The second national lockdown in England announced on 31 October is happening, says Boris Johnson, because there is no alternative to slow down Covid-19 (CV). One real alternative to national and local lockdowns, backed by a great many scientists – but not SAGE – is to enact measures to protect the vulnerable, mostly but not exclusively the aged; using resources which would be a fraction of those needed to subsidise the parts of society which a lockdown shuts down. It would allow the vast majority of people, especially the young, to go about a much more normal life, with basic protections such as distancing observed. The alternative (Plan B) is dismissed says Boris Johnson because it is impossible to protect the vulnerable while letting others live more normally: presumably that is the view of SAGE too. It is however notable that the WHO discourages lockdowns as a remedy because of all the adverse side effects.
It defies common sense to think that it is impossible to take measures, applying greater resources, that would at least protect a high proportion of the elderly most at risk, such as in care homes and hospitals, and younger people with the most risky conditions, and prevent a large number of CV deaths, so that a comparison with lockdowns can be made. It is said that most CV cases arise in hospital or care home settings, which should be capable of substantial reduction. If the most at risk could be protected, the numbers hospitalised or in ICUs would reduce and so the possibility of overwhelming the NHS would go down. Perhaps Plan B could fulfil the objective with less overall cost.
Chris Witty and others employed to advise on health, with SAGE backing them up, perhaps will never feel able to support anything other than lockdown: is that because the question they answer is solely a health one – what measures will best suppress the virus and reduce the number of related deaths, and protect the NHS. Obviously a lockdown is the answer: indeed had the first lockdown simply been continued through the summer, there would have been fewer CV deaths and a second one not yet necessary, although the state of the UK would be thoroughly bankrupt, the number of domestic abuse cases would be multiplied, as would suicides probably, let alone long term health damage from non-CV conditions.
Having said that, there is no palatable course as CV does kill and whichever one UKGOV adopts it will be chastised as it is now by some for following SAGE. Also, the position of the UK and its response is much in line with other countries of Europe: they are all in a catch-22 mess. This lockdown is materially different from the first as schools and universities continue to operate, and parents can go to work. The price will be considerable, but most economists say less than under the first lockdown.
WHERE IS PROPER ANALYSIS OF OPTIONS?
The data which supports the second lockdown advice, that, without one, deaths due to CV could rapidly rise to 4,000 a day with the NHS overwhelmed within a few weeks, is under attack. Imperial College’s very pessimistic model predicts far more CV deaths and more rapidly than that of King’s College. In the Daily Telegraph of 2 November, it is reported that the Cambridge University data used by SAGE was out of date and its most recent data denies the 4000 deaths a day possibility. Professor Heneghan of Oxford University “I cannot understand why they ever used this data when there is far more up to date forecasts from Cambridge…”. Indeed, the 4000 a day scenario is now agreed by Chris Witty to be unlikely. The recent death rate including due to CV has not been significantly above the average for the time of year.
UK Government (UKGOV) wishes to minimise the risk of the NHS being overwhelmed as SAGE is advising it would be by the second wave: would that risk be so major if the focus was on protecting the vulnerable instead of national lockdown? No comparative analysis is provided. And there is also no analysis provided of the number of for example cancer cases going undiagnosed or treated, or in relation to other non-CV conditions. Various senior doctors suggest that at least 50,000 cancers have gone undiagnosed, and late diagnosis, it is normally suggested, significantly reduces effectiveness of treatment. There is no analysis of mental health effects or domestic abuse. For example, as reported in the Times of 3 November, Carol Propper, an economics professor at Imperial College, says that research “showed that a 5% fall in unemployment leads to a 7 to 10 per cent increase in chronic illnesses among the working age population. That’s 900,000 more people with depression or heart problems”. A massive rise in unemployment due to lockdown, as businesses fold and furlough ends, is expected and it is not those close to death already who will suffer. The long-term effects of lockdown will only be assessable months or years later.
However, surely somebody competent should be estimating all the damages caused by say every week of national lockdown, not just in terms of economy but also indirect consequences for all age groups, it being generally accepted that the groups which will suffer most are younger generations and the most deprived. Any such analysis will of course be difficult and have variances and ranges: but that is the case with the models of the effects, deaths etc, caused by CV. The ranges of possibilities in SAGE models underpinning advice are vast.
And then it is reported in both the Times and Daily Telegraph, and the Guardian, that, in deciding on the second lockdown, Cabinet was not given an assessment of the economic effects of a second lockdown, and therefore it received no assessment of the health and other indirect consequences of economic decline and unemployment. Is not the job of UKGOV to balance all factors when weighing its health advisers’ and SAGE’s solely medical advice?
