COVID-19 Counter-Factuals and Trade-Offs

by James A. Bacon

A recent Columbia University study generated headlines after concluding that 55% of deaths reported as of May 3 could have been avoided if stricter social-distancing controls had been implemented nationally just one week earlier.

Responding to that story, President Trump created a mini-furor by engaging in his usual ad hominem attacks. Rather than addressing the underlying facts and logic in the study, he called Columbia a “liberal, disgraceful institution” — as if labeling the institution ideologically did anything to rebut the rigor of the study.

A nuanced critic of the study might have questioned the validity of using epidemiological models to run counter-factual simulations. The outcome of models like the one used by the Columbia authors depends upon an array of critical assumptions — often debatable — about the relationship between different variables. As the old saying goes, Garbage In, Garbage Out.

Whatever the merits of the particular study in question, the flap revealed that the U.S. academic and media establishments now accept counter-factual simulations as legitimate news. Perhaps someone could build a model to answer a different counter-factual question: Given the fact that most COVID-19 deaths have involved elderly patients with one or more coexisting conditions, how many would have died anyway?

It’s one thing to ask how many lives were lost, as the Columbia study did. It’s another to ask how many years of life were lost. That is a question which, in other contexts, liberal academicians have dwelled upon.

It is widely accepted that, all other factors being equal, the premature death of, say, a 35-year-old is more tragic than the demise of an 85-year-old Alzheimer’s patient with severe respiratory ailments. The thinking behind the so-called “death panels” of the Affordable Care Act was that society does not have the resources to prolong every person’s life indefinitely, even if it were medically feasible to do so. If we must ration resources, we should apply rational criteria to our decision making. It does not make sense to spend wildly disproportionate sums on extending the life of an elderly person with multiple chronic conditions who is likely to die soon regardless.

Suddenly, such thinking is nowhere to be found in the debate over COVID-19. Politics have turned all logic upside down. The current thinking on the left side of the political spectrum now is that every life is precious, and that society should act to bend every effort to save lives — no matter the cost. Any insinuation that one should put saving jobs over saving lives is deemed a moral abomination.

Even in a world polarized between the forces of Trump and anti-Trump, there does seem to be widespread agreement — mainly because the facts are incontestable — that there is a powerful correlation between a COVID-19 patient’s age and his or her likelihood to die from the disease. There is also widespread agreement that people with co-existing conditions such as diabetes, obesity, respiratory illness, and heart disease — are at heightened risk of mortality. The more preexisting conditions a person has, the greater the risk he is of dying from exposure to the virus.

We cannot tell from the Virginia Department of Health data how many Virginians who died from COVID-19 had underlying health conditions. But we can say two things without fear of contradiction. First, while people of all ages are susceptible to being infected by the virus….


… deaths are closely correlated with age.

An important question is whether age is the driving factor behind mortality or whether age is highly correlated with other factors associated with age, such as the prevalence of heart and respiratory disease. It is possible for both explanations to be true. The elderly may have more preexisting conditions and, by virtue of their age, also have weaker immunological systems.

As much as I love my time on earth, my life at 67 has less value than the lives of my children, or grandchildren, or younger generations generally. If I’m lucky, I’ve got 20 or 25 years ahead of me. Younger generations have 60 to 90 years ahead of them. Furthermore, while there may be no price tag that can be placed upon the brilliance that spews from my keyboard on the Bacon’s Rebellion blog, it is incontestable that younger generations have far more economically productive years ahead of them than I do.

Sixty percent of COVID-19 deaths in Virginia involved residents of long-term care facilities. With nursing homes, like the Hotel California, you can check in but you can never leave. The average length of stay in a long-term care facility nationally is 2.6 years for females and 2.3 years for males. If the new coronavirus hadn’t done them in, something else would have — and in relatively short order.

I share the conviction that an important measure of a society is how well it takes care of its older people. We need to expend every reasonable effort to keep the most vulnerable among us safe from harm. So far, we have done a dismal job. But saving the lives of the elderly is not an absolute value for which everything else must be sacrificed. Life is full of difficult trade-offs. When we seek the appropriate balance between “saving lives” and “saving jobs” we should give appropriate weight to those who have many years to live and those who don’t.

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47 responses to “COVID-19 Counter-Factuals and Trade-Offs

  1. “Given the fact that most COVID-19 deaths have involved elderly patients with one or more coexisting conditions, how many would have died anyway?” Duh. That would be all of them, and all of us for that matter, but the CDC “excess deaths” data I pointed to last week is quite strong evidence that the process has been accelerated. Some weeks have seen 30% plus excess, and the death certificates are still coming it. This is a real and deadly pandemic, Jim. Devastating in the greater New York area. Brazil may top it.

