What if…

As I write this the world is in the midst of the COVID-19 crisis and America is essentially shut down. The vast majority of Americans have been living under “stay at home” orders for several weeks, a majority of businesses have been shuttered, unemployment is growing by millions of people per week and there is a growing debate about when to open the country back up.

A central argument in the debate about reopening, and its timing, is about whether the lives saved by shutting down justify the economic damage and human suffering the shutdown is incurring. Of course there are a few problems we face when we have this debate:

  • We have no way of knowing how many lives we’ve saved with this action, partially because we don’t have widespread testing to know how many people have been infected, also because we have imperfect reporting of causes of death (numbers are constantly revised) and partially because we have imperfect models with which to estimate the true infection and mortality rates of the virus.
  • We don’t, as a society, have an agreed upon threshold for the lives we are willing to sacrifice in order to keep our economy functioning at a “normal” capacity.
  • We don’t, as a society, even agree what a normal economy should look like. At a time when we are experiencing extreme wealth disparity it’s almost a given that people will disagree with whether or not the economy that COVID-19 blew a hole in is the economy the majority of Americans want to return to.

I think we can all agree that we will disagree in fundamental ways about when and how we will get back to normal since we will disagree about what normal even is. But, for the sake of this exercise let’s just accept that we want to get the country working again so we can get back to some semblance of normalcy. So, what do we need to do that and what will “normal” look like when we do?

Let’s do this for a thought exercise: let’s assume that we decide that the benefits of some form of social distancing are great enough that they should be considered normal. Why? Well, let’s look at one of the arguments that people on social media seem to love when arguing for ending the stay at home orders: Since X number of people die every year from the flu and we don’t shut the country down then, why should we shut it down for COVID-19?

Again, we have no idea what the true number of COVID-19 deaths would have been without the shutdown, so let’s not argue about that. Instead let’s argue about whether we should do some form of social distancing every flu season. Here are the data points for the debate – all of the numbers are made up simply for the sake of debate:

  • In an average year we lose 100,000 people to flu-related deaths and 500,000 people hospitalized
  • After this COVID-19 crisis we learn that thanks to social distancing we reduced the probable mortality rate by 50% and hospitalization rate by 25% and if we implemented some forms of social distancing during flu season we would see a similar effect for flu-related deaths/hospitalizations.
  • We also learn during the crisis that because of the economic shutdown we, as a society, “lost” $10 million per person killed or $2.5 million per person hospitalized

What do we do? We know that we could save 50,000 lives but is it worth risking the trillions of dollars it would cost the economy to totally shut down the economy every year? Or do we find a middle ground? Do we decide to leave businesses open but require the wearing of face masks and gloves in any public space during flu season or when the signs of an outbreak are spotted? Do we reduce occupation limits on all businesses that serve the public? To help offset the economic impact on those businesses do we provide them tax breaks? If we discover that implementing socialized medicine reduces the overall impact on the economy – keeps us open while reducing the overall economic cost – do we go for it?

I’ve yet to hear anyone who isn’t a crackpot argue that we should have done nothing in the face of COVID-19. Rather, all the arguments have been about what and how much to do. That’s not surprising, because COVID-19 is new, very scary and in the absence of experience and accurate data our leaders have erred on the side of extreme caution. We literally go in the other direction with the flu because it’s a known quantity; as a society we’ve come to accept the tens of thousands of deaths that happen every year and shrug our shoulders and accept it. If we flip this debate we’re having on its head and ask ourselves, “If we can flatten the curve on COVID-19 can we do the same for the flu?” then maybe we can be honest with ourselves. We can ask the hard questions, that need to be asked, not just about COVID-19 but about our society’s priorities in general.

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