The Morality of Lockdown: Saving Some but Not Others?

Image description: a dark hospital room.

Morality has played a key role in the coronavirus crisis. Doctors were forced to choose who to save, public health officials were forced to weigh freedom against safety, whole societies were put on halt. All in the name of morality. After all, it would be criminal to stand aside and do nothing as a population suffers; however, lockdown measures have had a myriad of side-effects – which raise multiple other moral questions.

Many of these moral complications have been prominently discussed. The most recurring one was the economy. Millions of people are now unemployed, states’ finances are being drained, and both small and medium-sized companies are filing for bankruptcy.

Others highlighted how these measures exacerbate inequalities. In India the lockdown was announced with four hours of notice – leaving the most underprivileged hanging out to dry, often without housing. In many European countries, domestic violence reports rose drastically. In academia, female researchers saw a precipitous decline in publishing – as home-stay meant higher childcare burden.

More recently a far more crucial consequence was put to light. The healthcare system itself has been damaged by the lockdown – and with it, millions of other lives.

Globally the lockdown has undermined efforts against H.I.V., malaria and tuberculosis – the latter being an infectious disease which takes 1.5 million lives each year. As of 2018, tolls from these diseases were at their nadir. The lockdown-induced supply-chain disruptions have undone years of progress, and efforts to combat diseases are “back to where we were 20 years ago”, according to Pedro L. Alonso (the director of the WHO’s global malaria program).

The healthcare system itself has been damaged by the lockdown – and with it, millions of other lives.

As The Guardian put it in a recent piece: various elements of public health, including both mental and physical health, have “been sidelined in the fight against Covid-19.” Their chilling piece focuses on how the quality of cancer diagnostics and treatments has been severely hit by lockdown measures. To put it into crude figures: over 2 million people are waiting for cancer screening, tests and treatment.

It reports that various tools to prevent, fight and cure cancer have been disrupted – such as surgery, chemotherapy and diagnostics scans. This has led to patients being denied treatment, surgery and early diagnosis: ultimately, causing deaths.

But this trend extends beyond cancer treatments. GP references to the hospital in the UK, for instance, plummeted from 200,000 in 2019 to 80,000 in 2020 – meaning patients are not being treated.

In Portugal, the newspaper Publico has recently uncovered a similar picture. Its report shows that Portugal’s mortality rate in July 2020 was the highest in 12 years – but not because of Covid-19 (which only accounts for 1.2% of deaths).

Instead, they propose it might be due to an underperforming healthcare system. People fear going to the hospitals thus not addressing their health issues. Most units that are not the ICU are under-resourced thereby causing delays, postponements or outright rejections.

These figures shed light on the multiple unintended consequences of severe lockdowns. They show that the trade-off in this fight isn’t between health and the economy, nor is it between health and comfort – the trade-off is between lives and lives.

People fear going to the hospitals thus not addressing their health issues.

The debate on lockdown has unfortunately been politicized to a toxic extent. In the US support for lockdown measures have been polarized into a pro- and anti-Trump debate. Under hosting the world’s leading media, these U.S. debates have trickled down to the rest of the world.

Sweden, notorious for adopting a softer approach to lockdown measures, has been the focus of US outlets, and labelled a “cautionary tale” – often painting a misleadingly grim picture of the Scandinavian country. In this polarization, it seems that other bigger-picture moral implications of lockdown measures have been forgotten.

Lockdown is moral, but to what extent? At first, lockdown measures were justified as saving lives. Subsequently, they were there to limit the burden on a country’s healthcare systems. Then, they aimed at slowing the virus’ spread. Or more neatly: Stay Home, Protect the NHS, Save Lives. All these are morally sound arguments – but Covid-19 does not exist in a vacuum. ­­­­

All these are morally sound arguments – but Covid-19 does not exist in a vacuum. ­­­­

Thus societies are faced with challenging moral dilemmas: who and what to save? Covid-19 patients, cancer patients? People’s jobs and livelihoods? The population’s mental health? A generation’s quality of education?

Luckily, not all of these are trade-offs, and the option is not either-or. The economy, for instance, won’t magically recover if all measures are lifted. Sweden’s economy did not weather particularly better, despite its less intense lockdown, precisely because it is inextricably integrated with the world’s economy.

Moreover, it fundamentally depends on what kind of lockdown there will be. Can health services for conditions other than Covid-19 persevere? Having had 6 months to prepare for a second wave, one would hope hospitals and ICUs had been given the resources to confront this renewed peak. It remains to be seen whether that actually is the case. 

Ultimately the reports of the degrading healthcare quality are concerning. If our moral judgement was based on saving lives, then who do we save? I would not pretend to know the answer to such a question. My aim, however, is to show that there are more moral complications to lockdown than surface-level headlines would suggest. Just as there is no need to be a corona sceptic, there is little point in adopting a fundamentalist stance on lockdown.

Image credit: @daanstevens via Unsplash.