In 1968, at the height oflast major flu pandemic, all over the world at least one million people died, including 100,000 Americans. That year AMM Payne, a professor of epidemiology at Yale University, wrote:
In the conquest of Mount Everest anything less than 100% success is a failure, but in the case of a highly communicable disease we do not necessarily have to achieve such absolute goals, but rather we must try to reduce the problem to tolerable levels, as quickly as possible, within the limits of available resources…
On September 21, the British Medical Journal he reported that British scientists are divided between those who believe it is better to focus on the protection of those most at risk of seriously contracting Covid and those who would impose a lockdown for everyone.
A group of 40 scientists wrote a letter to UK chief health inspectors suggesting that they should aim at the “suppression of the virus in the whole population”.
In another letter, a group of 28 scientists suggested that “the great difference in risk by age and health status indicates that the damage caused by unitary policies (which apply to all people) will outweigh the benefits“. Instead, they required a “targeted approach and based on evidence for the political response to Covid-19 “.
After a week, the science writer Stephen Buranyi wrote an article on the Guardian arguing that the positions contained in this second letter represent those of a small minority of scientists. “The overwhelming scientific consensus still supports a general lockdown“, he has declared.
A few days later, over 60 doctors wrote another letter saying: “We are worry due to ever-increasing data and practical experience, which a single answer threatens more lives and more incomes than lives saved”.
It’s a back and forth which will undoubtedly go on for a while yet, although it is hoped that stakeholders will begin to view opposing scientific views and opinions as a gift and an opportunity to be skeptical and learn, rather than as a “Rival camp”.
Scientific consensus takes time
There are issues, like global warming, on which there is scientific consensus. But it takes decades to get there, and Covid-19 is a new disease. Uncontrolled lockdown experiments are still in progress, and the long-term costs and benefits are not yet known. I highly doubt that many British scientists have a clear idea of whether or not pub gardens or university campuses should be closed. The people I talk to have a variety of opinions: from those who accept that the disease has become endemic, to those who wonder if it can still be eradicated.
According to some, any epidemiologist who does not follow a particular line is suspicious or has not done enough models, and his ideas are not very reliable, going so far as to dismiss the ideas of other scientists and non-scientists as irrelevant. But science is not a dogma, and opinions often have to be changed in the light of ever-growing knowledge and experience.
I’m a geographer, so I’m used to this kind of academic hierarchy games played on my head, but I worry when people resort to insulting their colleagues rather than admitting that knowledge and circumstances have changed and that it takes a revaluation.
A grim calculation
Is the cure worse than the disease? It is the question that is currently dividing us. It is therefore worth considering what the answer might be.
We should know how many people would die from different causes, for example, from suicides (suicides of children including) that otherwise there would have been no, or liver disease due to increased alcohol consumption, cancers that have not been diagnosed or treated, to determine the point at which certain policies are taking more lives than they are saving. And then, what importance should be given to those lives lost or damaged in the face of economic consequences?
We don’t live in a perfect world with perfect data. For the children, for whom the risk of death from Covid is almost zero and the risk of long-term consequences is very low, it is easier to assess the negative effects of not going to school or being trapped in homes where domestic violence increases.
For the University students, generally young, a similar series of calculations could be made, including estimating the “cost” of getting infected now, versus the risk of doing it later, perhaps when the student is with older relatives for Christmas. But with the elderly, calculation – even in a perfect world – would become increasingly complex. When you are very old and there is very little time left, what risks are you willing to take? It is famous there declaration of an elderly person: “There are no pleasures worth giving up to spend two more years in a retirement home in Weston-super-Mare.”
A recent article, Published on Nature, suggests that even in Hong Kong, where compliance with the mask obligation has exceeded 98% since February, the local elimination of COVID is not possible. If it’s not possible there, it may not be possible anywhere.
On the bright side, older people everywhere have been protected even with high transmission rates and a general scarcity of resources. A recent study found that in India “it is plausible that stringent home confinement ordinances for elderly Indians, coupled with the delivery of basic necessities through social welfare programs and regular interaction with local health workers, have contributed to exposure reduced within this age group in Tamil Nadu and Andhra Pradesh ”.
However, reducing mortality is not the only goal. For those who will not die, the outcome it could still be a prolonged and severe debilitation. This too must be taken into consideration. But unless you are certain that a particular lockdown measure will do more good than harm overall, you shouldn’t apply it. In 1970, shortly before becoming dean of the London School of Hygiene and Tropical Medicine, CE Gordon Smith he wrote:
The essential prerequisite for all good public health measures is that careful estimates of relative advantages and disadvantages have been made, both for the individual and for the community, and that they are applied only when there is a significant balance of advantages.. In general, this principle has been a solid decision-making basis in many past situations in the developed world, even though quite different considerations such as convenience or industry productivity are introduced into such assessments by contemplating the control of less severe diseases.
The current beliefs of where the balance of advantages and disadvantages is are changing. The rhetoric of the “rival camps” must stop. No single and no small group represents the majority opinion.
* Halford Mackinder Professor of Geography,
University of Oxford
** This article is translated from The Conversation. To read the original go here