What Price Should We Pay to Fight COVID-19?

My Thoughts on the Pandemic

We need to have a hard conversation. These conversations are not natural, or even comfortable, for a lot of people but at this time, in this moment, it is necessary. To that end, I am going to be candid. I think it is important for us to be honest about what we are facing, the trade-off calculations that are going to have to be made sooner rather than later, and the political and social ramifications of those decisions.

Let’s start with a statement: The COVID-19 pandemic was a humanitarian disaster that could have been avoided. Yet, we didn’t so here we are. Now, it is becoming an economic disaster that was not, and is not, inevitable, but rather which flows from decisions politicians are making without considering the best interest of all their constituents. For example, consider the probable worst-case scenario in the United States: Yes, it would have been traumatizing. Yes, everyone who would have survived would have known, or known of, at least one person who passed away. Yet, as far as historical pandemics go, this is nothing like the traumas our ancestors faced. In strict numbers, assuming the most catastrophic probable outcome – 2,200,000 deaths from COVID-19 in the United States over the next year-and-a-half – the country would have been looking at our ordinary effective annual death rate of 2,800,000 people increasing to around 4,267,000 for eighteen months before returning to its previous level. That is a horrific human cost. The individual suffering would be unimaginable. Yet, those numbers are not civilization-ending in a country of roughly 331,000,000 and which experiences significant new births each year as babies are welcomed into the world. In all of the panic, in all of the chaos, this should be kept in mind. This is nothing like the Black Death, which slaughtered so many people that it took 200 years for the population to recover; a pestilence which, in Europe alone, killed 30% to 60% of people.

This means that as a country, most of the fall-out we are, and will, experience, is the result of not the pandemic itself, but our reaction to the pandemic; how we chose to fight it and the total dearth and failure of leadership.

Think of the Coronavirus as a War We Must Fight

I want you to think of the COVID-19 pandemic as a war. Each country must fight this war, whether it wants to or not, because the enemy, a virus called SARS-CoV-2, launched an aggressive invasion.

The first “weapon” in this war that we, the United States, should have launched was a massive ramp-up of medical equipment and supplies. The reason: The problem isn’t so much COVID-19 itself as, with aggressive treatment, often lasting for several weeks, many of the worst cases can be saved. Instead, the problem is that if everyone gets sick at once, the hospital system would be overwhelmed. Not only would those with COVID-19 not be treated, many, many other folks wouldn’t get treatment, as well, leading to a dramatic spike in otherwise preventable deaths. Consider someone who had a heart attack at the office only to find that it would be several hours, if at all, before an ambulance could get to him or her. Or a senior citizen who fell down at home and broke a hip. Or young students who get into a car accident.

By dramatically increasing the peak capacity of the medical system through a coordinated war-like response, and actively working to “flatten the curve”, as it is known – a short-hand way to describe the process of slowing the rate of spread so that the hospital system isn’t overwhelmed – hundreds of thousands, potentially millions, of lives could have been saved with little to no downside to the average American and almost no noticeable long-term consequences for the economy. This could have been accomplished by mobilizing the military, particularly the Army Corps of Engineers, as well as using special war powers to compel industrial manufacturers to mass produce temporary hospitals, hospital beds, ventilators, masks, cleaning supplies, etc. It would have meant mass testing, including drive-through testing like the kind deployed in South Korea, so those who tested positive could be quarantined. It would have meant providing nationalized health insurance for this disease so that anyone, regardless of employment status or health care coverage, could seek treatment without worrying about the financial costs.

Politicians and Physicians Are Asking the Wrong Question

We did none of that. This failure, which will be studied for generations, meant that by the time the pathogen was ripping through the population, unchecked and with exponential growth in infection rates, individual governors, mayors, and businesses were forced to react on their own. Desperate to flatten the curve in their local communities, and without properly weighing the net trade-offs involved, they began enforcing lock-downs on society, closing businesses against their will and forbidding people to congregate in even mid-size groups.

This was exactly the right advice based on what would lead to the best medical outcomes when looking at the pandemic only. Compassionate doctors, nurses, and other healthcare professionals, looking at their small piece of the pie and what is sitting in front of them, are giving the best, most rational answer to the question, “What should we do if we want to reduce the number of deaths from this specific virus.”

