11th May 2020
(Update at bottom)
While the mainstream media have generally done little more than boost fear on a daily basis, the Spectator magazine has often published far more reasoned material. Their latest contribution puts things so well that we reproduce their entire article below:
(Please note that this article is far longer than we normally publish. We believe in short and sharp. But at 2,500 words it only needs about ten minutes of your time. Well worth it.)
(Dr John Lee is a recently retired Professor of Pathology and a former NHS Consultant Pathologist.)
Writing in this magazine a month ago, I applauded the British government’s stated aim of trying to follow the science in dealing with COVID. Such promises are easier made than kept. Following science means understanding science. It means engaging with rival interpretations of the limited data in order to tease out what is most important in what we don’t know. Instead, the government in the UK (and many other places) seems uninterested in alternative viewpoints. The chosen narrative — that lockdown has saved countless lives — has been doggedly followed by all spokespeople. No doubt is allowed. We have been seeing the groupthink response to a perceived external threat that Jonathan Haidt describes so lucidly in his excellent book on human moral thinking, The Righteous Mind.
It has now become a matter of faith that lockdown is vital. Not only is it believed to be causally responsible for ‘flattening the curve’, but it is feared that releasing it too soon may cause a second spike in cases and ‘economic disaster’ (presumably due to further huge numbers of deaths). On what evidence is this made?
Even if you could understand why lockdown was imposed, it very rapidly became apparent that it had not been thought through. Not in terms of the wider effects on society (which have yet to be counted) and not even in terms of the ways that the virus itself might behave. But at the start, there was hardly any evidence. Everyone was guessing. Now we have a world of evidence, from around the globe, and the case for starting to reverse lockdown is compelling. Here are 10 reasons why I believe that it is wrong to continue with lockdown and why we should start to reverse it immediately and rapidly.
1. You cannot understand the significance of this virus simply by looking at the raw death figures
Lockdown was enacted on a prediction of 500,000 deaths in the UK, rapidly reduced to 250,000 and then to 20,000. As I write the UK death toll is 30,150. Broadcast media has relentlessly focused on the number of deaths and emotional stories surrounding victims. While every death is sad, the significance of a death toll can only be understood by looking at the big picture. This pandemic is unique in the way it has been observed and measured. This means that we are testing and counting a far greater proportion of COVID cases than have ever previously been counted for other respiratory infections such as influenza. This is true even though many COVID cases in care homes were not initially included in the numbers. We don’t really know how many people die of flu each year, because the surveillance relies mainly on surrogate measures rather than actual testing, but the estimated number for 2014/15, the highest of recent years, was 28,330. So yes, COVID is a nasty new disease. But even if you assume 40,000 COVID deaths, its death toll is in the same ballpark as diseases we live with, not something so extraordinary as to justify the lockdown reaction.
And because it is new, this is likely to be as bad as it gets (see 9 below). The majority of cases are asymptomatic. The most common symptoms are not fever, cough, headache and respiratory symptoms; they are no symptoms at all. The typical case does not suffer respiratory fibrosis; the disease leaves no mark. Somewhere around 99.9 percent of those who catch the disease recover. Of those unlucky enough to die, over 90 percent have pre-existing conditions and were anyway approaching the end of their lives. To say this is not being uncaring: it is simply a fact of life that older people are more likely to die in any event, and especially more likely to die from new types of infection.
2. The policy response to the virus has been driven by modeling of COVID — not other factors
Not only has such modeling been extravagantly wrong before in predicting the course of viral epidemics, but it says nothing about anything else. In this case, it has been bedeviled from the start by poor data and flawed assumptions. The data on virulence was hugely biased in favor of severe cases. There was an assumption that 80 percent of the population would rapidly catch the disease, when in fact 15 percent seems nearer the mark. Even the much-discussed transmissibility of the virus, the R number, is not something that is known accurately because there has been so little testing; it remains an assumption or an output of the models. Modeling can be very helpful in terms of pointing out the weaknesses in our data, which is why it is incredible that after six weeks of lockdown we have still done so little community testing. But, in complex situations, models are rarely comprehensive or accurate enough to be a sufficient basis for public policy. The very models that put us into lockdown — on the basis of predictions no longer believed accurate — are keeping us here despite their known flaws.
