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Inside the calculus of coronavirus risk: Everyday interactions bring about agonizing decisions

Karen and David Anderson, owners of the Main Streets Market & Cafe in Concord, need to reopen to pay their bills and employees, but they can’t imagine anything worse than putting their customers or workers in danger.Jonathan Wiggs/Globe Staff

Until just a few months ago, it all seemed so natural: We made dozens of decisions every day, without pausing to measure the risks.

Take driving a car, that most common of routines — and hazards. Sure, seat belts and speed limits made us safer — in exchange for a crimping of personal freedom. But we regularly accept the slim chance of tragedy in order to zip wherever we want.

But coronavirus has changed this and just about everything that once seemed normal.

As we emerge from lockdowns and a wave of coronavirus infections that has killed 7,353 in Massachusetts, many previously mundane activities make us pause and reckon. What time should I go to the grocery store? Can I see friends and family? Can we shake hands or hug?

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As states slowly reopen and we navigate the pandemic on the downslope of the viral surge, this kind of calculus is only going to get more common, especially if, as epidemiologists warn, infections and deaths rise as we resume ordinary activities.

Models project anywhere from dozens to hundreds of deaths a day will still occur months from now — different degrees of dire, but still grim. Governments, institutions, and families must try to determine an acceptable level of risk in exchange for a return to some semblance of former life.

“In ending isolation, it’s about not just gaining freedom, but quality of life," said Arthur Caplan, a medical ethicist at New York University. “What’s it worth to go to the beach? What’s it worth to sit at a pool? What’s it worth to go to a bar or eat outdoors?”

In Caplan’s view, the quality-of-life value of such experiences is unquantifiable, and there is no perfect balance between added risk and added benefit, between lives and livelihoods. Yet today, governors and officials across the country are trying to identify where to draw that line as they assess the impact of reopening.

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To understand this calculus, the Globe turned to scientists who crunch data and put a price tag on life itself, epidemiologists who study outbreaks, and a health care chief executive who helped guide Governor Charlie Baker’s reopening plan. We talked to small-business owners who lie awake each night mulling their options, as well as workers in entry-level jobs who feel they have little choice.

For so long, society has leaned on careful research to manage public safety. Officials use data to time traffic lights, set speed limits, and establish a blood-alcohol level that determines whether someone is legally drunk. We live by different barometers of risk. But in the case of this devastating coronavirus outbreak, as experts still grapple to understand the disease, it’s clear even the experts have to make it up as they go.

The cold, hard numbers

From her home in a sparse corner of Wyoming, economist Linda Thunstrom set out to answer a grim question: Is saving lives through social distancing worth the economic costs?

With fear and anxiety running high across the country, Thunstrom turned to cold, hard numbers that she believed would illuminate the most prudent path for America.

“It sounds incredibly callous,” she said, but a rational analysis devoid of emotion “is the way that we should think about it to make sure that we’re not going too far in either direction."

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It is commonplace to say that one life lost is too many, implying that all lives should be protected at any cost. But in truth, the US government has determined that the cap on the price of a human life is $10 million. Regulators use this numeric value to analyze whether new rules on pollution, auto safety, or drug approvals are worth the financial costs. To come up with the “Value of a Statistical Life,” economists studied people’s willingness to pay for safer conditions, such as buying top-rated bike helmets.

In the course of ordinary life, people constantly decide — consciously or unconsciously — to live with certain levels of risk, Thunstrom said, and the choices surrounding COVID should be viewed no differently.

“We can’t pay billions of dollars to save a life — we typically don’t do that,” Thunstrom said. “If we really wanted to protect our own lives at any cost, we wouldn’t get into a car every day.”

Thunstrom and her colleagues at the University of Wyoming concluded that social distancing efforts paid off: The benefit of the lives saved — $12.4 trillion — outweighed the value of the projected economic recession by about $5.2 trillion in the long run.

But there was a caveat. The pandemic has disproportionately killed the elderly. And many economists argue a child’s life is more valuable than that of an elderly person, because children have more years of life ahead of them.

Thunstrom and her colleagues determined that social distancing would still be worth the costs even if a human life was valued much lower, at $5.9 million, representing someone toward the end of their life. That $5.9 million figure, according to experts, was the “break-even point.”

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Danielle Allen, director of Harvard’s Safra Center for Ethics, had a different financial assessment on life and coronavirus. She said the United States could keep the economy open and reduce the virus’s risk level to that of the flu if it invested $75 billion to increase its abilities to run more tests and trace and isolate the contacts of those infected. That’s a small fraction of the trillions the US government has committed to fight the virus-imposed economic recession.

“This is the pathway that all succeeding nations have chosen — Germany, Taiwan, Australia, New Zealand," she said. ”That’s where the focus needs to be."

