Intended for healthcare professionals

Letters Covid-19: the long road to recovery

Covid-19: democracy and hard choices in public health

BMJ 2020; 369 doi: (Published 05 June 2020) Cite this as: BMJ 2020;369:m2090
  1. David Bell, independent consultant
  1. Issaquah, WA 98027, USA
  1. bell00david{at}

As covid-19 mortality grows, the global effects of “lockdown”—from mass unemployment to threatened famine—become increasingly stark.1 The phrase “but it has to be done” is threatening decades of norms on human rights by focusing whole countries, the world, on one problem and one outcome.

Dispassionate discussion of covid-19 is difficult, but we owe the public the right to information provided calmly, honestly, and with context. Data indicate that covid-19 mortality is well below 0.5%,2 probably far lower,3 and death is rare in people under 40 years of age.4 In the United States, total mortality of covid-19 is currently just 30% more than that of drug overdoses annually and is 16% that of cancer. Globally, it’s 20% of tuberculosis. Do the public really grasp this when hearing the terms “rampaging” and “catastrophe”? Would they react to 1 in 1800 people, predominantly unwell and elderly people, dying in the UK as they do to 36 000 deaths?45

With covid-19, decision makers are damned if they do and damned if they don’t. But good public health approaches include the public in decision making, not by scaring them, but by providing facts. Pushing millions of young people into unemployment and delaying evidence based health checks will substantially reduce life expectancy.6 “Waiting for the global vaccine” will increase famine and child mortality.78 Although all lives are of equal value, these life years lost will dwarf those of covid-19. No legitimate covid-19 response can ignore this.

How can we ensure that the public health values we held dear in 2019 still hold sway? We could insist on always giving numbers in context; ensure that modelling always includes all costs; and avoid the demonstrably false premise that this is about lives versus money. Money saves lives.

Politics and name calling are the people’s prerogative. We should inform them. Even at the risk that they might disagree with us. We have lives to save, economies to support, and democracies to nurture. That was, and is, public health.


This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.


View Abstract