Recessions don’t kill, COVID-19 does. Conservative Utilitarianism fails

Contrary to conservative argument, during economic downturns in “the West” mortality goes down as well. The cure is not worse than the disease, if death is the measure. But the rest is dependent on politics, which depends on weighing values. The predictable drama occurs in “the South.” By Daniel Plenge

For many, the last month may have felt like half a year. It is hard to keep track in any respect. Let’s remember a bit. On 9th March, Italy started its shutdown. Spain followed on March 14th, Netherlands March 16th, France March 17th, California March 19th, United Kingdom and Germany on March 23rd. What was due to the sovereignty in White House or the states in the US nobody can make out here in Europe. But somewhen in that week before April the whole country followed.

Dependent on the perspective, it has either been emphasized that social life or the economy has been shut down in order to flatten the curve of corona virus infections, to prevent the collapse of health services, and to pre-empt deaths of the most vulnerable groups, specifically the old.

From almost the very beginning, it has been calculated what the costs or the price of the lockdown would be and whether it is justifiable. A utilitarian standpoint at least tacitly opposed a categorical one. Whereas the former allows for trade-offs between anything as long as overall expected “utility” is greater in comparison with a second option, the latter implies that some values are not to be tempered with.

A pragmatic stance is also a natural, and probably the normal, approach when conditions change rapidly and there is no definite information suggesting what to do. After a few weeks, the much-praised German government slackened the lockdown (April 20th) and revealed that the aim of its policy is becoming ambiguous and probably always has been. Discussions about such easing started days after the shutdowns everywhere or before.

Although in most countries drastic measures found broad public support, not all groups of politicians were as positive from the start. Mostly in conservative quarters in the US and GB, it took a while, drastic pictures from Italy, and a drastic drop of the stock markets to convince the reluctant. Already on 23rd March, Donald Trump twittered: “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.” (Retwittered today.) The New York Times quoted David McIntosh, “the president of the anti-tax Club for Growth”: “We need to act to contain the virus, but at the same time more people would be hurt and have terrible health and life consequences if they don’t reopen the economy.”

The claims here are either that economic consequences of shutdowns might have as many health consequences as the pandemic or that they even cause more deaths than the virus.

On March 24th, The Times published an article titled “Economic crash could cost more life than coronavirus, says expert.” A professor of risk management at Bristol University, Philip Thomas, had claimed in an unpublished paper that shutdown-policies could potentially lead to a recession in which “more years of life will be lost … than will be saved through beating the virus.” This would happen as soon as GDP shrinks about “6.4%.” Of course, a “clear link” between GDP and life expectancy is maintained. The main idea is that a drop in GDP inevitably leads to a drop in spending on health care. The utilitarian stance is to be found in the idea to hypothetically add up the years lost by deaths through the virus and compare them with “quantity” of life lost due to a predicted recession. The paper is no longer to be found on the internet. According to Aaron Bastani, Novara Media, the idea is that “just under a million” British would die if nothing would be done against the pandemic. However, because the coronavirus would mostly kill old people, those lives would only count for 400 000 deaths of average age adults.

Thus, the thesis explicitly is that shutdowns will cause recessions which will cause deaths, which, measured in years of (hypothetically expected) life, will be higher than the cost of COVID-19, that is, above 400 000.

Similar claims are to be found elsewhere, though not as explicitly. The German conservative newspaper FAZ gave a newsletter the title “Also economic crises kill” on March 26th. Three days later, Jan Fleischhauer wrote in a column of the German Focus: “The medical profession recommends society to confine itself. Only in this way, lives could be saved. But the collapse of economic life necessitates thousands of dead people.”  

The politics of the epidemiologists would produce deaths, it is claimed, but we would not see them immediately. Quoting another newspaper and “financial expert,“ he refers to a study which would be exemplary in showing how a crashed and collectively impoverished society had suffered an increase in mortality of 17,8% between 2010 and 2016. Those numbers would mean 100.000 deaths per year in the German case. The supposed example is Greece.

Here the thesis is that Greece suffered a drop in mortality due to recession, and that the same is to be expected elsewhere.

On March 26th and 10th April, the German journalist Jakob Augstein invoked in Der Freitag a trade-off between saving lives, mostly those of a small group, the elderly, and tempering fundamental, constitutional rights of all: “According to all that we know, COVID-19 is a disease which seriously threatens the lives of a minority. Politics has decided to put very heavy burdens on the majority in favour of the minority.” In accord with Fleischhauer, he also suggests the consequences of the lockdowns would be invisible for many reasons: “speechlessness of the lonesome, pain of the victims of domestic abuse, hardship of the unemployed and fear of the self-employed and entrepreneurs.”

