Have the lockdowns been worth it?

post by Ben Pace (Benito), zhukeepa · 2020-10-12T23:35:14.835Z · score: 69 (28 votes) · LW · GW · 19 comments

This is a question post.

Contents

  Answers
    32 rockthecasbah
    22 mr-hire
    17 Jorge Velez
    13 SDM
    7 adamzerner
    6 Roko
None
19 comments

There’s been a lot of discussion about whether the pandemic lockdowns have been worth it. However, much of the reasoning that we’ve seen has been very motivated and un-nuanced in a way that for us has distorted a lot of the information.

So this is not a thread for taking a position on that. This is a thread for raising individual considerations that are relevant for thinking about the question “Have the pandemic lockdowns, in general, been worth it?”

Every answer to this thread should analyze a single belief that is relevant to whether pandemic lockdowns have been worth it, such as 

and provide relevant facts, data and information available about that factor.

Answers in this thread should not attempt to take a position on the overall question. Answers that take a position on the overall question will be deleted. This thread will live up to the virtue of holding off on proposing solutions [LW · GW].

(By ‘lockdown’ we refer to the thing that the US, UK and China have been doing, and what Sweden didn’t. There is naturally a lot of variation between countries, so this cannot have a canonical answer. If your consideration only applies to a small number of countries, that is fine.)

Answers

answer by rockthecasbah · 2020-10-13T02:46:09.395Z · score: 32 (17 votes) · LW(p) · GW(p)

The World Bank now forecasts an that COVID-19 will push 88 million to 115 million people into poverty in 2020. Extreme poverty in this case is defined as living on $1.90 or less per day. This is the first reversal in global poverty in decades taking us back 3 years. The change in trend is very sharp, see figure on page 5.

Many of the new poor are in the urban informal sector, where government redistribution is unlikely to help. The world bank report stresses government interventions in poor countries, but the informal sector is hard to reach (unregistered, less politically powerful, less organized).

Some of these mechanisms are intensified by lockdown policies. The World Bank's report scrupulously avoid that connection, but I suspect it is important. Disambiguating between rich-country lockdowns and poor country lockdowns is important.

Rich county lockdowns

Much of the effect comes from the contraction of global gdp of 5-8 percent. To the extent that lockdowns increase the GDP reduction, they contributed to the loss. The decisions of the wealthiest countries to lockdown contracted demand for tourism and manufactured goods. South-Asian exporters like India, Bangladesh and Indonesia come up repeatedly in the report. Also the new poor are more urban and formerly worked in tourism and manufacturing. This suggests that western consumer choices contributed to the increase. Probably a minority of total change, roughly.

Poor Country Lockdowns

Like in west, service workers have the least education. They got hit the hardest by lockdowns in counries like India and Ethiopia. Millions of Indian migrant workers had to migrate by foot in one crazy week in India. Documented events along indicate hundreds of deaths. Malnutrition likely the biggest killer. Kids have a lot if QALY's left.

Total effect?

Back of the envelope calculation. Let's assume the increase in poverty is 110 Million. It's unclear when he affect washes out over time, but let's say that it persists for 5 years. Currently 40% of the extreme poor in SSA and south Asia are 0-14. Over five years, the number of children who will go through the dangerous begining of life will be

110 x 10^6 x .4 x .33 = 15 x 10^6 additional children growing from 0 to 5 in extreme poverty.

A cursory look at OWID's child mortality and income plots suggests the change in child mortality is about 5%. So assume that an 5% additional counterfactual deaths. Assume 70 QALY's per child.

5 x 10^6 x .05 x 70 = 54 * 10^6 lost QALYs

Then also assume that lockdowns caused 1/4 of the increase in global poverty. Just a guess.

54 x 10^5 / 4 = 13 x 10^6 lost QALYs from lockdowns.

Given my high uncertainties, 1.3 to 130 QALY's is a 95% range.

