U.S. COVID-19 Lockdowns: Correlations, Outcomes, Idiocy

Covid Deaths, Not Lockdown Deaths, part 5

U.S. COVID-19 Lockdowns: Correlations, Outcomes, Idiocy

November 21, 2020

How Lockdown Failed Before it Began

I'll start with "Sweden Has a Lower COVID-19 Death Rate Than the US" by Jon Miltimore, September 9, 2020, Catalyst Independent, but first from FEEE (Foundation for Economic Education and Epidemiology - kidding on the last E). 

Miltmore writes: "The year 2020 will go down in history as a historic calamity. But this was not because COVID-19 struck," he declares, noting deadly respiratory viruses have existed as long as humans have." Longer, in fact. And they've always been fairly harmless, or whatever maybe not always, but this one is invisible, which makes it extra harmless, and the disaster arose "because central planners erroneously believed the best way to protect humanity from an invisible respiratory virus was to order healthy people to remain in their homes under almost all conditions, in many cases under threat of fine or imprisonment." I remember when they tested us all and made the healthy ones stay home. Sad day for humanity there. No, of course the point is it's invisible, you can't be sure who IS healthy and not contagious, so they ordered the sick and anyone who might be - which is everyone - to come out only as needed and cautiously. Just why that's an erroneous approach isn't clear, once the idea is unscrambled. 

Anyway, this piece cites something run in the Wall Street Journal as “The Failed Lockdown Experiment,” wherein "Donald L. Luskin, the chief investment officer of TrendMacro, a global investment strategy consulting firm, says data show lockdowns are actually correlated with a greater spread of the virus." Ah! Leave it to a business stimulation expert and data manipulator to find what all global disease experts have missed. He finds a correlation. There are a lot of those. 

Apparently Luskin checked virus spread until lockdown but not after, found that of all the times he checked, it was the worst right at the start of maximum lockdown. Luskin's explanation, re-worded just a bit so everything he has correlating is reversed from how he presented it. If they correlate, that should be fair; a = b is the same as b = a.

Measuring from the start of the year to each state’s point of maximum lockdown—which range from April 5 to April 18—it turns out that a greater spread of the virus correlated with lockdowns. States with larger Covid outbreaks also had longer, stricter lockdowns. The five places with the heaviest caseloads - the District of Columbia, New York, Michigan, New Jersey and Massachusetts — had the harshest lockdowns. 

It could be that strict lockdowns were imposed as a response to already severe outbreaks.

Yeah, it very well f@*#ing could be, huh? And it got way better after the lockdowns in each place. Case confirmation might increase, but transmission will decline if people follow the guidelines. Deaths always do increase afterwards, as that maximum caseload dies off over the following weeks (see here), and then it improves.  I'm not a subscriber, haven't seen any illustration Luskin used, but as I read it:

And so lockdown was said to have failed. 

Of course there were measures underway to slow the spread prior to that, including a suggestion of - basically - voluntary lockdown, during which time the virus spread rapidly anyway. He'll argue people keeping apart and even staying indoors with their families instead of taking the bus to work or going on a travel vacation is why it spread so widely between households and across whole regions. But clearly the orders - to the extent they were heeded - slowed what was going to be an even more amazing spread. This stuff has a reproduction rate over 5 sometimes, if left to run freely. This SARS CoV-2 is some powerful stuff.

Miltmore notes lockdown duration, but not what happens during that lamentable span, which is a vast improvement. Fox News' Dr. Marc Siegel told Tucker Carlson “Lockdowns don’t work if there is already a lot of virus in the area," but he did note "over 20 states that have come out of lockdown have actually seen an decreased number of cases." Again a = b, so we could say 20 states that finally saw a decreased number then came out of lockdown, enjoying that advantage. Does it get better or worse after that? Siegel wouldn't be able to answer that honestly. (Dr. Siegel Tells Tucker: Lockdowns Producing ‘More Deaths From Despair’ Than Coronavirus Daily Caller, May 20) he also claimed "that “deaths from despair” could surpass 75,000 in the U.S. “because of COVID-19 and people not having jobs.” ... "It’s going to be more deaths from despair than from the virus itself," while the headline says lockdowns are "producing more deaths" (present tense). See part 4 for my assessment of that claim.

