Can the economic and mental health costs of the Covid-19 shutdown be justified?

By Conor Friedersdorf

Should states ease pandemic restrictions or extend lockdowns and shelter-in-place orders into the summer? That question confronts leaders across the United States. President Trump says that “we have to get our country open.” And many governors are moving quickly in that direction.

Critics are dismayed. Citing forecasts that Covid-19 deaths could rise to 3,000 per day in June, they say that reopening without better defenses against infections is reckless. That assessment may well be correct. Many insist it is immoral, too. The columnist Amy Z. Quinn says the Trump administration is “choosing money over lives.” In a CNN news analysis, Daniel Burke offers this characterization of America’s choice: “Should we reopen the economy to help the majority or protect the lives of the vulnerable?”

Denunciations of that sort cast the lockdown debate as a straightforward battle between a pro-human and a pro-economy camp. But the actual trade-offs are not straightforward. Set aside “flattening the curve,” which will continue to make sense. Are ongoing, onerous shutdowns warranted beyond what is necessary to avoid overwhelming ambulances, hospitals, and morgues?

The answer depends in part on an unknown: how close the country is to containing the virus.

“The public, the media, the business community, and policymakers are largely unprepared for a pessimistic scenario,” the Foundation for Research on Equal Opportunity argued in a recent white paper. That is, the U.S. may have no treatment, no vaccine, and no ability to scale up testing and quarantining, due to technical hurdles or Trump administration incompetence or a lack of public buy-in.

A Covid-19 patient is walked to a treatment in Brescia, Italy.

If we knew that a broadly effective Covid-19 treatment was imminent, or that a working vaccine was months away, minimizing infections through social distancing until that moment would be the right course. At the other extreme, if we will never have an effective treatment or vaccine and most everyone will get infected eventually, then the costs of social distancing are untenable. We don’t know where we sit on that spectrum. So we cannot know what the best way forward is even if we place the highest possible value on preserving life and protecting the vulnerable.

That uncertainty means, at the very least, that Americans should carefully consider the potential costs of prolonged shutdowns lest they cause more deaths or harm to the vulnerable than they spare.

Ongoing closures and supply-chain interruptions in wealthier countries could have catastrophic ripple effects, Michael T. Klare warns in The Nation, highlighting the possibility that global starvation could soar. “Even where supply chains remain intact, many poor countries lack the funds to pay for imported food,” he explained. “This has long been a problem for the least-developed countries, which often depend on international food aid … It is becoming even more severe as the number of people without jobs multiplies and donor countries balk at higher aid expenditures.” His article wasn’t a brief for reopening the economy, but it implied a need to guard against shutdowns that cause more deaths via starvation than are saved by slowing infections.

“A prolonged depression will stunt lives as surely as any viral epidemic, and its toll will not be confined to the elderly,” Heather Mac Donald argues at Spectator USA. “The shuttering of auto manufacturing plants led to an 85 percent increase in opioid overdose deaths in the surrounding counties over seven years, according to a recent study.” Deficit spending may be necessary to keep people afloat, she continued, but the wealth that permits it could quickly evaporate. “The enormously complex web of trade, once killed, cannot be brought back to life by government stimulus. And who is going to pay for all that deficit spending as businesses close and tax revenues disappear?”

At Arc Digital, Esther O’Reilly asks, “Why should we assume that a crashing economy would leave the healthcare system standing?” Fleshing out the matter, she writes, “You can’t keep the hospital lights on without keeping on the lights of the economic sectors undergirding it. Yes, our doctors and nurses are running out of masks and gloves, which is a serious problem. It would also be a serious problem if we lost the means and the manpower to make more, or if the hospitals ran out of cash on hand to buy more beds, ventilators, etc. And there’s the rub. We are being told we can’t fight the virus without pausing the economy, yet we can’t fight the virus without the economy.”

School closures may do long-term damage, as well. A recent study in The Lancet concluded that “the evidence for the effectiveness of school closures and other school social distancing measures comes almost entirely from influenza outbreaks,” and that the effectiveness of school measures in a coronavirus outbreak is uncertain. Another article in The Lancet noted that “education is one of the strongest predictors of the health and the wealth of a country’s future workers, and the impact of long-term school closure on educational outcomes, future earnings, the health of young people, and future national productivity has not been quantified.” A given closure could add months to the lives of some and subtract from the lives of others.

The general point is that minimizing the number of Covid-19 deaths today or a month from now or six months from now may or may not minimize the human costs of the pandemic when the full spectrum of human consequences is considered. The last global depression created conditions for a catastrophic world war that killed roughly 75 to 80 million people. Is that a possibility? The downside risks and costs of every approach are real, frightening, and depressing, no matter how little one thinks of reopening now.

These facts may not be evident from the least thoughtful proponents of reopening, many of whom advance arguments that are uninformed, dismissive of experts, or callous. But the warnings of thoughtful shutdown skeptics warrant careful study, not stigma rooted in the false pretense that they don’t have any plausible concerns or value human life.
______________________

Credit: The Atlantic