Arguments against shutting down a country because of an epidemic. For future reference
It has been almost two months since the Italian government decided to pursue a policy of strict shutdown which, compared to other Western countries, is a de facto mass house arrest. Two months since it chose to strangle all civil liberties, crush its economy, and pose as a benign overlord protecting its subjects from an invisible menace. The result has been the most astonishing state intrusion into the lives of citizens in recent history. Yet, faced with this surreal state of affairs, those institutions whose role it is to check such power have fallen silent.
Parliament, the press, the legal profession and indeed civil society are all tacitly accepting the very premise on which Italy has been turned into a police-guarded nanny state. Some have expressed doubts, but their voices have been drowned out by a frenzied chorus of panic and hysteria. The whole of society is overcome by fear, and as Franklin D. Roosevelt warned long ago, it is fear itself, more than any virus, that will likely lead us to ruin.
The questions that should be considered when assessing whether an unprecedented nationwide shutdown is the correct response to the Sars-Cov-2 epidemic are threefold. The danger posed by the virus, the efficacy of a nationwide shutdown, and whether the latter is a proportionate solution to the problem at hand On all three counts there is a considerable degree of uncertainty.
In order to make sense of the lethality of the virus, one must begin by analysing the data. There are three types of figures one must to consider: the number of people who have been infected; the number of people who have died; and the relevant time period. The way in which these figures are reported by most of the media draw a picture that gravely distorts reality.
At the time of writing, Italy records 197,103 people as being infected. This number, however, is deceptive, because most tests are conducted in hospitals and care homes, where a disproportionate number of people are old and sick, and thus more likely to exhibit serious symptoms. Now these samples are not representative of the wider population. To use an analogy, it would be like trying to measure the incidence of alcoholism in a society by turning pubs into sampling centres. Furthermore, the Italian Ministry of Health has specified that asymptomatic individuals should not be tested, so the real incidence of the disease in the wider population is unknown.
In early March, Dr. Ilaria Capua, a professor of virology at the Emerging Pathogens Institute in Florida, speculated that the number of infections could be 100 times greater than those being recorded. With 26,644 deaths so far, this would in turn diminish the death rate by 100, from an apparent 13,5 percent to 0,14 percent, which is slightly above that of the seasonal flu.
As for the number of deaths, here too one must look carefully at the numbers. The Italian Ministry of Health is careful to specify that the number of deaths “can only be confirmed upon a certification of cause of death by the Higher Institute of Health (ISS).” This reveals a crucial distinction which cannot be highlighted enough. An article written in The Spectator by Dr John Lee, a recently retired professor of pathology and a former NHS consultant pathologist, is illuminating on this point:
The distinction between dying ‘with’ Covid-19 and dying ‘due to’ Covid-19 is not just splitting hairs. Consider some examples: an 87-year-old woman with dementia in a nursing home; a 79-year-old man with metastatic bladder cancer; a 29-year-old man with leukemia treated with chemotherapy; a 46-year-old woman with motor neurone disease for 2 years. All develop chest infections and die. All test positive for Covid-19. Yet all were vulnerable to death by any chest infection from any infective cause (including the flu). Covid-19 might have been the final straw, but it has not caused their deaths. Consider two more cases: a 75-year-old man with mild heart failure and bronchitis; a 35-year-old woman who was previously fit and well with no known medical conditions. Both contract a chest infection and die, and both test positive for Covid-19. In the first case it is not entirely clear what weight to place on the pre-existing conditions versus the viral infection — to make this judgement would require an expert clinician to examine the case notes. The final case would reasonably be attributed to death caused by Covid-19, assuming it was true that there were no underlying conditions.
On April 23, the ISS released its latest report on the characteristics of 23,188 patients who died after resulting positive to the virus. Among a sample of 2,041 positive cases, only 3.6 percent were fond to have died with no pre-existing conditions. 14.4 percent had a single comorbidity, 21.1 percent had two, and 60.1 percent had three or more. Assuming, then, that this is a representative sample of all covid-related deaths, and that the patients without comorbidities were healthy, the total number of deaths directly caused by Covid-19 is 96.
Another element worth considering when we look at the daily saturation of numbers and graphs is the time between a person’s death and its recording. Again to cite Dr Lee:
If people take quite a long time to die of a disease, it will take a while to judge the real death rate and initial figures will be an underestimate. But if people die quite quickly of a disease, the figures will be nearer to the true rate. It is probable that there is a slight lag — those dying today might have been seriously ill for some days. But as time goes by this will become less important as a steady state is reached.
If we add to this the fact that the incubation period of the virus, i.e. the time that elapses between infection and the onset of symptoms, is roughly fourteen days, the daily figures are already two weeks old. Why then has the Italian government waited to ‘record’ a decreasing trend in infections? Every day gone by is a deadly blow to peoples’ livelihoods.
I mentioned before the feebleness of those ‘checks and balances’ whose duty it is to scrutinize government measures to the hilt, especially in times of deep crisis. On Ferburary 26, when the Italian Parliament had to vote to enshrine the emergency lockdown decree into law, only two MPs opposed it. Not one representative stood up to ask the government to supply evidence that the extreme policy it was proposing was effective and proportionate. The following are only some of the questions our respectable parliamentarians could have asked the Italian Minister of Health. They remain valid today.
Firstly, if the virus had already been circulating among the general populace before the city of Codogno, the epicentre of the outbreak, was first locked down, any attempt to contain the virus there would have been futile. The ‘prior existence’ of Covid-19 was later confirmed by a joint study conducted by the Luigi Sacco Hospital at University of Milan. By following the trail of a cluster backwards, the researches dated the entry of the virus into Italy to some time in January. Furthermore, in a country with a high percentage of young adults living at home with their parents, a policy that confines families to prolonged close contact would quite possibly have increased the infection rate instead of reducing it. This theory too was subsequently explored in an interesting paper released by two economists at the University of Bonn.
One could also add a review of a body of 67 scientific studies conducted in 2011 by the Cochrane Library. It investigated the effects of non-pharmaceutical interventions to interrupt or reduce the spread of viruses. Among the findings, it concluded that there is “insufficient evidence to support social distancing as a method to reduce spread during epidemics.” The blind faith in a causal link between shutdowns and reduced cases has guided all measures since the beginning of the crisis, yet it remains unsupported by any evidence. Our World Data, an excellent source of statistics in many fields, offers a chart showing the number of daily confirmed deaths per million in different countries. I have selected some of those that have implemented the shutdown to compare the trend with Sweden, which has decided not to lock down.
We find that Sweden’s curve seems to be flattening. This suggests an absence of correlation between draconian measures and a decrease in infections, so there must be other factors at play. Stockholm moves slower than usual, but its citizens have the freedom to walk out of their homes as and when they please, without expecting to be confronted by an overly-zealous policeman. Other countries like South Korea, Japan and Taiwan have dealt with the wave without imposing a full shutdown.
Today we are told that the reduction in the number of infections over the last few weeks is a direct consequence of the public health measures that have been implemented. How can this possibly be known? Here we have a classic example of the post hoc ergo propter hoc fallacy. Its use comes easy when a government stakes a nation’s welfare on it being accepted en masse. Nevertheless, we must kindly ask those who deploy it to have more respect for our intelligence.
But let us suppose we suspended our critical faculties and accepted that these unprecedented public health measures rest on solid scientific ground, immune from all possible criticism. The question would still remain whether they are proportionate to the problem at hand; whether the public health benefits outweigh the social, economic and educational costs. Evidence to the contrary, I fear, will be forthcoming for some time.
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