2.1. Cost effectiveness analysis

We performed this cost analysis utilizing the methodology adopted by the Centers for Disease Control and Prevention (CDC) ⁽⁸⁾, commonly accepted figures as inputs, and both extreme and real-world minimal assumptions to respectively estimate the upper limit (extreme model) and mean (real-world model) of the expected success of the intervention (population-wide quarantine) relative to standard precaution measures for viral infection prevention and control (hand hygiene, healthcare worker respiratory precautions, and quarantine of cases and close associates) ⁽³, ⁴⁾. The cost analysis was focused on the time frame of February 1st to April 16th of 2020 for the following traits of this index time period based on prior pandemics and the current: the highest infection fatality rate (IFR), the majority of population quarantines or lockdowns, and the associated primary economic costs ⁽¹, ⁹, ¹⁰, ¹¹, ¹²⁾. While the clinical and financial consequences will continue beyond this point, the data was most robust and uniform for the above time frame ⁽¹, ³, ⁹, ¹⁰⁾.

2.2. Health equity analysis

Equitable health outcomes were assessed based on publicly available official estimates pertaining to socioeconomic and racial groups as defined in the current Covid-19 literature to determine possible divergences in outcome not adequately explained by biology and pathophysiology but potentially by modifiable sociocultural traits.

2.3. Ethical analysis

Ethical analysis with Artificial intelligence-driven Computational Ethics (AICE) was conducted by integrating the above quantitative analysis with the global bioethical framework of personalist social contract, a novel integration of Thomistic-Aristotelian personalism with the Kantian-based Rawlsian social contract as historically articulated in the 1948 United Nations Declaration of Human Rights⁽¹¹⁾ (UDHR) and formally defined by ^{Monlezun 2020 (13- 15)}. Personalist social contract was selected as the primary analytic framework for practical, political, and philosophical reasons. Practically, personalist social contract is the only known global bioethical model that facilitates convergence of diverse belief systems (including religiously unaffiliated, secular liberalism, Islam, Judaism, Christianity, Buddhism, Confucianism, and folk religions) which over 99% of the world’s population identify) ⁽¹⁶⁾ thus providing a better representation than Kantian and related post-European Enlightenment birthing modern philosophy that largely excluded 84% of the world’s population ⁽¹³⁾. Politically, the personalist social contract was chosen as it is the philosophical foundation and frame work of the world’s most dominant ethical system -human rights and duties as articulated by the UDHR- that generated the subsequent body of international law and was assented by nearly every nation through the United Nations. According to the Lebanese Thomistic-Aristotelian philosopher and the UDHR’s chief architect, Dr. Charles Malik, along with the French Thomistic personalist and UDHR chief philosopher who coordinated its philosophical underpinning, Jacques Maritain, and the UN Secretary General the year following the Declaration’s ratification, Carlos Rómulo ⁽¹⁷⁾ Thomist-Aristotelian metaphysics and its derivative natural law serve as the foundation of the UDHR ⁽¹³⁾ (and even Enlightenment inspired liberal democracies as the United States with its Declaration of Independence) which thus supports the philosophical frame of the social contract (later championed by its most prominent proponent, John Rawls) as the Enlightenment product arguing for pluralistic convergence of diverse belief systems through overlapping consensus of common principles that are thus commonly binding on each individual). Yet the modern social contract’s rejection of a metaphysical foundation (i.e. that justice objectively exists and binds individuals to give to each what is due because of their common human nature) limits its ability to consistently recognize and protect the individuality of each person, especially if they identify with religiously affiliated belief systems (as the majority if the world’s peoples) who are thus excluded from the social contract ⁽¹³⁾, leading to ethical systems intolerant to multicultural and pluralistic dialogue.

Philosophically, the personalist social contract was chosen for its Thomistic-Aristotelianism robust metaphysics that can form a durable philosophical foundation, while its recent exposition of personalist elements (as evidenced by the United Nations General Assembly 1995 Address by the former Polish philosopher, Karol Wojtyla) makes its classical system of thought subjectively more accessible for diverse belief systems (i.e. the common human experience that gives rise to subsidiarity and solidarity to build a family of nations not simply an administrative collaborative). And it is this metaphysics that in particular provides the legal system of natural law (as each person’s human nature allows it to be directly knowable as a universal imperative to do good and avoid evil) underpinning and uniting diverse belief systems while articulating commonly held principles such as human dignity and resultant individual rights and societal duty to respect those rights for every person due to her/his common human nature. The personalist social contract thus is a middle point or bridge between the post-Enlightenment liberal social contract (that lacks a robust metaphysics and thus recognition and defense of the individuality, dignity, and thus rights of each unique person by rather mischaracterizing individuals predominantly as replicable autonomous wills bound by artificial social rules limiting negative impacts of individual self orientated behavior) and classical personal communion (in the Aristotelian tradition flowing from a metaphysical foundation uniting diverse religiously affiliated and unaffiliated belief systems by accounting for the individuality of each person as a member of a global human community that is a family which can understand each individual as an embodied soul or form-animating matter binding each in organic social relationships guarding the good of each person in reciprocal inter-dependency facilitating positive other orientated behavior).

