In Owl’s opinion cost benefit analysis, where a monetary value is used to measure costs and benefits on a common scale, is as contentious as the use of obscure algorithms.
This article discusses some of the tricky ethical issues that arise when trying to evaluate the costs versus the benefits of lockdown. It doesn’t make for comfortable reading.
Larry Elliott www.theguardian.com
Cancer treatments cancelled. Children deprived of schooling. More cases of domestic abuse. Continued restrictions on personal freedom. Over and above the direct damage caused to the economy, the collateral damage from the Covid-19 pandemic has been colossal.
And the crisis is not over by any means. Travel restrictions come and go with mind-boggling frequency. Local quarantining has replaced national lockdowns. Every leading policymaker in the UK, from the chancellor, Rishi Sunak, downwards, knows that the job losses to come threaten to leave permanent scars.
An obvious question, therefore, is was it worth it? Have the costs of shutting down a great chunk of Britain for three months and leaving many restrictions in place after six months been outweighed by the benefits?
An obvious answer is that this is the wrong question to ask, because you can’t measure the value of a human life in terms of gross domestic product, the unemployment rate or the size of the national debt. The tough action taken by the government at the end of March saved lives, end of story.
By the same token, though, it is impossible to put a price on the fact that the number of cancer referrals fell by 70% in April, that there were hardly any follow-up appointments for people with long-term conditions and elective admissions dropped by 75%.
What’s more, the government does put a monetary value on a life when it comes to deciding on resource decisions when it comes to medical care.
It does this by estimating the number of years of life that will be saved adjusted for quality of life. A quality-adjusted life year is valued at £30,000.
Using this figure and estimates for the direct hit to the economy caused by the pandemic, a team of researchers including David Miles, a former member of the Bank of England’s monetary policy committee, have had a go at assessing the benefits of the lockdown against the costs.
This is by no means a simple process. Firstly, it is unclear how big the loss of output will be from the Covid-19 recession, and estimates of the length and the depth of the slump are changing all the time. Secondly, nobody is sure how many lives were saved as a result of the lockdown. Finally, the £30,000 figure for a quality-adjusted life year might be too low, even leaving to one side all of the ethical considerations in making such a calculation.
To allow for these difficulties, Miles and his colleagues use a range of estimates both for the number of lives that might have been lost in the absence of a lockdown, and for the drop in GDP caused by the Covid-19 recession. The trigger for the imposition of the lockdown was the prediction from Prof Neil Ferguson of Imperial College London that 500,000 lives would be lost unless tough restrictions were imposed. In their paper, using data from the summer, Miles et al say the number of excess deaths in the UK caused by the pandemic was 60,000. Subtracting that number from Ferguson’s 500,000 leaves an estimate of 440,000 saved lives.
Based on the ages of those who died from Covid-19, the Miles study assumes the loss of 10 quality-adjusted life years on average, each valued at £30,000. That generates a value for potential years of life saved at £132bn. The figure falls to £30bn if 100,000 lives were saved by the lockdown, and to £6bn if 20,000 lives were saved.
Early estimates that Britain was heading for a slump unparalleled since the first decade of the 18th century have proved too pessimistic. Instead of a 14% drop in national output, the latest forecast from the Bank of England is for a 9.5% contraction, making it merely the worst recession since the one after the end of the first world war.
The value of Britain’s annual output is roughly £2tn , so a 9.5% drop in GDP is worth £190bn. Obviously there would have been a drop in GDP even without a formal lockdown because people would have taken their own precautions. Miles and his colleagues assume that the lockdown was responsible for two-thirds of the damage, leaving a monetary cost of just under £130bn. That figure doesn’t take into account any further setbacks to the economy or the health and education costs.
This is all very well, but did the government have a choice? Wouldn’t going down the Swedish route, a country where far less stringent measures were imposed by the government, have led to Ferguson’s predictions coming true?
This is explored in another study, by Rickard Nyman and Paul Ormerod, in which they look at the difference between Covid-19 cases and deaths in Sweden and England and Wales.
Deaths in both Sweden and England and Wales peaked on the same day – 8 April – and by early August they were again similar. In between, however, the number of deaths in England and Wales was initially higher than in Sweden but then fell more quickly. In the early stages of the pandemic, there were estimates that Sweden would have 80,000 deaths as a result of not having a lockdown. In the event, the total currently stands at just under 6,000. Nyman and Ormerod estimate that the UK lockdown saved 17,700 lives in England and Wales, which they scale up to 20,000 for the UK as a whole.
If that estimate is anywhere near right, there are some obvious conclusions: namely that Britain has paid a very high price for tackling Covid-19; and the government needs to think long and hard before ever resorting to a blanket shutdown during this pandemic or any that may follow.