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The British Office for National Statistics concludes that the impact of the lockdown in terms of QALY (quality-adjusted life year) is higher than that of the di

The British Office for National Statistics concludes that the impact of the lockdown in terms of QALY (quality-adjusted life year) is higher than that of the disease itself: > from March 2020 to more than five years from now, the impacts of lockdown and a resulting recession are estimated to reduce England’s health by over 970,000 QALYs – the health impacts of contracting COVID-19 are still unclear in the long term, but between March 2020 and March 2021, these represent 570,000 lost QALYs[1] That being said, > While these negative health impacts of lockdown exceed the impacts of COVID-19 directly, they are much smaller than the negative impacts estimated for a scenario in which these measures are not in place; without these mitigations, the impact of direct COVID-19 deaths alone on both mortality and morbidity would be much higher – an estimated 439,000 excess deaths resulting from COVID-19, and 3,000,000 QALYs lost.[1] [1]: https://www.ons.gov.uk/news/statementsandletters/estimatingtheimpactsofcoronavirusonenglandsmortalityandmorbidity https://www.ons.gov.uk/news/statementsandletters/estimatingt...

iso1631 6y ago
So what you mean to say is The British Office for National Statistics concludes that the impact of the covid with lockdown in terms of QALY (quality-adjusted life year) is far lower than impact of covid without lockdown
- jozvolskyef 6y ago
  That is what I said in the second half of my comment. These two statements are not contradictory. To be precise, the cost of lockdown is 1/3 of the cost of unmitigated covid. The cost of lockdown is mostly borne by the young and healthy while the cost of non-lockdown is mostly borne by the vulnerable. It is a trolley problem.
  - onethought 6y ago
    But the cost borne is very different. One the cost is death. The other the cost is hardship... how can you compare the two?
    - jyBKJpc2P6 6y ago
      ONS compares QALY costs in both cases. In essence QALY is a measure of how much people value their life relative to suffering from some condition. The weighting for QALY calculations is based on asking relevant questions such as whether a patient would rather live with their condition or undergo an intervention that may either kill or cure them.
      - onethought 6y ago
        So I’m a perfectly healthy 65 year old, and there is a perfectly healthy 25 year old.* Could you explain how to use QALY to decide whether lockdowns are worth the (very treatable) risk of mental health deterioration vs not locking down and facing the very untreatable risk of death? *(Actually there are 10,000s of each)
        jozvolskyef 6y ago
        The report I'm quoting[1] estimates the lockdown scenario to cost 182k QALYs in mental disorders, 190k QALYs in musculoskeletal disorders, and 157k QALYs in cardiovascular disorders.[1] Note that if your only risk factor is being 65 years old, implying you are female, it isn't necessarily the case that covid impacts you worse than lockdown. [1]: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907616/s0650-direct-indirect-impacts-covid-19-excess-deaths-morbidity-sage-48.pdf https://assets.publishing.service.gov.uk/government/uploads/...
    - criddell 6y ago
      Isn't this actually a fairly routine calculation?
    - scatters 6y ago
      Everyone dies eventually. So a premature death means months or years of life lost, which can be compared against months or years of less full life due to hardship.
  - TheOtherHobbes 6y ago
    The cost of non-lockdown would also be borne by the young and healthy, because there would be second order effects - including job losses, business failures, panic buying and food shortages, possible civil unrest, collapse of existing health systems, and loss of essential skilled people at all levels. Among others. There is no trite healthy vs vulnerable tradeoff here, and it's simply a fantasy to believe that everyone under 40 would be able to get on with life without consequences while the over-55s were dying off quietly. The reality is far more complicated. Letting Covid run wild would have been far more damaging than mitigation in a huge number of ways - economic, psychological, political, medical, and more. The one area of valid debate is whether good mitigation strategies were chosen and implemented wisely. Often they weren't. Test and trace, masking, and PPE provision should have been central, allowing more limited lockdowns. In the most badly hit countries none of that happened, and without them full-spectrum lockdowns were the only (blunt) tool that was left.
    - filmgirlcw 6y ago
