For the Sake of Its Health, Let’s Get This Country Moving!

My initial skepticism about the way in which we have dealt with this real but exaggerated threat has only grown. In fact, the lockdowns and the shuttering of our medical and economic system have now become a greater threat than the disease itself.

After my essay on conservative skepticism about both the severity of the Coronavirus pandemic’s ultimate outcome and the wisdom of the many state lockdowns, I had a number of friends challenge me. After all, the numbers being thrown around by respected institutes such as the Institute of Health Metrics Evaluation (IHME) at the University of Washington, though much less dire than the predictions of the Imperial College London crew, were still pretty dire. Even President Trump was talking about 100,000-plus deaths at one point. Wasn’t I being naïve?

I do not think so. In fact, my skepticism about the way in which we have dealt with this real but exaggerated threat has only grown. In fact, the lockdowns and the shuttering of our medical and economic system have now become a greater threat than the disease itself.

It was indeed possible, I told my friends, that deaths due to this virus could get over 100,000, depending on how lethal it truly was. That would have been a difficult loss, about one and two-thirds the number of deaths of the very bad flu season in 2017-2018. But we did not shut down our society during that flu season nor did anyone propose it. Would we have done so if we had thought 70,000 or 80,000 would die of the flu (and the latter number is sometimes cited as a truer number for that year)? I did not think so. But we had been sold on the dangers of this pandemic by initial worst-case scenarios hawked by Neil Ferguson and his Imperial College Crew. Two million deaths! If we really got to work, maybe one million. Even as Dr. Ferguson changed his mind about the United Kingdom’s doom because of a shelter-in-place order that had not even been going more than two weeks, changing his estimates of their deaths from a quarter million to twenty thousand or maybe even five thousand, U.S. states were establishing lockdown orders everywhere, shutting “non-essential” businesses, closing schools, and telling people to stay at home except for “essential” activities.

At the time I wrote that essay my own state, Minnesota, had just enacted a shelter-in-place order Our state only had 2 deaths when the original order was set. Yet we were told by our own governor Tim Walz that state modelers predicted we would see 70,000 deaths if we did not lock down immediately. It was then reported that the initial order, which expired April 8, would only reduce our death toll to 50,000. How this was consistent with the IHME reports or others that were now predicting fewer than 100,000 deaths for the country was a mystery.

We were all to “flatten the curve,” it was said. We had to reduce the number of dangerous cases such that our medical system was not overwhelmed. This reasoning was used for lockdown orders all over the country. As it so happens, there have only been a few places where medical services have been close to overwhelmed. New York, which has recorded over 42% of American deaths from Covid-19 by itself, is one. Detroit, which, as I write, is racking up large numbers, is another. But for the rest of the country, there is almost no sign of the mythical overwhelming of the medical system that was promised.

In fact, not even New York was completely overwhelmed in their medical system. Other states, which had planned for massive numbers of patients, ended up abandoning makeshift Covid hospitals. Seattle, in the center of the original epicenter of the virus, built a large 250-bed army hospital to deal with potential overload. It has now been abandoned by the state of Washington, having never had one single Covid patient.[2] While Washington remains on lockdown and was put there very early, other states that resisted such drastic measures, such as Tennessee, Oklahoma, and Florida, are also not being overwhelmed. Oklahoma City has closed Integris Baptist, a 235-bed hospital except for its emergency room.[3] The Integris system has 32 Covid patients altogether. The same goes for hospitals all over the country. Having stopped elective surgeries and procedures to prepare for the onslaught of Covid patients, they are now furloughing medical personnel. Hospitals even in the cities, like Miami, where the virus has been most lethal have furloughed nurses and other employees because the apocalypse didn’t come.

