If our goal is to maximize collective lifespan -- which it should be -- then our models need to account for all lives, not just the ones we save today, but the ones our policies may cause to die tomorrow.

First, some cold facts and context.

The CDC estimates that more than 60,000 Americans died of the flu two years ago.  The vast majority -- 83% -- were seniors, but more than 1% -- 643 -- were kids.  It also estimates there were more than 800,000 flu-related hospitalizations.

Let's be honest: none of these numbers ever concerned you.  You likely didn't know them.  They received little news coverage at the time.  They certainly did not keep you up at night or make you think twice about sending your kids to school, let alone cause you to lose your job or be quarantined.

They were, basically, a non-event.  60,000 contiguous deaths.  Yawn.

Turning to today's pandemic, our latest figures state there have been 17,000 deaths, a fraction of the forgotten 60,000 flu deaths.  We also are approaching 500,000 confirmed corona cases (and rising fast). Experts tell us that 20% of these corona carriers will require hospitalization, meaning there have been about 100,000 corona hospitalizations, a small fraction of the 800,000 flu hospitalizations.  (Note: The real hospitalization rate for corona is likely much lower that 20% for two reasons: (1) many carriers are asymptomatic, and (2) testing has been relatively minimal).

Conclusion 1: To date, corona deaths and hospitalizations are a small fraction of our recent flu season, which triggered no attention, alarms, or changed behavior.

To be fair, there seems little doubt that corona morbidity is higher than the flu.  Experts don't know, but one scientific article cited by CNN from the medical journal Lancet suggests corona morbidity (0.66%) is about 4-5 times that of the flu (0.15%).   And when you add in that corona is 2-3 times more contagious -- meaning more of us would get it absent harsh measures -- there's little doubt that if unchecked, corona would overwhelm our health system, as New York and Italy show.

In short, our health system is not equipped to treat all those who would be infected absent our harsh lock down measures.  We -- and every other health care system -- lack the capacity for a pandemic.

But now comes a tough, seemingly callous question: might our harsh measures to save lives today actually cost more lives tomorrow?  At a minimum, shouldn't our models account for all lives?

Before proceeding, let me be clear about two things.  First, in posing this question I do not seek to compare life with money (i.e., the economy).  Instead, I attempt to only compare life to life.  Apples to apples.

Second, in pondering this, I would hope that we -- humanity -- would all agree on the goal: namely, to maximize, collective, quality lifespan.  That statement -- that goal -- should not be controversial.  It is, frankly, the framework for most "public health policy," what some call the greatest good for the greatest number.  It is the basis for how ethicists at places like Harvard instruct doctors on the morbid task of deciding whom to give the last ventilator.    It is the main statistic governments use -- average lifespan -- to measure health between countries.

Conclusion 2: Our goal should be to adopt policies that will maximize collective, quality lifespan.

To be clear, I do not know what policies will maximize our collective, quality lifespan.  But I do know that asking whether our one size fits all policies -- lock downs and shutting the economy -- are costing us lives is not just a fair question, it is a humane one.  Not asking it -- and not demanding that we all be forthright, rigorous, and disciplined in answering it -- is inhumane.

At a minimum the question needs to be asked to help determine when to ease restrictions and go back to work and school. Otherwise, in theory, we should stay locked down forever since whenever we open back it, it will be at the expense of a life that might have been saved had we stayed locked up longer.

In trying to answer the question and oversimplify, consider this: because of our harsh measures, we save an 84-year-old grandma today (either because she doesn't contract the virus or because there is a ventilator for her if she does).  Great.  We saved a life.

But what if in turn this means that a nameless, faceless 46-year-old somewhere has become unemployed.  And in two years she becomes a drug addict.  And two years later homeless.  And so on.  And because of all that, she's dead at 52.  Had she not become unemployed and unraveled, the "experts" and actuaries say she would have lived to 79 (27 more years).

Let's even give her a name: Jane.

Is that a good "trade" to make?  Were grandma's 4 more (yucky) year’s worth the loss of Jane's 27 years (and Jane's loss of six quality years before she died)?

Before you cringe and say that is crass or unfair, remember we are not comparing money to lives here.  We are comparing lives to lives. Apples to apples.  Grandma's life to Jane's.  Now multiply by thousands, millions, maybe tens of millions.

Let's be clear: Jane and grandma are constructs.  They are relevant for setting policy, especially at the margin.

And let's also be clear, it is a "trade," perhaps not a one-to-one trade, but a trade.  That word is purposeful.  You can't argue that we can have our cake and eat it too -- that we can save grandma today without other costs tomorrow, without other lives being lost.  The "costs" here include massive unemployment, massive deficits, and even nationalizing industries, which in turn may manifest in shortened lives for many.

Remember, almost all societal decisions cost lives (not just dollars).  When we raised the speed limit from 55 to 75, it came with a known cost: more lives would be lost.  Speed kills.  But we -- as a society -- made the trade because there were other benefits.  If saving lives was the sole goal for every decision, the speed limit might be just 30 on highways.

Likewise, we all sent our kids to school two years ago even though more than 600 kids died of the flu -- way more than will now die of corona.  Were we terrible, negligent, uncaring parents for doing so?  No, not at all.  Instead, we -- mostly unconsciously -- made a rational cost-benefit decision.

One important tangent here.  Most of these "decisions" are not made too consciously.  Most are made by what famed economist Adam Smith called the "invisible hand."  What's the invisible hand?  It's the collective decision-making tool we passively employ when we each make our own (selfish) decisions.

