Institute for Social Responsibility COVID-19 Blog Perspectives
COVID-19 & the (dis)proportionate case for lockdown 29th April 2020 Eri Mountbatten-O’Malley has been criticised for T hedoingGovernment ‘too little, too late’. But is this fair? One of the issues I identify here is the way mortality statistics have been recorded. This is important because mortality rates are fundamental to assessments of risk to public health, which in turn are fundamental to any rationale for lockdown. For example, the case fatality rate (CFR) is most often cited. However, this is a method of measuring fatalities amongst those who have sought emergency care. This clearly amounts to a form of ‘selection bias’ by only measuring extreme cases. Conversely, the infection fatality rate (IFR) is far more useful because it helps to account for all (or most) cases of infection, including asymptomatic infections, in the wider population so we get a more accurate assessment of populational risk. IFR alone is still not enough however. The single most influential study in the UK (Ferguson et al, 2020) –which provided the rationale for the UK Government lockdown on 23rd March – suggested that UK fatalities could be in the region of 500,000, in the UK. This figure was erroneous by any measure. These were revised down somewhat, but the damage has already been done. There has also been a huge issue with death certification practices based on new procedural guidance (in the UK and elsewhere). For example, it allows for a diagnosis of COVID-19 death based on a ‘positive test’ of COVID-19 alone, irrespective of the co-morbidity or direct cause. Further, in terms of reporting, ONS clarified that ‘it will not always be the main cause of death, but may be a contributory factor’ mentioned ‘somewhere on the death certificate’. But this doesn’t stop them presenting the data as a COVID-19 death.
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We therefore have a perfect storm of errors. On the one hand, the mere presence of COVID-19 through testing is enough to certify it as a cause of death, and on the other, a clinical assessment based on symptoms is seen as sufficient ‘[w]ithout diagnostic proof’. Similar issues have been noted in Italy, the US, and even Germany. Naturally this puts the whole methodology for any assessment of risk into doubt because the very basis of risk (fatalities) is hugely misleading. This is an issue that has also been recently raised by Francis Hoar QC who has undertaken a timely analysis of the relevant evidential grounds for lockdown and the ‘questionable’ scientific basis for lockdown. No matter what you see in the media, the advertised figures are likely to be significantly overstated rather than understated, bringing COVID-19 closer in line with the rather standard risks associated with seasonal influenza. Although the Government must rightly do everything it can to protect the public, it must do so in ways that are proportionate to the risk, striking a balance between respect for civil liberties and the legitimate aims for the protection of public health. If Government justifications for lockdown are predicated on misleading mortality statistics and poor methodological practices, then perhaps we need a rethink. For a fuller analysis of the issues raised here, please see Eri’s UKAJI post here.
Eri Mountbatten-O’Malley is a Graduate Teaching Assistant and PhD at Edge Hill University. He has been active in specialist advice and casework, social welfare law and mental health policy research for many years, notably through his work for Citizens Advice, NAWRA, NUS and the Centre for Welfare Reform. In recognition of the impact of his advice, policy and campaign work, he was awarded Student Money Adviser of the year 2016. He is a qualified Fellow of the Higher Education Academy and has spoken internationally about scientistic and reductionist accounts of well-being and flourishing in public policy.
