An Explanation of Why the COVID19 Numbers Appear High
In announcing the most far-reaching restrictions on personal freedom in the history of our nation, Boris Johnson resolutely followed the scientific advice that he had been given.
The advisers to the government seem calm and collected, with a solid consensus among them. In the face of a new viral threat, with numbers of cases surging daily, I’m not sure that any prime minister would have acted very differently.
But I’d like to raise some perspectives that have hardly been aired in the past weeks, and which point to an interpretation of the figures rather different from that which the government is acting on.
I’m a recently-retired Professor of Pathology and NHS consultant pathologist, and have spent most of my adult life in healthcare and science – fields which, all too often, are characterised by doubt rather than certainty.
There is room for different interpretations of the current data. If some of these other interpretations are correct, or at least nearer to the truth, then conclusions about the actions required will change correspondingly.
The simplest way to judge whether we have an exceptionally lethal disease is to look at the death rates. Are more people dying than we would expect to die anyway in a given week or month? Statistically, we would expect about 51,000 to die in Britain this month.
At the time of writing, 422 deaths are linked to Covid-19 — so 0.8 per cent of that expected total. On a global basis, we’d expect 14 million to die over the first three months of the year. The world’s 18,944 coronavirus deaths represent 0.14 per cent of that total.
These figures might shoot up but they are, right now, lower than other infectious diseases that we live with (such as flu). Not figures that would, in and of themselves, cause drastic global reactions.
Initial reported figures from China and Italy suggested a death rate of 5 per cent to 15 per cent, similar to Spanish flu. Given that cases were increasing exponentially, this raised the prospect of death rates that no healthcare system in the world would be able to cope with.
The need to avoid this scenario is the justification for measures being implemented: the Spanish flu is believed to have infected about one in four of the world’s population between 1918 and 1920, or roughly 500 million people with 50 million deaths. We developed pandemic emergency plans, ready to snap into action in case this happened again.
At the time of writing, the UK’s 422 deaths and 8,077 known cases give an apparent death rate of 5 per cent. This is often cited as a cause for concern, contrasted with the mortality rate of seasonal flu, which is estimated at about 0.1 per cent. But we ought to look very carefully at the data. Are these figures really comparable?
Most of the UK testing has been in hospitals, where there is a high concentration of patients susceptible to the effects of any infection. As anyone who has worked with sick people will know, any testing regime that is based only in hospitals will over-estimate the virulence of an infection.
Also, we’re only dealing with those Covid-19 cases that have made people sick enough or worried enough to get tested. There will be many more unaware that they have the virus, with either no symptoms, or mild ones.
That’s why, when Britain had 590 diagnosed cases, Sir Patrick Vallance, the government’s chief scientific adviser, suggested that the real figure was probably between 5,000 and 10,000 cases, ten to 20 times higher.
If he’s right, the headline death rate due to this virus is likely to be ten to 20 times lower, say 0.25 per cent to 0.5 per cent. That puts the Covid-19 mortality rate in the range associated with infections like flu.
But there’s another, potentially even more serious problem: the way that deaths are recorded. If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation.
We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.
Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu.
That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.
In the current climate, anyone with a positive test for Covid-19 will certainly be known to clinical staff looking after them: if any of these patients dies, staff will have to record the Covid-19 designation on the death certificate — contrary to usual practice for most infections of this kind.
There is a big difference between Covid-19 causing death, and Covid-19 being found in someone who died of other causes. Making Covid-19 notifiable might give the appearance of it causing increasing numbers of deaths, whether this is true or not. It might appear far more of a killer than flu, simply because of the way deaths are recorded.
If we take drastic measures to reduce the incidence of Covid-19, it follows that the deaths will also go down. We risk being convinced that we have averted something that was never really going to be as severe as we feared. This unusual way of reporting Covid-19 deaths explains the clear finding that most of its victims have underlying conditions — and would normally be susceptible to other seasonal viruses, which are virtually never recorded as a specific cause of death.
Let us also consider the Covid-19 graphs, showing an exponential rise in cases — and deaths. They can look alarming. But if we tracked flu or other seasonal viruses in the same way, we would also see an exponential increase. We would also see some countries behind others, and striking fatality rates.
The United States Centers for Disease Control, for example, publishes weekly estimates of flu cases. The latest figures show that since September, flu has infected 38 million Americans, hospitalised 390,000 and killed 23,000. This does not cause public alarm because flu is familiar.
The data on Covid-19 differs wildly from country to country. Look at the figures for Italy and Germany. At the time of writing, Italy has 69,176 recorded cases and 6,820 deaths, a rate of 9.9 per cent. Germany has 32,986 cases and 157 deaths, a rate of 0.5 per cent.
