The true mortality rate of covid-19 remains a matter of intense dispute, but it is undoubtedly true that a false public impression was given by the very high percentage of deaths among those who were tested positive, at the time when it was impossible to get tested unless you were seriously ill (or a member of society’s “elite”). When only those in danger of dying could get a test, it was of course not at all surprising that such a high percentage of those who tested positive died. It is astonishing how many articles are published with the entirely fake claim that the mortality rate of Covid-19 is 3.4%, based on that simple methodology. That same methodology will today, now testing is much more widely available to those who feel ill, give you results of under 1%. That is still an overestimate as very few indeed of the symptomless, or of those with mild symptoms, are even now being tested.
The Guardian’s daily graphs of statistics since January 1 illustrate this very nicely. It is of course not in fact the case, as the graphs appear to show, that there are now vastly more cases than there were at the time of peak deaths in the spring. It is simply that testing is much more available. What the graphs do indicate is that, unless mortality rates have very radically declined, cases tested on the same basis they are tested today would have given results last spring of well over 100,000 cases per day. It is also important to note that, even now, a very significant proportion of those with covid-19, especially with mild symptoms, are still not being tested. Quite possibly the majority. So you could very possibly double or treble that figure if you were looking for actual cases rather than tested cases.
I do not believe anybody seriously disputes that there are many millions of people in the general population who had covid and survived it, but were never tested or diagnosed. That can include people who were quite badly ill at home but not tested, but also a great many who had mild or no symptoms. It is worth recalling that in a cruise ship outbreak, when all the passengers had to be compulsorily tested, 84% of those who tested positive had no symptoms.
What is hotly disputed is precisely how many millions there are who have had the disease but never been tested, which given the absence of widespread antibody testing, and inaccuracies in the available antibody tests, is not likely to be plain for some time, as sample sizes and geographical reach of studies published to date have been limited. There is no shortage of sources and you can take your pick. For what it is worth, my own reading leads me to think that this Lancet and BMJ published study, estimating an overall death rate of 0.66%, is not going to be far off correct when, in a few years time, scientific consensus settles on the true figure. I say that with a certain caution. “Respectable” academic estimates of global deaths from Hong Kong flu in 1968 to 70 range from 1 million to 4 million, and I am not sure there is a consensus.
It is impossible to discuss covid-19 in the current state of knowledge without making sweeping assumptions. I am going here to assume that 0.66% mortality rate as broadly correct, which I believe it to be (and if anything pessimistic). I am going to assume that 70% of the population would, without special measures, catch the virus, which is substantially higher than a flu pandemic outbreak, but covid-19 does seem particularly contagious. That would give you about 300,000 total deaths in the United Kingdom, and about a tenth of that in Scotland. That is an awful lot of dead people. It is perfectly plain that, if that is anything near correct, governments cannot be accused of unnecessary panic in their responses to date.
Whether they are the best responses is quite another question.
Because the other thing of which there is no doubt is that covid-19 is an extremely selective killer. The risk of death to children is very small indeed. The risk of death to healthy adults in their prime is also very marginal indeed. In the entire United Kingdom, less than 400 people have died who were under the age of 60 and with no underlying medical conditions. And it is highly probable that many of this very small number did in fact have underlying conditions undiagnosed. Those dying of coronavirus, worldwide, have overwhelmingly been geriatric.
As a Stanford led statistical study of both Europe and the USA concluded
People <65 years old have very small risks of COVID-19 death even in the hotbeds of the pandemic and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic.
The study concludes that for adults of working age the risk of dying of coronavirus is equivalent to the risk of a car accident on a daily commute.
I should, on a personal note, make quite plain that I am the wrong side of this. I am over 60, and I have underlying heart and lung conditions, and I am clinically obese, so I am a prime example of the kind of person least likely to survive.
The hard truth is this. If the economy were allowed to function entirely normally, if people could go about their daily business, there would be no significant increase in risk of death or of life changing illness to the large majority of the population. If you allowed restaurants, offices and factories to be be open completely as normal, the risk of death really would be almost entirely confined to the elderly and the sick. Which must beg the question, can you not protect those groups without closing all those places?
