Beware: Coronavirus Can Cause Tunnel Vision

Deaths from unintended consequences are hard to count, but they must still count

2,977 people died in the attacks of September 11, 2001, and for a long time it was all the world could talk about. With the images of the exploding planes looming large, many Americans thought it prudent to switch their planned air travel for road trips. Their response was understandable, but their calculation was off: mile for mile, traveling by car is about 100 times deadlier than flying. It has been estimated that some 2,300 people died in car crashes attributable to this single-minded focus on not dying on a plane.

What lesson might we learn as we embrace a ‘better safe than sorry’ posture towards the Covid-19 pandemic?

Simply this: it’s not enough to look at the impact our policies have on ‘flattening the curve’ of Coronavirus; we must try to take into account the hidden and unintended consequences of our policies too.

The economic costs are devastating, but hardly ‘hidden.’ Businesses are shuttering, unemployment skyrocketing, and indices freefalling, all in plain sight. It is wrong, though, to dismiss these with the truism that “we’re not going to put a dollar figure on human life.” As Groucho Marx said, “There are many things in life more important than money, but they all cost money!”

Put differently, recessions, depressions, and unemployment take lives too.

How many lives? We’ll never know precisely, and the data are much debated. In the movie The Big Short, Brad Pitt’s character says that “every one percent unemployment goes up, 40,000 people die” — a sobering formula given that unemployment could jump to 30% in the coming months. Hollywood scripts are not science journals, but the BBC fact-checked the claim, and concluded it was a reasonable estimate.

And then there are the science journals. The Lancet, for example, calculated that the 2008 Great Recession resulted in 500,000 additional cancer deaths alone, with “patients locked out of treatment because of unemployment and healthcare cuts.” Another study published in the BMJ estimated that the recession caused 5,000 deaths from suicide alone, in 2009 alone.

In 2008 the collapse was purely financial, and we can expect countless deaths-by-recession in 2020 too. But this time around, we will also have many cases of death-by-pandemic-response.

A relative of mine, who was battling brain cancer, had her surgery postponed due to the pandemic and died four days later. The surgery was a long shot, and it may not have changed the outcome, but no doubt countless preventable deaths from stroke, heart attack, or late-diagnosis will not, in fact, be prevented because of the pandemic.

‘Countless’ is the operative word. We literally cannot count these deaths at the moment. But our inability to put a precise number on these deaths doesn’t give us license to round it down to zero — it seems more likely the number will be tragically high. Similar to the deadly car crashes following 9/11, these second-order deaths won’t be included in the official tally of this crisis, but their victims will be no less dead for it.

Even if the problem we’re solving for is narrowly defined as ‘saving the most lives,’ at some point the total lockdown we’re under will cost more lives than it will spare.

But it’s not just life preservation we care about — we also care about the things that make life worth living.

We care about our children’s education, and having a billion kids out of school is a problem. We care about families, and should be troubled by early reports of quarantine leading to the breakup of families. We care about the elderly, who are more isolated than ever. We care about the victims of domestic abuse, now holed up with their abusers. We care about the growing mental health toll evidenced by skyrocketing calls to help hotlines.

The list goes on.

I’m not calling into question the strict quarantine much of humanity is under. When the eye of the storm is bearing down, sheltering in place makes sense. But while politicians have explained what we’re to do now, we’ve heard little about what we’re all going to do next. As the costs of shutting down the planet mount, a roadmap to some kind of normal will become increasingly urgent.

When humans face an imminent threat, our brain is flooded with adrenaline, our pupils dilate, and our field of vision narrows to focus intently on the danger in front of us. When the menace is clear and contained (a hungry lion), this tunnel vision can save our life; but when danger lurks in our peripheral vision (as unintended consequences do), our fight-or-flight blinkers can get us killed.

So while our singular focus on Covid-19 is natural and defensible, it won’t be for long. In the days ahead we need to overcome our instincts, widen our aperture, and take in the full gamut of risks we face.

Difficult decisions await us; we must rationally assess their true costs, in all the currencies we care about, lest in years to come hollywood scripts and science journals count, and recount, the ways in which we sacrificed lives — and things worth living for — because our calculation was off.