THE EXPERT WITNESS: Health Economics and the Pandemic

By Dr. John F. Sase, Ph.D.
with guest author Allen C. Goodman
Grard J. Senick, general editor
Julie G. Sase, copyeditor
William A. Gross, researcher

“As a species, I think we have no choice but to try and forecast pandemics.”
—Nathan Daniel Wolfe, Ph.D., American virologist

          
During the present Pandemic, concern for human life as well as the economy seem to conflict within the political arena. Those who promote business shutdown to save lives and those who strive to reopen businesses to save the economy appear at odds with one another.

In our column this month, we have invited a guest who writes an ongoing blog that focuses on issues of our current Pandemic since March of 2020. I (Dr. Sase) have enlisted the aid of my Doctoral Dissertation Advisor, Economic Writing mentor, and long-time friend, Allen C. Goodman, Ph.D. During the recent decades, he has been developing the field of Health Economics at Wayne State University. Professor Goodman has served as Department Chair of Economics at WSU and developed its Health Economics doctoral program. Allen Goodman started his current blog of 80+ entries on 16 March 2020. Unlike many professional blogs that read like a sales pitch for services, Dr. Goodman’s writing reads like one of personal sharing from the head and the heart as an exercise of his human character. (http://allengoodman.wayne.edu/Blog/C-19-Blog.pdf). In writing this diary of recent events, Dr. Goodman has delineated many major developments that may help us respond to issues that affect our own families and business concerns.

Also of relevance, Professors Allen Goodman, Sherman Folland, and Miron Stano, have published the 8th edition of their textbook, “The Economics of Healthcare” (ISBN-13: 978-1138208049).




A Brief History of Pandemics


Ever since humans began to live in confined spaces such as villages, fortified enclosures, and larger, more sophisticated urban areas, we have needed to surmount infectious diseases on a larger scale than during the more dissimulated ages of hunting and gathering. Throughout most recorded history, urban dwellers have lived under crowded and less-sanitary conditions than rural residents.

In respect to the Athenian Plague, Thucydides writes in great detail of the Plague of Athens that extended from 430 to 426 BCE in his history of the Peloponnesian War. During that war, Typhoid Fever killed 25% of the Athenian troops along with 25% of the Athenian population. Early in the next millennium, the Antonine Plague brought worse consequences to human life.  This plague began when Roman soldiers returning from the Near East brought smallpox to the Italian Peninsula, leading to this Plague of 165 to 180 CE. This infection killed up to five million persons. Next, the Bubonic Plague from 541 to 750 CE eliminated 25% to 50% of the human population in the then-known world. As a result, the number of people in Europe dropped by approximately 50%. Closer to present time, the Black Death killed an estimated 75 million to 200 million people between 1331 and 1353 CE, including one-third of the total European population and spawned the first of the cycle of European Plague Epidemics that continued until the 18th Century. All of these events produced dire consequences for the economies which struggled to survive those times of mass infection and death.

Lessons Learned from the 20th Century

In modern times, unintended natural agents have caused pandemics including unintentional and accidental human events. In modern times, we have witnessed numerous Epidemics, including those of Smallpox, Cholera, Typhus, Leprosy, and Tuberculosis. More recent  Pandemics include the 1918 Influenza; the continuing HIV/AIDS infection; the 2002-04 SARS (CoV-1); the 2009 (H1N1) Flu; and the 2019 (CoV-2, aka COVID-19).

The Soldier Tale

The worldwide Influenza Pandemic of 1918 provides our largest data set and historical detail that we continue to use for understanding our current tragedy. In addition to robbing many countries of their economic wealth and vigor, this Pandemic brought death to 675,000 Americans in the United States. This number remains higher than that of the number of U.S. troops killed in combat during World War I, World War II, and the Korean, Vietnam, Iraq, and Afghan conflicts combined. The deadly 1918 Flu virus acted quickly and often meant death within twelve hours after infection. Most of its victims came from the young and healthy twenty- to forty-year-old age group. Victor Vaughn, the Surgeon General of the U.S. Army, noted in 1918 that this pathogen pushed civilized society to the brink of collapse. He stated, “If the epidemic continues at its mathematical rate, civilization could easily disappear from the face of the earth within a few weeks.” Without civilization, we cannot maintain the economies of our world. In turn, economic collapse would destroy the support for vast human life on this planet.

In his book “The Great Influenza: The Story of the Deadliest Pandemic in History” (Penguin Books, 2005), John M. Barry cites that in 1918, hundreds of thousands of workers and their families migrated to Philadelphia from rural and small-town America for employment in support of the War Effort. Families crowded into squalid, filthy slums due to a shortage of adequate housing and sanitation—a perfect breeding ground for an epidemic. Due to the need for vast amounts of basic medical help during this Pandemic, medical schools closed. First-year students left to volunteer at the hospitals. Unfortunately, 25% of the in-patients died every day because the city had ignored public-health guidelines.

Overall, four waves occurred from February 1918 through April 1920. Due to the length, severity, and data collected and analyzed, the Great Influenza continues to serve scientists as they develop new models and methods that help us forecast the trends of the COVID-19 infection. Though we remain embroiled in the midst of it, the push of medical science has produced hope for seeing the light at the end of the tunnel.

(Continued) ....