Journal of the Plague Year XI – When the cure killed more than the pestilence

Damn lies and statistics

Here is a statistic. The average age of death from Covid-19 in the UK is 82.4 years. That is well over one year longer than the UK’s average male life expectancy of 81.5 years. Intuitively, then, many – if not most – people who died from Covid-19 would have died anyway either this year or in the near term.

I am not going to argue, as some libertarians did at the beginning of the pandemic, that Covid-19 is no more dangerous than seasonal flu. It is a ruthless and subtle killer, the more so because many of those who carry it, and therefore spread it, remain asymptomatic. This is a undoubtedly a public health emergency: the problem is that the collateral damage of the public policy response could turn out to be even more harmful than the pandemic itself.

The evidence suggests that many victims contracted Covid-19 not in pubs or now-closed theatres and night clubs – but in hospitals and care homes. According to Nottingham University Hospitals Trust, in the week ending 11 October, 29 percent of Covid patients being treated in its hospitals caught it in hospital.

Moreover, the mortality figures are now suspect. Thousands of coronavirus deaths recorded by the ONS were not caused by Covid-19. In September, the Centre for Evidence-Based Medicine at Oxford University found that coronavirus was not the main cause of death for nearly one third of the fatalities recorded in July and August who had Covid-19 on their death certificates.

Counting the cost

Psychologists report that anxiety and depression have exploded, especially amongst the young. Nearly 27 million GP appointments have been “lost” according to the Care Quality Commission as people struggle to see their doctor. Hospital referrals are down by 350,000 on what would normally be expected. Delays in diagnoses for cancer and other maladies could result in an extra 35,000 deaths in the UK this year. Nottingham University Hospital last week instructed surgeons to postpone all non-urgent procedures. Birmingham University Hospital announced that it would turn away patients who presented at A&E if their conditions were non-urgent.

Since March, the figure for hospital admissions for patients with non-specific cardiac chest pain has fallen by 41 percent on last year. Such cardiac pain is a red flag for heart attacks. So even people with serious heart problems were too afraid to come to hospital, and of those it does now seem that many died at home. The British Heart Foundation reported 766 excess deaths from heart attacks and strokes in the under-65 age group between March and July alone.

Hospital admissions for gastrointestinal disorders were down by 90 percent. More than one million British women have missed breast cancer screenings. The number of people on waiting lists for routine procedures such as cataracts and hip replacements now exceeds 100,000 for the first time since records began. Many private hospitals have been requisitioned by the NHS to provide additional capacity, meaning that even people with private medical insurance are facing a long wait for treatment.

Clearly, even in the most optimistic scenario whereby a vaccine halts the virus in its tracks in Q1 2021, there will be a healthcare overhang from the pandemic for possibly years to come. On the other hand, the pandemic has forced the NHS in some ways to raise its game. Firstly, digital GP consultations on Skype or Zoom are now commonplace. Secondly, hospitals are sharing expertise more readily, including between the NHS and the private sector. Thirdly the pandemic has accelerated the introduction of new treatments.

The anti-lockdown movement gains momentum…

Dr Hans Kluge, Director of WHO Europe, said last week that lockdowns should only be “a very last resort” because of the collateral damage they unleash. He added that governments should use “proportionate, targeted and time limited” measures at their disposal.

The mood on the ground has also shifted. Back in late March-early April people overwhelmingly thought it was their civic duty to stay at home. Now the people of Britain are getting increasingly frustrated at the plethora of opaque rules which restrict their activities – depending on where they live.

Currently about half the population of England is under curfew and the people of Wales (where daily deaths peaked at just 11 on 07 October) will enter a complete two-week lockdown (the so-called circuit-breaker) tonight. North of the border, Ms Sturgeon is about to impose a new regime of swingeing restrictions. Christmas has been cancelled in Caledonia. Manchester has been forced into “Tier 3” along with Liverpool; and Sheffield is about to be plunged into the inner circle of Covid Hell.

