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Id Subject Object Predicate Lexical cue
T1 0-42 Sentence denotes Notes on cost benefit of COVID‐19 lockdown
T2 44-111 Sentence denotes The American population is without question suffering from fatigue.
T3 112-263 Sentence denotes The stress of this ongoing pandemic has resulted in many Americans making the decision to return to normalcy as restrictions are easing in most states.
T4 264-397 Sentence denotes In Kentucky as of early June, less than half of grocery and retail store patrons are complying with wearing face coverings in public.
T5 398-474 Sentence denotes Retail outlets requiring face coverings are enduring some public resistance.
T6 475-628 Sentence denotes Meanwhile, restaurants are allowed to reopen for in person dining and serve up to one‐third capacity and many houses of worship have been open for weeks.
T7 629-725 Sentence denotes Furthermore, private gatherings for graduations, weddings, and holidays have become more common.
T8 726-854 Sentence denotes Summer vacations and other settings with more lax restrictions have important implications for community‐level infection curves.
T9 855-999 Sentence denotes Some Americans have also chosen to engage in rallies and social activism, which involves large crowd gatherings and travel between major cities.
T10 1000-1370 Sentence denotes These expressions of fatigue coupled with re‐opening of economies are concerning as COVID‐19 case counts and hospitalizations have fallen mainly in heavily impacted settings like New York. https://abc7ny.com/health/coronavirus‐updates‐ny‐covid‐hospitalizations‐deaths‐continue‐drop/6248076/. https://www.washingtonpost.com/nation/2020/06/09/coronavirus‐live‐updates‐us/.
T11 1371-1452 Sentence denotes COVID‐19 is a novel virus that did not exist as a human pathogen until late 2019.
T12 1453-1576 Sentence denotes With information continuing to accumulate, early clinical and management strategies do not reflect many current guidelines.
T13 1577-1786 Sentence denotes Also, there is continued disagreement among experts regarding the future trajectory of the virus, with some predicting consistent infection and mortality numbers as others are sharing more hopeful predictions.
T14 1787-1962 Sentence denotes The first reports of possible mutations and decreases in potency came from Dr. Alberto Zangrillo, the head of intensive care at the San Raffaele hospital in Milan in Lombardy.
T15 1963-2237 Sentence denotes Zangrillo alerted Italian media of a study by his colleague that showed the virus was weakening and that, “in reality, from the clinical point of view, the virus no longer exists.” https://www.cnbc.com/2020/06/02/claim‐coronavirus‐no‐longer‐exists‐provokes‐controversy.html.
T16 2238-2536 Sentence denotes These findings were echoed by researchers from the highly respected University of Pittsburgh Medical Center also showing that COVID‐19 at UPMC is declining in virulence and infection levels. https://triblive.com/local/regional/upmc‐doctors‐say‐covid‐19‐declining‐in‐virulence‐and‐infection‐levels/.
T17 2537-2854 Sentence denotes However, World Health Organization experts and a range of other scientists have yet to find evidence to support any assertion that the coronavirus causing the COVID‐19 pandemic is losing potency. https://www.healthnewsreview.org/2020/06/reuters‐report‐is‐another‐classic‐case‐study‐in‐how‐not‐to‐cover‐covid‐19‐news/.
T18 2855-2950 Sentence denotes As the scientific evidence changes, public health policy and recommendations have also changed.
T19 2951-3095 Sentence denotes The use of face coverings and masks is an excellent example as early advice from the WHO and the CDC does not represent current recommendations.
T20 3096-3223 Sentence denotes The WHO initially maintained that only healthcare workers and the elderly at risk for infection should consider wearing a mask.
T21 3224-3447 Sentence denotes However, updated recommendations include those who have difficulty maintaining social distance should wear a three‐layer cloth mask. https://www.webmd.com/lung/news/20200608/who‐changes‐stance‐says‐public‐should‐wear‐masks.
