It’s Not “Lives versus the economy.” It’s “Lives versus lives.”
In the wealthier parts of the world, we may be reaching the peak of Covid-19 cases (nobody knows for sure). We’ve been social distancing, closing businesses, stopping work, or working from home…in short, doing all the things that were supposed to “flatten the curve,” i.e., make the peak number of hospitalized cases smaller so that ICUs wouldn’t be overwhelmed.
ICUs? They’re overwhelmed.
Here’s a lengthy message from a USA hospital surgical nurse friend:
There are very few masks, we get a surgical mask to use all day long with patients, same mask for five days. I’ve had a few Covid rule outs(presented for surgery then discovered they had fever or cough) and you don’t get an N95 for those. You put them in isolation, use the same mask, and then if they test positive you can upgrade to an N95. Makes sense right? . And those are collected at the end of shift by a person whom then takes them for decontamination so we can reuse them, and you don’t get your own mask back . So, we are not supposed to wear makeup anymore because they can’t get those marks off the mask during the decontamination process. Gross .
Not adhering to the PPE guidelines means disciplinary action, and naming the hospital on social media posts results in disciplinary action, probably termination which has been the case with dozens and dozens of RNs around the country.
. . .
… staff are getting cross trained to Med/Surg and ICU. If/when we peak [my unit] will become a Covid ICU and we will do emergent cases in the outpatient [unit]. So life could change substantially then. What is the most maddening is people not taking it seriously. I read dozens of accounts from hotspots on nurse [social media] groups daily and also speak to friends in [other cities]. The ERs and ICUs are insane; the ratios are incredibly unsafe, they are staffing with any warm body they can, so tons of travelers sent to those areas with no ER or ICU experience, they are running out of Fentanyl and Versed, they are short on pumps so drips are being managed in burettes, documentation is minimal, basic cares don’t get done as they are constantly dealing with crashing patients, nurses are doing physician exams as they don’t enter rooms and make nurses do them… it goes on and on. What people don’t also think about and it’s obviously not reported; the patients that come in with MIs, strokes, abdo pain, they aren’t getting triaged quickly or intervened on within guidelines and also patients are not getting procedures they normally would such as cardiac caths- the docs don’t want to do them. It’s minimal intervention medicine- so the standards of care in normal times are not getting done. I’ve seen many patients myself come in for something and state they have also recently discovered a mass somewhere but the surgeons are waiting to work it up “when this is all over”. We are also seeing a huge increase in D and Cs; we aren’t sure why, maybe stress, unknown viral load? We normally do one every couple of weeks and now we are doing 4–5 a week. The impact is far reaching and won’t be measured for some time. People say the media is fear mongering, I completely disagree. If people knew the stuff that was actually going on in these hotspots, they’d never leave their house. Unfortunately due to HIPAA and fear of litigation, not many people except healthcare workers will know the truth. Many are afraid of their licenses, I don’t know how this will be handled, perhaps the community will never know the extent of mistakes being made due to acuity and lack of resources, but I’m hoping there is some sort of bill/act passed where there can’t be fault/blame to practitioners during this time. It’s really nuts. And I think it’s going to go on for a long time, a lot of places are just having a slow steady climb instead of a huge overwhelming impact, so it’s just drawing it out all over the country.
The Predictions Keep Changing
In January, a model projected as many as 65 million people worldwide could die. In early February, a different model projected that 52.9 people might die within 45 days. Now, in mid-April, total deaths are 149,000. If we’re at the peak of a perfect bell curve now, meaning half of deaths occur before and half after, that’s 300,000 deaths on the entire planet, more or less.
Current USA situation:
“Well, that just shows how effectively social distancing, stay-at-home orders, and closing all but essential businesses worked,” you might say.
Fair enough. That’s a theory that should be testable by now.
Let’s compare US states with the laxest restrictions with the ones with the strictest ones:
Here’s Arkansas, probably the least locked-down state. Arkansas closed schools and banned mass gatherings, but didn’t issue any stay-at-home order and didn’t require “non-essential” businesses to close, measures that most other states have taken to stem the spread of the SARS-COV-2 virus:
And here’s Kentucky, about a 35% larger state (about 4.4 million to Arkansas’s 2.9), but comparable in population density and wealth, which did all the things that supposedly flatten the curve:
The difference is small. The peak in daily Covid-19 deaths for low-restriction Arkansas is projected to be 4 per day, while stricter Kentucky’s is projected to top out 300% higher, at 12 per day. 300% may sound enormous. It’s almost ten times the 35% population difference. One might even imagine that this proves that Kentucky’s stricter measures actually encouraged the virus, but given the small daily numbers and the wide variations in testing availability and case definitions from hospital to hospital, the difference is almost certain to turn out to be insignificant.
