Let’s talk about acceptable Covid death rates before restrictions kick in

Anybody who has lost a person close to them to an illness such as Covid-19 will know the impulsive feeling that, given the chance to turn the clock back, you would do anything to be able save them. It is human nature. The impulse is to swear that you would endure any weight or bear any cost, because how you can you put a price on the life of a loved one?

What parent among us would not gladly hand over the keys of their house, burn all their possessions, empty their bank accounts and rack up an Everest of debt to save the life of their child? You would do it in an instant. Thankfully, few children die from Covid-19, although some do.

But aren’t we all somebody’s child? Might not an elderly parent feel the same way about their beloved middle-aged son or daughter, gasping for breath in the Covid section of an intensive care ward? Turning the tables, what cost would you bear to save one of your parents?

Nobody likes to talk about the price of life because it feels grubby and inhuman. But such decisions are made. They must be made

Instinctively, we know that you cannot calculate the cost of a life, because life is priceless. Yet governments and public policy makers have to calculate the economic price of life every day when allocating resources for public-health care, or for traffic gardaí to fight road deaths, or deaths from alcohol, or any of the other ways in which people die and where State resources influence outcomes.

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It is sometimes viewed through a concept called the economic cost of life saved by a medical intervention. It is often measured per year of "quality life" saved. The threshold in Britain is generally £30,000 (€35,600), according to Prof Graham Medley, a member of the UK government's Scientific Advisory Group for Emergencies (Sage), their closest thing to Nphet. If a medical intervention costs less than £30,000 per year of life saved, it is usually accepted. This is grim but real.

Cost-benefit analyses

Sometimes the issue is viewed through a related concept known as the value of statistical life (VSL). Insurance companies deal with such concepts. So does our Health Service Executive. When it comes to the cost-benefit analyses of buying expensive life-saving drugs, for example, it is advised by the National Centre for Pharmacoeconomics in St James's Hospital. It deals in "cost-effectiveness acceptability curves" and "willingness-to-pay thresholds".

Nobody likes to talk about the price of life because it feels grubby and inhuman. It is contrary to everything that we like to believe of ourselves as decent people. But such decisions are made. They must be made. It is why we don’t spend 100 per cent of the value of the economy (measured by, say, gross domestic product) on healthcare. If we did, far fewer people would die of Covid, or cancer or diabetes or any other illness.

But a decision is taken on what is “worth it” in terms of the cost and addressing other priorities and, by implication, the acceptable level of death or suffering.

There is a clear economic cost to fighting Covid-19 with restrictions on the economy and society, and heavy borrowings to fund medical care. By the end of the pandemic, if it “ends” next year, it probably will be more than €50 billion, if State borrowings to plug the economic gap are a yardstick. The deeper the economic restrictions, the higher the economic cost of fighting Covid.

This issue is becoming relevant again.

There is also a cost – in terms of human suffering, illness and death – to not fighting Covid-19 with every possible resource to hand. As of Wednesday, 5,369 people had died with Covid in the Republic, 63 of them in the past week. Not all of them could have been saved even if we threw 100 per cent of GDP at it. But, obviously, some would have been.

Somebody, somewhere must make decisions on where to strike the balance. Or maybe it is a job for everybody, everywhere – a collective decision to emerge from society, that is then communicated to politicians and policymakers.

National conversation

If Ireland truly is to live with Covid, then a national conversation needs to take place about the acceptable level of death and illness before restrictions are put on the economy and society. It does not matter where you stand on the spectrum of deliberation over the cost of restrictions versus the cost of life. Like me, you might not even know where you stand. But it is relevant to all of us and it should not be shirked simply because it is an uncomfortable debate.

Apart from our innate sense of humanity, one reason why politicians, economists and people in general run scared from this conversation is that they fear the criticism they might face, the public shaming. It is easy to shout trite slogans. “Everything is worth it if it saves just one life.” But is it? What about the impact of that cost, the future borrowing capacity that is eaten up and the future priorities that cannot be addressed because of it? How do you weigh the impact on people’s lives of lost livelihoods?

One poster recently to an online thread of Irish academics discussing the acceptable level of Covid death said it was: “None. Anyone who is comfortable with more than that is a sociopath.” How can we have a proper discussion in a climate of judgment like that?

Britain is hardly a bastion of perfect Covid decision-making. But at least they have had a stab at discussing the issue over there. Jeremy Farrar, another member of Sage, last month reportedly said that an "acceptable" number of deaths there might be about 100 per day for the economy and society to function as normally as possible. Adjusted pro-rata for this State's population, that level would be about 7.5 deaths per day here, or more than 52 deaths per week.

That is not far from the recent level of deaths in Ireland, but deaths are rising. Most people would not know where to even begin with a discussion over whether 52 or 62 or 72 was an acceptable level of lives lost to keep the economy functioning.

But society is not yet heaving with demonstrations about the human impact of Covid policy, which maybe tells its own tale.

A discussion on the acceptable death and illness thresholds from Covid, versus how and when to protect the Irish economy, needs to be allowed to happen. With the winter that may lie ahead of us, the sooner it begins, the better.