In The Dugout: On Rhode Island’s Covid-19 Numbers ← A Town Run by a Triumvirate and a Union Achorn and the Constitution → Mario I don’t know if it’s the case, but there’s a strong possibility that no one has done more to try to figure out the total infection rate in the state than I have. Not trying to brag, but I’m desperate to find people I can check my numbers against, and very few people seem willing to share their guesses, if they are making them at all. So this was a nice video to watch, but please believe me when I say that I am quite confident that there is no way in hell that the total number of infected is 15%. Absolutely not. I’d put the total number as of July as being no higher than 8% at best, and even that would be extremely unlikely. The real number is probably somewhere around 3-4%. I can’t believe that we are back to questioning whether we should be pursuing a herd immunity strategy given the numbers we’ve seen. Obviously it comes down to my assumptions, but with probably close to 700 dead at 8%, even if you (correctly) assume that the death rate would decrease as the infection spreads, this is still thousands of extra, preventable deaths. Last I saw, even NYC only had an infection rate of 20% or so, which means that you would see roughly twice as many dead there above what they already have just to get up to herd immunity. And we still have no evidence that herd immunity would even work or, if it did, for how long it would last. This is not a serious idea. Lockdowns and social distancing have already proven to be a highly successful strategy, within the US and everywhere else. Justin Katz It’s fascinating how coming at a question from different angles leads to different conclusions. The first thing to note is that you’re only looking at one side of the ledger. Shutting everything down is not without consequence. Most obvious are the news reports we’re starting to see of evidence that suicide rates are up by a multiple of four or even 12. Add to those deaths overdoses and less-direct deaths related to stress. And THEN add to that all the non-death harm that is being done to people, especially the young. I’m not sure I’d characterize something as a “preventable death” when the solution is to sacrifice other people, even if those other people are fewer in number (which they might not be). Second, the numbers we’re considering are already skewed by our solution. A strong case can be made that going with the “shut it down” strategy rather than “protect the vulnerable” actually resulted in the deaths of so many people in nursing homes. Broadly promoted fear kept people from making good medical decisions. Attempting to protect the entire population led to shortages in supplies. And so on. Those were truly “preventable deaths,” and if so, the reaction of government played a role in killing those people. The third way a different approach to the problem makes a difference is in perspective. In my analysis Wednesday, I went with a low-ball estimate that infections are only 2.5 times cases. That would imply just over 3% of the population. The 10.7 possibility I show is pretty close to Mike Stenhouse’s number. Your 8% number would be about 6 times cases. Even at the 2.5, I don’t think it’s justifiable to lock everybody up when people under 60 years old have no less than a 99.5% chance of surviving if they catch the disease (and some won’t even catch it, of course). I guess the summary is that you can’t extrapolate the death rate under the decisions that we’ve made in order to gainsay an alternative approach. Mario The suicide number is just speculation, but one could point out that the suicide rate among people who weren’t already prone to it is much lower than among people who were considering it for other reasons. So, if you were inclined to, you could see suicide risk as a type of pre-existing condition, and the risk to the vast majority of us is much lower. So low, in fact, that you could argue that a lot of effort was wasted in trying to end the shutdown for everyone that could have been spent on targeted interventions in a small, but vulnerable population. That 2.5 number is quite good, I wouldn’t call it a low-ball estimate at all. My working number was something like 3 most of the time, and it looks like my final number would be just about 2. I think I meant to say something the day you posted it, but I get tired. I wouldn’t say that I’m looking at one side of the ledger, I’m just noting that that side is so big it has to dwarf any other consideration. Can you run the numbers and tell me that a herd immunity strategy wouldn’t have lead to at least 4000, 5000 extra deaths? And I don’t have the energy to put my thoughts in a coherent order, but I don’t see a way that nursing home deaths could have been prevented without preventing the disease from getting in at all. There is no treatment, that’s the only answer, and the only one there has ever been. I’ll be the first to say that the state failed in that regard, but there is no non-shutdown solution; you can’t just let the people that work there get it and expect to be able to save the patients. And you can’t prevent the employees from getting it while letting it go through their families unabated. I think a lot of those lives could have been saved, but keeping the disease from going around the general population has to be the first step, and, despite the failures, that part was successful. Justin Katz Well, if we’re discounting suicides that may have happened anyway, we have to ask how many of the COVID-19 fatalities involved people who would have died anyway, too. The fact is that the death rates for anybody under 60 are incredibly small. I’m much more optimistic about how much could have been done to protect nursing homes. I mean we’re not talking a standard situation. We’re balancing this against 17-20% unemployment and shutting down our economy, so the permissible price of an alternative is really, really high. So, pour a bunch of resources into additional personnel (National Guard type stuff) so people can be compensated to do two weeks in and two weeks off in the nursing home. That sort of thing. Mario Well, if we’re discounting suicides that may have happened anyway, we have to ask how many of the COVID-19 fatalities involved people who would have died anyway, too. That was my point, I didn’t want to make the argument, just contrast the relative callousness of saying that healthy people aren’t really at risk (even ignoring that the risks are people over 60, obesity, heart disease, etc, basically all highly common issues). It was just a bonus that a strategy to protect people at risk of suicide is a lot easier to accomplish, more likely to be successful, and targets a much smaller group. The suicide risk in the general population is exceedingly small, it can’t be more than a mere fraction of the COVID risk, and it’s not conventionally contagious. There’s just no comparison. I’ve addressed the “shutting down the economy” argument before. I just don’t think the shutdown is responsible for the bulk of the losses. I think it would be worthwhile even if it were all attributable, but I still don’t think it is. People acted to protect themselves, not having a shutdown wouldn’t have prevented it. They are still acting to protect themselves in fact, which is why ending the shutdown won’t just bring everything back. I’m not sure the alternate nursing home idea would have worked in retrospect, and I definitely don’t think that would have seemed like a viable option at the time. Not allowing COVID patients in group home settings and using more hospital resources would have been a good option, but that still requires the overall strategy to be containment (and I don’t quite blame them for screwing it up).