As I explain in Open Borders, a responsible advocate of government intervention always asks, “Is there any cheaper and more humane approach?” “Government should do something” is perfectly consistent with “Scrupulously avoid collateral damage.” Following Tim Harford, I call such responsible approaches “keyhole solutions.” This recent AIER piece from James Cooper (via Dan Klein) provides a fine example:
I am an American living in Stockholm. I have been living here for 17 years and am fluent in Swedish. I am from Northern Virginia.
Regarding this article, I will just point out that the American people have been buffalo’d into a very binary way of thinking – there are only two possibilities when dealing with COVID-19 – complete lockdown or nothing at all. This is also referred to as TINA (There Is No Alternative).
For many of my American friends, they find it difficult to understand that there are many possibilities in between the two extremes. In fact, a more nuanced approach not only makes more sense, but is more sustainable. That is precisely what the Swedish approach is all about.
If you look at the numbers, you will see that there is negligible risk to those aged 4-50 years old. This group also happens to represent the most economically productive group in society as well as the group that spends the most money. So why shut them down?
The response I get from friends is that they must be shut down because otherwise people will die. This is an emotion based argument.
The reality is that in Sweden all at-risk people have been asked to self quarantine. If they do that, how will their lives be threatened by allowing the under-50 crowd to go out, with some social distancing guidelines?
Keep in mind that if you live with an at risk person, or you are a primary caregiver for an at risk person, then (in Sweden), you are expected to self quarantine; or at least go to extreme social distancing.
I myself had some concerns about whether I was in the risk group, and I took the precaution of keeping my kids home from school until such time as I could get a more definitive answer from my doctor. My kids’ school fully supported me in this approach.
So, I go back to my American friends and ask, how can allowing the under-50 crowd out with social distancing put the at risk population in danger? Yes, it requires people to take personal responsibility and to actively work to protect those at risk. And, assuming this is followed, then those at risk can be expected to be reasonably protected.
Why did they have a complete lockdown in the U.S. in the first place? We were told that it was meant to flatten the curve so that the hospitals have a chance to deal with the patient loads. Mass lockdown simply pushes the problem out in time, to be dealt with later. Yes, over the next 18 months, at risk people will get the virus and there will be many that die. This is in large part unavoidable. I suspect that in the end we will see similar numbers within a range across all Western countries. This will play out over 12+ months.
If we can accept that statement, then we would need to admire Sweden for taking an approach that does not further burden its economy, does not destroy people’s God given right to freedom, while also working to protect those at risk, and augmenting immunity.
Let me add: The best objection to the Swedish approach is that high-risk people often live with low-risk people. If each person in the family does their own thing, the low-risk people are likely to sicken the high-risk people who live under the same roof. True enough, but I say that decision – like the decision to move your family to Africa to do missionary work – can and should be a family decision about the right way to trade-off the interests of people within the household, not a government decision about the right way for every household to operate.
READER COMMENTS
Alan Goldhammer
May 18 2020 at 9:36am
The emerging clinical picture of COVID-19 points to no “negligible risk population.” Look at all the children who are getting Kawaski Disease. Yes, age dependent morbidity and mortality are still the hallmark of the disease but one should not minimize other medical complications.
Mark Bahner
May 18 2020 at 11:45am
Would you say there’s any “negligible risk population” (in terms of age brackets) for vehicular fatalities (including drivers, passengers and pedestrians)? What about murders?
JFA
May 18 2020 at 12:13pm
Please provide citations and magnitudes when making claims. Provide base rates and also raw numbers relating to total covid infections. Yes, there are other medical complications, but you should not use the existence of those complications to make alarmist claims.
Like “all the children with Kawasaki Disease”: in Italy, where there were *10* children presenting with Kawasaki-like symptoms, 8 had Covid antibodies. Over the previous 5-years there had been 19 cases. So is 8 large? I don’t know, how many kids had positive PCR or antibody tests?
