Yesterday at Marginal Revolution Tyler Cowen featured in its own post this comment made by James Markels in response to Tyler’s link a day earlier to a Cafe Hayek post of mine – a post of mine critical of some remarks about Covid-19, and the response to it, that Tyler offered in the latest episode of EconTalk. My original post included my disagreement with Tyler’s insistence on discounting the fact that Covid reserves its dangers overwhelmingly for the very old.
James Markels believes my criticism of Tyler to be mistaken. One of Mr. Markel’s points is this one:
First, the fact that COVID-19 disproportionately killed the elderly was not something that was readily apparent right out of the box, when the virus was spreading rapidly.
This claim by Mr. Markels is incorrect. (Other of his claims also strike me as being either incorrect or inapt, but here I limit my attention to the point quoted above.)
Yesterday in the comments section of Tyler’s post I offered some evidence of the early recognition of the age profile of Covid’s victims. This evidence was questioned by at least one other commenter. This morning, I happened to learn of an op-ed by Dr. David Katz that appeared in the March 20th, 2020 edition of the New York Times. Dr. Katz is founding director of the Yale-Griffin Prevention Research Center.
I’ve tried twice this morning in MR’s comments section to share a quotation from Dr. Katz’s op-ed, but for some reason my latest attempts to leave a comment appear to be rejected. (NOTE: I sincerely and emphatically do not believe that anything sinister is going on. I’m quite sure that my failure to post a new comment results from a technical glitch.)
So I share here the relevant portion of Dr. Katz’s op-ed:
The data from South Korea, where tracking the coronavirus has been by far the best to date, indicate that as much as 99 percent of active cases in the general population are “mild” and do not require specific medical treatment. The small percentage of cases that do require such services are highly concentrated among those age 60 and older, and further so the older people are. Other things being equal, those over age 70 appear at three times the mortality risk as those age 60 to 69, and those over age 80 at nearly twice the mortality risk of those age 70 to 79.
These conclusions are corroborated by the data from Wuhan, China, which show a higher death rate, but an almost identical distribution. The higher death rate in China may be real, but is perhaps a result of less widespread testing. South Korea promptly, and uniquely, started testing the apparently healthy population at large, finding the mild and asymptomatic cases of Covid-19 other countries are overlooking. The experience of the Diamond Princess cruise ship, which houses a contained, older population, proves the point. The death rate among that insular and uniformly exposed population is roughly 1 percent.
We have, to date, fewer than 200 deaths from the coronavirus in the United States — a small data set from which to draw big conclusions. Still, it is entirely aligned with the data from other countries. The deaths have been mainly clustered among the elderly, those with significant chronic illnesses such as diabetes and heart disease, and those in both groups.
This is not true of infectious scourges such as influenza. The flu hits the elderly and chronically ill hard, too, but it also kills children. Trying to create herd immunity among those most likely to recover from infection while also isolating the young and the old is daunting, to say the least. How does one allow exposure and immunity to develop in parents, without exposing their young children?
The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.
Not only does Dr. Katz’s op-ed from nearly 13 months ago disprove the claim that the age profile of Covid’s victims was not known early on, note that Dr. Katz’s recommendation is essentially the same as that of the Focused Protection recommendation offered in the Great Barrington Declaration.
Dr. Katz’s entire op-ed is excellent. (I’m sorry that I learned of it only today.) I share below, from it, other slices the relevance of which will be recognized by people who follow closely the debate over the proper response to Covid-19. And I ask Tyler and others who dismiss the Great Barrington Declaration as wrongheaded: What, specifically, do they find to be a problem with the substance of Dr. Katz’s analysis and proposal? And surely Dr. Katz’s argument is further evidence (not that any is really needed) against the assertion that the Great Barrington Declaration represents only a fringe view or, worse, that the GBD is unscientific.
Also, as regards Dr. Katz, I don’t believe it’s possible to dismiss his argument by issuing an ad hominem – ad hominem argumentation, sadly, being a widely used means of dismissing the Great Barrington Declaration.
I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life — schools and businesses closed, gatherings banned — will be long lasting and calamitous, possibly graver than the direct toll of the virus itself. The stock market will bounce back in time, but many businesses never will. The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.
So what is the alternative? Well, we could focus our resources on testing and protecting, in every way possible, all those people the data indicate are especially vulnerable to severe infection: the elderly, people with chronic diseases and the immunologically compromised. Those that test positive could be the first to receive the first approved antivirals. The majority, testing negative, could benefit from every resource we have to shield them from exposure.
If we were to focus on the especially vulnerable, there would be resources to keep them at home, provide them with needed services and coronavirus testing, and direct our medical system to their early care. I would favor proactive rather than reactive testing in this group, and early use of the most promising anti-viral drugs. This cannot be done under current policies, as we spread our relatively few test kits across the expanse of a whole population, made all the more anxious because society has shut down.
This focus on a much smaller portion of the population would allow most of society to return to life as usual and perhaps prevent vast segments of the economy from collapsing. Healthy children could return to school and healthy adults go back to their jobs. Theaters and restaurants could reopen, though we might be wise to avoid very large social gatherings like stadium sporting events and concerts.
So long as we were protecting the truly vulnerable, a sense of calm could be restored to society. Just as important, society as a whole could develop natural herd immunity to the virus. The vast majority of people would develop mild coronavirus infections, while medical resources could focus on those who fell critically ill. Once the wider population had been exposed and, if infected, had recovered and gained natural immunity, the risk to the most vulnerable would fall dramatically.
A pivot right now from trying to protect all people to focusing on the most vulnerable remains entirely plausible. With each passing day, however, it becomes more difficult. The path we are on may well lead to uncontained viral contagion and monumental collateral damage to our society and economy. A more surgical approach is what we need.
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