Plan B Forum

I have been watching a lot of the briefings, but I seriously wonder what our long term strategy is. So far as I can see, these are what I have heard:

1. Remain in a lockdown posture indefinitely. This appears to be the approach of some public health officials and I don't blame them because they are presenting recommendations from the position they are sought for. It is clearly the best way to contain the virus, but the long term question is how long? The points I see offered are as follows:

a. Until we get a vaccine or useful treatment. Clearly this would be desirable from containment perspective, but it is not likely to occur anytime this year, and while the media posts a lot on vaccines available by late this year or next, from my experience with vaccine development, my guess is that these are likely too optimistic unless taking serious risks with people's health is countenenced (and then isn't that the opposite of why we are on lockdown?

b. Until the virus moutuates to a less virulent form, againthat something that may well take a ver long time.

c. What else? Any insights would be appreciated.

In any of the above, the economic costs will ve to be considered; some may say any economic cost is outweighed by safety, but the ecnomic cost gets larger as timegoes on

2. End the lockdown, but how/ Choices are:

a. Immediately; and stop all the BS about social distancing and maks. I think this is what Trump is publicly endorsing. It will clearly cost a lot of lives, but will eventually result with herd immunity within populations. But the cost in lives is likely to be way too high.

b. Have a phased in end of the lockdown with the idea to develop herd immunity in the population; it may be combined with recommendations for them most at risk to remain home, but will still cost many lives. But what we need here is medical and public heath advice. We do know that contracting the virus generates and antibodies and some immunity, but we have to get information on how long this immunity will last and its value to the community at large; a question might be would the immunity conveyed keep the community safe long enough to permit a vaccine to be developed Or the virus to mutate as above? But that question has to be asked, and not merely as something of academic interest but as something that is a public health priority.

c. Alternatives. Again, any ideas would be appreciated.

From the way I posted, I think it is clear that I favor option 2b if it will work (i.e. if the immunity granted by contracting the disease justifies it) but I think the only way the question will be answered is if we make it a priority, and that will be only occur if we make that clear to the medical and public health personnel involved in the decision making that this is something we are seriously considering and we need the information. Otherwise, their recommendation will be to continue our current lockdown until no longer necessary.

When I was involved with environmental risk assessments - specifically carcinogens - my recollection is that for cost/benefit purposes, use $2,000,000 as the value of a human life. This was 30 years ago.

Risk assessors always put at least one and often two orders of magnitude in as a fudge factor. That's nothing more than saying that the best models are fallible and based on often shady data but the best available. So if a real hard-nosed evaluation of toxicity of a substance is that X milligrams are probably OK for the bulk of people, we'd better recommend a level of 0.X or even 0.0X mg. That's a pragmatic approach: you might be trying to apply rat toxicity data to a human population and we know that rats, unlike corporations, are not people.

Similarly with the $ value of a life. We can reduce the highway death toll at a stroke by reducing interstate speeds to 15 mph. That could save 10,000 lives per year. But if every one of those lives is valued at $2,000,000 that is $20 billion per year. Although that's a huge number, it's only about 0.15 Bezoses or about 0.025 military budgets. My guess is that someone somewhere once did the math and determined that the cost to the economy of this speed limit would far exceed $20 billion annually (and recall I'm talking late 1980s numbers) and that 70 mph is a reasonable compromise.

Edited to correct a bit of mental arithmetic I had wrong. Not $200 billion but $20 billion. And of course I am talking US only.

So if a real hard-nosed evaluation of toxicity of a substance is that X milligrams are probably OK for the bulk of people, we'd better recommend a level of 0.X or even 0.0X mg.

Thanks for the post; this reminds me of something we used to say over and over again when I used to consult on chemical process safety--an engineer will calculate a value to the fifth decimal place, then double (or more) it for a safety factor.

Given the unbelievably high costs both, in life and economically, of this crisis, as well as how quickly it came on, I doubt any such analysis was performed on our current problem.

