The coronavirus crisis is hugely impacting most of humanity and dealing with it is immensely complex. As a scientist with broad interests, I was therefore eager to see how TU Delft is contributing to the debate and attended its recent public webinar about ‘Uncertainties in decision-making in times of COVID-19’.
The webinar took as basis the official WHO value for the Covid-19 mortality rate – 3.4%! – calculated as the number of deaths divided by the number of infections. I wish the discussion would have stated that the number of infections is most likely to be underestimated, with possibly up to 90% (!) of infected people going undetected, mostly due to limited testing, thereby resulting in an at least uncertain death rate. Of note, other Dutch experts work with values of between 0.4 and 2%, which is possibly still a high range. The chosen value of 3.4% did set a dramatic backdrop for the discussion: according to this percentage, a ‘no measures taken’ scenario would result in 500,000 deaths in the Netherlands!
But perhaps even more disturbing is that while the rest of the discussion was supposedly dedicated to a comprehensive and ethical approach to decision-making, the emphasis seemed to be mostly on the number of deaths and the necessity of limiting that number. Remarks on the age of the coronavirus victims were dismissed with the argument that after many decades of contributing to society, people deserve to live as long as possible. One conclusion of the discussion was that decision makers should take emotions into consideration more.
‘The sacrifice has only just begun’
The current situation shows all too well the moral dilemmas that accompany decision-making. We would do justice to the complexity of the questions that society poses by adopting a broader view on these matters. That unfortunately did not happen, possibly because technical webinar constraints conflict with open discussion. I would like to bring in a wider perspective by considering other consequences of the lockdown than only the death toll.
Jeopardising the future
What about children in poor and/or lower educated families being disconnected from school education or even lost (in France, schools have completely lost contact with 5-8% of their pupils), thereby further deepening the gap between the privileged and non-privileged in an increasingly unfair education system? And what about the young workers on the edge of a burnout because of lockdown stress? Or the women and children victims of the dramatic increase in domestic violence (50% more calls to the Kindertelefoon (children’s helpline) and >30% more cases of domestic violence in France)? What about poor families starving as a result of missing affordable school lunches? What about the psychological and economic consequences of job and small company losses? And since we are obsessed with death, scientists point out that this sort of psychological and economic damage impacts health and ultimately, life expectancy.
It seems difficult in our modern society to accept that death, even as late as possible, is part of life. I therefore wonder if the choice of jeopardising the future of the younger population in the hope of scraping a few more months or years (median death age of the Dutch coronavirus victims: 81) of life for the older population reflects a strong emotional component in the decision-making.
The most vulnerable
Let’s conclude with two questions to further ignite the debate that I think we dearly need.
While experts pretend to worry about hospitals having to choose who may survive, is the lockdown policy not actually already, without much debate, implicitly favouring a small minority of the population, that is the elderly, over a large majority? Even worse, the lockdown is sacrificing the most vulnerable among us: those living in precarious conditions in small unfit homes; the single-parent families; the least educated; those with temporary jobs or the self-employed; the wives and children of violent men; the psychologically vulnerable ones. The sacrifice has only just begun, as in France the boss of bosses and the Government are already hinting at violating workers’ rights by increasing weekly working hours and shortening the legal holiday entitlement to restore the economy.
Last but not least, were those supposedly protected by a lockdown even asked about their preference? Thousands of elderly people are currently dying in complete loneliness. Even worse, in many homes for senior citizens, where visits have been forbidden for weeks, the virus did find a way in nonetheless, and where it has not, loneliness itself will kill our elderly.
Everyone in society, from young to old, is affected, be it in terms of health, economically, educationally, psychologically or contracting or dying of Covid-19, and they all deserve to be considered equally in the complex equation underlying comprehensive and ethical decision-making.
- Geneviève Girard is a Policy Advisor at the TU Delft Strategic Development Service, Corporate Policy Affairs Department. This text reflects her personal opinion and not that of her Department or any official body at TU Delft.
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