Corona - An Alternative View

Premise

I have written a lot about Covid-19 over the last few weeks but recently I am getting very frustrated with the us-and-them positioning of both sides of the argument and extreme positions taken by people on both sides of the debate.

Take, for example, the following two statements...

1. Governments around the world have greatly over-reacted to the threat from this virus, implementing ever more draconian attacks on our civil liberties justified by a misrepresentation of the science mixed with a whole truckload of paranoia and fear 
2. The virus is real and has killed 40,000 people in the UK and 200,000 in the US. Some of these deaths were in working age people with no underlying health conditions - health workers for example, who contracted the virus treating others, have died despite being fit and healthy and having no other contributing factors existing – this is one of the most frightening diseases we have ever had to deal with

At first glance, these statements look to be completely at odds with each other. There is no way both can be true. They represent the two "acceptable extremes" of the argument. Yes there are conspiracy theories about 5G and government sponsored genocide but really...the above statements represent the most common extremes of the points of view being discussed online.

Within the argument you have two distinct viewpoints, often driven by a combination of age and your economic circumstances.

The self employed, entrepreneurs and company leaders under the age of 60 tend to identify with the first statement and want us to just get back to what we were doing. Salary earners over 40 and retired people tend to identify with the second and believe that whatever the cost, eradicating the virus is all that matters. The young are typically gung-ho regardless of their employment status and are more interested in not having their social lives disrupted than worrying about either the economy or the implications of spreading the virus more widely.

My postulation within this article is that actually both of the above statements are, to some extent correct that both sides of the debate have significant value to add when trying to engineer a recovery from the current situation.

Covid Facts

The virus is now widely accepted to have jumped species from Bats in India-China into humans - possibly through an intermediate species or possibly due to rural farming practises (human harvesting of bat guano which is also through by some to be responsible for the source of the Spanish Flu in the 1920's).  Bat guano is high in nitrites which makes it a good fertiliser and nitrites were required to manufacture explosives, in demand after WW1.

The virus has evolved to become an effective population control mechanic for bat colonies. By becoming easily transmitted and exploiting an ability to continually mutate (thereby making it "Novel" pretty much every time an individual is exposed to it) the virus is able to thrive within these Bat populations.

The virus is interesting in two ways. Firstly, the fact that it proves to be pretty much asymptomatic for colony members who are healthy, but lethal to the sickest and oldest members of the bat community. This is how the virus has been able to ensure the success of the colony overall - and why you don't tend to find bat colonies that don't have Covid - they burnt themselves out by growing too large or carrying too many unproductive individuals (remember, we are talking Bats here - there is no such thing in a civilised society as an unproductive human).

The second interesting aspect is that the ease with which an individuals immune systems can deal with the threat, is inversely proportional to the initial viral load. The more viral cells you are exposed to at the outset, the healthier and more effective a bats immune system needs to be to beat it. Why has the virus evolved in this way? What is it about a virus that exhibits this property that has meant it becoming so prevalent in vespertilio communities?

As a colony becomes more successful, it grows in size. Good sources of food, water and shelter means that colonies are able to grow and expand. Eventually this will always result in over-population unless some kind of control mechanic is introduced - and that is where Covid comes in. As populations increase, interaction between individuals becomes much more common. They roost closer together, more individuals occupy the same spaces, they hunt together, they pass through the same spaces together. In doing so the bats also shed and share more and more virus. As this happens the "bar" for an individuals immune system to be able to cope with the viral load received goes up. So healthier bats than before succumb.

This means that Covid in bats is a balancing mechanic that continually adapts to ensure the longevity of both the colony, and by symbiotic reliance, the virus.

The Human Condition 

What has evolved as a very successful control mechanic within the animal world now has to be dealt with by human beings. We are essentially ethics and socially driven, rather than simply survival driven. We have worked hard to eradicate all causes of illness and death where this has been possible and live in a world that has become, over the last few generations, so in control of its own environment that the majority of bugs that might cause us to become ill have been almost totally eradicated.

Into this almost clinically clean world we see new viral and microbial threats on an almost daily basis. If you kill all but the most resilient bacteria, the most resilient bacteria become more prevalent. If you treat every treatable illness with antibiotics then illness that is immune to today’s antibiotics will thrive. If you reduce individual’s exposure to microbes then it follows that our innate ability for our immune system to quash them will also decrease. Nature is always working to find new ways to challenge us.

