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The Morton’s Fork of the government’s coronavirus dilemma

There is little doubt that, despite what still appears to be widespread support, the coronavirus lockdown presents the government with a number of huge dilemmas.

Some columnists like to style the key dilemma as ‘health v wealth’, but another aspect is lives being saved versus lives potentially being lost.

No one would argue that the lockdown has not saved lives from COVID-19, but what is more difficult to gauge is what might be the consequential increase in other deaths both during lockdown and after it has ended.

Just as there are a range of predictions as to the course of the pandemic, we can only speculate as to the true infection fatality rate (‘the IFR”) because we simply have no idea how many people have actually been infected.

This is a far more important statistic than the case fatality rate (i.e. deaths arising amongst those who have tested positive) because the CFR ignores all those people who have had the virus - with or without symptoms - but who have not been tested or counted.

The CFR in the UK seems to be around 9% but, despite some COVID-19 deaths being left out of this statistic (e.g. initially those in care homes and other ex-hospital deaths), the IFR is certainly much lower.

To protect the NHS, the government’s ‘stay home’ (now ‘stay alert’) strategy is designed to contain the numbers getting infected but, as it can only report the CFR through a lack of widespread testing, we are not getting the full picture.

The Continuous Mortality Investigation of the Institute and Faculty of Actuaries is now producing a weekly paper analysing the excess deaths caused both by the pandemic and by other causes.

In the week ending 24 April (week 17) the expected number of deaths - derived by applying Standardised Mortality Rates to the exposed population - was 10,203. However, there were actually 18,440 deaths - an excess of 8,237 - of which only some 70% had COVID-19 registered on the death certificate.

In week 17 there were 116% more deaths than expected, 119% higher for males and 112% higher for females. In week 15 (ended 10 April) there were 77% more deaths than expected (88% in the case of males and 66% in the case of females). 

What is interesting is the volume of excess deaths ostensibly unrelated to COVID-19. In part this might be down to misreporting, but there will still be more than expected deaths from other causes and it has been speculated that this is due to the lockdown and people’s reluctance to call on the NHS at a time of stress. In addition to the evidence of excess deaths during lockdown, it is suggested that there will be more deaths after lockdown because of some of its consequences. Clearly this is much more speculative but it is telling that one mental health hotline has already reported an increase in call volumes of nearly 900%.

Health v wealth

The government had to face a dilemma in imposing the lockdown (health v wealth) but the dilemma of how and when to remove, or reduce, restrictions may be greater still.

As Professor Philip Thomas of Bristol University has opined “the difficulty for the government is that the electorate would place a higher value on the lives lost as a result of ending the lockdown (assuming it did result in more people dying from COVID-19) than lives saved as a result of avoiding a deep recession”.

Of course, the value equation might vary as between those in different age groups and it is unlikely that the effects of the lockdown will be evenly spread across the generations, or by social class.

Dilemmas have garnered a variety of names through history and from literature. I knew of Sophie’s Choice, Catch-22 and Hobson’s choice but until I went looking, I had never heard of Morton’s Fork.

John Morton was Chancellor of the Exchequer under Henry VII and he rationalised a tax by suggesting that those living modestly must have savings and so could afford a tax, whereas those who were living extravagantly must be rich and so be equally able to pay up.

In reality Morton’s Fork is a false dilemma in which contradictory observations lead to the same conclusions. Perhaps that best describes the government’s position at the start and the end of lockdown - damned if they do and damned if they don’t. But let us hope that Morton’s Fork does not become Sunak’s knife.

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What is more difficult to gauge is what might be the consequential increase in other deaths both during lockdown and after it has ended.

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