Following congressional testimony last week about frontline workers’ experiences during the Covid-19 epidemic, members of the U.S. House of Representatives raised the specter of a rise in “deaths of despair” due to Covid-19 shutdowns. They implied that the country had a moral obligation to reopen quickly, if only to avoid current and future deaths from suicide, homicide, opioids, and alcohol.

A comment by a trauma physician in California that his hospital had seen “a year’s worth of suicide attempts in four weeks” went viral this week, picked up by Fox News and presidential adviser Kellyanne Conway to support the argument to reopen the country, even though the remark was incorrect and there’s been no rise in suicide deaths in his county this year.

As an emergency physician and a psychiatrist, we have very real concerns about the well-being of our communities and our neighbors. We are the ones who are first to see the rise in anxiety and stress and changes in physical and mental health in our communities.

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We also know that tying deaths of despair directly to measures being used to reduce the spread of Covid-19 is, simply, wrong.

Deaths of despair are tragic and preventable. But they are not new. The label was first used in 2017 by two economists to describe the increase in U.S. deaths from suicide, overdose, and alcohol in the 2010s. Anne Case and Angus Deaton wrote that these deaths reflected rising hopelessness and inequity among American society. A series of investigations since have corroborated their findings. All three types of death have been on the increase among all Americans for the past decade, in parallel with a decadelong rise in hopelessness, inequity, and easy availability of lethal means. Where was the alarm from these politicians then?

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We do not actually know that these deaths are increasing during the Covid-19 pandemic. Police and crisis hotlines may — or may not — be receiving extra calls for domestic violence and child abuse. Firearm homicide rates are staying steady. Suicides are certainly occurring, but there is no evidence to date that their rate is on the rise (and we may not know the impact of the pandemic on suicide for years to come). Despite ample evidence that anxiety is increasing during the pandemic, anxiety alone is rarely a driver for suicide. It is not even a risk factor for it.

Right now it is all too easy to blame every tragedy on Covid-19. Science warns us, however, not to make this fundamental error of attribution.

Projections about future increases are also misleading. Earlier this month, a report by the Well Being Trust projected that these categories of deaths would likely skyrocket during the Covid-19 pandemic due to unemployment, isolation, and uncertainty. We know that the economy is deeply tied to physical and mental health. Yet these projections are based on data from the Great Recession, meaning the models weren’t able to factor in the unique aspects of what is happening today, such as how new technologies make possible increased virtual social connection and support.

And as the authors of the Well Being Trust report acknowledge, even if the models are correct, they are mutable. An increase in suicide, homicide, and deaths from alcohol and opioids is not a foregone conclusion. A complex constellation of risk factors, only a few of which are directly tied to Covid-19, are known to drive these tragic deaths. We have evidence-based interventions that can reduce the rates of many of the risk factors for all of these deaths whether or not the country is practicing social distancing, hand-washing, and mask wearing.

It is also wrong to imply that reopening the country will, in and of itself, stop deaths of despair. Jobs may or may not rebound when social distancing rules are relaxed. Much of the decline in travel and eating in restaurants predated formal rules about social distancing. Whether unemployment leads to desperation depends on whether we as a society feed and clothe those without incomes. Newly purchased firearms will still be in people’s houses and all too easy to use in a moment of despair even when we are not social distancing.

If politicians really care so much about vulnerable citizens, where were they a year ago, or five years ago, when those in the public health community began to raise the alarm about the rising tide of these deaths? And where are they now, in addressing the underlying social issues that drive despair and that won’t be fixed by reopening?

We would love nothing more than to see these politicians advocating for community cohesion; helping provide personal protective equipment for frontline health care workers; creating new tools to help reduce hunger; helping women have economic independence so they can leave abusive partners; and funding novel solutions to isolation and loneliness. But, ironically, those who are quickest to cite deaths of despair as a reason to reopen the country are too often the last to vote to fund research and services that could prevent them.

Whether these kinds of deaths increase or decrease is up to us. But reopening won’t solve what put us in this situation. As individual citizens, we can look out for our neighbors. We can learn the warning signs for mental health disorders and ask for help. But to truly create change, the government needs to fund the research to help us all do better — and fund the essential social supports and treatment that we know make a difference.

