Coronavirus 23rd March 2020

Dr Vernon Coleman MB ChB DSc FRSA

The fear seems to be out of control and so I will continue to provide fact based observations and thoughts in the hope that these give some explanations and reassurance to those who are kept awake by the terror which has been built up during the last month or so.

1. In the 2019-2020 flu season in the USA, a total of 149 paediatric deaths have so far occurred. The Centers for Disease Control and Prevention reports that `Influenza severity indicators remain moderate to low overall, but hospitalization rates differ by age group with high rates among children and young adultsí. This, remember, is the flu. The Centers for Disease Control and Prevention reports that there have been between 12,000 and 61,000 deaths annually from the flu since 2010. Those are the deaths in America alone. In the year to April 2019, the flu killed 57,000 people in America and made 41.3 million people ill. Global deaths from the flu have, in the past, exceeded 600,000 in a single year. My intention all along has not been to minimise the danger of the coronavirus but to draw attention to the danger of the flu, to compare the mortality figures for the two diseases, to explain the dangers which might result from overreacting and to ponder on possible hidden agendas. Since whenever the disease started in China (usually said to be late in 2019) the coronavirus has resulted in more than 15,000 deaths.

2. Why has Italy got such a high death rate from the coronavirus? There are several explanations but one is that many Italians smoke and there is much air pollution in areas such as Lombardy where there have been many deaths. Another explanation is that the majority of patients with the coronavirus in Italy are older and have serious underlying disorders. However, according to Professor Ricciardi, scientific advisor to Italyís minister of health, another reason is that anyone who dies in Italy and who has the coronavirus will be listed as having died of the coronavirus. So, 80-year-olds who die of cancer or heart disease, but who tested positive for the coronavirus, are listed as having died from the coronavirus. Professor Ricciardi says, in the Daily Telegraph, that when the National Institute of Health re-evaluated the death certificates only 12% showed a direct causality from coronavirus whereas 88% of those who died had at least one, two or three underlying illnesses. A study published in JAMA (`Coronavirus Disease 2019 (Covid19) in Italyí) on 17th March 2020 showed that 87% of deaths in Italy occurred in patients over 70 years of age. All this inevitably pushes up the number of deaths in the country. It is surely dangerous to extrapolate from one countryís experience. It is, perhaps, surprising that more publicity hasnít been given to these findings which seem to me extremely important. (If you remove just half of the Italian deaths from the global total the figure looks very different.) Yesterday, I said that I thought the Italian figures were wrong because they were putting down too many deaths as coronavirus. It looks as if I was right.

3. Self-isolating wonít work for most people unless everyone in their home is also self-isolating. Most homes have only one toilet which is usually also the bathroom. If the self-isolating is going to be effective then the toilet and bathroom fittings will all need to be thoroughly cleaned every time the person who is self-isolating has used them. A quick wipe down with a damp cloth wonít do. Putting patients into isolation is a more complex and precise business than is generally agreed. Everything needs to be cleaned and handkerchiefs, etc. should be placed in a sealed bag when handed to another family member.

4. For how long will councils maintain refuse collection services? My fear is that councils are already planning to cut costs by reducing or stopping collections. That would be a disaster for those who are in quarantine and cannot get out to queue at council dumps. Incidentally, the amount of food waste is going to soar when the hoarders realise that some of the stuff theyíve bought is too old to eat. And thatís then the already existing rat problem will explode.

5. It is absurd for councils to tell citizens to beware of the coronavirus while still expecting them to put out rubbish for recycling. I have long thought that recycling bins and boxes are a major cause of cross infection within our communities. Bin men (sorry, `community recycling consultantsí) touch hundreds of bins and when you pick up your recycling boxes they will be as full of bugs as a municipal lavatory. Bin men may wear gloves but that wonít stop the spreading of bugs. When you pick up all your bins you will be exposed to all the bugs left on the recycling boxes. The more boxes there are, the greater the risk will be. Councils would help cut the spread of infection by reverting to weekly black bag collections only. Black bags spread no bugs.

6. The Daily Telegraph is not alone in hiding material about the coronavirus behind its pay wall. I see that The Sunday Times is doing the same thing. Shame on them. If this is a national crisis, how about a bit more public spirit?

7. Why, when tests for coronavirus are allegedly only available to those who are seriously ill in hospital, are we constantly being told that football A or celebrity B have tested positive? Giving priority tests to those who have a little notoriety is surely unacceptable.

8. The ECB has recommended the suspension of all forms of recreational cricket. Amateur football clubs are shut. And there is talk of golf clubs closing. I understand that sweaty gyms have to close but if outdoor amateur sports are shut down for long there is going to be a massive rise in obesity and all the associated diseases. As long as players donít use a communal changing room it does not seem beyond the wit of man to ensure that the players keep their distance from one another. Players really donít have to hug one another.

9. Critics crouched in safe anonymity behind their screens and keyboards, seem determined to intimidate anyone offering a rational, alternative view about anything. Calling me a quack or a crank doesnít really seem to help anyone. I have seen it suggested that my thoughts are irrelevant because I am not a registered and licensed medical practitioner. Like the majority of retired doctors I had to relinquish my licence when the GMC introduced its bureaucratic revalidation scheme. Iím certainly not forcing my thoughts on anyone. Visiting this site is still voluntary.

10. Suggestions have been made, and are no doubt being considered, that Brexit should be reversed and that Britain should stay in the EU in order to help the economic recovery of all European Nations. Looking at the EUís behaviour over the last month or so I would have thought it was clear that Brexit was the right decision. There does not seem to be a usefully coherent EU policy about the coronavirus. Individual countries are making their own decisions and there has been no apparent leadership from the EU.

11. When this is over there will, without doubt, be a major, global economic crisis. The longer it takes the bigger the problem will be. Despite the Governmentís intervention it seems likely that unemployment will soar, property values will fall, businesses will go bust and investments and pensions will have lost much of their value. Taxes will have to rise considerably. According to a paper entitled `Mortality following unemployment during an economic downturn: Swedish register-based cohort studyí which was published in the BMJ it is older men who are particularly at risk of dying if they are made unemployed. Itís time for us all to assume that there is going to be a future and to start making plans for it. If plans arenít made then my fear is that the death rate from the consequences of the remedies introduced to control the coronavirus could well exceed the death from the virus itself.

12. Ron Templeman telephoned a newspaper and asked if they did not think it would help to tell us how many people were recovering from the coronavirus infection. He reports that he was told that people donít like good news. Well, this time I think theyíre wrong.

Copyright Vernon Coleman March 23rd 2020