'The Cold Calculations Governors Will Have to Make Before Reopening' diff viewer (6/7)

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The Cold Calculations Governors Will Have to Make Before Reopening	The Cold Calculations Governors Will Have to Make Before Reopening
2020-06-09 22:26:16 UTC	2020-06-13 04:14:31 UTC (3 days later)
WASHINGTON — How many deaths are acceptable to reopen the country before the coronavirus is completely eradicated? “One is too many,” President Trump insists, a politically safe formulation that any leader would instinctively articulate.	WASHINGTON — How many deaths are acceptable to reopen the country before the coronavirus is completely eradicated? “One is too many,” President Trump insists, a politically safe formulation that any leader would instinctively articulate.
But that is not the reality of Mr. Trump’s reopen-soon approach. Nor for that matter will it be the bottom line for even those governors who want to go slower. Until there is a vaccine or a cure for the coronavirus, the macabre truth is that any plan to begin restoring public life invariably means trading away some lives. The question is how far will leaders go to keep it to a minimum.	But that is not the reality of Mr. Trump’s reopen-soon approach. Nor for that matter will it be the bottom line for even those governors who want to go slower. Until there is a vaccine or a cure for the coronavirus, the macabre truth is that any plan to begin restoring public life invariably means trading away some lives. The question is how far will leaders go to keep it to a minimum.
Some of the more provocative voices on the political right say that with tens of millions of Americans out of work and businesses collapsing, some people must be sacrificed for the greater good of restoring the economy quickly. To many, that sounds unthinkable, but less inflammatory experts and policymakers also acknowledge that there are enormous costs to keeping so much of the work force idle, with many of the unemployed struggling to pay for food, shelter or medical care for other health challenges.	Some of the more provocative voices on the political right say that with tens of millions of Americans out of work and businesses collapsing, some people must be sacrificed for the greater good of restoring the economy quickly. To many, that sounds unthinkable, but less inflammatory experts and policymakers also acknowledge that there are enormous costs to keeping so much of the work force idle, with many of the unemployed struggling to pay for food, shelter or medical care for other health challenges.
And so the nation’s leaders are left with the excruciating dilemma of figuring out how to balance life and livelihood on a scale unseen in generations. “Every governor in the nation is asking that,” Gov. Gretchen Whitmer of Michigan, where 2,700 have died and more than 1 million have lost jobs, said this week. “There’s no such thing as zero risk in the world in which we’re living. But we know that not taking measures to control the spread means that’s going to translate into lives lost.”	And so the nation’s leaders are left with the excruciating dilemma of figuring out how to balance life and livelihood on a scale unseen in generations. “Every governor in the nation is asking that,” Gov. Gretchen Whitmer of Michigan, where 2,700 have died and more than 1 million have lost jobs, said this week. “There’s no such thing as zero risk in the world in which we’re living. But we know that not taking measures to control the spread means that’s going to translate into lives lost.”
With no cure available for the coronavirus and no vaccine likely for another year or more, governors in hard-hit states are seeking ways to minimize the number of additional deaths by staging and structuring any reopening. Time and testing are key, according to public health experts. The longer a quarantine can be extended the better, they say, and the more testing made available, the easier it would be to properly calibrate a reopening and respond to any new outbreak.	With no cure available for the coronavirus and no vaccine likely for another year or more, governors in hard-hit states are seeking ways to minimize the number of additional deaths by staging and structuring any reopening. Time and testing are key, according to public health experts. The longer a quarantine can be extended the better, they say, and the more testing made available, the easier it would be to properly calibrate a reopening and respond to any new outbreak.
Pushing to restore business sooner rather than later, Mr. Trump has dismissed waiting until comprehensive testing provides a better map of where the infection has spread. Instead, the federal government’s guidelines envision “sentinel surveillance” testing of vulnerable places like nursing homes and inner-city health centers, while gradually reopening businesses, schools and other venues in stages with precautions like masks, gloves and social distancing.	Pushing to restore business sooner rather than later, Mr. Trump has dismissed waiting until comprehensive testing provides a better map of where the infection has spread. Instead, the federal government’s guidelines envision “sentinel surveillance” testing of vulnerable places like nursing homes and inner-city health centers, while gradually reopening businesses, schools and other venues in stages with precautions like masks, gloves and social distancing.
All of which could mitigate future infections but would not halt them. The reason the death toll projection may be closer to 60,000 rather than the 2 million of one estimate was because society largely shut down. One recent study said that the 60,000 deaths would have been 6,000 had quarantine measures been imposed just two weeks earlier. So easing measures means the death toll will go up even with safeguards.	All of which could mitigate future infections but would not halt them. The reason the death toll projection may be closer to 60,000 rather than the 2 million of one estimate was because society largely shut down. One recent study said that the 60,000 deaths would have been 6,000 had quarantine measures been imposed just two weeks earlier. So easing measures means the death toll will go up even with safeguards.
