Is the Cure Really Worse Than the Problem?

Could social distancing create a bigger problem than COVID-19? No.

Posted Mar 24, 2020

David Kyle Johnson/Twitter
Source: David Kyle Johnson/Twitter

Around midnight two nights ago, an all-caps tweet raised a question that's likely been on everyone's mind: Could the cure be worse than the problem?

Across America, in an effort to save lives by preventing the spread of the COVID-19 virus, many people have been practicing "social distancing"—the practice of people eschewing crowds and staying (and working from) home to avoid others as much as possible. To encourage this, nearly all schools have either canceled or moved online, and businesses have closed—sometimes voluntarily and sometimes by order of state governments.

This has hit the economy hard: The stock market has lost all the gains since January 2016, by some estimates unemployment could reach 20 percent, and many restaurants (especially local ones) could close foreverPresident Trump has said if the economic slump stretches on for months, there would be “probably more death from that than anything that we're talking about with respect to the virus.” For example, there could be "suicide by the thousands." 

Are we shooting ourselves in the foot here? Or maybe, for a better analogy—are we shooting ourselves in the head to prevent stepping on a nail?

To answer this question, we need to answer three others: 

1. Is social distancing really necessary to prevent the spread of COVID-19?

2. If so, how many lives will preventing the spread of COVID-19 with social distancing save?

3. What will the costs of a wrecked economy be?

Let's ask each in turn.

Is social distancing really necessary to prevent the spread of COVID-19?

Wikimedia Commons/Wikipedia
What it means to flatten the curve
Source: Wikimedia Commons/Wikipedia

The effectiveness of social distancing in reducing the speed at which a disease spreads is well documented and easily explained. It's been proven by past examples (when the Spanish flu spread slower in St. Louis than in Philadelphia) and by present examples (compare Kentucky to Tennessee, and China and Japan to most places in Europe.) But it's also just common sense. The less people interact with each other, the less the infection will be spread to others. Social distancing flattens the curve by spreading out the number of infections over time.

To be fair, South Korea flattened their "COVID-curve" without extreme social distancing by relying on extensive testing. So, strictly speaking, social distancing is not necessary to curb the spread of COVID-19. But, despite repeated promises from the federal government, the U.S. still has not seen widespread testing. South Korea tested 5,200 tests per million inhabitants, the U.S. only 74 per million. So, social distancing is, as of this writing, necessary in the U.S. to help curtail the spread of COVID-19. We have to make up for the fact that tests aren't available by all acting as if we are infected.

Some have suggested that flattening the curve with COVID-19 is not necessary because it's just another exaggerated fear about the end of the world. But as I explained in a previous post, that argument doesn't hold water. Most importantly, there were never solid scientific predictions that Ebola would become a worldwide pandemic because the U.S. dispersed pandemic response teams around the globe to deal with it. There were such scientific predictions about COVID-19 at least partly because those U.S. pandemic response teams were fired in 2018, and thus the warning signs about COVID-19 went unheeded

Still, others suggested that it was all "media hoax," something being exaggerated for ratings or political gain. But not only was this demonstrably false at the time—the media was simply reporting the predictions of experts—but those who claimed this (in January and February), like Fox News, subsequently flip-flopped on the issue and admitted the situation's severity.

Lastly, people claimed COVID-19 is "no worse than the flu." But while it was true (in late February/early March) that the flu had killed more Americans (18,000) than COVID-19 had (around 15) up to that point in 2020, the ways in which COVID-19 is different made it very likely that it would eventually kill far more. Its mortality rate is higher, it's infectious before symptoms show in the host and for longer (two weeks vs. a few days), and humans have no immunity or vaccine. According to the COVID-19 response team at the Imperial College in London, if we went on with business as usual, 80 percent of Americans would get it, and 2.2 million of them would die (in 6 months, compared to 30,000 from the flu in a year).

And that brings us to our second question.

How many lives will preventing the spread of COVID-19 with social distancing save?

Stanford's John P.A. Ioannidis would likely argue such estimates are too high. He suggests that the mortality rate for COVID-19 that is often cited in the media, 3.4 percent, is far too high. That's only among confirmed cases; factoring in the mild and thus unreported cases would make that number drop.

