If we ask the right questions, we might get a lot closer to the answer much sooner
Iam almost never offended by criticism of anything I write. For one thing, I'm acutely aware that there is usually more than one side of an issue. Second, I'm an ardent proponent of the clarifying power of debate.
But I confess to being more than a little irritated by a private email sent to me in response to my first column on the coronavirus. The correspondent began by accusing me of having mentioned the economic impact of a prolonged shutdown because I'm in thrall to the "tropes of all the right-wing Trump supporters that we should revive the economy at the expense of the 'old, unproductive people.'" He suggested that I was prepared to watch thousands die to re-elect the president. And finally, I was characterized as being more "Greek (put the old people on the mountain to die) than authentically Jewish."
My column, in point of fact, was written before President Trump ever uttered a word about reopening the economy. And I have no wish to have my ninety-year-old mother — or my "elderly" self for that matter — left on a mountain top to die.
BUT WHAT I FOUND most frustrating was the framing of the policy choices as between valuing human life or valuing money, i.e., the economy.
Dr. Jay Bhattacharya, a professor at Stanford Medical School, specializing in public health issues, and a PhD. economist, framed the choices much more accurately, in an interview with Peter Robinson, host of the Hoover Institution's Uncommon Knowledge podcast, which has drawn over one million viewers: "[I]t's not just dollars versus lives; it's lives versus lives."
Twenty-six million Americans million have filed for unemployment benefits since the start of the lockdown. Most of those filing never contemplated that they might suddenly be left without a job. When the coronavirus hit, the economy was humming at near full-employment. Of the millions of small businesses that have closed, it is estimated that as many as thirty percent will never reopen.
And the loss of livelihoods will hit our community no less. Many are already panicked at the prospect of not being able to feed their families.
The economic figures presage a potential worldwide Great Depression. The recession of 2008, according to Bhattacharya, led to huge numbers of people who died from "deaths of despair" – from suicide, alcoholism, opioid overdoses – and to an unprecedented decline in life expectancy. The signs are all there that the same, or worse, will happen this time.
The National Alliance on Mental Illness reports a 40 percent increase in calls and emails from those suffering from depression or anxiety. Alcohol consumption has jumped fifty percent in the United States, and 67 percent in Great Britain. There are reports of a 35 percent increase in domestic violence.
And the situation will be much, much worse in the developing world. Bhattacharya, who is of Indian descent, predicts that many of the diseases that afflicted poorer countries in the past, and which were being slowly eliminated, will return.
"The rise in GDP worldwide has pulled billions of people out of poverty and raised life expectancy everywhere," he observes. If that is reversed, "lots and lots of lives [will be] shortened unnecessarily." Poverty remains the leading cause of premature death.
"To be concerned about the effects of the global shutdown," observes Heather MacDonald of the Manhattan Institute "is not to be indifferent to human suffering; it is to be moved by that suffering."
TO FRAME THE ISSUE as lives versus lives does not, by itself, dictate any particular policy prescription. But it is not without implications. For one thing, it should inject a modicum of civility into the policy debates. Let us stop with the self-righteous denunciations of anyone who dares to raise economic issues as someone who "doesn't care about people dying."
And it should make us make us sceptical of governors who claim, with great bravado, to be prepared to spend any amount of money "to save just one life." Besides inflicting untold suffering and thousands of premature deaths, the goal is unattainable. It would require a safe and effective vaccine – which could be 18 months away, if ever – or the development of herd immunity. And the latter cannot develop during a shutdown, especially when the youngest and least likely to be adversely affected are locked up at home. The models upon which the lockdowns were predicated were designed to spread out the number of cases to prevent a collapse of the health care system, not to eliminate the coronavirus. That has been achieved.
That goal of 100% safety reflects not an exquisite sensitivity but a total lack of empathy. If you are a journalist, who works from home, or Speaker Nancy Pelosi, whose two top-of-the line refrigerators are laden with expensive ice cream, the shutdown is no big deal. Not so if you are an out-of-work truck driver or a laid-off middle manager.
Framing the issue as a choice between lives and lives forces us, as is usually the case in life, to engage in a balancing process. Given the magnitude of the consequences, the public is entitled to a large degree of transparency. If a governor, for instance, extends the shutdown of business, he should be pushed to specify how many lives he expects to save by doing so and what the economic consequences will be, and then to identify the assumptions upon which he bases himself.
No balancing can take place without good information, and that has been woefully lacking. Only now are the first studies being done of how widespread are coronavirus antibodies among those who are asymptomatic. Yet without that information, we are clueless as to the lethality of the virus. All the studies to date show the number of cases of coronavirus to be at least an order of magnitude higher, and therefore the rate of fatality to be that much less.
No wonder the most influential models so far, however, have had the approximate value of astrologer's charts. One week, Professor Neal Ferguson of Imperial College London was projecting up to 510,000 deaths in the UK and 2.2 million in the US, and the next week, not more than 20,000 in the UK and 60,000 in the US.
The most influential models in the United States – those of the University of Washington's Institute for Health Metrics and Evaluation -- have fared little better. Within six days, from April 2 to April 8, the Institute's projections – all of them based on the assumption of a total lockdown through May -- were revised down twice. Estimated deaths from COVID-19 dropped one-third. The projected total number of hospital beds declined from 262,000 to 95,200, and those in ICU by over 50 percent.
A proper balancing would include many unintended consequences now being ignored, such as medical procedures and screenings being deferred because of the exclusive focus on COVID-19 virus. Hospital admissions in the UK for the first fourteen months of this year, for instance, were down nearly 40 percent from the preceding year, and that drop has been accompanied by a sharp spike in overall deaths. The British cabinet was told that up to 150,000 avoidable non-COVID-19 deaths may result from deferred procedures.
Balancing should entail far more nuanced policies. There can be no blanket policy for New York, which accounts for over forty percent of deaths nationwide, and El Paso, Texas. But even within New York State, circumstances vary so greatly as to require different guidelines. New York City's rate of death per 100,000 is nearly 25 times higher than 39 upstate counties. And so too are their respective economies different. New York City is a financial and entertainment center. It will revive. The upstate economy is almost entirely based on small businesses that cannot survive months of no income. Once gone, many of them will not return.
And finally, balancing reminds us that our choices are not binary. Ending the shutdown, or ending it for those not at high risk, is perfectly consistent with retaining a great deal of social distancing, such as wearing masks and limiting the number of customers in a store. I, for one, cannot presently imagine myself ever getting on an airplane again without a mask.
We will not soon be returning to our old world, as if awakening from a nightmare. But if we ask the right questions, we might get a lot closer much sooner.