Thursday, June 04, 2020

BMJ Debate on Extending the Lockdown

The BMJ has this interesting exchange on the issue of extending the COVID-19 lockdowns. I have posted a "rapid reply" to the article, which I reproduce here:

Dear Editor,

The case for lockdown was predicated upon the assumption, noted by Melnick, that a population is naïve to COVID-19. But in the months since the initial outbreak we have now gathered much more nuanced insight than this. We can say with some confidence, based on the data of who is most at risk of infection and death, that COVID-19 mortality afflicts a population much more like the chronic diseases associated with late life than the 1918-19 flu pandemic. In the latter nearly half of those who died were young adults between the ages of 20-40 years of age.

Like cancer, it is the elderly that are most at risk of developing, and dying from, COVID-19. There appears to be protection factors that make children more resistant to the virus. In making the case for prolonged lockdown Melnick argues that “even the most conservative predictions show that COVID-19 deaths may exceed those from any other infectious diseases in our lifetimes”. But if this turns out to be true that is only because of the significant progress we have made in reducing deaths from infectious disease. It would not establish the case that the health threat posed by COVID-19 is very severe. Not all deaths are equally comparable. The number of healthy years of life lost when a 10 year-old child dies prematurely from malaria is very different than what is lost when an 84 year-old with multimorbidities dies from COVID-19 during the final stages of life.

Given COVID-19 is much more severe for aging populations, rather than compare its death toll to other infectious diseases it should be compared to the chronic diseases associated with late life, such as cancer. The CDC estimates that 630,000 people will die from cancer this year alone in the United States. Globally that number will be closer to 10 million deaths. The pandemic of chronic diseases like cancer, heart disease and stroke will be exacerbated by prolonged lockdowns and yet they dwarf the severity of the COVID-19 pandemic. Prolonged lockdowns are a disproportionate response to an infectious disease that kills less children and less elderly persons than a chronic disease like cancer. I think that point strengthens the case for Ioannidis’ argument against prolonging the lockdowns. The harms now exceed, by a significant margin, the likely benefits.


PS- the image above is from the local park in my neighbourhood. It is the image that my son and I have seen for the past 3 months of the lockdown (with still no signs of it lifting in Ontario) when we go for our daily walk.