Two-faced virus
How in China the pluses of the epidemic outweighed the minuses
Alexander Berezin, Naked Science
The beginning of the introduction of quarantines in the West led to a sharp drop in stock indices and fears of a complete economic collapse. Many expect that following the economic downturn, mortality will jump sharply. However, historical experience shows that in fact, mortality during depressions and recessions is noticeably reduced. And it's not just about history. Recent data show that in China, the Covid-19 epidemic has saved dozens of times more people than it killed. In theory, the rest of the world can achieve the same result – if, of course, it is able to copy the behavior of the Chinese. Let's try to understand the reasons why the recession and quarantine will potentially save hundreds of thousands of lives.
Residents of Moscow and many regions observe the same patterns – restrictions on going to work and places of rest. Empty shelves in stores at the peak of shopping mania under the slogan "tomorrow the roads will be closed and nothing will happen."
Empty shelves of British supermarkets: as in Russia, this is not the result of a shortage of products, but a banal panic buying by the population of everything that the eye falls on / ©REUTERS, Reade Levinson.
Assessments of what is happening are unanimous: "No one is even trying to deny that the economy of Khan. It's already Khan, and then what will happen, it's better not to guess. Khan's economy is bad. These are unemployment, non-payments, impoverishment and hunger. Much worse than the coronavirus," a typical social media post reports.
It seems there must be a grain of truth here. Quarantine drops GDP – people consume less, work less – and strongly. In China, during the peak of quarantine measures, industrial production collapsed by 15%.
Nevertheless, in fact, coronavirus hysteria – because along with really useful measures, there are elements of hysteria in the actions of governments – there is also a bright, downside, only few people talk about it. The fact is that normally, as a result of the economic downturn, mortality is decreasing, not increasing. And specifically for the PRC, this has already happened.
The necessary digression is not for everyone: if you are not a citizen of Russia, you can not read
Any resident of Russia, after reading this, will inevitably grimace. What kind of game? Anyone who lived in the 90s knows that, in fact, the economic crisis kills. And on a scale that no modern wars or epidemics dream of.
Life expectancy in Russia in the 90s really fell by 5 years / ©Wikimedia Commons.
If in 1986 our life expectancy was 69.2 years, then by 1994 it was already 64.0. Minus 5.2 years, that is, society as a whole lost at least tens of millions of man-years of life. Our country was able to reach the Soviet level of its duration again only in the 2010s, decades after the beginning of the 90s. On the contrary, due to the economic recovery in 2005-2013, life expectancy in Russia jumped by 7.3 years.
In fact, there is no contradiction between "the economic downturn leads to an increase in life expectancy" and "in Russia, the 90s led to a reduction in life expectancy". It is simply necessary not to confuse purely economic problems and the systemic collapse of state structures.
It is easy to see a funnel-shaped increase in mortality in 1990-1994 and after 1998. However, it is not a consequence of economic processes. Suffice it to recall that in 1999-2003 the economy grew as never before, but the mortality rate did not fall, but increased / ©Rosstat.
In the 1990s, in Russia, the state did not know what to do, was influenced by the ideas that it was necessary to reduce its interference in everything, because the free market, by definition, is better and more effective than state forces. As a result, state budget revenues have sharply decreased. And then the financing of the healthcare system collapsed: many seriously believed that the transition to paid medicine would be better than continuing to finance "relict, soviet, state medicine."
But it's not just the collapse of medicine. In that era, the vast majority abruptly lost faith in the meaningfulness of what was happening. Outside of a very narrow circle of intellectuals who were waiting for prosperity according to the Western scenario, no one believed that with the chosen path of development of the country, in principle, anything good could happen in it. Not just in the economy, but in general in all spheres, in any distant future. It would seem that it doesn't matter what the population thinks there? Oddly enough, no. Moreover, this was the main factor in the mass death of people in the 1990s.
Yes, contrary to popular belief, at that time the main causes of death were not murder or poor nutrition. Of course, both of these reasons resulted in much higher deaths than today, but the bulk of the increase in mortality had nothing to do with them.
Back in 1990, less than 1.7 million people died in the country, and four years later – more than 2.3 million. The difference of 650 thousand cannot be explained by the increase in the number of murders and suicides: both of them did not even reach 0.1 million people per year. The most common cause of death was cardiovascular diseases, the frequency of death from which increased dramatically.
