December 12, 2023 - 11:00am
Dubbed “Dr. Death” for allegedly putting the economy ahead of lives during the pandemic, Prime Minister Rishi Sunak hit back at his critics yesterday. Unlike other Cabinet ministers, the former chancellor was not afraid to discuss the longer-term economic consequences of lockdown, arguing that the UK did a poor job of transparently discussing the costs and benefits. “Many of these impacts are not felt immediately,” he told the hearing. “They are felt over time. And that was a tough thing to deal with.”
Indeed, the long-term consequences of lockdowns remain underappreciated. One analysis published in August 2020 suggested lockdown harms in England were five times larger than benefits, while others have estimated much higher ratios. A recent report from the Centre for Social Justice claims that lockdown had a “catastrophic effect” on the UK’s social fabric, widening the division between the well-off and those who struggle financially.
Many use the Quality-Adjusted Life Year, or QALY, a standard metric in health economics that attempts to holistically measure reductions in quality of life. In a major new admission, the Prime Minister pointed to findings from Imperial College London and the University of Manchester that “applied a QALY analysis to the first lockdown” and “which suggested that the lockdown in its severity and duration was likely to have generated costs that are greater than the likely benefit”.
Yet this was dismissed by the inquiry barrister, Hugo Keith KC, who said that “we’re not interested in QALYs”.
Why not? After all, this was perhaps the only time a Government minister has acknowledged that the costs of the first lockdown exceeded any likely benefits. Sunak then noted the “enormous anxiety” at the Treasury in 2020, and argued that current historically high UK tax levels were a consequence of lockdown borrowing.
This is unquestionably true. Government spending during the crisis is estimated to have reached between £310 billion and £410 billion, much of which was used to mitigate the social blowback from non-pharmaceutical intervention (NPI) restrictions. Now, thanks to inflation and cuts in Government spending, public services — from criminal courts to hospitals to schools — have continued to deteriorate compared to pre-Covid times. According to some, they may have entered a “doom loop of decline”.
Instead, the inquiry targeted the “Eat Out to Help Out” campaign, which has been erroneously linked to the surge of Covid in autumn 2020. Sunak’s scheme provided a 50% discount on meals and drinks in pubs and restaurants for three days a week for the month of August 2020. It subsidised 160 million meals at a cost of £840 million, although the economic benefits remain unclear.
Sunak’s defence again invoked the need to study the harms of lockdown. Addressing concerns that he had not consulted scientists or health officials about Covid risks, he called the scheme a “micro-policy” implemented in the context of the Government’s overall reopening plans to safeguard millions of jobs and restart the economy. It was “reasonable, sensible and the right thing to do”, he stated, comparing it to other fiscal measures such as VAT cuts or furlough that traditionally do not require scientific rubber stamps.
In response, Hugo Keith reiterated his own biases, suggesting that Eat Out to Help Out “encouraged more people, additional numbers from different households, to come together in restaurants to eat […] It wasn’t just a fiscal issue: it was a behavioural matter.”
The inquiry’s disdain for QALYs and cost-benefit analysis is symptomatic of our flawed mental model of the Covid years. Sunak, by his own admission, was repeatedly frustrated in trying to incorporate this into Government decision-making at the time. The inquiry had a rare opportunity to question the former chancellor about trade-offs and the harms of Covid policies. Yet rather than pursue lockdown scepticism as a legitimate path of investigation, the inquiry blew it. Again.
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SubscribeThe whole Inquiry is no more than a disgraceful charade. Barristers know the law and are good at pushing a predetermined line and cross questioning witnesses in order to establish evidence to support that line but unsurprisingly are not the right people to examine complex trade offs of decisions in respect of epidemics that require a sound understanding of statistics relating to health, psychology and economics. The KC dismissed talk of QALYs because he had no briefing on it and was therefore ignorant.
The outcome of this vastly expensive charade is already predetermined. The KC is just looking for evidence to support it and seeking to sideline any evidence that questions it.
