It is an unfortunate fact of life that everyone who has been born is, at some point in the future, going to pass away. An inconvenient truth, if you like. It is human nature not to wish to overly ponder statistics related to mortality, for the obvious reason that as humans it is only proper to consider each and every life lost as one that has been lived. Every passing leaves family, friends and colleagues behind.
However, for the health and wellbeing of those who are left behind – and the society that the dearly departed have helped create, and the world inhabited by their descendants – it is only right to consider what is an appropriate response to an existential threat to a life.
The medical profession undertakes to “Do No Harm”. It is a principle that helps decide what courses of action may be applicable given an existential threat.
In March 2020, HMG enacted a U-turn of epic proportions, suddenly implementing a draconian lockdown, counter to its own stated strategy and crisis planning. It is now crystal clear in hindsight that the rate of increase of Covid-19 infections was already slowing by the time they introduced a nationwide shutdown. Deaths peaked on 8 April, incidentally the same day as in Sweden, a country that continued on a “community immunity” path.
What was also clear at the time was that Covid-19 was not as lethal as the Ebola outbreak. While there was anecdotal evidence that the coronavirus epidemic had spread rapidly, this was not borne out by serological data, leading many to believe that a large proportion of the British public was still susceptible. It subsequently transpired that other factors were in play, with research showing that T-Cells play a major part in fighting off the disease. More people had had it, fewer people were susceptible and due to this denominator effect, Covid-19 was not as deadly as feared. Like many other coronaviruses, it is likely here to stay – endemic – as part of the ecosystem, like with coronavirus OC43, which is thought to have caused the 1890 pandemic but now just causes a common cold.
It is in this context that it is worth narrowing down on yesterday’s announcement of some doomsday scenario modelling from HMG’s “scientific” advisors. I say scientific, but the method of data presentation was anything but scientific. Without any justification as to why cases might double over a weekly basis (recent new cases have in fact been falling, not rising), a highly un-scientific example scenario was trotted out (without error bars and with only limited assumptions) showing four consecutive weeks of said doubling of cases.
Sign up for the Week in Review Email
Every Sunday: Read the week’s most read articles, watch Iain Martin’s Authors in Conversation series, listen to The Reaction podcast & receive new offers and invites.
There is no evidence for such a trajectory existing, least of all in the comparable countries mentioned in the presentation, Spain and France. The voiceover was carefully worded to maximise impact while providing wiggle room for later denunciations. Yet this is the misguided thinking which continues to inform the strategy of Boris Johnson, who announced a new round of Covid restrictions in the House of Commons this afternoon. It is based on flawed, panicked reasoning and will cause untold harm across the country.
Instead, what we actually need is to be focused on Covid-19 hospitalisations and deaths. As some of the country’s leading scientists, such as Professors Sunetra Gupta and Carl Heneghan have said, this should be the foundation of our strategy.
Let’s take a dive into the statistics. Deaths from the new coronavirus fall into the category of deaths from “respiratory disease”, a statistic carefully monitored by the Office for National Statistics and published on a weekly basis. For England & Wales, these figures run at a “baseline rate” of c. 1,000 per week in the summer, rising to around 2,500 per week in the winter. These numbers are averages. So sometimes the weekly rate is lower in the summer, and sometimes higher in the winter. So yes, occasionally weekly respiratory deaths triple or even quadruple when moving from benign summer to harsh winter. Now assume a five-month period from end of August to the middle of winter, and we’re looking at a weekly growth in death rates of just under 7%, or a monthly increase of 32%.
It sounds scary, but that’s just seasonality. Virus infections fall in the spring and summer, and rise in autumn and winter. This seasonality is not the end of the world, especially if a large proportion of the population has already been exposed to the virus.
In fact, it is questionable if suppressing or eradicating a virus is a good idea, as it can suddenly become “unbottled” as a result – especially when a pandemic, which is a global phenomenon by its very nature, persists elsewhere. Sweden has not witnessed a material rise in Covid-19 infections, and despite a huge roll-out of testing programmes, other countries that are seeing a rapid rise in cases are not experiencing a material increase in mortality.
There is, therefore, no cause for alarm. Vigilance, yes, but certainly not panic. If it desired to eradicate mortality, HMG would have to start by eradicating respiratory deaths completely.
To put this into perspective: data from the Office of National Statistics shows that the weekly average for August 2020 (England & Wales) was c. 850 per week, comfortably below the 10-year average weekly baseline of 997 per week, itself a clue that the unfortunate pandemic in March/April was less existential than generally assumed. For context, weekly deaths linked (not even caused!) by Covid-19 had dropped to less than 100 per week by early September 2020.
So – as nights draw in, temperatures fall and this wonderful dry weather becomes a bit more soggy – a rise in respiratory deaths is unfortunately likely over the next few weeks and months. But it was ever thus, and we need to be honest with ourselves: we have never before done so much to destroy the life chances of the living by attempting to arrest this annual seasonality.
This raises fundamental questions about the apparently muddled strategy being pursued by the government and its advisers What is the purpose of the government’s plans today, you have to ask? If it is no longer to prevent the NHS from being overwhelmed, as it was in March, is it simply to stop any deaths from taking place whatsoever? This is not only a bad policy, one which completely ignores the damage which restrictions will now cause for mental and physical health, it is also, more the point, impossible.
Here’s the problem: mortality may or may not be linked to the new coronavirus, but an observed fact is that hospitalisations and deaths from Covid-19 have fizzled out wherever the virus has already spread. Viruses always spread at this time of year, but we have never before attempted to comprehensively measure the spread of other viruses, such as the flu, in healthy (i.e. asymptomatic) people to such an extent.
What’s more, the resulting data does not necessarily mean anything, as testing of an otherwise healthy population yields unpredictable results unless the test used is highly specific (hint: the C19 tests commonly used in the UK are not highly specific).
While every death is regrettable, we are well within normal bounds. We would do well to invest society’s resources in improving the lot of the living – as well as the dying – rather than promote expensive measures that reduce quality of life without measurable and demonstrable benefit.
Do no harm, as that is the only way you can do good.
Dr Alex Starling is an advisor to and non-executive director of various early-stage technology companies. He is a director of the Oxford Technology Venture Capital Trusts.