In a society where people do not believe in the possibility of a positive future, such ailments will inevitably kill much more than usual. After all, hopelessness causes stress, and that is the key, basic cause of problems with the heart and blood vessels. It is incorrect to compare the events of the 90s with ordinary crises, because, to paraphrase the classics, the devastation was not in the economy, but in the heads.
Take a look at the life expectancy growth curve in the 2010s. Over these ten years, cumulative economic growth in Russia is not much different from zero, but we are living longer and longer. Conclusion: if we are talking about purely economic problems, and not about the collapse of society as a whole, growth is not necessarily a condition for prolonging life. Even in 2008-2009, we did not have any decline in life expectancy. But the economic collapse in Russia was then three times deeper than in the United States, the homeland of the crisis.
What happens to mortality in a normal economic downturn
So, the experience of the Russian 90s is not suitable for assessing the consequences of the "quarantine" economic downturn in 2020. The planet as a whole is extremely far from the gloomy self-perception of the Russian population in the 1990s. To understand what will happen to the mortality of earthlings now, you need to choose other samples. Places where there was an economic downturn, but there was no collapse of faith in the future.
Red – mortality in the USA, green – unemployment rate in the same place. The average value of both indicators is taken as zero. It is clearly seen that the economic downturn leading to unemployment normally reduces mortality / ©voxeu.org .
Let's start with the biggest economic crisis of the industrial era. Following the mass culture, we represent the USA in the years of the Great Depression extremely darkly. Like in noir action movies: gangsters everywhere, prohibition, unemployment, malnutrition and a queue for free soup. All the learned cliches from childhood have one problem: reality was much more complicated. In fact, during the Great Depression, the average life expectancy in the United States increased by 6.2 years – from 57.1 in 1929 to 63.3 in 1932 (similar processes of lesser strength were going on in 11 European countries).
Let's think for a second: the average life expectancy of an American has increased by 10.9% in just four years. In 1929, 1.37 million people died there, and in 1932 - 1.29 million. How did it happen?
The main contribution to the rescue of almost 80 thousand a year was a reduction in mortality from pneumonia and influenza by 41 thousand people a year, as well as from tuberculosis – by 12 thousand a year. It is not difficult to understand what led to such changes. Pneumonia, influenza and tuberculosis also spread more actively the more mobile the population, and the economic recession leads to a drop in such mobility. People travel less to other cities, visit restaurants and cafes less often, and travel abroad less.
Interestingly, a huge decline in mortality occurred during the Great Depression, despite the sharp compression of medical spending of the population. In conditions when huge masses of people have basically lost access to the services of doctors. Even the American scientists themselves, who discovered this fact, were shocked. As noted by Jose Tapia Granados, the lead author of the work:
"Our discovery is very significant, but it goes against all expectations, it is counterintuitive. Many people think that times of high unemployment are harmful to health."
Of particular note: according to the work of his scientific group, mortality also fell during the weaker economic crises of 1921 and 1938. But with the relatively rapid growth that preceded these recessions, the opposite was true: mortality increased, and life expectancy decreased.
The authors of the corresponding article analyzed the six main causes of death in the States of that era, which accounted for two-thirds of the total mortality. Let's list them in ascending order of the number of victims: cardiovascular and kidney diseases, cancer, flu, pneumonia, tuberculosis, death in an accident and suicide. It turned out that for all ages and all genders, mortality from the first five causes either remained the same or decreased significantly. But suicide increased, but due to the small number of such events (2% of the total mortality), this did not affect the overall picture.
The upper black line is life expectancy, the gray line is the unemployment rate, the black columns are changes in GDP. All these figures concerning the United States in 1920-1940 demonstrate well that periods of recession and rising unemployment simultaneously lead to a lengthening of citizens' lives. There are exceptions to this rule – like the 90s in Russia - but here the problem is no longer in the economy, but in the heads / ©José A. Tapia Granados et al.
The figures are more eloquent than words: in 1928 in the USA the death rate was 12.0 per thousand population, in 1929 - 11.9, and then fell down to 10.7 in 1933 (the same "more than 10% reduction in mortality"). Only since 1934, the beginning of the active phase of economic recovery, it has grown again to 11.1. At that time, 122 million people lived in this country – that is, the Great Depression led to the rescue of up to hundreds of thousands of people a year in the United States.