Indeed, despite the apocalypse not coming, states have doubled down on their shelter-in-place orders. Despite Minnesota’s having fewer than 40 Covid deaths at the time, our governor extended his shelter in place order until May 4. Perhaps there was some reason for this? Maybe we didn’t have a lot of deaths but our system was in danger of being overwhelmed? Well, initial estimates for ICU capacity in the state were of 235 beds, but this was steadily increased such that we now have 2200 beds. As I write, three days after the second shelter-in-place order, state records show that we have 64 Covid patients in the ICU and 143 hospitalized altogether. Not only that, but the total number of patients hospitalized in any way for Covid is only 317 total. And of the now 57 deaths attributed to the virus, the median age is 87. In fact, the number of those hospitalized has never gone over 160 at a time.

Yet our state modelers, having revealed their data, showed that they are still predicting a minimum of 20,000 deaths and a top ICU demand of 3,300 beds.[4] To say this is unbelievable would be an example of Minnesota-nice understatement.

In fact, as one observer noted, the state’s largest daily increase in reported cases happened five days before the state’s shelter-in-place order.[5] One might conclude from all these facts that the social distancing guidelines put out by the state before were enough. But our state’s governor did not. What was he going to believe? The scary models or his own lying eyes?

In fact, the models have all been failures at providing any helpful guidance. The IHME models, which seemed modest in comparison to the Imperial College and Minnesota Department of Health models, have been continually revised because they too have either been completely off or have succeeded only in the sense that their claims about the needs for hospital beds have come in barely. What many people say when hearing this is, “Well, that’s because of the lockdowns and the social distancing!” Yet the IHME models were predicated on all of the social distancing and lockdown possible—and yet still predicted way too much utilization of hospital resources. They are now predicting 61,000 deaths for the country, the official summary of that bad flu system. I wonder if it will even get that high.

But our governments at the state level have continued to act as if the now-revised-and-abandoned models hold the truth.

The end result is that excessive measures have been enacted that have done tremendous harm to our economy but also to our public health. Since the rallying cry of those who are in favor of shuttering our economy for months on end is that anybody who objects “values money over lives,” I want to focus on the public health side first.

Effectively closing down our medical system because of a threat of its being overwhelmed—a threat that has failed to happen and is failing to happen—is seriously risking public health in four distinct ways right now.

First, by continuing to put off elective procedures, which are the ways in which most hospitals and medical practices actually stay solvent, we have jeopardized their future. My cousin and his wife, who served as a doctor and nurse respectively in northern Indiana for over thirty years, told me that the hospitals in their area may actually go under because of the financial pressure that they have been put under. This is true for many small hospitals around the country. And not just for hospitals. The American Association of Family Practice physicians is predicting that 40% of family practice clinics in this country could be destroyed by June due to the Covid situation. Dr. Brian Sachs tweeted about this, noting that along with an aging and burned-out workforce, there could end up being physician shortages very soon.[6]

Second, this putting off of elective procedures in a time when the system is not being overwhelmed is dangerous to our population at large. Dr. Harlan Krumholz, a professor of medicine at Yale, wrote in the New York Times of how his hospital is largely empty because elective procedures have been canceled. But his question is where all the heart attack and stroke patients have gone. “My fellow cardiologists have shared with me that their cardiology consultations have shrunk, except those related to Covid-19. In an informal Twitter poll by @angioplastyorg, an online community of cardiologists, almost half of the respondents reported that they are seeing a 40 percent to 60 percent reduction in admissions for heart attacks; about 20 percent reported more than a 60 percent reduction.”[7] Dr. Krumholz worries that patients are not seeking medical help because they fear contracting the virus. “As a result, many people with urgent health problems may be opting to remain at home rather than call for help. And when they do finally seek medical attention, it is often only after their condition has worsened. Doctors from Hong Kong reported an increase in patients coming to the hospital late in the course of their heart attack, when treatment is less likely to be lifesaving.”

In fact, this question ties into the controversy over how many people actually have died from Covid. Many suspect, because of the CDC guidelines allowing medical officials to count deaths if Covid has “caused or is presumed to have caused or contributed” to deaths, that there is perhaps something of an overcounting of deaths going on.[8] One of our Minnesota state senators who is also a doctor revealed that a seven-page letter had been sent to doctors seemingly nudging them to count deaths as Covid-19 even if there were multiple factors going on.[9] That this might be going on in other places is hinted at in a Pennsylvania story of a man who died after striking his head in a fall but had Covid listed as a contributing factor on his death certificate.[10] But in the case of New York City, I am willing to grant that there may have been some deaths in people’s homes that were due to Covid-19.

