Maintaining a Sense of Perspective and Proportionality During the COVID-19 Pandemic (Post #3- 1 year later)

This post is part of my ongoing series of reflections (Part 1, Part 2) on the COVID-19 pandemic and maintaining a sense of proportionality.  

Like in my previous posts, I start with my usual disclaimer... this pandemic is a very serious public health predicament.  At the same time, it is nothing close to the biggest public health challenge of today, nor of the past 100 years.  

One year since the start of this pandemic and I think there are both potential success stories (namely the speed of vaccine development) but also plenty of (repeated!) public health failures, the biggest of which are the continued lockdowns of healthy people and the cancellation of school for children.  In this post I want to draw attention to two parts of the media portrayal of the pandemic that exacerbate our tendency to mismanage this pandemic (leading us to cause more harm than good).

The first thing I will note is the fact that the death count of COVID-19 for the year 2021 has carried over the deaths from the previous year (2020).  This is unprecedented for any other cause of death in the world.  If we did this for cancer, for example, then there would be at least some 220+ million deaths and counting from 1990 through to the present (source).  The year 2021 should have re-set COVID-19 mortality, not carried last year's deaths over to this year.  This distorts our understanding of how severe this infectious disease is compared to other public health problems (all of which re-set their death counts at the start of the calendar year).

The problem with the media's fixation on COVID-19 deaths is there is no sense of comparison to other causes of death.  For example, in the year 2019 approximately 55 million people died.  In the year 2020 the World Health Organization estimates that approximately 1.8 million people died of/with COVID-19.  So this would account for roughly 3.2% of all deaths.  What killed the other 97% of human beings who died last year?  You probably never heard about these deaths in the news or social media.  When only COVID-19 mortality is reported on the news then the risk of COVID-19 mortality is "on screen" and all other deaths "off screen", giving the impression that everyone that is dying is dying from the virus.   The reality is that the vast majority of human beings in the world today are dying from cardiovascular disease, cancer, other infectious diseases like malaria and HIV/AIDS, traffic accidents, suicides, poverty etc.  

To get an accurate sense of how serious the COVID-19 mortality of 2020 was we should compare it to a disease that killed a comparable number of people.  Diabetes is such a disease (killed 1.6 million people in 2018).  But with diabetes a significantly higher proportion of those who died where younger than age 70 than those who died from COVID-19.  So diabetes is much more lethal to the young that COVID-19.  It is also one of the risk factors for severe COVID-19.  I did not hear one single news report on diabetes in the year 2020 (unless it was related to COVID-19).

This brings me to a second point I think it is worth emphasizing to help us keep everything in perspective.  I preface the following comments by repeating my point that the speed of the COVID-19 vaccines are an amazing public health breakthrough.  They are the one true success story in the public health response to this pandemic in 2020.  I have heard many a politician talk about these vaccines "saving" people living in long-term care facilities.  But, technically speaking, the vaccines will only protect the elderly from one specific risk factor- COVID-19.  Receiving the vaccine does not mean the elderly will be immune to the other health problems they typically suffer- such as heart disease, stroke, cancer, dementia, etc.  So the biggest health threats to this age cohort will continue despite the COVID-19 vaccines.    

The realities of global aging and multi-morbidity in late life have been neglected in our public health response to, and media coverage of, this pandemic.  I have been teaching courses on the ethics of life extension for over 15 years, and I have seen an amazing, rapid shift in many people's attitudes to the issues I have been studying for years since this pandemic.  Let me summarize the shift in attitudes as follows:

Prior to the year 2020:  Typical responses to the prospect of extending the "healthspan" of humans include  "People live too long already, this is harmful to... the environment, the job market... or..... we will get bored, etc."

Since the COVID-19 pandemic in the year 2020:  Typical response to protecting the elderly from COVID-19:  "Everyone should be locked down indefinitely, including healthy persons who might potentially catch the virus and spread it"  "Cancel in-person schooling"  "You can't put an economic value on saving lives" "Make people wear face masks!" "Force people to be vaccinated" "Report your neighbour if they violate social distancing or limits on people in their house", etc.  

The shift in attitudes has been unfathomable.  I am still trying to process what could account for this dramatic shift in attitudes.  

Now I myself am all in favour of promoting evidence-based, cost-effective, reasonable measures to promote health in late life.  What I strongly oppose are speculative, authoritarian measures that impose an indefinite quasi-quarantine on healthy persons to reduce one specific risk of death in less healthy people.  

When the dust has settled on this pandemic I believe we will have caused much more harm from our lockdown measures than good.  At the moment the news is dominated by the number of positive COVID-19 tests and deaths.  But the adverse impacts of lockdowns-  especially on our children (in terms of their education and mental health)- will be catastrophic and last for years.  

I finish here by linking to UNIFEC's call to end the school disruptions to children.  From the statement from the Executive Director of UNICEF:

“As we enter the second year of the COVID-19 pandemic, and as cases continue to soar around the world, no effort should be spared to keep schools open or prioritize them in reopening plans.

“Despite overwhelming evidence of the impact of school closures on children, and despite increasing evidence that schools are not drivers of the pandemic, too many countries have opted to keep schools closed, some for nearly a year.

“The cost of closing schools – which at the peak of pandemic lockdowns affected 90 per cent of students worldwide and left more than a third of schoolchildren with no access to remote education – has been devastating.

Cheers, 

Colin