Measuring Burdens on Personal Liberty: Facemasks

It's analysis time, analysis fans

Liberty: roughly, what one is allowed to do by law

Freedom: roughly, what one actually can do, legal or not

Context

Back in 2015 after the Supreme Court Obergefell v Hodges decision legalizing same-sex marriage, there was a huge outcry from people who opposed it. The arguments against Obergefell tended to speak in terms of an impending apocalypse. Religious liberties would be crushed and so would free speech. Those claims seemed to be overblown and usually irrational or incoherent. But when I searched, there was no published analysis I could find that did a cold, neutral analysis of what exactly burdens and benefits would come from legalized same-sex marriage and what groups of people would be affected.

In frustration, I decided to do my own analysis. After about 100 hours of searching, thinking about how to do the analysis and then doing it, I concluded that for the most part there was no impending apocalypse. The burdens on most people were low to trivial to non-existent. The people who got whacked hardest were business owners in the 22 or 23 states that had laws prohibiting discrimination in commerce. Those people and their businesses could be fined into bankruptcy for refusing to provide goods or services to same sex couples. You know, wedding cakes and wedding photos. But in terms of actual religious practice or speech, Obergefell imposed little or no burden on most people. And, Obergefell forced no couple to get married against their will, and it prevented no couple who wanted to marry from getting married.[1] Before Obergefell, in some states same-sex couples who wanted to marry could not get married. That was truly liberty crushing for those people.

The other thing that was problematic, was the almost total silence of the anti-same sex marriage argument about the benefits to same-sex couples. That was rarely or never mentioned. Most people who engaged in this complaint were almost totally self-centered. They could not care less what benefits others might enjoy from the new legal landscape. They mostly cared only about themselves based on their usually grossly exaggerated fears.

Facemasks & COVID-19: A quick seat of the pants analysis

Today, some people are refusing to wear face masks in public because they argue it is a large burden on their liberty. Some claim health regulations that require wearing facemasks in public is outright tyranny. Some state governors have compared it to living in China. As was the case with same-sex marriage, the complaints about facemasks imposing tyranny-level burdens on personal liberty (i) seem grossly exaggerated, and (ii) conveniently ignore the benefits to other people and society as a whole.

So, what might a cost-benefit analysis look like? Just collect some data, make some reasonable assumptions and think it through.

Current data indicates that the COVID-19 death rate is about 2.25% by dcleve's estimate. Assume it is 2% to keep things simple and not exaggerated. The benefits of not wearing a face mask vary from person to person. People like me who wear glasses are arguably higher because without a mask, my glasses aren't fogged most of the time. I find foggy glasses to be annoying and occasionally interfering with something I want to do, e.g., read the label on a product in the grocery store, which I often do for various reasons. I sometimes need to take my foggy glasses off to see or read. For people who do not wear glasses, this is a non-existent burden on their liberty to see freely without fog. The other burden that facemasks impose on some people is simply psychological discomfort. Some folks don't like facemasks for one or more of various reasons including:

1. they don't like the way they look and are inconvenient to wear
2. they are socially and/or psychologically uncomfortable with how face masks impair human social or interpersonal interactions, e.g., by hiding facial expressions thereby creating uncertainty and social or psychological discomfort
3. they feel they are not loyal enough to Trump or their own tribe when they wear a face mask
4. they feel that wearing a face mask supports democrats too much
5. buying a face mask usually costs money
6. they believe that COVID-19 is a hoax or the pandemic has passed and it is time to move on

For people who are not yet infected with COVID-19, the benefits of facemasks are that the odds of them becoming become infected are reduced. Existing data indicates that facemasks reduce the spread of virus from infected people to others and they reduce the odds that an uninfected person will get infected. Thus, masks work two ways to reduce the infection rate. That should allow some people who want to ride this pandemic out until a drug and/or vaccine is developed.

Simple logic and existing data indicates that people who do not wear face masks will spread virus to others and kill about 2% of them. If we stop trying to slow the virus spread and take no measures, one can assume that we will develop herd immunity the old fashioned way, e.g., by all out plague. Herd immunity is estimated to require about 80% of all people to have been infected. If one assumes that the American population is 320 million and 80% get infected and 2% of them die, then about 5.12 million Americans will die. Obviously, not wearing a facemask imposes the greatest possible burden there could be on that many people, i.e., it kills them. And, as dcleve's analysis indicated, it is reasonable to expect that at least another ~5 million will suffer serious long-term injury.

