What is an acceptable mortality rate?

Michael Gove was on the Andrew Marr show this weekend, discussing the reopening of schools, and I thought he did a better job than usual of answering the questions put to him without trying to tap dance around the issues. One question that Marr kept repeating, though, was, “Can you guarantee that teachers will be completely safe?” or “Can you guarantee that no one will catch Coronavirus from opening the schools?” I thought Gove did a reasonable job responding, saying something like no, he couldn’t absolutely guarantee it, because life is filled with risks, but the government would do as much as possible to ensure the safety of teachers and students. Now, given the government’s track record on being able to live up to its promises (100,000 tests a week), I am not going to comment on how well the government can actually deliver a reasonable level of protection to teachers and students, but supposing they really can do so before opening up, I think a better answer would be, “Unless that teacher has had absolutely no contact with the outside world, he or she already has some risk greater than 0 of contracting Coronavirus. Ideally, we would not want to raise that risk by opening schools. But of course, there will not be zero risk for quite some time.”

The question is, what are the risks right now, of contracting the virus, showing symptoms of the virus, or dying from the virus? And the answer is, we don’t know, because, as another epidemiologist, Saul Faust, said yet again on the BBC today, we need to test, track, and trace, which would probably be a much better slogan than the UK government’s Stay Alert: Control the Virus: Save Lives. It’s a point that every expert we’ve seen agrees with. We need more testing. We need antibody testing. We don’t know how dangerous what we’re dealing with is until we know how much of it there really is. How can people be expected to decide if they’re willing to take the risk in order to be able to get on with their lives if they have no clear idea of what the risk is? The best we can do is make estimates based on the testing in other countries that are ahead of the UK, which seems to have a population that wants to be tested but not enough tests, and the US, which may or may not have enough tests but has a significant faction in the population that somehow thinks testing is an infringement of their rights.

But back to the original question: What is an acceptable mortality rate? I’ve seen more than one scientist be asked that question, sputter, and say that no mortality is acceptable, but that’s not how life works, and it’s not how governments and regulations work. According to the Office of National Statistics, the number of people who died of asthma in the UK in 2015 was 1,298, with 153 in London. That’s 3 a day in the UK as a whole and about 1 every three days in London alone. (Sources: ONS mortality statistics, ONS asthma statistics.) According to the Pharmaceutical Services Negotiating Committee, 1 in 11 children and 1 in 12 adults in the UK has asthma, at a cost of £1 billion a year to the NHS. (Source: PSNC.) The link between asthma and pollution is well established.  (Source: Healthy London.) Yet we keep allowing cars in London, despite a continuing rise in pollution-related asthma and other breathing issues. So, it would appear that in London, an acceptable mortality rate due to asthma is about 153/8700000, or 0.002%. Is that the answer, then? Banning automobiles, though, would prevent other avoidable deaths, including other pollution-related illnesses such as heart disease, and deaths from car accidents.  In 2018, the Department for transport reported 1,784 deaths in auto accidents, and 25,511 serious injuries. Every time something is done to make it more difficult to drive in the most congested (and most accessible by public transport) areas of the country, things get scaled back to almost nothing. In London last year, a scheme to prohibit private cars on Oxford Street was abandoned very shortly after it was introduced. Given these numbers and the numbers for other deaths attributable to fossil fuels, we could probably give a very conservative estimate of about 4,000 deaths a year due to driving.  Of course, this is still a small fraction of the 35,000 deaths due to COVID-19 so far, but do we think 4,000 deaths a year due to COVID would be acceptable? Or let’s take the illness that people on all sides keep comparing to COVID-19, influenza. About 10,000 people die each year in the UK from influenza, according to the NHS (Source: Greenwich NHS influenza statistics). Is that the acceptable number?

The answer is, of course, that to many people, none of these numbers would be acceptable. But we accept risk in our lives as a matter of course. In the US, the rate of car accidents is even higher and the number of miles the average person drives is higher. What the government is faced with now, though, is a sudden increase in deaths. We all know air pollution causes illness and early death. But that hasn’t changed significantly in our lifetimes. The numbers of cars on the road and the size of those cars increases gradually, so we’re just accepting an incremental increase in the number, not the whole 4,000 deaths. So far, the convenience of some people has outweighed the cost in terms of human lives and illness. Now, we have a new virus that came and wiped out 35,000 people in the UK and 90,000 people in the US (so far) and we have no frame of reference. Closing down and then trying to figure out when to reopen is almost impossible, because you have to do exactly what no one wants to do—accept that a certain number of deaths is inevitable and work within those parameters. The best number, maybe, would be the number of deaths caused by the lockdown. There are people suffering from depression from being isolated, there are probably people suffering from depression over hopeless financial circumstances. There are people who have avoided going to the hospital for reasons other than COVID because they’re worried they will catch it and then they end up dying of a heart attack or some other condition that, in normal times, they’d have sought treatment for. Many people are gaining weight and doing less exercise. After having gained half a stone, I have forced myself to exercise in my rather small bedroom, because there’s nowhere else to do it, I can’t go to the gym, and I’ve been allowed only one exercise period a day outdoors until recently. I’m sure there are a lot of people in similar positions with even less room to move around in. I keep thinking about all the stories about obesity contributing to a worse experience with COVID and thinking, yeah, and there are going to be a lot more obese people by the end of this.

There are two statistics here that are important and we know only one. The percentage of the population in the UK and the US who have died of COVID-19 (or with COVID-19) is about 0.05% and 0.03%, respectively. The mortality rate that people keep asking about is quite different. It’s the percentage of people who get the disease who have died. We don’t know that with anything approaching certainty, because we only know the people who have had bad enough symptoms to contact the health service to begin with. Far more people are either asymptomatic or mildly symptomatic but not seeking treatment. Until we have some idea what percentage of the population has been exposed, we will not know the answers to all kinds of questions, including the mortality rate. I will end where I began. We need to test, track and trace. If the government can deliver on that, we can start to get back to business that is, if not quite “normal,” at least “sustainable.”

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