With scientists predicting a widely available coronavirus vaccine may be as far as 18 months away, policy-makers are bracing for unenviable choices.

There’s hope that voluntary lockdown measures avoid the catastrophe unfolding in northern Italy, that a drug treating symptoms might appear, or that warmer weather snuffs out the virus.

But if the battle drags on, life in the time of coronavirus will involve jarring trade-offs and ethical dilemmas.

At what point, for example, do physical isolation and economic shutdown do more harm than good? says Nicola Lacetera, a behavioural scientist and professor of strategic management at the University of Toronto.

The more the economy shuts down, the greater the increase in social factors that deteriorate health, including poverty, marginalization, anxiety and domestic conflict from people kept indoors. Conversely, the more we keep the economy going — even at a reduced rate — the longer the virus is transmitted and the more people die.

“It’s an impossible dilemma,” says Lacetera, chief scientist at the Behavioural Economics in Action at Rotman centre.

He adds that the debate will revolve around the values society considers absolute, and those it decides can be compromised.

Never one for subtleties, U.S. President Donald Trump flagged his support for a trade-off between human lives and the economy with an all-capitalized tweet earlier this week: “WE CAN NOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”

Three economists then published a study, “The Macroeconomics of Epidemics,” calculating the cost in U.S. lives and economic activity under different lockdown scenarios. If government takes no action, some frightened consumers and workers will stay away from stores and jobs. Consumer demand would decline by $800 billion (U.S.) and 1.7 million Americans would die of the virus.

“With vaccines as a possibility, it is optimal to immediately introduce severe containment measures to minimize deaths,” the economists write. “Those containment measures cause a large recession. But this recession is worth incurring in the hope that the vaccination arrives before many people get infected.”

But if a vaccine or treatment isn’t on the horizon, herd immunity needs to be created by allowing a sufficiently high number of people to become infected and recover, they argue. That involves “gradually ramping up containment measures as infections rise and slowly relaxing them as new infections wane and the population approaches the critical immunity level.”

This “optimal” containment policy would see consumer demand drop by $1.8 trillion and result in 500,000 fewer deaths, compared to the U.S. government doing nothing.

“Dealing with the trade-off is a key challenge confronting policy-makers,” write economists Martin Eichenbaum, Sergio Rebelo and Mathias Trabandt.

The good news is that COVID-19, while highly contagious and particularly deadly for older people, results in most people recovering. It’s not the bubonic plague that devastated Europe and Asia in the mid-1300s, or smallpox that killed an estimated 300 million people in the 20th century, or a new virus that threatens the species.

“This is not the doomsday pandemic,” says Steven Hoffman, director of the Global Strategy Lab and professor of global health, law and political science at York University.

What has Canadian public health experts worried is Italy. Like Canada, Italy’s goal was “flattening the curve” — implementing measures that spread the peak of infection over time, a policy that means dealing with the pandemic longer, Hoffman notes.

The objective was to prevent the health-care system from being overwhelmed while reducing economic activity as little as possible. Instead, the system in the northern region of Lombardy, one of the most affluent areas on the planet, was quickly flooded with patients and brought to its knees.

Italy’s virus death toll shot past China’s likely because of its higher proportion of older people with multi-morbidities — chronic health troubles such as heart conditions or diabetes, says Ross Upshur, head of the clinical public health division at the University of Toronto’s Dalla Lana School of Public Health and co-chair of a World Health Organization working group on ethical issues raised by the coronavirus challenge.

In Canada, 17.5 per cent of residents are 65 or older, compared to 22.6 per cent in Italy. Fully 63 per cent of Canadian residents are obese or overweight, which increases the risk of chronic health conditions. Among Canadians aged 40 years and over, 26.5 per cent have two chronic health conditions. Among Italians aged 45 and over, 38 per cent have at least two chronic conditions.

“You put those two together, and it’s not for the faint of heart,” Upshur says, referring to the virus’s potential impact due to Canada’s demographics and multi-morbidity rate.

