Enza?

BY EFFIE DEANS

There are essentially three positions on the lock-down:

1. We should get out sooner (Hawks).

2. We should get out later (Doves).

3. There should not be a lock down at all (Enzas).

Which is correct?

We just don’t know.

The correct decision depends on knowing how many people have been infected with Covid 19 around the world and what percentage have died. We don’t accurately know either of these things. Some people have been infected and got well without being tested or even consulting a doctor. Likewise, some people have died without anyone diagnosing them as having Covid 19, while some people who have been described as dying with or from Covid 19 would have died anyway.

But Governments have to make decisions in real time, just like generals conducting a battle. They don’t get to read all the history books, see where they went wrong and do it all over again. Generals make mistakes when they don’t have all the information they need available right now, so too do Governments. But still in the next few weeks our Government will have to make a decision and they will probably have to make it with limited knowledge.

I suspect most people would think the third (Enza) option was crazy, but historically this is the one our Government has taken on each of the prior occasions that there has been a major pandemic in the last hundred years or so.

Let’s look at the options:

  • In 1918-1919 Spanish Flu killed upwards of 100 million worldwide and 228,000 in Britain. It probably originated in Kansas. It had a Case Mortality Rate of 2% and is Level 5 on the Pandemic Severity Index.
  • In 1957-1958 Asian Flu killed between 1 and 4 million people world-wide and 14,000 in Britain. It originated in China. It had a Case Mortality Rate of between 0.1–0.5% and is at Level 2 on the Pandemic Severity Index.
  • In 1968-1969 Hong Kong Flu killed around 1 million people worldwide, 30,000 in Britain. It originated in Hong Kong. It had a Case Mortality Rate similar to Asian Flu and was likewise Level 2 on the Pandemic Severity Index.

In each of these previous pandemics, there was no lock-down. The illness went through the population and people were treated by doctors and hospitals as best they could. I don’t think there was even a suggestion that people would be kept at home for long periods.

The problem we have today is that we still don’t know the severity of Covid 19. If it were a Level 2 pandemic it might have made sense not to have a lock-down. But what if it were a level 3, 4 or 5? It may in time become clear that the Case Mortality rate for Covid 19 is similar to Hong Kong or Asian Flu. Considerably worse than ordinary seasonal flu, but manageable and unavoidable anyway. We are all going to have to get out sometime. But Covid 19 might be worse. We just don’t know yet.

This is where we are all going to face a genuine moral dilemma. Until there is a vaccine, which may arrive quickly or may not arrive at all, the only way we can get through this and back to normal life is if enough people catch Covid 19 get over it and develop immunity. As the proportion of the population who has had Covid 19 rises it becomes less and less likely that everyone else will get it.

Meanwhile the British and indeed the world economy is going to have the worst depression in living memory. This too will have an effect on health and healthcare. Life expectancy in poor countries is lower than in wealthy countries.

Our way of life is something that we have defended in war. But our way of life is made up of the jobs we do and the standard of living that on average we have. We would not have the present British way of life if we had a massively poorer economy.

  • The First World War cost Britain around 750,000 lives
  • The Second World War cost Britain around 400,000 lives.

How many lives would be willing to sacrifice to protect our way of life today?

This is where the whole thing becomes incredibly morally difficult. We don’t know yet how dangerous Covid 19 is. We don’t even know how many lives the Government’s lock-down strategy is saving. Someone who is kept well now by the lock-down might get sick later when it is eased. We can’t all cease working indefinitely, because the economy would completely collapse. So how do you save as many lives as possible while realising that damaging the economy also costs lives?

As a short-term measure, I think the Government’s lock-down strategy is morally correct. Many lives may be saved at the expense of some inconvenience and temporary, though severe, damage to the economy. If the NHS had been overwhelmed, many people would have died unnecessarily. It is obvious from the experience of other countries that when a healthcare system becomes overwhelmed horrific scenes can happen.

But we are all going to have to accept that there is a balance between extending lock-down and damaging the economy and also that quite probably we’re not going to be in a position to know definitely when to begin easing the lock-down. Hopefully the experience of other countries easing restrictions will aid us. But this is as much a moral question as a scientific one. Scientists cannot tell us how to value our way of life. They cannot tell us how to weigh up the lives of people who may die now because of Covid 19 versus people who may die in the future because we cannot afford to spend as much on healthcare as we would like.

What then should we do? We should listen to the scientists and be guided by them, but we must be brave enough to realise that it is a moral and a political decision to balance the needs and the wishes of the whole population against the unknown and unknowable.

I suggest a few more weeks and then gradually and carefully, step by step, we should begin to open up our schools, our workplaces and our streets.

I had a little bird
its name was Enza
I opened the window,
And in-flu-enza.

Which bird did you pick to come in your window? A Hawk a Dove or an Enza? How sure are you that your bird brings with it life or death? For each individual an invisible coronavirus can kill the whole world leaving him with nothing but a certain hope about a next world equally unseen and about which there is no proof, but merely faith.

Don’t dare to criticise those who have to make this decision for all of us. “I am become death, the destroyer of worlds” is a horrible responsibility for science and for morality.

The excellent Effie Deans writes at Lily of St. Leonard’s here.