In my view, the first step in developing a risk-proportionate response to an emergent threat is to assess the scale of risk and put the emergent risk in the context of other well understood and accepted risks. Clearly, humans react to emergent novel risks very differently from risks with which they are familiar. Consider our response to automobile accidents or the annual cold and flu season versus the reaction to COVID-19. Often, the response to an emergent and poorly understood threat is to try to reduce the emergent risk to zero and there are very few activities to which the 80/20 rule applies so well as risk management. To achieve zero risk for any threat is usually both impossible and extraordinarily costly. To further encourage thoughtful conversations about whether we should replicate the approach taken to deal with COVID-19, in this post I compare COVID-19 to threats with which we are more familiar.
Because once the response to COVID-19 at the national level became to quarantine the healthy California established a consistent and relatively aggressive approach, I will compare common risks to COVID-19 using statistics from California. According to the CDC, in 2017, 6,368 Californians died due to the flu and pneumonia, 4,226 in auto accidents, 4,311 due to suicide and 2,002 because of homicides. Obviously, deaths due to cardiovascular, cancer and other diseases dwarfed the causes listed above. To date in 2020, the COVID-19 deaths are 1,223.
We live with these and many other threats every day, and for many of them, there have been highly effective, cost-effective efforts to reduce these threats. Arguably, the best example of an effective intervention are the steps taken to reduce automobile deaths and much more could be done to reduce the risks of deaths by these causes, but quite appropriately, as a society we have decided that the investment to reduce these risks further is unwarranted. Consider auto accidents. Every year about four times more people in California die due to auto accidents than COVID-19 and we could dramatically reduce those deaths by bringing the California economy, the fourth largest GNP in the world, to a halt and making it a misdemeanor to drive. Of course, we scoff at such a silly idea because we believe that such an approach is disproportionate to the threat and therefore not justified. Our response to COVID-19 is truly unprecedented and the costs of the response are so extraordinary that they are probably not ever going to be fully understood. What troubles me most about the response is that there is no evidence that quarantining the healthy works or works better than the more traditional approach, quarantining the sick. Worse still, is that to date there has been no thoughtful discussion about the merits of the approach taken to COVID-19 and whether we intend to replicate the response when the inevitable next new infectious organism appears.
It is time that thoughtful and informed leaders examine the benefit/cost ratio of the COVID-19 response and consider other approaches. When the benefits of the current approach are analyzed, I think it is highly likely that there will be no answer to the question of whether the current approach reduced COVID-19 deaths, but it will be clear that it reduced deaths due to auto accidents. With that said, any unexpected loss of life is tragic, and I commend the healthcare workers who tend to the COVID-19, auto accident, flu victims, etc.