We have been through mass casualties before. And we have seen great ideas fall victim to inertia, thoughts, and prayers. To avert deaths of despair, evidence-driven actions speak louder than words.

Megan L. Ranney is an emergency physician, associate professor of emergency medicine and public health at Brown University, and co-founder of GetUsPPE.org. Jessica Gold is a psychiatrist and assistant professor of psychiatry at Washington University in St. Louis.

  • Nowadays it is a requirement that physicians list any possible conflict of interest when they lecture or write. It may or may not, consciously or unconsciously, influence the position stated. I certainly agree with the need for public health measures, even tough ones. However, I am concerned how cavalierly, and with no sympathy or mitigation tactics offered, some physicians want “reopening” America delayed as long as possible. Close inspection usually reveals such advisors have a secure, salaried, well-paying job in academia or government, and have not been furloughed or laid off without pay. They feel little pressure personally to reopen anything. Should not this situation be a footnote to every recommendation for extending closures and quarantines?

  • You’ve missed out on multiple other factors as well. This isn’t just eliminating jobs now, it’s eliminating futures. People who are dead certainly have no future, that is true. Yet, how much of a future is there for people who are now and increasingly being condemned to an increased lifetime of paying back massive loans, that may be increasingly for nothing, and working for smaller wages for larger companies that don’t care? How many people are losing their homes? How many people have lost their savings and any chance of ever not being a renter? How many people who might have wanted children will not be able to afford having them?

    In the same token, money comes from somewhere. Without a healthy tax base, the state and federal government stop functioning and stop providing unemployment. Without revenue, the hospitals shut down. The Atlantic had a fantastic article about this a few weeks ago. It ultimately comes down to this- if reliable medical solutions can be made available in a reasonable time frame, then continuing lock downs and restrictions make sense. If however, there may end up being no viable medical solution or one unavailable for years, then most of the restrictions are doing far more harm then good.

  • The critical issue is how virulent is the organism. The recent data suggests that it is no worse than a bad seasonal flu, and this includes the at risk population. The virulence of the organism for the general population is grossly overstated due to the following factors: all deaths with COVID-19 are considered deaths from COVID-19, and this includes vehicular deaths; hospitals are incentivized by reimbursements to classify as many deaths as COVID-19 related as possible; the Northeast death squad (Cuomo, Murphy, Wolfe) that put frail elderly patients at risk by insisting COVID-19 positive patients be put in nursing homes, and lack of sufficient information to know how the infection rate all conspired to grossly overstate the virulence of the organism.

    At alsmost every level, the official recommendations of Faucci, et al, were only applicable to blood-borne infections and defied every infectious disease/epidemiology protocol for containment of a respiratory virus.

    The persistent refusal of Faucci, et al to consider the zinc/ hydrochloroquine/azithromycin model early in the disease, before hospitalization level, based on a lack of controlled studies that indicated efficacy, but overwhelming anecdotal evidence that they worked, backed up by extensive biological mechanisms to support the evidence, is just not understandable. And worse, by purposely only quoting/promoting studies that showed the problems in patients with overwhelming disease on ventilators, despite the knowledge that the early disease is far different than end stage disease, and NO anti-virals work at the end-stage disease, is mind-boggling.

    Only exceeded by an article/opinion piece like this, published on a supposedly legit scientific site.

  • Hey Megan, this was supposed to be a science piece. Didn’t see a single reference to a study of any kind. Didn’t see any reproducible, predictive or falsifiable observation set or experiment.. or anything smacking of actual science.. this looked like a straight op-ed piece to me..

    • This article is part of STAT’s “First Opinion” platform, and as such is “a straight op-ed piece.” It was also labeled in STAT’s social media as “Opinion.”

      Pat Skerrett
      STAT

  • If “deaths of despair” is not a rational to reopen the country, how about city riots and burned out city centers from minorities with no jobs now going over the edge of despair with no savings and income?

  • Effective public health and policy is looking at all attributes and weighing the costs and benefits. It is hard not to see, how the methods imposed will neither mitigate the effect of infection (this virus may weaken but we all will be exposed and likely multiple times) but will lead to catastrophic impacts on the moral, social, and economic impact of this country. Mental health, despair, disempowerment, domestic abuse, suicide, theft, and murder to the young and healthy, not the 50% fatality rate to those confined to nursing homes, is a real and tragic thing. Research already suggests that opioid overdoses as a product of this mental anguish is already /surging/. As a society, as a community, we must weigh all the factors, both short-term and long-term, young and old, fortunate and impoverished.

