Sunday, 29 March 2020

Covid-19: preventing deaths is not the top priority

I'm being good, I really am.  No unnecessary journeys or contact with others.  Choosing to exercise either very early or in the shed.  Washing my hands.  No panic buying.  Being one of the 700,000+ Good Samaritan volunteers.

And yet, and yet....something troubles me about all of this, and it's not just the police forces who seem to be delighting in their new powers (Derbyshire, Humberside - yes, I mean you, though I'm sure there are plenty of others), nor the people calling the police to report their neighbour going for a second daily jog, worrying though those things are.

It's more than that.  It's understanding that though we're being presented with the current measures and restrictions as a reaction to a public health crisis, that's only the first, and least important part of the story.  Those restrictions are essentially a political response to Covid-19, designed to maintain public order and the fabric of society.  I'm not saying that's wrong, merely that it shows that all deaths are not equal.  I'm also not saying it's a UK issue, nor even one of liberal democracies. It applies the world over, in all kinds of regimes.

Here's how I see it.  The latest modelling - which may or may not be accurate - is suggesting the UK may have 5,700 deaths as a result of the virus, two-thirds of whom are people likely to be in the last year of their life.  That feels a bit low to me based on current trends, so let's double it, and say there will be 12,000 deaths, a third of which will be people who otherwise wouldn't have died any time soon.  That's 4,000 new, avoidable deaths.  Let's say we didn't have the current restrictions in place, and as a result that rate was 10 times higher, at 40,000 deaths.

Shocking, right?  Hard to imagine.  Coffins everywhere. But as a number it's dwarfed by the number of officially recorded avoidable deaths in a typical year, as defined and recorded by the Office of National Statistics. The year for which the most recent numbers exist show that by the ONS's own definition, 31,000 women and 56,000 men died from what it calls "avoidable mortality" (treatable and infectious diseases, accidents, suicides, drug use etc.).  So in a 'normal' year, we have double the number of avoidable deaths that we'd suffer even in an extreme version of the Covid modelling.

For Covid, in addition to the restrictions on personal freedom, we're essentially crashing our economy for the foreseeable future, and creating debt that I think will take at least a century to pay off.  (Did you know we only paid the last of our WW2 debts off in 2006? [to the US]). For all other avoidable deaths, however, it's business-as-usual. 

What's the difference?  To use a horrible modern term, it's the 'optics'.  Most avoidable deaths are relatively unseen; we might hear about a death on the roads, or someone taking their own life, or someone else whose cancer was discovered too late, and think that while each one is a tragedy, it's no cause to fundamentally change what we do as a society. They're drip-fed doses of the reality of modern life.  But there's no moral difference between our reaction to Covid and what could be our reaction to the regular avoidable deaths.  Roads could be engineered and rules applied to massively reduce deaths on them.  The funding for mental health services could be expanded massively for the at-risk.  Everybody could go through very regular screening that would discover most cancers at an early, treatable stage.  But those things don't happen, by-and-large. Governments of all hues maintain a relatively balanced view of the political and economic drivers of policy.  Deaths still happen, but fewer than with no government intervention, and more than if every resource were focused on stopping them. But they happen evenly, in chronological and geographical terms, making them unremarkable other than to the poor souls affected and their families and friends.

Covid is unlikely to be like that however - there would be a massive spike in avoidable deaths, and we'd see pictures like the ones emerging from Italy and Spain, of rows and rows of coffins, of hospitals that couldn't cope with the numbers, and people dying from want of treatment.  And that would trigger in all likelihood political and societal upheaval; unrest, riots, other crime. So governments are taking action to manage that.  I'm not saying they're wrong or irrational to do it.

But what I am saying is that we need to recognise our own inconsistencies, our own lack of understanding of what goes on in the world normally, and how essentially fear of our reaction to extra deaths is driving government policy across the globe.  That policy may, as I say, be a rational reaction to address the risk of society fracturing, but let's recognise that it's our irrationality, our lack of awareness, and our inability to truly assess risk, that are driving the formulation and implementation of the policy right now.  So let's not ask whether governments are doing enough to address the threat from the virus, but whether we, in fact, are doing enough to spread the knowledge and rational thinking we're going to need in the future - because if something like Covid recurs in the next 20 years, we will be truly screwed from an economic point of view, and be sufficiently serious that it might generate the kind of societal breakdown the authorities are working so hard to avoid at the moment.

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