Don't compound a health crisis with an economic crisis

I am a doctor working in Intensive Care.

In response to a novel infection (Covid-19) we have shut down economic activity in the country. This is to reduce the spread of the infection to ensure that there is no rapid surge in cases, potentially overwhelming the health services. However this is severely damaging the economy, harming the health of people with treatable diseases (who can't access healthcare), harming mental health, and impacting education, the effects of which will be felt for decades to come. This will be the worst economic downturn in living memory.

There is no effective treatment for Covid-19. Oxygen by a facemask is effective in sustaining life until the body heals (or succumbs). Patients admitted to Intensive Care and intubated have a mortality in the region of 60-80%. In health-economic terms this is not a cost-effective treatment, and would not be utilized in normal times.

The ultimate outcome of this infection is that it will spread to the majority of the population. Most will have a mild illness, a small percentage will die. But there is no effective treatment, so this outcome is unavoidable. Our current actions are merely postponing this, and decimating our economy in the process.

I propose all businesses and schools re-open immediately. All restrictions on movement and gatherings should be lifted. People should practise good hygiene (regular hand washing, coughing into a tissue etc), and work from home where possible. Anyone with any symptoms of Covid-19 should self-isolate immediately, be tested, and contacts traced. Mass testing of the population should be undertaken, with contact tracing. The Louisa Jordan hospital should be opened to treat severe Covid cases with oxygen by facemask, which can be done in large numbers. Patients with Covid should not be admitted to Intensive Care as it is not effective. Intensive care will not become overwhelmed, and can continue to treat the patients it can actually help. The economy can get back on track. The same number of people will die as under our current strategy, but we will still have an economy left at the end of it.

Why the contribution is important

Our current strategy is compounding a health crisis with an economic crisis. The economic crisis will do more damage to our country than the health crisis. We need to apply a health-economic model to this. The cost per QALY of treating severe Covid far exceeds that of any other diseases we currently treat. Rational health economics deems that we spend our money elsewhere, and desist from the current strategy of destroying the economy.

by thegasman on May 05, 2020 at 05:56PM

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Comments

  • Posted by AJL May 05, 2020 at 20:03

    Totally agree - the economic crisis we are creating will kill a lot more people in the long term than Covid will. We need an urgent plan for re-opening the economy. If we attempt to take all the risk out of the reopening there will be no jobs and economy to go back to. Look at what is happening with the situation in Italy with a huge number of people with no jobs or money. Stop sitting on your hands and do something Scottish Government!

  • Posted by mg68 May 05, 2020 at 20:26

    Totally agree. Lift the lockdown, let life continue, this is otherwise not sustainable, and is certainly not living. It is easier to the vulnerable for a shorter time frame, they wanted to smooth the curve, now lets shorten the graph.

  • Posted by Benthelobey May 05, 2020 at 20:46

    At last - a separate viewpoint to the crisis that I broadly agree with. We need action and leadership from the Scottish Government and not delay tactics such as this 'lets all think how we can get out of it' forum - we have plenty of seriously intelligent people in Scotland & the government should be using them to plan and get on with improving things. We have a chance to show how it could be tackled without crippling the economy to get there.
    I would however suggest to maintain social distancing for now and be selective about what businesses open first, since although people are now keen to move ahead they should not be put in (what they consider to be) dangerous situations, and I feel it will take some time for people to be confident to go to work/shops etc anyway so lets start now and manage it carefully from there - not in another 3 weeks of lockdown after analysing the strategy to death. Unfortunately the social aspects of the lockdown that we all want to see open-up will probably have to be last (ie bars and restaurants), but as the old saying goes the longest journey starts with the first step!

  • Posted by Cal May 05, 2020 at 20:49

    At last, someone is talking some sense! I am a radiographer, working in an NHS hospital in the cancer sector. I have never been so quiet. We are seeing less patients which we can help but we turning them away as covid "might" make us unwell. I have worked every day in my small department, where the staff do not follow social distancing as it is not practical, and surprise surprise, NO ONE has become ill. We absolutely need to get the children back to school to enable parents to get back to work. My mother is in a care home and fully supports this view (she is very frail but without dementia). My mother would happily sacrifice her life to save her grandchildren's future!

  • Posted by MrsBoggs May 05, 2020 at 21:51

    In many ways, I agree. There's no easy way of balancing the risk of death by Covid versus death by famine, increased suicide, or the future consequences of forcing intolerable distancing on everyone.

    This sudden shutdown of society may prove its collapse in the long-term. Or it may recover okay. We don't know. What we should acknowledge is that the measures in place are extreme, drastic, and applied with a single focus.

    We are following the example set in China. What would the response to this have been, had the disease been discovered in a less draconian society?

  • Posted by ISMactier May 05, 2020 at 22:26

    At last a very realistic account. If Scot Government read any of these postings, I hope it is this one.

  • Posted by JohnZed May 06, 2020 at 08:53

    Agree totally. The approach is being dictated by the World's governments, in a sort of 'Saving Private Ryan' scenario, because it is the human, moral nature to. That's not to say that is right or wrong, it's just what society does. As posted on one of my topics, more people die due to starvation and malaria, and we have occasional Winter flu blips.
    So we need to open back up, and supplement by testing - My own opinion - if the Iceland scenario is true - is that the Virus is more prevalent in the community. And the App will just become saturated by indicating that you've been in contact with someone who has symptoms

  • Posted by Arete May 07, 2020 at 02:36

    An economy is built on people, not the other way round, so if illness is widespread throughout a community, you can't have a functioning economy, no matter how much wishful thinking you employ. You can't operate a factory with the dead. It's that simple.

    I also find it very hard to believe that any actual doctor, given the absence of a viable vaccine, would wilfully commit any population to a substantial (and potentially exponential) number of avoidable deaths by promotion of a premature abandonment of lockdown, which is what mainstream medical opinion, the available statistics and known science clearly indicate would happen. (One can have one's own opinion, but one can't have one's own facts.) And all that unnecessary human sacrifice simply for the sake of business...?

  • Posted by Scotland_is_flatlining May 07, 2020 at 11:01

    The NHS has done too good a job of keeping people alive.

    As a result we have an unsustainable number of medically compromised and frail people in our society who need "life support" through this and other recurring crises. It's time to distance ourselves from emotions and and take sound quality of life and economic decisions.

    Where someone presents with a condition, one of the key questions is whether we can do something about their condition. Practitioners are incentivised to adopt a positive response and in many cases the answer to the question will be "Yes".

    However, quality of life, cost of the procedure, future care and medications costs together with the heightened risks of illness and formality need to be factored in.

    Cancer is a case in point. All too often the medics have the technology and celebrate the effectiveness of a treatment but put people through misery to deliver that result and increasingly they will be at risk of being a burden to the system.

    Led by Government, NICE and its Scottish equivalent need to recalibrate the whole approach to treatment and medication to improve the health of the UK as a whole.
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