What is cost of the shutdown in terms of lowered overall health and increased mortality?

Diagram of tradeoff. Image courtesy of Adobe Stock.

Found an article that well explains the worry I have from this extended shutdown of most of the US economy.

4/17/20 – Wall Street Journal – The Hidden Toll of Untreated Illnesses / As COVID-19 overwhelms doctors and hospitals, patients with other conditions receive less care, leading to a rise in mortality.

My concern is the shutdown, loss of income, and isolation will have adverse health consequences. What will we see in terms of the level of increased mortality of people with serious illnesses which would otherwise not occur?

How many people are going to die from the shutdown?

What the tipping point at which the shutdown has more cost in terms of health than benefit? The  first step in addressing that question is realizing the question even exists.

(Cross-post from my other blog Nonprofit Update.)

Author of the article is a practicing cardiologist.

He reports the number of heart attack victims seen in the hospital where he works has dropped from around 40 a week to about 5. He says the same thing is happening at specific hospitals in Detroit, Atlanta, and Boston.

He also says the number of people being seen for appendicitis, gallbladder infections, and obstetric emergencies have dropped off dramatically. A neurologist told him that they are seeing half as many stroke victims as usual.

Some portion of the drop in those cases may be people not getting sick because their stress is gone down from work or something that would have otherwise triggered heart attack or obstetric emergency was avoided.

Have the number of people having strokes dropped by half? Assess the likelihood for yourself.

Some small portion of the drop in cases is a benefit of the pandemic. That is not the explanation for all of it. Far more likely, both in his stated comments and from use of logic, is people are choosing to stay away from the hospital in marginal cases, or trying to treat at home, or ignoring the problem. None of those approaches improve health outcomes.  The driving factor in avoiding treatment is likely the fear of contracting coronavirus from the visit to the hospital.

Thus, it would appear that the fear and panic over the coronavirus is causing a decline in treatment of life-threatening illness.

Author says the death rate in areas of Italy hardest hit by the pandemic has gone up by factor of six over what would otherwise be expected. Mortality rates in Spain have doubled. A study published in Italy analyzed the anomaly in one particular city, suggesting that coronavirus is only causing about one fourth of the increase in death. Author suggests under-treatment of severe illness is the reason for three fourths of the increase in mortality.

These are called “indirect deaths.”

Author explains that during and after the Ebola epidemic in West Africa many illnesses, such as malaria, HIV/AIDS, and tuberculosis were under-treated. The result was an additional 10,600 deaths according to the study.

Another factor in the current pandemic, which the author does not discuss, is hospitals have halted all nonessential treatment and postponed all elective surgeries. That means a large number of people who need treatment for an illness are not getting it.

Hospitals are laying off staff because of the drop in patients. Don’t have a specific article to cite, but have read multiple articles in the last week mentioning layoffs.

People in nursing homes or assisted living facilities are prohibited from leaving their facility, even for necessary medical care. Therefore all of the seniors living in those places cannot receive routine care, screening tests for unknown disease, preventive treatment for known illness, or ongoing treatment for severe life-threatening illnesses.

What will be the cost?

What will be the increase in mortality because of the postponed, skipped, or declined treatment?

What will be the increase in suffering and mortality from depression and mood disorders during this isolation?

What will be the overall decline in health due to reduced medical care?

When do we get to the point of the shutdown hurting overall health more than it helps?

It is time to slowly open up the economy. It’s not just economics. It is a matter of life and maintaining health.