As the weeks go on, a moral dilemma in the coronavirus pandemic is emerging. Do we save lives — and continue to force everyone indoors — or save jobs, livelihoods and the economy? Officials in charge of Ireland’s exit strategy stand between the devil and the deep blue sea. Other countries are having the discussion before future waves hit. Shouldn’t we do the same?
The International Monetary Fund predicts that this will be the worst economic crash since the 1930s. Unemployment stands at 500,000 — and is predicted to rise. Chief Medical Officer Dr Tony Holohan sent a chill through the country when he warned that we face restrictions for up to 18 months until a Covid-19 vaccine is mass-produced. So do we strike a balance between saving lives at all costs and avoiding an economic depression that will cost lives in countless other ways?
“That is the really, really big question for society,” says Gar Holohan, businessman and chairman of the Aura group, which has over 400 employees.
The thought of re-opening the economy at the risk of lives might sound unthinkable, but Mr Holohan says this approach to public health is taken every day: “It is like if I said ‘I have an invention that will revolutionise transport, but it will kill a certain number of people a year’. This is about accepting there are risks and there are consequences and setting down a plan as to how we manage them.
“Proportionately, we need to strike the right balance, protect the most vulnerable and not throw them to the wolves.”
The sentiment is echoed in a memo circulated by Oaktree Capital, the global investment management firm operating in Ireland. In it, billionaire investor Howard Marks writes: “How do we make the trade-off? There is no algorithm for deciding whether to favour life for a few (or for thousands) versus economic improvement for millions.
“On the one hand, choosing the economy seems hard-hearted. On the other, we permit or even encourage many number of deaths such as driving.”
And overall Marks says: “The benefits from automobiles outweigh the costs. Individuals knowingly assume the risks.”
‘Not for the squeamish’
Lecturer at Technological University Dublin Conor Skehan says risk is calculated all the time when it comes to the cost of life: “But the reality is that it normally occurs behind closed doors. Doing it explicitly in front of the whole country as Taoiseach is where it gets painful. You are deciding how safe is safe enough?
How many deaths are acceptable?
“People are unaware of the fact that these big decisions are made about so many areas of our day-to-day life all the time. How much steel goes into a building, for example? How many rivets to put in for a plane?”
In the insurance industry, he says, companies calculate “dollar cost per life saved”, and politicians do that, too. “Relatively speaking, education costs almost nothing, but saves a lot of lives. Vaccines cost almost nothing but save a lot of lives. Whereas environmental stuff can cost a fortune and make very little difference but it makes us feel better about ourselves, you know? These are not conversations for the squeamish.”
It is naive to think choosing to lock down the economy doesn’t brings a cost to life. Pain may be endured behind closed doors, or spread over years, but it is there.
We have already heard warnings that people suffering heart attacks and strokes are leaving it too late to seek medical help, cancer patients have had treatment postponed and thousands of women have to forgo their IVF treatment until society reopens, possibly missing the vital window to become mothers.
In the Mater, private hospital consultant Michael O’Keefe expressed fears that some patients may go blind and others could die as a result of the State’s temporary takeover of the facilities.
We know too that the poor and vulnerable are hardest hit in a downturn. Disability services are impacted and domestic violence rises. Addiction also takes hold. Some areas of Dublin have already seen a resurgence in drug dealing in the most disadvantaged areas that took so long to regenerate.
In homes where there is alcohol dependency, Austin Prior, a psychotherapist and board member of Dublin’s Rutland treatment centre, says: “I have heard from families where consumption has gone through the roof, the problem has been exacerbated. Under lockdown, it’s gone through the Richter scale.”
The bonds that bind
Social isolation shouldn’t be ignored. There are many stories of cocooned elderly people pleading with family members to flout rules, travel cross country and spend time with them. Adult children are irate when elderly parents quietly slip outdoors.
But perhaps they know a greater truth. There is trauma in separation. Psychoanalyst Anna Freud, in her book War and Children, famously found that during World War II, children were “less upset by bombing than by evacuation to the country as a protection against it”. Those who were sent away from their families to live in safe havens suffered more severe long-term trauma than the ones who stayed behind in the bombed city. Physical injury is not the worst fate that one can endure.
One of the country’s leading insurance experts, Dermot Goode, says there will be “significant knock-on health-related effects” from continued lockdowns. “If we are back to normal by September, around 60,000 people will have had procedures delayed and the waiting list gets exponentially longer after that.”
Elsewhere, he says: “We are hearing anecdotally that people are going to die needlessly because they are not getting the proactive medical treatment they need. Anyone who normally gets health screenings done, that’s all parked.”
And on mental health, Mr Goode adds: “One private hospital has already told me the number of inquiries they are getting is way up. As this crisis becomes more prolonged, they say the demand for their services will be out of the door.”
Ireland’s suicide rate rose 15pc at the height of the last recession. Those most affected are middle-aged. One man who knows all too well about the pain of a financial crash is well-known publican Martin Keane. “I lost friends and acquaintances in the last recession,” he says. “Very successful businessmen and the pressure became too much. Alcohol took over with others. Another got stuck into the drugs. Nine years later, some are still suffering.”
Regardless, Mr Keane says: “I don’t think business people should make the call. If it is to be that we have the worst recession or depression we have seen then we will have to do what we have always done but the decisions should be left to the medical experts.”
Even scientists are not so sure if further lockdowns are for the greater good. Stanford epidemiologist John PA Ioannidis has warned that, with a case fatality rate of 0.05pc for Covid-19, lower than seasonal influenza, we are taking decisions that could be a “fiasco in the making”. Writing in Statnews, he said: “Locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.”
Consultant cardiac surgeon Jullien Gaer also posed an important philosophical question: “What kind of society and economy do we want to leave to our children and grandchildren?”
What about the young?
Economists predict that the bill to cover the fallout will be between €20bn and €40bn — a cost that will be handed down to the next generation. Harry McCann, a second-year student at UCC and founder of Trendster, says: “Young people have been missed in this debate. A lot of my friends worry this is going to send us into a depression and it’s all going to fall back on us. Is 18 months of lockdowns something we should be considering? Can we continue to pay for it in the long run?” The Government has spent €4bn in wages and benefits in just 12 weeks.
Mr McCann says: “The conversation centres around the idea that ‘if you are not considering the death toll you are heartless’. But young people will suffer in different ways, too. I agree that it’s important to save as many lives as possible but we are not considering anything else. There is no space for it to be discussed.”
He believes the older generation could carry on cocooning, while young people go out to work. “Eventually we have to give the people who have the most likely chance of survival a chance to continue on in the world. We can’t continue like this, it’s not realistic.”