The politics of the coronavirus have made it seem indecent to talk about the future. As President Trump has flirted with reopening America quickly — saying in late March that he’d like to see “packed churches” on Easter and returning to the theme days ago with “we cannot let this continue” — public-health experts have felt compelled to call out the dangers. Many Americans have responded by rejecting as monstrous the whole idea of any trade-off between saving lives and saving the economy. And in the near term, it’s true that those two goals align: For the sake of both, it’s imperative to keep businesses shuttered and people in their homes as much as possible.
In the longer run, though, it’s important to acknowledge that a trade-off will emerge — and become more urgent in the coming months, as the economy slides deeper into recession. The staggering toll of unemployment has reached more than 16 million in just the last three weeks. There will be difficult compromises between doing everything possible to save lives from Covid-19 and preventing other life-threatening, or -altering, harms.
When can we ethically bring people back to work and school and begin to resume the usual rhythms of American life? We brought together by video conference five different kinds of experts to talk about the principles and values that will determine the choices we make at that future point. One of them, the bioethicist Zeke Emanuel, led a group from the Center for American Progress that earlier this month presented a plan to end the coronavirus crisis. First, the group said, the country needs a national stay-at-home policy through mid-May. (Eight governors still haven’t issued such orders statewide.) In the intervening weeks, testing would have to ramp up to test everyone who has a fever, or lives with someone who tests positive for Covid-19. Contact-tracing — identifying and notifying people who have been in proximity to someone infected — would become comprehensive. People who have the virus or a fever, or those in proximity to them, would be isolated. There would also be testing of a representative sample in every county, to determine the rate of infection in the population, as well as mapping and alerts to inform the public about the location of Covid-19 cases.
If these efforts are successfully put in place, Emanuel hopes the current restrictions could begin to ease in June. At that point — or later, if the necessary steps have not been taken — we will need to rethink how we manage risk, recognizing trade-offs among various harms and benefits. That’s what the panel discussed.
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The Panelists
The Rev. Dr. William J. Barber II is president of the nonprofit organization Repairers of the Breach and co-chair of the Poor People’s Campaign: A National Call for a Moral Revival, which is holding a digital Mass Poor People’s Assembly and March on Washington on June 20.
Anne Case is an emeritus professor of economics and public affairs at Princeton University and co-author, with Angus Deaton, of the recent book “Deaths of Despair and the Future of Capitalism.”
Zeke Emanuel is vice provost for global initiatives and director of the Healthcare Transformation Institute at the University of Pennsylvania; host of a new podcast about coronavirus, “Making the Call”; and author of the forthcoming book “Which Country Has the World’s Best Health Care?”
Vanita Gupta is president and chief executive of the Leadership Conference on Civil and Human Rights and former head of the U.S. Justice Department’s Civil Rights Division.
Peter Singer is a bioethics professor at Princeton, author of “The Life You Can Save” and founder of the charity of the same name.
Emily Bazelon, a staff writer for The New York Times Magazine, moderated the discussion, which has been edited and condensed for clarity.
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What Are the Trade-Offs of Reopening the Economy in the Near Future?
Emily Bazelon: Zeke, how are we doing on reaching your goal of beginning to partly reopen in June?
Zeke Emanuel: I’m not wildly optimistic, would be my answer. We still don’t have a consistent shelter-in-place policy nationally; there are too many exceptions allowed in different states. We haven’t normalized things like wearing masks outside. We need infrastructure for testing in real time, so you don’t get results 5 or 6 or 7 days later. We need real contact tracing that uses technology so that you can do it very rapidly. Getting the ball rolling on this, I’m concerned about.
Bazelon: If we have to restart the economy step by step, not all at once, does that mean deciding whether a workplace can do social distancing safely?
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Emanuel: Yes, restarting the economy has to be done in stages, and it does have to start with more physical distancing at a work site that allows people who are at lower risk to come back. Certain kinds of construction, or manufacturing or offices, in which you can maintain six-foot distances are more reasonable to start sooner. Larger gatherings — conferences, concerts, sporting events — when people say they’re going to reschedule this conference or graduation event for October 2020, I have no idea how they think that’s a plausible possibility. I think those things will be the last to return. Realistically we’re talking fall 2021 at the earliest.
