Two-faced virus: how in China the pluses of the epidemic outweighed the minuses

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Two-faced virus: how in China the pluses of the epidemic outweighed the minuses
Two-faced virus: how in China the pluses of the epidemic outweighed the minuses
Anonim

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 mortality to rise sharply following the economic downturn. However, historical experience shows: in fact, mortality during depressions and recessions decreases markedly. And it's not just about history. The latest 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 can 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.

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Residents of Moscow and many regions observe the same pictures - restrictions on going to work and places of rest. Empty shelves in stores at the height of the shopping mania under the slogan "tomorrow the roads will be closed and nothing will happen." The assessments of what is happening are unanimous: “Nobody even tries to deny that the economy of the Khan. It is already a khan, and then what will happen is better not to guess. Khan's economy is bad. These are unemployment, non-payment, impoverishment and hunger. Much worse than the coronavirus,”a typical post on social media reports.

It seems that there should be a grain of truth here. Quarantine drops GDP - people consume less, work less - and much more. In China, during the peak of quarantine measures, industrial production collapsed by 15%.

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Nevertheless, in fact, coronavirus hysteria - because along with really useful measures in the actions of governments there are elements of hysteria - there is also a bright, downside, only about it is rarely spoken about. The fact is that, as a result of the economic downturn, mortality normally decreases, rather than increases. And this has already happened specifically for the PRC.

The necessary digression is not for everyone: if you are not a citizen of Russia, you can skip reading

Any resident of Russia, after reading this, will inevitably grimace. What kind of game? Anyone who has lived in the 90s knows that, in fact, the economic crisis is killing. Moreover, on a scale that no modern wars or epidemics dream of.

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If in 1990 our average life expectancy was 69.2 years, then by 1994 it was already 64.0. Minus 5.2 years, that is, society as a whole has lost at least tens of millions of person-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, the average 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 decrease in life expectancy". You just need to not confuse purely economic problems and the systemic collapse of state structures.

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In the 1990s, the state in Russia did not know what to do, was influenced by the idea that it was necessary to reduce its interference in everything, because a free market is, by definition, better and more effective than state efforts. As a result, state budget revenues fell sharply. And then the financing of the health care system collapsed: many seriously believed that the transition to paid medicine would be better than continuing funding for "relict, soviet, state medicine."

But it's not just the collapse of medicine.In that era, the overwhelming majority sharply lost faith in the meaningfulness of what was happening. Outside of a very narrow circle of intelligentsia, who expected prosperity according to the Western scenario, no one believed that with the chosen path of development of the country, in principle, something good could happen in it. Not just in the economy, but in all spheres in general, in any somewhat distant future. It would seem, does it really matter what the population thinks there? Oddly enough, no. Moreover, this was the main factor in the mass loss of life in the 1990s.

Yes, contrary to popular belief, the main causes of death during this period were not homicide or poor nutrition. Of course, both of these reasons gave 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 a year. The most common cause of death was cardiovascular disease, the frequency of death from which has 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, underlying 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 minds.

Take a look at the curve of life expectancy growth in the 2010s. Over these ten years, the cumulative economic growth in Russia does not differ much from zero, but we live 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 lengthening 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 birthplace of the crisis.

What Happens to Mortality in a Normal Recession

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-awareness 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.

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Let's start with the biggest economic crisis in the industrial era. Following popular culture, we represent the United States in the years of the Great Depression in an extremely gloomy way. Like noir action movies: gangsters everywhere, prohibition, unemployment, malnutrition and a queue for free soup. All the cliches learned from childhood have one problem: the reality was much more complicated. In fact, during the years of 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 force were going on in 11 European countries).

Think for a second: the average life expectancy of an American has grown 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 per year was made by a decrease in mortality from pneumonia and influenza by 41 thousand people per year, as well as from tuberculosis - by 12 thousand per year. It is not hard to understand what led to these changes. Pneumonia, flu and tuberculosis are also spread more actively the more mobile the population is, 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 less abroad.

Interestingly, a huge decline in mortality occurred during the Great Depression, despite a sharp contraction in medical spending. At a time when huge masses of people have, in principle, lost access to the services of doctors. Even the American scientists themselves, who discovered this fact, were shocked. As noted by José Tapia Granados, 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 bad for health."

Let us especially 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 all deaths. Let's list them in ascending order of the number of victims: cardiovascular and kidney diseases, cancer, influenza, pneumonia, tuberculosis, death in road accidents 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 it increased from suicides, but due to the small number of such events (2% of the total mortality), this did not affect the picture as a whole.

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The numbers are more eloquent than words: in 1928, the mortality rate in the United States was 12.0 per thousand of the population, in 1929 - 11.9, and then it fell to 10.7 in 1933 (those same "more than 10% decrease in mortality") … Only since 1934, the beginning of the active phase of economic recovery, it again grew to 11, 1. Then 122 million people lived in this country - that is, the Great Depression led to the salvation of up to hundreds of thousands of people a year in the United States.

What exactly coronavirus can 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 and less (PM2.5). This is the main source of deaths 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 one seventh of these deaths, almost three thousand people every day.

