It’s Not a Choice Between Lives or the Economy

There seem to be shortages of everything these days, not least a shortage of commentary on the COVID-19 virus, also known as the Chinese virus, the Wuhan flu, known to some as the Chinese Communist Party virus, or the CCP virus for short.

Since there has been so little discussion of this disease in the news or in the blogosphere, I thought I would weigh in with a word or two.

Regular readers will know that I have already, these past few weeks, had occasion to say something about this disease, and the reaction to the disease, here and at other venues. I seem to be in a distinct minority in thinking that the best reaction to the disease was not furnished by the protagonist of Edvard Munch’s “The Scream.

Let me begin, therefore, by acknowledging that this new virus can make people, especially older people, and most particularly older with other health problems very sick indeed.

COVID-19 is the big and nastier brother of SARS, another Chinese import, which made its way around the world in the early 2000s and killed nearly 800 people. “SARS” stands for “Severe Acute Respiratory Syndrome,” which can be the dreaded effect of COVID-19 infection and which explains why you are hearing so much about medical ventilators at the moment.

As of Saturday, there were in the United States some 111,000 recorded cases of infection and just over 2,000 deaths. Worldwide, the number of recorded cases so far is 657,434, the number of deaths just over 30,000. Obviously this number changes daily, indeed hourly. A good, and regularly updated, source for the numbers is at WorldoMeter. In the United States, half the total number of cases and nearly half of the fatalities are clustered in and around New York City.

Most people who are infected by the virus experience mild or no symptoms at all. But for those who do become sick, the disease can be horrible. A friend passed along these observations from an ICU doctor on the front lines in New York. He indicated that he did not object to his remarks being shared.

A large number of admitted patients end up needing to be intubated. . . . The two main things hospitals need to keep adding, and adding, and adding again are 1) emergency room beds and 2) ICU beds. Every day I feel there is yet another area being planned for one or the other. Our [emergency department] was packed with patients—either all with masks or already intubated. I have never seen such a sight. All providers were walking around with their (slightly worn) [personal protective equipment] and names written on the visors. Our ED has already outgrown the designated space and will be expanded so that, essentially, we have a respiratory ED. The nursing home that had been closed across the street from us has become our lifeline. Rec rooms have become treat and release respiratory testing centers. The former long-term care floors are being prepped to help with the load of vented patients. . . .

We continue to learn on the fly for this illness. The spectrum of how it presents is vast! Purely abdominal pain, to the point that they are admitted to the surgical service with nary a complaint. Syncope—patients just falling without any preceding fevers (so less likely due to dehydration from insensible losses) or other symptoms. . . . Encephalitis—definitely less numbers but I think it’s there.

Also, nothing—just nothing—but they get a chest x-ray for some reason and looky-there, bilateral patchy opacities. They develop acute kidney failure REALLY quickly. They are in the ICU and looking good but then, you blink, and they are arresting and die of sudden cardiac arrest. Also, and a bunch of my colleagues have been chatting about this one, anosmia (loss of smell) and dysgeusia (taste changes). These two symptoms are really common, I think more so with milder upper-respiratory disease rather than severe lower respiratory disease.

I quote this not to be morbid or to scare people but simply to acknowledge that I am aware that this is a nasty bug. Many precautions should be taken. People should wash their hands thoroughly as well as frequently. If you are out and about, hand sanitizer is your friend. You should stand a few feet away from others in public situations. (The jury is out, I think, on whether this should be called “social” or “asocial” distancing.)

If you have traveled somewhere in which the disease is prevalent, you should self-quarantine for a couple of weeks and be especially careful to avoid being around the elderly or infirm. Infection is most common in situations where there is prolonged contact with someone who is infected and “shedding” the virus (which is why Governor Andrew Cuomo has had second thoughts about closing all New York’s schools and colleges and sending all those students home to mama, papa, the grandparents, and poor old Uncle Joe who has been unwell for years).

That said, I continue to believe that shutting down the U.S. economy was insane (also here, here, and here). I maintain, in retrospect, this episode will furnish ample material for an addendum to Charles Mackay’s Extraordinary Popular Delusions and the Madness of Crowds.

Unfortunately, there is no arguing with insanity. As one friend of mine likes to note, arguing with such madness is like arguing with a hurricane. It is completely ineffective, indeed counterproductive, because making arguments at such a time is likely to distract one from taking precautions and making preparations.

From Millions Will Die to Hospitals Will Be Overwhelmed

In earlier columns, I have contrasted the annual toll in hospitalizations and fatalities from the seasonal flu with the known numbers form COVID-19. The former dwarf the latter—so far. We’ve had plenty of “doomsday scenarios” predicting millions of deaths in the United States alone, but cooler heads are beginning to prevail.

You don’t hear this from the megaphones of the media, but the fatality rate in the United States remains among the lowest in the world, barely above Germany and Norway, the lowest in Europe. Sweden, which is only slightly higher, has bucked the trend. Its borders remain open, as do its schools, restaurants, museums, etc. As of this writing, it’s not at all clear that they were wrong to do so.

There has been a gradual shift in the commentary over the last week or so as many scribes and pundits, tiring of the shopworn “millions will die” meme, have shifted to a “our hospitals will be overwhelmed” aria.

In New York, the epicenter of the epidemic, there will certainly be strains. But I think that this article, arguing that COVID-19 is not going to overwhelm our healthcare system, is persuasive.

