Prof. Robert van Voren. Getting Ready for the Next One

Prof. Robert van Voren, Director of the Andrei Sakharov Research Center for Democratic Development at Vytautas Magnus University

It might seem premature to start a discussion about future pandemics, but in fact it is already overdue. Three months into the lock-down which has gripped the majority of people on the planet and has already had unprecedented effects on the global community, we can already see where many things have gone wrong and how at least some of the consequences could have been averted.

Speaking about too extreme lock-down measures is a dangerous venture. One is quickly put in the same category as those who oppose lockdown in principle. One of the extreme examples is the Brazilian President Bolsonaro, who continues to oppose lockdown measures while his country has globally become the second in numbers of those infected and where medical services in cities like Sao Paulo are crying for help and are overwhelmed by people in IC units. Also, the U.S. President Trump belongs to this category as well, since he has systematically undermined all efforts to maintain physical distancing, while openly supporting heavily armed anti-lockdown demonstrators, who see the regulations as an infringement on their rights enshrined in the Constitution. Moreover, Trump preferred to go golfing on the day when the country reached the symbolic benchmark of 100,000 dead.

In spite of this, even when one is in full favor of physical distancing, it would be a gross mistake to postpone or avoid analyzing the price of the lock-down out of fear for repercussions in public opinion. From the onset of the pandemic it has been clear that societies were unprepared, and even now, after two-and-a-half months, affluent countries like the Netherlands have a chronic deficit of personal protection equipment (PPE). Sixty percent of the nursing homes in the Netherlands still have no PPE, and I have colleagues and friends working mental health care facilities in the country that have no masks and no other PPE except for a small bottle of disinfectant brought from home. How is this possible?

The Netherlands-based institute Gupta Strategists conducted an analysis of the consequences of the country’s response to the COVID-19 pandemic: “COVID goes Cuckoo”. The title refers to the fact that cuckoos lay their eggs in nests of other birds, and likewise the persons who fell ill with COVID-19 had to be taken care of in beds that otherwise would have been used to take care of patients with other “regular” diseases. The Institute analyzed all figures that are available at this moment and came to sometimes surprising, but often shocking conclusions.

In its calculations, the institute used the concept of “healthy life years” (QALYs, Quality Adjusted Life Years) in order to be able to translate its findings into easily understandable figures. In the Netherlands, the number of intensive care (IC) beds reserved for COVID-19 patients was quickly scaled up and, at the peak of the pandemic, more than 750 extra IC beds were created, a doubling of the previous number, and a total of more than 1,400 beds were used for COVID-19 patients during this period. As a result, 13-21 thousand healthy life years were gained. COVID-19 itself resulted in a total loss of 10-15 thousand healthy life years. However, because regular medical services were scaled down in order to be able to meet the COVID-19 pandemic, the institute calculated that between 100 and 400 thousand healthy life years were lost. This was the result of people who could not be helped medically because of the almost total focus on COVID-19, because people did not get their regular medical checkups e.g. because of cancer, and because people were afraid to see a doctor and rather stay home – and, in some cases, they died.

This issue was also raised by a group of 600 American doctors who wrote an open letter to President Trump in which they pointed at the “exponentially growing negative health consequences” of the COVID-19 lockdowns. They pointed out that the calls to suicide hotlines had increased by 600%, while 150,000 Americans who should have had their regular cancer screenings did not have their medical checkup. They too referred to the high number of people afraid to seek medical help, including persons who suffered heart attacks but did not call an ambulance out of fear of becoming infected and thus died at home. At least 40% less severe heart attacks were treated during the COVID-19 pandemic, and one only has to guess the cause of this.

Of course, this letter will support people like President Trump, who believes that with all lockdown measures we are throwing away the baby with the bathing water. He might also be encouraged by the economic figures. The Gupta Institute calculated that the cost of COVID-care for one healthy life year carried between 7 and 23 thousand euros. However, the COVID-19 response also drove up the cost of regular hospital unit costs, and the resulting true cost of one COVID-related healthy life year was rather between 100 and 250 thousand euros. The Dutch Ministry of Health always maintains the ceiling of 80 thousand euros per healthy life year gained, which has now been bypassed, resulting, according to the Gupta institute, into an untenable situation. The institute calls for a pro-active approach, among others, by developing a differentiation between hospitals, some of which would be immediately turned into COVID-19 hospitals while others would maintain the regular medical services.

The true figures will only be known in the years to come, but what is clear is that the effects of the COVID-19 pandemic are unprecedented and that a lot of this is the result of our unpreparedness. If the United States had closed its borders one or two weeks earlier, it would have saved between 36 and 54 thousand lives, up to 60% of the lives now lost, with all the financial (and emotional) consequences. Too slow bureaucracies, too much fear of political fallout and too much infighting, combined with the belief in our ability to control everything, have resulted in what to a large extent is a man-made disaster. The best we can do now is to monitor how we try to overcome the disaster and use that knowledge to be prepared for the next pandemic. Because that, almost certainly, is only a matter of time.