Coronavirus: the hidden health costs of the UK lockdown

Mel Clarke was in an abusive relationship for 15 years, suffering mental, physical and emotional violence. Being indoors with her abuser was “absolute hell”. Now she is gravely concerned for those trapped in similar circumstances by the UK’s nationwide lockdown. “Women are treading on eggshells and trying not to start disputes. Now it’s so much harder to run away,” she says.

Ms Clarke, who has a restraining order against her former partner, knows that those in abusive situations are desperate for the lockdown to end. “Some women are terrified, they’re going to bed at night crying, feeling very alone.”

The strict order to stay at home was issued five weeks ago by Prime Minister Boris Johnson to halt the spread of coronavirus. The UK government was following a pattern set by other countries — an estimated 3bn people worldwide are now living under some form of restriction. In the UK, citizens are only allowed to leave home for daily exercise, essential shopping and critical work and face fines of up to £1,000 if they disobey — measures that will be reviewed again on May 7.

Refuge, a charity supporting victims of domestic violence, has seen a 49 per cent rise to about 400 calls daily to its helpline since the lockdown began on March 23. Traffic to its website has risen by 417 per cent. London’s Metropolitan Police have arrested an average of 100 people a day for domestic violence offences since the lockdown began.

“Isolation alone doesn’t cause abuse,” says Sandra Horley, the charity’s chief executive, “but it can compound existing abusive behaviours.”

Since its introduction, debate about the lockdown has tended to pit health against economics: on the one hand, the dramatic increase in deaths and the risk that the health service will be overwhelmed as a result of coronavirus, on the other the costs of shutting down large parts of the economy in terms of bankruptcies and lost jobs.

Yet there is another, more nuanced discussion that is starting to take shape over the unintended health consequences of the lockdown. The blunt measures appear to have been successful in “flattening the curve” of coronavirus infections — ensuring that the health service was able to cope with thousands of additional seriously ill patients.

But they are also having a deep impact on wider society, in terms of mental health, domestic violence and people failing to seek medical help for strokes, heart attacks or cancer symptoms, that experts say could take years to play out.

These hidden health costs are now weighing on ministers as they debate how and when to lift the restrictions.
The government is split between those such as chancellor Rishi Sunak and business secretary Alok Sharma, who want to start reversing the economic damage wrought by the pandemic, versus those who want to keep the restrictions in place to avoid a potential second wave of infections. Health secretary Matt Hancock is one of those urging caution.

The government has been criticised over its handling of the coronavirus crisis — everything from testing failures to not providing health staff with enough protective equipment. It makes the politics of the lockdown even more delicate. No minister wants to be seen to be prioritising the economy over the health of people. But some at the top of government now warn that the impact on mental health, the rise in abuse and missed treatment for serious illnesses cannot be ignored in the May 7 review.

“We had no choice but to lock down, but I worry about where the country and society will be once everyone opens their front doors and emerges from weeks in hiding,” says one minister. “What are we going to find? Based on what I’ve seen and heard, I fear some of our deepest problems might only just be starting.”

Vera Baird, a former Labour MP, barrister and police and crime commissioner, is the victims’ commissioner for England and Wales. She is the most senior public servant involved in looking at the dark side of the lockdown. Through her work with the police, charities and victim support groups, she believes isolation is creating “significant issues” that “risk creating permanent harm”.

Shutting down the country has seen day-to-day crime such as burglaries drop, but, says Dame Vera, abuse has worsened. “Victims are facing a deadly disease outside and sometimes deadly abuse inside. This is an epidemic within the pandemic: nobody is in any doubt that abuse cases are rising — and far higher than what is being reported.”

She believes victims of historic sexual abuse are particularly vulnerable as the lockdown represents “the same removal of their own freedom that they suffered as children”.

The Internet Watch Foundation, a charity based in Cambridge, monitors images of child abuse circulating online It has found a threefold increase in people seeking such content in the UK since March 23 — from 100,000 to 300,000.
“We are getting scared by some of the trends we are witnessing,” says Susie Hargreaves, head of the IWF. “For children, being online is a lifeline; a brilliant tool for learning and dealing with boredom. But it also makes them potentially so much more vulnerable.”

Ms Hargreaves cites a recent example of a video her organisation discovered, the kind, she says, that the IWF are finding “every day”. It appears to show the online grooming of a young girl aged between 11 and 13. In an hour long video taken with a webcam, “she is reading instructions and will only follow certain instructions if she gets more likes for the video”, Ms Hargreaves says.

“In the course of this hour, she takes all her clothes off and engages in what we define as category A sexual activity. In the middle of the video you hear someone shouting, “dinner’s ready”. She is clearly very young and very vulnerable — and parents or carers have absolutely no idea what’s happening.”

The National Society for the Prevention of Cruelty to Children has reported a dramatic spike in demand for its services since the crisis began. Its helpline has provided 2,800 counselling sessions linked to the outbreak of coronavirus — mental health issues and family relationships are among the common themes. In the first week of April alone, the NSPCC took calls from 363 children suffering physical, sexual or emotional abuse or neglect.

Andrew Fellowes, the NSPCC’s head of policy and public affairs, is worried that many children will be experiencing “significant harm” during the lockdown — especially those already vulnerable and more dependent on the state. “There is a concern about foster and care placements breaking down, as foster carers and care workers self-isolate.”