The stage is set, and success of voluntary restrictions will largely determine the tough choices ahead.

China used the strong arm of an authoritarian state to severely lock down more than 50 million people around the virus’s epicentre, Wuhan, and unleashed thousands of search teams to trace and isolate contacts. After two months, Wuhan reported no new infections and the government expects to lift the lockdown April 8.

Goldy Hyder, president and CEO of the Business Council of Canada, says member companies with operations in China have almost all their workforce back on the job.

“The lesson is, attack the virus,” says Hyder, whose council represents 180 large companies in Canada employing 1.7 million workers. “Short-term pain, long-term gain.”

He criticizes what he calls the “smorgasbord” approach across Canada. He says a CEO called him Tuesday to complain that his supply chain had been broken because Ontario declared the company’s work essential while Quebec ordered it closed. Layoffs are the result.

Hyder calls for far more severe lockdown measures to combat the virus and considers talk of a trade-off between lives and the economy abhorrent.

“I think it’s sick to say, “People die and people are going to keep dying,’ ” he says. “Our fiduciary duty to each other as human beings is to do everything we can to not let that happen.”

The challenge ahead, Lacetera predicts, may determine the limits of democracy.

Europe provides an early glimpse of the choices that might transform life in Canada. In France, Spain and Italy, the army is on the streets enforcing stay-home orders and supporting medical services. In Canada, Gen. Jonathan Vance, chief of the defence staff, says the military is making plans for a yearlong role in the virus battle.

A growing number of countries are turning to GPS-enabled cellphones to trace infected people and determine who has come close to them, adding to an already flourishing surveillance industry.

“To what extent will this create a precedent?” Lacetera asks. “We may be willing to accept it now. But what if this is used in the future by questionable rulers to justify whatever?”

Italy and France restrict joggers to exercising near their homes; in France, they are allowed no more than two kilometres away. A video online shows excerpts of a Frenchman completing a marathon by running back and forth on his balcony. France has also banned cycling for sport.

Rituals that profoundly define human existence have been upended.

In Italy, women give birth in hospitals without the presence of a spouse or partner. In the north, at the end of life, loved ones can’t gather to mourn around a coffin or gravesite. Funerals are prohibited. Bodies are cremated regardless of wishes. There are no last goodbyes, no ritual closure. The way humans have long processed grief has been banned.

Even love, if some politicians have their way, will be transformed. “When you love someone, you should avoid taking them in your arms,” French Prime Minister Édouard Philippe has advised.

More mundane rituals have also been curtailed. Italian municipal authorities are demanding an end to the daily habit of going to the grocery store, often for a single item, creating the lineups and crowds that defeat the purpose of social distancing.

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A major Italian grocery store chain has cut its hours to reduce the number of cashiers getting infected. In Naples, some grocers are accepting only heads of families in alphabetical order. And in Lombardy, supermarkets are being advised to take the temperatures of customers before allowing them in.

In Canada, grocers have started reserving early opening hours for seniors and people living with disabilities. Lacetera believes it might be only a matter of time before postal codes are used to determine who can buy groceries on certain days.

Stay-home orders in Europe are backed by the threat of stiff fines — between $600 and $4,500 (Canadian) in Italy.

No one is sure how long people in democracies will accept being confined, or how they’ll respond to forceful measures if, from sheer exhaustion, they head back to the streets in large numbers. A social experiment of this scale has never before been tried.

The outcome will largely depend on the trust people have in official messengers at a time of sharp political divisions and internet-fuelled conspiracy theories, says Alison Thompson, a public health professor at the University of Toronto. She describes official communication so far as “patchy and confusing” and recommends that politicians let health experts take the lead.

“If we don’t understand what we’re being asked to do, we’re not going to do it,” Thompson says.

She believes the level of social responsibility and solidarity in society will also make a difference. It leads her to predict, based on research she’s done with colleagues south of the border, that voluntary measures will be more successful in Canada than the U.S.

