A few minutes ago the US Department of Labor announced the unsurprising news that payrolls had dropped by more than 20 million people in April, and the headline unemployment rate had risen to a catastrophic 14.7%, which is probably a few points lower than the reality because of quirks in the reporting. “We meant to do that,” insofar as these declines were the result of some combination of voluntary decisions to social distance and government policies, in each case to limit the casualties from Covid-19. In other words, we have chosen to take on massively more economic risk in order to reduce the mortality and morbidity risk from Covid-19.
News such as this and what we know from speaking with friends and neighbors naturally invites many questions. Among them: Do the government policies and individual practices to flatten the curve work? If so, in what respect do they work? And, finally, are they worth it?
As we wrote almost a month ago, it will be a long time before we are actually able to know which policies worked, and at what cost. Here are the criteria we proposed:
Ultimately, we will know three things in each applicable jurisdiction (itself a hot topic, of which a bit more below): (1) excess deaths (whether from the virus or the stress of the economy and confinement or from local collapse of the healthcare system) over the baseline experience, (2) excess morbidity and mental health problems, and (3) the decline in the jurisdiction’s GDP per capita against the baseline. Those three things in a given country or state will be the indicators of success or failure.
No matter the claims you read from competing media, politicians, and “experts,” we do not believe that we will be able to determine which policies most efficiently worked against these three values for quite some time.
There is, however, another way to think about the risk Covid-19 has added to American life: How does it compare to health risks within recent memory?
Through today, about 77,000 people have died of Covid-19 in the United States. Yes, the number might be somewhat higher or lower depending on how you count, but at that number we have lost roughly 23 people per 100,000 of population. Even if the total deaths this year quadruple in an awful second wave, we will have lost around 100 people per 100,000. (Neither of these figures are age-adjusted, which puts more weight on deaths of younger people and less on deaths of older people deaths, as most comparable data are.)
That still seems like a lot of dead people, and by recent standards it is. There is much tragedy in 77,000 incremental dead people, and vastly more in four times that number.
But how does the risk of Covid-19 compare to other risks with which we are familiar, and which we readily accept, or accepted?
See, for instance, this graph of age-adjusted mortality from cardiovascular disease in the United States. In 1960 we lost 559 people per 100,000 to cardiovascular disease, and as recently as 1990 we lost 322 people per 100,000. In 2017, that number was 165 per 100,000. In other words, if there had been no improvement in the treatment and prevention of cardiovascular disease since only 1990, in 2017 we would have lost an additional 157 people per 100,000, or more than 500,000 people.
Were you anxious about your risk of dying in 1990? If not, perhaps you shouldn’t be too afraid of Covid-19 this year.
Suppose we say that the deaths from Covid-19 this year will in fact quadruple, to about 100 per 100,000. Without adjusting for age, that probably overstates the Covid-19 death rate compared to cardiovascular disease. Even that many deaths from Covid-19 would be the equivalent of giving up the improvement in death rates from cardiovascular disease since only 2004. For one year!
Were you anxious about your risk of dying in 2004? Not particularly? Not enough to lose weight and strap on running shoes? With that framing, is the crushing poverty, which is increasingly looking long-term, from continued mandatory distancing too high a price for such a small relative benefit? If the numbers were presented this way, we believe that most Americans would say “no,” perhaps except for one thing.
One American does not kill another American by transmitting cardiovascular disease. But Americans do kill each other by transmitting Covid-19. We are obviously willing to risk killing strangers in the abstract, which we prove every time we drive too fast because we left the house too late. But nobody wants to kill their own mother or grandmother. The pain in that possibility is too great.
So, are we paying such an enormous price to avoid Covid-19 deaths, however few they are now likely to be compared to other health risks in recent memory, because we are personally afraid of the disease, or because we do not want to live with the guilt of killing a loved one?
Or, maybe, we humans just do a very poor job of thinking about risk. Never has that failing been more expensive.
13 Comments
You kill your mother first. Post pics. Let us know when the photos are up and public.
Well, I think you make my point, which is that people are more afraid of their complicity than they are of actual risk to themselves.