Some numbers: According to the CDC, during the 2018-2019 flu season, there were some 810,000 hospitalizations in the United States for flu and 61,000 deaths. As of March 26, we have seen more than 490,000 hospitalizations and 34,000 flu deaths. Add in the COVID-19 numbers and you get 565,000 hospitalizations and 35,264 deaths. In other words, seen in context, COVID-19 cases are a barely discernible blip.

With these differences: the patients suffering from the effects of COVID-19 tend to be much sicker, taking up hospital beds for longer, and they are arriving more quickly and in bigger clumps.

Our Disgusting Media and Democrats

One of the most disgusting features of this health scare is the behavior of the media and liberal Democrats. In this season of Lent, they seem to be on their knees, fervently praying for greater damage to the economy, for more people to lose their jobs, for a greater destruction of wealth. It’s not, exactly, that they think these are good things in themselves—though one senses an air of thoughtfulness as they ponder the rapidity with which the economy can be turned upside down and people brought to heel.

Left-wing progressives are not advocates of big government for nothing. Nothing seems to justify big government more than a dependent populace, and nothing guarantees dependency more reliably than economic distress. All that is in the background—present but unspoken.

What is patent is the fervent wish that this crisis might, somehow, be pinned on Donald Trump. So far, that hasn’t happened, indeed, the public seems to approve of the way he is handling the situation. His poll numbers are higher than ever.

Still, his enemies never tire. At a recent press conference, some wretched “journalist” asked the President, “How many deaths are acceptable?” It was intended to be a “gotcha” question. “Trump says that X number of deaths are OK!”

The president, after a moment’s incredulity, dispatched the question and the questioner. “None,” he said, “none are acceptable.”

Good answer. But while none are acceptable, it is in the nature of things that many are inevitable. New York’s pol of the moment, Andrew Cuomo, got on his shiniest soapbox recently and said “This is about saving lives. If everything we do saves just one life, I’ll be happy.”

Heather Mac Donald had a tart but appropriate response to that burst of sentimental hogwash. “Cuomo’s assertion that saving ‘just one life’ justifies an economic shutdown raises questions that have not been acknowledged, much less answered,” Mac Donald notes, “as public officials across the country compete to impose ever more draconian anti-virus measures.”

One question is this: “Is there any limit to the damage we are willing to inflict on the world economy to mitigate the infection?”

There are people, like Cuomo, who like to pretend that we have a choice between saving lives and saving the economy. But a moment’s thought will show that that is a false dichotomy. Unemployment just shot up by more than 3 million. That is more than 3 million people who have lost their livelihoods so far, many of whom face uncertain prospects for the future.

Expect a sharp rise in cases of depression, drug abuse, and suicide because of that.

A Word About the Difference Between “From” and “With”

In The Road to Serfdom, Friedrich Hayek observed while it “may sound noble to say, ‘Damn economics, let us build up a decent world,’ . . . it is, in fact, merely irresponsible.” Something similar can be said about the false opposition between humanitarian concerns and attention to the economy. Tending the economy is just as much a humanitarian concern, just as much a life-or-death matter, as manufacturing new ventilators.

Finally, a word about the difference between “from” and “with.” Over the past few weeks, I have been predicting a modest fatality rate from COVID-19. I began by predicting no more than a couple of hundred deaths and then upped my prediction to a 1,000-1,200. As of today, the number of deaths attributed to the virus is just over 2,000. So I was wrong about that.

Or was I? It is one thing to die from the effects of the coronavirus, quite another to die with the virus. Let’s say you are 87 years old, diabetic, with congestive heart failure and emphysema. You are infected with the coronavirus, get sick, and die. Did you die from it, or merely with it?

This is a point that Dr. John Lee, a retired professor of pathology in the United Kingdom, made in Spectator USA. “There is a big difference,” he writes, “between Covid-19 causing death, and Covid-19 being found in someone who died of other causes. . . . Much of the response to Covid-19 seems explained by the fact that we are watching this virus in a way that no virus has been watched before. The scenes from the Italian hospitals have been shocking, and make for grim television. But television is not science.”

“First do no harm.” Dr. Lee is right to warn that the panicked response to this new virus has neglected that age-old medical advice. “Unless,” he notes, “we tighten criteria for recording death due only to the virus (as opposed to it being present in those who died from other conditions), the official figures may show a lot more deaths apparently caused by the virus than [are] actually the case. What then? How do we measure the health consequences of taking people’s lives, jobs, leisure and purpose away from them to protect them from an anticipated threat? Which causes the least harm?”

That is an excellent question. Also excellent is his concluding observation that “The moral debate is not lives vs. money. It is lives vs. lives.”

It will take months, perhaps years, if ever, before we can assess the wider implications of what we are doing. The damage to children’s education, the excess suicides, the increase in mental health problems, the taking away of resources from other health problems that we were dealing with effectively. Those who need medical help now but won’t seek it, or might not be offered it. And what about the effects on food production and global commerce, that will have unquantifiable consequences for people of all ages, perhaps especially in developing economies?

In the United States, we have locked down whole counties and shuttered businesses across the country. We have erected scores of soapboxes upon which ambitious politicians and venal media hacks pontificate and spread panic and misinformation. Congress has just passed, and the president has just signed, a $2 trillion “stimulus” package. I put “stimulus” in quotation marks because what government stimuli stimulate is more government spending, along with inflation and ever increasing government bureaucracy.

President Trump has shown great leadership during this manufactured crisis. I hope he will continue to ponder his observation that we do not want to get ourselves into a situation in which the cure is worse than the disease.

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