The problem right now is that there is a balancing act being played out between medical science and political pragmatism. If science had its way the lock down would extend indefinitely until there was a vaccine or a treatment for Covid19.  Medical science has been guiding decisions so far, but treating the country as if it were a giant hospital won’t work in the long term. Businesses closed, mass unemployment. People cancelling their malignant cancer operations they are so scared of being in a hospital. Strokes and heart problems unattended. Mental health issues.  Other problems have not gone away.  Covid19 is not Ebola.  Everyone is not going to die.

The reality of politics means that some people are allowed to tell the rest of us what to do. Few of us dwell on the underlying trade-off between personal liberty and collective choice: it is built into our constitutions and democracies — the social contract.  Philosophers such as Thomas Hobbes (in 1651) and Jean Jacques Rousseau (in 1762) were thinking about this, the legitimacy of government and the science of morality, hundreds of years ago.

The point is, individuals consent to surrender some freedoms and submit to the authority of the state (the people we elect in a democracy) in exchange for the protection of their remaining rights and maintenance of the social order. The troubling bit is what will the state do with its power? 

Here, we were given a date, 5th May, when our good behaviour would be rewarded with more freedom.  We have fulfilled our side of the recent bargain the state made with us — to permit a police state/house arrest in the short term.  We have successfully suppressed Covid19 in the community while preparations were made in hospitals, staffing, beds, equipment, PPE, ventilators — these actions are to be highly commended.  And of course we need to maintain social distancing in public, hand washing, hygiene etiquette. and we must remember that the government has the right to bring back another lockdown should it be needed. 

But now the politicians need to show courage and consider changing to a hybrid of the models used in Sweden and South Korea in the following way.  

Vulnerable members and over seventies are still advised to continue to cocoon.  If they choose not to (cocoon), and in my view they should be free to make this choice, the state must make every effort to ensure they understand the risks.  This includes the risk that the health service is overwhelmed; that there may not be a bed for you; that you may be triaged, put further back in the queue, behind another who is deemed more urgent.  This is similar to educating people about the risk of smoking, overeating, undereating, lack of exercise, poor diet, excessive alcohol, crossing a busy road, or getting into a boat without a lifejacket. 

The South Korean model (which has kept deaths to a minimum) uses an algorithm:  Leave the house and go to a public space the authorities have the right to take your temperature.  If you have a temperature you are not allowed to return home, you are brought to a centre for follow up with a chest x-ray and then a Covid19 test if indicated.  If you test positive for Covid you are isolated and treated in the centre until you are negative.  Comprehensive contact tracing follows up to test all those you may have infected.  This kind of authority and right of the state I would support.  

In Ireland in 2019 there were 8,618 deaths in the first quarter.  On average this is equivalent to seventy-one deaths per day.  Yes, the death rate will be higher for 2020 due to the coronavirus, but shouldn’t the daily expression of regret and sadness about Covid19 deaths be extended to all the deaths in Ireland that day?  
It is not okay that we have allowed people to die without their loved ones seeing them, that they are buried without ceremony or celebration, no loving goodbye.  A way must be found for families to visit elderly relatives and to maintain social contact.  We need hope now, and this hope is nothing simpler than the freedom to see and hold and be present with the people we love.

#coronavirus #covid19 #TheState #social-contract #lockdown

© Alison Hackett 8 April 2020

I love the Guardian.  Every day it my reading go-to place as it offers high quality free online news.  Rare these days.  Don't forget you can donate to support its journalism. I do. 

However,  the frightening headline to an item on the Guardian's news blog stream in recent days made me pause. It stated that "The death rate of those admitted to intensive care with Covid-19 has topped 50%, according to the latest figures". The post was made at 08.11 on 4 April and based on data compiled by the UK’s Intensive Care National Audit and Research Centre.    

But on a closer look I realise this is an incomplete audit of 2249 patients as all outcomes are not yet known (although it is being conducted in real time).  To present the mortality rate of less than one third of the patients in the study sample “whose care outcomes are known” is cherrypicking from the data, and thus misleading.  Outcomes are still not known for more than two thirds of the group ("1559 patients still in critical care").  To a causal reader it might appear that 50% of people in intensive care with coronavirus were going to die.  

​Now that I'm checking my facts for this blog I have just found an almost identical report in the Mirror — so which came first in this misleading report, The Guardian or The Mirror?  Looks like the Guardian posting at 08.11am (but I can't find and prove that post anymore).  Either way it is a good example of how all the news these days (as it probably ever was) is recycled. Fake or not. 

A more measured approach is to wait to see how many of the remaining patients in critical care die, and how many recover to be discharged. Then, and only then, is it right to compare a possible coronavirus mortality rate with a historic rate for seasonal flu between 2017 and 2019 (which has 100% known outcomes, i.e. hindsight).  Indeed coronavirus is likely to have a higher mortality rate, but lets wait for the facts, i.e. all the data, before jumping to conclusions. 

It's a fact. There are lies, damned lies….and statistics. 

#coronavirus #covid19 #TheGuardian #statistics

​© Alison Hackett 8 April 2020