Lockdown or countdown?

We stand at a rather interesting crossroads in our response to the coronavirus outbreak. On the one hand, most scientific opinion suggests that coronavirus will be with us from here on in some form or another. On the other hand, our political representatives are, not surprisingly, painting a less bleak picture, hinting that we may have passed the peak and, shortly, be thinking in terms of alleviation of social distancing measures.

You can see the reasoning – they are under pressure from economists fully aware that a lockdown extending beyond the summer will inevitably see the permanent closure of those businesses that are currently surviving by hibernating or rethinking their business models. Politicians feel the need to offer hope. That after all is their stock in trade. And politicians, especially Tory politicians if we are honest, have never done much more than pay lip service to scientific minds. Who can forget Michael Gove’s off-the-cuff “well I think we’ve had enough of experts”. What an utterly fatuous remark.

I don’t envy the politicians. Most of the political nous, obtained on the hustings, has to do with trivia. And let’s face it, in the context of coronavirus everything is trivial. Whereas normally I might have been outraged at the closure of a local library or the restriction of transgender counselling services, these issues barely raise their heads above the parapet of my consciousness. Sorry chaps, but I really can’t get worked up about this at the moment.

Like I said, the politicians are having to balance the public’s patience against the scientific data. To appease the public, the lockdown must end soon. To keep the scientists engaged, the lockdown will be in place until the end of the year.

High streets will never be the same again either way. Some shops are gone for good already. And if I’m honest, it will not be the greatest tragedy in the world for me to see the back of Starbucks. Or any of the coffee shops. Do we really need double espressos at £4 per thimbleful or whatever it is. And would a world without Pizza Hut or Dominoes really be that bad. And as for those designer sandwich shops, don’t get me started.

That last paragraph probably came out harsher than I intended but you get my point. And these are the kind of decisions our political representatives are weighing every day. Do we save businesses or save lives? It really comes down to that. And on the one hand we have the scientists (Chris Whitty in the UK and Anthony Fauci in the USA), peddling harsh statistics and uncomfortable truths. On the other hand, we have Boris Johnson and Donald Trump, pragmatists masquerading as idealists, each with a penchant for political spin over persuasive science.

I imagine that you, like me, felt a shiver down your spine just now reading that. But the choice ultimately is as stark as that. If we take the scientists line completely, we will not open up again until 2021 at the earliest. By then there would be no business left to revive. Seriously. Nothing. Already the spectre of unemployment and isolation is meting out terrible consequences to the mental health of the isolated, to say nothing of the mortality induced by hospitals ‘clearing the decks’ of cancer patients and others to make room for the ongoing influx.

On the other hand, opening up for business again in May will potentially revive businesses (briefly) but at the expense of a second infection tsunami that will make the first look like a ripple in a bird bath. The truth is that we are going to have to live with coronavirus for a long time – years not weeks. We are going to have to find a way to keep isolated but at same time to keep business alive.

In the end, we cannot protect everybody. It is a simple biological fact that the older are more vulnerable. Their immune systems are lethargic, their circulation impaired. Naturally the deaths will be disproportionately distributed to all the elderly. And our current restrictive measures are seen by some to favour the elderly who are naturally used to isolation at the expense of the more gregarious young.

Already there are mutterings and murmurings of unrest. Some, especially the young, are asking whether the socio-economic price is worth paying to preserve granny and grandad. I have even seen one protest reported with individuals carrying placards of “Sacrifice the Old”, as though it were a simple trade-off and we could appease the gods by sacrificing the elderly. This is wrong thinking of the most egregious kind. This is the kind of thinking popular in the beginning of the First World War where bottles of Moselle were publicly poured down drains and where dachshunds were stoned in the streets. Really, this happened. I don’t want to see the country where we demonise the elderly, holding them responsible for wider ills. We need the elderly and their wisdom more now than ever.

But above all, and whichever position one espouses, whether pro-survival or pro-economy, we need to think about this. We are going to have to make a choice at some point and the sooner we start to have a frank and open discussion about this the better.

