Unintended Consequences of Shutdown

Reno Gazette Journal May 3, 2020


As COVID-19 epidemic struck around the world, several countries around the world and many states around the US ordered the closure of non-essential services and issued varying degrees of stay-at-home orders. While these orders have been focused primarily on flattening the curve on COVID-19 infections and mortality, the crushing impact such orders have on the economy and non-COVID aspects of healthcare cannot be ignored.

With many businesses closed by government order, federal unemployment for the week ending April 11 was at a historic high of 16 million (11%), with Nevada being the 3rd worst hit state at 13.7%. In addition to the financial hardship experienced by unemployed families, unemployment adversely impacts the population with higher incidence of domestic abuse, depression and suicide. Greater levels of depression is associated with unemployment as illustrated in this Gallup survey. According to another study, rising unemployment rates lead to more suicides. Even if one is not confronted by major issues like depression and suicide, staying at home also means easier, around the clock access to food and alcohol, which could result in obesity and alcoholism.

While many sectors of the economy have been impacted, the financial impact on the healthcare providers has not received sufficient attention. With directives halting all non-emergency procedures, hospital beds outside of the major hotspots are largely empty necessitating significant cutbacks by providers. Take Mayo Clinic as an example. There, in addition to a hiring freeze, salaried employees will be taking a 7-20 percent salary cut, and other workers will be furloughed. Despite these changes, Mayo Clinic will still face a projected $900 million shortfall at the end of the year. While Mayo Clinic is just one example, almost all healthcare systems around the country are facing significant financial hits. Healthcare is nearly a fifth of the economy and is one of the sectors financially impacted the most.

The claim that the COVID shutdown prevents loss of lives is a blanket claim that is debatable. When the Governors ordered the closure of non-essential services, many of them also ordered the stoppage of elective medical procedures. Under that order, procedures like mastectomies have been stopped and preventive screenings including those for various types of cancers have been cancelled. With such cancellations, there is an increased risk of an aggressive form of cancer going undetected until later. The longer a state continues the shutdown, the more it impacts the health of the general population from non-COVID health issues. While cancellation of elective surgeries may have been a necessity in early-April, we must constantly review the data and act accordingly. The peak was predicted and reached in mid-April and these procedures should have started then.

One final point: Crises like COVID-19 call for a balance between public health, civil liberties and economic freedom. While imbalances between the three for short periods of time are normal, it is important that balance is restored quickly. In ignoring that balance, Governor Sisolak has shirked his responsibility. When faced with the freeze-fight-flight question, the panic-stricken Governor froze. What is more troubling is the Governor’s tone during this crisis. Speaking of Easter dinner gatherings, the Governor said, “You are going to see what strict law enforcement looks like”. Governor, threats from elected officials belong in third world countries ruled by despots, not in America. While states like Florida took advantage of the shutdown by paving roads and fixing bridges, our Governor is inventing inanities like “Phase Zero”. Perhaps, Nevada will be better served if Governor Sisolak focuses on coming up with a plan to reopen the state instead of threatening its citizens.