A few disclaimers here at the top. I’m not a doctor. I don’t even play one on TV. I hang out with doctors, but they are predominantly philosophical rather than medicinal. I can’t speak to how SARS-CoV-2 affects your immune system and leads to COVID-19, and in advanced cases, ARDS.
I can’t speak to how infectious diseases spread other than to note that you don’t get sick because viruses attack you. You get sick because you set up conditions within your body to allow a virus to flourish once it gets in the wrong place (usually a mucous membrane). If you concerned with what happens after that, you should talk with your doctor.
I’m not an economist or a data scientist. I don’t know how the stay at home order has affected the economy other than what I discerned from the cover of the Wall Street Journal a few weeks ago:
Numbers would suggest more people have lost their livelihood than their lives. That will certainly have an effect on things down the road, and it is probably hard to compare the future unknown effects with versions of the past that didn’t happen, but we’ll get to that.
While I don’t have the skills to explain how a pandemic works, I do have a very particular set of skills, skills I have acquired over a very long career, skills that make me a nightmare for people prefer simplistic charts and memes to actual data.
Interestingly, I acquired these skills through studying apologetics, which as we all remember is not the science of apologizing. Rather, it is skill in the art of deconstructing arguments, pointing out things that can’t be known, and teasing out the implications of ideas. In short, it’s mostly critical thinking, but emphasis on the critical part.
With that in mind, I’m going to do two things. I’ll explain why we can’t know if that graph is right. Then, I’m gonna show complex things are by looking at data from my neck of the woods. I am going to limit my observations to the data I have collected, and make extrapolations based on that.
So, first, the red line is supposed to represent the rise of new cases over time under business as usual. Since it is not an actual graph, we don’t have a scale, but it certainly seems steep. Initial models projected something like a 40% daily increase. In many places though, those projections were off before measures were really even underway. Some places (e.g. New York City) were way way worse. Some were never going to see a 40% daily increase even if they tried. But, I think most of America, at least the more populated parts, weren’t quite seeing 40% increases even before shutting stuff down.
While this isn’t a problem in one sense (it means less people got sick and died), it is another. Since no one carried one with business as usual, we don’t have a control group to know what would have actually happened. Some states issued stay-at-home orders before others did, but by April, everyone was pretty much in under the same restrictions.
Now, someone might suggest that we can compare states and see how bad it got in states that drug their feet and delayed restrictions. I happen to live in one of those states (Florida) and was originally planning to visit another one (California) so I was paying attention to how things unfolded.
California issued a statewide stay-at-home order on March 19th, making it one of the first. Florida’s went into effect on April 3rd, making it one of the last, at least among more populated states (we’re #3). So, we are coming up on 3 weeks for Florida, and 5 weeks for California of staying-at-home (except for a long list of reasons you can still leave). Rather than compare total cases and total deaths, which isn’t fair because California is almost twice as big, let’s compare cases per million and and deaths per million.
Florida has 1335 cases per million, which ranks 19th among US states. California has 906 cases per million, and ranks 32nd. If we look at deaths per million, Florida has 41 (22nd) and California has 33 (28th).
Is it tempting to say that an extra two weeks of staying at home has saved 8 lives per million in California, or 320 people, which is roughly the difference between total fatalities of Florida and California (who are 9th and 10th in total numbers). But, I realize it doesn’t work quite like that. What is worth noting though is that we’re not talking about a radical difference, and Florida’s governor was right to resist pressure to shut the whole state down because one major metro area was having an outbreak (looking at you Miami).
Now, if California had waited two weeks, we don’t know how much worse it would be. I think we can somewhat assume they would have more cases and therefore more fatalities. Stay-at-home orders do have a noticeable affect, but we can’t really quantify it after the fact. Had Florida issued the order closer to when California did, I’m sure we’d have less cases and fatalities, but it’s hard to say how much less when locally we’re not looking at anything that would be remarkable if weren’t all over the news.