I will just assume that if we go into full blown plague mode, the cost to the economy will be ~$3 trillion the first year and another ~$2 trillion the next year. That is in addition to the trillions it has already cost (~ $5 trillion?). The costs could be, and probably would be, much higher. But, it is best to be conservative to avoid being called an effing liar.

Thus, wearing a face imposes what I consider to be a low liberty burden on individuals. People who oppose wearing a facemask and call it tyranny are grossly exaggerating. Probably most more rational people who oppose wearing facemasks will claim the liberty burden is moderate to high. Few or no people who oppose mandatory facemask wearing will even acknowledge that refusal to wear  a facemask will cause many deaths, certainly nothing remotely close to 5 million.

If one assumes the foregoing quick, informal analysis reasonably describes the cost-benefit situation, is the benefit of wearing facemasks much greater than the costs, somewhat greater, about the same, less, or much less? For individuals and their situation? For American society and its economy?

I suspect that most people who looks at it like this will conclude the benefits outweigh the costs for society and maybe also for individuals. I suspect that most Trump supporters will conclude the costs outweigh the benefits.



Footnote:
1. The anaylses are here for burden on liberty in commerce and here for burden on religious practice and speech for people who may be interested in the concept of one way to measure burdens and benefits when liberties are in conflict, or at least alleged to be. This way of thinking about liberties in conflict cuts through a lot of bullshit and lies very effectively.

That is probably why one doesn't see such analyses very often if ever. I do not know how many, if any, analyses like these are being done by experts or professionals. IMO, this sort of cost-benefit analysis and thinking should be front and center every single time people whine about how badly they are being oppressed. My guess is that most of the complaints (~80% ?) are either exaggerated or grossly exaggerated. The complainers rarely or never even mention benefits -- they only howl about the costs to them and/or their tribe. IMO, that tactic is a form of dark free speech called lying by omission.

Trust is the Normal Default Mindset

A 2009 article by social psychologist Roderick Kramer summarized the state of the human mind in many situations is trusting. That usually works well, but when a person is deceived and extends misplaced trust, it can cause serious personal damage. When millions of people are deceived, it can be catastrophic, even lethal. The article published in the Harvard Business Review. It addressed the matter of how Bernard Madoff managed to pull off a $65 billion Ponzi scheme and bilk many sophisticated wealthy people out of their money. 

Kramer's description is good to keep in mind when considering how propagandists and demagogues deceive and mislead people, sometimes with lethal consequences for people and whole societies. This OP is to compliment the review of the book, The Misinformation Age: How False Beliefs Spread, that I posted a couple of days ago. One reason to focus on trust is that propagandists are well aware of the fact that if they can win people's trust via one of various tactics, their deceit is much more powerful and people are easier to polarize, leading to loss of trust.

Kramer writes:

“Madoff is hardly the first to pull the wool over so many eyes. What about Enron, WorldCom, Tyco, and all the other corporate scandals of the past decade? Is there perhaps a problem with how we trust? 

I think it’s worth taking another look at why we trust so readily, why we sometimes trust poorly, and what we can do about it. 

In the following pages, I present the thesis that human beings are naturally predisposed to trust—it’s in our genes and our childhood learning—and by and large it’s a survival mechanism that has served our species well. That said, our willingness to trust often gets us into trouble. Moreover, we sometimes have difficulty distinguishing trustworthy people from untrustworthy ones. At a species level, that doesn’t matter very much so long as more people are trustworthy than not. At the individual level, though, it can be a real problem. To survive as individuals, we’ll have to learn to trust wisely and well. That kind of trust—I call it tempered trust—doesn’t come easily, but if you diligently ask yourself the right questions, you can develop it. 

In short, we’re social beings from the get-go: We’re born to be engaged and to engage others, which is what trust is largely about. That has been an advantage in our struggle for survival. 

