U.S. COVID-19 Restrictions Cost-Benefit Analysis

Using an unlikely assumption that COVID-19 restrictions cut the U.S. death and hospitalization count in half from what they would have been without restrictions, the U.S. spent 5 trillion dollars to lose 86 million QALY. The problem is doing population-wide public health measures on an illness that is disproportionally fatal for the frail aged.

Updated April 27, 2021

Public health cost-benefit analyses are usually done using Quality Adjusted Life Years (QALY). QALY ranges from 0 to 1, with 0 being death, and 1 being a fantastic year. When COVID-19 lockdowns began in the U.S. in March 2020, leaders rushed to implement unprecedented totalitarian public health measures that were first used in China. They ignored a viewpoint (later known as the Great Barrington Declaration) that, based on the 1000-fold difference in mortality risk between young and old, called for a focused protection approach for the vulnerable old, while letting non-vulnerable young people live normal lives. What is the cost-benefit analysis for these policies based on a year of experience?

The U.S. states had differing approaches that varied over time, from severe lockdowns to milder measures. Typically, Republican governors chose less restrictive measures than Democratic governors. No state (or Western country) did a full Great Barrington-type policy, which involved no general testing/contact tracing/quarantining, letting non-vulnerable younger people live near-normal lives, while protecting the vulnerable essential workers by giving them disability pay to stay home, protecting vulnerable people in multigenerational homes by giving them the option to live elsewhere at government expense, protecting vulnerable people living alone by delivering all food and supplies, and doing a better job protecting nursing home residents.

Regression analysis indicates that there is little correlation between level of restrictiveness of public health measures and COVID death rates, indicating that it’s unlikely that a less restrictive approach would have made much of a difference in death rates. It’s possible that a Great Barrington focused protection approach would have resulted in fewer deaths. It’s certain that a focused protection approach would have been much less expensive, and avoided the collateral damage of lockdowns and other restrictions.

I will do a cost-benefit analysis for the U.S. being especially generous to lockdown proponents, using CDC data for March 19, 2021. Let’s assume that the U.S. COVID death count of 535k is an accurate number of people who died of COVID (it actually includes many frail elderly with comorbidities who died with COVID). Let’s assume that without lockdowns and other restrictions that the U.S. death count would have doubled, from 535k to 1.07M. Considering the high percentage of elderly people in this death count, including 81% above 65 years old, and 59% above 75 years old, and about 1/3 nursing home residents, QALY lost will be much less than for younger people. Older people have fewer years remaining, and these years are far less than 1 QALY each due to health conditions, restricted mobility, etc. To be generous, let’s assume an average of 5 QALY lost per COVID death. That implies that lockdowns/restrictions saved 535k * 5 = 2.7M QALY.

Immediate family and close friends of the COVID deceased would have lost QALY. Let's assume 0.5 QALY lost for immediate family member, with an average of 3 immediate family members for every deceased. Let's also assume 0.25 QALY lost per close friend, with an average of 2 close friends per deceased. Then lockdowns/restrictions saved 1.6M immediate family members from losing 803k QALY, and 1.07M close friends from losing 268k QALY.

There have been 1.88M U.S. COVID hospitalizations. Let’s assume that these would have doubled without lockdowns/restrictions to 3.76M. Let’s assume 0.5 QALY lost per hospitalization. That implies that lockdowns/restrictions saved 1.88M * 0.5 = 0.94M QALY.

Let’s also assume that all of these extra hospitalizations would have stressed and sometimes overwhelmed hospital staff, and resulted in inferior care for both COVID and non-COVID patients. Some patients will immediately die, others will die sooner than they otherwise would have, and others will have lower quality of life due to lack of care. Many of these people would have been elderly, as they are more likely than younger people to have conditions that require hospitalization. Let's assume that the number of non-COVID hospitalized people affected by this is the same as the additional COVID hospitalizations, or 1.88M. Let’s assume an additional 3 QALY lost per additional COVID hospitalization. That implies that lockdowns/restrictions saved 1.88M * 3 = 5.64M QALY.

We need to account for the QALY lost for hospital staff that were stressed due to the doubling of COVID hospitalizations. There are about 6.6M hospital employees in the U.S. Let's assume that hospital employees would have lost an average of 0.25 QALY each due to the doubling of COVID hospitalizations. Then this implies that lockdowns/restrictions saved 6.6M * 0.25 = 1.65M QALY. 

