The debate over how long America’s economy should be kept in a medically-induced coma while we “socially distance” to fight the Wuhan coronavirus is usually phrased as a choice between saving lives and mitigating economic damage.

The truth is that the lockdown itself will kill people, and arguably already is. Drug abuse and suicide rates are two deadly dangers that bear watching long before we have to worry about deaths from social unrest or malnutrition.

The relationship between unemployment and drug use was studied with new urgency after a bump in mortality rates was detected at the turn of the century. In recent years, deaths from opioid abuse became one of our most urgent crises, with heated debates over which drugs were killing people and how abuse should be curtailed.

Like the coronavirus, the deadliest of those drugs traces back to China.

In 2009, the Department of Health and Human Services (HHS) posted a survey that found the rate of illicit drug use was over twice as high for unemployed persons as for those with full-time jobs: 17 percent to 8 percent. HHS found alcohol abuse is also worse among the unemployed, although the difference is not as dramatic.

In 2017, the National Bureau of Economic Research published a study on “Macroeconomic Conditions and Opioid Use” that found each percentage point in county unemployment rates produces a 3.6-percent increase in opioid deaths and a seven-percent increase in emergency room treatment for opioid overdoses. The latter is a disturbing statistic when medical resources in hard-hit cities are already stretched thin fighting the coronavirus. If emergency medical treatment is not readily available, more overdose patients are likely to die.

The International Journal of Drug Policy also found evidence that “drug use increases in times of recession because unemployment increases psychological distress which increases drug use.”

Some researchers hoped for a silver lining in the dark cloud of unemployment by theorizing that recessions would leave people with less money to spend on drugs, but most of the studies reviewed by the International Journal of Drug Policy said drug abuse gets worse, with abusers switching to cheaper (and often more dangerous) substances to get their fix. Some of the studies cited in the review demonstrated that drug abuse is one of many threats to life that become much worse during periods of high unemployment, and drug abuse tends to exacerbate the others, including stress disorders, cardiovascular disease, homicide, and suicide.

A 2018 survey of drug treatment centers found drug abuse getting worse in most areas during a crisis, although a few of the responding centers said they noticed less abuse due to people having less money to spend and more worries about losing their jobs because of drugs.

“The main reason given for increasing drug use was greater amount of free time available. Other important reasons were greater substance availability during this period, more stress at work and seeking comfort in response to the loss of a stable source of income, social status and/or family,” the survey said.

Similar studies in Europe after the 2008 financial crisis reached the same conclusion, discovering that overall substance abuse may decline in times of economic hardship, but “an increase in harmful use and negative effects is found within specific subgroups.” Broadly speaking, the most dangerous forms of abuse – including heavy drinking with fatal consequences – tended to get worse, while the milder forms of abuse practiced by the general population declined due to financial difficulties and employment anxiety. Newly unemployed persons were one of the subgroups that got worse.

“The relationship between substance use and unemployment is likely to be influenced not only by the duration of the unemployment but also by the overall employment rate for the area,” one research paper found – a troubling notion given how huge regions are seeing unprecedented spikes in unemployment due to the coronavirus lockdown.

One of the dismal findings in the European studies was that relapses among heroin users grew worse as unemployment rose, suggesting that stress from tough economic times is particularly brutal on those trying to kick the habit.

Another finding was that drug abuse surges because selling drugs is easier in times of economic distress, while the authorities are distracted or underfunded, and more young people grow interested in becoming drug dealers. U.S. studies have suggested young people from the lowest socio-economic brackets are most at risk from rising substance abuse rates when the economy declines. Add in the greater difficulty people in lower-income occupations have in working from home during the lockdown – the New York Times on Friday described working from home as a “luxury” the poor cannot afford – and you have a formula for an explosion of drug abuse, crime, and death.

The link between rising unemployment and suicide is also well established. A study from the University of Zurich in 2015 attributed one in five suicides per year to unemployment, a relationship made worse by the rising rates of substance abuse produced by job losses.

Suicide rates also tend to spike early during recessions – with unemployment surges that arrive less suddenly than the coronavirus did, suicides tend get worse before people actually start losing their jobs, due to the mental stress of an impending calamity.

Researchers from the University of Oxford argued in 2014 that the recession of 2008 caused at least 10,000 “economic suicides” across the Western world, with some 4,700 of them in the United States – and that was just the fearsome tip of what they described as a “looming mental health crisis.” The coronavirus crisis is severely straining the government and medical resources that researchers saw as vital to keeping depression and suicides from getting even worse.

A study from the U.S. Department of Veterans Affairs in 2019 found the link between unemployment and suicide is especially pronounced during mass layoffs, in part because people fighting depression and anxiety draw less support from their families and communities when everyone seems to be losing their jobs.

Some local officials are already reporting suicides related to anxiety over the coronavirus and the lockdown, which is making people feel isolated and physically unhealthy. Suicide hotlines are reporting increased traffic, while other support groups say a disturbingly large share of the people who complain of mental stress from the coronavirus lockdown have entertained thoughts of suicide.

The danger of more deaths from drug abuse during the Wuhan pandemic could be one reason why President Donald Trump announced a strong military effort against South American drug cartels on Wednesday, a declaration of war on the cartels that took many media observers by surprise given how much attention is focused on the coronavirus at the moment.

“We must not let the drug cartels exploit the pandemic,” Trump said on Wednesday. “U.S. Southern Command will increase surveillance, disruption and seizures of drug shipments and provide additional support for eradication efforts.”

Comments from the White House tended to focus on weakening the regime of Venezuelan dictator Nicolas Maduro, who was indicted on drug trafficking charges by the U.S. in March, but senior military officials referred to the 70,000 Americans killed by narcotics each year when discussing the new offensive.

Those who worry about the economic impact of the lockdown are sometimes taunted as callous or greedy, eager to “sacrifice Grandma to protect their 401k accounts” or “die for Wall Street.” We are not facing a binary choice between public health and financial security. The people who die because of the lockdown will be more difficult to pinpoint than victims of the coronavirus, but there will certainly be a cost in human lives if we prolong the most drastic measures and, at some point, that cost will exceed fatalities from the virus. None of the choices before us is easy, and none of the calculations simple.