Cost benefit analysis is important. But it's pretty clear the vast majority of excess deaths were covid related, because there's a very strong correlation between excess deaths and reported covid cases/deaths, even when you look at different states that had different peaks at different times, and no such correlation to other responses like different types of lockdowns. More delayed / indirect / long-term effects might be harder to measure though.
[1]https://www.axios.com/suicide-decreased-in-2020-pandemmic-me...
Looks like the CDC data is still preliminary? So I guess we'll have to wait and see what the actual number is.
EDIT: Looking through the charts on that link it does list a 14.8 for 2020 suicides but doesn't seem to have a source?
And it was much easier to commit suicide by lettin other people kill you too.
America is might be different, because it did not happened on their soil.
They — like my grandparents —considered themselves German because they were German.
The othering of Jews, that they are not really English/Spanish/German/Russian (to name a few examples), has been used to justify the persecution of Jews for the last 2000 years.
[1] https://www.marketwatch.com/story/deaths-of-despair-during-c...
Suicidal ideation does appear to have increased: https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm?s_cid=mm... But it doesn't correlate well to actual suicide rates. It's also quite possible that the emphasis on suicides has in fact raised awareness enough to prevent them. Or perhaps the way people are dealing with the stresses that lead to suicide has changed, resulting in that being expressed in some other way. Or a mix of all these factors.
Diagnostic delays are not caused by lockdowns. They are caused by an overwhelmed health care system or the fear of infection, both of which are caused by high incidence.
You also need to consider the damage that long covid possibly do over the next 30 years. If only 1% of the working age population that got infected suffers permanent disability, then the cost-benefit analysis will show that a low incidence strategy is clearly the better strategy.
Here are the statistics for Australia. They had a strict lockdown when cases where high.
https://www.abs.gov.au/statistics/health/causes-death/provis...
Arizona and Texas had weak lockdowns but high excess mortality.
It seems to help to be an island country or state though, or a geographically isolated region like South Korea or Alaska, as they can screen people coming into the country and there's not a lot of cross-pollination with tight border controls.
Remember that Florida has a significantly older population than California too. 2.1% of the population >85 years old vs 1.3%; 17.6% over 65 years old vs 10.6%. COVID deaths are very concentrated in the elderly. The CDC estimates that the 85+ age group has a 8700x higher chance an infection leading to death, and a 95x higher chance of infection leading to hospitalization, than the 5-17 age group. The article appears to be using non-age-adjusted excess deaths. So California and Florida being equal is a strong sign that California did significantly worse.
https://www.infoplease.com/us/census/florida/demographic-sta...
https://www.infoplease.com/us/census/california/demographic-...
https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investi...
Miami is a small city of 500,000 people.
https://en.wikipedia.org/wiki/List_of_metropolitan_statistic...
...with a density of 1004 people / sq. mi., compared to the NY metro area with a density of 5313 people / sq. mi..
https://en.wikipedia.org/wiki/Miami_metropolitan_area
https://en.wikipedia.org/wiki/New_York_metropolitan_area#com...
LA has more people (13.2 million) but appears to be less densely populated with 550 people per sq mile.
I didn’t follow California but I know Florida was offered as a place that not locking down worked.
I can look into it a little more. Florida has a lot of cases, and most came after the first wave. The same with Texas.
From the WSJ on July 16th, 2020, someone trying to promote the idea that it was only a Blue state problem:
=======•••
“Here are some real numbers to put things into context, and it's obvious the problem is certain incompetent blue state governors.
As of today:
Florida (population 23M) COVID deaths: 4,782
Texas (population 30M) COVID deaths: 3,561
New York (population 19M) Covid deaths: 25,014
New Jersey (population 9M) COVID deaths: 15,665”
=====
I recently compared these numbers in early March I believe
Florida: 31,523 for 26,741 additional deaths
New Jersey: 23,521 for 7856 additional deaths
New York: 48,410 for 23,396 additional deaths
Texas: 45,274 for 41,713 additional deaths
——————-
NY: 48,410/25,014 = 1.9 times more death
FL: 31,523/4,782 = 6.5 times more death
Florida and Texas lead in deaths after the first wave
March 6, 2021
Florida: 31,523 for 26,741 additional deaths
New Jersey: 23,521 for 7856 additional deaths
New York: 48,410 for 23,396 additional deaths
Texas: 45,274 for 41,713 additional deaths
Most lockdowns are not like that, for practical reasons. They are a random basket of restrictions that go into effect when the virus has already spread enough to cause great concern. At that point, it is hard to discern whether any of these restrictions cause a significant effect, much less a net benefit.
