Peak Fear or Peak Boris?

On 23 March 2020, I went through peak fear and hopefully peak Boris.   For weeks the fear of the CoronaVirus – Covid-19 – to the cognoscenti had built to a crescendo and on Monday Boris Johnson's talk to the nation took me to the summit.  Why?  It's because one thing will kill more people than C-19 - the first bug in history to have its own brand image - and that is uncertainty.

That is the big killer - uncertainty.  Uncertainty, unlike risk, has no certainties, no probabilities - it works at the non-conscious level of gut-wrenching worry.  It's the one thing we hate and seeing Boris Johnson parading his fear - nay - panic - left me with my bowels turning to water.  But, after falling asleep and waking in the early hours it occurred to me that in a month's time we might be wondering to ourselves: how do we get into that?  Are we stupid or what?  Is it possible that Donald Duck (sorry Trump), quacking in his demented way, might actually be right?

A number of issues passed through my mind: coronavirus, yes, fact, there are a few that cause the common cold. Yes, fact, two nasty coronaviruses have proved seriously lethal - SARS with its penchant for inhabiting foul drains and MERS - for which camels and their unpleasant tendency of spitting at their persecutors are the prime suspects. So after the last ten years or so there have been some bug-panics: SARS, MERS, H5N1 and H1N1 - plus M4 and M62 (I made the last two up).  So, a new bug hits the headlines and the recency heuristic kicks in.  The same heuristic that leads us to overweight the chance of dying in a plane crash (statistically very, very unlikely) if there has been recent publicity of a major crash somewhere in the world.

Going online and looking at some very respectable websites I began to wonder - how lethal is this bug?  We know the numerator more or less; we know who has died although to what extent the new bug was the direct or a proximate cause is not known with absolute certainty.  But what we don't know is the denominator.  What we do know is that on the Grand Princess cruise liner 712 people tested positive and nine died with a median age of 75 - truly a floating care home, with few medical supplies and possibly only one or two health professionals on board.  Many of the 712 were not in the best of health in any event and all had been stressed out of their minds wondering what would happen to them.  That is a percentage of 1.26% of elderly people with a wide range of underlying health conditions.  Integrating that data back into a population suggests that the actual mortality is much lower possibly about one in a thousand.

At that sort of level, we are talking about a severe flu epidemic - not good, but not a problem if it were to spread at a sedate pace.   Maybe we are talking about a huge iceberg, with a small proportion of its mass poking above the surface rather than a small iceberg with a large proportion of its mass in plain sight.  Maybe this crafty virus is a fast spreader and it can go through a population like a dose of salts.  Indeed, it may be that we are missing the large bulk of the infection because it may also be a cause of diarrhea and other stomach problems and not much else.  It's still infectious but where the symptoms are not being recognized. So the real denominator could be much, much bigger than we think and so the real problem is not its death rate per se.  The real problem is we don't know the size of the iceberg and until we know that we don't know this new bug's infectivity nor its actual death rate. 

What we do know is that it is hitting our health services all at once.  It's a bug in a hurry.  Imagine it thus: a new cold virus launches itself on an unsuspecting humanity.  There's no herd immunity and like all new viruses making the jump to a new host, it's over-enthusiastic.  It hasn't quite learned that killing people is bad - for them true, but also for it.  A dead host is a dead bug and in the great game of survival of the fittest well-behaved bugs, survive their encounter with humanity, spread, prosper and nobody takes much notice of them.  However, if it comes all at once infecting thousands, then it's a problem, especially when, as always, there is a small percentage who are very vulnerable.  The common cold we shrug off, even though it can devastate care and nursing homes where large numbers of old people succumb to this most innocuous of maladies.  

Our problem is that our health services cannot cope with wild-card, black-swan health events - even when it's a common cold bug - a new one - making its mark.  We need to flatten the sombrero in numpty speak so that the NHS can give the best care to all but will a vaccine work?  I doubt it.  Some anti-virals might aid in slowing it's progression but, in the end, this bug is here to stay and we have to accept like so many other such organisms it is going to take some of us down but in the great warp and weft of things not many - in the long run.  In the short run, however, we have a crisis, because the 'some of us' are sufficient to overwhelm our grossly underfunded NHS.

So, is Bob - the blogger you trust - got anyone else who supports his point of view?  Here I exclude numpties like Donald and Boris. You might be interested in this piece by one John Ioannidis.  John who?  The same voice in the wilderness who alerted us to the fact that 95% of the articles in the leading health science journals were likely flat wrong or couldn't be replicated.

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/