Friday, March 13, 2020

Coronavirus 10

13th March 2020
[If you are new to this blog, it might be worth your while glancing at previous parts, linked to on the right.]

There is general agreement that any delay in the now inevitable spread of Covid-19 reduces the intensity of peak demand on the health services. In the UK the NHS has little slack at the best of times and now the worst of times brings the threat of overwhelming demand in which people will die because there is a lack of physical space, equipment and staff.

There has been little mention in the news media or from government statements of the importance of smoothing the peak in terms of potential casualties numbers. Estimates, still with a deal of uncertainty, of case fatality rates under different local circumstances vary from under 1% to around 5%. The essential factor seems to be the ability of the health services to cope with the small proportion of victims with acute symptoms. And that is where smoothing the peak of demand is vital.

For the UK smoothing the peak is all about shifting the fatality rate from the 5% region to below 1%. What was missing from yesterday's government statements was how this translated into actual numbers, the shift from over 2 million deaths to under half a million deaths was not emphasised.

What we got instead was the argument about the importance of timing. This seemed to be based on some notion that the public would not accept drastic social distancing for very long, that we would somehow get tired of making the effort and give up. That is a political judgement.

The government makes much of its policy being based on the science and the Prime Minister makes statements while flanked by his medical and scientific advisers. But remember these are political appointments, people on the government payroll, and subject to political restraint in everything they say. (Recall the sacking of David Nutt by the then Home Secretary, Alan Johnson, or the way David King has become much more vocal on the climate emergency since retiring.)

The current government position on social distancing, amounting to little more than "wash your hands" is a political decision, not scientifically supported. It is a decision that will determine, along with the past decade of NHS funding policy, whether the ultimate death toll from Covid-19 in the UK will be about half a million or a couple of million.

The stakes are high. We have not seen a peace-time situation before where government could be responsible for two million avoidable deaths. At least, not since the Irish potato famine.



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