Spot on with one proviso. You are right that it appears “ The KC is just looking for evidence to support it and seeking to sideline any evidence that questions it.” but it is the Judge not the KC who writes the report. Lady Hallett is said to be politically astute and she gives the impression of having realised that the questioning is neglecting certain issues including the debate around lockdowns. She also has access to the written submissions which are more heterodox than the spoken answers are being allowed to be. I would not rule out a more sensible report than the current “charade” might lead us to expect.
Possibly. Her lack of intervention here compared to other areas where she has intervened would suggest otherwise.
You are quite right that it is for Lady Hallett to write the report but a Judge can only proceed on the basis of the evidence put before her and there seems to have been no steer on her part to develop lines of enquiry outside the lines being pursued by the KC. I think she would be reluctant to incorporate material from written submissions that has not been tested in cross examination – that is not the way the Judicial mind works.
I am not particularly reassured by your suggestion that she is politically astute ( something suggested in a Guardian article). The question as to the extent to which lockdown and the the way the pandemic was handled and should be handled in future should not be one of politics. We know that it was the political pressures on Johnson that led him to abandon the planned response that was nearer that of Sweden and adopt the course he did. The question is whether that was in fact the correct course. That requires a much broader consideration of fact than is currently being fed into the Inquiry. The cavalier treatment of QALYs is symptomatic of the narrowing of evidence being adduced coupled with an excess of time devoted to personal and personality issues.
I wasn’t privy to the various discussions by those in authority and I’ll admit I haven’t systematically read all the published evidence. But from what I have seen and my memory of the public debate at the time, this is exactly right.
There seemed to be, at best, an assumption in public discourse that a general lockdown was both optimally effective and cost free and, at worst, a visceral anger from some quarters towards anyone who even entertained the possibility that the decision to lock down should be considered in the balance with other factors.
In short, if you weren’t unequivocally in favour of lockdown to the point of not even admitting the possibility of other costs and consequences, then in the eyes of many you were no better than a murderer.
But responsible public policy making, and especially public health policy, rarely if ever works like that. Decisions almost always have to balance costs (both financial and others), future consequences, trade-offs, risks, compromises etc. There are lots of very, very hard choices and no perfect solutions. And when it comes to major health crises those hard choices by definition tend to involve balancing the health of one group against the health of another, whether now or in the future.
In some ways this episode was the apotheosis of the modern conviction that government can and should fix everything all the time and at no cost to us personally. It can’t and there is always a bill.
You are quite right about hard choices and balancing costs and benefits. The problem at the time was that there was neither the data nor the time to make that kind of judgement. The expected costs of lockdown were completely hypothetical, as were the costs of letting the virus rip, and the effectiveness – or very much otherwise – of the Barrington model. It was not a question that some people assumed that lockdowns were optimal and others were wise enough to consider costs and balances. On one side there were those who in an uncertain situation chose to limit the damage from COVID and pay the price – which required a collective effort from the whole population. On the other side were those who in an uncertain situation preferred to assume that it would all be fine, and sabotage the official plan to limit the disease rather than submit to the horrible indignity of wearing a mask or curtailing their social life.
The anti-lockdowners (not to mention the anti-vaxxers) were certainly no better at acknowledging the costs and risks associated with their chosen strategy than the lockdowners. And they still talk as if they were obviously right and everybody else are idiots – safe in the knowledge that since their prescriptions were not followed, no one can prove what the costs would have been.
I have to disagree with you. There was plenty of evidence at the time.
The Ferguson model was based on 3 assumptions
1. 100% of the population were susceptible to the virus.
2. 85% of the population would catch it in the first 12 months.
3. 0.9% of those who caught it would die.
He used an outbreak of measles from the 1840’s as the basis for these assumptions.
No evidence exists to show a 100% of the population are susceptibility to a coronavirus. There is no evidence that 85% of a population would catch it over a short period of time. Infection fatality rates are always high at the start of an outbreak, they reduce markedly overtime.
If the government had asked for evidence to support the models assumptions. We all know that if assumptions of a model change, then the output changes. The assumptions should have been questioned, there were many questioning them at the time, when the government finally decided to release them.
Dr Claire Craig has written a good book called Expired. She explains in detail how models were treated as science, which led to catastrophic outcomes.