When numbers become names

Close inspection of coronavirus infection rates and numbers of deaths, whilst on the face of it quite easy to understand are actually much harder to truly comprehend. It was quite easy to understand the numbers during the early phases of the pandemic. Dozens. A football team in essence. Then it was a hundred. That’s like two American football teams. Still the kind of number that one can visualise. Not long after that hundred had become a thousand. But at this point I begin to detach. What does a thousand people look like? Well, I guess it’s a theatre full. But I can’t now see the faces so the number is already becoming abstract. Ten thousand? Simply beyond my visual comprehension. Let me put those kind of numbers in context.

At Pearl Harbor, 2403 Americans and allied personnel died. On 911, 3000 died. During the whole of the US War of Independence, 6800 American soldiers were killed. The invasion of Normandy accounted for 4413 lives on D-Day. At Gettysburg 7058 Federal and Confederate soldiers lost their lives. History has taught us to accept these as huge numbers. Yet they pale into insignificance compared with the casualties from coronavirus. At time of writing (20 April 2020) the number of UK lives lost to coronavirus is 16,509. At the current rate of rise the number of American dead (41,356 today) will exceed the 58,000 US military deaths in the Vietnam war within 10 days. Coronavirus is rampaging through the record books.

You might expect loss of life at this level to render the dead anonymous, with makeshift mortuaries hurriedly erected in parks and mass burials even being shown on the news. Yet, paradoxically, the sheer scale of the mortality has personalised the illness. No longer is the person with coronavirus “that old chap who lives on the corner two streets away but I don’t really know him”. Now it’s “Mrs Brown, three doors along, used to take the kids to school when I was busy”. Coronavirus has given names to the dead. We all know somebody now. Beforehand, we all knew somebody who knew somebody. It’s getting closer.

For a brief moment, we will know the names. We will know they are or who they were. We will have shared conversations, touched each other’s lives, walked beside each other. And then perhaps, as swiftly as their names emerged, they will be lost again in death’s daily deluge, numbers once more.

It doesn’t have to be like this. We can still change things. But let’s hear no more of that “it’s a bit like flu”. Nor is it “a cough and chills”. You don’t build field hospitals and mortuaries for that. Let’s be under no illusion about this virus. It’s very nasty indeed. We have no treatments. We have no vaccine. We have nothing we can do except prevent the spread of it. So stay isolated and wash your hands. A lot.

The propaganda battle

In any war, truth is usually the first casualty as information and misinformation, news and fake news, battle it out for our attention. But at the same time, accurate information on the battlefield is essential in any fight whether it be against human or viral opposition.

Around a week ago, just as we are beginning to make sense of the UK numbers of deaths, one of the daily talking heads (I think it was Sir Patrick Vallance on this occasion) let slip that the daily numbers were relatively inaccurate since there was no time limit on reporting by individual hospitals. In other words Hospital A, up-to-date with its paperwork, might be reporting casualties from the previous 24 hours whereas Hospital B, overwhelmed with workload, might only catch up once a week. Sir Patrick counselled against reading too much into the daily figures because of this.

This makes me angry. Much of the government’s decision-making on when/if to lift the lockdown is based on the much vaunted “flattening of the curve”. If, by their own admission, these numbers cannot be relied upon, how do they expect to make a decision with any accuracy. If the numbers are meaningless, why publish them?

As if this wasn’t bad enough, the government went on to say, a couple of days later, that of course the numbers were an underestimate of mortality since they only reflected deaths in hospital and not those outside. There were no figures for these.

So in other words the data that is published is an inaccurate record of total mortality since it only reflects death in one particular context. And that data itself is inaccurate. We are publishing data that we know to be inaccurate and only partial.

Well why are we bothering?

No, seriously, why are we bothering? Publishing misleading data is a brilliant way of alienating all the people who have self isolated over the last several weeks and who fervently believe that their privations will be reflected in that flattening of the curve. In other words, pretty much everybody. 15,000 deaths. But it could be 10,000. Or maybe 20,000. Who knows.

And then, guess what?

In the last couple of days comes the admission that deaths in care homes have not been recorded at all. The National Care Foundation estimates that some 4000 deaths in care homes have gone unrecorded. And of course care homes are not hospitals, so the data is unrecorded.

I just throw my hands up in despair when I read this kind of information. The truth is that we have no idea how many coronavirus -related deaths there are in the UK. It could be 10,000. It could be double that. But how on earth are we meant to put together any kind of rational strategy to deal with the illness or timeframe to manage the social dimensions without accurate information.

