By Malcolm Kendrick, doctor and author who works as a GP in the National Health Service in England. His blog can be read here and his book, ‘Doctoring Data – How to Sort Out Medical Advice from Medical Nonsense,’ is available here.
The self-inflicted damage we’ve done to our economies in the name of combating Covid-19 will kill far more people than the virus itself. The economic collapse that followed the communist bloc’s break-up caused millions of deaths.
There has never been a situation to compare with what we have been living through these past weeks and months. Never in the history of the world have entire countries been locked down. Never have entire countries inflicted such enormous damage to their own economies and distorted their health systems away from all other activities, to deal with a virus.
I felt, right from the start, that the potential harms from lockdown could well exceed any – speculative – reduction in Covid deaths. I began by arguing against lockdown from an economic perspective, which many people hated. They felt it was impossible to put a value on a human life, even to attempt to balance money versus health.
Perhaps they were unaware that we do this all the time. It is why NICE – the UK’s National Institute for Health and Care Excellence – was established in 2000. It is what all healthcare systems are forced to do. No country can afford to throw unlimited resources at healthcare. We all must decide what we can, and cannot, afford to do. Tough decisions to make, but essential.
Perhaps I came at the lockdown from a different viewpoint from most other people. When the pandemic took off, I was analysing the impact of economic and social upheaval on mortality. I was looking specifically at the breakup of the Soviet Union, as I knew that there had been a massive health impact from the rapid and uncontrolled “transformation” from a socialist to a market-based system.
An exhaustive study by three Austrian academics of the fallout from the dissolution of the communist bloc demonstrates the economic devastation it wrought:
“The immediate economic consequences of transformation were significant falls in gross national product. For example, between 1990 and 1993, real GDP had declined in Lithuania -18 percent, Ukraine -10 percent, Russia -10.1 percent and Tajikistan -12.2 percent. The first 10 years of transformation was a period of great social disruption and chaos. The introduction of a market system of exchange led to a severe decline in gross domestic product, contraction of the labour market, and unemployment leading to social malaise including a rising death and suicide rate.”
What was the true impact on health? My main research interest is in cardiovascular medicine, and I was focussed on deaths from coronary heart disease (CHD). In lay terms, this means deaths from heart attacks. I had just put together the graph below, using Lithuanian data.
As you can see, there was a dramatic increase in CHD deaths in 1989, the year that the Berlin wall fell. Lithuanians commenced their singing revolution, and there were mass demonstrations for independence, along with significant social upheaval.
The Soviet tanks rolled in, stayed for a bit, then rolled back out again, without doing much. Meanwhile, the Lithuanian GDP fell through the floor, and the rate of CHD virtually doubled over the next three years. A great mountain of increased mortality which makes anything from Covid look like a speed bump.
Of course, there were things over and above economic woes going on in Lithuania. However, I know that economic worries, by themselves, can be deadly. Perhaps the single deadliest thing of all. For instance, a study in South Africa found that people with significant financial worries were 13 times more likely to have a heart attack:
“People who reported significant financial stress were 13 times more likely to have a heart attack than those who had minimal or no stress. Among those who experienced moderate work-related stress levels, the chances of having a heart attack were 5.6 times higher.”
Lithuania was not the only ex-Soviet country to see a massive increase in death. Not just from CHD, but in all-cause mortality. Here is a section of a report on the break-up:
“The transition to market economies in many post-communist societies of the former Soviet Union and other former eastern bloc countries in Europe has produced a ‘demographic collapse.’ Among the most serious findings is a four-year drop in life expectancy among Russian men since 1980, from 62 years to 58.
“There were also significant drops in life expectancy in Armenia, Belarus, Bulgaria, Latvia, Lithuania, and Romania. The immediate cause of the rising mortality is the ‘rise in self-destructive behavior, especially among men.’ Old problems such as alcoholism have increased; drug misuse, a relatively new problem in the former communist bloc, has risen dramatically in recent years.” The report, Transition 1999, stated that suicide rates climbed steeply too, by 60 percent in Russia, 80 percent in Lithuania, and 95 percent in Latvia since 1989.
Behind the self-destructive behavior, the authors say, were economic factors, including rising poverty rates, unemployment, financial insecurity, and corruption. Whereas only four percent of the population in the region had incomes equivalent to $4 (£2.50) a day or less in 1988, that figure had climbed to 32 percent by 1994.
“What we are arguing,” said Omar Noman, an economist for the development fund and one of the report’s contributors, “is that the transition to market economies [in the region] is the biggest… killer we have seen in the 20th century, if you take out famines and wars. The sudden shock and what it did to the system… has effectively meant that five million [Russian men’s] lives have been lost in the 1990s.”
Five million lives lost in Russia… alone. As I write this, we have reached a worldwide figure of slightly under 400,000 deaths from Covid, in total. Covid now seems to be on the way out, and we may never reach half a million deaths in total. The economic impact, however, is only just beginning.
Moving back to CHD again, what were the Russian figures for CHD deaths following transition? As with Lithuania, they are quite fascinating, and highly disturbing.
You may ask why there was a two-year time lag between CHD deaths between Lithuania and Russia. I think the answer is that when the Berlin wall came down in 1989, it triggered an almost immediate crisis in Lithuania. On the other hand, the rest of the Soviet Union limped on for a couple of years. In 1991 there was an attempted coup, which failed. However, this did signal the end, and the Soviet Union then rapidly broke up.
In late 1991, Russia became a separate country, under the leadership of Boris Yeltsin, and it quickly moved to a market-based economy. Some people became eye-wateringly rich – far more became extremely poor. This, the delayed break up, is almost certainly why the Russian death rate lags Lithuania by two years.
There is another important difference. Russia did not just have one CHD peak, but two. After rising, then rapidly falling, it changed direction and climbed back up again. Why the double peak?
I think this can be explained by the fact that, in August 1998, there was a massive banking collapse. It virtually wiped out the stock market and destroyed the value of the ruble. At the same time, unemployment skyrocketed and the savings of the common man were further obliterated. The recovery took years, as this report makes clear:
“The enormity of Russia’s financial collapse on August 17, 1998 only really hit home with me the next day.”
“We are so f**ked,” George Kogan, one of Moscow’s most famous and longest serving equity salesmen, explained to me standing in the apartment of Simon Dunlop, one of Moscow’s most famous entrepreneurs. “The whole system has just crashed. It will take years for Russia to recover.”
Having seen the health impact of economic crashes, I hope you can now see why I was deeply concerned about lockdown. It was clear to me that this could mean massive financial hardship, and I feared that the deaths that followed could be catastrophic.
When our pandemic “experts” were putting together their models on death rate, did they take any of this into consideration? They did not. But what is the point of any model that does not even bother to consider the potential negative impact of what they are recommending?
As a doctor, if I were advising any form of medical treatment, I would be considered negligent if all I did was talk about the benefits. I need to inform the patient about potential downsides. The procedure may not work; you may get worse – and suchlike.
We were persuaded into lockdown with the promise that hundreds of thousands of lives could be saved in the UK – and millions worldwide. We were never warned about the many millions of lives that could – and, I fear, will – be lost as a consequence of lockdown. I consider that to be negligent. Especially as, in this case, the patient in question was the entire population of the Earth.