Deadly Quarantine: Accounting for Total Costs in a Pandemic
COMMENTARY: Coronavirus threw the mighty engine of the U.S. economy into emergency shutdown and slammed straight into one of the oldest of questions: At what cost?
We saw the videos. Dystopian rioters in Walmart were fighting over toilet paper as local governments shut down businesses — and shut us in. In the end, the run on supplies was really a proxy for people’s deeper fears about their own mortality, up against an unseen lethal virus with no known cure. We all surprisingly and quickly became conversant with a whole new vocabulary: “flattening the curve,” “social distancing” and “transmission rates” became a part of dinnertime conversation.
And we all stayed home. The most powerful call was the one to altruism: Stay home to protect others. Don’t be an agent of transmission. And so we did.
Americans value the individual. We rally to save the one. The child who has fallen down the mine shaft. The teen who needs a transplant. The mother with cancer who needs a cure. Protecting each individual life is among our highest values faithful to the tradition of Catholic Social Teaching.
We threw the mighty engine of the American economy into emergency shutdown and slammed straight into one of the oldest of questions: At what cost? The economy shut down into Depression-level unemployment and businesses with household names like Hertz Rent-a-Car and J. Crew declared bankruptcy. It was, some argued, the necessary price to pay to save lives.
Indeed, we can say with certainty that collapsing the economy by placing the entire country in quarantine did save at least one life. Even using the wildly wrong death projections of more than 2 million without the lockdown, the loss of life is down to a fraction of the original graph that generated so much fear and propelled dramatic action.
Rooted in the incalculable worth of the individual, our current conundrum is shaping the correct public policy to save the greatest number of lives. The United States Conference of Catholic Bishops gives us direction through the foundational doctrine of the essential value of human dignity:
The basis for all that the Church believes about the moral dimensions of economic life is its vision of the transcendent worth — the sacredness — of human beings. The dignity of the human person, realized in community with others, is the criterion against which all aspects of economic life must be measured.
But as the costs on the other side of the lockdown ledger have burgeoned, the arithmetic of destruction looks more complicated every day. The “cost of despair” has too many variables to accurately measure directly in real time.
How could we construct those models? How many children will die from delayed vaccines? How many lives shortened by a postponed hip replacement? How many suicides by uncertainty? Or because a bookstore was forced to close?
The economic cost of an individual human life is an age-old philosophical question. But this crisis, where the medical recommendations necessitated widespread economic sacrifice, was an unusually stark rendition of the calculus. Is it possible to take, well, a business-like approach to life and death? What does a cost-benefit tradeoff look like when life itself is on the line?
Getting the numbers right and the right numbers is foundational to decision-making. And these essential details have turned out to be a central issue in this crisis. Confusion and conflicting calculations have predominated. The computer science of Garbage In, Garbage Out meets the sausage-making of political science. What, and who, can be trusted?
As of this writing a number of states are concerned about inaccurate documentation of the cause of death. Colorado is now “reclassifying causes of death…” Writing for National Review, John Fund and Phil Kerpen reviewed the death data and found that public health officials are confusing dying “with” COVID-19 and dying “from” the virus. Mortality from the coronavirus now appears to be some 25% lower than originally reported, according to the Denver Post.
Conversely, The New York Times, reporting on data released by the Centers for Disease Control, alleges that the body count is too low by looking at something called “excess deaths,” which is a comparison of deaths from this year to a similar time period in other years. Looking at the data from the previous five years, reporters Josh Katz, Denise Lu and Margot Sanger-Katz conclude: “The number of Americans who have died in recent weeks is much higher than normal.”
The elevated death toll may be attributed to the coronavirus. But a true assessment of the cost of our public policy decisions must include a figure known as “total deaths.” We have the coronavirus death-toll tally, such as it is, on one side of the balance. Dr. Marc Siegel, a professor of medicine at New York University's School of Medicine, reminds us that there is an opposing counterweight to add to total deaths. In addition to the significant economic consequences, lockdowns also generate mental and emotional crises.