And that’s just the mortality statistics. Don’t get me started on the issue of testing where we are lamentably slow and unfocused. Are we testing the frontline workers to ensure that they are safe and cared for? Are we testing the population of the country to get an idea of overall virus prevalence? Are we testing for antigens or antibodies? What exactly are we doing? Apart from nothing that is.

I’ve said it before and I’ll say it again because the analogy serves us well. This is a war. In any war you need accurate intelligence on your enemy. That intelligence, on strengths, weaknesses, numbers and disposition is essential to the development of any strategy for attack. Without intelligence we are fighting blind. And we cannot even work out if we are winning or not. Hard to believe but we are losing the propaganda war to some miserable little strand of RNA.

Can somebody go and dig Boris out of Chequers and remind him that there is a war on.

Norman Hunter RIP

Norman Hunter  (29 October 1943 – 17 April 2020) .

An appreciation of the great Norman Hunter and Don Revie’s mighty Leeds United of the late 1960s and early 1970s [from my 2012 book “A Piece of My Mind”


Anyone of a certain age who grew up in the tribalistic shadow of the 1966 World Cup, supported a football club. It was simply a part of growing up. If you were a Londoner, it might be West Ham, with their claret and blue shirts, led by Bobby Moore, the last gentleman footballer. If you were unfortunate enough to be born west of the Pennines you probably become misty eyed over Busby’s Babes (a moniker, incidentally, which still makes me think of top shelf magazines more than footballers). But if, like me, you grew up in God’s Country, your footballing allegiances had only one legitimate outlet, at Elland Road, home of the pride of Yorkshire, Leeds United.

Being in my mid-50s, the Leeds United that I remember was the iconic side of Don Revie. To this day, in the same way that Catholics can recite the Hail Mary, I can remember the details of that mighty team — Gary Sprake, Paul Reaney, Paul Madeley, Billy Bremner, Jack Charlton, Norman Hunter, Peter Lorimer, Allan Clarke, Mick Jones, Johnny Giles and Eddie Gray.

 Gary Sprake, a mixture of inspiration and exasperation in goal, was capable of pulling off acrobatic saves of almost balletic beauty and then, from nowhere, gifting the opposition a goal in circumstances that invariably find their way into “what happens next?” compilations. Such as the memorable moment in 1967 when he somehow contrived to hurl the ball into his own net at Anfield. For the rest of the afternoon, the Kop treated him to an unending chorus of Des O’Connor’s Careless Hands. It remains one of life’s injustices that he is remembered more for the tiny handful of occasions he cost Leeds a game than the huge majority where he saved the game.

 In front of Sprake were the Pauls — Reaney and Madeley — two of the finest, yet least celebrated, full-backs in the league at that time. In any other club but Leeds, with its array of talent, they would have been justly feted for their miserly goal allowances. Paul Reaney, the right back, was almost always looking to overlap the midfield, in essence the game’s first wingback, although there was no such term in those no-nonsense days at Elland Road. And at the same time, he was acknowledged even by George Best to be one of the finest man-to-man markers in the game.

 Paul Madeley could and often did play anywhere on the field. Although nominally a full-back he was comfortable even as a winger. During his time at Leeds he wore all the shirts from number two to eleven and, you have to remember, this was back in the days when shirt numbers related to position rather than squad numbers. His retirement, a time for reflection on the many glories of the time, has been dogged by ill-health — a brain tumour in 1992, a heart attack in 2002 and, as if this were not enough, he was diagnosed with Parkinson’s in 2003.

 The Leeds midfield trio of Bremner, Charlton and Hunter were the powerhouse of Revie’s dreams. Billy Bremner, the human embodiment of a fox terrier, never gave up on any ball, never stopped running and harassing opposition players. And when he had hounded an opponent into releasing possession, he would distribute the ball quickly and effectively, usually to Johnny Giles.

 In the same way that Bremner controlled the ground, snapping at opponents’ heels, Jack Charlton commanded the air. Supremely tall and imposing, Jack was more than a match for any centre forward, even “our kid” as he affectionately described his brother Bobby who just happened to play for a team on the other side of the Pennines.

