Categories:
Economics of Health Care
After a month of shutdown, I can’t help but wonder, “Who’s still getting sick?” Specifically, what is the breakdown between:
1. People who live with someone who was infected with coronavirus
2. Workers in direct contact with coronavirus patients
3. Other “essential workers”
4. Careless people
5. Outright scofflaws
6. The unlucky (including, of course, diligent people sickened by the careless and scofflaws)
READER COMMENTS
Shane L
Apr 16 2020 at 9:55am
I have had the same thought. Regarding number 5, it is fascinating and strange to continue to read news stories about crime. These, incredibly, include drunken brawls in the middle of the night on streets or in house parties. Who on earth is still going to parties, let alone getting into fights?
Here in Ireland the police have been operating checkpoints attempting to reduce unnecessary travel, which appears to have also led to considerable interception of illegal drugs. I wondered if some drug users may be feeling unusual pressure if they are unable to self-medicate, and may be more erratic in their behaviour. (That is highly speculative, of course.)
Ray
Apr 16 2020 at 9:57am
And of those getting infected with SARS-CoV-2, 0.1%-0.4% die.
Let’s do one on who’s losing their jobs & lives.
Alan Goldhammer
Apr 16 2020 at 10:03am
@Ray – do you have any special insights that those of us who have been studying this for some time do not? How are you coming up with the base number of infected individuals in the absence of mass testing? Don’t get me wrong, I ‘think’ the CRF will end up at about 0.33%, equivalent to the 1957-58 flu epidemic. this can only be a guess at this point in time.
robc
Apr 16 2020 at 12:00pm
That german town study (I think you linked to it the other day, but I saw it elsewhere too) said 0.37%
Alan Goldhammer
Apr 16 2020 at 12:25pm
It would be very nice if a German town of 12,000 served as the model for everything. We know that population density is critical and I don’t think that was the case there. There are other places in Europe where testing is robust and those data will better inform us. Community testing is beginning at a low level in Los Angeles as part of a modeling study but the numbers are too small.
mark
Apr 16 2020 at 4:33pm
As Prof Streek who does the study said:”It is the same virus.” – Heinsberg has normal western air-quality (good), normal western age-structure, i.e. pretty old. And a German town of 12.000 is quite a social place. and just around the corner from other small and medium places. The carnival-party that put the turbo in the infection was probably mostly visited by socially active 30-60 yrs. somethings, not just “the newly wed, very fat, and nearly dead” that go on cruises (ooops, and the Caplan-family and my parents). So the letality of 0.37 or so – if correct – there should be similar in the US, Italy, England (though lack of ventilators or ICU or medical personel was/is not a killing issue in any place in Germany – hospitals are complaining now about too many empty beds for which they do not get paid enough ) ….
robc
Apr 17 2020 at 7:20am
If we assume the german numbers are correct at 15% and 0.37%, that implies nearly 200k us deaths, 3 times what even the loosest model is predicting.
Although it looks about right for NY.
Fred_in_PA
Apr 17 2020 at 9:42pm
Ray;
My instinct is that you are right to point out the countervailing factor of economic damage. But my lay investigations into the subject have yielded ambivalent findings.
(1) M. Harvey Brenner, working at Johns Hopkins in the 1970’s found that, for each one percentage point increase in the unemployment rate, there were an additional 37,000 deaths over the next 3 to 5 years. Given that our population is 60% larger today, that might be an additional 59,000 today. Some of these were “deaths of despair” (see Case & Deaton). But most were the downstream effects of impoverishment — esp., more stress-related diseases and poorer healthcare. With unemployment up perhaps 17% above the 3.5% earlier in the year, that implies an additional 1,000,000 U.S. deaths from the economic catastrophe — above & separate from whatever the virus does. But,
(2) More recent work — the work I seem to see most is Ruhm’s 2000 paper in the Quarterly Journal of Economics — says that recessions reduce death rates. Some possible explanatory mechanisms might be: (a) People without jobs to commute to drive less and auto fatalities drop. Note that several auto insurers are issuing refunds to their policy holders because of the current drop in auto claims. (b) A collapse in driving and industry leads to an improvement in air quality. (c) Some people decide “I can’t afford the habit anymore” and give it up. (d) Obesity in the population recedes as more people have difficulty feeding themselves.
It seems to me (a layman) that Ruhm and other moderns are looking at more immediate effects. And if this all proves rather temporary, they will likely carry the day.
