Bill Mitchell-en Learning about epidemics
(i) Sarrera gisa
… As I continue to calculate various things along the way to my 10-point or something plan which I hope to have final by next Monday. (…) I have been reading a lot of the research literature about modelling epidemics. It is quite interesting and nurtures my penchant for modelling, estimation, numerical forecasting etc. But it has helped me understand the reason governments are now inflicting massive economic damage on our nations in the name of ‘flattening the curve’. I cannot say I know much about all this. But I know more than I did a week ago. Knowledge is good. And, generally, you get that from the scientific research literature rather than blogs and Twitter. I exclude economics (unless it is about MMT) from that recommendation. Back with my unemployment modelling tomorrow.
Some armchair – very – modelling
The ABS is now on the job – counting the dead!
Today, the Australian Bureau of Statistics released their – Guidance for Certifying Deaths due to COVID-19.
Pretty grim really.
I have received a lot of E-mails lately (and a few SMS messages) suggesting that I might be falling prey to the media beatup about the coronavirus.
The opinions expressed range from those who consider everything to be a conspiracy by dark forces to those consistent with Donald Trump’s latest ploy on the chaos – “let’s not make the cure worse than the disease”.
I take the latter to be symptomatic of the fear that is now obviously growing among the mainstream corporate world that the neoliberal game is well and truly up.
Not only are governments abandoning their fiscal surplus obsessions and demonstrating to all and sundry that they can spend as much as they like – and are doing so without talk of increasing taxes or becoming insolvent from being overburdened with debt, but the largesse is also being spread more liberally to the hoy polloi rather than to bail out the top-end-of-town when they overstep the greed mark and/or want their business models that are dependent on public procurement contracts nourished.
It is interesting that in times of change, common folk like us become expert in different, new lexicons.
(iii) Historia pixka bat
In the 1980s, as neoliberalism was emerging as the dominant economics narrative and our progressive political parties were selling out, all the talk was about ‘microeconomic reform’ – a.k.a how to scorch the earth with privatisation, outsourcing, cutting worker entitlements and pension, introducing user-pays on essential services (water, power, etc) and introducing pernicious work tests for the people made unemployed by all of the above.
In 1989, the Australian Labor Treasurer (who became Prime Minister) Paul Keating who was pushing this agenda very hard during the Hawke government years made the famous statement:
I’ll guarantee if you walk into any pet shop in Australia, the resident galah will be talking about microeconomic policy.
Everyone thought this was hysterical but many of those who laughed lost jobs, livelihoods, pension entitlements and were prematurely forced onto passive welfare.
This was just before the massive recession which the same Treasurer described as the “recession we had to have”.
In the period before the GFC, everyone became experts (not!) about how ‘budget surpluses contributed to national saving”. All these media types came out with statements about “ammunition in the locker”, and similar supercilious, deeply ignorant references and failed to understand that fiscal surpluses destroy non-government wealth and income flows.
The anathema of good sense – in most cases!
So we become nomenclature mavens.
(iv) Modeloak eta kopuru batzuk
I am now fully conversant – (-: – with the latest terminology like the “basic reproductive number, R0”, which epidemiologists have introduced to all of us so we can be armchair experts too.
And when I see a ‘number’ or a ‘rate’ I know it can be ‘numerically modelled’ and I become interested.
To get some purchase on the term, the Australian Health Department’s information article – 2.2 The reproduction number – says that:
The reproduction number (R) is often used to reflect how infectious a disease is. We will, in part, use this quantity to assess alternative interventions to control an outbreak, because R is changed by control measures. The basic reproduction number (R0) is the reproduction number when there is no immunity from past exposures or vaccination, nor any deliberate intervention in disease transmission. We refer to R as an effective reproduction number when there is some immunity or some intervention measures are in place.
It is useful to recall some of the characteristic of a reproduction number, because its interpretation is not always straightforward.
“Not always straightforward” – the eternal warning to commentators which is usually ignored as they lurch into the modelling part with less than due care.
