Nashville for Rational COVID Policy: The Costs of Mitigation.

Nashville for Rational COVID Policy acknowledges the need to navigate the COVID-19 pandemic safely, and to minimize the risk of infection for those at highest risk: The elderly, and those with significant pre-existing conditions. Simultaneously, however, it is important for policymakers to acknowledge and account for the costs of mitigation efforts, so as to balance these costs against the perceived benefits. 

Messaging from Mayor Cooper and the Metro Public Health Department, however, has been fairly one-sided, focusing only on how measures limit the spread of the virus in terms of transmission rate, new cases, and hospital capacity, without acknowledging the very real pain that they inflict on Nashvillians - both now and into the future. 

Among these costs are:  

• 99 additional overdose deaths in Q1-Q2 2020 as compared to the same 6-month period in 2019. This report, prepared by the Metro Public Health Department's Overdose Reduction Program, details a notable increase in overdose deaths in our city starting in April 2020. More than 50% of overdose deaths were of individuals between the ages of 25-44 - an age range in which there have been only 3 COVID-19 deaths to date. It also shows that Q2 2020 was the deadliest quarter on record in terms of overdoses in the city, and that ER visits for suspected overdoses were more than 50% higher than in any other quarter. 
• More than 130,000 residents of Middle Tennessee became newly unemployed between March and April of 2020, according to the Bureau of Labor Statistics. As of June 2020, more than 100,000 area residents remained unemployed. This is important because, in addition to the financial implications for families and individuals, there are also significant public health concerns associated with prolonged unemployment. Unemployment has been linked to increased rates of depression, suicide, and deteriorating mental health in a number of studies. Further, extended unemployment has been associated with increased mortality over a longer time horizon, suggesting a relationship between unemployment and overall health and well-being. 
• Many area businesses have been forced to permanently close due to extended restrictions. Across Tennessee, more than 1,100 businesses have permanently closed since March, including at least 410 in Middle Tennessee. These business closures alter the fabric of our communities, make re-employment of the aforementioned unemployed workers more challenging, and may facilitate pronounced wealth transfers from small business owners and lower/middle-income households to higher earners. Second-order economic effects may include further disadvantaging young workers and minorities, as this study shows. 
• More than 86,000 children in Metro Nashville Public Schools are beginning the fall semester in remote-only learning. This poses challenges for children in single-parent homes, or homes where parents work full-time in vocations which cannot be performed remotely. For older children, social isolation is already translating into increased depression rates, as shown by two independent surveys of college students. Younger students may have difficulty learning autonomously in remote settings, and may suffer effects that go beyond their academic achievement. Last but not least, studies have demonstrated that social isolation in childhood may lead to poorer adult health in the long term. 

We believe that these measures should not be in place a moment longer than absolutely necessary to maintain adequate health care resources for residents and frontline workers, in view of these costs. At the very least, Nashville deserves an open dialogue, accountability, and clearly-defined measures which remain fixed and which contemplate and balance these considerable costs to our community.

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