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April 13, 2020

How Many Uninfected People Will the War on the Coronavirus Kill?

Today we’re told that we’re in a “war on the coronavirus.” President Donald Trump began a March 18 press briefing by “announcing some important developments in our war against the Chinese virus” and repeatedly called the government’s response to the virus “war.” He invoked the Defense Production Act, designed to authorize the federal government to force companies to produce defense equipment in time of war.

By E. Calvin Beisner

Today we’re told that we’re in a “war on the coronavirus.”

President Donald Trump began a March 18 press briefing by “announcing some important developments in our war against the Chinese virus” and repeatedly called the government’s response to the virus “war.” He invoked the Defense Production Act, designed to authorize the federal government to force companies to produce defense equipment in time of war.

Former Vice President Joe Biden said in the March 15 Democratic presidential primary debate, “We’re at war with a virus.” Many other politicians and business leaders around the world are using similar language.

In The New Republic, Adam Weinstein asks, “How do our would-be commanders envision the war on coronavirus playing out? What sort of combat is this to be?” Weinstein followed up by (sometimes rightly) exposing our government’s incompetence and failures in conducting this war.

But there’s another, more important angle to how to answer those questions.

In World War I, about 9.7 million military personnel and 10 million civilians died. In World War II, 20 million and 40 million. In both cases, civilian deaths outnumbered combatant deaths — in the first, by a slim margin, but in the second, they were double.

Might the “war on the coronavirus” have similar results? That is, might “civilian” deaths outnumber “combatant” deaths in this, too? And what do “civilian” and “combatant” mean in this case?

For the purposes of this discussion, I use “civilian” to mean someone who doesn’t get infected and “combatant” to mean someone who does. Might the “war on the coronavirus” kill more people than the virus itself?

Up to now, reports have focused almost exclusively on modeled predictions and, along the way, actual counts of the number infected (“combatants”) and, of them, the number killed. There’s been little discussion of the number who will be killed not by the virus but by the war against it (“civilians”).

Estimating Deaths and Death Rates of “Combatants”

A widely influential model from Imperial College London, credited with prompting political leaders around the world to institute lockdowns, originally predicted over 500,000 deaths in Great Britain and 2.2 million in the United States. Later, in light of the United Kingdom’s initiating lockdowns, epidemiologist Neil Ferguson, its primary author, reduced the estimate for Britain by 96% or more, to under 20,000 — over half of whom would have died this year anyway from combined age and non-coronavirus illnesses (the difference between dying with the virus and dying from the virus). Ferguson did not issue a new estimate for the United States, which instituted similar measures, but by analogy it would have been around 88,000 instead of 2.2 million.

In terms of the counts, the numbers already infected appear to be vastly underestimated, probably by orders (note the plural) of magnitude (i.e., by 100 times or more), because most people infected show no or only mild symptoms and so are never tested.

But the numbers COVID-19 kills are probably overstated — perhaps not by orders of magnitude, but considerably nonetheless. In Italy, for instance, every death of someone infected is attributed to COVID-19, but “On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity [pre-existing illness] — many had two or three," according to Professor Walter Ricciardi, scientific adviser to the Italian government. Again, it’s the difference between dying with the virus and dying from it.

Correcting for underestimates of infections and overestimates of deaths means the death rate from COVID-19 is even more highly exaggerated than the infection rate. If infections are 100 times higher while deaths caused by the virus are 88% lower, the combined error exaggerates the death rate (deaths per 100,000 infections) by 833 times.

Estimating Deaths of "Civilians”

Will the “war on the coronavirus” kill more people than the virus itself? Most discussions so far have neglected that question. But it’s critically important.

How might we go about it? After all, no coroner is going to be able to write on a death certificate, “Cause of death: War on the coronavirus.” Are we left entirely in the dark?

No. For decades economists have studied the relationship between total economic production and death rates in a given economy. Their studies have led to various estimates of the amount of economic loss that results in what they call a “statistical death.” Such deaths may be from despair-driven suicide (already mounting) and opioid abuse or reduced spending on healthcare, food, shelter, and safe transportation.

I’ll have to ask your patience for a moment as we look at some numbers drawn from four representative studies (in 1994, by Randall Lutter and John F. Morrall III; 1997, by Ralph Keeney; 1999, by Lutter, Morrall, and W. Kip Viscusi; and 2017, by Viscusi and James Broughel). The three earlier studies estimated “the income loss that induces one death,” sometimes called “willingness-to-spend” to prevent a death, from a low of $10.0 million to a high of $23.3 million. The last, happily, put the “cost-per-life-saved cutoff value at which regulations increase mortality risk” at from $82.3 to $130.0 million with a midpoint of $108.4 million. (All amounts adjusted for inflation.)