This only includes from those people that crossed the magic line at $1.9 / day. Non-extreme poverty also increased.

answer by mr-hire · 2020-10-13T21:41:38.079Z · score: 22 (9 votes) · LW(p) · GW(p)

Claim: The decrease in driving during the lock down has significantly increased air quality (https://www.weforum.org/agenda/2020/04/coronavirus-covid19-air-pollution-enviroment-nature-lockdown) , saving many lives. Seeing as we're dealing with a respiratory disease, the increase in air quality has probably saved even more lives than it would otherwise.

 

comment by mr-hire · 2020-10-13T21:43:10.054Z · score: 5 (3 votes) · LW(p) · GW(p)

Related claim: the decrease in driving has reduced traffic fatalities, saving many more lives.

comment by Bucky · 2020-10-14T08:19:10.367Z · score: 4 (2 votes) · LW(p) · GW(p)

Global yearly deaths on roads are ~1.35mil (source).

In the US (well, 23 states) there was a 6% drop in the first 6 months of the year (source - see table halfway down). Naive approximation gives 81k lives saved globally if this turns out to be the yearly average.

Alternative calculation: In the max lockdown month(s) deaths were down ~40-70% (Various European countries, Turkey, UK). Assuming 2 months of severe lockdown this would give 124k lives saved.

answer by Annapurna (Jorge Velez) · 2020-10-16T02:48:21.985Z · score: 17 (6 votes) · LW(p) · GW(p)

Lock downs have led to significant decreases in seasonal influenza in the Southern Hemisphere.

Data from Australia

Data from New Zealand

answer by SDM · 2020-10-19T16:43:04.491Z · score: 13 (3 votes) · LW(p) · GW(p)

An important consideration is that the 'thing that the US, UK and China have been doing, and what Sweden didn’t', may not refer to anything. There are two meanings of 'lockdowns have not been worth it' - 'allow the natural herd immunity to happen and carry on as normal, accepting the direct health damage while saving the economy' or 'we shouldn't adopt legally mandatory measures to attempt to suppress the virus and instead adopt voluntary measures to attempt to suppress the virus'. The latter of these is the only correct way to interpret 'thing Sweden did that the other countries didn't'. The first of these is basically a thought-experiment, not a possible state of affairs, because people won't carry on as usual. So it can't be used for cost-benefit comparisons.

In terms of behaviour, there is far more similarity between what the US and Sweden 'did' than what the US and China 'did'. Tyler Cowen has written several articles emphasising exactly this point. What Sweden 'did' was an uncoordinated, voluntary attempt at the same policy that China, Germany, the UK and the US attempted with varying levels of seriousness - social distancing to reduce the R effectively below 1, suppressing the epidemic. This thread summarizes the 'voluntary suppression' that countries like Sweden ended up with. Tyler Cowen writes an article attempting to 'right the wrong question':

"The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection."

What exactly does the word “allow” mean in this context? Again the passivity is evident, as if humans should just line up in the proper order of virus exposure and submit to nature’s will. How about instead we channel our inner Ayn Rand and stress the role of human agency? Something like: “Herd immunity will come from a combination of exposure to the virus through natural infection and the widespread use of vaccines. Here are some ways to maximize the role of vaccines in that process.”

So, the question cannot be "should we allow the natural herd immunity to happen and carry on as normal, accepting the direct health damage while protecting the economy" - that is not actually a possible state of affairs given human behaviour. We can ask whether a better overall outcome is achieved with legally required measures to attempt suppression, rather than an uncoordinated attempt at suppression, but since people will not carry on as normal we can't ask 'has the economic/knock-on cost of lockdowns been worth the lives saved' without being very clear that the counterfactual may not be all that different.