As with other charities, the NSPCC has been forced to adapt. Working from home has made running its helplines securely more difficult: staff have been ill, while demand has risen. “That’s why we are working to maintain key services like Childline and the Helpline . . . to move away from face-to-face contact,” says Mr Fellowes. “Our message is that we are still very much open and here for any child who needs help.”

For Hope, 11 years into her recovery from anorexia, the lockdown has opened up what she calls “cracks” in that recovery. “For people with eating disorders we aren’t just navigating a pandemic and mental health but also diet culture,” she says.

Mind, a charity that specialises in mental health, has found that British adults are struggling. A third of the 4,000 people surveyed in a recent poll described their mental health as “poor or very poor”, while two-thirds said their state of mind had worsened over the past two weeks. Its research found that the most common issues were related to difficulties in buying supplies, anxiety about illness and fears about work and finances.

The economic impact of lockdown has been devastating. The UK’s unemployment rate has doubled to 2m. The Office for Budget Responsibility estimates that the economy could shrink by 35 per cent if the current measures remain in place for a full three months. While the Treasury hopes the recovery will be ‘V’ or ‘U’ shaped, the spectre of slower, much longer recovery remains — and with it, significant health consequences.

Despite the billions of pounds the government is pumping into the economy every day to prop up businesses, wages and the self-employed, thousands of companies of all sizes will not survive the lockdown. And with it, livelihoods will be destroyed. Torsten Bell, director of the Resolution Foundation think-tank, says that the “economic traumas” will last well beyond the lockdown.

“There is the scarring as firms go bust and unemployment rises — the question is how deep it goes,” he says. “There’s a very strong relationship between unemployment and wellbeing, as well as mental and physical health. Lasting high unemployment will have a significant effect on the country’s health.”

Mr Bell says that the economic shutdown is “bottom heavy”— having the hardest impact on the lowest socio-economic groups. “Those who are losing their jobs and facing the most significant health risks are the poorest in society. Almost 60 per cent of low and middle-income families don’t have any savings, up from around 40 per cent when the financial crisis hit.”

Within government there are growing concerns about the level of “avoidable deaths” in the longer term resulting from the lockdown. Several modelling exercises have taken place to attempt to figure out what that figure might be. One internal model circulated in the cabinet two weeks ago suggested there could ultimately be “without mitigation up to 150,000” premature deaths in the due to the lockdown, excluding Covid-19 victims — although Mr Hancock said this number was “wrong”.

The official death toll for coronavirus in the UK passed 20,000 on Saturday. But a Financial Times analysis last week showed that the official data — which only records hospital deaths — were under reporting the number of Covid-19 fatalities. “Avoidable” deaths are even more difficult to measure.

According to the Office for National Statistics, between March 23 and April 10 there were a total 46,000 deaths — of which 35,817 were not directly linked to Covid-19. That represents an 18 per cent increase on deaths over the same period in 2019. But until the rate of testing increases these figures are not wholly reliable.

Katherine Henderson, president of the Royal College of Emergency Medicine and a consultant at St Thomas’ Hospital in London, says “it is likely that there are a lot of people who are dying with Covid, as much as of Covid,” and the illness was “enough to tip them over the edge”.

Some in Mr Johnson’s cabinet fear that patients may be following the government’s rules too strictly: staying home when they should actually be visiting a doctor. St Thomas’ — which treated the prime minister for coronavirus — has seen an 80 per cent reduction in its minor injury work, “some of which you’d expect as people aren’t crashing cars or falling off motorcycles”, says Dr Henderson.

The hospital’s emergency unit is “not seeing the usual continual flow of people with worrying chest pains, who would normally be put through a fairly standard set of tests to see if it is something more serious”, Dr Henderson says. “We might end up with more people with serious illnesses such as completed strokes or heart attacks because they’re not being nipped in the bud.”

Cancer Research UK says there has been a 75 per cent drop in urgent referrals from GPs for those suspected of having the disease. Sarah Woolnough, head of policy, describes the figures as a “huge concern” and urges “that we get back to some kind of normality as soon as possible”.

Karol Sikora, dean of medicine at the University of Buckingham, an oncology consultant for 40 years, says he has “never seen such a fall-off in cancer patients”. Whereas 30,000 patients a month would typically be diagnosed with cancer, he says it will be closer to 5,000 in April.

“The NHS and private hospitals have essentially shut up shop for non-Covid business. We need to get them going again as soon as possible. A month delay in cancer diagnosis won’t cost a lot in terms of outcomes, but six months would cause considerable damage,” he says. “Patients are too frightened to come forward with symptoms, as they have been told to stay at home to save the NHS.”

The April 14 decision to renew the lockdown for a further three weeks was straightforward; the coronavirus threat was too great and lifting it would have been dangerous for the NHS. But by the time the next renewal decision is taken on May 7, the health service may have stabilised, the spread of the virus subsided and the picture of the non-Covid-19 health implications may be clearer.

As one Whitehall official who will be involved in the decision put it: “Most of the cabinet are aware that the lockdown is harming the nation’s health and its economy, but it’s collateral damage to save lives from coronavirus.
“But by the time we get to the middle of May,” he adds, “the balance will have likely tipped and the damage of keeping everything shut down could be just too great to ignore.”