28 januari 2021

COVID19 risks in perspective

I did some calculations to understand what we've been fighting for, for nearly 1 year now, and put some things in perspective. I tried answering two questions:

Question 1: What if everyone in Belgium got COVID19 (without flooding the healthcare system)?

What if we had taken a much more relaxed approach, allowing everyone in Belgium to get COVID19? I will, however, assume that everyone got good quality medical care (though I do not assume state-of-the-art: I assume an average IFR of 1.2% across the population). Thus, I assume medical capacity is never exceeded.

If we did that, an analysis based on age-based all-cause mortality data in non-COVID19 times, age-based COVID19 IFR, and the Belgian demographic makeup, then yields the following:
  • Of all remaining years to live of all Belgians presently alive (estimated based on age alone), 0.25% would be lost (i.e. 1 year in 400).
  • The mean number of years of life lost per person in Belgium would be 0.1 (1 month and a quarter).
  • The mean number of years of life lost per COVID19 fatality would be 8.7.

Question 2: What if pandemics such as COVID19 were the new normal?

What if we had to endure a similar pandemic each and every year from now on, and we let everyone be infected each year, though without exceeding medical capacity? (So I still assume the same IFR of 1.2% across the population.) Then:
  • Life expectancy in Belgium would drop by 6.2 years, bringing it down to what we had in 1989.

Some discussion...

The above estimates are most likely quite pessimistic, as COVID19 is more dangerous to those with comorbidities that reduce their remaining life expectancy as compared to others the same age - so on average fewer years of life are lost than roughly estimated here. But, for simplicity, let's make abstraction of that.

Now, we may ask ourselves the questions:
  • Looking back, was saving 0.1 years of life lived per person worth our efforts?
  • Would we rather live our whole life as we did in the past year to live 6.2 years longer and avoid possible long-COVID?
If the answer is yes: well done to us!

Note that, despite all efforts, ~30% (conservative estimate?) of the population did get COVID19 in the past year, so in fact we only saved ~70% of that 0.1 year per person (question 1), and life expectancy would drop by 1.9 years anyway even if we did react similarly if this were to become the new normal (question 2). So it would be more accurate to weigh our efforts against 0.07 years (<1 month) of life lost and 4.3 years reduction in life expectancy, respectively, in the two questions above.

Of course, each death is deplorable, and averages are just averages.
And of course, this analysis is imperfect. E.g.:
  • How can one safeguard healthcare in practice?
  • We should account for lower life expectancy of people most at risk.
  • How to quantify and model the effects of long-COVID?
  • What are the effects on life expectancy & quality of lockdowns & other measures?
One can (and someone should) refine this analysis by considering DALY (Disability Adjusted Life Years) instead of years of life lost, to account for long-COVID, effect of lockdowns, etc.

Yet, despite these shortcomings I believe this simple analysis already puts things in perspective. For one thing, such numbers allow us to rationalize debates about school closures, economy, psychological damage, lifestyle... as also these can be (and in many cases have been) translated in years of life lost/DALY.

We must dare to talk about such numbers, so we get our priorities right. I've seen very little of that.

We need to debate this even if it sounds insensitive, because not debating it is irresponsible.

(On that note: can someone please also wake up parliament?)

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