Do we think that the strain of virus is so different in these nearby countries as to virtually represent different diseases?
Or that the populations are so different in their susceptibility to the virus that the death rate can vary more than twentyfold?
If not, we ought to suspect systematic error, that the Covid-19 data we are seeing from different countries is not directly comparable.
Look at other rates: Spain 7.1 per cent, US 1.3 per cent, Switzerland 1.3 per cent, France 4.3 per cent, South Korea 1.3 per cent, Iran 7.8 per cent. We may very well be comparing apples with oranges. Recording cases where there was a positive test for the virus is a very different thing to recording the virus as the main cause of death.
Early evidence from Iceland, a country with a very strong organisation for wide testing within the population, suggests that as many as 50 per cent of infections are almost completely asymptomatic. Most of the rest are relatively minor.
In fact, Iceland’s figures, 648 cases and two attributed deaths, give a death rate of 0.3 per cent. As population testing becomes more widespread elsewhere in the world, we will find a greater and greater proportion of cases where infections have already occurred and caused only mild effects.
In fact, as time goes on, this will become generally truer too, because most infections tend to decrease in virulence as an epidemic progresses.
One pretty clear indicator is death. If a new infection is causing many extra people to die (as opposed to an infection present in people who would have died anyway) then it will cause an increase in the overall death rate. But we have yet to see any statistical evidence for excess deaths, in any part of the world.
Covid-19 can clearly cause serious respiratory tract compromise in some patients, especially those with chest issues, and in smokers. The elderly are probably more at risk, as they are for infections of any kind.
The average age of those dying in Italy is 78.5 years, with almost nine in ten fatalities among the over-70s. The life expectancy in Italy — that is, the number of years you can expect to live to from birth, all things being equal — is 82.5 years. But all things are not equal when a new seasonal virus goes around.
It certainly seems reasonable, now, that a degree of social distancing should be maintained for a while, especially for the elderly and the immune-suppressed. But when drastic measures are introduced, they should be based on clear evidence.
In the case of Covid-19, the evidence is not clear. The UK’s lockdown has been informed by modelling of what might happen. More needs to be known about these models. Do they correct for age, pre-existing conditions, changing virulence, the effects of death certification and other factors?
Tweak any of these assumptions and the outcome (and predicted death toll) can change radically.
Much of the response to Covid-19 seems explained by the fact that we are watching this virus in a way that no virus has been watched before. The scenes from the Italian hospitals have been shocking, and make for grim television. But television is not science.
Clearly, the various lockdowns will slow the spread of Covid-19 so there will be fewer cases. When we relax the measures, there will be more cases again. But this need not be a reason to keep the lockdown: the spread of cases is only something to fear if we are dealing with an unusually lethal virus.
That’s why the way we record data will be hugely important. Unless we tighten criteria for recording death due only to the virus (as opposed to it being present in those who died from other conditions), the official figures may show a lot more deaths apparently caused by the virus than is actually the case. What then?
How do we measure the health consequences of taking people’s lives, jobs, leisure and purpose away from them to protect them from an anticipated threat? Which causes least harm?
The moral debate is not lives vs money. It is lives vs lives. It will take months, perhaps years, if ever, before we can assess the wider implications of what we are doing. The damage to children’s education, the excess suicides, the increase in mental health problems, the taking away of resources from other health problems that we were dealing with effectively.
Those who need medical help now but won’t seek it, or might not be offered it. And what about the effects on food production and global commerce, that will have unquantifiable consequences for people of all ages, perhaps especially in developing economies?
Governments everywhere say they are responding to the science. The policies in the UK are not the government’s fault. They are trying to act responsibly based on the scientific advice given. But governments must remember that rushed science is almost always bad science.
We have decided on policies of extraordinary magnitude without concrete evidence of excess harm already occurring, and without proper scrutiny of the science used to justify them.
In the next few days and weeks, we must continue to look critically and dispassionately at the Covid-19 evidence as it comes in. Above all else, we must keep an open mind — and look for what is, not for what we fear might be.
John Lee is a recently retired professor of pathology and a former NHS consultant pathologist.