Two weeks before this quote has been published he claimed that usually 2550 persons die in Germany every day, 57 of pneumonia. To that day, only one hundred persons had died of (or with) Covid-19. At the time of writing, the number is 5.360. He then asked: “What meaning do we assign those numbers? And do they have a moral quality? In Italy the average age of the deceased is 80 years. How much will it be worth to us, to make it possible (“ermöglichen”) for them to live two, three or more years?” The next sentence states that 21.3 million German citizens could not afford unexpected expenses of 1000 Euro and it is suggested that an economic downturn would “ruin millions.”

Although Augstein is at pains only to formulate questions without explicitly taking a stance, this suggests that there would be a number or threshold of deaths, which he does not specify, at which it would – perhaps – be advisable to accept them rather than the “ruin” of millions of not so well-off Germans. The alleged consequences called “ruin” he does not specify either and at times the claim is, more generally, that society, culture, the economy and fundamental rights are at risk.

Accordingly, the claim is that the shutdown has (unmeasured) societal costs which (may) outnumber those of (unknown) deaths.

Photo by Zachary DeBottis on Pexels.com

The whole arguments and its unknowns float on the age-old problem of utilitarianism that it cannot specify in theory and numbers what utility. For many, it already sunk.  

On 6th April, the philosopher Peter Singer and Michal Plant sided with Trump: “It’s not so simple to escape the trade-off between saving lives and saving livelihoods,” because the question would also turn up as soon as the question has to be answered when lockdowns should end. If it is believed that any such lockdown would lead to otherwise non-occurrent deaths, as the authors plausibly do, then, for instance, the German government decided on April 15th over the deaths of people and allowed them to happen via legislation.

Here the idea also is that the “cost” of shutdowns would be bigger than that of COVID-19: “Could the images of people dying on stretchers in tents in hospital parking lots be blinding us to the greater harm we may be causing across society through our efforts to avoid those awful deaths?” Their utilitarian approach is to compare aggregate well-being and “to measure wellbeing by using individuals’ reports of how happy and how satisfied with their lives they are.” For short, they want to compare objective measures (health or death) with subjective estimates (what they call “well-being”).

They assume that unemployment would reduce the (subjective) well-being of people “by 20%”. They don’t say so, which may indicate a problem, but probably the case of death counts as a 100% loss of well-being. “With this information, we can compare the human costs of a lockdown to the well-being gained by extending lives.” Of course, the result of the computation in their view is obvious, although they don’t show how it would work out.

The claim is that the lockdown factually reduces the aggregate (subjective) well-being more than what would happen if the lockdown were terminated or had never been installed.

Parts of what Augstein fears to be at risk or already lost, they would call well-being.

On 10th April The Daily Mail titled “150,000 Brits will die an ‚avoidable death‘ during coronavirus pandemic.” Vanessa Chalmers revealed the source of this number and thereby in passing that it was mostly the product of rumours: “Fraser Nelson, editor of The Spectator and political columnist for The Telegraph, spoke of the stark 150,000 figure today. He did not reveal his source. He said: ‚Work is being done to add it all up and produce a figure for „avoidable deaths“ that could, in the long-term, be caused by lockdown. ‚I’m told the early attempts have produced a figure of 150,000, far greater than those expected to die of Covid.” Included in those numbers would be increases in suicides, domestic violence, and in the long run chronic illness of millions due to financial strains.

Here it is advisable not to mix up claims.

Claim one: The shutdown as such will produce excess deaths via domestic violence and suicide.

Claim two: The upcoming economic crisis (when lockdowns may or will have disappeared) will cause thousands of deaths.

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The science journalist Peter Andrews wrote slightly differently in his headline on 15th April that “UK lockdown could cause 150,000 ‘avoidable’ deaths.” That number would have been presented to government “by scientists who had modelled the likely effects of the restrictions.” As causes behind the numbers he also mentions “total overnight cessation of normal healthcare measures” within the crisis, people avoiding hospitals out of fear, drug overdoses, ruined careers and failed businesses.

What does “avoidable” mean? Andrews writes in plain words: “The use of the term ‘avoidable’ deaths by the scientists is telling. It stands in contrast to Covid-19 deaths, most of which are likely to be unavoidable, affecting as they largely do the very old and very infirm, who, callous as it sounds, would not have seen next Christmas anyway. It is for this reason that some have estimated that Covid-19 may not in fact cause any extra deaths by the end of the year, even if it does kill some people a bit earlier than they would otherwise have died.”

