WE sure don’t want all this to be happening, so the temptation is to tell ourselves that it isn’t and refuse to face the burgeoning number of coronavirus victims in the overall death rate.
We know the figures for causes of death require interpretation – a death certificate lists them in different parts, from the immediate cause to underlying factors. Quite apart from the reporting lag, it may be quite some time before the official statisticians agree, and recent Office of National Statistics (ONS) figures for this year are liable to revision – even in better times, hospital doctors sometimes have to be chased up for the certificate and now they are up to their eyes in urgent cases.
However, we can compare what’s happened so far with the ONS figures for 2010-2019 to see a general pattern for mortality in this country, week by week.
The snapshot here is for Week 10, which ended this year on Friday 6 March – the first in which we saw a death from coronavirus – to the end of the official flu season (Week 20, which will fall in mid-May.) You’ll see that as winter turns to spring, the average number of deaths from all causes (blue line) trends downward. For further comparison, the orange line is not one particular year but the highest number recorded for each week in those ten years.
The grey line shows the 2020 weekly figures for all deaths, up to 27 March. After a roughly average start, there’s an upturn in Weeks 12 and 13, the latter reaching a new high – but it’s early days. We have yet to see what the last three weeks’ surge in viral deaths will do to the general mortality numbers.
Nevertheless, since this new coronavirus can develop into an excruciating lung-eating disease it is clearly a respiratory ailment, and it so happens that the ONS extracts and records aggregated data on the latter cases separately. Here’s the graph for 2010 – 2019, plus weekly Covid-19-related deaths (info supplied by Worldometer).
Though it’s fair to say that ‘it’s not just flu’, the question yet to be resolved is whether in most cases, Covid-19 is more than merely a horrible end for people who had little time to live anyway, which is one of the popular ‘explain-aways’.
Another problem with the ‘it’s-just-flu’ thesis is that the influenza death toll itself is very inconsistent. A study by Public Health England (PHE) gives the following figures for the five years of ‘flu season’ ending in 2019: 28330, 11875, 18009, 26408, 1692 (Table 7, page 51). As a graph they look like this:
The last year is incomplete (ending Week 15), so I’ve added another column increasing the figure pro rata to show what it might have been – 1,995 instead of 1,692. Such wildly varying numbers hardly look like a good yardstick by which to judge ‘WuFlu’. Perhaps they reflect the choice of vaccine for that season – or which of the circulating strains was dominant one each year – but there may be other factors at work also.
They also invite the question of what we have been doing about influenza, and especially for people in care homes. The same document from PHE says (page 12) that some 70 per cent of all flu outbreaks in 2018/19 happened in care homes, the settings that provided by far the greatest share of outbreaks in the previous two years – so are the residents being protected properly?
Quite possibly not. The homes which responded to a 2014 survey by Public Health Wales (see page 3) revealed that although on average 75 per cent of residents had been vaccinated against influenza, only 10 per cent of care home staff had been given the jab! How is that not a condition of employment?
The old and frail, left to the mercies of often private, profit-making concerns and cared for by underpaid staff (many temporary and going not just from one resident to another but between the homes, as TCW reported here) seem at risk from neglect, incompetence and abuse. Maybe the story of Covid-19 is not so much about the restrictions we are now forced to take to protect the country but the lack of real care and attention focused on this vulnerable group in whose name and for whom social isolation was first mooted.
Debates about the beginning of life are well rehearsed, and many people have taken entrenched positions on the ethics; factually, suffice it to say that in the UK almost 9million unborn have been terminated since 1967, fewer than two per cent on grounds relating to a physical or mental abnormality in the developing being. Parliament has ruled on the subject, and some fear the battle is lost.
At the other end of the journey the law, though challenged from time to time, still forbids assisted suicide, though on the Continent they have been pondering allowing it (with strong public support) even for older people who are merely ‘tired of life’.
What if it becomes an issue of whether we are tired of the old people?
When the Government’s draconian response to Covid-19 first loomed, some weighed the possibility of letting them become victims so that the rest of the country could continue with normal economic life, that ‘spending £350billion to prolong the lives of a few hundred thousand mostly elderly people is an irresponsible use of taxpayers’ money’.
Others argued that the old might need to be ‘imprisoned’ in their home not just to protect themselves but to save the limited bed and ventilator resources of the NHS for those younger.
Yet even under normal circumstances, doctors have to decide who and whether to treat. In the past they used their own judgement and in the main the population respected that. Today with more sophisticated life-saving, but still finite, resources, medics have a formula – Quality-Adjusted Life Years (QALY) – so that they can determine whether it is worth treating a patient, or which of two or more patients should be preferred. In other countries under additional pressure we are seeing new rulings, for example in Italy the over-60s are denied intubation to support breathing.
Here there have already been incidents of NHS pressure put on the elderly to agree to Do Not Resuscitate notices. It’s not just the elderly – a Somerset GP has sent letters to a support group for autistic people, telling them their clients should not be resuscitated in an emergency.
The danger is that hard decisions made reluctantly and under the greatest constraint may eventually turn into established routine, like the cruelty of the ‘Liverpool Care Pathway’.
Are we again in danger of making cold calculations that decide that people in certain categories are essentially liabilities, worthless, disposable? Told you so, say the shades of the twentieth century’s monsters.
It’s interesting that Don ‘American Pie’ McLean said recently that society has become ‘nihilistic’. If the vulnerable have become nothings, what shall we become? What are we now?
Is that the much bigger story that coronavirus has re-catalysed? The abandonment of the notion that human life is special, intrinsically valuable?