Could the lockdown cost more lives than it saves?

The UK government’s daily coronavirus briefing on Friday drew more attention to a question that has already been troubling many people: could the wider economic and health impacts of the fight against Covid-19 actually do more harm than the virus itself?

My view, for what it’s worth, is that it is right to err on the side of keeping the lockdown in place for longer. But it is also obviously right to have a serious and open debate about these issues – and very unhelpful to continue to vilify anybody who dares to raise them.

There are two main reasons for thinking that the lockdown could be counter-productive. The first is the impact that the collapse in economic activity might have on the nation’s health, although there may be some benefits here as well as costs (as I will explain later).

The second and perhaps more immediate concern is that many other people might be missing out on NHS care, either because resources are being diverted to look after coronavirus patients or because they are simply choosing to stay away.

Or to quote from someone much wiser than me, ‘there is a health time bomb building up…all those conditions, known, unknown, going untreated…local GP services on hold…physical/emotional consequences of putting a nation’s health on a back burner…’ (thanks, Mum).

Here, Fraser Nelson is the latest to incur the wrath of the social media vigilantes. Nelson was one of the first to report on preliminary estimates made for a government working group which suggest that delays in NHS treatment could result in up to 150,000 ‘avoidable deaths’. This story has since been corroborated by other sources, notably the Financial Times.

If correct, this figure would be greater than some estimates of the likely deaths from coronavirus itself. What’s more, as far I can tell, it does not take account of any broader impact from the economic slump. (If anyone can clarify that, please do.)

In the government briefing, Health Secretary Matt Hancock downplayed these reports, stating that ‘we do not yet have an established estimate of the impact of the huge problems in the economy on the health of the nation.’

But he went on to say ‘it is a piece of work that I am working on jointly with the Chancellor to make sure that when we make the big policy decisions, especially around social distancing we take into account the entire impact on the health and wellbeing of everyone in the country – not just the highly visible impact on the deaths from coronavirus but right across the board including indirectly from the economic impact of the crisis.’

And he concluded ‘it is something that will be at the heart of our judgement as we make the decisions in the future. But what’s clear is that right now it is too early to make those judgements.’

This is a perfectly reasonable position. It makes a nod to what is sometimes called the ‘identifiable victim effect’, where we focus on the fate of specific individuals (those most at risk with coronavirus) rather than a larger but less visible group who might be just as deserving (such as people with other serious conditions, or who might be hit hardest by an economic slump).

Equally, though, coronavirus appears to be particularly vicious, and we don’t yet have enough evidence either way. It’s therefore right not to leap to any conclusions.

For now, my own judgement is that it is worth persisting with the lockdown. On the NHS itself, I’d have thought the biggest risk is still that the system could be so overwhelmed with coronavirus patients that it breaks down completely. But I’ll leave that to the health experts.

There also two good reasons NOT to rush to lift the lockdown on the basis of the impact of the collapse in economic activity on health and wellbeing. First, history suggests that brief recessions do not necessarily lead to a deterioration in health outcomes. Indeed, US research has found that a temporary rise in unemployment is more often associated with a small improvement in overall mortality rates.

Similarly, the US economist Anne Case notes that ‘fewer people died during the Great Depression in the 1930s than during the boom years of the 1920s. And during the Great Recession of 2008-9, a third of the people in Spain and Greece were unemployed, but their mortality rates fell.’

These perhaps surprising results appear to be due to indirect benefits, such as a reduction in traffic accidents, which can more than offset the more obvious costs, including an increase in alcoholism and suicides. Other factors include a reduction in pollution and in work-related fatalities, such as deaths on construction sites.

Second, even if a weaker economy does result in poorer health outcomes in the longer run, it may be worth taking a bigger short-term hit to activity in order to recover more strongly. This conclusion is supported by a recent study (by Correia, Luck, and Verner) of how different US cities responded to the ‘Spanish Flu’ pandemic of 1918. As you might expect, the cities that suffered the most deaths also saw a sharp and persistent fall in economic activity.

But, just as importantly, this study also looked at the impact of the sort of restrictions that the UK government is imposing today, such as banning public gatherings, closing schools and churches and entertainment venues, and reduced business hours. It found that those US cities where the authorities intervened earlier and more aggressively did better in terms of mortality rates without doing any worse in terms of economic activity. If anything, their economies grew faster than other once the pandemic was over.

(I’d just add that many of the economic costs are inevitable even without the lockdown. For example, people will still be reluctant or unable to work or shop if they or their families have symptoms of coronavirus or at greater risk of catching it.)

Obviously, none of these studies are exact matches for the current crisis. We are now probably more aware of other potential downsides from social isolation, such as increases in mental health problems and domestic violence (unfortunately, there is already evidence of both). A fall in GDP as large as 25% may also be a game-changer, even if it is only temporary. There are no easy answers here and more work is required.

In summary, though, it is important to think about protecting the health and wellbeing of everyone, not just those most obviously affected by coronavirus. But the NHS could be overwhelmed if the virus isn’t checked, and the long-run economic impact could be even worse. If this means extending the lockdown for a little longer, then so be it.

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