Research shows that increased poverty rates during recessions leads to Americans dying.

But even the dangers of a deep recession pale in comparison to the number of Americans who could die if we restart the economy before the coronavirus pandemic is under control.

Dr. Andrey Ostrovsky is the former Chief Medical Officer of the US Medicaid program. He is now the Managing Partner at Social Innovation Ventures and is a practicing pediatrician.

This is an opinion column. The thoughts expressed are those of the author.

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As a previous public official, I have been asking myself what I would do to manage the Coronavirus Disease 2019 (COVID-19) pandemic if I were back in public service. In light of the tanking economy and health risks associated with poverty, I didn't have an immediate answer. So, I ran some numbers to answer the specific question: What is the mortality due to the illness versus the mortality due to poverty resulting from COVID-19?

Research has shown that 47 out of every 100,000 deaths in the US are attributable to poverty. That equates to about 161,032 Americans dying each year because they are poor. Prior to COVID-19, deaths due to poverty exceeded deaths due to overdose and suicide combined. With jobless claims skyrocketing and global market uncertainty growing, there is a very real possibility that the poverty rate in the US will significantly increase.

As of 2018, the poverty rate in the US was 11.8%. Poverty rates during prior recessions have typically approached 15%; however, the rate has gone above 20%. In an attempt to see the human cost of a coronavirus-driven recession, I projected the number of deaths this year based on projections ranging from the current poverty rate up to 25%.

At 15% poverty, there would be 204,701 projected deaths due to poverty, which would be more than the number of accident-related deaths, making poverty the third leading cause of mortality in the US. At 20%, there would be 272,935 projected deaths due to poverty, which would be more deaths than diabetes and Alzheimer disease combined. At 25%, there would be 341,169 projected deaths due to poverty, which is equivalent to the population of New Orleans. Incidentally, cities like New Orleans are expected to be among the hardest hit by COVID-19.

These are staggering numbers, but if we compare projections of poverty-related mortality to illness-related mortality due to COVID-19, the answer to my public health strategy question begins to emerge.

Based on recent projections, SARS-CoV-2, the virus responsible for COVID-19, is expected to infect 20% to 60% of Americans. If the case fatality rate (CFR) of SARS-CoV-2 is similar to seasonal flu, we could expect 163,500 deaths from COVID-19. However, it is more likely that the CFR is at least 0.5%, approximately equivalent to measles in wealthy countries like the US. More likely, the CFR for SARS-CoV-2 is closer to 1%, meaning that the projected number of deaths could be as high as 1,635,000.

The colors represent relatively similar projected counts between illness-related and poverty-related deaths due to COVID-19. Based on this data, the mortality due to illness is most likely going to be higher than the mortality from poverty at pre-COVID-19 poverty rates (orange highlights).

Even at an unprecedented poverty rate of 25%, the deaths due to poverty would only approximate deaths due to illness in the best case scenario for containing the spread of SARS-CoV-2 (red highlighting). Tragically, based on these projections, the number of deaths due to illness from COVID-19 are likely to exceed 400,000 in the US.

We must deal with coronavirus first and foremost

Good leadership requires data-driven decisiveness balanced by humility. So in the spirit of humility, I will admit that these projections are back-of-the-napkin calculations and have significant limitations.

I am not an economist nor an epidemiologist. The review of literature was not exhaustive. The definition of poverty in the study referenced here is limited and doesn't account for the working poor. These calculations narrowly focused on mortality and did not take into account morbidity resulting from COVID-19 ranging from stress to severe chronic conditions. And most importantly, this analysis has not gone through peer-review.

Despite the limitations, these projections are probably directionally correct based on a recent study analyzing the economic impact of pandemics and the public health responses to them.

Based on evidence from the 1918 flu, which has many similarities to COVID-19, "cities that intervened earlier and more aggressively do not perform worse and, if anything, grow faster after the pandemic is over."

If I were back in public service right now and trying to make strategic decisions driven by the goal of decreasing mortality, I would double down on, rather than pull back from, strategies to flatten the curve.

In parallel, I would make dramatic investments in reinforcing the safety net, including Medicaid, the Supplemental Nutrition Assistance Program (also colloquially known as food stamps), and public housing. These investments would ensure the psychological and physical security of our citizens. And supporting these critical programs would help minimize poverty-related morbidity and mortality as well as optimally load the spring to launch equitable economic growth post-pandemic.

Dr. Andrey Ostrovsky is the former Chief Medical Officer of the US Medicaid program. He is now the Managing Partner at Social Innovation Ventures where he invests in and advises companies and non-profits dedicated to eliminating disparities. He is also a practicing pediatrician.