Unfortunately, that is no longer the relevant question. That ship has sailed due to our earlier choices and we face a much more difficult decision now. In fact, focusing solely on that question threatens catastrophic outcomes. The question that now matters is, “What should we do if we want to reduce the total number of deaths, as well as the society-wide consequences, for the most number of people; to minimize as much pain, suffering, and catastrophe as possible?”

An example of a failure to ask the right question can best be summed up by the statement by New York Governor Andrew Cuomo, who stated:

“My mother is not expendable and your mother is not expendable and our brothers and sisters are not expendable and we’re not going to accept a premise that human life is disposable and we’re not going to put a dollar figure on human life,”

As lovely as that sentiment might sound, and as difficult as it may be to accept, Cuomo’s words are not true. From the time civilization has consisted of a few tribes living in tents, people have made complex decisions about individual versus group survival. The entire history of mankind is one of various trade-off calculations determining which lives matter more, the cost a group is willing to bear to protect a given life, and how we prioritize the needs of one generation over another.

You know this on some level. Here are just a few examples:

These sorts of value judgments are made every time a civilization decides whether or not to go to war, determining how many of its young people it will send off to foreign shores to die based upon a weighing of net advantage and trade-offs.

Once engaged in conflict, Presidents, Prime Ministers, and military commanders continue to make such choices daily, sometimes even moment-by-moment. An excellent example comes from World War II when Winston Churchill was faced with the gut-wrenching decision to permit scores of young British soldiers to die horrific deaths, sailing into traps, in order to avoid tipping off the Germans that the Crown had found a way to break the Nazi’s coded messages, deciding that the net trade-off should result in far more British lives being saved in the long-run.

These sorts of value judgments are made every time a woman is in the delivery room and the doctor asks, “If there is a problem during the birth, do you want us to prioritize your life or the life of the baby?”.

These sorts of judgments are made when a person decides if he or she wants to work a dangerous, dirty job that pays more and involves risk to life and limb, or a safe, cushy job that pays less but involves more autonomy and comfort.

These sorts of value judgments are made when a society determines whether or not to permit automobiles, and what the traffic laws of a country will be, weighing an acceptable number of deaths of passengers and pedestrians against the net efficiency gains, economic advantages, and conveniences of reliable transportation.

These sorts of value judgments are made when a nation establishes tax rates and determines whether, and to what extent, to build a social safety net.

Workers compensation, life insurance, health insurance, the 9/11 victim compensation fund … all seek, or sought, to put an economic value on a given human life.

This time is no exception. No reasonable person wants to be faced with these decisions. Yet, adulthood requires them. They are part of maturity. As we enter the next phase of the pandemic, you are going to see that play out. Societies around the world will begin to have passionate debates on the trade-off decisions involved going forward so let’s look at the calculus.

Three Facts We Must Accept Before We Face the Trade-Off Decision

With the proper question now identified, let’s focus on three facts. For the sake of driving the point across and focusing on the big picture, I’ll use approximations and high-level estimates:

Fact 1: According to the most catastrophic estimate from the Imperial College of London – and estimate that has subsequently been reduced dramatically but I want to continue to use as a worst-case illustration to drive home the choices we are facing – If the pandemic is allowed to spread through the United States without any restrictions whatsoever, we are ultimately looking at somewhere around 2,200,000 people dying out of a population of roughly 331,000,000. That is, 0.66% will die and 99.34% will live. Putting it in starker context, for every 1,000 Americans, more than 993 will survive while fewer than 7 will die. Of course, we have already taken some mitigation measures so those numbers should be not just lower, but dramatically lower, than what is thought to be the more probable nightmare scenario. However, they will still be high based upon our present course.

Fact 2: Of those less than 7 out of 1,000 who die in our worst-case projections, nearly all will share two characteristics. (Yes, there will be exceptions – and we can count on the media to feature those outliers front and center, such as the six-year old transplant patient who had a suppressed immune system and was unable to fight it off or the perfectly healthy twenty-two year old athlete who suddenly died – but all available evidence indicates they will remain just that: exceptions.) The two characteristics nearly all who die will have are:

They will be within the final few years of their life expectancy, in many cases, having around 60 months, give or take, to live had the pandemic not occurred; and

They will have three or more comorbidities due to significant underlying health issues.

