The pandemic is highlighting a question: What should a public health response be in the absence of evidence of effectiveness? In particular what should a public health response be to the question of more or less restrictive lockdowns. Lockdowns are there to reduce transmission, illness, hospitalisations and deaths. And, the Covid crisis is clearly causing many excess deaths for the time of year compared to the last 5 year average. At the same time the evidence for lockdown effectiveness on reducing illness and death is persuasive, if circumstantial. Although, as well, lockdowns clearly cause harms to health in many ways.
So, how to decide whether lockdowns are a good thing? An important question as there have been many politicians campaigning against lockdowns in the UK parliament.
There are voices worrying about the sacrifice of so much by so many to save ‘so few’ lives (Pollock), and there is an organization trying to measure the collateral harms of lockdowns. But is it possible to empirically calculate the cost-benefit ratio of lockdown versus no lockdown. How many lives need to be saved by lockdowns for them to be good thing? Whose lives are saved and whose sacrificed and what harms are suffered and how much harm is suffered. Having numbers is never enough and I think this is asking the wrong question.
For me the question needs to draw on an aspect of moral philosophy, about a Kantian judgment that is not just about reason or rationale but focuses on the values a society places on a) honesty and clarity about the benefits and harms, b) when a government can be authoritarian in a crisis, c) the ability to value possible harms, d) the value of the lives of vulnerable minorities, and the most impoverished in society; and e) the aptitude of a majority to take individual action collectively to protect a minority .
Put most bluntly, for lockdowns, the choice between mitigation or zero Covid policies is about a choice between barbarism and civilization. This is the choice between a) intentionally and consciously sacrificing lives according to a law or voice of conscience that says: “Thou shallt kill” – most egregiously demonstrated in recent history by Germany’s National Socialism of the 1930s; and b) intentionally doing one’s best to protect the lives of all, even if this means causing harm to many in the process, to follow a law or ‘voice of conscience’ that demands care of all others (those strange to you) with love.
The consideration of cancer screening poses special questions here, and highlights what is at stake: mass cancer screening programmes arguably protect the lives of a relatively small number of people by preventing by their cancer deaths. In this sense it is caring, albeit impersonally (it is the programme that does the caring). Mass screening is a kind of lockdown – it restricts freedom to be free of the offer of screening that compels compliance. It also causes harms to many through overdiagnosis and possibly premature deaths due to over treatment. However cancer screening is: a) dishonest because it is marketed and offered on false pretenses because it invokes fear which incites desire and compels compliance; b) unjustly morally persuasive because the harm of over-diagnosis cannot be adequately valued by individual citizens because it is an as-if virtual, never sensorily experienced as such event, which is therefore unimaginable as personally relevant; and c) is intrinsically seflish, the individual acts for personal benefit not for the benefit of others. Cancer screening exists because it is first and foremost compatible with a selfish exploitative capitalist ideology.
Considering cancer screening helps us to see what is at stake when it comes to mass lockdowns to eradicate coronavirus.
Lockdown is resisted by capitalism because it threatens the continuity of commodity exchange and the compulsive need to extract surplus profits for so many.
But mass lockdown to redue viral transmission, illness and deaths of the most vulnerable, is honest, or better, at least more honest, it is a) transparent; and b) its harms are experienceable and/or visible to all. And mass lockdown is an intention to protect the lives of those most vulnerable to the virus – the old sick and poor. National lockdown is a zero Covid strategy that may fail in the end. But it is the only civilized strategy: according to a voice of conscience calling for care of the other rather than calling for hate, exclusion and exploitation. Of course, in the UK, capitalism and elitism is slow to take action to mitigate the harms of lockdown by providing anything like adequate financial support and the health service has been so degraded by privatization it cannot cope with the demands.
Any mass intervention carries moral overtones and becomes an imperative, with oppressive potential. The feature of lockdowns, like vaccinations, is that the individual’s participation is never only about benefit for the individual, there is always at least hope fthat the individual’s participation will benefit the community at large and in particular benefit for the most vulnerable. The participation has an altruistic component that values the lives of others, it could be regarded as an act of caring with love for the other. This is in contrast to the anti-lockdown, herd immunity, let-it-rip, approach, whhc consciously sacrifices the vulnerable and especially the older population, a selfish policy of disregard, de-valuation of the lives of others, a politics in the end of callousness and that opens the door to totalitarian destruction, and the banality of evil characterised by Eichmann.
However the pandemic is global and bearing in mind the sheer scale of the task and the likelihood that, for example, the USA, at least, will seed the world for years to come, there is a compelling argument, for example, to impose sever travel restrictions in and out of the UK, and especially to isolate the USA in particular.