Given the widespread modern breakdown of constructive ethical debate within and among diverse belief systems (with such Rawlsian claims as incommensurability) given the abandonment in general of natural law or any otherwise potentially logically compelling and politically popular system, the ethical analysis provided here will feature an explicit definition of terms (including explicit metaphysical presumption), argument structure (in the forms of premises and conclusions), and reliance on Aristotelian formal logic. This logical structure is utilized given Aristotle’s historic creation of this sub-philosophical discipline defining minimum requirements for a valid or good argument (in contrast to a logical fallacy invalidating an argument as otherwise valid or logically binding the reader to the conclusions arrived at from sound premises building stepwise to the conclusion), its profound influence on philosophy, the absence of any significant comparable competitor to it, and its endorsement by Immanuel Kant as one of the most widely recognized chief defenders of modern philosophy (defined here as principally Western post-Enlightenment philosophy due to the largely continuous and rich development of Eastern philosophy from its antiquity and classical periods, and the Western modern philosophies following the skepticism and nihilism championed by Nietzsche and Sartre) given their devolving into foundational metaphysical contradictions (i.e. in a circular logical fallacy metaphysically asserting there is no metaphysics or known that is knowable) and thus failing to produce overarching subsequent comprehensive and consistent philosophical systems ⁽¹⁸⁾.

3.1. Cost effectiveness analysis

The extreme model inputs include the global cost of the above intervention in the interval time period set at $2 trillion based on the lower estimated limit by The United Nation’s Trade and Development Agency relative to additional estimates (with economic production cut as workers were quarantined -with up to 0.03% total of the global population- during the above time frame becoming infected at the upper estimate limit with the large majority suffering mild transient symptoms) ⁽¹, ⁵, ¹⁹, ²⁰⁾. The upper limit of the intervention’s success was set at 70% mortality reduction through transmission reduction and subsequent improved health system capacities to care for critically sick COVID-19 patients. The cost averted was set at $51.33 testing per person for 70% of the world’s population based on the upper cost limit (in which cases are identified and standard precautions applied and medical care provided for them [with care being similarly provided in the intervention]) ⁽¹, ³, ²¹⁾. The intervention benefit was calculated as the product of the upper estimate of the US federal government’s value of a statistical human life ($7.4 million as the upper average limit among global statistical values), the Covid-19 IFR of 0.68% (based on the latest multi-state meta-analysis of published estimates for the interval time), its total cases, and the above mortality reduction ⁽¹, ¹⁹, ²², ²³⁾. The real-world model global inputs were based on similar pandemics and current Covid-19 trends: 0.04% tested, 0.03% infected, 5% mortality reduced with the intervention, and 90% test costs covered by governments ⁽¹, ^{3- 5}, ⁹, ¹⁰, ²³⁾.

Cost analysis indicated that in the extreme or best-case scenarios for the Covid-19 containment measure of population quarantine or lockdown, 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. Machine learning analysis produced comparable above results by RMSE.

3.2. Health equity analysis

Health equity analysis then considered the United Nations World Economic Situation and Prospects mid-2020 report identifying state lockdowns in response to Covid-19 (with up to 90% of the world’s economy in some lockdown as of May 13, 2020) as the primary driver of the $8.5 trillion related 2020-2021 total cost, pushing 34.3 million additional people into extreme poverty by 2020 and up to 130 milion by 2030.24 The World Bank projected this contraction to be the most severe since World War II and totaling up to 7%, with the hardest hit economies being in nations with developing and emerging economies disproportionately dependent on commodity exports, external financing, global trade, and tourism instead of for domestic consumerism and service provision in higher income economies ⁽²⁵⁾. The Covid -19 crisis is unfolding in the context of health spending globally that prior to it totaled $7.8 trillion, with high income nations (the majority in Caucasian-predominant North America and Western European nations) spending 70 times more per capita than low income nations who spent $41 per person annually according to the World Health Organization ⁽²⁶⁾. The scientific research community including with the Journal of the American Medical Association have recently highlighted the growing concern of such inequities especially racial inequities even in high income nations like the United States: racial minorities are significantly more likely to have lower socioeconomic status than the Caucasian majority in addition to at least 2.5 times higher likelihood of being hospitalized with Covid-19; African Americans in particular are twice as likely to die compared to Caucasians irrespective of disease severity and health system traits ⁽²⁷⁾.

