COVID-19, Children, and Cost-Benefit Analysis
“Excuse me sir, could you please pull your mask above your nose?”
The young man ignored me and walked right into Trader Joe’s. After asking a second time that he pull his mask above his nose, the man walked back outside and pushed his face up against mine. “I fucking heard you the first time you fucking piece of shit.” My heart rate increased. For a moment, I expected a punch to fly my way.
This is April 2021. We had been enforcing a strict mask policy for over a year. Rain or shine, two crew members would stand outside every hour; one would clean carts while the other would speak to customers about our mask requirements. Playing “mask-police” could prove challenging at times, but it was the right thing to do. Despite what many claimed, COVID-19 was more deadly than the seasonal flu; we know this because the CDC has tracked the data. The 2017-2018 flu season, in which 61,000 Americans died, was the most lethal in recent memory. In the 2018-2019 flu season, meanwhile, an estimated 28,000 people died. I mention these fatality numbers, which pale in comparison to the COVID death toll, as a jumping off point to the topic of this essay. The COVID skeptics were wrong in 2020.
But now, in 2022, when thinking of younger Americans in particular, the unintended consequences of pandemic restrictions pose a greater risk than the illness. Consider recent comments from President Obama’s CDC director. According to Tom Frieden, who served under Obama for eight years, “Eighteen months ago it was irresponsible and wrong to say: COVID-19 is similar to the flu. Now that's basically correct.” CDC data show that, for children, annual pediatric mortality from COVID-19 is similar to that of the flu.
Good health can’t simply be the absence of COVID-19. We must focus on the mental, social, financial, and emotional health of Americans. Indeed, as University of Virginia student Matan Siskind observes in a senior thesis paper, all along we should have been paying more attention to the unintended consequences of pandemic restrictions, which included “spikes in mental illness, suicide, substance abuse, and domestic violence; economic devastation and subsequent widespread poverty; disruptions in routine nonemergency medical care; and irreversible setbacks in education progress (particularly early childhood education).”
Surgeon General Vivek Murthy recently warned of a mental health emergency developing among the young. Children are experiencing rises in levels of anxiety, depression, and eating disorders, and suspected suicide attempts. An analysis of 29 studies found that depressive and anxiety symptoms doubled during the pandemic. A study of eating disorder hospitalizations found a 120 percent increase among adolescents. According to CDC data, emergency department visits for suspected suicide attempts in adolescent girls increased 51 percent. It’s likely that these numbers are only the tip of the iceberg. Dr. Joseph Allen, an associate professor at Harvard’s T.H. Chan School of Public Health, writes in the New York Times, “The harms to kids from mask mandates, school closures, and social distancing are accumulating and they could last for decades.” According to Allen, to think that two years of masking has had no negative impact on America’s youth is shortsighted. Or, as Dr. Leana Wen, a physician, professor of health policy, and Washington Post columnist, points out, “Many pediatric and public health experts are concerned that making young children wear masks might impair psychosocial, cognitive and language development.” (Dr. Wen, it should be noted, strongly supported mask mandates in 2020 and 2021.)
Before going on, I want to emphasize that I believe in the efficacy of masks. We have come to learn that masks, especially N-95s and KN-95s, make a big difference in reducing transmission of this deadly illness. But when we develop public policies and health regulations for other aspects of our lives, we begin with the premise that there is a boundary between acceptable and unacceptable costs to save lives.
Traffic policy is the classic example. As economist Ryan Bourne writes, “We could nearly eliminate road deaths by capping motor vehicle speeds at five miles per hour. But the lost time and business activity resulting from that regulation would be tremendous, making people poorer and leading to hardship and worse health conditions.” According to Vox, a left-of center news service, the annual average number of children under age eighteen who died in vehicle crashes from January through September in recent years was nearly six times higher than the number of those under eighteen who died of COVID-19 between January 2021 and September 2021. In fact, the leading cause of death for children in the United States is motor vehicle accidents. But we still allow highways to exist.
Our cost-benefit analysis of speed limits is just one example of many. As David Leonhardt summarizes in the New York Times, “The biggest risk to your child’s health today almost certainly is more likely to be an activity that you have long decided is acceptable— like swimming or riding a bicycle.” Leonhardt also looked at the number of youth sports injuries. He argues that there is a greater risk of serious injury for kids playing sports than there is for kids getting sick from COVID-19.
To sum up, I’m glad that the CDC recently changed guidelines for those in kindergarten and above. Upon hearing of the change, my sister and brother-in-law, who both teach elementary school in New York City (and who also have two young children), were delighted. After two years of online-education and socially-distanced classrooms, they could finally teach….really teach!!
In large measure, this Substack post is out of date. Masking requirements and pandemic restrictions have mostly disappeared as of March 27. Still, this discussion is relevant because there will be times in the future when policy makers will need to confront new public health challenges. When they do, I hope they incorporate cost-benefit analysis into their decision-making process.