Should we cripple the economy to stop coronavirus deaths? Will 2020’s fall in national output, probably of 15 to 20 per cent, with all the associated corporate bankruptcies and lost jobs, be justified by the saving of lives attributable to the lockdown?
In an open democratic society, with the media enjoying freedom of expression and much scope for intrusion, one point is obvious: politicians must never allow themselves to be blamed for avoidable deaths. The conceit of the modern state is that it has replaced God; it is all-powerful and omni-competent. If a cabinet minister endorses cuts in health expenditure, particularly in present circumstances expenditure on Covid-19, he or she might be accused of murder. In public and on the record, the saving of lives is a political imperative.
But the fact cannot be escaped: contemporary liberal democracies do not spend without limit on the preservation of life. Decisions have to be made which balance cost and benefit, and borderlines have to be defined and respected. In a February 2015 statement Sir Andrew Dillon, then the chief executive of the National Institute of Clinical Excellence (NICE), remarked, “We obviously can’t just say yes to anything and everything. We don’t have enough money and anyway, not everything is worth having.”
The preservation of life is not a moral absolute; it is a matter of cost relative to benefit
Pharmaceutical companies might be able to produce life-saving drugs, but would then charge too much for them. The threshold — about which NICE was not (and is not) reticent — was (and remains) between £20,000 and £30,000 per quality-adjusted life year. If a drug cost less than £20,000 a year to keep someone not just alive, but alive with an existence of quality and meaning, the National Health Service would pay for it; if a drug cost more than £30,000 a year for the same benefit, the NHS would not pay for it. The preservation of life is not a moral absolute; it is a matter of cost relative to benefit.
According to the Office for National Statistics, 150,047 deaths were registered in England and Wales between 28 December 2019 and 27 March 2020. Despite the coronavirus outbreak, this number was lower than the average for the last five years, partly because of a benign ’flu season. (The word “lower” may come as a surprise, but it is not a misprint.) But these numbers relate to a period before the coronavirus surge had started to have a serious impact on the mortality statistics. Unhappily, the week to 3 April was much more worrying. Deaths totalled 16,387, which was 6,000 above normal, with coronavirus mentioned on the death certificate in 3,475 cases.
I am citing these figures, which are from an official release, in order to give a perspective on the gravity of the excess deaths due to the coronavirus. The lockdown was intended to ensure that coronavirus deaths levelled out and started falling before the end of April. So total deaths in April might average, say, 14,000 a week, and be 3,000 to 4,000 above normal, with practically all of the excess due to the coronavirus.
No one knows exactly what will happen in May and June, but we do know that by then Prince Charles, Boris Johnson and Matthew Hancock will have recovered from the disease, and if they have done so it is plausible that many hundreds of thousands of others, perhaps even millions, will also have put Covid-19 behind them.
I am not an epidemiologist, but might I suggest that a reasonable figure for excess deaths from the coronavirus — if the lockdown ends in mid-May — is no more than 100,000? This is not out of line with the work from Imperial College and other universities. We know that the overwhelming majority of coronavirus fatalities are of the elderly with an existing health condition. (In the week to 3 April, of the 3,475 people where the coronavirus was identified as the cause of death, 3,020 were over the age of 65.) Let us say that on average the 100,000 would have lived five more quality-adjusted life years if the coronavirus had not taken them away.
A strong argument can be made that the policy reaction to the epidemic has been disproportionate and misguided
Suppose that public policy now says “no more lockdown, life must return to normal”, and suppose 500,000 quality-adjusted life years are therefore to be forfeited for the purposes of a cost-benefit calculation. If NICE guidelines are remembered, that can be justified if the saving to society is more than (£30,000 multiplied by 500,000), which is £15 billion or less than
1 per cent of gross domestic product. If the cost of the lockdown is put at 5 per cent of annual GDP per month, which is probably about right, well — I will leave readers to make up their own minds about this difficult and painful topic. The interests of the 65 million people who will still be alive after the epidemic cannot be ignored in any sensible calculation.
Politicians had no choice when the contagiousness and virulence of the horrid Covid-19 coronavirus became evident. They had to do something, and a lockdown “to flatten the curve” and to limit the strain on public health capability was inevitable. All the same, a strong argument can be made that the policy reaction to the epidemic has been disproportionate and misguided.
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