The death meter on the BBC news channel flashes repeatedly on the screen. The newsreader with mournful eyes – like a cancer doctor about to tell a patient that the tests have proved positive – informs us that the coronavirus mortality count for the UK has ‘soared’ to 233: the biggest day-on-day increase to date. The familiar image of the Italian intensive care unit, with seriously ill patients clinging to life, is flashed up for the thousandth time. The sense of doom is palpable.
Is it only me who believes we are witnessing a crazy over-reaction to the coronavirus outbreak? Am I missing something fundamental, or have the government responses to the coronavirus threat been disproportionate and, for the most part, counterproductive? Would there have been a more effective way of protecting the health and wellbeing of our citizens than the draconian measures witnessed to date?
I think so, and I will try to explain why.
The coronavirus threat
To be clear, the coronavirus (or COVID-19) is a nasty new virus that will, inevitably, contribute to the deaths of many people. This infectious agent presents a major challenge to our healthcare systems and there is little doubt that the government is right to emphasise the importance of slowing down the transmission of the virus so as to not overwhelm our National Health Service. Although many other coronaviruses have been around a long time and, for the most part, have posed little threat to humans, COVID-19 seems a more dangerous member of the group, attacking the lining of our lungs and throat and, in a small minority of cases, causing pneumonia-like symptoms. As a new virus, not much is known about COVID-19; this lack of familiarity understandably evokes people’s anxieties. The absence of a vaccine and the lack of inherent immunity within the population means that COVID-19 is highly infectious.
So this new bug presents a real threat to our health and a severe challenge to our medical services. But, let’s keep some perspective.
Let’s keep some perspective
Infectious diseases that compromise the respiratory system have been with us since time immemorial, and the early signs are that COVID-19 will be less deadly than other common viruses. According to the World Health Organization (WHO), somewhere between 290,000 and 650,000 people worldwide die from seasonal influenza each year. In England alone, between 2014 and 2019, the yearly average for deaths from influenza was 17,000 (figures from Public Health England); in 2014, over 28,000 deaths were attributable to the ‘flu’.
Further context is provided by the mortality rates for pneumonia (a bacterial infection of the lungs) that causes 30,000 deaths per year in the UK (British Lung Foundation, 2018). Worldwide, 4 million people succumb to pneumonia (WHO). Hepatitis B and hepatitis C – two viruses that attack the liver – will, together, claim 1.5 million lives each year (WHO).
At the time of writing, COVID-19 has been associated with 13,071 deaths worldwide, including 233 in the UK. Although these mortality figures will rise markedly over the next few weeks, it is extremely unlikely that the number will surpass those cited above. Of course, any death, from whatever cause, is a personal tragedy. But at this stage it seems likely that, in the future, the world’s scientists will view 2020 as one of the more difficult times in the ongoing fight against respiratory infections rather than as an apocalyptic year.
One American medical expert recently argued that, if we didn’t know there was a new virus out there, COVID-19 fatalities would have been lost in the ‘noise of the estimate of deaths from influenza-like illness’, and the media coverage would have been ‘less than for a NBA game between the two most indifferent teams’.
Lock-downs and the destruction of livelihoods: the government response
Despite lack of evidence that the COVID-19 threat is an exceptional one, the government response to it has been unprecedented.
The approach has been ‘top down’ and paternalistic, drawing on expert medical advice. Mathematical models have been used – and ‘worst case’ assumptions – to predict the likely number of people infected and consequent deaths. The policy makers seem to possess little grasp of the fact that if you insert one highly improbably assumption into a mathematical model of this sort, you will get a predicted outcome that is highly unlikely to materialise; insert several improbable assumptions and the number that pops out at the end would be best placed in a sci-fi fantasy novel. The calculations have clearly freaked the government.
With the emphasis on social distancing to slow the spread of the virus, we have witnessed a series of draconian measures the major driver of which seems to be ‘because another country has done it’ rather than whether it will achieve the desired aim; an attempt to avoid the ‘what’s taking us so long’ accusation rather than evidence-based decision making. To date we have endured: border closures and bans on travel; prohibition of mass gatherings; extensive closures of public buildings including theatres, cinemas, museums, pubs and restaurants; lock downs imposed on the elderly; school closures; and encouragement for everyone, apart from health and emergency personnel, to stay in our homes indefinitely. Life as we know it is no longer available, shut down for an indefinite period.
Meanwhile, 24-hour news channels drip feed us information about the apparent apocalypse taking place outside our bolted doors. Again and again we are bombarded with ‘breaking’ stories that indicate we are all doomed; as I write, a banner across the TV screen reads, ‘Virus is killing one person every 10 minutes in Iran’. The UK-deaths statistic is repeatedly announced, like the running total of money raised on Children-in-Need night. The viewing public is continually delivered a selected range of information to support the doomsday narrative:
- The mortality rate for those contracting the virus is over 3%. (Much more likely to be less than 1% once testing starts to include those outside of hospital);
- This pandemic is a once-in-a-century occurrence. (As described earlier, it seems less than extraordinary when considered in the context of the typical impact of the various influenzas);
- The number of cases and deaths ‘soar’ and ‘leap’. (We rarely hear that ‘The scale of increase is as would be expected’ for a new infectious disease).
