CHRIS, A 75-YEAR-OLD caller to a BBC phone-in (just before lockdown became compulsory) said she’d rather risk death than give up her simple pleasures. So she had visited the beach, laid flowers on her mother’s grave, and met up with a friend.
Calling her “irresponsible”, the presenter asked: “So you’re happy to die for a day on the beach?”, and Chris replied, “Yes”. Cue social media outrage.
Though arguably Chris was irresponsible, by potentially harming others (about which more later), her decision to risk her own life raises important issues.
Quality vs quantity of life
Discussion of the pandemic is mostly about saving lives. But concerns about lockdown, and the economy, are really about quality of life; confinement and unemployment are miserable.
People want to enjoy life, not just live forever — which is why they often do things that aren’t 100% safe. Such as smoking, drinking, driving, sports, and countless other pleasures and conveniences. Similarly, Chris cares more about her quality of life than a small risk of death from coronavirus.
But does her enjoyment really justify this risk? How can we compare these apples and oranges?
In fact, we can put numbers on them. Going out and about as normal might reduce Chris’s life expectancy by about half a year.¹ Or suppose she obeys the lockdown instead: if her main pleasures are the outdoors and meeting people, her quality of life could be halved. Someone living alone, with little to do at home, might well be tipped into depression. And such restrictions might continue for a year, until a vaccine or herd immunity means normal life can resume.
Losing half your quality of life for a year, by obeying the rules, is as bad as losing half a year of life expectancy by ignoring them. So if lockdown would affect Chris that much, she’d be better off going to the beach.
Even if it wouldn’t affect her so badly, her behaviour may still be rational. For people often prefer a small chance of a big loss (e.g. death) to the certainty of a smaller loss (e.g. lockdown).²
And I suspect those late in life value the quality of their remaining time more than its length. Consider, as an extreme case, someone terminally ill; would they rather die under lockdown, or live their final months as they wish, even if for shorter? (As I write, a man dying of cancer is being interviewed on the radio, forbidden from seeing his children.)
Risk to others
However, there is also the issue of the potential harm to other people, should Chris get infected. Though that’s not straightforward either.
Friends who agree to meet Chris presumably share her attitude, and accept the risk to themselves, or they’d refuse to see her. So we can set them aside.
As for those who don’t share her attitude, they will be social distancing, or if they’re medical staff they will/should have protective equipment; so the chance they will catch coronavirus from Chris is small. (Or she might take a fatalistic view, and just not seek medical treatment if she falls ill.)
Arguably, Chris’s behaviour is not unusually selfish; for people accept small risks to others. Americans lose nearly half a year of life expectancy to car crashes, in which drivers may kill passengers and pedestrians, not just themselves. Yet many car journeys are no more essential than going to the beach. And passive smoking kills a similar number, yet cigarettes are hardly essential either.
Sooner or later, lockdowns will gradually be lifted. Some businesses will re-open, children will return to school — even though this will increase the risk to others (e.g. transport workers and teachers). Again, people accept this. But those in vulnerable groups — like Chris, and the man with cancer — may be forced to remain at home, even if they want to risk their own lives.
To be clear, I’m not saying people should disregard others’ health. Or that current lockdown policies are wrong — governments have to decide what’s pragmatic and defensible. I am not offering a solution to these dilemmas. But they are more complex and nuanced than is often assumed.
For people care about quality of life at least as much as quantity; saving lives is not the only thing that matters. And people often do things that slightly risk others.
So perhaps an old lady who goes to the beach is no worse than drivers and smokers.
¹ If Chris ignores social distancing rules, suppose she has a 40% chance of getting symptomatic COVID-19 in the next year (at a guess), until a vaccine or herd immunity renders her safe. If infected, she has a 5.1% chance of dying (Imperial College model, Table 1), and a 24.3% –5.1% = 19.2% chance of non-fatal hospitalization. So that’s a 40% × 5.1% = 2.0% chance of her dying of COVID, and a 40% × 19.2% = 7.7% chance of serious illness from it.
