It's only fair to share…

As each month passes, we are discovering more about the cost of the response to Covid19. Whilst there is a daily update on the number of cases and deaths, we here little if anything about the medical and health consequences of lockdowns. In fact, any questioning of harsh lockdowns is dismissed by supporters as proof that either one wants to “kill granny” or  that one only cares about the economy and dollars and not people.

Before looking at the actual health costs, it is critical to remind ourselves that the economy is people. A functioning economy means jobs for people. Jobs mean income and the ability to feed oneself and family, to pay bills, to afford a house, and, shock horror, maybe buy some nice things for oneself and loved ones.

Unemployment and poverty are associated with poorer health outcomes and increased all-cause mortality. Even the WHO has warned that lockdowns will increase poverty worldwide and that the poor and disadvantaged are the most vulnerable to this. The WHO has gone as far as to (quietly) advise that lockdowns are not the answer and that they should only be used short term to buy time to prepare a health system. Any country which by now is not prepared either is incapable of being or is being run by people who are incapable.

Let’s look at a just a few examples. Firstly, this from Insight.

“Children are experiencing a range of adversities as a result, including parents struggling with mental health problems and substance misuse, relationship breakdowns, financial stress, and an alarming increase in family violence. Calls to Kids Helpline have seen a 28% spike in demand in Victoria between March and July 2020. An additional 4500 Victorian children will potentially enter out-of-home care as a result of the COVID-19 pandemic, burgeoning to a total of 27 500 children in out-of-home care by 2026.

Previous predictions have been of an up to 50% increase in suicides over the next five years. This would equate to over 7500 lives lost – mostly in those under age 45.  It must be said that these predictions may not come to pass but even a 20% increase would mean far more deaths in Australia  than from Covid itself.

Much of this will be (and is already) driven by job loss, loss of business (often built up over years or decades), and loss of life saving. But beyond this is the loss of purpose which can be emotionally devastating.

So much for it only being about dollars. It is worth noting that most of the supporters of harsh lockdowns are in full employment on government wages and have suffered no ill effects. In fact, the ability to work from home has made their lives easier. It is not possible for a plumber to fix your taps working from home or for a gardener to mow your lawns at their computer.

Ray Moynihan writing on Medical Republic reports a study on healthcare utilisation had dropped by 37% between February and May compared to the previous year. This was based on a review of 81 studies from 20 countries.

To quote “ Overall, there was a 37% median reduction across all categories of health care. Visits to seek care, such as going to a GP or the emergency department fell by 42%; admissions to hospital dropped 28%; the use of diagnostic tests fell 31%; and the use of treatments, such as procedures to treat heart disease, dropped by 30%”.

It notes “Rates have bounced back in many places, but some remain significantly lower than previous years.”

Moynihan does note that the biggest drops were for mild or minor conditions. Some of these may well resolve without medical input and less demand on the health system for issues which can be self-managed is not all bad. In Italy there was an 89% reduction in visits for childhood conditions such as viruses which generally don’t need medical input.

However, “Clearly many people will have been harmed by missing out on needed care. As the authors of the English study on heart attack admissions made clear … reluctance to call an ambulance when experiencing severe symptoms, they write, results in unnecessary deaths and disability”.

There will not be a daily toll at the daily press conference. Illness and deaths from heart disease, cancer, diabetes and mental health issues (to name a few) will be buried in the usual statistics and as they will emerge over the next decade or even longer and won’t attract attention. And this does not take into account the misery of not seeing grandchildren or grandparents, funerals not attended goodbyes not said, children not understanding why they cannot visit their friends. The list of hidden problems is long and the impacts will be long lasting.

These people and their lives also matter. Next time you hear that lockdowns save lives ask at what and more importantly whose cost. Those making the decisions and their boosters are not impacted by the decisions made – and therein lies the problem.