This fact is particularly important because:

For all of recorded history, most humans, at most times, and under most conditions, have decided that, holding all else equal and absent special circumstances, the only moral and ethical way to behave was to prioritize a younger life that has a long span ahead of it over someone who has had a full life, already. If this were a disease that killed nearly all children younger than the age of 10 years old, society would weigh it very differently due to millions of years of evolutionary biology. It is foolish to deny that. It is not a matter of saying older lives don’t matter, it is a genetic drive motivated by love and gene preservation. A young person has not, yet, had the opportunity to live a full life and so it would be an abomination to, say, save the life of a 90-year-old widow over the life of a 28-year-old mother of three; and It means that even in the highest risk group – people 80 years or older – a vast majority, including those with some comorbidities, will survive. This is not a death sentence. If we assume a horrific infection rate of 50% of the population, and a 15% mortality rate of those infected, it means that for every 1,000 Americans over the age of 80, nearly all of them – roughly 925 – will survive with only 75 of them dying a few years, or in some cases, a few months before they otherwise might have passed away.

Fact 3: Having failed to take the necessary measures that could have prevented this outcome, if we now become draconian and shut down most of society, we might be able to reduce that figure to a death toll of 50,000 to 100,000. This means saving potentially upwards of 2,100,000 to 2,150,000 lives under our established nightmare scenario.

What Is That Potential Outcome Worth to Us as a Civilization?

Knowing these things, we can better understand the problem, and better frame the trade-off decisions we, as a civilization, must make sooner rather than later if we value human life and our goal is harm reduction.

The Most Extreme Scenario

Let’s start with the most extreme scenario as it can help to put outer bounds on the scale and scope of a decision.

Imagine that a genie came down and said that he could save 2,150,000 out of 2,200,000 Americans who would have died. Again, in this particular pandemic, that means something different than in other pandemics. In the Spanish Flu, it would mean a lot of healthy twenty year olds would go on to get married, have children, become grandparents, and live full and productive lives. In this pandemic, it means mostly adding those extra months or years to the tail-end of an already long life expectancy for someone who is nearing natural mortality. Again, yes, there will be exceptions but when you’re dealing with this many people, that’s the pattern. “Yet,” the genie tells you, “the cost of me granting this wish is that I shut down the entirety of the U.S. by issuing a full-scale crackdown on all of civilization, including a military quarantine, the suspension of civil liberties, a vast expansion of government power, and the total destruction of the economy, sending the planet into a cataclysm equal to, or exceeding, the Great Depression.”

He looks at you expectantly.

Do you take the deal?

Quick. You have five seconds to decide.

Is this a fair trade-off?

What if there were no genie and, instead, the matter came down to a vote. Would you support it at the ballot box?

I want you to sit and really think about it, including your initial gut-level response. Be honest with yourself and try to identify the reasons you felt the way you did.

A Great Depression Kills People and Destroys Civilization

My strongly, and passionately, held opinion is that given this particular set of trade-offs, to accept the genie’s deal or to vote for such an outcome at the ballot box would be profoundly immoral once a person understands what is truly at stake because what looks like compassion – saving a life now – would ultimately kill far more people due to second-order and third-order effects, as well as destroy life for nearly every person around the globe given that the United States is not only the world’s reserve currency, but that if we go down, nearly the entirely of Europe, Asia, and Africa go down with us.

A Great Depression is not about preserving a few points of GDP, it is a catastrophe on a scale that is unimaginable to people who are treating it as some sort of afterthought. To even consider entering into one is the equivalent of drinking cyanide in the desert because you are thirsty. It doesn’t mean putting off a kitchen renovation for a year or two, or not buying a new car. We’re talking about condemning nearly the entirety of the world to a generational black hole. We’re talking about tens of millions of children being homeless. Starvation. Endemic poverty with the multi-generational scars that include addiction, depression, anxiety, heart attack, and suicide. The net harms, and ultimate deaths, are so much worse for humanity than what we are facing from COVID-19, to go down this route would be one of the greatest unforced errors in global history. It would be unbridled madness. The lives of your own children, grandchildren, great-grandchildren, nieces, nephews, friends, co-workers, and neighbors, will be destroyed. This isn’t a decision about money or economics in the way that most people think about it, this is about prioritizing human life and reducing suffering. The balance isn’t even close in this case. There is no possible justification for ruination on that scale, especially given that nearly all of the people who would benefit from such a disaster being unleashed would not be alive long enough to live through the nightmare that had been brought down upon society’s head for their sake.

