I have written several articles on the coronavirus and on masks.
A series of links have been provided at the bottom of this article for your convenience.
This article will, however address a different aspect of the virus.
Our governmental COVID-19 mitigation policy of broad societal lockdown focuses on containing the spread of the disease at all costs, instead of “flattening the curve” and preventing hospital overcrowding. Although well-intentioned, the lockdown was imposed without consideration of its consequences beyond those directly from the pandemic. Although decisions have been made by state and sometimes local officials, the United States is effectively subject to a national lockdown. States representing 95 percent of the economy are subject to statewide public health–motivated shutdowns. In response to the novel and deadly coronavirus, many governments deployed draconian tactics never used in modern times: severe and broad restrictions on daily activity that helped send the world into its deepest peacetime slump since the Great Depression.
The policies have created the greatest global economic disruption in history, with trillions of dollars of lost economic output. These financial losses have been falsely portrayed as purely economic. The equivalent of 400 million jobs have been lost world-wide, 13 million in the U.S. alone. Global output is on track to fall 5% this year, far worse than during the financial crisis, according to the International Monetary Fund. To the contrary, using numerous National Institutes of Health Public Access publications, Centers for Disease Control and Prevention (CDC) and Bureau of Labor Statistics data, and various actuarial tables, we calculate that these policies will cause devastating non-economic consequences that will total millions of accumulated years of life lost in the United States, far beyond what the virus itself has caused.
Pandemics have afflicted humankind throughout history. They devastated the Roman and Byzantine empires, Medieval Europe, China and India, and they continue to the present day despite medical progress.
The past century has witnessed three pandemics with at least 100,000 U.S. fatalities: The “Spanish Flu,” 1918-1919, with between 20 million and 50 million fatalities worldwide, including 675,000 in the U.S.; the “Asian Flu,” 1957-1958, with about 1.1 million deaths worldwide, 116,000 of those in the U.S.; and the “Hong Kong Flu,” 1968-1972, with about 1 million people worldwide, including 100,000 in the U.S. So far, the current pandemic has produced almost 100,000 U.S. deaths, but the reaction of a near-complete economic shutdown is unprecedented.
The lost economic output in the U.S. alone is estimated to be 5 percent of GDP, or $1.1 trillion for every month of the economic shutdown. This lost income results in lost lives as the stresses of unemployment and providing basic needs increase the incidence of suicide, alcohol or drug abuse, and stress-induced illnesses. These effects are particularly severe on the lower-income populace, as they are more likely to lose their jobs, and mortality rates are much higher for lower-income individuals.
Statistically, every $10 million to $24 million lost in U.S. incomes results in one additional death. One portion of this effect is through unemployment, which leads to an average increase in mortality of at least 60 percent. That translates into 7,200 lives lost per month among the 36 million newly unemployed Americans, over 40 percent of whom are not expected to regain their jobs. In addition, many small business owners are near financial collapse, creating lost wealth that results in mortality increases of 50 percent. With an average estimate of one additional lost life per $17 million income loss, that would translate to 65,000 lives lost in the U.S. for each month because of the economic shutdown.
In addition to lives lost because of lost income, lives also are lost due to delayed or foregone health care imposed by the shutdown and the fear it creates among patients. From personal communications with neurosurgery colleagues, about half of their patients have not appeared for treatment of disease which, left untreated, risks brain hemorrhage, paralysis or death.
Here are the examples of missed health care on which we base our calculations: Emergency stroke evaluations are down 40 percent. Of the 650,000 cancer patients receiving chemotherapy in the United States, an estimated half are missing their treatments. Of the 150,000 new cancer cases typically discovered each month in the U.S., most – as elsewhere in the world – are not being diagnosed, and two-thirds to three-fourths of routine cancer screenings are not happening because of shutdown policies and fear among the population. Nearly 85 percent fewer living-donor transplants are occurring now, compared to the same period last year. In addition, more than half of childhood vaccinations are not being performed, setting up the potential of a massive future health disaster. We do not consider social or public health costs such as increased child abuse, suicides, drug abuse, alcoholism, domestic violence, and other crimes that may be associated with the substantial economic reverses that the United States is enduring. Although difficult to quantify, these are likely to be significant.
