With no end in sight to the COVID-19 pandemic, the U.S. seems to be faced with an unappealing choice: If we prioritize saving lives, we court economic ruin. If we opt for economic recovery, we lose friends, colleagues and loved ones. The available options need not be so grim. With the right policy decisions, and well-coordinated action to implement them, America’s possibilities can improve substantially.
In a recently released National Bureau of Economic Research paper, we report on our research focusing on one strategy that can yield large gains: targeting lockdowns based on health risks–specifically, age. As is well documented, the mortality risk from COVID-19 is highly correlated to age. Because those over 65 years of age have around 60 times the mortality rate of those ages 20 to 49, lockdowns on the elderly as a protective measure can be very effective in reducing deaths. They also have lower economic costs than lockdowns for younger adults, as only around 20% of those over 65 are still working.
The choice between protecting lives and economic recovery is complex and difficult–not least because politicians and the public alike disagree on the trade-off between excess deaths from the pandemic and the economic damages. But our study shows, no matter what the priorities are, targeted policies bring both public-health and economic benefits.
Three key conclusions follow from our study:
First, simply “opening up” is a bad policy. Even if we cared only about purely economic costs, ending all lockdowns would lead to deaths in the millions. Because illnesses and deaths have economic costs (for example, workers who die are no longer able to work), a no-lockdown policy that overwhelms our health care system would result in higher economic losses than policies that involve lockdowns.
Second, there can be dramatic gains from a targeted policy that continues to protect the elderly but gradually eases lockdowns on those under 65. Lockdowns for the elderly not only help shelter them from the pandemic but also allow for a much quicker easing of restrictions for those under 65. This does not mean that lockdowns should be ended right away on those under 65. Doing so could lead to a renewed spike in infections and an overwhelmed health care system. Infections among the young would also spill over to the elderly, who can never be perfectly segregated from the rest of the population.
In these circumstances, an optimal lockdown policy should ease restrictions on the young gradually over a number of months. This easing might sensibly take into account factors such as the importance of the sector a person works in, the risks their work poses for infection, an individual’s comorbidities and the ICU capacity in local hospitals.
For example, while an untargeted lockdown applied regardless of age could keep the mortality rate among the adult population to 0.2%, achieving even this mortality rate would have significant economic costs, equivalent to over 35% of one year’s GDP. (These costs include both the current decline in GDP and the loss of the future contributions of those who die.) Simple targeting measures that protect the more vulnerable and older individuals can reduce these economic losses by more than 10% of a year’s GDP without causing any further loss of life. Or policymakers can settle for the same economic loss and reduce mortality, saving lives.
Third, and importantly, we can do even better by adopting complementary policies, such as increased testing to identify the infected quickly and isolate them, and other social-distancing actions (reducing large social gatherings, wearing face masks, curtailing contact between the elderly and younger people, etc.). Combined with targeted lockdowns protecting the elderly as well as similar measures applied to younger individuals with comorbidities, these strategies can dramatically improve the outcomes our country can achieve. With these additional measures in place, optimal lockdowns for younger and healthier groups can be much more limited and possibly even eliminated entirely, and society can benefit by reducing both deaths and economic damages.
Sadly, testing capacity in the U.S. is still grossly inadequate. According to the COVID Tracking Project, the U.S. is currently conducting slightly more than 300,000 tests per day–that is, about one-tenth of 1% of the U.S. adult population per day. Contact tracing is woefully inadequate in most states. Without a massive surge in testing and tracing, targeted lockdowns and social-distancing practices can greatly improve outcomes for the U.S., but the possibility for even more dramatic results in terms of lives and economic livelihoods will be squandered.
Implementing any of these policies is a challenging task. Targeted protections for the elderly need to cover roughly 50 million people over the age of 65. Approximately 10% of these individuals live with their adult children, 4% are in nursing homes and other residential care facilities, and the rest live on their own or with elderly partners. Careful planning needs to go into how to protect them and whether their isolation should come through an enforced lockdown or a voluntary, strongly recommended guideline.
For those in nursing homes, it is vital to limit outsider visits and make sure that the staff is infection-free. The latter can be helped by regular testing of nursing-home employees and proper hygiene and mask-wearing protocols. It may also need the redeployment of nurses and aides who have already recovered and are immune (though we need more data on how long immunity lasts and how extensive it is) or who agree to be isolated themselves.
For the roughly 86% of the elderly who live on their own or with other seniors, we need to find ways to support their continued isolation. One possibility would be to use some of the COVID-19 federal relief packages to launch and fund an Elder Care Corps that would provide for the elderly a few hours per week of support, such as doing shopping, handling deliveries and providing home-care services. Like nursing-home employees, members of this corps would need to be either immune, be regularly tested or undergo isolation themselves.
The corps could be made up of volunteers, those needing jobs, or the National Guard and military, and could be organized either through the government or by organizations like the Red Cross. For example, many of the roughly 1.9 million graduating college seniors are in need of employment and might welcome the possibility of living together with fellow corps members in isolation from others. Mobilizing these graduates to be “seniors helping seniors” would cost less than $1 billion (if we pay $30,000 a year to 30,000 of them) and would have the added benefit of providing jobs and a social purpose to this young generation during our hour of need. Other options include fostering private-sector solutions for ensuring virus-free deliveries of food, medicine and other essential supplies.
We must also pay attention to the mental-health implications of lock-downs. Gradual easing of lockdowns for those below 65 will go some way toward limiting the adverse consequences of social isolation for younger age groups. For the elderly, we have to find ways of managing social isolation while maintaining their physical isolation. Technology to communicate with loved ones and better organized social gatherings for the elderly can help.
The dichotomy between saving the economy and saving lives is a false one. Making lockdowns age-specific is an important pillar for an improved public policy. Our research shows that when combined with better social distancing between age groups and a ramp-up of testing and tracing, targeted lockdowns can minimize economic damage and save lives.
This appears in the June 01, 2020 issue of TIME.
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