I agree with the overall thrust of your point, but I think it would be naive to assert that the COVID-19 lockdown had had NO impact of people's utilisation of the medical system. There's certainly been claims of decreases in the number of people contacting doctors about notable symptoms.

Lockdown adds an extra layer of friction between "I've got this one weird symptom" and "I've just been diagnosed with early stage {insert major condition here}"

Of course, "no doctors are available because they're all ill, or dealing with COVID" also has a similar effect. As does "I'm afraid to go to the Clinic/Surgery/Hospital because I think it's dangerous". I'm just saying that it can't go exclusively in one column or the other.

(And that's not considering the effect of the insane US health insurance system interacting with unemployment!)

Not sure about the US, but in Europe so-called elective surgeries were reduced a lot, related hospital wards were emptied and the staff redirected towards care for COVID patients. This was done preventively and at least in Germany it turned out that hospital beds were utilized much less than feared in March. In theory, cancelling electjve surgery should not lead to live years lost, but the reality is probably less clear-cut.

@Brondahl I think ultimately what you're getting at is that teasing out this accounting is impossible, because the lockdown is basically just one more form of impact from the disease. Apologies if I'm putting words in your mouth (at least they're words I wholeheartedly agree with!)--but the article, and the entire debate, about "economy vs lives!" is misguided, because we don't get to pick which dials we turn, and the effect of a lockdown actually necessitated by COVID is hard to separate from the effect of COVID itself (or from half the workforce dying, etc).

@Jan that's a fair point; though you'd also have to look at excess vitality from avoiding botched elective surgeries, in-hospital infections from electives, etc. In any case, I think it's fair to say that that isn't lockdown, it's triage.

@Brondahl: How much of that lowered utilization was in fact ignoring potentially serious things, and how much non-serious "well, I'll go to the doctor 'cause it'll make me feel better and insurance will pay for it" things?

@jamesqf This is in the UK, so insurance isn't an issue :P. But IIRC (and it's only a vague memory) it was something like "detection rates of early stage heart disease (which is normally detected by individuals coming to doctors with moderately mild symptoms, and getting 'lets check just in case' tests) has fallen drastically".

You have some good points, and my concern was that an op-ed would be either biased or incomplete. A peer reviewed version, assuming quality reviewers who press for the fuller scope as you are suggesting, would be very nice.

@Jan elective surgery is any surgery that doesn't need to be performed as an emergency, so while it shouldn't lead to immediate loss of life to put it off (unless a mistake was made or another factor is involved), it could still lead to lost years of life.

@Jan Whilst that's true, it is still caused by COVID. The reason for lockdown is to stop this effect being any worse than it already is, because when emergency departments are overwhelmed, any semi-serious injury/illness has a good chance of killing you just because you can't get treated. That's why people track "excess deaths" and not just deaths with COVID on the certificate.

@Jan You need to be careful about the definition of "elective surgery". For example, in my own case a major operation to remove a cancer was officially classed as "elective", since an alternative would have been no treatment at all beyond palliative care, and the outcome of surgery was estimated to have a 15-20% chance of death within 30 days (though I'm still here and enjoying life two years later) Trying to estimate the consequences of a 3 or 6 month delay to that surgery if COVID had disrupted the hospital's schedule is another question, of course.

... and while the situation was not an "emergency" in the sense that the procedure was required immediately, it was made clear to me that without the operation, "something could go pop at any time, and if that happens, you would be dead within an hour and there is nothing that could be done to prevent it."

@Graham: in countries (or parts of countries) where the hospitals were rather far from being overwhelmed, cancelling elective surgery was a precautionary measure that reduced the overall health of the population for (with hindsight) little benefit re. dealing with Covid-19. So IMHO one cannot just reject the argument that the life years lost due to less elective surgery are lost to the fear of Covid-19, rather than to Covid-19 itself.

Btw I think the decision to restrict elective surgery (in my country) was probably sound. I also understand that elective surgery is quite different from unnecessary surgery. But I think the quality of this answer could be improved by adressing some of the related practical outcomes mentioned by @Paul Draper rather than claiming that in theory, non-Covid patients not getting their treatment means that their doctor must be busy with Covid patients.

@alephzero: Agreed, There is no clear border between elective and non-elective and cutting down on elective surgery will mean that people die prematurely.

@jan in re: elective surgeries--this is addressed in the answer already. US government mandates did not stop elective surgeries--there's no way this can be fairly described as due to "lockdown." It was voluntary triage on the part of hospital systems seeking to make space available and protect their staff. The cited article does not claim to compare "COVID" to "fear of COVID;" it claims to compare COVID to the government quarantine response, and tries to make govt policy recommendations from that comparison. It's dishonest to blame government policy for hospital administrators' decisions.

Welcome to Skeptics! Congratulations on getting so many upvotes from the HNQ, but the bad news is that this is largely an opinion piece which is off-topic here. In your opinion, the blame should be placed on the disease, not the lockdown. The authors hold a different opinion of how blame should be assigned.

@Jan Using "overwhelmed" as the measure of full usage is not realistic though. Having one spare bed most of the time may look like you're running at less than capacity, but statistically you'll often get no new cases for a little bit and then two arrive at once. If you didn't have that spare bed, the new person would straight-up die in the corridor waiting for treatment, even though your numbers may still say that over the day/week you're still only at 80% capacity.

