Why COVID-19 prevention at the margin might be bad for most LWers

post by Kenoubi · 2020-05-10T00:19:02.472Z · score: 20 (10 votes) · LW · GW · 23 comments

I'm surprised and confused that no one else seems to be saying this, but I think the most extreme measures LWers have been talking about are much more likely to harm than help the world, and probably those LWers themselves. These are things like using copper tape on frequently touched surfaces or leaving packages outdoors for 2 days. Note that I'm not just saying these aren't worth it on net; I think doing them is actively harmful and you should stop.

EDITED: A number of people have pointed out concerns that even in those whose acute illness is not severe, there may be significant long-term negative health effects. I definitely wasn't adequately accounting for that. I'm not thrilled about the quality of evidence for this one way or the other, but that's perhaps to be expected for such a new disease. (There's no real way to know how COVID-19 survivors will be doing a year later, yet.) If these effects are much more common than death in the young and healthy, that would be a strong argument against my first point below, and against the overall conclusion of infection being beneficial.

I've edited the title slightly to account for these. I still think the rest of these points would point towards infection being less bad than otherwise, and that I've seen a striking lack of people commenting on the fact that some factors point in that direction. From this point on I've left the post as is.

Here are my assumptions (I think these are pretty consensus, not extreme weird views):

Conclusion: for people who are at low risk from COVID-19, and with low risk of spreading it to vulnerable populations (most LWers), and who are likely to be exposed to COVID-19 before being vaccinated against it anyway, having the disease as soon and in as safe a manner as possible so as to become immune to it would allow them to act as firewalls towards the disease and help vulnerable populations handle their current inability to safely interact with anyone who might infect them. The marginal effort to prevent oneself from getting COVID-19 isn't very effective, and to the extent that it is, protects one from getting the disease in a way that is probably safer than other ways of getting it.

I feel like the kid in The Emperor's New Clothes. Am I missing something?

23 comments

Comments sorted by top scores.

comment by Elizabeth (pktechgirl) · 2020-05-10T03:50:40.631Z · score: 28 (12 votes) · LW(p) · GW(p)
COVID-19 isn't that bad for the vast majority of young and otherwise healthy people (no worse than a bad flu).

I disagree with this and disagree that it is the consensus. The risk of serious sequelae is uncertain but potentially quite high- certainly much worse than the flu.

comment by Kenoubi · 2020-05-10T12:27:49.969Z · score: 10 (5 votes) · LW(p) · GW(p)

What's your evidence for this? I've seen claims to this effect but none with more credibility than "stuff people say on the Internet". (I'm not claiming better evidence doesn't exist, just that I haven't seen it yet.)

comment by Elizabeth (pktechgirl) · 2020-05-10T16:09:53.420Z · score: 17 (9 votes) · LW(p) · GW(p)

It's pretty wide ranging and I don't have time to find all of it, but off the top of my head

  • Jim's Question on long term effects [LW · GW]
  • The Diamond Princess Data (both initial death rates and the subsequent finding that half the asymptomatic cases had severe chest x-ray abnormalities)
  • A baseline expectation that it would be weird for something to be 10x worse in one population and not at all worse in another
comment by gbear605 · 2020-05-11T01:27:05.127Z · score: 4 (6 votes) · LW(p) · GW(p)

https://www.nytimes.com/2020/05/10/world/europe/coronavirus-italy-recovery.html is another source about it.

comment by Kenoubi · 2020-05-11T21:23:35.795Z · score: 3 (2 votes) · LW(p) · GW(p)

Thank you. I've revised my post in light of this.

comment by James_Miller · 2020-05-10T00:48:23.866Z · score: 18 (8 votes) · LW(p) · GW(p)

We are quickly learning how to treat the virus. Your grandparents chances of survival if they get COVID-19 are likely significantly higher if they get it in three months than today. As the virus is new to humans there are likely a lot of "low-hanging fruit" mutations for evolution to find, and the more people the virus is in the more chance it will stumble upon a mutation that makes it better at invading the cells of young people. We don't have a good estimate of how much long-term harm it does to people it doesn't kill. While if you get the virus this year, you will probably be safe from it next year, we don't know this for sure. We don't yet know if viral loads matter and it could be that the rapid initial exponential growth of the virus once it is in you means it really isn't important what your initial exposure is.

comment by Jonathan_Graehl · 2020-05-17T18:45:56.723Z · score: 2 (1 votes) · LW(p) · GW(p)

We do know viral loads matter.

