After Thursday morning’s flurry of headlines, the Government has let it be known that any steps to lift the lockdown will be “modest, small and incremental’. But is the Government striking the right balance between the need for prudence to avoid a massive resurgence in the epidemic and the urgency of phasing out a lockdown as the dramatic human, social and economic consequences are becoming more visible by the day? Of course, should a treatment be identified within the next few weeks, as is indeed possible, this would change everything and would allow the lockdown to be fully lifted much faster, but we are not there yet.
So the key now is to assess three issues honestly and dispassionately: the cost/benefit of maintaining residual restrictions, the acceptability of an increase in fatalities as a result of a lockdown easing, and the challenge of a second wave.
Covid-19 is a disease that threatens older people much more than younger ones. The average age of the 29,000 people dying from Covid-19 as of 6th May is over 70. Over half are above 80 and only 8% under sixty. Just one in a hundred is below 40 years of age. If you are below the age of 50 and get infected the risks of death are just 1 in 650, and less if you are healthy. These numbers, estimated by researchers at Imperial College, don’t take into account that 19 out of 20 victims also have a pre-existing condition.
So yes, this disease is very nasty and can kill people of all ages, but so do many other diseases. (Living is dangerous!).
Can we continue to impose restrictions on an entire population of mostly healthy people of working age in order to protect much older people who are often not healthy and for whom can be put in place better targeted protection and support. Thanks
The normal approach of the National Institute for Health and Care Excellence (NICE), when assessing the cost-benefit of a treatment to tackle an illness, would be to measure the so- called “Quality, Adjusted, Life, Years”; QALY. A treatment is considered cost-effective only if its cost is less than the “value” of the number of “years” of good health that the patient will enjoy as a result. Under current guidelines we understand that the value of one year of good health is considered to be between £30,000-£50,000.
Given the profile of a typical Covid-19 victim (aged over 70) and considering that average life expectancy is 80.7 years (based on the 60/40 male to female ratio, typical of Covid patients), a successful outcome would be to extend the average patient’s life by 10.7 years. Adjusting this number for co-morbidity, and it’s anywhere between 9-9.5 years. In monetary terms, following the normal methodology used by health care economists and by NICE, this means an average benefit of very roughly £400,000 for each person saved.
In contrast, under the full lockdown the economic loss is estimated at 30% of capacity. Even if the loss is only 10%, this implies a £20 billion/month loss to the economy. In order to justify such losses using the cost-benefit approach outlined above, we would need to be avoiding more than 1600 deaths a day. Furthermore, these would need to be the number of lives saved outside care homes since, with adequate precautions by staff and families, the residents in care homes are de facto lock-downed anyway, whatever is happening outside.
Considering that, at its peak, the maximum number of Covid deaths per day was less than 1000 this simply doesn’t add up. Reduce the economic impact of residual restrictions to 5% and you still need to be ‘saving’ 800 or so deaths every day, outside care homes, in order to justify incurring such a cost in purely economic terms.
Of course to consider cost-benefit in this way is hugely discomforting, but the orders of magnitude are such that when applying anything approaching the same methodology that governments normally use to make such decisions, it is very difficult to justify maintaining restrictions that continue to have a negative impact on the economy.
What’s more, not all restrictions need to be lifted immediately and sensible precautions can still be taken to protect the vulnerable, so long as they do not hamper the ability of the economy to recover and the ability of the not-so-vulnerable to return to a more normal life.
This means lifting restrictions not just on larger companies and essential services, but also for most retail, personal services and small businesses that ultimately form the back bone of the economy.
Easing the lockdown will inevitably lead to an increase in the number of cases and possibly to an increase in the number of deaths, but while epidemics often come in waves the risk of an unmanageable Covid second wave is overblown.
The Spanish Flu is often quoted as a precedent, but it is a bad one. The first wave came against the backdrop of the ‘Great War’ and when it returned – facilitated by large troop movements, a lack of sanitation and few resources as a result of the War – it did indeed result in millions of deaths. The situation today, however, is very different. We are prepared for a second wave. The NHS has demonstrated that it can cope and we now have increased testing and infection tracing and much greater public awareness to manage infection. This is not Autumn 1918.
While the desire to place the protection of any human life above all else is wholly laudable, the Government must take a more holistic view – after all the destruction of our economy and the challenges to the physical and mental health of our wider population as a result of lockdown does also – every bit as certainly – costs lives.
It is time now to put things in perspective and evaluate more clearly these trade-offs. While guided by the science, the decisions are political and ultimately they must be taken dispassionately by political leaders with vision and courage, without falling hostage to group-think or political correctness. In the longer term, the public will punish any other approach.