The most important considerations have to be,

  • How long do we expect to have to wait for a vaccine or much more effective treatment? If not long, then any weaker suppression is 'akin to charging the hill and taking casualties two days before the end of World War I'. If a long time, then we must recognise that in e.g. the US given that a slow grind up to herd immunity through infection will eventually occur.
  • How does the economic and related damage vary for voluntary vs involuntary suppression? The example of Sweden compared to its neighbours is illustrative here.
  • How does the total number and spread of infections vary for voluntary vs involuntary suppression? You can't rerun history for a given country with vs without legally mandated suppression measures.
  • To what degree do weaker legally mandated measures earlier spare us from stronger legally mandated measures (or greater economic damage from voluntary behaviour change) later?
  • Edit: Tyler Cowen released another article arguing for a new consideration that I didn't list - what reference class to place Coronavirus in - 'external attack on the nation' or 'regular cause of death'. Since, for fairly clear rule-utilitarian/deontological reasons, governments should care more about defending their citizens from e.g. wars and terrorist attacks compared to random accidents that kill similar numbers of people. I also think this is a key disagreement between pro/anti-'lockdown' positions.

To emphasise this last point, although it falls under 'questioning the question', the focus on Lockdowns can be counterproductive when there are vastly more cost-effective measures that could have been attempted by countries like the UK that had very low caseloads through the summer - like funding enforcement and support for isolation and better contact tracing, mask enforcement, and keeping events outdoors. These may fall under some people's definition of 'lockdown' since some of them are legally mandatory social distancing, but their costs and benefits are wildly different from stay-at-home orders. Scepticism of 'Lockdowns' must be defined to be more specific.

comment by SDM · 2020-10-20T13:45:48.275Z · score: 1 (1 votes) · LW(p) · GW(p)
  • How long do we expect to have to wait for a vaccine or much more effective treatment? 

I can't think of a better source on this than the Good Judgment project's COVID-19 recovery dashboard.

  • How does the economic and related damage vary for voluntary vs involuntary suppression?

This is incredibly complicated and country-specific and dependent on all sorts of factors but maybe this graph from the Financial Times is a good place to start, it tells us how things have gone so far.

  • How does the total number and spread of infections vary for voluntary vs involuntary suppression? 

This is even harder than the previous question. 'All we can say for sure is "It was possible to get R<1 in Sweden in the spring with less stringent measures'. If you consider that Sweden suffered considerably more death than its comparable neighbours, then you can project that the initial surge in deaths in badly-hit locked down countries like the UK could have been much higher with voluntary measures, but how much higher is difficult to assess. I think that between-country comparisons are almost useless in these situations.

This is also where accounting for coronavirus deaths and debilitations comes into play. 'Anti-lockdown' arguments sometimes focus on the fact that even in badly-hit countries, the excess death figures have been in the rough range of +10%, (though with around 11 years of life lost). There are ways of describing this that make it seem 'not so bad' or 'not worth shutting the country down for', by e.g. comparing it to deaths from the other leading causes of death, like heart disease. This assumes there's a direct tradeoff where we can 'carry on as normal' while accepting those deaths and avoid the economic damage, but there is no such tradeoff to be made. There's just the choice as to which way you place the additional nudges of law and public messaging on top of a trajectory you're largely committed to by individual behaviour changes.

And if you do try to make the impossible, hypothetical 'tradeoff economy and lives' comparison between 'normal behaviour no matter what' and virus suppression, then the number of excess deaths to use for comparison isn't the number we in fact suffered, but far higher, given the IFR of 0.5-1%, it's on the order of +100% excess deaths (600,000 in the UK and 2 million in the US).

But again, such a comparison isn't useful, as it's not a policy that could be enacted or adopted, in fact it would probably require huge state coercion to force people to return to 'normal life'.

The basic point that it wouldn't be worth sacrificing everything to reduce excess deaths by 10% and save a million life-years is true, but that point is turned into a motte-and-bailey, where the motte is that there exists a level of damage at which a particular suppression measure (full lockdowns) is no longer worth it, and the bailey is that in all the situations we are in now most suppression measures are not worth it.

