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Imaginary Scramble Prologue: Diving far and deep (1/2)
I'm floating. I've been floating here for the longest time. Kinda lonely... So I call.
I call that name. Deep, deep... Far, far... I'm waiting... in the unknowable sea, inside the rainbow-colored dream... Ehehe.
Mash: Senpai, senpai.
[Fujimaru wakes up in a hallway]
Mash: What happened? You were spacing out in the middle of the hallway. Are you... having stomach problems?! Did you get an ulcer from anxiety for tomorrow's special mission?!
Fujimaru: No, I'm fine. / (I was daydreaming... nah, it's nothing)
Mash: You're fine? I sure hope so... After his power up in India, Nemo can now keep his Noble Phantasm constantly activated. Captain Nemo's Noble Phantasm, the almighty submarine Nautilus is now real. The vessel we cross the ocean with will be the most key element in our next operation: conquering the Atlantic Lostbelt. While it's necessary to check if the captain and the ship are functioning, we don't have all the equipment we need for the operation. Therefore, it was decided that all the Chaldea staff should be contributing to this last stage of development, while only you, me, the Captain and few Servants perform the test sail. We're calling it just a test, but it's actually quite the intense training program, with many more exercise besides just sailing into Imaginary Space. So I thought it would make for you to be nervous, considering we wouldn't be hearing from our usual bridge team in there.
Fujimaru: I'm more excited than nervous, really. / Looking forward to sailing with you, Mash.
Mash: Great. I'm also excited, to be honest. Still nervous, since we're going to the sea of Imaginary Numbers, but looking forward to board Captain Nemo's famed Nautilus! Oh, that reminds me, we finished selecting our boarding Servants. Have you heard who they are?
Fujimaru: Not yet. / I just heard we'd have 4.
Mash: The last 3 they selected were Osakabehime, Scathach-Skadi, and Xiang Yu.
Fujimaru: Can't find any patterns. / How do they choose these teams...?
Mash: We have relatively new Servants on our team, so I'm a bit worried if you can handle them well.
Fujimaru: By the way, it's just 3? / So I guess that...
Mash: Yes... We were going for a 4 Servant team with Abby, but Sion ultimately decided to take her out. The Trismegistus II provided with complicated suggestions today, so she struggled to interpret its content. Upon consulting all data, da Vinci decided that this was too intense for her, not to mention she's not compatible with the rest of the team. Sion had to agree and acknowledge that removing her from the team would also contribute to saving resources. I feel really sorry for Abby...
Fujimaru: Can't make da Vinci change her mind. / (I give her some pancakes later)
Mash: Sion is planning to pull an all-nighter, apparently to check the Trismegistus II's entropy. You should go to sleep early, if you plan to sleep today.
[Mash walks away]
Fujimaru: By the way, whose glare is this?
Fujimaru: I'm feeling glared by someone / we were just talking about.
[Abbigail is on the corner of the screen]
Fujimaru: Hey, little lady. / Can't sleep?
Abbigail: Master... I'm a bad girl... I'd be a burden for tomorrow's mission. I understand that... but... I just wanted to ride that iron nautilus ship with you...
Fujimaru: I'm just as sad as you are. / I promise I'll take you next time.
Abbigail: Really? You mean it?
Fujimaru: Of course!
Abbigail: I'm glad... but I won't be seeing you for a while. That's I'm sad about now...
Fujimaru: (I was weak...) / (She's really worried about me)
???: Yoo, Masutaa and Abigeiru. Not sleepin' tonight?
Abbigail: Oei? Why are you here this late?
Hokusai: Ye know Masutaa is sailing on the iron whale tomorrow, right? I was just thinkin' of drawin' them a treasure for good luck. On my way, i found a fellow Foorinaa being cranky. So now's yer chance. Wanna draw with me, Abigeiru?
Abbigail: Oh dear!? No, I mustn't, this is too much for a child like me.
Hokusai: It's all fine. Nothin' matches the taste of a kiddie's art. Besides, collaborative paintin' is real fun. Go pick yer pastel tools!
Abbigail: Sounds great! Can I? Do I have your permission, Master? A treasure ship... Master, I'd love to give you a good luck charm!
[Abbigail walks away]
Hokusai: Sorry for askin' this favor in this schedule, but ye think you can spend some time with us and still wake up in time for yer briefin'?