Poorer Outcomes: ND vs. NY

Finally, dr. Siegel also "mentioned the absence of coronavirus cases in South Dakota “which was never in lockdown.” Joel Smalley, MBA, also found this concept significant, penning the article "Study: Dems COVID19 Lockdown Measures Causing Most Deaths" which finds as of June 27, "the empirical data very strongly suggests that mortality outcomes are improved with fewer interventions." That doesn't seem to make sense, but he points out: 

"...of the 12 states that have experienced no excess death at all during the period in question (Alaska (R), Arkansas (R), Hawaii, Idaho (R), Kentucky, Maine, Montana, North Carolina, North Dakota (R), Oklahoma (R), South Dakota (R), and West Virginia (R)), 5 of them (Arkansas (R), Kentucky (D), North Dakota (R), Oklahoma (R), and South Dakota (R)) had no ostensible lockdown. " 

They tend to be Republican, as he selectively notes ... they're also all of our sparsely populated "podunk states," lacking much for big cities, with less using public transport, and none was hit by an early surprise outbreak that we know of.  Texas is pretty Republican too but faired poorly and had a lockdown - whatever the correlation there. Hawaii is Democrat but island-based, which seems to be a huge plus for controlling covid, especially with help of a lockdown. A lot of factors play, but being this is a highly contagious virus, Smalley found the political ones most worth considering, and just went the hell off:

"It is evident that Democrat states have a much stronger tendency towards intervention and this has led to much poorer outcomes for citizens of those states.... A possible reason could be in the nature of collectivism versus individualism, where Republicans might be more likely to take appropriate responsibility for their own welfare, making decisions and taking actions according to their own perceived risks, whereas members of the collectivist states may be more inclined to rely on the diktats of the state even though they may not be logical or reasonable. This conjecture would need much deeper investigation to be upheld."

He surmises Democrat states are full of irresponsible Socialists who follow the state's "diktats" - his actual word - and just to "protect the common good" rather than their own Ayn Rand interests, they hunker down in terror behind walls and masks, and then naturally, evil things happen and a lot of people die. The same was happening in more populous Republican states like Texas and Florida even as Smalley wrote, but ... Nebraskans for example take responsibility and do nothing about a harmless flu except washing their hands and praying, just like always. Naturally it spreads less because ... prairies and real American values scare the hell out of this commie Chinese virus? There's no point to studying that at all. If you believe it, you just keep doing that and re-arrange the facts so they seem to agree.

However it seemed in late June, we have a better view now in November to judge which approach truly has the worse outcome. A handy data map I saw on Twitter shows per-capita rates of confirmed infections for all48 contiguous states, as of November 13. Here it's annotated to show the five no-lockdown states as I recall it being when I checked way back. ND, SD, Nebraska, Iowa, and Arkansas. These are the kind of sparsely-populated states that could possibly do without stern measures, and perhaps did fine for a while. But Iowa and the Dakotas especially wore out that buffer - maybe by standing together like that - to become the most-infected states, per capita. It turns out they weren't spread-out enough. They didn't each have their own personal workplace, grocery store, or bar, so it finally spread all over. By this, a week ago North Dakota had nearly 8,000 per 100,000 infected, or near 8% - CONFIRMED. That's 2.7 times as infected as New York (which is at 2898.9, or 2.9%, and probably with a much higher confirmation rate). 

North Dakotans had come together to log 2,270 new COVID-19 cases on November 13 before before Governor Burgum announced a statewide "lockdown" as of the 14th: a public mask mandate would be in effect, with businesses limited to 50% or even 25% capacity, school sports and big gatherings banned. Critics of his reaction to another "casedemic" might fail to note it came with a peak of 334  covid-related hospitalizations on the 12th. Hospitals were reportedly at 100% capacity with more than 250 new patients a day since November 1st., and so shorthanded they had covid-positive nurses keep working (Grand Forks Herald). Since the lockdown, cases dropped sharply to about 1,000 a day but quickly began creeping back up to 1,500 now. Hospitalizations declined but remain high, and deaths are averaging 16/day, with up to 30 (reported) in a single day, and it seems to still be rising (Bing tracker - state site). Again, the state's population is not even one million. What they have now is terrible, but it was about to become enormous, even there.

Joel Smalley and Dr. Siegel must be disappointed. Even in North Dakota, Burgum locks the people down and again it correlates with a dramatic rise in cases and deaths. Is there no end to this Communist plot?

