By Dale Woodard on December 17, 2020.
Do COVID-19 lockdowns cause more harm than benefit?
Guest speaker Dr. Ari Joffe discussed the question at the Southern Alberta Council on Public Affairs Tuesday.
The response to COVID-19 across the world has involved lockdowns in order to “flatten the curve” of cases and deaths, said SACPA. The public health response was initially based on inaccurate estimates of infection mortality rates and high-risk groups, overestimating the threat from COVID-19.
As well, the response did not consider many unintended effects of lockdowns on population well-being, including so-called collateral damage (unemployment, loneliness, interrupted health care, interrupted education) and economic recession.
Recently, the debate has framed decisions as a trade-off between “lives and the economy”, but Joffe, a pediatrician who specializes in pediatric infectious diseases and critical care medicine, argued this could be a “false dichotomy,” because the economy is about lives, and a cost-benefit analysis of lockdowns shows they cause more harm than benefit in terms of population well-being and deaths.
“People often talk about COVID deaths versus the economy and that is simply a false dichotomy because the economy is about lives and what we’re comparing is COVID deaths versus death due to economic recession,” said Joffe, who has practised as a pediatric intensive care physician since 1995 at Stollery Children’s Hospital in Edmonton, and is a clinical professor in the Department of Pediatrics at the University of Alberta. “So, it’s lives versus lives and we need to choose the least harmful of two horrible choices.”
Joffe spoke on how to measure the effects of recession deaths.
“That can be based on two methods,” he said. “One is looking at historical evidence because there is a strong long-run relation between government spending and life expectancy and that makes sense because the government spends on services that affect life expectancy, things like health care, education, roads, sanitation, housing, nutrition, vaccines, safety, social security nets, clean energy and all the social determinants of health. If the public system is forced to spend less money on our future, then statistical lives will be lost because people will die in the years to come. The general maximum cost is $75,000 per quality-adjusted life year. We get a similar number looking at what the government uses to estimate how much they should spend on health and life. That’s how costly it is to save people from illness. It turns out a maximum cost for that is about $80,000, an expenditure that will buy one quality-adjusted life year.
“We’re treating the lockdown as a public health policy because that’s what it is. It’s about saving lives.
“We should treat decisions about lockdowns the same way we treat decisions about how to spend on other things that affect life, like cancer, heart disease.”
Another cost is the loneliness and anxiety effect, said Joffe.
“(It) causes people’s well-being to decrease (as well as) unemployment effect, which causes people’s well-being to decrease.”
Joffe referenced a review that came out this year about social determinants of health and survival in humans.
“As income goes up, life expectancy goes up and as social network indexing goes up, meaning people are more socially connected, their life expectancy goes up.”
Perceived loneliness is maybe the most potent threat to survival and longevity, he added.
“It’s among the top-three risk factors for death due to cardiovascular disease. It’s the top risk factor for death in the next decade and it increases the incidents of many other chronic diseases.”
Assessing his cost/benefit analysis, Joffe said the benefit analysis is preventing COVID deaths, while the cost is from the recession and the government spending austerity on determinants of health and longevity.
Going forward, Joffe spoke of using a cost-benefit balance in understanding the risk from COVID and the tradeoffs involved.
“We should focus on protecting those at high-risk, we should keep schools open, we should increase surge capacities in hospitals if necessary and invest improving the social determinants of health (addressing inequalities, homelessness and poverty).”
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