But wearing the number six shirt was the man who, more than any other, embodied the robust physical — even, dare one say, cynical — type of football that defined Leeds United in the early 1970s. If Bremner was a terrier, Norman Hunter was a Rottweiler. Hunter had no illusions about his role. The ball might get past him sometimes. Or the player might. But on no occasion would both pass him. And yet, whenever he was booked or sent off for brutally scything an opponent down, as he so often was, Norman somehow managed to feign a hangdog expression of innocence worthy of Shakespearean theatre. Norman never romanticised his role in the team. He knew his place and recognised that great footballing truth that you cannot play football if you don’t have the football. His role was very simple – get the ball from the opposition. When the Leeds trainer was once told that Hunter had broken a leg, his reaction was “whose?”

On the right-wing was Peter Lorimer, the youngest player ever to take the field for Leeds, making his debut at fifteen. A Scot with a cannon of a right foot, there was no more terrifying sight for a goalkeeper than Lorimer lining up a free kick. Capable of scoring from thirty yards out, pity the poor souls who had to form part of the wall. More than once Lorimer concussed players with direct hits. To my recollection, only one goalkeeper ever saved a Lorimer penalty, and that was at the expense of a broken wrist.

To his immediate left was Allan “Sniffer” Clarke. In a largely homegrown team (difficult to grasp in this age of highly paid mercenaries, but this was the norm then), Sniffer joined the club from Leicester City in 1969, immediately justifying Revie’s faith in him with twenty six goals in his first season. A stylish dribbler, he had that knack, like all the best strikers, of being in the right place at the right time. If Bremner and Hunter were rough purposeful earthenware, Clarke was fine bone china.

And Clarke could have no better foil than the Leeds centre forward Mick Jones, a strong, courageous old-fashioned work horse of a target man. His muscular energy in the middle created the havoc in opposition defences upon which Clarke thrived. I still remember him collecting his 1972 FA Cup winner’s medal, arm in a makeshift sling, his face contorted with pain from a dislocated elbow suffered in the last minute

In the number ten shirt was Johnny Giles, a genial, soft-spoken leprechaun of infinite subtlety and touch, a foil to Lorimer’s sabre. Along with Bremner, Giles controlled the game. Bremner won the ball and Giles would distribute the fruits of that victory. If Michelangelo had been reincarnated as a footballer, it would have been as Johnny Giles.

Completing this glittering side was Eddie “The Last Waltz” Gray. A classic winger, in many ways a throwback to a former era of football, the twinkle-toed Gray would ghost past defenders before cutting inside to shoot or lashing in crosses for Mick Jones or Big Jack. In a team built on the muscular ball winning of Bremner and Hunter, no player better embodied the finesse to which Leeds aspired. Amazingly, in a side that attracted cards like bees round a hive, Gray was never booked.

Don Revie’s Leeds were a Jekyll and Hyde enigma. Playing in an all white strip, an aspirational nod to Real Madrid and their fancy continental football, they somehow never quite achieved what their talents deserved. So often the bridesmaid, rarely the bride.

Never a popular side, Leeds were often demonised by the predominantly southern press for a brand of football that was seen as cynical. Certainly Leeds played a style of football that was, by any standards, physical and aggressive, but it was rarely as calculating as portrayed. And the media emphasis on the decisive, even brutal, tackling of the Leeds defenders somehow shone the spotlight away from the luminous creativity of the Leeds midfield and poetic expression of the strikers.

Even at their worst, they were a difficult side to beat. But at their best, Leeds played champagne football, posturing and preening like matadors. And for nearly a decade, Don Revie’s men were the footballing manifestation of Yorkshire — that unique combination of coal-fired grit and determination, with the poetry and lyricism of the North York Moors. 

When, in 1971, I went away to boarding school, I found myself alone among southerners. Among so many who supported Arsenal, Chelsea, West Ham and Spurs, I was the only boy from Yorkshire there. It marked me out.

 “So who do you support?” they would ask, in plummy Home Counties accents.

 “I support Leeds United” I said.

 And I was proud.

Is it safe to come out?

The media is currently obsessing over when precisely we will be able to stop social distancing, self isolation and quarantine and the many subtle variations on this. The press is hungry for a date, something to work around, some beacon on the horizon for the readers. The concern is that, faced with too distant a date, people may simply disobey.

