Home Flexcit Impact Assessments Monographs Contact Archive

Coronavirus: the killer with a benign face

2020-03-23 07:09:37

I am not sure I want to be part of a country where the prime minister (any prime minister) is delivering daily broadcasts to the nation, which then become a central part of our lives upon which so much hangs. But it is a singularly cruel deity (or one with a magnificently warped sense of humour) which foists upon me in particular a man who I detest so much that it is quite unpleasant merely to watch him.

Yesterday's press conference, therefore, offered the usual dose of torture (mercifully absent on Saturday), when the Great Leader told us why the government was taking its "unprecedented steps".

The reason "of course", he said, was that "we have to slow the spread of the disease and to save thousands of lives", at which point we entered something of a fairy-tale land - the one in which we actually have a government which knows what it is doing.

Thus today, said the Great Leader, "we've come to the stage of our plan that I advertised at the outset, when we first set out plan of the UK government, when we now have to take special steps to protect the particularly vulnerable".

Up to a point, Lord Copper, one might say, but reference to this fabled plan does not exactly support Johnson's claim.

Far from seeking to take the vulnerable out of the infection loop, it actually noted that "there could well be an increase in deaths arising from the outbreak, particularly amongst vulnerable and elderly groups". One was supposed to take comfort from the alertness of the beneficent UK Government and Devolved Administrations. These would "provide advice for local authorities on dealing with this challenge".

Nevertheless, Johnson told the assembled hacks that "You'll remember when I said the moment would come when we needed to shield those with serious conditions. There are probably about one-and-a-half million in all", but this is notably absent from The Plan. It was raised on 15 March, after the government had "faced pressure to do more to tackle the epidemic".

In response, Downing Street had said it would continue to be guided by its medical experts. Its Scientific Advisory Group for Emergencies (Sage) had thus listed "shielding the vulnerable" and "household isolation" as the next steps to tackle the spread of the virus.

However, all is well says Johnson. "This shielding will do more than any other single measure that we are setting out to save life. That is what we want to do. Also to reduce infection and to slow the spread of the disease".

One can hardly avoid wondering, though, why if this shielding is such a potent weapon - it wasn't specifically identified earlier. But then, if we are to believe the Sunday Times, young Master Cummings had originally convinced the Great Leader that slaughtering the sick and elderly was the way to go.

In a hotly disputed passage, dismissed as a "defamatory fabrication", the ST has it that Cummings "became convinced that Britain would be better able to resist a lethal second wave of the disease next winter "if the CMO's prediction that 60 to 80 percent of the population became infected was right and the UK developed "herd immunity".

Thus, at a private engagement at the end of February, the "career psychopath" outlined the government's strategy. Those present say it was "herd immunity, protect the economy and if that means some pensioners die, too bad".

Something of this "bring out your dead" policy, was evident even without the inside track, although we had pointed the way to a shielding strategy on 4 March when we suggested that:
Where most of the young(er) victims are only mildly affected, perhaps the best thing to do would be to isolate the "at risk" groups and then let the virus rip through the community until herd immunity reaches about 80 percent and the epidemic peters out naturally.
Deliberately or otherwise, this seems precisely the strategy on which the government is now embarking a strategy of last resort as its half-hearted measures are unlikely to have a decisive effect.

This clears the way for a timely intervention from Peter Hitchens, who asks: "Is shutting down Britain with unprecedented curbs on ancient liberties REALLY the best answer?"

He is not wrong to ask that question it should be asked. And in getting to that point, after recounting an unfortunate experience with a medical doctor, he asserts that, "A mere title, a white coat, a smooth manner, a winning way with long words and technical jargon, will never again be enough for me". One could not disagree with that.

As to the number crunchers of the Imperial College in London, about whom we have been less than complimentary, Hitchens has this to say:
In a pungent letter to The Times last week, a leading vet, Dick Sibley, cast doubt on the brilliance of the Imperial College scientists, saying that his heart sank when he learned they were advising the Government. Calling them a "team of doom-mongers", he said their advice on the 2001 foot-and-mouth outbreak "led to what I believe to be the unnecessary slaughter of millions of healthy cattle and sheep" until they were overruled by the then Chief Scientific Adviser, Sir David King.
In principle, I could hardly disagree with that and I can only agree with Hitchens when he adds that: "I despair that so many in the commentariat and politics obediently accept what they are being told. I have lived long enough, and travelled far enough, to know that authority is often wrong and cannot always be trusted".

As to whether all these restrictions are necessary, I have already articulated my view that, if the government had got to grips with "test and trace", they would not have been necessary. Probably now, because of earlier government failures, they are necessary, but I don't believe they are sufficient - we still need an aggressive programme of "test and trace".

Overall though, I think Hichens fails to understand the distinction between absolute mortality and mortality rate. Coronavirus produces a relatively low death rate but, because of its infectivity and the disease profile, it is capable of killing far more people (absolute mortality) than a less virulent organism.

The reason why this virus is so dangerous is exactly because of its relatively low virulence, causing only mild illness in the majority of the population that it infects. Ebola, by contrast, killed as many as 90 percent of the people it touched, so it never spread. It killed off its victims too fast.

The same goes for the clinically indistinguishable Green Monkey (Marburg) Disease which is so deadly that investigators in the early days were stumbling on whole troops of dead monkeys in the forests of Equatorial Africa, with no spread to their neighbours.

By contrast, coronavirus is our worst nightmare. The high proportion of asymptomatic infections and mild illness means that it can spread undetected throughout the population to become a huge reservoir of infection, and then pass to the vulnerable whom it kills.

Furthermore, because the mortality rate is so low, many people under-estimate the danger, mainly because like Hitchens - they don't understand the difference between mortality rate and absolute mortality.

This virus may kill a smaller proportion of the population it infects than Ebola, and the less deadly influenza virus, but because it is so supremely efficient at spreading, it will infect vastly more people potentially running to millions unless checked. In terms of absolute numbers, it could kill far more people than ostensibly more dangerous viruses.

But we cannot rely on this virus only infecting the sick and elderly. There are clear indications of a dose-response, which probably works both ways.

Low doses spread via air conditioning systems, or airborne transmission from pre-symptomatic carriers, may result in lower infection rates and more benign outcomes for most sufferers than heavy or multiple doses passed directly from symptomatic patients - putting medical personnel particularly at risk

There is no good argument, therefore, to support the idea that we should take a relaxed approach to controlling this disease. Should we be forced to take such stringent measures as a complete lockdown, this could be taken in part as a reflection of the incompetence of the authorities in dealing with the threat, but that doesn't mean they are unnecessary.

This is a killer with a benign face, and all the more dangerous for that.