To avoid getting into an excessive number of scenarios, let’s apply the midpoint of the first three estimates, $16.5 million, and the midpoint of the last, $108.4 million.

To calculate how many the “war on the coronavirus” will kill, we need to know how much it’s going to cost the U.S. economy. Again, estimates vary, and outcomes will depend heavily on decisions yet to be made by the president, governors, and mayors (and, if our federalism and separation of powers still mean anything, by Congress, state legislatures, and county and city councils) that will determine how many and for how long businesses remain closed or operating under capacity. But we can take a few examples from a news report and an editorial in The Wall Street Journal on March 21.

JPMorgan’s Bruce Kasman “expects U.S. gross domestic product will fall by 1.8% this year,” and “Before the outbreak, he had projected output to grow 1.5%.” That implies a combined difference of 3.3% between what could have been and what will be. Applied to 2019’s GDP of $21.4 trillion, that would mean a loss of $707 billion.

Joel Prakken, chief U.S. economist at IHS Markit, forecast a loss of $1.5 trillion in GDP for 2020, and Wall Street economist Ed Hyman predicted a loss of 20% of GDP, compared with a previously expected gain of 2%. Combining those implies a 22% difference, or $4.7 trillion.

Those estimates all predated the extension of the lockdown orders announced March 29, so each will need be adjusted upward after we know how long the shutdown continues, but they can serve for illustration.

If lost income that results in a statistical death is $108.4 million, then Kasman’s economic loss estimate entails 6,522 extra deaths; Prakken’s 13,838; and Hyman’s 43,358. If instead it’s $16.5 million, then Kasman’s estimate entails 42,848 extra deaths; Prakken’s 90,909; and Hyman’s a staggering 284,848.

All That, and for What?

In justifying his drastic measures, New York Gov. Andrew Cuomo said, “I want to be able to say to the people of New York — I did everything we could do. And if everything we do saves just one life, I’ll be happy.”

I won’t. I’ll be furious. If all we do with trillions, or even billions, of dollars is save one life, we’ve done something very evil. Why? Because by doing something else with those same dollars we could have “saved” (really just prolonged — we all die sometime) thousands of other lives.

I don’t know — and no one knows — just how much our economy will lose due to the “war on the coronavirus” or how many deaths that loss will cause. Neither does anyone know yet how many deaths the virus itself will cause. Neither will we ever know just how many deaths from the virus the war prevents — because we’ll never know how many would have died without the war. Nor will we ever know how many “civilian” deaths might be prevented by ending the war — or at least its more extreme, economy-killing aspects. To argue otherwise, in every case, will be hypothesis contrary to fact.

But it’s indisputable that the virus won’t be the only killer — and not even the only killer on a mass scale. The war will kill, too. Just as surely as in World Wars I and II, there will be some ratio of “combatant” to “civilian” deaths. I strongly suspect that in this war, too, “civilian” deaths will outnumber “combatant” deaths — whether by 3%, as in World War I, or by 100%, as in World War II, or by some other ratio.

What Will the “Civilian” Deaths Buy?

In those real wars, what did we gain in exchange for the civilian deaths? The preservation of limited, democratic government with liberty and the Rule of Law instead of totalitarian, dictatorial government with neither.

What about in the “war on the coronavirus”? What will we gain? Certainly not the preservation of limited, democratic government. All the movement is in the opposite direction. Governments all over the world, including in the “land of the free, and the home of the brave,” are exerting control over their citizens that exceeds anything we’ve seen before outside the worst Communist, Nazi, and fascist governments of the past — and maybe even worse.

Will we be able to regain our liberties to force governments back within limits? I don’t know. Do you?

It’s time our elected leaders and appropriate scholars began paying as much attention to this threat as to the virus. We need a prudent path between underreaction and overreaction. We’ll find one only as we widen our perspective beyond medicine and epidemiology and include economics and political philosophy as well.

E. Calvin Beisner, Ph.D., is founder and national spokesman of The Cornwall Alliance for the Stewardship of Creation, author of Prosperity and Poverty: The Compassionate Use of Resources in a World of Scarcity and Prospects for Growth: A Biblical View of Population, Resources, and the Future, and former associate professor of historical theology and social ethics at Knox Theological Seminary.

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