Did Shelter in Place Save Lives or Cost Them?

Covid-19 might kill 100 thousand of us in the US, but maybe not. We still have hope that it will kill far fewer. What we do know is that putting 200 million people under a relaxed house-arrest costs lives too. We have to ask if shelter-in-place saved lives or cost them. Who gets to decide that more young addicts committing suicide was worth it in order to have fewer old people die in nursing homes?

You want us to do what?
The entire discussion rests on shifting definitions. At first, we were told to “flatten the curve”, and that made sense. The mortality rate from the virus and from every other disease would skyrocket if our hospitals were overwhelmed and couldn’t take new patients. Fortunately, we flattened the curve really well. Once our medical facilities had some breathing room, then shelter in place didn’t save lives.

That is when some politicians announced that we needed to keep the disease from spreading. Diseases like this coronavirus are not easily contained. They spread as easily as the common cold, since many cold viruses are also coronaviruses. Did those orders serve a public health goal, or were they serving a political goal of putting the politicians in front of the news cameras? There isn’t data that they saved lives.

Died with the virus or because of the virus?
To make the entire question harder to understand, we also starting fudging the numbers. You might already know that many men die with prostate cancer, but not from prostate cancer. It is unclear how we should record it when a person who has several diseases and only a few years left to live dies with the coronavirus. Some deaths were recorded as being from the novel coronavirus while the patient could also have died from the seasonal flu which caused similar symptoms. The early numbers have large error-bars and overcounted the lethality of Covid-19.

We made the illness worse.
We’ve seen some very strange information coming from New York City. One bad practice was to move seriously ill patients with the virus to nursing homes to recover. These patients no longer needed critical care in a hospital, but they remained infectious. Many residents of these nursing homes are elderly people who are very vulnerable to the virus. That may explain the unusually high number of deaths that we saw among old people in New York city while we didn’t see that rate of lethality in other cities.

There are other medical costs.
Telling a hundred million people to stay home has secondary effects that go way beyond toilet paper. We told people with serious health problems to avoid medical treatment so we could make room for the flood of Covid patients. That flood never came. Instead, we had people die of heart failure or of cancer while they waited for medical treatment. Treating the entire USA the way we treated New York City was a mistake.

Does social distancing save lives?
It isn’t clear that mandated social distancing and shutting down schools and businesses actually saved lives. Sweden and South Dakota never issued stay-at-home orders. Their rates of infection were not much different from other states. Some were better, and some were worse. Japan had extraordinary success by isolating their vulnerable population and issuing voluntary health recommendations.

Isolation is dangerous.
There are a number of other fragile populations that politicians put at risk with lockdowns. As of yet, we don’t know the cost in human lives. We kept mental health patients from seeing their therapists. We kept addicts from attending their support meetings. We know that a regular schedule helps people keep their life on an even keel. Feeling useful at your job helps you feel like your life matters. People adapt, and therapists and addicts developed schemes to work around the edicts for social distancing. We don’t know how many more people relapsed or committed suicide because stay-at-home orders removed their support network. We do know that we made more addicts and more suicides.

The human cost of unemployment
Politicians put 15 million people out of work. That increased the unemployment rate by 8.2 percent. Earlier, we’ve seen the opioid death rate increase by 3.6 percent for each percent increase in the unemployment rate. We had about 114 thousand people die in 2018 from drug overdose and suicides. That number increases to about 192 thousand when we include deaths due to alcohol. If deaths due to alcohol abuse and suicide are as sensitive to unemployment as drug overdose deaths, then government mandated lockdowns might have killed an additional 57 thousand people. We’re not sure yet, and I hope it is less. Far less.

That doesn’t mean that mandatory stay at home orders failed. It means we have to see about a 40 percent reduction in the rate of death due to Covid-19 after states and counties impose lockdowns, or else the stay at home orders could cost more lives than they saved. We’re not seeing that sort of reduction in illness yet.

Other people with a sharper pencil will generate more accurate numbers than I have. This quick glance is enough to know us we have to be careful. Putting people into social isolation costs lives and is only justified once we have evidence it actually reduces deaths from Covid-19.

Until we have that evidence, shelter-in-place orders are political theater.

Rob Morse

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