Harms of public health interventions against covid-19 must not be ignored

Type Journal Article Author Itai Bavli Author Brent Sutton Author Sandro Galea URL https://www.bmj.com/content/371/bmj.m4074 Rights Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. 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.https://bmj.com/coronavirus/usage Volume 371 Publication BMJ ISSN 1756-1833 Date 02/11/2020 Extra Publisher: British Medical Journal Publishing Group Section: Analysis PMID: 33139247 Journal Abbr BMJ DOI 10.1136/bmj.m4074 Library Catalog www.bmj.com Language en Abstract The harmful consequences of public health choices should be explicitly considered and transparently reported to limit their damage, say Itai Bavli and colleagues The SARS-CoV-2 pandemic has posed an unprecedented challenge for governments. Questions regarding the most effective interventions to reduce the spread of the virus—for example, more testing, requirements to wear face masks, and stricter and longer lockdowns—become widely discussed in the popular and scientific press, informed largely by models that aimed to predict the health benefits of proposed interventions. Central to all these studies is recognition that inaction, or delayed action, will put millions of people unnecessarily at risk of serious illness or death. However, interventions to limit the spread of the coronavirus also carry negative health effects, which have yet to be considered systematically. Despite increasing evidence on the unintended, adverse effects of public health interventions such as social distancing and lockdown measures, there are few signs that policy decisions are being informed by a serious assessment and weighing of their harms on health. Instead, much of the discussion has become politicised, especially in the US, where President Trump’s provocative statements sparked debates along party lines about the necessity for policies to control covid-19. This politicisation, often fuelled by misinformation, has distracted from a much needed dispassionate discussion on the harms and benefits of potential public health measures against covid-19. Collateral damage The harmful consequences of public health interventions can be direct or indirect—for example, psychological harms, equity harms, group and social harms, opportunity harms, and inequalities in intervention benefits.12 These interventions can increase the adverse outcomes they seek to prevent or affect other health outcomes.234 Policy makers, acting to protect public health, need to weigh the possible side effects when deciding on, implementing, and evaluating specific public health interventions.1 Public policy efforts that have been implemented to deal with the covid-19 pandemic have been caught in a political maelstrom precisely because these efforts, in their first iteration, did not consider the potential negative consequences. Although policies to bring about mass social distancing may have slowed viral spread, they also brought about unprecedented levels of unemployment that led to justifiable resistance from some sectors. Had these policy efforts explicitly considered these consequences from the start—and social distancing has long been an element of planning for a severe pandemic—this would have obviated some of the political backlash, leading to more uniform and more effective implementation of these policies. We offer three areas of harm that should become part of all efforts to evaluate, assess, and respond to the harmful consequences of strategies to contain SARS-CoV-2.