Pandemics impose both tangible and intangible costs on society. These costs come directly from deaths and from providing medical care, and indirectly from lost wages and business revenue, and the many mental health and well-being consequences of disrupted lives. To control the COVID-19 pandemic from its outset, public health measures — such as stay-at-home orders, physical distancing, and temporary restrictions and closures of some businesses —have been needed. Without such public health measures, the numbers of COVID-19 cases could have quickly exceeded health care capacity, leading to the dilemma of triaging ill people to receive potentially life-saving care, or not.
These transmission control measures have proved effective in Colorado, which has not exceeded its overall hospital capacity nor the number of needed intensive care unit beds. Lives have been saved, and the health costs of the pandemic reduced as a result. Yet, the “costs” of public health measures have been questioned by critics who view the broader economic consequences of these interventions as too high. Pitting the economy against public health creates a false dichotomy. With irony, as an epidemiologist and an economist, we note that this dichotomy has been simplified to “epidemiology versus economics.”
To understand the consequences of public health measures, we need to know what would have happened if steps were not taken to control the pandemic. While we never experienced this alternate reality, scientific evidence suggests that the public health toll would have been higher. The Great Influenza of 1918 killed 50 million worldwide and 675,000 in the United States, equivalent to more than 2 million deaths with today’s population. Evidence also suggests that people have voluntarily stopped patronizing businesses for fear of contracting the virus, which reduces revenue and employment. Indeed, recent data indicate that residents of high-income zip codes are less likely to patronize businesses when COVID-19 is prevalent in the area. The reason is that people with higher incomes are more likely to work from home and can afford to avoid potentially risky interactions.
In Colorado, the approach to epidemic control has been measured, titrating the public health measures against the status of the epidemic with the goal of optimizing the balance between epidemic control and maintenance of normal activities — commerce, education, social activities, and more. That strategy has avoided catastrophe while sustaining commerce, education, and other activities to the extent possible. These measures' adverse economic consequences have played out unevenly with some sectors, e.g., restaurants, experiencing severe hardship. Unfortunately, the needed relief for the hardest-hit sectors has not been sufficient or sustained, in spite of economic sacrifice for public health.
Turning back to those who question the public health measures, we have not seen evidence-based approaches offered as an alternative to what has been done to protect us. While economics offers a framework for weighing the public health and economic costs, the estimates depend on assumptions and figures that are very uncertain. Early estimates of the strictest control policies suggested that they generated net benefits of more than $5 trillion for the entire U.S., comparing the value of lives saved against the reduction of gross domestic product (GDP) from policy measures. Estimates of this sort will evolve as we learn more about the disease and its consequences, observe how people respond, and gather economic data.
We think that no one would argue against some level of public health measures to control the COVID-19 pandemic. Finding an acceptable balance between public health and economic hardship is challenging because opinions about the balance point depend on perspectives. People at low risk of severe illness facing lost revenue may perceive public health orders as too strong, whereas those at risk and in a strained healthcare system may perceive the orders as not strong enough. Life-changing interventions and their adverse consequences have proved challenging, and we recognize that some will want different balance points than others for various reasons. That complexity cannot be escaped, and we should not simplify this societal discussion into a false dichotomy that pits the health of all of us against revenue and employment. The bottom line is that the COVID-19 pandemic is costly, but failing to control it would be catastrophic.
Jonathan Samet, a pulmonary physician and epidemiologist, is dean of the Colorado School of Public Health. Jude Bayham is an assistant professor in the Department of Agricultural and Resource Economics at Colorado State University and the Department of Epidemiology at the Colorado School of Public Health.