And of course an engineer usually has good data: we know the strength of a steel beam or a concrete block very accurately because we are allowed to try to break them. Toxicity data is based on the population studied and the assumptions made. It's difficult to get people to swallow large doses of poison so that we can get good toxicological data: and no matter how big the sample you are always going to miss the guy with diabetes, Minamata disease and hermit tendencies. That's who the 10x or 100x factor is for.

“It’s going to disappear. One day, it’s like a miracle, it will disappear.”

Or not, and we have to plan for the contingencies. And that's my concern, we need to look forward to where we want to/can be in the coming months/years, to be proactive (how I detest that word after years with larger companies), rather than reactive.

ex-khobar Andy wrote: ↑

Thu May 14, 2020 5:42 pm

When I was involved with environmental risk assessments - specifically carcinogens - my recollection is that for cost/benefit purposes, use $2,000,000 as the value of a human life. This was 30 years ago.

I see from a Paul Krugman piece in yesterday's NYT that current estimates for the value of a human is around $10 million. That accords well with my estimate from 30 years ago of $2 million.

Joe Guy wrote: ↑

Fri May 15, 2020 6:12 am

“It’s going to disappear. One day, it’s like a miracle, it will disappear.”

Seems fitting for Trumps eulogy

I never thought I'd post a "Dilbert" cartoon here, but...

OTOH...
What is your body worth?
According to a recent article in Wired magazine, a body could be worth up to $45 million — Calculated by selling the bone marrow, DNA, lungs, kidneys, heart … as components.

Now, what about the value of a body based around just the chemical elements that make up a corpse?
http://www.datagenetics.com/blog/april12011/

Summing up all the amounts in the Value column, we come to a grand total of just over $160.

You'd better keep eating those bananas!

I wouldn't be surprised if antibody testing finds a mortality similar to flu which is two out of 100,000.

I don't expect much success with a vaccine because it's a corona virus just like the common cold. I'm sure a vaccine will be available only with probably less success than the ones each year for flu.

That means the long term strategy is zip. We'll have a vaccine. Remain calm. And BTW, some of us will die anyway.

I really should stop doing this . . .

I don't expect much success with a vaccine because it's a corona virus just like the common cold.

There are a multitude of virus types which cause the common cold. A few of these are indeed coronavirus type but the vast majority are not. Most are rhinovirus which is not coronavirus.

I wouldn't be surprised if antibody testing finds a mortality similar to flu which is two out of 100,000.

From a strict pov, this sentence is difficult to evaluate. There are usually two measured fatality rates for a condition: the case fatality rate which is the percentage of people diagnosed with the disease who die from it, and the infection fatality rate which is the percentage of people infected who die from it. So if half the people who become infected are asymptomatic and are therefore never diagnosed with it, the IFR would be half the CFR.

The CFR for seasonal 'flu is around 0.1% and, because there are known to be lots of undiagnosed case of infection, the IFR is around 0.04%. Note that 0.1% is 100 out of 100,000 and 0.04% is 40 out of 100,000. So your estimate, Darren, of flu's mortality rate is way low.

Initial estimates of COVID-19 CFR were up to (and sometimes over) 10%. They are coming down and partly that's because although we are only 90 days into understanding it (first then-known US death was late February; since then earlier US deaths have been identified) we are getting better at identifying the disease. CDC's current estimate of CFR is 0.4%. (Note - if you look at the reference I link, it gives the CFR as 0.004. For consistency I have converted this to a percentage so that we have apples and apples.) So even by this measure (which is NOT the whole story) COVID is 4 times worse than seasonal 'flu. I have not been able to find age-stratified number for 'flu. For the 65+ age group. CDC gives a best estimate COVID-19 CFR of 1.3% but maybe up to 3.4%.

In one specific sense I agree with one point of your sentence there: we don't yet know, and we won't know until the dust has settled and we can make accurate counts of cases and deaths and occurrence. But it's very clear to me already that it ain't just the 'flu, bro.