Commentary

The Acceptable Loss – The Trolley Dilemma of Managing COVID-19 Pandemic

by Isaac Ashkenazi & Carmit Rapaport

The COVID-19 pandemic takes its toll in terms of human lives and global economic consequences. Social distancing has proven to be the most promising strategy against emerging viruses without borders, but the heavy economic damage that follows puts in question the possibility of its continuation. In fact, weighing the two elements raises an important debate: What is the acceptable loss in order to win this battle?

Isaac Ashkenazi headshotStrategically, the burden of considering acceptable loss is on the decision makers. This means the price the nation is willing to pay for achieving a balance between the length of the quarantine, economic losses, level of public compliance, and healthcare capacity. Evaluating the acceptable loss is a professional, financial, ethical, legal, social, cultural, and historical dilemma. Despite this, it is an inevitability in order to choose the appropriate crisis management strategy and, more importantly, the condition to end it.

In the military perspective, the acceptable loss refers to the assessment of the fatalities and damages that might be caused by a specific action or operation. Industries use acceptable risk to define the degree of risk to human lives and environmental damage that is acceptable after mitigating the maximum risks.

When managing a pandemic, many questions must be asked to determine acceptable losses and risks:

  • Loss of what: loss of lives, economic aspects, or loss of control?
  • Acceptable by whom: the public, decision makers, politicians?
  • Contrary to the acceptable loss, what is the benefit?
  • How much loss is acceptable in order to achieve (an adequate degree of) benefit?
  • How many fatalities of various groups (e.g., young, healthy, unemployed, elderly) of COVID-19 are considered 'acceptable'?
  • What is the alternative economic cost of 100, 150, etc. coronavirus deaths? Are these costs acceptable?
  • Since this pandemic puts the elderly at higher risk, is the cost of an 85-year-old lower than a child’s life?
  • How can the economic cost of the lives be measured for those who developed mental health conditions, lost their jobs, or committed suicide?

Saving lives also depends the meaning of the number of COVID-19 deaths against the meaning of the economic losses damage to the healthcare system. It is not just about examining the numbers – deaths and dollars.

Similar to the triage performed by medical personnel in mass causality events, the acceptable loss should be put forward to a public debate. Discussing the price of life is complicated but inevitable. As in the case of medical triage, it is based on two basic principles: beneficence and distributive justice. And, as in the case of triage, one way should be prioritized over the other.

Eventually, one fact should be remembered: DEAD people do not work.

This article is adapted from a LinkedIn post published on 4 April 2020.

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Professor Isaac Ashkenazi is an international expert on disaster management and leadership, community resilience, and mass casualty events with both extensive professional and academic experience. He is considered one of the world’s foremost experts in medical preparedness for complex emergencies and disasters. He is the former director of the Urban Terrorism Preparedness Project at the NPLI Harvard University. He is also an adjunct professor in the Department of Epidemiology at Emory University; an adjunct professor of disaster management at the UGA; a Professor of Disaster Medicine at Ben-Gurion University in Israel; founder of NIRED Center at the College of Law & Business; commander at Mobile Med One Foundation; Advisory Board of Israel Homeland Security; and a consultant to Harvard University, Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the U.S. Department of Homeland Security, FEMA, the White House, the World Bank, High Threat Institute U.S., Tactical Combat Casualty Care US, Rio Olympic Games, the Brazilian Ministry of Defense, India NDMA, SAMUR – Protección Civil, China Ministry of Health and other national and international agencies. He served as the Surgeon General for the IDF Home Front Command.

Carmit Rapaport (Ph.D., the Technion-Israel Institute of Technology, 2011) is the academic coordinator of the MA programs in Disaster Management and Fire Studies at the Department of Geography and Environmental Studies at the University of Haifa, Israel. She is also the director of the Institute for Regulation of Emergency and Disaster at the College of Law and Business in Israel. Recently, she was appointed as the academic advisor and head of the evaluation unit at Israel's National Center for Resilience. Her fields of interests are population behavior during emergencies and disasters, crisis leadership, adaptive behavior, and business continuity. She has received research grants from the Ministry of Science and Technology, Ministry of Tourism, and Ministry of Defense among others. She participated as a senior researcher the EU FP7 BEMOSA project.