What We Must Learn from the COVID-19 Response | Opinion

Public Policy Should Balance Competing Goods, Not Opt for 'Safety' at All Costs

In our book The Price of Panic, we argue that the cost of the political response to COVID-19 will likely exceed the benefits—in lives, jobs, health and dollars. Why? Because officials assumed a worst-case scenario and treated the response as low-risk. Both were serious mistakes. Now even the World Health Organization seems to agree that lockdowns are a bad idea.

The flawed computer model from the Imperial College London, from which both WHO and U.S. officials took cues, assumed that COVID-19 would kill 3.4 percent of the people it infected. That's a good thirty times more deadly than the flu in a severe season. We can now estimate the coronavirus's actual infection-fatality rate between 0.15 to 0.26 percent. So, the risk was exaggerated by thirty times.

At the same time, officials, the press, and much of the public acted as if lives were only at risk from the coronavirus. As New York governor Andrew Cuomo said, "If everything we do saves just one life, I'll be happy." But what if the response saved one life at the cost of two or more? What if it saved no lives at the cost of two or more? These prospects should have been part of the calculation from the beginning. They weren't.

We can't change the past, but we hope we can learn from it. One lesson we should all learn: The goal of a public health response can't be to reduce the number of deaths without respect to potential costs. After all, when all is said and done, the number of death certificates always equals the number of birth certificates. We can delay death, sometimes for decades, but we can't abolish it.

It's good to avert death and save life as much as we can, consistent with our other goals. But reducing an abstract number of deaths can't be the goal of our public policy.

What makes more sense is to count the years that are lost to premature death and try to save them. Obviously, losing one day of your life is less costly than losing a month, or a year, or a decade. We shouldn't compare the value of one person's life to another. Each person is unique and unrepeatable. Still, the death of nine-year-old Billy in a car wreck is tragic in a way that Billy's death at age ninety-nine from natural causes isn't.

Economists can figure out (roughly) how much we would be willing to spend to reduce the risk of losing a year of our lives by studying how much we spend (collectively) on fire alarms, airbags and the like. Right now in the United States, that number is around $150,000. Using that figure, we can measure the cost of premature deaths in terms of "years of life lost."

Of course, we don't know ahead of time how long anyone will live. So for health policy questions, we use averages. As the Organization for Economic Cooperation and Development explains, we can calculate years of life lost by "summing up deaths occurring at each age and multiplying this with the number of remaining years to live up to a selected age limit." This limit is usually around average life expectancy at birth, about seventy years.

The point is not to put a utilitarian price on every life, or to say that your value declines with age. The point is to get a grasp of how much deadly risk we freely tolerate in living our lives. That is, how do we as a society weigh the risk of death, injury and the like against other ends we pursue? This is how we think about other risks, rather than pursuing safety at all costs.

NYC park
A sign at a public park instructs people to keep their distance due to COVID-19 on September 14, 2020 in the Brooklyn borough of New York City. Spencer Platt/Getty

With that in mind, we can use age-at-death statistics published by the CDC to calculate the (reported) cost of the coronavirus in years of life lost. As of May 28, 2020, this number comes out to just over 400,000 years. That's a lot of life, to be sure. But it's far less than the years-of-life cost we accept for more familiar risks. When we do the same calculation on U.S. traffic deaths in 2017, we find that these caused the loss of about three times as many years of life—more than 1.2 million. Although collisions killed about half as many people as the coronavirus—just over 40,000 as compared to just over 80,000 on one estimate—the mean age of people killed on the roads was much younger—45 years compared to 76 years.

In other words, for generations we have accepted a higher annual loss of years than the coronavirus has caused. We've done this because we valued our freedom to travel by road more than we valued the 1.2 million years of life we give up for this freedom. And we weren't crazy to do so.

Safety is rarely our main goal. For most ventures, the first goal is to do something. For instance, you get in the car to drive to work. Safety is important, but if it were your primary goal, you wouldn't get in the car. Mike Rowe often reminded viewers of this in his show Dirty Jobs. He even started talking about "Safety Third," in response to the ever-present OSHA posters in workplaces he visited. Safety should be a high priority, but not the priority—not if you want to work a job, have a family and live a life.

This is one reason the one-size-fits-all policies made no sense. There's a vast difference between a disease that kills indiscriminately—the old and the young, the healthy and the infirm—and a disease that mostly causes or contributes to the deaths of people near the end of their lives. It's the difference between losing 60 percent of your life and 2 percent, given that we all lose our lives in the end. No doubt this was what Texas lieutenant governor Dan Patrick meant when he said that "there are more important things than living...saving this country for my children and grandchildren.... I don't want to die, nobody wants to die, but man, we got to take some risks and...get this country back up and running."

Of course, the press portrayed this statement as callous indifference toward the elderly—even though Patrick was referring to self-sacrifice. The point is not that we should sacrifice the lives of the old and frail for the young and healthy. We shouldn't. Rather, as a matter of public health, we should make sure that the costs of our interventions don't vastly exceed the benefits. Acting as if the virus was of equal danger to everyone—as if everyone's risk assessment should be the same—was bound to ensure the opposite.

Measuring the cost in life years gives us a way to take into account how we balance risk against other goods in real life. Economists are just starting to put a price tag in life-years on the lockdowns, but one early estimate put it at 700,000 per month, and 1.5 million by mid-June 2020. Whatever the final total is, it will surely be much higher than that.

We can now see how foolish and costly it was to impose a lockdown on most of the population. COVID-19 is far more deadly to the old and infirm, who are also least likely to work or be in school. We should have channeled resources toward protecting them, rather than overriding everyone's basic rights, forcing young children inside, shutting down businesses, emptying hospitals and setting up thousands of hospital beds that no one needed. We chose great pain for little or no gain.

The predictable refrain, of course, is that the pandemic would have claimed far more lives without the lockdown. But we argue in The Price of Panic that the evidence strongly suggests otherwise. The U.S. opted for a public health response that may have saved us nothing and will cost us hugely in life years.

We recognize that choices in a crisis are hard to make. No one intended for more lives to be lost than gained, but that seems to be what happened.

Jay W. Richards, Douglas Axe and William Briggs are the authors of The Price of Panic: How the Tyranny of Experts Turned a Pandemic into a Catastrophe.

The views expressed in this article are the writers' own.

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