The (absent) ethics of lockdown

Is it ethical to lock us down again? This is not a facetious question. Over the past eight months, we have heard a great deal about the policies used to manage the virus, but very little about the ethics. This is a mistake. We should be asking how we can critically and reasonably strike a balance between conflicting values and interests. Yet even now, with so much at stake, this basic question on the ethics of our policies is not being properly asked.

When it comes to public health, the ethical balance is simply expressed: how do you achieve a certain public health goal with the fewest restrictions on individual rights? If the goal is to reduce obesity, for example, then is it justifiable to tax sugar — and if so, to what extent? There are issues to weigh up carefully on both sides — it is about finding the right balance. This is more acute in pandemic handling because it is not simply the case of lives vs liberty. Lockdown kills, too, so the right balance is even harder to strike.

We have heard repeatedly from the government that ‘lockdown is a measure of last resort’. If that is the case, why are we locking down now? For make no mistake, there are alternatives that better strike a balance between individual rights and collective interest. They have been ruled out, however, without adequate, rational ethical scrutiny.

One of the most obvious alternative policies would be to shield the vulnerable members of our society. We know that the virus is far more likely to hospitalise the elderly and those with certain pre-existing health conditions. Shielding is a form of selective lockdown that involves minimising the interactions these people have with other members of society in order to contain infections among them. Pragmatically how would it work? Either by incentivising the vulnerable to self-isolate or by placing restrictions on these members of our society. The resources could be made available to ensure that it works.

Of course shielding would be unpleasant for those who are subject to it. But so are the effects of lockdown. This minority would find their liberty curtailed to stop the damage of lockdown being inflicted on the majority. It is a policy that results in unequal treatment of different groups of people. But not all forms of unequal treatments are unfair. In this case, shielding would be ethically justified not only because it would benefit the collective, but because it would be in the interest of those at higher risk to be protected from Covid.

It might be a difficult policy to implement in practice — but it is one that should at least be explored calmly and rationally. Instead it has been met with hyperbolic fury. The NHS England chief executive Simon Stevens, for instance, has said that shielding the elderly would be a form of ‘apartheid’. Meanwhile, in one highly-regarded bioethics forum, shielding-based policies were compared to a ‘genocide of the aged, the disabled, and the sick’. Such loaded, politicised language runs contrary to rational ethical analysis. If shielding is a far worse idea, then the idea should be properly assessed and weighed up against the alternatives. Of course a full lockdown should not be ruled out on principle — it is good to keep the option on the table. But if it is to be a measure of last resort, then we must examine the alternatives.

In every slide show delivered during the Downing Street press conferences, we only ever see data about the virus. This is regrettable. To allow rational and ethical scrutiny, we would need slides showing how many will die from the effects of lockdown, as a consequence of job losses and deteriorated mental and physical health. For example, we know that during the first lockdown thousands of cases of cancer went untreated or undiagnosed and were inoperable as a consequence. According to the mental health charity Mind, two-thirds of adults with mental health problems reported a worsening of their condition. This was particularly significant among the young. Meanwhile, the London Ambulance Service has said that the number of suicide and attempted suicide incidents has surged — up 68 per cent from last year. The UK is in the largest recession on record, hundreds of thousands of jobs have been lost and almost ten million people have been furloughed. It is well-established that recessions have a huge impact on public health, chronic disease outcomes and on mortality.

In other words, the intended solution to the problem has become part of the problem. Lockdown undermines people’s health and it threatens lives, as surely as Covid. Unlike the virus, however, lockdown inflicts its agony across the whole population (especially on young generations) instead of on a well-defined portion of the population who could be protected with shielding measures. If lockdown were a kind of public health chemotherapy — a poison that would at least kill its target — it might be easier. But we know lockdown only ever delays the onset of the virus, kicking the can further down the road.

When the pandemic started, we did not know much about the virus and most feared it was much more infectious and more dangerous than it is. Initial estimates based on World Health Organisation data suggested a mortality rate as high as 5-6 per cent; we now know how much the true death rate varies by age: probably around 0.5 per cent in 50 to 69-year-olds and significant (above 5 per cent) only in the over-70s. That is low enough to ask whether, overall, a full lockdown is based on a rational, calm balancing of the values at stake. We also know that there are risks of long-haul Covid symptoms, but these are also relatively rare, with only one in 20 symptomatic cases lasting for more than eight weeks. By some estimates, two in five cases are asymptomatic.

Lockdown will inflict more harm on society than perhaps any other measure in our peacetime history. This damage might or might not be ethically justified. But we will never know if we don’t ask the question.