When it comes to when and how we should reopen the economy, there are very few dispassionate voices but the data is emerging, writes Terry Maguire

Many are doubtless bored with protracted and pedantic discussions on the rights and wrongs of lockdown as a tool to mitigate Covid-19 deaths. No-one is dispassionate; we are either vehemently in favour of opening-up the economy, or against, or demanding our economy and our grannies back. As we in N Ireland move to lessen restrictions more or less in step with RoI, there are concerns from government scientific advisers here that now is too early, accompanied by a whiff that there might be protest resignations from our academic boffins if their views are not respected. To most European governments, it was clear when the virus emerged; — to do nothing would have been criminal and the more they did, the more lives they would save. 

Ivor Cummins, an Irishman better known as the ‘Fat Emperor’ for his promotion of low-carb diets to reduce heart deaths, has an interesting view which is, he claims, dispassionately based on only the data and logic. And this focus on data is emerging as we move through the pandemic.

Ivor’s conclusion is that this novel coronavirus, once spreading in the population, runs its course. Data from a number of sources confirms his view that implementing lockdown after the virus had been moving in the population has had little, if any, additional impact on deaths compared to basic distancing and good hand-washing. 

I suppose we need to look back and see why we locked-down in the first place, and the main reason was to stop our health systems being swamped. We have now got the necessary ICU capacity required by the statistical models, so opening up society and the economy can happen

Excess deaths in Europe in 2018, when Covid-19 did not exist, were 140,000, and this year are 161,000. And it’s not finished yet. So Covid-19 is a killer; there is no dispute. 

Covid-19 has given us a pointy, painful peak of deaths in the last three months up to June end mostly in groups vulnerable to the infection. Ivor argues that the milder winter of 2019, with fewer than normal excess deaths, provided a cohort that are more vulnerable to Covid-19 once it appeared. If we look away from the toxic, infectious environments of nursing homes and hospitals, we find that lockdown has not had much impact compared to social distancing, as is happening in Sweden. 

The grocery trade across the island of Ireland, for example, had few if any workers off sick because of Covid-19 and these are people on the front-line eight-to-10 hours a day, mixing with each other and bumping into us getting a pint of milk, a packet of sausages or a dozen cans of stout. 

Ivor refers to countries that have reversed their lockdowns relatively early, for example Denmark and to a greater degree Israel, suggesting that the death curves for those countries just continue to do their thing — that is, fall — without the dreaded second spike in infection rates followed by deaths that UK scientists are so worried about. 

If Ivor is right, and he has a number of high-profile experts on his side, then lockdown has only added about 5 per cent more to the reduction in deaths compared to sensible social distancing. I cannot fault his logic, but really hope that he is missing something, because we all put some considerable effort into this lockdown and we would like to think it was worth it.

Other commentators make similar points that Covid-19 is surprisingly nosocomial, meaning it is spread in the healthcare settings of care homes and hospitals. Infection from this virus results from close-up, sustained exposure that we never get from strangers in supermarkets. Ivor and the experts are concerned about the collateral deaths that will occur because our health service and or economy have been locked down. He predicts that excess deaths from heart disease, cancers and mental health in the coming years will swamp the Covid-19 death spike. 

I suppose we need to look back and see why we locked down in the first place, and the main reason was to stop our health systems being swamped. We have now got the necessary ICU capacity required by the statistical models, so opening up society and the economy can happen. 

One thing that government and the media did exceedingly well in lockdown was keeping people on board with the safety messages. The message was about saving lives, and we never seemed to stray into discussions that saving lives only meant postponing deaths. 

This is an important point; if you had a choice between dying today or in six months, which would you choose? This leads us into the ethics. If a new drug or surgical intervention is found and it costs more than £30,000 for a quality-adjusted life year (QALY), the NHS in the UK is unlikely to pay for it, as it is not deemed to be value for money. I’m sure someone is already working out the costs per QALY of lockdown and when we take into account the hit to the economy, it will make £30k per death postponed seem like spare change.

Terry Maguire
Terry Maguire

Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University of Belfast. His research interests include the contribution of community pharmacy to improving public health