13 December 2020 — Sebastian Rushworth M.D.
You would think that governments always do a cost-benefit analysis before embarking on a certain course of action, especially if it is likely to have significant effects on many different aspects of society. The global lockdowns in response to the covid pandemic probably constitute the largest, most extreme measures taken by western governments since the second world war. So, you would think a careful cost-benefit analysis would have been done before the decision was made to lock down.
Apparently, if you thought that, you would be wrong. As far as I am aware, not a single government anywhere has presented a carefully deliberated cost-benefit analysis, in which they look at all aspects, and then explain why they think lockdown is the right decision, in spite of all the likely harms.
Since no government has bothered to do this (at least publicly), we’re going to help out. This article will by no means be exhaustive, since the harms are innumerable, affecting every aspect of life. Instead, I’m going to focus on two things that I think are representative of wider harms, cardiovascular health and children’s health.
As I mentioned in a previous article, during the covid peak in spring in Stockholm, hospital admissions due to heart attacks were down 40% . Presumably the number of people having heart attacks didn’t decrease by 40%, so most likely a lot of people were having heart attacks but choosing to stay home for fear of catching covid. It seems similar patterns have been seen around the world. This is a big problem, for two reasons. Firstly, the risk of sudden cardiac death immediately after a heart attack is big. Secondly, if you have a heart attack and don’t get emergent treatment, you are at much bigger risk of permanent damage to your heart, which can result in chronic heart failure.
A study was published in Heart in September that sought to understand what the effects of the first lockdown were on cardiovascular mortality in the UK. The researchers looked at official mortality data for the first UK lockdown (March to June), and compared it with the average for the same time period during the preceding six years. What did they find?
There was an 8% increase in cardiovascular mortality during the lockdown, compared with what would normally be expected for the time period. At the same time, the proportion of cardiovascular deaths happening in hospitals decreased from 63% to 53%, while the proportion happening out of hospital (in private homes or care homes) increased from 37% to 47% .
What does this tell us?
Well, the data is observational, so it’s hard to draw causal conclusions, but we can make some reasonable guesses. The authors of the article think it is likely that fear of covid caused people to seek help later than they normally would have. Therefore, more people died outside of hospital, and more people died overall, because they didn’t get the help they needed for their cardiovascular emergency. I think that is a very reasonable conclusion. And it is supported by one additional data point, which is that a larger share of the people who died in hospital after having a heart attack died of cardiogenic shock or ventricular arrythmia – complications that are more often seen when people seek treatment late.
Another study was published in June in Neurological Sciences. The purpose of the study was to see what impact lockdown measures had on patients with stroke. The study was carried out in one hospital in Italy. All journal data from patients entering the hospital from March 11th and one month forward (the first month of national lockdown in Italy) were gathered. The data were then compared with journal data for the same time period in 2019. In total, 52 people came in to the hospital with strokes during the one month period in 2020, compared with 41 in 2019.
Before we get in to the results, I should mention that a stroke is a time critical emergency, just like a heart attack. A common saying, that I’m sure many people will have heard before, is “time is brain”. In other words, every extra hour of delay before getting treatment increases the risk of a bad outcome.
In 2019, the average time from beginning of symptoms to arrival in the hospital was 161 minutes. In 2020, the average time had more than doubled, to 387 minutes.
One treatment that is used for strokes is thrombolysis, where a drug that breaks up blood clots is infused in to the blood stream. But thrombolysis is a time critical treatment – studies have shown no benefit when it is given more than 4,5 hours after the beginning of symptoms, so patients who arrive later are not eligible for this treatment. The delay in arrival in the hospital meant that there was a significant reduction in the proportion of patients who received thrombolysis, from 32% to 14% .
Now, this was a small study, but the doubling in time to arrival at the hospital was highly statistically significant, and unlikely to have been due to chance. As with the previous study, the authors suggest that the delay in seeking help was due to fear of covid.
