Look her in the eyes
...and tell her that her life is worth one tenth of a COVID patient
EVERY YEAR, WE ALLOW THOUSANDS of people to die in the United Kingdom, including young people with families, and children. These are the people with treatable illnesses, for whom we could budget more money to pay for treatment that would extend their lives, but for whom we choose not to.
And so they die. It’s not comfortable, but almost everyone accepts it (or, more accurately, almost no-one thinks about it) because—what else can you do, when the supply of money is not infinite?
The rules by which we decide whom we treat, and from whom we withhold treatment, are set out in the National Institute for Health and Care Excellence (NICE) “Guidelines manual”.1 Broadly speaking, the cost of a proposed treatment is divided by the number of years that the treatment is expected to extend the treated person’s life by. If that cost is more than £30,000 per year of extended life (£50,000 for the elderly), then treatment is withheld,2 and the person is allowed to die.
Because the elderly have lower remaining life expectancies than the young, a consequence of this approach is that we generally spend less per person on the treatment of the elderly than on the treatment of the young. That’s not because we value the people whom we love and who are elderly any less. It’s because we—and they—recognise instinctively that diverting finite resources from preventing the death of someone with a full life left to live to someone who has lived a full life would be one of the deepest kinds of injustice.
Knowing this, we can ask a simple question: how much did we spend on the policies intended to prevent death from COVID-19, and how does it compare to the amount we usually spend preventing death?
To answer this, we need an estimate of the number of lives saved by these policies; the median life expectancy of the saved; and the amount of money spent saving them. Dividing the amount spent by the product of the number of lives saved and the remaining life expectancy of years of each saved life gives us a rough number we can compare with the NICE threshold at which we deny treatment to non-COVID disease.
Estimating the number of lives saved by COVID policies is complicated by the order-of-magnitude errors in every estimate ever produced by SAGE models. But The London School of Economics has used SAGE’s model to estimate it at 159,000, and it’s no worse that any other.3 The Office for National Statistics estimate the median age of death due to COVID to be 81 for men and 85 for women4, and remaining life expectancies at those ages to be 85 and 7 years respectively: let’s use 7.5.6 The National Audit Office estimates government spending on COVID-19 policies at the end of March 2021 at £372 billion.7
This yields ( £372bn / (159,000 x 7.5) ) £312,000 per year of life extension, to mitigate a single disease that largely targets geriatrics, and largely substitutes for (rather than adds to) one of the dozens of other major causes of death for those who have lived longer than the average human lifespan.
That’s six times the usual limit for end-of-life treatments, and ten times the limit for “ordinary” fatal diseases, i.e. those that kill young people. To put this another way: under UK COVID policies, the life of a young mother at risk from breast cancer is worth one tenth of the value of the life of someone who has lived longer than the average human life span and is who is at risk from COVID.
And this simple estimate is highly conservative. We’ve taken at face value the SAGE estimate of lives saved.8 We’ve ignored costs and harms incurred after March 2021, which will continue to accumulate for decades. And we’ve ignored any adjustment for differences in quality of life (QALY) between sufferers of COVID and other diseases.9 In practice, we value the young woman’s life far less even than this.
£372 billion is a lot of money. Specifically, in the UK, it’s the equivalent of 700 years of funding for cancer research; 2,200 years of funding for chronic heart disease; 4,100 years of funding for dementia; and 6,700 years of funding for stroke—the leading causes of death, especially in geriatrics.10
The UK government continues to refuse to publish a cost/benefit analysis of its COVID policies. A government study that demonstrated that there has been a net benefit—that is, protecting geriatrics has saved more years of life (on a QALY basis) than it has cost—would be very helpful in its struggling £1 billion propaganda programme. From its silence, it’s reasonable to assume that they are unable to demonstrate there has been a net benefit.
Meanwhile, even if spending £374 billion on preventing deaths from this disease in older people has provided some net benefit, that benefit is far less than it would have been by using it to prevent deaths from diseases affecting younger people.11 For that amount of money, for example, on behalf of the entire world the UK could have found a cure to one of the cancers and prevented millions of deaths. With the amount we spend every week fruitlessly testing symptomless young people in schools for the infinitessimal threat they pose to older people, we could have built a new General Hospital every week to treat actual disease in.
