As of last week, there have been 127,000 deaths in a little over a year – a tragic outcome by any measure. If those are the kinds of numbers we can expect every year, then clearly the most drastic measures will be necessary to keep Covid under control. But unless some dramatic and unexpected twists are about to occur, there are good reasons to hope the annual death rate from coronavirus will be much, much lower in the future – no worse than, or possibly well below, a normal flu season, which kills around 17,000 people a year. This in turn means there are strong arguments for a quick relaxation of the UK’s currently draconian restrictions.
It would be unfair to ascribe blame for what initially went wrong to public officials who had never encountered something like this before. When Covid hit the world at the beginning of 2020, no one knew what to expect. Yes, it was behaving in some ways like flu, but it quickly became clear that it was far more virulent, and had unique characteristics, such as its impact predominantly on the oldest members of society.
Different countries tried different approaches, with different – sometimes good, sometimes bad – outcomes. Countries that prioritised developing a vaccine program were attacked for thinking that it was possible for such a magic bullet to be produced within a year. But, amazingly and thank goodness, the vaccines were created. Sweden was condemned for refusing to lock down as tightly as other countries, but the jury is still out on whether they were right to do so. Trump was condemned for shutting off flights from China – yet a year later, national quarantines have become the norm.
Clearly, every nation made mistakes, but each also got something right; the variation from country to country was wide, but what was common was a general lack of data to help proper understanding of how this deadly disease worked, and how we should deal with it. So, rather than concentrating on who to blame, we should look forward and figure out how to capitalise on what we now know – which is far more than we did a year ago.
And one of the things we know is that we have reasons to be somewhat more cheerful about the future impact of Covid. Yes, it will still kill many more people around the world, especially in countries that don’t have a fast-moving vaccination program. But in countries like ours, absent any new mutant strain breaking completely through our vaccine defences (and what concerns there currently are on that front do not seem to imply this is happening), we should be able to start treating this disease more like the annual flu epidemic.
In what follows, forgive the cod mathematics – anything attempting more precision would be futile guessing. But within that context, let me offer 10 reasons to be cheerful, that collectively add up to a conclusion that our current overly pessimistic view of Covid can be laid aside – for now and, with luck, for good.
1. Deaths from Covid in the UK have not been as great as we thought. It’s now recognised that government policies on how deaths should be registered during the pandemic, including the decision not to require a second opinion on the death certificate, have meant that many deaths attributed to being ‘from’ Covid were in fact deaths ‘with’ Covid – in other words, where the cause of death was not Covid. There are different estimates as to how big this effect is, but a consensus is growing that around 25% of reported Covid deaths were, well, not simply Covid deaths. So instead of 127,000 the total may be nearer, say, 95,000
2. We quickly understood that we should have better protected both care homes and patients in hospital, and now we do. Early on, some 40% of Covid deaths were in Care Homes, and up to 40% of deaths were from patients who did not have Covid when entering hospital – but caught it there. (There will be overlap in those two numbers.) One improvement since then has been much better protective clothing and basic hygiene, but the biggest impact is going to come from an insistence on vaccinating staff. Overall, death rates in care homes and hospitals from Covid are going to be way lower going forward, because of all of that we have learnt about how to protect residents and staff. Early death rates were high because we were unable to handle transmission in these settings properly; now we’re doing better, and that should reduce death rates by half; so from 95,000 to, say, 50,000
3. We now understand it was a mistake to ventilate as many patients as we did. This was something that nobody could have known. Ventilation was, pre-Covid, the indicated treatment for patients in dire respiratory distress. It now appears that this approach killed people who would otherwise have lived (and the big push to manufacture and distribute more ventilators was a distraction that wasted time and taxpayers money). Again, though, we won’t be repeating that mistake, which in turn means that death rates won’t be as high as at the beginning of the pandemic. This is not a mistake that people particularly want to talk about, so there is sparse data on how many patients could have survived had they not been ventilated. Let’s guess, conservatively, that just another 5% of lives could have been saved (and will now be saved in future) by avoiding ventilators – that cuts the death toll from 50,000 to 47,500.
4. We have discovered that dexamethasone saves critically ill patients from death. This was an unexpected result, which astonished many seasoned emergency care professionals. Again, death rates will be further reduced now that we know this, and potentially by a significant margin, but let’s guess, again conservatively, some 5%; that gets us from 47,500 to 45,000.
