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Economy or Covid-19 deaths? Someone just doesn’t get it… October 22, 2021

Posted by guestposter in Uncategorized.
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Mark Paul in the IT Business section today has an article of such remarkable ignorance that one has to wonder just how it was published. It’s not that it is more than borderline offensive in its framing: “Let’s talk about acceptable Covid death rates before restrictions kick in”, though it is. It is that it betrays a fundamental lack of understanding of the public health issues that face this state long before we arrive at the economic implications, even though the two are intertwined.

So Paul can write with not the slightest hint of reflection:

Instinctively, we know that you cannot calculate the cost of a life, because life is priceless. Yet governments and public policy makers have to calculate the economic price of life every day when allocating resources for public-health care, or for traffic gardaí to fight road deaths, or deaths from alcohol, or any of the other ways in which people die and where State resources influence outcomes.

It is sometimes viewed through a concept called the economic cost of life saved by a medical intervention. It is often measured per year of “quality life” saved. The threshold in Britain is generally £30,000 (€35,600), according to Prof Graham Medley, a member of the UK government’s Scientific Advisory Group for Emergencies (Sage), their closest thing to Nphet. If a medical intervention costs less than £30,000 per year of life saved, it is usually accepted. This is grim but real.

And:

Sometimes the issue is viewed through a related concept known as the value of statistical life (VSL). Insurance companies deal with such concepts. So does our Health Service Executive. When it comes to the cost-benefit analyses of buying expensive life-saving drugs, for example, it is advised by the National Centre for Pharmacoeconomics in St James’s Hospital. It deals in “cost-effectiveness acceptability curves” and “willingness-to-pay thresholds”.

And:

There is a clear economic cost to fighting Covid-19 with restrictions on the economy and society, and heavy borrowings to fund medical care. By the end of the pandemic, if it “ends” next year, it probably will be more than €50 billion, if State borrowings to plug the economic gap are a yardstick. The deeper the economic restrictions, the higher the economic cost of fighting Covid.

To which he counterposes:

There is also a cost – in terms of human suffering, illness and death – to not fighting Covid-19 with every possible resource to hand. As of Wednesday, 5,369 people had died with Covid in the Republic, 63 of them in the past week. Not all of them could have been saved even if we threw 100 per cent of GDP at it. But, obviously, some would have been.

But this analysis is completely – and I use the word deliberately, idiotic. Because the choice isn’t between an open economy and those dead. It’s near enough simple-minded to place it in those terms. He sort of draws back a little way ‘Somebody, somewhere must make decisions on where to strike the balance. Or maybe it is a job for everybody, everywhere – a collective decision to emerge from society, that is then communicated to politicians and policymakers.’

But he continues:

If Ireland truly is to live with Covid, then a national conversation needs to take place about the acceptable level of death and illness before restrictions are put on the economy and society. It does not matter where you stand on the spectrum of deliberation over the cost of restrictions versus the cost of life. Like me, you might not even know where you stand. But it is relevant to all of us and it should not be shirked simply because it is an uncomfortable debate.

Though not so uncomfortable that he already looks to the UK for a pathway. And he throws out numbers like ‘100 deaths a day’, which would be about ‘7.5 deaths a day’ here in Ireland, though he has to admit that the numbers there are rising already.

But all that is empty rhetoric because there’s a fundamental reality that this self-proclaimed speaker of supposedly necessary truth ignores. And that is that with a respiratory virus there’s a choke point in terms not merely of ICU beds and hospital beds available but more broadly with the health system as a whole. The discussion over ‘acceptable levels of death’ is irrelevant because the instant that Covid begins to hospitalise people that brings one pressure to bear on the health system (due to knock on effects in terms of beds available, other care for other conditions foregone and so on). The moment that one of those hospitalised enters an ICU that has further implications in terms of health care (Ireland has approximately 300 ICU beds, with some other beds that can be pressed into service – so say up to 550 Critical Care/ICU beds). The more of those occupied by Covid-19 patients the less available for car crashes, industrial accidents, and so on. The terms ‘surges’ and ‘swamped’ appear to have passed Paul by entirely in the past two years. Andrew Flood has argued that if we were to allow the virus to circulate more broadly even with as many vaccinated as possible that would likely necessitate between 500 and potentially 3,000 ICU beds (and of course would also have a knock-on effect in terms of general hospital beds needed  – fun fact, we have about 14,000 general hospital beds – some time ago, pre-Delta I did some calculations, so did David McWilliams coming to much the same conclusions). It’s worth noting it takes a considerable length of time to train staff for ICU beds and each bed requires multiple staff. How long do the Paul’s of the world think it would take to spin up matters to have a health service able to absorb those numbers? A year, two? And in the meantime? It’s a nonsense.

In other words it’s not about acceptable levels of death, but about how we preserve a health service that can function sufficiently well to absorb both Covid-19 and all else that is thrown at it in the context of a broad range of fairly minor other measures to restrict spread of the virus (mask-wearing, some social distancing, working from home as much as is possible and so on) or alternatively allow that health service to collapse.