Tentative conclusion number one: stay-at-home orders and business closings don’t have any measurable effect on deaths from the virus.
One caveat: both the states we examined here have low population density. They’re highly car-dependent, so people don’t pack together on buses and trains. They lack huge metropolises, with streets where people move on foot in close proximity. It might be that strict shutdowns work better in more densely peopled areas. Look how well they worked for New York City (Ouch! Maybe not.).
Take a look at the US Department of Labor unemployment claims for our two example states, Arkansas and Kentucky.
In Kentucky, after new unemployment claims averaged roughly 3,000 for the previous 12 weeks, suddenly in the week of March 21, they jumped to 49,023. The next week, 113,149. The week after that, 117,575. Once all these claims are processed and receiving benefits, the number of unemployed will clearly be at least a quarter of a million Kentuckians, or 5.7% of the state’s total population.
In Arkansas, on the other hand, unemployment still jumped, but not as high (Arkansas did close its schools and cancel sporting events, festivals, and entertainment performances, and no state is an island). From a background averaging about 1,760 weekly claims, it jumped to 9,275, then 27,756, and then most recently 62,086. It can expect, then, to have perhaps 98,000 on the unemployment roles once the claims get worked into the system, or 2.5% of the state’s population.
Tentative conclusion number two: stay-at-home orders and compulsory business closings result in much higher unemployment than canceling mass gatherings and closing schools.
Temporary unemployment has been demonstrated, in a study of 282,364 people published in the Journal of Epidemiology and Public Health, to increase all-cause mortality to 1.76 times the background level. These were USA people who were unemployed, presumably eligible for unemployment insurance benefits. This increase is due mainly to increases in heart attack deaths, stroke deaths, cancer deaths, diabetes deaths, and COPD/emphysema deaths. We’ll refer to these five as “Stress-Illness Deaths”
In light of this, let’s look at our two example states again. According to the CDC’s interactive statistical reporting system, Arkansas loses 20,096 people to those five causes: heart attacks, strokes, cancer, diabetes, and lung disease, as of the most recent reported year, 2017. Kentucky loses 27,492.
So, how many extra people will die in Arkansas, with a 98,000 unemployed, versus Kentucky, with 250,000?
Before the pandemic hit, when averaging 1,800 unemployed, Arkansas lost 20,096 people to Stress-Illness Deaths. Its population is roughly 2,900,000. If you remember your high-school algebra, pull out your calculator and stay with me here. If not, skip the next few paragraphs to where you see *** three asterisks:
(2,900,000–1,800)x + 1,800 (1.76)x =20,096
Solve for x and you get .0069
That’s the risk, for a not-unemployed* Arkansan, for Stress-Illness Death in a given year.
Now let’s figure out how many people will die in a year with the new unemployment rate:
2,900,000(.0069) + 98,000 (1.76)(.0069) = y
Solve for y and you get 21,200. Subtract 20,096 from that and you get 1,104
***If you skipped the math, look here: There are 1,104 additional Arkansans who will die of disease due to Covid-19 measures and consequent unemployment.
In Kentucky, which was averaging 3,000 unemployed, there were 27,492 annual Stress-Illness Deaths. Kentucky has about 4.4 million humans living in it. So, feel free to skip the algebra *** once again:
(4,400,000–3,000)z + 3,000 (1.76)z = 27,492
Solve for z and you get .0062, which is the risk of a not-unemployed* Kentuckian’s Stress-Illness Death.
So, let’s see how many extra people will die of Stress Illnesses due to Kentucky’s:
4,400,000 (.0062) + 250,000 (1.76) (.0062) = k
Solve for k and you get 30,008. Subtract 27,492 from that and you get 2,516.
***If you skipped the math, here’s the result: In Kentucky, 2,516 additional Stress-Illness Deaths will occur as a result of lockdown-related unemployment.
That’s right. Kentucky, with only 35% more population, will have over twice the number of Stress-Illness Deaths, just as a result of taking stricter, more economically damaging measures to stem the virus.
