We all know the lockdown imposed by our government to slow the spread of the coronavirus was devastating to our economy. Unemployment rose from an historic low of 3.8% to 13% on average and even higher for women (14.3%), blacks (17.2%) and Hispanics (19.5%) according to the Pew Research Center. The booming Trump economy was voluntarily halted in the interest of controlling the virus.
The Wall Street Journal editorial board says Democratic Presidential nominee Joe Biden was recently asked if he were in charge, would he call for another lockdown. His response, “I would shut it down. I would listen to the scientists.” Is that the correct decision?
Scientists have been used as scapegoats for many who want to justify their policy decisions, but which scientists do you follow? The scientists said masks were unnecessary early, and even prohibited except for medical personnel and first-responders. Today we’re all told to wear masks, even in circumstances that don’t make scientific sense such as riding your bicycle or walking your dog. Biden wants to make mask-wearing a national mandate, even though he doesn’t have the Constitutional authority to demand that.
But what about the medical cost of the lockdown? While the lockdown probably slowed the spread of the virus and avoided medical rationing of services, a real cost was being paid for limiting other medical services, like cancer screening, diabetes control, and cardiac testing, just to name a few. Now we have an answer to that question.
The Journal of the American Medical Association (JAMA) just published a report that newly identified cancers fell 46.4% from March 1 to April 18. That doesn’t mean there are fewer cancers – just that they aren’t being detected! This drop in detected cancers means those cancers will be diagnosed later at advanced stages when clinical outcomes will be worse.
The Cleveland Clinic last month reported the incidence of stress-induced cardiomyopathy from March 1 to April 30 increased four-fold. Tufts Medical Center last month warned that psychological distress, fear and emotional stress, “coupled with worse clinical outcomes when patients avoid seeking effective care, creates a double hit from this pandemic in which morbidity and mortality associated with cardiac disease might well overtake the risks directly linked to the virus itself.”
The Centers for Disease Control and Prevention (CDC) last week reported that 13.3% of Americans in June said they had increased substance use to cope with pandemic-related stress. About half of those ages 18 to 24 reported severe anxiety and depression, and a quarter said they had seriously considered suicide in the last 30 days.
A new study from Brigham and Women’s Hospital in Boston reports a spike in injuries indicative of domestic abuse, especially severe injuries from strangulation and use of weapons, from March 11 to May 3.
The JAMA report was summarized by epidemiologist Tyler J. VanderWeele of Harvard’s T.H.Chan School of Public Health: “While confronting the possibility of a second wave of the pandemic, these calculations of total lives lost, both from SARS-CoV-2 (Covid-19) infection and because of social, psychological, and unemployment outcomes, may prove important in policy decisions.”
The WSJ editors say, “Mr. Biden says he’d order another shutdown if scientists say it would save lives. But by that standard he’d have to keep the economy constrained for months and for many contagious diseases. He wants to blame Mr. Trump for unemployment but another lockdown would cost millions more jobs. A President has to consider the larger national interest, and that means listening to economists and health experts beyond epidemiologists. Mr. Biden’s comments misjudge the duty of a President.”
As a physician with scientific training, I certainly respect science and its importance when evaluating and treating disease. But decisions about treating one disease must always be weighed against the impact that treatment will have on other medical conditions. We cannot celebrate the elimination of one disease if our treatment kills the patient.