Restaurants where you can space tables out, maybe sooner. In Hong Kong, Singapore and other places, we’re seeing resurgences when they open up and allow more activity. It’s going to be this roller coaster, up and down. The question is: When it goes up, can we do better testing and contact tracing so that we can focus on particular people and isolate them and not have to reimpose shelter-in-place for everyone as we did before?
Anne Case: The idea that tables could be spread far enough apart that it would be safe to open restaurants — maybe that’ll happen in many cities, but it seems highly unlikely that sector will bounce back, which means there are all these service workers who are not going to find work in the sector they were working in. Losing that for 18 months, that’s enormous. Eventually, when the time comes for people to go back to work, I worry that some large fraction of working-class people won’t have work to go back to.
Peter Singer: If we’re thinking of a year to 18 months of this kind of lockdown, then we really do need to think about the consequences other than in terms of deaths from Covid-19. I think the consequences are horrific, in terms of unemployment in particular, which has been shown to have a very serious effect on well-being, and particularly for poorer people. Are we really going to be able to continue an assistance package to all of those people for 18 months?
That’s a question each country will have to answer. Maybe some of the affluent countries can, but we have a lot of poor countries that just have no possibility of providing that kind of assistance for their poor people. That’s where we’ll get into saying, Yes, people will die if we open up, but the consequences of not opening up are so severe that maybe we’ve got to do it anyway. If we keep it locked down, then more younger people are going to die because they’re basically not going to get enough to eat or other basics. So, those trade-offs will come out differently in different countries.
The Rev. William Barber: Even when we take the rich countries, poor people know from history that every time there is some great struggle, whether it’s the Great War, or the Spanish flu, or the recession of 2008, they are hit the hardest.
The United States has a whole lot of wounds from decades of racist policies and the criminalization of the poor. In 2011, Columbia did a study that we’ve updated: At least 250,000 people die every year from poverty in America. Now, in a pandemic, that’s an open fissure.
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Washington made a terrible mistake by passing a $2 trillion bill without providing for a living wage or including all workers in the promise of sick leave or providing for free treatment for this illness. Millions of people won’t even get the $1,200 checks, for example if they are undocumented.
It’s almost as if some people think they can put a fence around the groups they left out. But the more people you have caught in the gaps — people who don’t have a home to stay in, or who have to go to work even if they’re sick — the more it keeps the virus alive. If you don’t address poverty, you can’t stop the virus, and you can’t reopen the economy.
Vanita Gupta: Even now we’re making trade-offs. We should be more honest about it. Many of the folks we call essential are low-wage workers, and we depend on them to keep grocery stores and pharmacies open. To a degree, the decisions about reopening in the future are about whether we’re comfortable with the professional classes becoming part of the trade-off by going back to their offices. And the pandemic highlights the divide between workers with paid sick leave and without. Only 47 percent of private-sector workers in the bottom quarter for wages have paid sick leave, compared with 90 percent in the top quarter, according to the Economic Policy Institute. Covid-19 is further revealing the country’s profound inequality and structural racism.
Bazelon: The economist and philosopher Amartya Sen recently pointed out to me that the presence of disease kills people, and the absence of livelihood also kills people.
Case: It’s true that poor people, on average, die younger than well-off people. But their death rate hasn’t precisely tracked the unemployment rate. It’s the long-term decline in jobs for people without a bachelor’s degree that has increased mortality among working-class people, by leading to drug overdose, suicide and alcoholism-related deaths. This is a process that has been going on for 50 years, since the 1970s. That’s the main finding of my work with my husband, the economist Angus Deaton.
That said, we also found something counterintuitive — fewer people die during recessions than in boom times. During boom times, more people die in motor-vehicle accidents and on construction sites. There’s more pollution, which is bad for infants and young children. And the elderly get less care. So all of those groups, but especially the young and old, are better protected during recessions than they are during boom times.
It’s hard to predict the future based on the 20th century. But fewer people died during the Great Depression in the 1930s than during the boom years of the 1920s. And during the Great Recession of 2008-9, a third of the people in Spain and Greece were unemployed, but their mortality rates fell.
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Emanuel: But Anne, this is going to be a different kind of recession, right?
