As coronavirus shutdowns and remain-at-home orders spread across the U.S., a growing number of people wonder what the tipping point is when the response becomes worse than the actual disease.
The question has been whispered in conversations at homes, debated by academics in the back alleys of the internet, and shared quietly via e-mail messages among work colleagues.
President Trump ripped the curtain back Monday, saying it can’t go on like this.
“We can’t have the cure be worse than the problem,” Mr. Trump said at the White House, saying he’s giving the shutdown only a little more time, and then he’ll announce plans to get most people back to work, while focusing medical efforts on vulnerable populations in key geographic areas.
“We will be quarantining many people in these areas. There are other areas that just aren’t affected, or are affected very little. Why would we close down 100% of the country?” he said.
A senior administration official told The Washington Times there’s a “universal” sense within the White House that the health-vs-economy equation needs to be rebalanced and it will take more than the bill working its way through Congress right now.
“Liquidity is great. Small business loans are great. Beefed up unemployment insurance is great. But none of it will mean anything unless people go back to work and we start having people buying and selling and working and doing,” the official said.
“For the last week we’ve been a socialist country. You know what? It has been terrible. It turns out being Denmark sucks,” the official added.
Mr. Trump’s blunt declaration stunned some policy-makers.
“We’ve got to think about the human cost here,” New York Mayor Bill de Blasio told CNN, defending shutdown orders as “extreme” but necessary to stymie the virus. “If you don’t slow this thing down, it will sacrifice a lot more on the other end of the equation.”
The trouble is nobody knows for sure the size of the sacrifices on either end.
James Bullard, president of the Federal Reserve Bank of St. Louis, told Bloomberg News over the weekend that the unemployment rate could hit 30% over the next three months, and the country’s gross domestic product could drop 50%.
Those are educated guesses, but then, so are current estimates of the threat of the disease, which are based on infection and mortality experiences in China, Italy and several cruise ships where outbreaks occurred.
Dr. Deborah Birx, the White House’s coronavirus coordinator, said the mortality rate in Wuhan, where COVID-19 was first detected in China, was 3%. In the rest of China it was about seven-tenths of a percent. And in South Korea it was seven- or eight-tenths of a percent.
But she cautioned against reading too much into those stats, saying asymptomatic people weren’t tested so the true mortality rate is still unknown.
Experts say major decisions are being made without knowing enough.
“The response ought to be more, ‘Let’s try to resume production as quickly as we can,’ ” said Chris Edwards, an economist with the Cato Institute. “We’re going to ruin people’ lives in my view if all these mandatory closings go on too long.”
The debate over where the tipping point is has raged in academia for weeks.
A professor at the University of Chicago pegged it at $65 trillion — what a a three-year shutdown of the U.S. economy would cost. Anything less than $65 trillion is an acceptable loss in exchange for the lives that could be saved, Luigi Zingales said in a piece for Chicago’s Stigler Center.
He looked at rates of infection and mortality and said left unchecked, COVID-19 could account for 9 million deaths in the U.S. But if social distancing and shutdowns can slow the spread of the disease, hospitals can lower the mortality rate, saving 7.2 million of those people, he calculated.
That 7.2 million number, then, must be stacked up against the economic damage.
Mr. Zingales said economists use a figure of $9 million per life for those age 65 and older — it’s derived from the statistical tipping point Americans see between risk reduction and safety enhancements — to place a value on a decision.
That works out to $65 trillion in value of lives that could be saved by self-quarantines, social distancing and nonessential shutdowns.
“Thus, even the simplest cost-benefit analysis suggests that the U.S. government should be willing to spend up to $65 trillion to avoid extra deaths,” Mr. Zingales wrote. “Since $65 trillion is 3 times the U.S. GDP, the United States should be willing to stop production for up to 3 years in order to eliminate the extra deaths.”
John P.A. Ioannidis, an epidemiologist at Standard University and co-director of the school’s Meta-Research Innovation Center, weighed in with a contrary view, saying there’s just not enough data right now to say whether economy-killing decisions are merited.
He said the mortality rates are too uncertain, but if it turns out to be on the low end, the worldwide lockdown “may be totally irrational.
“It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies,” he wrote.
Mr. Ioannidis said the most valuable step would be to try to figure out the prevalence of the infection by testing a truly random population.
He said assuming 1% of the U.S. population gets infected, and using a mid-range mortality estimate of about three-tenths of a percent, it works out to about 10,000 deaths. At that rate, it’s background noise for the annual rate of deaths from flu-like illnesses.
“In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns. Unfortunately, we do not know if these measures work,” he wrote.
Mr. Trump, at the White House on Monday, said he’s worried about the human costs of the economic chaos. He ticked off anxiety, depression and suicide.
The senior administration official who spoke to The Times said the White House is pondering how to reframe the situation.
“There’s a general sense now that you are essentially quarantining 250 million healthy, non-vulnerable people to protect what might be as few as 50 million vulnerable people. It would be much more favorable to protect who you want to protect, and let other people get back to work,” the official said.
The Cato Institute’s Mr. Edwards concurred, saying there needs to be a way to clear and return some people to work.
“I see people framing this as the economy on one hand and healthcare on the other. I think that’s a false dichotomy,” he said.
New York Gov. Andrew Cuomo was among those to say there’s got to be a balance, though he said he doesn’t regret his order forcing non-essential workers to shelter in place.
“I did the right thing, I’m proud of it. At the same time, at one point you have to open the valve,” he said Monday. “You have to open the valve because that is oxygen for the economy. And this is not sustainable.”
Mr. Cuomo said there might be a way to “stratify” who goes back to work first — for instance, younger people who are less vulnerable to the disease or people who’ve gotten sicker, recovered and have some immunity.
“Can you have a more refined public health strategy that is also more productive or less destructive to the economy?” Mr. Cuomo said.
• Tom Howell Jr. and S.A. Miller contributed to this article.