Quality-adjusted Life-year

Abstract
The present coronavirus crisis caused a major worldwide disruption which has not been experienced for decades. The lockdown-based crisis management was implemented by nearly all the countries, and studies confirming lockdown effectiveness can be found alongside the studies questioning it. In this work, we performed a narrative review of the works studying the above effectiveness, as well as the historic experience of previous pandemics and risk-benefit analysis based on the connection of health and wealth. Our aim was to learn lessons and analyze ways to improve the management of similar events in the future. The comparative analysis of different countries showed that the assumption of lockdowns’ effectiveness cannot be supported by evidence—neither regarding the present COVID-19 pandemic, nor regarding the 1918–1920 Spanish Flu and other less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: by using the known connection between health and wealth, we estimate that lockdowns may claim 20 times more life years than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown for either COVID-19 or any future pandemic.

Conclusions
While our understanding of viral transmission mechanisms leads to the assumption that lockdowns may be an effective pandemic management tool, this assumption cannot be supported by the evidence-based analysis of the present COVID-19 pandemic, as well as of the 1918–1920 H1N1 influenza type-A pandemic (the Spanish Flu) and numerous less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: we estimate that, even if somewhat effective in preventing death caused by infection, lockdowns may claim 20 times more life than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown in the future.

https://www.mdpi.com/1660-4601/19/15/9295/htm