It’s also worth noting, that come the Omicron wave, Fergusson was still using his old models. Luckily for us, they had around 40+ plus modelling groups working on it as well. They gave a different outcome, which reflected the reality that we saw.
Funny, you are not quoting any of all that evidence you claim there was. All you are saying is that Ferguson could not *prove* that his assumptions were correct – but no one could prove that they were wrong either. The evidence was not there.
Anyway, ‘all models are wrong, but some are useful’. You try out various plausible assumptions and see where they lead. And the decision makers (unless they are stupid) take input from more than one model or one person, so no point in blaming it all on Ferguson. The Danish health authorities started out by predicting that COVID would never get to Europe, and if it did it would quickly fizzle out, so there was no need to do anything except follow the standard flu-epidemic plan. I believe they were proved wrong, but their sin was not in making a wrong judgement call, but in not allowing for uncertainty. One of the Barringtoners (Gupta?) were pushing model calculations not long after Ferguson based on the assumption that COVID had been around quite a while, there was a lot of immunity, and the epidemic was just about played out already. Oh boy, was she wrong, but fair enough, it was worth trying out that assumption too to see what the absolute-best-case scenario would be. Fortunately the decision makers preferred to listen to Ferguson rather than her.
So, never has 100% of o population being susceptible to a coronavirus before, does that not raise questions with you? Never has a coronavirus infected 85% of a population in a short space of time before, does that not raise questions for you? These two are evidence from history, so I’m baffled by your assumption that his models couldn’t be proven wrong. The first Covid death was in January 2020 in the UK, so it had been round a longtime before lockdown. I don’t recall the top people supporting the Barrington approach, that there would be a single wave. It didn’t get pushed forward until the first wave had passed.
He used the same models for Omicron, they proved to be completely wrong.
There is one thing that is always baffled me about the response to COVID. It was known from the beginning that COVID was a respiratory virus (of which there are many), and that it was a coronavirus (of which there are a number). That being the case, why did medical authorities behave like it was something from outer space? I mean, they seemed genuinely surprised when they learned that it spread by airborne means.
Never in well-documented history have we had a completely new and (to some extent) lethal coronavirus, where there was no pre-existing immunity. Susceptibility to AIDS (also new, but yes, rather different) seem to have been pretty close to 100%. I do not remember any scientific consensus back then about what would be the obviously probable figures to use – it is now, with hindsight, that people think it is all obvious. And, frankly, what difference would it have made if the true figures had been 97% and 80% instead? The model was a calculation of how bad it might realistically get. There were other models that (very deliberately) predicted lower figures. If Fergusons work was really so bad, it was up to the decision makers (one Boris Johnson, I believe) to evaluate the available evidence and decide how much weight to give each alternative. The big advantage politicians can have over scientists is that they are more used to taking important decisions under uncertainty. But of course, that would require someone competent and serious.
As I understand it, there is some evidence that China did delay in bringing the virus to the attention of the world, and that it was in Europe by late 2019. Had this been known, it might have changed the modelling.
“Expired” by Dr Claire Craig is very relevant to this discussion, as well as being an excellent read.
Fully agree. This conviction could equally applied to forcing motor vehicles off the road. They kill thousands every year, without even counting deaths by pollution. The government has to stop them in order to save lives. To illustrate the point, here is a running tally of all the deaths increasing each night on the evening news (calculated by counting anyone who came into contact with a motor vehicle in the week before they died). Anyone who objects, even on the grounds that in saving those pedestrians you will completely destroy the economy and kill far more people in the long run, will be dismissed as a crank at best and basically a serial killer. They will be shown photos of people who died in car accidents and asked what they would say to the parents of the poor victims.
Not only are they uninterested in evaluating the costs of lockdowns, but they are hostile to the idea.
Why could some of us see with clarity the ultimate costs of lockdowns from the get go and so many could not. Not even the unpopular bell curve can explain this. Throw in a serving of moral posturing?
A very good question which has finally destroyed what lingering respect I had for civilisation.
It just proves beyond all reasonable doubt that the late Bertrand Russell was absolutely correct when he said:- “ Most people would rather die than THINK and MOST do”.