Trust kicks in on remarkably simple cues. We’re far more likely, for example, to trust people who are similar to us in some dimension. Perhaps the most compelling evidence of this comes from a study by researcher Lisa DeBruine. She developed a clever technique for creating an image of another person that could be morphed to look more and more (or less and less) like a study participant’s face. The greater the similarity, DeBruine found, the more the participant trusted the person in the image. This tendency to trust people who resemble us may be rooted in the possibility that such people might be related to us. Other studies have shown that we like and trust people who are members of our own social group more than we like outsiders or strangers. This in-group effect is so powerful that even random assignment into small groups is sufficient to create a sense of solidarity. 

So what does all this research add up to? It shows that it often doesn’t take much to tip us toward trust. People may say they don’t have a lot of trust in others, but their behavior tells a very different story. In fact, in many ways, trust is our default position; we trust routinely, reflexively, and somewhat mindlessly across a broad range of social situations. As clinical psychologist Doris Brothers succinctly put it, “Trust rarely occupies the foreground of conscious awareness. We are no more likely to ask ourselves how trusting we are at any given moment than to inquire if gravity is still keeping the planets in orbit.” I call this tendency presumptive trust to capture the idea that we approach many situations without any suspicion. 

If it’s human to trust, perhaps it’s just as human to err. Indeed, a lot of research confirms it. Our exquisitely adapted, cue-driven brains may help us forge trust connections in the first place, but they also make us vulnerable to exploitation. In particular, our tendency to judge trustworthiness on the basis of physical similarities and other surface cues can prove disastrous when combined with the way we process information. 

One tendency that skews our judgment is our proclivity to see what we want to see. Psychologists call this the confirmation bias. Because of it we pay more attention to, and overweight in importance, evidence supporting our hypotheses about the world, while downplaying or discounting discrepancies or evidence to the contrary. 

A confirmation bias wouldn’t be so bad if we weren’t heavily influenced by the social stereotypes that most of us carry around in our heads. These stereotypes reflect (often false) beliefs that correlate observable cues (facial characteristics, age, gender, race, and so on) with underlying psychological traits (honesty, reliability, likability, or trustworthiness). Psychologists call these beliefs implicit theories, and the evidence is overwhelming that we aren’t conscious of how they affect our judgment. .... But they can cause us to overestimate someone’s trustworthiness in situations where a lot is at stake (for instance, our physical safety or financial security). 

....researchers have identified two cognitive illusions that increase our propensity to trust too readily, too much, and for too long. The first illusion causes us to underestimate the likelihood that bad things will happen to us. Research on this illusion of personal invulnerability has demonstrated that we think we’re not very likely to experience some of life’s misfortunes, even though we realize objectively that such risk exists. .... The second and closely related illusion is unrealistic optimism.

As if all these biases and illusions weren’t enough, we also have to contend with the fact that the very simplicity of our trust cues leaves us vulnerable to abuse. Unfortunately for us, virtually any indicator of trustworthiness can be manipulated or faked. A number of studies indicate that detecting the cheaters among us is not as easy as one might think.”

Some COVID-19 Data

Some data from New York City

Introduction

The following analysis and write-up was done by dcleve. I appreciate the time and effort he put into writing this up. I corrected a couple of typos but and did a bit of formatting, but I did not research or write this. My thanks to dcleve for taking the time to lay this out.

Unhappy lungs

The analysis

This is my effort to figure out where we are with Covid-19, without doing exhaustive research.
The summaries available from the CDC are vague, and US data appears poor due to limited testing, and deliberate underreporting. To get better understanding, I looked to overseas reports.
So – what is the risk from the disease? It has a moderate death rate, and is a dangerous disease, to people in every age group. But the risk increases with age. Also, there are multiple reports of long term health consequences in survivors. So both death and disability are risks.

The risk of death is skewed in many reports in three ways: by under-reporting of infections, by under-reporting of deaths caused by the disease, and by snap-shot reports before the ill people have either died or recovered. The best data on total fatality rate would come from a country which tested a lot, and reported tests accurately, and has pretty much beaten the disease. I looked at New Zealand, which had a 2% fatality rate, and S. Korea, which had a 2.4% fatality rate, as the best data sources.


