Dying for a day at the beach

[revised version]

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.

Conclusion

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.