The implications of treatment delays for situations other than COVID-19 result in 8,000 U.S. deaths per month of the shutdown, or about 120,000 years of remaining life. Missed strokes contribute an additional loss of 100,000 years of life for each month; late cancer diagnoses lose 250,000 years of remaining life for each month; missing living-donor transplants, another 5,000 years of life per month — and, if even 10 percent of vaccinations are not done, the result is an additional 24,000 years of life lost each month.
These unintended consequences of missed health care amount to more than 500,000 lost years of life per month, not including all the other known skipped care. If we only consider unemployment-related fatalities from the economic shutdown, that would total at least an additional 7,200 lives per month. Assuming these deaths occur proportionally across the ages of current U.S. mortality data, and equally among men and women, this amounts to more than 200,000 lost years of life for each month of the economic shutdown.
In comparison, COVID-19 fatalities have fallen disproportionately on the elderly, particularly in nursing homes, and those with co-morbidities. Based on the expected remaining lifetimes of these COVID-19 patients, and given that 40 percent of deaths are in nursing homes, the disease has been responsible for 800,000 lost years of life so far. Considering only the losses of life from missed health care and unemployment due solely to the lockdown policy, we conservatively estimate that the national lockdown is responsible for at least 700,000 lost years of life every month, or about 1.5 million so far — already far surpassing the COVID-19 total.
Policymakers combatting the effects of COVID-19 must recognize and consider the full impact of their decisions. They need to be aware of the devastating effects in terms of lost life from shutting down significant parts of the economy. The belated acknowledgement by policy leaders of irreparable harms from the lockdown is not nearly enough. They need to emphatically and widely inform the public of these serious consequences and reassure them of their concern for all human life by strongly articulating the rationale for reopening society.
To end the loss of life from the economic lockdown, businesses as well as K-12 schools, public transportation, parks and beaches should smartly reopen with enhanced hygiene and science-based protection warnings for any in the high-risk population. For most of the country, that reopening should occur now, without any unnecessary fear-based restrictions, many of which repeat the error of disregarding the evidence. By following a thoughtful analysis that finally recognizes all available actions and their consequences, we can save millions of years of American life. When the next pandemic inevitably arises, we need to remember these lessons and follow policies that consider the lives of all Americans from the outset.
Several months later, the evidence suggests lockdowns were an overly blunt and economically costly tool. They are politically difficult to keep in place for long enough to stamp out the virus. The evidence also points to alternative strategies that could slow the spread of the epidemic at much less cost. As cases flare up throughout the U.S., some experts are urging policy makers to pursue these more targeted restrictions and interventions rather than another crippling round of lockdowns.
“We’re on the cusp of an economic catastrophe,” said James Stock, a Harvard University economist who, with Harvard epidemiologist Michael Mina and others, is modeling how to avoid a surge in deaths without a deeply damaging lockdown. “We can avoid the worst of that catastrophe by being disciplined,” Mr. Stock said.
The economic pain from pandemics mostly comes not from sick people but from healthy people trying not to get sick: consumers and workers who stay home, and businesses that rearrange or suspend production. A lot of this is voluntary, so some economic hit is inevitable whether or not governments impose restrictions. Still, because of the close connection between the pandemic and economic activity, many epidemiologists and economists say the economy can’t recover while the virus is out of control. “The virus is going to determine when we can safely reopen,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in April. The Federal Reserve said in late July that “the path of the economy will depend significantly on the course of the virus.”
Such statements leave wide open what represents an acceptable level of infection, which in turn determines what restrictions to impose. If the only acceptable level of infection were zero, lockdowns would have to be severe and potentially repeated, or at least until an effective vaccine or treatment comes along. Most countries have rejected that course.
Prior to Covid-19, lockdowns weren’t part of the standard epidemic tool kit, which was primarily designed with flu in mind.
During the 1918-1919 flu pandemic, some American cities closed schools, churches and theaters, banned large gatherings and funerals and restricted store hours. But none imposed stay-at-home orders or closed all nonessential businesses. No such measures were imposed during the 1957 flu pandemic, the next-deadliest one; even schools stayed open.
Lockdowns weren’t part of the contemporary playbook, either. Canada’s pandemic guidelines concluded that restrictions on movement were “impractical, if not impossible.” The U.S. Centers for Disease Control and Prevention, in its 2017 community mitigation guidelines for pandemic flu, didn’t recommend stay-at-home orders or closing nonessential businesses even for a flu as severe as the one a century ago.
