Guest Post: Lockdown at any cost? Medicine and economics can tell the same story.

A guest post from MrTips:

The lockdown for COVID-19 had to happen, there is unlikely to be anyone with a combined pulse and brain who thinks life could continue ad lib as it did before. But I personally believe there is room for genuine debate about how much lockdown is/was needed. Hindsight is always 20-20, but there is also a case to be made based on “fool me once on me, twice on you”. We need to address the REAL consequences of severe lockdown before we contemplate doing it again.

Prior to us going to Level 4, many of my scientific and medical colleagues had already thought beyond the 4 weeks and expressed concern about the potential for loss of acute clinical service to people who genuinely needed it. Heart attacks, cancer, road accidents, important elective services. On top of this, the government and MOH flu vaccine and PPE distributions to GPs and some tertiary health divisions have been claimed as abysmal. Being closer than most to the action, I know who I believe.

In the last week or so, the economic consequences and debates have begun. The economic, societal and mental health consequences of lockdown are predicted to be severe. This could be classed as an understatement. But now, the medical consequences of a Level 4 type lockdown are becoming apparent. On the 16th of March 2020, Austria went into a Level 4 harsh lockdown, about 2-3 weeks after its first COVID19 case. Sounds familiar. They are now loosening the restrictions. Also sounds familiar. But is there a previously unappreciated medical cost? This research article in the number one ranked European Heart Journal suggests there is. Metzler and colleagues looked at the cost of lost services in acute coronary syndromes (ACS) during the first two weeks of the lockdown, compared with the two weeks before. The conclusion? Estimated excess ACS deaths due to the lockdown likely exceeded actual COVID-19 deaths in Austria to 29 March (110 vs 86). So, the true COVID-19 related death toll at the time could reasonably be argued as more than twice the “official” rate. Given that the Austrian COVID-19 death toll went from 86 on the 29th March to 491 on the 21st April, one could be forgiven for being concerned that unmet acute cardiac service deaths rose to over 600! And that is just for one condition. What about cancer? Suicides?

If this single result bears out in further post-lockdown research (underscored by ICD-10 COD records) then it paints a bleak future indeed. Unfortunately, this outcome will almost certainly be repeated in other European jurisdictions, once their data comes to publication. So, its highly likely Austria got more than they bargained for; so will we. Now that we plan to loosen from our Level 4 restrictions, it is going to be very important for authorities to consider the TOTAL medical consequences of the lockdown. We only have 14 COVID-19 deaths to date (22 April). How many heart attack deaths do we have over the last month, who could have been saved but for reduced service, or its non-take up? Given that one New Zealander dies every 90 minutes from heart disease under normal circumstances, we really need to know. Further, the Austrian data suggests if we go into lockdown again, it’ll just get worse, and could be absolutely futile. Losing your hard earned business from this virus would be absolutely heart breaking – possibly fatal. Turns out, it may be just as heart breaking in medicine as well.

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