How exactly can coronavirus reduce mortality today
In 1929, humanity burned much less fossil fuels and polluted the air much less. Today, one of the main threats to human health is microparticles with a diameter of 2.5 micrometers or less (PM!!!!!!!!!!!2.5). This is the main source of mortality from air pollution in the world, and it is equal to seven million people a year, or a couple of tens of thousands per day. China accounts for a seventh of these deaths, almost three thousand people every day.
Based on the reduction of emissions of such microparticles recorded by American observational means, scientist Marshall Burke roughly estimated how many lives the decline in economic activity due to quarantine should have saved in China. The concentration of microparticles in all the cities for which he had data fell by more than 10% – in fact, closer to 15%. Such a reduction should save at least 77 thousand lives in two months of quarantine.
But, as Burke himself honestly notes, to simplify the calculations, he threw out of them the influence of microparticles on the deaths of persons older than five, but younger than 70 years. And this is the main part of the population. It turns out that his figure of 77 thousand rescued clearly downplays the real positive impact of the coronavirus on Chinese mortality from air pollution.
Let's try to roughly assess such an impact from the other end. More than a million people per year die from air pollution in China, but the bulk of such deaths occur in winter. The thing is that the content of microparticles in the air depends not only on the industrial emissions themselves, but also on the time of year.
When the weather is cool, the concentration of such particles in the air of Chinese cities reaches a peak (133.1 milligrams per cubic meter of air), and in July it is minimal (38.76 milligrams per cubic meter). Of course, in winter in China they burn a little more coal (heating), but not three times more. The main reason is that the colder air is noticeably denser, it is easier for microparticles to "float" in it, and their leaching by precipitation is more difficult.
In other words, winter deaths from air pollution can be several times higher than summer deaths, which Marshall Burke did not take into account in his calculations. Consequently, the Chinese "coronavirus" quarantine is able to reduce the mortality of the population not by 77 thousand people, but by an even larger figure.
On the planet as a whole, five times more people die from air pollution than in China. If the coronavirus quarantine were global and lasted two months everywhere, reducing emissions would save the lives of at least half a million people.
Coronavirus against pneumonia and influenza
Common flu and pneumonia still kill a lot of people. For example, in the USA, they kill over fifty thousand people a year, and in the world – more than 4.2 million. The frequency of occurrence of these diseases, as well as 90 years ago, during the Great Depression, depends on the intensity of contacts between people, which inevitably decreases during an economic downturn.
For example, in 1929, 167 thousand people died in the States from pneumonia and influenza, and already in 1930 - 120 thousand. A reduction in the number of pneumonia deaths by a quarter is unlikely to happen these days: most of the world's population still lives outside the active quarantine zone for Covid-19. But if it covers all countries, then even a two-month quarantine and a reduction in mortality from pneumonia and influenza by a quarter will save the lives of 280 thousand people.
Flu is still a massive disease, although this year its prevalence in China does not look very high. Is there a connection with the quarantine from the coronavirus? / ©José A. Tapia Granados et al.
Let's turn to the Chinese example. According to estimates, for 83% of the population of the PRC (some provinces were not covered by the calculations), about 18 thousand people should die from influenza a year. For the country as a whole, this figure is hardly lower than 20 thousand per year. At the same time, the vast majority of deaths occur in the local winter and early spring (the same pattern in other countries). Thus, a two–month quarantine could save several thousand Chinese lives from the flu - about as many as the coronavirus took during the epidemic.
Mortality from common pneumonia in China is estimated at 125 thousand people per year. Again, the bulk of such events occur during the cold season. That is, in 2020, they coincided in time with the current quarantine. Obviously, the reduction in mortality from common pneumonia, the spread of which is hindered by coronavirus quarantine, should save more Chinese than Covid-19 carried away.
Does the virus save you from an accident?
In the world, 1.35 million people per year die from car accidents, including more than a quarter of a million in China. The PRC does not report statistics of this kind on a monthly basis, so it is difficult to assess the effect of quarantine in this area so far. Almost all scientific papers on the topic agree that economic recessions – that of 2008-2009, that of 1929-1933, that of smaller ones - lead to a decrease in accidents and the number of deaths on the roads.
Why this happens is a more complicated question. The idea suggests itself that the population travels less because they don't have money. But the problem is that the accident rate per kilometer of mileage is also decreasing: that is, one "no money for gasoline" cannot explain anything. Certainly, the crisis reduces the availability of driving for the youngest part of drivers, but this cannot fully explain the changes in statistics. Many researchers believe that in a crisis, the behavior of drivers on the roads somehow changes, for some reason they drive more carefully, and most likely they themselves do not realize what the matter is.