The state’s calculus

A few days after Governor Charlie Baker’s stay-at-home advisory ended last month, Dr. Mark Keroack, an infectious disease specialist and chief executive of Baystate Health hospital network, surveyed the new landscape as he waited for his car to be repaired in Western Massachusetts. He saw chairs in the shop covered in plastic. He noted the coffee pot was no longer a free-for-all. Everyone wore a face mask.

A member of Baker’s reopening task force, Keroack understood the logistics of coexisting with the virus better than most. Still, it felt strange to venture into a business.

“It’s the weird world we’re going to have to get used to," Keroack said.

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In reopening, Keroack said, caution was clearly warranted. Massachusetts saw the third-highest rate of coronavirus cases in the country. He and other task force members pored over the plans of other states and countries and mapped out “baby steps."

“It’s an incredibly difficult balance,” Keroack said. “There is a certain level of infection and therefore death — a percentage point or two are going to die, of those infected — that is kind of inevitable unless we’re willing to completely shut down.”

Before a vaccine becomes available, he said, the best Massachusetts can hope for is a steady decline in infections to a point where the disease is no longer widespread, and when it does emerge it’s small, isolated outbreaks in a nursing home here or among restaurant-goers there. Those flare-ups could be quickly addressed.

“Like a brush fire," he said. "The critical thing is being able to jump on those hot spots.”

He hopes no one becomes cavalier about COVID deaths, which he considers largely preventable.

The Baker administration declined a request to discuss the elements of the calculus behind the state’s reopening plan but has said it will rely on infection data to drive reopening decisions.

“As we move forward in reopening our economy, we understand the importance of balancing public health and economic health, and we need to do everything we can to support both," Lieutenant Governor Karyn Polito said in a recent press conference.

The business equation

Karen and David Anderson, owners of the Main Streets Market & Cafe in Concord, go to bed each night wracked by the daunting equation they face.

They have a $100,000 credit card bill for food and liquor ordered just before the pandemic hit. They have one retail tenant unlikely to make rent, another who already bailed. And most importantly, they have 50 employees in limbo.

In light of state infection rates, with 50 employees, chances are at least one could be infected at any time.

They need to reopen to pay their bills and employees, but they can’t imagine anything worse than putting their customers or workers in danger. One cook’s wife is pregnant — what if he brought the virus home from work?

“Reopening is a hundred times worse than staying closed," Anderson said. Every day, the couple reconsider the risks and benefits of each option: “Do we open, do we do delivery, all the different aspects of how to do it, and is there a way to do it without losing more money.”

Their story is hardly unique. About 30 percent of 4,000 business owners surveyed recently across Massachusetts said their firms were unlikely to survive the pandemic.

That’s troubling to Retailers Association of Massachusetts president Jon Hurst, who believes businesses need to reopen, and the benefits outweigh the risks.

“I get it, it’s a tough calculus," Hurst said, but "we can’t keep printing money down in D.C. forever and there has to be some level of economic activity until there is a vaccine, and hope there is one as soon as possible.”

As employers start calling workers to return, he said, many are encountering resistance: Some employees are making more money from expanded unemployment benefits than they would on the job; others, especially older workers, more acutely fear getting infected on the job. To Hurst, vulnerable employees should stay home if that makes sense for their safety.

Hurst was at a loss to describe what the business world could look like in the fall.

“Let’s hope,” he said, “we don’t have a bunch of dark storefronts come Labor Day.”

The workers

The phone calls to Milagros Barreto multiply with each slight loosening of the restrictions on Massachusetts business. From her kitchen table in Lynn, the workers’ rights advocate fields calls from uneasy restaurant workers, those who clean offices, and others who staff recycling and manufacturing plants.

Over and over, they’ve called the Massachusetts Coalition for Occupational Safety and Health to report their bosses not taking virus risks seriously, Barreto said.

Some employers reportedly haven’t notified colleagues of a team member’s positive test result, leading to others unknowingly being exposed, she said. Some workers have become infected and requested time off to quarantine but instead been fired, she said.

Some communities, especially ones of color and lower income, have been hit disproportionately hard by the virus and bear the brunt of officials’ reopening decisions even more acutely. Public health experts say these disparities merit special resources as states reopen, but minority advocates say Massachusetts’ mostly white reopening task force overlooked them.

“There was no one on the board to speak on behalf of essential workers," Barreto said, "who have to take the train, and go to the restaurants, no protections at all.”

Facing the threat of job loss — and for some undocumented immigrants, the fear of deportation — many workers believe they’re better off ignoring a cough or fever and continuing to work, potentially endangering everyone else, she said. Yes, low-wage workers are terrified of getting sick, but they are also fearful of their families starving.

“It’s a battle every day,” Barreto said. “What is right, what is wrong, and what will be the consequences of their decisions.”


Naomi Martin can be reached at naomi.martin@globe.com. Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.