Fujimaru: I don't mind, you just did me a big favor here. / You're really good with kids.
Hokusai: Ahahahahaha. I feel much better now ye said that. And of course we are, Poppa and I are still kiddies on the inside. Plus, we Foorinaas are sorta extraordinary, right? We got this criminal record as threats to humanity for whatever reason. Me and Abigeiru got our difference, but we put'em aside to help each other out. Form a comradery with people hangin' in the same boat. Ye said ye'll come, so whatcha ye're waitin' for, Masutaa? If ye get bored along the way, I got ye some scrolls illustrated by yer's truly!
Fujimaru: Oei's picture scrolls...!? / I wanna see them!
[The scene cuts to Fujimaru running all the way to the dock]
Fujimaru: Sorry! / Am I late...?
da Vinci: Good morning, Ritsuka. Oh wow, you arrive at the exact second! To be precise, you're 0.008 seconds late, but I won't hold it against you! You know what you have to do, hop in!
Goredolf: I see you were in a hurry to get here, Fujimaru. Did you take your breakfast? Honestly, a good Master would have arrived 10 minutes before the schedule. It show you're still 7/10 as a Master. Devote yourself to your cause. Always be elegant.
Sion: Just like you were already at the dock one hour early, Mr. Goredolf? I agree arriving too tight on time is a problem, but I think so is arriving too early.
Goredolf: Ghh! Did you see me here, Sion?! N-no, I was just talking a walk. Just a walk, pal. I was most definitely not riddled with anxiety about the Nautilus test run. Listen, Fujimaru. The success of this test leads to us raid the Atlantic Lostbelt. I know you're thinking about fun times in the new Nautilus, and how cool submarines are and whatnot, but you must take this seriously. Stay alert, and leave while you're ahead! I hear that the Japanese are the most punctual and methodic population in the world! Prove it when it's time for you to return! That's all!
Fujimaru: Sir, yes, sir!
Holmes: What an honor it is to witness such a magnificent briefing. I like especially how brief it was. If it were a single word longer, I'd have to intrude to say "Excuse me sir, but your magnificent words of encouragement are delaying the operation". What a shame I didn't get my opportunity today.
Goredolf: Enough of your shoddy interjections. I may be an aristocrat but I'm also a pacifist!
Sion: That's our classic Chaldea party. Starting the day filled with wit and trust. I don't think I still need to give any more warnings.
da Vinci: Yeah. Our times together weren't all that long, but we still overcame many challenges to be here today.
Sion: I see. Together through the joy and the pain. Even the most bitter of enemies can work together on the same crew, right?
da Vinci: ...
Sion: That's why I thought this test was necessary. Captain and I are still new to Chaldea. Our relationship is not solid enough for me joke around if you. This test is an important mission to measure the limits of the Nautilus' mobility, but it also aims to deepen the relationship between Ritsuka and Captain. If possible, I want to make your relationship with him as solid as your relationship with da Vinci, if not more.
Goredolf: Hmpf. We already have one moron among us trusting the Captain more than we trust one of our own. He may be quiet, unsociable, and often handle guns, but for all his unsettling behavior, he's still one to trying cornering maneuvers while his tight submarine is on it's max acceleration. I can't not be his friend. I can say with confidence because I befriended a local kid on a safari for the exact same reasons... But, alas, our race was cancelled despite being the most important part of the test...
da Vinci: Ritsuka already feels familiar to Captain for me. I don't see this going wrong.
Sion: Really? You like Captain, Ritsuka? That's a seasoned Master for you, I'm getting jealous. Don't forget Captain is my Servant.
Holmes: How unusual for you to be jealous, Miss Sion. Are you feeling tired from working all night long?
Sion: No, what's really getting to me is that I'm unsure about the Servants we chose. I still can't understand why the Trismegistus II selected them specifically as "the optimal combination"...
Goredolf: Is that really safe to trust the machine's decision without interpreting it?
Sion: Yeah. You don't need to see all the maths inside a calculator to trust the anwer. Same concept here. It the Trismegistus II reports printed the "reasons" for everything, we would take half an year to decipher it. I'm not worried about the Trismegistus II, worried about the kind of environment that would demand this three's abilities. What kind of environment would Abbigail Williams be recommended to? And was leaving her out the right idea? What I'm unsure about is our personal decisions.
da Vinci: Yup, the main problem was that we had to limit ourselves to 3 members, and it's was really hard to take out any of the other 3. In any case, let's get ready for our next operation. It's up to you to consider it a breather, or research, or whatever you feel like this is.
