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Collective Action to Personal ResponsibilityThe Big COVID Leap of Faith the Government Wants Us All to Make
Adam Hamdy considers how the public is to realistically assess its own risk from the Coronavirus and ‘live with it’
Collective action over COVID-19 will gradually be replaced by individual responsibility, according to the Government.
This time last year, I was asked to write a report for Health and Social Care Secretary Matt Hancock on the long-term risks of a Coronavirus pandemic. I called for much stronger collective action to protect public health and the economy, advocating what would later become widely known as the ‘Zero COVID’ strategy, which has been followed by New Zealand, Taiwan and other countries.
Zero COVID – or elimination – has been ruled out by Boris Johnson and some scientists who often mock its proponents as idealists not living in the real world. Yet, roughly a quarter of the world’s population are currently living with the benefits of an elimination strategy: greater personal freedom, more productive economies, and lower rates of COVID-19 morbidity and mortality.
It could have been assumed that the advent of highly effective vaccines would only have increased the possibility of treating COVID-19 akin to measles, aiming for its elimination even though we might not achieve it. However, our political leaders have told us that elimination is not an option and, unless the Government has a change of heart or we have a change of government, it seems that we will be stuck with the prospect of a widely circulating virus.
We will have to ‘live with it’ and make our own assessment of the risks we are willing to take.
Assessing Risk
When people talk about risk, they often focus on likelihood – but risk is a calculation of likelihood plus consequence.
There is a very easy way to understand this. If someone offered me £100 to jump from one concrete slab to another located 10 feet away, with a sand-pit in between them, I would probably take the risk and try to make some easy money. Now imagine that, instead of a sand-pit there was a mile drop to the street below. As I stand at the edge of one slab, I can see tiny people on the pavement far below. The risk profile changes dramatically because the consequence is very different. That £100 becomes much less attractive.
Now imagine that there is an impenetrable fog between the slabs and I am told that there is probably a sand-pit there – but there might also be a mile drop. How do you assess the risk?
I don’t know anyone who’s run a fever for nine months following flu. None of my friends were left so incapacitated by a cold that they couldn’t walk 10 metres without the aid of a cane. No one I know has developed a heart condition following a stomach bug.
These, and worse, have all happened to people I know in their 30s and 40s following supposedly mild COVID-19 infections.
Most of us are now familiar with Long COVID. We can see the serious symptoms people are suffering and measure biological changes in their bodies, but we can’t explain what is causing them. More importantly, we don’t yet know how to help these people get better. How do we quantify a risk we don’t understand?
Vaccines have altered the course of the Coronavirus pandemic, but we don’t yet know whether they will prevent Long COVID. Intuition should not be the basis for an informed assessment of risk when the stakes are so high.
The brief history of this pandemic is littered with experts who have been wrong about one thing or another, from the effectiveness of masks, to T-cell cross immunity and the likelihood of a second wave. There are also questions about the duration of protective immunity following vaccination. How will people be able to assess their personal risk as time goes on?
Countries that have opted for elimination strategies will be able to give their citizens data based on the population-scale experiments that they are currently conducting. We, it seems, will have to find the answer through lived experience.
Children and Long COVID
For now, the vast majority of people haven’t been vaccinated and children in particular look as though they are to be the very last in the queue. How do we assess their risk?
They are certainly at less risk of dying or suffering from severe illness in the acute phase of disease but, in addition to rare cases of Multisystem Inflammatory Syndrome, some children are also suffering from Long COVID and are enduring the same as adults: skin lesions, arrhythmias, shortness of breath, fatigue and many other debilitating symptoms.
The advocacy group Long COVID Kids now has more than 1,700 children as members, and it is growing fast. If we are to assess risk on behalf of children, surely we need to know the prevalence of Long COVID in them and whether it has any detrimental impact on their long-term health?
There are some politicians and scientists who dismiss Long COVID as post-viral malaise, but multiple studies have detected raised biomarkers and conditions such as thrombotic microangiopathy in children, neuro invasion in adults, and disruption of the immune, mitochondrial and cellular processes that, along with many other concerning characteristics, distinguish COVID-19 from influenza and its endemic coronavirus cousins.
Presentation of symptoms is being borne out by laboratory and clinical investigation, yet this cohort – one in 10 of those infected, according to Public Health England – and the long tail of morbidity that will follow COVID-19 does not factor into the Government’s ‘living with it’ strategy.
Guess and Hope
We are being asked to take a leap of faith. To jump over the fog that separates the two slabs without knowing how far we might fall.
We are being told to take personal responsibility, but to assess our own risk we need data that answers some of the questions raised in this article – and data we can trust.
This has been a year of U-turns and reversals, so it is not surprising that people are concerned and confused. Rapid shifts of position such as ‘schools are safe’ to ‘schools need to close’ in less than 24 hours hardly inspire confidence.
We now need evidence and data rather than bland reassurances from people who have been wrong more than once.
We can quantify the chance of dying in a car accident, of suffering serious injury riding a motorbike, of serious complications from flu, or developing cancer from HPV infection. All our personal risk assessments are underpinned by the assumption that, if a risk is too high, the government will step in to mitigate or eliminate it. The presumption from many in and around government has been that COVID-19 will behave like flu in terms of the complications and long-term illness it leaves in its wake. We are already seeing that it is quite different, but we don’t know how different.
In the case of COVID-19, the public is being asked to guess and hope for the best. If the Government won’t advocate for the collective action necessary to prevent the additional deaths of tens of thousands of people, it needs to at least provide people with the data to enable them to make informed decisions.
Some may say ‘don’t be unrealistic. COVID-19 has only been with us for a year. We can’t possibly provide that data yet. We haven’t had time to fully understand the virus’.
And that is exactly the point.
Adam Hamdy is an author and helped to organise and write the ‘John Snow Memo’