How will it all end? Policies to address the worldwide crisis brought about by COVID-19 must satisfy three criteria. First, they must aim to minimise the loss of life directly resulting from the disease, while recognising that there remain deep uncertainties about its true nature.
Second, they must restore the elements of economic and social life as soon as possible, so as to avoid disastrous and lasting consequences, including for other aspects of health, schooling, food security, and livelihood. The costs of lockdowns have already been massive and will deepen if they result in foregone health treatments, dropouts from school, and permanent closure of businesses. The direct effect of COVID-19 on the life expectancy of the non-elderly will be modest. But the indirect effects of the lockdown on health and well-being may be severe, especially for poorer persons and countries. An approach that values all lives must give attention to the costs as well as benefits of the lockdown, conceiving the public health comprehensively.
Third, they must aim at a glide path out of the crisis, that can reasonably be projected to end it once and for all — not merely to manage it indefinitely through, for instance, periodic lockdowns. That idea has been motivated by abstract epidemiological models which do not take account of other health effects, let alone non-health effects, of draconian policies, and which make mechanical assumptions about individuals. On and off policies can result in deep damage. There are costs involved in starting and stopping schools and business, but beyond this, human beings need regularity to plan and act sensibly.
An effective health system
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