bsolutes are rarely the appropriate response to complex issues, even when life and death are involved. This is because there are extreme costs to extreme policies. Benefit-cost analysis is a common tool used in policy setting and decision-making. This generally leads to less extreme policies. For example, speed limits are not set at zero despite the thousands of lives that could be saved due to the enormous economic cost of such a policy.
Putting a value on human life is one of the most difficult aspects of benefit-cost analysis, but it must not prevent us from considering and developing alternatives to absolute lock-down policies.
In the rush to protect the physical health of at-risk groups of our population from COVID-19, absolute measures have been implemented without consideration for their extremely high cost.
These policies include stay home alone, school closures, and prohibitions against visitors at senior residences and hospitals. These measures cost a significant deterioration in the mental health of many as well as a loss in a little piece of our humanity as social beings.
According to an article published in April by the Journal of the American Medical Association, many COVID-19 preventative measures have been disadvantageous from a mental health standpoint. It cites the negative consequences of economic stress, social isolation, constant exposure to news focusing on the virus, lack of religious and community support, and reduced availability of non-critical medical care as increasing the potential for a mental health crisis.
Researchers at NYU Langone Health and UMass Medical School have also found that COVID-19 responses such as school closures and home confinement have likely traumatized many children, particularly those with pre-existing mental health conditions, anxiety, mood problems, or developmental issues. According to a recent article in the Journal of the American Medical Association, school closures were likely not effective in preventing the spread of COVID-19. Based on evidence from other countries and previous pandemic responses, they found that the closures might have led to even worse medical outcomes as well as emotional and economic effects.
Additionally, the fact that humans are social creatures has been overlooked, putting those who benefit most from social interaction at greatest risk of increased mental and physical health deterioration. Where is the humanity in preventing a mother from holding her newborn baby, as cited in the New York Times? What of the elderly occupants at memory care residences, kept in isolation away from family members who are likely their only connections to reality? What of the tens of thousands who succumbed to COVID-19 or other conditions who were unable to have loved ones at their deathbed? And what of their family members who could not share final words or expressions of love at their children’s or parents’ passing? These real-life experiences took place across the nation. They have been heartbreaking beyond measure. We ask, “Who was saved by these prohibitions? Wasn’t there an alternative?” Any benefit was overwhelmed by the unmeasurable loss of something we as humans value most: of being together in those moments which can never be regained.
How Benefit-Cost Analysis Suggests We Can Do Better
As we move forward in this crisis, and in any similar future crisis, time must be taken to consider the costs as well as benefits of policies. In particular, there needs to be some allowance for individual decision-making where the consequences of the decision apply only to those involved, such as family members or small groups. For example, immediate relatives of patients facing imminent death or mothers giving birth could be given the opportunity to be with their loved one, so long as they follow an established protocol to protect others. They could be required to enter the hospital through a designated entrance, shower just prior to and after being in the hospital, wear full PCP while in hospital, and self-quarantine following the visit. The one or two direct family members who attend their loved-one’s birth or death would incur minimal personal cost (risk) for an unmeasurable gain of being there during one of life’s irreplaceable moments.
To reduce the trauma and sense of alienation felt by school children denied the company of their peers, and the economic impact on families, parents could be allowed to form small, 5 to 10 student pods. All involved would agree to socialize only with other pod members, and parents would rotate hosting and facilitating the on-line instruction of the children. This would allow parents to be fully engaged in their own work 4 days of the week as well as allowing the children to retain a sense of belonging to a group. These benefits clearly overwhelm the minimal costs of increased risk of exposure.
Flexible vs. Absolute Policies
Policy-makers during pandemics should work with scientists and social workers to develop options that preserve the mental as well as physical health of our population and important aspects of our social human nature. This will require moving away from the absolute measures taken to save lives at all costs. It will require more flexibility, such as offering a range of precautions tailored to specific scenarios, especially where the larger group is not affected. Let us consider the quality of life for those that are saved and the quality of death for those that are not.
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The Unmeasurable Costs of Extreme Policy Responses
August 28, 2020
Amid COVID-19, policy-makers should work with scientists and social workers to develop options that preserve the mental as well as physical health of our population and important aspects of our social human nature.
