One year since it began, there are still more questions than answers about Covid-19. Just about the only reliable data on it are the mortality rates for various countries. In a murky world, they give us clarity.
I’ve not written much about Covid-19 recently. What can be said? In my opinion, the world has simply gone bonkers. The best description can be found in Dante’s Inferno, written back in the 14th century.
In it, Dante describes the outcasts, who took no side in the rebellion of angels. They live in the vestibule. Not in heaven, not in hell, forever unclassified. Naked and futile, they race around through a hellish mist in eternal pursuit of an elusive, wavering banner, symbolic of their pursuit of ever-shifting self-interest.
I find this description of the desperate pursuit of an elusive wavering banner an apt description of where we are today. Which banner are you following?
The one that says, ‘Covid-19’s the most terrible infection ever, and we must do everything in our power to stop it, whatever the cost’?
Or the other that states: ‘What on Earth are we doing? This is no worse than a bad flu, and we are destroying the world economy, stripping away human rights and killing more people than we are saving’?
There may be others.
Between these two completely incompatible positions lies the truth. It’s in poor shape. It’s been crushed, bent out of shape, and left as a broken heap in the corner. I search where I can to find the fragments in an attempt to bring together a picture that makes some kind of sense.
But what to believe? Who to believe?
I have stripped away at the accuracy of PCR Covid-19 testing. I found myself left with nothing I could make any sense of. I hacked down to establish the way that Covid-19 deaths are recorded. All I found were assumptions and difficulties.
Did someone die with Covid-19, of Covid-19 – or did it have nothing to do with the virus? Who knows? I certainly don’t, and I’ve written some of the death certificates myself.
Have we overestimated deaths, or underestimated deaths? I do not know… and so it goes on.
So, what do I know?
Is Covid deadlier than influenza? Well, it is certainly deadlier than most strains of influenza. However, Spanish flu was estimated to have killed 50 million, when the world’s population was about a fifth of what it is now. So it is definitely less deadly than that. About as deadly as the influenzas of 1957 and 1967, probably.
Will it mutate into something worse? Who knows. Will the current vaccines work on mutated strains? Who knows. Can it be transmitted by asymptomatic carriers? Who knows. How effective are the current vaccines going to be? Who knows.
What are we left with?
What I have been waiting to see is the virus’ impact on the one outcome that you cannot alter, or fudge. The outcome that is overall mortality i.e. one’s chances of dying, of anything.
I have waited for this because, when it comes to recording deaths from a specific illness, things can go in and out of fashion. A couple of years ago, I looked at deaths from sepsis, an infection that gets into the blood, releasing deadly toxins. At one time, this was a low priority condition. Doctors didn’t routinely search for it, or record it, on death certificates.
Then, all of a sudden, there was a gigantic push to look for it more diligently, and treat it better. This was generally a good thing, as sepsis is eminently treatable and lives can be saved. We now have initiatives, and warnings that pop up on computers. ‘Have you considered sepsis?’ and suchlike. I love it… not. Because I do not love being told how to think, and do my job, by a computer algorithm programmed with ‘zero risk’ as their touchstone. But, hey ho.
In 2013, a UK report from the health ombudsman urged action, stating: “Sepsis is a more common reason for hospital admission than heart attack – and has a higher mortality.” That is somewhat disingenuous, as many people with sepsis are very elderly, often with multiple morbidities. They were probably going to die, shortly, from something else.
With all this increased sepsis recognition and treatment, you would expect the rate of deaths from sepsis to fall. It did not. The rate has gone up by around 30 percent since 2013. Does this mean there is far more sepsis going about? Or that it is just more often written on death certificates? I suggest the latter. I use this example simply to make it clear that even the cause of death written on a death certificate is far from solid evidence.
With Covid-19, this is a massive problem. In the UK, and several other countries, if you have had a positive Covid test (which may, or may not, be accurate) and you die within 28 days of that test, you will be recorded as a Covid-19 death. I may not know much for sure about Covid-19, but I do know this is complete nonsense.
Someone with terminal cancer catches Covid-19 in hospital and dies. What killed them?
There are so many cases where – even if the test was accurate – Covid-19 would have had nothing to do with the death. Another that we probably know is that the vast majority of people who die with the virus had many other things wrong with them.
The US Center of Disease Control (CDC) found that 94 percent of people who had Covid-19 ‘related deaths’ had other significant diseases, or comorbidities. This 94 percent would only be the comorbidities that were known about – who knows what lurked beneath? Especially as we’ve stopped doing post-mortems (or autopsies in the US).
So yes, the patient had Covid-19 (or at least they had a positive test – which may not be the same thing), but they were often very old and severely ill. Using an extreme example, someone with terminal cancer who is a week from death, catches Covid-19 in hospital, and dies. What killed them? The statistics say Covid-19. I say, rubbish.
When I started in medicine, ‘bronchopneumonia’ (a bad chest infection) used to be known as the ‘old man’s friend.’ For those who were very old, and frail, often demented, lying in care homes, often incontinent, a chest infection represented a reasonably painless way to die.
Very often we would not actively treat it; instead we allowed for a peaceful death. Indeed, this still happens. Less so now, as someone, somewhere, often a relative living a long way away – who has not visited for years – is more likely to sue you.