But there’s another angle on this which is that behaviours tend to be self-limiting to some degree too. In a context where there are few or no restrictions large numbers in the population will not engage in economic activities – this is going to be particularly so should the health service move close to collapse, but it is true too of the situation prior to that (it’s very clear that behaviours change depending upon numbers of cases). So even if Paul’s proscription was followed, that being the economy must take precedence (and that for all his denials is clearly the thrust of his argument) over deaths, it would be irrelevant. At a certain point people will draw back from economic activity.

They won’t go to pubs, or restaurants. They’ll avoid as best they can working in offices – and companies too take note of this. The last thing they need are large numbers of ill staff. Of course there are those who have no choice in this in terms of working but presumably Paul is uninterested in their fate (by the way, as was put to me this week, ‘I’m still working from home even though I want to go back so some people can go pubbing and clubbing’. That’s not the whole truth but I can understand why people feel that way).

But why hasn’t that happened in the UK? How is it that people there are being so laissez-faire? Well, there’s a media there that is tilted hard right, there’s a lack of public and state supports (by the way, his point about the multiple billions in expenditure is poorly made given no one is arguing for lockdown at this point, indeed quite the opposite – it does not appear necessary and the level of restrictions that might be necessary at least as matters stand would be quite minor). But even more to the point there’s a growing push to impose the sort of restrictions that we have – masks etc… Indeed we know from the report just recently published just how much of an outlier the UK is and how poorly served it has been by this over the past year and more.

But again, it’s not either or. He’s simply having the wrong discussion entirely but no doubt with the headline grabbing that works for him. But having that conversation this far into the pandemic suggests an Olympian detachment from reality.

 

 

 

Comments»

1. EWI - October 22, 2021

Instinctively, we know that you cannot calculate the cost of a life, because life is priceless.

And yet he did. I’m strongly reminded of another one-time Irish Ti es contributor, the unlamented Richard Tol, who was caught putting a vastly lesser value on the lives of non-Westerners in his ‘sensible’ economic calculations of the seriousness of climate change.

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EWI - October 22, 2021

It also bears mentioning that Tol, though Dutch, once claimed not to be able to understand why people might want to use bicycles instead of cars in cities. He also argued for the economic benefits of Cork City being catastrophically flooded.

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WorldbyStorm - October 22, 2021

God, there’s a blast from the past, and an unwelcome one (not your fault, in fact useful to be reminded about him). Whatever happened to Tol? He was awful.

But it’s like you say, ‘you cannot calculate the cost of a life’ – ‘and yet he did’.

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EWI - October 22, 2021

God, there’s a blast from the past, and an unwelcome one (not your fault, in fact useful to be reminded about him). Whatever happened to Tol? He was awful.

Still at University of Sussex, still obsessed with his personal ranking as an economist. His career trajectory does remind strongly of another, now-deceased young buck with likewise unfounded sensationalist claims.

Liked by 1 person

WorldbyStorm - October 22, 2021

Doesn’t he realise how unhealthy that is mentally to think about where he relative to others? Some rugged individualist he.

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EWI - October 22, 2021

Doesn’t he realise how unhealthy that is mentally to think about where he relative to others? Some rugged individualist he.

And counterproductive. Being exposed as someone prone to such unreliable findings has killed his career advancement.

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EWI - October 25, 2021
2. WorldbyStorm - October 22, 2021

And for a bit of reality away from Paul’s rhetoric how about this from RTÉ this lunchtime:

“Dr Mary Favier, Covid Advisor to the Irish College of General Practitioners, said said while it is great to see a further reopening of society, there are many “conflicting” paths on the road.

[she said]…there are currently no paediatric intensive care beds available and a “majority of our hospitals have no intensive care beds available, so if there is a major road traffic accident or someone has significant cardiac surgery over the weekend, people are vulnerable”.

She said vaccines have offered a level of protection, but added, “we have to be careful we don’t return to where we were before.””

https://www.rte.ie/news/coronavirus/2021/1022/1255267-coronavirus-ireland/

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3. crocodileshoes - October 22, 2021

Puzzlingly, Paul Reid described recent Covid developments as ‘a rain check’ and this was quoted by Brian Dobson on the one o’clock news. Does neither the head of the HSE nor our leading newscaster know what a ‘rain check’ is?

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4. Jim Monaghan - October 23, 2021

Enforce the rules and strengthen them. No one should be in hospital because of the irresponsible, feckless behaviour of others.My daughter had to get off a bus because a person was coughing away, with the mask below her nose. Indeed why should the driver have to worry.
The schools are a problem. There will, probably and hopefully, no special arrangements this LC.
Oh and take the flu jab, free for over 65s and if a carer. The flu can kill too.

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Jim Monaghan - October 23, 2021

Oh I add the huge numbers who are not, repeat not, getting medical procedures because there is no space or staff available in hospitals.

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5. NFB - October 23, 2021

I hate this brand of editorial spoofery. “We need to have a difficult conversation though I myself will not actually venture any opinions”. Give me a number so we can see how much you value human life.

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WorldbyStorm - October 23, 2021

+1

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6. Tomboktu - October 23, 2021

Meanwhile over on Twitter the thread this reply is in is worth reading…

Liked by 1 person

Tomboktu - October 23, 2021

and on it goes

Liked by 1 person

WorldbyStorm - October 24, 2021

The testy tone of Paul is hilarious. A guy who makes unsubstantiated assertions, ignores basic fact and then gets stroppy because people who know what they’re talking about call him on it.

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