Even after the pandemic dust settles and all the direct Covid-19 deaths are counted, Americans will continue dying for decades due to economic stress from job losses and other financial impacts, history suggests. The economic fallout could lead to an additional 1.4 million excess, pandemic-related deaths over the next 20 years, according to new projections.

The deaths could be prevented. Policymakers should consider the grim prognosis when crafting plans to curb the spread of the coronavirus but also when pondering economic stimuli, health care policies, and especially disparities in health care access, researchers argue in a working paper published by the private, nonpartisan, nonprofit National Bureau of Economic Research.

The analysis, based on known historical recession effects and assumptions about how fast the overall U.S. economy will recover, was done by Francesco Bianchi, PhD, an economist at Duke University; Giada Bianchi, MD, a physician at Brigham and Women’s Hospital; and Dongho Song, PhD, an assistant professor of finance at Johns Hopkins University.

Life expectancy to decline

Significant past unemployment shocks have led to increased death rates due to psychological and physical stresses contributing to everything from heart attacks to depression and suicide.

Based on that premise and the historical data from multiple previous studies, the researchers analyzed the long-term effects to be expected from the current economic crisis, in which unemployment in 2020 was near the worst it’s been in the post-WWII era. Notably, the job losses have disproportionately affected Black people, women (particularly Hispanic women), people age 24 and younger, and poorer people.

As a backdrop, U.S. life expectancy had already leveled off in recent years, actually falling in 2015, 2016, and 2017, after decades of steady increases. Globally, the United States ranks 50th in life expectancy, an exceptionally poor showing rooted largely in extreme disparities in health care between the best-performing counties and the worst, and a growing number of “deaths of despair,” including opioid overdoses, excess alcohol consumption, and suicide.

Covid-19 deaths — officially now above 350,000 and expected to surge even more — will depress life expectancy even further, as I wrote back in May, especially for minority groups that already suffered poorer access to health care and are being hit disproportionately hard by the pandemic.

The additional economic-related deaths will lower U.S. life expectancy by an additional 0.5% over the next 15 years, the fresh calculations find.

“We also predict that the shock will disproportionately affect African-Americans and women, over a short horizon, the researchers write, “while white men might suffer large consequences over longer horizons.”

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How the analysis can help

Regardless what the economy does and the exact impact of any fallout, the researchers offer suggestions for policymakers and health officials.

“We interpret these results as a strong indication that policymakers should take into consideration the severe, long-run implications of such a large economic recession on people’s lives when deliberating on Covid-19 recovery and containment measures,” they write. “Without any doubt, lockdowns save lives, but they also contribute to the decline in real activity that can have severe consequences on health. Policymakers should therefore consider combining lockdowns with policy interventions meant to reduce economic distress, guarantee access to health care, and facilitate effective economic reopening under health care policies to limit SARS-CoV-19 spread.”

To be clear, they’re not advocating against lockdowns or other necessary containment measures, Francesco Bianchi told me.

“We are bringing attention to the costs linked to economic hardship,” he said by email. “We are in full support of public health measures focused on swiftly containing Covid-19, as by no other means this pandemic can otherwise be contained and lives saved.”

But those measures should be combined with other efforts to soften the blow.

“These include economic relief measures, but also other policies that can help the population from the health care, psychological, and social perspective,” Bianchi said. “We also believe that these policies should be directed to those mostly affected by direct Covid-19 morbidity and expected to suffer mostly the recession consequences. We believe that only by combining these two types of policy interventions the anticipated death toll we calculated can be effectively reduced.”