I first joined UnHerd in 2020 during the lockdown. Every day was full of posts from the two sides – one pro and one anti. Neither side won. The politicians muddled through and now, with hindsight, we are giving them a good kicking. There is no right or wrong, only opinions.
I remember it well!
The anti lockdown people were resoundingly proved right.
I’m surprised some people today still think lockdowns were the best solution. I think a recent study has shown that most people would support a lockdown today.
What utter nonsense.
Defending what they supported. Bonkers.
The whole thing is a national disgrace, even worse than the Saville Enquiry but hopefully NOT quite as expensive!
This inquiry is clearly predicated on the notion that lockdowns and NPI’s offered far greater benefits than any harms done and anyone who has the temerity to disagree is either of an unsound mind or a doer of evil. Fortunately my jaw has long become used to dropping!
I will never stop beating this drum – 165 million people have been pushed into $2 a day poverty because of lockdowns. Starting in 1998, extreme poverty declined year after year. That streak ended in 2020.
Ignoring QALY is a terrible idea, all but guaranteed to lead to a cascade of problems. I’m tempted to make the snarky remark that it is an idea so stupid that only an academic could make it – but I am aware of, and wish to respect, the experts who have been beavering away quietly, for decades, exploring and finding answers to unpaletable but vital questions.
A life is not a life – a good life is 80 QALYs. Spending £30k, on saving a 80 year old’s life or on a 10 year old’s life, is not an equal outcome. The NHS/govt has decided that it’s worth £30k if it leads to a QALY, whether you live Chelsea or Mosside, man/woman, black/white or indifferent. The toughest question remains unasked and unanswered – why did we spend £10,000,000* per QALY, if you had covid, when we normally spend £30,000 on all other health issues? (*admitedly my back of a fag packet calculation – a fair estimate of lockdowns effectiveness is that it reduced deaths by 3.6% = about 10,000 lives. Average age of fatality is 2 years younger than average norm (typically, covid took away 2 years of life). Lockdowns costs conservatively estimated at 200 billion).
The enquiry is the finest example of confirmation bias i have seen in years and I mark about 300 UG scripts a year.
In the U.S., I think there is greater awareness of the social, educational and economic costs associated with lockdowns. You don’t hear anyone saying they should have locked down sooner and harder. Maybe that’s because there were a few states that didn’t lockdown.
Whether intentional or not, the lockdowns served as essentially an in vivo experiment regarding the response of various populations with regards to totalitarianism.
I am certain that this aspect will be thoroughly studied by some, either now, in the future, or probably both.
You know what is needed in an analysis of the real effects of an action is a control or an action that differed significantly from the one under investigation. We have that here, it is called Sweden or any of the other countries that behaved very differently (not a lot I know).
This stops the claims that there was no way to know what the outcome would have been if the other path was taken.
We have that information and barring some bad choices they have managed to get through the same situation with far less impact to their children, their economy and their health outcomes from other conditions that were neglected by our choices.
We are not in a vacuum; we need to look at all the ways that this pandemic was handled and find out what really worked and what really didn’t work!
The grandstanding KC is an embarrassment . His pompous hand gestures trying to look sagacious (he doesnt) and his discourtesy to the prime Minister were a disgrace. He will decide what he thinks is important . Ignoring the single most important question about the govt actions in a pandemic – as he hunts for low grade tittle tattle.
Rishi Sunak earns back some points from me today on this. Not many, and not enough for me to believe that his tenure as PM will be anything more than a damage limitation exercise before we get a Labour government, but still, he would appear to be a rare sane voice where this utter joke of a public inquiry is concerned.
What a mess this government is – and I’m not referring just to the party in government, I refer to the entire establishment. The Prime Minister himself is almost the only person in power who tells the actual truth to this otherwise transparent charade that is simply intent on exonerating the machinery of government from culpability for the worst public policy mistake in history.
There are times when I do actually wonder whether the Tories are just taking the blame for widescale public sector inertia and incompetence that they in reality have no power to change. This is one of those times.
So Boris had the right approach afterall?
