Do we need to bother with COVID?

I’d been planning to finish this blog when the first vaccine was approved, which may be close but not quite yet, so I’ll save writing about that for the moment. Instead, I thought I’d give my thoughts on the current situation in the UK in about a 10 minute read (no pressure…). This was incredibly hard to write because I know I’m writing about people’s lives, livelihoods and loved ones, so I hope I’ve managed to find some balance in this.

Take-home message (TL;DR): I think most people are right about this situation, regardless of what their worries are… We need to balance all the impacts of this crisis, but unfortunately that means there will be impacts everywhere. Any solution to a global pandemic that contains the word “simply” is undoubtedly missing something. Unfortunately, although it’s really painful, we do need to keep going with what we’re doing.

So here we go again….

“One of the great problems of the world today is undoubtedly this problem of not being able to talk to scientists, because we don’t understand science; they can’t talk to us because they don’t understand anything else, poor dears.”

Michael Flanders (1964, but seems relevant today)

There’s obviously many different aspects to (mis)managing the Coronavirus pandemic: ‘lives vs. the economy’, balancing restrictions against freedom, COVID deaths vs. non-COVID deaths, mental vs. physical health… Personally I’d see all these aspects as fundamentally interconnected. The solution to managing this pandemic will not be anything “simple” like deciding lives are more important than the economy or vice versa. It’s like driving a car, we can’t “simply” decide the most important part to focus on… The accelerator? The steering wheel? The brakes? We have to find a balance between all of the interlinked parts.

“The cure can’t be worse than the disease…”

Speaking as a scientist, I completely agree with this statement. It’s common sense and is why we don’t accept the same side effects with aspirin as we do with, say, chemotherapy. What confuses me though is that this statement often comes with an assumption that for some reason governments/experts/scientists everywhere around the world suddenly stopped making this calculation. Many things that benefit us feel pretty horrible when we do them, quitting smoking, jogging, being vaccinated (I wonder how much anti-vaccine feeling is driven by childhood experiences?)… So perhaps we could add a caveat:

The cure can’t be worse than the disease… BUT it may appear worse if it works”

And that brings us to the question of how bad this disease could actually be:

So what has Corona ever done to us? Kill 0.5% of infected people who are mainly elderly or sick, so should we just let it happen? Why should the whole population suffer to protect 0.5%? I’d agree that fatality rate is low and the majority of people do recover, but every one of the numbers we see in the news is a person, a family member, a loved one. The desire of parents and grandparents to sacrifice themselves to protect children’s future is completely understandable – as is the desire of others not to have themselves or their loved ones thrown under the bus. People should indeed have a right to choose how they live, but as we’re still considering consequences perhaps let’s just keep the Greatest Generation out from under the bus for a minute.

OK, so aside from potentially killing the Greatest Generation, what has Corona ever done to us? One of the highest risk groups is actually healthcare workers (I’m going to refer to the NHS healthcare system in the UK in this post for simplicity). The increased fatality rate in NHS workers results from increased viral exposure, yet these people are still turning up to work. Literal superheros. Many Intensive Care Unit (ICU) workers are already facing emotional and mental burnout, but it’s hard to imagine what it would be like in their shoes if the people they’re trying to save were the very same people that decided not to try to protect them. Would they keep coming in?

OK, so aside from potentially losing NHS staff and killing the Greatest Generation, what has Corona ever done to us?

Long COVID.

OK, aside from long COVID, potentially losing NHS staff and killing the Greatest Generation, what has Corona ever done to us? The 0.5% death toll also isn’t equal. Minority communities (BAME) are at higher risk of fatality and vulnerable people are disproportionately affected because of cramped living conditions, poor health and higher social contact jobs that favour viral spread.

OK, so aside from the vulnerable, long COVID, potentially losing NHS staff and killing the Greatest Generation, what has Corona ever done to us?

The statement “COVID-19 only kills 0.5% of infected people” should also come with a caveat:

COVID-19 only kills 0.5% of infected people, BUT that will be higher without medical treatment.

As I see it, the threat from Coronavirus was never really how deadly or infectious it is… The real threat is that we all get sick at pretty much the same time. That’s the big difference between Coronavirus and the flu – Coronavirus is new – so we would all catch it in one go. We often hear the phrase “overwhelming the NHS” and some people (mainly on Twitter) seem to think overwhelming the NHS looks something like this:

Obviously reality is different. According to the WHO, on average 0.5% of infected people die, 5% need ICU treatment, and 15% need hospital treatment. So what % die if there are no ICU or hospital beds to treat them? I’d imagine it’s more than 0.5%. Our reliance on healthcare in the developed world and older population already makes our infection fatality rate higher (about 5x higher than low-income countries by some estimates). But it’s also worth bearing in mind that age doesn’t have as big an effect on the chances of needing hospital treatment from COVID as it does on the chances of dying – it’s not just the elderly that need hospital beds, younger people need them too:

Data from the CDC.