But remaining closed is not without a cost either. In just four weeks, a staggering 22 million Americans have lost their jobs, the equivalent of the entire labor force of 23 states.	But remaining closed is not without a cost either. In just four weeks, a staggering 22 million Americans have lost their jobs, the equivalent of the entire labor force of 23 states.
The question divides not only the nation but even families. Rahm Emanuel, the former mayor of Chicago and White House chief of staff, and his brother, Dr. Ezekiel J. Emanuel, a prominent medical ethicist and vice provost of global initiatives at the University of Pennsylvania, have engaged in a running quarrel about how soon society should reopen.	The question divides not only the nation but even families. Rahm Emanuel, the former mayor of Chicago and White House chief of staff, and his brother, Dr. Ezekiel J. Emanuel, a prominent medical ethicist and vice provost of global initiatives at the University of Pennsylvania, have engaged in a running quarrel about how soon society should reopen.
Rahm Emanuel considers it untenable to keep most of the country closed until the virus is completely under control, while Ezekiel Emanuel maintains that the pandemic is too much of a threat to rush back to life as usual.	Rahm Emanuel considers it untenable to keep most of the country closed until the virus is completely under control, while Ezekiel Emanuel maintains that the pandemic is too much of a threat to rush back to life as usual.
“There’s nothing you can do risk free. Nothing,” Rahm Emanuel said last week. “And the missing ingredient is what do you think the public can accept and what will you do to be forthright and honest?” The public, he said, understands that life comes with peril as long as measures are taken to minimize it. “If you reduce the speed limit dramatically, you’d have less deaths,” Mr. Emanuel said. “But we allow it to go to a certain level.”	“There’s nothing you can do risk free. Nothing,” Rahm Emanuel said last week. “And the missing ingredient is what do you think the public can accept and what will you do to be forthright and honest?” The public, he said, understands that life comes with peril as long as measures are taken to minimize it. “If you reduce the speed limit dramatically, you’d have less deaths,” Mr. Emanuel said. “But we allow it to go to a certain level.”
In a separate call, Ezekiel Emanuel said: “I think Rahm is wrong on how bad it could be by letting it run around the population. I’m not for keeping the economy closed forever. Sometimes my brother paints me in a picture. But you have to do it safely. Safely doesn’t mean no deaths. I never said no Covid deaths. But you have to do it in a way that is measured, not irresponsible where you’re going to get to 2 million deaths.”	In a separate call, Ezekiel Emanuel said: “I think Rahm is wrong on how bad it could be by letting it run around the population. I’m not for keeping the economy closed forever. Sometimes my brother paints me in a picture. But you have to do it safely. Safely doesn’t mean no deaths. I never said no Covid deaths. But you have to do it in a way that is measured, not irresponsible where you’re going to get to 2 million deaths.”
The trade-offs have stirred angry exchanges since the start of the lockdowns. Lt. Gov. Dan Patrick of Texas, who is 70, said last month that older people like himself should be ready to risk death to save the economy for their grandchildren, comments he defended on Fox News on Monday night. In a separate appearance on Fox last week, Dr. Mehmet Oz, the television host, cited a study to argue that reopening schools “may only cost us 2 to 3 percent in terms of total mortality,” calling it “a trade-off some folks would consider.” After a backlash, he said he “misspoke” and expressed regret that he “confused and upset people.”	The trade-offs have stirred angry exchanges since the start of the lockdowns. Lt. Gov. Dan Patrick of Texas, who is 70, said last month that older people like himself should be ready to risk death to save the economy for their grandchildren, comments he defended on Fox News on Monday night. In a separate appearance on Fox last week, Dr. Mehmet Oz, the television host, cited a study to argue that reopening schools “may only cost us 2 to 3 percent in terms of total mortality,” calling it “a trade-off some folks would consider.” After a backlash, he said he “misspoke” and expressed regret that he “confused and upset people.”
Some of those charged with making these decisions said far more information is required to reopen with enough confidence to constrain further spread of the virus and avoid a deadly second wave. Gov. Philip D. Murphy of New Jersey said his state would need to double the number of tests.	Some of those charged with making these decisions said far more information is required to reopen with enough confidence to constrain further spread of the virus and avoid a deadly second wave. Gov. Philip D. Murphy of New Jersey said his state would need to double the number of tests.
“You have to crack the back of the personal health piece before you can crack the back of the economic piece,” he said this week. Noting that 177 people in his state died the day before, he added: “The house is still on fire and the fire brigade is still out there trying to put the fire out.”	“You have to crack the back of the personal health piece before you can crack the back of the economic piece,” he said this week. Noting that 177 people in his state died the day before, he added: “The house is still on fire and the fire brigade is still out there trying to put the fire out.”
