People dispute that money and goods should be given up to save lives. Every person having their heart in the right place will answer that saving lives has priority. If it was just that simple. Unfortunately, when done without caution, one might give some people additional years of life while taking away far more healthy years of others.
Resources generally are limited. The more resources are directed towards a single objective, the fewer are left for other objectives. Spending more resources in reducing fatal COVID-19 casualties means that fewer resources can be spent on preventing fatal casualties of hunger and other infectious diseases. A country with a partial or complete lockdown sacrifices vast resources while not strictly focusing on protecting people vulnerable to COVID-19. But these resources are missing elsewhere - for example to prevent children from dying around the world. Saving children with vaccinations against, for example, polio costs less than 20 cents per child [1]. “The looming global recession resulting from the COVID-19 pandemic could cause hundreds of thousands of additional child deaths this year, effectively reversing recent gains in reducing infant mortality, a new UN report issued on Thursday has revealed. [2]”
To make this a bit easier to understand: I am an occasional donor for, among others, Unicef, SOS Children's Villages, Wikipedia and various open source software projects. If I spend my money on preventing the spread of SARS-CoV2 instead, all those other institutions will lack resources. If I lose my job due to the massive economic distress brought upon us by many governments, I won’t be able to donate at all which will lead to people dying.
To summarize - redirecting resources to save some lives will cause other lives to be lost. We need to stop thinking about the economy as a separate actor. The economy requires healthy people while healthy people require a working economy. Public health and the economy coexist in a strong, inseparable symbiosis. One cannot flourish without the other. Public health needs the economy to provide food, shelter and safety. The police and doctors are paid by the surplus of the economy. Reaping havoc to the economy means reaping havoc to public health. Austrian government officials proclaiming that COVID-19 casualties have to be minimized “whatever the cost” have no moral high ground. They drop too many of the Austrian health targets [3] and might destroy considerably more healthy life years than they save - partially by focusing the entire health system almost exclusively on COVID-19 [4]. “Whatever the cost” should, in this context, be understood as desperately trying to achieve something while potentially maximizing the damage on everything else. Worst of all, it might split our society. Making important decisions without proper data and cost-benefit calculations is grossly negligent.
That said, it is important to fight against the COVID-19 pandemic in a resource efficient way. The SARS-CoV2 virus is so widespread that it will not cease to exist in the coming years regardless of all lockdowns. That means that any strategy to fight it must be possible to continue for months or years, if necessary. And to be able to do so, it must be as resource efficient as possible.
Countries like Germany, Austria or Sweden have excellent health systems and disciplined societies. There are reasonable guidelines for avoiding an uncontrolled spread of the disease, for example
- staying home when having any symptoms
- physical distancing
- properly washing hands often
- not touching eyes, nose and mouth
- coughing and sneezing into your elbow
- doing work from home whenever possible
- avoiding public transportation so that those who rely on it have the required space
Of course Sweden has prepared itself for a lockdown if things ever get out of hand. Being prepared is a good thing as the cost is miniscule in comparison to the actual lockdown. So they will be able to move swiftly when the data suggests a need. As a consequence, the public’s trust in the Swedish government and the public health agency of Sweden are increasing steeply [5].
People frequently criticize Sweden for not minimizing fatal casualties caused by COVID-19. Granted, they could have protected retirement homes better - just as Austria should have done. Unlike other European countries, the Swedish government has a holistic view on the crisis. Instead of emphasizing a “local optimum” of direct COVID-19 casualties as their sole goal, they protect the well being of every member of their society. The mental health and prosperity of children younger than approximately 16 is protected by allowing them to routinely go to school. Far less people have lost their jobs, require short-term work or struggle with bankruptcy of their company. Far less people have to fear for their economic existence. Businesses still provide required goods and services. People don’t go to bed anxiously every evening. Swedish children still get important preventive medical checkups and vaccinations while some Austrian pediatricians had to send their staff off to short time work schedules as demand has dropped significantly. The latter is an extremely dangerous and worrying development that might lead to horrific collateral damage.
Let me try to wrap this up. I am not saying that COVID-19 should be ignored. But we must not continue to pretend that we can either do nothing about it or have to employ the most drastic measures. A large part of the crisis was brought upon Europe by our own arrogance. I heard too many people claim that SARS-CoV2 won’t be a problem in Europe as we have much better hygiene and healthcare systems than China. Instead of preparing we lost precious time. At the point Italy announced its lockdown, their health care system was collapsing. That was not the case in Austria. Nevertheless, the Austrian government proclaimed an early and tough lockdown based on too little data. Such a lockdown likely only postpones “the curve”. The Austrian government did mimic an autocratic regime instead of consulting with other European nations upfront on how to best proceed. We could have learned from the Swedish approach, led by a task force of people with notable experience on dealing with epidemics, already in the beginning of March. The early Austrian lockdown also put public pressure on, for example, Germany not to follow the Swedish approach.
But what is done is done. Now, we need to look forward, critically reflect on all of our mistakes and try to learn from the holistic approach to tackle this crisis that is successfully demonstrated by the Swedish people. Fortunately, the learning has already started by at least partially opening the stores. But in addition, we must not give up the future of our children to win in a morbid race of short term COVID-19 body counts. We have to acknowledge that lockdown measures have a vast impact on other lethal casualties like hunger, other infectious diseases, heart attacks, alcohol abuse or suicide (see, for example, https://policy-rfc.blogspot.com/2020/04/on-comparing-numbers.html to get a better understanding of the scope of these problems). We must encourage discourse for making better decisions in the future. Publish the data and models we base our decisions on so they can be critically reviewed and improved before it’s too late. Apparently, the Austrian government miscalculated by at least a factor of 10, at least when it comes to the cost of their measures [6]. In the end, we should remember that governments tend to do what is best for them (for example, get themselves re-elected). So it is our public opinion that needs to open up for discussion of better approaches if we want to see them implemented by any government.
And who should pay for all the cost caused by Mr. Kurz’ government’s decisions? Many sources quote 38 billion Euros so far, that is 4268 Euros per capita, or more than 17000 Euros for a family of four ... and that will likely increase. I don’t know. But increasing the tax on alcohol and tobacco (maybe even sugar) would be a good start as each of these measures have the potential to save lives and improve public health as a synergy.
[1] https://www.market.unicefusa.org/inspired-gifts/polio-vaccines-to-protect-100-children/S359190/, https://unicef.at/shop/produkte/
[2] https://news.un.org/en/story/2020/04/1061892
[3] https://gesundheitsziele-oesterreich.at/english-summary/
[4] https://www.diepresse.com/5802225/kein-arzttermin-ohne-negativen-test-der-schaden-im-schatten-von-corona
[5] https://www.aftonbladet.se/nyheter/a/70OzwW/fortroendet-for-tegnell-och-lofven-okar
[6] https://www.diepresse.com/5800140/mehr-als-eine-million-osterreicher-in-kurzarbeit-oder-arbeitslos
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