Covid-19 (like its predecessors SARS and MARS) is now prevalent in the human population. These are related to a number of bugs we have been unable to completely eradicate over the years - the most pesky of these being the common cold (HCoV-xxxX) or flu (Covid-7). These virus's mutate quickly making immunisation difficult and are at the heart of the annual Excess Winter Death Syndrome within developed communities the world over.

In the UK, for example, between 35,000 and 50,000 people die every year from Excess Winter Death Syndrome. This is where a usually innocuous infection like a cold, flu or simply poor living conditions react with an individuals underlying medical conditions to cause death. We have become adept at managing many of these issues through things like the winter fuel allowance and the Flu Vaccine and this has resulted in a large decrease in these winter deaths over the last few years - from an average of 50k+ each winter down to 28-30k more recently.

The flu vaccine reduced deaths in hospitals from people presenting with Flu and progressing to and then succumbing to Pneumonia, came down from around 30k a couple of years ago to just 3k this last winter.

The end result of this is a continued reduction in the death rate and a continued improvement in life expectancy. The side effect of this is a lot of people alive who are just one infection away from death - be that a flu bug, Covid, gastrointestinal infections or skin infections (MRSA as an example).

The UK, for example, has seen life expectancy increase from 72 in 1970 to 86 today.  Life expectancy has been continually and significantly increasing over the last 5 decades after being flat since WW2.  

At some point that increase will flatline – it has to.  Over the last 5 years a number of large financial investors have been analysing data and believed that this point was likely to have been reached – which is why you have seen “investment in death” as a strategy for a number of PE firms globally (funeral care being one such sector).

Wealth is also a significant factor in life expectancy.  The difference between average life expectancy across council tax bands in the UK varies by as much as 20 years.  Countries with the very highest life expectancy are those with the best social and healthcare services.  Studies in the US show even greater variances and the lack of effective, universal social care is at the heart of the fact that the US life expectancy trails the UK (currently US is 78).

I mention all of this to highlight some of the challenges in looking at one factor in isolation and trying to make absolute determination of outcomes. I raise the investor point to highlight that a number of statistical models have been predicting an increase in mortality rates was overdue to the point it was worth investing in.  

Transmission And The Relevance of Environment

Covid-19 in humans behaves exactly as it does in bats.  It overwhelms elderly people with other underlying conditions with a relatively low viral load.  At the same time it flits through the healthy population without impact at normal levels of social exposure.  

Our reaction in terms of treatment has been very different to the way we deal with flu admissions.  The standard NHS pathway for an elderly, infirm patient presenting with flu / pneumonia used to be called the Liverpool Pathway.  This effectively meant a “Do Not Resuscitate” notice and the use of opiate based pain killers like morphine that allowed an individual to slip away comfortably.

Covid-19 was seen as something very different (despite the commonality with Covid-7).  Every effort was made to save every patient.  This meant an unprecedented number of elderly and already terminally ill patients being intubated and placed into induced comas within NHS intensive care units.  As NHS front line staff battled through the crisis, they became exposed to very significant levels of Covid-19 virus – way beyond anything that you could have expected to be exposed to in the outside world.  Before adequate levels of PPE were available (largely based on early government and WHO advice that human to human transmission was unlikely), this led to a number of NHS staff who were otherwise young, healthy and fit individuals succumbing to Covid.  

Some of the ways we live our lives these days, particularly in London and other commercial centres, also created significant issues.  Tube trains, with the inherent overcrowding, poor ventilation and perfect temperature for virus survival created perfect transmission points by replicating the overcrowded environments within bat communities that the virus has evolved to exploit.  Nightclubs, with their over-heated atmospheres, over-crowded dance floors and lack of effective ventilation (no longer needed since smoking was banned in communal areas) also provided the opportunity to become un-naturally exposed to large quantities of the virus.

Due to the difference in demographics between the Tube and your average nightclub, the resulting transmission was very different.  Yes, young people in nightclubs became infected and some suffered mild flu-like symptoms but most recovered leaving only those with significant underlying health conditions requiring treatment.  On the Tube, people young and old were infected and in some cases suffering much large levels of individual exposure than you would see in normal social interaction.  This definitely led to additional illness and severe reaction in younger people who would not normally have been affected.