Read more at www.spectator.co.uk
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Dr Roger Higgs (geologist)
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John, thank you. This superb article ought to be published tomorrow on the front page of every serious newspaper in the world. Due to the virus hysteria, society is very rapidly spiralling downward toward bankruptcy and therefore anarchy (probably within weeks), driven by the unholy trinity of 1) computer models (garbage in, garbage out), 2) gross media exaggeration (as usual), and 3) extreme political over-reaction, the same trio responsible for the mythical ‘climate crisis’ … https://www.researchgate.net/publication/340272745
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Robert Beatty
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Well said Roger,
My fear is that we have lit the fuse leading to an international financial crisis. Traditional economics says printing money leads to higher inflation. So far the opposite appears to be happening, but where does depressed value for money lead? It seems we are in the midst of a world wide economic petri dish experiment. The results will not be pretty.
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John O'Sullivan
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Roger, Yes, I agree. This article by John Lee, a recently retired professor of pathology and a former NHS consultant pathologist deserves to be spread far and wide as antidote to mass hysteria founded on junk science. .
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Doug Harrison
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If you lay on top of the article by Dr Lee the fact that the tests are for coronavirus of which there are thousands of different species any one of which will give a positive reading then you have a horrible picture of a huge over reaction to a non problem.
I had my first pneumonia event in 1936 and have lost count of the number of times I’ve had it. Therefore it can be said that I am in the forefront of those vulnerable to covid 19. However, with careful management of my hygiene and personal distancing I have no fear of this disease but I’m terrified by the economic effect it will have on my children and grandchildren. Their futures are being destroyed by these mad men and women.
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A Thorpe
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I have no family and I like you I would be very concerned if I had. Dr Higgs rightly compared this with the fake climate crisis. I do know about thermodynamics and therefore I am 100% confident that CO2 is not warming the earth, either from natural or human causes. I am in a completely different position with health issues and the truth is hard to find. Science is about evidence and whilst I don’t know anything about viruses the lack of supporting evidence is not difficult to see. I’ve never given it any thought before but in most cases death is not from a single cause and it is difficult to isolate the individual risk of each factor, as discussed in the article. This is exactly the same as climate science. Many factors determine the climate and it is impossible to isolate the effect of CO2 and even more difficult to isolate the effect of human released CO2. its all rather like radio transmission, if you cannot identify the carrier wave then you cannot extract the radio signal.
But returning to children and grandchildren. I cannot understand their attitude today of blaming their parents and grandparents for destroying their future. They owe everything they have to them. We all owe our high standard of living to every past generation and this has happened because of a warming climate and cheap energy from coal. Now we have the ridiculous Greta Thunberg and her child army being treated as the most knowledgeable on the planet.
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John Titolo
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Question; Why do we have so few recoved by covid-19 compared to china?
usa has 162,665 cases total , 3126 deaths, 5254 recoverd, 154,285 active ….
china has 81,470 cases, 3304 deaths , 75,700 recovered , 2466 active…..
quite the difference in stats wouldnt you say? Whats china doing that we arent in the USA?
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Jt
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Lying?
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Andy Rowlands
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I just read this article. Sounds a perfectly reasonable, measured response to what is actually happening, rather than what the media would have you believe is happening.
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Jt
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“That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.‘
This is true as far as it goes, however there is a mandatory scheme in the UK that does record every ICU/HDU positive test for flu and every mortality attributed to flu.
They keep accurate statistics which are publicly available.
‘USISS mandatory scheme: a national mandatory collection (USISS mandatory ICU scheme) is operating in co-operation with the Department of Health and Social Care and NHS Digital to report the number of confirmed influenza cases admitted to intensive care units (ICU) and high dependency units (HDU) and number of confirmed influenza deaths in ICU/HDU across the UK “
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Rick
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If you don’t know the whole story then you can only report half the story. If you know community prevalence (through testing within the community) then you have a better denominator. If you choose to be like China and stop testing or under (aka not) report then who knows what’s going on… Isn’t it interesting that the US has over taken the number of cases world wide according to the MSM…pee on my leg and tell me it’s raining. Fake news, enemy of the people spreading misinformation like a Russian diplomat
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Michael Clarke
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What an insightful article thanks Dr John and PSI.
This escapade into the un-known for many countries will end up badly for most while giving great profit to some.
This is CAGW on steroids!
There will be far reaching results, Governments will fail or fall as will Monachies and dictatorships.
The Almighty $$$ will also be looked at very carefully.
Millions working from home… doing exactly what?
The producer of the world will want answers for why they get ONE$ a kilo for beef when the Supermarket charges 25$ a kilo for Beef mince!
The value of an MBA in management was always questionable, managers everywhere will be looking over their shoulder as to exactly what they produce.
The times are ‘a changing’.
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Steve Parker
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Thanks. Many of the thoughts that were at the back of my mind are well discussed in this article. It’s too late now though we’re on a runaway train to “who knows where”.
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A Thorpe
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A train to hell!
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