Covid-19 population lockdowns may worsen socioeconomic inequities disproportionately impacting racial minorities: Machine learning-augmented cost effectiveness and computational ethical analysis with personalist social contract

Abstract

The novel coronavirus disease of 2019 (Covid-19) produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a pandemic creating a growing global health crisis given its novelty, scope, and initially limited efficacious treatment options. Yet little is known about optimal non-pharmaceutical interventions to improve its morbidity and mortality, particularly their cost effectiveness and ethical aspects. This is thus the first known machine learning-augmented cost effectiveness and ethical analysis of Covid-19 containment measures (and of population quarantine measures in particular for any pandemic) to assist health systems and governments in ensuring the most clinically and cost-effective care that can be equitably provided to as many patients as possible during this pandemic and future similar global crises. This analysis utilized the methodology adopted by the Centers for Disease Control and Prevention (CDC), commonly accepted figures as inputs, and both extreme and real-world minimal assumptions to provide the most robust and reliable results possible. Cost analysis indicated that in the extreme or best-case scenarios for the Covid-19 containment measure of population quarantine, there is a cost-effectiveness ratio of $154.86 million spent per averted death and a net cost of $1.92 trillion globally. In real-world scenarios, this intervention has a ratio of $2.52 billion spent per averted death for a net cost of $1.99 trillion. Personalist social contract ethics as articulated by the United Nations’ popular ethical system of rights and duties highlights the particular concerns that such lockdowns may be unethical injustices perpetuated by states in a manner that undermine individual lives and liberties while disproportionately negatively impacting lower income communities particularly racial minorities. This study thus suggests that the prevalent practice of population quarantine compared to standard precautions and more targeted interventions may provide inadequate net benefit for its financial and ethical cost. At a time of global shortages straining health system capacities to adequately detect and care for Covid-19 patients particularly in developing nations and underserved communities, this study supports focusing resources less on interventions with unclear benefit-cost trade-off and more on better affordable, ethical, and equitable interventions with greater evidence for their life-saving net benefits.