This is an interim post in the mini-series of three that I’m publishing on coronavirus contingency planning. I felt compelled to publish this in-between post after an exchange on Facebook between a doctor-friend and me. In this post I’m questioning whether exhorting one’s family, friends and acquaintances to ‘stay safe’ is in fact inimical to getting us out of the Covid-19 pandemic crisis. In publishing this post, I’m reminded of my psychiatrist-wife’s advice always to separate the issue from the person. So, if a friend and you should disagree about something, argue the issue robustly by all means, but protect the friendship. With that excellent advice in mind, here goes …
Doctor Finlay’s Case Book
In the past few days on social media, I invoked a rebuke from a doctor-friend and best-buddy of mine; let’s call him Doctor Finlay. I’d put up the following post on Facebook:
‘Just a controversial thought. During the Falklands War, as we were boarding the Landing Craft to go ashore at San Carlos, I don’t recall anybody saying, “Stay safe”. Have we become a totally risk-averse society?’
Doctor Finlay responded promptly by pointing out that going ashore in the Falklands War was the same as healthcare staff and other key people going to work in the face of Covid-19. Fair enough; there are similarities, albeit being in a situation knowing that another human being is hellbent on killing you day and night with weapons of modern warfare does have a certain uniqueness as you try to do your job. Doctor Finlay went on to say that Covid-19 could well hit us in waves, and we’d need to be prepared for this. Fair enough; I agree. Next, he made it clear that Covid-19 could well be with us forever. Fair enough; I agree. Key point: Doctor Finlay then said that ‘Stay safe’ was not about being risk-averse; it was about understanding the danger and adjusting to it. I’ll abstain on that interpretation of ‘stay safe’ for reasons I’ll explain below. Finally, rather worryingly, Doctor Finlay said that neither our economy nor our society was disintegrating. He said both were resilient and ‘adjusting amazingly’. On that one, I’d have to disagree …
Choosing just one of many such analyses, here Oxford Economics declares that ‘high frequency indicators for the UK suggest economic activity collapsed in mid-March and has shown no sign of recovery since’. That’s not an ‘amazing adjustment’, other than in the wrong direction. Meantime, in society, the rates of suicide, domestic violence and children calling abuse helplines are all rising sharply. Again, not an ‘amazing adjustment’ in a positive sense for society as far as I can see. That said, I do always try to work with facts.
Doctor Finlay signed off by telling me to ‘behave!’. Well, fair enough because I did say that my Facebook post was controversial!
My Facebook post and Doctor Finlay’s reply got me thinking about the risks associated with the Covid-19 pandemic. In fact, long before that social media exchange, I’d given considerable thought to Covid-19 risk management. I’m talking here about the risk associated with not ‘staying at home’ (contrary to the lockdown requirement) compared to the risk associated with switching off the economy (the consequence of lockdown). In other words, is the risk of harm associated with not ‘staying at home’, greater than the risk of collapsing the economy – which is the reality of our current circumstances. The government’s judgement today is that we face greater risk of harm (death by Covid-19) by going about our normal business than we do if we ‘stay at home’. Therefore, by law, we ‘stay at home’.
The prevailing mantra is ‘stay safe’. When we exchange the valediction ‘stay safe’, what we’re saying to each other is that we should prioritise protecting ourselves from risk; it means we must not be harmed. Although Doctor Finlay would disagree, what we’re doing by chirping ‘stay safe’ to each other is building a national subconsciousness which defaults to risk aversion. Indeed, it reflects the Health & Safety culture and precautionary principle approach which now pervade our society, and which have costs and benefits to our way of life. As the Covid-19 crisis proceeds and the economy and our normal social functioning disintegrate, we’re telling ourselves – by chanting ‘stay safe’ to each other – that above all else we must not risk death by Covid-19. That’s what ‘stay safe’ means.
Here’s the worrying thing: polls show that the British are more nervous about ending lockdown than almost anyone else in the world. We’ve had it drummed into us at every waking moment to ‘stay home’ and ‘save lives’ whilst telling each other to ‘stay safe’. It’s small wonder, therefore, that we’re not minded to come out of the bunker any time soon.
But is this the correct strategy? For how long should we chant ‘stay safe’ to each other before we should start chanting ‘let’s do it!’ to each other? What determines the moment at which we’re sufficiently ‘safe’ to start heading towards whatever post-lockdown normality looks like? On balance, will we be happier as a society in the long run having stayed at home, locked down for a protracted period keeping ‘safe’, or would we be happier as a society in the long run if we behaved normally and kept the economy functioning? On what basis is the government calculating that ‘stay at home’ until further notice will make us happier than going about our lives in what was a normal fashion up until 23 March this year?