    Now, no question, Columbia’s study became news because they thought it would reflect badly on Trump. The history of how the politics screwed this up will be fascinating. But leaders everywhere were slow to react. Had Roosevelt heeded warnings, the fleet wouldn’t have been napping in Pearl Harbor. Had MacArthur heeded warnings, the North Koreans wouldn’t have overrun the south so easily. Hindsight being 20-20 is not news. And like you, I’ve said from the beginning: Don’t destroy the economy just to save me and my peers – I’ll go hide on my own.

    • Steve, would nursing home COVID-19 patients with Do Not Resuscitate or Do Not Intubate orders in effect that would have prohibited being placed on ventilators be excluded from the excess deaths numbers when more details are known?

      I recall reading Va inspection deficiency reports where the nursing homes failed to have properly signed DNRs on file and procedures to avoid that in the future were discussed so that the patient’s (or responsible party’s) choice could be honored.

    • “Now, no question, Columbia’s study became news because they thought it would reflect badly on Trump.”

      They? Who they? Columbia’s researchers? Are you suggesting the researchers conducted the study just to hurt Trump? Evidence! I might concede that there are those, not associated with Columbia, who would amplify the results beyond the community for that purpose, but the reaseach itself? You best have a hacked email.

      You? Save you? What makes you think this is about your death now? This animal has morphed from the concern for the immediate dead to the change to the medical condition of survivors. Brace for it, but survivors, and that includes the asymptotic, may face a whole host of COV2 induced early onset morbid conditions.

      • “They” would be the media. The study itself sounds interesting, useful and I’d read the summary. I don’t dispute it all. And sure, this is all about me :). As to your ending…hm. Now that the peak is passed, you wants us all losing sleep over long term damage? Where’s YOUR evidence?

      • Columbia’s “study” was based upon the notion that a shutdown a week earlier in march would’ve impacted us greatly. That is a false premise, as we don’t even know the date at which the virus arrived.

        The timeline has been skewed so many times that making such claims is just a guessing game.

        • “Here we use county-level observations of reported infections and deaths11, in conjunction with human mobility data12 and a metapopulation transmission model13,14, to quantify changes of disease transmission rates in US counties from March 15, 2020 to May 3, 2020. “

          • and other countries like South Korea and Germany did just that and successfully reduced the extent of the infections.

            but water under the bridge now… except that uniform contact tracing on a central database would also reduce new infections.

            Just seems to be two “schools” of thought… and one basically is “let it all hang out and after the dust settles… the survivors will do their thing and sorry about that to youse guys that croaked”

          • Your point?

            If you have no idea when the virus first arrived making prognostications that it could’ve been contained better if only we’d acted sooner is a fallacy.

          • Nancy_Naive

            Extrapolation works in both directions.

          • the point? that you don’t need to know the start date to go back on the timeline…from where you are now…….

            the real point is folks opposed to doing it.

            right?

          • Nancy_Naive

            Yes, see extrapolation.

  2. The median age of our workforce is 43. Anthony Fauci is 79. A lot
    of professionals (like those “liberal” scientists) take decades to reach their most productive years, often into their 50 and 60’s and older to reach their prime.

    You say “protect the vulnerable” but you say so as if they are not actually still working in the economy and that’s simply not the reality.

    You just can’t make this kind of distinction on age alone. There is
    no neat dividing line. It’s a false narrative.

    Many, many older people and people with health conditions are very much still in the workforce and in society doing all the same things that younger folks do – like shop and have doctors appointments , walk in the park, even go to the beach! Ye Gads!

    (and I agree with Steve… I don’t know the motivation of that study but yes… it’s being used as yet another cudgel against Trump…).

  3. Well, let’s push it back up the hill and see if it crashes in the same place.

    There’s just too much Kool-Aid in this opinion for one person to have drunk. No wonder you regurgitated everything including the “death panel” kitchen sink.

  4. Bacon. Want me to pull the plug? But, then, I am three weeks older than you.

  5. The cause of death and the finality of death for someone who had the virus are same for people of any age -95, 25, or 50. The RO factor mentioned in the Columbia study tells us nothing we don’t already know about any contagion, take precautions and slow the spread. Now we have to quit the blame game of who, what, how, and when and get people back to work and fix this economy. The sooner the better.