If you were to open up everything as normal, but exclude those aged over 60 who would remain isolated, there would undoubtedly be a widespread outbreak of coronavirus among the adult population, but with few serious health outcomes. The danger lies almost entirely in spread to the elderly and vulnerable. The danger lies in 35 year old Lisa catching the virus. She might pass it on to her children and their friends, with very few serious ill effects. But she may also pass it on to her 70 year old mum, which could be deadly.
We are reaching the stage where the cumulative effect of lockdown and partial lockdown measures is going to inflict catastrophic damage on the economy. Companies could survive a certain period of inactivity, but are coming to the end of their resilience, of their financial reserves, and of effective government support. Unemployment and bankruptcies are set to soar, with all the human misery and indeed of deleterious health outcomes that will entail.
There is no social institution better designed than schools for passing on a virus. The fact that schools are open is an acknowledgement of the fact that there is no significant danger to children from this virus. Nor is there a significant danger to young adults. University students, the vast, vast majority of them, are not going to be more than mildly ill if they catch coronavirus. There is no more health need for universities to be locked down and teaching virtually, than there would be for schools to do the same. It is a nonsense.
The time has come for a change in policy approach that abandons whole population measures, that abandons closing down sectors of the economy, and concentrates on shielding that plainly defined section of the population which is at risk. With this proviso – shielding must be on a voluntary basis. Elderly or vulnerable people who would prefer to live their lives, and accept that there is currently a heightened risk of dying a bit sooner than might otherwise be expected, must be permitted to do so. The elderly in particular should not be forcefully incarcerated if they do not so wish. To isolate an 88 year old and not allow them to see their family, on the grounds their remaining life would be shortened, is not necessarily the best choice for them. It should be their choice.
To some extent this selective shielding already happens. I know of a number of adults who have put themselves into voluntary lockdown because they live with a vulnerable person, and such people should be assisted as far as possible to work from home and function in their isolation. But in general, proper protection of the vulnerable without general population lockdowns and restrictions would require some government resource and some upheaval.
There could be, for example, a category of care homes created under strict isolation where no visitation is allowed and there are extremely strict firewall measures. Others may have less stringent precautions and allow greater visitation and movement; people should have the choice, and be assisted in moving to the right kind of institution for them. This would involve upheaval and resources, but nothing at all compared to the upheaval being caused and resources lost by unnecessary pan-societal restrictions currently in force. Temporary shielded residential institutions should be created for those younger people whose underlying health conditions put them at particular risk, should they wish to enter them. Special individual arrangements can be put in place. Public resource should not be spared to help.
But beyond those precautions to protect those most in danger, our world should return to full on normal. Ordinary healthy working age people should be allowed to make a living again, to interact socially, to visit their families, to gather together, to enjoy the pub or restaurant. They would be doing so in a time of pandemic, and a small proportion of them would get quite ill for a short while, and a larger proportion would get mildly ill . But that is a part of the human condition. The myth that we can escape disease completely and live forever is a nonsense.
Against this are the arguments that “every death is a tragedy” and “one death is too many”. It is of course true that every death is a tragedy. But in fact we accept a risk of death any time we get in a car or cross a road, or indeed buy meat from the butcher. In the USA, there has been an average of 4.5 amusement park ride fatalities a year for the last 20 years; that is an entirely unnecessary social activity with a slightly increased risk of death. Few seriously want amusement parks closed down.
I genuinely am convinced that for non-geriatric people, the risk of death from Covid-19 is, as the Stanford study suggested, about the same as the risk of death from traffic accident on a daily commute. The idea that people should not commute to work because “any death is a tragedy” is plainly a nonsense.
The problem is that it is a truism of politics that fear works in rendering a population docile, obedient or even grateful to its political leaders. The major restrictions on liberty under the excuse of the “war on terror” proved that, when the statistical risk of death by terrorism has always been extraordinarily small to any individual, far less than the risk of traffic accident. All the passenger security checks that make flying a misery, across the entire world, have never caught a single bomb, anywhere.
Populations terrified of covid-19 applaud, in large majority, mass lockdowns of the economy which have little grounding in logic. The way for a politician to be popular is to impose more severe lockdown measures and tell the population they are being saved, even as the economy crumbles. Conversely, to argue against blanket measures is to invite real hostility. The political bonus is in upping the fear levels, not in calming them.
