What Lies Ahead: Covid19

⏱ 9 Minute Read ✍🏻 30th March 2020

As the UK death toll approaches 1,500, the arguments between those who claimed that COVID-19 is “just like flu” and those who took it more seriously are falling quiet. Even for those with their head still stuck firmly in the sand, it is becoming increasingly difficult to ignore the noise of Italy and Spain on the tracks ahead.

Those trains are not slowing down, but gathering pace – at the time of writing, the death toll in each country is more than 800 per day. Yesterday, these two embattled nations lost 1,577 people between them in just 24 hours. In the last 30 days, over 10,000 have died in Italy. In little more than 3 weeks, over 6,000 have died in Spain.

Here in the UK, doubters can be found at every turn. The gaps in the lockdown rules, created by the government’s lax approach, continue to be exploited. Meet-ups are being orchestrated under cover of the daily exercise allowance. Late-night parties are arranged via social media, the organisers bragging that there are too few Police to catch them. In Derbyshire yesterday, 25 people gathered in a front room to sing karaoke and share a buffet. It is difficult to think of a more efficient way to spread the virus, short of coughing in someone’s face, than passing around a microphone and eating finger food. It would be funny if people weren’t dying.

It is a sad fact that even amongst young adults, a significant percentage of the infected will require critical care. This will increase the load on the NHS, which is already stretched. The result will be avoidable deaths. And if we come to the point where ICU doctors have run out of resources and must effectively decide who lives and who dies, the young will be given priority over the old.

Still, large corporations continue to make excuses for putting profit before saving lives, demanding that staff come to work in call centres, warehouses and construction sites. The government cannot seem to provide clarity on what is classed as non-essential work. The self-employed, having been told they must wait until June to receive sustenance pay-outs, choose to take their chances.

There is a pervasive scepticism about the impact the virus will have in the UK, as though the footage of patients struggling to breathe through respirators might be Hollywood fiction, or the convoy of Italian army trucks transporting corpses to makeshift morgues fake news. Even the pleas of shattered Italian ICU doctors continue to fall on deaf ears, despite their clear warnings that the British are making all the same mistakes. This refusal to accept the inconvenient truth echoes the mindset of climate change deniers.

A key complaint seems to be ‘lockdowns don’t work anyway’, the (faulty) logic being that Italy has been locked down for three weeks, yet its death toll continues to climb. No mention is made of the overwhelming likelihood that the number of dead would be considerably higher had the lockdown not been implemented, or that the country locked down at least a week late. It is apparently irrelevant that its measures are nowhere near as strict as those enforced by China, or that mobile GPS data shows that around 40% of the Italian public have been ignoring restrictions.

There is no shortage of clues as to what is really contributing to these death ramps. Consider the Champions League match that took place in Bergamo in late February, attended by 39,500 Italians and 2,500 Spaniards. Might this have something to do with the rapid acceleration of cases in Bergamo thereafter? Is it pure coincidence that when people subsequently began to fall ill in Spain, many of the first cases were Valencia fans who had flown to Italy for that match?

What of the 375,000 people who marched through Madrid shoulder-to-shoulder on 8th March for International Women’s Day? Two days prior, the head of Spain’s Centre for Health Emergencies was asked whether it might be a bad idea for the event to go ahead in the midst of a global pandemic. His answer was that the public ought to make up their own minds, adding: “If my son asks me whether he can go, I’ll tell him to do what he wants.”

On the day of the Madrid march, a total of 27 people had died in Spain. A week later, three Spanish cabinet ministers—all of whom had attended the event—announced that they had tested positive. Five days after that, the death toll had risen to 1,378. Four days later, it had more than doubled to 3,644. Around 50% of all the deaths were in Madrid.

Demonstrators marching for International Women’s Day in Madrid, March 8, 2020. © Reuters / Susana Vera

Had these mass gatherings been stopped, would the spread of the virus in Italy and Spain have been slower? Might the strain on their hospitals have been significantly less?

Dr Hugh Montgomery, a Professor of Intensive Care Medicine at University College London, thinks so: “The reason for that is the simple mathematics of doubling. If you assume, in the worst case, that every person with the disease can infect three more, then by the time each of those has infected people and gone out to ninth or tenth cycle, you’re knocking somewhere in the region of upwards of 55,000 – 60,000 people infected….yet we still saw these completely crazy mass gatherings….six days of incubation, six to ten days before people hit intensive care units, and then time in intensive care units before they die. So this death rate is going to go up steeply.”