It’s a very real possibility but, at the same time, it cannot be justified on current medical evidence. Shutdown was initiated on March 23 at which point in time there were 6650 cases of coronavirus, an increase of around 1000 on the previous day. So if we assume that a daily occurrence rate of 1000 new cases per day is enough to shut down the country, it makes sense that a similar figure should be the earliest point at which we consider scaling down the shutdown and starting to open up again.

You can be sure that, once businesses are reopened, there will be an upsurge in the number of cases. How big an upsurge is hard to predict but, if everybody follows their oft declared intention to party, the rise may be sufficient to reinstate the lockdown.

But even 1000 new cases per day hardly amounts to a medical victory. Projected over the summer, that would amount to around 200,000 cases by autumn and around 8,000 deaths. Far from being a medical victory, the figure is more a pragmatic and political decision weighing into the equation the profound sociological, political and economic damage resulting from shutdown.

On purely medical grounds alone, one would wish to keep the social distancing measures in place until the daily caseload had fallen way below 1000. It is currently around five times that figure. If it takes as long to get the caseload down to 1000 as it has taken to go from 1000 up to the present 5000, then lockdowns will continue, on medical grounds alone, for another 3 to 4 weeks. And all of that is based on the premise that 1000 new cases per day was enough to trigger lockdown and therefore would be enough to trigger the cessation.

In all probability, the epidemiologists and statisticians, making their decisions on purely medical grounds, would rather see a much more substantial and sustained reduction in the number of cases than the token 1000 per day. The politicians doubtless view it differently and will be pressing for an earlier release, if only to preserve those businesses that are hibernating rather than simply going to the wall. Already economists are predicting the worst recession in 300 years.

There is of course also the sociological damage. We have never before had occasion to incarcerate the entire country’s population. But that’s fundamentally what we are doing. Social isolation means exactly that and will be a test (is already a test) for the more mentally fragile of our society. What happens when we unlock those dark chambers? Are we ready for the tsunami of mental illness that will likely follow? Primo Levi once said that a major cause of death amongst the Jews post-Holocaust was suicide, often triggered by an inability to understand why they had survived but others had died. There was guilt for being amongst the saved rather than the drowned.

Each of these three caucuses (medical, sociological and economic) doubtless have different ideas of when it will be best to relieve the lockdown. Clearly each must have their say. And all of these factors must be weighed in the decision to be taken, I’m sure, as a compromise between the needs of all three aspects.

From a purely medical stance, one would not, out of preference, remove the lockdown until either significant herd immunity was in place or a reliable vaccine was in place. Herd immunity can only occur when the majority of the population has immunity. In order to achieve this, much of the population has to be infected. If we knew we could fight the infection confidently with anti-viral agents that would perhaps be our preferred course of action. But the problem is that we have no effective treatment for the illness and therefore to infect the majority of the population is simply not an option. Unless of course one is prepared to accept a death toll in the region of 2 million (don’t even think about it, Boris).

So we have no effective antivirals. What about the vaccine, I hear you ask. I’ve been impressed by the sheer number of people who have said that a vaccine will be here by the end of the year. I think they are perhaps confusing hope with reality. We would like it to be here by the end of the year but that’s not the same thing. But let’s look at our record. As far as I know we have never successfully produced a vaccine for any coronavirus (and yes, there are others – the common cold for instance). So we’re back to square one – our only weapon against coronavirus is to cut of the route of transmission, which means social isolation. The problem with social isolation is that not only do you cut off the route of infection but you also prevent the development of herd immunity. And if you have no herd immunity through infection, the only way is to generate immunity by vaccination and we are still a long way off. Isolation prevents transmission but it also means that people do not have immunity. It’s a catch 22.

In truth, the only solution will have to be one that balances social, economic and medical dimensions. In order to save the economy, we may have to accept a certain level (and likely a high level) of mortality to preserve society. In the end comes down to the disparity between the rationales for imposing and lifting the lockdown. We made the decision to impose a lockdown on purely medical reasons. Economic and sociological implications were given barely a thought. And nor could they have been – the mood of the populace called for action. The government more or less had to respond. But as the lockdown has bitten hard, it has become apparent that we simply cannot sustain a lockdown on medical grounds which might last as much as a year. At that point there would be no economy left and that itself will have taken a toll in terms of suicides and deaths due to deferment of routine and nonroutine surgery and medication. Either way lives will be lost due to coronavirus whether explicitly or secondarily.