The claim is that corona is a rather weak virus and won’t cause excess deaths, but the lockdowns do and will.

Photo by Kristina Paukshtite on Pexels.com

In debating all such claims, one should minimally differentiate between

what is or what is not (believed to be) a fact,

what is or what is not a plausible prediction,

and what is or what is not a philosophical blunder from the start.

At least one philosophical blunder is involved in claiming with Andrews that a death of an old person due to Covid-19 would not have been avoidable. It is rather common in some forms. But this doesn’t make it better.

A German expert claimed that some of those “who now die because of the coronavirus would possibly have died anyway without the virus, but only later.” You don’t need to be a Nobel Prize laureate to notice that this is true of all of us, whether we are infected with whatever virus there is or not.

The German expert means that the cause of death might not have been Covid-19 although somebody has been infected. Andrews means that an unknown number of those elderly who die due to Covid-19 would perhaps have died within a period relevant for statistics. However, this does not change that their specific Covid-death would have been avoidable if they had not been infected. Therefore, the alleged case against lockdowns or strict measures is not made.

Moreover, a week after the publication it turned out that the tentative prediction that there would not be excess deaths is false. In March and April, the number of excess deaths is estimated to be 15.175 in GB, within a lockdown. The claim that Covid-19 is not much more than a flu has turned out to be most likely false.

The claim of the victims of the shutdown in the Daily Mail are only speculations, bolstered by anecdotal evidence. Although there have been signs of the (expected) increase in domestic violence around the world, there are none of thousands killed. In Germany consumption of alcohol seems to have risen since the shutdown. This may have adverse health consequences, but it is hardly plausible that thousands will die from it within the lockdown. Furthermore, here we might also witness a significant difference between a lockdown and a recession. In the latter case and GB, alcohol consumption declined a decade ago.

The problem with the case about the Greek crisis is that the actual study is not named, but it seems to be presented in a misleading or downright false way. Studies within the journal named claim that mortality kept on declining (!) in Greece after the onset of crisis, but the trend slowed down in comparison to pre-crisis times. 

Regarding some specific causes, the trend was even strengthened: “deaths due to vehicular accidents, cancer, respiratory diseases, disorders related to pregnancy and childbirth, and infectious diseases declined faster after the onset of the crisis.” In other cases, it is the other way around: “Deaths from suicides and from nervous system diseases increased slightly but significantly after the onset of compared with before the crisis.” In fact, it is a rather established pattern that suicides tend to increase within crises. However, the overall numbers of suicides are comparatively small in relation to other types of deaths.

One remarkable result is that mortality declined slower for those 65 and older, which is attributed to “adverse events during medical treatment.” One possible explanation for this is austerity. Something similar has been claimed for Great Britain. Another remarkable result in our days, in which “essential” or “systemically relevant” jobs are suddenly valued, is that the mortality of women was affected more than that of men. 75% of “essential” jobs in Germany are done by women.

On the one hand, all this reveals another common philosophical fault, namely to claim that large scale social events such as recessions/crises or declines of values of aggregate properties such as GDP would cause something on a par with a fist hitting a face. This hides that, among others, what happens depends on human interpretation and political action. There is no direct link of a fall in GDP to a decline in health-care whatsoever. But there are political decisions how to allocate resources (measured in money or in skillful people). Such “scientific” claims hide ideologies.

On the other hand, contrary to the intuitions of politicians of all shades and colours who tell us otherwise, the common scholarly opinion is that recessions generally lead to a decline in overall mortality because, among others, there are less fatal car accidents, people exercise more, the air is cleaner, people live and eat healthier, and those unemployed feel less deprived. It is also rather well-known that higher incomes do not make happy and that a decline in income does not necessarily make you unhappy.

This does not change that on the individual level many people suffer, which manifests in increases in anxiety, stress, depression, alcohol and tobacco consumption, and an increase in suicides. At this point, however, some would want to claim that the real scandal is that, for example, in the booming United States every year 150.000 people die of causes mentioned when it comes to recessions, namely suicide, drug overdose, and alcoholic liver disease.