T22 3448-3982 Sentence denotes Also, the CDC currently recommends the use of face coverings in public and continued social distancing, https://www.cdc.gov/coronavirus/2019‐ncov/downloads/cloth‐face‐coverings‐information.pdf, but these guidelines were updated from early advice discouraging the use of face coverings by the general population due to a shortage of personal protective equipment (PPE) for healthcare workers. https://www.nytimes.com/2020/03/31/health/cdc‐masks‐coronavirus.html These positions are in contrast to the prevailing advice in many nations.
T23 3983-4172 Sentence denotes Japan, Korea, and China have reported very low Coronavirus infection and death rates despite limited and short‐term business and school closures, and even the lack thereof in some settings.
T24 4173-4392 Sentence denotes Evidence suggests that low transmission and mortality rates can be attributed to cultural differences that support compliance of mask adoption. https://www.nytimes.com/2020/06/06/world/asia/japan‐coronavirus‐masks.html.
T25 4393-4552 Sentence denotes Social distancing policy and lockdowns enforced by the closure of nonessential businesses and mass gatherings remains a controversial policy throughout the US.
T26 4553-4795 Sentence denotes With equivocal federal leadership, a wide variation in state policy, and a significant economic cost in all settings, much of the fatigue in the US is secondary to both short‐term economic measures and concerns of long‐term economic solvency.
T27 4796-4950 Sentence denotes As of the second week in June, there is still no consensus of the actual cost of this policy in the US, as the number of net lives saved is also disputed.
T28 4951-5167 Sentence denotes Ultimately, these are questions of great importance because of the enormous financial implications, including food and drug supply chains not to mention the financial hardships for many families and small businesses.
T29 5168-5363 Sentence denotes In addition to current and future economic costs, there is no question that other important consequences resulted in routine medical and physical health as well as mental and social health costs.
T30 5364-5466 Sentence denotes For cancer care specifically, important preventative screenings and elective surgeries were postponed.
T31 5467-5585 Sentence denotes This may have prevented early detection and treatment in some cases and led to poor outcomes for many cancer patients.
T32 5586-5814 Sentence denotes With other nonemergent care postponed, there is no question that common chronic illnesses were not diagnosed and treated timely and patients continue to delay care for many illnesses as healthcare systems resume most operations.
T33 5815-6305 Sentence denotes As many Americans experienced fatigue from the pandemic as well as wrestled with financial concerns, social issues such as alcohol and substance abuse, domestic violence, and mental health risks including depression and suicide became exposed. https://www.realclearhealth.com/articles/2020/06/04/more_flexibility_still_needed_in_health_care_for_covid‐19_response_111052.html. https://thehill.com/opinion/healthcare/499394‐the‐covid‐19‐shutdown‐will‐cost‐americans‐millions‐of‐years‐of‐life.
T34 6306-6599 Sentence denotes It is important to note that some of these impacts can be offset by a drastic decrease in gun violence, car accidents, and other crime that added unanticipated capacity to the healthcare system in some settings. https://abc7ny.com/nypd‐crime‐statistics‐new‐york‐city‐coronavirus‐nyc/6071137/ .
T35 6600-6877 Sentence denotes The failure of the federal government to act swiftly, which includes but is not limited to preparing the healthcare system for surges by expanding capacity and personnel, ensuring the availability of PPE, and dispatching test kits to all settings, left the US with few choices.
T36 6878-7050 Sentence denotes Early identification and contact tracing were not an option and preserving healthcare resources including PPE was critical to prevent the healthcare system from collapsing.
T37 7051-7164 Sentence denotes Given the available data and projections, this costly intervention was one of the few choices left in March 2020.
T38 7165-7253 Sentence denotes The cost estimates of the lockdown are widely variable and based on varying assumptions.
T39 7254-7534 Sentence denotes The Heritage Foundation reported that an 8‐week shutdown could raise the unemployment rate to as much as 23 percent and decrease immediate economic output by as much as $2 trillion. https://www.heritage.org/economic‐and‐property‐rights/report/the‐cost‐coronavirus‐shutdown‐orders.
T40 7535-7779 Sentence denotes A report by the Congressional Budget Office projects that the U.S. gross domestic product will lose nearly $16 trillion over the next decade because of the pandemic. https://www.washingtonpost.com/nation/2020/06/01/coronavirus‐live‐updates‐us/.
