Would a more deadly virus have induced greater compliance with US lockdown restrictions?

post by rockthecasbah · 2020-12-20T18:24:40.433Z · LW · GW · 14 comments

This is a question post.

Relative to other pandemics and our initial fears, Covid has a low infection fatality rate (IFR). The IFR varies between societies depending on age and obesity distributions, such that it was more severe in the US than in India. Estimates of the US initial IFR are about .5% of infected persons.

Some American persons have not complied with social distancing guidelines and some states have refused to apply restrictions. Justifications vary. Some argue that the virus is not severe enough and we are over-preventing Covid (example 1, example 2). Others argue that lockdowns violate some moral/political right or whatever (example).

If the virus were more severe such that all IFR's were increased, would the US people have responded differently? At a 5% IFR with no change infectivity would a would a New Zealand path become likely?


answer by gbear605 · 2020-12-20T19:14:04.714Z · LW(p) · GW(p)

I don't know about a New Zealand path, but I do think that there would have been a much more significant response.

Consider that to a significant degree, populations seem to be fairly good at maintaining COVID-19 spread to a constant rate (ie. an R_t of around 1). This seems to be based on feedback mechanisms that operate through hearing news of the virus, through official channels, mainstream media, and social media. For instance, if you hear that the government is telling you not to go out and that the hospitals are full and that many people are dying, you will likely comply, but once those are working, you will become less cautious, causing the cycle to repeat.

I would suspect based on this that a more dangerous disease (either higher IFR or higher infectivity) would result in more cautious behavior, likely causing a flatter behavior rather than the peaks that we have had with COVID-19, but the response would be substantially the same. That said, if it was especially more dangerous (black death or smallpox levels), then a substantially different response might be possible.

answer by Stuart Anderson · 2020-12-21T06:18:15.970Z · LW(p) · GW(p)


comment by Walker Vargas · 2020-12-21T17:19:07.350Z · LW(p) · GW(p)

This isn't the flu. America has had 318,000 deaths so far. That's ~8.5 years worth of flu deaths. One of those years was from the last 26 days. If the world had America's almost 1 death per 1,000 people mortality rate, that would be about 7.8 million deaths. There are 1.7 million deaths globally. That's 6 million people spared! And frankly America is in at least a half banked lockdown.

If your country has almost no cases, that isn't something to complain about. Mass graves would mean that your country had failed to the point that they were having difficulty manages all of the corpses. This point will vary country to country, but it is a lot harder for a first world country to hit that point than you seem to think.

Replies from: stuart-anderson
comment by Stuart Anderson (stuart-anderson) · 2020-12-24T03:48:54.615Z · LW(p) · GW(p)


Replies from: Viliam
comment by Viliam · 2020-12-26T17:13:21.457Z · LW(p) · GW(p)

By contrast, smoking causes one out of every five deaths in America but I'm going to go out on a limb and say that you don't advocate for a proportionately greater response to smoking than you do to covid. Why is that?

Smoking is not contagious. And there are already responses against second-hand smoking, e.g. in many countries it is no longer allowed to smoke in restaurants. And yes, smokers complained about their freedoms a lot when the law was new.

There is no realistic way to protect the lives of me and my family from corona without pressuring other people to change their behavior. There is no way for you to credibly precommit not to spread the virus further in case you get it (because during the first few days, you won't know).

I am of the opinion that business as usual with minor measures to reduce the risk of vulnerable populations is the best approach.

Seems to me that minor measures do not reduce the risk of vulnerable populations much.

Also the timing of measures is critical. If you start applying them soon enough, you can stop the virus. If you start applying them too late, you can barely slow it down. Unfortunately, people who object against major measures usually also object against early measures, because early enough even minor measures seem unnecessarily big.

Replies from: stuart-anderson
comment by Stuart Anderson (stuart-anderson) · 2020-12-29T01:35:15.761Z · LW(p) · GW(p)


Replies from: Viliam
comment by Viliam · 2020-12-29T22:22:04.424Z · LW(p) · GW(p)

In case of STIs, knowingly infecting someone is considered a crime in some countries. (Which is another reason why many people avoid testing for STIs; so they are never left in the uncomfortable situation of having to give up sex.) And you can protect yourself from STIs by insisting that your partners take tests and behave responsibly. You don't get an STI by simply sitting in a train with an infected stranger.

