It is easy to embrace the pervading sense of fear provoked by relentless rising death tolls. Reports of overwhelmed hospitals, the spread of COVID-19 to the very heart of government, city centres transformed to ghost towns, and bare Tesco shelves (where scarce loo roll once stood) all contribute to a dystopian – but understandable – panic about this invisible killer.
A false dichotomy of “lives vs money” is constantly being presented in the media. The economic hardship caused by stringent lockdown measures is justified on the basis that such measures save lives. No politician wants to be viewed as responsible for lax measures which lead to preventable deaths. Boris Johnson was widely criticised for his reluctance to implement lockdown measures in the early stages of the outbreak following his scientific advisors. Strict measures now show the government’s commitment to fighting the pandemic. However, lockdowns, whilst protecting citizens from the visible threat posed by COVID-19, present a more subtle, but similarly as profound threat.
The official UK death toll of over 27,000 (as of 2 May) which is likely to rise further in the coming weeks, is an unprecedented number of deaths from an infectious disease in the modern era. But, it’s important to understand the complexities of the situation and the context behind the statistics.
Headline-dominating figures don’t explain the nuances of how deaths caused by the virus are likely to have occurred in individuals who were more vulnerable to infection, due to their age, socio-economic background or pre-existing health conditions. Indeed, many will be dying of conditions other than coronavirus, but will be infected with COVID-19 too. The nature of disease is that it primarily kills those already close to death, even if there have also been tragic cases of younger, healthy people dying of COVID-19.
The inaccuracy and lack of early testing means that governments do not know how widespread or deadly the virus actually is. Recent antibody tests in Los Angeles suggest that the virus may have infected a far greater proportion of the population than initial testing indicated, with a death rate of only 0.1% to 0.2% rather than the previously projected 1-2%. Instead, headlines fixate on the small number of deaths of those we told are not at risk – those young and healthy without any underlying conditions.
Although every death is a personal tragedy, the economic consequences of the measures needed to mitigate the virus expressed in reductions in life expectancy and living standards may ultimately exceed the deaths caused by the disease itself.
The lockdown will have dramatic economic consequences, as we are set to enter a period of economic decline that may rival, or even dwarf, the Great Depression of the 1930s. As it stands, the primary cause of death in developed countries is not heart disease, cancer or stroke but poverty – reducing life expectancy by up to ten years. The stress of insecure work, or, for those lucky enough to be employed, terrible wages. Poor housing. Children going hungry because their parents cannot afford to put meals on the table, rising crime rates. These all contribute to early deaths in the UK. Future governments, struggling with the debts incurred during the coronavirus crisis, are likely to be restricted in their ability to provide well-funded public services; in education, this will adversely affect generations to come. In a vicious cycle, the dramatic reduction in economic output caused by coronavirus will limit the government’s capacity to fund the health service and deal with the long-term consequences of the virus itself, and to treat other illnesses.
Medical professionals are already being forced into heart-breaking trade-offs. Since 30 March, screenings for breast, cervical and bowel cancer have been paused in Wales, Scotland and Northern Ireland. Such cancers cumulatively kill over 30,000 people each year in the UK and early diagnosis and treatment are massively important in reducing the mortality rates of such cancers. Coronavirus-related deaths have yet to reach one-fifth of those caused by cancer in the UK annually. Access to life-saving vaccines for infants, a growth in mental health problems, and a rise in domestic violence are all being touted as potential problems as the lockdown continues.
There remains much popular support for the lockdown, but that will be placed under strain as time goes on. The government’s two epidemiological models plan for at least six months of restrictions. American unemployment has already reached staggering levels: 22 million Americans filed for unemployment benefits in the last four weeks. British figures will surely follow suit. It remains to be seen whether majority support for lockdown measures will remain, as small businesses are forced to close down and government stimulus payments dry up for those made unemployed by the economic downturn. Alternative solutions, which both seek to protect the vulnerable whilst easing tough lockdown measures, could offer a more sustainable approach. For example, might ring-fencing the vulnerable whilst systemically reopening parts of the economy lower the cost to society as a whole over the longer term?
Despite the virus disproportionately affecting the elderly and those with underlying health conditions, it is those most well-equipped to deal with the virus itself, the young and healthy, who will have to bear the brunt of the economic cost of the pandemic. The nature of the virus means that there will be no immediate or miracle solution, save for a potential vaccine within twelve to eighteen months. A balance is needed somewhere between both “flattening the curve” and protecting the most vulnerable in our society, who now more than ever need our help, but also maintaining some semblance of normal economic life.
Lockdowns will not just save lives. They will trade them. They dramatically reduce spread of the disease and reduce immediate deaths – essential for protecting the NHS – but we should remember that the resulting depression will have major consequences for standards of living, and will take lives as well.
When does the benefit derived from reducing peak strain on the NHS, no longer outweigh the cost of compromising the ability of the NHS to deal with other illnesses in the future? When do measures which save lives in the short-term ultimately cost more in the long-term? The government will continue to have to wrestle with evermore difficult trade-offs as the virus progresses.
It is a task I do not envy.