“New normal” is buzzing around. Messaging will seek to embed unnatural behaviours. Wariness is required against establishing a behaviour described as a “new normal”, unless it enhances the long-term quality of lives.
PERSPECTIVE ON STATISTICS
Deaths and death rates are at the centre of discussion and reporting about Covid-19(CV). People argue about these and other statistics. It is constant focus on death which perhaps more than anything else has created a stultifying fear which the UK Government (UKGOV) and the public must overcome in establishing the path to recreating a desirable economic and social existence.
Only last week on 29 April at PM’s question time Keir Starmer recorded his large total of deaths (more than official figures) to conclude that the UK was possibly on track to have the worst death rate in Europe, as if there is some competitive league table. Andrew Marr on 3 May asked Ian Diamond, the National Statistician, if he agreed this was the case. Just as expert after expert has done, Ian Diamond retorted that no sensible comparison can be made between countries or relative conclusions drawn, given the multiple different contexts and circumstances applying to each. He was however categoric that “We (UK), and I would say this wouldn’t I, have the most transparent reporting”- the best death recording in Europe. However, the death toll in the UK is sadly very high and clearly the old are bearing the brunt.
Making too many conclusions out of sets of statistics around deaths is dangerous. That is clear from David Spiegelhalter, a top statistician at Cambridge University, in an article in the Guardian of 1 May. He is unjudgmental and says it is remarkably difficult to count deaths: it is obvious the number is greater than the daily official number at the UKGOV press conference which has a defined limited basis. He cites some European numbers saying, “but these are deeply unreliable….” He also says many feel that excess deaths give a truer picture of the impact of a pandemic. He observes “But people are not so interested in the numbers themselves – they want to say why they are so high and ascribe blame”. He concludes “but my cold, statistical approach is to wait until the end of the year, and the years after that, when we can count the excess deaths. Until then, this grim contest won’t produce any league tables we can rely on”. Indeed, rather than worry about UK death tolls relative to continental cousins, is a more interesting question why the highest death rates by far are in densely populated Western European countries and the United States.? The “death maps” for CV show very low fatality rates in Africa, the Middle East and nearly all of Asia , at least so far. That is, the nations with generally the greatest wealth are seemingly the most vulnerable.
There is endless research, with different statistics leading to different conclusions, sewing confusion. For some reason, the media insist on interviewing and broadcasting the words of the bereaved from individual deaths – these are deeply personal things, and grief is not best aired on a news show: perhaps personal loss should stay just that. What is the purpose behind probing into individual deaths and their impact, for example on BBC breakfast shows, during the time of CV but not the rest of the year? Is the obsession and constant focus on death healthy or desirable when important and tough decisions, with, in all scenarios, some unpalatable consequences, and which have to be made with rational balanced judgment, are imminently necessary?
THE FEEDING OF FEAR
To date UKGOV has had a specific simple message to stop people mingling “stay home, protect the NHS, save lives”. It has done a great job, with people incarcerating themselves and having observed a strange social distancing (a phrase now tripping off every tongue, but barely heard before CV) to great effect. Many people have become perhaps unhealthily and irrationally afraid of the world out there; it will be necessary at some point soon to get lives up and running again, out of the unreal world currently enveloping citizens; and embedded fear, affecting people in different ways for a variety of reasons, could be a significant impediment. For many people, the risk factor that CV represents may be out of all proportion to reality when compared to other risks taken every day. As the next phases must begin, those with influence, from UKGOV to opposition parties to broadcasters, journalists etc, rather than feeding fear, perhaps should be feeding balance and perspective. New guidelines and even constraints should engender hope and energy, not deep wariness.
After all, each individual will have to make choices as to the risks they are prepared to take, with reasonable precautions, balancing needs, wants, quality of life of themselves and those close to them and so many factors.
DEATH IS NORMAL
While CV is taking a huge toll (over 30,000 deaths in the UK at time of writing), as every death is special, a CV death is of a same sadness and loss as any other. Perhaps it should be remembered that:
- cancer kills in the UK in the ordinary course over 3000 people a week
- heart disease kills a similar number
- other causes of death , illness, dementia, accidents etc mean that the total each week in the ordinary course is about 11,000
A considerable number of such deaths are of younger people (under 60) “before their time”. Most however are older people who have lived life to the last laps, where death is natural and is something of which, the older a person is, the more acutely aware they become. Most deaths produce grief for someone left behind. That grief is personal and none the less for the cause in most cases. Outside the time of CV, the grief is left as a private matter and not paraded or dwelt on.
Why is the world turning itself upside down and inside out over a virus which mostly threatens the elderly who have had a full life? Normally, the world accepts the deaths of more children and young people each year for reasons that could be controlled, including hunger as well as controllable disease, than CV is likely to involve at this time.
