There are essentially three positions on the lockdown.
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 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. Let’s look at the options.
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.
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
lockdown. 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 don’t know the
severity of Covid 19. If it were a Level 2 pandemic it might have made sense
not to have a lockdown. 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 lockdown strategy is saving. Someone who
is kept well now by the lockdown 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 also realising
that damaging the economy also costs lives?
As a short-term measure, I think the Governments
lockdown 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 lockdown 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 lockdown. 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 gradually 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.
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.