    What can be done to make workplaces safer for the non essential workers? What have we learned about the safety of the workplace for essential workers that might apply? How does and the research that has been done improve our ability to get the economy up and running?

    This decisive split in politics is worse than the virus. It is keeping us at a place where we don’t move forward. On this blog, we argue, but it brings out good ideas. The media is not attracted to the good ideas, only the decisive argument. It gets us nowhere.

    What are we going to do now to make sure that our loss of tax income due to unemployment and lack of business revenue doesn’t kill us next year? We still have to a afford schools, prisons, the dept of motor vehicles, etc. It seems to me we should be deciding now what we consider essential and make sure it is in the bucket for the future – not arguing over masks required or not required in public.

    Another question, how is the vaccine going to be distributed and regulated?

  6. I ran out of time, but here is another question- What industries need the quickest repair? Airline to support tourism? Restaurants to support workers? I don’t know the answers to most of these questions, but collectively, we need to sort it out – not by party politics with someone looking for credit, but good fellowship and idea sharing.

  7. been reading this and wondering and worrying a little … I guess for vegetarians it’s no big deal:

    “Tyson Foods, the largest meat processor in the United States, has transformed its facilities across the country since legions of its workers started getting sick from the novel coronavirus. It has set up on-site medical clinics, screened employees for fevers at the beginning of their shifts, required the use of facial coverings, installed plastic dividers between stations and taken a host of other steps to slow the spread.

    Despite those efforts, the number of Tyson employees with covid-19 has exploded from under 1,600 a month ago to more than 7,000 today, according to a Washington Post analysis of news reports and public records.
    What has happened at Tyson — and the meat industry overall — shows how difficult getting the nation back to normal is, even in essential fields such as food processing. Meat companies are spending hundreds of millions of dollars — on everything from protective gear to paid leave to ventilation systems — since they were forced to shut dozens of plants that were among the top covid-19 hot spots outside of cities.”

  8. been reading this and wondering and worrying a little .. most of these workers are likely not “old” and yet the virus is still not under control in these workplaces……

    “Tyson Foods, the largest meat processor in the United States, has transformed its facilities across the country since legions of its workers started getting sick from the novel coronavirus. It has set up on-site medical clinics, screened employees for fevers at the beginning of their shifts, required the use of facial coverings, installed plastic dividers between stations and taken a host of other steps to slow the spread.

    Despite those efforts, the number of Tyson employees with covid-19 has exploded from under 1,600 a month ago to more than 7,000 today, according to a Washington Post analysis of news reports and public records.

    What has happened at Tyson — and the meat industry overall — shows how difficult getting the nation back to normal is, even in essential fields such as food processing. Meat companies are spending hundreds of millions of dollars — on everything from protective gear to paid leave to ventilation systems — since they were forced to shut dozens of plants that were among the top covid-19 hot spots outside of cities.”

  9. Larry G,

    My point exactly! Will the 7000 workers go back to work? When? What is the financial impact to the state’s system of support? How can we ensure that these kinds of phenomena from Covid19 are being addressed? Does this mean something with regard to the vaccine? We have to switch our thoughts (within reason) from finding Covid 19 supplies to solving these kind of problems.

    • The meat packing plants are seldom addressed in discussions about “opening back up” – by protecting the old and vulnerable.

      The belief is that younger workers won’t get it or will not get it in high numbers…

      We’re going to find out if the same problem happens to churches, beaches and beach restaurants in a week or two.

      The skeptics are not going to be convinced unless it really does become contagion.

      Just the way it is right now.

      • And what have they done wrong that the shipyard in Newport News did right? Few cases there, last I saw. PPE is part of the work culture, they did turn third-shift into a period for cleaning rather than production (already the case is parts of the plant), and can test everybody coming in the gate or office door. It’s a much better educated workforce. But its record so far is stellar.

        • Meat packing — done on an assembly line indoors.
          Shipbuilding — done on an assembly line indoors? That would be cool. I would love to see that building.

          BTW, twice in my life I worked in that yard. The mean free space between workers, except at the gates and in the heads, can be measured in yards, not feet.

          • Steve Haner

            Then you were not inside the hull of a submarine, sir. (But mainly I credit the fact that everybody there uses PPE everyday, so it is ingrained.)

          • Nancy_Naive

            Uh, for a while, and then I was inside boilers. In retrospect, I’ll take a submarine and COV2 over the boiler 12 hours after shutdown every time.

          • Reed Fawell 3rd

            Tell me, Nancy, do you own and control this website, your private playground?

