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What's a life worth? According to the governor of New York, Andrew Cuomo, every life is priceless. "We will not put a dollar figure on human life," he tweeted last month, adding, "My mother is not expendable. Your mother is not expendable."
It is a sentiment widely shared at this stage in the world's battle with a killer virus that's forced governments to shutter businesses and put economies on hold to save lives.
But as governments desperately struggle to flatten coronavirus infection curves and to supply equipment and ventilators to overwhelmed hospitals, national leaders and their officials are also debating exit strategies and trying to plot how and when they can relax their strict lockdowns and free up their citizens from confinement in order to fire up economies currently at a standstill.
Much as doctors have to evaluate the worth of a life when they decide who should be hooked up to ventilators and who shouldn't, governments are engaging in a bleak calculation as they weigh lives against economic well-being. The priority now is to save as many lives as possible, but as the lockdowns prolong, the calculation will start changing, officials and analysts acknowledge.
There is little agreement about when the calculation will change, and little consensus on when the health of economies should outweigh lives saved. Wealthier countries, able to absorb the economic shock better, may have more time before they are forced to shift away from lockdowns than poorer ones, already struggling to feed their people.
Risk in prolonged lockdowns
But for all countries at some point, prolonged lockdowns risk causing more suffering than the killer virus itself, according to British government adviser Graham Medley, a senior pandemic specialist to Prime Minister Boris Johnson.
"The measures to control [the virus] cause harm," Medley said. "The principal one is economic, and I don't mean to the economy generally, I mean to the incomes of people who rely on a continuous stream of money and their children, particularly the school closure aspect. There will also be actual harms in terms of mental health, in terms of domestic violence and child abuse, and in terms of food poverty."
Britain will soon need to face the trade-off between harming the young versus the old and vulnerable, he told the British newspaper The Times. He said there is no agreement yet on a plausible exit strategy, adding that the country has "painted itself into a corner."
The rationale so far by governments in the battle against the coronavirus has been to try to tame the transmission of the virus, provide breathing room for the development of effective therapies, be they repurposed drugs or a vaccine, and avoid having hospitals become hopelessly overwhelmed. Once hospitals do reach that point, the death toll surges, as found in Italy and Spain, which have seen 10 percent mortality rates.
According to disease modelers advising Western governments, the pandemic will only worsen if people return to work. They can't see a way yet of easing lockdowns, while at the same time containing or managing the disease.
British officials and disease modelers are trying to quantify "health harms" caused by lockdowns with those caused by the pandemic, hoping to come up with a solution that is hard-headed while not being hard-hearted.
'Less intensive measures'
The key, say some experts, remains in expanding quicker testing for the virus, helping to identify the progress of the disease and to trace contacts, enabling the chains of transmission to be snapped.
"The critical thing first is to get case numbers down, and then I'm hopeful in a few weeks' time we will be able to move to a regime which will not be normal life, let me emphasize that, but will be somewhat more relaxed in terms of social distancing and the economy, but relying more on testing," another British government adviser, Neil Ferguson of London's Imperial College, told the BBC.
He said if there was a swift decline in case numbers, ministers would consider whether they could relax certain measures in "a way which is safe and still ensures the epidemic goes down." He added: "We want to move to a situation where at least by the end of May that we're able to substitute some less intensive measures, more based on technology and testing, for the complete lockdown we have now."
Other experts say that, however, is a more optimistic picture than they can foresee. They warn any abrupt lifting of restrictions will inevitably see a jump in cases, undoing the sacrifices that are starting in some countries to flatten infection curves.
They also highlight Britain's shambolic rollout of testing, which has seen just 2,000 of the country's 550,000 front-line medical staff tested so far for the virus.
Britain is struggling to test daily about 8,000 patients for the potentially deadly virus. Meanwhile, Germany is testing roughly 25,000 patients a day and is ramping up testing with the country's laboratories, capable now of conducting up to 500,000 COVID-19 tests a week. That has helped Germany keep its coronavirus case fatality rate at a low 0.9 percent.
Phased return to education, commerce
The debate in Britain about virus exit strategies is echoed elsewhere. In Belgium, Prime Minister Sophie Wilmes has tasked a panel of experts to come up with a plan to scale back restrictions amid what Belgian officials say are "encouraging" signs that social distancing has brought the spread of the disease under control.
The options they are exploring include a phased lifting that would see schools reopen first, followed then by offices, nonessential shops and restaurants.
Another option would see the population divided into high-risk and low-risk groups, with people released in stages to return to work.
Israel, too, is looking at trying to ease its lockdown by April 19. In a proposal submitted to the National Security Council midweek by the Intelligence Affairs Ministry, according to the Haaretz newspaper, officials are exploring several ways in which Israel could gradually relax the restrictions, depending on whether infection rates decline.
One option developed by researchers from Israel's Bar-Ilan University envisages Israel's population split into two "shifts." Each would be released from lockdown on alternate weeks, thereby reducing the risk of asymptomatic carriers infecting others. A person infected during his active week would enter a weeklong lockdown, at the end of which he could resume work, if healthy.
Another option, proposed by the Weizmann Institute of Science, would have the entire economy cycle in and out of lockdown, with four days of work for every 10 days of lockdown in a bid to sharply decrease the rate of infection and eventually leading "to the virus disappearing." But the exit strategy risks being upended, if, as predicted, the strategy sees a second major spike in infections later in the year.
Two poles of argument in Germany
German politicians and officials are also trying to grapple with developing exit strategies, balancing costs and benefits as the pandemic unfolds. The two poles of argument over exit strategies are represented by two rivals to succeed German Chancellor Angela Merkel - Markus Soder, the head of the Christian Social Union and state president of Bavaria, and Armin Laschet, the president of North Rhine-Westphalia.
Laschet says Germany must start thinking about easing virus restrictions. Soder says the time is not right to contemplate easing the battle to contain the coronavirus, arguing that a comparison of costs and benefits comes down on the side of maintaining a strict lockdown.
Debates about exit strategies are being echoed in the U.S., even as the number of infections soar and the death toll rises. Those proposing an early exit from restrictions say the lockdowns and damage to the economy and rising unemployment will likely cause other "health harms" in terms of suicides, alcohol abuse and mental health.
But a string of studies exploring the impact of the 2008 financial crash and the Great Depression, the worst economic downturn the U.S. has seen, suggest overall mortality rates actually fell in the wake of those crashes, according to the Economist magazine.
Health harms aside, political pressure will only ratchet up to exit the lockdowns as Western GDPs start falling precipitously, savings are exhausted and bankruptcies soar.