Monday, April 20, 2020

How effective is a hard lockdown against the COVID epidemics? The data say not so much



Data about the mortality of the coronavirus epidemic start being available. Above, a list of mortality rates for Western European countries (including the US) taken from the Institute for Health Metrics and Evaluation (IHME) of the University of Washington. The data are ordered by the projected number of deaths per million inhabitants. In addition, I built a "lockdown score," also based on the data reported by IHME (except for the US, where different states chose different options). It would be difficult to say that these data support the idea that a "hard" lockdown that includes a stay home order is more effective than a looser kind of lockdown. (for a live version of the table, write to me at ugo.bardi(whirlette)unifi.it)



Your friend has a headache. She takes a pill and, after a while, she feels much better. And she is sure that it was because of the pill. Maybe, but how does she know that the headache didn't go away by itself? Was the pill a homeopathic medicine? In this case, you could tell her that she ingested pure sugar, unlikely to cure anything. But, if you ever tried something like that, you know that it is nearly impossible to un-convince someone who believes to have been healed by the miraculous powers of homeopathy or the like. It is a typical problem of medical studies: how do you know that a treatment is effective? That's why there exist precise rules defining how you can test a new drug or treatment.

Now, let's go to the coronavirus epidemic: practically every region in the world has been affected and practically every government has implemented some kind of rules to stop the epidemic from diffusing, from voluntary social distancing (Sweden) to stay home orders enforced by the police. Almost everywhere, most people are convinced that the lockdown has been effective in reducing the spread of the epidemics. Maybe, but how can we say? Not having a "blank experiment" to compare with, it might be argued that all these new rules are the equivalent of homeopathic pills: a little sugar and nothing else.

Right now, the data are still uncertain, but they are accumulating and I think we can at least try some sort of preliminary analysis by comparing the results of countries where the lockdown rules have been implemented in different ways. An especially interesting way to do that is to look at the data from the Institute for Health Metrics and Evaluation (IHME) of the University of Washington. These data are good for this purpose because:

1. The IHME provides a large dataset for several relatively homogeneous countries in Europe in addition to the US.

2. The data include projections for the total mortality at the end of the epidemic cycle and so we can compare countries where the epidemic started at different moments

3. The data also include a list of the rules implemented by each government, whether they include "stay home" orders which we may see as defining a "hard" lockdown, or just invites to citizens to maintain a certain distance from each other. (but note that a "hard" lockdown in Western countries is much softer than the versioni implemented in China and other Asian countries)

Here is an example of the IHME projections. In the case of Italy, you see how the epidemic follows its typical curve and it is going down after the acute phase is over.

Note that I focused on the records on mortality because they seem to be the most reliable ones, unlike those on infected people that depend on the number of tests. About Italy, I checked with independent data on the excess mortality from all causes from the Euromomo site. It seems that the mortality rates coincide, these data are reasonably good.

The results I found for several countries are shown in the table at the beginning of this post (not the complete data set, only Western Europe). You can peruse the table yourself (for a "live" version, write to me) and come to your own conclusion. In practice, the mortality rates range from a maximum of about 700/million to a minimum of 10-20. I cannot find a clear relationship between the mortality rate and the harshness of the rules imposed by local governments.

My impression is that the kind of "hard" lockdown imposed in countries such as Italy or Spain didn't help so much, perhaps not at all. For instance, Germany and Austria do well in the list without the need for a stay home order. But, of course, you might also focus on Sweden's relatively poor performance to argue that very loose rules are not a good idea. However, in this case, you might also note that Norway, a country similar to Sweden, is doing much better also with a relatively soft lockdown. Then you might consider other factors, for instance, population density. A colleague of mine (Claudio Della Volpe) examined the data for this factor and he found that there may be a weak dependence but, at present, it cannot be said for sure.

So, my conclusion is that the hard lockdown is unjustified and probably useless, but let me repeat: these are PRELIMINARY data and this is a TENTATIVE analysis, justified only on the urgency we have to manage the epidemic the best we can. Consider that the lockdown is causing a lot of suffering for a lot of people and risks leading us to complete collapse. We should try to do what we can to understand if it is effective. Let me also note that I am NOT DENYING that the COVID-19 virus is killing people, and I AM NOT SAYING that nothing should be done to stop the spreading the epidemics. (and I am not saying that the virus is an engineered bioweapon, or that it is an evil plot to enslave all of us, gosh!). I just placed on line the data I found for the benefit of the readers of Cassandra's Legacy who may interpret them the way they like. When we'll have better data, we'll be able to arrive at more solid conclusions.