The impact of COVID on other health problems is controversial. During the pandemic, people have died from heart attacks, strokes, suicide, drug overdoses, dementia, etc. Did some of these people who wouldn’t have died if there were no pandemic die because of COVID, or because of restrictions? COVID made a lot of people afraid to get care, or find it hard to get care. The lockdowns and restrictions almost certainly increased this fear. Lockdowns and restrictions didn’t cancel emergency care, but did cancel some elective surgeries and other non-critical care. Social isolation is a risk factor for many medical problems, especially mental health and cardiovascular issues. Enforced social isolation due to COVID social distancing restrictions likely contributed to additional excess deaths, along with increased morbidity from many non-COVID health problems. Missed cancer screenings will contribute to excess deaths in the coming years. For the sake of simplicity, and to be generous to lockdown proponents, I will ignore this impact on other health problems in the QALY calculation.   

Long COVID is another problem that costs QALY. It’s unclear how many people have long COVID, but one suggestion is 10% of COVID infections. There have been 29.4M U.S. COVID cases. A CDC estimate of total infections is 4.6 * cases, or 4.6 * 29.4 = 135.2M. 10% of this number of 13.5M. Let’s assume that these long COVID cases would have doubled without restrictions to 27M. Long COVID is more common among younger and healthier people than being hospitalized for or dying of COVID, so QALY lost should reflect that. Let’s assume that QALY lost for long COVID is the same as that lost for hospitalizations, or 0.5. That implies that lockdowns/restrictions saved 13.5M * 0.5 = 6.75M QALY.

Total QALY saved from lockdowns/restrictions is 2.7M + 0.80M + 0.27M  + 0.94M + 5.64M + 1.65M + 6.75M = 18.75M. Deaths, impact on family, impact on friends, COVID hospitalizations, non-COVID hospitalizations, impact on hospital workers, and long COVID would have affected a total of 1.07M + 3.21M + 2.14M + 3.76M + 1.88M + 6.6M + 27M = 45.66M people without lockdowns/restrictions.

Now we need to find the QALY lost from lockdowns/restrictions. Everyone who didn’t die, wasn't family/friend of deceased, be COVID or non-COVID hospitalized, was a hospital worker, or develop long COVID lost QALY due to the lockdowns/restrictions. To simplify the analysis, I will assume a uniform level of moderate restrictiveness in the U.S. (in reality, there was a lot of variation across states). Healthy young people, who had the least to fear from COVID, lost the most. A normal year for them is about 1 QALY. Being denied the ability to socialize, travel, go to school in person, participate in group sports, go to concerts, shows, sporting events, etc. for a year deprived them of much of this 1 QALY. Being subjected to testing/contract tracing/quarantining/masking for a virus that posed little risk of death or serious illness also deprived them of QALY. Being subjected to stay-at-home orders (essentially house arrest) for periods of time deprived them of QALY. Being subjected to periodic unemployment due to business closures deprived them of QALY. Some young people did better than others. Considering that restrictions limited most social activity outside of the home, married people and people in relationships did better than single people, and single people living alone did the worst. Social distancing and masking made it difficult for single people to meet other single people in the few public places that were open. Children who attended in-person school did better than children who attended remote school. The parents of children who attended in-person school did better than the parents of children who attended remote school. Introverted/socially anxious people did better than extraverted people. Professionals who were able to work remotely did better than essential workers who were forced to show up for work and risk exposure to the virus. Small business owners did especially poorly, and many lost their businesses. Let’s assume that young people lost an average of 0.5 QALY each. Older people have less QALY to lose, and would have isolated even without lockdowns/restrictions. But some older people would have wanted to travel, see family, go to concerts, etc. While they were at much higher risk of dying of COVID, a year is a lot more valuable to a person who doesn't have many years left. Let’s assume that QALY lost for older people was 0.1 QALY each. Middle-aged people would be somewhere in between older and younger people, say 0.3 QALY each. There are 171.2M younger Americans (under 40), 103.3M middle aged (40 – 65), and 54M over 65. Weighted mean of QALY lost is (171.2 * 0.5 + 103.3 * 0.3 + 54 * 0.1)/328.5 = (85.6 + 31.0 + 5.4)/328.5 = 0.37. Subtract the 45.7M who died, were family/friends of deceased, were hospitalized, denied hospitalization, were hospital workers, or developed long COVID from 328.5M to come up with 282.8M. 282.8M * 0.37 QALY = 104.6M QALY lost.