Stop to think for a moment about the medical consequences. Do you realize what happens to pharmaceutical research and funding in a Great Depression? It dries up for years. We’re already seeing long-term consequences from shut-down orders issued by governors and mayors. For example, multiple advanced drug trials for life-saving medicines ranging from treatment for diabetes to liver disease have already been ruined. There are people who will die as a result. Likewise, during a Great Depression, funding for so-called “orphan drugs” also evaporates meaning that rarer conditions receive little to no attention; those who have them simply being told to suffer and die. That is a cost of the COVID-19 response even if it doesn’t show up in the easy-to-count numbers.

Do you realize what happens to philanthropic organizations during a Great Depression? Funding collapses. There are hundreds of millions of people around the world who are able to survive solely because of charitable decisions made by the middle and upper classes across multiple continents and countries. Many of these most vulnerable, including children, receive food, clothing, shelter, and education. Nearly all of that goes away. They will be plunged back into the dark ages and many of them will die as a result of being totally abandoned. That is a a cost of the COVID-19 response even it doesn’t show up in the easy-to-count numbers.

Do you realize what happens to scientific research during a Great Depression? Funding collapses. The innovations and inventions that make life better, and allow people to live longer in greater comfort, never materialize because too many people are busy trying not to starve and almost no one has surplus cash to fund non-guaranteed risk assets. Companies like Tesla and SpaceX will not be able to continue their projects along with the massive societal benefits that come with them. This destruction extends to public research institutes and universities, which rely on tax dollars as tax revenue collapses due to the implosion of economic activity. That is a a cost of the COVID-19 response even it doesn’t show up in the easy-to-count numbers.

Do you realize what happens to the education system during a Great Depression? Assuming that kids are even in school – families with nowhere to live or who are suddenly crammed with multiple relatives into a tiny, unworkable space living multiple people to a room might decide it’s necessary for survival to put their kids to work however they can rather than studying spelling, mathematics, and history – their options for higher education evaporate as scholarship funds disappear, college and universities are suddenly insolvent (or at the very least, have such reduced endowment income and funds raised from tax revenue and/or donations that they have to severely curtail their offerings), meaning a university education becomes the domain solely of the elite, leaving everyone else out in the cold. Special resources for at-risk kids are not going to be there as the funding for those jobs won’t exist. The ordinary K-12 system will see classroom sizes explode upward as individual attention won’t be possible for a vast majority of districts.

We haven’t even scratched the surface. In the last recession, an estimated 10,000 people committed suicide in despair. A Great Depression would make that look insignificant in comparison. An untold number of lives will be destroyed due to significantly higher rates of alcohol abuse, harming not only the health of the addict but their spouse and their children. Leaving aside technological innovations, which we already discussed, many of the best ideas in society come from small start-ups. Those businesses will never come into existence due to a lack of private capital; start-ups that save lives, help the planet, and reduce suffering. Food insecurity becomes unbearable during a Great Depression as even formerly-middle class individuals and families are forced to beg, overwhelming support networks that then make the poorest in society suffer even more. All result in exponentially more human suffering and death.

The Shut-Downs As Presently Structured Will Send Us Into a Great Depression If They Go On For Too Long

Going back to our earlier discussion, the shut-downs that are rolling across the United States and that are meant to buy time for the hospital system are a result of America’s earlier failure to plan and react. Yet, these shut-downs, as they are presently structured, are creating a mass liquidity crisis that will hurl us into a Great Depression if they don’t end sooner rather than later. This means that if our moral desire is to save as many lives as possible, and reduce human suffering as much as we can, we must have the discussion as to the extent to which we are willing to maintain them indefinitely just as we do when we send young soldiers off to war and determine how much death and injury we are willing to risk for the good of the nation.

To help you understand why this is the case, I want you to imagine a restaurant in downtown Chicago. It will serve as our case study.

This restaurant generates millions of dollars in sales per year. Every time a sale occurs:

Some of that money goes to the farmers and supply chain who provided the food, especially if this is a farm-to-table restaurant where individual small farmers are hand-selected by the chef. Many farms are already in a catastrophic tailspin due to the trade war with China, particularly around areas such as soy beans, meaning there is not a lot of slack for further revenue collapse. The moment the restaurant shuts its doors, the cash to the farm stops. Now the farmer can’t pay his or her bills and, if it is like most farms, may be unable to pay its mortgage to the bank.

