Jon Allsop, who writes the Columbia Journalism Review's daily newsletter, argues that the conversation about when and how to relax COVID-19 lockdowns is a "false debate" that misleadingly pits "lives" against "livelihoods." In reality, Allsop says, there is "no choice to be made between public health and a healthy economy—because public health is an essential prerequisite of a healthy economy."
While that is true at some level, broad business closure and stay-at-home orders nevertheless entail tradeoffs that cannot be wished away by such anodyne assurances. Those tradeoffs are a recurring theme of a recent roundtable in The New York Times Magazine that Allsop himself mentions. The title of the forum is telling: "Restarting America Means People Will Die. So When Do We Do It?" The five panelists—especially Princeton bioethicist Peter Singer—repeatedly call attention to the moral implications of reducing COVID-19 transmission by shutting down large sectors of the economy.
Singer forthrightly questions "the assumption…that we have to do everything to reduce the number of deaths." That assumption is manifestly wrong, as reflected in the decisions that government agencies make when they assess the cost-effectiveness of health and safety regulations—decisions that routinely take into account not just the deaths that might be prevented but the resources expended to do so. Those assessments assign a large value to preventable deaths, but the value is not and cannot be infinite.
"At some point," Singer says, "we are willing to trade off loss of life against loss of quality of life. No government puts every dollar it spends into saving lives. And we can't really keep everything locked down until there won't be any more deaths. So I think that's something that needs to come into this discussion. How do we assess the overall cost to everybody in terms of loss of quality of life [and] loss of well-being as well as the fact that lives are being lost?"
Singer is equally frank in discussing the weight that should be assigned to COVID-19 deaths, whether they are prevented by current control measures or allowed by loosening those restrictions:
This is killing mostly older people. I think that's really relevant. I think we want to take into account the number of life years lost—not just the number of lives lost.
The average age of death from COVID in Italy is 79½. So you do have to ask the question: How many years of life were lost? Especially when you consider that many of the people who have died had underlying medical conditions. The economist Paul Frijters roughly estimates that Italians lost perhaps an average of three years of life. And that's very different from a younger person losing 40 years of life or 60 years of life.
Similarly, the British epidemiologist Neil Ferguson has estimated that "as much as half to two-thirds" of the people who will die from COVID-19 in the U.K. would have died "anyhow" by the end of the year because deaths from the disease are concentrated among people who are old and/or have serious preexisting medical conditions.
Another participant in the New York Times forum—Zeke Emanuel, vice provost for global initiatives at the University of Pennsylvania—reinforces Singer's point. "I am a big believer in using life-years saved, rather than just number of deaths avoided, as the goal," he says, noting that allocation of scarce medical resources such as ventilators and organs routinely takes that factor into account. Emanuel argues that COVID-19 restrictions could be loosened in June if appropriate testing, surveillance, and contact tracing is possible by then.
Singer emphasizes that the economic cost of aggressive control measures is morally important and not simply a matter of elevating crass financial concerns above issues of life and death (the way that New York Gov. Andrew Cuomo, among many others, has misleadingly framed the issue):
If we're thinking of a year to 18 months [the projected amount of time required to develop and deploy a vaccine] of this kind of lockdown, then we really do need to think about the consequences other than in terms of deaths from COVID-19. I think the consequences are horrific, in terms of unemployment in particular, which has been shown to have a very serious effect on well-being, and particularly for poorer people. Are we really going to be able to continue an assistance package to all of those people for 18 months?
That's a question each country will have to answer. Maybe some of the affluent countries can, but we have a lot of poor countries that just have no possibility of providing that kind of assistance for their poor people. That's where we'll get into saying, "Yes, people will die if we open up, but the consequences of not opening up are so severe that maybe we've got to do it anyway." If we keep it locked down, then more younger people are going to die because they're basically not going to get enough to eat or other basics. So those tradeoffs will come out differently in different countries.
The economic cost, Singer notes, goes far beyond the immediate impact on people forcibly deprived of their livelihoods:
We need to think about this in the context of the well-being of the community as a whole….We are currently impoverishing the economy, which means we are reducing our capacity in the long term to provide exactly those things that people are talking about that we need—better health care services, better social-security arrangements to make sure that people aren't in poverty. There are victims in the future, after the pandemic, who will bear these costs. The economic costs we incur now will spill over, in terms of loss of lives, loss of quality of life, and loss of well-being.
I think that we're losing sight of the extent to which that's already happening. And we need to really consider that tradeoff.