Healthy Americans in a Healthy Economy

Newt Gingrich,  A Public Health Strategy for Economic Recovery.

Some in the news media would like to pit economic recovery against public health. They write and talk as if you can have one or the other – but not both.

This is a profound misunderstanding of the necessary connection between healthy Americans and a healthy economy. First, public health measures and economic growth and prosperity measures are rheostats rather than on/off switches. They can be moved to different intensities based on need.

Even in the direst health emergency, a large part of the economy must function. Without electricity, water, sewage, trucked-in supplies, groceries, etc., the entire health system would collapse. The loss of life would be far greater.

Even with a booming economy, there are public health aspects – including safe food, medicine, effective emergency drugs, and a host of other elements we blend to help Americans have healthy lives with healthy jobs.

The challenge today is how we blend the best of public health with the best of economic growth, so we can have an America which is both healthy and prosperous.

  1. We need an integrated health-economy policy goal so the country can see the public health and economic teams working synergistically. They can help solve each other’s challenges and to work through the values and judgement questions which are inevitable. The mission statement should be something like: “The Trump administration is committed to growing the American economy and putting Americans back to work within a framework of saving lives through the aggressive campaign to defeat the coronavirus.”
  2. Our economic goal should be a V-shaped decline and recovery. This would enable America to – as rapidly as possible – get back on the track of historically low unemployment and jobs for everyone. Part of the public health equation must be stemming the loss of lives and the health costs that will come from continued unemployment in suicide, alcoholism, drug addiction, depression and other human responses to economic despair. The best example of a pure V-shaped decline and recovery is James Grant’s The Forgotten Depression: 1921: The Crash That Cured Itself.
  3. The Vice President Mike Pence-led Coronavirus Task Force has been doing an amazing job of coordinating a national, and in some cases international, response to a suddenly emerging pandemic. Thousands of lives have already been saved because of the aggressiveness and competence of the task force team. Drs. Deborah Birx and Anthony Fauci have become household celebrities as a result of their obvious competence and professionalism. The daily briefings have restored a great deal of confidence that the crisis is being handled competently. A similar Task Force for Economic RecoveryJob Creationand Prosperity needs to be established. In coordination with the public health-focused task force, this new team should focus every day on reopening the economy, solving bottlenecks, and developing policies for more rapid, dynamic economic growth.
  4. A special focus should be built around keeping senior citizens as safe as possible. Home health companies, which already have trained people provide in-home testing, should be utilized so fewer seniors have to go to the doctor’s office. We should develop an intense program of teaching seniors to use telemedicine – both for convenience and to minimize visiting potentially dangerous offices. Working with companies such as Amazon, Walmart, Peapod, and others, home delivery for drugs and groceries should be optimized, so seniors can minimize time in settings where they might encounter the virus.
  5. One key to reopening the economy is to switch the public health-focused task force from focusing on what we can’t do in the economy to exploring what we could do. For example, using an inkblot strategy developed for defeating insurgencies, we could focus on reviving the economy of the least threatened states. There are eight states with fewer than 100 people infected. As of this writing, the least infected states are South Dakota (41), North Dakota (52), West Virginia (52) Wyoming (53), Alaska (59), Nebraska (68), Montana (71), and Hawaii (95). In those states, there must be entire counties with zero infections. Surely, a strategy could be developed to focus on the infected and liberate the healthy in those eight states – while keeping people safe from risk of infection. New York, with more than 25,000 cases must be severely constrained for the moment, but most of America is not New York and doesn’t have to be. In fact, many rural counties (even in New York) could perhaps be treated with more openness because they resemble South Dakota more than New York City or Westchester.
  6. A system of routine checks must be developed that will apply virtually everywhere — and for as long as the virus threatens us. I was in South Korea during the first phase of the virus and, already, every hotel had someone at the door who checked the temperature (with a skin responsive thermometer) of every person who walked in. High temperature meant no admission. Thermometers may ultimately be as important as tests. Early openings for restaurants in low-threat areas could come with a protocol that only a limited number of tables could be filled at a time to ensure physical distancing. It could also require that staff and customers had to have their temperatures checked. Thinking through behavioral protocols that allow the public health experts to say “yes” is a key part of accelerating economic recovery.
  7. Big companies may be able to work with the public health community to develop healthy protocols for their employees and customers. If WalmartTargetCostcoMcDonald’sCVS, the major grocery stores, etc., all developed sound protocols for checking on the virus and for keeping people safe, a significant part of the American economy could begin to reopen almost everywhere except in the most infected areas. These processes should be quickly documented and shared, so smaller businesses that don’t have the resources to develop such practices can replicate them.
  8. More emphasis needs to be put on therapies. We may eventually get to a vaccine (and like the flu, it might have to be redeveloped annually as the coronavirus mutates). However, in the short run, we can save a lot of lives by simply adapting existing therapies already approved for human use and developing new therapies as they are discovered. Two keys will be finding some method of validating when off-label use of existing therapies works and then getting the knowledge of those therapies to the physician community as rapidly and thoroughly as possible. If we could reduce the threat of the disease to manageable illness rather than death, we would have a lot more latitude to open the economy and get back to job creation. Therapies may be able to be applied in the next 30 to 60 days with dramatic improvements in survivability.
  9. Americans are going to have to learn a lot to live in this new world. The coronavirus may disappear for the summer but come back in the fall. As Americans go back to work, they need to know a lot more about staying safe and about doing their jobs in a biologically more dangerous world. As the new therapies, testing and other capabilities come on-line, Americans need to learn about them. The faster we learn, the healthier we will be and the more we can open up the economy. One example of the need for learning is the use of telemedicine by senior citizens. A combination of public service announcements by trusted celebrities (for the Medicare population Tom Selleck or Gary Sinise would be good examples) and on-line learning need to be used. For those Americans who must stay home, a lot of learning can take place on-line. This can improve their lives at home, prepare them for working from home (the new economy will almost certainly have more distance work than the old economy), and help them use best practices as we learn more about the coronavirus. We are watching an enormous experiment in distance learning with all the schools closed. This system must be built upon as people need knowledge about new testing systems, therapies, rules for reopening the economy, and lessons about staying safe as you go back to work. The Pence team should establish an electronic learning working group with advisers like Sebastian Thrun of Udacity and Brandon Busteed of Kaplan.
  10. Unlocking a locked up and closed-down economy is a lot more complicated than simply increasing the incentives in an otherwise healthy, functioning economy. It is probably worthwhile to convene experts on the World War I and World War II demobilization efforts to learn what lessons there are to re-launch a domestic economy after a period of massive government intervention. The objective, legitimate requirements of public health are going to make renewing the American economy a lot more complicated than anything we have done in the last 75 years. It might be worth studying those who had to disentangle the government and private sector and relaunch a robust economy to see if those lessons learned can be applied to our project of a healthy America with a healthy economy.

This essay is just a start. More ideas must be developed. Keeping Americans healthy and prosperous right now is our society’s most critical challenge.

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