“I’m very glad I’m in Canada right now not the U.S. because in my experience from doing pandemic planning down there, they aren’t so big on the solidarity piece,” Thompson says. “I’ve actually seen people take it out of their pandemic planning because it doesn’t apply in the U.S.”

Professor Steve Joordens, a University of Toronto psychologist, says much will depend on how we use our hours of confinement. He says public health officials and politicians should start by a change in vocabulary, replacing the call for “social distancing” with one for “physical distancing.”

The last thing Canadians need to feel during their time indoors is socially isolated. Studies on people in extreme situations — inmates placed in isolation for prolonged periods — have found they emerge with “all kinds of mood disorders,” says Joordens, whose research focuses on the mental health impact of isolation and epidemics.

“Eventually, the person literally often starts to question who they are,” he says.

Daily rituals, from the work we do to the people we interact with, “remind us who we are and what our purpose in life is,” he adds. “And when all that gets taken away, in the extreme sense, these people really lose their sense of identity.”

Confinement will be harder on the most vulnerable, including the already marginalized, those on low incomes or in jobs they can’t do from home, and those without internet access. If anxiety levels spike, so might domestic violence among all social groups. The Canadian government has expanded unemployment benefits and child supports, but more will likely need to be done, Joordens says.

His biggest concern is that at some point anxiety turns to depression.

He describes a psychology experiment about “learned helplessness.” A dog is placed in a chamber divided by a barrier. A light is flashed, followed by an electric shock sent through the floor. The dog quickly learns to avoid the jolt by jumping over the barrier when the light flashes.

Each time the experiment is repeated, the barrier is raised a little higher. Eventually, the barrier is too high for the dog to jump over. After several failed attempts the poor dog gives up, curls up in a corner, disregards the warning light and helplessly takes the jolts — even when the barrier is lowered back down to a height the dog can easily jump.

“It’s a nasty experiment,” Joordens says. “But a lot of (psychologists) see it as a model for depression.

“If people start believing that whatever we do it’s not going to help, it’s not going to get us out of this situation, then they might just stop trying. And that’s a bad line to cross … The worry is that we could start seeing suicide rates spike.”

Managing expectations will be important. In the meantime, the internet buzzes with cooking courses, exercise routines and artists performing for free — plenty to create a daily routine that gets the mind off the virus. Joordens sees the shut-in period as a time to reconnect with family, and to reach out regularly to those most vulnerable by phone if not by social media.

“And budget your news consumption,” he advises. The relentless stories about being under threat raise stress levels.

The biggest stress relief will be getting people back to work.

Some researchers argue that after an initial two weeks of everyone staying home, confinement and supports should be reserved only for the most vulnerable, including the elderly and those with compromised immunity. The rest should head back to jobs, where they’ll likely survive the virus and build herd immunity.

Employees able to work at home have demonstrated they can keep productivity high, an outcome likely to result in more flexible workplaces and schedules once the virus is snuffed out, says the business council’s Goldy Hyder.

Internet credit courses — a policy that provoked a backlash when Premier Doug Ford’s government introduced it months ago — will play a greater role in education, at least at the university level. And airlines will eventually resume flights, first to countries that have largely controlled the virus, and perhaps with temperature tests for passengers and more leg room for some physical distancing.

Hyder says the virus also provides the tragic opportunity to reimagine the economy. The federal government’s $85-billion aid package is to keep people and companies afloat during the crisis. Almost double that, he believes, will be needed after the crisis to create jobs and sustain social programs.

The business council is pushing Ottawa to set up an advisory group to map out the new economy. It plans to set one up itself if the federal government doesn’t act.

Emphasis should be placed on developing a greener economy, Hyder adds, from high-speed trains to infrastructure for more affordable electric cars, and one that broadens opportunities for Indigenous-run businesses, women entrepreneurs and others currently at a systemic disadvantage.

“You want to honour those who lost their lives?” Hyder says. “Make life better for those who lived.”

Data analysis by Andrew Bailey

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