As a final note, the story of the coronavirus epidemics shows how we humans tend to politicize/polarize everything. Not that the virus itself, poor critter, is left- or right-leaning, but by now the Right and the Left have taken sides. The right in the US is against a hard lockdown, while the left favors it. At this point, speaking against the lockdown turns you automatically into a Trumpist and a supporter of the NRA, if not of the Ku-Klux-Clan (and of Bolsonaro, too!).

As an example, yesterday I posted on Facebook a link to a study by Yitzhak Ben Israel, (*) of Tel Aviv University that seems to support the idea that most lockdown rules are not very effective against the virus (and note that I didn't even say I thought the paper was correct -- I can't read Hebrew!). But, as I should have expected  I was defamed and abused just for having linked that obvious piece of Israeli propaganda, surely a hoax thought to support the bad orange man and his ilk (surprisingly, my readers on Facebook seem to be familiar enough with Hebrew to be able to easily detect the mistakes in a scientific paper written in that language).

So, why is the stay-home ruling "Left" while no stay home is "Right"? Beats me. For those of you who can understand Italian, I leave you with a scene from a movie by Francesco Nuti, where he examines various kinds of cold meats concluding, among other things, that mortadella (bologna) is communist, while prosciutto cotto (cooked ham) is fascist.







(*) Dr. Ben Israel was so kind to send me a version of his paper in English. If you would like to have it, write to me






26 comments:

  1. The pressure is on here on the Last Great Frontier to "unlock" the economy. Tourista season is coming, and they don't want to lose the revenue. They'll get with it a lot of infected Homo Sap meat packages delivering more than just money.

    Latest Shopping Adventure with On Location videography. :)

    https://youtu.be/98ncXd7sato

    RE

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  2. The virus transmits from person to person. If people are separated that will stop the spread. I don't see what there is to argue. The question is whether people are indeed separated from each other.

    If you impose a lock down only after a million people have been infected, then of course it is not going to appear to have been very effective.

    And then there are lockdowns and lockdowns.

    Italy and Spain only gradually tightened the restrictions when they should have done a hard lockdown from the very beginning. If you are going to get to harsh measures anyway, better do that early than late. That way you at least stop the spread -- a couple weeks of "not hurting the economy" are irrelevant. And they still never did one on the same level as China.

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    1. I agree with Georgi. Have a look at Australia and New Zealand which locked down early. Some countries implemented lock down too late, when the virus had already spread widely through the population. A big factor in deaths is how well the hospital system coped. A large influx of cases into hospitals increases the death rate. There is also the example of the small Italian town that locked down early.

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    2. Another agreement with Georgi. Whatever measures are taken have to be taken before the virus has gone wide. Whether those measures are more focused on locking down or on test&trace is less critical to the spread (but a rigorous test&trace means you can avoid the economic consequences of locking down). Once it's gone really wide like it has in the US, test&trace becomes effectively impossible and even lockdowns just slow it down.

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    3. @GFQ

      And the more you let it out of control, the longer and harder you have to lock down

      At every step along the way governments refused to take serious measures because they prioritized the "economy", which in turn guaranteed much larger economic destruction mere weeks later.

      Now they are looking to "reopen" even though the virus has not been contained at all. Who in their right mind is thinking the result will be any different?

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  3. They may have lockdown rules in place, but do we know if they are being followed by enough people to matter? I don't know, but I keep seeing harsher penalties enforced which obviously means some amount of people are playing by their own rules. Covid days are something I'm reserving judgment on. So much information, plenty of unknowns & judt as many agendas using the pandemic to try & further their agendas. As per usual, their are millions of instant, overnight, experts on infectious diseases & pandemics. An internet connection is all that is required to "know" & the most tribal humans know the most....again.

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  4. You've ranked the U.S. as 0. Most of the cases and deaths have been in states and cities that would be ranked 4-5 on the scale of lock down criteria.

