Covid-19 Update: What I Got Wrong

About 6 months ago, I wrote this article: Post-Corona Trends: Life After COVID-19.

At the time, there wasn’t much data available on Covid-19, but the picture seemed bleak. I accepted this picture at face value – in fact, I was preparing for a pandemic while the media and government were saying not to worry:

(extracts from my diary)

Watching the Bill Gates Ted Talk a few years back had sowed the seed in my mind that pandemics are not only perfectly possible but pretty much inevitable. Viruses mutate all the time and, despite being against international law, the potential of biological weapons is so huge that you have to expect nation states are at the very least researching them. It seemed only a matter of time before a disease would emerge that posed an existential threat to the human race.

But, in the weeks that followed my initial post, more data on Covid-19 emerged. With hindsight it’s clear that Covid-19 wasn’t as deadly as many feared. It’s not even in the same ballpark.

What follows below is my updated take on Covid-19. I realise the points here aren’t particularly new, but I wanted to write this update because I don’t want to play any part – however small – in perpetuating hysteria and a ‘new normal’ of dispropotionate fear, snitching, and tyranny.

Flattening the curve

Early on in the Covid-19 pandemic the emphasis was on ‘flattening the curve’. Measures to prevent the spread of the virus – social distancing, working from home, avoiding social gatherings, and eventually stay at home orders (lockdowns) – would avoid completely overwhelming the health system.

Number of cases over time with preventative measures vs. without

It was argued that without these measures doctors would have to make heart-wrenching triage decisions. Compund growth would lead to a sharp spike in cases and people would very quickly be dying in hospital corridors for lack of resources to treat them all.

“For an uncontrolled epidemic, we predict critical care bed capacity would be exceeded as early as the second week in April, with an eventual peak in ICU or critical care bed demand that is over 30 times greater than the maximum supply in both [the UK and the USA]. The aim of mitigation is to reduce the impact of an epidemic by flattening the curve, reducing peak incidence and overall deaths.”

Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand

At the time, it seemed most people were fully behind these measures to flatten the curve. Although unprecedented, policies such as lockdowns would buy the health system precious time and save thousands of lives. It was truly inspiring to see ordinarily bureaucratic organisations spring into action and make use of this precious time to, for example, construct the NHS Nightingale hospitals in mere days.

Thankfully, it turned out the curve was nowhere near as steep as the now infamous Imperial College model predicted:

“But such high demand for intensive care never materialised. Just 51 patients have been treated at the 4000 bed medical facility situated in the refurbished Excel Centre in London’s Docklands since it opened. Nightingale units in Birmingham and Harrogate have not treated a single patient, while a facility in Manchester has had just a handful of admissions.”

– Covid-19: Nightingale hospitals set to shut down after seeing few patients, BMJ

Even with hindsight, I still think the decision to construct the NHS Nightingale hospitals was justified. You can only act on the knowledge you have at the time, and the information available in late March suggested the excess capacity would be needed. It was one of those situations where it’s better to prepare and not need something than not to prepare and be left wanting.

So, thankfully, we avoided overwhelming the health system – by a considerable margin. And yet despite this, UK authorities are still imposing strict restrictions in October 2020. These restrictions were initially framed as temporary measures to ‘flatten the curve’, but now the justification for them is to prevent the spread of Covid-19 – a justification that can be used indefinitely. But, as more data comes in, this justification looks increasingly weak in proportion to the danger.

Putting the risk in perspective

“A substantial number of people still do not feel sufficiently personally threatened… The perceived level of personal threat needs to be increased among those who are complacent, using hard-hitting emotional messaging.”

March 2020 paper from the UK Government advisory body SAGE

Given these unprecedented restrictions and the hysteria whipped up by the media and authorities, I strongly suspect most people overestimate how dangerous Covid-19 is – likely by several orders of magnitude.