Some seriously tough decision making ahead. And I wouldn’t want to be in Boris’s slippers.

Home sweet home…

I’m very fortunate. I have a house with a garden. During the current lockdown I can escape my four walls, weather permitting, and sit in the garden. I’m doubly fortunate in that I have very little work to do and such as there is can be done using a laptop. For me, the lockdown makes very little difference. My friends are largely international, at the end of a messenger or Skype video call. I see them as much today as I did before lockdown. And since my car crash in October, I no longer drive. My friends, the local ones, help out with groceries and so on. Nothing has changed. And of course there is always Amazon if my penchant for retail therapy periodically gets the better of me.

I feel sorry for office workers, compelled to work from home and deprived of the water cooler conversations and office gossip. “You’ll never guess who she’s going out with now – yes, Brian from accounts. That’s right. Gold digger!” Or those compelled to work from home at high power jobs whilst attempting to keep young Freddie or Florence entertained or educated. Who can forget that wonderful video clip last year of the South Korean correspondent attempting to conduct a Skype call with his children invading the room. A brief but wonderful moment where the reality of family life imposed itself upon the illusion of business as usual.

But I feel especially sorry, really I do, for those in flats and bedsitters, unable to leave their cells during the recent sunshine. I feel sorry for those confined against their will with abusive partners, the home a weapon of oppression not sanctuary. Or those Eleanor Rigbys, deprived of what little social contact they have, sinking deeper into that mire of loneliness and depression. For them, lockdown is no mild inconvenience. It amounts to a severance of their lifelines. We should not underestimate how narrow is the mental health precipice along which many are walking. Everyone is facing tribulations of some sort, tests and trials of their resilience and fortitude.

Comparisons are drawn between the deprivations our parents and grandparents had to endure during the Second World War and those that we face in this conflict, fundamentally the Third World War. We may be fighting germs rather than Germans but it amounts to the same thing. And in some ways it has drawn out the same Dunkirk spirit if you will. The same determination to resist. Comparisons have even been made, somewhat laughably, between Boris Johnson’s press briefings and Winston Churchill’s speeches. Hard to believe that there are people out there who cannot distinguish between a blonde buffoon’s stuttering utterings and the timeless oratory of this country’s greatest war leader. But there you have it.

Even at this stage, after less than four weeks of lockdown, some are beginning to ask when this curfew will be ended. As though it was imminent. Maybe that’s how people continue to endure the hardships, by believing in the unbelievable. So let’s be clear on this. Until we have clear evidence that the rate of infection dropping dramatically, there will be no lifting of the curfew. There cannot be. If you believe it will be lifted in the next couple of weeks, you are deluding yourself. We are looking at the beginning of June as a earliest possible date. And in my view, it will be later than that. As far as normal living goes, you can write this year off already. And all of that assumes that we comply with the curfew as it stands, that we stay home, don’t socialise and only leave when permitted. If we fail to do so, the death toll will be even more astronomical.

We are fundamentally mortgaging the entire social structure of the country, indeed the world, in order to beat this virus. And there will come a point when we ask ourselves whether the price is right. There will come a point when we weigh the perhaps irreversible collapse of society against the desire for individual survival. We will have to balance a risky social structure against a future lived virtually as cave dwellers.

How will it end? Will it end? The truth is we don’t have an answer to this. We have done the only thing that we could do to stem the tide of this virus. Isolation. Our only card. And even then, we probably played the card too late. But we don’t know how to end it, how to emerge from our caves blinking in the sunlight at the end of this. Because we neither know what the end is nor how we would recognise it. We can only buy time in the hope that an ending, an ending that will suit us as humanity, can be conceived and implemented. And it’s important that we do. Because, if not, nature is ready with her ending.

An epidemiologist’s dream

There’s no escaping the fact that this is a fantastic time to be an epidemiologist. Often regarded as one of the geeky backwaters of medicine with more hours in the library and behind a computer terminal than actually seeing patients, suddenly it finds itself pushed to the front. Throughout the world, epidemiologists are looking for their shirts and ties, as the media circus draws them in.