Some of that money goes to the landlord, which owns the building. That landlord almost assuredly has a mortgage on the building and consists of either an individual or a property group. If it is the latter, the shares of that property group may be sitting in your index fund, portfolio, university endowment, or pension fund that provides checks if you’re retired. The moment the restaurant shuts its doors, the cash to the landlord stops. Now the landlord can’t pay the owners, including retirees who rely upon the income stream, or the mortgage holders, which may include banks and financial institutions.

Some of that money goes to the payroll for the staff; waiters, waitresses, cooks, etc. The moment the restaurant shuts its doors, the paychecks stop. Now, the staff can’t pay their rent or mortgage, cover their utilities, or buy groceries. Keep in mind, too, that a huge part of those payroll checks went to fund Medicare and Social Security at the Federal level so now those two programs are seeing a collapse in funding, threatening the income of every recipient including those who are retired and/or disabled.

Some of that money goes to outside professionals who advise the business, including white collar work such as accountants and lawyers. Those people watch their income from the restaurant go to nothing the moment the doors close.

Some of that money goes to outside vendors, including advertising on television, the Internet, in magazines, on radio, perhaps even on billboards. That income evaporates the moment the restaurant closes its doors.

In a city like Chicago, restaurant sales are subject to the ordinary 10.25% sales tax plus an additional 1.0% restaurant tax that provides essential funding for the city, its citizens, and its employees. That income evaporates the moment the restaurant closes its doors. Even worse, in many cases, Chicago has issued tax-free municipal bonds to pension funds, endowments, retirees, institutional investors, retail investors, mutual funds, etc., which ware backed by those sales tax revenues. When the restaurant closes, those bonds suddenly don’t have the cash flow to distribute what was supposed to be their “safe” income stream, meaning that non-profits, financial institutions, and retirees across the country suddenly find their funding collapsing. Many may be compelled to dump the bonds at fire-sale prices if they are subsequently downgraded even if they ultimately think the bonds are worth full intrinsic value because they aren’t allowed to hold non-investment grade securities, causing funding costs for the entire city of Chicago to spike and creating a downward vortex that causes its budget to collapse further, necessitating additional layoffs; the cycle feeding on itself.

Some of that money goes to the profit for the investors or entrepreneur who started or acquired the restaurant. That profit is then taxed at the Federal, state, and local level, including not only income taxes, the aforementioned payroll taxes, but, also, property taxes that fund local schools. That income evaporates the moment the restaurant closes its doors.

All of these people along the supply chain may find themselves in a panic, dumping their stocks, bonds, and/or other holdings to try and raise cash to avert a disaster, then causing the financial markets to collapse as the number and relative size of sellers overwhelms the number and relative size of buyers. This then causes retirement plans and investment portfolios across the country to implode, suffering enormous losses. What is worse, many of these losses are not simply a matter of stocks or bonds getting cheaper, the actual underlying economic engines are falling apart, meaning intrinsic value is collapsing, as well. I cannot emphasize that latter point enough.

All of this is bad enough when a handful of restaurants shut. Now, consider that mayors and governors are ordering all non-essential businesses shut simultaneously, which means this is happening to nearly every company all at the same time. As a result, the only thing keeping the system from collapsing into a self-liquidating cycle that brings us into a Great Depression is the level of cash reserves or borrowing capacity each person in this chain has at his or her disposal. Every single day that goes by, those cash reserves continue to get reduced as people and companies burn through their savings. At some point, when the weaker economic members of the chain start breaking because they have exhausted their emergency reserves, all hell will break loose and nearly everyone else will fail, too, like a series of dominoes toppling each other.

This is a cascading liquidity failure. This is what we are facing. For the first, and only time, in my life I see a very real possibility of it on the horizon.

The choice we face: Every day we stay in shut-down, we save lives that would have died from to COVID-19 but we do so at the cost of getting closer and closer to that breaking point when the entire structure collapses. No one can tell you where that line is. We won’t know until it happens. Instead, we have to look at as many businesses as we can and figure out how much cash they have on hand, and how long they can survive this, before they fail, then examine their supply chains to see who would be wiped out as a result of their failure. If we go too far, and trigger a Great Depression, we’ll kill and harm more people than the worst-case COVID-19 response.