I looked at the North Dakota's covid and all-causes deaths and compare them to New York state - minus New York City because that's how the CDC table I use lists it, and for a fairer comparison. There are some tallying issues here; New York's numbers per CDC are higher than I get subtracting NYC's dead from the state's total at Bing, while Bing lists considerably more deaths than the CDC for North Dakota. I haven't taken the time to sort that all out, so the comparison here may be skewed. Also the numbers for ND are so small it's hard to be sure about any pattern that seems to emerge, but ..., As of now, ND seems to have roughly or exactly caught up with 'the rest of New York' for COVID-19 fatalities, per capita - just over one in a thousand killed so far, or by week 42 ending Oct. 17. They've both gotten sharply worse sincer then, but the public data on that isn't clarified yet. 

* 12,134 COVID-19 deaths in NY aside from NYC (by CDC's numbers) = 1,091/m or 0.109%

* 824 in ND (by Bing's fuller-seeming numbers) = 1,081/m or 0.108%. (it's gone up 16 since the graphic: 840 now = 1,102/m. But NY's gone up too.)

Here are the numbers for those plotted covid deaths (red line). That's the same actual number, not population-adjusted. Any week where they have the same death toll is a week where North Dakotans died at 14.6 times the rate of New Yorkers (again excluding the even worse-hit New York City). They're close to equal these days, with North Dakota usually being lower, but sometimes higher. Right now (not sure how to get a comparable daily tally for NY), North Dakota might have hit triple digit deaths first. 

Expanding a bit to consider "non-covid" excess deaths: starting with natural causes rather than all causes, and calculating excess over same-week 2019 levels, New York aside from the city had 14,173 above 2019 levels up to week 42  (after that, the numbers are too incomplete to bother with). Using a baseline of 80 deaths/week below 2019 (a possibly high average level) adds 3,360 to w42 = 17,553 excess deaths, almost all of them probably due to COIVD-19, confirmed or not. Adjusted for population, that would be 1,577 per one million, or 0.158% dead up to week 42 ending October 17. 

Natural Causes excess for North Dakota: total to w42= 470 - more than the CD's total to then of 384 covid deaths, or Bing's 404, but not by much, considering the mini-spikes seen at weeks 10-12, 17/18 and 35 forward. The baseline here is hard to call, and I went with a mild 14/week from week 14, and just half that before. That would give 967 excess deaths to w42, which feels a bit too high. But then again the scale of unconfirmed deaths is unknown and it's had a normal-length spring and summer to add up. That would be 1,269/million, or 0.127% of North Dakotans killed by then. That's still better than New York, but of course it's gotten worse since. 

By my rough baseline-adjusted calculations, New York has had 30.8% of covid fatalities go un-noted (otherwise, it's less than that - or more if I did it low). That would be a bit on the good side of normal, where a U.S. average seems to be roughly 1/3 missed, or about 33%, and 50% or more missed is not uncommon; the U.K. seems close to that. Belarus, by apparent policy of counting low, misses perhaps 90% of its massive covid deaths (to be addressed in a future post). North Dakota looks good in contrast, but it seems they keep a bit looser track than in New York and have so far missed close to half of their deaths (probably less than the 58% I get comparing 967 excess to 404 covid). 

Anyway, we'll see who has the worse outcome as we move deeper into flu season, but I'll say it now: nice outcome there, Joel Smalley, MBA. That was just as stupid as the Trend Macro guy's correlation work.

"Deaths of Despair" in the U.S.

Covid Deaths, Not Lockdown Deaths, part 4

"Deaths of Despair" in the U.S. 

November 18, 2020

As part 3 explained (will explain), any sizeable deaths caused by "lockdown" would be found under natural causes like heart disease, but mainly what we see there is a lot of apparently misdiagnosed COVID-19 fatalities, These are equal to around 50% of the virus deaths reported, or one in three goes unnoted, and the U.S. death toll may be over 400,000 already. Lockdowns, mask mandates, and other measures have kept that number from being even higher, but that's not to say they don't also have a heavy cost, including lives lost due to denied medical care and screening for a range of serious conditions. 

