Donald Trump's Sophie Choice - public health or financial pain

"Public health risks need to be addressed with stringent public health measures; economic risks must be addressed with various economic measures. Mixing these risks and strategies will only result in worse public health outcomes (potentially a million lives lost) as well as worse economic outcomes..." Leonard M. Fleck.

Ethics professor: In the coronavirus crisis, don't prioritize economics over public health- an echo opinion published in the Detroit Free Press by Leonard M. Fleck.

Donald Trump said this week that he hopes to see economic activity ramped up and social distancing practices and other public health measures reduced (as soon as possible, even prior to the designated May 1, 2020 target date). 

This is a recipe for disaster and it again vividly illustrates his dismissal of medical and scientific expertise for his own political goals.

The rhetoric he uses suggests that the financial pain the nation will experience over the next year or longer is not worth the lives that will be lost as a result of dialing back public health restrictions. I am an ethicist. To me, Trump is forcing Sophie’s Choice decisions by people who have taken an oath to “first do no harm.” Trump and his advisers ignore the ethical pain that health professionals will have to endure who must decide who lives and who dies because we have too few ventilators or too few ICU beds to treat all the patients who need those beds for survival. Those harsh choices are very real right now. They would become even more tragic if public health measures now in place were loosened in order to improve economic activity.

Trump casually and thoughtlessly suggests that many fewer lives will be lost as a result of loosening public health restrictions regarding COVID-19 than is currently the case with the flu season (60,000 lives) or automobile accidents (40,000 lives). 

However, these analogies are entirely misleading. We have vaccines and effective treatments for addressing the flu. Some people choose not to get the vaccine. That is often a tragic choice. Auto accidents are also very often the result of bad personal choices: excessive speed, distracted driving, drunk driving. 

These are not things that can be readily controlled through public health measures of any kind. By way of contrast, we have no vaccine and no cure on the horizon, in spite of grossly exaggerated reports earlier this month from the Trump administration to the contrary. Further, we now know that asymptomatic people can infect others with COVID-19. That makes the virus especially insidious. That is the relevant medical scientific fact that requires the social distancing practices emphasized by every public health official.

Readers can readily recall the casual “happy talk” promulgated by Trump that the virus was completely under control several weeks ago and that we would have drugs to cure it in no time at all. We now have instead “unhappy facts,” such as 80,000 infected in the US and more than 1,000 deaths. We are very much on a steep upward curve in this regard that Dr. Fauci and other health experts expect to continue for at least the next seven to eight weeks, assuming that the stringent public health measures now in place remain in place for at least that period of time. Relaxing those measures would only result in something much worse with respect to the loss of life. 

Recall the recent images in the news of college students partying on the beach in spite of the risks of transmission (remember we do not know who is infected but asymptomatic). Those images generated a substantial public outcry regarding how irresponsible that behavior was. Trump relaxing public health and social distancing measures so that young and healthy people can go back to work, then have a friendly drink at the local bar after work, essentially says that the college student behavior was acceptable. 

Economically, the worst-case scenarios suggest a 24% decrease in GDP (Gross Domestic Product is the monetary value of all finished goods)  for the next quarter, not much better beyond, and 10% unemployment. However, the economic pain can be reduced by the $2 trillion dollar package Congress is poised to pass. If properly crafted, it will put money in the hands of workers that will allow them to buy food, pay their rent and utility bills and sustain the economy in that way. Millions of people are successfully and productively working at home and maintaining public health at the same time. That is the real take home message that Dr. Fauci and many others are emphasizing. 

Public health risks need to be addressed with stringent public health measures; economic risks must be addressed with various economic measures. Mixing these risks and strategies will only result in worse public health outcomes (potentially a million lives lost) as well as worse economic outcomes, though those will be a bit further out, likely past November. My apologies, I forgot to say anything about political risks. But the astute reader can figure that out.

Leonard M. Fleck is a professor and director of the Center for Ethics at Michigan State University's College of Human Medicine.