One suggestion is also that this pattern only holds for rather temporal declines. Another issue is that this trend plausibly depends on the current state and former history of the relevant societal institutions within a country, i.e. a welfare state or ‘well-being state’ that people can count on because they exist and have the funds to do something. Whereas in current Germany no-one, except the homeless, needs to fear not to be able to buy food, in the USA, somewhat similar to third world countries or emerging economies, millions have to consult food banks. The strange difference only is that they drive there in their SUVs. It is hardly surprising that  it has been found in relation to “less affluent countries” that  there is an increase in mortality within recessions. In developing countries, the other way around, an increase in GDP, if used accordingly, leads to better health and declining mortality in the long run.

In summary, the claims that shutdowns or recessions have excessive health and mortality consequences in “the West” is farfetched and, in the main, ideological. Predictions in that directions are intuitively right, but nonetheless unfounded and false.

The claim that shutdowns and recessions reduce aggregate well-being more than what would have happened if the lockdowns would be terminated or would never have been installed is also week. For one thing, the recession would have come anyway. Given the former exposition, it is not clear whether a reduction in (subjective) well-being by the newly unemployed would not be compensated by an increase in (subjective) well-being by those employed, due to less competition, less work-related stress, and overall better health. Furthermore, the subjective measure of well-being opens the door for a different self-understanding of social actors due to an economic crisis. They could newly invent social relations and an overall new society which would increase their subjective well-being despite a reduction in GDP. And in relation to the lockdown it could equally well be argued that it is the task and duty of (humanist) politics to prevent the rise of fear via adequate measures.

And a philosophical problem or mistake is that the dead cannot any longer subjectively estimate their well-being at all. Accordingly, it may be argued that there is a clear, qualitative difference between a loss in subjective well-being (“-20%”) and a loss of one’s life (≠ -100%). Perhaps this is why lockdowns found support by the majority of people in many countries, if not all (which is unknown here). Another may be that when it comes to their own health and the lives of others within their neighbourhood, people are risk-averse.

What is puzzling and pressing about the overall problem is, indeed, that it is practically unavoidable.

To treat it as a taboo is accordingly as unhelpful as to insinuate that some cheap utilitarian answer is convincing and empirically proven. What is bad, irresponsible and undemocratic is that politicians as well as journalists don’t say clearly what they want, value, and which trade-offs they believe are justifiable. (Unfortunately, those are tough calls.)

This also hides which social, economic, political and legal inequalities are taken to be normal and therefore, not to be tempered with as soon as “normality” is re-established, and that new policies may in fact enshrine old inequalities and establish new. Although the dilemma is real, for instance, one question about arguments of the Augsteinian type may be whether it is plausible to open up “society,” “the economy” and “democracy” in Germany under the prospect of letting a few or thousands of the old die in order to let (or make) 21 Million work again, because their situation within “normality” had already been next to miserable. Given this, such debates are reactionary as long as they are not combined with critical debates of pre-lockdown “normality.” Although this is probably not his intention, to invoke constitutional rights and their equality may just be distracting from other inequalities. At least there is a slippery slope.

However, if utilitarian arguments are invoked, they should be made explicit to be convincing. This means to explicitly determine which groups would gain what and which groups would lose what. If the (liberal) idea is that everybody should (and can) be responsible for his own health, or that the stakes are not so high that states should intervene to protect the human right to live because liberty is the highest good, then a pandemic is an excellent occasion to discuss this. The same holds for all the utilitarian claims about the consequences of shutdowns and recessions. They hide that the costs are normally to be shouldered by specific groups and that those who are talking don’t belong to them. Those who suffer declines in health and premature deaths in recessions are those who cannot afford stuff and lifestyles. Those who suffer the same within the lockdowns are primarily those “essential” and “system-relevant” nobody cared about and most looked down to only a few weeks ago. For short, the problem is that beyond ideologies of getting closer within the crisis “to get through it” the well-being of some is valued in normal times but not that of others, or not equally. In the end, obviously the latter are supposed to contribute to the overall well-being of the former.

This is most obvious when we get back to the question whether COVID-19 or the shutdowns plus recessions will produce more deaths.

Taken from ILO Monitor: COVID-19 and the world of work. Second edition – Updated estimates and analysis

On a worldwide scale, this is still open. In most parts of the world, people cannot afford to lock themselves up. While already 820 Million people are permanently at risk of suffering from hunger and billions have no safety net to rely on, it is estimated that at the end of the year “265 million people could be pushed to the brink of starvation.”

On the backdrop of this, it does not matter whether you are a utilitarian of sorts, a pragmatist or something else.

A major part of policies countering the costs of shutdowns and recessions should find their origin in “the North” and should be directed towards “the South,” although thus far hardly anybody cares. Probably from a European perspective the South already begins at what in pre-modern times was a natural border: the Alps.

Daniel Plenge

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