So when China locked down Wuhan and surrounding Hubei province in January, and Italy imposed blanket stay-at-home orders in March, many epidemiologists elsewhere thought the steps were unnecessarily harmful and potentially ineffective.
By late March, they had changed their minds. The sight of hospitals in Italy overwhelmed with dying patients shocked people in other countries. Covid-19 was much deadlier than flu, it was able to spread asymptomatically, and it had no vaccine or effective therapy.
Taiwan, South Korea and Hong Kong set early examples of how to stop Covid-19 without lockdowns. Their reflexes trained by SARS in 2003, MERS and avian flu, they quickly cut travel to China, introduced widespread testing to isolate the infected and traced contacts. Their populations quickly donned face masks.
Sweden took a different approach. Instead of lockdowns, it imposed only modest restrictions to keep cases at levels its hospitals could handle.
Sweden has suffered more deaths per capita than neighboring Denmark but fewer than Britain, and it has paid less of an economic price than either, according to JPMorgan Chase & Co.
Sweden’s current infection and death rates are as low as the rest of Europe’s. That has prompted speculation that it is pursuing herd immunity—the point when enough of the population is immune, due to prior exposure or vaccination, so that person-to-person transmission declines and the epidemic dies out. There is no consensus on where that point is, in Sweden or elsewhere.
By March, it was too late for the U.S. to emulate the test-and-trace strategy of east Asia. The CDC had botched the initial development and distribution of tests, and limited testing capacity meant countless infections went undetected for months. President Trump continued to downplay testing, and even today the U.S. conducts fewer than 20 tests for every confirmed case, compared with more than 500 in Taiwan and South Korea at their peaks.
The Swedish strategy was also taken off the table. Britain ditched it in mid-March after a team of experts from London’s Imperial College predicted that in the absence of social distancing, 81% of the population would eventually be infected, while 510,000 people would die in Britain and 2.2 million in the U.S.
Those estimates may have been high. Some experts think it takes less than 81% of a population to reach herd immunity. Nonetheless, such predictions helped persuade leaders in Britain and the U.S. to lock down.
Yet at the outset, their goals were unclear, a confusion aggravated by the multitude of terms used. Officials sometimes said their goal was “bending” or “flattening the curve,” which originally meant spreading infections over time so the daily peak never overwhelmed hospitals. At other times they described their aims as “mitigation” or “containment” or “suppression,” often interchangeably.
“There have been few attempts to truly define the goal, and partly it’s because policy makers and epidemiologists haven’t thought well enough about the vocabulary to define what they mean or want,” said Dr. Mina, the Harvard epidemiologist.
A key determinant in an epidemic’s spread is the reproduction number, or “R value”: how many people each infected person goes on to infect. When R is above one, new infections continue until enough of the population has been infected or vaccinated to achieve herd immunity. When R is below one, new infections eventually fall to zero, although imported infections can trigger outbreaks. Dr. Mina said mitigation generally aims for an R of just above one, while suppression aims for an R of below one.
The U.S. never resolved “whether we were going for mitigation or suppression,” said Paul Romer, a Nobel laureate economist. Mitigation, he said, meant accepting hundreds of thousands of additional deaths to achieve herd immunity, which no leaders were willing to embrace. But total suppression of the disease “doesn’t make sense unless you’re going to stick with it as long as it takes.”
Some countries did achieve suppression through lockdowns. China wiped out the epidemic in Hubei province and has suppressed subsequent outbreaks elsewhere, with sweeping quarantine and surveillance methods that are difficult to replicate in Western democracies.
New Zealand imposed one of the most stringent lockdowns for two months. The country—relatively small and geographically isolated—went on to enjoy 102 days without a new case. Nonetheless, an outbreak this month prompted a reimposition of widespread restrictions.
The U.S. for the most part lacked China’s authoritarian bent and New Zealand’s patience. Asked in March if lockdowns would last months, President Trump replied: “I hope it disappears faster than that.” Indeed, at the end of March his health advisers suggested one more month of restrictions would be enough.
