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23. The diverging approaches to getting back to normal

As these words appear on the screen before me, towards the end of April 2021, Covid-19 cases and deaths are soaring in India. The country has registered record daily case numbers for several days in a row now, and the number of deaths attributed to the disease is now reaching a few thousand each day — yesterday (Tuesday, April 27th) saw a new record for the country of more than 3,200 deaths.

This is being described as India’s “second wave”, but on the face of it — both the raw numbers and stats, and the on-the-ground reports — this bears no real resemblance to the first one.

Coronavirus data India

 

While India is getting the headlines, it is — relatively speaking, and while acknowledging the healthcare system stresses that make spikes much worse — far from obviously the worst situation in the world. Its deaths per million people figure is 1.93, compared to, say, more than 11 per million in Brazil and Poland, 17 in Bosnia-Herzegovina or 20 in Hungary.

Coronavirus COVID-19 deaths India

 

The problems with raw numbers

There have been many (reputable) scientists who have questioned some of the numbers that get routinely trotted out in data analyses and evening news bulletins. The PCR test, for example, which quickly became the gold standard for measuring daily case numbers around the world, has been criticised as being too sensitive, and overall not a good mechanism for recording official figures.

For example, a report titled “Covid-19: the problems with case counting” published in the reputable British Medical Journal last September included a section under the heading “What is a case?” (my emphasis):

One issue in trying to interpret numbers of detected cases is that there is no set definition of a case. At the moment it seems that a polymerase chain reaction (PCR) positive result is the only criterion required for a case to be recognised.

“In any other disease we would have a clearly defined specification that would usually involve signs, symptoms, and a test result,” says Carl Heneghan, director of the Centre for Evidence Based Medicine at the University of Oxford and the editor of BMJ Evidence-Based Medicine. “We are moving into a biotech world where the norms of clinical reasoning are going out of the window. A PCR test does not equal Covid-19; it should not, but in some definitions it does.”

Angela Raffle, honorary senior lecturer in social and community medicine at Bristol Medical School, is also concerned about this. She says, “In the early phase back in March, deaths were just reported numbers—you couldn’t tell quite what was being counted—then after a while the small print appeared defining what is counted as a Covid-19 death.

I’m still waiting to see the small print to clarify what we are counting as cases.”

Added to that, there is the grand uncertainty that comes from the variance of symptoms and suffering, ranging from zero symptoms for some to prolonged breathlessness and death for others.

All of which means that the official number of “cases” — which at the time of writing stands at 148 million cases — is very likely to be much lower than the real one. (Even the World Health Organisation, as far back as September 2020, put forward its belief that as many as 10% of the global population had been infected. That equated to approximately 760 million people at a time when the official case number stood at *just* 35 million.)

Problems with case numbers aside, as those in frontline health services in India or Brazil or Hungary might attest — all of whom seem to be experiencing something similar to the suffering in northern Italy which attracted so many media headlines in February 2020 — the virus, and the suffering it brings to a small percentage of people who contract it, is very real.

The race to get back to normal

And yet, despite all this, the world is quickly opening up.

What’s the right thing to do?

Lockdown, close borders, impose restrictions … and wait it out?

Or open up fully, give people back the freedoms that had been hard-won over centuries of human progress, protect the vulnerable as much as possible and allow the virus to take its course?

Neither course of action is good for everyone, but then again, could it be that one of the big drawbacks of developments in politics and social activism and the drive for equality of the past 50 years is the idea that anything can ever be good for everyone?

Inequality is part of life. This does not mean that we should strive to stamp out injustice wherever we see it, but to equate injustice with inequality is to fail to understand life.

You can do everything right and get the wrong outcome, and someone else can do lots of things wrong and get the right outcome.

Luck is the great intangible that seeps into all of our days. The challenge for everyone is to keep striding forward with purpose in the knowledge that only a certain amount of things are within our control.

As F Scott Fitzgerald wrote in The Great Gatsby, “we beat on, boats against the current, borne back ceaselessly into the past”. The current will be against us at times, that’s for sure. Sometimes it will be behind us, and we might not even know it until it changes. (And we have no idea when it will change.)

There is always some lurking temptation simply to give up, to admit defeat against the countless array of troubles that await us, to concede that if survival is the goal, then the goal is eventually doomed to failure for all of us.

Many people have fallen victim to such nihilism in the past. Many more will do the same in the future.

Nihilism is no way to live from day to day. But equally, sinking our heads in the sand and refusing to face any of our troubles is no good either.

And so, things open up.

Pubs serve beer once again.

Outdoor dining will become normal, even in places where outdoor dining was previously curtailed by climate and culture.

Sports fans will return to arenas, taking some precautions and ignoring others, like sports fans always will.

The different approaches being adopted in different places are fascinating to observe.

So in Ireland, you have a situation where the European Football Championship matches due to take place in Dublin this summer have been moved elsewhere in Europe because of the Government’s inability to meet the requirement from Uefa, the tournament’s governing body, that 25% crowd attendance should be allowed.

Hungary, on the other hand, have taken the 25% requirement and run with it. They are trying to stage games before capacity attendances.

Ireland’s Covid-19 7-day rolling death rate is 1 death per million people. Hungary’s is 20 times higher.

Ireland Hungary Covid-19 Deaths per million

Who’s right?

Who knows?

Should we continue to postpone all the things that we see as normal in a free-thinking, free-living democratic society?

Or should we take our chances?

There are no easy answers here.

But maybe, when in doubt (and doubt is permanent), the best bet is to bet on living life, rather than delaying death.

This essay is part of a series of 30 short essays to make the Covid-19 pandemic, one year on. Sign up below to receive these pieces by email.