So, we have two studies which point in the same direction, that people have been slower to seek help for medical emergencies due to an overblown fear of covid. This delay has likely resulted in a significant number of deaths. Now, of course, deaths due to delays in seeking treatment aren’t directly due to lockdown. Rather, they are due to government and media fear mongering. But that fear mongering has been, and continues to be, knowingly used as a tool to get people to accept tough restrictions.
In an earlier article, I mentioned that childhood vaccination programs in many developing countries had been put on hold due to the global obsession with covid, and that this will likely result in many more years of life lost than are lost directly due to the SARS-CoV-2 virus. But we don’t need to go to developing countries to see children being harmed by the disproportionate response to covid.
An article was published in the Journal of the American Medical Association (JAMA) in November, that sought to calculate the cost, in terms of life years lost, of taking children out of school. Now, this article was based on modeling, which I’m generally skeptical of, because you can get pretty much whatever outputs you want, depending on what inputs you choose and what assumptions you make in the model.
However, the study sought to do something which has largely been ignored in the public debate around school closures, which is to make the harms of school closures concrete in a way that would allow them to be compared to the more direct and obvious harms of SARS-CoV-2. In other words, they sought to create a situation where you’re comparing apples with apples. Therefore I think it’s worth talking about.
So, what they did was model to what extent being taken out of school for a period of time affects longer term educational attainment. The assumptions that were fed in to the model came from an earlier analysis of a teacher’s strike in parts of Argentina, which had resulted in significantly lowered long term educational attainment for children in regions where the strike resulted in prolonged absences from school.
The outputs of these calculations were then fed in to a second model that used data on how educational attainment affects longevity, in order to determine the effect of school closures on long term mortality for the affected children.
Schools across the US were shut for a median of 54 days during the first covid wave. Based on their modeling, the authors estimate that this 54 day hiatus will result in affected boys living four months shorter lives, on average, than they otherwise would have, and affected girls living two and a half months shorter lives than they otherwise would have.
Overall, 24 million primary school children across the US were affected by the school closures. That would mean about 6 million years of life lost just due to the school closures in spring. At this point in time, 300,000 people have died in the US from covid. If we assume around 7 years of life are lost per person dying of covid (probably generous, as I have discussed in a previous article), that would mean around two million years have so far been lost directly to covid in the US. So by that estimate, the two month school hiatus in spring will result in three times as many years of life lost as have so far been lost directly to the virus.
Like I said, this is a modeling study, so the specific inputs used and numbers arrived at can be criticized in plenty of different ways, but the overall point that is made is sound. Taking children out of school is harmful to them, both over the short term and the long term, and that should be factored in to any decision to keep children out of school “for the greater good”. Just because harms are invisible over the short term doesn’t mean they’re not real.
So, the global covid hysteria has resulted in suspension of childhood vaccine programs, and in school closures, both of which will likely result in many more years of life lost than will ever be lost to the virus directly. Can the situation for children get any worse?
Apparently, yes it can. An article was published in the British Medical Journal in July, written by a group of doctors working at the Great Ormond Street children’s hospital in London. The authors noted that the incidence of abusive head trauma in children arriving at their hospital had increased by 1,500% in the first month of lockdown (23rd March to 23rd April), when compared with the same period in preceding years. In other words, there was a 15-fold increase in children getting beaten so badly by their caregivers that they ended up in hospital with severe head trauma.
The authors report that all the children lived in poorer neighborhoods, and 70% had parents with known underlying vulnerabilities (criminal records, mental health issues, or serious financial distress). Obviously, most people won’t start physically abusing their children just because they’re stuck at home with them all day for months on end, but for children that are already at risk, the risk increases substantially.
So, what can we conclude from all this? Very simply, lockdown and the fear-mongering that goes with it almost certainly kills many more people than it saves, and it certainly results in many more years of life lost.
You might also enjoy my article about whether lockdown prevents covid deaths or my article about how many years of life are lost, on average, when someone dies of covid.