In New York, there were 102 possible cases of Kawasaki-like symptoms. From the state report: “60 Percent Tested Positive for COVID-19 and 40 Percent Tested Positive for COVID-19 Antibodies”. I don’t know whether those test overlap, but a max of 76% (78 kids) of those cases were covid related. Is that big? Depends on how many kids have or have had Covid.
See this article and links therein: https://www.medpagetoday.com/infectiousdisease/covid19/86484
There was also an article of perfectly healthy 30 and 40 year olds having strokes. The Washington Post had an article discussing a “stroke surge” based on a paper looking at 12 stroke patients, 5 of which were under 50. Now I understand that strokes in younger people are rarer than in older people, but is 5 large? I don’t know. How many stokes would you expect? How many individuals in that age range who have had Covid have also had a stroke?
Peter
May 19 2020 at 7:29am
Those numbers are trivial. The same line is trotted out all the time. “It’s it just grandpa dying.” Correct, it’s not, but it nearly always is. Keeping my daughters out of school is not necessary to keep their grandmothers safe.
Peter
May 19 2020 at 7:31am
Whoops “it’s not just grandpa dying.”
Thomas Hutcheson
May 18 2020 at 10:24am
Response to the pandemic, including messaging, should take account of the fundamental problem of externalities. A person taking proper precautions not to become infected, and even to infect his immediate family, still is not internalizing their risk of infecting others.
I think that if information were readily available on now to avoid infecting others, including how school, businesses, and churches could operate to reduce the risks of one person infecting another, regulation would be hardly be necessary although I would not rule it out entirely as not everyone is rationally altruistic.
Jon Murphy
May 18 2020 at 10:33am
Why do you assume that?
Thomas Hutcheson
May 19 2020 at 11:25am
I thought it was obvious from context that I I meant that a person who ONLY acted on information about the efficacy of a vaccine for their own health would not be internalizing the benefits they are providing to others. If everyone had the incentive wrapped up in a piece of information about all the consequences of their actions, then there would be no externalities to getting vaccinated, emitting CO2 or anything else.
Tyler Wells
May 18 2020 at 12:08pm
The problem with externalities is that it cuts both ways. You can argue that allowing people to circulate, instead of lockdown, is an externality as potentially someone might get sick and then spread the virus. However, locking people down and restricting their freedom (and their ability to take care of their families) is also an externality. Plus, the people who are hurt most by the lockdowns are almost the opposite of the people who could potentially get sick and die from the virus.
Also, people have different risk thresholds. Don’t forget, peoples actions constantly show that there are many things more important to them than an extra year of life. Smoking, obesity, sedentary lifestyles and many other beviors are probably much more deadly than coronavirus but these are accepted risks. In short, it is impossible to have a “right response” to coronavirus. Sadly, people are going to die.
MarkW
May 18 2020 at 12:59pm
It seems to me that the U.S. is moving toward ‘keyhole’ solutions by restrictions being increasingly ignored and enforcement being lax or non-existent. In my state, golf is permitted now but social gatherings with people outside your household are still forbidden, so according the rules, it’s not OK for four friends to get together to play a round of golf. Is this restriction being observed? HA! No. Are authorities attempting to enforce this? Again, no. In theory, people are not even allowed outside except for essential trips and exercise near home. Still being observed? Not even close. More and more local authorities are refusing to enforce state mandates, and so on. It seems to me that we’ve already been slouching toward Sweden for some time.
Dylan
May 18 2020 at 3:57pm
I don’t even know how recent that is. I’m in NYC, and while there are certainly stories on the news both about people ignoring the rules, and some arbitrary sounding enforcement…the reality that I’m seeing on the ground is that there’s been very little difference in behavior pre and post lockdown orders. I’ve been to a local park a few times, and when the weather was nice there were plenty of people there, way more than usual for this time of year, and while some were wearing masks and trying to social distance, others were playing soccer. I’ve biked across the Brooklyn Bridge a couple of times, and it was just as crowded as it always is.
PaulS
May 18 2020 at 2:23pm
“People’s actions constantly show that there are many things more important to them than an extra year of life.”
