How Should We Value the Lives of Those Most at Risk?

4 April 2020. Updated 7 May 2020.

Generations to come are being saddled with high levels of public and private debt. These things kill, too. If all this is the price of saving human life, we have to ask whether it is worth paying.

The truth is that in public policy there are no absolute values, not even the preservation of life. There are only pros and cons. Do we not allow cars, among the most lethal weapons ever devised, although we know for certain that every year thousands will be killed or maimed by them? We do this because we judge that it is a price worth paying to get about in speed and comfort. Every one of us who drives is a tacit party to that Faustian bargain.

A similar calculation about the coronavirus might justify a very short period of lockdown and business closures, if it helped the critical care capacity of the NHS to catch up. It may even be that tough social distancing measures would be acceptable as applied only to vulnerable categories.

But as soon as the scientists start talking about a month or even three or six months, we are entering a realm of sinister fantasy in which the cure has taken over as the biggest threat to our society. Lockdowns are at best only a way of buying time anyway. Viruses don’t just go away. Ultimately, we will emerge from this crisis when we acquire some collective (or “herd”) immunity. That is how epidemics burn themselves out.

Jonathan Sumption, The Sunday Times, April 5th 2020

Attempting to place a monetary value on human life, using that quantum to calculate the financial benefit of extreme social distancing, and then weighing that benefit against the financial cost of the lockdown is always going to upset a lot of people, as I discovered when I had a stab at it in the Critic. There are those who think it’s morally wrong to attach a price tag to a human life – and some people reacted to my back-of-the-envelope calculation as if no decent person would ever attempt such an exercise. But it’s worth pointing out that all British governments put a cash value on the cost of extending people’s lives, including Labour governments. This may shock those unfamiliar with health economics, but there has to be an upper limit on what taxpayers can reasonably be expected to pay to keep people alive. As Dominic Lawson pointed out in the Sunday Times, “This is especially true of the NHS, a centralised, free-at-the-point-of-use system unique in the western world, which can only function on the basis of rationing (since demand for healthcare is, in effect, limitless if ‘free’).”

In my calculation, I took as a given Professor Neil Ferguson’s prediction that there would be 230,000 additional deaths from coronavirus if the Government didn’t move from a mitigation strategy to suppression and then tried to work out how many years, on average, those 230,000 had left to live. Putting to one side the issue of whether people who’ve died with COVID-19 have died from COVID-19, the average age of those patients recorded by the NHS as having died of coronavirus is 79.5. For reasons you can interrogate here, I concluded they had an average of six years left to live, so a total of 1,380,000 additional years. The National Institute for Health and Care Excellence (NICE) values a quality-adjusted life year (QALY) at between £15,000 and £30,000 when deciding how much money to spend on new medicines, with an additional year of perfect health being valued at the top end. My assumption that each of the people who would otherwise die of COVID-19 will live another six years is based on data from Wuhan showing that 67% of patients who’ve died have had comorbidities – but I haven’t factored in the 37% of them that didn’t and would have had longer to live, on average, than six years. But to compensate for this, I’ve attached the upper limit of £30,000 to each QALY (unrealistically high, given that a majority of the people in question have underlying health conditions), giving a total value of the lives saved of £41.4 billion. So the question is: Will the lockdown cost more or less than £41.4 billion?

Actually, £41.4 billion is probably an under-estimate. For one, Professor Ferguson predicted an additional 230,000 would die if we didn’t introduce extreme social distancing and if everyone who become critically ill with COVID-19 received the hospital care they required. In fact, according to Imperial College’s modelling, the demand for critical care in the mitigation scenario would be eight times greater than the NHS’s emergency surge capacity. And even if we inflate that 230,000 to allow for this, that still doesn’t account for the number of deaths that pursuing a mitigation strategy would result in because it doesn’t include the increase in the number of people dying from other diseases because the NHS would be overwhelmed. According to Fraser Nelson, the Government has calculated that 150,000 non-COVID-19 patients will die if the lockdown remains in place because hospitals are prioritising patients with the virus. As far as I know, no one has calculated how many non-COVID-19 patients will die if the lockdown is ended.

So the financial benefit of keeping the lockdown in place, in terms of the monetary value of the additional years of life granted to those people who would otherwise die of the virus, is greater than £41.4 billion. But then, so is the cost of the lockdown. According to the Resolution Foundation, it could cost the Treasury as much as £40 billion every three months just to pay the wages of furloughed workers. The Centre for Economics and Business Research estimates the lockdown is costing £2.4 billion-a-day. That means that by April 12th we were already £50bn out of pocket. Of course, the Treasury would have to be paying out some of that money anyway even if we’d stuck with the mitigation strategy. As Sam Bowman said in his reply to my article in the Critic, “the relevant counterfactual is not business as usual, but some unavoidable level of economic slowdown caused by the virus and people’s individual attempts to avoid it”.

I should say that even if the financial cost of the lockdown is higher than its financial benefit in terms of QALYs, I don’t consider that a knock-down argument for ending the lockdown. (And by “ending”, I don’t mean the total abandonment of non-pharmaceutical interventions, just something more like the Swedish approach, i.e., the quarantining of the vulnerable, banning gatherings of over 50 people, washing hands, wearing masks, working from home where possible, etc.) From a moral point of view, I can see the argument that the vulnerability of those most at risk – their advanced age, as well as their poor underlying health – means we have a greater obligation to protect them, not a lesser. But if we accept that argument, we’ll have to overhaul the current method we use for attaching a monetary value to human life, which is based on QALYs.

While this isn’t a decisive way of settling the argument about the lockdown, it’s a factor that should be taken into account and weighed alongside the others. A more important factor is the long-term damage a prolonged lockdown will do to the economy and the impact that will have on public health, ultimately leading to a greater loss of life than ending the lockdown will.

Further Reading

The Corona Dilemma‘ by Paul Frijters, Club Troppo, March 21st 2020

All lives aren’t equal, but we still want them saved‘ by Dominic Lawson, The Sunday Times, March 29th 2020

A Health Economic perspective on COVID-19‘ by Dr Malcolm Kendrick, drmalcolmkendrick.org, March 29th 2020

Has the government overreacted to the Coronavirus Crisis?‘ by Toby Young, The Critic, March 31st 2020

Why the coronavirus shutdown is worth it‘ by Sam Bowman, The Critic, April 1st 2020

A response on the cost of the coronavirus shutdown‘ by Toby Young, The Critic, April 2nd 2020

How to live with Covid-19‘ by Andrew Sullivan, New York, April 3rd 2020

The ‘False Debate’ About Reopening the Economy Is the One That Ignores the Enormous Human Cost of Sweeping COVID-19 Control Measures‘ by Jacob Sullum, Reason, April 13th 2020

Coronavirus: Nine in 10 dying have existing illness‘ by Nick Triggle, BBC News, April 16th 2020

Why are we really in lockdown?‘ by Jemima Kelly, Financial Times, April 17th 2020

“Discriminatory” lockdown should be eased for the healthy elderly, say senior doctors‘ by Chris Jewers, Mail on Sunday, May 2nd 2020

The cost of saving lives in this lockdown is too high‘ by Russell Lynch, Telegraph, May 5th 2020

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