@Oddthinking That's not the case though. Epidemiologists do include deaths due to secondary issues as being caused by the epidemic, and deaths due to a lack of medical access are explicitly included. So this isn't just an opinion, it's a statement of how epidemiology works. Disagreement with this would probably constitute new research, which is explicitly disallowed by SE.

@Oddthinking The part which could not-unreasonably be attributed to lockdown is any effect from unemployment. The studies quoted are not clearly relevant though, because they relate to longer-term unemployment. A more realistic study would cover the impact on unemployment after a natural disaster such as Katrina. It should be clear that not working due to lockdown is exactly equivalent to not working due to your workplace being under 6 feet of water; and that it is not at all equivalent to not working due to, say, Ford moving production to Singapore or a coal mine being played out.

@Graham: If your answer is "Technically speaking, this claim is incorrect because epidemiologists use the word ''responsible' (or 'blame' or 'cause') in a different way to general English." that's fine, but you'd have to come up with references to support that. claim. I don't know why you think disagreeing with you would count as Original Research; that's a new one on me.

My intuition is that you are right that studies on the marginal cost of of unemployment aren't applicable here, but if you want to argue that, let's see some references.

It's likely no one will get this far into the comment chain, but please know that your statement, "Health care access has never been prevented by quarantine measures" is untrue. The majority of my health care visits were canceled. I understood why and actually preferred to avoid hospitals and any health care facilities located in the hospital. And this was during the healing process of a complex leg fracture among other things. (I did upvote your answer though.)

@Brondahl: OK, in Europe change the wording to "the government will pay for it" :-)

"The article authors' argument is incorrect because they misattribute the 500,000-lost-years-per-month from foregone medical care to lockdown..." No, they really don't. The "foregone medical care" part is an afterthought, presented in the article after discussing the real killer: the massive spike in "diseases of despair" (suicide, alcoholism and drug abuse, etc) caused by economic hardships.

@Oddthinking A basic guide to excess mortality for people who've only just found it in connection with COVID-19: health.org.uk/news-and-comment/charts-and-infographics/… Another more detailed explanation: channel4.com/news/factcheck/… The work of the EU monitoring organisation tracking the impact of epidemics, who as usual define their research in terms of excess deaths: euromomo.eu/about-us/history

@Oddthinking Thanks for pulling me up on references BTW - good to have the challenge to do better. :) A study about unemployment after Katrina suggests that New Orleans unemployment went from 5% to 25% over the year of the disaster, then recovered to around 10%, so peak unemployment during the event is clearly not a good indicator. Katrina also caused significant damage to buildings and population displacement, none of which applies to our current situation. bls.gov/opub/ted/2015/mobile/…

@Oddthinking It's not that disagreeing with me constitutes original research, it's that this is simply how epidemiologists track the effects of an epidemic (link above). My understanding of SE is that this isn't a place to suggest new ways to change SOP for a profession, and suggesting those changes would constitute new research unless backed up by someone who's already doing/done that work.

Just so we are clear. This answer is currently headed toward deletion. Let's get more serious about fixing it. I am not suggesting Original Research. I am not suggesting that epidemiologists change their practices. That's silly. I AM suggesting that if there is an overreaction to a threat, it is perfectly reasonable to assign responsibility for the costs to the overreaction, rather than the original threat. If you want to argue that it is unreasonable (or even merely non-standard for epidemiologists to do so) you must provide references. You're the one making the claim.

@Oddthinking And this, Mr. Oddthinking, is precisely why people are talking about abuse of moderation here. It sure looks like the main reason you're threatening to delete the most popular answer is because you personally disagree with it.

@probably_someone: Please read my comments again, and try defaulting to an interpretation where my objections are in good faith and legitimate.

@PaulDraper, can you argue that those healthcare offices were closed as a government-enforced quarantine measure, as opposed by at the behest of the healthcare organizations themselves, which were reorienting themselves to deal with a surge in COVID patients and worried about becoming infection vectors themselves? Granted, in some states we've had governors' offices relaying recommendations wrt. delaying non-urgent procedures, but I'm not aware of those having force of law, as opposed to being driven principally by the healthcare industry itself.

(One of my family members had a chat with her doctor at the local hospital where a scheduled procedure was being cancelled, and the word was that they were trying to repurpose staff -- even specialists in unrelated fields -- to be able to deal with the potential influx of COVID patients; that's not "the government made us do it"; to reiterate: I'm aware of state-issued recommendations to defer nonessential surgeries; I'm not aware of mandates.).

@CharlesDuffy you are reading more into this than was said. The claim wasn't specific to recommendation vs directive vs mandate.

@Oddthinking: Re "...try defaulting to an interpretation where my objections are in good faith and legitimate", those of us who have been around for a while have seen plenty of evidence that your objections are emphatically NOT in good faith. You abuse your position by deleting anything that you personally disagree with, no matter how interesting or relevant it might be.

@oddthinking apologies, I have not had access to StackExchange since the question was flagged. I'll be adding citations to original sources regarding US government policy, and how it did & did not impact access to healthcare, sometime in the next 24 hours.