This is the full article that Charley Hooper and I had published in the Wall Street Journal 30 days ago.
Leaders’ greatest failure was not focusing on the elderly, who had lower costs and far greater benefits.
By Charles L. Hooper and David R. Henderson
Now that the Covid-19 pandemic seems to be abating, it’s a good time to look at lessons that observers have, or should have, learned. The list of mistakes is long, but the most glaring was the failure to understand and act on the virus’s propensity to attack the old and vulnerable. Policy makers failed, in other words, to understand the enemy.
Some clear thinking based on data that were available last spring would have led to two insights. First, the benefits of protecting the old and vulnerable exceed the costs.
For our purposes we are combining voluntary and coercive (e.g., government lockdown) nonpharmaceutical precautions—mask-wearing, hand-washing, quarantining, distancing and isolation of infected people—under the umbrella of protection. The benefits of protection include reducing the potential for death, pain, suffering and healthcare costs, along with reducing the chance of infecting others. But the main benefit of protection is that fewer people die from Covid-19.
The infection fatality rate is the probability that a person will die once becoming infected, whether that person has symptoms or is unaware of the infection. The global average infection fatality rate of SARS-CoV-2, the virus that causes Covid-19, is roughly 0.23%. The average U.S. fatality rate is higher, probably 0.3% or 0.4%, because Americans are older and less healthy than those in most other countries. Underneath this average, the infection fatality rate increases exponentially with age. For an 85-year-old it may be 2,000 times as high as for an 18-year-old. This increase in the death rate by age is partly due to comorbidities, which increase with age.
The primary risk from SARS-CoV-2 is infection leading to death. Those who die lose years based on statistical life expectancy. A person’s expected years lost is equal to the infection fatality rate times life expectancy times probability of infection.
Had the Moderna, Pfizer /BioNTech, and Johnson & Johnson vaccines never been developed, the pandemic would have continued until natural herd immunity was reached. That’s the point in the life cycle of an infectious disease when enough of the population has immunity that the average number of people to whom a newly infected person passes the disease drops below one. In effect, those who are immune protect those who are still vulnerable, and the disease largely disappears. Herd immunity for SARS-CoV-2 would be reached after perhaps 70% of the population has been infected.
While perfect protection would eliminate the risk of infection, few people can practice it. Based on data analyzed by economists at the University of California, Berkeley, we assume that actual protection reduced the risk of infection by roughly half. Therefore, imperfect protection reduced the risk of infection for the average American from 70% to 35%.
We find that the benefits of protection are disproportionately higher for older people. Consider two extremes: the 18-year-old and the 85-year-old. If the 18-year-old dies, he loses 61.2 years of expected life. That’s a lot. But the probability of the 18-year-old dying, if infected, is tiny, about 0.004%. So the expected years of life lost are only 0.004% times 35% times 61.2 years, which is 0.0009 year. That’s only 7.5 hours. Everything this younger person has been through over the past year was to prevent, on average, the loss of 7.5 hours of his life.
Now consider the 85-year-old. If he dies, he will lose 6.4 years of expected life. The probability of dying, if infected, is much higher for him, about 8%. So the expected years of life lost are 8% times 35% times 6.4 years, which is 0.179 year—65 days. The benefits of protection, measured in life expectancy, are 210 times as high for the older person.
The costs of protection include reduced schooling, reduced economic activity, increased substance abuse, more suicides, more loneliness, reduced contact with loved ones, delayed cancer diagnoses, delayed childhood vaccinations, increased anxiety, lower wage growth, travel restrictions, reduced entertainment choices, and fewer opportunities for socializing and building friendships.
In a 2020 study for the Organization for Economic Cooperation and Development, Eric Hanushek and Ludger Woessmann estimate the loss to lifetime income for individual students to be 6% (assuming schools were closed or reduced for the equivalent of 67% of a year). Given U.S. median lifetime earnings of $1.7 million, that 6% translates into $102,000 per student. This loss of income from protection disproportionately affects younger Americans. Those who are retired are largely unaffected.
Assuming that reduced lifetime earnings are the only costs and reduced life-expectancy losses are the only benefits, the 18-year-old faces a cost of protection of approximately $102,000 and a benefit of 31% of a day. Would you pay $102,000 to live an extra 7.5 hours? What 18-year-old values his time at $13,600 an hour? The costs for the 85-year-old are close to zero (remember, this person is probably retired) and the benefit is 65 days. To be sure, there are other costs for both groups. For the 18-year-olds, that makes protection even less of a good deal. The 85-year-old, by contrast, may be willing to endure more risk for the sake of time with loved ones.
In hindsight, the 18-year-old should have invested only minimally in protection; the costs exceeded the benefits. Work, school, sports and socializing should have continued, perhaps with some minor precautions. But the 85-year-old should have worked hard to protect himself—the benefits exceeded the costs.
SARS-CoV-2 is highly discriminatory and views the old as easy targets. Had policy makers understood the enemy, they would have adopted different protocols for young and old. Politicians would have practiced focused protection, narrowing their efforts to the most vulnerable 11% of the population and freeing the remaining 89% of Americans from wasteful burdens.
Mr. Hooper is president of Objective Insights, a firm that consults with pharmaceutical clients. Mr. Henderson, a research fellow with the Hoover Institution, was senior health economist with President Reagan’s Council of Economic Advisers.