Exactly right. And it’s not even close to a year, it’s around three weeks.
Three weeks, based on the early, apocalyptic Imperial College study. According to them, at the time, the typical loss of life would be 10 years (if the age profile were uniform it would be more like 40, but it’s not; those about to die anyway take more of the brunt), and the gross probability 0.6% (yielding the famously and hysterically quoted 2 million US deaths.)
The risk goes up with age, perhaps as co-morbities accumulate, while the years lost go down. Thus their loss expectation would have worked out – if they had bothered to work it out, but that would have spoiled the apocalyptic look – to around three weeks (0.6% of 10 years, 500 weeks), with not much age variation, at least for late 20s and over. In the real world it’s probably more like 0.3% rather than 0.6%, or a loss expectation of maybe 10 days.
It follows, alas, that in this sense, it will usually not be possible to identify and imprison a group that’s truly at extraordinary risk of losing life-years; many who think themselves immune really aren’t quite. That leaves no effective, sustainable Puritanical solution at all. No: life carries some finite risk, suck it up, buttercup.
Note that nursing homes are a huge exception, as they seem to account for 1/3 to 1/2 of the deaths when detailed local analyses are made in various countries. (And shielding residents fully will be impossible until virus/swab tests attain accuracies far greater than now and can done every day for all staff, which will not happen anytime soon. Too many false positives: no staff. Too many false negatives: infected staff leak through.) So the risk to those outside nursing homes is likely rather lower than 0.3%.
Now since the USA is chock-full of wannabee “socialists”, let’s consider QALYs as in England or France. So how many months or years of near-house-arrest is three weeks – or more likely one week or ten days – really worth?? Typical QALY discounts (which are based on surveys) range to 20 or 25 percent for serious conditions that greatly limit activity. And house arrest is obviously a serious condition that hugely limits activity.
The answer to that will vary with the individual, but it seems to me that most of us have either (1) already overpaid considerably, or (2) are on the verge of overpaying considerably and will have done so within another month. It should be no surprise that we are seeing loud protests – even in Germany of all places, whose citizens nowadays seem more inclined than Americans to kneel in subservience to arbitrary rules and regs from government.
On the other hand, since so many Americans style themselves on Twitter as radical virtue-signaling Puritans, we must all be forced (at police gunpoint if necessary) to cling tightly to the fatuous notion that the only acceptable risk is literally zero. (Recall Andrew Cuomo and his “if even one life was saved” comment a few weeks ago.) It follows that we should never drive lest we crash, never get out of bed lest we fall down, lock down forever lest we catch flu or god-knows-what god-knows-when, and so on. Zero risk.
It seems inevitable, then, that the arrogant Nurse Ratcheds of various public-health boards will continue running the show to the detriment of almost all for quite some time yet. Until a majority become so sick and tired of house arrest that there are social explosions. Those will be accompanied by liberals-in-the-American-sense yelling self-righteously at the top of their lungs that everyone except themselves is a murderer, so have some popcorn handy for the show.
And so it goes. Sigh.
Scott Sumner
May 18 2020 at 2:39pm
I don’t know why people keep touting the Swedish model when there are much better models in places like Taiwan.
robc
May 18 2020 at 3:52pm
Taiwan’s model is only applicable if you prepare in advance.
Taiwan’s model includes unacceptable privacy concerns.
Mark Z
May 18 2020 at 8:11pm
The ‘Taiwan model’ may only work when a small enough % of the population is infected. The viability of thorough testing and tracing diminishes as prevalence increases. For the US and western Europe, Taiwan is less informative for prospective decision-making than for retrospective assessment of what could’ve been done.
JFA
May 19 2020 at 6:24am
All the models that have “worked” did so because of early action. The US still can’t get its testing game in order as the FDA shuts down Gates-funded testing in Washington state just a few days ago.
I imagine that Taiwan being a small island helped, too.
Tom West
May 18 2020 at 5:29pm
It seems to me that policy is being decided the usual way. Politicians try to weigh the trade-offs, and choose policy that they hope will eventually get them re-elected.