One thing is clear, though: Wal-Mart, Target, Amazon, Microsoft, Alphabet … they are going to come out of this better and stronger than ever while smaller upstarts, mom and pop stores, and local entrepreneurs are going to be obliterated. That is a cost of this policy; greater dependence upon a handful of mega-corps. Is that the society in which we want to live? That conversation has to take place.

Less Extreme Scenarios

Thankfully, the most extreme scenario is not necessary. Instead, our choices fall along a spectrum of trade-offs that can be made where different choices can result in net harm reduction as the welfare of all citizens is considered. Consider shelter-in-place for twelve weeks. How about eight weeks? Four weeks? Where is the line? You’ll have to answer that for yourself and infectious disease specialists have provided multiple models to try and predict what each of these would mean.

The Bottom Line

Personally, I would argue that it is our moral obligation as a people, not to mention in our own self-interest as God forbid any of us could be infected, to suffer a severe recession, perhaps even on par with 2009 and even if it lasted several years and included significant unemployment and an accompanying stock market crash, if it meant we could reduce the worst-case COVID-19 death count materially. That said, basic human empathy and compassion requires that we evaluate that decision in light of the net harm that comes from the cure we have chosen to employ. Every day that passes, we effectively inch ourselves closer to the line when a cascading liquidity failure is inevitable and no amount of government effort or intervention will stop it. At that point, we must be willing to say, “Enough. We have done all we can. To continue this fight, in this way, would be immoral because every life we save from COVID-19 will result in far more people dying and suffering after all second-order and third-order consequences are considered.”

To do so will not be easy. It will take an act of moral courage, just like Winston Churchill in the example I mentioned earlier. It’s not going to feel good. It’s going to be horrific. Those who choose the moral path will wrongly be called murderers or sociopaths, often by the doctors and nurses who are going to be facing unimaginable conditions that will be the defining moment of their careers, almost assuredly leading to PTSD, depression, and anxiety in innumerable healthcare professionals. It is going to be necessary to forgive them as they are too busy doing everything in their power to save the person in front of them from a horrific death – perhaps it is not reasonable for us to expect them, in them midst of that chaos, to think ten years out and about the scores of children who will die as a result of pharmaceuticals never developed or the masses that will put a bullet to their head in despair as their life implodes around them. That is the cost. Demanding a line in the sand, a point beyond which society must not go in order to reduce death and suffering, is the right thing to do even if it causes others to hate you.

My guess: We have approximately twelve to sixteen weeks of shut-down before a Great Depression can be avoided. That is by necessity an imprecise figure but it’s the closest I can get. Accordingly, I refuse to support an indefinite shut-down longer than that period because I feel to do so would be immoral. It would be choosing what feels good, and compassionate, today at the cost of exponentially more misery and death tomorrow. As a result, I cannot, and will not, abide this idea that it is a foregone conclusion the United States of America should use a humanitarian crisis that pales in comparison to the ones our ancestors faced as an excuse to commit cultural, political, social, and economic suicide.

Regardless, I still believe the United States should do anything and everything it can to reduce mortality from COVID-19, including many which will involve significant disruption in day-to-day life, such as:

Mass testing so those who have had the infection and recovered can return to work and society.

Closing schools for six months or longer.

Keeping shelter-in-place restrictions in effect for at-risk demographics, including passing employment protections so employers had to accommodate work-from-home arrangements if they are possible for a given job.

Requiring all employers to offer paid time off of four weeks or more per annum, just like many other first-world countries, even if it means increasing their prices and the overall level of inflation and/or automation. A lot of sickness is spread because people can’t stay home. I’ve heard first and second hand accounts of terrible managers and executives telling people who are likely sick to come into work, anyway. This should be standard, just like the 40 hour workweek and child labor laws. What seems rational on a firm-specific basis (but isn’t) causes lots of sub-optimality on a country-wide basis.

Using the military’s engineering expertise to mass produce temporary hospitals, as well as invoking war powers to compel certain manufacturers to mass-produce necessary equipment and supplies. I would not want the companies to suffer, though, so I’d drown them in bailout cash if necessary, even if it meant spending a few billion too much to buy, say ventilators that ended up in a warehouse somewhere.