[Everyone nods. Scene cuts to Fujimaru inside the Nautilus]
Nemo: And that's all I had to say. Our small talk time is over. Prepare to set off.
Fujimaru: I learned my lesson. / (It's so claustrophobic inside the submarine)
Nemo: Caring for mentally young Servants is an important job for a Master, but that's no excuse for being late. Being punctual is our most important duty. I'd never turn back for a sailor who was to late to board. Don't ever be late inside my ship.
Fujimaru: Yes, my captain!
Nemo: "My captain"... Ok, how are the arrangements, deputy commander?
Fujimaru: A real representative arrives one hour before the scheduled time... / Now I'm embarrassed, too...
Nemo: An eye for an eye. And Mash, stop clinging to Fujimaru like a live sharksucker and get to work, too.
Mash: Sharksu... No, I-I was just feeling sorry for Master for not getting enough sleep last night! Sorry, I mean, yes, my captain!
Nemo: Are all passengers ready?
Scathach-Skadi: Indeed. Due to lacking the Authority of a godess of ships, I shall obey the guidance of the sea god's son, looking very forward to our voyage.
Osakabehime: I won't ever be ready! But per Maschan's request, I'll show you all that I can be a shut-in in a submarine just as well as I can be a shut-in in a bedroom!
Xiang Yu: ...
Fujimaru: Huh, Xiang Yu is nervous?
Xiang Yu: Incorrect. All is moving according to my regular calculations. I was merely reminiscing on the lovely image of my wife rolling on the floor in frustration after her relentless requests to accompany us ended rejected.
Fujimaru: She tried so hard. / (Xiang Yu's head is in the clouds...)
Xiang Yu: This shall be no obstacle to carrying out thy orders. My bellwether, and captain, I recommend setting off posthaste.
Nemo: Excellent answer. We will. [The engines start revving] Assault Landing Submarine "Nautilus" speaking. Sion from dock, report the results of the final pressure hull check. Over.
Sion: Sion from Novum Chaldea speaking. There's not a single scratch on the hull, of course. How are you feeling, Captain? When I summoned you I promise I'd do everything to provide you with the ship you deserve. Did I fulfill my promise?
Nemo: You sure did. I can't thank you enough, Sion from Novum Chaldea. I don't have a single complaint about this vessel. It's as comfortably tense as the whiskers of a North Pacific right whale. So I'll waste no more words and set sail immediately. Over and out!
Sion: Yaaaay, you really got into it, Captain! I'm glad I could fulfill my promise. Have a nice maiden trip. The door to your room will stay locked tight while we wait for you. Count on me to not let anyone in! Fujimaru, take care of my Captain! You won't have any support from us, but I hope you take this as a rare, fresh experience!
Fujimaru: Of course. / I'll do my best.
Nemo: Vents unlocked! Starting cruise at regular speed!
[The Nautilus dives]
Part 2: The case for #FlattentheCurve – the significant costs and benefits of elimination and lockdown, including perspective on ‘long-term effects’ alarmism
Part 2: The case for #FlattentheCurve – the significant costs and benefits of elimination and lockdown, including perspective on ‘long-term effects’ alarmismsubmitted by HomerQuotingHomer to CoronavirusDownunder
In the first post of 'The case for #FlattentheCurve' I dedicated some time to the question of:
“Are we being successful; by what standard?”This question is a much better question than making arguments from a position of “who’s right and wrong?” (i.e. generally how the Sweden debate is framed). We should be looking to optimise our strategy and using this frame we could still improve our approaches even if we were to believe we are the best in the world.
I also pointed out that we should bring some perspective to the issue of COVID-19 mortality as compared to background mortality. We should recognise that there is an inherent need for public policy to weigh up the “value of a life” and the “quality of life” alongside many other measures of public good – personal freedoms, economic outcomes, education, social cohesion, etc.