            You act that way.

          • Nancy_Naive

            Yes, but feel free to join in with something smart at anytime.

            (Someone respond to one of Reed’s comments. Methinks he feels neglected)

          • Reed Fawell 3rd

            “Methinks he feels neglected.”

            No, you can’t stop babbling on and on, playing roll of a nasty little girl, insulting other people and those they admire, while you hide behind your little child disguise.

          • Nancy_Naive

            Keywords: something smart.

            His parents wanted to homeschool him, but he wasn’t accepted.

  10. Once one clears the underbrush of Conservative knee-jerks and dog whistles, e.g., “death panels” linked to Obamacare (as opposed to for-profit insurance, which is, BTW, where they have been since the first denial of coverage letter was mailed in the 1940s), you actually ask some questions to which I think you might want answers, albeit you then start off on pronouncing old people as cannon fodder, so who knows?

    But, e.g.,…

    Should modeling be used for “counter-factual” events? Do you fly? Then stop; because models are used all of the time to study the “whataboutisms” of flight safety and crash investigations that lead to design and procedural changes that save lives – countable numbers of lives. I could give a tedious list starting with the Challenger and going through Sully’s Miracle on the Hudson, but you just think about it instead.

    Then we get to the crux of your biscuit. Quantity of life. Old people die. And then you begin down the rabbit hole of saving money over lives (that’s a “death panel”, you know).

    Sometime (1990s), the EPA went into some city in Colorado and began scraping earth, processing it to remove lead, and putting it back. Some conservative Congressmen went into a tear on the waste of money just to add days to the average lifespan of the residents.

    They held hearings. Some Represetative dragged out charts and graphs, culminating with a chart that showed the lives saved by simply installing a stoplight at a dangerous intersection in the city, thus saving more lives and adding more time to the citizens average span than the EPA project.

    The EPA scientist sat there quietly being berated.

    At the end, he stated something akin to, “That stoplight is a good idea too, Congressman, we should tell CDOT, but the issue isn’t longevity. It’s the quality of a life without lead poisoning.” The EPA was scraping dirt at schools and playgrounds to reduce the chronic conditions of children poisoned by lead, and the cost associated with, among other things, reduced IQ.

    Let me throw a stick in your mud in the form of a whataboutism, “chronic Kawasaki’s disease”. Uh oh, now young people enter your mix. What’s the cost of the loss of lifespan to arterial and heart conditions of perhaps the entire Millennial generation?

    • Finally, a substantive response! Congratulations, Nancy Naïve, this is far superior to your snarkier contributions. Needless to say, I disagree. But I have to take your arguments seriously. Let’s see more like this.

      • NN has actually saying that in the snark also but people react to the snark and not the points made. It’s shorthand but the points are there.

        This post, she/he expanded it, fleshed it out, beyond the snark but it really is consistent with many of the prior comments.

      • Thanks. You’re welcome.

        BTW, it was Leadville. Doh. As I was writing, I kept trying to think of the city. I fixated on Telluride, but knew that wasn’t it, although given proximity, it may have been both.

  11. On what do you base your example of “the entire Millenial generation?” And what would you want done that isn’t being done?

    The CDC’s Clinician Outreach and Communication Activity (COCA) held a webinar on May 19, foll0wing an alert about multisystem inflammatory syndrome in children, and reporting to the CDC so the incidence can be monitored.
    https://emergency.cdc.gov/coca/calls/2020/callinfo_051920.asp

    One of the presenters said, “I think it’s possible that there may be a spectrum for the illness and we’re just catching the most severe cases who are hospitalized and wind up in the ICU. That has happened in Kawasaki disease. There are severe forms of the disease and there’s also a milder presentation or atypical or incomplete presentation of Kawasaki disease. So it’s possible that that could also happen with MIS. This is one of the reasons that we need to conduct more data to better understand the clinical phenotype of the illness. But as currently stands, not all of these cases are hospitalized and most of them end up in the ICU.”

    There is a treatment for KD, and up to 80% receiving it do not develop coronary artery aneurysms. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC427377/

    • per·haps
      /pərˈ(h)aps/
      adverb
      used to express uncertainty or possibility.

      Please put the word back in.

      COV2 is still spreading. And, do we treat everyone for KD who, under the age of 20, test positive for COV2?

      My reply was to death paneling old people with a complete absence of the evidence associated with newly discovered complications.

