Sree Gururaja / Times of India: What's the cost of saving lives?

For the first time IMR raised in the press via a via covid deaths - interesting perspectives


Sree


The question confronting us: What’s the cost of saving lives?
By
Chetan Bhagat
timesofindia.indiatimes.com
4 min
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If you are easily offended, or incapable of discussing unpleasant choices, such as lives vs livelihood, which we face right now, I’d suggest you do not read this article. As we head into the fifth week of the lockdown, with little clarity on what lies ahead, it is nonetheless important to discuss the consequences of our current choices. We have currently chosen to lock down our entire country to protect ourselves from the dangerous Covid-19 virus.

The Indian lockdown is being regarded as one of the toughest in the world. Case growth in India has been modest so far. It is fair to say that the lockdown is working to a large extent and we have saved some lives. And since lives have no price on them, all this is worth it. The logic is sound. If lives are priceless, they’re worth saving at any cost — that’s the current mantra.

Except, we Indians have never really applied this principle when it comes to saving lives from causes other than Covid-19. For instance, in 2019, according to a UN report, over 8,00,000 Indian infants died. The key causes were preventable — poor nutrition, sanitation and healthcare. If we spent ‘whatever it takes’ on these measures, we surely could save say a quarter, or 2,00,000 of these lives. But we don’t, do we?

The overall infant mortality rate in India is around 3%. This fatality rate is higher than that of coronavirus. Yes, the chances of a child dying simply because s/he was born in India is higher than the probability of someone dying if they contracted Covid. Most of these infant deaths are preventable. In the developed world, infant mortality rate is only 0.3%, a tenth of the Indian level. If we attacked infant mortality like we are attacking corona right now, we would see dramatic results in terms of saving lives. Yet, we don’t. We don’t think the additional resources are worth it.

In Gorakhpur, an oxygen supplier to a hospital didn’t get paid a sum of Rs 60 lakh despite repeated reminders. As a result, oxygen was cut off. At least 30 children died in 48 hours. That translates to roughly Rs 2 lakh per child. How come we didn’t think that ensuring good payment systems for our hospitals was worth it?

Various research houses and industry bodies estimate cost of up to Rs 10 lakh crore to the Indian economy due to current lockdown. Worth it? Well, lives can’t be quantified. However, let’s do a quick analysis by comparing these measures to others. Let us say if we did not do any of the current measures. Hence, say a million lives would be lost (a highly exaggerated figure). If we divide this cost of the lockdown with the lives saved, it gives us a figure of around Rs 1 crore per life saved. Also, most of the lives saved will be those of the elderly.

Now look at the number of total government hospitals in India, which is a little over 10,000. Let us say the government gave Rs 10 crore to each of them to upgrade facilities/hire doctors. The total bill for this will be Rs 1 lakh crore. If with these extra resources, each hospital could just save a mere 2 lives per week (will be much higher in reality), it would amount to 100 lives saved per year per hospital or a million lives saved overall. On a per life saved basis, it comes to 10 crores per hospital divided by 100, or Rs 10 lakh, a tenth of what it costs to save a life fighting Corona. These are conservative estimates. In reality, even a mere Rs 1 lakh can save a life sometimes, or a hundredth of what it costs to save a life from Covid.

It seems heartless to discuss lives in terms of money. But governments across the world make such tough choices daily. One life may be priceless, but the hard-statistic on what it costs to save a life is not. The cost comparisons are not just in healthcare. New footbridges in Mumbai local train stations could have saved a lot of lives. We chose not to make them — as we didn’t think saving those lives was worth the cost. People died. We don’t always spend to upgrade the quality of water or air — the costs involved and lives saved don’t seem worth it.

A major economic downturn has other costs too. Unemployment and bankruptcies will lead to a rise in all of the following — depression, suicide rates, domestic violence, crime, terrorism. All these directly cost lives, if not just great economic hardship and pain. As we remain in lockdown, many cases of cardiac diseases, cancers, diabetes are going undetected. These will cost lives later too.

The media frenzy around corona, our own panic regarding this disease, a desire to be seen as a responsible country in the eyes of the international community are making us look at corona differently than almost anything else we have in the past. There is definitely a genuine, underlying intention to protect Indians from this disease. However, we cannot ignore the economic reality of our country and our existing problems versus the rest of the world.

Mere emotion can’t drive this anymore. We have to balance our fears about corona, with the ugly tradeoffs the measures will create. Maybe a plan with somewhat less stringent measures may be more sustainable. Frankly, it might all we can afford as a nation anyway. As we continue with the lockdown, it is time we unlock our minds and see this problem from every perspective before we decide what to do next.