A commentary by an adjunct professor of health policy at Simon Fraser University.
The end of the world as it was in 2019 has been proclaimed, the planet now under permanent siege to an endless series of novel coronavirus-like pathogens. The economy must be rebuilt on different foundations. Cities will barely resemble their former selves. Flasks of hand sanitizer will be tomorrow’s water bottles and the shuttered shopping mall will be the new Stonehenge.
The old normal wasn’t Eden: Planet-destroying fossil-fuel dependency, obscene wealth concentration, unaffordable housing, critical infrastructure decay, overburdened public transit, underinvestment in vaccine development and immunology research.
But there was also unwary human contact, freedom of movement, maskless faces, busy cafés, peaceful demonstrations, game night, concerts in the park. I miss it.
I’ll give it up if there is no other pathway to self-preservation, but I need proof that a) life as we knew cannot be made safe enough to resume; and b) the benefits of the proposed remedy — fundamental redesign of how we live, work, play, and entertain ourselves — outweighs the costs, notably the risks to physical and mental health and overall well-being.
Jurisdictions are reopening their economies, most slowly and in stages, their plans comprehensive, staged and prolonged. Incremental liberty is to be earned through adherence to a long list of behavioural injunctions for businesses and individuals, some of which may be permanent. Risk aversion rules.
But only the risk of harm from COVID-19 infection.
Every day of suspended economic and social activity causes predicable harm. The short-term effects include an increase in domestic violence, deteriorating mental health and a surge in suicides.
Shutting down elective surgeries adds months of misery to the lives of people awaiting procedures. Sudden job loss almost instantly increases the risk of stroke and heart disease among middle-aged people.
The long-term impact is even more devastating. A European study found that involuntary unemployment during the first decade in the workforce results in a six percentage point increase in the proportion self-rating their health status as fair or poor — 30 years later. Each one per cent increase in unemployment generates a two per cent increase in the incidence of chronic disease.
As usual, the poor bear the brunt of the costs. Globally, five per cent contraction in income or consumption could plunge 100 million people into poverty. At 20 per cent, these numbers could quadruple.
For some, the health impact will be immediate: Starvation, the inability to access even basic health care, lower levels of immunization and the violence that often accompanies deprivation. Others will decline and die later; they will not be counted as pandemic-related deaths, and their numbers will blend into overall mortality figures. They will be invisible victims whose health and lives are steeply discounted.
Whatever we do to contain the pandemic is, then, a trade-off against some present, and a great deal of future health and well-being. Focusing only on the short-term impact of the pathogen amounts to pandemic exceptionalism: Nothing else matters and no costs are too high to bear in the battle against COVID-19.
Other things — sickness and deaths due to other causes, general well-being — ought to matter. Trade-offs are the DNA of public policy formulation. Drug-plan decisions to cover some drugs and not others knowingly prolong some lives at the expense of others. Twinning every highway would save lives, but no government twins every highway.
“You can’t put a price on life” is not just demonstrably false. Policymakers have an ethical obligation to put a price on lives and justify why they value some more highly than others.
Preventing harm caused by COVID-19 infections is a benefit. The harm caused by prolonged economic shutdown is a cost. No reasonable notion of distributive justice could possibly conclude that the benefits of the former invariably outweigh the costs of the latter. At some point that trade-off becomes irresponsibly short-sighted and at worst an ethical travesty.
Is it acceptable to cause 1,000 future deaths by prolonged economic slowdown to prevent 1,000 COVID-19 deaths now? Sure. Fifteen thousand vs. 1,000? Doubtful. Where should we draw the line? I don’t know, but we must draw it somewhere. We can’t draw it sensibly if we don’t recognize the trade-off and do the math.
The stakes are incredibly high. Perhaps we can sustain and recover from the economic shock once. If every novel outbreak triggers a similar economic paralysis, it may not be possible to keep pulling multi-trillion-dollar stimulus packages out of the hat. In that case the health and social impact of prolonged economic disruption will be even more catastrophic.
Categorical refusal to investigate the feasibility of rapid and near-complete normalization locks in devastating current and future economic and social harms. If we never test how much can be restored quickly, we may doom ourselves to recurring and massive lockdowns followed by lengthy recovery periods. The result will be countless lives permanently diminished.
That is a Hobbesian future, solitary, poor, nasty, brutish and, for too many, too short.