While daily routines and regular paychecks have come to an abrupt halt for millions in the United States as a result of the novel coronavirus outbreak, the U.S. economy and most American households are under incredible strain. The pressure to get back on track — in the middle of a pandemic that has not yet peaked — is enormous. But so are the public health perils.
If we prioritize health over the economy, or vice versa, what are the costs? The number of jobless claims on Thursday hit a record high, and Congress is poised to pass a massive emergency stimulus deal just to keep money flowing. At the same time, the U.S. now leads the world in the number of virus cases, according to one estimate. More than 1,100 Americans have already died from COVID-19 with no end in sight. The dilemma begs the question: Do we need to choose?
President Donald Trump wants the nation to return to normal life by the Easter holiday on April 12, he said on Tuesday.
“I give it two weeks,” Trump said during a Fox News town hall, suggesting a mid-April end to social distancing campaigns around the nation that aim to halt or slow the spread of the virus.
But that deadline contradicts the guidance of public health officials, who say the U.S. needs several more weeks, if not months, of social distancing to get control over this pandemic and avoid the worst-case scenario for the nation’s health care system. Trump’s words deliver “a highly dangerous message,” said Dr. Lawrence Gostin, who directs the World Health Organization Collaborating Center on National and Global Health and the O’Neill Institute for National and Global Health Law.
So far, more than 68,000 people in the U.S. have tested positive for the virus, according to the latest reporting from the Centers for Disease Control and Prevention. An estimate from Johns Hopkins University puts the number at over 82,000 cases in the U.S.
“The president is being confronted with a false choice,” said Dr. Harvey Fineberg, chair of the National Academy of Medicine’s Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats.
Instead, Fineberg suggests, the U.S. should save the economy and save lives — work to reduce the risk of more COVID-19 cases and loss of life by stabilizing public health, which would also ensure the economy could recover. Avoiding a second wave of illness would mean not suffering a repeat of the current lost productivity and uncertainty.
“We need this intensified focus, an all-out victory on the health front, so that the economy can in fact be reinvigorated with full confidence,” Fineberg said.
But getting both positive outcomes is not that easy, said Emma Rasiel, an economist at Duke University.
“This is not just saving lives -— period,” she said. “This is trading off lives saved now for life and health and basically pursuit of happiness in the years to come.” The nation must get back to normal as soon as possible, she argued, to avoid long-running consequences that could blunt life expectancies and impact long-term health if the country sinks into a deep recession.
The stock market has plunged in recent weeks, and roughly a fifth of Americans said they had already lost income or jobs due to the pandemic, according to a PBS NewsHour/NPR/Marist poll conducted March 13-14. Since then, several states and cities have issued stay-at-home orders, closing nonessential businesses to contain the virus and putting more people out of work.
More than 3.3 million people filed initial jobless claims between March 15 and March 21, according to the Department of Labor Thursday, marking the most initial claims made in a single week in history. Nearly every state blamed the pandemic for the spike in unemployment, the department said in a press release. If true, this rise would crush the nation’s 3.5 percent jobless rate that preceded the arrival of the virus in the U.S.
Should the U.S. heed the Easter deadline that Trump suggested? If the “very famous curve will be flattening” by then, Rasiel said she would defer that call to epidemiologists and medical professionals.
Health economist Michael Chernew had a somewhat different take. If the U.S. were to allow the virus to spread, unchecked by social distancing measures, the economic consequences could be massive. “Both for the health of Americans and the health of the economy, it’s probably better if we shut things down stronger and sooner,” said Chernew, a professor of health care policy at Harvard Medical School.
He believes that even if the government relaxes social distancing before the outbreak is under control, people “will naturally pull back” and avoid restaurants, movie theaters, sporting events and more to avoid exposure and potentially needing medical care.
“You’ll have some version of the exact same economic impact that you would have had if you just shut everything down,” Chernew said.
Too soon to talk timelines?
For months, the U.S. has had far too few diagnostic test kits to help health officials determine who is infected with novel coronavirus and where COVID-19 is spreading. As a result, the country was slow to recognize the extent of the outbreak and to start mitigation strategies, such as social distancing, to slow the rate of new infections and prevent hospitals and clinics nationwide from being overwhelmed by a surge of patients sick with the virus. Public health officials say these measures will help “flatten the curve,” which spreads out the number of people who are sick over a longer period of time and reduces the kind of avoidable fatalities and catastrophic outcomes that Italy faced when COVID-19 cases strained its medical system.
The U.S. is slowly ramping up testing capacity, but people across the nation are still reporting their struggles to get approved for a test. Without more tests, the U.S. doesn’t have accurate data. And data and evidence should be the basis for any timeline for dealing with a public health crisis, said Dr. Leana Wen, emergency physician and public health professor at George Washington University who previously served as Baltimore’s Health Commissioner.
Wen says it’s premature to talk about scaling back public health efforts now, adding that economic recovery is lost “if tens of thousands of patients lay dying and hospitals are overrun, with no end in sight.”
“The solution to the economic crisis is to prevent the public health crisis from turning into a societal catastrophe,” she said.
To prevent the new virus from breaking the nation’s health care system, the American Hospital Association, American Medical Association and the American Nurses Association pleaded with the public in an open letter Tuesday to stay home, which they said “is our best defense to turn the tide against COVID-19,” adding that millions more Americans must join the effort in order to contain the outbreak.
“Physicians, nurses and health care workers are staying at work for you,” the letter said. “Please stay at home for us.”
If social distancing measures are lifted too soon, data suggests the U.S. would suffer “a resurgence of cases,” as well as “patient hardships and even avoidable deaths,” the WHO’s Gostin said. He called the Easter deadline “artificial” and warned it “could badly backfire,” in large part because it “does not have sound scientific support.”
“Having a national goal of relaxing mitigation measures could significantly amplify the epidemic in America,” he said.
The path to recovery, according to health experts
To gain traction in the fight against COVID-19, Wen said the U.S. needs to do three things it’s not fully doing right now.
She would expand the health care system to handle a flood of COVID-19 patients with adequate supplies for both those being treated as well as health care providers. Social distancing measures should be broadened nationwide to reduce the rate of transmission. And testing should be expanded to everyone who needs and wants it to understand how and where the virus is really spreading.
Fineberg echoed that the nation should “rev up testing kits” to “monitor where the disease is occurring.” But he also went further, recommending that the country must adopt a far more aggressive approach to the pandemic, “as if we are in a war to win,” he said.
Trump should appoint a commander who can capitalize on civilian and military resources with state-level support, Fineberg said. Once the country can test more people and diagnose them with the virus if they are infected, the health care system should then separate people in “critical categories of care” to self-isolate patients, offer treatment and prevent further spread.
And health care workers must have enough personal protective equipment, such as face masks, respirators, gowns and gloves, so they can safely monitor and treat patients who are or may be infected.
“We would not send soldiers into battle without armor,” and it is just as inappropriate to send health care workers to see patients without protection, Fineberg contends. The nation needs “an all-out effort.”
“Right now, if we fail to do that, this will take much longer to deal with,” he said. “It will be a continuing source of drain on the economy. It will be a continuing threat to the health of the American public, and we can do better.”
Businesses want the government to contain the pandemic, Gostin said. After that happens, he said “the economy should snap back.”