      • Currently reading Preston’s new book. Now Ebola, that scares the %$# out of me. I do want some scalps on the wall after this. People in the public health business had every reason to expect, not fear, expect such a pandemic. The plans were in place, the items to be stockpiled well known, the early steps that worked fully understood. Yet we were caught flat and fumbled for weeks. We should be grateful this isn’t something far more dangerous, like Ebola or Lassa. If we remain unprepared for the next one, well there is no excuse now.

        The after action on this will mainly blame: 1) China and WHO lies, 2) the FDA’s initial bungling of efforts to get widespread testing and 3) the contradictory early advice on using even basic face masks, since nobody had properly stockpiled N95s. Imagine if Twitterman had used his overactive thumb to send out a photo of him and his gorgeous wife in masks about February 10….As Governor No Mask proved again this weekend, it means nothing if you don’t lead by example.

        • WHO lies? You have to ask that with over 16,000 documented in 3 years?

          https://www.immunopaedia.org.za/breaking-news/2016-articles/the-link-between-malaria-and-cancer/

          I’ll come back to that. HPV — 1960, “Oh you poor dear, you have vaginal warts.” 1990 — “Oh you poor dear, you have ovarian cancer.”

          Biologically, we are the sum total of our DNA and the pests we tolerate, and then don’t.

          1942 — my uncle’s greatest concern was dodging Japaneses bullets in the skies over Papua New Guinea, but it was probably the mosquito in his tent that got him.

          • Steve Haner

            Maybe – but Corona viruses are not new or without some history. Like filoviruses, etc. But maybe. I’ve never said getting this bug is a good idea. From the moment of conception, the world is trying to kill us somehow.

          • Nancy_Naive

            The difference between corona viruses (Virii?) is the DNA/rna strands within.

          • Coronavirus is an RNA based virus, there is no DNA.

          • Nancy_Naive

            Good. You can correct when I do that again, and I can strive to forget it.

        • Hey Gub’na “Warning: The Surgeon General Has Determined That Cigarette Smoking Is Dangerous to Your Health.”

        • re: ” Now Ebola, that scares the %$# out of me. ”

          yeah, but do you expect/desire a Federal public health system to lead the way on issues like that?

          We had complaints on that also… if you remember… and lawsuits…

  12. Yesterday New York’s Governor declared that he will answer no more questions about Covid – 19 modeling projections. His reasoning behind this flat refusal is that:

    “Now, people can speculate, people can guess, I think next week, I think two weeks, I think a month,” Cuomo said. “I’m out of that business, because we all failed at that business. All the early national experts, here’s my projection, here’s my projection model, they were all all wrong, they were all wrong.”

    Unfortunately, New York now must admit that 24% of Covid 19 deaths nationwide occurred in New York, while New York has 6% of nation’s population. And still earlier unreported nursing home deaths in the State are coming in. See this, for example:

    “Additional 1,700 Coronavirus Deaths Reported in New York State Nursing Homes

    “(ALBANY, N.Y.) — New York state is now reporting more than 1,700 previously undisclosed deaths at nursing homes and adult care facilities as the state faces scrutiny over how it’s protected vulnerable residents during the coronavirus pandemic.

    At least 4,813 residents with confirmed or presumed cases of COVID-19 have died at 351 of New York’s 613 nursing homes since March 1, according to Gov. Andrew Cuomo’s administration’s new list. The list, released late Monday, includes the reported number of both confirmed and presumed deaths as of Sunday evening.

    Nursing home residents have made up roughly one-fourth to one-fifth of the state’s official tally of fatalities. But just how many nursing home residents have died of COVID-19 remains uncertain despite the state’s latest disclosure, as the list doesn’t include deaths of nursing home residents at hospitals or any details about the number of COVID-19 cases at individual nursing homes.

    The data shows that 22 nursing homes largely in New York City and Long Island have reported at least 40 deaths and that 64 nursing homes have reported between 20 to 49 deaths.”

    For more, see: https://time.com/5832141/new-york-nursing-home-death-toll/

  13. Coumo has had to make life changing decisions every day. Someone, I hope, is chronicalling his data and actions. Now he has a big mess to clean up biologically, medically, socially, and economically and he must still worry about someone who says he should have started lock down earlier. Really? He is right, everyone running around with models and predictions in March doesn’t change a thing for the lives of people in New York in the present. It’s alot of people. It’s alot of jobs. It’s alot of lost revenue. It’s alot needed for the future. Let’s concentrate on that.

  14. The floor of the New York stock exchange just reopened after two months. I doubt anyone can say that doesn’t sound good!

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