The NY Times headline today reads:
U.S. Deaths Near 100,000, an Incalculable Loss
But if it’s “incalculable,” how did they calculate it?
In reality, we need more calculation, not less.
But how to do it?
From the Washington Post news section:
The government has spent decades studying what a life is worth. It hasn’t made a difference in the covid-19 crisis.
The U.S. government often studies the trade-off between cost and safety. But the White House has failed to release any analysis of the pandemic, which could offer clues to what’s ahead.
by Todd C. Frankel
May 23, 2020 at 3:29 p.m. PDT
When President Trump said in late March he didn’t think the economic devastation from stay-at-home orders was a good trade off for avoiding covid-19 deaths, tweeting, “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF,” economists across the country already were busy working on the exact kind of cost-benefit analysis implied by the president.
They reached a very different conclusion from Trump.
Exactly what “conclusion” has Trump reached? He seems to be reacting to this novel virus and novel situation by taking in new information and talking out loud about what might be the appropriate response given what we know now. This instills fear and loathing in millions who want the President to act like The Science is absolutely certain about exactly what to do and order them to do it, like a good democratic leader would, instead of an authoritarian like Trump who seems to act like he’s leading a national talk show as we try to make up our minds.
Economists at the University of Wyoming estimated the economic benefits from lives saved by efforts to “flatten the curve” outweighed the projected massive hit to the nation’s economy by a staggering $5.2 trillion. Another study by two University of Chicago economists estimated the savings from social distancing could be so huge, “it is difficult to think of any intervention with such large potential benefits to American citizens.”
In other words, the economists are saying, “the cure” doesn’t come at a cost at all when factoring in the economic value of the lives saved.
Uh … actually, it is expensive.
What these academics are doing — and what Trump’s tweet is getting at — is measuring how the extreme efforts to avoid covid-19 deaths compare to the devastating economic fallout. They do this by putting a price tag on the deaths avoided. It’s something the federal government does all the time when deciding whether to require carmakers to install new safety features or drugmakers to add new warning labels. And it’s required by law for big-ticket new regulations, such as road safety laws and pollution controls.
But this kind of approach has been missing from the debate about how to respond to the covid-19 pandemic, which has killed almost 100,000 Americans and fueled historic unemployment rates.
The calculation — known as Value of a Statistical Life or VSL — is the amount people are willing to spend to cut risk enough to save one life. The VSL at most federal agencies, developed over several decades, is about $10 million. If a new regulation is estimated to avoid one death a year, it can cost up to $10 million and still make economic sense.
At what age, though?
I looked at Wikipedia’s list of notable American deaths from Coronavirus and the mean age was 78 and the median age was 82. Only a tiny number of these people who had at one point in their lives made themselves prominent within their professions were still in their primes, and only a limited number were still earning much income.
The debate over letting the economy reopen or protecting more lives has become one of the many political fights dividing the nation. But a cost-benefit analysis using VSL, while far from perfect, would force policymakers to confront the reality of their decisions in a much more precise way. Without it, they are left to gut feelings, educated guesses or political arguments.
But is VSL the proper metric for a disease that slays primarily the aged and infirm? The feds have other, less crude measures such as Disability-Adjusted Life Years. From Wikipedia:
The DALY is becoming increasingly common in the field of public health and health impact assessment (HIA). It not only includes the potential years of life lost due to premature death, but also includes equivalent years of ‘healthy’ life lost by virtue of being in states of poor health or disability. In so doing, mortality and morbidity are combined into a single, common metric
For example, if somebody with Alzheimer’s is killed, they first estimate how many more years he was most likely to live, then deduct 2/3rds of those years on the grounds that having Alzheimer’s is only 1/3rd as good as being alive and healthy.
The British call their equivalent of DALY the Quality-Adjusted Life Years or QALY.
… But the most controversial aspect is whether older people should be assigned the same VSL as younger people.
As an older person, I say: of course not.
It’s sadder that Mozart died at 35 than that Beethoven died at 56, even though Beethoven’s late stuff is phenomenal and it’s sad to think of what we are missing from Beethoven not living his three score and ten. A while ago we discussed how Beethoven perhaps invented ragtime in his last piano sonata, and his Grosse Fuge of 1825 appears to have invented metal:
If Beethoven had lived to be 70, he probably would have invented Debussy’s impressionist music and Schoenberg’s twelve-tone, and swing. If he’d lived to be 80, he would have invented disco. 90, rap.
But, still, we are likely missing Mozart’s peak (Charles Murray’s Human Accomplishment lists creative individuals whose birthdate isn’t known by when they “flourished,” which Murray sets at age 40). The notion of Mozart and Beethoven both in Vienna competing from 1792 to 1826 (along with the elder Haydn [d. 1809] and the younger Schubert [d. 1828]) is staggering.
The Environmental Protection Agency in 2002 suggested a clean air rule would offer less of a benefit to senior citizens. Some academics agreed with the agency’s reasoning. But when critics decried it as a “senior discount,” it proved politically untenable.
But that’s silly. We need to try to estimate the Quality-Adjusted Life Years lost to this disease.
One analysis of Italian deaths, which have been highly skewed toward the elderly, probably because the residents of Northern Italy Alpine foothill small cities are among the healthiest people on earth, suggested that 10 years of life expectancy were lost per life lost. But that ignores the likelihood that those who died rather than recovered were likely frailer. Plus it ignores quality adjustments. Some of the dead likely had Alzheimer’s or other disabilities.
But … Americans and Britons both appear to be getting hit younger and harder than Continentals are by coronavirus. In John Ionannidis’s paper on the toll by age, the only American state that is skewed as much toward the old as the Continent is the best-educated US state Massachusetts.
On the other hand, it’s quite possible that the bigger danger in terms of QALYs is less immediate mortality from those who die right now than illness and early death in the future.
Say that the infection fatality rate is 1% (I hope it’s lower and that it can be lowered much further, but a 1% IFR makes for easy calculations to illustrate broad concepts) and that 5 QALYs are lost o average: that’s a loss of .05.
But, say that 10% of those who get infected and survive lose an average of 5 QALYs off their lives. That’s an order of magnitude greater QALY toll than that from immediate lethality.
Or say that only 1% of all survivors of the infection suffer major long term problems that take 5 QALYs of their lives. That toll would be the same as from the immediate deaths. (But then there’s the question of whether to use an interest rate to discount the Net Present Value of distress that would happen over the rest of the 21st Century? And if so, what interest rate?)
And there’s also the QALY loss from feeling really sick for one to six weeks. Say that 50% of those infected lose 0.05 QALY from being sick: that’s half as big of a toll as the immediate deaths.
In summary, while there is much to be learned about the toll of this disease, we really need to get serious about learning it and stop playing partisan games like this article does with an extremely serious subject.