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4/23/20, 9)17 AMThe Cold Calculations Americaʼs Leaders Will Have to Make Before Reopening - The New York Times

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With no vaccine or cure, the president, governors, mayors and county executives will have to decide how many deaths would be acceptable to restore a shattered economy.

By Peter Baker

April 22, 2020

WASHINGTON — How many deaths are acceptable to reopen the country before the

coronavirus is completely eradicated? “One is too many,” President Trump insists, a politically

safe formulation that any leader would instinctively articulate.

But that is not the reality of Mr. Trump’s reopen-soon approach. Nor for that matter will it be the

bottom line for even those governors who want to go slower. Until there is a vaccine or a cure for

the coronavirus, the macabre truth is that any plan to begin restoring public life invariably

means trading away some lives. The question is how far will leaders go to keep it to a minimum.

Some of the more provocative voices on the political right say that with tens of millions of

Americans out of work and businesses collapsing, some people must be sacrificed for the greater

good of restoring the economy quickly. To many, that sounds unthinkable, but less inflammatory

experts and policymakers also acknowledge that there are enormous costs to keeping so much of

the work force idle, with many of the unemployed struggling to pay for food, shelter or medical

care for other health challenges.

And so the nation’s leaders are left with the excruciating dilemma of figuring out how to balance

life and livelihood on a scale unseen in generations. “Every governor in the nation is asking that,”

Gov. Gretchen Whitmer of Michigan, where 2,700 have died and more than 1 million have lost

The Cold Calculations America’s Leaders Will Have to

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jobs, said this week. “There’s no such thing as zero risk in the world in which we’re living. But we

know that not taking measures to control the spread means that’s going to translate into lives

lost.”

With no cure available for the coronavirus and no vaccine likely for another year or more,

governors in hard-hit states are seeking ways to minimize the number of additional deaths by

staging and structuring any reopening. Time and testing are key, according to public health

experts. The longer a quarantine can be extended the better, they say, and the more testing made

available, the easier it would be to properly calibrate a reopening and respond to any new

outbreak.

Pushing to restore business sooner rather than later, Mr. Trump has dismissed waiting until

comprehensive testing provides a better map of where the infection has spread. Instead, the

federal government’s guidelines envision “sentinel surveillance” testing of vulnerable places like

nursing homes and inner-city health centers, while gradually reopening businesses, schools and

other venues in stages with precautions like masks, gloves and social distancing.

All of which could mitigate future infections but would not halt them. The reason the death toll

projection may be closer to 60,000 rather than the 2 million of one estimate was because society

largely shut down. One recent study said that the 60,000 deaths would have been 6,000 had

quarantine measures been imposed just two weeks earlier. So easing measures means the death

toll will go up even with safeguards.

But remaining closed is not without a cost either. In just four weeks, a staggering 22 million

Americans have lost their jobs, the equivalent of the entire labor force of 23 states.

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The question divides not only the nation but even families. Rahm Emanuel, the former mayor of

Chicago and White House chief of staff, and his brother, Dr. Ezekiel J. Emanuel, a prominent

medical ethicist and vice provost of global initiatives at the University of Pennsylvania, have

engaged in a running quarrel about how soon society should reopen.

Rahm Emanuel considers it untenable to keep most of the country closed until the virus is

completely under control, while Ezekiel Emanuel maintains that the pandemic is too much of a

threat to rush back to life as usual.

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President Trump has dismissed the idea of waiting until comprehensive testing allows communities to better understand how far the virus has spread. Anna Moneymaker/The New York Times

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“There’s nothing you can do risk free. Nothing,” Rahm Emanuel said last week. “And the missing

ingredient is what do you think the public can accept and what will you do to be forthright and

honest?” The public, he said, understands that life comes with peril as long as measures are

taken to minimize it. “If you reduce the speed limit dramatically, you’d have less deaths,” Mr.

Emanuel said. “But we allow it to go to a certain level.”

In a separate call, Ezekiel Emanuel said: “I think Rahm is wrong on how bad it could be by

letting it run around the population. I’m not for keeping the economy closed forever. Sometimes

my brother paints me in a picture. But you have to do it safely. Safely doesn’t mean no deaths. I

never said no Covid deaths. But you have to do it in a way that is measured, not irresponsible

where you’re going to get to 2 million deaths.”

The trade-offs have stirred angry exchanges since the start of the lockdowns. Lt. Gov. Dan

Patrick of Texas, who is 70, said last month that older people like himself should be ready to risk

death to save the economy for their grandchildren, comments he defended on Fox News on

Monday night. In a separate appearance on Fox last week, Dr. Mehmet Oz, the television host,

cited a study to argue that reopening schools “may only cost us 2 to 3 percent in terms of total

mortality,” calling it “a trade-off some folks would consider.” After a backlash, he said he

“misspoke” and expressed regret that he “confused and upset people.”