DISCUSSION STIFLED: WHY CAN DEATH NOT BE ACCEPTED AS NORMAL?
Already it is predicted (though denied by Boris Johnson) that the second national lockdown will run until at least 2021: retail shops and hospitality could substantially lose Christmas, which normally sustains them for quiet periods of the year. Boris Johnson has always said a second lockdown would be disastrous. Many commentators predict now a second recession or a full-blown depression. Rishi Sunak clearly regards it as unaffordable. If SAGE says on 2 December, the day lockdown is due to end, that not to extend it would negate all the benefits then gained, will UKGOV sensibly be able to resist that in the face of media and other barrages?
Discussion gets stifled and suppressed because the real underlying criteria is fear for the number of deaths that may happen over a short time (the number of lives estimated to be foreshortened over the next few or more years due to lockdowns is not clearly publicised and should be). As far as CV is concerned, for a lot of very old people longevity may be reduced by a few weeks, months, or a year or two. Lockdown may buy those people a little time at the end of their lives, though for many that time will be of poor quality due to other conditions. It is also stifled because certain people say that doctors should not have to choose between people as to providing treatment. In extreme circumstances is that not precisely the task of doctors? Even in non-CV times, is not that decision often necessary? Does not NICE decide what drugs can be afforded and often not approve life-savers due to cost? In the first wave of the pandemic hospitals in effect rejected hundreds of thousands of non-Covid patients. Does not the NHS have a formula for valuing lives?
Some say any death is unacceptable – an absurd statement. Deaths is inevitable and has to be accepted: it’s purely a matter of timing and It cannot be accepted that all lives have to be prolonged to the Nth degree whatever the cost, in economics or adverse consequences for other people.
All human beings have physical weaknesses. For a small minority these are manifest and cause suffering early in life. But for the vast majority these simply arise as people get older or special circumstances arise, and bodies get weaker. Some weaknesses are made worse by our own actions, such as bad diet causing obesity, drinking too much alcohol or smoking and so on. At some point a weakness will get exploited by all the enemies, such as a virus like flu or CV, that attack human frailty. That is normal, and sometimes a person is lucky when there is a medicine to the rescue, and sometimes not. Today it is as if society and the media expect UKGOV to take responsibility for and prevent all deaths. If a person catches CV and dies, it is CV combined with that person’s weakness which kills, not UKGOV doing or not doing something. Perhaps the health services, and their remarkable ability sometimes to delay demise, should be seen as a privilege not a right. To some degree the media must bear responsibility, as they insist with CV on showing daily people suffering from it and focussing on death, often searching to make someone rather than CV responsible.
Does not society need to get death in perspective and accept perhaps that delaying death, often for a short period, has to be weighed against the cost of so doing? And stop obsessing with saving lives at any cost, while respectfully accepting death’s sadness for those affected.
THIS WAR REQUIRES A DIFFERENT SOLUTION THAN SACRIFICING THE YOUNG
Some choose to liken the pandemic to a war, summoning up the spirit of resistance of real wars, in which there is some merit. It may be worth reflecting that in say the first and second world wars, the remedy to win was to send out thousands, or millions, of young men mostly, say aged between 17 and 30, to fight and die or be maimed for life, with all the accompanying misery for others too. What a waste but there was perhaps no alternative. In the fight against CV, the lockdown option is to wreck the lives of millions of younger people, including causing long term damage which cannot be assessed, and leave them with an economic mess of which they must bear the consequences. And all that when CV barely should worry them from a health perspective. There is an alternative possibility, Plan B. That may result in a price being paid in some more early deaths for aged people who have lived a long life. This pandemic is not a war which needs a solution like the great wars. Perhaps a reset is necessary?
Perhaps it could be hoped that this lockdown’s effects will be a lot less adverse than the first, with education continuing and fewer businesses closed. Perhaps too the time could be used to develop Plan B and a real comparative, so that it is not inevitable that, without a vaccine which is not anticipated to be widely administered until well into 2021, a third national lockdown awaits in February or March 2021. In the meantime, it is to be hoped that daily swiping at those making decisions can be minimised and efforts directed to finding ways to make the UK more productive, exploring new and better ways of doing things. Maybe that could include how our health services can be brought up to world class standards, and the culture of just spending more hard-earned wealth to solve all issues being reversed.