The table below is from the Centers for Disease Control and Prevention’s (CDC) COVID-19 Pandemic Planning Scenarios:

Coronavirus fatality rate CDC
Parameter Values that vary among the five COVID-19 Pandemic Planning Scenarios (retrieved 6th October 2020)

Scenario 5 (the far right column) contains the current best estimates for the infection fatality ratio (IFR) – i.e. if you contract Covid-19, how likely it is that you will die. The IFR is presented as a decimal here, and converting it to a survival rate % (i.e. how likely you are to survive if you contract Covid-19) we get the following survival rates:

Age Survival Rate
0-19 99.997%
20-49 99.98%
50-69 99.5%
70+ 94.6%

The notion that Covid-19 is only serious for the elderly and those with underlying health conditions turns out to be entirely accurate. Of course, there are anecdotal examples of healthy 20 year olds killed by the virus, but these are rare outliers. I’m sure there are unfortunate people under 40 who’ve died from Alzheimer’s – but this doesn’t mean the average 35 year old should consider themselves at risk.

For comparison, the survival rate of regular flu is roughly 99.9%. This is an average and so, like the table above, you can expect that figure to be lower depending on age (and other risk factors). You can nitpick the exact numbers if you like, but the point is this: The IFR of Covid-19 is in the same ballpark as seasonal flu – it’s not orders of magnitude more deadly like you would expect given policy responses.

The fact that Covid-19 is pretty much only deadly for the elderly (and those with underlying health conditions) is further illustrated by comparing the average age of people who die of Covid-19 with the average life expectancy:

Country Average age (years) of deceased and Covid-19 positive patients Average life expectancy (years)
UK 81 (men)

85 (women)

82.5 (men)

85 (women)

USA 75.3 78.5
Italy 79.5 83.2
Spain 86 83.3
Average (not weighted) 81.36 82.5

I can already hear the objections for pointing this simple fact out: “Oh, so you think we should just let old people die then? That their lives don’t matter?”

Obviously not. I have elderly relatives and would be heartbroken if they died from Covid-19. But I would be heartbroken if they died from anything! And, unfortunately, the older you get, the greater your chance of dying from something gets:

Annual risk of dying UK
Annual risk of dying (from anything) each year normally for England and Wales, 2016–2018

Early on in the pandemic, University of Cambridge statistician Sir David Spiegelhalter wrote a great article comparing the risk of dying from Covid-19 with normal risk in a given year. Sir David describes how your chance of dying from the virus – that’s if you’re unlucky enough to contract it in the first place – is roughly the same as your chance of dying from something in any given year.

“So, roughly speaking, we might say that getting COVID-19 is like packing a year’s worth of risk into a week or two.”

How much ‘normal’ risk does Covid represent?, Sir David Spiegelhalter

And so, because older people have a higher risk of dying in general, they also have a higher of dying from Covid-19.

let's all stay inside until people never die again NPC

Obviously you don’t want to increase the risk of you or your loved ones dying unnecessarily. But does this mean we should reduce all speed limits to 5mph so nobody ever dies in traffic accidents? Or ban sugary or fatty foods so nobody dies from heart disease? Of course not!

Good public health policy is in proportion to the risk it prevents and, now that we have more data on Covid-19, it is clear that the extremity of the policies is not in proportion to the severity of Covid-19.

I’d even go further and suggest Sir David’s already reassuring analysis is overstating the risk of dying from Covid-19. In his article, which was written in March 2020, Sir David uses the Imperial College IFR numbers – numbers that are significantly higher than the more recent and more accurate CDC figures posted above. So, rather than packing a year’s worth of risk into a week or two, contracting Covid-19 might be more like packing 6 months worth of risk into a short space of time! Of course it’s possible you might die in the next 6 months, but do you let that paralyse you into staying home forever?

And keep in mind this 6 month’s worth of risk only applies if you actually contract Covid-19 in the first place!

Are lockdowns justified?

There’s been a lot of debate (although not in Parliament, where government and opposition quibble only over minor details) about whether the draconian policy responses to Covid-19 resulted in a net gain or a net loss for society.

UK Unemployment spike Covid-19Defenders of the lockdowns of course argue that the extreme measures saved thousands of lives. Sceptics, on the other hand, point to deaths potentially caused by lockdowns, such as suicides brought on by isolation and deaths caused by postponing or cancelling cancer screenings. There were, of course, negative economic consequences too – many businesses went under, and unemployment skyrocketed – as well as less tangible effects such as reduced mental health and the long term consequences of taking so many children out of school for extended periods.