Lockdown – For How Long?
In my previous worst-case post I posited that 325,000 British people could die of Covid-19. This is fewer than the official UK government’s worst-case, do-nothing Covid-19 death rate of 510,000 (from Imperial College modelling). The source of my lower figure assumed certain risk mitigation factors (eg behavioural changes and health and social care equipment and learning curve effects). Notwithstanding, 325,000 Covid-19 deaths would be shocking.
However, what has yet to be fully disclosed as equally, if not ultimately more shocking is the disintegration of the economy and the transformation of our way of life if we try to ‘stay safe’ for even a few more weeks, let alone many months or a year or more. Can we seriously keep the country in lockdown until a vaccine is discovered? Even if lockdown is relaxed, it’s inconceivable that we should spend potentially months or even years, wearing flimsy face masks, living our lives two metres from every other human being outside of our homes, waiting for a Covid-19 vaccine (which might never come).
Crunching the Numbers
So, on what basis do we decide what to do?
Every year in the UK about 600,000 people die of natural causes or some illness or other, excluding Covid-19. The population of the UK is 66,650,000. This means that I have a 1% chance of dying this year from anything other than Covid-19. The Covid-19 UK mortality rate today is 384 deaths per million, but this is under lockdown rules and without a clear understanding of the prevalence of infection across society (currently thought to be about 5%). So, as far as we know at the moment, I have a 0.04% chance of dying of Covid-19. I suppose that could mean I’m ‘safe’. Perhaps the mortality rate should be 0% to declare unequivocally that I’m ‘safe’? Who knows? Who decides and how?
Under my worst-case scenario (325,000 deaths) I have a 0.5% chance of dying of Covid-19, ie about ten times worse than the current measured mortality rate (0.04%). Under Imperial College’s free-for-all worst-case scenario (510,000 deaths) I have a 0.8% chance of dying of Covid-19. So, with fewer lockdown restrictions (325,000 deaths) or no lockdown restrictions (510,000 deaths), I face an overall risk of dying of any cause over the next year in the range 1.4% to 1.7% (you can do the maths). Can you see where this is going?
From a purely personal perspective (you’ll have your own attitude to risk), to keep my risk of dying below 1.75%, I’m being expected to buy into the deepest and swiftest global economic collapse in 100 years, if not in all history. Furthermore, I must buy into a dystopian social arrangement which has me confined to quarters and, when allowed outdoors for ‘essential’ reasons, I must treat every other human being as my potential killer. Developing herd immunity is a non-starter. Moreover, nobody can tell me how or when this Kafkaesque state of affairs will end. The situation is, arguably, absurd and certainly unsustainable.
It’s a Tough Decision (Understatement)
I understand and accept that politicians faced with taking decisions under these circumstances are under excruciating pressure. It’s not easy. One of the measures of a civilised society is how we look after our most vulnerable. Whilst it may be a utilitarian approach simply to look at the bottom line (maximising happiness for the maximum number of people), every death is a person, with a family and friends. If one were being cynical, one might call the politicians’ response expedient. Governments are generally unwilling to kill off the electorate – even if it would save the economy – as it tends to be unpopular with voters.
That said, there has to be a balance. If we get to a point where the lockdown harm is outweighing the benefits, then obviously restrictions will have to be lifted. The economy is closely linked to the nation’s health; research shows that the 2008 recession knocked three months off the average lifespan. What seems to happen is that in an economic crisis we increase our chances of dying prematurely. According to Fraser Nelson, a Swiss study has already looked at the effect of lockdown on alcoholism, depression and suicide, and suggests the most vulnerable 2% of the population could see their life expectancy cut by almost a decade. These findings challenge Doctor Finlay’s assertion that in an economic crisis we ‘adjust amazingly’.
The government now has a matter of just a few weeks at the most to provide details of our release from lockdown. We have to weigh the risks of death by any cause, including Covid-19, against the risks of socio-economic meltdown with all that that entails for a generation and maybe more. Forget having a 1.7% chance of dying this year. If we keep this up for much longer, we’ll have a near-100% chance of destroying 100 years’ worth of socio-economic development and all of the adverse health impacts and other national and global geopolitical and socio-economic risks that go with it.