A
bsolutes are rarely the appropriate response to complex issues, even when life and death are involved. This is because there are extreme costs to extreme policies. Benefit-cost analysis is a common tool used in policy setting and decision-making. This generally leads to less extreme policies. For example, speed limits are not set at zero despite the thousands of lives that could be saved due to the enormous economic cost of such a policy.
Putting a value on human life is one of the most difficult aspects of benefit-cost analysis, but it must not prevent us from considering and developing alternatives to absolute lock-down policies.
In the rush to protect the physical health of at-risk groups of our population from COVID-19, absolute measures have been implemented without consideration for their extremely high cost.
These policies include stay home alone, school closures, and prohibitions against visitors at senior residences and hospitals. These measures cost a significant deterioration in the mental health of many as well as a loss in a little piece of our humanity as social beings.
According to an article published in April by the Journal of the American Medical Association, many COVID-19 preventative measures have been disadvantageous from a mental health standpoint. It cites the negative consequences of economic stress, social isolation, constant exposure to news focusing on the virus, lack of religious and community support, and reduced availability of non-critical medical care as increasing the potential for a mental health crisis.
Researchers at NYU Langone Health and UMass Medical School have also found that COVID-19 responses such as school closures and home confinement have likely traumatized many children, particularly those with pre-existing mental health conditions, anxiety, mood problems, or developmental issues. According to a recent article in the Journal of the American Medical Association, school closures were likely not effective in preventing the spread of COVID-19. Based on evidence from other countries and previous pandemic responses, they found that the closures might have led to even worse medical outcomes as well as emotional and economic effects.
Additionally, the fact that humans are social creatures has been overlooked, putting those who benefit most from social interaction at greatest risk of increased mental and physical health deterioration. Where is the humanity in preventing a mother from holding her newborn baby, as cited in the New York Times? What of the elderly occupants at memory care residences, kept in isolation away from family members who are likely their only connections to reality? What of the tens of thousands who succumbed to COVID-19 or other conditions who were unable to have loved ones at their deathbed? And what of their family members who could not share final words or expressions of love at their children’s or parents’ passing? These real-life experiences took place across the nation. They have been heartbreaking beyond measure. We ask, “Who was saved by these prohibitions? Wasn’t there an alternative?” Any benefit was overwhelmed by the unmeasurable loss of something we as humans value most: of being together in those moments which can never be regained.
How Benefit-Cost Analysis Suggests We Can Do Better
As we move forward in this crisis, and in any similar future crisis, time must be taken to consider the costs as well as benefits of policies. In particular, there needs to be some allowance for individual decision-making where the consequences of the decision apply only to those involved, such as family members or small groups. For example, immediate relatives of patients facing imminent death or mothers giving birth could be given the opportunity to be with their loved one, so long as they follow an established protocol to protect others. They could be required to enter the hospital through a designated entrance, shower just prior to and after being in the hospital, wear full PCP while in hospital, and self-quarantine following the visit. The one or two direct family members who attend their loved-one’s birth or death would incur minimal personal cost (risk) for an unmeasurable gain of being there during one of life’s irreplaceable moments.
To reduce the trauma and sense of alienation felt by school children denied the company of their peers, and the economic impact on families, parents could be allowed to form small, 5 to 10 student pods. All involved would agree to socialize only with other pod members, and parents would rotate hosting and facilitating the on-line instruction of the children. This would allow parents to be fully engaged in their own work 4 days of the week as well as allowing the children to retain a sense of belonging to a group. These benefits clearly overwhelm the minimal costs of increased risk of exposure.
Flexible vs. Absolute Policies
Policy-makers during pandemics should work with scientists and social workers to develop options that preserve the mental as well as physical health of our population and important aspects of our social human nature. This will require moving away from the absolute measures taken to save lives at all costs. It will require more flexibility, such as offering a range of precautions tailored to specific scenarios, especially where the larger group is not affected. Let us consider the quality of life for those that are saved and the quality of death for those that are not.
