Spartacus Blog

Why the coronavirus (Covid-19) will probably kill a higher percentage of people in the UK than any other country in Europe.

The evidence so far shows that Covid-19 is especially infectious when people are in a room together for an extended period. In China only 5% of those people infected needed intensive care and of those only 1% died. According to Tim Cook, a doctor in an NHS intensive care unit: "Severe Covid-19 leads mostly to lung failure but also causes kidney and cardiovascular (heart and blood vessel) failure. All these are rapidly fatal without intense and prompt treatments only available in intensive care units (ICU). In simple terms, treatments include a ventilator taking over the patient's breathing while the patient is anaesthetised (placed in an induced coma), a dialysis machine cleaning the blood and drugs or machines supporting the heart and blood pressure." (1)

People over the age of 65, are especially vulnerable to complications from this disease. Most people are dying from pneumonia as a result of being infected with Covid-19. If you can get people to a "critical care" bed in an intensive care unit in time, they will probably survive. That has been the case in China. For example, in Wuhan, ICU capacity was increased by over 1,000 beds in two weeks by building a new hospital. The two-floor facility was staffed with 1,400 military medics, including some with experience dealing with Sars and Ebola. (2)

However, in Italy, the latest figures show that 5.7% of people infected with Covid-19 have died. The media have been arguing that the real reason given for this is that they have a high percentage of people over 65. It is true, that Italy with 23% of the population over 65, puts them in second place to Japan (27%). However, is this the answer for their high death-rate? For example, Germany is in 4th place with 21% over 65, yet it has the lowest radio in the world of deaths to confirmed cases. (3)

The World Health Organization publish daily updates concerning the number of cases and deaths. So on the 16th March it stated that Italy had had 27,980 cases and 2,158 deaths. It is interesting to compare Germany (7,241 cases and 15 deaths) with another countries that has a similar number of cases such as Spain (9,682) and France (6,633). Spain has had 342 deaths and France 148 deaths. It is also worth looking at countries that have had far smaller numbers of cases (under 1,600). UK: 1,543 cases - 56 deaths;, Netherlands: 1,413 cases - 24 deaths; Austria 1018 cases and 3 deaths; Luxembourg: 81 cases and one death. As you can see that the UK does very badly when you look at the deaths compared to cases of Covid-19. (4)

The main reason for the high death-rate in Italy has been the inability to get patients into critical-care beds where they can be put on ventilators (breathing machines that help keep your lungs working). If you look at the table-below you will see that Germany is ranked as having the best ratio for critical-beds in Europe. Italy is in tenth place, but it is very short of doctors and nurses. This point is highlighted by the positions of France (12th), Spain (16th) and Netherlands (26th). Whereas those countries like Luxembourg (2nd) and Austria (3rd) are doing well. (5)

However, it is the UK's place in the table that is very concerning. With a figure of 6.6 critical beds per 100,000 population, we are ranked 24th out of 31 European countries. This is made worse by the fact that we are ranked 29 out of 31 for available hospital beds. Germany has approximately four times as many ICU beds per capita as the UK. Like Italy we also have the problem of staff shortages. Currently the NHS has 106,000 vacancies, including over 44,000 in nursing. (6)

As early as 2011 a report warned the government about the shortage of ventilators: "Critical care services… are likely to see increases in demand during even a mild influenza pandemic. In a moderate or severe influenza pandemic demand may outstrip supply, even when capacity is maximised… it may become necessary to make decisions concerning priority of access to some services.” In October 2016 the UK government ran a national pandemic flu exercise, codenamed Exercise Cygnus. The report of its findings was not made publicly available, but the then chief medical officer Sally Davies commented on what she had learnt from it at a conference in December 2016. “We’ve just had in the UK a three-day exercise on flu, on a pandemic that killed a lot of people,” she told the World Innovation Summit for Health at the time. “It became clear that we could not cope with the excess bodies,” Davies said. One conclusion was that Britain, as Davies put it, faced the threat of “inadequate ventilation” in a future pandemic. She was of course referring to the fact that compared to other advanced nations, the UK was desperately short of ventilation machines. (7)

