As Britain reached the milestone of 100,000 coronavirus deaths, it is clear we will exceed the government’s "reasonable worst-case scenario”.
There is nothing like a crisis to remind us to prepare properly for the next one, not just in how we reduce mortality risks but also in how we deal with death.
We must press for the government’s “follow the science” protocol to be extended to “follow all science”. Yet people like me continue to be excluded from the decision-making process and that has had consequences.
Let me state first that I am a social scientist. To date, the government has relied entirely on the science of virus transmission and the associated mortality and morbidity risks.
But Covid-19 represents an economic and social crisis as well as a health crisis, and we should also have heard governments say just as loudly that “we’re following the social science” to include economists, psychologists and education specialists.
By not including social scientists, we have seen the almost-unquestioning acceptance of some potentially very harmful policies, such as school closures. This has been at the expense of harm elsewhere in society.
Social scientists have experience and understanding of how difficult life can be for those children, adults and families who cannot easily learn or work from home.
The decisions we make, whether as public officials or private citizens, can never be made in a vacuum, and will always reflect self-interest, no matter how hard we try.
It should concern all of us that decisions with such a profound effect on our society are being made by those with the least to lose from lockdown measures.
As a matter of urgency, decision-making must involve a wider range of diversity of perspective and experience.
The information, beliefs and behaviour that have come from this narrow frame of reference may turn out to be much more harmful for human life after Covid-19 has been brought under control.
We need to have an open discussion on trade-offs and comparative value of life.
If people’s lifetime prospects are an important measure of human welfare, then we have engaged in one of the biggest redistributions of resources from those who have the least, to those who have the most in human history.
To explain: the average life expectancy for an 18-year-old in the UK today is about 81. About 60 per cent of the deaths from Covid-19 in the UK have been people aged 81 or over.
Most of those bearing the biggest burden from Covid-19 will not live as long as those who are dying from it.
At the time of writing, fewer than 1 per cent of Covid-19 fatalities have been in the under-40s age group. Yet every policy measure taken by this government has caused the greatest economic and social harm to younger people.
And if older people were consulted, even they may not agree with the measures taken to protect them.
My research has shown strong cross-generational support for trade-offs that give priority to younger people over older.
The elderly are usually in favour of trading life expectancy for quality of life. They are often more strongly in favour of prioritising younger people in healthcare resource allocation.
Giving representation to these perspectives in the deliberations would seem to me to be an obvious need.
Ever since I worked with Alan Williams at the University of York in the 1990s, I have supported the fair innings argument (FIA).
This is the egalitarian principle that everyone is entitled to some "normal" span of health (usually expressed by life years) and, in Alan’s words, “anyone failing to achieve this has been cheated”.
Several empirical studies have shown that the general public broadly agree with the argument.
As a matter of urgency, then, we must afford younger people more priority and seek to accommodate their needs in our fight against Covid-19.
In 1789, Benjamin Franklin famously wrote that America's new constitution "is now established and has an appearance that promises permanency; but in this world nothing can be said to be certain, except death and taxes".
We must now urgently discuss these two certainties.
On taxes, we have the opportunity to recast the narrative of status and success that is reflected simply in earning more money (and ideally paying more tax).
We will always need what are currently regarded as low-status jobs, so we should pay much greater attention to improving the status – and pay and working conditions – of these jobs so that people do not feel desperate to escape them, or are dissuaded from joining them.
The past few months have reminded us just how essential this work is, but its status is not fixed or obvious. We should use this crisis to broaden our idea of what success looks like.
On the issue of death: we will all die. The question is when – and how.
We have seen above how little attention has been paid to "when", and in some ways, this stops us considering "how" too.
We should use the context of Covid-19 to have a more honest conversation, as individuals, about how we would like to die and what, as citizens, we would like our healthcare priorities to be.
We should open up difficult conversations with our loved ones about death. At a societal level, we can start to restructure our end-of-life care system to meet the needs of dying patients and their families better.
This requires greater investment in both high-quality palliative and community care services and research into people’s preferences. Many people will prefer quality over quantity at the end of their life.
There is a hopeful paradox in all of this: we have the potential to live better if we can accept that one day our life will end. But only if we start discussions now.
Paul Dolan is a professor of behavioural science at London School of Economics and author of the bestsellers 'Happy Ever After' and 'Happiness by Design'; www.pauldolan.co.uk.