T41 7780-7868 Sentence denotes Terence Corcoran notes that the lockdown costs are certainly real at around $9 trillion.
T42 7869-7963 Sentence denotes This includes the $2.5 trillion CARES Act passed by Congress and signed by President Donald J.
T43 7964-8094 Sentence denotes Trump. https://business.financialpost.com/opinion/terence‐corcoran‐the‐price‐of‐life‐lockdown‐costs‐are‐real‐but‐are‐the‐benefits.
T44 8095-8317 Sentence denotes The mathematical‐level evaluation of this policy involves the calculation of cost aggregated to the estimates of lives saved as a result of the intervention while also considering the human cost of unintended consequences.
T45 8318-8443 Sentence denotes This evaluation is standard in measuring the effectiveness of policy and in evaluating the need to continue ongoing programs.
T46 8444-8632 Sentence denotes To determine the value of a life while also considering the economic costs of the lockdown from lost jobs and business closures requires the calculation of the value of a statistical life.
T47 8633-8964 Sentence denotes The United States uses a value of $10 million. https://theconversation.com/the‐costs‐of‐the‐shutdown‐are‐overestimated‐theyre‐outweighed‐by‐its‐1‐trillion‐benefit‐138303. https://www.resourcesmag.org/resources‐radio/value‐statistical‐life‐and‐coronavirus‐alan‐krupnick/. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3379967.
T48 8965-9083 Sentence denotes In medicine, we use an analogous concept to specify the desired cost/benefit of a therapeutic or medical intervention.
T49 9084-9393 Sentence denotes The benefit is measured in quality‐adjusted life‐years (QALY), and the valuation is usually $50 000 per QALY. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497852/. https://www.tandfonline.com/doi/full/10.1586/14737167.8.2.165?src=recsys. https://www.science.gov/topicpages/q/quality‐adjusted+life‐years+qaly.
T50 9394-9513 Sentence denotes The QALY measure is a volatile number that depends on the nature of the intervention as well as the age of the patient.
T51 9514-9568 Sentence denotes The older the patient, the fewer remaining life‐years.
T52 9569-9721 Sentence denotes For example, if the majority of patients are over 65, then perhaps a reasonable valuation would equate to 20 quality‐adjusted life‐years, or $1 million.
T53 9722-9897 Sentence denotes The order of magnitude difference between that and a statistical life reflects that the statistical life encompasses the entire economically productive life of the individual.
T54 9898-10073 Sentence denotes For medical interventions most of the productive life for such individuals is in the past; note that 42% of COVID‐19 deaths are in nursing homes or assisted living facilities.
T55 10074-10290 Sentence denotes This cohort represents just 0.6% of the US population. https://www.forbes.com/sites/theapothecary/2020/05/26/nursing‐homes‐assisted‐living‐facilities‐0‐6‐of‐the‐u‐s‐population‐43‐of‐u‐s‐covid‐19‐deaths/#7548521c74cd.
T56 10291-10545 Sentence denotes This means that the statistical life estimate of $10 million might be an overestimate of the actual valuation of the lives lost, as these lives are mostly typical of the age range of the Medicare population and beyond their economically productive years.
T57 10546-10645 Sentence denotes The true economic valuation could be closer to $1 million per statistical life than to $10 million.
T58 10646-10816 Sentence denotes The final question to consider is how many more deaths would have resulted if the US had opted for a more limited lockdown that was much less hazardous to the US economy.
T59 10817-11067 Sentence denotes It is clear that anticontagion policies significantly slow the growth of COVID‐19, but what policies and how much slowing are optimal? https://www.nature.com/articles/s41586‐020‐2405‐7. https://www.nature.com/articles/s41586‐020‐2404‐8_reference.pdf.
T60 11068-11195 Sentence denotes The best example of what might have happened is found in Sweden, and that country is an imperfect surrogate for the US economy.
T61 11196-11290 Sentence denotes Sweden now has one of the highest COVID death rates in the world—almost 44 per 100,000 people.
