As all 50 states reopen, leaders weigh tough questions

Michael Flood feels for America’s government leaders. They have difficult choices to make in deciding how quickly to reopen economies. As president of the Los Angeles Regional Food Bank, he’s seeing both sides of human hurt in the coronavirus pandemic.

On one hand, a lockdown to prevent spread of the virus has caused great economic and mental stress, illustrated in the skyrocketing demand for food pantries in Los Angeles County, the most populous county in the nation. The food bank’s distribution has surged 80% since the beginning of March – nearly twice the increase during the Great Recession. Several times a week, upward of a thousand cars line up at parking lots for drive-through groceries.

At the same time, two people who worked at the food bank’s partners have died from the virus. Los Angeles County is the epicenter for the outbreak in California, with about 2,000 deaths so far. The disease “feels like a personal threat to all of us,” explains Mr. Flood.

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“We’re seeing on both ends, people who have died from COVID and this huge impact. I really struggle with this. It’s so hard to figure out.”

It is no wonder that Mr. Flood is wrestling with trade-offs in the reopening. Much of the country is entering a “gray space,” as Los Angeles Mayor Eric Garcetti puts it. That space lies between flinging open the doors and cautionary measures to prevent a virus resurgence. It includes ethical dimensions as governors and local officials make life-altering choices, while those unhappy with the decisions push back in the courts and on the street. Americans need to have a national conversation about these choices and their consequences, say social scientists. But it’s a tough subject.

As New York Gov. Andrew Cuomo recently put it, “How much is a human life worth? That is the real discussion that no one is admitting, openly or freely.”

The national narrative on choices surrounding the pandemic is evolving, says Anita Chandra, director of the Rand Corp.’s research on social and economic well-being. It started with “we’re all in this together” and “sheltering in place” to save lives and not overwhelm hospitals. Now, with the curve flattening in states like California, Washington, and New York, some people are saying that their personal liberty and other aspects of their well-being are more important.

The bottom-line question

But the conversation needs to advance further, and be more directly addressed, says Dr. Chandra. She puts it plainly, “How much do you weigh different parts of our total well-being against each other?” It’s an “uncomfortable” question, she says, but necessary, because it forces moral questions about American values and prepares the country to deal with a possible resurgence of the virus – and learn from it.

For instance, what choices will government leaders make if the nation muddles through a summer of retail and restaurants at half capacity and sees an uptick in the economy – and then faces a spike of infections? Many people will want to keep the economic vitality going, while others will worry about contracting the virus.

“There’s a lot of fear. Even as we reopen, a lot of people say to me, ‘Don’t reopen. I don’t want to work. It’s not safe,’” says Dr. Barbara Ferrer, director of the Los Angeles County Department of Public Health.

Weighing the costs

This week, COVID-19 deaths topped 93,000 in the United States, far more than the 58,000 Americans who died in the Vietnam War. Marginalized and vulnerable populations are bearing the brunt.

At the same time, isolation and joblessness have their own costs – among them, mental health, children’s welfare, and financial ruin. Unemployment stands at 14.7%, the highest rate since the Great Depression. The pandemic could lead to 75,000 additional “deaths of despair” resulting from drug or alcohol abuse and suicide, according to the Well Being Trust, a national wellness foundation.

In trying to prevent COVID deaths, the medical profession is doing exactly what you would expect them to – save lives, says Dr. Chandra. But that needs to be “balanced against all these other aspects of well-being.”

Governments do have a mathematical way to figure a cost-benefit analysis for policies as they relate to risk of a lost life. It’s called the value of a statistical life, or VSL, and it’s based on how much individuals themselves are willing to pay to reduce the risk of death. Right now, VSLs range between $9 million and $11 million per life and are used to determine, for instance, the cost of environmental regulations or road improvements.

But some say that’s too blunt of an instrument to use – or at least use by itself – because it’s rooted in narrow trade-offs that don’t fit a broad condition like a pandemic. Questions about American values also have to be considered, says Dr. Chandra: “What are the ethics around liberty and freedom of movement? What are the ethics around whose life is worth more? And what are the ethics around protecting the most vulnerable?”

Not a dichotomy

Wellness experts regret that public health and the economy are being pitted against each other. The two are actually inextricably connected and support each other, they say. “The question should be: How do we prevent the most number of people from dying from anything, period,” says Benjamin Miller, chief strategy officer of Well Being Trust.

