And money is the harshest reality
being asked to put people out of work and into poverty, when we know these are key drivers of poor health and early death.
If all public health decisions result in some good and some harm, how do we go about choosing the right path? I don’t have the answer, but here are three options.
Plan A: Continue to aim for eradication or at least serious suppression.
Pros: We would have a very low Covid-19 mortality rate. We would develop very good testing capability and a health system well equipped to deal with future novel viruses.
Cons: We would have health harms (including death) from continued restrictions, and other socially harmful aspects, like unemployment, crime and domestic violence, would go up. These are deaths and harms to real people and their families. We may also have little to no immunity to Covid-19 and similar viruses in the future.
Plan B: Mitigate carefully, acknowledging we have a potentially lethal endemic virus.
Pros: We would develop immunity, at least seasonally, to Covid-19 and similar viruses. We would develop a reasonably good testing and tracing system, helping us to deal with future novel viruses. We would have enough hospital capacity, provided we were conscientious.
Cons: More people would die from Covid-19. These too are real people with real families. The economy would still suffer quite a lot of damage.
There would be other serious health harms, because we couldn’t afford to attend to all causes of ill health. Plan C: Do nothing.
Pros: This would leave the economy in the best possible shape. It may also create the least inequality in income and other social fabric, or it may not. We would have strong herd immunity.
Cons: Even more people would die of Covid-19. Potential overcrowding in hospitals would restrict access to other essential services. We would have little capability to deal with future novel viruses. This is the agony of decision-making in public health – there are harms everywhere. In the end, we must choose an option. My view is to go with plan B. We aren’t going to do nothing (plan C). And, there is no easy way out of plan A.
Ideally, there would be no endemic viruses; a million people wouldn’t die each week from cancer, cardiovascular disease and stroke; 80 percent of people wouldn’t live in poverty and there would be enough budget to meet all health needs. But we don’t.
Tradeoffs involving health, mortality and money are uncomfortable to discuss, but it’s the reality of public health.