I gave a specific example of Melbourne and I was implying a specific timeframe when their lockdown went into effect. They went from having uncontrolled community spread, with tens of thousands of infections, to actually zero. They did it by having a very detailed plan, strict enforcement, high compliance, and an excellent testing regime. They also had clear goals and thresholds for lifting restrictions and communicated them to the public.
I generally agree that ineffective lockdowns mostly just slow down the spread. The spread picks up again exactly in proportion to restrictions being lifted. However, effective lockdowns have actually been able to eradicate the virus completely from whole areas: from Melbourne, from Victoria, from all of Australia, New Zealand, and several Asian countries. You need to be able to quarantine international travel and have high compliance. The places where the virus have been eradicated have to remain on high alert and remain extremely vigilant until they can roll out mass vaccination. I spent 10 months in Australia during the pandemic, 99% of the time stuck in the ACT. The extreme vigilance was contact tracing, social distancing, and some restrictions. There wasn't a mask wearing mandate, ever, because they never allowed uncontrolled community spread.
The US and European countries cannot meet those criteria, so they have the virus simmering until they can roll out massive vaccination. The US and Europe were too slow to take the pandemic seriously because their political leaders rolled in BS and denial for months and seeded their idiot followers with denialism. It's too late for them, and the only way out is vaccination. And yet, some idiots are still rolling out conspiracy theories about vaccination and want to f** that up, too. It's so disappointing.
Not sure what that did to the death rate.
Yes, and also the long term damage of lockdowns. Some children will be permanently harmed by the loss of education, and many people will be dealing with the effects of social isolation for quite a while.
That's a dangerous way to phrase it. People would delay the elective medical procedures due to covid, even without lockdown. Overwhelmed hospitals would enforce the same. The covid/lockdown split of excess deaths is very complicated in itself.
From that definition, I think a lot of the conclusions people are drawing would be substantially less surprising.
If we’re going to call a polite suggestion to stay home and a potential for small fines which were never or rarely levied a “lockdown” then it’s not surprising it had little impact.
Not necessarily. There is always the option of triaging COVID victims into palliative care (which can be very fast and administered even by non-specialist personnel) and away from intensive care. While that has never been official policy due to the political optics, there have been claims that it was done on a hospital-by-hospital basis in Italy and Sweden for elderly victims. If the voting public were clearly informed that it was an option they could choose as an alternative to lockdowns, it may well have seen significant support from the population.
And you can add Canada to that list of countries that have had to do that, by the way. Like the others you mention it’s been a forced decision due to the healthcare system becoming overwhelmed.
Here in Canada, excess deaths in 2020 for the 15 to 64 age range has been abnormally high, starting in March. Yet, unlike older age groups, the level of excess does not follow the pattern of reported COVID infections. That looks like deaths from lockdown and delayed medical care.
I personally know people who, for example, put off getting potential cancers checked out due to fear of covid. Similarly, I had to convince some people to go to the hospital for potentially serious non-covid symptoms who were afraid to do so because of covid.
1. covid-related mortality and morbidity would not make up for any drop in other excess deaths
2. short-term stops on all non-critical care would, on balance, result in a significant drop in excess deaths over longer-term stops on a smaller percentage of non-critical care
3. hospital systems and their staff would still be intact after such a large wave. This may sound crazy, but while we're trading anecdotes you may be surprised at how many ICU nurses considered quitting because of how hard the latest surge hit. These are the people who dictate how many "ICU beds" we have, not the physical beds themselves!
4. that we can make any kind of meaningful analytical statement on covid mortality vs excess mortality for a specific age group given the lack of reporting data on both. In particular, data from coroner's offices on covid deaths has a huge lag time at present. Looking at case counts only is a poor proxy given you have to model infection -> death/recovery/discharge lag times, geographical variations and healthcare capacity as well. The HMD link merely provides total counts and proportions with no additional commentary. You can find more specific discussions on the subject [1], but they don't cover demographic breakdowns over time and necessarily maintain a high degree of uncertainty.
I don't think it's controversial to say governmental policy here has been sub-optimal at best. But to say that one extreme approach or the other is what we ought to have done based on woefully incomplete data is a stretch too.
[1] https://health-infobase.canada.ca/covid-19/epidemiological-s...
No I'm not. Remember, what I said was: "So in many circumstances the hospitals would be overloaded for less total time and thus lead to less non-covid excess deaths."