“I think the way the choice is being presented is between saving grandma and saving the economy, and the way we look at it is if we’re not careful, we’re going to kill grandma and kill the economy,” says Alex Tabarrok, director of the Center for Study of Public Choice at George Mason University in Fairfax, Virginia. “These two things are not in opposition to one another.”

He co-authored an Op-Ed in The Washington Post arguing that quick, congressional funding of sufficient testing, contact tracing, and quarantining would provide the confidence and safety needed to open up businesses and bring people back to work. This should be combined with “zones” that open at different paces, recognizing that the virus has not hit all regions equally.

Others see more federal spending as the way to protect against harm from disease and a decimated economy, pointing to Federal Reserve Chairman Jerome Powell’s remarks that Congress may need to do more in the way of fiscal support. The House passed a $3 trillion stimulus bill that would aid state and local governments that faces an uncertain future in the Senate. On the other hand, President Donald Trump is pushing for a speedy reopening, as is his treasury secretary, Steve Mnuchin.

Can ingenuity provide a bridge?

And then there are those who point to American creativity as a bridge to carry the country forward. A case in point: Didi Hirsch Mental Health Services, which provides free mental health, substance abuse, and suicide prevention help.

The group completely reoriented its work from on-site only to allow people to work remotely. In a herculean effort, it outfitted its 80 staff and 215 volunteers with laptops and headsets, trained them, and changed the setup for callers to the crisis line.

The inflow of calls related to COVID-19 has been huge, and for the first time, caller and counselor have been experiencing many of the same things. The nonprofit had to contend with virus exposure, quarantining staff. Some staff have lost family members, says Carolyn Levitan, the crisis line director.

On the other hand, the forced reorientation has opened a whole new way of operating, says Ms. Levitan. “It’s a huge eye-opener. I’m really excited about it,” she says. It turns out not everyone wants to endure Los Angeles traffic to volunteer in person, and people have other reasons for wanting to work from home.

No matter what state and county officials decide about the pace of reopening, though, her group will take a “thoughtful” approach. “It’s going to be a very slow return for us,” in part because of people’s fears about safety, though the center has put social distancing and extra hygiene measures in place.

County leaders are now hoping to open up more fully by July 4, but they still want to keep a lid on hospitalizations.

“We do acknowledge there are trade-offs,” says Paul Simon, chief science officer for LA County’s Department of Public Health. Early on, everyone was focused on locking down the disease, but now health officials are looking closely at other indicators such as suicides (a lagging indicator that has actually decreased slightly).

“We’re in a tough situation with this pandemic and hard choices are going to have to be made, but I think they can be made in a thoughtful way.”

Forcing their hand

In California and across the country, pressure is on to reopen, expressed in lawsuits and protests. Over it all looms an election in November. No fewer than a dozen suits have been filed against California and Gov. Gavin Newsom by gun shops, churches, businesses, and even a bride to be. Last week, the Wisconsin Supreme Court overturned the state’s “safer at home” order, saying it needed approval in the Legislature.

Eugene Volokh, who teaches at the University of California Los Angeles law school, says it is unlikely that it will be the courts that push reopening. Governments have “extremely broad authority” in a pandemic, especially over everyday business, he explains, citing the 1905 Supreme Court smallpox case, Jacobson v. Massachusetts. It may be a little different where some specific individual rights are involved – such as with churches or guns. Stay-at-home orders also may violate some state constitutions.

But it is economic pressure that will do the pushing, he says. “Long before the courts accept any of these business claims, many states are going to recognize that at some point, the shutdown causes more harm than good.” Governors don’t want to be seen as causing more deaths than the pandemic, he says, and at the same time, they need revenues to implement their programs and balance their budgets.

“The interests of business, and the interests of citizens, and the interests of government officials, while not completely aligned, will be largely aligned in favor of opening things up as long as it is seen as marginally safe.”

Indeed, with decreased hospitalizations, Governor Newsom this week relaxed criteria for counties to move further along the road to reopening. LA County officials, too, feel a sense of urgency from businesses to open or risk permanent job loss.

“Time is of the essence,” said Kathryn Barger, chair of the county’s Board of Supervisors after meeting with business leaders this week. “Now it is time to begin to move from safer at home, to safer at work, and safer in our communities.”

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