The cold, hard maths of whether a coronavirus shutdown is worth everyone’s loss of quality of life

If we go into lockdown every year, we can prevent many deaths from flu. But why don’t societies do this? In the case of the Covid-19 shutdown, there are not just jobs at stake but also quality-of-life costs being borne by everyone

Paul Christensen

Published: 6:30am, 11 Apr, 2020

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Do the benefits of the Covid-19 economic shutdown justify the costs? This is a fundamental question that governments need to address, and they should address it explicitly, regardless of how uncomfortable it may make people feel.

The Post reported that in 2019 the annual influenza outbreak caused 601 intensive care unit admissions and 356 deaths in Hong Kong. But, this year, the flu season was stopped in its tracks by the Covid-19 containment measures; when the annual outbreak ended in February, there had been only 182 ICU admissions and 113 deaths.

If we had gone into lockdown at the beginning of 2019, we could have probably prevented around 300 deaths from influenza alone.

So the question is: why don’t we go into lockdown for the first three months of every year to save 300 lives? The answer must be that society has implicitly decided that those 300 lives simply aren’t worth the costs of shutting down much of the economy for a quarter of every year.

Governments make similar decisions all the time. Take an accident black spot, for example. In most cases, the risk could be reduced by realigning the road or building a footbridge. But it is often deemed not worth the cost.

In 2018, Britain put the value of a human life saved at just under £2 million (HK$19.3 million today). All other things being equal, if an accident black spot can be eliminated at a cost of less than the value of those lives saved, then the project is justified, otherwise not.

In health care, the concept of a quality-adjusted life year (QALY) is used to determine whether a medical treatment is worth the cost. Most people would agree that it is worth spending more to give a 20-year-old patient another 60 years of healthy life (many QALYs) than to give a bedridden 90-year-old an extra few months (a fraction of a QALY).

In the case of Covid-19, the issue is much broader than that: there is a quality-of-life cost being borne by the whole of society. In Hong Kong, tens of thousands of people have already lost their sources of income.

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That number will continue to increase as long as the economic shutdown continues. Some people have savings that can tide them over, but many don’t.

The current restrictions on economic activity are condemning many thousands of people who had basically comfortable lives to years or decades of poverty. There may be significant increases in suicide, divorce and domestic violence rates as people are cooped up to an unprecedented degree in small living spaces.

Most of the people who might die from Covid-19 are old or chronically ill (many would likely be among the roughly 50,000 people who will die in Hong Kong this year anyway); most of the people whose quality of life will be reduced for months, years or even their lifetime by the shutdown are not. Surely the government’s goal should be to maximise QALYs for the population as a whole?

An argument for lockdowns is that the alternative would be an overloaded hospital system. But this shouldn’t be a factor that overrides all others.

There is no doubt that a rigorous triage system could be put in place to keep the hospital system functioning for cases where larger numbers of QALYs are at stake. If society keeps running, then the government could spend the tax revenue it receives on expanding hospital capacity so that fewer hard decisions have to be made when, say, Covid-25 comes along.

And finally, now that we are under a shutdown, we need some clear understanding of when and how the government will determine that life can return to normal.

These questions don’t have simple answers, but it is the duty of our government to analyse the trade-offs in detail, and to be open with all Hongkongers about the reasoning behind its conclusions. It may be that a case can be made for the Covid-19 shutdown that can’t be made for an annual influenza shutdown.

But, given the pain being inflicted on all of us, the government needs to be more forthcoming, instead of just appealing to people’s emotions with vague talk of saving lives.

Paul Christensen immigrated to Hong Kong in 1999 and took early retirement from a career in telecoms general management

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