I did support lockdown (incl stronger measures than what the US employed) early on hoping for improved treatment. It's barely improved. Nothing great is coming.

comment by Jay Molstad (jay-molstad) · 2020-05-10T21:06:31.212Z · score: 15 (8 votes) · LW(p) · GW(p)

I agree with many of your points, but have a few areas of disagreement that lead me to different conclusions:

  • There is considerable evidence of permanent lung damage, even in cases with no noticeable symptoms.
    • A one-time ten percent decrease in lung function will barely inconvenience a 20-year old. If the same person gets the same disease every year, (s)he won't live to 30.
    • The linked article quotes studies indicating potentially permanent lung damage in 77% to 95% of the test subjects.
  • The virus is mutating in ways that complicate the development of treatments and vaccines.
    • Each person infected has a tiny chance of becoming host to a problematic mutation, and passing it on.
    • The fewer infected people, the less of a problem this will be.
  • I do not know (at this time) whether we will have a vaccine in a year, or ever. AFAIK we've never created a vaccine for a respiratory coronavirus before (we have some veterinary vaccines for intestinal coronaviruses, but not respiratory ones). Some vaccine trials for the related SARS-1 coronavirus made the disease worse, not better.

To me, this adds up to "coronavirus is potentially much more serious than you think, even for young people, and it would be better to be very cautious until the uncertainties are resolved". I understand that the economy is doing very poorly, but I think the risks, at this time, militate against opening up. I strongly support measures to help those who've lost jobs because of the situation, though.

Note: This represents my opinion as of a particular time. As new information comes in, I expect to update my opinion accordingly.

comment by Kenoubi · 2020-05-11T21:25:11.333Z · score: 5 (4 votes) · LW(p) · GW(p)

Thank you for the Vox link. It was a lot more useful than anything I had previously seen about post-recovery health problems. I've revised my post in light of this.

comment by gbear605 · 2020-05-10T02:44:27.495Z · score: 11 (6 votes) · LW(p) · GW(p)

One difference is that people on LW are more likely than average to be able to almost-entirely self-isolate for long periods of time, given the slant towards work that is doable online, being relatively well-to-do, and are more able to fulfill their socialization needs digitally. Personally, I'm planning to avoid any public spaces, aside from short tasks like getting groceries (with a mask on), until I can get a vaccine. Of course not all of those apply to everyone, and the first two of those are examples of privilege, but it still explains people on LessWrong.

According to most predictions I've seen, the very worst of the peak where I am has hit at this point. Perhaps it could get worse in a resurgence after opening up, but it seems likely to go down from here. Therefore, I want to get infected as late in this curve as possible. This is doubly true since as James_Miller points out, the methods for treating the virus are getting much better over time.

In addition, I'm willing to take a lot of personal sacrifices to avoid the chance of having significant long term damage to my lungs. I've seen some evidence online that even young people who get it and don't seem to have negative symptoms still sustain lung damage that could take years off of their lifespans as well as lower long term quality of life.

Given all of that, it doesn't make personal sense to get exposed now. Looking at the cost/benefits to the general community, I think it also makes sense for me to not get exposed. If I get sick, it's an additional on local medical resources. My job is valuable enough that it wouldn't make sense for me to work in that category of jobs where I would be interacting with vulnerable communities, especially since I don't have any training as a healthcare worker.

comment by waveman · 2020-05-11T07:35:49.103Z · score: 6 (3 votes) · LW(p) · GW(p)

1. Most people tend to be right about 60% of the time when they feel fairly certain. If we apply this logic to your assumptions, the chance that they are all correct is approximately 0. Many things we were told about CV2 turned out to be wrong. That is a bit simplistic, but your analysis should take into account that your assumptions may not all be correct, and the consequences of this. For example what if young people have silent organ damage, as has been reported? What if immunity is limited, uncertain, or short-lived, as if often the case with corona viruses? Such errors could be very costly. In general the strategy of "pick the most likely scenario and bet erh farm on that one scenario" is a poor strategy.

