In recent days there have been numerous announcements and statistics published concerning Covid-19 for the UK and overseas. For my part, I had originally crunched the figures for the UK as shown below on the 7th March. I had done that as a personal interest and I emphasise that they do NOT represent a prediction of any kind. Rather they possibly indicate what our government is seeking to avoid!
I should also clarify that they do NOT represent a model of the kind the scientific advisors are using. Such models are far more sophisticated than the calculations underlying the figures presented below and would demonstrate a number of different conclusions depending upon the assumptions made.
Although there has been a lot of attention to the effect on everyday life there has been rather less information provided on the potential mortality associated with the epidemic or its consequences, so that is what I want to examine here.
I must declare an interest as a 66-year-old British male with some respiratory difficulties; my situation is frequently mentioned as being in the most vulnerable category. Sadly, the implications of the information presented below are rather dramatic for me and for others. Although I’ve considered these facts solely with in the context of the UK, the prognosis should apply to other developed nations mutatis mutandis.
As background, we have been told that we may expect up to 80% of UK population to become infected with Corvid-19, as a worst case. This compares with the figure recently provided by Chancellor Merkel of between 60-70% for Germany.
We have also been told that 1-3% of people infected die, and the vast majority of these are older people. In common with our worst case theme table 1 below assumes the higher figure because I have been unable to identify a modelled probability distribution for the infection rate and therefore provide a ‘most probable’ rather than the worst case analysis.
Table 1: Mortality effects of Coronavirus epidemic (population figures in ‘000’s)
|Age group||UK Population||Working population||Infection rate 2||Population infected||Mortality rate3||Deaths ‘000||Population after||Working population after|
Assuming that everyone gets the care they need, and using the 80% infection rate, we can expect to lose around a million people to the virus in the coming months. So everyone will lose someone (as the Prime Minister has now warned, speaking on March 12th).
The argument of “NHS Capacity” below suggests we will lose at least 300m working days to illness (plus days when workers self-isolate and are unproductive or with reduced productivity). This is a huge impact, suggesting severe staff shortages in all sectors, but probably not enough to be crippling to critical infrastructure other than the NHS. So panic buying is inappropriate, but may be helpful to ailing supermarkets, and ultimately food banks.
The government’s “delay” strategy is intended to spread the peak of infection so that the maximum demand for NHS acute care is minimised. While that is entirely appropriate, the numbers provided below indicate that it will be practically unattainable if there is a high infection rate, given the mortality rates that have been published.
Moreover, although not emphasised in the media, It seems that so far all except the very earliest cases in China have received the best available acute care after diagnosis. I infer this because I have been unable to trace an estimate of the mortality rate amongst people who need hospitalisation but cannot get it. However, a reading of the US CDC description of the clinical progression of severe cases is not encouraging; it indicates that the limiting factor on treatment of the more critical phase of the disease is the ability to support breathing with supplemental oxygen and mechanical assistance. The necessary expertise and equipment for this treatment is not widely available outside hospitals. This has been acknowledged in the UK by the proposal to encourage an early increase in the manufacture of the necessary equipment.
Meanwhile I am unaware of any published quantitative information on the effects of the epidemic on hospitals and medical services in other countries. However, one may infer that it has had significant consequences, as evidenced by the rapid expansion of services undertaken in China and the stress experienced by the Italian medical authorities. It is these considerations that have led me to hypothesise the proportions and other figures provided in italics in table 2.
Table 2: Hospital Admissions and Sickness Days
|Age group||Population infected ‘000||Proportion requiring hospital admission||Number of admissions ‘000||Admission duration||Bed days ‘000||Number sick at home ‘000||Days off work||Work absence days ‘000|
Thus the figures in Table 2 are not real although they may be optimistic should infection rates reach the worst case scenario.
On this basis, the NHS would require 11m extra bed days UK-wide.
Table 3: Hospital Bed availability
|Total acute care beds in England ‘000||102|
|Typical availability (daily)||8,128|
|Expected annual bed-day availability ‘000||2,969|
The capacity figures in Table 3 suggest that the availability during 2020 will be about 3m bed-days (in England, before any reduction due to health worker absences) and at the time of writing 20% of that is already gone. There is rather more capacity adding the other UK nations, but not to make a radical difference.
So it seems that the NHS may be overwhelmed by a factor of at least 3 on average, assuming the epidemic is spread over the whole of 2020 so it would be significantly more at peak times,
This does not take account of saving capacity by postponing non-essential operations making part of the current 92% occupancy. While this could be very important, particularly at peak times there are other factors such as staff sickness which may compromise capacity.
It therefore follows that most people who need admission will not get it without denying the acute services presently offered to other patients. Thus the mortality figures associated with the disease are likely to be higher than indicated above.
It also follows that triage may need to be quite brutal, with only people with a good prospect of survival, primarily younger people, getting a hospital bed at all at the peak times.
However, because of the selectivity of the virus, any lack of capacity within the NHS is unlikely to have any further economic impact than the 300 million lost working days as suggested above.
A year from now it will be all over. Suddenly, the economic picture is very different.
We will have lost a million people, but only 0.5% of our productive workforce, and almost none of our children. The million of us who have died were not only mostly unproductive (of course many of us were part-time workers, volunteers, carers for grandchildren etcetera), but extractive – through state pensions and other benefits, not least the services of the NHS.
There are some big implications from this:
In summary, 2020 will be a very difficult year, but for the survivors the outlook is very positive.
There will be a similar effect in other fully developed countries with ageing populations, resulting in a dramatic regeneration of the Western world (and China?).
Countries with younger populations won’t experience the same trauma, despite less robust health systems.
Maybe historians will look back on this crisis as a turning point in the industrial destruction of the environment.
Meantime, those of us 65 and over had better hope that 80% is far above the reality of infection rate in our age group.
That may be achievable with precautions focused on the fact that the most at-risk group has little overlap with the working population. If all residential care homes are rigorously quarantined for the duration of the crisis, and the elderly living independently are supported in continuous self-isolation, then perhaps the rate of infection can be kept within shouting distance of hospital capacity until the virus has run its course. This is quite feasible because these people do not rely on employment for their support, nor does employment rely on them.
Otherwise, cue Greta Thunberg singing “The Future Belongs to Me”.
– By Iain MacKay
These were downloaded March 7 2020