[neilmock]

If you look at the parameters for the "valuation" of a SARS-CoV-2 infection, they are hard to take seriously. They are based on a mapping of typical workplace injuries to viral infections. This is the paper referenced: http://ftp.iza.org/dp13632.pdf.

A purely asymptomatic infection is valued at $11,000

A symptomatic but non-hospitalized infection is valued at $33,000

If you are in the hospital for any reason with an infection, $512,000

If you are in the ICU for any reason with an infection, $1,100,000

If you are in the ICU on a ventilator, $2,900,000

[chishaku]

> they are hard to take seriously.

Why? What convention would you use?

If you think these are estimates of related healthcare costs, you should probably re-read the paper.

[neilmock]

I would not value the public health cost dollar estimate of an asymptomatic infection at 11k. I would not value the public cost dollar estimate of a non-hospitalized infection at 33k.

[mumblemumble]

They do have some discussion in there about the option of valuing asymptomatic cases at $0. So it's not like they didn't think of this option. But they went with $11,000 as the default option in their model, anyway. This leaves me thinking we may be looking at a Chesterton's Fence situation: the reason isn't obvious to me, but that doesn't mean it doesn't exist or isn't a good one.

I'm guessing there is some subtext here that an armchair analyst isn't going to catch from reading just this paper. Perhaps, for example, the cost of asymptomatic cases is there because "asymptomatic" doesn't actually mean "no symptoms at all", it means "the patient didn't subjectively feel ill enough to seek care." In which case there probably is some real cost to factor into the average. Or perhaps the argument is that asymptomatic cases still carry some risk of secondary effects such as myocarditis that absolutely need to be taken into account and averaged into the group from a public health perspective.

It's hard to say for sure, since the paper clearly isn't written for a non-expert audience and therefore doesn't spend much time on defining jargon.

[dboreham]

I've seen reporting recently that studies showed some large percentage (63%?) of asymptomatic patients had visible signs in chest x-rays. So asymptomatic doesn't seem to always mean "absolutely no measurable effects".

[blaser-waffle]

How does that compare to x-rays of people with the common cold or the standard flu?

[neilmock]

I'm probably going to perma-delete my HN account after this, but this is my main complaint with popularized scientific research being parroted for political purposes. "The paper isn't written for a non-expert audience" yet one of the authors is going on Anderson Cooper tonight to talk about it to a non-expert audience.

[rblatz]

Wouldn't that be the best way to communicate this to a non-expert audience? Bring the expert in to explain the report and fill in the context that the layman is missing compared to an expert?

[mumblemumble]

The same researcher can speak to a popular and expert audience. And that researcher should absolutely say things in the paper that they don't say in the popular outlet, and vice versa. They're different audiences with different needs and different background knowledge.

Compare the experience of reading one of Einstein's scientific papers with the experience of listening to one of his interviews. It's almost like they're not even the same person.

[dhimes]

That's the difference between a paper and someone explaining it to the layperson.

[chishaku]

Why?

The authors thoroughly outline their approach (and its limitations) based on available literature.

What specific criticism do you have?

[neilmock]

If you read the literature, they compare a symptomatic viral infection to having your hand or foot broken, or a pelvic fracture, or a mild to severe head trauma. I do not see any evidence of those things being equivalent.

[kube-system]

For the person who suffers them, they are not equivalent. But that isn't what is being measured.

When measuring economic impact, they could very well be equivalent. A dollar lost when someone can't work due to a broken bone is economically equivalent to a dollar lost when someone bedridden with a virus.

[chishaku]

The paper doesn't make those things equivalent.

Best case, your comment is an oversimplification of what the authors spent a dozen or so pages explaining. The limitations they describe perhaps encompass some of your concern. They also describe alternative calculations.

[NationalPark]

On the surface it doesn't seem like a bad comparison. Out of work for weeks, potentially protracted recovery including possible long term limitations. What's the problem?

[bachmeier]

Downvoted because this is not an argument, just a statement that you don't like their estimate. That doesn't contribute to the discussion. If you're asymptomatic and you make someone else sick and they die, the cost is a lot more than $11k.

