Amelia Janaskie, Jenin Younes, and Taleed Brown show us some faces of lockdowns. David Cook offers a thorough and intelligent explanation of Quality Adjusted Life Years (QALYs) and of why public-health-officials’ failure to properly account for these leads to undesirable outcomes. A slice: David Miles and his colleagues have done an extensive analysis of the economic value of lockdown using QALYs. In this they clearly demonstrate that even in the most extreme modelling scenarios, where the number of COVID-19 deaths avoided is at its maximum, based on the normal NICE criteria lockdown is not cost effective: if lockdown had been nivolumab then it would have been rejected as a treatment. The reason for this is, in part, due to the age of those who benefit limiting the number of QALYs
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David Cook offers a thorough and intelligent explanation of Quality Adjusted Life Years (QALYs) and of why public-health-officials’ failure to properly account for these leads to undesirable outcomes. A slice:
David Miles and his colleagues have done an extensive analysis of the economic value of lockdown using QALYs. In this they clearly demonstrate that even in the most extreme modelling scenarios, where the number of COVID-19 deaths avoided is at its maximum, based on the normal NICE criteria lockdown is not cost effective: if lockdown had been nivolumab then it would have been rejected as a treatment. The reason for this is, in part, due to the age of those who benefit limiting the number of QALYs generated. This is an excellent piece of analysis and so I’m not going to reiterate it here. Instead, I’m going to park the costs and focus on thinking about the broader impacts of lockdowns purely from a quality of life perspective.
Unlike the predicted benefits of lockdown on QALYs, the reduction in QALYs to the population under lockdown are here and now, real and not computer simulated, and, if we so desired, to an extent measurable. This is for the simple reason that lockdown requires societal changes to be effective and these changes have negative consequences. To steal some drug terminology; there is no margin between the beneficial effects and the negative (side) effects; there is no safe dose of lockdown.
Because of the very nature of lockdown, everyone’s quality of life will be reduced to some extent due to the loss of normal social activities. The loss of these things on an individual level is minimal compared to the impact of a severe case of COVID-19, and so they only produce a more modest reduction in the quality of life. The problem is that a lot of people suffer this reduction and so those small losses soon add up a large number of QALYs.
Philippe Lemoine, a PhD student in philosophy at Cornell, offers a Twitter thread in which he reasonably argues that lockdowns have, at best, only a limited impact in reducing the risk of dying from Covid-19.
There is also a strange drop in influenza this year. Amazingly, lockdown enthusiasts are crediting this to the closure of our society. But if strangling almost all normal life is so effective against flu, why is it not working against Covid?
Or is it perhaps that flu is still in our midst, but under a different name? I believe figures are also showing a reduction in excess deaths from Alzheimer’s and dementia. Why is that?
At the beginning of this, on March 18, the distinguished professor of medical microbiology, Sucharit Bhakdi, issued a warning.
His credentials are impressive. An infectious medicine specialist, he is one of the most highly cited medical research scientists in Germany. He is a former head of the Institute for Medical Microbiology at the Johannes Gutenberg University of Mainz, one of Germany’s most distinguished seats of learning. He is also a prophet.
He said that older people had the right to make efforts to stay fit, active, busy and healthy. But he warned that the shutdown of society would condemn them to early death by preventing this.
Of course, in the present context, the notion of risk is quite immediate and absolute. Liberty is no use to you if you are dead, and few people would claim that you should have the right to put other people’s lives in jeopardy. And we are not, however much political rhetoric has been expended, in anything like a war with a sentient enemy. By shutting down so many of the most fundamental personal freedoms we are going further than most countries would ever have done in wartime but we are not handing any sort of moral victory to the enemy – because there is no enemy. This is not an ideological battle with an alien force. It is an argument we must have with ourselves.
I don’t propose to engage yet again in the dispute over the present lockdown restrictions – whether they are effective and how urgent it is to lift them. What interests me is how public opinion has responded to these measures. Do people want to be free? Or do they want to be, above all else, safe? Both, paradoxically, but when it comes to an unavoidable choice which way do they go? It isn’t the imposition of these measures that needs examination here but the willingness to comply with them: the positive eagerness to embrace such unprecedented repression to the point of demanding more of it.
Perhaps the most important thing we have learned from this deranging time in our history is that fear remains such a strong human impetus that it can easily stampede all the principles that were assumed to underpin democracy. Does this make it more likely that governments will be prepared to close down all social interaction again, in response to future crises? Almost certainly, and maybe not just for disease epidemics – perhaps for crime waves, terror threats, rioting or mass unrest of any kind. After all, look how easy it was this time.
“There simply must be some collective action solution that stops covid. The ones we’ve tried haven’t worked, and I don’t know what a successful solution is. But dammit, we’re gonna keep trying until we find it!”