In fact, a New York Times story indicates that overall deaths in the home have spiked recently. Over eight times the number of people were found dead in their homes or on the street than during the same time in 2019. The Times, to its credit acknowledges that while many of these deaths might be from the virus, many of them involve elderly people with multiple co-morbidities, so it is difficult to tell.[11] Putting this article together with Dr. Krumholz’s column makes me think that if there were more virus deaths, there were probably a lot of deaths from people putting off treatments for fear of the virus or because they thought they should wait.

Indeed, two women I know have had procedures put off in Minnesota. One has a tumor that is believed to be benign. She’ll probably be ok, but what about the other one whose kidney transplant has been put off? While fewer than 150 people are in the state’s hospitals for the virus, she is now waiting for . . . what exactly? Our extreme measures designed to protect the vulnerable are putting the vulnerable in danger.

Third, we are going to have to open things up at some point. What happens if an actual surge of Covid patients were to arrive in the summer with an actual second wave? I frankly doubt this prospect, but imagine those people currently waiting for treatment while hospitals sit nearly empty and the numbers are flat suddenly getting to summer and then having to wait some more. The prospect is frightening.

Fourth, the shutdowns are seriously threatening tax revenue for the states in such a way that the public health that is provided for or supported by the states will be put in serious jeopardy. While there is serious waste involved in every government’s budgets, the reality is that the good spending that we do will be eliminated as well—given how governments work, probably before the fluff is.

Which leads us to the economy. We now have close to 17 million people unemployed in this country. Not all of those jobs will be there if we continue on for another month of shutting down businesses. In addition to medical practices, a lot of small businesses are at risk of permanent closure, even with federal help of various sorts. But even for the ones that survive there are going to be new expenses in order to prevent the spread of this virus that we do not have a vaccine for. Many people have suggested that it’s a false choice to pit the economy against health in debates about our country’s policy. Even countries such as Sweden that have not locked down are having difficulty. I agree that this is true. We cannot simply “go back to normal” immediately. But this is all the more reason that we need to start getting businesses back into the game now when there is no apocalypse at hand. We need to turn things around before this recession becomes a depression.

Why not? Because, to get back to public health, recessions and depressions end up taking a lot of lives, too. James Freeman of the Wall Street Journal has eloquently chronicled the vast increase in hunger right now, noting that this is a government-caused malady that has miles-long groups of cars lined up to get food in the Monongahela Valley.[12] On the basis of these models, many people have been put out of work by their own elected officials and now are seeking out food banks. This is not just because they don’t have money but because the shuttering of vast parts of the economy has led to supply-chain breaks resulting in shortages of food as well. Perhaps you’ve seen articles about dairy farmers having to dump milk because their processors have not been able to sell their products because food service and restaurant chains have been interrupted? Or perhaps you’ve seen the vegetables dumped by many farmers? Because of the short-sightedness of these shuttering of businesses, many people can neither pay for nor find food.

It’s not just food, though. Work is natural to and good for human beings. When we don’t have it, despair is very quick to come. Reports from around the country about the increase in drug problems and suicide have been thick. In Indiana, where I grew up, the state’s 211 hotline for people in crisis has seen call numbers go from 1,000 per day to about 25,000 per day. The hotline specifically for suicide has seen its numbers go from 20 per week to 20 per day.[13] Indeed, we know that suicides increase during times of recession.[14] President Trump was mocked for saying that with a recession we could have more suicides than Covid deaths. But given that we have about 50,000 suicides a year and the predictions are now that we will have only 61,000 Corona deaths, a spike could indeed make that a reality.