And who should be surprised. So much of an epidemiologists career is spent writing papers for dusty journals, looking at small outbreaks of far-flung diseases that people can’t pronounce let alone express any interest. Some 30 years of bookish research, then a chair and the respect of your peers. And as for the general public, you have almost complete anonymity.

Epidemiologists dream of a pandemic. A real monster, spreading round the world in real time. The chance to witness an old-fashioned biblical plague playing out in front of their very eyes. They certainly know about pandemics – they read it in the books. The books written by other epidemiologists. But to witness one first-hand is beyond their wildest imaginings. It’s like all their birthdays and Christmases at once.

Epidemiologists appearing on television! Who’d have thought it. From the token geek on medical discussion panels, to prime-time television with journalists and the general public hanging on every word they say. Graphs and projections. Who could imagine something so big that Joe Bloggs in the pub (well actually in his own home now I hope) would be using epidemiological language and talking of ‘flattening the curve’ and the role of different social behaviours influencing mortality. This is epidemiology.

It’s rather like a physicist being present at the big bang. It’s the stuff of dreams. Yes, there has never been a better time to be an epidemiologist.

Crunching the numbers

The one problem with being a scientist for many years is that you can take the scientist out of science but you can’t take science out of the scientist. It’s in their nature. When I left research science, I didn’t cease to be a scientist.

I still have a scientists instincts, motivations, thoughts and ideas. I cannot leave a piece of data alone without thinking of alternative analyses or different ways of looking at the same. Like all scientists, when I look at data I think “what if…”.

Like so many others I have watched this unfolding catastrophe with a kind of morbid fascination. The same fascination that prevents you from averting your gaze from a car crash. And the numbers emerging from the WHO and elsewhere (Johns Hopkins is a very good page) are fascinating in their insights into each national response to the pandemic. The data are, to use President Trump’s comically inappropriate adjective “beautiful”.

But you have to know how to think about the data. The raw numbers themselves are a code and it’s up to the scientists to decode the information. Let me give you an example.

Take the UK for instance (not that anybody would bother). 8000 cases of coronavirus more or less. 400 dead more or less. On the face of it that amounts to a 5% death rate for the condition. The number of dead divided by the number of cases. 5% is an awfully high figure even for this virus so can it be accurate? Other countries publish much lower kill rates. How can this be?

It comes down to testing. Covid-19 is not the only illness to present with a dry cough. Nor is it the only illness characterised by fever, aches and pains. And it wouldn’t be the first lung infection to mature into pneumonia. So a patient presenting with any or many of these symptoms could well have Covid-19. It’s a fair bet.

But it’s exactly that – a bet and not a certainty. The only way to be sure that it is Covid-19 is to test. Without the certainty of a test result, it is no more than a backed hunch. So it’s clear that you have to test in order to have a firm diagnosis, the correct treatment plan and the appropriate recording of outcome whether good or bad. Individuals need to be traced and tracked through the entire sequence of diagnosis to treatment to outcome.

In the UK, although things are changing rapidly, patients are mostly tested when they present in hospital. Many of these patients will be transferred to intensive care where their outcome will be documented. Not surprisingly, these are very sick people. Many die. So our testing programme in the UK is, until recently, focused on those who present as hospital and are therefore already very sick and thus more likely to die.

In order to get a true picture of the mortality of Covid 19, we need to know how many people in the country either have had the illness or currently have it in a very mild form. We have been told throughout that, say, 4 out of every 5 people who contract the illness will not find themselves hospitalised. We don’t have those numbers because, until recently, it was not part of the testing programme.

Yet these data are critical to our understanding of how the disease spreads and how ultimately it may be defeated. Without this information we are applying controls and measures of uncertain value. Why? Because we can’t assess their efficacy without a knowledge of the whole population. As it stands, all we have is this 5% mortality in the UK. If it turns out that four out of every five recover in their own homes, then we are in reality looking at a 1% rate. Much more plausible.

Don’t get me wrong – an illness which kills 1% of the country’s population, particularly the old and wise, is cataclysmic by any standard. A 5% kill rate on the other hand is apocalyptic.