The most useful breakdown of death rate by age I could find was from China. Here is a link to the Chinese fatality rate data by age, showing the risk of death if one gets infected. This Chinese study showed an overall death rate of 2.25%, with men ~1% more at risk than women (~2.75% vs 1.75% death rates). With the average from China matching the more recent data from New Zealand and S Korea, this seems like trustworthy data.

There is some additional useful data in this Chinese study about the effect of pre-existing conditions. Long-term health concerns like diabetes and cancer increased individual risks to between 6-10%. The risk of death to those without health complications was ~0.9%. So, this table can be adjusted by ~3X up for those with pre-existing conditions, and down by ~2X for those without.

However, as a statistics caveat, older patients almost all have health complications, so the oldest patient data likely tend to mix these two effects, and these multiplication rates would give inaccurate predictions for the top two categories. I will take my own guess at this in my own table below.

Death, unfortunately, is not the only risk. As I noted earlier, a significant number of survivors have major organ damage post-recovery, the most common being significant lung scarring, and strokes. I was not able to find much in the way of statistics on this. One of the few sources I found was a UK estimate reported by Vox:

"The UK National Health Service assumes that of Covid-19 patients who have required hospitalization, 45 percent will need ongoing medical care, 4 percent will require inpatient rehabilitation, and 1 percent will permanently require acute care."

I am treating all “need ongoing medical care” as long term effects. This is per “hospitalized” patients, which I couldn’t find a good estimate on. I tried piecing together bits of data to figure this out: China reported 5% of cases were severe -- and 13% had significant symptoms -- it is not clear how either of these relate to hospitalization rates in the UK, but one can assume UK hospitalization is at least 5%. Using my 2.25% overall death rate estimate, if 5% hospitalization ==> 2.25% death rate, and 45% of the 5% need ongoing care, which is also 2.25%, then the rate of post-recovery injury is about equal to the death rate.

If I assume that severe symptoms track with age the same rate the deaths track with age, then , if one cares about BOTH death OR long-term injury, one can double the death rate numbers for Italy to come up with health risk.

Here is my best estimate table:

Age Average health risk (death or long-term health issues) Risk without preconditions Risk with preconditions
80+ .........29.6% ..... 7.5%*..... 44%*
70-79 ......16.0% ..... 4.5%* .... 27%*
60-69 ......7.2% ....... 2.5%* .... 15%*
50-59 ..... 2.6% ....... 1.0%* .... 6%*
40-49 ..... 0.8% ....... 0.3% ...... 2.5%
10-39 ..... 0.4% ....... 0.15% .... 1.25%
Overall average 4.5%
Note, * is my guestimated adjustment to decouple age and preconditions

Note, there is risk in every age group, even among the healthy. A 0.15% risk for younger healthy people is a risk that most would not like to take – it is one death or disability for every 667 people who catch the disease. As a check – this is about the rate seen in the US aircraft carrier – one death in ~800 cases.

How is COVID-19 transmitted? Early studies focused on contact transmission – COVID-19 was found on computer mice, door handles, etc in hospitals. This IS a way it can be transmitted. But there has been a lot of evidence for a while that airborne transmission is the greater risk. The spread in cruise ships, even when passengers were in lockdown, shows it can go through ventilation systems. But the lack of spread within the apartment buildings locked down in China shows that larger spaces and better filtration than on ships can limit its spread inside a building. The lower rate of spread in east Asia, where people wear facemasks, vs the US and Europe, shows facemasks help. When New York and Italy imposed face mask requirements on their populations, in ADDITION to social distancing, they both turned the corner on the disease.

How to stop the disease: the strongly controlling countries of China, Taiwan, Japan, S Korea, N Zealand, and Australia have almost eliminated COVID, because they were willing to mandate extreme measures, country-wide.

The US government has not set policy in the US -- the initial lockdown was initiated by sports leagues, and then the implementation of mandatory restrictions has been an uneven patchwork state-state. And none of our state mandates have even remotely approached what the successful countries noted above have done. This is why the US leads the world in COVID deaths.

Reopening an economy only makes sense if the COVID infection rate has been brought under control, so that normal behaviors do not carry a high risk of infection. This is what the successful countries above have done, and they are opening safely. They did not reopen until the "curve" had almost re-hit zero. If the undiagnosed COVID infection rate in the country were only a few thousand, and we had tracing, the US could open safely. We instead have millions of undiagnosed cases, so full re-opening will just lead to an even more massive infection rate nationwide.

