You Should be Angry

If you are under the age of 30, in the west, your future has turned grim.  In a fair world, you would be in the streets, screaming to get back to your job and building your life.

But instead, you are inside, while the police sweep empty streets.

As of late March 2020, the economies of the US, and most of western Europe, have been shut down.  This action does not have precedent, and it will cripple a generation in poverty and debt. Short term, this will likely mean 20% unemployment, vast GDP contraction, and trillions in debt.

This price will be paid by those under 30, to save — some of — those over 80.

It is not necessary, and is not worth the price.  It was an instinctive reaction, and I hope history will not be kind to the politicians who caved to it.  The best time to stop this mistake was before it was made. 

The second best time is right now.

You are being lied to

We have been asked to shut down the US for two weeks — and similar timeframes in Italy, France and elsewhere.  Two weeks (15 days, per the Feds) is a palatable number. Two weeks is a long Christmas break.  The technorati elite on Twitter think the shutdown is a vacation, and for them it is, because their checking accounts are overflowing from the fat years of the 2010’s.

Two weeks is not the goal, and it never was the goal.

The Imperial College report is the study which inspired the shutdowns — first of the Bay Area, then all of California, then New York.   This report measured the impact of various mitigation strategies. For those not “in the know” (aka, normal humans) there are two approaches to treating this pandemic:

  • Mitigation, where we “flatten the curve” enough to keep ICUs full, but not overflowing.  Eventually, we will build up herd immunity, and disease persists at a low level.
  • Suppression, where we eliminate the disease ruthlessly and completely.  

You don’t have to read the paper.  This graph tells you everything you need to know:

The orange line is the optimal “mitigation” strategy.  We try to keep ICUs full, try to keep businesses and schools running, and power through it.  But people will die.

The green line is suppression.  We shut down businesses, schools, universities, and all civic life.  Transmission stops, because there is no interaction with the outside world.  The economy does not depress — it stops.

We aren’t following the orange line, because: people will die.

That is the IC report’s conclusion: no amount of curve flattening gets us through this pandemic in a palatable timeframe.  Thus, we must suppress — for 18 months or longer — until we have a vaccine.  I’m not paraphrasing. This is the quote:

This leaves suppression as the preferred policy option…. this type of intensive intervention package … will need to be maintained until a vaccine becomes available (potentially 18 months or more)

Italy, France, California, New York, Illinois, and more in the days to come, have nearly shuttered their economies.  All schools, universities, and social gatherings are cancelled, at risk of ostracization or police enforcement. This is the green line.

By enacting the green line — closing schools, universities, and businesses — the US is choosing to give up on mitigation, and choose suppression.  This doesn’t mean 2 weeks of suffering. It means 2 years to start, and years of recession to follow.

We are eating the young to save the unhealthy old

COVID-19 does not kill, except in the rarest of exceptions, the young.   Old politicians will lie to you. The WHO and CDC will lie to you — as they lied about masks being ineffective — to nudge you to act “the right way”.  Do not trust them.

Here are the real, latest, numbers:

In South Korea, for example, which had an early surge of cases, the death rate in Covid-19 patients ages 80 and over was 10.4%, compared to 5.35% in 70-somethings, 1.51% in patients 60 to 69, 0.37% in 50-somethings. Even lower rates were seen in younger people, dropping to zero in those 29 and younger.

No youth in South Korea has died from COVID-19.  Fleetingly few of the middle aged. Even healthy seniors rarely have trouble.  The only deaths were those seniors with existing co-morbidities.  In Italy, over 99% of the dead had existing illnesses:

With the same age breakdown for deaths as South Korea:

As expected, the numbers for the US so far are the same:

More than raw numbers, the percent of total cases gives a sense of the risk to different age groups. For instance, just 1.6% to 2.5% of 123 infected people 19 and under were admitted to hospitals; none needed intensive care and none has died… In contrast, no ICU admissions or deaths were reported among people younger than 20.

These numbers are under-estimates — the vast majority of cases were never even tested or reported, because the symptoms don’t even exist in many of the healthy.   The vast majority of the young would not even notice a global pandemic, and none — generously, “fleetingly few” would die.

The young — the ones who will pay for, and live through, the recession we have wrought by fiat — do not even benefit from the harsh medicine we are swallowing.  But they will taste it for decades. 

This is not even necessary

To stop COVID-19, the west shut itself down.  East Asia did not. East Asia has beaten COVID-19 anyway.

China is where the disease started (conspiracy theories aside).  Through aggressive containment and public policy, the disease has been stopped.  Not even mitigated — stopped:

There are two common (and opposite) reactions to these numbers:

  1. China is lying.  This pandemic started on Chinese lies, and they continue today.
  2. China has proven that the only effective strategy is containment

Neither is true.  But we also know that China can, and has, used measures we will never choose to implement in the west.  China can lock down cities with the military. China can force every citizen to install a smartphone app to track their movement, and alert those with whom they interacted.