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    1. Yes, the "0" is there by mistake. the US has no rank in the table, should be calculated taking into account all the states

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  5. Yes , there isn't much trend relationship to be made out of this table that shows overall national mortality, sorted in order of deaths per million of population, and a score of physical isolation measures. This isn't how the success of isolation practices is estimated, although they will influence the result. The table removes all notions of starting conditions and time course. The effectiveness of measures to break down networks of susceptible people seems to use as a criteria of success, some sort of model that calculates a rate of case to new cases transmission. R(t) - How many new cases are created by any confirmed index case. More than 1, the pandemic grows, less than 1 , it diminishes. Published modelling that takes all important factors into account to estimate R, is beyond my time and ability to process, like this one -- which looks at the effect of measures in Wuhan in January. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30144-4/fulltext
    Many assumptions are made for behaviour of people and virus infections, and uncertainty has to be modelled. Time course of new cases is required.

    Human social network links vary in terms of contagion opportunity, so the best measures will include stopping ways that allow the virus to jump to new high opportunity networks with high R potential. Like large group crowd events. Or stopping highly linked politicians from shaking everyone's hands, like Mr B Johnson. Once all high R network links are consumed, or broken, in theory overall national R value is choked down.
    The overall mortality rate then depends on how many and how quickly the high infection rate chains got going. R needs to be modelled from before and after the various measures , in each society, to demonstrate the effect in those particular social networks as they were applied, with all the attendant time delays for effect.

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  6. Great video - I am not fluent - but I understand enough from the time I spent living in Italy - the Avellino region - and specifically working at the Air Force Base on Mt. Vergine - now abandoned.

    Here is a fun return video:

    https://youtu.be/ENMuOq2L7I0

    There was a Trattoria de Pizza run down in Mercogligano by a man named Franco - who I always bought the most delicious Calzones from - who swore we were CIA and had missiles and airplanes hidden in the Mountain. Nothing could be further from truth - we were just a Communications site.

    I won't dispute"I cannot find a clear relationship between the mortality rate and the harshness of the rules imposed by local governments".

    But what is the toll it is taking on healthcare workers and morgues?

    Be safe - and stay healthy - Ugo. Always interesting posts.

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    1. Of course we know that Monte Vergine was a secret UFO base. That's why the Italian secret service placed an agent named Franco nearby, posing as a restaurant owner. "Calzone" was the code word -- you were under still control! And now, of course, that base is no more. There are reasons for that, but I am not allowed to tell them here. Calzone over!

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    2. What fun! My Italian friends taught me a little bit - but all in the Neapolitan dialect - and they seemed to get a kick out of me speaking their dialect of Italian. Instead of "me piagge: - it was "me biagge" - and they were amused by this - I became one of them.

      Seems as though American Political Activist Michael Moore is coming around:

      What if wind farms, solar panels and other green energy projects are not enough to save the planet and humanity simply cannot sustain life as we know it?

      “Planet of the Humans,” executive produced by Oscar-winning filmmaker Michael Moore and written and directed by Jeff Gibbs, asks hard questions about what it sees as the failure of well-meaning efforts to halt climate change.

      “It seems like we have been losing the battle,” Moore told Reuters. “We are in deep, deep trouble.”

      "Planet of the Humans," which will be released on YouTube youtu.be/Zk11vI-7czE on Tuesday free of charge to the public, argues that the mainstream environmental movement has sold out to corporate interests and that solar and wind energy components and electric cars rely too heavily on deforestation and electricity generated from coal and natural gas to produce them.

      “What we have been calling green, renewable energy and industrial civilization are one and the same thing - desperate measures not to save the planet but to save our way of life,” Gibbs says in the film.

      A better approach, Gibbs suggests, would be people having fewer children. “Infinite growth on a finite planet is suicide,” he says.

      https://www.reuters.com/article/us-earth-day-documentary/michael-moores-planet-of-the-humans-asks-what-if-green-energy-cannot-save-the-planet-idUSKCN2231U8

      Ciao'

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    3. We need to use current industry to transition to solar, wind, battery, hydrogen, geothermal, hydro, tidal, wave, etc, renewable energy. But once that transition is complete, oil, coal, gas and deforestation will no longer be required. Having fewer children will also be needed. The biggest problem is changing our mindset.

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  7. As a college student under lockdown, I can tell you that even in America the lockdown is a hit or miss. I live in a town with lots of old hippies, and so social distancing had been implemented and most people follow it. However my town has a lot of space to wander, and business is suffering. A hard lockdown would be met with extreme opposition here. At least our governor isn't stupid enough to declare churches, and WWE matches essential businesses.

