President Trump was right, and I don’t say that often. He correctly warned that the economic shutdown could kill people, perhaps more than the virus itself. But his solutions have been wrong and dangerous, and his motivations are at best uninformed and more likely driven by corporate interests and politics. For example, his recent impulse to “restart” the economy by Easter or to send people back to work in areas of the country not yet impacted could be catastrophic to public health and cost the lives of thousands of Americans.
Public debate in the past few days has wrongly advanced a false choice, to either continue a public health approach that keeps everyone home to save lives but devastates the economy, or to return to business as usual and forfeit a certain number of lives for the greater good. But there are other options, a more nuanced strategy that people with political agendas, including the President, would prefer to sidestep.
Public debate in the past few days has wrongly advanced a false choice, to either continue a public health approach that keeps everyone home to save lives but devastates the economy, or to return to business as usual and forfeit a certain number of lives for the greater good.
For example, the current public health approach, in which states keep everyone home and shutter businesses, need not devastate American families if policymakers and large corporations intervened to ease the impact, especially on low-income families who are suffering the most, and did more to backstop the health care system to help it handle COVID-19 and the needs of patients with other diseases. The President rightly warns that the economic shutdown could cost lives, but he fails to mention the corrective action he could take to spare those deaths—and chooses to eschew. For example, the Federal government could do more to keep paychecks flowing to low-income workers and help struggling families meet basic needs like food and housing. Conservatives are dismayed by such policies—they carry the scent of government spending and social welfare. Business interests are unsatisfied because worker-centered remedies do little to curb the slide in corporate earnings or stabilize the stock market.
Corporate America, and a restless public, are understandably impatient to jump-start the economy and return to work. White House advisers have urged the President to ignore the public health experts who warn of catastrophe. But wishing it away will not stop the pandemic. The nation is at the start of an exponential increase in COVID-19 cases and deaths, made steeper by our delayed reaction as the virus reached our shores. Allowing life to “return to normal” now, before the case load has spiked, will pour fuel on the fire, intensifying the pandemic as viral carriers leave their homes and quickly spread the disease throughout their communities or carry it to other states. More people will get sick and the number of deaths will rise, not only costing lives but also defeating the purpose of restarting the economy. With case numbers on the rise, Americans will be reluctant to return to work or visit stores for fear of catching the virus, and the infrastructure to keep industries afloat will limp along with inadequate crews to maintain supply chains.
The President rightly warns that the economic shutdown could cost lives, but he fails to mention the corrective action he could take to spare those deaths—and chooses to eschew.
These competing agendas played out as the U.S. Senate debated the recent stimulus package to deal with the crisis. Politicians on both sides of the aisle endorsed the urgency of bringing relief to Americans and saving major industries hurt by the pandemic, but they parted company about priorities. The business community, with support from the White House, focused on securing bailouts and stabilizing financial markets, while Democrats worried that money intended for workers might find its way into stock buybacks and shareholder pockets. Democrats wanted to do more for workers—including unemployment benefits, underwriting payroll checks, helping with food and housing, and strengthening access to health care.
As this debate unfolds, Americans should keep the following points in mind: First, the virus will not wait for policymakers, and doctors know this. Health care facilities across the country are bracing for a tsunami of COVID-19 cases that will overwhelm their capacity, and the public should not be surprised when it occurs. The tsunami will first sweep over primary care practices on the front lines and quickly move on to overwhelm emergency rooms, hospitals, and intensive care units. This has already occurred in New York City, where health care workers have run out of personal protective equipment and will dwindle in numbers as they grow sick or die from exposure to the virus. States are already facing shortages of ventilators, forcing physicians to ventilate two patients at once or make horrific decisions about which patient to save. Decisions about where to surge supplies and where to cut off community spread remain guesswork, because of the nation’s delay in testing the population.
. . .disruptions in health care and the intense economic and social strain on Americans families will increase deaths from other causes unless bold steps are taken to cushion the blow.
Second, disruptions in health care and the intense economic and social strain on Americans families will increase deaths from other causes unless bold steps are taken to cushion the blow. For now, the leading causes of death in the United States remain heart disease, cancer, unintentional injuries (from car accidents to drug overdoses), lung diseases (e.g., emphysema), stroke, and Alzheimer’s disease. They claimed 1.8 million lives in 2018 alone. As I write this, 2,200 Americans have died from COVID-19, and 125,000 have tested positive. These numbers will be higher when you read this, but the nation’s death toll will be far larger if the crisis engulfs people with other diseases. There are 16 million Americans with cancer, 23 million with diabetes, 28 million with heart disease, and millions more with other potentially fatal conditions. Even slight increases in those risks could claim many lives. For example, as of March 29, New York—which had the largest number of COVID-19 cases—had experienced 720 deaths. Suppose the crisis triggered a 10% increase in the state’s deaths from heart disease and cancer. That increase alone would claim an additional 800 lives in the first month.
Third, the effects on mental health should not be overlooked. Social distancing and economic worries are likely to increase stress, anxiety, loneliness, and depression. The opioid epidemic was already wreaking havoc before COVID-19 stole the headlines, and new levels of desperation could escalate a surge in drug overdoses and suicides that was already underway before the pandemic. People with mounting emotional pain or addiction disorders face an urgent need to stay personally connected, despite social distancing. A mental health system weakened for years by chronic disinvestment must find new ways to deliver counseling and treatments. Children are often resilient, but a subset may emerge from this period at greater risk for diseases. ACEs, or adverse childhood events, increase the risk of substance abuse and other problems among young adults and of chronic diseases later in life. Our youth may be at lower risk of succumbing to COVID-19, but neglecting their experience as witnesses of this crisis could have lasting health consequences.
A mental health system weakened for years by chronic disinvestment must find new ways to deliver counseling and treatments.
Fourth, Americans have poorer health and shorter lives than people in other wealthy countries, and this crisis will not help. It’s a myth that we have the world’s best health care system and the best health status. Year after year, the U.S. health care system has ranked poorly in comparisons with other rich nations, which perform better not only in terms of access to care and lower costs but also more coordinated care and better health outcomes. Politicians from Reagan to Trump, intent on curbing the size of government, have hollowed out public health infrastructure, a mistake that has claimed lives for decades. U.S. life expectancy began to lose pace with peer nations in the 1980s, fell below the OECD average in 1998, plateaued in 2011, and decreased after 2014 for three consecutive years. American workers are more likely to die before age 65 than those in other high-income countries, putting U.S. businesses at a competitive disadvantage with those in countries with healthier workers and lower health care costs. The fall in life expectancy and growing “U.S. health disadvantage” was front-page news as recently as Thanksgiving, a month before events began in Wuhan. Put simply, our nation was on dangerous footing before the pandemic began, and mishandling the crisis in ways that cost more lives could move U.S. health status from bad to worse.
These complexities make it alarming to see the national debate reduced to a simplistic choice between social distancing and reopening businesses. The nation’s health deserves better. Lives will be lost unless the U.S. acts boldly to strengthen health care—to simultaneously treat COVID-19 and other diseases—and to bring economic relief to struggling American workers and their families. Politicians and business leaders have an understandable impulse to rescue industries and staunch the blood loss, as GDP falls and unemployment rises, but reckless decisions that put lives at risk will cause needless deaths and ultimately slow the nation’s return to normalcy.