WE NOW HAVE Project Fear on steroids in Scotland. Headlines shriek about the mutant virus as if it’s an extraterrestrial invader. The First Minister parries questions from the Conservative and Labour leaders at Holyrood with a petrified mien and repeated warnings about “a train … coming down the track to run us over”. We are facing an open-ended hard lockdown on Boxing Day – schools and non-essential premises shut, and house arrest potentially enforceable by law for anyone not exempt.
What exactly is this train threatening to mow us down?
It’s certainly not death directly from Covid. Numbers are falling or flatlining, even counting the very many recent deaths not primarily caused by the virus; people are categorised as dying “with Covid” if they tested positive in the previous 28 days or exhibited symptoms. Excess deaths, the only accurate measure of mortality, are not significantly higher than expected for the time of year.
Perhaps the Covid train will send us into intensive care or hospital. But figures for ICU and hospital occupancy are also flatlining or falling. They are high, but they always are at this time of year. The rate of Covid, or more specifically the number of PCR tests in hospitals, is also high, but given the false positive rate of PCR testing, particularly for people without symptoms, and the frequent testing of patients, this is not surprising. To be clear: most people with positive PCR tests have not been hospitalised or put in ICU because they are desperately ill with Covid. Critical coronavirus cases are a minority.
The Covid train, then, must consist of the one statistic that has been growing: the number of positive cases – or rather, of positive PCR tests. However, this will include a significant proportion of false positives, especially given the routine testing of asymptomatic people in hospitals, care homes and elsewhere. This is the only way to explain the continuing emergence of isolated positives in the islands, where there never seems to be any community transmission. The rise in positive test results is also, obviously, a direct result of testing more. But how much does an increase in genuine positive cases matter if people are not falling seriously ill? Very many people remain asymptomatic or exhibit only mild symptoms; it’s only this year that individuals are panicking about the standard winter colds and respiratory tract infections which have come round every year since I was a child, encouraged to assume they have contracted the dreaded virus.
The explanation for this rise in positive infections is, according to the UK and Scottish governments, the emergence of a new viral mutation which is “up to 70 per cent” more transmissible. Yet no evidence has been presented for how this figure has been arrived at, and after the modelling showing exponential rises earlier this year in both London and Scotland was thoroughly discredited by the actual figures, only the hopelessly naive would set any store by it at this stage.
The panic about the new strain seems odd, not just because viruses mutate all the time – more than 3,000 variants of Covid-19 have been identified – but also because this particular mutation was first detected in September. History suggests that SARS coronaviruses become less severe as they mutate, and there is no evidence to suggest that this recent iteration is more lethal, as Nicola Sturgeon herself had to concede yesterday – although, needing to keep the fear topped up, she did helpfully point out there was a suggestion, unproven as yet, that it was more liable to infect children and young people.
To me, it doesn’t seem that rational to fear the Covid train much more than the flu or pneumonia trains. On an individual basis, Nicola Sturgeon doesn’t appear to be that bothered either, happily participating in a wake in a bar without wearing a mask. Why then is she so petrified?
The answer, I think, is the NHS, and the political blowback if hospital care were to collapse, which no political leader could survive. Hospitals were the immediate cause for the lockdown in March – remember the pictures of overflowing Italian wards? – and the worry about their capacity to cope has never gone away. While the bald data on hospital occupancy does not look bad for the time of year, it conceals the fact that they are struggling more than usual. What they are struggling with, however, is not the number of seriously ill Covid patients, but the number of infections.
Nosocomial infections (or positive test results) have become a highly sensitive political issue. Transmission has risen and remained stubbornly high in hospitals, which people rightly expect to be at the forefront of infection control and Covid safety. One of the major means of suppression is to isolate or segregate patients with a positive test. This causes a kind of internal bed-blocking, inhibiting the through-flow of patients across wards and increasing the likelihood of overflowing A&E departments. The second problem is created by the number of self-isolating hospital staff: both those testing positive in the regular mandatory PCR testing, and the colleagues with whom they have had close contact. Both these problems are made more intractable by the fact that there is so little slack in our hospitals. Unlike in Germany, for example, with its greater number of beds per capita, the NHS has sacrificed resilience for efficiency over years of cost-cutting.
The train really threatening the First Minister is the crisis in our hospitals, especially if positive tests continue to grow. Interestingly, she now barely talks about Test & Protect, which was supposed to mitigate the need for so many widespread restrictions. That’s because its implementation remains shambolic and it has been demonstrably ineffective, partly due to the disinclination of the asymptomatic to self-isolate (which accords with the latest work on Covid’s low rate of asymptomatic transmission).
There is worldwide evidence now that lockdowns generally don’t work, creating unjustifiable collateral damage to health, education and the economy and delaying the inevitable progress of Covid through a population. The First Minister may feel now is the time for Project Fear on steroids, but fewer and fewer people are prepared to hide under their beds.
Photos of train in tunnel by xy from Adobe Stock