Which brings us back to the graph. We don’t know what business as usual might have been like. We do know that measures have reduced the number of cases and numbers of fatalities, but we don’t know to what extent because we don’t have a local control group to use as a comparison. We may very well have overreacted, and mandatory social distancing and voluntary staying at home could have worked just as well. Moving forward, we can see how that would work compared to a mandatory stay at home for all, and maybe that’s the path forward. Just because everything starts to open up again doesn’t mean you have to go out.
Let’s shift gears a bit, and look at some of my local numbers as an example, and I’ll leave it to you to draw conclusions. I live in a northern suburb of Orlando, in a county of roughly 500,000 people. Prior to April 3rd, we had been applying social distancing only with no official stay-at-home order. With just social distancing, we were looking at a daily increase of 20% and falling. The models were already on track to be way off (we were 50% less than expected by the time the statewide order started).
Let’s assume we kept social distancing, but didn’t have a stay at home order in place. Let’s assume too that the daily increase didn’t decrease, but stayed stable. That would mean by today we would have 3616 cases instead of 328. If our fatality rate was roughly the same, we would have seen 56 deaths instead of 6.
Now, on the assumption that that is how it would have played out (something we can’t know for sure), we can know consider other factors. In Florida, unemployment rose 1.5% from February to March. Applying to that my county, that means 7500 people lost their jobs in March (that we know of), and we don’t have full numbers of April yet, but I’m gonna go out on a limb and guess it’ll be more. The numbers from March probably reflect (to some extent) people who stopped working when things shut down voluntarily, or because they couldn’t maintain social distancing or because the governor closed dine restaurants and bars mid March.
Also worth considering is how staying-at-home affects some people’s home lives, outside of employment issues. I am also not familiar with the numbers of domestic violence incidence or suicide. We could at the end of the month compare those numbers from this April to previous Aprils and perhaps draw some conclusions. Too soon to say now, but I wouldn’t be surprised if both of those things spiked.
The reason I invoke all of this is because we might say that the stay-at-home order in my county has saved 50 lives so far, but that’s not even entirely true. The vast majority of fatalities in central Florida have involved people with heart disease, something that is already the leading cause of death. By keeping people from getting COVID-19, we aren’t saving their lives. We are prolonging them, which is a noble calling if you believe in the sanctity of human life (and even if you don’t). But let’s not overestimate our powers.
Notice things are not very cut-and-dried if you’re trying to make policy decisions. Is it reckless to start thinking about opening things back up? If your highest value is keeping people from getting sick whether they like it or not, then probably so. But, if you’re highest value is more economic, then heck yeah let’s get them gyms and bars back open.
On the other hand, if your highest value is the greatest good for the greatest number of people, then you have difficult decisions to make. Ultimately, we should want what will lead to the greatest amount of human flourishing in whatever part of the world we find ourselves in. Simply keeping some people from getting sick is one way of doing that, but it comes with other costs that diminish human flourishing in other ways that we can’t quite quantify yet, but soon might be able to.
Ultimately, things can’t be boiled down to memes or charts like the one above. Prevailing narratives are often unhinged from hard data, but make for good shots at political rivals.
It is perhaps ironic that most progressives I see want to take away people’s right to choose in order to protect the weak and vulnerable (a line of logic that also works to restrict abortion). Conservatives have their own ironies (like the ones suddenly in favor of civil disobedience), but I see more progressive recoiling at the idea of re-opening things because they are more concerned about potential loss of lives rather than definite loss of livelihoods. I don’t think continued stay-at-home orders are necessary or good, but I also don’t think just re-opening everything quickly is good either.
Thankfully, Georgia is about to give us a test case. Later this week they’re going to start the process of re-opening things and we’ll be able to see if it turns into a disaster. The governor is for it (a Republican) and the mayor of Atlanta is against it (a Democrat). Let’s see who the data proves right in a few weeks. Anyone who wants to can do what I did for Florida and for my counties. You can track the numbers for yourself (or check here in a few weeks) and see what the data looks like and not rely on memes, charts, and political narratives to make sense of how this whole things is unfolding.