5. We have discovered that vitamin D can be protective against Covid. This discovery is now saving lives, although we still have a long way to go. The Government has recommended that vitamin D supplements be given to those considered vulnerable to Covid, but they recommend a daily supplement of only 10 micrograms. The reason for this laughably low recommendation is, itself, somewhat comic: it is the amount you get from a teaspoon of cod liver oil, which is what all schoolchildren (such as myself) were given in the 1950s. A progressive public health policy for vitamin D – raising awareness of its importance in ethnic minority communities, testing people at risk of vitamin D deficiency, and prescribing much higher doses – could further reduce Covid mortality by another 5%, from 45,000 to 42,500.
6. We are all now pretty much agreed that it’s extremely difficult to catch Covid outdoors. It might seem that this insight might not actually help reduce Covid disease, but there’s a perfectly good argument that it could; if people are encouraged to go outdoors and soak up some sun, then their bodies will synthesise more vitamin D, and they’ll be more protected against the disease. (And it would at least stop police being asked to chase those people who are harmlessly enjoying the outdoors – people who might otherwise be cooped up in cramped, soul-destroying and, yes, Covid-promoting indoors environments.) But let’s not appear to be overoptimistic; on this one, we’ll leave the future mortality ‘level’ at 42,500.
7. We now know that obesity is a health issue, particularly for Covid. Partly thanks to the Prime Minister’s own admission that being overweight contributed to the severity of his Covid bout, people people have got the message that obesity is a risk factor for Covid and are starting to do something about it – many of us have pals who have boasted about just how many pounds they have shed over the last year. Ultimately, a less corpulent population means a lower risk of Covid deaths. I knock off another 5% for that; so we’re down to 40,000 deaths a year.
8. Budesonide can knock Covid on the head if applied within a few days of symptoms appearing. This is a very new finding, but it appears that two stiff doses of this corticosteroid a day in an inhaler can help the body fight off the virus. If this impact can be fully confirmed, and the Government can come up with a protocol for giving patients Budesonide, both hospitalisations and deaths should drop even further. The study just reported in the BMJ showed that the approach lowers hospitalisations from 10.3% to 8.5%, but a mass Budesonide programme has not yet been mooted, yet alone implemented, so it’s far too early to have any information on the impact on deaths; let us therefore conservatively also leave this one alone, and keep our number at 40,000.
9. Vaccines work. There seems to be some confusion about the impact of the vaccines. The latest forecasts from SAGE seem to assume surprisingly low efficacy from the vaccines, even though the evidence so far suggests a reduction in cases of at least 80%. Worse still, the SAGE assumptions seem to embrace a logically and medically unsound view, which is that if, say, vaccines reduce cases by 80%, then it will also only lower hospitalisations, and deaths, by that same 80%. But that must be a very pessimistic assumption; if vaccines promote resistance, leading to only 20% of those individuals who come into contact with the virus catching the disease, then it is logical to assume that those 20% will, because vaccinated, be more resistant to the ravages of the virus and less likely to develop serious illness (let’s wait till point 10 for an estimated impact on mortality rates).
10. In the UK at least, the vaccine rollout has been a triumph. Since 80% of Covid deaths have been people over 70, and now almost everyone in that category has been vaccinated, we can see a future very soon where deaths from Covid are minimal and will not go back up. Indeed, we may already be at that point. Confusingly, ministers seem reluctant to draw the appropriate conclusions from this, claiming that the possibility of new variants that are resistant to existing vaccines mean that we cannot drop our guard. But those variants have not emerged yet. It seems odd to base policy on what does not as yet exist. For now, in any event, the crisis may be over. The Government should focus on what is, not on what could (but won’t necessarily) be. But in any event, even if only 80% of deaths are prevented, then we are down from the 40,000 in point 8, to 8,000 deaths a year in the UK from any future waves of Covid.
The cumulative impact of these 10 reasons to be cheerful are, as can be seen, enormous. Taken together, they mean that the pandemic should in future be controllable. Our citizens are sensible and will, of their own accord, wash their hands, distance themselves in closed crowded spaces, stay away from their workplace if feeling under the weather.
Of course, the estimate of 8,000 could be ridiculously optimistic, or in fact way too pessimistic; but many conservative assumptions have been kept to in arriving at that number. The above 10 points imply, I would argue, that annual Covid deaths in the UK will, starting now, be well below our historical level for annual flu deaths. We don’t lock down for flu, so we should now stop locking down for Covid.
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