But we also need to consider non-COVID deaths, because life’s not all about COVID-19. Cancelling other treatments, cancer screenings, etc. is also a result of the NHS nearing capacity because there’s only so much the NHS can physically do. They could stop treating COVID-19 patients and focus on other illnesses, but then how high will the COVID fatality rate be? Or they could choose who to treat and who dies (and if COVID patients have over 90% chance of survival with treatment, those odds are much better than many conditions…)?

In the UK we have around 10 ICU beds and 250 hospital beds per 100,000 people. 5% of 100,000 people is 5,000 people per 10 ICU beds. 15% of 100,000 is 15,000 people per 250 hospital beds. Even the 10,000 Nightingale beds are only an extra 15 beds per 100,000 people. Obviously not everyone arrives at hospital at exactly the same time, we may reach herd immunity, and improvements in treatment/understanding mean less people need ICUs or can recover quicker. But even if those numbers are 100-fold out, I don’t see how the maths adds up to say an unchecked COVID wave couldn’t fill the NHS, leaving patients without treatment, as the NHS is over 75% full normally. Hospitals are already filling and operations cancelled in areas where 1-2% of people are infected, so it seems that unless we could build (and staff) a couple of extra copies of the NHS, the possibility of exceeding capacity is real. And if you think about what the scale of deaths with no NHS would be like, you’ll probably see that it would have it’s own massive knock-on effect on mental health (survivor’s guilt, PTSD) and the economy. Because it’s all interconnected. So really we can forget ridiculous arguments about ‘COVID vs. flu’, ‘inaccurate tests’ or ‘dodgy models’, because just counting how many sick people are arriving at hospitals and how many beds are available is really what’s driving this.

That’s also why lockdowns may not be simply prolonging the inevitable… Yes, it’s kicking the can/brick down the road, but each time we do it we keep the NHS under capacity and that saves the lives of people who weren’t inevitably about to die (from COVID or something else).

So it seems to me that the sacrifices we make through lockdowns are not primarily to save 0.5% of people – they may do that somewhat, but really that battle is being fought hard by doctors, nurses and scientists. The battle that we, the general public, are fighting is to keep the NHS under capacity, keep the COVID fatality rate to “only” 0.5%, save the lives of people who would survive other conditions with NHS treatment, and avoid the resultant economic/mental health fallout. Even if we are to fail in this, the blow will be lessened by every one of us who does not give up and goes down fighting.

What about the cost of a lockdown?

Make no mistake, lockdowns are horrendous. It’s a medieval way of controlling disease. The effect on mental health alone is devastating, and I would really encourage anyone struggling with this to speak to someone (you are not alone, many of us are feeling this). The economic cost is huge, and that affects livelihoods which in turn costs lives – it’s not ‘lives vs. the economy’, it’s ‘lives vs. lives’. The impact on children, their education and their future is huge and heartbreaking. The young are disproportionately impacted by a virus that they’ve got an incredibly low chance of being seriously ill from. The cost of lockdown has been estimated as equivalent to about 560,000 lives lost, or about 0.8% of the population (this is from an article saying the cost of lockdown is too high to justify). I’d say just going by that cost then, you could only justify lockdown if the infection fatality rate were to go far above 0.8%, for example, as could happen when the NHS is overwhelmed. That’s why governments have tried all these bizarre rules and Tiers before resorting to a national lockdowns: they know how high the cost is.

So, the million dollar question:

What’s the f***ing plan and how did it go so wrong that we’re back in lockdown?

Find a sustainable balance. Like driving a car, we’re never going to get far if we only concentrate on one part of it. We have to learn to live with Coronavirus because it’s not going away – but that doesn’t mean “simply” living like 2019 and taking our chances, because if we all do that then all our chances are worse as that hospital bed may not be there if we need it. Living with Coronavirus means balancing the economy, not overwhelming the NHS, all deaths, education, restrictions, mental health, freedom, loneliness, EVERYTHING – because they are all fundamentally interconnected. We’re going to take hits/restrictions in all of those areas, because that’s what it will take to keep the balance. Lockdown is not the answer, it’s an incredibly painful way of resetting to have another shot at finding that balance. To try to give some evidence that governments are trying to balance these different aspects (aside from the fact that they say this literally all the time!), we know Coronavirus spreads through interactions between people, e.g.

