We need graphs for coronavirus misery as well as mortality

Policy response to Covid-19 must include our psychological and social wellbeing

Covid 19 sign at St Stephen’s Green: research shows mental health benefits from access to pleasant outdoor spaces. Photograph: Gareth Chaney/Collins

Covid 19 sign at St Stephen’s Green: research shows mental health benefits from access to pleasant outdoor spaces. Photograph: Gareth Chaney/Collins

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In the current crisis, governments are paying enormous attention to the mortality risks of Covid-19 to the exclusion of the misery hits borne elsewhere. The only data presented at news conferences is that relating to the number of infections and deaths. Such data is transparent and provides an important summary of the loss of human life and the potential strain on healthcare.

But as physical distancing restrictions extend from weeks into months, graphs showing the immediate costs of the virus on mental health, loneliness, domestic violence, physical health, child development and nutrition, and addiction are long overdue (as well as some benefits too eg reductions in air pollution and car accidents).

It is not straightforward to estimate these effects, but Covid-19 cases and deaths are also very difficult to forecast yet considerable effort is going into updating the estimates every day. We need to start seeing graphs for misery as well as for mortality.

In the very early stages of the pandemic, it may make sense to focus almost exclusively on the infection risks to preserve life and to allow time for acute care, testing and other systems to adapt. But this is not sustainable as a long-term strategy.

Data is already beginning to emerge that there have been significant increases in domestic abuse, child malnutrition and alcohol consumption in a month of restrictions in the UK. We need sustainable physical distancing strategies that seek to minimise the overall impact of Covid-19 and not solely its effects on mortality risks.

Mental health

There is an immense amount of research into the factors that determine someone’s mental health. They show the significant part played by access to services, outdoor spaces, social connections and employment.

Grafting existing evidence on to the specific case of a pandemic and a much-altered physical and social environment is challenging but not impossible.

A recent article in the Lancet, for example, outlined a wide range of potential issues for mental health services, and argued for greater focus on understanding the implications of different policy scenarios across a wide range of mental health issues.

People lose skills, social connectedness, time structure and a sense of identity

In terms of social connectedness, it is crucial to understand further the extent to which different policies have implications for the quality of relationships, which is a critical component of human welfare. Furthermore, a large body of research has confirmed that someone’s mental health benefits from having access to, and spending time in, pleasant outdoor spaces. The effects are relatively small but spread over many people.

Such benefits are not currently counted when evaluating physical distancing strategies and need to be included in the development of sustainable medium-term strategies.

The fallout in terms of mental health effects of unemployment also threatens to be immense. Unemployment has effects on mental health that rival those of chronic illness, and its scarring effects increase substantially as temporary unemployment moves to longer-term unemployment.

People lose skills, social connectedness, time structure and a sense of identity. Many regain these when they re-enter the labour market, but many do not. Public policy must therefore emphasise a large-scale employment stimulus aimed at those at risk.

Entertainment and leisure

This is far from straightforward because many of the most marginal employment areas, such as in entertainment and leisure businesses, are also those that will be the most difficult ones in which to impose physical distancing restrictions. Policies that render it safe to return to work may have both economic and strong wellbeing effects.

Do the health and wellbeing effects of recommending older adults to take outdoor exercise outweigh the infection risk?

We are all fully aware that we cannot have it all, and that every policy choice (just like every personal one) involves weighing up competing objectives to reach an overall decision. As we think about future strategies on physical distancing and infection control, which will involve judgments about which groups of people to “release” first and in what ways, we need to see the gainers and losers in terms of both mortality risks and misery hits.

Do the health and wellbeing effects of recommending older adults to take outdoor physical exercise outweigh the infection risk arising from this? Are the wellbeing effects of physical social contact among younger people worth potential infection risks in different scenarios? Answers to these questions are matters of judgment not fact, but facts on both mortality and misery are urgently needed if we are to make ethically defensible decisions. Governments must formally embed mental health impacts into their scenario planning.

Liam Delaney is professor of economics at UCD and Paul Dolan is professor of behavioural science at the London School of Economics

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