Covid-19: The colossal health and social costs of lockdown and loss of liberty
On the morning of March 24th, following Boris Johnson’s speech to the nation, like everyone else in the UK, my family prepared to face the Government’s extensive lockdown regulations and braced ourselves for what we thought was going to be just a few weeks of isolation, in order to ‘save lives and protect the NHS’. Admittedly, we were lucky to live in beautiful countryside, in a comfortable house with outside space – it was immediately obvious that many were not so fortunate and would be more seriously challenged by the experience.
The government had my support. Even if I didn’t completely trust the politicians, during an emergency the likes of which we had not seen for a generation, the appearance of the CMO and CSA at daily briefings led me to believe that decisions were at least being made in the interests of public health. Throughout the period of lockdown, accepting that little was known about Covid-19, I trusted SAGE and the advice that was forthcoming. My husband and I are now both self-employed and, although his event-catering business had completely ceased under lockdown, we planned ahead for a six-month period and were cautiously optimistic that we could cope.
The dark side of lockdown
As rising numbers of people dying from Covid-19 featured in briefings and in the mainstream media, it was difficult to think about much else. However, very soon I began to see the dark side of lockdown that could be found behind closed doors and in the wider community. A relative, living with us during lockdown, is a neighbourhood housing officer. Working from home, he hosted emergency phone lines every day, but was often unable to offer demonstrable help to solve complex, social and emotional crises that were either precipitated by lockdown or exacerbated by the complete withdrawal of support services. Soon there were serious incidents of domestic violence. There were neighbourhood disputes, as communal spaces were closed down and outside areas overwhelmed. Some residents became seriously unwell, physically and psychologically; others locked themselves away too frightened to leave their homes. In one building alone, there was at least one (non Covid-related) death, where it was difficult to ascertain whether the person was too frightened to seek help, or whether they simply died because no one knew they needed support. It was clear to me that these situations were being replicated far and wide across the country, but no one was exposing them on the news. In my own work, it was obvious that connecting with people remotely by Zoom or phone was vital, but still a poor substitution for face to face contact. Some people faced urgent cancer care in hospital with no visitors; others had procedures delayed or cancelled and lived with chronic pain. None of them were able to seek support from their close family and friends, which was particularly detrimental for those struggling with depression and anxiety. Another relative – a cardiac physiologist – expressed concern that heart attack symptoms were presenting at hospital too late, seriously affecting patients’ prospects of recovery. At the same time, friends around me were furloughed or lost their jobs. Despite the comprehensive package of help from the Treasury, it is impossible to overstate the demoralising effects of prospective unemployment and financial hardship.
Proportional trade-offs?
Increasingly, it has become clear that the costs of lockdown are colossal. A recent research paper by health economists suggests that lockdown was always likely to have led to non-coronavirus-related health costs: ‘These may arise from diverse sources, many of which may have medium-term and long-term consequences that are not yet visible, through preventative and curative services addressing other health conditions, the impact of unemployment and poverty on physical and mental health, the impact of lockdowns on domestic abuse, use of addictive substances, lack of physical activity and social isolation, the effect of interruptions to schooling, and many other factors. Non-coronavirus-related health consequences, some potentially very sizeable, were largely if not wholly overlooked in the early stages of the response to the pandemic, and they are still receiving inadequate attention.’ An article published just last month in The Lancet Public Health, examined autopsies undertaken during the first two months of lockdown and provides clear-cut evidence of preventable out-of-hospital deaths in which patients contacted the health services by telephone and were advised to self-isolate at home rather than attend hospital. Reduced access to health-care systems associated with lockdown was identified as an important factor, and deaths from drug and alcohol misuse significantly increased during the lockdown period. In the beginning, SAGE was understandably grappling with unprecedented uncertainty; however, as we have accrued more knowledge about the virus, we need to focus urgently on all causes of morbidity and mortality, not just one.
Unemployment precipitates poverty, stress and unhealthy coping behaviours; it also negatively affects prospects for future employment. The young, the old, the unskilled, the disabled and the socially disadvantaged are usually overrepresented in the data. So too are middle aged men, who are more likely to be made redundant and find it more difficult to find a job. Middle aged men are the top ‘at risk’ group for suicide in the UK – with last year’s data showing a worrying rise in numbers. The most recent annual data states that a staggering 5,691 people died by suicide in England and Wales in 2019. We do not yet have data for suicide during the lockdown period, because no inquests took place during that time.
