The Problem With COVID International Comparisons

Introduction

Like many other European countries, the UK is seeing a rapidly increasing number of COVID infections at present. The national lockdown earlier in the year was very effective in suppressing spread of the virus, but governments are aware of the very severe effects that the lockdown had on the economy, and on the mental health of many in the population. The Westminster Government was, by all accounts, surprised at the degree of compliance of the population with full lockdown, but there is growing evidence that a significant sector of the population is unwilling to comply with the various measures now being proposed to slow the spread of the disease. These measures seem to change from day to day, which is a major part of the problem. The current advice in most of the UK is that there should be regional partial lockdowns of varying severity, depending on the local prevalence of COVID infections. Another possibility that has been mooted is a so-called “circuit-breaker” national lockdown lasting around 2-3 weeks. In fact, it emerged 2 days ago that this was the policy recommended by the advisory group SAGE for England 3 weeks ago!

The “Libertarians”

The “libertarians” in the population appear to resent any form of lockdown (and many of them oppose mask-wearing as well as vaccination), although the more sensible of them feel it would be wise to shield the vulnerable section of the population. Apart from the difficulty of defining this at-risk group of people, there is little evidence from anywhere that it is possible to isolate fully the vulnerable while letting the disease run riot in the rest of society. Many of the libertarians point to the example of Sweden, which had a much less severe imposed lockdown than, say, neighbouring Norway. They point to the fact that currently cases don’t seem to be rising in Sweden, but they don’t seem to be rising much in Denmark or Norway either. There is also the inconvenient fact that Sweden had a higher mortality from COVID than other Scandinavian countries, including a lot of deaths in nursing homes. Current evidence suggests that perhaps 10% of the UK population have been exposed to the virus, and we have had over 40,000 deaths. The proposal that we should have a more relaxed attitude to containing the virus could result in a huge number of fatalities.

The libertarians seem very keen on policies aimed at the development of herd immunity to SARS-CoV2. As many experts have also said, Professor Devi Sridhar (chair of global public health at the University of Edinburgh) has commented that herd immunity to coronavirus is “illusory”. She points out that immunity to coronaviruses wanes quickly, and that reinfection has been shown to be possible. As she says, “After decades, we don’t have herd immunity to cholera, yellow fever, polio, measles, TB, malaria or plague. Public health measures were used to control their spread until vaccines or elimination strategies were developed.”.

An Ideal Approach?

Professor Sridhar does not, however, think that lockdowns are the answer to COVID either. She proposes a strategy the most important component of which is “a robust system for testing, tracing and isolating, where test results are returned within 24 hours, at least 80% of people’s contacts are reached and there is high adherence to a rule of 14 days’ isolation for those exposed to the virus.”. People of all ages should try and avoid infection by getting outside as much as possible, and avoiding indoor, crowded, poorly ventilated areas. She encourages social distancing and the wearing of masks. She is also an advocate of much stricter border control measures than we have at present.

Why It May Not work In The UK

Sridhar’s policy makes a lot of sense, but it is well recognised that the so-called “NHS” Track and Trace System in England does not have performance figures anything like those above. Even more worrying is the finding that most people in the UK who have COVID-19, or are a contact of somebody who has tested positive, fail to fully self-isolate. SAGE has informed the Government that only 18%-25% of people who needed to were self-isolating. Others were still going out to work or to shop, even though they risked infecting others. The group called for financial support primarily for low earners, but also in middle-income groups. The latter advice makes the assumption that the main reasons people don’t comply with self-isolation are financial, but it seems to me that urgent exploration of the health beliefs of the non-compliers is required.

International Comparisons

The approach Sridhar suggests results from international comparisons. She makes the point that out of a population of 1.4 billion people, China has only had 4,634 Covid-19 deaths, while Vietnam, Taiwan and New Zealand together have had 67! The success of these countries in dealing with COVID has a lot to do with effective leadership from the governments concerned. I suspect, however, behavioural factors are very important as well. It is almost certainly no accident that 2 of the least united countries in the World, ironically called the United Kingdom and the United States of America, have been amongst the poorest performers in managing the COVID pandemic. These two countries are so dysfunctional that in both of them management of the biggest public health crisis in our lifetimes has become a political football.

This horrific situation is most obvious in the United States where, in the run up to the Presidential Election, Trump, not content with being a climate change denier, has decided to become a coronavirus denier too. Even though Trump has, allegedly, had the virus as well as several of his associates, it appears you can’t be a true Republican without gathering in huge, closely packed groups while not wearing masks. Trump’s constant down-playing of the seriousness of the situation completely ignores over 200,000 American fatalities from COVID.

Much of Britain’s abysmal performance in handling COVID can be attributed to the current Conservative Government’s serial incompetence. The most obvious recent example of this has been the pathetic performance of the extremely expensive privatised track and trace system. Now we find that Johnson, largely to appease libertarian factions within his party as well as business interests, is no longer “following the science” as represented by SAGE.

Final Thoughts

You could argue that these problems are purely political, but the governments that we elect reflect the values of the societies that they represent. It is easy to see why the Chinese population, with a totalitarian government, would comply with draconian control measures for COVID. Although it’s geographical isolation is probably a benefit, the performance of New Zealand is more impressive. Their population, however, is also very united, treating their prime minister Jacinda Arden almost like a saint. In the USA, Trump has been such a divisive influence that there is little in common between his supporters (who think that he can do nothing wrong), and those who oppose him (to whom he is virtually the Devil incarnate). Trump’s bizarre attitude to COVID has meant that an united community response to the virus has virtually been impossible. In the UK, I would argue that the continued divisions caused by Brexit have also hampered an united response to SARS-CoV-2. Some of the arrogant exceptionalism that led to the UK leaving the EU, with its lack of respect for the opinions of experts, has spilled over into reluctance in a significant section of the population to comply with advice regarding the virus.

Medicine Politics

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