  • To what degree do weaker legally mandated measures earlier spare us from stronger legally mandated measures (or greater economic damage from voluntary behaviour change) later?

This raises the difficult question of how much to take into account panic over overwhelmed hospitals and rising cases. Tyler Cowen:

In that sense, as things stand, there is no “normal” to be found. An attempt to pursue it would most likely lead to panic over the numbers of cases and hospitalizations, and would almost certainly make a second lockdown more likely.

answer by adamzerner · 2020-10-13T21:21:49.206Z · score: 7 (7 votes) · LW(p) · GW(p)

If there was a strictly enforced lockdown for 2-4 weeks, it seems likely that:

  • The pandemic would dwindle down and end soon afterwards.
  • Many lives would be saved.
  • The economy would be able to re-open soon.
  • There wouldn't be any sort of large-scale panic.

A potential downside is setting a precedent for too much governmental power. I don't feel strongly about that but I suspect that the benefit of the government having such power outweighs the cost.

comment by William_S · 2020-10-13T23:32:54.092Z · score: 18 (10 votes) · LW(p) · GW(p)

I'm skeptical of this.

  • Wuhan needed 2 months on lockdown: https://en.wikipedia.org/wiki/COVID-19_pandemic_lockdown_in_Hubei
  • I'd expect that imposing China-style lockdowns in the West would require significant force and might end up causing a large-scale panic in and of itself.
  • I'd expect that any lockdown in the West wouldn't have been effective enough to stamp out 100% of cases, and if you don't eradicate it then you need ongoing measures or it will just flare up again later, so one strictly enforced lockdown wouldn't cut it. (Though maybe you could do very rigorous contact tracing and lock down just people who might have been in contact with cases, which could be less costly than full lockdown but probably still need significant enforcement).
answer by Roko · 2020-10-18T22:35:24.290Z · score: 6 (3 votes) · LW(p) · GW(p)

A spreadsheet model I made investigates the trade-off between lost life-years from covid-19 deaths versus lost life-years from reduced quality of life being locked down. You can make a copy of it and play with the various parameters.

The spreadsheet uses real data about the mortality risk from covid-19 and the population structure (life expectancy, population pyramid) for the USA.

With the parameters that I chose, lockdowns of 1.25 years destroy about 0.25 life-years per person on net.

https://docs.google.com/spreadsheets/d/1wBcHkt9i_4hGSXRrqurr82j-R_X03nyr_Eds6YLjkzc/

19 comments

Comments sorted by top scores.

comment by Stuart Anderson (stuart-anderson) · 2020-10-13T07:58:19.673Z · score: 28 (16 votes) · LW(p) · GW(p)

Probably not the answer you want: I don't get to see my father. He's 95 and cannot be expected to live much longer. I'm not the only one that loses out that way, plenty of people have had their time with people they care about reduced or removed.

I've done a lot of palliative care in my life. Quality beats quantity every time. People should be allowed to take the risk when it comes to trading a long time for a better time. Dying isn't the worst thing that can happen to you.

comment by Flakito · 2020-10-13T13:48:22.852Z · score: 6 (5 votes) · LW(p) · GW(p)

I agree (given the negative score of your comment) that this is a bit out of topic, or that it should be reframed to fit the given problematic.

But I wanted to extend my sympathies to you. I lost 2 amazing grand-parents during the first lockdown. Couldn't see them during the weeks they were ill. I was lucky to be able to get a few minutes with the coffins before they got cremated. That period was very rough for all of my family. Good luck, I hope you and your father get out of this safe and sound.

comment by Stuart Anderson (stuart-anderson) · 2020-10-14T04:42:26.291Z · score: 2 (2 votes) · LW(p) · GW(p)

It's a comment and not an answer for that reason. OP set narrow parameters for the conversation and I wanted to talk about it without those constraints. I didn't want to derail his conversation or piss him off without cause. 

Your sympathies are appreciated. 

