The Crisis

The Corona Virus has brought us COVID-19, and has led to the worst crisis since world war II in Switzerland, at least in terms of economy, military mobilization and limitation of basic rights. Along it has caused more than 1000 deaths in Switzerland, which is a tragedy. However, even if Trump used to words that the cure shouldn’t be worse than the disease, there is still truth in it.

The Pantheon in Rome

Only time will tell us the answer to the question whether the lockdown and other actions taken have been appropriate or not, and this will involve a big ethical discussion on balancing limitations of basic rights vs. safety in a pandemic situation.

However, we can still use some assessment to quantify the impacts of the lockdown on human health to balance with the toll of the disease. An obvious choice is the approach of the World Health Organization (WHO) to account for the “burden of diseases”. They quantify the burden as a lost year of "healthy" life and call it disability adjusted life year (DALY). It accounts for years lived with a handicap as well as years lost to premature death (life expectancy at birth is around 80years). An example: Living 50 years with Asthma, corresponds to 5 years premature death, since Asthma leads to a 10% disability as reported by WHO; dying from a disease with age 10 is corresponding to ~70 years premature death.

The Disease

Before Easter 2020, 755 people died from COVID-19 in Switzerland and some report assumed as many have been saved due to the actions taken by the government. By now, probably many more have been saved and we did not know about the impact in March. The average age of people dying is 83 and thus above the expected lifetime at birth, while only 5 people died below age 50. WHO accounts for life expectancy at the age of death and for people aged 80+, there is still ~5 years life expectancy. Applying the Burden of disease calculation with conservative assumptions, COVID-19 caused ~6000 DALY at that time (in Switzerland), with an average loss of 8 DALYs per death, which is a low number. Since 97% of people dying from COVID-19 had serious previous health issues, life expectancy is supposed to be lower than the average at their age. Therefore, the DALY estimate is most probably an over-estimate. Numbers for the US also indicate that about half the COVID-19 fatalities are 80 years or older. It has to be noted that the potential long-term impacts of the disease are not accounted for here.

The Cure

In Switzerland, ~8 million people are affected by lockdown, which has reportedly led to mental health impacts as well as domestic violence. Assuming that the lockdown affects our health (or quality of life by 1%, 5% or 10% leads to a hypothetical “burden of disease” of 6’666, 33’333 and 66’666 DALYs for each month of lockdown in Switzerland.

Personally, I would assume the toll to be similar to Asthma (10%), which makes the number of the lockdown toll 10 times higher than the direct impact of COVID-19 for the Swiss population (when not accounting for potential long-term impacts of the disease).

The Ethics

Above considerations are on top of the economic dimension and of course it involves ethics: the toll of death is suffered mainly by the old and sick people, while the lockdown largely affects the working class and kids. I don’t judge here, but WHO does weigh old people’s death lower than younger ones. In fact, it is nice to see the solidarity the crisis has provoked among the people.

However, if we go into ethics, there is some other considerations. For instance, Malaria kills > 400’000 people every year, which means downscaled to Switzerland 400 people/year. The affected people are predominantly kids with a much higher life loss per case of premature death: Based on WHO reports, the average loss of years is about 40 years per death, which makes the DALY toll of Malaria almost 20 millions per year (and every year), scaled to Swiss population it would be ~20’000 DALYs/year.

While Switzerland spends ~ 20 billion US dollars per month to fight the crisis (and compensate the lockdown economic costs), in whole 2016, less than 5 billion US dollars have been spent worldwide to combat Malaria (estimated by a Lancet study). And this is just Malaria, which is one of many causes killing millions of people every year due to underdeveloped health and food supply systems.

The Learnings

We need to have the ethical discussion after the crisis is over, but we can already take some learnings: If we can spend so much money for saving DALYs from COVID-19, we should spend much more money on combating Malaria and other health issues around the world, which is affecting way more people and causing much higher burden of diseases, continuously. Obviously, we don’t know this people and human nature might limit empathy over distance.

Not sure what COVID-19 will cause in Africa and other poor regions, but strengthening the health system and access to food and safe water should be again a priority of our society – we live in a globalized economy and thus we have a globalized social responsibility. We should therefore extend our solidarity beyond national boundaries and the current time of crisis. Reducing our living standard to finance basic healthcare and nutrition around the world wouldn’t be as hard as the lockdown.