I realize that some people might think I’m crazy. Indeed, on April 10, Good Friday, the U.S. reported a new high in deaths for the day: 2,035 according to Worldometer’s record. Shocking, right? But the reality is that starting early in April many states began to report deaths from a back log. We can argue about whether some of those deaths were falsely put down under the loose CDC guidelines and state pressure to have more deaths (and thus justify lockdowns and also get more money from Covid-legislation). Let’s say they are accurate, however. They tell a different story than what one might think. So Indiana reported 55 deaths that day but they were clearly spread out over several weeks because the death count for April 10 according to Indiana’s state health site was only 7 but the total number of deaths matched Worldometer. The high water mark was actually April 1 when that state counts 26 deaths.[15] The trend does not look apocalyptic at all. Instead, it has been trending downward.

The same goes for all the other states, who have been reporting old deaths. New York, that possessor of the dubious distinction of having over two-fifths of our Coronavirus deaths, has seen its hospitalizations drop over 60% over the last week. Since deaths are a lagging indicator, a drop in hospitalizations means that even their numbers are likely to drop very soon. And when they do, the scare-factor is likely to drop quite a bit.

But we will still have that nearly 20 million people without work—and all the problems I’ve outlined above. This will still be bad. The only governor to have announced he’s trying to get his state back to work is Greg Abbott of Texas. God bless him. In other states, though, politicians have started to show some spine. Minnesota’s Republican leader has balked at our new order, and politicians in other states have begun to demand a timeline for getting their states back to work. The President has himself announced a new taskforce dedicated to getting our economy started again.

It’s time to do it. While we have indeed seen a great many deaths and we will see some more, the apocalypse that was foreseen has not come about. The “surge” never came in many states. It seems perpetually two weeks away in the minds of those who have kept their eyes on the models and not on the facts at hand. We skeptics were right to be skeptical not just about the predictions but about the prudence involved in the shutdowns of our businesses. They are now a greater threat to our country’s health and safety than the virus itself. Let’s stop panicking at models and start acting prudently.

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[1] Liz Brazile, “Army field hospital for Covid-19 surge leaves Seattle after 9 days. It never saw a patient,” KUOW, April 8, 2020

[2] Kaylee Douglas, “INTEGRIS Baptist closing Portland Ave. location except ER during COVID-19 outbreak,” Oklahoma News 4, April 8, 2020.

[4] Eva Enns and Shalini Kulasingam, SARS-CoV-2 (COVID-19) Modeling (Version 2.0) (April 10, 2020), distributed by University of Minnesota Department of Health.

[5] Scott Johnson, “Coronavirus in One State,” Power Line, April 6, 2020.

[6] Brian Sachs (@BrianSachs), “This is concerning. The @aafp is estimating 40% of family medicine clinics are at risk of closing by end of June, due to #COVID19. Coupled with an aging and burned out workforce, physician shortages may soon worsen significantly. https://healthlandscape.org/covid19/,” Twitter, April 7, 2020.

[7] Harlan M. Krumholz, “Where Have All the Heart Attacks Gone?“, The New York Times, April 6, 2020.

[8] Steven Schwartz, New ICD code introduced for COVID-19 deaths (March 24, 2020), distributed by the National Center for Health Statistics.

[9] Cali Hubbard, “MN Sen. Dr. says reported coronavirus deaths may be off,” Valley News, April 8, 2020.

[10] Nick Falsone, “Coronavirus a contributing factor to Lehigh patient’s death, coroner says,” Lehigh Valley Live, March 21, 2020.

[11] Ali Watkins and William K. Rashbaum, “How Many People Have Actually Died From Coronavirus in New York?“, The New York Times, April 10, 2020.

[12] James Freeman, “Now They Tell Us,” The Wall Street Journal, April 9, 2020.

[13] Elizabeth DePompei, “Indiana sees ‘alarming’ spike in mental health, addiction issues amid coronavirus,” Indy Star, April 3, 2020.

[14] Mary Elizabeth Dallas, “Recession linked to more than 10,000 suicides,” CBS News, June 12, 2014.

[15] n.a., 2019 Novel Coronavirus (COVID-19), distributed by the Indiana State Department of Health, last updated April 13, 2020.

The featured image is courtesy of Pixabay.