The novel coronavirus pandemic has already begun to take its toll on the U.S. economy as businesses have shuttered, millions of Americans have been laid off and large swaths of the country have been told to shelter in place.

The financial implications are clear, though their full extent won’t be known until the economy begins the task of getting back on its feet. But less clear are the public health consequences of the downturn.

While past recessions provide some insights, health economists emphasize that how the U.S. responds to this crisis will affect the number of people who die not only from the virus itself, but from the side effects of an economic downturn.

President Donald Trump has repeatedly said that if constraints put into place to contain the novel coronavirus spark an economic depression, there will be a different human toll.

“It’s common sense. You are going to have a massive depression, meaning mental depression but a massive depression in the economy also,” Trump said during a news conference in the White House Rose Garden, in response to a question from PBS NewsHour White House correspondent Yamiche Alcindor.

Data from previous recessions indicates economic downturns can cause a spike in mental health issues.

But researchers caution that the number of deaths from the novel coronavirus, if left to spread unchecked by the sort of mitigation measures that are now currently impacting the economy, will most likely surpass those that would result from an economic recession.

They also say that government aid for workers and businesses could reduce the economic hardships that often lead to negative health outcomes.

Overall mortality rates actually decrease in times of recession, but not for everyone

Overall, mortality rates actually tend to decline during a recession but appear to increase for certain workers who are most impacted by the downturn, as well as for a wider swath of people decades after the fact, due to the lingering effects of job loss and lost earnings.

A 2017 study that looked at mortality rates during the Great Recession found that increased unemployment correlated with a drop in deaths in the U.S — in particular, a decline in deaths from cardiovascular disease and motor vehicle accidents. The findings were consistent with other studies.

That correlation isn’t evidence of causation, but the study’s primary author Erin Strumpf said researchers have a few hypotheses.

People tend to drive less during an economic downturn because they have less money to spend, which could lead to fewer car crashes, she posited.

During recessions, people tend not to dine out as much because they are trying to save money, and that may be better for their cardiovascular health.

Stress could also play a role.

“People living during a recession might be stressed because of economic uncertainty. On the other hand, we aren’t experiencing the stress of being at work all the time,” said Strumpf, a professor of health economics at McGill University in Montreal.

There isn’t enough data to analyze from the current economic shutdown, but Strumpf said the coronavirus measures could lead to some of the same drops in mortality, particularly from vehicle accidents.

Mortality rates increase among those groups most impacted by economic downturns

Even if mortality rates tend to decline overall, researchers note that groups hit particularly hard by job loss or a decline in earnings are likely to experience an increase in deaths during a recession.

“One of the things that does happen during recessions generally is you get a bifurcation,” said Aaron Reeves, a sociologist at Oxford University. For example, “lots of people drink less because they are going out less, but there is a small group of people who drink a lot more.”

That increase in alcohol consumption is not only harmful to a person’s immediate physical health, it’s likely a sign of serious mental health issues.

Trump said Sunday if there is an economic depression, “you are going to have tremendous suicide.”

Reeves said Trump’s assumption that suicides will increase if there is a prolonged economic downturn “is probably correct.”

“There is a real risk of suicide, but I don’t think it’s inevitable,” Reeves said,

Reeves and his colleagues published a 2014 study in the British Journal of Psychiatry that found that there were at least 10,000 more suicides than the average in the U.S. and Europe between 2008 and 2010, during the Great Recession.

Job losses during a recession lead some people to become socially isolated and fall into depression, which can be one cause of suicide.

Because the U.S. has privatized health insurance that for many is tied to employment, job loss can mean people who need mental health care the most are not able to access it.

The U.S. could also be particularly vulnerable to the threat of suicide because of access to firearms. Data shows access to a means of suicide — including guns — tends to increase suicide rates. And in recent weeks, stores have reported an increase in gun sales as Americans prepared to shutter themselves in their homes.

Reees noted that an increased focus on mental health and government efforts to help people retain their jobs during the lockdown could go a long way to reducing occurrences or effects of depression.

NATIONAL SUICIDE PREVENTION LIFELINE: 1-800-273-8255

Short-term economic hardship can take long-term toll on health

Financial strain and the mental and physical health issues it causes can last decades after a recession has ended.