Whereas Brenner was looking at longer run effects. So the question becomes how long will the effects on the economy linger. If we get a second wave (or just a second winter — with consequent seasonal effects), Brenner may start to look more prescient.
I do note that the effects of this are not falling evenly across the society. Retirees are somewhat insulated from unemployment effects (and typically have built up more assets). The college educated often are dealing in information. And courtesy of the internet, knowledge-work can often be done (and earn a paycheck) from home. And these fortunate workers typically were better paid that their less educated brethren anyway. It is the less well-established and less well-educated who — if they want to eat — most go out and face the virus to work. And they’re the ones whose jobs we’ve shut down.
The pandemic is aggravating inequality in our society. And the reviews I’ve read say Case & Deaton blame growing inequality as a major driver of those deaths of despair.
Mark Z
Apr 16 2020 at 10:26am
Also: People who live in the same apartment buildings as essential Or healthcare workers (and thus have to touch the same doorknobs). And people making emergency trips to the pharmacy or grocery store and having to touch cash or touch screens. Maybe even people who walk in hallways or outside – even if they don’t go near other any people – anywhere where someone has sneezed in the past few hours, then later touch their now contaminated shoes.
Each or all of these may turn out to be negligible contributors to contagion, but I wouldn’t totally dismiss them yet.
AMT
Apr 16 2020 at 11:18am
What I have found pretty surprising, is the indistinguishable amount of traffic still on the roads (during the 3 times I have left the house in the last month for groceries), compared to the pre “shutdown” era. It seems likely to me that people are not really staying home all that much.
Steve
Apr 16 2020 at 11:42am
Guess it depends on where you live. I walked a couple blocks to pick up a take-out order in Jersey City last night and couldn’t believe that I did not see a single car driving down Grove Street at 7pm. It’s the first time I’ve ever crossed Grove without doing some kind of surely illegal dodging of slow-moving cars.
Dylan
Apr 16 2020 at 11:46am
Here in Brooklyn road traffic seems to have been considerably reduced. The busy road near my apartment used to be impossible to cross without waiting for the light, and now everyday is like early Sunday morning. Still traffic to be sure, but feels like less than a quarter of what it had been, or less.
But I’m not noticing much difference in pedestrian traffic.
Mark Z
Apr 16 2020 at 6:55pm
In Manhattan foot and car traffic are down I’d guess at least 80%. It took awhile of course, in late March it still seemed like business as usual to most people.
Alan Goldhammer
Apr 16 2020 at 12:28pm
Traffic here in Bethesda MD is greatly reduced. NIH which is right nearby only allows essential personnel to enter. I went to CVS to pick up some meds at 2pm yesterday and there were maybe 6-7 other people in the store. Those behind the counter were not wearing masks as required by the Governor’s statement two days ago. I always use self-checkout anyway.
Steve S
Apr 16 2020 at 12:52pm
I agree. I live in suburban Colorado, south of Denver. Relatively similar amounts of traffic. People constantly getting takeout food, groceries, drive thru at the bank…lots of people driving with mountain bikes on the roof…
The only noticeable difference is the lack of traffic around school pick up and drop off times.
JK Brown
Apr 16 2020 at 2:19pm
Found this site last night. They are synthesizing the various studies and reports. Gives generalizations on who is getting infected. But more informative than the juvenile information given out by those experts that have the mic.
Steve S
Apr 16 2020 at 2:48pm
Unfortunately I think #2 is pretty high. Whenever you hear about an outbreak at some assisted living facility, it’s like “72 tested positive, 41 of which were employees”.
There are 311 total reported cases in my county. Probably 150 of them active. Can I put on a mask, wash my hands a lot, and go about my day? I’ll roll those dice.
Yaakov
Apr 16 2020 at 8:31pm
In Israel it is not 1 as they long have been infected or immune. The government does not bother testing children unless you are very persistent due to a shortage of tests.
It may be 2, although the number is quite limited. They are well protected.
The answer is in my eyes, is a certain percentage is essential workers and shoppers. I note that the police and army do not obey minimal rules of social distancing so they have some infections.
Another large group is careless people. In Israel, among the ultraorthodox jews and arabs there are large groups that simply ignore the rules altogether. Though, being that they are mainly young and healthy, it is hard to say they are careless. The risks are very low for them and the elderly just keep themselves locked at home.