3. We don’t know if lockdown is working
You may be forgiven for thinking that we do. But the fact is that direct evidence for the effectiveness of lockdown in this situation is minimal, and the approach is mainly based on modeling. Many counties with very different approaches to lockdown seem to have similar curves, in so far as their different testing and recording of the virus allows meaningful comparison. Are the curves a result of our actions or are they just a manifestation of the way this virus is coming into equilibrium with its new human hosts? The curves on ships affected by the virus seem similar to the population curves too. It’s easy to make plausible-sounding arguments that what we are doing ‘must’ be slowing the spread. But Sweden’s model of voluntary social distancing seems equally effective, but with much lower costs.
4. We should ease the lockdown to save lives
The economic and direct health costs of lockdown are enormous. Lockdown has caused huge disruption to healthcare of conditions other than COVID, which is having significant immediate effects and will also have significant delayed effects. But apart from this, economic downturns are a direct cause of ill health. One way to try and measure health interventions is by using ‘quality of life years’, or QALYs. One QALY equates to one year in perfect health. In the UK, the average age of someone who dies of COVID is 80. Most of those dying have a relatively small number of QALYs left. But the direct health effects of lockdown and economic downturn have a disproportionate effect on younger people with many more QALYs left, so comparing deaths between COVID and other causes such a suicide does not do justice to the scale of the health effects attributable to lockdown. Also, we should not forget that there is more to life than death. One year with depression (for example) is not one QALY. When you factor in all the lockdown-attributable mental and physical health effects short of death, as well as the deaths, it is clear that lockdown is having a huge impact on QALYs across the population that far outweighs those caused by COVID.
5. Lockdown is not sustainable
Unless we are to live this way forever, lockdown will have to be eased. Then what? Pandora’s box is open. No one thinks this virus will be eradicated. It will be present within the population and will spread in its own way. To understand the overall effects of a virus we cannot just look at now or the next few weeks. The impact of this pathogen will be measured, like flu, over years. Some years will be worse than others. There is no guarantee or even probability that this lockdown will have made any impact on the overall numbers of deaths in say five years time. Lives ‘saved’ now may well be claimed later. Our own immune systems have been honed by hundreds of millions of years of evolution to cope with viral threats. They are the only way we survive in a world full of viral pathogens, many of which we have all already had without ever knowing. Countries that are now pleased to have a low incidence of the virus will have to face it later unless they are to enter a North Korea-like state of isolation. Even then the virus may enter on the wind, or domestic cats, or some other way we haven’t yet thought of. No country has ever improved the health of its population by making itself poorer. Lockdown is impairing our ability to live with the effects of this virus, while not changing the long game.
6. Lockdown directly harms those most likely to be affected by coronavirus
Coronavirus affects mainly the elderly and those with pre-existing conditions. But the large majority of this group who catch the disease recover. In the meantime lockdown is preventing many of the things that make life worth living: seeing children, grandchildren, and friends; eating out, hobbies, charity work, traveling. Doing all the things that people work so hard to be able to enjoy. Isolation is dangerous for everyone but particularly the elderly.
What about people who have died during this period of COVID or — many more — of other diseases? Is it right that they should have had lonely deaths, that they and their loved ones should not be able to say goodbye? What effects will this have on the survivors? How many elderly people have died because they did not access care? In whose name is the lockdown being prolonged? Do the healthy old, as well as ‘vulnerable’ groups, need the state to extend this damaging experience for their own good or would they like to make their own risk assessments in the face of uncertainty, as they have always done before?
There are 10,832,396 people aged over 65 in England and Wales. In the US it’s 49.2 million. Even if we assume 50,000 deaths from COVID in this spike, and all occurring in this age group, the probability of death is less than 1 in 200. Would you rather see your family and live your life (with reasonable precautions as necessary) and take your own chances, or be locked up by the government for your own good?
