Challenges Estimating Total Lives Lost in COVID-19 Decisions: Consideration of Mortality Related to Unemployment, Social Isolation, and Depression.

The coronavirus disease 2019 (COVID-19) pandemic has claimed hundreds of thousands of lives, directly and indirectly, and threatens to claim many more. Nations have made different policy decisions that have affected the rate of infection, mortality, the economy, and the life of the country differently. The choices between various alternative policies have led to different trade-offs between what are arguably incommensurable goods, such as survival, mental health, social connection, and economic growth. It can seem difficult or impossible to weigh these numerous factors, yet policy decisions must be made, with countless implications for society. In the early stages of the pandemic, and when information was limited, a cautious approach was arguably most appropriate. As further information becomes available, it becomes possible to make better-informed decisions. However, the inherent challenges involved in the very real, and very difficult, trade-offs remain. One approach to weigh these different outcomes, which are difficult to directly compare, is to attempt to use a composite measure such as well-being–adjusted life-years.1 In such an approach, each year of life saved