Friday, March 27, 2020

How Many Will Die in the Coronavirus Pandemic? Neil Ferguson's Surprising Turn

You may remember that the decision of the Trump Administration to impose a partial shutdown of the American economy to slow the spread of the COVID-19 virus was based largely on the pessimistic predictions of Neil Ferguson and his colleagues at Imperial College London.  Now, suddenly, Ferguson has changed his mind.

In his original report, Ferguson said that the COVID-19 virus showed "comparable lethality to H1N1 influenza in 1918."  That was scary, because the 1918 flu pandemic killed over 50 million people around the world, including 675,000 in the U.S. and 228,000 in Great Britain; and that's a stunning proportion of the world population at that time--about 1.9 billion as compared with 7.8 billion today.

Ferguson's epidemiological model predicted that if nothing drastic was done to slow the spread of the virus, there could be 510,000 deaths in Great Britain and 2.2 million in the U.S.  To avoid this terrifying death rate, he recommended a massive effort at epidemic suppression that would shut down much of the economy in the U.S. and Great Britain.  He has been an adviser to Boris Johnson, and a few days ago, the British government imposed a shutdown like that in the U.S.

But now, two days ago, Ferguson testified to the UK's parliamentary Select Committee on Science and Technology; and he said that deaths from the COVID-19 virus in the UK are unlikely to exceed 20,000, and they could be even lower than that.  20,000 is an amazing drop from 510,000!

In the 1918 flu pandemic, the 228,000 deaths in the UK were 0.53% of the population of 43 million.  If the same proportion were to die today, that would be 339,200 out of a population of 64 million.

By contrast, Ferguson's prediction of 20,000 deaths is 0.03% of the UK's population of 64 million.  The same proportion of the U.S. population of 330 million would be 99,000 deaths.

The possibility of 99,000 deaths is disturbing.  But keep in mind that the typical rate of deaths from the yearly flu epidemics in the U.S. is 12,000 to 61,000.

Ferguson has recommended that the shutdown should continue until a vaccine is developed, which would require 12 to 18 months.  But in his testimony, he admitted that this was "impractical," because this would be an unacceptable social and economic disaster.  "We'll be paying for this year for decades to come," he said.

In his original paper, Ferguson said that he was not considering the "ethical or economic implications" of the possible strategies for dealing with the pandemic.  But that's not true.  By recommending an economic shutdown, he was making the ethical and economic decision that the moral costs of such a shutdown were less than the benefits of saving some lives of people who would otherwise die.  Is that true?

The 1918 flu pandemic was much more terrifying than this COVID-19 pandemic, not only because the death rate was much higher, but also because over half of those deaths were young adults (20 to 40 years old), so that the loss of prospective lifetimes was much greater than is the case with COVID-19, which tends to kill only older people with health problems, who already have short life expectancies.

Some people say that the harm from an economic shutdown to slow the pandemic is justified because life takes priority over liberty.  But when people's livelihoods are destroyed, isn't that an assault on their life?  And can't we predict, as I have in a previous post, that as this shutdown continues, people will engage in civil disobedience by reopening closed businesses and resuming their normal lives--in defiance of governmental orders?  Don't they have a natural right to do that?

Most of what is required to slow this pandemic--such as social distancing, washing one's hands repeatedly, staying home when one is sick, and isolating those older people who are vulnerable--can be done without shutting down the economy.  Why isn't that the most prudent policy?


W. Bond said...

FWIW, Ferguson clarified his comments yesterday on Twitter: "1/4 - I think it would be helpful if I cleared up some confusion that has emerged in recent days. Some have interpreted my evidence to a UK parliamentary committee as indicating we have substantially revised our assessments of the potential mortality impact of COVID-19...2/4 -This is not the case. Indeed, if anything, our latest estimates suggest that the virus is slightly more transmissible than we previously thought. Our lethality estimates remain unchanged...3/4 - My evidence to Parliament referred to the deaths we assess might occur in the UK in the presence of the very intensive social distancing and other public health interventions now in place...4/4 - Without those controls, our assessment remains that the UK would see the scale of deaths reported in our study (namely, up to approximately 500 thousand)."

W. Bond said...

While the data continues to emerge on this pandemic, one might note that the mortality rate at the Kirkland nursing home is now 30% in three weeks -- of the total residents (fixed denominator). This is with full access to all available critical care, i.e. prior to any potentially overwhelmed medical system.

Reports from New York hospitals at this moment are far from encouraging.

We will see.