Her life expectancy aged 75 would ordinarily be 13.1 years. Suppose that if she dies of COVID at all, it’s likely to be soon (as the UK is near peak deaths), in say 0.2 years, so she would lose 12.9 years of life.
Suppose instead she is hospitalized but doesn’t die. I’ll guess serious illness (e.g. permanent lung damage) might lose her 3 years of life expectancy (or an equivalent, lesser but longer reduction in quality of life). And I’ll ignore dying or serious illness without being hospitalized.
Together, these result in a loss of 2.0% × 12.9 years (from death) + 7.7% × 3 years (from serious illness) = 0.5 years of life expectancy.
² So-called risk-seeking behaviour, which is normal and often rational in this kind of situation. Given the choice between a certain but moderate loss and an unlikely big loss, people often pick the latter — even if it’s worse on average (because preferences don’t have to follow the average).
For example, a desperado who, faced with arrest and inevitable jail-time, chooses the riskier alternative of a shootout with cops in the hope of getting away. Similarly, Chris is risking death to avoid imprisonment (indeed, for some, solitary confinement). Though at far greater risk to herself than to others.
Something that could explain the public backlash is the large percentage of people who are so called 'non-traders' or 'zero traders' when asked to do time trade offs when weighting QALYs. About 57% of respondents don't trade off any length of life for quality increases. As you note the public revealed preferences show they will trade off quality for quantity but when asked to actual think about this a lot of people refuse to do this. Which explain why a large proportion of the public would view an argument for an improved quality of life vs reduced life poorly. This finding is the same when looking at QALY vs $ trade offs with a large proportion of people unwilling to trade off any amount of money against the value of a life.
Interesting and curious. I wonder if this is partly due to health only being one aspect of quality of life (happiness/life satisfaction).
Also I wonder whether the framing of the question is important. People have trouble thinking about this stuff clearly.
More understandable with $ trade-offs (people being funny about money).
A significant further thought:
The above calculation is done on life expectancies, treated as expected utilities; but human psychology doesn't work like that:
Arguably in Chris's particular case she may lose somewhat less than half her quality of life by conforming with the lockdown. In which case her behaviour looks irrational in life expectancy terms.
But Chris's behaviour is rational if she is risk-seeking. She prefers gambling her life (and perhaps others') by going to the beach, to the alternative of suffering a sure loss of quality of life by staying at home. This is normal behaviour in prospect theory - the same as a 'desperado' who, faced with arrest and inevitable jailtime, prefers the higher risk, less certain, lower expected utility option of stealing a car, shooting at cops etc. in the hope of getting away.
I.e. Chris, a 75-year-old desperado, is risking death to avoid imprisonment (and for some people, solitary confinement).
A 1/2 drop in quality of life sounds wildly implausible for what this caller is describing, or for any of the hardships of social distancing unless basically everything that could go wrong does. I could plausibly see it looking like that big a drop if you've never experienced anything really bad, and maybe it's halfway between a normal day and the worst day in a pretty easy life. But it's not halfway to zero.
If you lose your job, don't have any savings, and it forces you to be long-term separated from your spouse/your significant other, on top of losing your favorite recreational activities, mayyyybe that's a loss of 1/2 of your quality of life for that timeframe. But being healthy and the people you care about not dying is a pretty big part of total quality of life in itself. Unless you specifically enjoy the crowds, you can find ways to relax outdoors without being exposed to crowds. And maybe it's only 1/2 as fun as the crowded beach, but that's not a 1/2 drop in your total quality of life, only a 1/2 drop in enjoyment of that one activity.
Well, the specific caller in question aside, a fall from 8/10 to 4/10 (on a happiness or life satisfaction 0 to 10 scale) is plausible for a significant minority of people, e.g. if you're elderly and live alone and have nothing much to occupy you indoors. In the UK (more so in some other countries) you're not allowed out to relax; you need to be exercising, e.g. walking, not sitting on a bench or whatever (and police in my area are enforcing this); and the guideline is max 1 hour per day. And many with underlying health conditions in the UK are being told not to go out at all.
