The Equivalent Deaths Debate

Introduction

More than a million U.S. confirmed COVID-19 cases and tens of thousands of deaths have accrued. President Trump and Fox News downplayed the virus for months, but rhetoric and bravado didn't slow the virus down. What was eventually required, unfortunately, were massive shutdowns to prevent a smothering of the states' health care systems. These shutdowns came at great economic cost.

The United States eschewed the severe, pristine shutdowns of countries like South Korea and New Zealand. It also refused a shutdown the duration of Italy's or Spain's. Instead, the U.S.  sought to re-open by shortening Italy's shutdown example by more than a month.

All of the models predicted additional tens of thousands of lives would be lost by re-opening quickly without extensive testing or contact tracing in place. The president, the GOP, and key southern governors all jumped on the re-opening bandwagon anyway.

A country that for decades had been the technological and health care leader of the entire world now found itself exposed as knowingly trading thousands of lives to truncate economic damage. Other nations, however, had managed to avoid the same death-generating choices. Questions like, "Why is the U.S. economy unable to handle a shutdown similar to Italy?" were rarely asked by the American media.

Those who pushed for early re-opening invented a rationale for the fast re-opening in an effort to soften the perception of U.S. callousness. The rationale, which I'll refer to here initially as the "equivalent death" argument, has not been adopted by other nations. This has placed the U.S. president, the GOP, and certain red state governors in the position of trying to defend their equi-death reasoning.

I find the language and details of the equi-death arguments fascinating. Exploring them is a real intellectual, cultural, and emotional adventure. What I hope to eventually make clear is that equivalent death arguments are less about logistical harm reduction decisions and more about defending the idea of an unyielding current American societal structure.

Basically, the equi-death rationale starts with the core argument that additional lives lost to the virus due to quickly re-opening are somehow balanced by lives saved because people get back to work faster. The equi-death perspective posits that another four to eight weeks of extended shutdowns would create such economic hardship that the resulting suicides, depression, drug use, and domestic violence would balance the tens of thousand of lives saved from the virus if shutdowns were maintained until science said it was prudent to open.


Conceptual and Language Misdirection

I'd like to tighten up the language here a bit. Obviously, if depression, drug use, and domestic violence are going to be called into play as variables on the side of early re-opening, the proper term  should be equi-misery as opposed to equi-death. Actual dying is not usually the outcome of depression or other mental illness, drug use, or domestic violence. Thus, the argument being pushed by early-openers becomes loaded with a very subjective component, a misery index of sorts, as opposed to a raw tallying of deaths.

Here's an interesting detail regarding this -- each time that I have seen the listing of bad outcomes from extending shutdowns, "suicide" has always been listed first, followed by other deleterious events that are not deaths per se. The argument is always made in this manner. Increased deaths by virus, it's explained, are balanced by reduced suicides (a death number), followed by events that are primarily misery indices but are rarely actual deaths. The argument is made in this particular sequence so formulaically that I have to think that it's a very purposeful presentation.

Increased virus deaths due to early re-opening are presented as being counter-balanced by far fewer deaths from suicide and measures of misery that are not quantified in terms of deaths. This is what, for now, I'll call an "asymmetrical presentation" that tries to compare a tally of actual deaths to a tally combining real deaths (suicides) with various subjectively defined misery indices.

It's a clever debate trick, as it fails to measure or even mention the misery indices associated with the tens of thousands of extra deaths due to early re-opening. This is why I call the presentation asymmetrical. It's trying to define extra tens of thousands of lives lost as not having its own, very weighty set of misery indices. The equi-misery balance proposed by the early openers does not acknowledge the extra depression, drug use, or domestic violence that might result from the extra virus deaths themselves. Somehow the hardships of added deaths are not considered to have these miseries attached, while economic hardships are. It's a truly obvious blind spot in the argument, and it suggests much about the perspective and priorities of the proponents of early re-opening.


Structural Issues

The equi-misery argument fails to address some basic obvious questions. Why is the American economy so vulnerable as to require the briefest of shutdowns? Why do other nations not feel it necessary to make the same equivalency arguments?

One main problem with the equi-misery stance is that it pre-supposes a completely crystalline, inflexible structure to American priorities and the U.S. budget. Let me give you an example. We have no cure for COVID-19 right now, no real treatment, and no vaccine. The deaths from the virus are going to be in a certain range given an infected population percentage, assuming health care is not overwhelmed. Deaths will be deaths, in other words. On the other side of the equi-misery equation, the open-early proponents have lumped suicides, depression, drug use, and domestic violence. The United States, however, has enormous human, technical, and financial resources that could be shifted and brought to bear on all of these problems. Suicides, depression, drug use, and domestic violence are each miseries where a massive re-allocation of human and material resources can be redirected to intercede. Massive intervention could have huge positive effects. Those at risk for suicide, the depressed, drug users, and victims of domestic violence do not face inevitable outcomes to the same degree that x number of deaths per virus-infected person are inevitable. Changing crystalline U.S. priorities and resource allocation, however, are not considered options in the early re-openers' equi-misery arguments.

The equi-misery stance also ignores the ameliorating effects that a universal basic income could provide during this pandemic. It would certainly reduce concerns regarding suicides, depression, drug use, and domestic violence. People pushing the equi-misery equation, however, do not mention such a thing, even though it is an obvious tool for preventing these misery events.

The idea that the U.S. is a society, not an economy, is rarely broached by equi-misery advocates, and for good reason. Additional waves of COVID-19 are almost a certainty, and additional pandemics may be only a few years down the road. The head of the South Korea Infectious Disease Institute, for example, expects another in about four years. If the structure of the U.S. is so stressed by a single viral wave that it is willing to sacrifice tens of thousands of lives to quickly re-open, what happens when second or third waves or second and third viruses hit? The crystalline U.S. economic structure would clearly not endure without horrific loss of life. Radical change would be required to prevent an American abattoir. The equi-misery arguers are not ready to discuss or even admit these implications.


Numbers and Next Tme

Suicides in the U.S. have been on the rise, recently averaging about 45,000 per year. The U.S. is currently 42nd in the world in suicides per capita. Allowing for a 50% increase in suicides this year due to economic hardship and stress (and no cultural response or mitigation), the number of lives lost to virus due to early re-opening will dwarf any suicide addition that might have occurred due to an additional four to eight week shutdown.

In next week's second installment on this topic, I'll explore three additional problems with the equi-misery argument, including the absurdity of trying to attribute all suicides, depression, drug use, and domestic violence to economic hardships as separate from the contextual stress of an existential disease threat.


Bob Dietz
May 23, 2020