I was recently forwarded some self-described “interesting World Health Organisation statistics about India”. This was on a day when around 3,500 Indians had lost their lives to covid.
The sender sought to provide some ‘perspective’. On any given day, one might expect over 4,500 people to die from air pollution on the sub-continent, 2,000 from diarrhoea, over 400 from car accidents, even 158 from snakebites. His point was that, given the size of India’s 1.3 billion population, what may appear terrifying figures in the context of the UK required a more context.
He is, of course, right… and also horribly wrong.
Relative to the size of our respective populations, 3,500 deaths in India equates to around 170 here, barely an eighth of the 1,500 that were dying daily in the UK at the height of our second wave. Seen through this lens the current focus on India does indeed seem panicky and disproportional.
I am not, however, convinced that the fact that lots of people die non-covid related deaths in India takes us very far. Are we to conclude that we can as a result ignore coronavirus just because we have failed to improve air or water quality or kill all poisonous snakes? And if our neighbour is run over by a car today and we fail to improve traffic management, would we still tolerate this, were it to lead to an exponential rise in car accidents?
And even taking the comparisons between India and the UK at face value, all might not be as it seems. What about the apparently massive under-reporting from rural parts of India, the relative ages of our two countries’ populations, that many Indian covid deaths may be the unnecessary result of political incompetence, complacency and corruption?
My purpose in highlighting these arguments is not to discredit them, but because they shine a light on the all-important follow up question: what level of risk is tolerable in relation to covid?
Despite the huge success of the vaccine roll out in the UK, it has barely just begun globally. And even once we have offered vaccines across the world, they can’t offer complete protection presently or against future variants.
So, we must learn to live with covid at a level which we deem tolerable. And that means that people will continue to get sick and die. But what level of infection, illness and death are we ready to accept from this new disease? What level of disruption to our ‘normal’ lives?
As a cricket fan, I struggle to take the Indian Premier League seriously but were the creeping infections within the teams’ respective bio-bubbles likely to represent a serious threat to young, fit athletes, their coaches and support teams, cut off as they were (if apparently not completely) from the general population? Wasn’t the distraction of the IPL in a cricket-mad country a price worth paying, and its cancellation more a matter of taste than life or death?
In the UK, as we open up our theatres and cinemas, pubs and clubs and restaurants, if infections begin to creep up once more at what point might we tolerate the reintroduction of lockdowns, mandatory mask wearing and social distancing?
Is the requirement that we carry ‘proof’ of the covid antibodies in our system a price worth paying for the freedoms it might infer?
In June and July last year, as the UK recovered from its first wave, wishful thinking meant that we failed to engage with such questions properly. Rather like cancer and climate change many of us assumed a cloak of invincibility, that we had collectively seen out the worst.
Now we know that that was not – and may not in the future be – the case. So we need to make public policy now which helps us to understand and engage more seriously with levels of risk. This means more research on what outcomes we will tolerate. It means proper education to understand statistics both amongst the public at large and in the media. It means the use of polling and citizens’ assemblies to inform decision-making. It means more bottom-up decision-making, so as not, once again, to infantilise the population.
There are no right answers. There are only very difficult decisions based on balancing freedoms. For me, there are worse things than death: protracted severe illness, absolute poverty, loneliness and isolation, all of which are potential consequences of future covid prevention strategies. Some of you will agree – others not. But unless we start asking these questions, our politicians will once again decide for us and, next time, we might not be so willing to comply.