singer181_Lane TurnerThe Boston Globe via Getty Images_uscoronavirusclosedsign

When Will the Pandemic Cure Be Worse Than the Disease?

Apr 6, 2020 Peter Singer , Michael Plant

As government mandated lockdowns to combat the coronavirus pandemic affect a rising share of the global population, fewer will die of COVID-19, as well as other transmissible diseases. But how should we weigh those benefits against the costs of unemployment, social isolation, and widespread bankruptcies?

MELBOURNE/OXFORD – As of today, almost half the world’s population, nearly four billion people, are under government-mandated lockdowns in an effort to stop the spread of the COVID-19 coronavirus.

How long should the lockdowns last? The obvious answer, to paraphrase UK Prime Minister Boris Johnson, is until we’ve “beaten” COVID-19. But when exactly will that be? Until not a single person on Earth has it? That may never happen. Until we have a vaccine, or an effective treatment? That could easily be a year away, perhaps much longer. Do we want to keep people locked down, our societies shuttered – restaurants, parks, schools, and offices closed – for that long?

It pains us to say it, but US President Donald Trump is right: “We cannot let the cure be worse than the disease.” Lockdowns have health benefits: fewer will die of COVID-19, as well as other transmissible diseases. But they have real social and economic costs: social isolation, unemployment, and widespread bankruptcies, to name three. These ills are not yet fully apparent, but they soon will be.

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Peter Singer

Writing for PS since 2001
185 Commentaries

Peter Singer is Professor of Bioethics at Princeton University and founder of the non-profit organization The Life You Can Save. His books include Animal Liberation, Practical Ethics, The Ethics of What We Eat (with Jim Mason), Rethinking Life and Death, The Point of View of the Universe, co-authored with Katarzyna de Lazari-Radek, The Most Good You Can Do, Famine, Affluence, and Morality, One World Now, Ethics in the Real World, and Utilitarianism: A Very Short Introduction, also with Katarzyna de Lazari-Radek. In 2013, he was named the world's third "most influential contemporary thinker" by the Gottlieb Duttweiler Institute.

Michael Plant

Writing for PS since 2017
3 Commentaries

Michael Plant is a post-doctoral research fellow at the Wellbeing Research Centre, Oxford, and Director of the Happier Lives Institute.

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0 Comments on this paragraph, 15 in all 15 Comments on this article

LookieLouE 1707 Apr 24, 2020

It's a shame you're buying into this false assessment of the issue at stake here. There's no tradeoff between harm due to illness and harm due to economic losses, for the 99% at least. Governments could make those economic losses completely whole, since the world's economies aren't really shut down, just restricted a bit - all it would take is some wealth transfers, direct or indirect, from the wealthy to everyone else. Here in the US conservative politicians have explicitly rejected this solution on the grounds that if benefits are too generous people will be incentivized not to go back to work. That's the real issue - conservatives want it to be capitalism, not the welfare state, which turns out to be the solution to the problem. This is a matter of political/ideological tribalism, not a utilitarian calculation, and pushing the latter only clouds the real issue being fought. As is so often the case, utilitarian analysis is mere pretext for political tribalism.
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gwen v Apr 20, 2020

There appears to be unwarranted assumptions put on the ability of 'a large economy' being able to provide more 'well-being'. Markets and governments have already changed the shape of the economy, in part burning a lot of capital yet jumping in to support people without work or unable to pay rent or even suspending developing countries debt repayments (how much well-being would that produce?).

In short authors want to predict even though they have next to no variables as to what is going to happen economically or politically, they simply assume the only future possible is the past. In contrast, epidemiologists know relatively well (in comparison) how the epidemic will unfold depending on the steps taken, they actually have a predictive model - they know the disease AND the cure.

Following this kind of utilitarian crystal ball predictions, was Hitler* 'ethically' justified to start WWII because it ultimately brought about social welfare, the UN and neo-colonialism (as opposed to regular colonialism)? Hitler's intentions should not matter right? Only the outcome. Five years of war for 70 years of prosperity for the 'world', sounds like good calculus to me.

The point is that the exact counter argument could be made: by stopping economic activity for humanitarian reasons, society may decide to organise differently long-term and aim for so-called 'well-being' rather than profit. Who knows.

