/SPRING BREAK 2020/

Peter Singer + Michael Plant

Medical workers treat patients in the isolated intensive care unit at a hospital in Wuhan in central China's Hubei province Thursday, Feb. 6, 2020. (Chinatopix via AP). Published by CTV News, Saturday, February 22, 2020 12:55PM EST.

MELBOURNE & LONDON – As of today, almost four out of every ten people on Earth, more than three billion people, are under government-mandated lockdowns in an effort to stop the spread of coronavirus.

How long should the lockdowns last? The obvious answer, to paraphrase Boris Johnson, is until we’ve “beaten” COVID-19. But when exactly is that? Until no single person on Earth has it? That may never happen. Until we have a vaccine, or an effective treatment? That could easily be a year away, perhaps much longer. Do we want to keep people locked down, our societies shuttered – restaurants closed, parks closed, offices closed – for that long?

It pains us to say it, but Donald Trump is right: “We cannot let the cure be worse than the disease”. Lockdowns have health benefits: fewer will die of coronavirus, as well as other transmissible diseases. But they have real social and economic costs: social isolation, unemployment, and widespread bankruptcies, to name three. These ills are not yet fully apparent, but they soon will be.

Some people insist that there is, in practice, no trade-off: lockdowns are better for saving lives and the economy. This seems to be wishful thinking. Presumably, such people are supposing lockdowns really will end soon. But if we end lockdowns before we’ve vanquished COVID-19, that means we’re prepared to allow some people to die from the disease who would otherwise have lived. It’s not so simple to escape the trade-off between saving lives and saving livelihoods.

It seems safe to say that the right time to end the lockdowns is sometime between today and ten years. But that’s not very helpful. If we want a more useful answer than that, we must think carefully about how to make trade-offs.

How should we do that?

First, we must not overlook the potential costs of containing coronavirus. Research in moral psychology has revealed an “identified victim effect”. People prefer to offer aid to a specific, known victim rather than provide the same benefit to each of a larger, vaguely defined set of individuals. We think the identified victim effect is a moral mistake – we should strive to do more good, even when we do not know exactly who gains.

Something equivalent – call it an “identified cause effect” — may be limiting our collective thinking about COVID-19: we are focusing on a specific known source of suffering, even if we do not know who suffers, and neglecting other problems. Could the images of people dying on stretchers in tents in hospital parking lots be blinding us to the greater harm we may be causing across society through our efforts to avoid those awful deaths?

Second, to make trade-offs we need to convert different outcomes into a single common unit of value. A problem with the current conversations about whether we should strangle the economy to save lives is that we cannot directly compare “lives saved” against “lost GDP” – we need to put them into some common unit.

One way to make progress is to consider that a lockdown, if it goes on long enough, will bring about a smaller economy that can afford fewer doctors, nurses, and medicines. In the UK, the National Health Service estimates that for about £25,000 (US$30,000) it can pay for one more “Quality-Adjusted Life-Year.” In effect, that sum can buy a patient an extra year of healthy life.

If we then estimate how much lockdowns reduce the economy, we can estimate the years of healthy life we are likely to gain now by containing the virus and compare it to how many years we are likely to lose later from a smaller economy.

We have not yet seen any sufficiently rigorous attempts to do this. Paul Frijters, an economist, has offered a back-of-the-envelope analysis that reaches a startling result: it would have been better, in terms of years of healthy life lost, not to have started the lockdowns. In reaching that conclusion, a major factor is that most of those who die from COVID-19 are elderly, or have underlying health conditions. Frijters makes some questionable assumptions. He attributes all the economic downturn to government actions, whereas COVID-19 would have caused significant economic disruption anyway; and his estimate of the fatality rate per infection does not take account of the additional deaths likely to occur when intensive care units are overburdened and unable to admit new patients.

In any case, thinking solely in terms of health-years is still too narrow -- health isn’t all that matters. What we really need to do is compare the impact different policies have on our overall well-being.

How can we do that? We think it’s best to measure well-being by using individuals’ reports of how happy and how satisfied they are with their lives, an approach pioneered by academics in the World Happiness Report.

Doing this means we can, in a principled way, weigh up otherwise hard-to-compare considerations when deciding how to respond to COVID-19 – or to anything else.

To focus on one major concern, a record 3.3 million Americans filed for unemployment last week in large part due to the pandemic. In India, the lockdown has devastated migrant workers, many of whom have no other means of support. We all agree unemployment is bad, but it’s not obvious how we should trade unemployment against years of healthy life.

Thinking directly in terms of well-being allows us to make this comparison. Unemployment is dire for well-being, reducing individuals’ life satisfaction by 20%. With this information, we can compare the human costs of a lockdown to the well-being gained by extending lives. A broader analysis would include other impacts, such as social isolation and anxiety, and tell us when a lockdown should be lifted.

COVID-19 will be with us for some time. Are months of government-enforced lockdowns the right policy? We don’t know, and as moral philosophers, we can’t answer this question on our own. Empirical researchers need to take on the challenge of counting the impacts, not in terms of wealth or health, but in the ultimate currency, well-being.

Peter Singer is professor of bioethics, with a background in philosophy. He is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University and a Laureate Professor at the University of Melbourne, in the School of Historical and Philosophical Studies. He is the founder of The Life You Can Save.
Michael Plant is a moral philosopher, founder-Director of the Happier Lives Institute and a post-doctoral Research Fellow at the Wellbeing Research Centre, Oxford. His research is focussed on whether and how to make people happier.

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