The need to address both health and economic issues and also for stability

Some of the Covid debate has tended towards health versus economy, but it can’t be an either/or argument. Good health of the population is important for the economy, and a good economy is important for health and wellbeing – “there are many dimensions to health and well-being, many of which build fundamentally on economic stability”.

We had to go into some degree of lockdown, and we have to come out of lockdown. The big challenge is to do this as safely as possible as far as Covid health is concerned, but taking into account the importance of the economy in general, but also specifically in relation to individual and community health.

Many of us have kept a close eye on Covid data, numbers and rates of cases, deaths, tests and more.

Economic signals have been much more mixed, for example share markets plummeted, but have since recovered a lot of the lost ground.

But there’s a key difference – Covid proved to be able to spread fast, and deaths started to surge within a month of an outbreak. Containment has been observable. In contrast a lot of the economic effects are spread over many things, and are likely to lag somewhat. Some companies and jobs will survive, and while some have already been lost the economic impact will take months (at least) to play out.

One of the go to websites for data has been the Johns Hopkins University Covid map.  Caitlin Rivers is an assistant professor in Outbreak science + epidemiology + health security, but she acknowledges the importance of considering both health and the economy,

I’ve been noticing a dangerous polarization in our discussions around navigating our way through the pandemic.

She’s in the US were polarisation has been a growing problem since well before Covid struck.

Reopening is said to be playing games with people’s lives. Continuing stay at home measures is said to be without regard for the economy. This is a false choice.

We were the first group to put out detailed reopening guidance back in March, the same week that many states were issuing stay at home orders. The goal is and has always been to reopen – the question is how to do it safely

Staying home was always meant to be temporary, to prevent the healthcare system from being overwhelmed and to put in place capacities to enable a transition to case-based management. The question is how and when we will reopen. It was never about if we will reopen.

I’ve written about the answers to these questions extensively. The ‘how’ is through test-trace-isolate. The ‘when’ is as soon as we have that in place. The ‘then what’ is by re-introducing low risk activities, waiting to see what happens, and moving up from there. 

As I’ve said many times, what we want to avoid in the reopening process is creating the conditions that led to us having to stay home in the first place. The conditions of NYC, Lombardy, Wuhan. And yes, those places are all urban centers, but rural areas are vulnerable, too.

In April an average of ~2,000 people died of coronavirus in the US each day. That is more than daily average from cancer or heart disease. I fear there is growing complacency that this level of loss is a new normal. Are we really ready to add a new leading cause of death?

My answer to Q’s about whether x, y, z place is ready to reopen is to ask whether those places have the capacities, and if not, how do we build them. Yes, it’s a big lift, but (my current fav phrase) we have done hard things before. We can do this too.

But – and I’ve said this before too – there are many dimensions to health and well-being, many of which build fundamentally on economic stability. I worry as much as anyone about secondary consequences of e.g. poverty and other gaps in care of chronic conditions.

My job is to provide public health counsel, and so that’s what I do. It’s a missed opportunity to have a deeper discussion when I or other experts are set up in an either-or, economy-public health discussion. It’s about how we do both, safely

Again I’ll quote “ there are many dimensions to health and well-being, many of which build fundamentally on economic stability” – this suggests that now is not the time to launch into radical economic or social change, which would be certain to result in instability.