In the short term, mortality may decline because people are driving less or eating healthier, but “those factors are gone once the recession is gone because they are specific to the moment,” UCLA economist Till von Wachter said. “Then, long-term factors take over.”

Data shows that people who are negatively affected by a recession, including people who graduate into an economic downturn or lose their job as a result, tend to die earlier than they would have otherwise.

A job loss, a demotion or graduating into a recession tend to result in lower lifetime earnings and years of increased financial stress.

A job loss, a demotion or graduating into a recession tend to result in lower lifetime earnings and years of increased financial stress.

In addition to suicide, these factors could lead to people drinking more or using drugs, both of which correlate with higher mortality rates — especially in middle-aged men — from heart attacks, liver failure and overdose.

Based on historical data, including from the early 1980s recession, von Wachter estimates that if the unemployment rate rises to 6 percent, up from the recent 3.5 percent, because of the coronavirus containment measures, about 5.4 million total years will be lost from Americans’ lives.

Some economists have predicted the unemployment rate will rise much higher, which would lead to even more lost years.

Still, the long-term losses have to be weighed against the likelihood that hundreds of thousands or even millions of people could die if the novel coronavirus is not contained.

Without strict social distancing the virus is likely to spread so rapidly that hospitals will become overwhelmed with patients and more people who contract the virus will die from lack of adequate care.

“These are very tricky comparisons to make,” von Wachter said. “You face a very likely number of deaths in the short run with uncertain death in the long run.”

A new report from researchers at the Federal Reserve and the Massachusetts Institute of Technology found that after the 1918 flu pandemic, cities that implemented strong intervention measures, like closing businesses and schools, early on in the outbreak were more successful at reducing mortality and also saw stronger economic growth after the pandemic ended.

The report’s authors said the findings indicate pandemics themselves are more disruptive than the measures put in place to mitigate the spread of the disease, but they also note that today’s economy — with global supply chains, a greater reliance on service industries and improved remote technology — is very different from the economy 100 years ago.

Finding the balance between protecting short- and long-term public health

Right now, Americans appear to be coming together, encouraging people to stay home and ride out the storm.

But that could change in the coming weeks as the financial reality _ and the stress that causes — sets in.

“Soon, the bills will start coming due. They might give you a break, but at the end of the day you still have to pay the rent,” said Kasisomayajula Viswanath, a professor of health communication at Harvard University.

Researchers note that social safety net programs and better access to both physical and mental health care could keep economic-related problems at bay, even if businesses in the U.S. were to remain closed for several more weeks or even months.

If workers can keep their jobs through the shutdown, businesses could get back up and running quickly once social distancing measures are relaxed.

“If you imagine a world where we hold everyone in place and three months later, we switch the economy back on, there is no reason to expect widespread earnings losses,” von Wachter said. “And I wouldn’t expect these dramatic scenarios [of higher mortality rates] to come to pass.”

Several European countries are offering to pay portions of salaries so companies are less likely to lay off their employees during shutdowns.

The U.S. has not gone so far, but it is subsidizing paid sick leave in hopes that workers can stay home from work if they contract COVID-19 without fear of losing their jobs. The U.S. has also expanded unemployment benefit eligibility to freelance and gig economy workers.

The $2 trillion bill Congress passed and Trump signed late last week could stave off a lot of economic pain for now, but economists warn if businesses remain closed for months instead of weeks more, much more government assistance is going to be required. House Speaker Nancy Pelosi is already discussing the need for another economic stimulus bill.

“For the foreseeable future, the government is able to support workers,” von Wachter said. “All bets are off if this lasts a year.”

For now, the president has backed off his earlier push to reopen shuttered businesses by Easter. On Sunday, he extended social distancing recommendations through April 30 and said he expects the nation to be on the road to recovery by June.

“Hopefully by what we are doing we are going to get the best of both worlds. We won’t have 2.2. million deaths,” Trump said during his news conference Sunday, referring to a model showing the number of people who could die in the U.S. if no actions were taken to stop coronavirus. “We are going to have much less, much much less and at the same time we get our country running again.”