Category: Covid 19

Flu and covid-19: numbers, trust and owen jones

1/3/2021

387 words; 3-minute read

I like Owen Jones, the Guardian journalist. He’s generally close to my political opinions and he’s written three first-class books dissecting aspects of the corrupt and moribund state of British politics and society.

So I was a little surprised when I read in a recent article of his that Covid-19 is ‘at least 10 times deadlier than the flu’. Even to my untrained eye this looked rather on the high side given what I’ve read elsewhere, so I opened the link. It turns out that Owen’s source was a May 14th article in JAMA Internal Medicine. This was some time ago - quite near the beginning of the pandemic in fact, and it was based on Worldometers data rather than primary research.

I wondered if there was any more recent evidence that Jones might have used. A quick search turned up this December 17th article in The Lancet comparing flu and Covid deaths in France. There I read that, ‘In-hospital mortality was higher in patients with COVID-19 than in patients with influenza (15,104 [16·9%] of 89,530 vs 2,640 [5·8%] of 45,819), with a relative risk of death of 2·9 (95% CI 2·8–3·0) and an age-standardised mortality ratio of 2·82’.

So in the light of this most recent evidence Covid-19 is three times, rather than ten times, more deadly than flu. I would imagine that Jones did the same as me when he was looking for flu/Covid-19 comparative figures - he carried out an internet search - and I would imagine he came across the Lancet figures, just like I did.

So why did he use seven-month-old research based on secondary data rather than two-week-old research based on primary data?

Could it possibly be that the Lancet figures didn’t fit his narrative, summed up in his article’s title: ‘Giving people false hope about the pandemic isn't “balanced” – it's dangerous’? As dangerous as cherry-picking figures to suit an unexamined position, perhaps. 'The media should not promote disinformation under the guise of debate', says Jones.

In keeping with the polarised state of public debate on most things nowadays we’ve all (me included) got a bit entrenched in our Covid-19 foxholes. Perhaps Jones has too.

sweden reprised

12/23/2020

482 words; 4-minute read

On the 10th July I wrote a blog called ‘Two Cheers for Sweden’, arguing for a broader range of criteria for success in dealing with Covid-19 than just counting Coronavirus deaths. So how’s that going? On the face of it things don’t look too good, and even the King of Sweden is now putting the boot in. The Swedish light-touch approach was criticised at the outset for the country’s much higher death-rate then neighbouring Scandinavian countries. This remains the case. (But it’s also true that Sweden’s Covid death figures are still better than heavy lockdown countries such as the UK, Spain and Italy).

It’s fair to point out that my airy claim on 10th July that the Swedes would experience no second wave has been proved completely wrong. Along with much of the rest of Europe Sweden is in the grip of a second spike of cases, hospitalisations and deaths - with more deaths at the beginning of December than at any other time during the pandemic.

It’s also true that the Swedes are adopting measures that look increasingly mainstream: reducing public gatherings from 50 to 8, banning sales of alcohol after 10 pm, moving high school teaching online, and advising mask wearing.

So does this mean that the Swedish experiment has failed, and that those of us who held (hold?) a candle for it have been sadly misled? It’s only honest to say that things are less clear-cut and more complicated than they looked back in July.

But what seems to be happening is something like policy convergence in the short term. So just as Sweden is taking baby steps lifted from the lockdown playbook, so lockdown countries are moving their own red lines in the Swedish direction. This is most obvious in the schools context. Where Sweden was the outlier in keeping schools open at the beginning of the pandemic, now virtually everyone is doing it.

Beyond the short term, the Corona jury should stay out for a few months - maybe years - yet. The evidence on other criteria - the economy, children missing out on school for months, the mental health problems that go with lockdown and isolation, lonely deaths, divided families, the non-Covid patients missing out on treatment, an increase in domestic violence, and the corrosive effects of policing lockdown - will take a while to come in.

What the last few months do seem to have shown unequivocally is that calls to eliminate the virus are utter fantasy. The question remains how to live with it, and it could be that experience and experiment are distilling a series of practices that will serve us well in the next pandemic.

Because, give the total unwillingness to address the root causes of this one, there surely will be more.

Covid success criteria - what should they be?

7/27/2020

637 words; 6-minute read

A friend of mine recently sent me a link to an episode of the Alex Salmond show on Russia Today.