Put plainly, a human life cannot be “priceless” otherwise we would attempt to take no risks and counter-productively shorten our own lives (and certainly destroy our happiness and prosperity). If we were to pretend that human lives are priceless and seek to protect them “at all costs” then we would degrade our ability sustain overall public health and good (given limited resources). For example:
The Pharmaceutical Benefits Advisory Committee rejects 69 per cent of anti-cancer drugs because they are not cost-effective.So, there is obviously a need to consider whether the Australia’s strategy for COVID-19 is balanced. I think everyone will understand this is worthwhile thing to assess. Unfortunately, it is largely ignored in the daily cycle of cases and deaths. Even worse, the topic can become a point scoring exercise over narrow data-points.
So, this post is intended to extend the discussion from fundamentals of the “skeptical position” (Part 1) to a view of whether the cost and benefit trade-off from our approach to SARS-CoV-2 / COVID-19 makes sense. As I asserted in Part 1:
“COVID-19 currently holds a very special place in [our willingness to pay to reduce the risk of death]. Governments, at least in Australasia, have had a sudden and massively increased willingness to incur unprecedented costs (not just financial expense) to reduce the risk of death. The appetite to do “whatever it takes” is not being applied simply to those who are truly at risk, but also to prevent any transmission to those who are not at much risk at all.”I am attempting to put that assertion to the test here in the best way that I can. I would very much welcome any constructive critique, discussion, or recommendations to improve the analysis. I have tried to layout the basis and data as simply as possible.
… Everyone right to go?
Framing the discussion
Per Part 1, there is a need to outline some key points to frame the discussion.
First, the IFR of COVID-19 is undergoing continual revision and is variously estimated by different authorities and studies, e.g. ~0.6% (WHO), and ~0.4% in the above study. The IFR is also likely to be variable by region and demographics. For example, a recently study puts the IFR at 0.3% for Icelanders:
Of the 1797 persons who had recovered from SARS-CoV-2 infection, 1107 of the 1215 who were tested (91.1%) were seropositive; antiviral antibody titers assayed by two pan-Ig assays increased during 2 months after diagnosis by qPCR and remained on a plateau for the remainder of the study. Of quarantined persons, 2.3% were seropositive; of those with unknown exposure, 0.3% were positive. We estimate that 0.9% of Icelanders were infected with SARS-CoV-2 and that the infection was fatal in 0.3%.The point of this is not to say that COVID-19 is not deadly. That would be ignoring the mortality that has already happened. However, we do need to recognise that the originally feared IFR (2.5%+) has not eventuated, and accordingly we should factor this into our weighing our response moving forward. We should also consider whether that fear drove us to take actions which were disproportionately costly to the threat posed.
Second, is that the mortality risks of COVID-19 within the general population are well established. The risk stratifies to the elderly and those with comorbidities.
The estimated IFR is close to zero for children and younger adults but rises exponentially with age, reaching 0.4% at age 55, 1.3% at age 65, 4.5% at age 75, and 15% at age 85. We find that differences in the age structure of the population and the age-specific prevalence of COVID-19 explain 90% of the geographical variation in population IFR. Consequently, protecting vulnerable age groups could substantially reduce the incidence of mortalityThis knowledge should influence the way we view the mortality impact of COVID-19 as compared to our expectations of mortality in normal settings. We know that as you get older your mortality increases and your life expectancy decreases. Utility and quality of life also tends to degrade, although the experience is different from individual to individual, so is difficult to weigh. We do know that as you enter aged-care facilities or palliative care you are probably nearing the end of your life (an unfortunate reality).
Thirdly, we are going to need to find a way to quantify “the benefits and costs” of our strategy. This means that we need to attribute some value to a “life year” for the analysis. From my research, Australia does not have a set standard for the value of a life year (or I couldn’t find it). So I have referred to the number used by Professor Tony Blakely and Professor Nick Wilson in their March 2020 analysis:
How much do we spend to try to reap this expected gain? Based on rules of thumb in the health sector (e.g. decisions on which medicines to approve and fund) – about $A100,000 per life year.Another good baseline is to look at our overall healthcare expenditure. According to this source:
In 2017–18, an estimated $185.4 billion was spent on health goods and services in Australia. This equates to an average of approximately $7,485 per person https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2017-18/contents/summaryIt is worth noting that includes personal, private insurance and non-government spending; with Federal and State combined spending at ~127 billion. Apparently, our spending is 7th highest in the OECD, so we can probably safely say that Australia’s appetite for spending to achieve better health outcomes is quite high.
