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Coronavirus: the wrong disease

2020-04-06 07:14:55

Spending £350 billion to prolong the lives of a few hundred thousand mostly elderly people is an irresponsible use of taxpayers' money, wrote Toby Young at the end of the month.

Johnson, of course, was too late to have benefitted from the lockdown to which Mr Young so heartily objected (and still does), arguing that it is an overreaction. He asserts that the government should end it as soon as possible and encourage people to return to work. Social distancing measures, he says, should be limited to the elderly and those with underlying health conditions.

Young's original article was actually published four days after the Great Leader had been reported positive for coronavirus, after suffering symptoms for the previous 24 hours. But, after a period of self-isolation and "working at home", we learn that he has been admitted to hospital as a "precautionary step", for routine tests.

If one was to embrace the hard logic of Young's position (assuming we can take his calculations at face value – which is something I will address shortly), one assumes that we should write off the prime minister, as the cost of treating him will undoubtedly exceed the notional value of a person of his age.

Like the rest of the 230,000 theoretically saved by government intervention, he should be written off and allowed to die. After all, there is no shortage of applicants for the position of prime minister, so there should be no particular problem in filling the post (once the accommodation has been disinfected).

If this is taking the argument to extremes, it does nevertheless point up the difficulties of taking a strictly economic view of an event such as an epidemic. It is all very well applying comparative cost assessments to deaths occurring in isolation but an epidemic is a very public event, involving large numbers of people.

That makes it a political event and, even if it did make sense to assess the economic implications of taking action, the "do nothing" response which Young advocates is simply not tenable. At times of crisis, when people are exposed to great peril (real or perceived), the government is expected to act – at whatever the cost. If it didn't, it would very quickly become an ex-government as people took their own actions – which might not exclude violent overthrow of the denizens of No 10.

That is the point that Young misses. Political events have their own rules, as we recall from Jean-Claude Juncker who, in the aftermath of the 2008 financial crisis, wistfully declared, "We all know what to do, we just don't know how to get re-elected after we've done it". What makes economic sense (assuming it does) it not always an option.

However, in making an economic case, Young seems to assume that his "do nothing" stance is without cost. But, as we saw in the early days of this epidemic, with government havering about whether to take action, people did start to take their own actions.

We had a number of firms instruct their staff to work at home, football clubs decided to abandon fixtures, leaving the football authorities to abandon the season, and Formula 1 then cancelled its races. Universities started shutting down, as did schools and more and more enterprises ceased to operate as staff and managements voted with their feet.

Thus, the clinical picture that Young paints, with nice, neat divisions between courses of action, simply doesn't exist. The alternative to the government not imposing a lockdown would have been chaotic, unofficial action with a drastic economic impact, and serious implications for public order- while the spread of virus continued.

Even then, we have to consider the arithmetic. Like most amateurs in the field, Young has a naïve respect for the "modellers" and quotes with reverence Neil Ferguson's figure of 230,000 lives saved, on which he bases his economic assessment.

The mistake here, of course, is in treating the epidemic as a single event. Yet, as we have seen, it comprises multiple outbreaks at different stages, with some hotspots, the largest of which are in London and the West Midlands.

Simply taking out of circulation the elderly and those with underlying health conditions (even if it was possible) would mean a far more rapid spread of the virus, with multiple hotspots developing throughout the country. And while the illness is fatal mainly to elderly people and particularly those with underlying conditions, that is not always the case.

One wonders, therefore, whether Mr Young really thinks that people would go calmly about their lives as the epidemic ripped through the country, with the media recounting stories of hospitals overwhelmed, as health staff fell victim to the virus and the government daily announced a death toll soaring up to the hundred thousand level, and then doubling.

But then, as one might recall, Ferguson's estimate of 230,000 is not the only figure in town. The government itself has cited as many as 750,000 deaths and any estimate is precisely that – an estimate. Which government is going to have the nerve to sit tight and test the accuracy of the modelling, and put its money on Ferguson being right?

Then, there are the dynamics of epidemics to be considered. Given that it is still between 18 months to two years before a vaccine is administered to the population, the virus has ample time for second helpings, and even third.

One might recall that the 1918 "Spanish flu" epidemic lasted until 1920 – three years in all. Given three years to rampage, it is unlikely that this coronavirus would obediently stick to a quota of 230,000. What are the chances of a government surviving in that event?

In the real world, therefore – the world in which people exist and even prime ministers are mortal – Young's thesis is absurd. It is simply not a viable political proposition.

What one might also say is that, like so many of his ilk, he misses the bigger picture – lacking any understanding of what could have been. Increasing numbers of voices can be heard advocating the "test and trace" option for controlling the epidemic and I would be happy to argue the case that if this had been adopted right from the very start, the government might not have had to impose a nation-wide lockdown.

The costs to which Young objects, therefore, might be more accurately attributed not to the lockdown, per se but to the failures of successive governments to plan properly for an epidemic, and their willingness to allow the public health system in this country to decay.

If there is a lesson to learn, this might be it. There is nothing to say that Covid-19 is the only epidemic this nation will suffer. The growth in international air traffic and the mobility of the world's population (to say nothing of its growth), might make pandemics a routine event.

Thus, Covid-19 might actually be our wake-up call. But, as it is, theoretically it could be worse and, if from this emerges a better appreciation of what it takes to fight such epidemics and, as Pete points out societal changes to allow that to happen, the money spent will not have been entirely wasted.

For my part, I'm beginning to get to grips with this issue. I would not say I'm there yet as the last time I looked at the epidemiological system for dealing with a communicable disease – for my PhD thesis – it took me five years.

However, I am tending to the view that the first mistake in a fatal cascade started with the promulgation by the World Health Organisation of the 2005 International Health Regulations.

It was these which, for the first time, specifically listed pandemic influenza and Severe Acute Respiratory Syndrome (SARS) as potential "events of international public health concern". This formal status required member nations to "develop, strengthen and maintain… the capacity to detect, assess, notify and report" these diseases, and then to the develop "the capacity to respond promptly and effectively to [the] public health risks".

This led to the rash of the preparedness plans produced by members, including the UK, then under the Blair government, supposedly based on WHO guidelines. Where it all went wrong, in my view, is that members were allowed to produce influenza plans and use them as the template for dealing with SARS which, as it now transpires, demands a very different approach.

To that extent, we might have the right plan – for influenza – but it is being used to fight the wrong disease. Covid-19 is not influenza - it is a SARS. And as we record 47,806 cases and 4,934 dead, that represents the true failure, and why we are now having to embark on costly lockdowns.

There were plenty of other mistakes, not least the EU's European Centre for Disease Prevention and Control reporting on 14 February (by which time the UK had reported nine cases) that, "the risk associated with SARS-CoV-2 infection for the EU/EEA and UK population is currently low".

Elsewhere, one might argue that the public health profession lost its way, but that is another, longer story. As it stands, it may be of small comfort to the prime minister that, as he defies Mr Young's spending constraints, the mess we're in is not entirely of his making.