COVID-19 Part 1: The Costs and Benefits of Coronavirus "Panic"

by Michael C. Dorf

On Sunday, New York Governor Andrew Cuomo publicly pleaded with the federal government for authorization for expanded COVID-19 testing. In the course of his remarks, Cuomo sought to reassure young and healthy people about the small risk that the coronavirus poses to them: “There’s a level of fear here that is not connected to the facts,” he said. “This is not the ebola virus, this is not the SARS virus. This is a virus that we know a lot about… The dangerous aspect again, that vulnerable population.” Put differently, we might characterize Cuomo's advice to young healthy New Yorkers as "don't panic."

Is that good advice? The costs of COVID-19 panic are obvious and serious. People who are not sick hoarding hand sanitizer and masks that will not protect them but that deprive health care workers of essential supplies put others at risk. Yet some panic--in the sense of actions motivated by fear that is disproportionately large relative to individual risk--may actually be socially beneficial here.

COVID-19 is very dangerous to people with weakened immune systems and especially those with prior cardiac, respiratory, or other systemic illnesses. Old age is also a major contributor to risk, although it's not clear whether age itself is the problem or that other health problems tend to correlate with age. The tragically and alarmingly high death rate in Lombardy is probably due to some combination of an Italian testing regime that deflates the denominator relative to, say, South Korea's, where more widespread testing detects more mild and asymptomatic cases, a very old population, and an otherwise excellent health care system that has been overwhelmed by the volume of cases.

Those factors in combination suggest that the US faces the prospect of a catastrophe broadly similar to what has been unfolding in Italy but on a larger scale. Although our average age is substantially lower, many millions of Americans are in their 70s or older and our health care system is much less reliable in the best of times. One modestly mitigating factor is that the people who face age-related risk do have government-provided health insurance via Medicare. But grossly inadequate testing is likely also going to be a factor as the virus continues to spread throughout the US. South Korea's testing regime has allowed that country to use isolation as an effective means of combating exponential growth. Here it is probably already too late to bend the curve sufficiently to avoid thousands of individual tragedies, although of course that's not a reason to fail to try to avoid each additional one.

Accordingly, I find Cuomo's claim that the level of fear is unconnected to the facts to be wrongheaded and arguably callous. True, the vast majority of generally healthy people under the age of 70 face a non-trivial but fairly small direct risk from COVID-19, especially with early medical attention if they end up with a serious case, but early medical attention might soon be unavailable if America's hospitals are overwhelmed. Further, even generally healthy non-elderly people will face added risk from an overwhelmed health care system. Experience in Wuhan and Lombardy indicates that hospitals that are short-staffed due to sickened doctors and nurses will divert their depleted resources from "routine" medical emergencies to caring as well as they can for COVID-19 patients, leaving everyone vulnerable to medical misfortunes that do not discriminate based on age, such as life-threatening traumas from automobile accidents.

But purely for the sake of argument, let's grant what seems to be Cuomo's assumption that young healthy people would be sensible to treat the risk of coming down with COVID-19 somewhat but not a whole lot more seriously than the risk of coming down with a bad case of the flu: something to try to avoid if at all possible, to be sure, but not something to obsess about or to dramatically change routines in response to. And yet even then, that attitude and the likely associated behaviors pose grave risks to others.

Suppose that you told a random healthy 22-year-old that while she faces a very small risk of dying from COVID-19, she should be very careful to avoid transmitting it to her grandfather, for whom it poses something on the order of a 10-15% risk of death. A 22-year-old with a conscience who loves her grandfather will then be especially cautious. Some 22-year-olds live with their grandparents. If she is one of that group, she will be extra cautious to avoid getting sick so that she does not transmit the disease to her grandfather.

However, many young healthy people do not live with or have regular contact with elderly or infirm relatives. We can assume that most such young healthy people also have consciences and so don't want to transmit COVID-19 to random people at risk whom they do not know personally. But human nature being what it is, a typical such person is understandably likely to exercise substantially greater caution to avoid spreading a life-endangering disease to her own beloved relatives than to strangers.

Accordingly, panic--that is to say, an exaggerated sense of personal risk--is affirmatively useful in slowing the spread of the disease. The fewer young people who are infected, the fewer points of transmission there will be, so that some vulnerable people will be spared or at least will not be at risk until later in the pandemic, when more effective treatments might be available.

Panic is almost certainly not enough to protect our most vulnerable, however, especially given the grotesquely reassuring comments coming from the White House. I'm not trained as a doctor or a scientist (beyond an undergraduate degree and a year of grad school in physics), but I know and trust math. Exponential growth means that measures that will have seemed draconian just a few days ago will soon be too little too late.

That's all I have the strength to say on this subject today, and I apologize to readers if I come across as alarmist. I very much hope that I am proven wrong. In the meantime, as the title of this post indicates, I expect to write follow-up posts as this catastrophe unfolds.