Perspective on ‘long-term effects’ alarmism
One of the persistent points of concern is that of the potential “long-term” or chronic illnesses which could result from COVID-19. I expect it would be raised in reply to this post. You could make comparisons between this and the initial fears for the IFR; in the absence of good data (and responsible reporting) people will assume the worst possible or most extreme outcome is going to eventuate.
This video by a UK Cardiologist, shared by u/frawks24, does a really good job of putting quite a bit of the alarmism into perspective.
But, how to approach it in this analysis?
It is quite difficult because there simply is not a great deal of data or meta-analysis for ‘chronic illness or morbidity’ as being a widespread issue following COVID-19 recovery. Studies have commenced but they a long way from being completed. Some initial studies have been conducted but they demonstrate narrow effects or have even been debunked / retracted.
There are plenty of anecdotes, alarmist articles and social media posts, but nothing all that substantive so far in terms of systemic studies. Apparent illnesses following COVID-19 range from headaches and lethargy, all the way through the horrible burning pains for months on end. People are claiming all kinds of things, making comparisons to HIV, and generally conflating so called “mounting evidence” with actual evidence.
Governments which have seen widespread community transmission and recoveries are not (yet) raising the alarm over a sudden increase in other chronic illnesses popping up across their populations. Of note:
More to come on this later.
Establishing a range of ‘years of life’ saved
We need to start with a baseline of the years of life we expect we will have saved by pursuing the path we have.
In the first post I provided the example of Japan, which did not implement any general lockdown, has much greater community transmission, and an older population - yet has roughly one-third the death rate per million that we do in Australia. It achieved this specifically by protecting aged-care facilities and the vulnerable. Yet, we are told there is “only one option” for Australia…Anyway, that was the last post.
For the purpose of this analysis I am going to look at a range of potential mortality outcomes under alternative settings. This does not require any fancy or difficult calculations, because we can simply look at deaths per million from overseas.
Confirmed deaths per million - Sep'10 2020 Source: Our World in Data: https://ourworldindata.org/graphetotal-covid-cases-deaths-per-million?tab=table&year=latest&time=2019-12-31..2020-09-10
San Marino and Andorra are very small countries, so we will remove them from our analysis, and take the average of the remaining countries, as well as the world average, which gives:
Australia’s current population is ~25.5m. So, a proxy for lives saved to-date would be between 2,200 and 16,200 lives (just by scaling to the top and average death rates above). This estimate is actually a little bit higher than Federal CHO Brendan Murphy’s estimate of 14,000 avoided deaths.
Now, let us calculate the expected age-stratification of those deaths. I will apply the Australian mortality data, and to cross-check I have also selected Italy given that we have much lower transmission.
This provides the following results:
What we see here is that applying Italy’s mortality seems to output a greater burden on the young. So, if we use Italy as the assumption then our ‘life years” saved will be greater (i.e. we assume we are saving more life years). We can reference the Australian Life Tables as a guide to calculating an expected “numbers of years lost” for each age group, as follows:
So that gives us a range of ‘gross life years saved’ between ~27,000 and ~203,000 to-date, prior to any adjustments we need to make.
Excess mortality and adjusting for real-world observations
You will hopefully note that there are two material adjustments which are required:
Put another way, given that ~160,000 Australian’s die per annum would the ~16,200 lives saved (high-end) in this analysis be entirely in excess to that (i.e. they would not have died except for COVID-19)? Probably not. However, in the interests of keeping this simple (and conservative) I will assume that these are entirely excess deaths.
I will use the figure provided by Professor Blakely of $100,000 AUD per life year; if it is good enough for him, it is good enough for me.
This equates to ~$16bn. A pretty large number. No wonder elimination and lockdowns seemed like a great idea in March… even more so when doomsday mortality figures were being thrown around. Let us move on to the next section.
Mounting costs of massive government intervention
I’ll start this section by saying that it is obvious Victoria is creating all kinds of issues, not just for the people of Victoria who are enduring the longest and strictest lockdown in a western democracy, but for the national strategy.
Stepping back. In March, the Grattan Institute said ‘shutdown’ for 8 to 12 weeks (Endgame C) and wait for a vaccine if it was coming shortly. Unless of course the 8 to 12 week shutdown was not successful, in which case we should #FlattentheCurve (Endgame A). There are a few things they did not account for:
Recalling a quote from Part 1:
“Not surprisingly, willingness to pay to reduce the risk of death varies significantly with the type of death.”It bears repeating that COVID-19 seems to hold a special place on our willingness to do “whatever it takes”. So, we should reflect for a moment on whether the costs we are incurring to eliminate COVID-19 makes sense when compared to normal settings.