The states which have reopened anyway, have seen an increase in COVID rates. By reopening before taming this disease, they insure they will never get a "second wave" because they will never end the "first wave".

Enough individuals have noticed the difference between effective responses and the US response, and self-imposed more extreme personal behavior, that the US death and infection rates have not been nearly as bad as they could have been. This is particularly true for "reopening", where we have not seen the massive increase in infections that one would expect. This is BECAUSE so many people are not listening to their governments, and are instead trying to personally apply more stringent transmission control, to minimize their own risks of catching COVID-19. Self-protection like this, while officially re-opening, will pretty much insure a long-term economic recession, as a significant fraction of the population tries to save their lives and health.

Long-term: The demonstratedly successful long-term approach is for the US to re-impose strict national controls, but this time with masks, testing and contract tracing. This brought the disease under control in China, even thought it was initially widespread. And it worked in most of the countries around China.

A second long-term solution would be if we develop a vaccine. Widespread vaccination would end this threat. The earliest plausible dates I have seen for a good vaccine to have been shown effective are Jan-Feb of next year, which would then need to be followed by mass production and distribution, which would take months more. The earliest I think mass vaccinations are possible would be ~1 year from now. However, there have been some diseases where developing a vaccine took up to 30 years, so ~1 year to get a vaccine may be wildly optimistic.

The US policy is effectively "spreading the curve" -- distributing deaths over months and years, so that morgues are not overwhelmed. The curve would not be spreading if individuals were not exceeding state guidelines, we would instead be seeing a massive infection spike. Spreading the curve could eventually bring this infection under control through herd immunity, which needs ~80% of the population to have gotten the disease. The rational choice under a "spread the curve" policy, is to over-protect oneself, letting the rest of the population get the disease and its risk of death or debilitation, then only re-engage society after herd immunity brings levels of infection under control.

How long this would take depends on how successful people are at preventing the spread though personal protective measures. There are not very many random tests of the population to see what the infection rate nationwide has been. One recent random study in Indiana showed a 2.8% infection rate as of May. If one extrapolates this out to the US population, we are currently under 5%. If our rate of spread is ~1% per month, it would take ~75 more months for us to get to herd immunity IE~6 years. (emphasis added by me)

Personal protection if disease is untamed: The worst infection rates have occurred indoors when people are in close proximity. Cloth or simple paper facemasks and hand sanitizer help, but with long-term exposure in hospitals, the staff still suffer from significant infection rates. If one has to go indoors, exposure time seems to matter. Quick trips indoors are lower risk, while long exposure indoors is of greater risk. For longer term exposure, the meat packing plants with their high transmission rate show that masks alone do not stop the disease fully, and that social distancing plus masks helps. The cruise ship results, with the disease traveling between small cabins, show that infection can occur at greater than 6-ft “social distance” separation, and any additional distance above 6-ft is also helpful.

Personal protection should therefore be to avoid possible infection circumstances (proximity to those not in one’s household, or being indoors outside one’s household) as much as possible, and always wearing masks, and regularly hand sanitizing.

"It's deja vu all over again"

Today, in Tulsa Oklahoma, kicks off the first so called “presidential rally” of the year, for second-term wannabe, Donald J. Trump. We already know in advance that there will be a full court press on hand to cover it.

Of course, as was true in 2016, today's broadcast coverage plays right into Trump's political agenda. I.e., he needs his media foils, and all the better if they’re present, right there in the crowd, to unload on... not to mention the additional perk of millions of dollars worth of the free publicity he will get.  Yep, it's a total "win-win" for Trump.

True, like that unruly teenager who steals the car keys when no one is looking, it is important that we adults all stay aware of what Trump is up to. But is the press, by giving him such national attention, only making things worse?  Emboldening his chances of winning re-election?

We know Fox will be there, in all it’s “fair and balanced” glory. But does the "left-leaning” “lame stream media” willingly play right into Trump’s “nasty p-grabbing hands,” by pimping themselves out to Trump with such "news" coverage?

What do you think?  Should or shouldn’t the media cover the Trump’s rallies?  Will you be watching??

Thanks for posting and recommending.