Dispelling DisinformationIf COVID-19 Doesn’t Kill the Young and FitWhy Can’t We Just Ignore It?
NHS Consultant David Oliver dissects some of the dangerous and dismissive arguments pushed by lockdown sceptics and COVID-denialists
The older you are, the poorer you are and the more long term medical conditions you have, the more likely you are to be admitted to hospital or to die, if those conditions progress or if you get any new acute illness, including COVID-19.
Lately, some talking heads and factions in news and social media have been talking as if this is a revelation, an investigative scoop when it is just business as usual for NHS services whose biggest workload lies in helping people like this.
Let’s dissect the ways some people are using this for propaganda.
‘COVID-19 Only Kills the Old and the Sick, After All’
The insinuation behind this claim is pretty disturbing. As COVID-19 doesn’t kill or harm many ‘normal’ people (i.e. younger, fitter and less socioeconomically deprived), it shouldn’t concern the rest of us. By extension, public health protection measures from behavioural restrictions and changes, through to vaccines or lockdowns, aren’t worth adopting. This is a covert manifesto for age discrimination and discrimination against the old, sick and disabled.
Here are two recent variations on the theme.
The Daily Mail on 21 November carried a piece entitled ‘What they Don’t tell you about Covid’. It has since been widely criticised for a very selective presentation of data and careful reframing of graphs to support its agenda. The author, Ross Clark, wrote:
“So who is Covid killing? To put it simply, the victims are overwhelmingly the elderly and those with pre-existing conditions … 53% of deaths recorded by NHS England up to November were of people aged over 80” with “only 0.7% in people under 40… Only 42 of them with a pre-existing condition… Crucially, 95.6% of those who died of Coronavirus had at least one pre-existing condition.”
Similar data were tweeted out enthusiastically by talkRADIO’s host Julia Hartley-Brewer on the same day, adding in that of those who had died “92% were over 60” and “the total number under 60 with no underlying health problems” was 339.
The numbers are sourced from official ONS and NHS England data. But two main questions arise. Why are some commentators so keen to cite them? And do they offer any constructive help in responding to the COVID-19 infections in populations and in people requiring health care, often in crisis?
The answer to the first is clearly public fatigue over the serious impacts of lockdown and other behavioural restrictions, not least collateral damage for health, employment and the economy, a loss of trust in government and its agencies and a concern that people with non-COVID-19 health needs, like cancer, are being marginalised or harmed.
All of this is understandable. None of it justifies casually writing off people over 60 with some long-term medical conditions as ready for the COVID-19 knacker’s yard and dismissing their rights or their human dignity. And none of the arguments stand up to scrutiny.
Survival of The Fittest is Fine – Until You or Your Loved Ones Aren’t the Fittest
A large proportion of the business of modern healthcare is the support of people with two or more long-term medical conditions. Over 65, at least three conditions are the norm. Socio-economically deprived populations also suffer health inequalities and the onset is up to a decade earlier.
Nearly 12 million people in the UK are over 65 and 3 million over 80. That’s a lot of people to casually dismiss.
Care homes and hospital wards, district nurses, home care teams and GPs surgeries expend a major proportion of their time, beds and budgets supporting these people because healthcare is based on need and their needs are generally greater. Even on our scarce Intensive Care Unit beds, you won’t find too many fit young people with no underlying health problems.
People in these categories are more likely to die than fitter or younger or individuals. This really isn’t news to anyone who understands healthcare and public health. ‘Long term conditions’, especially ones linked to higher death rates from or with COVID-19, include dementia (1 in 13 people over 65), diabetes (around 1 in 16 adults) high blood pressure (about 1 in 4), obesity (1 in 4), as well as cancers and chronic heart and lung disease which also affect a high percentage of the population.
Nearly 12 million people in the UK are over 65 and 3 million are over 80. That’s a lot of people to casually dismiss. These include our own parents, uncles, aunts, grandparents, our current or future selves. These are citizens who have contributed to society, families, workplaces and the economy. They are as entitled to protection and care as the rest of us.
It’s About People Who Survive COVID-19, Not Just Those Who Die
This is not just about deaths or even hospital admissions in people who survive. One in 10 of those affected are frontline health workers who are far more likely to get infected than the general public, despite being fit and young enough to work. They also deserve some protection.
Many others suffer severe and debilitating ‘Long-Covid’ symptoms for weeks. This has now been recognised by the National Institute for Health Research and NHS England.
And it is not a binary choice between services for those with and without COVID-19. If we allow our hospitals to be swamped by Coronavirus admissions this Winter for want of adequate prevention strategies, this will make other outpatient, investigations, procedures and operations for other groups impossible. This will put many vulnerable individuals at risk of further delayed care or of cross-infection when they visit a hospital.
There is neither the space nor the staffing to run entirely separate “cold” centres for non-urgent care, away from main hospital sites. Nor is there the capacity to magically cohort those with COVID-19 (currently around 16,000 in English hospitals – many very sick) in warehouse facilities to keep them away from the rest of us uninfected folk.
Killer Stats and Sound Bites Don’t Make for Workable Real-World Solutions
It might sound plausible to say that we should just protect the vulnerable and let the rest of us get on with our lives. It’s certainly better than a “do nothing, let it rip through the population and wait for herd immunity” approach condemned by both the WHO and Sweden’s pandemic supremo Anders Tegnell as “dangerous, unethical and unevidenced”.
But moving from rhetoric to reality, vulnerable people live in multigenerational households, they rely on the support and company of younger people – whether families or paid care workers. This remains the case even within hospitals or care homes.
We can’t pack them off to a remote island. And if the infection rate rises in the general population they will be infected too or find themselves with too few uninfected people to support them.
Unless the Covid-denialists and lockdown sceptics can serve up some useful solutions with their rhetoric, they need to stop the discriminatory dog whistles.
I can guarantee if it was a member of their own family who got sick, they wouldn’t be saying “they have a pre-existing condition so let them die”.
David Oliver is an experienced NHS acute hospital consultant who has worked on COVID-19 wards throughout the first second waves in 2020 and played a variety of senior roles in health leadership and policy. He writes a weekly column in the ‘British Medical Journal’