For years health-care professionals have been warning the government that they have not been spending enough money on the NHS. For example, a survey by the UK Faculty of Intensive Care Medicine (FICM) in March, 2018, showed that critical care units were under intense pressure, with three out of five not having a full complement of nursing staff, two out of five having to close beds on a weekly basis and a fifth having to transfer patients elsewhere at least once a week because of a lack of beds. It also pointed out that the government had been publishing false information concerning the number of ICM doctors that had been trained since May 2010. (8)

In the UK it is estimated that an average of 600 people a year die from complications of influenza (usually pneumonia). In some years it is believed that this can rise to over 10,000 deaths. In 2008-2009, 13,000 people died as a result of suffering from influenza. The World Health Organization (WHO) claims that an average of up to 500,000 people die annually across the globe due to influenza. How well different countries deal with outbreaks of influenza depends on the number of critical-care beds in intensive care units. (9) The media nearly completely ignored the fact that in the winter of 2017-18, here were 50,000 unnecessary deaths in the UK. (10)

Germany's view has always been that you have to fund a health service in a way that you have spare capacity in the system. In this way you can deal with unusual events like an outbreak of a new disease. This of course means having a lot of beds and expensive equipment not being used. Germany has 29.2 critical beds per 100,000 population compared to the UK's 6.6. Germany's philosophy is to develop a system that enables you to deal with a health crisis. Given the current figures available it is likely that whatever measures the government bring in the death-rate in the UK will be higher than that in Italy (12.5 critical beds per 100,000 population). Although, it is the USA that is likely to suffer the most. This is not because of a shortage of critical-care beds (34.7 per 100,000 people), but public access to them. (11)

In fact it has been suggested that this Covid-19 might change American attitudes to the concept of the "safety social net". As Will Bunch has pointed out: "It’s fascinating to watch how a pandemic-inspired fear of the unknown - flavored by the fact that COVID-19 initially tended to spread through the things that more affluent Americans do, like travel overseas, book cruise-ship vacations or attend business conferences - has finally caused at least a slight bump in awareness of the kind of problems that everyday folks, working two or three jobs in a gig economy, have been screaming about for years. Many experts noted that America’s mad scramble to suddenly guarantee paid sick days or coverage for necessary medical procedures must look strange to Europeans, or other developed societies with a generous safety social net, where leaders don’t think the only solution to every problem is to throw more tax breaks at corporations and pray that a few dollars trickle down. The New York Times recently noted that Germany, France, Denmark and the Netherlands are among the nations where workers have a right to paid sick leave - and that sense of security, along with the knowledge that folks won’t get surprise medical bills, have dampened both the economic fallout and some of the fear from the pandemic." (12)

Countries with the most critical care beds per capita

The UK government has been aware of this problem for a long time. In October 2010, The Lancet medical journal warned that the UK has one of the lowest ratios of critical-care beds in the developed world. It pointed out the need for "specialised hospital care will rise because of the ageing population, as well as increasing in the event of a disaster". Dr Gordon Rubenfeld of the department of critical care medicine at Sunnybrook health sciences centre in Toronto, Canada, lead author of the paper, said: "It is clear that the UK is at the low end of ICU bed capacity and thus would have decreased ability to cope with a large-scale disaster with many critically injured casualties." (13)

According to a report in The Guardian last week: "England only has 15 available beds for adults to treat the most severe respiratory failure and will struggle to cope if there are more than 28 patients who need them if the number of coronavirus cases rises, according to the government and NHS documents. Ministers have revealed in parliamentary answers that there are 15 available beds for adult extracorporeal membrane oxygenation (ECMO) treatment at five centres across England. The government said this could be increased in an emergency. There were 30 such beds in total available during the 2018-19 winter flu season. But an NHS England document prepared in November 2017 reveals the system will struggle to cope if more than 28 patients need the treatment, describing that situation as black/critical. It suggests that if no beds are available 'within the designated and surge capacity' in the UK, they might have to be sourced from other countries, for example, from the Karolinska Institute in Sweden." (14)