Some of those charged with making these decisions said far more information is required to

reopen with enough confidence to constrain further spread of the virus and avoid a deadly

second wave. Gov. Philip D. Murphy of New Jersey said his state would need to double the

number of tests.

“You have to crack the back of the personal health piece before you can crack the back of the

economic piece,” he said this week. Noting that 177 people in his state died the day before, he

added: “The house is still on fire and the fire brigade is still out there trying to put the fire out.”

The situation, not surprisingly, looks different in different parts of the country. The trade-offs in

Wyoming, where there have been six deaths, or in Hawaii, with 12 deaths, hardly compare to

those in New Jersey, where more than 5,000 have died, or in New York, where more than 15,000

have died.

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The United States has always tolerated a certain amount of preventable death. To use Rahm

Emanuel’s example, Americans reduce traffic fatalities by requiring seatbelts and airbags,

imposing speed limits and employing police. But until better technology is perfected, the only

way to actually stop all car crashes — banning cars — is untenable, so some deaths are

countenanced, a total of 38,800 in 2019.

Auto accidents are not communicable so not an apples-to-apples comparison to the coronavirus.

But the ordinary flu still claims thousands of lives a year — anywhere from 12,000 in the 2011-12

season up to an estimated 61,000 in 2017-18 — which society accepts without stay-at-home

orders. Those seasonal deaths, however, are spread over many months, while the coronavirus hit

with catastrophic fury in a matter of weeks and would have caused even more devastation

without the quarantines.

Government makes money-versus-lives trade-offs all the time. When a regulatory agency

weighs a new safety rule, it measures the cost to industry or consumers against the gain by

assigning a dollar value to each life that might be saved. If a new rule costs billions of dollars but

would only prevent a few dozen deaths, it likely would not be adopted — even though someone

would die as a result.

The idea that the government translates life to dollars and cents may sound bloodless but it is

not unusual. A White House report from 2017, for instance, estimated the cost of 41,000 deaths

attributed to opioid overdoses in 2015 at $431.7 billion, an average of $10.5 million per person.

By that calculation, the 60,000 deaths projected from the coronavirus would be valued at $631.8

billion — while the roughly 2 million lives theoretically saved by lockdowns would be worth

about $21 trillion, or nearly eight times the $2.7 trillion in relief spending brokered by Congress

and Treasury Secretary Steven Mnuchin.

But James H. Stock, a Harvard economist who served on President Barack Obama’s Council of

Economic Advisers, said this crisis goes beyond such ordinary calculations because a shuttered

economy represents an almost existential threat to the very idea of America.

“We really have to be talking not just about our reduction in consumption in the short run but

what this is going to be doing to the economy and the republic in the long run,” he said. “It’s those

big issues that we’ve been afraid to talk about. A year of this and we would just see an

unrecognizable transformation of what America would look like coming out of it.”

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Stephen Moore, a conservative economist who serves on Mr. Trump’s reopening committee, said

those advocating restarting the economy are caricatured as putting profits over lives.

“I reject this idea that the people who are for keeping the economy shut down are the angels

because they’re the ones who care about human life,” said Mr. Moore, who has coordinated with

lockdown protesters. “What about the poverty? What about the suicides? What about the child

abuse cases and the alcoholism and the drug overdoses and the depression and all of the

negative effects to health and well-being that are associated with an economy in recession?”

Studies show that depression, drug use and suicides spike during economic hardship, including

after the last recession, and the all-consuming focus of the medical system on the coronavirus in

certain areas has delayed other medical care. Yet that might be offset by falling violent crime,

car crashes, workplace accidents and air pollution. Vehicle collisions in California decreased by

half after its stay-at-home order went into effect while murder and air pollution are each down 25

percent in New York City.

Some scholars argue that reopening too quickly would actually hurt the economy, particularly if

it resulted in a second wave that destroyed public confidence. A study of the 1918 influenza

pandemic found that cities that closed schools and banned public gatherings earlier and kept

them shut longer not only had fewer deaths but emerged better economically.

Governor Murphy said resuming public life would not succeed if people did not feel certain that

the virus had been contained. Indeed, 76 percent of Americans said social distancing should

continue as long as needed to curb the virus even if it meant continued damage to the economy,

according to a new poll by Politico and Morning Consult, while just 14 percent favored an end to

restrictions to stimulate the economy even if it meant spreading the virus.

“If you opened every restaurant in New Jersey tomorrow, I don’t think anybody would show up,”

Governor Murphy said. “It’s not like we’re holding back some pent-up demand. I don’t blame

them — there are folks out there who are frustrated, who have cabin fever, who want to break

free. So do I, by the way. But I think folks also want to have confidence that they’re not going to

get sick and die.”

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READ MORE

Updated April 11, 2020

When will this end?

This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who

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