They have impoverished our country, and irreversibly harmed the education and social development of our children. The burden has fallen disproportionately on the most disadvantaged.
They didn’t have to.
The symptoms of COVID-19, for the vast majority of people, are no worse than the symptoms of bad flu—which each year causes little significant economic damage.
For the relatively small number for whom those symptoms are worse, they could have continued to apply the £30,000-per-year limit (£50,000 for the elderly) we apply to all diseases, treating tens of thousands and protecting hundreds of thousands more—without quarantining and harming the healthy.
Treatment costs would have risen, and rightly so—but to a fraction of the debt we’ve imposed on a generation of young people. To the number of people who normally die every year because we limit treatment budgets, more would have been added—because we applied exactly the same limit. Each death would have been sad—but no sadder than any of the thousands of deaths we routinely allow each year by withholding preventative treatment. No death would have been unfairer than any other death that we can prevent but choose not to.
But instead, despite routinely tolerating the deaths of young and old people from many diseases, they decided not to tolerate the deaths in a single group of people from a single disease. They increased the funding threshold by an order of magnitude, diverting finite resources from preventing the deaths of those with their whole lives still to live to those who have lived full lives, and accumulating an extravagant level of debt that will kill the economy and decimate life expectancy when global interest rates rise in a few years. They even neglected the diagnosis and treatment of existing diseases in young people, harming them even further.
18 months ago, almost everyone accepted that we have to let some people die. What changed?
National Institute for Health and Care Excellence (NICE) . “The guidelines manual: 7.3 Economic evidence and guideline recommendations” [link]
For clarity, it’s not a hard cut-off. NICE guidance states the following: “As the [incremental cost-effectiveness ratio] of an intervention increases in the £20,000 to £30,000 range, an advisory body's judgement about its acceptability as an effective use of NHS resources should make explicit reference to the relevant factors considered above. Above a most plausible ICER of £30,000 per QALY gained, advisory bodies will need to make an increasingly stronger case for supporting the intervention as an effective use of NHS resources with respect to the factors considered above.” You can get more, but above £30,000 per year, it quickly gets harder and harder.
Dolan, P., Jenkins, P. ‘Estimating the monetary value of the deaths prevented from the UK Covid-19 lockdown when it was decided upon – and the value of “flattening the curve”’. London School of Economics, 18 April 2020 [link].
This is a very conservative estimate. The median life expectancy is 8 years. But if someone has died of COVID-19, they are more likely to have had one or more critical pre-existing illness relative to the average person. So their median life expectancy is lower. This is demonstrated in this YouTube video.
Using the same model, SAGE estimated that deaths in Sweden would be 30,000 to 60,000 if it didn’t follow their lockdown policy advice. Sweden politely ignored the advice. Deaths in 2020 in Sweden were fewer than 8,800, and their death rate (adjusted for the 2019 mild influenza season) is indistinguishable from the decade’s rising trend.
Oxford University: “Research Spend in the UK: Comparing stroke, cancer, coronary heart disease and dementia” [link]
For avoidance of doubt, this essay is not intended as an expression of callousness towards older people (of whom I’m one). Rather, it’s recognition of the explicit and largely unacknowledged callousness towards younger people inherent in UK COVID policies.
How many lives have been saved by mask wearing? How much has been spent on the purchase of masks? Could that expenditure have been more effective in saving lives by being spent elsewhere? That's a question that occurs to me when I see so many masks littering the streets. 'Tis a minor point compared the points you raise but worth seeking an answer to.
Hi, agree with the above but there's a major omission. Your quick analysis assumes that a lockdown "saves" someone from Covid and goes on saving them, so they get their remaining life expectancy. If instead (as I understand) lockdown has only ultra-short-term benefit, then you either have to assume the costs of lockdown (to secure 7.5 years life) last 7.5 years;. Or assume the benefit of lockdown is only (say) a year, you delay Covid death by a short time but then the risk of death is still there.
Your analysis is correct if a new treatment arrives in the time granted by lockdown. So perhaps looking back you have a point as we now have the vaccine. But looking forward (which is really the point) ... We already have the vaccine. So hard to see what significant future gains are possible.