Let's look at the fiscal costs which have been incurred to-date. From a federal perspective, the Parliamentary Budget Office provides a good summary of the fiscal impact - noting that this is pre-extension of lockdown in Victoria.
“The analysis shows that the impact of COVID-19 may result in Commonwealth Government net debt in 2029–30 being between 14 and 24 per cent of GDP (up to $800 billion) higher than it would have been otherwise, as shown in the chart”In fact, the fiscal forecast has continued to deteriorate month-on-month since April, and is likely to continue to do so as the lockdown in Victoria is ongoing, international borders remain closed, and hard borders across the country prevent the recovery of key industries and economic drivers (tourism, migration, hospitality, etc.). State debts are also ballooning with Victoria’s predicament looking particularly dire right now. Given the $116bn hit is estimated for inner Melbourne alone, we can be pretty certain that the overall economic situation is looking pretty bad.
Scott Morrison’s ‘hibernate the economy’ concept which he touted at the outset of pandemic was a complete fallacy. I believe it was misleading. It is increasingly looking like the cost of COVID-19, including the drive to achieve elimination, could be well north of 1 trillion AUD when you combine lost GDP, as well as ballooning federal and state government debts.
Of course, we could not attribute all of this to our strategic choice of elimination. A recent paper by a New Zealand economist Dr Martin Lally, who analyses the cost/benefit of the New Zealand approach, makes the following point:
“Some of these GDP losses would have arisen without any government-imposed restrictions, because some people would have reduced their interactions with others anyway; for example, a foreigner electing not to make a trip to New Zealand that they would otherwise have made. Further losses would have arisen due to the additional actions of foreign governments; for example, foreign governments preventing their citizens from making foreign trips. Further losses would have arisen if the New Zealand government had followed merely a mitigation strategy. Further losses would have arisen from the New Zealand government instead following a suppression strategy. It is only the last of these losses that can be attributed to the New Zealand government choosing to lockdown rather than mitigate.”Dr Lally suggests 25% of New Zealand’s overall projected GDP impact as attributable to lockdown, and that is also prior to their second lockdown in Auckland.
It is right to claim that we would have seen significant impacts from COVID-19 even without lockdowns and hard borders in Australia. However, it is relatively indisputable that the forced closure businesses and industries by the government, and repeated lockdowns, is going to incur a very heavy cost on its own as well.
Even if we only assume that only 10% of the potential GDP impact of $800bn (ignoring state debts etc.) is due to lockdowns, hard borders, and other restrictions then we are looking at an $80bn cost. If we used 25% (Dr Lally’s number), we would have a range between $80bn to $200bn.
Using the 'lower-end' 80bn, this equates to ~$500K to ‘per life year saved’ under our high-end projection - which is 5 times higher than Professor Blakely’s value for a life year. At the low-end projection of life years saved it would be nearly $3m per life year. Given the Pharmaceutical Benefits Advisory Committee generally approve drugs and medicines which cost less than $50K per quality adjusted life year, we know that we’re in pretty rich territory in terms of our intervention costs so far.
Another way to put it in perspective is that the cost ‘per life’ (rather than life year) would be ~$5m. For this kind cost to make sense under normal settings, then every single death / life saved (in our high projection), of the ~16,000, would need to be a relatively young adult with 40 years of life ahead of them. We know that is not the case from the IFR data.
So, at this point we have some reasonable assumptions for what we could call our “core” benefits and costs. However, there are two ‘quality of life’ assumptions we should be attributing some values to and the magnitude of these numbers could swing things substantially:
Assuming some numbers for ‘long-term effects’
Earlier I provided some perspective on ‘long-term effects’; recognising that we should factor in some cost because we don’t yet know the extent of this (maybe it's real, maybe it's not). A calculation for long-term effects could also be a reasonable proxy for the often stated “fear of contagion” negative impacts if we had community transmission occurring.
So, for the purposes of this analysis let us use the following assumptions:
These are some staggering figures given that they are actually greater than ‘years of life saved’ we calculated earlier. Still, that is what people seem to be fearing so we will keep them for our purposes. The ‘benefits’ accrued by avoiding this, again using the $100,000 AUD figure, would be ~$39bn AUD.
