Threading the Needle Between Public and Economic Health

The nasty Chinese coronavirus is taking a massive toll, not only in America, but also around the world. While not as deadly as past flu epidemics, the final numbers are not yet known. Most of those who catch the virus have mild symptoms, but a small percentage are not so lucky.

Those with severe disease may find themselves in an intensive-care unit, connected to a ventilator for several weeks, with no guarantee of returning home. Mitigation methods are in effect, expanding our vocabularies with now familiar terms of social distancing, quarantines, and stay-at-home orders. While mitigation reduces the spread, preventing hospitals from being overwhelmed with sick patients, the virus may persist longer in the community as a result, lengthening the duration of restrictions.

But this comes at an economic cost, the elephant in the room that few want to talk about. Do we rip the band-aid off quickly, causing more short-term pain, or remove it slowly, causing only discomfort, but for a much longer time? There is no right answer here. Sweden is trying its own “no lockdown” approach, radically different from its neighbors. Time will tell if Sweden’s plan worked. Perhaps every country, just like every state, needs a different approach, based on their unique circumstances.

How does America thread the needle between economic and public health? What’s the sweet spot? Both aspects must be addressed

27,000 jobs were lost from February to March, better than expected, but only the tip of the iceberg as closed businesses are forced to lay off employees in the coming weeks. 6.6 million Americans filed for unemployment last week, not surprisingly a record high. The stock market lost a third of its value over the past month, decimating savings and retirement accounts. Those who are healthy, willing, and able to work cannot until the stay-at-home restrictions are lifted at the end of April. At least that’s the plan. What if it goes on longer?

Economist Herbert Stein once said, “If something can’t go on forever, it will stop.” One could say that about a viral pandemic or an economic shutdown. Viruses eventually burn themselves out, after more and more are infected, recovering with immunity, diminishing the number of potential hosts to infect. A virus can’t go on forever and it too will stop.

An economy with massive business failures and depression level unemployment cannot go on forever either. Fewer people working means fewer earning, without money to spend on those goods and services still provided.

Government assistance goes just so far. Massive stimulus bills, each in the trillions of dollars, not far from normal government expenditures each year, adds to an ever-growing national debt. Relief is available to businesses able to navigate the myriad rules and regulations attached to anything emanating from Congress.

If printing money can’t go on forever, it too will eventually stop. There is talk of stimulus 4 and 5. Soon there will be more stimulus sequels than the Fast and Furious movie franchise. Businesses are becoming insolvent at an exponential rate. It is estimated that half of small businesses have enough cash on hand to survive only 27 days without new money coming in. Can a country also become insolvent and bankrupt? Does anyone want to really know the answer?

Then there are the social costs of a prolonged economic and social shutdown. This headline from the Colorado Independent sums it up, “Amid coronavirus quarantines and job losses, Colorado girds for wave of domestic violence.” Quarantines may keep families confined under one roof, but when stress levels reach a certain point, things can pop.

What else follows in an atmosphere of economic helplessness and hopelessness? Mental health issues, including depression and suicide. The Suicide Prevention Resource Center is prepared with resources to support coping and mental health with coronavirus.

Mother Jones reports, “The mental health effects of coronavirus are a slow-motion disaster.” Phones at the federal Disaster Distress Helpline are ringing off the hook, far more than for past major hurricanes.

Substance abuse will rise, as Business Insider reported, “…the trauma of a pandemic may cause a spike in addiction.” There is certainly precedent, “The hospitalization rate for alcohol use disorders rose 35% in the wake of Hurricane Katrina.” That was only one city, the virus is affecting the entire world.

Apart from virus fatalities, what will the numbers be for suicides, domestic violence, homicides, and overdoses? Few want to discuss this elephant in the room.

While most Americans are obeying stay-at-home orders, how long will such obedience last? If social order can’t go on forever, it will stop. As Italy hits four weeks on lockdown, social unrest is spreading. First responders, including police, are not immune from the virus and as their ranks diminish, who will keep the order?

Keeping people at home and not working mitigates viral spread but the longer the economy is shut down, the deeper and more widespread the resulting economic misery. Where is the sweet spot, enough virus containment without irreparably destroying the economy?

That the question President Trump and his task force wrestle with every day. There are huge downsides to getting it wrong, in either direction. And the sweet spot may be different in Colorado than in New York City.

The U.S. economy, just a month ago setting records, has been shut down. This is analogous to those severely afflicted with the virus, in an ICU, in a medically induced coma while their lungs heal. But this can’t go on forever and won’t. Sick patients eventually recover, or they don’t. Will the economy follow a similar course?

Humans need predictability in their lives. Now we have only uncertainty. How long can that go on? Costs are adding up both on the medical and economic side.

Economic and public health both need to be topics of discussion. There is no magic formula, only the wisdom and best judgement of those making these decisions. Such discussions will be painful and there will be reasonable disagreements, much like daily discussions in ICUs today regarding palliative care. But these topics can’t be ignored.

Despite those in the media claiming to know more than the President and his team, they don’t. It’s President Trump, and other world leaders, who have the unenviable job of deciding where the sweet spot is, the balance between public health and economic health. Pray that they get it right.

Brian C Joondeph, MD, is a Denver based physician and freelance writer whose pieces have appeared in American Thinker, Daily Caller, Rasmussen Reports, and other publications. Follow him on Facebook,  LinkedIn, Twitter, and QuodVerum.