Based on the reduction in 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 cities for which he had data fell by more than 10% - in fact, closer to 15%. Such a decrease 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 effect of microparticles on the deaths of people over five, but under 70 years old. And this is the bulk of the population. It turns out that his figure of 77 thousand rescued clearly underestimates the real positive impact of the coronavirus on Chinese deaths from air pollution.

Let's try to roughly assess this influence from the other end. More than a million people per year die from air pollution in the PRC, but the bulk of such deaths occur in the winter. The thing is that the content of microparticles in the air depends not only on the industrial emissions themselves, but also on the season.

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, a little more coal is burned in the PRC in winter (heating), but not three times more. The main reason is that colder air is noticeably denser, it is easier for microparticles to "float" in it, and their washing out 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 death rate of the population not by 77 thousand people, but by an even greater figure.

On the planet as a whole, seven 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

The common flu and pneumonia still kill many people. For example, in the United States more than fifty thousand people per year die from them, and more than 4.2 million in the world. The incidence of these diseases, like 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 from pneumonia and flu in the United States, and already in 1930 - 120 thousand. A quarter reduction in pneumonia deaths is unlikely to happen these days: most of the world's population still lives outside the active Covid-19 quarantine zone. But if it covers all countries, then even a two-month quarantine and a decrease in mortality from pneumonia and flu by a quarter will save the lives of 280 thousand people.

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Let's look at the Chinese example. According to available estimates, for 83% of the PRC population (some of the provinces were not covered by the calculations), about 18 thousand should die from influenza a year. For the country as a whole, this figure is hardly less than 20 thousand per year. At the same time, the overwhelming majority of deaths occur in the local winter and early spring (the same picture in other countries). Thus, a two-month quarantine could save several thousand Chinese lives from the flu - about the same as the coronavirus took during the epidemic.

The death rate from common pneumonia in China is estimated at 125 thousand people a year. Again, most of these events occur during the cold season. That is, in 2020 they coincided with the current quarantine. Obviously, the reduction in deaths from common pneumonia, the spread of which is hindered by the coronavirus quarantine, should save more Chinese than Covid-19 took.

Does the virus save you from road accidents?

Worldwide, 1.35 million people die from car accidents every year, of which 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 still difficult to assess the effect of quarantine in this area. Almost all scientific works 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 fatalities on the roads.

Why this is happening is a more complicated question. The thought suggests itself that the population travels less because they have no money. But the problem is that the accident rate per kilometer is also decreasing: that is, “there is no money for gasoline” alone cannot explain anything. Certainly, the crisis reduces the availability of driving for the youngest segment of drivers, but this cannot fully explain the changes in statistics. Many researchers believe that during 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 road traffic deaths during coronavirus quarantine should, in theory, be greater than usual. A ban on visiting a number of public spaces, and in some places blocked roads, should reduce not only the specific accident rate (per kilometer), but also the total mileage of drivers around the world.

If we assume that the decrease is 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 - it is already quite solid.

Plus or minus: what will outweigh?

Of course, we have listed far from all the factors in reducing mortality during a large-scale quarantine or a major economic downturn. Those moments that are difficult to fully calculate remained unlit.

Jose Tapia Granados, who was the first to reveal the fact that during an economic downturn, mortality decreases, and he himself identified these factors without quantitative estimates. During an economic boom, people can experience increased stress levels, work harder and sleep less, he said. Sleep disturbances and stress are known to directly affect the efficiency of the body's immune system, as well as the heart and blood vessels.Alas, the stress and sleep hours of the hundreds of millions of people involved in a major economic downturn are simply impossible to measure accurately.

Let's summarize. In China today, quarantine has indeed saved dozens of times more people than the new virus killed. If a similar two-month quarantine had been introduced in other countries, it would hardly have led to a serious increase in deaths from hunger and other causes.

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After all, humanity now has an average GDP level slightly higher than the American one in 1929-1933. If mortality was able to decline then, then it is extremely unlikely that things 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 the coronavirus is unlikely to be 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 the worst food security is, have a younger population, it is more difficult for the virus to "jump" to a new carrier: there are not so many elderly people who are vulnerable enough for him. 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 can provide the population with food for months, even despite a temporary drop in income. Consequently, 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, under the scenario of a global two-month quarantine, the total mortality on the planet could 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 accident frequency.

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 there are 3,200 deaths, of course, the answer would be "yes." Then around the world from the coronavirus would have killed no more than 20 thousand people, which is 40 times less than 0.8 million, which could save the economic recession from the introduction of quarantine on Covid-19.

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However, the observed reality tells us that the EU and the US have not been able to copy the Chinese methods of dealing with epidemics. They did not manage to contain it as effectively: they did not create a system of quarantine measures in time that would allow crushing the epidemic close to the start.

Therefore, in China, one person out of 17 thousand has fallen ill with coronavirus today, and in Italy - one out of two thousand, 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: there, as of March 16, only 32 thousand were made, almost four times less than in Russia, where there are not so many cases.

All this tells us that an epidemic should be expected in Western countries that is 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. Hopefully, reason will prevail, and copying the Chinese approach to the issue will allow countries outside of East Asia to avoid hundreds of thousands of deaths. But whether this will happen - only time will tell.

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