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Stevan E. Hobfoll: We must move from a sledge hammer to a scalpel approach

(Francisco Kjolseth | The Salt Lake Tribune) College students from numerous institutions gather in Herriman on Thursday, May 4, 2020, before fanning out into the community to explain the Utah Health & Economic Recovery Outreach program in hopes of finding people willing to be tested for COVID-19, to find out how widespread the disease actually is in the state. Educators and business leaders are hoping the HERO program, where college-age volunteers are now randomly finding residents to be tested for COVID-19, will blossom into something bigger. They are proposing to expand it into what will be called Hope Corps, with hundreds of students and other volunteers offering hands-on advice and resources to restaurants and retailers who's businesses are struggling in the pandemic.

Political tribalism and an epidemiology that is entirely biological, instead of bio-behavioral, has painted us into the proverbial corner. We are presented with a choice of listening to those who advocate for maximum social distance, at the expense of our economy, versus those who wish to sacrifice millions to the gods of Wall Street and carnivorous capitalism.

Both sides are partially correct, and a compromise need to be found, as behavioral epidemiology has been lost in both equations.

Quite simply, a prolonged economic depression would not only have economic consequences, but also result in significant loss of life-years. Here are some facts about the health consequences of economic depression that have not been considered.

First, economic depression will drive up suicides, drug-related deaths, domestic violence and child abuse. Such economic hardship will also result in prolonged anxiety, PTSD and depression, which are indirect killers. We know from research on veterans, as well as studies of inner-city people of color, that prolonged depression, PTSD and anxiety are related to as many as 10 to 15 lost life years.

This not only occurs due to suicide or drug abuse, but because these mental health disorders are inflammatory diseases, which give rise to and exacerbate the consequences of early onset diabetes, heart disease, and virtually any disease process that is genetically or otherwise biologically programmed in people.

The rise in child abuse that will occur with great increases in economic strain will translate to a lifetime of both psychological and health difficulties, including shortened life. We can estimate such increases in child abuse to be epidemic, in response to the likely prolonged economic depression that is forecasted.

Prolonged economic hardship will break up families and erode the very fabric of social support that is vital to both psychological, and yes again, physical health. With prolonged economic hardship, millions of people’s sense of what psychologists call “self-efficacy,” the belief in “can do,” will be compromised. This is another of the key psychological determinants of both health and well-being. Such erosion of self-efficacy will not only be devastating to psychological health of millions, it will greatly impact physical health.

Knowing these facts does not mean we end social distancing, but it does mean that they must be introduced into the false calculus that has been presented.

We have attacked the coronavirus with the bluntest of social instruments — separation and isolation. Alternatives are available for us right now that will both save lives and life-years and save our economy.

These include massive screening of those at low risk and ready to work. Targeting quarantine with more force and persistence, once those carrying the virus are identified. Careful social tracking of their recent social footprint, to identify others at risk. Increasing the targeted physical isolation of those at risk, and not having them go out for groceries or medications, but instead arranging state-sponsored delivery.

It will be vital to accelerate public health screening to identify those under 60 with underlying heart disease, diabetes, respiratory ailments and high blood pressure, as they also have increased risk. Where and when the virus is substantially suppressed, we can move to staged return to work, and even shopping organized in a time-schedule by, say, first initial of one’s last name.

And yes, we must consistently wear masks and practice frequent hand washing to protect ourselves and others. This will allow retail stores to open and enable a low-density shopping experience. Restaurants can increase distance between tables. All this will require training monitors at stores and restaurants, but monitors mean jobs that can be created at less than the cost of the long-term demise of our economy.

In the end, integrating infectious disease science, behavioral epidemiology and economic strategies will save lives, ignite optimism, and enhance trust in our leadership. It will allow us to simultaneously protect the most vulnerable and hand a legacy to the next generations without the damage that was wrought by the Great Depression, which required decades for recovery.

Stevan Hobfoll

Stevan E. Hobfoll, Sandy, is a clinical and community psychologist and the former presidential professor of behavioral sciences and medicine at Rush University Medical Center in Chicago and the author of “Tribalism: The Evolutionary Origins of Fear Politics.”

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