The reduction in mortality from road accidents during coronavirus quarantine should, in theory, be greater than usual. The ban on visits to a number of public spaces, and in some places blocked roads should reduce not only the specific accident rate (per kilometer of mileage), but also the total mileage of drivers around the world.
If we assume that the reduction will be 5%, and the quarantine will last an average of two months, at least 20 thousand lives will be saved. Against the background of the impact of quarantine on the burning of fossil fuels and the spread of other diseases, the figure seems small. But if we remember that we are talking about people – already quite solid.
Plus or minus: what will outweigh?
Of course, we have not listed all the factors of reducing mortality during a large-scale quarantine or a major economic downturn. Those moments that are difficult to fully count remained unlit.
Jose Tapia Granados, who was the first to reveal the fact that mortality decreases during an economic downturn, and himself identified these factors without quantitative estimates. According to him, during the economic boom, people may experience increased stress levels, work more and sleep less. Sleep disorders and stress are known to directly affect the effectiveness of the body's immune system, as well as the heart and blood vessels. Alas, the stress and sleep hours of hundreds of millions of people involved in a major economic downturn simply cannot be measured accurately.
Let's summarize the results. In China today, quarantine has really saved dozens of times more people than the new virus has killed. If a similar two-month quarantine were introduced in other countries, it would hardly lead to a serious increase in deaths from hunger and other causes.
After all, humanity now has an average level of GDP slightly higher than the American one in 1929-1933. If the mortality rate was able to decrease then, it is extremely unlikely that everything will be different today.
The reader will object: what about Black Africa, where people sometimes die of hunger even without quarantines? I must say that it is unlikely that the coronavirus is so relevant for this part of the world. After all, it is most dangerous for developed countries.
The younger the population, the more difficult it is to spread Covid-19. As we have already noted, only 10% of those infected with the new virus are under 30 years old, and more than half are over 50. It is clear that the countries of Black Africa, where food security is the worst, have a younger population, it is more difficult for the virus to "jump over" to a new carrier there: there are not so many elderly people who are sufficiently vulnerable to it. In addition, the climate there is warm, that is, one where viral diseases are more difficult to carry by airborne droplets.
Yes, it will be more difficult for developed countries: their climate is worse, the population is older. But many of these States today have serious emergency food supplies in case of war and natural disasters. Their distribution is able to provide the population with food for months, even despite a temporary drop in income. Therefore, by analogy with the Great Depression, even a fairly sharp economic downturn should not cause a collapse in the supply of food to the masses.
As we indicated above, the total mortality on the planet under the scenario of a global two–month quarantine can be reduced by about 0.8 million: half a million due to cleaner air, 0.28 million due to a decrease in the number of deaths from common pneumonia and influenza, plus a little more from a decrease in the frequency of accidents.
Whether these 0.8 million will cover all the victims of the epidemic is still extremely difficult to say. If all countries reacted like China, where 3.2 thousand people died, of course, the answer would be "yes". Then no more than 20 thousand people would have died from coronavirus worldwide, which is 40 times less than 0.8 million, which can save the economic downturn from the introduction of quarantine for Covid-19.
However, the observed reality tells us that the EU and the US have not been able to copy Chinese methods of combating epidemics. They failed to contain it as effectively: they did not create a system of quarantine measures in time, which would allow them to crush the epidemic close to the start.
Therefore, one person out of 17 thousand has fallen ill with coronavirus in China today, and one out of two thousand in Italy, and this is clearly not the limit. There are already thousands of infected people in the United States, and local authorities have not been able to provide the country with tests: as of March 16, only 32 thousand were made there, almost four times less than in Russia, where there are not so many cases.
All this tells us that in Western countries we should expect an epidemic more powerful than in China. From this, the total number of its victims can rise to tens of thousands. If non-Asian countries continue to avoid full quarantine, the death toll from SARS-CoV-2 could reach hundreds of thousands.
That is why it is still difficult to say for sure whether the fight against Covid-19 will save more lives than it will take itself. I would like to hope that reason will win, and copying the Chinese approach to the issue will allow countries outside East Asia to avoid hundreds of thousands of deaths. But whether this will happen, only time will tell.
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