The UK’s position in the Covid pandemic is happily much better than the media or even the government would have us believe. Boris Johnson’s first daily briefing to the nation after his return from hospital came with announcement that the pandemic has ‘passed its peak’. In fact, the peak was on Wednesday April 8th when there were close to one thousand deaths in a single day. This occurred two weeks after the lockdown began on March 24th.That peak was over three weeks ago, and the daily death toll has subsequently been falling fast and is now in the two hundreds a day bracket.
The picture is a somewhat muddied by the ways in which figures have been presented and by several different and changing definitions. The number of Covid cases is difficult to interpret since it is dependent on the number of tests and, as we know, the latter has been changing fast. Many people infected with the virus also have no symptoms but can pass on the virus. Fatalities are a surer guide to how the pandemic is progressing but even here there are uncertainties.
All deaths in the daily announcements have been for people whose passing was accompanied by a positive test for the Covid virus. This does not necessarily mean that the virus was the cause of death, although it may well have been. Rather, the patient was infected with the virus at the time of death which may have been from another cause, often a respiratory condition. In England all the announced deaths have been in hospitals until last week when care-home fatalities with a positive test were added. In Scotland and Wales care-home deaths had been added earlier, and in Northern Ireland the figures were for deaths associated with a positive virus test, some of which had always been in care homes.
The clearest figures for deaths are presented in the form of the day on which people died, as opposed to the day on which the death was registered. The daily figures presented by the government, and repeated by the media, each day are based on the day that deaths were registered. When a figure is given for the number of deaths yesterday, those whose deaths are being announced might have actually died the previous week or even a month earlier. This induces a good deal of randomness into the picture, including large reductions in the number of deaths at weekends and corresponding surges in mid-week.
Source of data: NHS England. Covid-19 Daily deaths
Not surprisingly, the public has been confused by these complexities and it is not clear how aware the government is of how the fast is the rate of improvement. To appreciate the latter, it is best to focus on the number of daily certified hospital deaths on the basis of the actual day of death. Such figures are available, a few days in arrears for England and Wales. In Scotland and Northern Ireland there is a longer lag. The figures for England are shown in the chart above. The predictions in the chart are a simple extrapolation of the trend decline in deaths since the April 8th peak.
As can be seen in the chart, the number of deaths has been declining rapidly and if the trend of the last three weeks continues, the number will soon be below 100 a day reaching a level last seen on March 21st. When the number reaches single figures, as seems likely at the beginning of June, there can surely be little reason to keep the lockdown. A similar reasoning applies to Wales, Scotland and Northern Ireland, where the epidemic is a few days behind England.
It seems logical that at least a partial exit from the lockdown can begin much earlier than June and perhaps as early as next week. There are several reasons to be optimistic. The first is that even before the lockdown the trend in fatalities was heading towards a peak and would have begun to turn down, albeit later than actually occurred with the lockdown. If the trend merely reverted to that experienced in the UK before the lockdown took effect, the decline in deaths would still continue. In practice, it is more than likely that individual behaviour would be much more cautious than prior to the lockdown. People are likely to continue to work from home, avoid public transport and social spaces, and maintain social distancing.
This is what has happened in Sweden where the pandemic has been kept in check by the prudent behaviour of individuals rather than by government rules. It is true that the per capita death rate from Covid is much higher than in neighbouring Baltic countries, but it is much lower than in the UK despite the absence of a lockdown. Indeed it is a little over half of the UK rate.
This is of course only part of the story, since thousands of deaths are occurring outside hospitals, in care homes, hospices and at home. In addition, around a third of the excess deaths recorded, and estimated by comparing with the same period in previous years, have not been formally associated with Covid-19. They have neither had a test for the virus, nor has a doctor suspected a probable Covid link and written this on the death certificate. Even so, these ‘excess’ deaths must either be related to the virus or be the result of other medial causes not being attended to during the pandemic. The strong suspicion must be that the majority of these unexplained excess deaths are in care homes, where death is a regular occurrence, and in circumstances where the Covid symptoms were not obvious.
This leads to a strategy for an early exit from the lockdown. With death rates outside care-homes declining fast and soon to reach low levels, most people can be allowed back to work, and a Swedish system adopted with appropriate advice from government to the public. Care homes need to be treated differently with special measures to minimise the spread of the virus. Will the Government do this? Having failed keep the virus at anywhere near the low levels as in the Far East, Australasia, Germany or even Greece, there is palpable nervousness about exiting too early. If this is the case it would double the error, entering lockdown too late and exiting too slowly.
Whatever the Government’s decision, the end of the lockdown and indeed the pandemic is now in sight. The damage to the economy has been immense but should now be repaired as quickly as possible. And what of Brexit? With the pandemic out of the way, even with a damaged and an only slowly recovering economy, the Government appears committed to leaving the Customs Union and Single Market in seven months’ time. It seems that, at last, at least some in the EU are beginning to see this and to accept the logic of not extending the so-called transition period.