Case: Probably, yes. We don’t know.
Emanuel: Well, I would say we do know in two important ways. First, we’re going to be separated from each other by this physical distancing. We still have no idea what that will wreak for human beings, as a social species.
Second, this recession is wiping out huge swaths of types of employment. Yes, some of these service industries will eventually come back. But they are wiped out for a lot of people who were in them. And so I do think the sort of negative consequences — deaths from drugs, alcohol, suicide — that you’ve identified in your book, “Deaths of Despair and the Future of Capitalism,” may in fact come back to haunt us. Previous research might not be able to get at this, and I truly worry about it.
Case: I agree with that. Two points, though. Some of the things that reduce mortality are happening in this recession. One being less pollution, which protects children, and another being fewer motor-vehicle accidents.
But as you say, isolation is a risk factor. Community is lost, people breaking bread together. If you can’t go to church because your church is closed, if you’re in recovery and you can’t go to an Alcoholics Anonymous meeting, if you can’t go see your parents and get some solace from them, then yes, I think that that kind of isolation puts people at higher risk for drugs and alcohol and suicide. But the risk of death from Covid-19 is larger than someone dying from the use of alcohol or drugs. There are now around 50,000 suicides in the United States each year. Pit that against how many lives we can save by keeping social distancing longer, and I think I’d weigh in favor of social distancing.
When people are unemployed for more than six months and knocked off their life path, yes, it’s very harmful, but it takes a long time to die a death of despair. It’s long term, over years, largely because of the social effects — the difficulty of having a stable home life and the loss of ties to your community. We might see it in the mortality figures in five years. At some point we consider those longer-term consequences, but it’s a very tricky balance to strike.
Gupta: When we talk about the impacts of the recession, who will be first to be hired back, and who will be last? Not everyone will experience the recovery evenly. After the 2008 financial crisis, home-ownership rates bounced back for most people, but not for African-Americans. Their home-ownership rates were as low in 2015 as they were when the Fair Housing Act was passed in 1968.
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Singer: Can I just get on the record that we’re talking about affluent countries? Because the consequences of economic recessions in low-income countries are quite different. In India, for example, it has been reported that the lockdown has forced many of the country’s 120 million migrant workers to return to their homes, and with public transport shut down, some of them are walking hundreds of kilometers with no food or water other than what kind people along the way give them. When they do get home, many will have no income.
Case: Yes, I was talking just about the richer countries.
Singer: We need to think about this in the context of the well-being of the community as a whole. Even if what Anne says about the recession is right, we are currently impoverishing the economy, which means we are reducing our capacity in the long term to provide exactly those things that people are talking about that we need — better health care services, better social-security arrangements to make sure that people aren’t in poverty. There are victims in the future, after the pandemic, who will bear these costs. The economic costs we incur now will spill over, in terms of loss of lives, loss of quality of life, and loss of well-being.
I think that we’re losing sight of the extent to which that’s already happening. And we need to really consider that trade-off.
I think the assumption, and it has been an assumption in this discussion, that we have to do everything to reduce the number of deaths, is not really the right assumption. Because at some point we are willing to trade off loss of life against loss of quality of life. No government puts every dollar it spends into saving lives. And we can’t really keep everything locked down until there won’t be any more deaths. So I think that’s something that needs to come into this discussion. How do we assess the overall cost to everybody in terms of loss of quality of life, loss of well-being, as well as the fact that lives are being lost?
Barber: You know, as a pastor, I live with death. What I struggle with is not that people are going to die. I struggle with the history, in this country, of deaths not counting equally. Of saying it doesn’t really count the same if First Nations people die off. Or poor people. Or black people. Even during slavery, certain slaves were expendable, because slave masters took out life-insurance policies on them. Now I’m hearing numbers that 40 percent of those dying in Michigan are African-American even though they represent 14 percent of the state population, and that in Louisiana, 70 percent who have died are African-Americans even though they are one third of the state.
Much of that traces back to the structural inequities that make people more susceptible to this sickness — the lack of health care and a living wage. The virus exists on top of the underlying vulnerabilities, and those exist without major outcry. That’s what troubles me: the way we accept in this country the death of 700 people a day from the effects of poverty, without the virus.
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