Note: This article has been updated from the initial post (as of April 22, 2020).
Nearly 2,000 years ago, a sage spiritual leader asked those who would take on any project of consequence to "first sit down and figure the cost so you'll know if you can complete it." Just to make sure that no one misunderstood the range of costs to be considered, this founder of what became the Christian movement offered up two illustrations : the cost of a physical construction project (building a tower), and the cost of going to war (assessing the capabilities of one's army against that of the enemy).
So, in our current pandemic, count not only the costs of those who will be directly stricken by an unseen enemy, but also those who will be affected by potential loss of livelihood and home. In 2020, the U.S. and much of the rest of the world have gone into virtual lockdown in a mad rush to avert or mitigate the mortality effects of COVID-19 virus — albeit with minimal consideration of the short and long-term cost necessary to beat this previously unknown foe.
As David Farragut, flag officer of the U.S. Navy declared in a battle of the American Civil War: "Damn the torpedoes, full speed ahead."
In 244 years of the American republic, there has never been an occasion when the U.S. and most states effectively shut down the social and economic life of the country. Not even in wartime have such radical steps been taken.
Yes, there's lip service given to mitigating the collateral damage, but no meaningful initiative to date to directly and honestly answer the threshold question: Is the cure worse than the disease? Is the price we are paying to combat this pandemic too high?
Or perhaps the question is better phrased as: What price is too high?
COMPARING THE COST
For some perspective on the human toll of the virus, it is useful to make comparisons with other conditions affecting mortality in the U.S.
Consider this. As shown by the following graph, there were over 2.8 million deaths in the U.S. for calendar year 2018. By comparison, as of April 16, 2020, COVID-19 has claimed close to 31,000 American lives. The number of deaths attributable to coronavirus, to date, equates to about 1.4% of total annual mortality in the U.S.
New York Times figures do not include more than 4,800 people in New York City who died and are believed to have had the coronavirus. As reported by the Times, many of those patients died without being tested, a consequence of a strained medical system and a persistent lack of testing capacity.
As depicted by the graph, a few other selected indicators are of note. The number of people in the U.S. who have died of COVID-19 to date can be calculated as equivalent to:
Approximately 5% of the number deaths of all persons age 85 and over who passed away in 2018 (for any and all reasons)
6% of the number of deaths for those age 75-84
6% of the number deaths of those who die of heart disease each year
(the number 1 killer in the U.S.)7% of the number of deaths attributable to cancer
24% of the number of deaths caused by accidents of all types
(Just over 100% of the number of deaths attributable to vehicle accidents)47% of the number of deaths attributable to diabetes
68% of the number of deaths attributable to flu & pneumonia
78% of the number of deaths attributable to kidney disease
83% of the number of deaths attributable to suicide
While lost jobs are not a form of physical mortality, they do represent human and economic loss. As of April 11, the increased joblessness of more than 22 million means that well over 500 jobs have been lost for every coronavirus death, to date. And like COVID-19 deaths, the number of unemployed has yet further to go on its upward trajectory.
Bottom line and while tragic, the number of deaths attributable to COVID-19 is only a small fraction of all mortality — only a small fraction of deaths attributable to the major causes of death in the U.S. Why this undue focus on an unseen killer which has, so far, added only marginally to the on-going death toll associated with the everyday cycle of life and death across America?
Would we lock America down like this to go all out to stamp out the causes of diabetes or cancer? What about to eliminate all car accidents by shutting down all motor vehicle transportation? Or to prevent all suicides?
What is it about COVID-19 that gives the fight to take on this pandemic a higher priority than addressing any other substantial form of mortality? Is this a battle worth impoverishing large segments of the American population for years to come?
As of mid-April, the chief economist of the International Monetary Fund (IMF) has stated that:
As countries implement necessary quarantines and social distancing practices to contain the pandemic, the world has been put in a Great Lockdown. The magnitude and speed of collapse in activity that has followed in unlike anything experienced in our lifetimes.
Do we care about the cost to America? Do we care about what the IMF now says will be the worst downturn since the Great Depression of nearly a century ago? Or is our answer to be that of the medical bureaucrats who, like Farragut, would command: "Damn the torpedoes, full speed ahead."
