The following article was written by Dr. Timothy Tomkinson, a medical doctor. 

All governments have an unenviable job. Balancing the immediate and very visual deaths of Covid with the longer-term morbidity and mortality of government policy is an impossible equation and it will be many years from now if we ever know what was right. The precautionary principle suggests we should err on the side of caution, however there are a number of unknown variables about which we are prognosticating. When some of these are known, it may be shown that the lock down was the right thing to do. However, the opposite may very well be true as well.

The Imperial College epidemiology centre has released the worst-case scenario modelling which looks very drastic, predicting hundreds of thousands of deaths. It’s difficult for any government to ignore this, particularly when other countries are taking drastic measures. However, being a worst-case scenario, it’s liable to be wrong. Oxford University differ in their opinion, as do studies from other centres and other countries. This is one example of many regarding factors about which we know very little. A few of these are as follows:

Mortality Rate. One of the most fundamental things about this illness we don’t actually know! It differs wildly in each country. From 130,072 infections, Germany has a 2.5% mortality rate; France on the other hand has a mortality rate of 11% from a similar number of infections and in the UK our mortality rate is 12.7%. Other countries include Italy 12.8%; USA 4.5%; Sweden 8.4%; Australia <1%. Multiple factors will determine these disparities including the respective healthcare systems, the rates of testing, and other factors like government policy. However, it’s fair to say that a response for a virus with a mortality rate of >10% would be very different to one with a mortality rate of <1%. It seems like it will be closer to the latter.

Transmission rate. This affects the number of people who will die, but furthermore it is fundamental for designing preventative policy. We do not know the transmission rate. However, in countries like Australia with a low population density where people drive most places, the transmission will be much lower than in Europe with a high density and a more interactive population. As societies, countries and regions differ in their interactions, so policy must reflect this.

Effective methods of stopping transmission. To the best of our knowledge, this is a disease transmitted by droplets rather than aerosolization. This means the most likely source of transmission is from fomites (3rd party objects like furniture and door handles), where talking or coughing releases droplets of spit onto surfaces which people then touch with their hands and scratch their face. Given the lax approach many of us had to handwashing prior to this, it is possible that simple measures such as regular handwashing and frequent cleaning of surfaces would have a dramatic impact on the transmission of this virus without the need for a government lockdown. It is also possible that without banning anything, our personal choices in response to the threat we perceive would be sufficient to reduce transmission.

Some countries, such as South Korea, Singapore and Taiwan have managed to reduce infection rates by widespread testing, as well as population surveillance in taking routine temperatures. This may work in the UK but it feels like the cat is now out of the bag.

The effectiveness of the lockdown itself. The epidemiology of this disease seems to bare very little correlation to government policy. Germany and France have done similar things yet have wildly different mortality rates. Sweden has done very little at all and has a mortality rate which is significantly better than countries which have taken draconian measures.

Effective treatments. A large part of the global rhetoric around Covid has been to “Flatten the curve”, with a view to having enough hospital capacity to deal with unwell patients and prevent avoidable deaths. We have learnt a lot in a short space of time, including the fact that – unlike similar illnesses – there is a much lower efficacy from medical intervention. Even in Italy, most deaths were not caused by a lack of ventilators. The most recent UK study shows that only 50% of intubated patients survive. Of these, many more will die in the next year due to the physiological strain of being intubated for up to a month. The reason there is discussion about not ventilating people over a certain age or with certain comorbidities is not so much due to a lack of capacity, but increasingly due to the fact that those patients are not only unlikely to survive, but – having been put through intubation – even the survivors are likely to die shortly in a protracted and painful manner. As with any illness it is up to the individual doctor’s discretion and expertise about whether a specific intervention is more likely to cause harm than have a beneficial impact. What if there is a comparatively limited role for medical interventions and that we have to face up to the reality that a large percentage of critically unwell patients will die regardless of what we do?

Whether or not a vaccine will be produced. Ultimately, most national policies are based around the presumption that we will develop a vaccine and then things will go back to normal. However, it is not always possible to find a vaccine for pathogens, and were we able to, it will probably still be the best part of a year away. The lockdown is not sustainable for this period of time.

An exit strategy. Without the development of a vaccine there is no way out of this except herd immunity. If Australia and New Zealand manage to eradicate the disease it will be a Pyrrhic victory, for they won’t be able to open their borders. They also now have massive unemployment due to their own shutdowns. For the UK, being so densely populated it seems unlikely we can eradicate this virus, and even were we to, the same problem of border control would still exist. 

Speaking as an individual rather than a doctor, although we simply don’t know at the moment, my personal view is that when we know some more information about the above, it will be shown that we have over-reacted. I have the strong feeling, like Peter Hitchens, that this lockdown is going to create a mortality and morbidity burden far greater than Covid itself. That said, I don’t think I would have the strength of character to do other than the government is doing. At the moment there are no obvious answers: it was only a couple of months ago that the WHO declared there was no human-to-human transmission. Perhaps that’s why I like practicing medicine, there is a single variable: doing the best we can for each patient with the resources we are given. I don’t envy the prime minister; doctors can’t damn a whole nation by our decisions.

Photo Credit: U.S. Air Force photo illustration by Airman 1st Class Joseph Barron