And what have been the consequences of this government’s actions to shut down life as we know it? The whole country is now held in fear-instilled paralysis. Multiple businesses have been sacrificed. Millions of hard-working people – many on low incomes – have been wilfully stripped of their livelihoods. Our economy has imploded. And all these adversities are already starting to trigger some of the worst kinds of human behaviour in the form of hoarding and panic buying.
In brief, I fail to see how the protection of those people most likely to be harmed by coronavirus – the old and those with existing respiratory ailments – can best be served by plunging many millions more of our citizens into hardship and imposed inactivity.
Is there an alternative approach?
Regrettably, the political cost of the government making radical shifts in its ‘top down’ approach to the crisis would be too great for it to be contemplated. Whatever the ultimate outcome, Boris Johnson and his advisors will argue that it would have been a lot worse if it wasn’t for their draconian measures – an assertion that will be impossible to prove or disprove. But surely there was – maybe still is – a much more effective way of minimising the human cost of the COVID-19 epidemic.
The alternative approach that occurs to me would contain the following four elements:
- Concentrating our efforts on protecting the elderly and those with existing physical health problems;
- A bottom-up, community-focused strategy;
- A much greater emphasis on testing whether or not people have the virus;
- Ensuring a critical mass of the less vulnerable continue to function as usual.
These four elements overlap, and interact, but I will discuss each in turn
- Concentrating our efforts on protecting the elderly and those with existing physical health problems
COVID-19, and some established influenza viruses, can cause a serious illness in any person, irrespective of age or current health status. Nonetheless, it is undoubtedly the case that risk of life-threatening consequences requiring hospitalisation is much greater in the elderly and those with existing health problems. As such, the protection of this vulnerable group should be the overarching, pre-eminent driver of all policy decisions and subsequent actions.
- A bottom-up, community-focused strategy
As well as revealing our dark sides, crises also bring out the best in human nature. Among the mayhem, it is clear that many people are caring, compassionate and desperate to help others. We should harness this force for good in a systematic way.
Rather than drastic pronouncements from above, the government should insist that local authorities develop comprehensive plans for enabling the vulnerable, and those with symptoms suggesting COVID-19 infection, to isolate. With explicit responsibility for a section of the local community, I imagine a small cluster of health and social care professionals leading and supervising many volunteers. These teams could perform a number of vital roles: knocking on doors to check people are ok; helping with shopping; and offering health advice. I have no doubt that many of us would be keen to offer our services to our neighbours in this way, providing essential help to others, while benefiting ourselves from the feel-good associated with acts of kindness.
- A much greater emphasis on testing whether or not people have the virus
As the WHO recently pointed out, directives for social distancing and self-isolation are ineffective if we do not know who has and (equally important) who has not been infected with the COVID-19. Without this knowledge we are going into battle blindfolded. Although apparently increasing on a significant scale, the number of tests taking place in the UK is shamefully low; no one is tested unless they are admitted to hospital.
All health and social care staff should be tested. All volunteers involved in the community effort should be tested, to ensure that they are not inadvertently spreading the disease. Anyone symptomatic, and in self-isolation, should have easy access to a confirmatory test – within 48 hours – so they can decide whether or not it is safe to return to their normal routine.
South Korea – a country with a population not that much smaller than the UK – managed to test suspected cases intensively, and subsequently trace the recent contacts of those afflicted, an approach that proved to be very effective in slowing the spread of the virus. Surely, if South Korea can do it, we can too.
4. Ensuring a critical mass of the less vulnerable continue to function as usual
A sharper focus on the vulnerable, alongside mass testing and a comprehensive network of community support for those isolating, would allow healthy younger people to continue to work and socialise. There would be no need to ban events where masses of people gather, and pubs cafes, gyms, restaurants and sporting events could continue. Aided by educational information about hygiene and awareness of symptoms to watch out for, these healthy people would make informed choices about their day-to-day lives – just as we have over many years when faced with the challenges of infectious diseases. Enabling a critical mass of functioning people would maintain a sense of normality, protect our economy and businesses, and prevent many millions of our citizens from losing their livelihoods.
A personal perspective
What I’ve written above is my personal take on the current crisis. Feel free to disagree and tell me what I’m missing and where I’m going wrong with regards to my assessment of the problem and my suggested alternative.
Given my escalating levels of anger and dismay in what I’m witnessing around me, I found writing this blog a cathartic experience. As I sit at my laptop today I’m reflecting on my current situation. In a week’s time, the funeral is planned for a close family member who died as a result of a stroke. We’ve today been informed that the planned reception after the funeral, where a small group of close family and friends could gather and reminisce about the life of the deceased, will not now go ahead. Who knows, we may even be denied attendance at the funeral service and cremation, reduced to watching it via video link. I think back to Wednesday when I was doing the weekly shop for my 90-year-old parents only to find shelves empty of toilet roll and tinned vegetables. I think of the months ahead – my wife’s 60th year and one where we had much planned – now devoid of opportunities to socialise and enjoy life. I think of my two children, now young adults, and the impact the current constraints and the floundering economy might have on their work, livelihoods and futures.
So when I again ask myself the question, ‘Did it have to be like this?’ there is only one answer: a resounding NO.
Photo courtesy of renjith krishman at FreeDigitalPhotos.net