2. By getting infected now, you are giving away much by way of option value. The value of getting immunized later, of having better treatment later, of having better and less costly methods of limiting infection, etc.

3. You are falling for the false dichotomy of lockdown versus uncontrolled pandemic. I suggest you have a close look at Taiwan, which has had approximately 1/700th the death rate of the US for example, and which did not have a lockdown. While Taiwan did make a fast start, Australia got down into the Taiwan range of active cases within about 5 weeks, and other countries could also do this with a brief lockdown.

Techniques used by Taiwan include contact tracing, strict controls on entrants to the country, enforcement of quarantine of cases, use of soft metrics like temperature and cold/fever symptoms with exclusion from schools/work/transport for the symptomatic, and others. They have selectively closed some high risk businesses like "hostess bars".

This problem of becoming fixated on one aspect of a problem or one one thing generally, "Einstellung" in German, is an important cognitive bias that is not talked about often enough IMHO. A common example these days is the notion that the USA has one problem, Donald Trump, and with him gone all would be right with the world again.

comment by Kenoubi · 2020-05-11T21:12:08.805Z · score: 2 (2 votes) · LW(p) · GW(p)
  1. Most people tend to be right about 60% of the time when they feel fairly certain. If we apply this logic to your assumptions, the chance that they are all correct is approximately 0.

I don't think there's any point in applying extreme outside views like this here. One of my premises is "Most LWers are young, otherwise healthy, and not living with anyone for whom those things aren't true." Maybe that's not true, but if so, wouldn't it be obvious to those people? Also, I think it's pretty obvious which of these points are cruxes and which are just a bit of additional support. (See my edit about long-term damage, though.)

  1. By getting infected now, you are giving away much by way of option value.

That's true, but if we assume a reasonable amount of immunity, you're also giving away a lot of option value by NOT getting infected now.

  1. You are falling for the false dichotomy of lockdown versus uncontrolled pandemic. I suggest you have a close look at Taiwan, which has had approximately 1/700th the death rate of the US for example, and which did not have a lockdown. While Taiwan did make a fast start, Australia got down into the Taiwan range of active cases within about 5 weeks, and other countries could also do this with a brief lockdown.

Techniques used by Taiwan include contact tracing, strict controls on entrants to the country, enforcement of quarantine of cases, use of soft metrics like temperature and cold/fever symptoms with exclusion from schools/work/transport for the symptomatic, and others. They have selectively closed some high risk businesses like "hostess bars".

I think this is orthogonal to my point, which was about individual decision-making, not setting societal policy. However, for the sake of argument:

I don't think Taiwan's (and South Korea's, and probably some other places') approach is feasible in the USA (I'm not sure about Europe). It requires extraordinarily high levels of voluntary compliance, or ignoring civil liberties and privacy, or both. Culturally, I don't think the USA's rate of voluntary compliance can be high enough, so the only way to make this work would be to force people to follow these policies. I don't think that's politically feasible, and I myself would find it difficult to support.

I do think getting to that point is what the medical authorities who recommended lockdowns had in mind. I don't think it's going to happen, though. If that's right, the USA will pay the costs of lockdowns (which are actually much higher if we lock down repeatedly and/or for a longer time because we aren't there yet), without ever getting most of the benefits.

But hey, let's hope I'm wrong.

comment by ESRogs · 2020-05-10T20:30:44.170Z · score: 5 (3 votes) · LW(p) · GW(p)
having the disease as soon and in as safe a manner as possible so as to become immune to it would allow them to act as firewalls towards the disease and help vulnerable populations

Note that preventing yourself from getting it also acts as a firewall.

If there are no long-term effects, then I'd think the ideal would be to get the virus and then not pass it to anyone else. So, following your argument, one might want to marginally increase their chance of getting it. But it seems hard to do that w/o also marginally increasing your chance of passing it to someone else.

You'd want to find a way to get a little bit of exposure for yourself, w/o exposing anyone else to you. So, if you live alone and are completely isolating from other people, maybe it would be a good idea to go ahead and lick all your delivery packages. (See also Robin Hanson's variolation proposal.)