      > The one area of valid debate is whether good mitigation strategies were chosen and implemented wisely. Often they weren't. Test and trace, masking, and PPE provision should have been central, allowing more limited lockdowns. > In the most badly hit countries none of that happened, and without them full-spectrum lockdowns were the only (blunt) tool that was left. This exactly. I get really frustrated with the simplistic argument over whether lockdown measures have been better or worse than doing nothing, because it misses that these were not the only two options. Not even close. When you look at how countries that reacted quickly to the virus and implemented, masking, testing, PPE provisions and sensible social-distancing requirements, it is clear that those countries were able to recover, both economically and socially. In areas, like the United States, that waited until it was too late to do anything, and then were forced to implement lockdowns, the outcome is far worse and the aggregate human toll — irrespective of death count due to the virus — much greater. As a strong supporter of civil liberties, I’m in a difficult position, when I try to balance some of the more draconian state-run actions of places like Singapore, Taiwan, and South Korea, with the effects we see in the United States. For all of the many negatives of that kind of government/militaristic control, I can’t help but think that if the US had done that, the global economy, not to mention all of the industries that have evaporated in the US, would have recovered much more strongly by now. This is absolutely not a trolley problem. This didn’t have to be a choice between two negative outcomes. There were ways to mitigate exposure that could have saved people from dying from the coronavirus, while also limiting the debilitating impact of lockdown. The world's biggest superpower just didn’t do that.
tylerjwilk00 6y ago
That's a fair shake and glad to read about this report's details. Reassuring knowing the thought that went into the decisions. That said, one scenario is a theoretical estimate (based on data from July) which we will never know for certain the outcome.
greedo 6y ago
These studies all assume that there wouldn't be a recession without a lockdown. This is fallacious. Even without a lockdown, consumers are going to stop going to large events, restaurants, movies etc when they see that it causes death...
- stouset 6y ago
  You might have missed reading the entire comment you replied to. The authors of the study explicitly stated that while the effects of the lockdown exceed the effects of COVID, the net effects of no lockdown would be worse.
  - Thorrez 6y ago
    I think what greedo is saying is that since the stuff would happen anyway, it shouldn't be attributed to the lockdown, but should be attributed to COVID. That is, instead of having 2 categories: (1) effects of COVID and (2) effects of lockdown, with economic downturn put in effects of lockdown, there should be 3 categories: (1) direct effects of COVID, (2) indirect effects of COVID, and (3) effects of lockdown, with economic downturn put in indirect effects of COVID (or at least largely there).
    - jozvolskyef 6y ago
      The paper is available here if anyone's interested: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907616/s0650-direct-indirect-impacts-covid-19-excess-deaths-morbidity-sage-48.pdf https://assets.publishing.service.gov.uk/government/uploads/...
- Mediterraneo10 6y ago
  Every time lockdown has been lifted in the country I live in, the restaurants and pubs have quickly gone back to full capacity even as deaths continue and the state only lessened restrictions to improve consumption. The general public has a vague awareness that the victims of COVID are overwhelmingly people aged 75+ with multiple comorbidities. Deaths of younger people are statistical outliers, and claims of "long COVID" are mainly uniformed self-diagnosis by people on the internet, the same people who before COVID were claiming to have "chronic Lyme disease". Furthermore, that elderly demographic that represents the real risk group, doesn't contribute to the economy much anyway. (In Russia and other economies based on resource extraction, for example, thinktanks have referred to such as "superfluous population").
disabled 6y ago
Just FYI, QALYs/DALYs are considered an unethical measure by the European Union, and they have asked governments to abandon its use. One of the reasons why is because it is a simple, linear calculation that values abled-bodies’ lives over disabled people. That is basically the entire premise of the measure, too. It is a human rights issue. Unfortunately countries like the UK, Canada, and Australia routinely use it. The UK does so especially, and it is well embedded in its NICE guidelines. In the US, this practice was generally abandoned with the passing of the Affordable Care Act. The US system, certainly is the most problematic system of all, though.