“Flattening the curve” is another term that is now regularly spoken about across the dinner table. Everyone knows what it means and implies, well sort of.
So, we also have to be mindful of – 2.4 The infectiousness function – which modifies the way we use R0 estimates.
I venture to add that we will need to throw in the “the case-fatality ratio” for some sense of completeness.
And so it goes.
And in the classic tradition of ignoring all useful warnings, we can do some ‘modelling’ ourselves.
There are many studies of these ratios etc available.
1. One such study (which is fairly representative) found the R0 for seasonal influenza to be between 0.9 and 2.1, converging on around 1.3 or 1.4 (Source).
This is the figure the World Health Organisation (WHO) regularly suggests.
So, on some sort of average, if I have the misfortune of acquiring the flu in any season I will pass it on to 1.4 other persons.
2. In the case of COVID-19, the studies are still coming in and have been mostly concentrated on the Wuhan situation (For example).
While it is early days, we are getting some consensus around 2.5. I have seen estimates of the R0 up to 3.9.
So, it seems the coronavirus is more infectious than the seasonal influenza.
Further, the hospitalisation rate for severe cases of influenza has been estimated by the US – Centers For Disease Control and Prevention (CDC) – to be around 1 to 2 per cent of all cases.
There are some estimates that the hospitalisation rate for COVID-19 is 10 times higher than that.
(vi) Gripea eta koronabirusa
But even if it was just the same rate as the seasonal influenza here is the issue.
1. Imagine I get influenza, then on average 1.4 persons get it from me.
2. Iterate that infection cycle 10 times and there would be 28.9 persons suffering from the virus (compute Reproduction = R0^iterations. You can also work out how many would be hospitalised.
3. Now imagine I acquire the coronavirus, and immediately infect 2.5 persons while I am contagious.
4. Iterate that infection cycle 10 times and there would be 9,536.7 persons infected. The following table shows the sensitivity of the estimates around different R0 values.
Calculate 1 or 2 per cent hospitalisation rates if you care.
Our health systems simply cannot cope with that sort of incidence in a short time period (10 iterations could be a very short period in time).
So while all these E-mails that I am receiving tell me stuff like – “people die from the seasonal flu”, “COVID-19 is mostly a mild illness” and all the other conclusions, which are probably true, the evidence is pointing to a much larger number of people requiring hospitalisation – a hugely, much larger number.
And it doesn’t help much then to launch into a narrative that neoliberalism has run down our health systems etc. It has and that is a massive issue. But it still doesn’t alter much in the immediate period.
(vii) Sendaketa okerragoa ote gaixotasuna baino?
So what the ‘cure worse than the disease’ logic really comes down to is some natural selection argument.
It suggests that we want profits to continue and if a large number of people, particularly our parents etc are going to die more quickly and in terrible circumstances, then so be it.
The WHO report (February 16-24, 2020) – Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) – describes a shocking death – multi-organ failure, respiratory failure and septic shock and drowning in excess fluid in the lungs.
I don’t support the ‘cure is worse than the disease’, when the cure is really about maintaining the current neoliberal distribution mechanisms, increasing inequality, elevated levels of labour underutilisation, increased precarious of work, rundown public infrastructure and service delivery, flat pay growth, and all the rest of the elements that have defined, in increasing intensity the last 3 or so decades.
(viii) Koronabirus eta neoliberalismoaren aurka
We need a cure for both COVID-19 and neoliberalism.
But first we need to protect workers’ wages and incomes, find productive activities for displaced workers to be transitioned into while the health crisis continues, protect our older population from exposure (which will generate thousands of interim and ‘safe’ jobs in the process), and use the period to begin the process of fighting the other emergency – the socio-ecological crisis.
And finally, I am working on estimates of the way costs are being transferred from corporations and other employers to workers (charges for data, telephone usage, depreciation of furniture, electricity, heating, etc) as we are all encouraged to ‘work from home’. That needs to be taken into account when we are arguing for government support.