Loneliness, loss of connection and mental health
I have written before about the extraordinarily negative health effects of isolation and loneliness on health. If we didn’t have an epidemic of this prior to Covid-19, then we most certainly do now. Studies have shown that the impact of isolation on mortality is similar to that of well-known risk factors such as obesity and cigarette smoking. The most recent ONS data suggests that one in five adults (19.2%) were likely to be experiencing some form of depression during the Covid-19 pandemic in June 2020; this had almost doubled from around 1 in 10 (9.7%) before the pandemic (July 2019 to March 2020). Furthermore, a 62.4% of disabled people were worried about the effect of the coronavirus pandemic on their well-being.
If like me, you are missing physical contact with wider family and friends, the impact on health extends far beyond a sense of hollowness and sadness. Touch deprivation, or ‘skin starvation’ has been scientifically proven to increase stress, depression and anxiety, triggering a cascade of negative physiological effects. The body releases the hormone cortisol as a response to stress, activating the body’s ‘flight-or-fight’ response. This can increase heart rate, blood pressure, respiration and muscle tension, and can suppress the digestive system and immune system—increasing the risk of infection. The body’s healing and immune responses to every single medical condition are hampered by loss of touch, loneliness, anxiety and depression. Not an ideal situation where a population needs to bolster its defences against a new virus.
Nowhere have these effects been seen more acutely than in children and the elderly. Young children, separated for months from extended family and placed in ‘bubbles’ at school, are increasingly anxious about normal physical contact. Meanwhile, sweeping bans on visiting at thousands of care homes presents the sobering risk of residents dying prematurely this winter, as they give up hope in the absence of loved ones. Any care homes affected by local interventions, must once again move to stop visiting, except in exceptional circumstances, such as end of life. Restrictions also prevent visits to windows and gardens. Age UK has warned that this will result in the ‘raw reality of residents going downhill fast, giving up hope and ultimately dying sooner than would otherwise be the case’. The Alzheimer’s Society has received calls to its helpline reporting that without visits loved ones have stopped eating and ‘lost the will to live to the point of dying’. ONS figures show that deaths in April from dementia were 80% higher than average in England, and 50% higher in Wales. People can – and do – die of heartbreak. Professor David Spiegelhalter, featured in the BMJ, declared that ‘the huge number of unexplained extra deaths in homes and care homes is extraordinary. When we look back . . . this rise in non-Covid extra deaths outside the hospital is something I hope will be given really severe attention’. He added that many of these deaths would be among people ‘who may well have lived longer if they had managed to get to hospital’. The charity John’s Campaign, which promotes the importance of families in the care of elderly people, reminds us that people in care homes have an average life expectancy of two and half years. In nursing homes, this is reduced to just 13 months. For six of these already, many residents with dementia have felt abandoned and believe that they are no longer loved. Of course, there is the need for safety and caution; however, Age UK has stated that they are not aware of any evidence showing that visits, if carefully managed, have been a significant risk in spreading the infection so far.
Are we ‘led by the science’?
An increasingly vocal group of senior immunologists and epidemiologists argue that the evidence on population immunity is incorrect. Public health ‘lockdown’ responses around the world are predicated on the assumption that the virus entered the human population with no pre-existing immunity before the pandemic. Seroprevalence surveys measuring antibodies have been the preferred method for gauging the proportion of people who have been infected by Covid-19 (and have some degree of immunity to it), with estimates of ‘herd immunity’ providing a sense of where we are in this pandemic. Whether we overcome it through naturally derived immunity or vaccination, the sense is that it won’t be over until we reach a level of herd immunity.
‘Antibody’ testing indeed indicates that between 14% and 21% of the UK population is likely to have immunity to the virus. However, there is now mounting evidence that there is widespread T-cell response in the population to four endemic ‘coronavirus family’ members that cause common cold symptoms and are similar to the new virus. Professor Sunetra Gupta, contributing to an opinion piece in the BMJ, suggested recently that a much larger percentage of the population might be immune because of T-cell responses. The evidence is mounting, with calls increasing for a shift of focus towards T-cells: ‘the real question is why mainstream media and others continued to focus efforts and narrative on antibodies’. T-cell reactivity has been found widely in studies of people who test negative in seroprevalence tests and in asymptomatic cases of Covid-19. A recent German study found that a staggering 81% of individuals had pre-existing T-cells providing immunity. Vitamin D appears to be critically important for the activation of T-cells, perhaps explaining why some people are unable to mount a strong T-cell response to Covid-19 and go on to fall seriously ill. The importance of Vitamin D is further emphasised by many immunologists who have already shown its importance in reducing ICU intervention and numbers of deaths.
