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Weighing the Economics, Public Health Benefits of Sheltering in Place Ira J. Bedzow, Ph.D. Adam E. Block, Ph.D.

Imagine trying to hold your breath. Some of us can hold it only for a few moments, others for a bit longer. Now imagine trying to hold your breath as someone starts taking the air out of your lungs. The impulse to breathe becomes much stronger. This is what is happening all over the country as we feel the effects of “sheltering in place.” We sit at home watching the stock market fall and companies lay off employees or put them on furlough. We all want social distancing to end and for life to go back to normal. However, the consequences of emerging from our homes too soon will be catastrophic for everyone. It will affect young and old, fit and frail, in terms of both health and wallet. Over the past several weeks, many Republicans have framed the debate in terms of saving people from economic threats to life, while Democrats framed it in terms of saving people from pathogenic threat. Despite the debates in Congress and on political talk shows, when to end social distancing is not simply a matter of either public health or the economy. Our leaders need to recognize the consequences of both sheltering in place and opening up for business. They must then make decisions that reduce the negative effects of each choice and maximize the benefits of both. Public health and economics are aligned in this case. There is no recent precedent for what is happening, so we have limited evidence. However, economists at MIT and the New York Federal Reserve Bank found that, after the 1918 flu pandemic, cities that instituted social distancing earlier and more aggressively fared better economically. They also found that less social distancing led to higher flu mortality and lower economic activity. Given our current ability to engage in virtual meetings and shift our transactional activity online, we should expect fewer negative economic impacts per extra day of social distancing.

public health and an economic strategy to stop the long-term effects of the spread of COVID-19. This may be difficult to imagine in areas where the pandemic so far has had little impact, but if we wait until COVID-19 is on the rise in these places, it will be too late. If we open up for business too early, we will not get the economic improvement we all desperately desire. Even in places where contagion may be in check, without mass testing and home isolation for those who test positive, fear of a second wave will limit economic improvement. Just because a restaurant or store is open doesn’t mean that people will want to eat there or be willing to risk their health to work there. If contagion is not held in check, the virus will rip through the country, leaving any market that we still have without either supply or demand. There will be few consumers willing to risk getting sick to buy goods and few workers willing to go into the market to produce their goods. Any state or federal investment in recovery will have been wasted. As the virus continues to spread across the country, working its way from the predominantly Democratic coasts and major metro areas into the predominantly Republican heartland, we must be careful not to make rushed decisions. Opening up for business too soon would be like telling people it’s safe to go back to work on the middle floors of the building as the bottom and top floors are still aflame. Sheltering in place—even as it starts to really hurt—is still the better option in terms of both public health and economic well-being. When we do finally open for business there will be more pent-up demand and more confidence in the restarted economy. We will also have greater faith in our government, especially if it continues to pass legislation that helps the people weather the pandemic. The cost of an extra few weeks of sheltering in place is primarily financial—painful and stressful, but curable. This does not trivialize the complications households and small businesses are facing. It recognizes that the government is still well-equipped to handle crises that can be solved with money. However, once a pandemic spreads without control, the government cannot stop it. And as Italy has seen and New York City is on the verge of experiencing, once we run out of hospital beds and clinical staff, it is very hard to create more. Public policy is where our economic and social values meet the practicalities of our daily life. We need a plan to get back to the lives we once lived. But, if we tell our citizens to take that breath too soon and they continue to contract COVID-19, then no ventilator will be able to help our country. As appeared in Modern Healthcare on April 6, 2020.

Social distancing should therefore be seen as both a

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