Misinformation and Covid

I saw this headline from the New York Times on Twitter the other day. It was accompanied by this image.

The first thing that popped into my mind is that the headline is crazy. In both images, COVID cases go to zero some time between April and July. So the vaccine WILL end the pandemic. Sure, the model argues that keeping restrictions in place will cause the pandemic to affect more people before vaccines end it, but in both cases, the pandemic will end, because of the vaccines. It’s amazing that a headline writer could look at these two images and conclude that the picture on the right is the pandemic not ending.

But then I clicked through. The story summarizes a model created by Dr. Jeffrey Shaman, who estimates that if the current restrictions are kept in place until July, there will be around 50 million more COVID infections in the US. If, on the other hand, they are lifted in February, once all health care workers and nursing home residents are vaccinated, there will be an additional 29 million infections, which means thousands more deaths in the US.

Models are notoriously difficult to design for accuracy, as everyone remembers from last March. In this case, by the time the New York Times article was published, the model was already quite wrong. Here’s why:

The model predicts cases rising until the end of January and then beginning to drop. In fact, cases peaked on January 12 and have already dropped around 25% from their peak. This is not nitpicking, because the level of cases when restrictions are lifted is very important for the prediction of 29 million additional cases.

In addition, the article tells us nothing about how many deaths to expect from those 29 million additional cases. In fact, Shaman’s model implies that about 4 in every thousand COVID infections results in a death. That would mean that 29 million additional infections would lead to 116,000 additional deaths. But, of course, the true number will be much, much lower, because most COVID deaths occur in the elderly population, who will have already been vaccinated. So even if Shaman were correct and there were 29 million additional infections from lifting the restrictions, it would mean far fewer deaths, perhaps between 10–20,000.

And this leads to the biggest problem with this article. Of course, even if Shaman is wrong and lifting the restrictions leads to “only” 10 million additional infections and 5–10,000 additional deaths, it is still a tragedy. But the article makes no effort to grapple with the question of whether the massive restrictions regime is worth it to prevent these infections.

In the beginning of the pandemic, the risk was very large and its full extent was unknown. It was quite possible that COVID killed 1/100 people who were infected. It was possible that a large wave of infections would cause our entire health care infrastructure to be swamped, killing millions. Over time, our understanding of the risk that COVID poses has improved. Covid probably kills about 5 of every thousand people who are infected and both the deaths and other bad health outcomes are concentrated in the elderly. (This doesn’t mean that tragedies never happen to younger people. But they are relatively rare.) And now that we have a vaccine, we know that the risks are much smaller.

But, for some reason, the author of this article seems to give no thought to the question of whether the massive restrictions regime is still warranted. Coldly, Dr. Shaman recommends that we just “keep them going until the end of July”. Another six months of restrictions that are devastating economically, socially and psychologically.

How many people will be destroyed by six more months of restrictions? Let me give one example. I have a dear friend who owns a business that employed about 100 people before COVID. He put his entire life into building this business. The business has been completely crippled by the COVID restrictions. My friend has had to reduce the number of employees in the business, but he is trying to keep the business alive. In November, he told me that he could survive if life starts to come back to normal by the summer. If the summer is also wiped out, he is finished.

This is just one business. How many businesses in the United States are like this one? How many people’s lives will be destroyed if we just follow Dr. Shaman’s recommendations and keep everything closed until the summer?

Life is precious. And it may very well be that in the grand calculus, the saving of 10,000 lives is worth the ruining of several million livelihoods. But COVID policy should always have been about balancing the lives saved by restrictions against the livelihoods and quality of life destroyed by restrictions.

At the very least, that calculus has changed. The vaccine means that, even without any restrictions, we will save most of the lives that are left to be saved. So the restrictions are certainly accomplishing less lifesaving now than they were when they were put in place. The fact that no effort is made to grapple with the question of whether the very limited number of lives that can be saved with restrictions is worth the devastation that the restrictions are wreaking shows that, for many public health leaders, there never was a calculus.