Tuesday, 6 July 2021

A high stakes gamble


As part of their justification for removing Covid-related restrictions in England, English ministers have argued that we need to get used to Covid, just like flu. It requires us to simply accept a higher level of preventable hospitalisations and preventable early deaths than would otherwise be the case. They are apparently unwilling to spell out the numbers which they consider ‘acceptable’, but the continued references to flu suggest some sort of parallel.

It’s not an easy comparison to make, though, for several reasons. Firstly, in non-pandemic years at least, very few people die directly of flu; most of those who die do so of complications such as pneumonia. We also know that most of those who die with flu are older and poorer than the population at large, and that fuel poverty is a key factor in turning illnesses resulting from flu into deaths. Some of those points are true of Covid as well; Covid also causes pneumonia and other complications, which is why the news reports keep reporting the numbers of people who have died ‘with Covid’ rather than ‘of Covid’. Like flu, it is also more serious for older people. Claiming that flu and Covid are now on some sort of par is a bold claim, but it’s noticeable that it’s one being made more by politicians than by epidemiologists.

Even if it were ‘true’ in simple numerical terms, there are other complications. Whilst the current numbers of infections are already way higher than flu (although it’s hard to be certain about the extent because flu is not a ‘notifiable’ disease), there are few, if any, experts in the field who don’t believe that they would be significantly higher again were it not for the measures currently in place. As the government itself admits, removing those remaining restrictions will undoubtedly lead to a surge in infections, and that in turn will inevitably lead to a surge in hospitalisations and deaths, although hopefully the vaccination programme will mean that it won’t be on the same scale as in the second wave. And any comparison with the actions taken to mitigate flu in a non-pandemic year as opposed to those which might be necessary in the event of a pandemic caused by a new variant of flu are misleading to say the least.

The government chooses to present figures for the vaccination program in terms of the ‘proportion of adults’ who have been vaccinated. This is not unreasonable in itself given that vaccinations have not yet been authorised for the younger groups, but it also serves to disguise the fact that, as of this week, only 33.7 million people in the UK have been fully vaccinated, a figure which is barely above 50% of the population (66.6 million). Whilst more will be done before 19 July, that will still leave up to 40% of the population open to infection, a level far higher than is consistent with any suggestion that ‘herd immunity’ can stop the chain of infections. And free of restrictions, a large proportion of that 40% are likely to become infected, even without raising questions about repeat infections and the duration of the immunity provided by vaccination for other groups.

Most of those will be younger people, of course, and to date it seems that younger people are less likely to be seriously ill or die. But ‘less likely’ isn’t the same as a zero probability; some of the young people concerned will be hospitalised and some will die. Some will develop ‘long Covid’, and be seriously ill for months. The even bigger concern is that the more the virus circulates the more it will evolve. As some scientists have already pointed out, removing restrictions which have been proven to work is like building variant factories in the UK. That there will be new variants as a result is inevitable; the only question is whether those variants are more infectious, more dangerous and/or more vaccine resistant than the variants already circulating. They might or might not be; but the government is effectively taking a massive gamble with people’s lives. It is running a major medical experiment using millions of people, predominantly but not exclusively the younger generations, as involuntary and unconsenting guinea pigs. Normal ethics considerations relating to large scale experiments require that people are given enough detail to make an informed choice as to whether to participate or not. It’s a choice being denied by a government obsessed with the dogma of balanced budgets and shrinking the state.

There was a rather unsubtle attempt to bully the devolved administrations into meekly following suit yesterday, but all the signs are that they will continue to show more sense than that. It’s hard to avoid the suspicion that the English government simply want to avoid having a less damaging comparator on their doorstep if things go badly wrong – and it will be hard to avoid the ‘let it rip’ philosophy in England directly impacting on Wales in any event. We may be lucky, we may not – both individually and collectively. But gambling on the current government making the right choice in the light of its record to date is not exactly what anyone would call a sure-fire thing.

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