Public Policy Implications of IFR

My previous article made the case that

  • CFR is significantly, perhaps wildly, overstated owing primarily to a lack of widespread testing and showed that the more a country tested, the lower it’s CFR.
  • Even the best testers are likely still missing cases and the real fatality rate (the infection fatality rate, or IFR) is likely between 0.1% and 0.5%, and probably at the low end of that range.

I also suggested that R0 might be significantly higher than currently believed, leading to a very large number of infections occurring in a short period of time, thus overwhelming our hospitals as a result not of virulence, but of prevalence.  It has also been suggested to me that data from the Netherlands shows that, compared to the flu, HB19 patients in ICU have a much higher probability to die, and the time they occupy the beds is also much longer, which again increases the load for healthcare systems (if anyone has a reliable source for this, please send it to me).

In addition the data from Italy shows clearly that fatalities are occurring almost entirely amongst the elderly and already sick.  The mean age of those that have died is 81, and two thirds of them were already seriously ill.

The final input we need to understand how best we should be responding to this threat as a society is what will cause the pandemic to end.  Every suggestion I have seen seems to suggest that the outbreak will only end once we have achieved herd immunity and this, as an approximation, requires 1-1/R as a fraction of the population to become immune.  While we all hope for a vaccine, I think the odds of getting one in a useful timeframe are slim:

  • vaccines are not trivial to develop
  • they require extensive testing to be safe; there are several examples of vaccines that were more dangerous than the disease even after testing, and given that this disease has such a low fatality rate it would be foolish indeed to administer an untested vaccine in response
  • previous coronavirus vaccines, e.g. the flu vaccine, have proven only marginally effective.  Yes they probably offer some protection on balance, but it’s nothing like full immunity and they seem to provide no direct benefit at all to the elderly.

So, for the purposes of this discussion let’s assume that we will have to acquire herd immunity the old fashioned way, by everyone getting the disease.

What measures then, should we then adopt in order to minimize the loss of life and suffering?

If we, as we seem to be doing today, shut down huge swathes of our economies and ask everyone to minimize contact with each other it is certainly true that we should be able to slow the pace of the epidemic, and consequently avoid overwhelming our hospitals and that will indeed result in fewer people dying than if we did nothing at all.  But it will come at a huge cost to people who will lose their educations, their social lives, their jobs and their businesses.  The elderly, perhaps still alive, may themselves be newly impoverished as their pensions collapse and inflation rages in response to the government’s epic upcoming money-printing spree.  And although people may receive better care as a result of our hospitals not being overwhelmed, the young and the elderly will all isolate themselves equally and will therefore be infected equally and in the end the same proportion of each group, we’re told about 70%, will catch the disease.

Surely it would be more sensible to ask the old, the sick and the immuno-compromised to isolate themselves as far as possible for three months while the rest of society carried on with their lives in an almost normal fashion.  By all means cancel sporting events, concerts and other large gatherings, avoid mass transit as far as possible and ask people to work from home who can do so without impacting their productivity too much.  But keep the schools open, the gyms, the restaurants and the bars.  The economy could continue without massive dislocations. And let’s let the disease run its course among the healthy people who are under sixty years old.  The overwhelming majority of these folks will have only mild symptoms or no symptoms at all, and the hospitals should be able to cope with the tiny proportion who do suffer more severe symptoms.   And once enough of them have had the virus and recovered they will act like boron rods in a nuclear reactor, making it much safer for the elderly to emerge from isolation.  And yes I realize that we will not be able to complete isolate all elderly people and prevent any of them from becoming infected.  But perhaps we can reach herd immunity with only 30% or 50% of them having to risk their lives instead of 70%.

2 thoughts on “Public Policy Implications of IFR

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