This is a difficult time for a lot of people. It makes me consider what is actually important in life, which for me is family. I can lose many things that I can get back, but time with those I care about is limited (even with those that aren't aged). I am very conscious of the ticking clock, and it gnaws at me.

comment by Ben Pace (Benito) · 2020-10-14T04:34:13.573Z · score: 4 (3 votes) · LW(p) · GW(p)

(Just a note that this overall seems fairly fine as a comment and not an answer, which you did. Defying the rules in the comments isn't generally good, but I did appreciate reading this comment, it did help me think a bit more clearly about how the lockdown affects families.)

Also, I'm sorry you don't get to see your dad.

comment by ChristianKl · 2020-10-13T08:37:25.384Z · score: 4 (4 votes) · LW(p) · GW(p)

People should be allowed to take the risk when it comes to trading a long time for a better time. 

That risk is not the one motivating policy. If a person in a hospital or nursing home gets infected that's not only a risk for them but also for others in that place. 

comment by Stuart Anderson (stuart-anderson) · 2020-10-14T04:29:35.760Z · score: 4 (3 votes) · LW(p) · GW(p)

That's true, but it's little different to any other risk of illness in those populations. 

Prior to the covid panic a flu season wasn't treated this way, and provided I was asymptomatic (nb. not uninfected) I could walk into a ward full of ancient and immunocompromised people any time I liked. Old people dying from flu in a normal year was the direct product of social contacts. We didn't find that intolerable then, so why now?

I have a legitimate gripe about policy here as well as a purely emotive objection. Risk always exists, and the risk from covid doesn't justify the vast majority of what we have done (and certainly not what continues to be done).

comment by simon · 2020-10-13T00:47:37.187Z · score: 12 (8 votes) · LW(p) · GW(p)

By ‘lockdown’ we refer to the thing that the US, UK and China have been doing, and what Sweden and Italy didn’t

It seemed to me that Italy (after the initially hit areas were pretty much saturated) did a much harder lockdown than much of the US has been doing.

https://en.wikipedia.org/wiki/COVID-19_pandemic_lockdown_in_Italy

comment by Ben Pace (Benito) · 2020-10-13T01:17:41.312Z · score: 3 (2 votes) · LW(p) · GW(p)

Thx, have removed Italy.

comment by fraidykluofficer.com · 2020-10-16T16:22:03.445Z · score: 1 (1 votes) · LW(p) · GW(p)

By ‘lockdown’ we refer to the thing that the US, UK and China have been doing, and what Sweden didn’t.

 

You should also mention that the approach in the US is not uniform.

Although many states had blanket lockdowns, some were a patchwork of rules, with cities and counties mandating their own restrictions.

Also, a hard lockdown demonstrated to be very useful to flatten the curve in New York.

comment by Mere Jester · 2020-10-14T16:09:14.248Z · score: 8 (6 votes) · LW(p) · GW(p)

Sweden’s GDP fared worse than Norway’s and Finland’s, with greater loss of human life to boot. Denmark‘s economy has fared similar to Sweden, perhaps a bit worse even, but with much less loss of life.

It’s an evolving situation, but at this point, yes the lockdowns appear to have been worth it both for economic benefits and loss of life. Swedens strategy, thus far, has led to greater loss of life as well as no economic payoff.

comment by Ben Pace (Benito) · 2020-10-16T21:47:18.749Z · score: 2 (1 votes) · LW(p) · GW(p)

Moved to comments for taking a position on the overall question.

comment by alkexr · 2020-10-14T22:58:03.580Z · score: 4 (3 votes) · LW(p) · GW(p)

Lockdown incentivized politicians to establish positions on a lockdown, which has led to people having strong opinions about it. Even assuming no damage from further polarization, we have a roughly 50% chance of having an anti-lockdown government when the next pandemic hits, with a 10% chance of this new incentive being the deciding factor in not enacting a lockdown (or failing to implement it). Even if we assume that only 10% of the effects of this polarization is the result of the lockdown actually happening, with a 1% yearly chance of a pandemic more dangerous in expectation than the current one (~100M dead), we have ~1M QALYs lost, extrapolated worldwide over the next 10 years (while this effect is most pronounced).