“Suicide, drug abuse, alcoholism,” Siegel told FoxNews. "There are going to be more deaths of despair than from the virus itself.”
Siegel is not alone in this concern. On May 19, 600 doctors wrote a letter to President Trump on the cost of a national shutdown, calling it “a mass casualty event:”
“The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction…”
One objective measurement of an increase in mental health issues would be outreach to the Federal Disaster Distress Helpline. The Washington Post reported that texts to the hotline increased from 1,790 texts in April of last year to around 20,000 this April.
The despair can also be measured in drug overdose. In 2017, researchers from the National Bureau of Economic Research found that for every 1% increase in unemployment, there is a 3.6% increase in the opioid death rate. That alone is troubling. But they found further that emergency room visits for overdose increase by a full 7%.
What does that begin to look like when unemployment is now projected to exceed 30%?
In their letter to the president, the doctors also noted that every month, 150,000 Americans receive a new cancer diagnosis through routine screening. Or they did, until the shutdown precluded such screening in many cases. Let’s look for example at lung cancer, which is the leading cancer killer for both men and women. The survival rate is influenced dramatically by early detection. The American Lung Association estimates that screening high-risk individuals can increase survival rates by up to 20%. But routine screenings for any kind of cancer have also abruptly halted.
Catholic Social Teaching
What then shall we do, with lives at stake on both sides of the ledger? In this uncomfortable space is precisely where the Church is called to live and speak. Developed over centuries of addressing the question of how the state approaches the difficult questions of preserving life and advancing justice, Catholic Social Teaching offers guidance for those of all faiths — or no faith tradition. The classic precepts of subsidiarity and solidarity provide guideposts to mark the way.
As Americans faced the escalating fear over the spread of the virus, calls increased for a national plan and a federal approach. But looking toward the federal government for a local solution is an upside-down, lopsided approach to the Church’s teaching on how to best care for the sick, the widow and the “least among us.”
The American federalist system, where most governing is delegated to the state and local leaders, reflects the same principle as the Catholic doctrine of subsidiarity. Decision-making should be relocated from elites on-high to those closest to the problem or opportunity.
Managing a tradeoff as complicated as the one the virus presents requires local control. The National Coronavirus Recovery Commission, convened by the Heritage Foundation, recommended local decision-making as the best approach for both health and the economy. This is the wisdom of subsidiarity in action. The chairman of the commission, Kay Coles James, president and CEO of The Heritage Foundation, writes on solutions to managing COVID-19:
The first thing to understand is there is no single national solution. What works in Wyoming won’t be as relevant in Manhattan. State leaders, more so than the federal government, must drive the decision-making.
Subsidiarity provides the conditions for building solidarity. A focus on the local brings community into high relief. And this is where we truly support one another. We are not alone and not designed to be isolated islands unto ourselves. Solidarity is more than the assembly of believers for Mass on Sundays. We also strive for the common good, the total of conditions to enable all people to flourish. I am, indeed, my brother’s keeper.
Without the essential building block of trust, society fractures. The shoppers fighting over toilet paper were stockpiling a critical commodity. The rioters did not trust their local government or our city mayors. There was no trust in the management of supply chains, nor in the promises that quarantine was for the best. The sense of solidarity — of having the solid ground of community supporting them — had frayed.
Pope St. John Paul II predicted that “our cities risk becoming societies of people who are rejected, marginalized, uprooted, and oppressed, instead of communities of ‘people living together.’”
Church teachings, based on timeless tradition and foundational principles, show us a path forward for the hard public policy decisions — and also for building the communities that sustain us through difficult times.
Jack Yoest is assistant professor of practice in leadership and management at The Catholic University of America’s Busch School of Business in Washington, D.C. He served as assistant secretary for Health and Human Resources in the Commonwealth of Virginia. He is the author of The Memo: How the Classified Military Document That Helped the U.S. Win WWII Can Help You Succeed in Business