Could not agree more. At FTAlphaville:
When considering which measures are appropriate for tackling coronavirus, and which should be eased first, it’s crucial that we think seriously about the various trade-offs that we are making, and the potential collateral damage wreaked by various strategies.
Clearly, there will be massive effects from the lockdowns imposed to varying degrees across much of the world, including severe economic damage that will indirectly have a significant negative impact on health, as well as direct health damage — both physical and mental — that comes from being locked up indoors for weeks or months on end (a problem that is likely to be particularly acute in lower-income countries).
Yet the secondary health effects from the lockdown are constantly conflated with the secondary health effects from a far more sinister enemy than even “the biggest suspension of civil liberties since Oliver Cromwell’s Protectorate” (aka lockdown).
And that enemy would be . . . Covid-19.
A common refrain among lockdown sceptics is that “lockdown will kill more lives than the virus”, and that might be true, though we won’t know for sure about that for a long time (and perhaps ever). But it is important that we disentangle the damage that is caused by the virus from the damage caused by the lockdown, because those are two separate issues.
One prominent argument is that it is the lockdown that is behind the steep falls in A&E admissions and vital medical treatment. Here’s an excerpt from a piece by the excellent Tom Chivers in UnHerd on Tuesday, which quotes Dr Babak Javid, an infectious disease specialist at Cambridge and Tshinghua universities (all emphasis ours):
But the lockdown comes at significant social, health and economic costs. He stresses that he’s not saying that we ought to do it all at once (“I don’t want to comment on the overall net cost or benefit. That’s a policy issue, not a scientific issue”), but merely that it’s not a straightforward decision; many lives will be lost and damaged if we carry on with lockdown, as well as if we come out of it. “A&E attendance is way down,” Javid says. “Can heart attacks really have dropped by 30%? We’re delaying cancer diagnoses and treatments. These are genuine, real risks to prolonging lockdown, and they’re medical and sociological, not just economic.”
There is now accumulating evidence that as a direct result of the lockdowns, people are either dying or are going to die. For instance a distinguished NHS oncologist has predicted that because of the suspension of the cancer screening programme in the UK as a direct result of the lockdown — prioritising Covid-19 patients in hospitals — up to 50,000 people will needlessly die of cancer over the next five years or so.
This argument does not make sense. In what way is the suspension of cancer screening a direct result of the lockdown? Surely that is a result, rather, of the virus? Covid-19 patients have been prioritised at the expense of other patients; doctors have discouraged patients from going in to see them in order to prevent them catching the disease (which seems to spread especially well in hospitals).
Even those who are conducting the vital studies into indirect health damage are not suggesting the cause of this is the lockdown. We wrote up a UCL study back in April that predicted cancer deaths in England could soar by one fifth in the coming year, as a result of both chemotherapy attendance and cancer referrals plummeting, and noticed in the comments section a debate over whether it was the lockdown that had caused this.
But we quoted the lead author of the report, Harry Hemingway, explaining why that might be, and he did not even mention the lockdown (either to us directly or in what we quoted):
The NHS policy was to protect cancer patients by not bringing them to hospitals where they could acquire the infection.
However, an unintended consequence . . . is there’s a response in the public to maybe say: ‘I don’t want to burden the NHS, and I don’t want to present for my urgent diagnostic referral.’
These numbers have gone down, and maybe that’s a consequence of both patients not wanting to trouble the NHS and possibly also GPs for whatever reason not wanting to refer.
It could feasibly be argued that the lockdown itself is what has really been scaring people (although we think this is a bit of a stretch), or that some people thought that they weren’t allowed to leave their house even in an emergency during the strictest period of the lockdown (though the government guidance specifically mentioned that going to see a doctor was one of the few things that was still permissible).
What is more likely is that some people de-prioritised getting themselves checked out (perhaps subconsciously), self-diagnosing their ailments as non-urgent despite lacking the expertise to make that call. This is likely to have been partly the result of the government’s guidance that people should avoid seeing their GP or attending A&E if possible, and this may have been a mistake. .
Overall it is very important to realise that without the lockdown, there would probably have been many more Covid-19 cases in hospitals, which would have led to an even greater hesitancy among the public to seek treatment — with potentially even more health resources having to be reallocated to deal with the virus (and many more health workers exposed to sickness and time off work).
There would also have been moral and mental health implications if we had allowed the virus to run wild or if our health systems had been overwhelmed, and if — in a worse-case scenario — we had started to see bodies piling up on the streets. So the mental health problems aren’t confined to being stuck indoors for months on end.
Scrutinising the case for lockdown is entirely justifiable. But we need to be careful that we are using the right counterfactuals when discussing the pros and cons. A similar problem arises when arguments are made about the economic impact — it is no good imagining that if we hadn’t been locked down, we would all be getting on with our lives as normal, with no impact on business and no impact on health services. We would still have had a deadly virus taking out huge sections of the workforce and uprooting day-to-day logistics. The virus would probably be killing more of us too.
Using “lockdown” as shorthand for government coronavirus strategy is lazy. We need to be able to work out what we’ve done wrong, and what we’ve done right, so that we can do better the next time we are faced with a global health emergency. Getting the logic right is the first step on the road to a thorough evaluation of our response to this crisis, and will allow us to make proper comparisons with other countries.