Wednesday 29 April 2020

The logic of lotteries and lockdown

Sometime in the next few weeks we are all going to have to be a little brave. We have been told repeatedly to stay home, protect the NHS and save lives, but soon that message is going to change just a bit. We are going to have to do something a touch risky, go outside, go to work, come into contact with other people.

The Government has succeeded in keeping people at home partly because many of us are genuinely scared. We have all read stories of people getting sick and dying. Naturally we don’t want the same thing to happen to us or those we love.

I have been working from home. I’m very lucky that I can. I have been going shopping once a week at the quietest possible time and apart from that I have not left the house. There has been no need for anyone to enforce the rules, because I haven’t wanted to go out. This is partly because most of what I do, reading, writing, watching old films has always involved staying in. But also, I live with my elderly mother and I don’t want to infect her. The Government’s message has been all too effective with me. I could quite happily stay this way indefinitely.

But I have been using the time to think. We are going to have to relearn how to be brave and accept that life is risky and that this risk cannot be avoided.

It helps however to understand risk, because we are very bad at doing it. Many people are scared of flying, but the actual risk of a plane crashing is very small indeed. We are scared because every time a plane does crash the media covers the story in detail and we imagine it could have been me. For the same reason people play the lottery even though their chance of winning is so small that it may as well be discounted. The lottery is a tax on stupidity. The reality is that "It won't be you."

We must get beyond lottery slogans. We must understand the level of risk we face from Covid 19. This might just help us to be both brave and realistic.

I have supported the Government’s lockdown measures, not merely because I am timid by nature, shy and not very sociable anyway, but more importantly I began to realise not so much from the science, but from the logic that what we were up against was quite possibly the worst pandemic since 1918. 

We know that Covid 19 spreads quickly. One moment it was in China, the next moment it was everywhere. We also know that it kills a lot of people and would have killed more if there had been no lockdown. We don’t know for sure what percentage of the population who catch Covid 19 will die. The reason for this is we don't know how many people have caught it and we don't know how many have died because of it. It is only possible to estimate.  We know that the over eighties are most and risk and the under forties least at risk. But certainty about the exact levels of risk will have to wait. 

If it turned out that the Covid 19 fatality rate was much the same as the Hong Kong Flu epidemic of 1968-1968 and the Asian Flu epidemic of 1957-1958 (0.1-0.5%), then nearly all the Governments in the world will have made the greatest mistake in human history. They will have grossly overreacted and the lockdown while hugely damaging the economy will have saved few if any lives. 

It’s only on the assumption that the death rate is between 0.5 and 1% or higher that the actions of Governments around the world and the scientific experts advising them make any sense at all. This is not least because the actions that these Governments have taken are only advised under the circumstances that the Covid 19 pandemic would without lockdown kill a percentage of the population between 0.5 and 1% or more. The information is freely available, you just have to search.

Therefore, it is logical to deduce that either nearly all the Governments and their scientific advisors are wrong, or we are really facing the worst pandemic since 1918. To suppose that everyone is wrong except me puts you in the I am Napoleon category, no one knows it except me. If it turns out you are right, you may be the greatest general since Alexander, but I would still advise you not to invade Russia.

So, let’s assume a 1% death rate. This would mean that Covid 19 would kill around 650,000 people in Britain. We are in First World War military deaths territory and more people in Britain would die from Covid 19 than from Spanish Flu. That is a catastrophe that any Government would take all measures to avoid. We cannot even begin to imagine what such an event would be like. The equivalent of a large British city would be wiped off the map as if it had been vaporized by a Hydrogen bomb. This is why we are inside, and the Government has acted as it has. They had no choice.

But from an individual’s point of view the odds look quite good. At present 1% of households in Aberdeenshire have Covid 19 symptoms. So, if I meet one hundred people, I might be unlucky enough to meet one of them and catch the illness from him. But even if I were infected I would still have only a 1% of dying. We are in winning the lottery territory here.

When we start to go out, we will not have Personal Protective Equipment (PPE). If I am made to wear a mask I will do so with reluctance, because I will realise that viruses are rather smaller than the holes in the face mask cloth and will penetrate it quite easily and anyway can go around the sides. But so long as we continue to practice social distancing and hand-washing, the risk of our going to other shops than supermarkets or into offices will still be small.

But in order to make the odds work still more in our favour we are going to have to discriminate between those most likely to die from Covid 19 and those least likely. Children especially should be allowed to intermingle as much as they please so long as they do not come into contact with anyone over 40 and especially anyone over 80. If the under 40s intermingled as much as they wanted while practicing social distancing with everyone else, it just might be possible for the disease to spread in such a way that it wasn’t life threatening either to the under 40s or the over 40s. This could save all of us.

In 1918 nurses fought Spanish Flu with a gauze mask and a skirt. Many of them caught the disease and huge numbers died not least because Spanish Flu was most dangerous for the young and catastrophic for the pregnant. Today we have much better equipment than they did even if we don’t have enough and even if we have to make do and mend.

It is the lot of those who choose to be doctors and nurses that they are more likely than the rest of us to come into contact with infection, just as it is the lot of soldiers sometimes to have to go to war. To complain about the dangers of warfare when you chose to be a soldier is to say you misunderstood the job you chose to do or else that you were willing to do it when it was safe, but unwilling when it became dangerous. 

In an unprecedented crisis we all have to be willing to take a risk.

A thirty-year-old nurse faces a lesser risk even with less than perfect PPE than any 80-year-old in a care home. You and I also will face a smaller risk than our elderly relatives when we resume ordinary life. We are all going to have to be brave, because we will have to face odds of around one in a hundred. Meet the wrong person and you might die. But that is not nearly as brave as doctors and nurses who in the past treated yellow fever, cholera and typhoid with next to no equipment and no thought for themselves but only for their patients. Such heroism was indeed worthy of applause not merely on Thursdays.