The situation, not surprisingly, looks different in different parts of the country. The trade-offs in Wyoming, where there have been six deaths, or in Hawaii, with 12 deaths, hardly compare to those in New Jersey, where more than 5,000 have died, or in New York, where more than 15,000 have died.	The situation, not surprisingly, looks different in different parts of the country. The trade-offs in Wyoming, where there have been six deaths, or in Hawaii, with 12 deaths, hardly compare to those in New Jersey, where more than 5,000 have died, or in New York, where more than 15,000 have died.
The United States has always tolerated a certain amount of preventable death. To use Rahm Emanuel’s example, Americans reduce traffic fatalities by requiring seatbelts and airbags, imposing speed limits and employing police. But until better technology is perfected, the only way to actually stop all car crashes — banning cars — is untenable, so some deaths are countenanced, a total of 38,800 in 2019.	The United States has always tolerated a certain amount of preventable death. To use Rahm Emanuel’s example, Americans reduce traffic fatalities by requiring seatbelts and airbags, imposing speed limits and employing police. But until better technology is perfected, the only way to actually stop all car crashes — banning cars — is untenable, so some deaths are countenanced, a total of 38,800 in 2019.
Auto accidents are not communicable so not an apples-to-apples comparison to the coronavirus. But the ordinary flu still claims thousands of lives a year — anywhere from 12,000 in the 2011-12 season up to an estimated 61,000 in 2017-18 — which society accepts without stay-at-home orders. Those seasonal deaths, however, are spread over many months, while the coronavirus hit with catastrophic fury in a matter of weeks and would have caused even more devastation without the quarantines.	Auto accidents are not communicable so not an apples-to-apples comparison to the coronavirus. But the ordinary flu still claims thousands of lives a year — anywhere from 12,000 in the 2011-12 season up to an estimated 61,000 in 2017-18 — which society accepts without stay-at-home orders. Those seasonal deaths, however, are spread over many months, while the coronavirus hit with catastrophic fury in a matter of weeks and would have caused even more devastation without the quarantines.
Government makes money-versus-lives trade-offs all the time. When a regulatory agency weighs a new safety rule, it measures the cost to industry or consumers against the gain by assigning a dollar value to each life that might be saved. If a new rule costs billions of dollars but would only prevent a few dozen deaths, it likely would not be adopted — even though someone would die as a result.	Government makes money-versus-lives trade-offs all the time. When a regulatory agency weighs a new safety rule, it measures the cost to industry or consumers against the gain by assigning a dollar value to each life that might be saved. If a new rule costs billions of dollars but would only prevent a few dozen deaths, it likely would not be adopted — even though someone would die as a result.
~~Updated June 5, 2020~~	Updated June 12, 2020
	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.	Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.	Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.	Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.	The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.	If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The idea that the government translates life to dollars and cents may sound bloodless but it is not unusual. A White House report from 2017, for instance, estimated the cost of 41,000 deaths attributed to opioid overdoses in 2015 at $431.7 billion, an average of $10.5 million per person.	The idea that the government translates life to dollars and cents may sound bloodless but it is not unusual. A White House report from 2017, for instance, estimated the cost of 41,000 deaths attributed to opioid overdoses in 2015 at $431.7 billion, an average of $10.5 million per person.
By that calculation, the 60,000 deaths projected from the coronavirus would be valued at $631.8 billion — while the roughly 2 million lives theoretically saved by lockdowns would be worth about $21 trillion, or nearly eight times the $2.7 trillion in relief spending brokered by Congress and Treasury Secretary Steven Mnuchin.	By that calculation, the 60,000 deaths projected from the coronavirus would be valued at $631.8 billion — while the roughly 2 million lives theoretically saved by lockdowns would be worth about $21 trillion, or nearly eight times the $2.7 trillion in relief spending brokered by Congress and Treasury Secretary Steven Mnuchin.
But James H. Stock, a Harvard economist who served on President Barack Obama’s Council of Economic Advisers, said this crisis goes beyond such ordinary calculations because a shuttered economy represents an almost existential threat to the very idea of America.	But James H. Stock, a Harvard economist who served on President Barack Obama’s Council of Economic Advisers, said this crisis goes beyond such ordinary calculations because a shuttered economy represents an almost existential threat to the very idea of America.
“We really have to be talking not just about our reduction in consumption in the short run but what this is going to be doing to the economy and the republic in the long run,” he said. “It’s those big issues that we’ve been afraid to talk about. A year of this and we would just see an unrecognizable transformation of what America would look like coming out of it.”	“We really have to be talking not just about our reduction in consumption in the short run but what this is going to be doing to the economy and the republic in the long run,” he said. “It’s those big issues that we’ve been afraid to talk about. A year of this and we would just see an unrecognizable transformation of what America would look like coming out of it.”