Yet attention has been grabbed by a smaller, more optional class of deaths - people who died from lockdown-related unemployment or social distancing, via suicide or fatal overdose. The former is highlighted as driven by loneliness and sheer desperation, while those who drink themselves to death or overdose might do so out of boredom and idiocy. All of them have a hand in their own deaths, yet previously existing mental conditions don't matter to the critics like medical ones do with covid - people who kill themselves died OF, not WITH lockdown, and they're sure the number is immense and set to grow.

There is little reason to doubt that deaths from both suicide and over-intoxication have increased with idleness, isolation, and depression, and there's various evidence to support it. Overdoses especially seem easy these days with all these opioids making the rounds. But the proportions are unclear, and can hardly compare to the other scales of fatality involved here; all non-natural deaths combined (suicide, homicide, other violence, accidents) are usually less than 10% of a yearly total, while >90% are from natural causes and, as part 3 showed, those are all in a general and massive elevation this year. 

But as an RT article warned back on May 7 Lockdown-inspired suicides on course to DWARF coronavirus deaths in Australia & in time, even in US – studies. This noted how President Donald Trump had "warned early on in the pandemic that there would be “suicides by the thousands” if prolonged economic shutdowns were imposed" over what he considered a harmless "kung-flu" that would soon vanish via "herd mentality." With such advice widely refused, the article foresaw "fallout looming on the horizon", citing an Australian professor's predictions of up to 1,500 extra suicides there by year's end - a 50% increase - and a dramatic increase already underway in Tennessee. 

Martin Armstrong / Armstrong Economics reported back on developments on September 6, claiming "there have been far more deaths from suicides and drug overdoses than from COVID-19," a claim he falsely attributes to the head of the U.S. Centers for Disease Control (CDC). I'll come back to that below, but first, Armstrong whined "the leftist media will no doubt claim the CDC is wrong. The social media firms will scrub any mention that this COVID has been a hoax." With that set and the CDC's backing secured, Armstrong turned on the people "allegedly responsible for the rising death toll from destroying everyone’s future. ... Everyone should write to the Attorney General and demand a criminal investigation into Zucker, Gates, Soros, Schwab, and of course Fauci." 

On June 16, James Lucas at the Federalist alerted readers Research Finds Lockdowns Are Far Worse For Health And Lives Than Coronavirus. Mainly, he was worried about unemployment caused by all the stay-at-home orders and business closures:

"[U]nemployment has very deleterious effects on public health, particularly due to an increased risk of cardiovascular disease and stroke. ... Unemployment also adversely affects mental health ... directly increases mortality by increasing suicides. ... Extended unemployment can reduce average life span by up to two years. Applying that to the more than 40 million unemployed in the United States right now and the results are frightening."

Of course circumstances will vary, and it will be quite stressful for some workers, and especially for many business owners. But usually such job-related anxiety comes from loss of income, while in many if not most cases, pandemic relief ensured unemployment benefits at 100% for lockdown-related temporary layoffs. Some people including myself enjoyed a fully paid "staycation" and have been back to work for a while now, no worse for the wear. 

75,000 "Deaths of Despair" in the U.S. - a desperate distortion

One study Mr. Lucas cited found that being unemployed was historically “associated with a twofold to threefold increased relative risk of death by suicide,” while the current situation was worse, not better; "an even more recent study has put the increase in lockdown-related “deaths of despair” at 75,000 in the United States alone." That's an astounding claim. An increase over normal levels of 75,000 would account for all the non-covid excess deaths to that time (around 50,000, non-adjusted) and then account half of them a second time, with no help from any other cause.

Let's examine the claim. This would be suicides and drug-alcohol overdose, with "despair" likely just presumed as universal. This data is usually delayed 1-2 years before release, but for reference: 

* In 2018, some 48,000 people died from suicide in the United States (CDC)

* In 2019, almost 71,000 people died from drug overdoses. (CNN) 

These numbers should be fairly similar year to year, so we could plug them into 2020 and have a decent idea what to expect otherwise. I hear both are rising each year, but let's skip that here to let lockdown have a try at explaining any increase.  They total 119,000, with about 40% suicide and 60% OD. In context, that 75,000 would be about 30,000 EXTRA suicides by early July (atop some 48,000 expected all-year), and 45,000 people who drank/shot up too much and died in that same span, beyond the usual yearly number around 71,000. 

