the house we increase the risk of harm and death to both ourselves and others. We are used to that and we accept it because we cannot eliminate all risks and it's senseless to ruin lives just to extend them.

Ultimately, can we really say that one person's access to hospital care outweighs 100 others' right to find love, earn a living, or enjoy dinner with friends? If you think hospital care trumps everything else, then should we also arrest people if they don't serve as nurses when there's a shortage? If the jails overflow with these "criminals", should we then begin executing them? Where is the line? Hospitals didn't even exist for the vast majority of human history; it's bizarre to witness the derangement they can cause.

We have principles of liberty that are supposed to prevent this kind of thing from happening. These principles are what protect us from turning into North Korea. It's shocking how quickly people can abandon such treasured principles with just a small dose of fear.

The sooner we can come to a rational reaction to this pandemic the better. Even without forced lockdowns, more people will voluntarily self-isolate as the infections spread, and higher risk groups will self-isolate more. Additionally, those who don't self-isolate will naturally take more precautions since everyone has a chance of being in the half of the population that doesn't get infected in the first wave. Those who do get infected will be predominantly those who chose to not self-isolate; they are taking their own chances.

Even if this argument doesn't convince you that lockdowns are harmful, I hope it will at least make you doubt that they are clearly beneficial. This is a complex situation involving epidemiology, economics, and moral philosophy with many unknowns. If you support a lockdown, then you are claiming that you are so confident in your opinion that you are willing to use authoritarian measures to impose your opinion on those who disagree with you. Or worse, that you just blindly support whatever your political leaders say, which is likely just a reflection of the psychology of a fearful mob.