My bias is obviously that the extreme response to Covid-19 resulted in a net loss for society compared to more moderate measures. However, I admit that it’s a hugely complex issue and one that’s impossible to prove definitively either way. Each side in this debate gets to point to an unfalsifiable counterfactual world: Sceptics describe how much better things would be if we didn’t have the lockdown, and advocates describe how much worse it would be if we didn’t. Unlike a lab test, though, we can’t run the experiment twice to compare. At best, we can compare between countries. I might, for example, point to the lower per capita death rate in Sweden (no lockdowns) compared to the UK – but there are so many variables to control for with such comparisons that each side will likely end up tweaking these to suit their biases.

And I dislike these sorts of reductionist arguments anyway. It’s an irritating trend these days that everything has to be quantified and justified in economic and consequentialist terms.

The lockdown advocates are both right and wrong in their criticism that “you care more about the economy and money than saving lives!” They’re right that there is more to life than economics and certainly more to life than money. But there’s also more to life than simply being alive like some sort of battery chicken. We should act to preserve life, of course, but not at any cost.

And, for me, the loss of freedom is a cost not worth paying in this case. Not even nearly.

Covid-19 update: risk, IFR, dangerLook around you: We’ve completely overhauled our way of life. You can’t meet more than 5 friends. Sports and social events are banned. You can’t go for a drink in the pub after 10pm. And authorities are bringing in ‘Covid Marshalls’ to ensure compliance.

Everywhere you look there are constant reminders to be afraid: One way systems telling you which way to walk, signs telling you where to stand, everyone wearing masks and shaming those who don’t. It’s particularly depressing seeing the number of discarded masks littering our streets.

And for what? A bad flu.

Until Covid-19, it was common sense that people should decide their own risks. We don’t ban sugary foods, say, despite the fact that they cause heart disease when consumed in excess. We don’t ban alcohol even though it causes liver damage.

We do, for example, ban heroin – because it’s just that addictive and harmful. Even hardcore libertarians can at least appreciate the rationale: Banning heroin is proportionate to the damage it causes.

But unlike banning heroin, lockdowns and similarly draconian policies are not in proportion to the risk of Covid-19. Again, they’re not even in the same ball park.

Let’s say you’re five times as likely to die from Covid-19 than seasonal flu (you’re not) and twice as likely to contract it. Were you anything like 10% as concerned as you are now compared to 2019? Nevermind the ‘rule of six‘, how would you have reacted to a rule of sixty last flu season? Such ideas would have been laughable because they are disproportionate to the risk.

For most people, flu was so far down the list of concerns prior to Covid-19 that it didn’t even register as one. And if you scale that concern up 10x (which is very generous, given the data above) it still doesn’t scratch the surface – much less justify these extreme policies.

Seasonal flu has always been a risk for the elderly and vulnerable and so, yes, we should take extra care to shield them from Covid-19. But even so, government does not have grounds to compel such actions.

Even someone at very high risk – an 85 year old Grandfather with asthma, say – should be allowed to see friends and family if he wishes. It’s his choice. He might prefer to accept the risk and enjoy what time he does have rather than possibly extending that time slightly only to live alone and in fear. What right does anyone have to make that choice for him?

It’s all so inhumane.

Finally, I’m sure there are people who got bent out of shape by my comparisons of Covid-19 to drinking alcohol or driving a car: “But those things aren’t contagious!”

This is basically the objection that freedom to choose doesn’t mean freedom to harm others. However, giving people the freedom to decide risk for themselves – like adults – negates this objection anyway. People who are so scared about getting Covid-19 are also free to choose: To stay safely locked up and socially distanced at home. Public policy could – and indeed does – make provision for such people to avoid social contact (especially the vulnerable, which I wholeheartedly support). But beyond this, why should a paranoid few expect everyone else to accommodate their fear of possibly catching a virus with a >99% survival rate?

This ‘new normal’ meme needs to die. If you agree, please consider signing the Great Barrington Declaration below.

Great Barrington declaration

“As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.

Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.

Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.

As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e. the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.”

Leave a Reply