The main message from the programme (or at least the one I picked up) was that the New Zealand approach to Covid is a model for others to follow. Leaving aside the particularities of the NZ case that might have given the country an advantage to start with (small population widely dispersed, relatively few entry points that are easily covered and closed), NZ was clearly incredibly successful in keeping case numbers and deaths very low.

So, assuming the criteria for success are reduced to one - suppression of the virus - NZ was (and is, to date) clearly a massive success story.

I think, though, that measuring success by this one criterion is a mistake.

First, it’s extremely reductive as an interpretation of what ‘public health’ means. It’s been interesting to see how epidemiologists and related health professionals have come to dominate the political and mediatic interpretation of what ‘public health’ is. There is obviously much more to public health than treating Corona patients, from the mental health issues caused by lockdown to the thousands of cancer patients whose symptoms have been missed and treatment delayed because of the relentless Covid focus - and everything between and beyond.

If we take ‘public welfare’ to be the criterion for policy-making rather than ‘public health’ (however widely we interpret that term) then leaving the field to epidemiologists and virologists seems even more odd. My sister has lost her job in New Zealand as a direct result of the collapse of the NZ tourist industry brought about by the severity of the lockdown there. She is a Covid casualty too. From their public pronouncements it is hard to avoid the impression that the 650,000 people who have already lost their jobs to Covid in the UK are regarded by epidemiologists and the like as collateral damage to be put up with in the name of a greater good, much as civilian deaths in a war are regarded as a regrettable price to pay for winning the war.

How did we get to this point? One factor is the composition of the Scientific Advisory Group for Emergencies (SAGE) - and, more broadly, the triumph of science over the humanities in regard to what’s regarded as useful, worthwhile and actionable knowledge. SAGE is stuffed full of people whose expertise lies in narrow fields of medicine. Where are the historians, philosophers, sociologists and - yes! - musicologists? (A philosopher might at least have brought up the possibility of a utilitarian approach to Covid - ‘the greatest good for the greatest number’ as opposed to the deontological ‘save every Covid life’).

It might be that a more multidiscplinary SAGE would have come up with a more balanced approach to Covid, in which ‘public welfare’ rather than virus suppression would have resulted in a different policy mix (and maybe people like my sister would have kept her job).

More broadly, the severe lockdown approach to Covid, recommended by Salmond’s epidemiologist, prepares us very badly for crises such as the Climate Emergency and for participatory politics more generally. There might be a top-down, do-as-we-tell-you approach to climate change but a) I doubt it would be successful in the long term, and b) I doubt I’d want to live in the paternalistic kind of society that took such an approach.

In sum, if some malign force had been asked to design a method for sowing fear, suppressing public participation and inducing a sense of helplessness, such a force would be hard pressed to come up with something better than Covid and the SAGE-type response to it.

two cheers for sweden

7/10/2020

(796 words - 7 minute read)

For the past few months I’ve held something of a candle for the Swedish approach to Covid-19, mostly because I think that, in the Anthropocene, living with the non-human world - yes, even the lethal bits - is in the long run better than fighting it. One way or another, that’s what the Swedes have been trying to do.

Support for the Swedish approach is regarded as misguided - at best - on the grounds that it’s killed more people per head of population than its Nordic neighbours. A friend sent me an article - and there are plenty - confirming this just the other day.

Debate over? Well, no. Even if Covid success were judged solely on deaths per head of population it wouldn’t be an open-and-shut case, as Sweden has fewer deaths per 100,000 inhabitants than Spain, the UK, France or Italy, all of which went through periods of total lockdown.

But this has never been Sweden’s pitch anyway.

It’s been much more about avoiding the disadvantages of the mainstream lockdown approach to dealing with Coronavirus: collapsing economies, children missing out on school for months, the mental health problems that go with lockdown and isolation, lonely deaths, divided families, the non-Covid patients missing out on treatment, an increase in domestic violence, the threat of second and subsequent waves, the crazy Great Escapes when lockdowns are eased and the sun comes out, and the corrosive effects of policing lockdown.

Sweden has done its best to keep the economy going while other countries have shut theirs down. Has it worked? It certainly did to start with: at least in March it performed better than much of the EU as it recorded a decline of just 0.3 per cent, compared with a 3.8 per cent fall for the Eurozone.

