SAINT PATRICK’S DAY 2020: LETHAL GAME CHANGER 2004 CXLVIII

SAINT PATRICK’S DAY 2020: LETHAL GAME CHANGER

How strange and surreal it is to be writing this. Two weeks ago it would have been inconceivable. A week ago, hopefully, unlikely. That was then and this is now. The Corona Virus has struck with all the immediacy of an asteroid impacting. It’s not in China, like SARS, nor in Central Africa, like Ebola. It’s here in Ireland, in Europe, in North America, in the prosperous First World.

Again, pursuing the asteroid metaphor, the dust and debris have not yet settled so we have no idea, other than a pessimistic inkling of the damage wrought. It promises to be fearsome. Western Europe, now deemed to be the Epicentre, has five hundred million people, North America three hundred and sixty. If left unchecked up to seventy percent could be infected; repeat 70% or 600 million. For most, perhaps up to ninety per cent, it will be mild, for ten percent more serious, requiring hospitalisation, and for the unfortunate minority – fatal. Based on the evidence from China, the death rate could be 2% or higher; and 2 % of 600 million comes to 12 million deaths. For the island of Ireland, with 6.9 million, this works out at around 100,000 dead. For Britain, with ten times the population, the estimate is around one million. Even an infection rate of 10% would yield figures of  fifteen and one hundred and fifty thousand dead. Do the math for North American deaths.

These are wartime figures. For make no mistake. Our societies are at war. The casualties have begun to mount, the infection rate appears to be doubling perhaps every three or four days and if we do nothing will continue at that pace. The collateral damage will be colossal; already the Western economies are taking severe hits with a downturn and recession now a virtual certainly. But the societal damage is even worse, again akin to that in war. Italy, the country outside China worst hit so far has seen its health system buckle under the strain and has even begun to triage patients in need of the limited supply of respirators. That on the basis of casualties, as I write, of 31,000 infected, half of one percent of Italy’s population. And as the system buckles, as the earlier experience in Wuhan demonstrated, the mortality rate rises; in Italy with 2,500 deaths, it is already well over 5%, culling brutally and disproportionately the elderly and the already sick.

The first case was diagnosed in Italy on 21 February, less than four weeks ago, and it is the sheer speed with which the virus has spread which has thrown Western politicians and populations off balance. They – we – had watched with  fascination as the virus picked up tempo from its still murky origin in Wuhan, China last December. We watched as the Chinese government, authoritarian and therefore able to mobilise, control and direct its population had gradually fought against the virus, effectively locking down hundreds of millions of people for lengthy periods. We marvelled, but were complacent enough to think it could never strike in Europe, and, moreover, that it would be unthinkable to contemplate, yet alone introduce, similar curbs on personal freedoms into western democracies.  A comforting sub – text to this thinking was that by the time it DID strike, a vaccine would have been developed, and/or like SARS or some of the other flu like viruses that originate in China it would be self-limiting or would weaken and attenuate.

The vital lessons which the Asians had learned from combatting SARS and were relearning and applying to control the current virus, were noted but not applied in time, particularly the essential devices of adequate testing and then contacting and isolating the wider pool of those third parties potentially infected. Even as the horrific developments in Italy were played out on the European media, politicians and governments seemed content to concentrate what testing there was on people who had visited Northern Italy, completely underestimating the virulent contagion rate of the virus.

Now it’s a massive “Operation Stable Door” throughout Europe to emulate the Asian success in slowing down the rate of infection (“flattening the curve”) and it is clear that the reputations of the current crop of governing politicians will be determined by how they handle this crisis.  Sport has been cancelled, even not-so- large gatherings banned. Pubs and restaurants are being closed in more and more countries. People, the elderly especially, encouraged to stay home. Italy is in lockdown, as are Spain and France – Macron yesterday declaring that France was at war. Borders have been closed, States of Emergency have been declared throughout Europe as the figures for infections have rocketed – and will continue to increase dramatically as more people are tested.

The other grim lesson from Italy is that where a society is mainly healthy and prosperous, a country’s health system is likely to be tailored and resourced to reflect this, with an embedded assumption that it will never have to face a massive and immediate existential threat. Italy is running short of essential equipment to cater for the ever increasing numbers of seriously ill. It is doubtful whether any other European country is much better equipped. With catastrophe threatening and doctors facing the prospect of who to save or not, the avowed aim of the measures taken thus far is to try to slow down and flatten the rising curve of infection. Even some flattening would relieve pressure on Europe’s national health systems.

Ireland had its first confirmed case on 29 February. The current figure for the island is 354 (69 new today), including 62 in the North and is increasing sharply. According to Taoiseach Leo Varadkar, a doctor, the daily figure is expected to increase by 30% and the total infected could reach 10-15,000 by the end of March, two weeks today. The vast majority will not require hospital treatment, but at 2%, 2-300 could die. The Chief Medical Officer, Dr Tony Holohan, has stressed that the next seven days will be vital in flattening the curve and partially heading off disaster. The economy is shattered and further emergency measures seem likely. No one can even speculate what the final outcome will be.

Thus far our nearest neighbour, Britain, has marched to a different drum, initially downplaying the threat (though not on the scale of Trump), while eschewing the more drastic measures taken by other major European countries. Perhaps there was an illusion that, as an island, Britain would be spared the worst (which may well turn out to be partially the case, and for Ireland also). Perhaps also through adherence to the notion of “herd immunity,” which might eventually prove valid, but which constitutes a hell of a risky policy bet. As the figures mount British policy is now changing, perhaps too late.

For us all this is a war. And even if we succeed in “flattening the curve” this will not constitute victory. It will not constitute a Stalingrad, a Midway, a Kursk, a D-Day. At best, to quote Churchill, a Johnson favourite, it will constitute an “end of the beginning.” And even that will require “Blood, Sweat, Toil and Tears.”

Happy Saint Patrick’s Day!

END

17/3/2020

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