How to decide whether to close schools in the next pandemic

But the discussion of Dr. Collins’s remarks is not just an opportunity for potshots; after-action criticism of federal and state governments’ response to the public health emergency is legitimate and necessary, and it is to Dr. Collins’s credit that he is engaging in the conversation. School closures and business lockdowns imposed massive costs with which the nation is still reckoning. Next time, society needs to be better prepared to make tough public health decisions that realistically factor in these costs.

As Dr. Collins put it, federal public health officials attached “infinite value to stopping the disease and saving a life” but “zero value to whether this actually totally disrupts peoples lives, ruins the economy and has many kids kept out of school.” That, he acknowledged, was “real unfortunate.”

It might surprise some, but the government routinely does cost-benefit calculations involving people’s lives. The Environmental Protection Agency, for instance, plugs in a value of about $11.25 million per life saved to determine whether, say, cleaning up a toxic waste site is worth the money. By law, every new regulation must be run through a cost-benefit filter.

Economists from Northwestern University and Germany’s Goethe University attempted this kind of analysis during the first few months of the pandemic: valuing lives saved at about $9 million, they concluded that the optimal social distancing policy would save about half a million lives at a cost of slashing consumption in the first year by 22 percent, compared with 7 percent without restrictions. Still, in this optimum scenario, 1.2 million people would die.

It’s not easy for a doctor who has embraced the Hippocratic oath to accept this kind of thinking. The political system has a hard time grappling with it, too. Despite the massive cost overruns in American health care, Medicare is forbidden from using cost-effectiveness to determine which treatments to cover. The idea that the government might get involved in life-and-death decisions elicits references to “death panels.”

It is, of course, easy to criticize policy after the dust has settled and covid has been contained. During the pandemic’s early phases, governments at all levels had to make decisions amid great uncertainty about how the virus was transmitted, which populations were vulnerable and how lethal it was. Since then, however, evidence piled up to prove the enormous costs school closures imposed on children — in terms of both their mental health and their education, deficits that will cost American society dearly.

When the next pandemic strikes, it is unlikely that whoever is running the teachers unions will accept that teachers should return to class because their risk of death is low while the cost to children is high. And, yet, for all the political complications, refusing to account for the damage to children’s future should be unacceptable, especially now that society has a much better understanding of the costs.

Cost-benefit analysis in this area could open new paths to negotiate between priorities in tension, by making clear what is at stake. Stanford University’s Eric Hanushek, for instance, estimated that states’ gross domestic product will be 0.6 to 2.9 percent lower “each year for the remainder of the twenty-first century” because of the educational decline since the start of the pandemic.

That adds up to a ton of foregone tax revenue for state treasuries — to name just one form the losses can take. A rational response in state capitals might be to “borrow” against the higher tax receipts they would reap in the future if school closures were prevented, and use the money to compensate teachers, cut a deal to keep schools open and pay for upgrades to suppress the spread of disease. Understanding what society stands to lose from the lockdowns could help decide what society should be willing to pay to prevent them.

This kind of thinking is unlikely to tame the politics that took the debate over covid into strange conversations about injecting disinfectant and how vaccines were a means to insert microchips into people. Moreover, some restrictive public health measures might again be necessary in response to a new bug. The point is that, in considering such measures, policymakers should account for the entire spectrum of social harms in a transparent conversation about all the trade-offs.