What is the collateral damage of sheltering in place, quarantine measures, and isolation?

I have no doubt that this is the right public health decision and that social distancing is making a difference in the course of the pandemic. In the Bay Area where we instituted early social distancing and work-from-home measures for many tech companies, we are hopefully avoiding the steep surge of cases that have overwhelmed hospitals in other places. It's too early to say if the curve is flattening, but I think there's enough data to say it's helping. I am hopeful that these extreme public health measures will save a significant number of lives.

But what's the cost? As in medicine, necessary interventions are often accompanied by unavoidable side effects, risks, and harms. The most obvious, apparent, and devastating complication is the economy, which is far from my area of expertise. In writing this blog, I wanted to set aside the big-picture financial impact of the pandemic, leaving that to those who know more than I do. But there are small, tangible ways that this has entered my life, and I wanted to focus on my personal experience. After sensing the sincere gratitude of local restaurants when I get take-out, I've really tried to step-up my support for those small businesses struggling to keep afloat. All parts of this community are interlinked and the more we are able to help each other, the more resilience we have as a whole.

The other strange economical consequence of this pandemic is that although health care is in high demand, health care organizations are struggling financially. By and large, hospitals make money off procedural departments like surgery, interventional radiology, and cardiology. Although there are definitely exceptions, in general, emergency departments and inpatient medicine tend not to generate much income. I'm not going to tackle the controversies of these skewed incentives, but their implication in a pandemic is clear. As we postpone and cancel elective procedures, physician groups and hospitals lose their main stream of revenue. At the same time, hospitals are spending money to purchase more protective equipment, expand clinical capacity, and pay staff overtime. The severity of this imbalance between costs and revenue are recognized in the bills passed by Congress which set aside money for health care organizations. But it's frightening that in the midst of crisis, hospitals don't know if they will stay solvent or need to shut down once the dust clears. Doctors and nurses put themselves at greater risk for less pay. I am glad to have a job and to take care of patients, and I don't want to make this seem like a tragedy when other sectors face financial ruin and soaring unemployment. But as I write about my personal experience, I think we face the reality that first-line responders to this pandemic feel tangible financial uncertainty.