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  8. IMO,there exists too many parameters and different initial conditions for all of them for this simplistic data to have any meaning or remotely tentative conclusions.

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  9. Have a look at NZ which did serious hard lockdown. (Not coming out of level 4 till 29th, and level 3 is still pretty damn hard). Look at Google data for actual compliance as opposed to rules. Social compliance varies enormously across culture. Australia not quite as hard but still be pretty damn effective. Both went relatively early.

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  10. We should also take into account that Scandinavians are generally less social than Mediterraneans. Which probably at least partly explains why Norway is doing excellent with so-so measures and Sweden isn't doing horrible even with almost no measures.

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  11. Variability of death rates is so large among regions in a single country that political entities don't seem to be a good choice of independent variable to check anything against, p.-

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  12. https://www.polimi.it/en/scientific-research/news/news-details/article/8881/uno-studio-sullimpatto-dei-decreti-nella-diffusione-del-covid-19-8509/

    Segnalato da Sylvie Coyaud.

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  13. We know that a virus keeps reproducing itself using human cells if he manages to jump from one body to another. Stopping this possibility of passing from one body to another, and then all virions (which are the instances of the virus or virus particles) will disappear and we would be freed from the outbreak. There is one theoretical method to reach that point: starting from today, nobody is allowed to move out of the place he lives, for any reason (of course it is in practice impossible). Infected people will either recover or die. They will trasnmit eventually the virus just to the persons living together. Wait for one month. All people are now healthy or dead. But virus is not part of the Earth anymore. Thus we could tend to think that the harder is the lockdown, the quicker we could get rid from the virus. The problem is: at which point of degree of lockdown severity we really start to see real effects and at which point of time we should start the lockdown to see meaningful effects: indeed the latest you start the lockdown, most probably the more difficult it would be to see effects immediately.

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  14. Canada seems to me to be doing quite well with a hard lockdown. We were told only a few days ago that our numbers of illness and deaths came short of the modelled numbers, and our hospitals were in great shape

    I have not heard of or seen that much pushback from the people about the lockdown, except for the ones like my son who says it's "just the flu"
    Our federal government is Liberal and the Provincial government is Conservative and they have been on the same page from day one. The provincial government is in charge of healthcare and the decisions at both levels have been in total agreement.

    They have started talking about opening up but,on that,they are still working together.

    Marieann

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  15. Happy Earth Day to all!

    Is the current Human population, consumption and lifestyle the problem? Or a mere technological problem which will require more resources and advanced technology to overcome?

    Since I live in an Urban Environment - and get my food from Supermarkets - surely - I don't need Farmers.

    Since I get the gasoline for my car at the Gas Station - surely I don't need drillers or refineries.


    Do you think that if Humans could live forever Earth would never run out of room?

    Exponential Growth Arithmetic, Population and Energy, Dr. Albert A. Bartlett

    https://youtu.be/kZA9Hnp3aV4

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    1. Their is also an opposing opinion:

      https://youtu.be/DmeUuoxyt_E

      In the multi-verse - it is always a possibility....

      But - well - others will have already figured out to solve over-unity production dilemmas.

      Still does not solve the Human dilemma of being physical vs spiritual Beings:

      https://etheric.com/om-the-cosmic-vibration/

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  16. Planet of the Humans:

    https://youtu.be/Zk11vI-7czE

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  17. Just a thought - but if a Steady State was maintained - NO - Thing would exist. Things exist because of Oscillations.

    Industrial Civilization based upon exploiting and burning stored and non-renewable resources produced such a comfortable standard of living - especially for the Baby Boomers - that eternal life for all on a finite Planet - with no regards for the cost - would be ideal.

    In logic - that is a fallacy:

    Living on a finite Planet - on borrowed time - with Central Banks issuing fiat money with interest - pushing future demand to the present - creates a dilemma for which the only solution is either a debt Jubilee - or extinction. And if we have a debt Jubilee - it means we must "power down".

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    1. I'm hopeful that we will get through it with civilization intact. But we are going to need new goals, because as you say: steady state leads to stagnation. Maybe expansion into the solar system?

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Who

Ugo Bardi is a member of the Club of Rome, faculty member of the University of Florence, and the author of "Extracted" (Chelsea Green 2014), "The Seneca Effect" (Springer 2017), and Before the Collapse (Springer 2019)