So we can look at the countries we can emulate:  South Korea, Japan, Taiwan, and Singapore.  None (well, at most one) of them are authoritarian.  None of them have shut down their economies. Everyone one of them is winning against COVID-19.

South Korea

South Korea is the example to emulate.  The growth looked exponential — until it wasn’t:

South Korea has not shut down.  Their economy is running, and civic life continues, if not the same as normal, within the realm of normal.  So how did they win, if not via self-imposed economic catastrophe?  Testing.

The backbone of Korea’s success has been mass, indiscriminate testing, followed by rigorous contact tracing and the quarantine of anyone the carrier has come into contact with

Their economy will suffer not because of a self-imposed shutdown, but because the rest of the world is shutting itself down. 

Singapore

Singapore won the same way: by keeping calm, testing, and not shutting down their economy.

Singapore is often the “sure… but” exception in policy discussions.   It’s a hyper-educated city-state. Lessons don’t always apply to the rest of the world. But a pandemic is different.  Pandemics kill cities, and Singapore is the world’s densest city. If Singapore can fix this without national suicide, anyone can.  So what did they do? 

  • Follow contacts of potential victims, and test
  • Keeping positives in the hospital
  • Communicate
  • Do not panic 
  • Lead clearly and decisively

I could talk about Japan and Taiwan, but I won’t, because the story is the same: Practice hygiene.  Isolate the sick. Social distance. Test aggressively.   

And do not destroy your economy.

“The economy” means lives

The shutdown has become a game — fodder for memes, fodder for mocking Tweets, and inspirational Facebook posts, because it still feels like Christmas in March.  

It is not.  If your response to the threat of a recession is:

  • “The economy will just regrow”
  • “We can just print more money”
  • “We just have to live on savings for a while”

The answer is simple: you either live a life of extraordinary privilege, are an idiot, or both.  I can try to convince you, but first, ask yourself:  how many people have the savings you’ve built up — the freedom to live out of a savings account in a rough year? I’ll give you a hint:  almost none.

Likewise, working from home is the correct choice, for anyone who can manage it. Flattening the curve is a meaningful and important improvement over the unmitigated spread of this disease. But the ability to work from home is a privilege afforded to not even a third of Americans:

According to the Bureau of Labor Statistics, only 29 percent of Americans can work from home, including one in 20 service workers and more than half of information workers

If you are able to weather this storm by working from home, congratulations — you are profoundly privileged. I am one of you. But we are not average, and we are not the ones who risk unemployment and poverty. We are not the ones who public policy should revolve around helping. The other 71% of Americans — who cannot — are the ones who matter right now.

To keep the now-unemployed from dying in the streets, we will bail them out.  And that bailout, in the US alone, just to start, will cost a trillion dollars.  That number will almost certainly double, at a minimum, over the next two years.  

What else could we spend two trillion dollars on?   To start, we could void all student debt:  $1.56 trillion, as of 2020.  We could vastly expand medicare or medicaid.  You can fill in the policy of your choice, and we could do it.  But we won’t.

We are borrowing money to pay for this self-inflicted crisis.  We should be spending that money investing in the future — perhaps freeing students from a life of crippling debt — but instead, we are throwing it at the past.

The rest of the world

The US is not the world.  The US will muddle through, no matter how poor our decisions, usually (but not always) at the cost of our futures, not our lives.  The rest of the world does not have this luxury.

GDP saves lives.  GDP is inextricably linked to life expectancy, child mortality, deaths in childbirth, and any other measure of life you want to choose.  This is so well proven that it shouldn’t require citations, but I’ll put up a chart anyway:

A depression will set back world GDP by years.  The US and Europe buy goods from the developing world.  The 2008 recession — driven primarily by housing and speculation in western markets — crushed the economies not just of developed nations, but the entire world:

we investigate the 29 percent drop in world trade in manufactures during the period 2008-2009. A shift in final spending away from tradable sectors, largely caused by declines in durables investment efficiency, accounts for most of the collapse in trade relative to GDP

If you are unswayed by the arguments that a self-inflicted depression will hurt the working poor in the US, be swayed by this — that our short-sighted choices will kill millions in the developing world.

How did we get here?

Doctors are not responsible for policy.  They are responsible for curing diseases.  It is not fair to ask them to do more, or to factor long-term economic policy into their goal of saving lives right now.   We elect people to balance the long-term cost of these decisions.  We call them politicians, and ours have failed us.

The solution to this crisis is simple — we do our best to emulate East Asia.  We isolate the sick. We improve sanitization.  We mobilize industry to build tests, ventilators, and respirators, as fast as we can — using whatever emergency powers are needed to make it happen.   And we do this all without shutting down the economy, the engine which pays for our future.

We do the best we can.  And accept that if we fail, many of the sickest elderly will die.  

Next time will be different.  We will learn our lessons, be prepared, and organize our government response teams  the way that Taiwan and South Korea have. We will have a government and a response which can protect every American.

But now, today, we need to turn the country back on, and send the rest (the 71% who can’t work from home) back to work. We owe them a future worth living in. 

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