Given the world-wide experience with coronavirus so far, it is reasonable to ask if the common government response of lock-down orders worked. There is little question that the concept of lock-downs has a logical appeal to it, in that it theoretically deprives the virus of the means of spreading. Obviously, the virus has continued to spread.
A distinction must be made between intent and reality. A fundamental issue is what is the intent of a lock-down order, specifically one that affects a large, diverse area with heterogeneous coronavirus exposure. Is the purpose to "flatten the curve," "protect the vulnerable," "stop the spread," "save one life," and so on? It does not appear, from day to day, that the rationale is consistent and therefore the criteria by which to assess the effectiveness of lock-downs are protean. It's hard to say if lock-downs work if it is unclear why we are doing them. More importantly however is the distinction between the theory and practice. The lock-downs of theory are not possible in real life, therefore it is unreasonable to expect lock-downs to deliver their theoretical benefits. The experience of New York seems to be that lock-down orders are not effective because of the dynamics of viral spread and the impracticality of implementing an effective order in that location. The answer to the question "do lock-downs work?" is therefore"no one knows because lock-downs are impractical." This implies that the answer to the more relevant question "Do lock-down orders work?" is "No."
At a certain point, interventions to slow or stop the spread of coronavirus hit the point of diminishing returns, to the point at which the marginal benefit is not worth the associated undesirable consequences. If we were to list all of the theoretical interventions that might affect the spread of coronavirus, the list would probably begin with frequent hand washing, covering coughs, and wearing masks. The middle of this spectrum might include keeping six foot distance from others in public places, sanitizing frequently touched objects in public places and closing schools. At the low yield end would be discouraging people from using words that the contain the letter "p" because they may result in aerosolizing more virus than words with less aspirated phonation. Lock-down orders appear to fall somewhere after the middle portion of this spectrum. This is largely a result of their marginal benefits and significant costs. One may speculate as to the marginal benefit of prohibiting the sale of "non-essential" items and preventing families from being in otherwise empty parks. A relevant question for this consideration is "Are shutdown orders worth it? Again, with respect to the experiences in such places as Italy and New York, the answer appears to be "not really."
The perceived benefits of lock-down orders may be undone by or frustrated by conflicting policies. The same may said of exacerbations of their costs. The most obvious example is the decision by New York to require nursing homes to admit "stable" coronavirus patients. The rationale for this decision is unobvious, because whether or not a person is stable is a separate consideration from whether or not they are infectious. This illustrates another weakness of lock-down orders: they are subject to vitiation by other governmental decisions. A relevant question in this regard is "Are the beneficial effects of shut-down orders durable in the setting of other interventions?" The answer is apparently "Not always."
The cost/benefit considerations of shut-down orders requires consideration of their adverse consequences. The economic consequences are obvious; less so are the psychological and paradoxically the medical down-sides. It does not take much of the latter to tip the risk/benefit calculation away from government mandated lock-downs as a beneficial intervention.
A significant weakness of lock-down orders, obvious from the outset, is that they are un-focused. They are inelegant and largely uncontrollable interventions that produce positive and negative results capriciously. They are justified by fallacies and superstition as much as by science, and among their many drawbacks are significant opportunity costs. More effective interventions may be foregone to maintain the otherwise illusory project of keeping people away from each other. One such foregone intervention is the opposite of the New York policy mentioned above. Rather than pretending to isolate everybody, it would have made more sense to actually isolate nursing home residents. It would make much more sense to thoughtfully classify persons as to their risk of not only contracting the infection, but also of experiencing a bad outcome from it, and employ more focused interventions accordingly.
This is mostly hind-sight, and it it may be worthwhile to consider why government-mandated lock-downs seemed reasonable when they were implemented. One reason was because of the uncertainty accompanying the spread of the virus. Much of this uncertainty persists, such as what is the actual prevalence, duration of infectivity, and case fatality rate; do infected people become immune, what are the virulence factors, etc. Couple these with alarming observations such as the experience in Italy and the the contrasting one in Taiwan and it becomes unclear what the correct course would be. The early part of the pandemic was also complicated by distracting issues: the availability and usefulness of ventilators, the controversies surrounding choloroquine and hydroxycholoroquine, the availability and effect of testing, and not insignificantly the huge uncertainty regarding the expected number of cases and deaths. Given this uncertainty, an initial resort to lock-downs was not unreasonable. Now that we have a couple of months of experience, the evidence that they had a significant positive impact is mostly speculative; there is no hard evidence that places with strict lock-downs fared any better than those with less restrictive interventions; in fact an argument can be made to the contrary. This is possibly a reflection of the overly general and indiscriminate nature of lock-down orders; they do not account for the factors that distinguish Taiwan from Italy or Oregon from New Jersey. This makes it only more ridiculous to ignore these distinctions and substitute others such as those between essential and non-essential, or between lottery tickets and garden seeds. Lock-down orders were not unreasonable at the time, but they become more so the longer they persist. Lock-downs in the abstract seem to make sense, lock-downs in reality do not work, at least it would seem, well enough to justify the enormous destruction they cause. Lock-downs may work if they could be efficiently implemented, but because they can't lockdown orders do not work. They do not control spread of the virus, limit mortality, or prevent the use of medical resources, except to an almost trivial degree.
No comments:
Post a Comment