But in today’s interconnected world Covid in one country is as tough to pull off as socialism in one country. Sweden’s small, open economy has been a victim of Covid-induced disruption of international supply chains. Truckmaker Volvo Group and carmaker Volvo Cars were both forced to stop production for several weeks, not because of conditions in Sweden but due to lack of parts and difficulties in their supply chains elsewhere in Europe. If only the rest of Europe had followed the Swedish example?

Even so, according to the Financial Times, Swedish prospects post-Covid are better than the rest of Europe, with a 7% decline in GDP comparing favourably with numbers for Germany, Belgium, UK, France, Spain, Italy, and neighbouring Nordic countries.

Sweden has kept its schools open (up to age 16), avoiding the interminable squabbles in lockdown countries between government, teachers, parents and unions. Swedes support the policy for helping with children’s mental health as well as allowing parents to keep on working.

Crucially, Swedes reckon that public health is about more than preventing Covid deaths - the opposite of the notion that has taken a vice-like grip in countries like the UK where only Covid seems to count. There are the well-documented mental and physical health problems associated with lockdown, for example, as well as the health problems that have gone undiagnosed or untreated during lockdown, including 18,000 possibly dying from cancer in the UK sooner than they should have because of Corona delays.

In avoiding lockdown, Sweden is also set to escape the problems that come with releasing it. The idea of a ‘second wave’ makes no sense, for example. While there may be fresh outbreaks like those in Germany, Italy, South Korea, Beijing, Melbourne, Leicester, and Galicia, there will be no accompanying disruptive lockdowns. There won’t be any riots protesting a second lockdown, as there have been in Belgrade. Nor will there be any need to police quarantine hotels after breakouts, as in New Zealand.

More positively, Sweden is operating a citizen-centred, everyone-for-the-community strategy that is a better model than top-down lockdown for dealing with crises like climate change. ‘Treating citizens as children lacking the judgment to make wise decisions is not a sustainable approach’, writes Elizabeth Braw of the Royal United Services Institute for Defence and Security Studies. ‘Addressing a prolonged crisis, or one that comes in repeated waves, will require citizens to be active and responsible participants in their security — not mere recipients of government instructions’.

So when it comes to judging a country’s Covid success, let’s allow a wider range of criteria than Covid deaths per head of population. And let’s not make snap judgements. As Chinese Premier Chou en-Lai is supposed to have said when asked about the impact of the French Revolution: ‘It’s too early to say’.

But ...

6/1/2020

(376 words - 3 minute read)

'But' is a short word that is sometimes asked to do an awful lot of work.

In Saturday's Guardian Review supplement (30th May), Dr Rachel Clarke tells of her time as a Covid-19 doctor. 'Behind the statistics the pandemic unfolds one human being at a time', she writes. Hers is the story of one such person, an old man dying in a Covid-19 ward, and of his sons, dazed and confused, witnessing the last hours of their father's life.

'You could argue', she says, 'that there was little point to a man like Winston' - he was old, unproductive, and probably near the end of his life anyway. Others should take precedence, the argument might continue, the young, the productive, those with more life to live than Winston.

'But,' she continues, 'to those of us close up to this dreadful disease - who see, as we do, the way it suffocates the life from you - such judgments are grotesque'. It is easy to see why she thinks this, and Clarke's account of the bewilderment of Winston's sons as they see their father's life slipping away, and their determination that he not become just another statistic in Number 10's 5 p.m. press conference, is heartrendingly powerful.

'The moment we rank life according to who most "deserves" it,' writes Dr Clarke, 'we have crossed into a realm I don't want to be a part of'.

But this is a realm none of us can escape from, not even Dr Clarke.

The lockdown Clarke thinks should continue for fear of a second Coronavirus wave has caused its own casualties. The 1.5 million Britons who haven't eaten for a whole day during lockdown, those unable to work from home, those whose operations have been cancelled or postponed, the women and young people who will do worst out of lockdown, the victims of a spike in domestic abuse, and the sufferers of extreme social isolation - all these are victims of Covid-19 too.

Are the lives of these people less deserving than Winston's? I honestly don't know, but in writing so powerfully in favour of Winston and those like him, Dr Clarke is surely in the business of 'ranking life' - as are we all, like it or not.

Notes from a cliff-edge

Flu and covid-19: numbers, trust and owen jones

sweden reprised

Covid success criteria - what should they be?

two cheers for sweden

But ...

Andrew Dobson

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