[mcguire]

How many subsequent infections are caused by an asymptomatic infection? How much effort is expended to prevent those infections, by the asymptomatic individual and others?

"We first use the Department of Transportation (2016) guidance on value per statistical life (VSL) and severity/injury estimates as a basis for our non-fatal valuations by category. After updating the figures for earnings and inflation the DOT guidance recommends using a VSL of about $11 million in 2019 dollars. We use the severity classifications in the DOT guidance as a basis for our non-fatal valuations. DOT (2016) recommends using six different severity categories in benefit-cost analyses including Level 1 (minor), which corresponds to using a 0.3 percent amount of the VSL, Level 2 (moderate), which uses about a 5 percent amount,Level 3 (serious), which uses about a10 percent amount,Level 4 (severe), which uses about a 27 percent amount fraction,Level 5 (critical), which uses about a 59 percent amount,and Level 6 (unsurvivable) which uses a 100 percent amount(the full VSL). We therefore value asymptomatic cases at about $11,000 (in 2019 dollars) each which corresponds to using a 0.1 percent amount of the VSL in DOT (2016)."

0.1% of a statistical life is about a month? It's also a third of the "minor" classification.

How would you value it? $0? Clearly, that's not right.[1] Less than $11,000? More?

[1] Consider a new infectious disease which has only minor symptoms immediately, but may have unknown health consequences in the future.

[shajznnckfke]

Despite the criticism, I think you’re asking a great question. These figures do appear surprising and I think a lot of people will feel the same skepticism. I’d hope that someone can help us understand the paper rather than chastise you for being impertinent. Thanks for reading past the headline and provoking some discussion on the details.

[anigbrowl]

Simply repeating your disagreement is no substitute for a counter-proposal.

[kube-system]

Why not? The US GDP dropped by over 2 trillion in just the second quarter. That's over $300,000 per infection right there. And that's if we don't count future quarters, Q1 2020, or any of the trillions in stimulus that has been pumped into the economy. It doesn't seem these numbers are out of line with the back-of-the-envelope math.

[votepaunchy]

You’re off by a factor of 4. US GDP is a little over $20T/year, and dropped a little under 10% 2020q2, so a drop of about $500B.

[kube-system]

Ah, I was looking at an annualized dollar amount. Still, it would be a reasonable back-of-the-envelope number considering that the economic impact is still present and is going to continue into the future at least a year.

[tellmelies]

Are you from America? Those numbers look pretty reasonable for US healthcare bills.

[neilmock]

I didn't realize I would get a bill when not seeking medical intervention at all, especially for $11,000 or $33,000.

[valenciarose]

This isn’t an attempt to estimate a typical bill for an asymptomatic individual. It’s an attempt to set an expected value for the costs that will eventually be incurred across the population of asymptomatic patients. They are using a mean to describe how costs will scale with the size of that population (asymptomatic SARS-CoV-2 positive) and NOT as a way to describe the typical costs of individuals in that population. The cost distribution is almost certainly a power law. I’d guess the median is zero and the mean is many thousand dollars.

[nick_kline]

As others have said, there are unknown but already detected cases of asymptomatic impacts. One football team doc said he thought 1/8 had some impact on heart function long term. Those who see this as no big deal for some reason are stuck on arguing the exact percentage of impact.

[klyrs]

Several studies have shown that asymptomatic infections may have long-term impact. The valuation may be taking that into account -- you might not get that bill today, but maybe you (or your insurance) will pay that over the course of your lifetime

[liability]

> Several studies have shown that asymptomatic infections may have long-term impact.

To the tune of tens of thousands of dollars on average? That's not plausible.

[jbeam]

Sure it is. If 5% of asymptomatic cases require care that costs $200k, you come to $10k a person. This is entirely plausible in the US, particularly if you are amortizing the cost over the lifetime of the patient.

[liability]

Can you cite any paper that suggests serious complications for asymptomatic patients is anywhere even remotely close to 5%? All I've seen is a handful of rare anecdotes, nothing to suggest it's a remotely likely outcome.