Collateral damage from the Covid-19 pandemic

Damage to mental health and economy may rival damage caused by virus itself

We are now tentatively approaching the end of the Covid-19 pandemic which began in Ireland in March 2020. Extraordinary efforts were recruited to deal with this pandemic; including a massive public vaccination program, national lockdowns with severe travel restrictions, social distancing, face masks, hand sanitisation, working from home, distance learning at all education levels, greatly restricted public transport, and more.

Whole sectors of the economy were shut down; hospitality, tourism and entertainment. The Government borrowed huge monies to bolster health services and to support industries closed by pandemic restrictions, and their out-of-work employees. Many health screening services were put on hold.

This pandemic precipitated a veritable tsunami of mental health problems while decimating the mental health resources necessary to deal with them

Merely listing these Covid-19 associated restrictions highlights the inevitability of collateral damage. While the full magnitude of this damage remains to be uncovered by future study, it is already clear collateral damage is very substantial, perhaps rivalling the damage caused by the Covid-19 virus itself. An articleby G Kampf and M Kulldorff in The Lancet last February made some preliminary estimates of collateral health damage. For example, deaths from acute coronary syndrome in UK nursing homes, from February to June, were up by 41 per cent compared with historic baselines. Hospital chemotherapy appointments were down by 60 per cent and appointments for early diagnosis of suspected cancers were down by 76 per cent compared to pre-Covid levels. This could cause an additional 6,270 deaths within a year.

Although good mental health is fundamental to overall health, mental health services are chronically underfunded even under normal circumstances. Mental health was particularly badly affected by Covid-19 restrictions. Mental ill-health was precipitated by bereavement, social isolation (particularly ill-advised cocooning of over-70s), loss of income and fear. Insomnia and anxiety levels soared and many turned to alcohol and other drugs for relief. A WHO survey reported that Covid-19 halted or disrupted mental health services in 93 per cent of 130 countries surveyed. This pandemic precipitated a veritable tsunami of mental health problems while decimating the mental health resources necessary to deal with them.

Ireland may have been far too cautious in dealing with this pandemic. UCD's professor of infectious disease Jack Lambert argued on Newstalk in August, that since elimination of the virus is not achievable, "this is going to be an annual pandemic similar to influenza". We must therefore learn to live safely with Covid-19 and get on with life. Lambert argues that restrictions can be eased safely as evidenced elsewhere and we should stop having Covid-19 numbers solely dictate our actions because the collateral damage is so enormous. Government is now starting to lift Covid-19 restrictions but Lambert argues that we should have put people back to work months ago. Every life matters, whether directly threatened by Covid-19 or, for example, by lockdown-induced depression.

Some support programs will stop as the pandemic passes, pushing some businesses to the wall

Ireland may also suffer severe economic consequences from this pandemic as explained in a piece by Cliff Taylor in The Irish Times in January. We borrowed heavily to boost health services and support businesses and individuals, pushing national debt to €238.5 billion. National debt was about €70 billion in the 2008 crisis when tax increases and severe spending cuts were introduced to deal with it. But, the cost of paying interest on our debt has fallen, assisted by massive European Central Bank (ECB) intervention in the markets. National debt has increased, but the debt burden has fallen.

Nevertheless, big risks remain. National debt is refinanced every eight to 10 years and who knows what interest rates will apply then. Also, ECB intervention will wind down as the pandemic passes and interest rates will rise, although probably not quickly to the high rates seen in the past. However, key factors here are whether our economic growth rate continues to exceed the national debt interest rate and whether corporation tax returns hold up.

Current spending levels cannot last much longer. Some support programs will stop as the pandemic passes, pushing some businesses to the wall. One legacy of the pandemic will be a much bigger State. We are moving in that direction anyway with huge State investment in home building and the green agenda. Recently increased health services will be maintained, mental health services must be greatly boosted and demographic trends, eg ageing population, will add an additional €6 billion annual spending by 2030. Economic growth and increased tax revenue won’t pay all the bills. New sources of income will be necessary. Difficult times lie ahead.

William Reville is an emeritus professor of biochemistry at UCC