Further criticism is mounting about the PCR testing, that is supposed to confirm whether or not you are actively infected with Covid-19. Aside from the chaos surrounding access to tests across the country, many experts argue that the programme is producing large numbers of false positives or ‘cold positives’ (detecting fragments of virus which are not capable of infecting other people). Given that testing has increased substantially over the last month, this might account for recent ‘spikes’ which do not appear to be followed by proportionate numbers of deaths and hospitalisations. On August 24th, the United States CDC changed its guidance on when PCR testing is appropriate, and now recommends not testing people with no symptoms, yet our Health Secretary Matt Hancock has yet to address this issue and admits that the British Government do not know the false-positive rate of testing. There are no published studies on the operational false positive rate of any national COVID-19 testing programme.
Finally, NHS data suggests that hospitalisations and deaths from Covid-19 are still very low but are rising. Can we trust the data? There has been widespread criticism once again about recorded data on hospital admissions and deaths. This is not to underestimate in any way the tragedy of the ‘first wave’ and the reality of Covid-19 as a new virus which is very dangerous for some. However, it is well known that in the early stages of the pandemic, death certificates repeatedly stated ‘Covid-19’ if a positive test indicated active virus, even if the cause of death was unrelated. Covid-19 was also listed as a cause of death ‘on clinical balance of probabilities, without testing’. Currently, we simply cannot tell from the data on hospital admissions, whether or not a patient is actually ill with the virus or asymptomatic from Covid, but very ill with something else. Any positive test undertaken in hospital, or an anyone who is admitted within 14 days of a positive test, will be listed as a ‘hospital admission for Covid-19’, whether or not they are actually ill with the virus. Currently, official deaths include anyone who has died within 28 days of a positive test for Covid, and data produced for the public states that numbers are ‘deaths where Covid-19 is mentioned on the death certificate’. However, as far as I can tell, it is impossible to distinguish from the figures whether or not any such person had been asymptomatic and died from something completely unrelated – or whether they were previously seriously ill with Covid. Surely these factors are of critical importance to a strategy of widespread lockdown and economic collapse, based fundamentally on ‘the science’ about the risk of severity and current virulence of a virus?
“In the questions of science, the authority of a thousand is not worth the humble reasoning of an individual.” Galileo.
Where are we heading?
When you target everything that brings joy (culture, arts, music and sport); when you deprive whole populations of the richness of life – the close, physical dimensions of love, celebration, festivity and comfort; when you deny people gladness, merriment, compassion and human contact; when you remove agency and basic individual freedoms with sweeping and extended parliamentary powers not seen in a generation; when you dehumanise people with face-coverings in settings where body language and communication are essential – and vilify those who are exempt for medical reasons; when you exclude people from public spaces because their phone is too old to download the government tracing app; when you undermine community spirit by encouraging neighbours to spy on and report each other – and peddle damaging slogans such as ‘Don’t kill your granny’; when you decimate the job market – and forcibly close whole sectors and small independents – making us all more dependent on the large conglomerates and the state; when there is mounting scientific evidence that things could be done differently with an age/vulnerability approach, but the Government and SAGE refuse to openly address valid questions about ‘the science’ . . . you risk the total demoralisation of society and permanent loss of trust in science, democracy and governance. How our communities will respond to this over the coming months remains to be seen.
At the very least, the Government and its scientific advisors need to make themselves available for discussion with the electorate, about the catastrophic social and medical consequences of lockdown, the growing evidence for T-cell response and concerns about testing. The data on hospitalisations and deaths should be clarified so that we can all distinguish between those who died of the virus and those who died with a positive test, but from something else. Instead of sending out the CMO and the CSA to broadcast to the country, armed with info-graphs based on unlikely trajectories, designed to terrify the public, we all deserve open debate about these issues. A more accurate picture of immunity and testing would enable us to protect those who are vulnerable (should they desire so – for I have met many who no longer feel that life is worth living locked away) and allow others to engage in more normal activities. As a historian of science and medicine, one of the central tenets of my research has been that neither science nor medicine are value free – everything is driven by broader agendas. It is a concern to me and many others that policy is being guided by the interests of big pharma and the Bill and Melinda Gates Foundation. When you take time to explore, there is a tangled network of financial interests and influence that extends from the WHO, CEPI, GAVI and our own UK Vaccine Network, to individuals themselves: Sir Patrick Vallance and Professors Chris Whitty and Neil Ferguson. I am ashamed with myself that it took me so long to question received wisdom, because there are such obvious ethical issues with large-scale philanthropy, which, although it undertakes good work, is rarely democratic and often unaccountable – I recently heard it described as a ‘cartel’, suppressing diversity of scientific opinion. Never has there been a more important time to ask questions.