It has been argued that national governments are faced with some stark choices. Roy Anderson, one of the UK’s most eminent epidemiologists, has pointed out that there are essentially four options. "You could try to minimise the number of fatalities or the economic impact. You could attempt to flatten the peaked curve in the incidence so that the cases are not all concentrated in a narrow time span, which could overwhelm healthcare resources (already severely stretched in the UK). Or you could try to delay the spread in order to buy time for development of a vaccine – although most experts don’t expect one to be available for at least a year." The politicians and policymakers want a strategy to achieve all four, says Anderson - but that’s not possible. "In particular, the first two crucial goals - reducing the mortality rate and economic impact – are incompatible." (15)

The coronavirus Covid-19 is more contagious than influenza: every person who gets coronavirus will typically pass it on to 2.5 people, compared to an infection rate of around 1.3 for ordinary flu. The World Health Organization (WHO) has estimated the mortality rate from Covid-19 is about 3.4%. Another factor that will affect the number of deaths, and hence mortality rate, is who gets infected. According to figures from the Chinese Centers for Disease Control and Prevention, those aged 10-39 have a 0.2% mortality rate, while those in their 60s have a mortality rate of 3.6%. For those aged 80 and older this rises to 14.8%. Those at most risk of dying when they developed Covid-19 were those with underlying health problems: cardiovascular disease (10.5%), diabetes (7.3%), chronic respiratory disease (6.3%), hypertension (6.0%) and cancer (5.6%). These statistics from China suggests that protecting the vulnerable, including those with underlying health conditions, is crucial. (16)

One thing that is clear is that mortality rates do differ from country to country. Some countries such as South Korea, the mortality rate has been estimated at below 1%. Roy Anderson thinks the places to learn from are Hong Kong and Singapore. Both are, of course, very crowded places, yet they have kept case numbers in the hundreds. How? “The population reacted very differently to Europeans,” says Anderson. “They had seen Sars” in 2003, and so knew what was needed. They stopped going to restaurants and public events; they wore face masks. To bring about such changes in behaviour here, Anderson says, requires clear and responsible public information. This is the opposite to what has been happening in the UK. (17)

Tomas Pueyo was one of the first to recognize the danger of Covid-19."The coronavirus is coming to you. It’s coming at an exponential speed: gradually, and then suddenly. It’s a matter of days. Maybe a week or two. When it does, your healthcare system will be overwhelmed. Your fellow citizens will be treated in the hallways. Exhausted healthcare workers will break down. Some will die. They will have to decide which patient gets the oxygen and which one dies. The only way to prevent this is social distancing today. Not tomorrow. Today. That means keeping as many people home as possible, starting now." (18)

The UK government has been accused of taking a far too passive approach to this problem. Richard Horton, editor-in-chief of Britain’s leading medical journal The Lancet, warned that we risk sleepwalking into a hurricane as officials delay their response to an escalating crisis. He said Matt Hancock and Boris Johnson “claim they are following the science, but that is not true. The evidence is clear. We need urgent implementation of social distancing and closure policies. The government is playing roulette with the public. This is a major error.” Jack Peat added: "There is no justification for half-hearted measures. The Government and the mayor keep saying they are simply following ‘scientific advice’. But the scientists are clear that this is now a political decision – on whether the Government are prepared to spend very serious sums of money, and take a large economic hit, to maximise protection of the population." (19)