This is a significant number and even if it is only a general assumption it is quite revealing of something else. The hyper-focus on deaths and preventing deaths (by government and media), with little value attributed to other aspects of life, misses what is a much larger part of the overall equation....
... which takes us to the next section.
Costs on people and society
Aside from GDP, there are other costs to our lives as a result of our strategy. Many of the things which are typically of value and importance to us have been temporarily taken away – such as the ability to see family who are interstate, travel, and larger social events. We know that people are being prevented or restricted from participating in some of the important milestones of their lives, such as funerals, weddings, birthdays, births, etc. These are all "worth something". As is the ability to exercise your own agency, work and just generally determine your own day.
I do not want to labour the point or make this too complex, so for the purposes of this analysis let us say that for every state, except Victoria, the balance is OK on a temporary basis (until the vaccine). The restrictions on life in these states are generally reasonable (unless you are unlucky), and as such the overall quality of life in 2020 is pretty much as it was in 2019.
Victoria is another story entirely. Some will have been devastated, some will be hanging in there, and others will be doing OK for now and just want it to be over. Every single one has had their lives impacted in some way though. For all intent and purposes, this is not a dissimilar calculation to the concept of ‘lingering effects’ in that Victorians have had some faculty they valued taken away temporarily. Even if you support the measures and you're a Victorian, there will have been some personal cost to you (unless you already lived inside 23 hours a day and never ventured outside your suburb).
Intuitively (and it has been reported as such), the costs of these measures will more greatly affect the younger age groups, who are more social and physically active. It still is not without cost to the elderly who are no doubt more isolated than ever before. So, if we assume that overall quality of life for Victorians over the last 6 months (or until 24 October) has only been reduced by a maximum of 10% in any age group (5% for the elderly) then we get something like the below.
Converting to monetary terms, in the same way as above, this equates to ~$25.4bn.
It’s not near the level of ‘long-term effects’ that we calculated above, but it is not insignificant (and it is probably underestimated given the severity of actual restrictions in Victoria).
This also does not include any of the costs associated with chronic illness or deaths which might be exacerbated by the lockdowns. For example, we know that Victoria has some inordinate number of elective surgeries that have been delayed. I am not going to try and calculate those here, but they are no doubt significant as well. If you do not believe that the above ‘quality of life’ figure is reasonable, then you might choose to use it as a proxy for exacerbated illnesses… or calculate your own.
Playing (or is it praying?) for a vaccine
So, we know the vaccine is close right? We bloody well hope it is given the state of things.
Let us assume we get it before end-March 2021 and it is 100% effective, which means that we have saved every life year we would have otherwise lost in the above analysis. Victoria comes out of lockdown on time and the nation re-opens by Christmas. We do not end up spending any more money intervening through lockdown measures by that point (it's all baked in).
Under this kind of described scenario, I should increase the ‘life years saved’ because presumably we will "save more lives" over the subsequent six months. In fact, in the interests of remaining conservative, I will double that benefit and only use the low-end fiscal costs.
What does the summary look like then?
It looks like we are well and truly underwater in terms of strategy; by some ~$30bn. Even if you make no allowance for the temporary ‘quality of life costs’ of lockdown in Victoria, but assume you will have avoided long-term effects, the equation still appears to be negative for our strategy.
How would we reconcile this given we were told this is the best way? Or the "only way" if you're in Victoria.
The elimination and lockdown strategy may have made sense at 8 to 12 weeks, but it's downside risks and costs were vastly underestimated. In the panic of March 2020, an “at all costs” approach probably made sense. If the mortality rate from COVID-19 was 2.5%, then it would have been justified. However, the mortality rate is simple is not that high in observation. Further to this, if the vaccine does not prove to be fully effective at preventing community transmission and mortality from COVID-19, then our claimed benefits can only get worse.
In fact, if you support elimination and lockdown at this point, a useful question worth asking is:
If you have managed to get through this ~5000 word analysis / argument, then I say to you “congratulations, but what are you doing with your life?”… :)
Really though, you may vehemently disagree on the assertions, calculations, or assumptions used here. You may agree in parts, but think some of these are underestimated or overestimated. Ultimately, this is to prompt discussion and I will correct any mistakes I've made or even happy to make reasoned adjustments.
Any feedback or genuine discussion is much appreciated.