Sitting next to someone on a train who is infected and symptomatic leads to a 3.5% chance of ingesting some virus.  On an aircraft (where cabin airflow is usually good) it is lower than this. Outside in the fresh air during transitional exposure (walking past someone for example) you are talking minute levels of transmission risk.  Yes it is theoretically possible for aerosolised viral particles to be breathed in when walking around a supermarket but all of these represent very low level social exposure that will result in a positive test, no symptoms and your immune system taking care of the issue.

Cramming into a tube train with hundreds of non-symptomatic sufferers without PPE is very likely to results in transmission beyond normal social levels and may (if you are already run down or ill) result in your immune system being overwhelmed.  Many of the cases we saw in London and beyond can be traced back to trips on overcrowded public transport and this is clearly an area where PPE is recommended.

The Actual Threat

Covid-19 is real.  It is also here to stay.  Any sensible investigation into the control and eradication of Covid-19 will conclude that it is somewhere between unlikely and impossible that any action we take will lead to the virus being totally eradicated from humans any time soon.  The percentage of people who would have to be vaccinated repeatedly through the year to bring this about would be so much greater than any previous vaccination programme has been able to achieve that it is simply not realistic.

If you are very old and already ill, it is likely that Pneumonia as a complication from Covid-19 will replace Pneumonia as a complication of Covid-7 as a likely way your life will end.  The debate about this being a true Covid death or just old age is an ethical dilemma I am not qualified to have.  What we need to do is ensure that the Covid count be changed to include some kind of quality of life / life shortening statistic.  The vast majority of Corona deaths to date have involved people who were already dying of cancer, or heart disease, or liver failure or the myriad of other issues you have when you get old – this needs be reflected somewhere in the statistics.

There are high risk environments where failure to be sensible about wearing PPE can cause you to become ill even if you are young and healthy.  These are over-crowded areas and in the treatment of others with the virus.  As the actual point at which risk becomes too great is difficult to pinpoint, it is reasonable to suggest people utilise PPE when in crowded situations.  If you are particularly susceptible then it is probably advisable that you avoid these kinds of situations entirely.

The reality of the threat is that if you are below 75 and healthy, and you are exposed socially to someone with the virus you have a tiny chance of becoming “exposed.  You will almost certainly be asymptomatic and your immune system will sort out the problem.  You will TEST positive as you will have suffered exposure and there will be traces of viral DNA in your system, but you are extremely unlikely to get ill.  The majority of positive tests are people in this group – exposed, asymptomatic to very mild symptoms, no further intervention required.

The next largest group of positive tests are actually false positives.  The people who designed the tests state that a false positive results of 0.8% is to be expected…that means that if you tested 100,000 people from a remote island that has never been exposed to Covid-19 ever…you would see 800 false positive tests. The UK is currently testing around 1.5m people per week…so we can expect up to 12,000 false positives per week.  That when combined with the previous asymptomatic groupm leaves a tiny percentage of genuine “infection” requiring intervention or presenting risk to life.

At the outset the health service had no idea how to manage the virus during the early stages and were often unable to prevent the onset of pneumonia, especially in elderly victims.  Intrusive intervention (intubation, intensive care, induced coma’s) were utilised often undertaken by NHS staff who were misled by China, the WHO and NHS management about the risks of being exposed to large quantities of virus. This led to a number of very poorly NHS staff, some of whom succumbed to the huge viral loads they had been exposed to and died. 

We now know that PPE is required by all healthcare staff working with the virus and have identified new, viable ways of managing the virus at its early stages to ensure people do not go on to suffer more severe symptoms and death.  Death rates for patients admitted to hospital with Corona have plummeted. The number of people who end up in intensive care after presenting with Corona has also plummeted.  The number of NHS staff ending up with severe illness due to infection has reduced to effectively zero.

