Miles et al. 1%DIFDELCMD < ] %%% recently produced an analysis of the  costs and benefits of lockdown policies in the face of COVID-19 , focussing on the case of the U. K. They argue that the March- June UK lockdown was more costly than the benefit of lives saved, if the latter are evaluated using the NICE threshold of {\pounds}30000 for a quality-adjusted life year (QALY) . Looking forwards, they argue that the costs of a lockdown for 13 weeks from mid-June would be vastly greater than the benefits under any plausible QALY costing, even in a scenario in which easing lockdown led to a second infection wave that caused more than 7000 deaths a week by mid-September. I note here two key problems that certainly significantly affect their estimates and cast doubt on their conclusions. Firstly, they cut off their calculations arbitrarily  after 13 weeks, without costing the epidemic state at the end of the period . That is, they assume that we should be indifferent between mid-September states of 13 deaths a week and 7500 deaths a week, and corresponding infection rates. This seems indefensible unless one assumes that (a) there is only a small chance of any future vaccine and no future improvements in treatment or in non-medical interventions , (b) that COVID-19 will inevitably continue to propagate until herd immunity is reached . Even under these assumptions it is very questionable. Secondly, they ignore the costs of serious illness, possible long-term lowering of life quality , and possible lowering of life expectancy for COVID-19 survivors. These are uncertain, but clearly not negligible, and plausibly comparable to or larger than the costs in lives lost .
 %DIFDELCMD < ] %%% I critique a recent analysis (Miles, Stedman Heald, 2020) of COVID-19 lockdown costs and benefits , focussing on the United Kingdom (UK). Miles et al. (2020) argue that the March-June UK lockdown was more costly than the benefit of lives saved, evaluated using the NICE threshold of {\pounds}30000 for a quality-adjusted life year (QALY) and that the costs of a lockdown for 13 weeks from mid-June would be vastly greater than any plausible estimate of the benefits, even if easing produced a second infection wave causing over 7000 deaths weekly by mid-September. I note here two key problems that significantly affect their estimates and cast doubt on their conclusions. Firstly, their calculations arbitrarily cut off after 13 weeks, without costing the epidemic end state . That is, they assume indifference between mid-September states of 13 or 7500 weekly deaths and corresponding infection rates. This seems indefensible unless one assumes that (a) there is little chance of any effective vaccine or improved medical or social interventions for the foreseeable future , (b) notwithstanding temporary lockdowns, COVID-19 will very likely propagate until herd immunity . Even under these assumptions it is very questionable. Secondly, they ignore the costs of serious illness, possible long-term lowering of life quality and expectancy for survivors. These are uncertain, but plausibly at least as large as the costs in deaths. In summary, policy on tackling COVID-19 cannot be rationally made without estimating probabilities of future medical interventions and long-term illness costs. More work on modelling these uncertainties is urgently needed .
D
Miles et al.
D
1
R
recently produced an analysis of the
I critique a recent analysis (Miles, Stedman
A
Heald, 2020) of COVID-19 lockdown
D
of lockdown policies in the face of COVID-19
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case of the U. K. They
United Kingdom (UK). Miles et al. (2020)
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March- June
March-June
D
if the latter are
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. Looking forwards, they argue
and
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the benefits under any plausible QALY costing, even in a scenario in which easing lockdown led to
any plausible estimate of the benefits, even if easing produced
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that caused more than
causing over
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a week
weekly
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certainly
D
they cut off
A
cut off
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state at the end of the period
end state
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that we should be indifferent
indifference
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deaths a week and
or
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deaths a week,
weekly deaths
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only a small
little
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future vaccine and no future improvements in treatment or in non-medical interventions
effective vaccine or improved medical or social interventions for the foreseeable future
R
that
notwithstanding temporary lockdowns,
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inevitably continue to
very likely
D
is reached
R
, and possible lowering of life expectancy for COVID-19
and expectancy for
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clearly not negligible, and plausibly comparable to or larger than
plausibly at least as large as
R
lives lost
deaths. In summary, policy on tackling COVID-19 cannot be rationally made without estimating probabilities of future medical interventions and long-term illness costs. More work on modelling these uncertainties is urgently needed