Let's assume hospitals are severely overloaded, and are simply unable to treat COVID patients. The pedantic meaning of what I said will certainly be true: non-covid excess deaths will be less.
But the steel-manned version - less excess deaths in total - could still be true if lockdown drags on sufficiently long, and COVID-19 is sufficiently mild, and/or the marginal benefit of hospital care on survival is low enough.
> hospital systems and their staff would still be intact after such a large wave. This may sound crazy, but while we're trading anecdotes you may be surprised at how many ICU nurses considered quitting because of how hard the latest surge hit. These are the people who dictate how many "ICU beds" we have, not the physical beds themselves!
I'm well aware. Frankly, I suspect that problem is made worse by a long, dragged out, pandemic. People can often handle a short period of extreme stress better than they can handle a much longer period of high stress.
Even the pedantic interpretation does not necessarily hold. Though healthcare resources for life-threatening conditions are not strictly zero-sum, many of them would effectively be once covid overwhelms existing ICU and ED capacity. There are plenty of examples of personnel being pulled from e.g. cancer care or cardiology teams to help in covid wards. This directly translates to increased wait times for patients in those categories, much like would happen if people were putting off getting checked out themselves.
Moveover, hospitals and healthcare systems to not just "bounce back" after being severely overloaded. Staffing is already strained, and unless you ban clinicians from taking leave you would see cascading reductions in capacity after a couple months of being overloaded. This is to say nothing of the equipment shortages we had in the early days of the pandemic. Ultimately, patients who would require care for non-covid reasons would still suffer because of a massive backlog. Determining whether this backlog would be larger or more/less harmful when amortized compared to what we have now requires health economics analysis that I am certainly not qualified to perform.
> Frankly, I suspect that problem is made worse by a long, dragged out, pandemic. People can often handle a short period of extreme stress better than they can handle a much longer period of high stress.
This feels right to me too, though I've not the literature to verify it. However, it's an equally valid argument for strict short-term lockdowns a la New Zealand, Australia, Vietnam, Taiwan, etc. That is to say, it does not follow that not mitigating is the only reasonable strategy to prevent a dragged out pandemic.
A better (if grim) post-hoc analysis of Canada would be to compare the Atlantic provinces (less densely populated, strictly enforced interventions), the other smaller provinces (less densely populated, few interventions until recently) and the large provinces (densely populated, moderate but very poorly enforced interventions). My guess is that all three approaches will not be found to be equally effective.
In other words, the comparison isn't between how many people Covid-19 did kill and how many preventative measures did. It's between how many it would have killed and how many preventative measures did. While there's a lot of uncertainty in how many people Covid-19 would have killed, it's still certainly higher than the preventative measures.
India did have very strict lockdowns. Yet, very high rates of antibodies were also measured in some areas. Those strict lockdowns may have been successful in shielding some of the population from covid, and that part of the population is getting infected now. India is a very unequal society, with a very wide range of wealth present in the same areas.
In the US in some lockdown states there have been dramatic differences between infection rates between different socioeconomic levels. While in other states that were more open, that has tended to be less true.
It will be decades before we know the answer to this, if we ever do. Trying to justify these lockdowns while in the middle of the storm is fools errand. Heads are running way to hot and brains aren’t thinking clearly.
What we’ve done over the last year represents one of the largest uncontrolled public health experiments ever performed. The best part is all the billions caught up in the experiment never consented and many don’t even know it was an experiment.
Society has never, ever had a pandemic plan that includes what we’ve done over the 14 months.
Only through the passage of time, when all the people who instituted these policies are no longer with us and all the costs of these lockdowns will be laid bare, will history truly be able to judge our actions.
(Personally I think history will take an incredibly dim view of lockdowns and those who enacted them)
If they hadn’t locked down for the first wave, they probably would have reached herd immunity before the second, more devastating wave. This time, we have a vaccine, so we’ll probably avoid that, at least.
That’s a long-winded way of saying that it’s a safe bet that people will take a dim view of the 2020 lockdown in hindsight.
I looked at this a while back and, as far as I can tell, there were relatively limited interventions in the US. If you read beyond the headline of this link [1], for example, it doesn't seem as if you had much in the way of workplace closures and, in general the "non-pharmaceutical interventions" were for a fairly limited period of time. This study concludes they helped but the data is inconsistent and hard to interpret.
[1] https://www.cidrap.umn.edu/news-perspective/2007/08/study-sa...
"The researchers report that all the cities used at least one of the three main categories of NPIs, and 15 used all three at the same time. The most common combination was school closures and public gathering bans, used by 34 cities for a median of 4 weeks. All the cities except New York, Chicago, and New Haven (Conn.) closed their schools for some period of time; the median was 6 weeks."