But unless you can find a way to make the exposure profile asymmetric like this, marginally increasing your exposure doesn't seem net beneficial. (And that's even after assuming there are no harmful long-term effects and that one's personal risk is low enough not to matter.)

comment by Kenoubi · 2020-05-11T21:21:03.749Z · score: 3 (2 votes) · LW(p) · GW(p)

Technically as long as everyone else you expose to it has a similarly low risk profile and low likelihood of transitively passing it to anyone with a high risk profile, I think it would still be beneficial until herd immunity has already been reached. In practice, of course, that's incredibly hard to assess except for one's household members, and household exposure is probably high-dose. So I think I agree with your conclusion, but for slightly different reasons. (Maybe if everyone in your household licks the packages, it would still work? :P)

comment by Lukas_Gloor · 2020-05-10T14:05:01.797Z · score: 4 (3 votes) · LW(p) · GW(p)

I get the impression that you might be thinking about this in terms of a false dichotomy. It seems correct to me to note that much longer lockdowns are politically infeasible in large parts of the US, but this doesn't mean that most states will just let their entire population catch the virus. Maybe there'll be a second wave and then states that are similarly badly hit as New York and New Jersey will change their stance. Or maybe some states succeed at lessening the restrictions in a smart way, with masks and so on. Maybe the people are sufficiently afraid to catch the virus that they socially distance themselves of their own accord, even when businesses reopen.

Expert predictions say that there have been between 4.8M—28M infections in the US so far (80%) confidence interval. Those infections are responsible for 73k+ deaths so far, and predictions say the median number of deaths will be below 300k in the US (probably even below 200k but I think there was an upward trend in the latest survey, and some chance they're now between 200k and 300k).

I've been doing predicting as well and I agree with those predictions (I'm saying this because it can be justifiable to not always trust experts). Therefore I don't think it makes sense to assume you'll likely be exposed to the virus anyway. (The case for this is even stronger if you live in Germany or the UK; the upward trend in predictions about the US is a bit concerning.) For those who want to avoid low-ish but non-negligible risks of becoming sick for sometimes quite a long time, with a virus that in some instances can do do all kinds of strange and scary things that we don't fully understand yet (see also Elizabeth's comment above), it's good to have the advice available! (Of course, I'm not necessarily saying I endorse all of those pieces of advice.)

comment by Kenoubi · 2020-05-10T15:47:54.031Z · score: 3 (2 votes) · LW(p) · GW(p)

I don't think I'm thinking about it in terms of a false dichotomy. I tried to argue against what I think are the countermeasures that are the least likely to be helpful, not all countermeasures. The only strong stance I took (as far as I can see) is that the countermeasures are harmful even without considering their costs. In the real world, the costs are non-negligible.

I certainly don't think any state will just let their entire population catch the virus! Rather, I think that some people, due to job, lifestyle, and how dangerous the infection is likely to be to them (both in relative and absolute terms) are very likely to catch it sooner or later. The sooner those people have it, the more of them will recover from it while we're on lockdown (be it state- or self-imposed). I expect this to have a positive effect on the outcomes when lockdown is released. This can also be a self-selecting group to some extent - sure, you don't have to visit your grandparents, but wouldn't it be good (both for you and for them) to be able to? Similarly, immune people volunteering at or temporarily working for retirement homes might produce large gains for those living there.

I think the expert "predictions" about what is currently the case are reasonably accurate. I'm far less convinced about their predictions about the future - they were totally wrong about what things would be like now.

Certainly having the information on prevention available is useful - you might be a member of a vulnerable group! It just seems to me like the discussion on LW has been totally one-sided. The only person I've run into who could be described as rationalist-affiliated making points anything like these is Robin Hanson.

comment by Lukas_Gloor · 2020-05-10T16:44:32.153Z · score: 4 (3 votes) · LW(p) · GW(p)

Thanks for clarifying, that makes sense.

The only strong stance I took (as far as I can see) is that the countermeasures are harmful even without considering their costs.

I think your wording also kind of implied that a large fraction of the population is going to get the virus. Maybe you were primarily thinking of people with jobs that put them at risk, but I think even for those populations, expecting >50% of people with such jobs to get it is very much taking a strong stance. I was wondering if you'd think differently about your dislike of the LW emphasis on advice if you thought that the expert predictions were spot on.

