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Tuesday, 7 April 2020

Policy frameworks for pandemics - part 3 - cost evaluation...

Every day we hear the news about the number of cases of people dying from Coronavirus.
These numbers are shocking and every death is a tragedy. How can we look at this with more structure?
How do we evaluate costs?  Specifically, the costs of the loss of a human life? Or of a marked degradation in the quality of a human life?

These two factors are generally termed
(a) Mortality
(b) Morbidity

Increases in death - mortality - are generally easy to measure - is someone alive or dead?

If we look at the derived data from 

We can see that on any day in 2018 in England and Wales we see approximately 734 males deaths and 749 female deaths. Look at the table below, for females aged 3034 we see 2.4 deaths per day in 2018 in England and Wales.

Sum of NDTHS Sex 365
Age 1 2 Grand Total Male Female
Neonates 1040 811 1851 2.84932 2.22192
<1 400 320 720 1.09589 0.87671
01-04 215 164 379 0.58904 0.44932
05-09 137 133 270 0.37534 0.36438
10-14 194 116 310 0.53151 0.31781
15-19 561 270 831 1.53699 0.73973
20-24 981 378 1359 2.68767 1.03562
25-29 1242 581 1823 3.40274 1.59178
30-34 1658 876 2534 4.54247 2.4
35-39 2260 1347 3607 6.19178 3.69041
40-44 3185 1835 5020 8.72603 5.0274
45-49 5251 3454 8705 14.3863 9.46301
50-54 7870 5094 12964 21.5616 13.9562
55-59 10755 7425 18180 29.4658 20.3425
60-64 14355 9950 24305 39.3288 27.2603
65-69 21232 14616 35848 58.1699 40.0438
70-74 31296 22884 54180 85.7425 62.6959
75-79 36041 29195 65236 98.7425 79.9863
80-84 44735 41951 86686 122.562 114.934
85+ 84552 132229 216781 231.649 362.271
Grand Total 267960 273629 541589 734.137 749.668
When elderly people die they often die with a complex presentation.  There are of course some cases of simple causes - electrocution due to faulty wiring, aeroplane crash and so on.  But in many cases the cause of death is a secondary infection. As an example, many cancer patients die from pneumonia, although one could argue quite reasonably that the cause of death is cancer.

So, there is a difference between people dying "from" a condition and people dying "with" a condition.

How does this link back to Covid-19?  

How many deaths in England and Wales are from people dying "with" Covid-19 and how many are "from" Covid-19?

The difference in deaths, broken down by age cohort, broken down by "with" and "from" is the key metric.

So far I have been unable to find any source of this data.  


Why is this important?  Let's look at a thought experiment.  A patient with terminal lung cancer and an estimated life expectancy of one month develops Covid-19 and dies.  Should that death be attributed to Cancer or Covid-19?


If this death is attributed to Covid-19 then this may lead politicians to invest more money in treatment of Covid-19, at the expense of Cancer treatment.  Is that equitable, sensible and efficient?



What we really need is a table with data rather like the below:

Sum of NDTHS Sex 365 Estimated for 2020
Age 1 2 Grand Total Male Female Male Female Delta(m) Delta(f)
Neonates 1040 811 1851 2.84932 2.22192
<1 400 320 720 1.09589 0.87671
01-04 215 164 379 0.58904 0.44932
05-09 137 133 270 0.37534 0.36438
10-14 194 116 310 0.53151 0.31781
15-19 561 270 831 1.53699 0.73973
20-24 981 378 1359 2.68767 1.03562
25-29 1242 581 1823 3.40274 1.59178
30-34 1658 876 2534 4.54247 2.4
35-39 2260 1347 3607 6.19178 3.69041
40-44 3185 1835 5020 8.72603 5.0274
45-49 5251 3454 8705 14.3863 9.46301
50-54 7870 5094 12964 21.5616 13.9562
55-59 10755 7425 18180 29.4658 20.3425
60-64 14355 9950 24305 39.3288 27.2603
65-69 21232 14616 35848 58.1699 40.0438
70-74 31296 22884 54180 85.7425 62.6959
75-79 36041 29195 65236 98.7425 79.9863
80-84 44735 41951 86686 122.562 114.934
85+ 84552 132229 216781 231.649 362.271
Grand Total 267960 273629 541589 734.137 749.668


Why? So we can take the fear out of the headline numbers and start to look at the real impact of Covid-19 on our populations.

If we look at the mortality from and with Covid-19 we also have to look at the change in mortality brought about by social distancing.  One would assume that the number of drink driving deaths would fall - since pubs are closed.

There was an epidemiological study after the 1990-1991 Persian Gulf War that showed that US military deaths were reduced versus a non-war situation, since troops in Saudi Arabia were not able to drink and engage in normal activities.  Could it be that Covid-19 results in a lower overall mortality/morbidity figure for polities such as Australia and the UK that have brought in strict social distancing?

See also:
Policy frameworks for pandemics - part 4 - incidence of costs versus incidence of benefits...


The regular reader may note that this really is rather off-topic.  And from the perspective of a blog that has traditionally looked at topics such as Fixed Income Trading: New venues ( How many Fixed Income trading venues are there? ) , Product Management and Fintech and What's the difference between an EMS and an OMS? this may seem a little unusual.  However, your author was trained as an Economist and took a keen interest in Health Economics and the interface between rationality, efficiency and morality.  As such, with the usual topics somewhat becalmed I decided to repurpose this blog for an intellectual diversion.  I can assure the reader that normal service will be resumed sooner or later... 

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