Infringement of some of the rules can result in a £10,000 fine. Churches are being visited by policemen with clipboards to determine that rules are being enforced – just as Stasi officers hung around places of worship in the former East Germany. In Bridgend recently, mourners at a funeral were prevented from reciting the Lord’s Prayer on the ground that chanting is against the rules. The sense of one-nation co-operation prevalent in the spring has now dissipated. The mood is not lifted either by the unseemly wrangling between metropolitan mayors and Westminster.

The government here and elsewhere claims to be following the science – but whose science?

Professor Sunetra Gupta of Oxford University and Professor Carl Heneghan, Director of Oxford’s Centre for Evidence-based Medicine, as well as countless medical practitioners, now believe that the lockdown strategy is misguided. Professor Heneghan wrote last week:

If policy keeps intervening at the first sight of rising cases, then we shall never learn if any given intervention has worked. Policy should be less reactive.

The Great Barrington Declaration, crafted by Professor Gupta, Martin Kulldorf, Professor of Medicine at Harvard, and Dr Jay Bhattacharya of Stanford Medical School, was shamefully suppressed by Google and Facebook in an attempt to stifle expert opinion. It has since been signed by thousands medical experts from across the world. It proposes that the vulnerable should be shielded (that’s about 17 million people in the UK) and sensible precautions observed – but that people at low risk (the young) should continue to live as normal. Herd immunity will arise naturally thereafter. Predictably, Great Barrington has now been countered by the pro-lockdown John Snow Memorandum which claims to reflect the scientific consensus.

A few brave dissident academics and economists are now undertaking rigorous cost-benefit analyses of the impact of lockdowns – better late than never. And the balance sheet just does not add up. Lockdowns result in a huge loss of economic output – UK GDP will probably fall by an unprecedented 10 percent of GDP this year. There will be long-term economic scarring – there will be fewer jobs for young people and thus higher unemployment going forward.

Ultimately, people like Professor Gupta think that we will need a social contract in which we accept that a limited number of Covid deaths (mainly people who would have died anyway) is the price we pay for social freedom and continued prosperity. We accept that around 26,000 road traffic injuries and deaths every year is the price we pay for motorised transport – no one seriously demands that all cars be banned because they occasionally kill people.

Where we are now

Right now, in the UK and elsewhere, the virus is spreading most rapidly amongst young people – particularly students returning to university – without hitting the most vulnerable. Scientists like Matt (Lord) Ridley think this is not such a bad thing as it will create immunity which will eventually slow the pandemic. Last week in the USA 70,000 students tested positive; but nearly all were asymptomatic: only three were hospitalised and there were no fatalities. Matt Ridley wrote last week: If you cannot extinguish an epidemic at the start, the best strategy is for the healthy to get infected first.

Sweden, which famously refused to impose a full national lockdown experienced similar levels of mortality to France and the UK. Like them, Sweden also failed to protect care homes. But, crucially, Sweden is not now experiencing a second wave like much of Europe and its economy is faring much better than those of France and the UK.

Of course, case numbers are up because testing is up. The figures that matter are hospitalisations and mortality. These are concerning but nothing like those experienced in late March-early April. In fact, data from the Secondary Uses Service (SUS) in England suggest that there has been a reduction in hospital admissions for respiratory conditions compared with what we would normally expect for October. Moreover, the chances of surviving Covid-19 after falling critically ill from it are increasing.

It is becoming evident that a relatively small number of super spreaders are responsible for most of the transmission. If it were possible to identify them and to isolate them then uninfected people might be able to go about their business as normal.

Digging deeper

One reason why the German mortality figures are so much better than those in the UK might be related to the fact that, according to the Global Burden of Disease study reported in The Lancet last week, British people have one of the lowest levels of healthy life expectancy in Europe. The average Brit can expect to live for just 68.9 years before some debilitating chronic condition kicks in. Healthy life expectancy has risen more slowly in Britain than anywhere else in Western Europe.

