Doctors save lives today. It’s part of their oath and ethics. Unsurprisingly, most doctors faced with the Covid-19 pandemic recommended the drastic measure of mandatory confinement orders, or lockdowns. The main objective was to ‘flatten the curve’ of new infections so that it did not lead to overcrowding in hospitals.
Ireland had an extremely limited capacity to treat seriously ill Covid-19 patients: 6.0 ICU beds per 100,000 population at an occupancy rate of 88%. This is compared to an average of 11.6 per 100,000 across Europe. In the absence of measures the hospital system would have been quickly overwhelmed through widespread contagion of the disease, and many people would have died, including health workers.
On the other hand, governments should not only care about the lives of its citizens today, but also be concerned with the longer term health and wellbeing of the nation. To mitigate the next crisis and guide future investment, the government should first consider how many, and which, lives confinement saved, and which it destroyed.
Which lives did the confinement save?
For Ireland, we have no estimate of how many lives were saved thanks to confinement. All we know is that, to date, 1,717 people died of Covid-19.
To get a sense of proportion, it is estimated that in France, a month of lockdown saved up to 60 000 lives*. France is fourteen time the size of Ireland.
Lives however are never really saved. In any given month, about 2,500 people die in Ireland to the relative indifference of the media. The mortality rate of humans has been and will ever be 100%. Death can only be temporally avoided. This is important as it transforms the notion of ‘saving lives’ into the more accurate calculation of prolonging years of life.
Life expectancy in Ireland is 82, so dying after that age means living longer than expected. In the case of Covid-19, 90% of people dying from the virus were above the age of 65 at an average age of 82, and a median age of 84. It is therefore reasonable to assume that the number of years of life lost (YLL) due to Covid-19 is relatively small. Consequently, confinement primarily benefited the population that would have otherwise been lethally affected by the virus, i.e. citizens over the age of 65.
Which lives are and will be affected by the lockdown?
While all of us were affected by the confinement, vulnerable children have been the most exposed and the effect of the lockdown on mental health, the education deficit, and domestic abuse has to be accounted for.
Many adults’ lives are and will be dramatically affected by the economic recession. According to the Economic and Social Research Institute (ESRI), the Irish economy could contract by 17% in 2020; in comparison, the Irish GDP “only” contracted by 7.1% in 2009 and worldwide GDP contracted by 15% between 1929 and 1932.
Ireland’s Covid-19-adjusted unemployment rate reached a record high of over 28% in April. In the Northern hemisphere, the link between economic shutdown and loss of lives (through suicide for example) is likely, but difficult to demonstrate.
The relationship between economy and heath/lives is more subtle and sacrificing one for the other does not make sense. The two are intrinsically linked. For example, in 1997, life expectancy in pre-Celtic Tiger Ireland was 76, a full year less than more developed Germany. From the mid-90’s, Ireland’s GDP grew rapidly, allowing governments to gradually increase their health spending from €3.6bn in 1997 to €15.6bn in 2017.
Ireland now has a longer life expectancy than Germany, standing at 82.35 versus 81.41 for the latter. What this indicates is that governments can prolong the lives of citizens by investing in hospitals, but may only do so thanks to a healthy economy.
Africa has not been dramatically affected by Covid-19, but lockdowns in advanced economies have created economic chaos. Poverty and malnutrition already kill 9 million people every year. This is set to kill substantially more very soon as the chief of the UN’s food relief agency is now predicting a hunger pandemic of ‘biblical proportions.’
Hence, there may be a domino effect at play. An extreme scenario – yet likely to occur over the next five to ten years – could look like this: a public health crisis triggering an economic crisis, which triggers financial and monetary crises (avoided for now), triggering a hunger pandemic, triggering mass immigration, triggering a ‘Populist’ far-right reaction, triggering a geopolitical crisis. This is of course speculative. Yet everyone should be in a position to judge whether saving the lives of our parents justified taking such risks for the future of our children.
Just as choosing health at the expense of the future of the economy may prove counter-productive, choosing the old economy now over our future health and wellbeing is a lost opportunity. Hence this Irish government or the next should consider the following proactive options.
The severity and length of the confinement in Ireland can be directly attributed to a lack of ICU capacity. To mitigate public health crises in the future, the government needs to invest massively in public health infrastructure and reduce the gap with our European partners.
The government should also invest in infrastructure that will directly benefit future generations. Investment in public transport infrastructure and energy efficient housing will not only reboot the economy, but will also offer some long term societal and environmental benefits. Equally, investment in education, which has long been recognised to offer the best return for the welfare of any nation, should also be a top priority. This will help Ireland to sustain its position as a knowledge-based economy.
Whatever Irish government comes to power should already be considering how to finance these investments. The opportunity is there to revise Ireland’s business model and redefine a more sustainable tax system. This may help Ireland avoid tensions with economic partners, as the current low corporate taxation model may not be tolerated by American and European counterparts for much longer.
In sum, it is now time for the government to be proactive and invest in the future of our children: Young lives count too.
*Editor’s Note: other studies have questioned the effectiveness of lockdowns.