Saving Lives by the Numbers
Could we save more lives with spending less money than we did on fighting Covid-19?
It’s time to ask the uncomfortable but important questions: Was it worth spending trillions of dollars on protecting people from Covid-19? Or could we have used it to save even more? And what should we do going forward?
The Trade-offs of Saving Lives
The costs are high because the stakes are high. Experts see the virus as here to stay. Only once before humanity managed to eradicate a disease: smallpox. Over the course of the next years, we can therefore expect billions of people to get infected, and eventually vaccinated. It only ends when effective Coronavirus ”herd immunity“ has been reached and between 60% and 80% of humanity have developed sufficient levels of Antibodies.
In the meantime, flattening-the-curve strategies will at least temporarily have slowed the spread. Their goal is to reduce fatality numbers until treatments and then vaccines become available. Lockdowns and social distancing, though, also have massive and in many ways devastating economic consequences. 33 million in the U.S. are unemployed, exceeding 20% of the working population (and counting). Many businesses have collapsed or are on the brink of bankruptcy.
As in other countries, the government temporarily mitigates these effects by spending trillions of dollars. The total economic cost of flattening-the-curve measures for the U.S. reaches $5 trillion, and possibly far more. This exceeds the amount of money spent on any other endeavor in human history.
What have we achieved?
Lives Saved
It’s complicated. By May 15, 2020, the CDC reported about 60,000 deaths due to Covid-19 in the U.S., with other reports mentioning up to 90,000. The highest-probability scenarios of several reputable institutions estimate this number to roughly double by the end of summer 2020. A possible secondary wave during the fall and winter could again at least double these numbers.
This is in line with other extrapolations. Toward the end of April 2020, the mortality rates in New York were around 0.5%. For the entire U.S. this rate would result in about one million fatalities, until 70% of the population were infected. One million would be about 18% of all U.S. deaths over the period of two years (2017: 2.813 million). Countering this, optimistic predictions see new treatments becoming available by August or September 2020, reducing the Covid-19 mortality rate.
Social distancing and lockdown decisions would then have provided a life-saving bridge to when treatments become available and, eventually, vaccines. Tens or even hundreds of thousands would have been saved.
But what about the 90% of deaths that are not due to the Coronavirus?
Lives not Saved
Each life is valuable and worth saving. But since this is the case, compassion and logic require to look beyond Covid-19.
If treatments and vaccines arrive as optimists expect, we will have spent more than $10 million per life saved. If not, that number will be much higher. $10 million is at least ten times as high as lifetime healthcare spending in the U.S., including treatments for other diseases and conditions.
On a general level, the amounts currently spent are also two to three orders of magnitude higher than common estimates for achieving some other worthy goals: feeding all those starving in the world, eradicating extreme poverty, or moving from a fossil fuel-based economy toward an emission-free energy world. Or giving each African $1000 — five times over, many times the money that whole continent is currently spending on healthcare.
Each of these could have massive effects toward saving human lives and improving living conditions. But we do not need to stray far from more common healthcare challenges. Let us look at alternative live-saving investments in three areas: (1) other sources of death in America, (2) infectious diseases in the world, and (3) aging and the eradication of nearly all non-infectious diseases anywhere.
Other Sources of Death in the U.S.
While our Covid-19 strategies may end up saving several hundred thousand lives over two years, the U.S. will lose about 1 million people to heart disease, 1 million people to cancer, 1 million people combined (and at least 200,000 each) due to lower respiratory diseases, stroke, and Alzheimers, and 500,000 people combined (and at least 100,000 each) due to diabetes, kidney disease, the flu, and suicide.
Even marginal progress would rival Covid-19-related numbers of lives saved, costing only a fraction of the amount spent. But there are much larger and easier targets.
Infectious Diseases Around the World
If we were to tackle other infectious diseases across the whole world, we could achieve much more for much less money. Over the course of two years of battling the Corona virus, the flu alone will kill almost 0.8 million people. Minnesota infectious disease expert Dr. Michael Osterholz estimates that developing a flu super-vaccine would cost $10 billion.
For other diseases we already have vaccines or effective treatments today. Infectious diseases that by and large are eradicated in the rich world will kill about eight million people: 3 million due to Tuberculosis, 2.4 million due to HIV/AIDS, 1 million due to Hepatitis C, 1 million due to Malaria, and about 0.6 million due to others like Cholera and the Measles. Some diseases, even polio, are making a comeback due to Covid-19 related social distancing.
Until 2030, the combined total of these preventable deaths will reach 40 million, young and old. And still, none of this addresses the by far biggest killer of them all.
The Whale in the Room
Aging.
David Sinclair, Harvard scientist and author of “Lifespan — Why We Age and Why We Don’t Have To“ points out that most of our mortality numbers are misleading. The term “lives saved” sounds grand because it insinuates that the dying would continue to live for a long time.
Unfortunately, for most situations this is not the case. Rather, we need to differentiate. As of 2020, the brutal reality is that saving the life of an 80 year old person with a challenged immune system and several chronic diseases may extend life by a few months. But preventing the death of a healthy teenager may do so for decades.
We must consider this context to maximize the number of lives and lifespan we save. For the old and frail, focusing on Corona individually over other sources of death has only limited effects on their mortality. Sinclair compares it to a game of Whack-A-Mole, in which we are spending “trillions of dollars trying to eke out a few more weeks of life from people who were already teetering on the edge of death”.
As he says:
“Surviving cancer or heart disease doesn’t substantially increase the average human lifespan, it just decreases the odds of dying of cancer or heart disease. […]
[I]f we could stop all cardiovascular disease — every single case, all at once — we wouldn’t add many years to the average lifespan; the gain would be just 1.5 years. The same is true for cancer; stopping all forms of that scourge would give us just 2.1 more years of life on average, because all other causes of death still increase exponentially.”
In other words, if we could successfully battle aging, we could achieve the equivalent of not just saving hundreds of thousands or millions of people, but most of the 60 million dying every year on our planet. Sinclair is convinced this is realistic.
But here is the bottom-line: The U.S. non-Alzheimer research budget for this biggest source of human deaths is only 1/50,000s of what we already have spent on Covid-19 this year. The imbalance is staggering. We could multiply the current number by 100, save countless lives that then could healthily continue for years and decades, and would still only spend 0.5% of what we spent on Covid-19.
The Tough Questions Leaders Must Answer
Debates about reopening our economies and societies must ask some key questions about health, lives lost, and what we can do about it, beyond Covid-19. As a first step, we can immediately distribute a small share of Coronavirus relief money toward alternative life-saving measures. In the light of all the above numbers, just imagine what $150 billion could achieve — just 5% of the next (already earmarked) $3,000 billion!
Such investments would visibly link the economics of reopening to the long-term and sustainable caring about people’s health and lives. And in the long run this could even reduce costs.