This is an unpleasant disease which, if you are susceptible, can make you quite poorly (certainly bed bound for a week or so) and, like many other viral infections, can leave you feeling ill, weak and not yourself for many weeks afterwards.  To compare this to the Flu is actually a reasonably fair comparison…to compare it to a cold certainly is not.  Influenza is actually quite an impactful disease.  People suffering from influenza are forced to their beds for 3-5 days and can take weeks to recover.  We should draw a distinction here between Infulenza and a bad cold…which is what most people are actually suffering from when they say they have the flu.  If you suffer significant, extreme exposure to large quantities of virus, which then multiply quickly in your body and overwealm your immune system, serious illness and death can result at any age, without contributory underlying conditions.

The Fear Factor

The key factors driving the paranoia and fear surrounding this disease are many and varied.  There are huge socio-political issues at play and fundamental changes in the balance of power that may be driving a politically led, rather than science led, approach to the problem.

The WHO has overstated the risk, potency and transmission of this disease as they have in the past with outbreaks of SARS and MARS. In a very real sense this would have been a third strike and out for this dysfunctional organisation if Covid hadn’t turned into something substantial. Almost no real context to the advice, the stats or the science has been published and there is no attempt to stop similar outbreaks in the future.  

The inactivity of the WHO, beyond Pepper Pig telling us to wash our hands, is symptomatic of this organisation and its approach to public health.  Almost no preventative steps are taken, no restrictions are placed on activities that carry high risk (Bat Guano gathering in IndoChina, Wet Markets that provide rich environments for the transmission of illness etc) but they are happy to recommend arbitrary use of powers to restrict life in the developed world.  The politics favoured by WHO decision makers and team members would be an interesting study – anti-capitalist, anarchistic, communist sympathies?  Who knows – but their assault on western values has been continuous for the last three decades and is now proving devastating to capitalist democracies all across the globe.

News media have picked up on the outlier cases (younger, healthy victims) and used these to create sensational stories about the risks posed to the general population – this makes a good story but greatly skews public perception as to the risks.  It is their job to take facts and make the best story they can – but as has been repeatedly seen over the years, the news media are happy to make up or ignore more inconvenient facts when it suits them.  Fake News didn’t start on the internet or with Covid or with President Trump.

A significant increase in populist governments around the world means a media led response to any global issue becomes inevitable.  Governments that are not ideologically led and rely on the wavering and fickle support of the people they represent are less likely to lead and more likely to play to the wants and desires of their supporting electorate.

An aging and frail elderly population in developed countries who have been protected from most of the bugs and diseases that might bring out their demise provided a rich seam of victims for the disease.  We have done amazingly well increasing the average life expectancy from around 72 to around 86 in the last 50 years.  This increase has a cap and at some stage the death rates were always going to go up again.  Has this inevitable adjustment coincided with Covid to create the large numbers of deaths and does it play into the impact Covid-19 has had that MARS and SARS did not?

News media and government have used the death tolls out of the context of total / normal mortality rates to overplay and sensationalise the number of people dying after exposure to the disease – this produces sensational numbers and a better story.  People are genuinely shocked to learn that the percentage of deaths from Covid represents circa 10% of all deaths and that since the beginning of May, death rates overall are actually falling significantly rather than increasing.

The number of people dying from the disease have been inflated by the use of very unscientific methods of recording deaths.  Initially the measure was “Covid is mentioned on the death certificate” – this resulted in around 11,000 thousands of deaths from a number of other causes being falsely recorded as Covid.  The current (tested positive within 28 days of death) approach also greatly risks overstating as we have no clue as to the health of the individual prior to the test.  Did a terminal cancer patient who had been given 6 weeks to live who tests positive in week 3 and dies in week 6 from Pneumonia as a complication of Covid die of Covid or did they really get ill because of Cancer and the virus had no impact on their life expectancy?  Should someone who was killed in a car accident after testing positive for Corona be counted as a Corona death (accidental death, Cancer and Heart Disease are responsible for the majority of deaths in the UK – statistically it is likely that a large proportion of the people with a life shortening underlying condition were tested, and tested positive (false and real) in the weeks running up to their deaths).  Should we be counting these in with the Corona numbers? Are we in fact?  

False positives are almost as likely as a true positive test.  We should be filtering these out accordingly.  75% of people tested pre-selection where asymptomatic.  Since symptomatic selection was introduced, this dropped to 25% – because to get a test you have to claim to have symptoms.  What is interesting is that the percentage of positive tests has increased, but not in proportion.  How many of this swing of 50% symptomatic are making up symptoms to get a test (the worried well).  A demographic breakdown of those being tested would be really interesting.  Is the system being swamped by the middle class worried well and their children – most of whom have little to fear from the virus? We don’t know because no-one is sharing the data.  I did see some data that suggest the majority of demand in September was from children or healthy younger parents.

