COMMENTARY

How Many Deaths Are an Acceptable Cost of Doing Business?

Disclosures

November 12, 2020

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Human beings have a remarkable capacity to adapt. So do their social systems. That is a good thing, up to a point. But, just like the metaphoric frog that remains in a gradually warming pond until it dies from the heat, too much adaptation can be a killer.

Societies do grow callous to circumstances over time, accepting as tolerable that which should be unthinkable.

Consider the out-of-control homeless situation tolerated in San Francisco, one of the most affluent cities in the world...before COVID-19.

Or the approximately 90 deaths a day that the Centers for Disease Control and Prevention estimates are the cost of using motor vehicles.

Or the estimated 100 deaths a day that result from allowing a powerful guns and ammunition industry to sell to the general public.

Or the 1300 premature American deaths a day that are the "cost of doing business" for a legal tobacco industry.

Could 1000 daily COVID deaths become yet another tolerated "cost of doing business"?

The extent of the lockdown required to prevent or subsequently rid a given geographic area of the SARS-CoV-2 virus is extreme. But it is the only known way to prevent hospitalizations, severe complications, and deaths from the virus. A few small or medium-sized countries (New Zealand, Taiwan, South Korea, Singapore) and one large country (China) have been successful with this approach.

In the United States, we never did lock down enough to accomplish anything other than temporarily tamping down the number of infections. Some local successes were achieved as a result of state or municipality leadership that followed the science and a populace that complied with public health measures. But overall, the virus continued its inexorable march.

Yes, we will all die, eventually. But in the United States alone, excess deaths in 2020 are likely to be in the range of 300,000-400,000. And most of these, probably two thirds, are the direct result of SARS-CoV-2. This is not a trivial number nor one to which we should grow accustomed.

I'm a physician with a strong interest in the health of the public. I don't like these numbers and believe we must do better. I advocate the approach that D.A. Henderson, MD, MPH , and my old friend Bill Foege, MD, MPH , took with smallpox: worldwide viral disease eradication. Eliminate the sucker.

But I recognize that that will be very hard to do.

What I want to raise an alarm about today is the adaptability of human nature. Our ability to allow the once-unthinkable to gradually become a norm. And the way to prevent such cultural adaptation before it is too late will be by keeping our focus on the public's education and public health efforts. We must fight our own human nature and our tendency to adapt.

That's my opinion. I'm Dr George Lundberg, At Large at Medscape.

George D. Lundberg, MD, is a contributing editor at Medscape, contributing editor at Cancer Commons, president and chair of the board of directors of the Lundberg Institute, and a clinical professor of pathology at Northwestern University. Dr Lundberg has more than 30 years' combined experience in medical publishing, having previously served as editor-in-chief of JAMA and the 10 American Medical Association specialty journals. Follow him on Twitter.

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