7. Lockdown directly harms those who will be largely unaffected by coronavirus
The vast majority of people under 65, and almost everyone under 50, will be no more inconvenienced by this disease than by a cold. They are being asked to make huge sacrifices for something that will not affect them. Education, jobs, businesses: these are not abstract concepts, they are people’s lives. This group includes the people who are the most productive part of our society and whose efforts support everyone else, including those who are ill. Why is removing them from activity a sensible thing to do? The argument that they might unknowingly pass the virus on to others and so are best kept at home — the ‘stay home, save lives’ message given to us by government — is spurious (see also 9 below). There is no evidence that self-isolation of those at special risk is a worse option. Lost education, lost job opportunities, and destroyed livelihoods cannot necessarily be made good.
8. The British health service has not been overwhelmed, nor is it likely to be
The epidemiological models had nothing to say about how quickly our health service could adapt to a new disease. As it turned out, it adapted quickly. It has not been overwhelmed nor been close to it. That fear can no longer be a justification for continuing the lockdown. In fact, lockdown has merely harmed our ability to adapt more quickly. Unfortunately, the episode has also revealed less palatable things about the National Health Service. The gusto with which managers followed the COVID refrain meant that many vital treatments and investigations for conditions that we can and were dealing with were summarily put on hold. What is the moral equation that shows why a patient with one particular disease takes priority over all others? Is it right that healthcare staff can simply be ordered who to treat by managers? Who takes responsibility for patient care? I know many who are deeply unhappy to be working in an NHS where the command and control culture is so embedded that doctors can be told to stop, for example, cancer chemotherapy halfway through a course and feel they have no option but to comply.
9. The virus is almost certainly not a constant threat
As I explained in my last magazine piece, an evolutionary view suggests that the virus is likely to change quickly, with less virulent forms becoming dominant. Lockdown could potentially slow this beneficial tendency. On this view, asymptomatic people spreading the virus is a good thing because it means that the disease becomes milder more quickly. This could already be contributing to the flattening of the deaths curves that we are seeing. In this case, the sooner we lift lockdown, the better. It also implies that the peak in illnesses we have seen this time is likely to be as bad as it gets. In future, the virus will come into equilibrium with the population as wider immunity combines with predominantly milder forms of the virus to cause a lower overall death rate that nevertheless fluctuates from year to year, much like flu.
10. People can be trusted to behave sensibly
Six weeks of lockdown have clearly demonstrated that the British people are grown-ups and can be trusted with making sensible decisions about their health. All they ask is to be presented with a true picture including a realistic assessment of what we don’t know. Following science, I am afraid, means living with uncertainty. Our politics doesn’t generally like associating with uncertainty but in this case, I would have thought that most people would be delighted to see the government acknowledging the changing landscape around COVID and the effects of lockdown. It is already quite obvious that COVID is far from the existential threat that was initially feared and that lockdown, in itself, is a major harm on many more axes than COVID. The UK government’s continuing elaboration of the consequences of its incomplete initial narrative just puts it in the position of piling further harms on top of those that already exist. The state cannot control what it doesn’t understand. In such a scenario, the only reasonable solution is to inform people of the risks and let them, sensibly, calmly, and individually, make their own decisions.
It turns out that ‘following the science’ on COVID is not at all easy or even really possible. One thing has become clear: COVID is not, in fact, an extraordinarily lethal pathogen, just a nasty one, similar to many others. So it makes no sense whatsoever to follow the science on COVID to the exclusion of everything else. The government should rapidly lift the lockdown to a condition similar to that of Sweden’s.
The first step is often the hardest. It will be much easier to plot a course back to normality from there. And despite the fears that we continue to harbor over this virus, our new normal should look very much like our old, perhaps with the addition of some social responsibility in the face of respiratory illness. It is the only way for us to live in the world.