Net QALY lost is 104.6M – 18.8M = 85.8M. The U.S. federal government spent $5 trillion to lose 86 million QALY.

While all of the numbers used as input to this calculation are open to reasonable criticism, it’s unlikely that any change will affect the outcome that net QALY will be negative. I show QALY lost being over 5 times QALY gained from the restrictions. The reason for this is that even for an aging society like the U.S., people over 65 who are most vulnerable to COVID only make up about 16% of the population. Due to their age and comorbidities, dying from COVID results in a relatively low number of QALY lost. Taking away a fraction of a QALY from the much larger healthy younger and middle-aged population to save some elderly people from dying has more cost than benefit.

Assuming that COVID lockdowns and restrictions cut the death and hospitalization rates in half is almost certainly an overestimate, even if nothing at all was done. “Letting it rip” would have resulted in front loading deaths and hospitalizations to the first (spring) and second (summer) waves, but would have had a much milder impact for the fall/winter wave. It would have allowed for the buildup of herd immunity with the less contagious earlier variants of COVID-19, which would have protected a majority of the population from the more contagious later variants. Most remote working, unemployed or retired vulnerable people living in the community would have self-isolated regardless of government restrictions. Nursing homes and assisted living facilities would have been pressured to restrict visitors and socially distance residents regardless of government regulations. Letting it rip would have avoided the collateral damage that the lockdowns/restrictions occurred.

Following the Great Barrington focused protection approach would have also avoided the collateral damage, but would have better protected the vulnerable. It’s possible that the Great Barrington approach would have ended in the same or lower death/hospitalization count than what actually occurred, while allowing the non-vulnerable to live near-normal lives. The government would have spent a fraction of the $5 trillion, and avoided the QALY lost from locking down the non-vulnerable.

COVID-19 Pandemic Will Trigger Collapse of the Global Political Left’s Soft Totalitarianism

Soft totalitarianism is an unstable mix of anarchy, democracy, and totalitarianism. The good news is that it will not survive the COVID-19 pandemic. The bad news is what will likely replace it.

Updated October 18, 2021

The political left in Western countries has transitioned since the 1960s from a movement primarily promoting the interests of the working class to a strange mix of disparate elements. On the one hand, there continues to be the traditional leftist redistribution advocacy, including support for higher taxes, increased minimum wage, unions, regulation, etc. But the 1960s added social liberalism and identity politics. Social liberalism is the belief in unrestricted personal freedom, including collapse of the traditional family and traditional gender roles, fighting for the rights of sexual nonconformists like LGBT, psychotropic drug use, and extreme anti-authoritarianism, including handcuffing law enforcement while extending the rights of criminals. Identity politics is viewing all public policy from the lens of one’s group, rather than the general public interest. Feminism and black advocacy are examples of identity politics.

Since the 1960s, social liberalism has resulted in a condition of semi-anarchy in regions of many Western countries. In the U.S., this began with the 1960s and 1970s explosion of crime and drug use in the big cities. As people escaped to the suburbs, crime and drug use migrated there. Crime was successfully reduced beginning in the 1990s with a combination of more effective policing, mass incarceration, and legalized abortion. All three of these crime-reduction tactics were controversial, with the left opposing policing and mass incarceration, and the right opposing legalized abortion. Mass incarceration, especially, has been both extremely expensive and partly self-defeating, as it is enabling future crime by expanding the number of fatherless children in minority neighborhoods.

The explosion of drug use and addiction, on the other hand, has never been successfully managed, and it has only gotten worse with prescription drug abuse and deadly synthetic opioids like fentanyl. A recent partial surrender to the war on drugs by legalizing cannabis will help with states’ revenues and redirect law enforcement to more serious drugs, but will probably have little impact on the overall drug problem.

Identity politics has produced a condition of warring groups, which fight each other to the death, while the general public interest is ignored. The U.S. in the new millennium is an extreme example of this trend.

The recent George Floyd protests and riots demonstrate how social liberalism and identity politics combine to promote the indefensible notion that the police are the enemy, and black men who defy the police and resist arrest, and who are subsequently killed, are heroes. This is an ideology of anarchy, which does nothing to address the real economic and social problems in the black community. Seattle’s autonomous zone was a recent example of a failed attempt to create a small region of anarchy in a big city.