  • Over 40 million Americans lost their livelihoods as a direct consequence of shutting down the economy. The authors, safely working from home without interruption in their incomes, denigrate the suffering of the marginalized. These self-appointed arbiters of what words we are allowed to use to describe that which we are seeing with our own eyes reveal an elitism that, sadly, has become a noxious and thriving disease in contemporary society. We forbid you from talking about despair, you whiners. Your children won’t be going to ivy league schools anyway, so who cares if they miss out on their educations. You’ll be going back to your counter-service, hair styling, and waitstaff jobs soon enough.

    • Your comment might apply to some people, but the author bio at the bottom of the article says one doctor is, Ranney, is an emergency room physician who is involved with GetUsPPE.org – PPE stands for Personal Protective Equipment – it sounds like she is paying her dues taking care of sick people under dangerous, perhaps very dangerous for her, not knowing her risk factors, conditions.

      I know there are wealthy people sitting at home getting self righteous but you should not assume everyone is in that camp because they are on the other side.

  • What does “too soon” mean? It appears to be an abandonment of the science that rationalized the shutdown. The curve has been flattened, and in many cities, the fatal curve never happened. There is no science behind continuing this madness, except political science.

  • I think the article did a pretty good job of refuting some of the claims made by the people who want to fully reopen the country, but it did not make a very strong case for the opposite view.
    In other words, some of the re-openers have misrepresented the facts and been insincere about how much they really care about despairing people, but that does not mean their basic claims are wrong.
    Leave aside suicide -and let’s remember, most people have not lost their homes yet – or become totally bankrupt – let’s wait and see how much despair people feel after their homes are foreclosed and they are thrown out on the street – but leaving suicide aside – the revised death rates, bad as they are still – seem to indicate we could reopen most of the country – and reopen for people under 55 or so, if they have no particularly dangerous pre-existing conditions – without big increases in death rates.
    I would be interested to know, is that pretty much what is happening anyway? Are young people, knowing their risk is very low, blowing off the restrictions in large numbers? It certainly appears that way. Are old people, aware of how vulnerable they are, doing a lot more to protect themselves, as they learn to do for the seasonal flu?
    Perhaps what we need to do is carefully formalize the best practices by age and implement them by law, with a strong view to minimizing economic loss.
    Obviously, that is an obvious goal – no one would disagree with it – but i do not see it being formalized and given as the reason for various policies – and it is not clear it is the working principle used by many public health people who are willing to implement extreme restrictions to keep their numbers low.
    Where I live, the public health people recently said no opening, because there was, per the media a “spike” in numbers – but it was a tiny “spike” and meant a few dozen more cases, in a very large metropolitan county, with about 1.5M people.
    At some point, if, realistically, our choice is to shut down most of the county, with all the economic disaster that entails, or open up and live with more illness and death – we are going to have to at least partly open up and live with the disease.
    None of this is meant to endorse pointless stupid actions, like not wearing masks, to make a political statement.

  • No comments on there is a difference between “suicide ATTEMPTS” and deaths? Seriously? And going to disparage the models showing increased suicide/deaths from job loss etc but yet we take every Covid19 model as absolute truth?
    Let’s talk again when the reality really hits the fan and unemployment/stimulus runs out in a few months. If every life matters as we are being told with NO MORE CV19 deaths, you’ve just shown rather blatant disregard for “these deaths would happen anyway” relating to suicide. This is why people are getting sick of the narrative- the blatant bias that unless you die from CV19 your life doesn’t matter.

    • There’s no question that the hardships associated with the lockdown are not being borne equally. I want to hear from someone who’s lost their business or career, who’s about to lose their home, go on record as supporting a continued lockdown. There are many for whom this has been an opportunity to bake bread or hone a hobby, who don’t worry overmuch about the essential workers who supply their electricity and their groceries; and who have no trouble advocating for a continued lockdown. Many in this group do not hesitate to label as selfish the so-called “inessential” who oppose continuing the lockdown because they stand to lose everything. If you’re among the latter group and advocate for a continuation of this until you’re “safe” (who’s ever safe?) please speak out. I will listen respectfully.

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