And as is the case for so many of these policy decisions, freedom to choose is largely illusionary. Due to network effects or prisoner game-style defections, almost everyone will settle on a single standard and any deviation from that will be heavily punished, either by law or economics.
Since with these policy decisions there’s only going to be one winner, and different people have different preferences, of course everyone is going to use the usual political tools to get particular preference blessed by the government.
Appeals to science, philosophy, religion, and human nature are all part the usual tools. Same thing happens with setting speed limits.
So at least for me, there’s nothing particularly startling about these debates. It seems pretty much business as usual for how to govern.
Walter Boggs
May 19 2020 at 4:36pm
It’s hard for me to visualize legislators having a private discussion about the need to value and protect individual choice. I just don’t think it’s on their radar.
Tom West
May 20 2020 at 8:45pm
Well, if the people care about individual choice, those politicians aren’t going to last.
The very few times I’ve heard politicians being people (“off the record”), they seemed just like people. My experience is that freedom isn’t all that important to most people, but it’s not completely absent as a concern.
Thomas Hutcheson
May 19 2020 at 12:14pm
It seems to me that far from being a “keyhole” there is a wide range of policies between the “first thing that comes to mind” (about reducing the spread of Covid 19 by enough to preserve the capacity the health care system to provide health- restoring treatment or any other other policy problem) and doing nothing. If this is the case, then a Libertarian critique of the “first thing that comes to mind” policy, even if bolstered by the insight that “pubic choice” considerations mean that the first thing that comes to the politician’s mind will not be optimal, is of very limited help.
Tom DeMeo
May 19 2020 at 1:00pm
“Let me add: The best objection to the Swedish approach is that high-risk people often live with low-risk people. If each person in the family does their own thing, the low-risk people are likely to sicken the high-risk people who live under the same roof. True enough, but I say that decision – like the decision to move your family to Africa to do missionary work – can and should be a family decision about the right way to trade-off the interests of people within the household…”
This seems to imply that there is some sort of clear moral delineation of rights here that can be applied to the viral spread; that we can control and manage the infections and control our personal risk according to our values. We cannot. We have some personal control, but ultimately, our community response will matter far more.
We should all understand the dynamics here.We use the term “viral” as a metaphor all the time, and we all get what it implies: a spreading phenomenon that is not controlled.
The argument really should be whether we want to give exceptions to our core values for a disaster or a public health emergency or not. We may decide that our basic freedoms are so central to who we are that we must occasionally accept the notion that under certain conditions, we may be more likely to die than we might under a different social contract.
That argument makes some sense to me. Arguing that we can segregate as a practical matter, and maintain notions of independent personal control over our risks does not.
Mark Z
May 20 2020 at 7:20am
He is specifically talking about the risk of intra-familial transmission, and each member of a family has considerable control over that, not only personally but because family members can influence one another and reach a mutual agreement. For example, all members of a family may agree to self-isolate so as to minimize catching the disease from others, thereby allowing them to continue to interact with each other at lower risk; or they may agree that the younger members won’t self-isolate and will reduce contact with the older members. Familial bonds (and small size) make it much easier to coordinate behavior in a family than in a society at large, so society-level issues are less of a problem.
Pajser
May 20 2020 at 4:23am
Shouldn’t you, as libertarians think that contagion is aggression? What is the difference between infecting someone and unintentional gun shooting?
robc
May 20 2020 at 5:02am
In some cases, yes. And the solution is a tort.
Mark Z
May 20 2020 at 7:27am
If contagion is aggression, then we were already constantly aggressing against one another before all this. It’s obviously not a binary issue. Standing behind someone in line while you have a cold and doing so while you have Ebola virus both threaten giving them a disease and might be called aggression, but only the latter would likely be treated as such. It’s probably hard to find an intuitive ‘cutoff’ for deciding how dangerous a disease has to be before it justifies a coercive response. Also, I think negligence is probably a better description than aggression, absent intent to infect someone.
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