Inexcuseable Ignorance About Covid-19

 Here is a recent post by Tyler Cowen in which he quotes a comment, presumably with his endorsement given the context. Don Boudreaux, who like Cowen is an economics professor at George Mason University, has some disagreements with his colleague about how best to approach the pandemic. You can probably get the thrust of their disagreement from Boudreaux's recent post here. Specifically, Boudreaux is baffled (as am I) by commenters like Cowen who downplay the relevance of the age-mortality curve for covid-19. There is something like a three orders of magnitude difference in mortality for the youngest versus oldest cohorts. (Almost four orders of magnitude, according to this page from the CDC.) It would be shocking if this fact had no relevance whatsoever for advising which institutions to shut down, or advising individuals on what kinds of risks they should take. But Cowen plays this down like it's not even a thing. 

Boudreaux is responding to a recent Econtalk in which Cowen was the guest. I listened to the same podcast and was likewise scratching my head at Cowen's comments. I wanted to respond specifically to some of the remarks made in the post linked to above (first link):

It is simply not a tenable policy to oppose pandemic lockdowns on the premise that COVID-19 only negatively affects a certain portion of the population. First, the fact that COVID-19 disproportionately killed the elderly was not something that was readily apparent right out of the box, when the virus was spreading rapidly. Hindsight is 20-20.

The first sentence is a raw assertion, not really justified by anything that follows. It was indeed apparent immediately that this virus had a disproportionate effect on the elderly, and it left children almost untouched. The Diamond Princess cruise ship gave the world the closest thing possible to a controlled experiment. Some very good information on the age-mortality curve came out of that episode. Here is a link I posted to my Facebook page March 14, 2020, right around the time that schools were closing and everything was shutting down. From that piece: 

Of the 416 children aged 0 to 9 who contracted COVID-19, precisely zero died. This is unusual for most infectious diseases, but not for coronaviruses; the SARS coronavirus outbreak also had minimal impact on children. For patients aged 10 to 39, the case-fatality rate is 0.2 percent. The case-fatality rate doubles for people in their 40s, then triples again for people in their 50s, and nearly triples yet again for people in their 60s. A person who contracts COVID-19 in their 70s has an 8 percent chance of dying, and a person in their 80s a nearly 15 percent chance of dying.

So, no, this isn't a case of "hindsight is 20/20". We knew very early on that children were basically not at risk, and young people up to about 40 or so were at no more risk than from other seasonal viruses. At any rate, there's not excuse for someone not knowing that. This calls for a directed approach to risk mitigation, not society-wide lockdowns (voluntary or involuntary). Closing schools outright was a mistake, and it was knowable at the time that it was a mistake. (Certainly, children with at-risk adults in the home should have had the option of doing their school work remotely. I'll even say that anyone who didn't feel comfortable sending their kids to school for any reason, good or bad, should have had the same option. That's a very different proposition from saying everyone must do school remotely. Come to think of it, I've seen Tyler endorse the idea that schools are basically safe and should be reopened. How can one take such a position without acknowledging the age gradient?) 

Back to the comment that Tyler re-quoted:

Second, focusing solely on mortality is short-sighted given that approximately one-third of all people who get over COVID-19 suffer “long haul” symptoms that persist for months and may even be permanent in some. We cannot simply claim that the non-elderly have no reason to fear COVID-19.

I feel like I've talked this point to death. I wish they would be more precise about the harm of "long haul" symptoms. Do one third of survivors have permanent severe scarring of the lungs? Does having a persistent cough for a month that then goes away count one as a "long hauler"? If it's the latter, it's really not so horrifying, probably not "become a total shut-in" worthy. People experience long-haul symptoms from seasonal flus and colds, too. Ever gotten a sinus infection or persistent cough after a bad cold? I have. It certainly sucks, but it's not "turn the world upside-down to avoid" level badness. I feel like people who are making this point are combining common but minor after effects with severe but rare after-effects to get a scary-sounding total. I've spoken to a couple of friends, both about 50, who had covid and had some long haul symptoms. One had a cough that took two months to clear up, the other said he'd been free of asthma medicine for ten years but now has to take it again. Those are pretty serious after effects, and I would personally take precautions to avoid them. But I just don't see those harms as warranting the extreme measures we're taking. 

The commenter next tries a war analogy:

So far, COVID-19 has killed more Americans than we lost in World War II, and it took the war five years to do what the virus did in one year. Even though the majority of the deaths were 65+, these are staggering numbers. Losing well over 100,000 people under the age of 65 in one year alone is nothing to sneeze at, and that’s with lock-downs and other harsh measures being taken. A “let them live their lives” approach would doubtlessly have escalated those numbers greatly.

I've always found this to be a pointless exercise: comparing the death total from some kind of social problem or public health crisis to the death toll from a major war. It's not even a remotely useful comparison. Cancer kills about 600k people a year. Should we have a society-wide mobilization of resources to fight cancer? Probably not. That depends on how responsive the problem is to our proposed policy "fixes". It's such a confused comparison, and yet I see it all the time. Deaths from disease are to a large degree unavoidable and unresponsive to public policy. Deaths from war are, in some sense, a price that a society (or its government anyway) has decided to pay to avoid some greater evil or to stop a looming threat. (Of course wars are often terrible blunders, but WWII is probably the best historical candidate for "involving ourselves in war to prevent an even greater number of deaths.") Death totals from disease and death totals from war just aren't comparable, and there are no sensible policy implications that follow from noticing that this number is bigger than that number. 

The line about "losing over 100,000 people under the age of 65" misses some important nuance. I don't understand where this cutoff of age 65 comes from. When virus "optimists" like myself mention the age gradient, virus "pessimists" start talking about numbers (or worse, individual cases) of people below age 65 dying or having serious complications from the virus. There is an age gradient, not a cutoff. People age 55 are at a greater risk than people age 45, who are at a greater risk than people age 35, and so on. People who talk about the age gradient as having policy implications (and how could it not?) are implicitly acknowledging the deaths at all ages. There is simply nothing special about the number 65. Perhaps more importantly, this glosses over the issue of comorbidities. Yes, there are younger people who die of covid-19. The vast majority of them have some kind of pre-existing condition that makes them vulnerable. If there are identifiable conditions that make us many times more likely to die from covid-19, that probably has policy implications with respect to "focused protection." (Again, how could it not?) 

I put this all down a couple of weeks ago when I was feeling annoyed with Tyler's flippant remarks, but then Don Boudreaux and Dan Klein ably responded. I hope to retire from this subject. Death counts from covid are falling and the vaccine rollout appears to be a huge success. Hopefully it will be a non-issue soon. But the matter of future policy implications looms large. "Who was more right?" is an important question, not merely for ego-stroking and bragging rights. Some of these issues really do need to be settled, because they will come up again the next time there is a major pandemic, or even the prospect of one that fails to materialize.