Anyone who has been in a standard nursing home in this country knows the truth about this. Nursing homes are not the idyllic places you see on TV sitcoms where the residents play horse shoes and checkers while being served lemonade. With very few exceptions they are warehouses of very old human bodies – the spirits and the personalities of the people have long since left. These bodes are just waiting to die. If the COVID didn’t do it, something else would in very near time. It is absurd to bankrupt the nation to give these bodies a few more days of s-called life
We can do both: just like we don’t need to molest every child or eldery missionary at the TSA. We can be selective about who we protect or quarantine: and let folks accept risk themselves. I’ll work the checkout counter on weekend shifts without a mask if that helps. I am not interested in living in a garbage bag because some commie democrat boyfriend unleashed a pandemic. Certainly not while they’re still breathing.
Must me nice to be so simple minded – you’re not troubled by the complexity and nuance of life.
Thank you for posting this article. FYI – I found you through InstaPundit. What is sorely lacking in this “crisis” are numbers that make sense and are given in context. We see headlines like CV counts are rising without understanding the increase in testing. Or we see headlines that tie the lifting of shelter-in-place orders to increased death rates the day after.
The lack of understanding of relative risk is staggering and your article attempted to shine a little light on the subject in a rational and non-political manner. Thanks again! Kevin
we humans just do a very poor job of thinking about risk
Absolutely, yes. And again, I say, YES.
Fine essay, I’d make an additional point. We put people at risk not by “driving too fast”, but by driving, period. Yet we accept this risk imposed on others. We put even more people at risk by drinking, and we accept this risk imposed on others. All societies make decisions about how much risk one person is permitted to impose on others based on the value of the right of the person to freedom of action vs. the right of others to be free of externally-imposed risk. This is not, as is often asserted or implied, something new to the argument. The debate properly involves where that line is drawn, not whether it is drawn at all. It is patently absurd to suggest that putting anyone at any risk by one’s actions is inherently immoral, without regard to the context and circumstances.
Great point. It’s what I wanted to say, but couldn’t shape the words at that moment.
Real risk analysis involves both risk likelihood and risk impact. Normal human response is almost entirely to the impact, and not the likelihood (though sometimes vice versa). Driving is a certain level of likelihood, drunk driving is a higher level, drunk driving at high speed is another level of likelihood altogether. Driving has a certain level of impact, and increasing speed changes the impact (no pun intended). Good risk analysis asks the question, “At what point do likelihood and impact create unacceptable risk?”
And, of course, we keep getting told the likelihood is high (with Winnie The Flu), when we honestly don’t know those numbers.
And I guess using the “em” tag does weird things here. Sorry.
“But Americans do kill each other by transmitting Covid-19.”
I take issue with that statement. Kill is an active verb that assumes agency on the part of the killer. That is not the case with the Wuhan virus. It is what’s killing people. We are not killing each other. But that is now the rationale for the continuing house arrest of healthy people who pose no existential threat to their neighbors just by living their own lives.
People will still be exposed to the Wuhan virus, contract it and maybe get sick, and maybe die. There is little that can be done about that in spite of our best efforts. Holding strangers responsible for the safety of others is unreasonable by any objective standard and it is damaging to the social fabric. There is open hostility for anyone who dares think independently or refuses to live in fear. Zero risk as a goal or a benchmark is a child’s wish.
[…] Blueberry Town: Covid-19 and incremental risk in American life […]
Nice post. Got me thinking about comparable voluntary risks we take all the time. I thought about swimming pools & decided to look up some stats there. Didn’t realize that Dr. Phil had recently talked about drownings and is getting slammed for having his numbers off by 2 orders of magnitude. Nevertheless, it’s an reasonable comparison to make. With limited research, it looks like there are ~10 million residential pools in the US and ~1,750 residential pool deaths per year (50% of all drownings). So, you have roughly 17.5 deaths per year per 100,000 pools. Granted, more than 1 person will use each pool, so it’s not exactly the same as the per 100,000 people figure for COVID, but the pool also generated deaths every year. If going out in public during COVID is an unacceptable risk, then so is installing a pool.