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Diabolical dilemmas of COVID-19: An empirical study into Dutch society's trade-offs between health impacts and other effects of the lockdown.

ABSTRACT: We report and interpret preferences of a sample of the Dutch adult population for different strategies to end the so-called 'intelligent lockdown' which their government had put in place in response to the COVID-19 pandemic. Using a discrete choice experiment, we invited participants to make a series of choices between policy scenarios aimed at relaxing the lockdown, which were specified not in terms of their nature (e.g. whether or not to allow schools to re-open) but in terms of their effects along seven dimensions. These included health-related effects, but also impacts on the economy, education, and personal income. From the observed choices, we were able to infer the implicit trade-offs made by the Dutch between these policy effects. For example, we find that the average citizen, in order to avoid one fatality directly or indirectly related to COVID-19, is willing to accept a lasting lag in the educational performance of 18 children, or a lasting (>3 years) and substantial (>15%) reduction in net income of 77 households. We explore heterogeneity across individuals in terms of these trade-offs by means of latent class analysis. Our results suggest that most citizens are willing to trade-off health-related and other effects of the lockdown, implying a consequentialist ethical perspective. Somewhat surprisingly, we find that the elderly, known to be at relatively high risk of being affected by the virus, are relatively reluctant to sacrifice economic pain and educational disadvantages for the younger generation, to avoid fatalities. We also identify a so-called taboo trade-off aversion amongst a substantial share of our sample, being an aversion to accept morally problematic policies that simultaneously imply higher fatality numbers and lower taxes. We explain various ways in which our results can be of value to policy makers in the context of the COVID-19 and future pandemics.

SUBMITTER: Chorus C

PROVIDER: S-EPMC7494093 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Diabolical dilemmas of COVID-19: An empirical study into Dutch society's trade-offs between health impacts and other effects of the lockdown.

Chorus Caspar C Sandorf Erlend Dancke ED Mouter Niek N

PloS one 20200916 9

We report and interpret preferences of a sample of the Dutch adult population for different strategies to end the so-called 'intelligent lockdown' which their government had put in place in response to the COVID-19 pandemic. Using a discrete choice experiment, we invited participants to make a series of choices between policy scenarios aimed at relaxing the lockdown, which were specified not in terms of their nature (e.g. whether or not to allow schools to re-open) but in terms of their effects ...[more]

PMID: 32936815

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Project description:The emergence of the COVID-19 pandemic forced most countries to put in place lockdown measures to slow down the transmission of the virus. These lockdowns have led to temporal improvements in air quality. Here, we evaluate the changes in NO2 and O3 levels along with the associated impact upon premature mortality during the COVID-19 lockdown and deconfinement periods along the first epidemic wave across the provincial capital cities of Spain. We first quantify the change in pollutants solely due to the lockdown as the difference between business-as-usual (BAU) pollution levels, estimated with a machine learning-based meteorological normalization technique, and observed concentrations. Second, instead of using exposure-response functions between the pollutants and mortality reported in the literature, we fit conditional quasi-Poisson regression models to estimate city-specific associations between daily pollutant levels and non-accidental mortality during the period 2010-2018. Significant relative risk values are observed at lag 1 for NO2 (1.0047 [95% CI: 1.0014 to 1.0081]) and at lag 0 for O3 (1.0039 [1.0013 to 1.0065]). On average NO2 changed by -51% (intercity range -65.7 to -30.9%) and -36.4% (-53.7 to -11.6%), and O3 by -1.1% (-20.2 to 23.8%) and 0.6% (-12.4 to 23.0%), during the lockdown (57 days) and deconfinement (42 days) periods, respectively. We obtain a reduction in attributable mortality associated with NO2 changes of -119 (95% CI: -273 to -24) deaths over the lockdown, and of -53 (-114 to -10) deaths over the deconfinement. This was partially compensated by an increase in the attributable number of deaths, 14 (-72 to 99) during the lockdown, and 8 (-27 to 50) during the deconfinement, associated with the rise in O3 levels in the most populous cities during the analysed period, despite the overall small average reductions. Our study shows that the potential trade-offs between multiple air pollutants should be taken into account when evaluating the health impacts of environmental exposures.

Dataset Information

Diabolical dilemmas of COVID-19: An empirical study into Dutch society's trade-offs between health impacts and other effects of the lockdown.

Publications

Diabolical dilemmas of COVID-19: An empirical study into Dutch society's trade-offs between health impacts and other effects of the lockdown.

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