Edit: But maybe that's just not the crux. Maybe you're not saying "you're going to get it sooner or later anyway" but rather "sooner or later, you're going to _decide_ that you're fine with probably getting it anyway."

And that's a stronger argument, I think. But I think a lot of people have probably thought about it, and I don't think keeping your probability of getting this virus <3% is extremely socially restrictive for the rest of how long it'll take. That said, I'm an extreme introvert so probably I don't quite factor in all the things that social people are missing.

comment by Jonathan_Graehl · 2020-05-17T18:49:43.584Z · score: 2 (1 votes) · LW(p) · GW(p)

20% of NYC had antibodies (per random pop sample). We can expect some small regions will make it out with sub 1% but I think there's a 90% chance at least 4% of the US will be antibody positive from exposure (with or without severe symptoms) after a year (and a 90% chance no more than 60% will). We'll apparently know more when the sedars-sinai antibody test is in wide use.

comment by Lukas_Gloor · 2020-05-17T20:14:13.630Z · score: 2 (1 votes) · LW(p) · GW(p)
We can expect some small regions will make it out with sub 1% but I think there's a 90% chance at least 4% of the US will be antibody positive from exposure (with or without severe symptoms) after a year

That sounds exactly right.

(and a 90% chance no more than 60% will)

I'd say you can go up to 97% for that.

I think the median will be somewhere around 10% of the US population very roughly and that's why I disagreed with the OP. It's unlikely I'd change my mind too drastically about those numbers, at least not in the near future and without new info, because I've spent a lot of time forecasting virus questions. :)

comment by Kenoubi · 2020-05-10T18:35:41.321Z · score: 2 (2 votes) · LW(p) · GW(p)

Trying to think about my own thinking here, this is what I came up with:

Most of the points I've listed are commonly believed and mentioned. However, in every case I can recall, it was not pointed out that they support infection (for some people, in some situations) being less bad / more good than it otherwise would be. I realize that what I wrote seems one-sided. In my defense, almost every other article I've read seems one-sided the other way.

This creates the impression for me that other people are treating their arguments as soldiers. They've already made up their minds that stamping out the virus as aggressively as possible is the right thing to do, so anything that would go against that needs to be suppressed. I don't think that's epistemically valid, and I think it's dangerous.

If I believe this, and if I assume that the people in question are rational other than this one blind spot, that would imply that the most expensive, least effective measures that they're taking are not worthwhile. I don't think the specific percentage of people who will eventually get infected is a crux of my argument. An individual's decision should IMO relate mainly to the chance that that individual will eventually get infected, for any reason including through choice.

Since I don't wish to treat my arguments as soldiers: the presence of a meaningful level of immunity very much IS a crux of my argument. If that isn't true, it erases pretty much all of my other points and means we need to stamp this thing out even if the cost of doing so is unbelievably high.

comment by Jonathan_Graehl · 2020-05-17T18:44:57.766Z · score: 3 (2 votes) · LW(p) · GW(p)

No, you're not missing anything. This should be obviously true to anyone who's observing. Hints of vaccine or treatment-magic-bullet just around the corner, anecdotal scary nonfatal effects, false hope of keeping sub-1% US-wide infected, etc have simply been upvoted in media for political reasons (esp. sunk cost fallacy, but it's complicated - no lockdown leader wants to be blamed for even one death caused by their decision to relax even partially). People have taken sides for/against lockdown and are digging in (there's also phony stuff on the open-up side - overexuberance for mostly-false-positive antibody results suggesting widespread infection so lower severity per infection).

comment by Kenoubi · 2020-05-18T14:38:24.613Z · score: 1 (1 votes) · LW(p) · GW(p)

That all matches my priors. What I was surprised by was the seeming onesidedness on LW. I'm slightly more optimistic about LWers at least trying to take all arguments on either side into account now - I half-expected this post to get downvoted into oblivion, and instead its score is mildly positive, and https://www.lesswrong.com/posts/5u5Het5Lkcb2nSWJp/162-benefits-of-coronavirus [LW · GW] also exists and its score is a bit more positive.

comment by romeostevensit · 2020-05-10T22:37:55.278Z · score: 3 (2 votes) · LW(p) · GW(p)

What changed my mind was the argument that it is good practice for a worse pandemic.