Underlying conditions make people more likely to succumb to Covid-19. Non-communicable diseases such as diabetes, stroke, heart disease and chronic pulmonary disorder now make up 88 percent of the disease burden in the UK. Obesity is certainly a factor – as it is in the USA and Mexico. And obesity is directly related to diet.

The Italians, who live to eat and eat well every day have much lower levels of obesity than we do. But they eat slow-cooked meals with their families while Brits and Americans eat take-aways solo in front of the TV. British people venerate the National Health Service – even though it compares unfavourably in terms of outcomes with the localised German social insurance model – but do not manage their own health sensibly. This is a classic case of what economists call moral hazard. If people had to pay a monetary price for getting sick, they might be more assiduous about keeping themselves healthy.

As investors, we should favour countries where life expectancy is increasing and where human health is evidently improving. That would exclude fat, couch potato Britain and the USA, then. Mind you, India, where half the population still do not have access to sanitation, would not score well either.

Long Covid

If you think 2020 will be a one-off, it now seems likely that people with long-term Covid-19 symptoms will continue to suffer and to require medical support for years to come. Professor Tim Spector, professor of genetic epidemiology at King’s College London, who was the scientist behind the UK’s symptom-tracking app, recently warned that the virus behaves like an auto-immune condition in some sufferers, adversely affecting many parts of the body, resulting in breathlessness, chronic fatigue, mental impairment and even deafness.

An estimated one in fifty Covid-19 sufferers experience symptoms for a month and one in 50 still suffer after three months. Although men have suffered higher mortality from Covid than women, long Covid seems disproportionately to affect women. Professor Spector thinks that these long-haulers could turn out to be a bigger public health problem than the excess deaths from Covid-19 which mainly affect the elderly with pre-existing health issues.

How the pandemic will play out: less anthropocentrism, please…

From the get-go, policymakers (apart from Mr Trump) have deluded themselves that a vigorous policy response – usually involving scientists with dour PowerPoint presentations – would be the saviour of the people. They are now focussed on the arrival of a vaccine which, as they see it, will end the pandemic. As I stated recently, that is a chimera – I shall unpack that in more detail shortly.

The fact is that some things lie beyond mankind’s control. My best guess is that SARS-CoV-2, the virus causing Covid-19, will have a life-cycle like all other pathogens and will recede of its own accord within the space of about two years – maybe three years at most. The Spanish flu epidemic of 1918-20 caused mayhem, with possibly 50 million deaths worldwide – and then vanished as quickly as it came. The SARS epidemic in East Asia (2003) and the Ebola epidemic in West Africa (2014) burnt themselves out within two years without a vaccine. Bubonic plague is still out there somewhere – but we don’t fret about it because it is not in general circulation; even if, once in a while, some poor soul contracts it.

We simply cannot put the global economy in the freezer until the virus goes away. If we do, we shall face penury – and all other health outcomes will suffer accordingly. We just have to work out how to live with a very nasty pathogen in our midst. To a high degree we are already doing that – most of us observe social distancing protocols, wash our hands and obediently wear masks in shops. Even when the pandemic is behind us these new social practices will persist, just as mask-wearing persisted in East Asia after SARS receded.

The people who love lockdowns are the same people who love globalisation, eco-austerity, academic censorship, high taxes and wokery. They think people should be paid full salary at state expense for doing nothing indefinitely but should be fined for not taking the knee. And they are invariably on the public payroll.

What is staggering is that in the UK and elsewhere they have taken a nominally pro-enterprise governments hostage. They are led by academic sorcerers with black box models who are given license to promulgate death by PowerPoint without taking questions. A health emergency has now become a Kafkaesque nightmare with a vicious culture war in tow.

They must be out-argued – soon – or our economy and national finances will be destroyed.