Matthias Goergens
Apr 17 2020 at 2:13am
Those young and healthy aren’t so much risking anything for themselves, but they are risking other people’s lives. That makes them careless in a sense.
Phil H
Apr 16 2020 at 10:00pm
The question is… interesting, I suppose, but there’s an important sense in which the question of how one gets infected is completely irrelevant. An infection is an infection is an infection. From the point of view of the health system, they’re all equivalent; from the point of view of future epidemiology, they’re equivalent.
The question is relevant in that the answers could help us to adjust for a more effective lockdown. But in particular, the moralistic tone attached to “careless” “scofflaws” and “unlucky” is unhelpful, and unscientific. Containing the epidemic to only the morally unworthy is not a goal that anyone should be aiming for.
Dylan
Apr 17 2020 at 9:58am
This is the part that I think is interesting, and where I think data would be extremely helpful. Knowing with better certainty where and how people are getting the virus can do a lot to modulate our response, both on a societal level and at the individual level.
A couple of weeks ago someone shared a text supposedly from a doctor talking about the transmission vectors, and how people were at risk even if they walked through the place where someone with the virus sneezed two hours before. Rather than encouraging me to be more careful, that information gave me a pretty fatalistic view on how likely I was to get it. Even if you take all the precautions in the world, in a busy city like New York you just can’t avoid some contact with a lot of other human beings on an almost daily basis.
If we were finding that a significant percentage of the people that were getting it had been carefully following social distancing guidelines, wearing masks and gloves on their weekly trip to the supermarket, washing hands frequently, etc… That’s valuable information to know. If it is the 20 or so people I saw in the park on Easter playing soccer that are the ones spreading it, that is also useful information to know.
Phil H
Apr 19 2020 at 4:35am
Hi, Dylan. That’s right, but I think we have the answer to your question. China went into lockdown and the epidemic stopped. That’s the brute fact. People aren’t dying here any more. It was a pretty hardcore lockdown, and the lockdown was three months long. We know that that works, so that’s the baseline.
Then, yeah, there’s a lot of questions you can ask about how much that kind of hardcore lockdown can be modulated without losing its effectiveness. But the clear knowledge that lockdown (+masks) works should be reference point no. 1 for this conversation, I think.
Ken P
Apr 17 2020 at 2:12am
Death rate is a lagging indicator. If death rate peaked around the end of March, the infection rate likely peaked around a month earlier (before shelter in place). My guess is that there is considerably less risk now than in February in most parts of the country. So good question who’s still getting sick?
My hope is that enough people have already had it to slow the spread if a second wave comes around.
OriginalSeeing
Apr 17 2020 at 10:24am
I expect a big impact is occurring because of #1. If one person in a household is infected, then I expect several or all other members of the household to eventually become infected.
In the WHO report or WHO-China report (I forget which) it was reported that the most common location for transmission in Wuhan, China was within homes.
A home is probably the hardest location to protect against infection in. People aren’t protecting themselves within their own homes in the same manner that a careful grocery worker is. It takes an average of 5 days for a person who show symptoms of infection, coronaviruses can stay active on plastic, metal, etc. for up to 5 days, and any second person who is infected becomes a virus spreader. Put all that together and it’s very likely that a single person in a household becoming sick means that everyone within the household will become sick.
This will also screw with the statistics of the spread because a household of 4 where only 1 person ever goes outside their home could lead to a count of 4 people infected but only 1 infected person who should count as a spreader in terms of infecting people outside the home during the days because they began showing symptoms.
Sophy Ramírez
Apr 17 2020 at 10:43pm
Hi! well, I’m not an economist, I’m a Guatemalan screenwriter/filmmaker, first… I came to write here because I’ve been working at UFM and had to write a little synopsis for your videos about open borders, and I became like your fan, then I worked in another video of James Schnider and writing his bio for the website I realized that you knew each other so I was amazed and just wanted to tell you that you have a little fan haha.
And to make this comment “wierdless” I will tell you the actual situation in my country, yes we had been in “quarantine” for a month now but in here the majority of the population are middle-class low or in extreme poverty, so people still go to work every day. Then is the thing about education, most of our population have ever heard the world exponential and don’t know the heaviness of the situation and still visit their loved ones to the hospitals, and most of the people don’t respect quarantine even though there are consequences.
Here, the president can’t even make an official quarantine of more than a week because some private companies are suing him for abusing power, even though he really hasn’t, and we are in State of Calamity.
So I would say that it is mostly because of the 4 and 6
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