While the left has been in favor of participatory democracy, including a universal franchise (e.g. the Voting Rights Act of 1965), and mass protests, on the intellectual side there has been a soft totalitarianism. Unlike the old-fashioned totalitarian tactics of arresting, jailing, torturing, and sometimes executing dissidents, soft totalitarianism uses more subtle tactics to ensure intellectual conformity. These tactics include gaining near-total control of major institutions which employ artists and intellectuals, including academia, the media, art and cultural institutions, think tanks, publishing, etc. That resulted in most dissidents without a way to financially support themselves, forced to work in non-intellectual fields. For the few dissidents who remained employed by these institutions, the leftist soft totalitarians utilized social pressure, protests, boycotts, and other means to force them out, or at least keep them silent (e.g. preventing Charles Murray from speaking at Middlebury College). Even dissidents working in non-intellectual careers such as technology weren’t immune from this pressure to conform, finding themselves fired from their jobs for speaking out (e.g. at Google and Cisco).

Anarchy is inherently unstable. There is no known stable anarchic society in history. The extreme social and intellectual control of totalitarianism requires extreme restrictions on liberty and democracy. There is no known stable soft totalitarian society in history. This instability implies that soft totalitarianism is destined to be a fad, to be swept away in a major crisis. COVID-19 is the crisis that will end soft totalitarianism.

While the leftists in Western societies were able to gain near monolithic control of intellectual life, they have not been able to maintain totalitarian control of economic and political life. As long as they stayed in the intellectual realm, they were probably reasonably safe. But the COVID-19 pandemic has extended their control in unprecedented ways. Mass lockdowns are a totalitarian tactic learned from China, which have no precedent in the U.S. or other democratic societies, even for the far-worse Spanish flu of 1918 - 1919. The business restrictions are driving many small and medium-sized businesses to bankruptcy, and also are without precedent in democratic societies.

There are three types of totalitarianism in history:

1. Communism, e.g. Soviet Russia and Red China.
2. Fascism, e.g. Nazi Germany.
3. Religious Theocracy, e.g. post-revolutionary Iran.

Communism is the most economically destructive of the three. Businesses are mass-expropriated in the name of the proletariat, and the economy is centrally planned by the state. Beginning with the 1917 Russian Revolution, communist revolutions have cratered their countries’ economies. This economic destructiveness has been protective, as there is no example in history of a successful communist revolution, or communists being voted into power, in a major world economy. Russia during World War I, China after World War II, Vietnam, Cambodia, Cuba, etc. were all basket-case economies. The only times that major, advanced economies have gone communist is after a military invasion, e.g. Eastern Europe after World War II.

Our contemporary soft totalitarians have made a major tactical error in destroying their countries’ economies in the name of public health. They have crossed a line, going beyond the intellectual realm to affect daily life. That will be their undoing.

The similarities between the COVID-19 response and a communist takeover are uncanny. In both cases, you have “idealists” who claim that economic devastation is justified by a higher purpose. For communists, it’s Marxist-Leninist ideology, which promotes the ideal of a classless society. For contemporary leftists, it’s saving lives. Both share a blithe disregard for the economic destruction their ideals engender, and for the “selfish” capitalists whose businesses are expropriated (communism) or killed via regulation (contemporary leftists).

In both cases, they make an appeal to science. Marxism-Leninism is supposed to be a scientific way to run a country (religion is outlawed, for example). Contemporary leftists say that they are following scientific guidance from epidemiologists. But this scientific justification is a sham. Marxism-Leninism was a pseudoscientific political-economic theory that was one of the greatest failures in world history. Epidemiology can assert that if you shut everything down and force people to stay at home, you will have fewer infections. But epidemiology doesn’t take into account other factors that should also be considered in political decision making, such as the effects of shutdowns on the economy and individual liberty, the destructive mental and physical consequences of social isolation, the detrimental effects on child development of not going to school, etc.

While clueless leftists call for a second major U.S. lockdown  (if it didn’t work the first time, why do they think it will work the second time?), and say that the economy won’t come back until the virus is “crushed,” I argue for the opposite extreme of ending all U.S. COVID-19 restrictions. The COVID-19 pandemic is not unprecedented historically, and is not comparable to the deadly 1918 – 1919 Spanish flu, contrary to what the leftists keep telling us. It is instead comparable to milder flu pandemics of the 1950s and 1960s, which most people alive at the time don’t remember because there weren’t any economically-destructive public health measures. COVID-19 is hard to control in democratic countries because it is so mild, with many infected people experiencing either no symptoms or minor symptoms, especially the young and the healthy. It is not in the public interest to sacrifice the young and the healthy to the old, the sick, and the fat, as we are doing with these idiotic restrictions.

