While the shortage of beds and staff distress are all too real, what hospital doctors and nurses see on the wards does not reflect the average experience of Covid-19, writes Professor Robert Dingwall (pictured)
The reports from Britain’s hospitals in the past few days have been truly worrying. No one should doubt the reality of what they are facing, or the suffering of gravely ill patients and their families.
Yet troubling infection rates and daily death counts, although impossible to ignore, are not the only way to understand this pandemic and our attempts to defeat it. After all, there is real hope for the future thanks to the creation of new vaccines.
But we still need clear heads if we want to phase out the restrictions crippling normal life. Above all, we must dispel the current mood of fear and the arguments of those who thrive upon that fear.
The first thing we need is perspective. While the shortage of beds and staff distress are all too real, what hospital doctors and nurses see on the wards does not reflect the average experience of Covid-19.
Footage from intensive care units looks dramatic on television, but, as the Government’s Chief Scientific Adviser Sir Patrick Vallance noted last March, most people go through the infection and recover quietly in the community, not on wards. Distressed and angry voices from hospitals appeal to our emotions but they must not dominate the way we think. Crisis management is not the same as planning.
Then, look at the vaccination programme and what it can achieve. My medical colleagues expect that the population’s average risk of death from Covid-19 will fall to something like that of a healthy person aged 16 to 60. In other words, very low indeed.
When we have vaccinated all the highest risk people, some time in late February, what precautions can we stop taking? Which restrictions will be lifted? And when we have completed Phase 1 by vaccinating all the people with above-average risk in late March or April, what will we stop doing then? These are important questions but as yet, there are no answers
All this can be done quickly. Around 80 per cent of the drop in risk will be gained by vaccinating the first four priority groups in the country, which means all those aged 70 and above, approximately 13 million people. The Government hopes to accomplish this by the middle of next month.
It is a game changer. In a vaccinated population, Covid-19 will mostly mean a few days off work and will very rarely result in serious illness. It will sometimes go completely unnoticed.
Chris Whitty, the Chief Medical Officer, points out that we already expect 7,000 to 10,000 deaths from influenza in an average year. On any reasonable calculation, the vaccination programme should take Covid deaths below this level, and make Covid less deadly than flu.
Most of us would get it from time to time but we would shrug it off and get on with our lives. There would certainly be no point in the sort of restrictions we see now.
We do not lock society down for common colds, seasonal influenza or other respiratory viruses because we accept the occasional inconvenience of infection as the price of living our lives the way we choose and enjoying the benefits of an open society.
In the same way, a vaccinated population will not need Test, Trace and Isolate, or vaccine passports or special border controls. We can make a bonfire of face masks and embrace whoever we want.
And this is a choice that starts to become available to us from next month. The only question is how quickly we choose to grasp it.
Most of us would get it from time to time but we would shrug it off and get on with our lives. There would certainly be no point in the sort of restrictions we see now
Why, then, do the restrictions and lock downs seem never-ending? In part, it is the result of misunderstandings, including confusion between Covid and the fear of Covid.
There is also pressure from commercial and other interests that have developed to take advantage of the pandemic, and which now have a stake in perpetuating alarm and anxiety.
Most of all, however, we are unable to think beyond a world of lockdown because the focus on hospitalisation and death has completely distorted our understanding of what Covid means as an infection in the future.
Our anxiety levels have been pumped up high, partly as a deliberate act of public policy and partly by the constant drip feed of bad news stories. And this is a major threat to our future and our ability to grasp it.
When we have vaccinated all the highest risk people, some time in late February, what precautions can we stop taking? Which restrictions will be lifted? And when we have completed Phase 1 by vaccinating all the people with above-average risk in late March or April, what will we stop doing then?
These are important questions but as yet, there are no answers. And, make no mistake, we will only see a timetable of this sort laid out if there is active pressure to achieve it.
Even the Chief Medical Officer has hinted that a number of restrictions and controls might continue for a longer period, perhaps even into next winter. His main concern seems to be managing winter demand for the NHS (although I believe this can be managed with increased investment in the health service and a modest improvement in the current surveillance systems for respiratory infections).
Remember this, too – many groups are doing well out of the controls and will want to see them maintained for as long as possible. Some of these groups are obvious, including the suppliers of masks, sanitisers, visors, screens and other equipment used in controls and the people whose jobs are wrapped up in them.
Closing Test and Trace would be a big deal for some businesses, including those that supply the chemicals and services involved.
Covid has its medical winners and losers, too, as different specialisms compete for their share of NHS resources. This has been a good time for those in virology, behavioural science and mathematical modelling, for example.
For many areas of science, Covid research funds have been an important hedge against the uncertainty of future funding from European research programmes. Research groups are like small businesses and cash flow is crucial to sustaining colleagues’ jobs.
Yes, Long Covid is a concern, but it should not be confused with the promotion of Long Covid anxiety to sustain funding.
More chilling is the zero-Covid faction, those who believe we must keep the pressure on the virus until it is completely eliminated. Their campaign programme often spills over into demands for permanent restrictions and controls to ensure that, in future, no one suffers a respiratory infection from which they might die.
Such people are really in the immortality business, a trade for hucksters, not scientists.
Although relatively few are vocal in this aim, their objectives are tacitly shared by many well-meaning people who have not thought through the implications of defending lockdowns, restrictions and controls beyond their justification.
As Dr Mike Ryan, Head of the World Health Organisation Emergencies Programme, has noted, societies would do better to focus on recovery than chasing ‘the moonshot of eradication’.
In the end, this is a question of democracy. Chris Whitty has rightly challenged the country to think about what level of deaths might be tolerable in exchange for a return to the lives we led in 2019.
That is not a matter for any group of experts – scientific, medical, ethical or even sociological. If citizens are to debate this properly, though, we must get beyond emotions stirred up by fear to understand the real – but modest – risks that go with an open society and a thriving economy.
lRobert Dingwall is a professor of sociology at Nottingham Trent University and a member of several Government advisory groups. He is writing here in a personal capacity.