Focus on the 12.8% - Village Magazine

40 November/December 2020

Sure apart from dying other people get the

disease and other people get nasty long-term

side effects. But we have to put them in the same

rank as those at greater risk of dying from ﬂ u or

cancer or suicide because the virus is hogging the

medical resources.

OVID IS sly. It needed to be to thrive with

humanity’s unnatural new-found

sophistication. Just when you thouht

somethin was clear you turn out to be

wron: it’s not airborne; masks don’t

work; youn people don’t et it; children don’t

spread it; lockdowns don’t work. That’s part of the

reason it’s such an uninterestin topic to debate.

Almost any view of the facts passes. Nothin really

is ospel.

I was fast out of the tracks in March. Determined

to work out what the pattern of this new bad thing

was, for personal and journalistic reasons. I wrote

several articles saying the media reﬂ exively parlay-

ing government were misleading people based on a

false assumption that Ireland would su er 1.9 mil-

lion cases and implicitly 114,000 deaths in a ﬁ rst

wave. It was clear that counter measures taken would

result in a small fraction of those ﬁ gures. I came, just

a little late, to the realisation we were not taking care

of the egregiously vulnerable: of the elderly with co-

morbidities; of the vulnerable in congregated set-

tings especially nursing homes.

For me the problem is getting to the facts (in this

case this means the science) of the virus. Village’s

motif is ‘Facts ﬁ rst; then the ideology’. In Village’s

case the ideology is radical: equality of outcome,

sustainability and accountability. Broadly speaking

these would suggest a state-funded high-spend, sol-

idarity-based approach with clarity between medi-

cal scientists and politicians and a clear, scientiﬁ c,

documented balancing of social, economic, envi-

ronmental and cultural imperatives as well as the

imperatives of other medical conditions, especially

mental health conditions, against the imperatives of

suppressing the vicious Coronavirus. But really the

issue is factual not ideological. It’s more about as-

certaining the facts, relying on the best predictions

and weighing the common good, than applying an

ideology such as egalitarian or liberalism. Probably

the most important inﬂ uence of ideology is in deter-

mining whether a common-good or a rights-based

solution is favoured but I think ideology’s place is,

in the case of Coronavirus, massively outweighed by

common sense, and evidence-generation, in the face

of phenomenon that is as elusive as it is devastating.

It seems to me that clear thinking requires recogni-

tion now that there has been an accumulation on the

side of the balance that represents everything except

Covid-19. This, miserably, is because frankly the vi-

rus has gone unchecked for longer than seemed like-

ly when there was an innocent belief in easy circuit

breakers. It is this circularity – that not checking the

by Michael Smith

OPINION

We need to refocus on those who could actually

die from Covid – and de-focus on the rest

Focus on

the 12.8%

November/December 2020 41

Tánaiste Leo

Varadkar recently

pointed out that

Belgium took

into account

“hospitalisations,

ICU capacity and

. . . deaths” in its

Covid response.

Maybe we should

be focusing on

that.

virus spawns disproportionate non-Covid eects -

that generates the diculty and the stress.

Tánaiste Leo Varadkar, who beguilingly alternates

slavish adherence to, with subversion of, the ocial

medical advice, recently pointed out that Belgium

took into account “hospitalisations, ICU capacity

and . . . deaths” in its Covid response. “Maybe we

should be focusing on that”.

We need to focus. Clearly Varadkar, no Village

favourite, meant we should consider the criteria of

hospitalisations, ICU capacity and… deaths more

that NPHET does. That is a legitimate analytical view

that delivers the proper role of politicians – weighing

the medical evidence put before them not accepting

the totality of the evidence blind.

He was implicitly saying we can tolerate cases –

pending a vaccine or herd immunity – according to

The Economist: “Some models which assume plau

sible variety in contact rates have concluded that the

herd-immunity threshold in western Europe could be

as low as 43%”

- if they do not aect hospitalisations, ICU ca

pacity and deaths: medical indicators that show a

response is required and is at risk of not being avail

able. I think he was right. But I would go further.

Hospitalisations and exhaustion of ICU capacity

dealing with Covid-19 are outweighed by other im

peratives.

Unless they lead to deaths.

The problem is deaths, not cases.

The problem is in older people with co-morbidities

– and a third of people of all ages have a co-mor

bidity.

Sure other people get the disease, other people

die, other people get nasty long-term side eects,

though according to the Guardian “10% of Covid

patients experience symptoms lasting longer than

three weeks, and around one in 50 will still be ill at

three months”.

But we have to weigh the small danger to the

young healthy against the greater risk to them, and

everyone, of dying from ﬂu or cancer or suicide be

cause the virus is hogging the medical resources and

draconian measures now are generating dispropor

tionately negative; health, social and economic, up-

shots – even if they are short of death.

According for example to the ‘high-risk, ‘high-

reward’ ‘Great Barrington Declaration’ (contradicted

by the ‘John Snow Memorandum’) we need to focus

on the elderly. A paper published in the BMJ on

October 20 considers a covid-19 risk calculator that

predicts an individual’s probability of hospitalisa

tion and death, using data on six million people in

Britain. Validation of this algorithm on two million

others showed that the 5% of people predicted to be

at greatest risk by the calculator accounted for 75%

of the covid-19 deaths. In Ireland 90% of deaths are

in the over-65s, albeit the awfulness of the ﬁgure is

in theory mitigated by the reality that the median age

of all Covid-19 deaths, 83, is currently slightly above

the current average life expectancy is actually some

where above 82.

60% of deaths have been in nursing homes. We

have 460 nursing homes and 25,000 residents in

them. We need to keep the vast majority who have

avoided the virus tight from it. 19.1% of the popula

tion was aged over 65 according to the CSO in 2016;

half of them have at least three chronic conditions.

That’s 637,567 people who could die facilely if we

don’t protect them from Covid.

We should protect older people with co-morbid

ities – probably in practice requiring special atten-

tion to all over-65s. Like we mean it. That means

increasing the protection for them rather than going

through the motions. It means clamping down on

nursing home visits, and controlling and assiduously

testing nursing-home sta.

But if we divert resources away from over-protect

ing people who don’t overall need it, if we divert re-

sources from the savings we make in re-opening the

economy, there will be resources to make the clamp

ing down and the cocooning tolerable for older peo-

ple with co-morbidities and we can treat their car-

ers properly. So they can live with it. That means a

single-minded deployment of resources into making

cocooning tolerable. I do not need to say what this

might involve – professionals in logistics and psy

chology can do this better than I – but for example

manpower should be available on a colossal scale

to avoid loneliness among the cocooned elderly.

Massive resources to ensure risk-free transporta

tion of the elderly wherever they need to go to pre-

serve their sanity, whether to shops or to see loved

ones. Massive resources on PPE-equipped sta to

help them, on barriers that allow them to communi

cate personally but safely, with friends and family.

Divert resources saved by no longer tying down 4.3

million people on to the 637, 567 who need protec

tion and safety but also logistical and psychological

help. Be scientiﬁc. Focus on the 12.8% who need it.

Just focus; and respect their human rights. Weigh the

common good and respect the human rights of all.