I am writing to my MP to ascertain the following:
1) Why is SAGE refusing to discuss evidence about T-cell response and the possibility that there is more widespread immunity in the population which could influence policy on restrictions?
2) Will SAGE and the government please comment on mounting evidence that PCR testing produces high numbers of false positives when community infections are low?
3) Why does our Government not know the false positive rate of testing? And is this acceptable?
3) Will the Government change the way it presents hospital data, to distinguish between those who discover, unexpectedly, that they have tested positive for Covid, but are asymptomatic and being treated for something else – and those who are admitted ill with Covid symptoms?
4) Will the Government change the way it presents data on deaths, to distinguish between those who have died from something non-Covid related, but within 28 days of a positive Covid test?
5) What is the Government doing to mitigate the catastrophic health effects of lockdown and economic collapse?
Reading
Helen Coffey, ‘Affection deprivation: What happens to our bodies when we go without touch?’ The Independent, 8 May 2020
Andrew N Cohen, Bruce Kessel, Michael G Milgroom, ‘Diagnosing COVID-19 infection: the danger of over-reliance on positive test results’, medRxiv, 28 September 2020
‘Employment and unemployment: How does work affect our health?’ The Health Foundation
B Healy, ‘Covid-19 testing, low prevalence and the impact of false positives’, BMJ, 369, September 2020
C Heneghan, ‘How many Covid diagnoses are false positives?’ The Spectator, 20 July 2020
Fredrik Norström et al., ‘Does unemployment contribute to poorer health-related quality of life among Swedish adults?’ BMC Public Health, Volume 19, 2019
Molly Rosenberg et al., ‘Depression and loneliness during Covid-19 restrictions in the United States and their associations with frequency of social and sexual connections’, medRxiv, 20 May 2020
Jacqui Wise, ‘Covid-19: Experts divide into two camps of action – shielding versus blanket policies’, BMJ,370, September 2020
Links from text above:
Bans on care home visiting:
Office for National Statistics, ‘Coronavirus and depression in adults: Great Britain June 2020’
Office for National Statistics, ‘Coronavirus and the social impacts on disabled people in Great Britain: May 2020’
Peter Doshi, ‘Covid-19: Do many people have pre-existing immunity’, BMJ,370, September 2020
Shaun Griffin, ‘Covid-19: “Staggering number” of extra deaths in community is not explained by Covid-19’, BMJ, 369, May 2020
https://www.bmj.com/content/369/bmj.m1931
John’s Campaign
Eshani M King, ‘T-cells really are the superstars in fighting COVID-19 – but why are some of us so poor at making them?’ Rapid response, BMJ, 370, September 2020
https://www.bmj.com/content/370/bmj.m3563/rr-6
Paul Kirkham, Mike Yeadon and Barry Thomas, ‘How likely is a second wave?’ Lockdown Sceptics, 8 September 2020
https://dailysceptic.org/addressing-the-cv19-second-wave/
Carl Mayers and Kate Baker, ‘Impact of false-positives and false-negatives in the UK’s COVID-19 RT-PCR testing programme’, 3 June 2020
Rise in deaths from dementia:
Robert Pell et al., ‘Coronial autopsies identify the indirect effects of Covid-19’, The Lancet Public Health, 10 August 2020
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30180-8/fulltext
Samaritans, suicide data
https://www.samaritans.org/about-samaritans/research-policy/suicide-facts-and-figures/
Sanjay G Reddy, ‘Population health, economics and ethics in the age of COVID-19’, BMJ Global Health, Vol 5, Issue 7, June 2020
https://gh.bmj.com/content/5/7/e003259
Touch starvation and the immune response:
https://www.tmc.edu/news/2020/05/touch-starvation/
Artwork: Courtesy of Sacha Freemind, Clement Falize and Marianne Bos, on Unsplash