In the Western world perhaps it is a fair question to ask whether CV death is being taken out of all proportion? Acceptance of death is a lesson which all people need to learn, being that in all cases the stay on this earth is very short indeed in the scheme of things. The mantra “save lives” to persuade people into behavioural gymnastics needs to be reconsidered. It is also surprising that the leaders of religions around the world have not played a bigger part in giving death some perspective.
PERSPECTIVE ON NHS
It is a strategic imperative that the NHS can function properly, at least for the most debilitating and threatening conditions that need treatment, as well as CV. The NHS has managed well within capacity, a credit to a great many people. The empty Nightingale hospitals and available ventilators are useful insurance if CV bounces back as the stay at home rule slackens.
However, again perspective is to be maintained. “Protect the NHS” has been a good message for the lockdown objectives. But that is not the purpose of society: the NHS is there to protect and care for the public and is its servant, and the public fund it. Of course, it is a key public service, but, without overwhelming it, there should be no hesitation in using it to a full extent. It is as subject to scrutiny as any other service. The medical, care and support staff are to be especially applauded for their courage and commitment in the face of CV, but they and the NHS itself are not to be deified: its shortcomings and required improvements should be fully aired. “Protect the NHS” as a slogan is defensive and hardly energising. Perhaps encouraging positive consideration and care for all would be better.
PERSPECTIVE ON CV
CV is very nasty, particularly as it is so contagious and surreptitious: but it is very relevant to keep the risks attaching to CV in perspective. Take for example statements by Scott Atlas, MD, and a Senior Fellow at Stanford University’s Howe Institute reported in the Daily Telegraph in arguing that lockdown is a mistake: in New York City (accounting for one third of all U.S. deaths) the death rate for people aged 18-45 is 0.01% (10 per 100,000). For people under 18 it is zero. Of all fatal cases in New York State, two thirds were aged over 70; more than 95% were over 50; of 6,570 CV deaths fully investigated for underlying conditions 95% had an underlying illness… ”Young adults and children have almost no risk of any serious illness”. “Protecting older, at risk people eliminates hospital overcrowding”. This is not to say the UK lockdown was wrong, just that the risks to people need to be kept in perspective.
Assuming a roughly similar risk position in UK, subject to underlying conditions, even for the old CV is not high risk, and for young adults and children it is very low. Inevitably there are a lot of care home deaths, a special case, and efforts need to continue to keep CV out. As previously observed by Sherbhert, the old in care homes in any event, sadly commonly die within 6 months of arrival and the average “stay” is under 2 years. CV in a care home is a fox in the chicken run. Perhaps it should be recognised that the emotional energy being expended around care homes needs control and perspective, as old people deaths are balanced, among other things, against the destruction of young livelihoods.
While the vulnerable must be extra careful, and all should observe basic hygiene and certain other restraints, CV is but another life risk to get on with, with special eyes on the impact on the NHS and reasonable protection for the most vulnerable. Discussion this week about workplace safety precautions as more return to work needs to be realistic and not feed or feed off exaggerated fear. The Guardian reported that certain Unions are demanding a UKGOV guarantee of safety before people return to work: absurd. No workplace can be guaranteed to be safe, before, during or after CV. Guidelines will be important, but it is implementation of sensible precautions by citizens which will decide efficacy.
ADULT CONVERSATION – THE PHRASE “NEW NORMAL” SHOULD BE USED WITH CARE
The UK must return urgently to proper productivity.
So many cry for an adult conversation: no subject can be taboo and excessive correctness is not allowed, while maintaining proper respect for all people. It is commonly agreed that a second spike which overwhelms the NHS is to be avoided: that depends on limiting hospitalisation, mostly achieved by protecting the old and very vulnerable from infection. Fear and death must be put in perspective. There will be balancing acts of risks to different age groups and sub-groups against the damage to other groups and society as a whole, and, very important, the prospects for the younger generations. Arguably the driving factor, second spike apart, which should be decisive, is the paramount need to nurture the livelihoods of the younger sectors of society; to minimise damage to the poorest sector which always bears the brunt of decline; and to preserve hope for people pondering a full life of real quality ahead, not blighted by over protective measures requiring dehumanised behaviour. Perhaps alert wariness is required before describing any behaviour as a “new normal” unless satisfied that it will ultimately add to the quality of lives long-term.
In most wars, it is necessarily the young who sacrifice lives in great numbers to protect the weaker. In the CV war, perhaps there is an important rebalancing in the other direction. It would be surprising if the over 70s did not agree that they would not want to be the yoke around the neck of future prospects of younger generations.