  1. Having some friends round your house/garden
  2. Seeing mates down the pub
  3. Meeting friends/family for a meal out
  4. Seeing people at work/school

To try to slow the second wave, we had to stop some of those interactions. Many people tried to “follow the science” (whatever the hell that means!) to understand the bizarre restrictions that were introduced in different Tiers. In my eyes, it’s a combination of scientific and economic factors. Meeting indoors was banned first which is easy to understand scientifically, but order those interactions for their economic value (as above) and it appears that the interactions that were restricted first were actually the ones that contributed less to the economy… because it’s not just ‘lives vs. the economy’. It’s ‘lives vs. lives’.

So where did it all go wrong: Test & Trace (the world’s most expensive Excel spreadsheet)? Eat Out to Help Out? The ‘winter wave’?

Well it doesn’t seem to be just the £12,000,000,000 Excel spreadshit (that I hope we’re getting a refund for?), otherwise the UK would be the only country with a second wave *N.B. Test & Trace will not stop the outbreak; the ‘Isolate’ part does – the whole thing’s pointless if people aren’t able/supported/willing to isolate. I also don’t think it was Eat Out to Help Corona Out because cases really kicked off after that scheme stopped (ONS data below):

It also doesn’t look like a ‘winter wave’, because rises were mainly in the 7-24 age bracket, and the weather’s the same for them as for the rest of us. We shouldn’t entirely blame young people for this wave either, because cases really kicked off when schools started so more social contact was unavoidable for young people. So if we want to stop the second wave, maybe we could just close all the schools and re-open all the pubs? Simple, probably popular with teachers (?), but somehow doesn’t seem like a long-term plan… After all, education is incredibly important and young people are at very low risk, so it looks like adults are forced to take more risks and restrictions to keep the balance. Closing schools also has a massive immediate economic impact through stopping parents working – that costs jobs, and ultimately lives – because everything is interconnected. Maybe that’s why schools remained open this lockdown.

Finally, “isn’t it all inevitable, and all the masks/handwashing/social distancing pointless if we ended up back in lockdown?”

I’d say just look back to the first wave: R was about 3. In the second wave, R was about 1.2-1.5. That’s the same virus, the same people (similar weather!), yet half the rate of spread. What changed? Part of the answer is you. You and your actions likely bought the government exponentially more time to try to find that balance in restrictions to avoid lockdown, and from the ONS/REACT/Zoe studies it looks like some areas of the UK lowered R to 1 before lockdown (until maybe our pre-lockdown blow-out anyway). I don’t have the expertise/data/time to say if the NHS would have been overwhelmed with cases levelled off at that rate, so I’m not even going to try. But there is at least a glimmer of hope there that we can find some balance of restrictions, the NHS and education in this.

Ultimately, there will be impacts on every aspect of life in this crisis because, tragically, that’s what happens in a pandemic. The better the situation is managed, the less the impact in every area. Governments have squandered our trust in many ways, but we shouldn’t confuse poor execution of the strategy to find a sustainable balance with that strategy being wrong. Whatever worries you the most in this crisis – deaths, the economy, lockdown – the answer is the same because they are all fundamentally interconnected: mask up, wash your hands, socially distance, isolate when sick, and follow the rules however bizarre they may seem. There will undoubtedly be more challenges, heartbreak and hardship to come, because sadly that’s what living through the biggest global health crisis in a century will be like. It will be tough, especially when those around you say it’s pointless, but giving up is not a way out. COVID-19 will not be the last challenge that the human race faces, and evolution does not look kindly on species that roll over when the fight gets tough… But just remember this: scientifically speaking, each and every one of us is also the result of millions of years of evolution. We are the product of generations upon generations who endured and overcame, of countless ancestors who never rolled over. We weren’t born to be quitters. We were bred to be fighters. It’s in our god-damn DNA. It’s that little niggling, frustrated feeling you’ve been having that says “if I could pick up a weapon and charge into battle to make this all go away, I would“. You want to fight – but the way you fight this is by masking up, washing your hands, socially distancing, isolating when sick, and following the rules. We will overcome this challenge, one way or another, because that is what we do, and the more of us that act together the easier it will be. People built the pyramids, walked on the moon, and eradicated two viruses from the face of this planet. And the way they did that was by working together, because when we act together our power is far greater than the sum of our parts. Every single action you take as an individual to fight this virus will have it’s own exponential impact. You CAN do this. WE can do this. Together. And we need the resilience of the Greatest Generation now more than ever. We’ve been rowing our little boat out of the storm for long enough that science has nearly got a sail up, but we’ve got to keep going for at least a little longer. And personally I’ll be happy if we make it out the other side of this and the cure appeared worse than the disease that many of us never fully saw.


Next time, the last post of this blog: the vaccine and why the level of vaccination needed to avoid a lockdown may not be as high as you’d think if we keep social distancing and keep fighting this… but for now, dig deep and stay safeand if you’ve found this post helpful, please feel free to pass it on to others if you think it may help them too.

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