If this tipped you into depression, which it might with some, that could easily cause a fall from 8/10 to 4/10 or 6/10 to 3/10.
Of course the precise numbers are not really the point - I was just wanting to illustrate that the loss in quality of life can be large and of a similar scale to loss of longevity, so far from negligible.
I suspect also that if you're elderly and may only have a few years of life left then you put a very high value on maintaining your regular activities, maybe weighting quality of life rather higher than quantity (no doubt there is research on this). Hence why when very ill they sometimes forego treatment, choose to die sooner at home rather than be kept alive in hospital, etc.
Do you have data or expert analyses to back up that loss of utility? I agree that people might fill out surveys saying their happiness has halved, but I think that's because they lack perspective on how much worse life could be. This is something that calls for some hard analysis of the factors that contribute to quality of life, from experts (economists, psychologists, public health people, I'd accept anyone in the general vicinity).
Yes there's lots of research & data on this, particularly in recent years. The best summary is the new book Can We Be Happier? by Richard Layard. The largest factors (from memory) are health (especially mental - much larger than physical health), not being unemployed, having a partner, income. The most common measures are happiness and satisfaction with life, on a 0-10 self-reported scale.
Indeed people may lack perspective; so there's lots of work on how objective these self-reports are, what precisely they measure, whether they are absolute or relative to other people (in the same city or country) or relative to people's own past or whatever. I think the current consensus is that they are largely absolute measures.
Not sure (without looking up) what magnitude of changes to someone's life it would take to halve these numbers, but I have little doubt depression could do it.
Also (on a slightly technical point) most people reckon there are states worse than death, so death should be located not at 0/10 but maybe around 2/10. Which means halving your quality of life as compared with death (as an alternative) would only require a reduction from say 8/10 to 5/10 (since 5/10 to 2/10, the same distance, is a reduction to death).
Never heard of Layard, but the Guardian hates him despite him being Labour Party, so I take that as a strong signal that he's credible.
Layard is one of the top happiness economists.
Indeed the Guardian review of the book was dreadful. I almost wrote a point-by-point refutation of it (but no-one would read it). Turns out the reviewer is a self-described Marxist with a website called 'Leninology' so has a political axe to grind. As is hinted at towards the end of the review - for Layard advised the Blair government (on increasing mental health funding), and Blairites are the enemy.
Quite why a national newspaper would commission & publish such a misleading, bilious, partisan piece is beyond me.
Thanks for the feedback here and on Facebook. I've just revised the post as a result - tightened up my arguments and added a few new points.
0.5 years = aprox. 182 days going to the beach. So, she shouldn't go to the beach today - and we're not even discussing the odds of her infecting someone else.
However, I think limiting the access to open spaces to a number of people per day would be a better policy than just shutting then - since it seems extremely unlikely you can catch covid in sunny open spaces if you're careful enough.
Nevertheless, I totally agree with you that we should consider a little bit more how much is being sacrificed in terms of quality of life in the current lockdown, and try to find ways to mitigate this loss. Too often, the fiercest defenders of a strict lockdown are something like aspies who spend more time in front of a computer/phone than outdoors (and enjoy it), so they don't see it as a real sacrifice. I just think your example is not very good.
The comparison is with her not going to the beach, socializing etc. for a year (rather than one-off), which I'm arguing could well halve her quality of life, so be equivalent to losing 0.5 years of life expectancy.
I assume the concerns about people visiting open spaces - even if social distancing - are largely about the other associated risks, from people using public transport to get there, going into shops to buy sandwiches/drinks, etc.
Why not restrict only those sources of contagion? Is it easier to prevent people from accessing parks than buses? (honestly, I don't know)
This confirms my priors that outdoor contagion must be really rare. Moreover: if that's true, then outdoors / environmental disinfection would be a waste, if not overall harmful.
Presumably they need to keep public transport operating for key workers, e.g. medical staff, supermarket staff etc. So if it's available then others will use it to get to parks.