Wikimedia Commons/Wikipedia
An early outbreak happened on The Diamond Princess
Source: Wikimedia Commons/Wikipedia

But Ioannidis's evidence for his extremely low number, 0.125 percent, seems to be flimsy. He took the mortality rate among the elderly on the Diamond Princess (1 percent) and extrapolated to the general U.S. population (which has more younger people). But that is only one small sample; its mortality rate could be low because of other factors, and COVID-19 might affect all age groups more equally than Ioannidis assumed.

Indeed, recent reports suggest that blood type might be a factor and that younger people might be more susceptible than previously thought. In fact, Ioannidis acknowledges that the mortality rate could be as high as 1 percent, and 0.9 percent is the mortality rate the Imperial College assumed to arrive at their 2.2 million figure. (Scarily, if you only look at "closed cases," the mortality rate is more like 10-13 percent.)

Wikimedia Commons/Wikipedia
Not flattening the curve could overwhelm the health care system
Source: Wikimedia Commons/Wikipedia

To make matters worse, the current mortality rate is not the only relevant factor. If too many people are infected all at once, it will overwhelm our health care system. If that happens, not only will many COVID-19 patients be unable to get the care they need—which would spike the mortality rate—but no one else would be able to get the care they need either. Broken leg? Heart attack? "Sorry, we're full."

Factoring this in, the Imperial College projects that "life as normal" would generate 4 million American deaths—more than the Civil War. Even with preventive measures, like isolating the known infected, without social distancing, 2 million Americans would still die. (Worldwide: 45 million.)

But could the economic effects of social distancing be worse? That brings us to our final question.

Wikimedia Commons/Wikipedia
A run on the American Union Bank during the Great Depression
Source: Wikimedia Commons/Wikipedia

What will the costs of a wrecked economy really be?

The economic effects of social distancing could be dire—maybe even another Great Depression. Could that cost more lives than social distancing will save? It's sometimes said that the Great Depression caused 7 million Americans to starve to death. Since 7 million is more than 4 million, one might argue that the cure is worse and that we should just accept the deaths of 4 million Americans as the lesser of two evils. 

But there are essentially three things wrong with this argument.

First, it relies on a strict utilitarian calculation—maximize happiness for the most amount of people—and that is only one of many ethical theories. Kantians, for example, would argue that it's morally wrong to just go about willingly spreading a disease that you know will kill millions, regardless of whether the consequences of not doing so would be worse.

Second, the projections for the death rates of COVID-19 are based on scientific evidence. Projections about a COVID-19 economic downturn death rate are not. Yes, 23,000 committed suicide when the great depression hit; and if we extrapolated based on population growth, that would be about 62,000 today. But there is absolutely no scientific evidence we would see such a number today--and it's much less than 2-4 million.  We should take the larger more certain threat seriously.  

And third, that "7 million deaths" statistic seems to just be uncertain. The evidence suggests that there wasn't a dip in the death rate of Americans during the Great Depression, and some recent research has even suggested that the effect of economic downturns (on mortality rates) might be positive.

Wikimedia Commons Public Domain
Free coffee and donuts for the unemployed
Source: Wikimedia Commons Public Domain

To be fair, the reason the Depression didn't cause people to starve to death is massive social programs (that were a part of FDR's new deal), which gave money and food to the unemployed. If we continue to do social distancing, but don't couple it with an economic stimulus package that either keeps people working or gives them money for food and rent, perhaps we could see more than 4 million deaths. But that's not an argument against social distancing. That's an argument for such social programs.

One might also argue that the health of the economy, and a higher standard of living, is a fundamental good that is worth the millions of humans lives that COVID-19 would cost. Or one might argue that the cost is worth it to preserve our freedom of movement—that the right of 300 million people to live their lives freely is more important than the right to life of the 4 million who would die as a result. A politician might even argue that since a poor economy might cost them the next election, and their election is in the best interests of the nation, the lives of 4 million Americans is just the price we have to pay.

I, however, do not think most Americans think a higher standard of living, the freedom to live life as usual for a few weeks or months, or the election of a political figure is worth 4 million American lives. I doubt many would actually take these arguments seriously.

All in all, I think it is safe to conclude: No, the cure is not worse than the problem.

Copyright 2020, David Kyle Johnson