If the government wants people at home and doing nothing that would be trivial to achieve: just pay them to do so.

I agree that this would be good. If we have enough money for bank bailouts, we should have more than enough to help people at the bottom. Unfortunately, politics doesn't work like this.

I'm willing to bet you have the masks, sanitiser, and Vit D to prove it.

Yes, all of the above. And more importantly, we have the privilege of staying at home (I can work from home, my wife still has a few months left of maternal leave) that other families do not. But this all (except the part of staying at home) only reduces the probability. There are doctors in hospitals, who have the proper education and professional equipment, who literally see people dying of covid so they are properly motivated... and they sometimes get infected, too.

The best protection against this kind of disease is to keep the reproduction rate so low that it most likely doesn't even get anywhere near you. All precautions you take, they mostly benefit the other guy who would otherwise get infected through you.

Covid is the flu.

On the scale from flu to ebola, it is much closer to flu. Numerically, covid kills as many people in one week as flu kills in one year. Also, killing is not the only bad thing that can happen to infected people. On the scale from flu to ebola, it is not obvious at which point what should be done; the choice is arbitrary.

If we could get enough people infected without unacceptable risk then we'd have herd immunity

I admit I never understood how exactly this is supposed to work. How much is "enough"? Would perhaps "fifty percent" be a reasonable value for a thought experiment?

So, you have a disease that is contagious like flu and fifty percent of population have it. From my perspective, it seems almost inevitable that everyone else gets it too, unless they completely isolate themselves from everyone. My family could do it, yeah -- unless one of us gets sick and needs help from a doctor... who is either part of the infected fifty percent so we just invited covid to our home, or is also isolating from everyone and won't see us. What about maybe 90% of people who cannot isolate the same way my family can?

If you decide to spread covid left and right just because you can, it's not really my family you put in risk. It's all the people less privileged than us, who need to leave their homes regularly in order to pay their bills, and now every time they leave their homes, the risk they return with covid is slightly increased. And their choice is to starve or watch their parents die.

I think the big picture of what you're saying is something like "if you want people to do something they don't want to, provide some incentives". I think this would be nice, but isn't necessary. For example, we do not provide incentives to people so that they don't murder others; we stick with disincentives only. Similar arguments about freedom could be made: some people are less afraid of death, some people have a higher survival chance in a dog-eat-dog world; perhaps the proper solution would be to pay them some kind of danegeld. But we don't.

Replies from: stuart-anderson
comment by Stuart Anderson (stuart-anderson) · 2020-12-31T17:35:57.026Z · LW(p) · GW(p)


Replies from: Viliam
comment by Viliam · 2020-12-31T21:55:45.821Z · LW(p) · GW(p)

If I understand your model of herd immunity correctly, it's like a binary split of population, where everyone in group A gets infected at the same time, and becomes healthy 14 days later, while group B spends 14 days (plus some safety margin) in shelters, so at the end both groups are healthy and the pandemic is over -- at least within the country.

I believe this is something that works as a mathematical model, but not in reality, because the differences between the map and territory are big enough to make it fall apart. Specifically, getting infected by covid is hard to do reliably. I don't remember the exact numbers, but when you had two people living in the same household and one of them got covid, there was a two-digit probability the other also got infected, and two-digit probability the other did not get infected. So in a zero-precaution situation (for group A), some people would get infected quickly, some in a month, some in two months... Also, it is possible to get infected by covid repeatedly -- I don't know what is the shortest interval, but there are many people who got infected both in spring and autumn 2020. Which means the group B would never be able to safely leave their shelters.

In Slovakia, covid in spring 2020 was managed very efficiently; best results in the entire Europe, if I remember correctly. We started in early March with face masks, when most experts (including most experts in Slovakia) were saying that masks don't work and we shouldn't buy them because doctors need them. Schools were closed, people were discouraged from using mass transit. When 0.017% of population got infected, we believed it was pretty bad ("oh my sweet summer child!"), and had one week of lockdown, which reduced the number of infections again. In June schools were opened again, for one month.

Result: only one week of lockdown, two months kids out of school, only 28 people died of covid. In my opinion, this is an experimental proof that impressive results can be achieved with relatively minor inconvenience -- as long as you do not hesitate and do the inconvenient thing quickly.

