What have we learned from the covid-19 pandemic?

On March 11, 2020, the World Health Organization declared the covid-19 pandemic. Given the rise in infections and deaths, many countries have joined the strategy of the Chinese city of Wuhan, the epicenter of the disease, to implement a partial or total ban policy to stop the spread of the virus.

In Spain, we suffer one of the harshest prison measures in the world. You were only allowed to go to the supermarket, bank and pharmacy. The children did not go outside for 58 days. Adults could not go out for physical exercises, as it happened in other countries. We have never faced anything like this. It was very difficult.

A friend called us almost daily, asking why the children couldn’t go outside, but the dogs could. Other days she wondered why we, the working-age population, are not allowed to go to work. And he got excited saying that we will go crazy locked in small apartments, without a terrace, living 24 hours a day with small children. I was on the verge of a nervous breakdown!

In his opinion, it makes no sense to isolate everything. The elderly and those most susceptible to the virus, yes, but not all. She wasn’t the only one who thought so. In those days, there were videos of young people who demanded that only the elderly be imprisoned. They were not very well received because they asked for it in a derogatory way. Can it really be an effective and, moreover, morally acceptable solution?

Why did mental health deteriorate?

After the closure, news began to emerge that the mental health of the population had deteriorated significantly since the start of the pandemic. But its causes are practically not investigated. Was it because of the fear of disease and infection? To the work instability that has arisen? To the overload of the health care system? Or is it directly caused by quarantine and social distancing?

We, as health economists, felt it was our duty to deepen our understanding of this mental decline. We decided to focus on the group of adults over 50 years of age, for whom there were hardly any studies, despite the fact that the World Health Organization considered them a group very vulnerable to social isolation.

Our data

To conduct the research, we combined three sources of data on a sample of 40,501 people from 16 European countries and Israel.

First, we use the government’s pandemic response indicators provided by the Oxford COVID-19 Government Response Tracker. We focus exclusively on those indicators aimed at limiting mobility and social contacts. In this way, we built an index that enabled us to classify 17 countries according to the severity of the measures.

Classification of European countries according to the severity of restrictions due to the covid-19 pandemic.
‘Lockdown severity and mental health effects among the elderly population in Europe’. Economics and human biology. April 2002

Second, the Survey of Health, Aging and Retirement in Europe (SHARE) covid-19 questionnaire allowed us to identify individuals who reported experiencing a deterioration in their mental health following the outbreak of the pandemic. Thus, we found that 9.9%, 23.1% and 18.7% of individuals had more problems with insomnia, anxiety and depression. We also note that there is great variability across countries.

Worsening of insomnia, anxiety and depression in different European countries.
‘Lockdown severity and mental health effects among the elderly population in Europe’. Economics and human biology. April 2002

Finally, SHARE data from 2015 helped us measure the frequency with which people over 50 interacted face-to-face before the pandemic.

Is captivity the cause of deterioration?

To understand how much of the deterioration in the health of the elderly population in Europe is caused by the severity of mobility limitations rather than other factors, we adopted a causal approach based on a two-difference model. In our estimates, we also control for other observed characteristics of individuals such as their age, gender, or physical health.

The results confirm that imposed isolation actually harmed the mental health of the over 50s. More specifically, the frequency of insomnia, anxiety and depression increased by 74.6%, 39.5% and 36.4%, respectively, as a direct result of strict confinement.

These figures do not change when we include other variables that may also affect mental health, such as the exposure to the coronavirus of the individuals studied (for example, the number of infected close relatives) and the global prevalence of the disease in their countries of residence. .

Shutterstock / Spasić – nef

Among the most affected are women and the age group of 50 to 65 years

It was also important to find out how the lockdown affected different subgroups of the population – based on gender, age, etc. – and we got four results:

  1. The group of women was clearly the most affected.

  2. Individuals who reported being in good physical health prior to incarceration also saw their mental health suffer more.

  3. People between the ages of 50 and 65 were the ones who had a more pronounced deterioration compared to those between 65 and 75 and over 75.

  4. Across all age and gender groups, individuals who lived alone were most affected by mandatory incarceration.

Are selective locks desirable?

Countries such as Spain and Italy considered the possibility of instituting selective lockdowns and finally decided to lock down the entire population. Other countries, such as Turkey, Russia or the Philippines, have imposed isolation only on those over 65 and/or those with health problems.

The results of our research suggest that, in the face of future pandemics, it would be interesting to adopt measures by population groups, to limit older people and those with weaker health or more susceptible to serious diseases. Furthermore, as Daron Acemoglu, Victor Chernozhukov, Iván Werning, and Michael D. Whinston recently pointed out, selective confinement could mitigate the economic losses of locking entire populations in their homes.

So, after all, it seems our friend was right: perhaps the best solution, both economically and in terms of mental health, would be to restrict only those over 65 and the population most susceptible to becoming seriously ill from covid-19. It is obvious that, for this type of measure to be morally acceptable, it must be accompanied by a good package of support measures for the mental health and psychosocial well-being of the incarcerated group.

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