Respectful disagreement: the covid-19 shielding listBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n382 (Published 09 February 2021) Cite this as: BMJ 2021;372:n382
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Dr Williams' letter laments Covid shielding as a draconian process with substantial impact on 'mental health, income, and on the economy generally'. While the effect of shielding on the economy are not controversial, the assertion on the effects on mental health and income is merely playing to the gallery and reciting the official manifesto without recognizing ground realities. In fact, in the terminology of labour economics - work is an undesirable 'economic bad' (as opposed to leisure time, which is a desirable ‘economic good'). Work, however sugar-coated, when compared with paid leisure time, is largely unappealing for individuals to pursue. In fact, except perhaps for those who are seized with missionary zeal, at the level of the individual, often, work itself, has little or no intrinsic or immediate utility. Dr Williams may wish to remind himself that since most UK organizations provide full pay to employees for staying off work for the purposes of Covid-shielding, so most employees do not suffer any loss of income. A moral hazard situation has therefore prevailed, compounded by the reality of ‘information asymmetry’ involving stated medical symptoms. As long as workers do not suffer loss of earnings, workers see staying off work, as good for them (full pay for no work, what can be better!) – regardless of official medical opinion and government reports (Public Health England, 2019) on the salutary effects of toil on mental health or physical health. In my experience, the burden of work in the present, outweighs considerations of the future effect on the economy and security of jobs (‘the time value of toil’), from the perspective of both individual workers as well as trades unions. Given this economic reality, the poor handling of the shielding of the vulnerable in the United Kingdom, has given rise to some interesting labour economic phenomena.
As an Occupational Health Physician, I am privileged to have a ring side view of unfolding labour market phenomena. I have had employees submitting unjustified ‘shielding letters’, in support of claims for staying off work on fully paid ‘sickness absence’. Employees have even successfully stayed off work citing a member of their household as being on a shielding list. In an interesting case of the Freudian slip, a manager of an organization that is heavily subsidized by public funds, even referred to an employee’s absence as involving as ‘shielding from work’ (not from Covid-19!). I have noted employees with a diagnosis of cancer on long-term follow up, submitting claims for shielding although they are not on active cancer treatment and functioning well at home. Of late, a commonly cited medical reason for paid absence from work has been ‘Covid-stress’ and ‘Long-Covid’, neither of which are medically objectively provable, leading to an information asymmetry fueled quagmire. In the occupational health setting, the oft heard phrase ‘I love me job’, not uncommonly belies the reality of the ‘revealed preference’ of employees availing themselves of paid leisure time, using sick notes. The Covid crisis has compounded the situation with the addition of shielding letters to the card deck. I find that absenteeism due to lenient and liberal issue of shielding letters (and sicknotes) leads to workplace discontent and lowering of morale especially because not all employees - especially those of minority ethnicity - can access such paid leisure time.
The economic impact of opportunistic claims relating to Covid-19, on individual organizations and the wider economy must be immense. However, the apportionment and economic impact analysis of the deleterious effects of Covid-19 shielding is probably not even possible, since managers and companies, whether public or private sector and government organizations, will not publicize or publish data that casts themselves in a poor light. This is an interesting case of governance failure due to conflicts of self-interest.
While doctors (and governments) see themselves as having a duty to relieving suffering and would like to be seen as ‘nice’, the duty to serve the long-term public interest should be upheld despite the pressing pressure of public opinion and popular demand for staying off work, citing medical reasons. It probably does not need an economist (using the framework of 'the tragedy of the commons'), to predict that the lowering of economic productivity by organizations, through short term gains for individuals, will eventually translate to long term pains for all.
Public Health England (2019). Health matters: health and work. UK Government. Guidance. Published 31 January 2019. https://www.gov.uk/government/publications/health-matters-health-and-wor...
Competing interests: Dr Chind is an Occupational Physician and Director of Proshen Health & Risk Consulting Ltd, providing advice to individuals and organizations on occupational health, industrial hygiene and labour practices and policies.