That seems faintly possible, but something says they calculated high or, as it turns out, the findings were misrepresented, maybe by accident. As the linked press release explains "new research released by Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care" predicts "as many as 75,000 more people will die from drug or alcohol misuse and suicide." Lucas made it sound like that was an estimate of the actual deaths so far, but it's the high end of an estimated range of future deaths over an unclear timespan, anticipating ... hold on ... 

Here's the report, direct PDF link. A key issue is increase in mortality per one point rise in unemployment (is it 1%, 1.3% or 1.6%?) and rate of economic recovery. "the negative impact of isolation and uncertainty" suggested the highest increase in mortality (1.6%) would apply, as it did in the Great Depression. With a slow recovery (Same as Great Depression) they estimate that would cause up to 154,000 deaths of despair, but spaced out over a span of 10 years, and apparently with little mitigation possible in the meantime. 

A fast recovery would take 4 years, as the report considers it, and at just 1% mortality increase, might drive as few as 27,644 to the grave in the end. The number 75,000 doesn't come up, but is similar to medium recovery at +1.6% mortality and 80,735 deaths of despair over 7 years. 14,932 of those were estimated by the end of 2020. Now that sounds plausible, as far as I know. 

119,000 despair deaths annually could be split into 29,000 per quarter, except for the last quarter getting 32,000 (holidays increase suicide). The lockdown period in question is roughly second quarter, so around 29,000 deaths normally. I could see a full doubling of the rate for an extra 29,000 deaths, though that seems high. I'll defer to the WBT/Graham Center report that predicted a total of 14,932 such deaths by the end of 2020. Even if we put all those in the acute lockdown span in question, that would be a roughly 50% increase over the expected 29k - 15,000, not 75,000. I'll plot this out below.

A 50% increase is apparently kind of extreme. The cited RT article noted "In the best-case scenario, suicide rates will increase 25 percent, Professor Ian Hickie predicted, observing that 40 percent of those would be among young people. If the Australian economy continues to deteriorate, suicide rates could increase 50 percent." Someone more expert than me trying to raise alarm predicts 25% and maybe 50% increases, and the WBT/Graham Center report doing the same proposes something close to or less than 50%. So in my plotting below, I'm more than fair in considering 50% and 75% increases in the U.S. and still finding the alarmist claims fail even my lenient plausibility test. First though - why I "claim the CDC is wrong" or, as it turns out, was misrepresented.

Redfield's Comments: True?

Center for Disease Control Director Robert Redfield has been widely cited for his statements on July 14 that "We’re seeing, sadly, far greater suicides now than we are deaths from COVID. We’re seeing far greater deaths from drug overdose that are above excess that we had as background than we are seeing the deaths from COVID. " That's a direct quote from a fairly balanced article with some detail, which I'll mainly cite below: CDC Director Compares Rate of Suicides to COVID-19 Deaths, by Micaela Burrow, Town Hall, July 28. See also National Review.

Armstrong Economics for one was less balanced, reporting sloppily: "The Director of the CDC has come out and bluntly stated that there have been far more deaths from suicides and drug overdoses than from COVID-19," as in comparative totals to date. But Redfield was clear it's something "we're seeing ... now," at a moment when covid deaths had been brought much lower than they had been or would be. In fact he may have meant to make a dual point that covid was brought so low it was even lower than the increased self-endings now on par.

His exact meaning is otherwise a bit unclear. For example, were there "far greater suicides" and "far greater deaths from drug overdose" - as it sounds - or did the two combined outstrip covid? As I'll show below, that makes more sense by the data. Michael Thau seems to get the "now" aspect, but decided "Even Redfield admits lockdowns are now killing at least two times the number of Americans as COVID-19," exceeding it "by far" once for suicides, once again for ODs. (Head of CDC Admits Lockdown Killing Way More Americans Than COVID! Urges Masks. When Will These People Be Held Accountable for the Carnage They've Caused? Redstate.com, July 27, 2020) 

COVID-19 was killing around 500-700 a day at the time, so that's at least 1,000-1,400 lockdown deaths per day suggested between the two causes. The stats used here yield a normal rate of ~128 suicides and 192 ODs per day, or ~320 combined, as an expected norm. Thau's reading would be around four time the normal rate, while data and realistic predictions suggest more like 1.5 times at most. 