A long-term requirement that certain medical supplies be listed as crucial to national security and must be manufactured in the United States.

Massive bailout funds for hospitals, including hazard pay for doctors and nurses. (I also believe that physicians needs to unionize. What I’m witnessing in how doctors are treated relative to nurses, the latter of whom have union protections, is absurd.)

I believe that no American should have any direct financial cost as a result of the pandemic. This was a Black Swan event and the idea that hospitals are giving out $10,000+ bills for testing and treatment is self-defeating. I am happy to pay taxes to avoid this. I don’t want some struggling person making $12 an hour to worry about how he or she is going to get medical care for a 1-in-100 year event.

Frankly, I hate even writing this because I don’t want us to be in this situation.

I don’t want to die.

I don’t want my family to die.

I don’t want you to die.

I don’t want anyone to die.

I accept, though, that it is going to happen at some point. To all of us. There is no getting around it. We cannot let the fear of death make us party to an act of madness that results in leaving the world a worse place for the generations that come after us. We cannot sacrifice the most vulnerable members of society for the next quarter-of-a-century because we panicked in the face of a pandemic. Those who came before us made hard decisions and put our needs before their needs. It is our duty and responsibility to do the same for future generations.

Again, I am ready, able, and willing to endure enormous pain to save as many people as we can. I am willing to suffer enormous economic hardship, knowing Aaron and I will be fine because of the choices we’ve made in the past even if it means the stock market declines, unemployment spikes, and things look gloomy for a few years. Until this passes, I will worry, to some degree or another, nearly every single day about myself, my husband, our family, and our clients. I am particularly worried about my younger brother, who is going to be on the frontlines of this thing saving lives because he’s doing his anesthesiology residency in Kentucky and hospitals do not have enough masks and protective gear for physicians, as well as my older family members and clients of the firm. It is constantly on my mind. But I just cannot go so far as to advocate for policies that will destroy the world and the lives and livelihoods of billions of people such as shelter-in-place regulations for 12 to 16 weeks. Doing what is right is not always easy nor does it always feel good. You still do it because it is right.

Heed my words: If the only voices in this conversation are well-meaning billionaires, doctors, disease specialists, and white collar professionals with independent wealth who are focused solely on their discipline but without any understanding of the catastrophe they are on the verge of unleashing, they will send us into a cataclysmic abyss comparable, or worse than, the Great Depression. Should it materialize, it will be among the most substantial regrets of your life. If they succeed in taking us down this path for too long, and politicians continue to listen to them, your life is going to not only be materially worse, the lives of your children, grandchildren, nieces, nephews, neighbors, friends, coworkers are going to be destroyed. You will beg for a do-over but the crushing weight of the collapse will neither relent or abate. I cannot emphasize this enough. I want you to understand not only the horrors of what we are facing but also that, as of right now, all this can be avoided; that if we take this forbidden road, it is a choice, an unforced error, for which we have no one to blame but ourselves because we were unwilling to treat this as a war worthy of the same careful trade-off decisions we do in times of military conflict.

It’s going to be ugly just as it has been in every past human disaster. There are going to be a lot of bodies. Some of them, God forbid, might even be yours or mine despite the probability being less than 7 out of 1,000 under our worst-case scenario (which, again, has now been severely reduced as a result of a subsequent update in the calculations). Over the next 30 to 60 days, it may even feel like the sky is falling. The media will not show the enormous majority of people who get over this without any problems. Instead, you are likely to see photos and videos of bodies being stored in refrigerated trucks; mass cremations; doctors and nurses breaking down in tears; grieving spouses and families. It doesn’t change the analysis about what we should do and how we should behave if we want to save as many lives as possible and reduce the net harms on a planet-wide basis. There are times when the community has to come before the individual and this is one of them. I don’t matter right now. You don’t matter right now. What matters is saving as many lives as possible without blowing the foundations of civilization out from underneath us.

Update I: Based upon feedback in the comments, I’ve updated and re-written part of this post as of 03/29/2020. Thank you to those who suggested the changes. I appreciate it.

Update II: The U.S. COVID-19 mortality projections have been slashed to only 100,000 to 200,000, representing a dramatic reduction from prior top-end estimates. It may not seem like it but considering the alternatives, this is really, really great news. While the tragedy will still be immense, if this turns out to be the case, the country got off lucky because it could have been so much worse given the total lack of preparation.