It seems to me we should all state our positions now with the information we have available now, and let the future take care of itself.
I'll go a step further and actually suggest that authoritarian lockdown measure haven't done as much as they've been touted as doing. This is pretty easy to see by comparing states with less lockdown measures vs. ones that went full economy shutdown. Most of the "open" states aren't any worse off than the ones who went lockdown crazy and in some cases they're actually better off when you look at spread and death.
This could also indicate that states where Covid-19 had a bigger impact responded by enacting stronger mitigations. What makes you prefer your interpretation?
You can say that but there's no data that supports this at all.
NYC(not state) tops the charts for deaths per 100k. Notice how low FL is?
https://covid.cdc.gov/covid-data-tracker/#cases_deathsper100...
What you can easily notice is that strict lockdown measures don't seem to make any difference at all.
So, it would have killed 2-3x more people, max. There were strategies that were developed after the 1918 pandemic that probably would have saved more people than the lockdown at much lower cost, but they were ignored by the politicians. The basic idea was to focus all resources on protecting the vulnerable, and let the disease run its course quickly. Effectively protecting the vulnerable during extended lockdowns is extremely difficult, and the COVID lockdown was no exception.
Rounding, that's possibly another 1-2 million people. Those are big numbers!
Also one quibble in that most of the US did not have an extended lockdown. Here in GA ours lasted basically a month. As others have said, people voluntarily stayed home, in part because the exponents of letting the disease "run its course" tended to exhibit a level of comfort with millions of deaths that perhaps is not widely shared in the population.
You are very cavalier with somewhere around 1.1-1.6 million extra deaths, to date. That's your GOOD number?
If that's your anti-intervention argument, I'm unconvinced. Saving a million lives is worth a lot to me.
Where did that number come from?
I have read more like 8% (https://www.thelancet.com/article/S0140-6736(20)32009-2/full...)
So - 2 to 3x... Nope. 8 - 10x.
What I want to know is why you have constructed this belief and want to propagate it when it is refuted by a google search in 10 seconds flat?
Using more current antibody data, the CDC released updated estimates yesterday [0] that there have been ~115 million actual COVID infections in the US. That makes the 2x-3x number pretty reasonable (especially since herd immunity is supposed to kick in around 70%).
[0] https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
I had no real reaction to the first one and a day of increased fatigue so far with the second.
Anecdotally, many more people are having stronger reactions to the second.
The "what ifs" get harder to calculate.
I see this line of reasoning a lot, even in mainstream media here in Sweden, but it seems flawed to me. As I see it diagnostic delays and delayed elective care is caused by a lack of lockdown or other stringent decease control measures. It’s when hospitals are overrun by people infected with SARS-CoV-2 that they have to delay other care. This happens due to rapid spread of the virus, which happens when lockdown is not imposed.
What’s the argument for the parents opposite line of reasoning?
In 2019 more than 800 000 screenings were done (with 8288 cancer cases discovered in the country that year) and this system has been credited for pushing down the yearly cancer deaths due to earlier discoveries.
In 2020 there was 160 000 less screenings so we can probably expect an increase in number of deadly cases in the coming years.
(Source, https://www.dn.se/sverige/en-av-fem-kvinnor-screenades-inte-... )
Something that has never been properly explained to me is how "overwhelmed" the hospitals were in relation to their normally "overwhelmed" state.
I wrote a script which extracted time series data from one of the hospital bed data APIs in my country around April last year and ran it for a couple of months. I wasn't able to make any useful conclusions from the data other than more patients were coming than going for a certain time periods and some wards had beds reassigned to other wards. It would have been a lot better if I had access to historical data to compare it to previous years.
(Btw I'm not in healthcare. If anything my point is a logical alternative to the idea that overwhelmed covid wards could be the only thing affecting other services. But it's my impression of how things seemed to be, at least in the UK).
What evidence do you have of this? This seems like a baseless criticism.
In the UK a study predicts a 7.9-9.6% increase in breast cancer deaths within 5 years of diagnosis due to diagnostic delays caused by COVID. For other cancers their estimates vary, i.e. 15.3%-16.6% for colorectal, 4.8%-5.3% for lung, etc. thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30388-0/fulltext
Basically I guess what I'm really trying to get at is that while COVID is certainly a terrible disease, there seems to have been little to no cost-benefit analysis performed by policy makers regarding the lockdowns and other attempts to combat it.