*Cheap Godwin's law I know, but I figured that if we were going to be engaging into cold-hearted calculus this could be a good example.
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Andre OBrien Apr 19, 2020

Perhaps we could also objectively compare life satisfaction vs life length as a single unit of measurement. Length and quality of life are fundamentally just different dimensions of life overall. Effects on the length and quality of life can be viewed as a percentage and multiplied together to create an overall sum

For example, if lockdowns lower average long term life quality by -5%, and increase average life expectancy by +2% then we can multiply these factors together to crease a single unit (0.95 * 1.02 = 0.97 or a 3% reduction in overall life)

Also, if we’re measuring things as a percentage we’re thinking in abstractions. So in theory I think this might allow us to compare data between health and economic models to create an overall model which considers the direct health and economic effects, as well as a broader range of factors such as the effect of reduced air pollution during lockdowns
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vivek iyer Apr 15, 2020

It makes sense to sympathize with an 'identified victim' whose reality we can verify rather than some statistical abstraction which may be purely imaginary.
This is a medical problem. Places with previous experience of similar outbreaks- e.g. Kerala which suffered the Nipah outbreak just a couple of years ago- were quick to take the necessary action. In the U.K and the U.S we have had poor leadership. Boris Johnson was shaking hands with COVID victims to show off his machismo. Then he fell gravely ill. It is only now that the West has learned it has no natural immunity to problems which arise in East Asia or Africa etc. However, we have a template before us from countries like Taiwan- or States like Kerala- and so we can take proper steps. It may be that there will be a cultural change. People in the West will take to face masks and to greeting each other without shaking hands. Organizations are likely to introduce the type of screening measures for employees used in East Asia to get ahead of the problem. In affluent countries, consumers will themselves happily bear much of the expense so as to protect themselves and their loved ones. Even in relatively poor States- like Kerala- ordinary people have shown they can change their behavior and Govt. Agencies have proved quite effective. However, other parts of India are in a very dangerous position. If migrants return to their villages, there is a strong chance that the thing will become endemic and virtually impossible to eradicate.

Pandemics are not once in a lifetime occurrences. It makes sense to build administrative capacity to cope with this type of threat. Furthermore, the ageing populations of affluent countries need to take more responsibility for their own, and their families' health.

A methodologically flawed Utilitarian Cost Benefit approach, whose foolishness was realized in the Seventies, must not be allowed to drive public discourse in the third decade of the Twenty First Century. It is time for a lockdown on stupidity.
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Peter Brooks Apr 12, 2020

The calculations are false, because they assume the amount available for health care is fixed and will reduce if the lockdown continues.

If Trident is canceled and foreign occupations and invasions stopped, huge amounts of money will be available for health care, and for stimulating the economy.
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j. von Hettlingen Apr 11, 2020

Peter Singer and Michael Plant weigh the tradeoffs between a continued government lockdown to contain the pandemic, which aims to save lives, and a reopening of the country for business, in order to stave off an economic meltdown. With stock markets tumbling across the globe and millions of Americans filing claims for unemployment benefits, Trump wants to get back to business, saying: “We cannot let the cure be worse than the disease.”
The authors say Trump is right, arguing “fewer will die of COVID-19, as well as other transmissible diseases,” despite its spread. But the question is how to weigh the health benefits of a lockdown “against the costs of unemployment, social isolation, and widespread bankruptcies?” No doubt social distancing measures – limiting close contact between people by banning gatherings, closing schools and offices, encouraging remote work and urging people to maintain a six-foot distance from one another — are vital to slowing the spread of the virus.
Desperate to prevent the economy from tanking Trump said he would reassess the recommended period for keeping businesses shut and millions of workers at home, amid millions of job losses. While public health officials maintain it will take several more weeks until people can start going about their lives in a more normal fashion, Congressional Republicans resent that medical experts were allowed to set policy that has hurt the economy, pushing Trump to find ways to let people start returning to work, and to revamp the economy.
Business owners are divided – some are eager to end the more draconian measures that have been put in place, others – sharing medical experts’ concern – would rather endure the pain at once rather than face repeated, disruptive orders to stop activities in the event of a second wave of COVID-19 infections. Should Trump defy advice, there will be businesses still fearful to reopen, and employees fearful of going to work, because thousands of new infections are still being diagnosed each day.
As the economy slides deeper into recession and 16 million jobs gone in the past three weeks, a trade-off will become more urgent. Difficult compromises between doing everything possible to contain the pandemic and to save the economy will have to be reached. To keep the lockdown until “not a single person on Earth” is free from COVID-19 “may never happen.” It could take a year, “perhaps much long” until we have a vaccine to beat the virus.
The authors proposes to limit “our collective thinking” about COVID-19 and focus on the “identified cause effect”, targeting a “specific, known victim” rather than “each of a larger, vaguely defined set of individuals.” Instead of pitting “lives saved” against “lost GDP,” we need to “put them into some common unit” in making trade-offs. He believes unemployment following a lockdown, would have a very serious effect on well-being, and particularly for poorer people. And poor countries can not afford to provide that kind of assistance for their poor people.
According to the authors people will die if we open up, because of contracting the virus. But the consequences of not opening up are so severe that we will have no choice, because more people – young and old –are going to die because they are not going to get enough to eat or other basics due to the loss of income. A lockdown brings “real social and economic costs: social isolation, unemployment, and widespread bankruptcies,” hurting more people, than a pandemic kills.
He urges us to assess the overall cost to everybody in terms of years of lost – loss of quality of life, loss of well-being, due to draconian measures. “If we then estimate how much lockdowns cost the economy, we can estimate the years of healthy life we are likely to gain now by containing the virus and compare it to how many years we are likely to lose later from a smaller economy.”
COVID-19 “will be with us for some time. Are months of government-enforced lockdowns the right policy? We don’t know, and as moral philosophers, we can’t answer this question on our own. Empirical researchers need to take on the challenge of calculating the effects, not in terms of wealth or health, but in the ultimate currency, wellbeing.”
The problem is that the sense of “wellbeing” is individual and subjective. Yet containing a pandemic requires collective actions based on one-size-fits-all policies or approaches that are not tailored to individual needs. It explains why people look to China for inspiration. The authoritarian regime in Beijing is known for its utter disregard for human rights and civil liberties, placing state sovereignty before the collective good, let alone the wellbeing of individual citizens.
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Barry Rosenfeld Apr 9, 2020

