Latest Thoughts on the Pandemic

Written on 03 May 2020.

Author : Dr. Christopher Payne from UK

The coronavirus pandemic from the perspective of a doctor practicing in the UK (1.5.20)

In my opinion, the UK government have handled and continue to handle the coronavirus Covid19 pandemic well, all things considered.

There seem to be three variants in the presentation of Covid19 in Britain. All those affected have an elevated temperature, if only for a day or two but sometimes longer.

Then the patients can be divided into the coughers, the anosmics (smell/taste disturbance) and the exhausted. The most frequent patterns in Britain are the anosmic and the exhausted. Some unlucky patients get all three and of course there are rarer presentations, including cutaneous ones, such as Covid toes. For the vast majority of people, the illness is not any worse than a very bad flu.

Severity is age dependent, being so trivial that it usually passes unnoticed in children.

In young adults in most cases, the illness is so mild as to be difficult to be certain it has happened at all.

In the elderly, especially males and the obese, particularly in Black and Asian patients, the illness can be very severe, especially if there is also dementia, obesity or hypertension (metabolic syndrome) or concurrent serious ill health.

Doctors realize that the lockdown reaction to the pandemic carries very very big risks, not only to the economy but also to people’s health. GP services, outpatient services and non-urgent operations have more or less ceased with the UK “s extreme lockdown and this carries large risks (e.g. undiagnosed early cancers, late treatment of new cancers, mental health problems exacerbated by the lockdown).Any dentistry is extremely difficult to access anywhere at the moment. Children’s education is suffering.

If we concentrate too much on the overall daily or cumulative death rate, we will lose perspective. It is normal for 1,600 people to die every day in Britain. Over and above the normal death rate are the 25,000-50,000 people who die from excess winter mortality every year from flu and other respiratory diseases, these deaths are usually in old people.

The current death rate from coronavirus is not terribly dissimilar at the moment and most Corona deaths are amongst elderly people. The median age of the dead is over 80. As is usual with excess winter mortality, flu and pneumonia, 40-60% of deaths from Covid19 are occurring in particularly vulnerable people in nursing or care homes. Only about 1% of the deceased have no other serious illnesses (Swiss propaganda website).

Moreover, the current recorded death rate from coronavirus is greatly exaggerated as anybody who dies with coronavirus is counted as a death due to Coronavirus which is absolutely (and almost fraudulently) wrong medically, epidemiologically and scientifically.

The problem in this pandemic, both medically and politically, is the sharp and viscously pointed tip of the Corona iceberg, which is the mortal illness it causes not only in the elderly but also in a very small proportion of people under the age of 60.A very small proportion, 0.1%,of the whole UK population under 65 years old is a lot of people (0.1% x 55,000,000 = 55,000 people) .It is these unfortunate people who have been overwhelming intensive care units across the country. There have been so many many more very serious ill, relatively young people in this coronavirus epidemic than is usually the case during a standard or bad winter flu epidemic. There have been so many that intensive care units have been almost unable to cope. Taking the load off the nation’s intensive care units has been the primary aim of the UK government policy of lockdown. The lockdown has slowed the rate of new cases and therefore the rate of new severe cases. The opening of the new field hospitals has increased the NHS” s capacity to care for more bad cases. Both have helped take the load off the nation’s intensive care services.

Now that the peak of the surge of intensive care cases has passed, which probably happened in the last 2 weeks, then the aim of government policy should return to that seeking herd immunity among the under 60s, so that the epidemic can wane which will then allow the over 70s to emerge from isolation and return to life again, even if a vaccine is never discovered. It must be a form of torture for a grandmother not to be able to hug her grandchildren.

The government have done a fantastically effective job in terrifying people about the dangers of coronavirus, so much so that the young are unashamedly terrified because nobody is really teaching them now how statistically low is the risk for their youngish age group. The dangers to young people are exceedingly small. We can indeed say that for anyone under 40 (or even 50) the chances of dying from Covid are about the same as being eaten by a Great White shark. The dangers to the economy are extraordinarily large.

Herd immunity is much more prevalent than is suspected.50-60% of the patients I see have had an illness which I can diagnose as coronavirus but most of them were not really aware that they had had the illness at all, as it was relatively mild in most of them.

Many people now will have had the illness without realizing that they have had it.

It is my clinical impression that probably 50[ of the population of London have already had the virus. The development of herd immunity is therefore well advanced.

In my opinion now, all children should go back to school and the under 50s should all be told to go back to work. The over 75” s should remain in lockdown. The 50-75 age group should be allowed to work from home if they want to or to go back to work if they are otherwise fit and prepared to take the risk.

No test is available or even required to predict risk of death from coronavirus. We already know the answer. The danger of death is greater in the following groups:

Over 60s, especially over 80s
Black and Asian people
Male gender
Dementia
Obesity
Hypertension
Smoking
Concurrent serious disease.

If more than two of the above applies, the risk is greater still.

The above groups need to be careful and consider continuing isolation pending the development of herd immunity or a vaccine. The rest of us should be getting back to work as soon as possible.

Making these changes now though will inevitably result in another wave of cases. But how big a wave? If herd immunity is well developed already, as I believe it is in London and other large urban centres, the second wave will be small. In countries where the clamp down has been more draconian, such as South Korea, China and New Zealand, very large second waves can be expected. This is already happening in countries lauded for their very swift and effective control of the initial wave, such as Germany and Singapore. In countries which have not had a lockdown, such as Sweden, the second wave will be trivial or non-existent Britain, where we have trodden a middle course, the second wave will be notable but probably not enormous and almost certainly smaller than the first wave. Will it be large enough to risk possibly overtaxing intensive care units? We cannot say as we have no clear epidemiological evidence of the proportion of the population that have been infected and are now therefore immune. So, the government may have to do these things in a step-by-step way or wait another couple of weeks before making these changes.

In the meanwhile, some of the ridiculous Orwellian restrictions, like the closure of some parks, not walking on windy beaches or hillsides, not having picnics with your family etc. should be explicitly ceased. Lord Sumption should be asked to join the Cabinet and be tasked with reforming the police force (not only during the crisis but thereafter also).

I am sure that all the above is correct. The only thing I am not quite sure about is the rate at which the current lockdown should be relaxed. We do not want to overwhelm intensive care units by ceasing the lockdown too soon or too precipitously.

Christopher Rowland Payne