Damn the cost, damn the livelihoods lost. Damn the kids whose educations are disrupted. Damn the increased disparity between the haves and have nots. Damn the loss to public revenues essential to provide public services. Damn the death of small businesses and gig workers into the hands of an engorged corporate America. Damn the deplorables to strengthen the self-proclaimed rule of the medical-bureaucratic elites.
When will anyone have the guts to answer these questions?
REJOINDERS
There are those who would undoubtedly say this is over-the-top hyperbole. Even if there has never been an explicit policy pronouncement that this fight is worth any cost, there seems to be some implied social contract to make this effort, no matter what price it takes.
And there are technical issues, like:
This is a disease of unknown proportions unlike other diseases for which risk can be more readily measured and calibrated — so it's worth going all out to beat the unknown (unlike such known maladies as cancer, diabetes, car accidents or suicides for which risks are now well defined).
What we do know is that the more than 40,000 deaths (as of April 21) will grow larger by the time this is over — maybe now to 100,000 or 200,000 or if we relax too much off measures like social distancing, conceivably increasing to less likely worst case scenarios of perhaps 1 - 2 million.
And there may be recurrences, flare-ups in the infection rate, as a start-stop stutter process that continues indefinitely — at least until a vaccine is found.
There are counters to these likely responses. No choice of this magnitude should occur merely as part of some implied social construct. If cost be damned is to be the order of the day, that should occur via informed and explicit legislative actions at federal, state and local levels including a policy commitment to hold the rest of society harmless, not impoverished — no matter what it takes, whether short or long term.
And regarding the technical issues. While this is a disease with many unanswered questions, the unknowables have been pared back as the health care community learns more day-by-day. We certainly know that the major variables to managing the risks going forward involve slow and measured ease-off of social distancing, widespread testing for the virus and for antibodies, getting therapeutic drugs and vaccines quickly to market (to reduce and ultimately stop the ravages of this disease), and (quite possibly) contact tracing using the tracking powers of ubiquitous smart phones.
In instances where the private market is not responding quickly enough — whether with masks or testing equipment — the powers of the presidency could be more actively applied to compel production and distribution. Now, not later.
We even have learned enough from disease modeling to better understand the potential range of outcomes and how the key variables likely influence these outcomes. And the monitoring tools related both to COVID-19 and economic recovery are there to gauge what is happening in real time — then scale the regulatory mechanisms to ease-off or tighten accordingly.
But there's one step that is essential to make all this work. There needs to be some general and explicitly communicated consensus of what a reasonable mortality target should be. It's not good enough to say that we aim to bring the rate down as much as possible. That approach suggests that our resources are infinite and that the cost imposed to get that one extra life saved is worth the universe.
Rather, aim for realistic targets. Based on what is known today, it now appears reasonable to aim for a goal of less than 100,000 deaths before this is over - but accept the possibility of going as high as 200,000 (as within the range of variability). Note: Even if there were 200,000 COVID-19 deaths this year, annual deaths in the U.S. would increase by only about 7% — going from an underlying rate of about 2.8 - 2.9 million per year to perhaps 3.0 - 3.1 million.
Coronavirus mortality targets should ideally exclude estimates of co-morbidity where an elderly or immune-compromised individual is likely to experience near term death anyway, with or without the virus. The medical profession needs to come clean and quantify the extent to which co-morbidity is or is not occurring.
WHICH WAY FORWARD?
Maybe it’s time to pay a bit more attention to sage advice — historically proven. Count the cost before going into battle. Do it before continuing to spend extraordinary sums of funds while impairing business and household incomes with minimal regard to both foreseen and potentially unforeseen consequences. Not just the cost from one perspective, but from all relevant viewpoints before making decisions as to the most viable course of action.
Putting this in today's context, this could mean continuing to follow the course of continued lockdown if the cost to the rest of humanity is widely viewed as worthwhile to save a small percentage of deaths, including at least some who are likely to die anyway. Alternatively, tack toward a new course of COVID-19, social and economic recovery if this is the more acceptable price.
Either way, make the choice consciously and with the consent of the governed. The worst of all worlds will be to attempt to muddle through — putting the cart ahead of the horse. The interests of the self-anointed over those doing the work — on whom the future of our republic ultimately rests.