A Decision Must Be Made
Andrew Lilico echoed my point in a newspaper article on 30 April. He argued that ‘we have two routes by which this could all be over quickly. Either the Swedes could prove to be right about lethality being no higher than feared, or new therapies could cut lethality. It could well be worth waiting a few weeks more to see. However, at that point, unless evidence emerges that Covid-19 lethality is worse than feared, we really must bite the bullet – even if that means tens of thousands more deaths whilst we achieve herd immunity. We cannot allow this to drag on for years, changing our whole way of life indefinitely. Whatever path we take, the whole situation must be over within a few months. Maintaining strong social distancing for years in the hope a vaccine turns up cannot be considered an option. And that is not a matter for medical scientists to decide on our behalf’.
This is why the likes of my dear friend, Doctor Finlay, should not be allowed to influence significantly what must be a political decision. There is no ‘amazing adjustment’ going on in our economy and our society in the face of Covid-19; there is simply socio-economic destruction, much as Doctor Finlay believes – but will not be able to prove – otherwise.
Mr Lilico emphasises that ‘the whole situation must be over within a few months’. That would take us to, say, the end of July. By then, the UK economy won’t be so much as on its knees; it’ll be on its back on the canvas being attended to by the team doctor. The number of suicides, incidents of domestic violence and children pleading for help to counsellors will have risen, probably exponentially. The portents for high unemployment are already looming large, with all of the economic and social ills that go with potentially millions of people being out of work.
First, Do No Harm
Here’s the rub. Doctor Finlay’s attitude to tackling the Covid-19 pandemic is characterised by the maxim, ‘primum non nocere’ (first, do no harm). My wife is also a doctor. I know that doctors are magnificent at protecting and preserving life and we should be inordinately grateful for what they’re doing right now in protecting us from the ravages of Covid-19. Doctors will encourage you to ‘stay safe’ until the cows come home; that’s what they’re paid to do; moreover, that’s genuinely what they want you to do.
However, as a general rule, I can’t think of any practising doctors who distinguish themselves in the fields of economics and politics. I feel I can say that having lived with an extremely competent doctor for forty years (light-hearted quip, by the way). I feel I can also say that in the light of Doctor Finlay’s unfortunate illusion that we’re ‘adjusting amazingly’ to Covid-19; sorry, we’re absolutely not.
Let’s Do It!
Meanwhile, as an erstwhile soldier myself, I’m characterised by mission focus and risk analysis. I’m also a semi-retired businessman with twenty-five years’ experience in commerce at board level and as a company owner-director. Now self-employed, I’m being hit hard financially by this crisis (although nowhere near as hard as many people). I’m having great difficulty seeing how the future will unfold and how I can plan to get back to business. All I can see are two black curtains deliberately drawn in front of me with a head poking through between them, smiling sweetly and telling me to ‘stay safe’. I’m confident in saying that the economy is heading for catastrophe and our society is being turned upside down. That’s what the hard evidence is telling us; there are no ‘amazing adjustments’ taking place. Consequently, we need to move swiftly from a ‘stay safe’ culture to a ‘let’s do it!’ culture. Yes, I know, it’s a staggeringly difficult political decision. However, we’re at a critical stage where if we maintain lockdown and everything that goes with it for much longer, we’re stuffed.
It’s important to recognise that we each view life through our own lens. Doctor Finlay’s lens has ‘first, do no harm’ etched on to it, and mine has ‘stick to the mission’. The mission is to get back to normal, before it’s too late. So, please can we swap the mantra ‘stay safe‘ with ‘let’s do it!‘. That’s what we muttered to each other undramatically as the Landing Craft ramp went down.
Finally, I hope I’ve adhered to my psychiatrist-wife’s advice and focused objectively on the facts and the issues in this post and, moreover, protected my friendship with Doctor Finlay.
Keep buggering on.
To stimulate debate, please share this post on social media using one or more of the buttons below. Tell people you share my views; or tell people I’m talking cobblers; I don’t mind either way. I just want us all to use peaceful means to effect change. Jaw-jaw is better than war-war.
Feel free to join the 390-odd other followers of my blog by clicking on the ‘Follow Blog via Email’ box over to the right of the page. I didn’t plan it this way, but Moraymint Chatter now gets tens of thousands of hits during the course of a year, so if you comment your views will be widely read. At the last count, this blog had received almost 2000,000 hits from readers all over the world, as well as countless shares on other social media platforms.
See you down the pub … eventually.