Several articles (including Thau, above) cite Redfield's comments as applying to all Americans, but that makes little sense even at early-mid-July's lower death rate, let alone compared to the masses of mortality seen in April. And he specified this is a "cost that we’ve seen, particularly in high schools," and perhaps only to there to the cited degree. At the time, schools were closed as normal for summer break, but had been closed for lockdown prior to that, and re-opening in the fall was a big question Redfield was addressing. 

Overdosing-overdrinking and suicide are always top killers for teenagers - a promising but moody segment with overall low mortality, and especially low COVID-19 mortality. It is logical that the situation had increased those tendencies, plausibly even doubling the relevant rates for this demographic. Yet all ages and all pandemic phases considered, COVID-19 has definitely killed far, far more people this year than all such deaths combined, normal and excess, and was probably outstripping them both even in early July. But "probably" is boring, so let's have a look. 

Suicide-OD estimated norm (as mentioned above) = ~29,000 each quarter (13 weeks). Lockdown measures began variously from the end of week 12 and more widely in week 14. If we start lockdown counting at week 14 to week 26, that's a full second quarter and covers the span to lowest covid deaths Redfield likely referred to. Plotting this in: 

* 29,000 divided by 13 weeks = 2,231 weekly average.

* at 50% elevation: 43,500 = 3,346 weekly av

* at 75% elevation: 50,750 = 3,904 weekly av

* of course the real numbers would vary more, maybe about normal in some spots, and up past 75% in others. The slight wiggle I added to the green lines was just for effect, so it looks like plotted data and not part of the scale.

This finds that if a 75% increase was in effect at weeks 25 and 26, they would exceed COVID-19 deaths slightly (by about 100 each week), for those two weeks only. And recall lockdown isn't responsible for all of those, just the smaller half in excess of normal (the 75% in a 175% situation). So the data suggests Redfield might be referring to a real but remarkable fact, covid deaths were briefly outstripped by elevated deaths of despair, underlining the need he was addressing - to relax controls, get schools re-opened, etc., while keeping the virus reined in so those covid deaths could stay low. 

Conclusion

Burrow at Town Hall noted "Where Redfield obtained his data is unknown ... health authorities will not have verified data regarding suicides and drug overdoses in 2020 for two more years." One CDC source says "For deaths due to external causes of death [including suicide, accident] or unknown cause, provisional data are highly unreliable and inaccurate in recent weeks, and it can take six to nine months to ensure sufficiently accurate estimates," while another says "Upward trends in other causes of death (e.g., suicide, drug overdose, heart disease) may contribute to excess deaths in some jurisdictions." But in general, these deaths are most likely not even reflected in the data we have, or only in small part - which would mean deaths of despair explain very little or none of the excess we have numbers to fret over. 

We may have yet to see how many extra thousands actually killed themselves due to lockdown. Even a 25% average increase for quarter 2 seems high to me, but if it ever hit 75 (as Redfield's comments suggest at weeks 25 and 26), then it may be too low. Let's say 30-35% = 8,700-10,150 extra deaths.  The 2nd quarter should be less acute in this regard as activity increased and much work resumed, But economic issues may still drive an increase of 10-20% = 2,900-5,800.  There may have been even more, or less, but a fair and broad estimated range might be 11,600 to 15,950 "deaths of despair" so far. 

Meanwhile, a somewhat reined-in COVID-19 has actually caused the bulk of overall U.S. mortality that, up to mid-November, is surely past 320,000, and may be as high as 405,000 (see here). All-causes mortality in the entire United States increased to at least 45% in the peak of deaths at week 15 (ending April 11), largely because New York State (including NYC) saw up to 416% its normal fatalities that same week (4,663 to 1,952 in 2019), because New York City saw 746% the usual deaths (7,863 vs. 1,054 in 2019). Importantly: that peak was kept from being higher and later because of lockdown, etc. As always, it gets its spike shape - narrow peak with a solid and sharp downslope - over the few weeks following a successful lockdown. Otherwise it would be just the lower upslope of a big, fat mountain, as shown above in orange and brown. The actual number is hard to say and depends on what else exactly would have happened. But it must be a comparable number - maybe much lower (50%?), equal, or twice as high. That puts it anywhere between 160,000 and 800,000 Americans who might have died by now but haven't. 

And I concede, these measures also contributed heavily to probably at least 11,600 additional self-cancellations in the last 6 months, and possibly over 16,000. Seeing that trade-off does give pause and reminds us of the need for balance, a chance the lockdown critics largely squandered.