Then in autumn we fucked up everything, and got the same results as the rest of Europe. People returned from vacations abroad and immediately put their kids in schools, so since September the numbers started growing exponentially. Government ignored everything until end of October... then we got mandatory testing and lockdowns, but it was too late, 1% of population was infected, which made tracking logistically impossible, so by now we have about 2000 dead and lockdowns and the number of sick people keeps growing slowly.

I am posting these data to illustrate that I reject the dilemma "deaths or lockdown". If you do the smart thing, you can have minimum deaths and minimum lockdowns. If you do the stupid thing, you get lots of lockdowns and also lots of deaths.

Unfortunately, what stops us from doing the smart thing is... well, the people who fight hard against lockdowns in principle, including in situations where a short lockdown would be able to save the day. Because you can't make me and it's hopeless anyway and herd immunity and...

By the way,

In the context of covid a good measure is to buy one of those cheap pulse oximeters that clip on your finger. It takes five seconds to get a reading on O2 saturation that could be the difference between dying or not.

this information is only actionable if the hospitals still have some capacity left. Here, now, they don't.

Replies from: stuart-anderson
comment by Stuart Anderson (stuart-anderson) · 2021-01-01T13:32:40.306Z · LW(p) · GW(p)


Replies from: Viliam
comment by Viliam · 2021-01-01T16:28:38.781Z · LW(p) · GW(p)

There is the perverse relation that sooner lockdowns are more effective but less politically defensible. It can even backfire -- the good outcome of Slovakia in first wave was ironically used as "evidence" by people saying that covid is harmless or completely made up.

Good data is hard to get. First, too many things happen at the same time, it is hard to separate their effects. For example, I find it quite likely that closing schools makes a huge difference. It is one of those things Slovakia did immediately in spring, and refused to do in autumn -- but as they say, correlation is not causation; and you can't make people do controlled experiments. We used to believe at the beginning that kids are immune to covid. Now it seems more like they are asymptomatic but spread the virus... although not enough good data here either. If that is true, then lockdowns while schools are open (and school attendance is mandatory) are completely insane.

Second, people are busy. Like, in spring in Slovakia we pretty much knew who got infected by whom; and when a person died, it was possible to have a wide debate whether a person who had X and Y and covid should actually be counted as "killed by covid" or something else. Now, the hospitals are unable to take care of all the sick people, so no one bothers doing autopsies. Which leads to all kinds of complaints about methodology of calculating actual covid deaths. Okay, but...

...there is something wrong about the chain "too many dead to count properly" -> "dead not counted properly" -> "we do not have solid data" -> "so, maybe no one really died, or only few". Like, each step is defensible separately, but the entire chain definitely is not. Well, there are attempts to justify the entire chain, like attributing the excess deaths directly to lockdowns. Which doesn't quite explain why those people, presumably dying from poverty or depression, need so many ventilators. And the death toll of lockdowns is also ambivalent: more people dying from poverty and depression, but fewer by traffic accidents or flu. Another data point from Slovakia: during spring 2020, the total mortality was lower than during the same periods of previous years, i.e. the lockdowns were net life savers, at least in short term.

We do have an oximeter at home, still unpacked. I hope it stays that way.

Replies from: stuart-anderson


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comment by shminux · 2020-12-20T20:05:19.488Z · LW(p) · GW(p)

I'll just copy my comment on a Zvi's post:

the Covid-19 mortality rate is in the Goldilocks zone for allowing (bad) choices: 

  • If the mortality rate was 20+%, the choices of herd immunity, doing slow full-scale trials or doing nothing would not be on the table. It would be "let's try everything, anything, now, now, now!" and the vaccines made in February would have been produced and used before summer.
  • If the mortality rate was within an order of magnitude of the annual flu (0.1% or so), "do nothing" would have been the only choice

As it is, 0.5%-3% mortality rate is exactly the wrong number, since the right decision is not immediately obvious to everyone. And so we have the largest number of overall deaths and the largest damage to the economy possible from anything short of Oryx & Crake-style plague.

comment by rockthecasbah · 2020-12-27T00:57:37.915Z · LW(p) · GW(p)

Thank you all for answering. I generally concur that the IFR and response are related. The current feedback mechanism cannot be a coincidence.