For instance, it is why the government doesn't have to dictate how many plumbers we have.  The "market" mostly "invisibly" figures it out.  Too few plumbers and they can charge $1000 to fix your toilet, but then many others will quickly become plumbers.  Too many plumbers and they'll only be able to charge $10 to fix your toilet while competing with each other, and soon many will find other trades.  So, the "market" invisibly gets it just about right.

What's the point of the tangent here?  Well, what makes this -- a pandemic -- so difficult is the invisible hand mostly disappears.  Instead we -- as a society -- have to quickly make very conscious decisions.  We can't rely on our passive, collectible invisible hand.  We have to own it.  

And I wonder, since nobody wants to be accused of killing grandma today, even if means effectively killing faceless Jane in six years, are we making the right decisions?  Grandma is on CNN tonight, while Jane will die quietly without cameras in six years.

Conclusion 3: It seems unclear whether our harsh policies today are maximizing collective, quality lifespan.

I wonder: given the life and death stakes, are these decisions better left to a computer?  I am serious.

Before you scoff, consider this: the most skilled surgeons in the world use computers and robotic arms to guide them.  They do so precisely because it's life and death.  They want to get it right and so do you, the patient.  We are not just good with them using computers -- and having our biopsy cells analyzed by a machine -- we demand it.  It is best practice.

So why not here with the stakes so high?  Why not feed into the computer the question I hope we all share: "Dear computer, what policies will maximize collective, quality lifespan?”

We already are using all sorts of models and computers to guide our policies -- i.e., flatten the curve -- so the question is not whether to use them, but rather do our models account for Jane?

The computer can better juggle all the dozens -- maybe hundreds -- of variables, some of which we can't even fathom.  The computer could factor in Jane.  And the computer could factor in many other more subtle factors.

 Here's one many can relate to: the lockdown is causing people to eat more and people can't go the gym.  So many arteries are becoming clogged that otherwise never would have.  Some will never return to their gyms even after they re-open.  That too will shorten many lives, albeit in a way more subtle and less dramatic then grandma not having a ventilator.

And then there's the increased suicides, domestic violence, and other collateral consequences -- like rioting, looting, and massive crime -- that may flow from our policies.

There are amazing epistemology calculators that show exactly how the "curve" changes based on differing assumptions.  You can literally drag a button, change a variable, and see exactly how it affects death.  Here's one, check it out.

But what bugs me is none of these amazing tools and models seem to factor in Jane.  If the goal is indeed to maximize collective, quality lifespan, then these calculators -- and Dr. Fauci & Co. -- need to factor in Jane and all other related factors that will reduce lifespan.

The irony is that accounting for Jane should be a liberal proposition.  After all, don't we care about all people -- those like Jane who fall between the cracks -- and all life?  Closing our eyes and covering our ears does not mean that Jane doesn't exist. 

It speaks to President Trump's question -- that caused immediate rebuke -- of whether the cure is worse than the disease?  It is a fair and humane question to ask.  Michael Burry -- the famous physician investor profiled in the movie The Big Short – says:

"...universal stay-at-home is the most devastating economic force in modern history [that] very suddenly reverses the gains of underprivileged groups, kills and creates drug addicts, beats and terrorizes women and children in violent now-jobless households, and more." 

 In asking -- and even referencing the economy -- you are not comparing life with money, you are actually comparing life to life, with the goal of maximizing it for all, a noble pursuit. 

Conclusion 4: Once we agree on the goal -- maximizing collective, quality lifespan -- we need to adjust our models and account for all factors, which a computer may do better than we humans.  At a minimum, just like using a surgeon's robotic arm, it should help guide us.  Doing so should not be controversial. Failing to do so should be controversial.

Post Script: I first shared this piece with some peers -- who provided some criticisms -- which I address here:

1. How do you know how many "Janes" are out there?  I don't, but that is not the point.  The point is they exist, and they should be included in our modeling if the goal is to maximize collective lifespan.  
2. Is it fair to compare Jane's life to grandma's?  Most public health models -- which seek to maximize collective lifespan -- compute one Jane (27 years) equals about seven grandma's (4 years).  And "no," I am not suggesting there is one Jane for every grandma saved.  I have no idea.
3. What makes you think that we can't save Jane too, that after this all settles down, we can't include her in the safety net, meaning there are no collateral casualties -- we can have our cake and eat it too?  That would be great but is unlikely.  All social policy comes with "costs," or trade-offs.  Economics -- the science of scarcity -- is based on this.
4. Isn't it hard to include Jane in these models?  Perhaps, it's one thing to say it’s too hard, but another to say they don't exist or aren't relevant.  All models are, by definition, imperfect, but we still try to account for all factors, and we should try here.
5. Do you really think we shouldn't lock down or engage in social distancing?  I have no idea.  Candidly, the policies seem to make sense to me, but it is not -- or should not be -- an all or nothing analysis: either we lockdown fully or we engage fully.  My instinct is the elderly and compromised should be segregated as much as possible until there is a vaccine or better therapies while the rest should live their lives with changed behaviors (washing hands, social distancing, masks).  At a minimum, even if our policies are right on the target, Jane should be factored in to help determine when it is the optimal time to loosen them.  Again, too many variables for a human to juggle, so bring on the computer.   
6. Are you against closing schools?  I answer with a question: if closing schools for months is appropriate, when will it ever be safe to reopen them?  After all, way more kids die from the "regular" flu each year than Covid will kill.

Born and first raised in Gary, Indiana followed by Chicago's south suburbs, William Choslovsky is a Harvard Law School graduate and lawyer in Chicago. His wife is not named Jane.