I learned an important thing from working with Jonathan Van Tam, the UK deputy chief medical officer: “Never begin an intervention,” he used to say, “unless you are sure how and when to end it.” A big problem of COVID-19 management in the UK has been its lack of clarity about precisely this: when do we stop lockdowns, face coverings and social distancing, and dial our lives back to 2019?
As the vaccination program rolls out, the average risk of serious illness or death for anyone in the UK is falling very rapidly. This process is being accelerated by the introduction of the Oxford/AstraZeneca vaccine and the decision to give first doses to as many people as possible.
No current vaccine has been shown to stop transmission of the infection, which is why vaccination passports are pointless. If you do get infected, though, vaccination means that you are very unlikely to need hospitalization and even less likely to die.
Well before the end of Phase 1 – sometime hopefully in late March or April – vaccinated people will have little more risk of serious illness or death than a healthy 16 to 60-year old. Since the beginning of the pandemic, there have been fewer than 400 deaths in that group.
The risk of “Long COVID” is real but should not be exaggerated. Many reported cases can be explained in one of two ways. First, the easy availability of antibiotics over the last 70 years has led us to forget how long recovery can take from any infection that has a big impact on the immune system. Viral infections cannot be treated with antibiotics and “post-viral syndrome” is well recognized.
Second, the physical consequences of any prolonged period under sedation in intensive care can be confused with the impact of COVID-19. Muscles deteriorate very quickly and psychological distress is common. Thankfully, the vaccine program will greatly reduce the numbers of people who have to experience intensive care.
The challenge that faces us as a society now is to decide between two views of the future. Are we going to try to pursue the elimination of Covid-19 within the UK, regardless of the social and economic cost, or are we going to decide on what we consider to be a tolerable level of deaths in order to enable a return to the life we considered normal before 2020? With the extension of the tier system across much of the country yesterday and warnings that schools could be closed until February, with a disastrous effect on children, it is clear that this is a debate that needs to be had urgently. The sooner we can begin to dismantle restrictions, the better.
The chief medical officer, professor Chris Whitty, pressed the need for such a debate during evidence he gave to the science and technology select committee on December 9. “At a certain point, society, through political leaders, elected ministers and Parliament,” he said, would have to decide on what is an appropriate level of risk, “just as we accept that in an average year 7,000 die of flu and in a bad flu year 20,000 people die of flu.” He also recognized that it was “very unlikely that we will get to a zero level of risk,” and that deciding the level of COVID we are willing to accept relative to the damage that is being done to society and the economy is ultimately a political question and not one that could or should be left to medics and doctors.
He is far from alone in holding such a view. Dr Michael Ryan, head of the World Health Organisation Emergencies Programme, agreed, in an end of year message, that societies would do better to focus on getting back to full strength, rather than on the “moonshot of eradication.”
Unfortunately, a significant faction of medics and scientists do not seem to agree. Their goal is to eliminate respiratory infections – even one as trivial as COVID-19 will be in a post-vaccine world. It is possible that we could abolish this cause of death by continuing the restrictions of 2020 indefinitely – the problem, of course, is that we would simply die from something else.
The scientists who support such a strategy are genuinely trying to make the world a better place according to their ideals. But their vision is of a future where people walk every day in fear for their lives. The rest of us should not accept this.
The experienced clinicians that I have been lucky to work with over the last 50 years share Prof Whitty’s more balanced view. They know that they cannot deliver immortality and that quantity of life should not be confused with quality. I suspect many citizens will share that view. But if we want to turn the clock back to 2019, we cannot assume that this will happen unless our representatives demand that democracy prevails over iatocracy – rule by medics.
At some point, the Government has to say to some of its pandemic advisers: “Thank you for your service to the country – but it is time to go home.”
Robert Dingwall is professor of sociology at Nottingham Trent University and a member of government advisory groups. He is writing here in a personal capacity.
This article first appeared in the Daily Telegraph on January 1, 2021.