We must consider the negative health consequences of the lockdown

Muiris Houston: It is time for a national conversation about the ethics of lockdown

People with cancer symptoms  risk missing out on a cure by not attending hospital during the lockdown.

People with cancer symptoms risk missing out on a cure by not attending hospital during the lockdown.

 

We have been in coronavirus lockdown since late March.

More than two months of strict physical distancing and the closure of many businesses. Regular healthcare disrupted with the aim of maximising our resources for a surge of viral infection. A drastic set of public health measures have worked - the surge curve has been flattened, intensive care capacity remains unbreached and now the number of Covid-19 cases and deaths are in decline.

As an emergency response, the public health measures have clearly succeeded – there can be no argument about that.

But the time has come to consider how to proceed now – and to do that comprehensively we must look critically at the negative health and social consequences of the coronavirus lockdown.

Sunetra Gupta, professor of theoretical epidemiology at the University of Oxford, offers a contrarian view to many of her peers. “I think it is very dangerous to talk about lockdown without recognising the enormous costs that it has on other vulnerable sectors in the population,” she says. The homeless, older people and those with disabilities are among those who must be prioritised.

Evidence is mounting on the negative experiences of these groups. Women’s Aid, the national organisation supporting victims of domestic violence and abuse, has experienced a 39 per cent increase in calls to its national helpline during the Covid-19 emergency. “Home has not been a safe place for thousands of women and children affected by domestic abuse over the last two months. The Covid-19 restrictions provide the ideal environment for abusers to exert their power and dominance in homes across Ireland, ” it says.

According to the Alzheimer’s Society of Ireland, the coronavirus health crisis has been a perfect storm for carers of people with dementia with the closure of day centres, social clubs and Alzheimer cafés. “Many carers have nowhere to go each day to help keep their loved ones active and stimulated,” it warned.

Mental health

The damage to our mental health due to lockdown is evident in a survey of members by the Royal College of Psychiatrists. Some 43 per cent of psychiatrists have seen an increase in urgent and emergency cases - involving suicidal ideation and self -harm -following the Covid-19 lockdown. At the same time, 45 per cent have seen a fall in their most routine appointments, leading to fears of a ‘tsunami’ of mental illness after the pandemic. Dr Maeve Doyle of the College of Psychiatrists of Ireland said:

“It is essential that people with mental illness continue to connect with their mental health service and practitioners . . . particularly when the Covid-19 situation is causing exacerbation of their symptoms and worsening of their condition.”

There are other missing patients of Covid -19. Many people with life-threatening emergencies have stayed away from hospital. Stroke specialists are highly concerned about the dramatic fall in the number of admissions since the pandemic began. In one survey, the number of people going to hospital with a stroke had dropped by 40 per cent. This at a time when social isolation is associated with an increased risk of a cardiovascular event of more than 40 per cent. So where are the missing heart attack and stroke patients who feel they cannot access medical care during lockdown?

Missing out on a cure

People with cancer symptoms are also holding back. They risk missing out on a cure. And what about our stalled national cancer screening programmes? We have allowed people return to playing golf, but there are no plans to restart BreastCheck, BowelScreen or CervicalCheck.

It’s time for a national conversation about all of this. One that includes the ethics of saving the lives of people infected with Covid-19 while allowing others to die because they cannot access essential healthcare. We need to consider the plight of vulnerable groups who are clearly suffering the effects of lockdown.

There are no easy answers but debate the issues we must.

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