In mid-April, his health advisers issued guidelines for when states with lockdowns should reopen, including 14 days of declining cases and the ability to test and trace anyone with flulike symptoms. “The predominant and completely driving element that we put into this was the safety and the health of the American public,” Dr. Fauci told reporters.
But that same day Mr. Trump made it clear his priority was the economy: “A prolonged lockdown combined with a forced economic depression would inflict an immense and wide-ranging toll on public health,” he said. Within weeks he was praising states that had reopened despite not meeting the guidelines and was tweeting “LIBERATE” to supporters protesting lockdowns.
Many Republican governors prioritized their economies, but some Democrats more committed to lockdowns also struggled to stay the course. When California became the first state to issue a stay-at-home order on March 19, its Democratic governor, Gavin Newsom, said the goal was to “bend the curve.”
The experience of the past several months suggests the need for an alternative: Rather than lockdowns, using only those measures proven to maximize lives saved while minimizing economic and social disruption. “Emphasize the reopening of the highest economic benefit, lowest risk endeavors,” said Dr. Mina.
Social distancing policies, for instance, can take into account widely varying risks by age. The virus is especially deadly for the elderly. Nursing homes account for 0.6% of the population but 45% of Covid fatalities, says the Foundation for Research on Equal Opportunity, a free market think tank. Better isolating those residents would have saved many lives at little economic cost, it says.
By contrast, fewer children have died this year from Covid-19 than from flu. And studies in Sweden, where most schools stayed open, and the Netherlands, where they reopened in May, found teachers at no greater risk than the overall population. This suggests reopening schools outside of hot spots, with protective measures, shouldn’t worsen the epidemic, while alleviating the toll on working parents and on children.
If schools don’t reopen until next January, McKinsey & Co. estimates, low-income children will have lost a year of education, which it says translates into 4% lower lifetime earnings.
Research by Dr. Mina and others has shown that “super-spreader” events contribute disproportionately to infections, in particular dense indoor gatherings with talking, singing and shouting, such as at weddings, sporting events, religious services, nightclubs and bars.
Bars and restaurants accounted for 16% of Covid-19 clusters (five or more cases) in Japan; workplaces, just 11%. Bars, restaurants and casinos accounted for 32% of infections traced to multiple-case outbreaks in Louisiana.
Masks may be the most cost-effective intervention of all. Both the World Health Organization and the U.S. Surgeon General discouraged their use for months despite prior CDC guidance that they could limit the spread of flu by preventing the wearer from transmitting the disease.
The German city of Jena in early April ordered residents to wear masks in public places, public transit and at work. Soon afterward, infections came to a halt. Comparing it to similar cities, a study for the IZA Institute of Labor Economics estimated masks reduced the growth of infections by 40% to 60%.
Klaus Wälde, one of the authors, said nationwide mask wearing is helping the German economy return to normal while keeping infections low. Goldman Sachs Group Inc. estimates a universal mask mandate in the U.S. could now save 5% of gross domestic product by substituting for more onerous lockdowns.
It is evident that we have to open up country. Prolonged closures are causing undue harm to our people and to our economy. Social distancing and mask wearing are having some effects, to slow down the spread of the disease. We need herd immunity and a vaccine. They are the only way we are going to get back to the old normal. I refuse to believe that we have to live in a new normal where masks wearing is the norm. It is not natural and it is harmful. It prevents people from developing relationships. It is harming our children. We are going to have a generation of recluses and introverts, people that don’t know how to interact socially. It started with video games and cell phones, now it is becoming worse because of a virus. We are social creatures. Studies have shown that single people who live alone and have few friends, tend to have shorter life expectancies. A hug a day is good medicine. We need physical contact. There is a reason that sex is called making love. It helps to reinforce relationships between couples. We also need fresh air and sunshine. The utilization of Vitamin D requires sunlight to be effective. We can’t be locked away in our basements.
thehill.com, “The COVID-19 shutdown will cost Americans millions of years of life,” BY SCOTT W. ATLAS, JOHN R. BIRGE, RALPH L KEENEY AND ALEXANDER LIPTON; heritage.org, “The Cost of Coronavirus Shutdown Orders,” By Norbert Michel and David Burton; wsj.com, “New Thinking on Covid Lockdowns: They’re Overly Blunt and Costly,” By Greg Ip;
covid-19 and Healthcare Postings