In July, Ezekiel Emanuel — the bioethicist and COVID adviser to Joe Biden — signed an open letter insisting that the country be locked down again — only this time, in an even more draconian manner than before, including significant restrictions on interstate travel. From the letter:
Non-essential businesses should be closed. Restaurant service should be limited to take-out. People should stay home, going out only to get food and medicine or to exercise and get fresh air. Masks should be mandatory in all situations, indoors and outdoors, where we interact with others.… You should bar non-essential interstate travel. When people travel freely between states, the good numbers in one state can go bad quickly.
The idea, obviously, is to keep people from catching the Wuhan virus until a vaccine is readily available. As Emanuel and the many other “experts” signing the letter put it darkly, “If you don’t take these actions, the consequences will be measured in widespread suffering and death.”
Emanuel clearly believes that stopping infection is the highest priority. After all, when the disease first struck, he urged the entire country to be closed for 18 months, the time expected then to create a vaccine. More importantly, what Emanuel believes matters. Vice President Joe Biden has repeatedly promised to shut down the country again “if the scientists” tell him to. In a Biden administration, the most influential scientist is likely to be one Ezekiel Emanuel.
But there’s more to the COVID story than the virus itself, and focusing on preventing infection reflects a dangerous policy myopia. As the old saying goes, sometimes the “cure is worse than the disease,” and in this pandemic that is acutely true for the young and healthy who have little danger of lethality or long-term consequences if they get sick.
Not so with shutting the country down. Lockdowns and media fearmongering about COVID are extracting a terrible toll on the mental health of the entire population, in some age groups causing more lethal danger than the virus. For example, there has been a dramatic increase in suicide ideation, domestic abuse, opioid addiction, and significant anxiety disorders since the virus hit and the economy imploded.
While this issue has been addressed by the CDC and others, it has not been sufficiently discussed in the media and during political debates. Thankfully, the problem caught the rapt attention of UC Irvine psychiatrist Aaron Kheriaty, who has been ringing the warning bell, most recently in an important article in Public Discourse. From “The Other Pandemic: The Lockdown Mental Health Crisis”:
Last month the CDC published a devastating report on the mental health effects of lockdowns, based on a population-based survey in June of over 5,000 Americans. The findings are entirely consistent with what I’ve seen among the patients in our psychiatric clinics — namely, enormous harms.
Four out of ten respondents reported at least one adverse mental or behavioral health condition. Three out of ten reported symptoms of anxiety disorder or depressive disorder, and one-quarter reported symptoms of a trauma- and stressor-related disorder due to the pandemic. Thirteen percent reported having started or increased substance use to cope with stress or emotions related to COVID-19 lockdowns.
The toll on the young is even worse:
Of particular concern, 11 percent reported they have seriously contemplated suicide in the past thirty days. Among those aged eighteen to twenty-four years old, this number was 25 percent. We should pause to consider this statistic: one-quarter of young adults in America contemplated suicide in the month of June. Rates of suicidal thinking that month were higher among minorities (Hispanic 19 percent, black 15.1 percent), among unpaid caregivers for adults (31 percent), and essential workers (22 percent).
Kheriaty warns that the death toll could become almost as significant as that from COVID:
One recently published model of deaths of despair due to COVID lockdowns projects that as many as 75,000 more people will die from drug or alcohol misuse and suicide. In addition to the sudden emergence of the novel virus, this study cites unprecedented economic failure paired with massive unemployment, as well as mandated social isolation for months and possible residual isolation for years. An analysis of CDC data by the Washington Post found about 13,200 excess deaths due to Alzheimer’s and other forms of dementia since March.
Kheriaty urges that we look at the ancillary costs of shutdowns and other restrictions as well as the danger of the disease itself:
It is time for a real public conversation about these social distancing and lockdown policies. Deferring to “science,” which cannot answer inescapably political questions, and where no single model can take account of all the various harms, will not do. There are massive human costs to our current course. It is past time for us to take stock.
I’m with him. Throughout this crisis, the media have obsessed on the death toll exacted by the virus — which is a big story, to be sure, but the toll mostly afflicts the elderly or those with comorbidities. In contrast, the mental health catastrophe impacting young and old alike has been given terribly short shrift.
The election plays into all of this as well. It seems to me that this campaign reflects two good faith, but opposite, approaches to coping with COVID:
- President Trump wants the country to be open, the economy rebuilding, children back in school, and people allowed to live freely despite the threat of the disease — as a concerted push is made to find therapeutics and a vaccine. (That is what I took Trump to mean when he tweeted from Walter Reed hospital, “Don’t be afraid of Covid. Don’t let it dominate your life.”)
- Vice President Biden supports a much more stringent focus on avoiding the virus itself, and as stated above, even if it requires another lockdown and its associated costs to the economy, and at the risk of the mental health impact described by Kheriaty.
The way the election goes will tell the tale about which policy approach the country will likely pursue in 2021 and going forward.
As for me, even though I am at an age with a significantly higher risk for serious illness if I catch COVID, I am with Trump. The country needs to gird its collective loins and soldier on. Of course, proper public health precautions should be taken — social distancing, hygiene, masks where appropriate, and all of that. But it should be primarily up to me to protect myself. The social and mental well-being of those in their prime shouldn’t be sacrificed to on the altar of those whose lives are mostly in the rear-view mirror.