The past month has seen a deluge of coronavirus statistics and analysis, with some of us left scratching our heads as the complexities of what the world is facing continues to confound all and sundry.
Much of the Irish media, for instance, has spent the past week congratulating people on avoiding a sudden spike in spread, even though the real reason we are not confirming a lot more cases is simply because we don’t have enough testing kits and results from laboratories are delayed.
This has been admitted reluctantly and quietly by some officials, but the media’s unwillingness to lead with such stories is symptomatic (yes, I said it) of the overall lack of perspective on offer as cabin fever takes hold across the world.
As someone who was in favour of a lockdown initially, I have since moved onto the fence as evidence from other countries emerges that forcing everyone indoors may not be the most effective way of overcoming Covid-19.
So here are 5 pressing questions that need to be answered quickly if we are to ensure the cure is not worse than the disease.
1. Why has Sweden managed to avoid a lockdown and keep its death rate relatively low?
The Swedes are still living life almost as normal, with the stay-at-home restrictions only being placed on those over-70 and those who are ill. They have decided not to risk economic collapse in coping with the virus, and, as of 30th March, had suffered 10.8 deaths per million citizens, which compares favourably with their locked-down neighbour Denmark’s 12.42 deaths per million. To put things in perspective, Italy’s death rate is 178 people per million.
There has been much speculation about whether their hospitals will be overrun in the coming weeks, with 5,568 cases confirmed so far, but the overall strategy of trying to keep the elderly and vulnerable out of harms way whilst letting everyone else go about their business appears to be working.
2. Is the UK’s mortality rate inflated because of how pathologists are recording cause of death?
The UK has suffered 18.47 deaths per million, which puts it eleventh internationally in terms of mortality rates from Covid-19. Writing in the Spectator, former NHS consultant pathologist John Lee has questioned how deaths are being recorded however, explaining that officials might be giving Covid-19 undue recognition as the cause of death:
“If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.
Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.
In the current climate, anyone with a positive test for Covid-19 will certainly be known to clinical staff looking after them: if any of these patients dies, staff will have to record the Covid-19 designation on the death certificate — contrary to usual practice for most infections of this kind. There is a big difference between Covid-19 causing death, and Covid-19 being found in someone who died of other causes. Making Covid-19 notifiable might give the appearance of it causing increasing numbers of deaths, whether this is true or not. It might appear far more of a killer than flu, simply because of the way deaths are recorded.
If we take drastic measures to reduce the incidence of Covid-19, it follows that the deaths will also go down. We risk being convinced that we have averted something that was never really going to be as severe as we feared. This unusual way of reporting Covid-19 deaths explains the clear finding that most of its victims have underlying conditions — and would normally be susceptible to other seasonal viruses, which are virtually never recorded as a specific cause of death.”
If Lee is correct in his assessment of how deaths are being recorded, this could drastically change the outlook for other countries too.
3. Won’t the eventual transition from lockdown to normality bring about a renewed spread and pressure on our hospitals?
There has been much talk of second waves of the virus, whether caused by new arrivals to the country or the eventual lifting of restrictions, but if we are to assume the virus is as dangerous and contagious as experts believe, then there seems little chance that the spread will cease when the lockdown ends. Governments will have to prepare for a significant spike in cases when the restrictions are lifted, but the spectre of another major outbreak raises the question of whether we should have followed Sweden’s model in the first place, of isolating the vulnerable and being resigned to the fact most other people will sooner or later contract it and recover.
As for hospitals, the biggest unknown might be estimating how many people will need urgent attention should the restrictions be lifted across the board. Perhaps the most sensible way out of this is to ask the elderly and those with underlying conditions to continue isolating and protecting themselves whilst everyone else gets back to work.
4. Is “herd immunity” the unspoken goal of every government hoping to cope with Covid-19?
World leaders are not naive. They know what hospitals can and cannot cope with, and although the term “herd immunity” has become taboo, leaders who are desperate to avoid a total economic and social collapse are relying on their citizen’s ability to avoid hospitalization and recover at home if and when they do contract the virus. There are plenty of reasons to believe tens of millions of people have unknowingly had Covid-19 and recovered, which will come as a relief to many politicians and hospital chiefs tasked with managing the outbreak.
Developing widespread immunity seems the only realistic way of ensuring the lockdown won’t last long into the summer, whilst the steps taken so far by most governments have always been premised on the reality that the outbreak can only be slowed, not stopped.
5. Will the economic devastation cause a greater loss of life than Covid-19?
For some, the 2008 recession brought with it suicide, depression and family breakdown, not to mention the impact it had on standards of living among the poorer sections of society. Although quantifying the human cost of an economic collapse is difficult in retrospect, and almost impossible in advance, it’s safe to say that lives will be lost in the future due to the decisions being taken today. We won’t just have the aforementioned ills, but the health service in many countries will also suffer as a result of decreased tax funding, thus jeopardizing more lives.
Coupled with that, there will be an inevitable decrease in charitable giving and international aid, which will similarly impact poor people more severely. Whether or not Covid-19 will take more lives directly might never be known, but the stakes are only getting higher as economies continue to contract.