The false positives are such a high proportion of the positives recorded that they are materially affecting the public’s perception of the numbers and being used maliciously by some of the experts as proof of threat.  If you pre-select those who can be tested, you will inevitably drive up the true positive count, the false positive count will remain and the result will be less negative tests. That doesn’t mean an actual increase in transmission. The testing approach, when looked at from the perspective of measurement compliance, fails most of the accepted tests for accuracy.

The political landscape across the world has never been so volatile.  People have never been so influenced by their peers rather than the state. As a result, populist governments have been elected the world over.  It is a widely held belief that the power and control of the state has been greatly undermined by these new information channels and the people who govern us have never been under as much scrutiny.  In this landscape, you could understand why the political class might want to redress the balance of power and how this pandemic may be seen as a lever to do this without de-stabilising governments core voters.  The scrutiny has exposed big gaps in the ethical and honesty of some in power and this has had the effect of turning many young people away from politics, putting the balance back into the hands of the older generations.  With this backdrop you can see why there might be a willingness to trade the lives and prosperity of younger people, who don’t tend to vote, for the protection of the older people who do.

Totalitarian regimes have for decades used a three step plan to control their people. First, control the information flow – make sure that whatever happens, the people hear your version first last and always.  Secondly, stifle dissenting voices – never allow anyone to gain prominence through challenging what you do or what you say.  Finally fear – keep the populous fearful that any deviation from the official line will be reported and acted on.  Encourage the Populus to self manage through the use of informants and make people feel as though any deviation from the rules will be met with draconian punishments meant to send a message rather than apply the rule of law.  In this internet age of free flowing information, only Fear remains as a viable lever.  We are now seeing these basic principles being applied to what were liberal democracies and this is a very worrying trend indeed.  Stifling debate, only soliciting advice from those who will tell you what you want to know, controlling the conversation and keeping the electorate in fear has become a growth industry in 2020

The Impact Of The Response

In the UK, the cost of Corona is likely to be 30-40% of GDP in 2020, plus the cost of measures to protect the economy plus the ongoing financial, social, medical and mental health impacts that will come about due to the restrictions that have been in place.  There will be an effect on GDP through until 2025.

At the end of July, the cost to the UK was estimated to be ￡1.4Tr. This was the cost of the stimulus packages, a recorded 25% drop in GDP, increased unemployment and NHS costs.  The expectation at this point was that the worst was over and the country would start to return to some kind of normal.  This hasn’t happened and, with the latest announcements about further lockdowns and second waves, there is now a general feeling that this recovery won’t begin until Q2 2021.  With that in mind a total cost to the UK economy of between ￡2.5-3Tr would probably be optimistic.

Never before has the country faced a downturn of such massive proportions.  As a service industry led economy we now face a catastrophe the likes of which has never been seen before.  The cost of government responses to Covid dwarfs both the 2008 crises and the Great Recession – even when you adjust for monetary values over time.  Make no mistake this is the defining fiscal event of the 21st century.  

Back in the Great Recession the suicide rate in the US ran at 22 deaths per 100,000 people per year.  As a comparison, Covid currently runs at 62 deaths per 100,000.  So you are only 3 times more likely to die of Covid than you are from committing suicide. The suicide rates went on for a number of years though, so this evened out. If you break this down by age group then back in the late 20’s, age 45-60 and living in a recession way less damaging than the one we are facing, the suicide rate was 75 deaths per 100,000 population through the course of the great depression.  As a comparison, death from Covid per 100,000 in this age group was below 50 this year and is trending to be very, very much less in future due to changes in the way we manage the disease and the use of PPE within healthcare settings.

This is a frightening statistic for a couple of reasons, one – it shows that an economic failure becomes a significant impact on mental health and results in a big increase in suicide rates.  Secondly because the suicide deaths remain high over a number of years whereas the covid death rate has dropped sharply since May.  It is not inconceivable for Suicide Deaths, Post Covid Economic Failure, to be 3-4 times the number of actual Covid victims in this age group.  Add to this undiagnosed cancer, heart disease (increased through stress), obesity etc and you have a very worrying outlook for public health that will make Covid look almost irrelevant.

