The narrative during the coronavirus pandemic is strong and pervasive: we must sacrifice either jobs or lives. This debate about the economic and ethical grounds of lockdowns has seemingly polarised American society. However, in reality, we all want to protect both the economy and public health. The good news is that this horrible choice might be a false dilemma. Indeed, the best way to save the economy is actually to save lives. The first thing to consider is whether we are ruining the economy with social distancing. Millions in the United States have filed for unemployment and businesses of all sizes are teetering on bankruptcy. It is tempting to see a direct correlation between social distancing policies and economic suffering. However, global pandemics like the Covid-19 crisis are akin to wildfires ripping through the economy. Social distancing mandates are the controlled fires we set to contain the devastation. Both are damaging to the economy, but the primary destructive force is the pandemic itself. A working paper by the University of Copenhagen has compared the economic impacts of the Covid-19 crisis in Denmark and Sweden. The two Scandinavian countries both suffered outbreaks at the same time. Denmark imposed severe social distancing restrictions, while Sweden famously did not. Sweden experienced an estimated drop of 25 per cent in aggregate spending, while Denmark suffered a loss of 29 per cent – a difference of only 4 percentage points. The data implies that much of the damage to the economy was done by the pandemic itself, not the mandated lockdown. Why is this the case? While social distancing prohibitions result in supply-side restrictions, the horrors of a dangerous and contagious pandemic simply crush demand. Most people are highly motivated to avoid illness, disability and death. Even without restrictions on businesses, events and gatherings, many consumers will stay at home until the threat is reduced. How will social distancing affect economic recovery once the pandemic eases? Economists from the Federal Reserve Board, the New York Fed and MIT attempted to answer this question by comparing the diverse social distancing policies of American cities in response to the 1918 Spanish flu pandemic. They found that cities which imposed stronger measures actually had more robust economic recoveries after the pandemic. Coronavirus could leave the world an even more unequal place Cities that implemented the most timely and strictest social distancing policies subsequently enjoyed a relative increase in employment, manufacturing output and bank assets. Conversely, cities that allowed the pandemic to ravage their communities were stuck in the economic doldrums afterwards. Clearly, the short-term costs of social distancing are mitigated by long-term economic gains. One reason for the long-term economic impact of a poorly controlled pandemic is the financial cost of fatalities. Each life lost to Covid-19 represents a permanent loss of future productivity and demand. Scores of retirees, hardworking parents, and young people on the cusp of their careers might be erased forever from our economy. While jobs are replaceable after a lockdown ends, the lives of consumers and workers are not. The cost of deaths alone does not capture the full magnitude of the economic impact of Covid-19. As an emergency medicine doctor working on the front line of this pandemic, I have been shocked by the potential of this disease to cause severe long-term illness and disability. Almost every organ system could be permanently damaged. A majority of patients are left with lung scarring which might result in permanent loss of function . Abnormal blood clotting is thought to lead to strokes and kidney failure in previously healthy Covid-19 patients. The virus also attacks the heart, causing inflammation and injury. The loss of productivity and the medical costs of disability among Covid-19 survivors could potentially dwarf the cost of fatalities. Although the current economic burden of the pandemic is heavy for all of us, we must play the long game: saving lives and preventing illness will save the economy. Why Trump’s about-turn on the US dollar is right on the money The savings are potentially immense. A study published last month in the Journal of Benefit-Cost Analysis calculated that the lives saved by social distancing might result in net economic benefits of US$5.2 trillion to the US. Another study by the University of Chicago estimated that moderate social distancing would result in mortality benefits of US$8 trillion to the US economy, or US$60,000 per US household. To reap these economic benefits, lockdown measures do not need to be draconian or interminable. Economists at Cambridge and the Federal Reserve Board recently reckoned that a targeted lockdown affecting only one-third of the US population for eight months would reduce economic output by 15 per cent, half the amount of damage that would be done by inaction. A more recent study suggested that rolling cycles of 50 days of strict measures followed by 30 days of relaxed measures might greatly reduce deaths while allowing populations time to “breathe”. As the US moves to reopen, it should be flexible and consider the use of such dynamic and tactical restrictions. Although future economic benefits might seem intangible to those of us now facing financial ruin, controlling this pandemic aggressively today will bolster our economic heath tomorrow. The stakes are high and the actions we take now will reverberate through the years to come. We must be mindful that the best economic policy is the best pandemic policy. Saving lives and preserving health is the key to saving the economy. Dr Yenting Chen, MD, is a board-certified emergency medicine physician practising at the Alta Bates Summit emergency departments in Berkeley and Oakland, California Help us understand what you are interested in so that we can improve SCMP and provide a better experience for you. We would like to invite you to take this five-minute survey on how you engage with SCMP and the news.