This is very plain in Scotland, where Nicola Sturgeon has achieved huge popularity by appearing more competent and caring in managing the covid-19 crisis than Boris Johnson – which may be the lowest bar ever set as a measure of political performance, but it would be churlish not to say she has cleared it with style and by a substantial margin.
But when all the political gains are on the side of more blanket lockdowns and ramping up the levels of fear, then the chances of measures tailored and targeted specifically on the vulnerable being adopted are receding. There is also the danger that politicians will wish to keep this political atmosphere going as long as possible. Fear is easy to spread. If you make people wear face masks and tell them never to go closer than 2 metres to another person or they may die, you can throw half the population immediately into irrational hostility towards their neighbours. Strangers are not seen as people but as parcels of disease.
In these circumstances, asking ordinary people to worry about political liberty is not fruitful. But the new five tier measures announced by the Scottish government yesterday were worrying in terms of what they seem to indicate about the permanence of restrictions on the, not really under threat, general population. In introducing the new system, Nicola Sturgeon went all BBC on us and invoked the second world war and the wartime spirit, saying we would eventually get through this. That of course was a six year haul.
But what really worried me was the Scottish government’s new five tier system with restrictions nominated not 1 to 5, but 0 to 4. Zero level restrictions includes gatherings being limited to 8 people indoors or 15 people outdoors – which of course would preclude much political activity. When Julian Assange’s father John was visiting us this week I wished to organise a small vigil for Julian in Glasgow, but was unable to do so because of Covid restrictions. Even at zero level under the Scottish government’s new plans, freedom of assembly – an absolutely fundamental right – will still be abolished and much political activity banned. I cannot see any route to normality here; the truth is, of course, that it is very easy to convince most of the population inspired by fear to turn against those interested in political freedom.
What is in a number? When I tweeted about this, a few government loyalists argued against me that numbering 0 to 4 means nothing and the levels of restriction might equally have been numbered 1 to 5. To which I say, that numbering the tiers of restriction 1 to 5 would have been the natural choice, whereas numbering them 0 to 4 is a highly unusual choice. It can only have been chosen to indicate that 0 is the “normal” level and that normality is henceforth not “No restrictions” but normal is “no public gathering”. When the threat of Covid 19 is deemed to be sufficiently receding we will drop to level zero. If it was intended that after level 1, restrictions would be simply set aside, there would be no level zero. The signal being sent is that level zero is the “new normal” and normal is not no restrictions. It is both sinister and unnecessary.
UPDATE I just posted this reply to a comment that this argument amounts to a “conspiracy theory”. It is an important point so I insert my reply here:
But I am not positing any conspiracy at all. I suspect that it is very easy for politicians to convince themselves that by increasing fear and enforcing fierce restriction, they really are protecting people. It is very easy indeed to genuinely convince yourself of the righteousness of a course which both ostensibly protects the public and gives you a massive personal popularity boost.
It is argued that only Tories are worried about the effect on the economy in the face of a public health pandemic. That is the opposite of the truth. Remarkably, the global lockdowns have coincided with an astonishing rate of increase in the wealth of the richest persons on the planet. That is an effect we are shortly going to see greatly amplified. As tens of thousands of small and medium businesses will be forced into bankruptcy by lockdown measures and economic downturn, their assets and their markets will be snapped up by the vehicles of the super-wealthy.
I am not a covid sceptic. But neither do I approve of fear-mongering. The risk to the large majority of the population is very low indeed, and it is wrong that anybody who states that fact is immediately vilified. The effect of fear on the general population, and the ability of politicians to manipulate that fear to advantage, should not be underestimated as a danger to society.
There has been a substantial increase in human life expectancy over my lifetime and a subsequent distancing from death. That this trend should be permanent, in the face of human over-population, resource exhaustion and climate change, is something we have too readily taken for granted. In the longer term, returning to the familiarity with and acceptance of death that characterised our ancestors, is something to which mankind may need to become re-accustomed.
In the short term, if permanent damage to society is not to be done, then the response needs to be less of an attack on the entire socio-economic structure, and more targeted to the protection of the clearly defined groups at real risk. I greatly dislike those occasions when I feel compelled to write truths which I know will be unpopular, particularly where I expect them to arouse unpleasant vilification rather than just disagreement. This is one of those times. But I write this blog in general to say things I believe need to be said. I am very open to disagreement and to discussion, even if robust, if polite. But this is not the blog to which to come for comfort-reading.
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