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Balancing Virus Response With Economic And General Health Consequences

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The coronavirus is not the only threat we face. As I wrote in The Hill on last Thursday and The Wall Street Journal editorialized last Friday, we may face a far greater threat from a collapsed economy, which would devastate everyone’s financial and medical condition.

This should be of special concern in Connecticut which entered the current crisis already economically anemic and financially shaky.

While this may not be popular to say, we should rethink shutdown policies in Connecticut. Actually, it may not be unpopular. A new Pew Research Center poll shows that 70 percent of Americans see the virus as a major threat to the economy, while only 27 percent see it as a major threat to their own personal health.

It should be a priority to keep people working and return to work the tens of thousands suddenly being idled. The Connecticut Labor Department received 56,000 unemployment claims in the first four days this past week versus a weekly average of 2,500.

A deep recession or depression would bring an inevitable deterioration in public health along with economic pain. It would push us backward down the Preston Curve, which demonstrates that life expectancy varies directly with income level: wealthy societies are relatively healthy, poor ones less so.

We should balance the “incidence curve” with the Preston Curve, putting as much effort into moderating economic devastation as we put into flattening the incidence, or infection, curve to keep coronavirus hospitalizations below hospital capacity.

In both efforts, we should maintain a realistic optimistic outlook. First, we enjoy a cultural advantage over China, the original and still the biggest location of virus outbreak. In China, the virus was spread far and wide by the tradition of returning home during Chinese New Year. There’s been nothing equivalent here and now.

Indeed, what seems to be occurring in the U.S. is that spread is a function of hot spots, such as the Seattle area around the Life Care Center nursing home, and a function of population density, notably in New York State (mainly New York City), where more than half of the nation’s 28,000 cases are now concentrated, according to the Johns Hopkins Coronavirus Resource Center. Indeed, Dr Fauci made remarks very much along these lines in Friday’s White House coronavirus briefing.

Apart from southwest Connecticut’s proximity and interrelationship with New York City, the state has neither hot spots nor heavy urban density equivalent to New York City. Notably, as of publication, the state had only 223 cases and five deaths, four of people over age 80.

While strict shutdown and shelter in place measures make sense in New York City, where the incidence curve may already be exceeding hospital capacity, it is doubtful that such measures do in most of Connecticut.

Another point of optimism comes with the “advantage” of experiencing the pandemic after other nations. We can put aside the scaremongering of some alarmists that COVID-19 may be the equivalent of the Spanish Flu. The 1918 Flu attacked people of all ages, whereas coronavirus spares the young. The median age in the U.S. is seven years younger than Italy, where the death rate is now the highest in the world.

During the White House briefing Tuesday, Dr. Birkes, the Coronavirus Response Coordinator, said “We do know from other countries that mortality under 30 [years of age] is extraordinarily low.” U.S. experience indicates the same. A report on nearly 2,500 of the first recorded cases in the U.S. found that people 19 and under accounted for less than 1 percent of the hospitalizations and no I.C.U. admissions or deaths, according to The New York Times. We should be grateful that our youngest are being spared.

So how should these lessons inform public policy? What should we consider doing even in face of the inevitable looming announcements of rapidly increasing cases, hospitalizations and deaths?

We should maintain an optimistic outlook, realizing that these increases will be, to a significant but unknown degree, a function of increased testing. As more people are tested, more cases will be discovered. However, increased case discovery should not be confused with an equivalent increase in actual cases.

We should maintain perspective, despite that we are beginning to see truly alarming increases in cases, hospitalization and deaths — which will escalate even more in coming days and weeks: According to the CDC, from 12,000 to 61,000 Americans die annually from the flu, and more than  67,000 Americans died of opioid overdoses in 2018. As of publication the Johns Hopkins Coronavirus Resource Center showed less than 300 nationwide deaths from the virus.

One policy we should re-evaluate constantly is that of keeping schools closed.

If children are not at risk of serious infection, and teachers below 30 have little risk of mortality, we might consider re-opening schools with young teachers only, leaving older at-risk teachers at home. Understaffed, schools would not operate at peak efficiency, but re-opening schools would enable parents to return to work.

Of course, the benefit of re-opening schools would be lost if all “non-essential” businesses must remain closed in Connecticut and other similarly situated states.

What might concentrate Governor Lamont mind is the outlook for state revenue.

With states now following the IRS delay of the deadline for filing and paying income tax for 2019 from April 15 to July 15, how will Connecticut and other states make it to July 15th? Connecticut’s rainy day fund is strong, but we are facing a perfect storm, not a rainy day.

Borrowing may not be an option. Municipal bond investors have taken huge losses, leaving little appetite for new offerings, especially from a state with the third lowest bond rating in the nation.

States that have not shut virtually all businesses can still collect sales taxes.

The general point is that public officials must balance the immediate virus crisis with a looming economic – and ultimately general health – crisis.

Connecticut has its own unique situation and needs which seem to be sufficiently different from other states to suggest different policies. As a nation we are all in this together, but, from state to state, we are in it to different degrees and in different ways. Ultimately, all states benefit if individual states optimize their individual policies.

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