Happenstance, coincidence and enemy action, the doctrine of three developed by Dr No’s colleague Goldfinger, is as good a guard as any against the risk of over-reacting to chance events. The time to sit up take notice is when something exceptional has happened not once, but three times in a row. The ONS has now reported exceptional rises in the weekly number of all cause deaths in England and Wales for three weeks in a row. It is time to sit up, take notice, and ask, what is going on?
As an appendix to yesterdays post, Dr No is going to do a run through of another reason why high hopes of antibody testing being a game changer will most likely turn out to be false hopes. It is also an introduction or aide-mémoire to the more general question of how do you go about establishing the usefulness of a diagnostic or screening test, using screening for covid-19 antibodies as an example. As always, complex formulae and other numerological devices will be avoided in favour of plain words and simple numbers. You really can do these sums on the back of an envelope.
It is a truth universally acknowledged, that a population assailed by a pandemic, must be in want of a game-changer. More often than not, the game-changer for covid-19 involves antibodies. Antibodies tests will both allow us to know the true community rate of infection, and allow us to manage the safe return to work of those shown to be immune. Knowing the true community rate of infection in turn allows us to assess how close we are to achieving herd immunity, which in turn can be achieved not by letting the virus rip through the community, but by the benign stimulation of antibody production through vaccination. One way or another, a lot of high hopes rest on antibodies. Hope is a good thing in dark times, but like the stewardess in Moonraker who warns Mr Bond that if he goes any higher, her ears will pop, we too should remember that hopes that get too high can also pop. Instead of a speedy deliverance by Apollo from a modern pandemic, we may as time goes by find we have set our scientists a Sisyphean task.
Even in the bleakest of lockdowns, a Sunday evening dose of The Good Karma Hospital fills the unforgiving hour with sixty minutes’ worth of pure escape. ITV’s Call the Midwife with commercial breaks avoids confinement in an East End convent, and instead sets itself in the bright colours and bustle of an Indian cottage hospital with ideas above its station. There is enough energy in just one episode to keep the lights on in Leeds for a week. All human life is there, from the impish kid to the rheumy old man with signs of Parkinson’s disease. Unafraid of difficult subjects — a recent story line tackled sexually driven acid burns, made all the more poignant by Amanda Redman’s presence, while another took on traditional resistance to vaccination — the characters swing from overflowing, as Clive James would surely have observed, with amused compassion and quizzical adoration, to exchanging smouldering eye work over their surgical masks. Overseeing all is the hospital chief, the splendid Dr Lydia Fonseca, played to perfection by Redman as Sir Lancelot Spratt in drag.
The news event of the week so far, apart from all the other news events of the week so far, is yesterday's release by ONS of weekly deaths for 2020. For total deaths, weeks 1 to 12 are unremarkable, week 13 showed a none too remarkable rumble in the jungle up-tick, and then it happened in week 14 — the numbers went through the roof. This isn't an exponential rise, it's a stratospheric rise, like a rocket taking off for space.
This sudden rise, up to 16,387 from 11,141 the week before, in the number of total deaths is the remarkable event — see the chart below — but for some unfathomable reason the mainstream media focused more on a similar but less dramatic rise in the number of covid–19 deaths, up to 3,475 from 539 the week before.
The higher one lies in national life, the more one suffers from the indignities of precautions. When Prince Philip drives his Range Rover over a cliff top at ninety miles per hour, does three full somersaults in the air before landing wheels down in the water, and drives ashore as smooth as James Bond, he nonetheless gets taken to hospital ‘as a precaution’. When the Prime Minister’s covid-19 symptoms failed to settle he was admitted to hospital ‘as a precaution’. Eminent doctors were on hand to speculate as to what tests might be done on the PM, purely as a precaution. Then the PM was admitted to ITU ‘as a precaution’; but happily the tide turned, and Mr Johnson was soon back on the wards. In the last few hours, Mr Johnson has been discharged from hospital, and Dr No wishes him a full recovery which, as his father Mine’s-a-Pint Stan, never one knowingly to keep his mouth shut, has already observed, may take some time.
While the European states are learning about the agonies of little nations, the United States are learning about the agony of a big nation. As the overflow of covid-19 bodies starts to hit the American fan, Orange Eye is reaching out as only he can, to find someone to blame. C.h.i.n.a and WHO both got it in the neck. “The W.H.O. really blew it. For some reason, funded largely by the United States, yet very China centric. We will be giving that a good look,” Donald Trump tweeted yesterday. Orange Eye was turning red. Very red.
As the four horsemen of the apocalypse gather to ride through our hospital wards, we are about to see a collision between the brutality of the covid-19 epidemic and the Easter message of deliverance and hope. Across the Christian world, the very reverent are even now penning sermons to be live-streamed over the Easter weekend. Those that manage to avoid setting fire to themselves or activating the wrong sort of video filter will Dr No expects focus on the message that while media vita in morte sumus, there is beyond sure and certain hope of the resurrection. Never mind the divine escape hatch buried in that wonderful familiar phrase — the noun is hope, sure and certain merely adjectival flummery — there can be no doubt that the over-arching message will be one of sure and certain deliverance from the evils of plagues.
The GMC, in typically high handed fashion, yesterday dropped emails in countless retired doctors email inboxes, informing them that they have been co-opted back on the register with a license to practise, without so much as a by your leave. Many of these doctors will not have seen a patient in years if not decades, and many will be elderly. With due respect to Peter Cook and Jonathan Miller — who would no doubt have got today’s email had he not died last November — Dr No offers this update of a classic Beyond the Fringe sketch.
Happy is the epidemiologist who works on deaths. This observation arises because death is the ultimate hard end point (the patient is either dead or alive), and usually there is a more or less certain cause of death. These normal certainties however come under threat in times of crisis. In the face of the double barrelled assault of a combined pandemic and panicdemic, and the ensuing rush to ‘get something done’ it is all too easy to gloss over details, and start getting things wrong, perhaps seriously wrong.