T62 11291-11345 Sentence denotes The number of U.S. deaths per 100,000 is just over 32.
T63 11346-11497 Sentence denotes In Denmark, this number is 10, and in Norway, less than 5. https://www.bostonherald.com/2020/06/08/sweden‐backtracks‐on‐its‐low‐pain‐coronavirus‐plan/.
T64 11498-11590 Sentence denotes Sweden’s plan is now considered to be less than optimal, but what if the US had followed it?
T65 11591-11661 Sentence denotes How many additional net deaths would we have suffered due to COVID‐19?
T66 11662-11792 Sentence denotes How many fewer deaths would we have suffered from postponing health interventions, suicide, and domestic violence, and alcoholism?
T67 11793-11870 Sentence denotes Let us assume 100,000 additional deaths for the sake of a simple calculation.
T68 11871-11983 Sentence denotes To save these 100,000 individuals, the cost to the economy was $9 trillion, or $90 million per statistical life.
T69 11984-12146 Sentence denotes And keep in mind a large component of these individuals could have an economic life valuation much less than the $10 million standard value of a statistical life.
T70 12147-12340 Sentence denotes This calculation is obviously much simpler than the very sophisticated modeling used by the many government and academic institutions that struggle mightily to develop coherent and fair policy.
T71 12341-12423 Sentence denotes Additionally, these numbers are offered in hindsight and are only rough estimates.
T72 12424-12551 Sentence denotes Still, the result, that the US suffers an economic cost of $90 million per life saved, is quite sobering and merits reflection.
T73 12552-12720 Sentence denotes It is important to note that policy makers enacted social distancing and lockdowns not only to save lives but also to save America’s fragile healthcare delivery system.
T74 12721-12966 Sentence denotes The pause in many operations gave hospital systems time to prepare, create, often from thin air, testing systems, and enact critical policy that dictates how COVID‐19 patients are managed while also ensuring patient and healthcare worker safety.
T75 12967-13148 Sentence denotes Lockdowns also allowed time to research treatment protocols, with some hopeful treatments proving ineffective and even dangerous while ramping up the supply for emerging treatments.
T76 13149-13327 Sentence denotes Although this lockdown may have helped to save the healthcare system, it is clear that a second lockdown of the economy at a high cost to save a few lives is not a viable option.
T77 13328-13459 Sentence denotes As this pandemic remains ongoing despite fatigue from many Americans, future policy must be both evidence based and cost effective.
T78 13460-13593 Sentence denotes Policy makers and health experts must be clear in messaging, consistency, and model the behavior publicly that we should all emulate.
T79 13594-13778 Sentence denotes While some limited iteration of social distancing remains important, the single most critical intervention that all Americans should be encouraged to adopt is wearing a mask in public.
T80 13779-14106 Sentence denotes This is a low cost and remarkably effective intervention that widespread scientific evidence continues to support. https://www.forbes.com/sites/alicegwalton/2020/06/13/face‐masks‐may‐be‐the‐key‐determinant‐of‐the‐covid‐19‐curve‐study‐suggests/?fbclid=IwAR2ZxIa4wJjSfEEfnnXVNToS‐CQOrW7x3Crb1V6WFFlQs6LHCMAjck8px‐c#72c1d9a56497 .
T81 14107-14239 Sentence denotes There is some evidence that we may be able to be normal much sooner if we were all willing to do this very limited and simple thing.
T82 14240-14468 Sentence denotes In fact, one study suggests that if more than 80% of the population are willing to participate, the results could be comparable to herd immunity achievable from population‐level vaccination. https://arxiv.org/pdf/2004.13553.pdf.
T83 14469-14597 Sentence denotes If that is correct, a cotton face mask costing a few dollars could theoretically save millions of lives and billions of dollars.
T84 14599-14614 Sentence denotes ACKNOWLEDGMENTS
T85 14615-14725 Sentence denotes We thank Deputy Editors‐in‐Chief Timothy Solberg and Per Halvorsen for their valuable and perceptive comments.
T86 14726-14786 Sentence denotes We thank Bob Esterhay, MD, for his enlightened observations.