Regardless of what other dissenters and I argue, the leftist soft totalitarian establishment has determined that we need to respond to COVID-19 as if it were the second coming of the Spanish flu, with even more extreme measures than were taken a hundred years ago. They have, true to form, silenced dissenters by utilizing their usual tactics. They have forced every Western country (except Sweden) to follow the harsh Chinese lockdown tactics and economically destructive restrictions.

The fact that supposedly conservative governments like those in the U.S., U.K., Australia, and Israel went along with the totalitarian lockdowns reveals the intellectual bankruptcy of modern conservatism. When faced with a crisis, the conservative leaders of these countries were unable to resist the monolithic advice of people with MD or PhD degrees to lockdown. Sweden’s more laid-back approach came not from a conservative government (Sweden is run by Social Democrats), but from a nonconformist state epidemiologist named Anders Tegnell. “Once you get into a lockdown, it’s difficult to get out of it,” he said. “How do you reopen? When?” As other countries have reopened, cases have increased, forcing more lockdowns.

Major world economies will not fall to communism, and will not fall to the neo-communism of contemporary leftists. At some point in the near future, there will be a reaction. This reaction will depend on a country’s individual circumstances, including its history, strength of democratic institutions, how quickly an effective COVID-19 vaccine or treatment is invented and made widely available, and how rapidly the country’s economy is brought down by shutdowns and other COVID-19 restrictions. This reaction will spell the doom of soft totalitarianism, to be replaced by something different. This replacement most likely will be worse, sometimes much worse.

In most countries, soft totalitarianism will be replaced by either authoritarianism or (hard) totalitarianism. The U.S. will most likely turn authoritarian, and eventually become a Christian religious theocracy. This will mean that the three most powerful countries in the world (the U.S., China, and Russia) will be either authoritarian or totalitarian. Unlike during the bipolar Cold War, when the U.S. promoted liberal capitalistic democracy, and the Soviet Union Marxist-Leninist communism, the tripolar post-COVID-19 world will have three powerful countries promoting their political-economic systems to smaller countries. China will promote its unique type of totalitarian quasi-capitalistic communism to smaller countries in East Asia. Russia will promote its brand of Putin-type authoritarianism to smaller countries in Eastern Europe, and possibly Western Europe. The U.S. will promote its version of capitalistic authoritarianism to countries in Latin America. Africa and the Middle East will be a free-for-all, with all three major powers competing. India will be the major authoritarian power in South Asia, and will likely be a lesser superpower competing with the big three.

Liberal capitalistic democracy will live on in smaller Western countries, but unlike during the Cold War, they won’t have the backing of a superpower, and will be impotent to affect world events. Eventually, their number will shrink as one or more superpowers use persuasion or coercion to bring them into their fold.

Why such pessimism? After all, things were looking so bright after the end of the Cold War, with the U.S. liberal capitalistic model seemingly victorious. The reason has to do with the creative intellectual vacuum of our age, which I talk about here. Liberal capitalistic democracy was born in the U.S. in the late eighteenth century during one of the greatest Western intellectual movements in history, the Enlightenment. The modernist movement that began at the turn of the 20th Century has become an anti-Enlightenment, reversing a 500-year glorious history of Western progress in the arts and culture. Science continues, but global progress is held back by lack of individual accomplishment. COVID-19 is an example of this lack of accomplishment, as this pandemic could have been prevented if we had responded appropriately to the threat that SARS revealed to the world in 2002 – 2003. This response should have been using the past 18 years to develop panviral (i.e. universal) coronavirus vaccines and treatments. Such an effort would have required a combination of political long-term, strategic planning along with scientific genius, which are globally lacking in today’s world thanks to the anti-Enlightenment.

As I indicate here, there is some hope for the future. The cause of the modernist movement has to do with the interaction of modern technology with the human magnetic sense, which has led to an explosion of drug abuse and mental illness. We are starting to make progress in understanding human magnetoreception, which will take some time. This understanding will lead to both better treatments for mental illness, and fewer people being affected. Eventually there will appear creative geniuses who will lead a future major intellectual movement that will replace modernism. This movement will also lead to a restoration of liberal capitalistic democracy.