If you look at the guidance over use of QALYs, it warns us that QALYs can over simplify calculations and restrict what is taken into account in those calculations. Many post covid effects that ‘are felt over time’ [Sunak’s words] and therefore unknowable without a crystal ball, but the increasing death rate was highly knowable. This is precisely the type of calculation that QALY guidance warned us to be careful of, the issues around covid are too disparate and unquantifiable for accurate QALY analysis. How do you split the difference between mass deaths and difficult to quantify broader harms? How do you separate out harms caused by lockdowns from harms caused by the pandemic, are people suggesting that without lockdowns everyone would be happy? QALYs can’t answer these questions. Then there’s the medical ethics of the thing, Doctors care for the sick in front of them, they won’t play God with huge numbers of people, and QALYs weren’t designed to do that either. Then there’s the question of economic and societal harms caused by incompetently locking down, and we need to be clear that a competent lockdown, test and trace, border controls package would completely change the calculation. Sunak is using QALY talk as a smokescreen.
Another overwhelmingly biassed and garbage article from this author who is creating strawmen and misleading narratives out of his backside.
And complete lies – where and when did Sunak say ‘lockdown costs outweighed benefits’? He didn’t and wouldn’t ever say that. Curious really how in the Tory Landlslide article comments there are complaints about media coverage, yet Unherd publish this BS and it gets liked by the same audience!
I’m not convinced by the Author’s contention re: Lockdown 1. The counter factual can’t be fully assessed – what would have happened without a LD to health services, and if overwhelmed what would have been the consequences? The assumption too easily seems to be they wouldn’t have been overwhelmed.
For example if Ambulance services couldn’t get to an RTA because stuck at overwhelmed hospitals or staff off with Covid or frightened, what then happens? People just remain helpless on the roadside? Police then try to cover as best they can but at expense of other tasks? Army called out? Just an example of what happens when overwhelmed and would be thousands of those sort of scenarios. Remember NHS sustained emergency services, just. If it hadn’t the consequences need to be laid against any assessment of cost/benefits.
Subsequent LDs and there is a stronger case cost/benefit.
There were no good options we certainly all agree.
Please, give it a rest. You’re fighting the last war.
It is quite clear now that no consideration whatsoever was given to the potential harms of lockdown at any stage of the pandemic and there was zero ‘assessment of cost/benefits’. Even Rishi now admits that the harms exceeded the benefits. You’re on the wrong side of history.
To repeat, as I will for every discussion on lockdowns. All of the blame and shouting and anger will lead to one thing only: no politician in the world will ever again take responsibility for our actions in a future pandemic.
So next year we will sign a legally-binding treaty where the WHO will be given the responsibility of saying who locks down, when they lock down, who is allowed to supply vaccine, who gets the vaccine, times when international flights will be forced to stop….etc.
Happy now?
That will happen whatever the general public thinks of it. We will not be given a choice.
That does not mean that we should go gentle into that good night, giving a free pass to those who caused so much pain, distress and long-term damage to so many.
My wife was diagnosed with Stage 2 cancer after missing screenings for two years, because hospitals were effectively closed for anything but Covid. So no, I will not accept that ‘they did their best under the circumstances’.
I am very sorry to hear it. But how many screenings do you think they would have been doing if there had been no lockdowns but hospitals would have been full of COVID patients anyway? What would you have wanted them to do, that would have helped?
Exactly. It is easy to be clever after the event.
It wasn’t easy to be clever during the event. That’s for sure.
And you still think that lockdowns prevented people getting COVID. Still laughing.
I believe that if a virus is transmitted short distance via the air, reducing contact with others makes it less likely that you catch or transmit it, yes. Don’t you?
I couldn’t know about your wife. I can apologise for my tone but not for my opinion.
My opinion says that everybody was floundering about and it is too easy to judge things with hindsight.
Floundering they most certainly were. But locking down healthy people was never part of public health policy until ‘Dr Doom’ Ferguson scared the pants off the politicians with his dodgy model and they did a 180 degree U-turn.
It was obvious to many on here from the outset what the outcome would be in terms of future health issues and arrested child development, let alone the destruction of businesses and livelihoods. Is it possible that NO-ONE in government even considered these adverse effects? Or did they all just succumb meekly to groupthink and SAGEwashing?