Note: This is just a quick check to see that the effect is at least plausibly on an order of magnitude worth taking into consideration. I'm only somewhat confident that the effect isn't in the opposite direction. I'm only commenting (as opposed to answering) because primarily I expect weak points in my general process of speculation pointed out, not because I believe this to be well-informed enough to be useful.

comment by mattyy · 2020-10-16T13:07:39.700Z · score: 3 (2 votes) · LW(p) · GW(p)

If lockdown reduces the quality of life of the population by 10% (conservative estimate IMHO), then each month of lockdown for a country with a population of 60M corresponds to 60M * 0.1 = 6M months = 500k QALYs lost. The average number of life expectancy years lost for a death by COVID is estimated to be ~10 years so 50k COVID deaths ~= 500k QALYs lost. This means that in a population of 60M you need to expect to be saving 50k COVID deaths every single month of lockdown just to break even and this is using a conservative estimate of the reduction in quality of life and ignores all other factors such as the damage to the economy, impact on third world countries etc. Currently the worst hit country in the world is Peru with a death rate of ~0.1% of the population which would correspond to 60k deaths in a population of 60M. 60k deaths corresponds to a little over a month of lockdown reduced QALYs in this analysis.

comment by Kaj_Sotala · 2020-10-17T12:31:31.456Z · score: 4 (2 votes) · LW(p) · GW(p)

This seems to be only counting the direct QALYs lost from deaths, but not the grief and general disruption that the dead people's loved ones suffer? Nor the lowered quality of life to people who survive, but suffer long-term damage.

comment by fraidykluofficer.com · 2020-10-16T16:14:53.190Z · score: 1 (1 votes) · LW(p) · GW(p)

The average number of life expectancy years lost for a death by COVID is estimated to be ~10 years so 50k COVID deaths ~= 500k QALYs lost. 

 

Where did this number come from?

The life expectancy of a 65 years old man is 19 years.

Source: Life Expectancy Calculator

Now, you must consider that Peru managed to reduce their death rate to ~0.1% with a lockdown. The situation is terrible but it could have been worse -- if they didn't act.

So: your analysis is minimizing the cost of a death and failing to take into account the reduction in the number of deaths thanks to the lockdown.

comment by mattyy · 2020-10-16T17:48:00.971Z · score: 3 (2 votes) · LW(p) · GW(p)

Here's an example paper estimating the number of years of life expectancy lost is ~10 years.

https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdaa159/5901977

 

Note that in the UK for example the average age of COVID deaths is around 80 with many of those from care homes where their life expectancy is particularly low. This statistic makes the figure of ~10 years of life expectancy lost fairly plausible.

comment by rockthecasbah · 2020-10-23T13:42:29.077Z · score: 2 (2 votes) · LW(p) · GW(p)

Hanson's quite compelling post on the subject. https://www.overcomingbias.com/2020/10/we-are-over-preventing-covid.html

comment by Annapurna (jorge-velez) · 2020-10-16T02:52:26.103Z · score: 1 (1 votes) · LW(p) · GW(p)

I read this today and I found it a great resource. Not necessarily and answer to your question, but relevant. 

We all know the success of New Zealand's lock down. This case study explains in detail the steps New Zealand took at a national level to achieve its success. 

comment by fraidykluofficer.com · 2020-10-16T15:59:16.260Z · score: -9 (7 votes) · LW(p) · GW(p)

Have the lockdowns been worth it?

 

Are you serious?

Just remember what happened to Italy -- or New York -- before they implemented the lockdown.

People were dying like flies, they had to park trucks to collect bodies from hospitals.

The answer is a resounding yes.