iso1631 6y ago

So what you mean to say is The British Office for National Statistics concludes that the impact of the covid with lockdown in terms of QALY (quality-adjusted life year) is far lower than impact of covid without lockdown

jozvolskyef 6y ago
That is what I said in the second half of my comment. These two statements are not contradictory. To be precise, the cost of lockdown is 1/3 of the cost of unmitigated covid. The cost of lockdown is mostly borne by the young and healthy while the cost of non-lockdown is mostly borne by the vulnerable. It is a trolley problem.
- onethought 6y ago
  But the cost borne is very different. One the cost is death. The other the cost is hardship... how can you compare the two?
  - jyBKJpc2P6 6y ago
    ONS compares QALY costs in both cases. In essence QALY is a measure of how much people value their life relative to suffering from some condition. The weighting for QALY calculations is based on asking relevant questions such as whether a patient would rather live with their condition or undergo an intervention that may either kill or cure them.
    - onethought 6y ago
      So I’m a perfectly healthy 65 year old, and there is a perfectly healthy 25 year old.* Could you explain how to use QALY to decide whether lockdowns are worth the (very treatable) risk of mental health deterioration vs not locking down and facing the very untreatable risk of death? *(Actually there are 10,000s of each)
      - jozvolskyef 6y ago
        The report I'm quoting[1] estimates the lockdown scenario to cost 182k QALYs in mental disorders, 190k QALYs in musculoskeletal disorders, and 157k QALYs in cardiovascular disorders.[1] Note that if your only risk factor is being 65 years old, implying you are female, it isn't necessarily the case that covid impacts you worse than lockdown. [1]: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907616/s0650-direct-indirect-impacts-covid-19-excess-deaths-morbidity-sage-48.pdf https://assets.publishing.service.gov.uk/government/uploads/...
  - criddell 6y ago
    Isn't this actually a fairly routine calculation?
  - scatters 6y ago
    Everyone dies eventually. So a premature death means months or years of life lost, which can be compared against months or years of less full life due to hardship.
- TheOtherHobbes 6y ago
  The cost of non-lockdown would also be borne by the young and healthy, because there would be second order effects - including job losses, business failures, panic buying and food shortages, possible civil unrest, collapse of existing health systems, and loss of essential skilled people at all levels. Among others. There is no trite healthy vs vulnerable tradeoff here, and it's simply a fantasy to believe that everyone under 40 would be able to get on with life without consequences while the over-55s were dying off quietly. The reality is far more complicated. Letting Covid run wild would have been far more damaging than mitigation in a huge number of ways - economic, psychological, political, medical, and more. The one area of valid debate is whether good mitigation strategies were chosen and implemented wisely. Often they weren't. Test and trace, masking, and PPE provision should have been central, allowing more limited lockdowns. In the most badly hit countries none of that happened, and without them full-spectrum lockdowns were the only (blunt) tool that was left.
  - filmgirlcw 6y ago
    > The one area of valid debate is whether good mitigation strategies were chosen and implemented wisely. Often they weren't. Test and trace, masking, and PPE provision should have been central, allowing more limited lockdowns. > In the most badly hit countries none of that happened, and without them full-spectrum lockdowns were the only (blunt) tool that was left. This exactly. I get really frustrated with the simplistic argument over whether lockdown measures have been better or worse than doing nothing, because it misses that these were not the only two options. Not even close. When you look at how countries that reacted quickly to the virus and implemented, masking, testing, PPE provisions and sensible social-distancing requirements, it is clear that those countries were able to recover, both economically and socially. In areas, like the United States, that waited until it was too late to do anything, and then were forced to implement lockdowns, the outcome is far worse and the aggregate human toll — irrespective of death count due to the virus — much greater. As a strong supporter of civil liberties, I’m in a difficult position, when I try to balance some of the more draconian state-run actions of places like Singapore, Taiwan, and South Korea, with the effects we see in the United States. For all of the many negatives of that kind of government/militaristic control, I can’t help but think that if the US had done that, the global economy, not to mention all of the industries that have evaporated in the US, would have recovered much more strongly by now. This is absolutely not a trolley problem. This didn’t have to be a choice between two negative outcomes. There were ways to mitigate exposure that could have saved people from dying from the coronavirus, while also limiting the debilitating impact of lockdown. The world's biggest superpower just didn’t do that.

tylerjwilk00 6y ago

That's a fair shake and glad to read about this report's details. Reassuring knowing the thought that went into the decisions. That said, one scenario is a theoretical estimate (based on data from July) which we will never know for certain the outcome.

greedo 6y ago

These studies all assume that there wouldn't be a recession without a lockdown. This is fallacious. Even without a lockdown, consumers are going to stop going to large events, restaurants, movies etc when they see that it causes death...

stouset 6y ago
You might have missed reading the entire comment you replied to. The authors of the study explicitly stated that while the effects of the lockdown exceed the effects of COVID, the net effects of no lockdown would be worse.
- Thorrez 6y ago
  I think what greedo is saying is that since the stuff would happen anyway, it shouldn't be attributed to the lockdown, but should be attributed to COVID. That is, instead of having 2 categories: (1) effects of COVID and (2) effects of lockdown, with economic downturn put in effects of lockdown, there should be 3 categories: (1) direct effects of COVID, (2) indirect effects of COVID, and (3) effects of lockdown, with economic downturn put in indirect effects of COVID (or at least largely there).
  - jozvolskyef 6y ago
    The paper is available here if anyone's interested: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907616/s0650-direct-indirect-impacts-covid-19-excess-deaths-morbidity-sage-48.pdf https://assets.publishing.service.gov.uk/government/uploads/...
Mediterraneo10 6y ago
Every time lockdown has been lifted in the country I live in, the restaurants and pubs have quickly gone back to full capacity even as deaths continue and the state only lessened restrictions to improve consumption. The general public has a vague awareness that the victims of COVID are overwhelmingly people aged 75+ with multiple comorbidities. Deaths of younger people are statistical outliers, and claims of "long COVID" are mainly uniformed self-diagnosis by people on the internet, the same people who before COVID were claiming to have "chronic Lyme disease". Furthermore, that elderly demographic that represents the real risk group, doesn't contribute to the economy much anyway. (In Russia and other economies based on resource extraction, for example, thinktanks have referred to such as "superfluous population").

disabled 6y ago

Just FYI, QALYs/DALYs are considered an unethical measure by the European Union, and they have asked governments to abandon its use. One of the reasons why is because it is a simple, linear calculation that values abled-bodies’ lives over disabled people. That is basically the entire premise of the measure, too. It is a human rights issue. Unfortunately countries like the UK, Canada, and Australia routinely use it. The UK does so especially, and it is well embedded in its NICE guidelines. In the US, this practice was generally abandoned with the passing of the Affordable Care Act. The US system, certainly is the most problematic system of all, though.