Tentative conclusion number 3: Unemployment due to lockdowns kills people.
What About the Entire USA?
Because I’m sitting at home with nowhere to go, let me take the time to figure out the situation for the USA as a whole.
Oh, wait, we can’t. US national figures last posted on the DOL website the week of March 21st. Let’s go with the number that the news media is running with this week (Based on summing the state claims? That’s unclear): 22 million, versus the recent average of 245,000. And let’s use a rough national mortality figure based on 2017 for Stress-Illness Deaths: 1.6 million. And let’s use a rough 330,600,000 for the population.
Without Covid measures: 1,600,000 die.
With Covid Measures: 1,667,136 die.
How sure are we that stay-at-home orders and business closings will prevent more than 67,136 Covid-19 deaths?
The answer: Not sure at all. Trying to flatten the curve, so that more seriously ill patients can be treated in the ICU and put on ventilators, assumes that being treated and ventilated greatly improves survival. Yet, in New York, Associated Press reports that 80% of ventilated patients die anyway.
Remember the “flatten the curve” graphic? The goal of this stoppage we’re in now is not to lower the number of infected. It’s just supposed to slow down the rate at which people become infected. So, the same number will eventually be infected, they’ll just be spread over a longer period of time.
Eventually, most people will be exposed to SARS-COV-2, the virus that causes Covid-19. As Johns Hopkins epidemiologists explain, once 70% of us have recently had the virus and recovered, the spread will be confined to small outbreaks. Explosive spread will be dampened wherever it meets an immune person in the population, so-called “herd immunity.” In the rosiest of scenarios, a vaccine will take 18 months to be available, but scientists have been trying for years to make a vaccine for SARS, the most similar coronavirus, with no success.
Stress-Illness Deaths are a Sure Bet
But we can be sure that those heart attack deaths, stroke deaths, cancer deaths, emphysema and COPD deaths, and diabetes deaths will happen. It’s baked into the cake already. Every week the economy stays shut down, more people will be unemployed, and more of those Stress-Illness Deaths will happen.
More Illness and Death
And that’s on top of suicides. It’s on top of deaths due to loneliness and touch hunger. It’s on top of Stress-Illness Deaths caused by the pandemic itself, which will happen regardless of what we do about it. It’s on top of the deaths that will occur because, as my nurse friend observes, people aren’t getting needed diagnoses and surgeries because all hospital resources are going to Covid-19, and people aren’t controlling their diabetes or getting potentially serious illnesses cared for early because doctors’ offices are closed and doctors don’t want to send their patients to hospitals for fear of the patient being infected with SARS-COV-2.
Remember my friend, the surgical nurse?
Here’s the kicker: She was just laid off. As I was writing this article.
Yes, a highly-skilled nurse was just laid off in the middle of the fastest-moving pandemic in known history. Her words, again:
Yep, it’s the same story… all over the country. … That’s another largely untold story, there’s thousands and thousands of nurses furloughed all over the country due to low census. The only absolute guaranteed work right now in healthcare is ER, ICU and Covid designated floors in hotspots. Some hospitals are already bankrupt. …Not to mention the ratios, all the non qualified help that has been sent into these areas with no ICU experience… it’s insanity. So we shall see. One day at a time…
We’re at a Crossroads
We’ve seen that the extreme measures we’re currently allowing to be inflicted on us will kill tens of thousands of people, in addition to the people killed by the virus. We’ve seen that there’s no indication that those measures will ultimately save lives; they may well just push most deaths into future months. We’ve seen the potential for a cascade of untreated illnesses to further degrade the health and lifespan, as doctors’ offices close and medical staff is laid off in the wake of the lockdowns.
It’s time for the world to recognize that “the economy” is not the stock market. It’s time for us to realize that “the economy” is the web of exchange and work, labor and trade, that gives us life. By choking the economy, we’re choking ourselves to death even before any virus can make it hard for us to breathe.
It’s time to recognize that we can still live our lives, prudently and cautiously. Festivals, theaters, and sports events may be out for now. Groups will need to be smaller, hygiene will need to be better, and the elderly and immunocompromised will still need to limit social interactions. But the wisest, kindest, and bravest thing to do right now is to open the world back up.
*Not-unemployed is not the same thing as employed. “Unemployed” is used here in the labor-statistic sense of the word, meaning someone who wants to work and is unable to find work.