We also need to be careful of comparing data over different time frames. The number of people diagnosed is straightforward and up-to-date. But the number of the dead does not have the same temporal consonance. Going back to the figures for a moment – 8000 diagnosed, 400 dead – we are looking at different time points. To put it bluntly, most people do not die immediately after being clerked. Patients may be treated for a week, two weeks perhaps, before they die. In this case, the 400 dead should not perhaps be compared with the current 8000 diagnosed but with the figure a week ago. Looking at the date of this way paints a more bleak picture. On this basis, the kill rate is much higher.

Let’s also factor in health service resources. The death rate obviously bears a relationship to the provision of ventilators and staff to operate them correctly. If the number of intensive care beds needed falls below those available, then patients are in with a good chance. If on the other hand the number of beds needed exceeds those available, the outcomes are inevitably going to be worse. In Italy, demand outstrips availability manyfold and doctors are having to triage the arrivals. Triage, most often applied in the battlefield context but then this is a battlefield, means dividing patients broadly speaking into three categories – those that will most likely survive without ventilating, those that will most likely occupy a ventilator and then die and finally those where there is a realistic chance of improving the outcome by treatment. Only the last category will have access to a ventilator. And the doctors in Italy have found themselves having to make those choices.

When the health service resources are inadequate, the death rate rises dramatically. And this is why when there’s been so much talk about “flattening the curve”. I have seen illustrations with graphs, memes and buckets of water. They all illustrate the principle well, that of keeping demand below supply by flattening out the number of cases per week. And on the face of it it looks reasonably optimistic until you factor in the harsh reality of numbers and acknowledged that even the best estimates put demand way above supply. Our health service already cannot cope and we haven’t even begun this battle yet.

Much is said where we are on the curve relative to Italy. Italy has become the tragic illustration of what happens when you don’t get it right. Complacency for perhaps two weeks when the condition wasn’t taken seriously as led to the present viral holocaust. In turn, other governments have learned or ignored the lessons of Italy. Only time will tell.

That is why social distancing, self isolation or whatever we want to call it needs to be taken seriously. Because this is where everyone of us can make a difference. If we become ill, we may need an intensive care bed. And if we are occupying it, somebody else isn’t. By becoming ill, we are in essence depriving another person of life-saving treatment. So when the Prime Minister talks about everybody doing their bit, this is what he means. We have to stay well so that others can stay alive. It’s that simple. For every one of us that stays out of hospital, somebody who needs to will be able to. This is what flattening the curve is all about. Because if we don’t, the alternative is unthinkable.

Mutation is not all bad

People are already beginning to talk a lot about virus mutation, in essence taking the view that the virus is one step ahead of us in our development of a vaccine. The inference is that with every successive mutation it becomes a more dangerous little chap, and we’re left chasing shadows.

I’m no virologist, let me make that clear. But I don’t think that’s the case. My recollection, from the limited amount of microbiology I have been exposed to, is that with time viruses become less pathogenic. Not always but in general.

Look at it from the virus’s point of view, if it had a point of view. The virus has only one purpose in life – to replicate and therefore spread. Any mutation that improves the chances of doing so is likely to be successful. And vice versa. So in terms of propagation of one’s genome, killing the host is not just rather ill mannered but also counter-productive.

You have to remember that being harmful to the host does not improve your chances, as a virus, of proliferating your genome. Actually a pretty bad idea. If a virus is particularly virulent and kills its host in too short a space of time, it actually reduces its reproductive capacity.

It’s a fine balance. The virus needs the host in order to replicate its genome. It’s best chances of doing that are by reducing its pathogenicity or by increasing its infectiousness during the presymptomatic stages in the host. The latter is perhaps more difficult to achieve so in general viruses become less virulent with time. Presumably mutations which cause less damage to the host allow more opportunities for virus transmission.

There are of course exceptions. The 1918 influenza pandemic was biphasic. The first phase, in the early months of 1918 killed many but the second phase in autumn killed twice as many.

There are no guarantees in virus mutation. Each is in essence a throw of the dice. But to mutate to a less pathogenic form makes the virus more successful in its own terms of replication. From a Darwinian perspective it makes sense for the virus to be less harmful. With time, less pathogenic forms will win out. So my message to the coronavirus is to try and be a little less antisocial. Play nice.

*If a proper virologist has time to skim through these ramblings, I would be very grateful. I don’t want to spread misinformation. Or sound like Donald Trump.