One thing’s for sure, this enquiry will make very sure that we get none of the answers.
My view is that the drivers of most government decisions are cowardice and incompetence. I think the COVID policies adopted neatly illustrates that.
This WHO initiative is proof that they’re grooming us for the next masking+lockdown. I agree with other commentators here: “people” will acquiesce to lockdows and masking again, and again will pour vitriol on those who ask questions. People guard their freedom very carelessly. You can read today that the media is grooming the people for a new explosion of fear (“concern”) about a new bug that they report is “going around”. Academia will back the grooming, as they did for Covid. and when The Government attempts its next assault on our freedom of speech — eg: the Irish situation; it will happen in my corrupt country (Canada) as well. The Gov has us all under a expanding system of surveillance, supported by more civil servants that we can’t afford. The people go to Drag Queen Story-Time at the public library with their grand-children, and think “how wonderful”. The Masses surely do get off on the opiates.
There was a bias, certainly. In an uncertain and dangerous situation, people preferred the choice that was likely to save lives right now, and left for later the possible costs of losing money and missing school. Whatever the final balancing turns out to be, I hope we will have the same bias in the future.
We saved on average 1 year of life for people in their 80s, even after vastly inflating the statistics for deaths ‘with Covid’.
And that takes no account of the lives lost as a consequence of ‘mitigation’ policies and untested, injected gene therapies, which are becoming more and more apparent in people under 40.
Was it really worth it?
But perhaps you should answer the question, to show quite how you judge that you are on the right side of history.
We have all seen the effects of nursing home deaths on the media agenda, and it’s not difficult to imagine what a hurricane of press hysteria would have been whipped up by deaths arising from ambulance no-shows – that would instantly be linked to the failure to lock down. Try answering those questions with your QALY PowerPoint at the evening presentation.
Those who saw with great clarity what the effects of LD were going to be must also, I guess, have seen quite clearly what the concomitant risks of not locking down were, and how politicians might account for them to the people. But as the post above made clear, there were no easy answers (or at least not for the tabloids).
But I hear about ambulance no shows in the UK even from my coffee shop lady down the road.
This should be something we can all agree with.
Overwhelming hospitals is a bit of a red herring IMO. NYC brought in a hospital ship to handle the overflow, but it was never used. In some regions of Canada, the hospital bed shortage is so acute there is a crisis every time we get a bad flu season. If you have a mismanaged and underfunded health care system, even the slightest stress causes a crisis.
The UK NHS is in perma-crisis, evidenced by ever-rising waiting lists and some of the worst health outcomes in Europe. Yet a dozen temporary hospitals were built in anticipation of the Covid surge, which were never used because the surge never materialised.
And before anyone tells me this was because the lockdowns worked, please look at the infection curves which show that in every ‘wave’ infections were already falling before lockdowns were implemented, exhibiting the natural cyclical behaviour of coronaviruses like flu.
I have read frequently about the health services being overwhelmed. From years ago to today. You cannot easily even see a dentist in the UK. This is not anything to do with COVID. Lockdowns played a part though.
Sunak does not seem to be the best person to consider trade-offs between health and the economy. After all he did not even consider the health cost of his “Eat Out to Help Out” campaign. Could it be because he expected that his policy would increase the number of COVID cases (and COVID deaths) but preferred not to know it for sure?
It would be great to know more about the costs and benefits of lockdown – in the unlikely case we can find anyone who is trying to find out the truth, and not just to confirm his political prejudices. But Sunak is definitely not the man to ask.
There wasn’t a health cost to EOTHO. The rest of Europe didn’t have similar schemes yet had a very similar autumn second wave to our own.
The article claims that ‘Eat Out to Help Out’ was ‘erroneously linked to the surge of Covid in autumn 2020‘ But if you follow the relevant link, you find an article with the title:
“‘Eat Out to Help Out’ scheme drove new COVID-19 infections up by between 8 and 17%, new research finds.“. Which is rather the kind of thing one would expect for a policy that increases inter-household contacts in the middle of a respiratory pandemic. This is not a simple question – and claiming that you know with absolute certainty that you and your friends were right all the time is, well, not the way to gain respect.