Suicide is already the leading cause of death in the 20-49 year old age group and you can expect this to continue to rise significantly as this is the age group likely to be most disadvantaged by the problem.  Heart disease and cancer are the main cause of death in the 50-64 year old age group and this is likely to increase greatly following the impact of Covid on the NHS drive for early diagnostics. Heart Disease is the biggest killer in the 65-79 age group and Dementia in the over 80’s.  

Deaths from these causes so far this year dwarf Covid in every one of these age groups except the very oldest. Almost all (somewhere between 90% and 98%) of Covid deaths were in people with life threatening underlying conditions, the fact that the underlying cause of death in a medical context was Covid needs to be combined with an estimate of the individuals chances of dying in the next 1, 3, 6 or 12 months.  This data is held against every patient in the UK and it would be a very interesting statistic to be able to quote. We would then be able to see how much real impact Covid has had on death rates in the UK.  We know that a significant number of deaths occurred in April and May but the decline in overall death rates since suggests that rather than being truly additive, Corona has pulled deaths that would occur in the next few months forwards slightly.  13.7% of all deaths have been attributed to Covid year to date but this is hugely concentrated in sections of the population already likely to suffer mortality in the immediate future.  

Summary

There is no question that for many people, Covid has been the reason their very long lives came to an end. This is not in doubt and the notion that this is a bad cold that could be ignored is nonsense.  That said, we have committed our current and future generations to a hand of cards that mean they far less likely to live the kinds of lives their parents did in a world far less comfortable or generous than the one their parents enjoyed.

Our continued reaction to this virus is shortening lives and damaging livelihoods of everyone every day that restrictions remain in place.  There is no balance here…no one is weighing risk against opportunity cost.  The perilous state of the Western economies will be felt deeply, and be the cause of more anxiety, upset and distress than the virus could ever hope to cause.

Every time we react to a perceived “problem” there are consequences.  This is why government and politics exist – to ensure that any response is proportionate and not ultimately more damaging than the issue we are trying to resolve.

For all of the reasons mentioned above it appears that the normal controls, checks and balances of government have failed and that we are embarking on ever more draconian, damaging and totalitarian responses to what is a significant, but manageable problem.

There is no question that the government needs to listen to expertise other than people with an absolute vested interest, whose though processes are constrained by years of intense focus and risk aversion.  Whitty himself said “you can’t expect people who have spent their lives chasing down viruses to suddenly choose to let one run freely through the population”.  This is the key to the advice they are giving – to not act is a completely alien concept to them.  Both Whitty and Valance are so obsessed with the threat from the virus that they have lost perspective and balance of everything else.  The only thing that matters is the virus.  Everything else is secondary.  This point of view needs to be in the debate – but it cannot be the only point of view.

To every action there is a reaction. A sometimes disproportional, occasionally exponential reaction of unexpected but ultimately predictable consequence that need to be considered through careful examination from all sides of the debate.  Regardless of your views on Corona, no one can pretend that this full, frank and open assessment from all sides of the debate encompassing all elements of the argument has happened in recent months.

It may be that some form of social control is required at times to protect our hospitals.  It is definitely a good idea to keep those at greatest risk safe until there is a vaccine.  The debate that needs to happen is how we do this without consigning the rest of us to decades of poverty, pain, stress, mental health, declining levels of healthcare and loss of livelihood.

We are at a turning point, but not in the way the government likes to talk about the issue.  The turning point is how we minimise the damage already done by getting back to normality in such a way that keeps our elderly safe and isolated from this virus.  That is the challenge.  Unfortunately, as we stand today, that is not the conversation.

We need to move away from our bi-polar view. The world isn't black and white or shades of grey. It is a huge myriad of colour with nuance, variance and depth. To pretend that either side of this debate has all the answers is crazy. What we need is to broaden the conversation, add a bit of proportionality, a dash of empathy and a little bit of common sense. We need to look beyond the immediate issue and put it in the context of the unexpected consequences of our actions might be. If we fail, the echoes of this economic disaster will continue to be heard long after Covid is replaced in our consciousness with the next challenge we face as a species.