Updated 11.10am, adds comments from Victor Grech

Pandemic restrictions need to be carefully lifted while sheltering the vulnerable, lest economic decline ultimately kills more people than COVID-19 itself, a medical paper has advised.

While public health measures have mitigated morbidity and mortality, the excessive loss of GDP will lead to years of life lost due to recession, with diminished spend on healthcare, safety and the environment, the paper, published at the end of summer, stresses.

Published in the Early Human Development journal by paediatric consultant Prof. Victor Grech and economics student Peter Grech, in collaboration with economist Stephanie Fabri from the University of Malta, the paper reviews the estimated COVID-19 economic impact internationally.

Any additional economic slide would continue to intensify an already risky situation and further impact overall global average life expectancy, it says.

The paper goes into the factors related to COVID-19 that have wreaked economic havoc.

Penned amid debates in other countries revolving around health versus the economy, it calls for “unbiased” evaluations of all possible decisions.

A “nuanced approach” to the easing of restrictions must consider immediate mortality and morbidity against the longer-term risks of widening health and wealth inequalities and decreasing life expectancy from poverty, the paper argues.

The idea that COVID-19 does not discriminate is patently incorrect, Grech writes.

The adverse impact on low-income households is expected to be particularly acute

He says that governments have correctly prioritised reducing viral morbidity and mortality through social-distancing interventions over economic growth.

But while self-isolation and travel restrictions have saved millions of lives, they have also had “detrimental effects on global healthcare systems and a disruptive ripple effect on literally every aspect of human endeavour and economic activity”.

The reduction of restrictions will not undo the damage done and the collateral effects.

The excessively lengthy enforcement of health measures, severely restricting tourism and other revenue-generating activity, would be counterproductive to general public health in the long term.

“Income is causally related to health not only via a direct effect on the material requirements necessary for simple survival, but also by influencing the ability to participate in society, including at work.”

More years of life would be lost due to recession than would be gained through lives saved.

A modelling study comparing the UK with European countries of similar income and healthcare resources showed that the costs of continuing draconian restrictions are so great in relation to lives saved that a quick easing of restrictions was warranted.

In an attempt to avoid a recession of the magnitude witnessed in the 1930s, developed countries have pledged various stimulus packages. But despite those efforts, forecasts remain bleak, the paper shows.

And the adverse impact on low-income households is expected to be particularly acute, endangering the significant progress in reducing world poverty since the 1990s.

Even with a vaccine by early 2021, “lasting scars through lower investment, an erosion of human capital through lost work and schooling, and fragmentation of global trade and supply linkages” would be left.

The paper also sends out a reminder of the unknown costs of lasting illness, also known as “long COVID”, which would have to be factored into restriction removal policies.

Following the publication of the story and the reaction it brought about, Times of Malta received these comments from the author:

"With reference to the article published in The Times today. The title of the paper is 'COVID-19: Combined supply-side and demand-side shocks, so lift restrictions (carefully) lest GPD declines ultimately kill more than COVID-19'.

"The paper looks at the lives saved due to public health restrictions and the inevitable economic losses that have ensued. The argument and thrust of the paper is the logical conclusion that without any form of economic activity, countries will not be able to afford anything, including health services, and this will lead to lives being lost, say, from cancellation of cancer screening programs, the introduction of new free drugs and operations on the national health service and so on.

"However, in an effort not to be misconstrued, we embedded the word 'carefully' in the very paper title itself. Restrictions cannot simply be lifted. Each easing (while continuing to shield our vulnerable) must be carefully, and scientifically evaluated by our public health colleagues – and all this is explained and laid out in this paper.

"We regret any confusion that may have arisen and are certainly not advocating the lifting of all restrictions! The last thing we need (in any country) is a repeat of the scenes we witnessed in Lombardy earlier this year.

"The paper also notes that we must continue to suppress COVID-19 as 10-50% of survivors go on to develop a variety of debilitating symptoms (known as 'long COVID').

"Sufferers will require treatment and social support and will further negatively impact economies. Stay safe.

"Remember: hand washing, social distancing, masks etc. etc. as this is our only protection until an effective vaccine and/or treatment is available."