The above translates into Covid-19 lockdowns exceeding global health spending by 110% and annual health expenditures in low income nations by 3’306,000% who are already at a 70-fold spending deficit compared to higher income nations, reinforcing pre-existing structural racial and socioeconomic disparities ⁽²⁸⁾ as an additional barrier to social and economic upward mobility of minority-predominant nations with developing and emerging economies and minorities in higher income communities who are more vulnerable to the lockdown effects including job loss, wage reduction, decreased health system access for pre-existing conditions, and increased maladaptive health behaviors including substance dependence and related overdoses, self-harm, domestic abuse, and impaired acute and chronic disease management. Machine learning analysis produced comparable above results by RMSE.

3.3. Personalist social contract computational ethical analysis

The primary material object of the current case is state-mandated population lockdowns that require over 50% reduction in movement of over 50% of the population and thus making such people’s principal location their primary residence. The primary formal object or analytic framework is the above described personalist social contract. The Thomistic-Aristotelian metaphysical presumption is that objective human good exists, is knowable, and expressed concretely in the individual flourishing of each person through her/his commitment or duty to the common good of the community (in this case the state) which in turn is committed to protecting the rights or the enumerated concrete goods required for the flourishing of each person that is required therefore for her/his ultimate good or end that is her/his perfection as a human person. The metaphysical first principle of non-contradiction is additionally invoked (Aristotle: It is impossible for the same thing to belong and not belong simultaneously to the same thing in the same respect) ⁽¹⁸⁾. The extended defense of this presumption and principle is outside the scope of this manuscript and thus is referred to ^{Monlezun 2020 (13)}.

The ethical analysis is therefore provided according to the following argument:

Premise 1. Every state has a duty to each citizen to secure justice collectively and individually by giving or at least not withholding to each what is her/his due.

Premise 2. Per the above analysis and literature review, population lockdowns are a cost-ineffective approach to reducing preventable Covid-19 deaths (in such a manner that also lacks compelling clinical effectiveness evidence, either by convincing biological and public health plausibility or the current relevant literature outside of modelling studies not verified with real-world outcomes) resulting in net clinical and financial harm according to the above cost effectiveness analysis (without a widely accepted consensus in the current Covid-19 or modern pandemic literature that refutes the above conclusions). Such harms disproportionally and negatively affect lower socioeconomic communities particularly nations with developing and emerging economies and non-white minorities in North American and Western European nations, and thus reinforce societal stereotypes grouping such individuals into these minority groups by impairing upward socioeconomic and thus public esteem of such individuals that would otherwise allow them to be self-identified rather than more readily identified by society according to such groups, with such characterization and even such grouping potentially identified as racist.

Premise 3. Such net clinical and financial harm is preventable and withholds from each citizen what is due to them which is at least no harm committed by the state in programs or policies whose aim is the optimization of individual and collective survival likelihood. This net harm limits the liberty of each person to pursue her/his good (which supports typically the sustainability of her/ his life such as work and individually identified goods of social interaction with family, friends, and co-workers) without correlative sufficient individual or collective benefit.

Premise 4. Personalist social contract underlines how persons from diverse belief systems have common individual experiences by virtue of their common human nature (as a rational animal nature) about the subjectively grasped good of justice (that is an objective good in its essence) that protects them from undue and particularly preventable harms.

Premise 5. The vast majority of the world’s persons are citizens of states of which the vast majority explicitly recognize and agree to be bound by the UDHR and its ethical articles that recognize «everyone has the right to life, liberty and security of person» because it is this «recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family [that] is the foundation of freedom, justice and peace in the world» (Preamble, Article 1-3) ⁽¹¹⁾. Respect for the rights of each person in general is consistent with ethical behavior and disrespect with unethical behavior.

Conclusion. Therefore, state-ordered and/or enforced population lockdowns are unethical and so logically indefensible when they unjustly limit individual rights without sufficient concrete or theoretical justification for their net individual or collective benefit, with the additional unethical aspect in that they subsequently accelerate disparities and through this accentuate pre-existing health challenges primarily for lower socioeconomic peoples, particularly racial minorities.