Of course, the classic rebuttals will now be wheeled out: Italy and Spain have older populations. Both countries have a tactile culture; kissing both cheeks is their standard form of greeting. Several generations tend to live in the same house as grandparents, and so on and so forth. Are these things contributing factors? Absolutely. Does this mean that the UK won’t fare as badly as Italy and Spain? Possibly. The question is, what does ‘fare as badly’ mean? What exactly is the acceptable level of avoidable loss of life?

Some seem to doubt that there will be any loss of life at all. Writing in the Spectator recently, a retired NHS pathologist named Dr John Lee suggested that the death toll figures are completely overblown. He asked: “are more people dying than we would expect to die anyway?”, pointing out that “statistically, we would expect about 51,000 to die in Britain this month [of other causes]”.

The crux of Lee’s argument seems to be this: if, say, a thousand people ‘officially’ die of Covid-19 in Britain in one month, but the overall number of deaths in that month is no higher than it otherwise would have been, then it must mean that those thousand people actually died of something else, but just so happened to have tested positive too. On the face of it, he makes a good point. Statistics can be misleading, particularly if the data is driven by inappropriate criteria. But now let me give you a real-world example:

My father had leukaemia. After several cycles of chemotherapy, his oncologist suggested that he might be a good candidate for a bone marrow transplant – he was otherwise healthy and fit for his age. The procedure would be hard on him, but because it offered the only hope of cure, he agreed.

The transplant was a success, and after some time recovering in hospital, he was given the all clear and allowed to go home. He had become one of the lucky few to be cured of leukaemia. About a week later however, he developed a cough with fever, and was readmitted to hospital. Following tests, it transpired that he had contracted hospital-acquired MRSA during his period of convalescence, which had caused severe pneumonia. He developed difficulty breathing and was placed on a ventilator for ten days, but subsequently died.

The official documented cause of my father’s death was leukaemia, despite the fact that he had been cured of the disease and released from hospital. Obviously, the true cause of his death was pneumonia, which was caused by an MRSA infection. This is to say that had he not been infected with MRSA, he would not have developed pneumonia, and he would not have died during that period of time. The fact is that he didn’t die of leukaemia (or even with it). According to Dr Lee however, to record the cause of death as MRSA would have artificially inflated the death rate of MRSA. It is not difficult to see how his approach benefits the government’s track record during the Covid-19 crisis.

Then there are those who claim that the virus will spread regardless. In fact, there may be a sort of truth in that, but not in the way those making this argument think. I say this because of a fundamental mistake made at the very beginning – a lack of substantial testing, tracing and isolating of cases. This is what set Italy, Spain and the UK on the terrible trajectory that we now see unfolding. Whilst it could be argued that there is no point crying over spilt milk, it is important to recognise that it was this very same mindset—failing to take the virus seriously and wanting to protect the economy at all costs—that facilitated that negligence in the first place. These last-minute lockdowns are simply a panicked attempt to put the genie back into the bottle.

With that said, how does it follow that we ought to abandon the only mitigation measure that definitely works? Would it really be better for society at large if we all just got on with it and allowed the virus to spread freely? It would certainly be an opportunity to test the herd immunity theory. Most attractively of all, we could protect our economy and get straight back to normalcy. A seductive proposal perhaps, but not one I would want to pitch to grieving relatives (or indeed frontline NHS staff, many of whom are likely to become statistics themselves).

I do, however, completely understand the pragmatism of the ‘shield the old and vulnerable, the rest of us get on with our lives’ movement – there is no doubt that the economy will be severely damaged by these lockdowns, or that prolonged isolation carries health risks of its own. The problem is that the success of such an approach relies on the public at large behaving reasonably and responsibly, of their own free will. As we have already seen, that is hardly a realistic goal.

Finally, not everyone innocently misperceives reality – some wilfully distort it. They accuse dissenters of scaremongering and overreaction, blaming them for the damage to the economy (or, more likely, their own personal circumstances). The evidence for the effectiveness of ‘impractical and costly’ lockdowns is scoffed at, countered with incomplete studies of incomparable countries which seem to have taken a different approach. But if this cohort are honest, their true motivation is individualism; a value system where the preservation of personal comfort takes priority over saving faceless, nameless lives.

I think Paul Simon said it best: “a man hears what he wants to hear…and disregards the rest.”