All this is based on one estimate, whose construction is not discussed. Try making the value a bit higher, say by $10,000, and see what trade off emerges. And we are talking about one year, not several or many. It is little wonder that so many people dismiss "expertise" as just another elite game. Perhaps the authors would like to put a dollar value on their own lives and those of their loved ones to provide a more accurate assessment of the value of a human life.
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Mark Thomson Apr 8, 2020

The article is framed in terms of the trade-offs associated with mandatory lockdowns, yet the response of many governments to the pandemic is far from limited to this. So however you weigh up the impact on overall well-being, it's important to take account of the impact of the full suite of measures, including, for example, wage subsidies, business support packages, accelerated infrastructure spending etc.
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Dean Travers Apr 8, 2020

Thank you for this article. It begs the question what the marginal impact in average life expectancy COVID-19 (with and without measures) will be in different countries and then compare this to average life expectancy across different countries. Almost without doubt differences between countries will dwarf the impact of COVID-19. The containment measures we are taking reflect society's aversion to tragegy as protrayed on TV. The "identified cause effect" described by the authors describes the mechanism well. We should really be doing more to alleviate the differences between rich and poor counties than containing COVID-19 but that would assume that a rich life and a poor life are equal. And what an assumption that would be.
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M BW Apr 8, 2020

To everyone I have communicated with since the lockdown began in my country a few weeks ago, I have posed this very question. Unfortunately it is difficult to have this discussion without coming across as a sociopath. Therein lies the main issue for addressing it widely in the mainstream media. You come off as cold and calculating, willing to trade lives for pure hard cash. I believe it is far more nuanced than this, but it takes considerable time to explain my views further. This article will really help me share many of my own same thoughts on the issue. Much appreciated.
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Emanuel Müller Apr 7, 2020

Good and bad are subjective notions so some people might have objectively recognized that producing objective good is impossible.
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Geoff Russell Apr 7, 2020

Did people die in large numbers during the Great Depression of the 1930s? Surprisingly not. https://www.ncbi.nlm.nih.gov/pubmed/19805076

The suicide rate certainly rose, but in much smaller numbers than reasonable predictions of the rate of deaths from this virus. Some of the lives being lost already are "collateral damage"; not virus victims directly but indirect victims as a result of health systems being overwhelmed.

Fritjers back-of-envelope guess at 0.2 percent seems far too low ... but his reasoning is sound and nobody should believe the naive rates of ~10% that you get by dividing the deaths in many countries by the cases. I've seen experts saying 7-10 times worse than a bad flu season ... which implies 0.7 to 1 percent. At that rate, the collateral damage will be massive.

Fritjers argues that the additional deaths due to the virus are, in Italy, dwarfed by normal deaths ... which he puts at 2,000 per day. The actual daily deaths in Italy are closer to 1,600 per day and the thing about them is that they are very stable (it's a poisson distribution). Which means there is a little extra capacity to handle the occasional disaster, but not 600-800 per day for weeks.

So I think Fritjers greatly underestimates the impacts of the virus and overestimates the impacts of the massive economic downturn we will most certainly experience.
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Patrice Horner, CFP, MBA Apr 7, 2020

Thank you for this insightful article. This line says it all "Would the images of people dying on stretchers in tents in hospital parking lots be blinding us to the greater harm we may be causing across society......?" As posited "What we really need to do is compare the impact different policies have on our overall wellbeing.." as a community or a populace. It appears there have been errors in the initial forecasts, which prompted the shut-down policy. This complex crisis is proving difficult for economic modeling.
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