Whereas other European competition football games were played behind closed doors because of their government's actions, Boris Johnson thought it would be a good idea that 3,000 Atletico Madrid fans should arrive to watch the game at Anfield on Wednesday night (11th March). This is at a time when Madrid is in a state of effective lockdown after a major outbreak of the virus. One Liverpool fan who deliberately didn't go to Anfield was Professor John Ashton, a former director of public health from the city. He instead appeared on BBC Newsnight to criticise the lack of action taken by the government: "I'm tearing my hair out with this. I'm very frustrated here, we've got a complacent attitude, it feels wooden and academic and we've wasted a month when we should have been engaging with the public. If this now spreads the way we think it will, there will not be enough hospital beds and people will have to be nursed at home. We should have got a grip on this a month ago. I want to know why we haven't tested those people who have come back from Italy and who are now amongst us - we've got a recipe for community spread here." (20)

It was not until 14th March, that Matthew Hancock, the Health Secretary, admitted that the country was desperately short of ventilators. He told British manufacturers, “If you produce a ventilator, we will buy it. No number (you produce) is too high.” He urged firms from Rolls-Royce to JCB to stop what they do and to begin making ventilators. Hancock’s entreaty to manufacturers was the first time the government has publicly recognised Britain’s urgent need for more ventilators – six weeks after the first cases of coronavirus were reported in the UK. However, it is all too late. It will be many months before these ventilators arrive. This order should have been made when this problem was reported to the government in 2011. (21)

The government developed the idea of "herd immunity" to defend its current policy. On 15th March, 2020, the UK's Chief Scientific Adviser said a degree of herd immunity will help the UK population as Covid-19 spreads. Patrick Vallance said the aim would be to "reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission". This view was supported by the UK's chief medical adviser, Professor Chris Whitty. (22)

The World Health Organisation quickly cast doubt on the UK’s approach to developing "herd immunity" against Covid-19. Spokeswoman Dr. Margaret Harris said scientists do not know enough about the virus to say whether "theories" around people becoming immune to it are correct. Questioning the approach, Dr Harris told BBC Radio 4’s Today programme: “We don’t know enough about the science of this virus, it hasn’t been in our population for long enough for us to know what it does in immunological terms. Every virus functions differently in your body and stimulates a different immunological profile. We can talk theories, but at the moment we are really facing a situation where we have got to look at action." (23)

Dr William Hanage was especially critical of the government's approach: "When I first heard about this, I could not believe it. I research and teach the evolution and epidemiology of infectious disease at Harvard’s Chan School of Public Health. My colleagues here in the US, even as they are reeling from the stumbling response of the Donald Trump administration to the crisis, assumed that reports of the UK policy were satire - an example of the wry humour for which the country is famed. But they are all too real." He goes on to argue: "We talk about vaccines generating herd immunity, so why is this different? Because this is not a vaccine. This is an actual pandemic that will make a very large number of people sick, and some of them will die. Even though the mortality rate is likely quite low, a small fraction of a very large number is still a large number. And the mortality rate will climb when the NHS is overwhelmed. This would be expected to happen, even if we make the generous assumption that the government were entirely successful in restricting the virus to the low-risk population, at the peak of the outbreak the numbers requiring critical care would be greater than the number of beds available." (24)

Boris Johnson has continued to argue that he is making decisions based on the best scientific advice. However, Johnson has been unable to explain why their advice is so different from the advice being given to all other European governments. This was reinforced when on 15th March, a group of scientists wrote to the government urging them to introduce tougher measures to tackle the spread of Covid-19. In an open letter, 229 scientists from UK universities said the government's current approach will put the NHS under additional stress and "risk many more lives than necessary". (25)

Unfortunately, too many large organizations are relying on advice from the government. The University of the Third Age (U3A) has over 440,000 members in 1050 local groups across the United Kingdom. Every day, a large number of the most vulnerable members of society meet in rooms in people's houses. I run six sessions every month in my home. I visited the U3A website but there was nothing about canceling meetings. On 7th March, Chief Executive of the U3A, Sam Mauger, issued the following advice. "If a member has returned from one of the areas identified by the government and has any of the symptoms identified on the government website they should not hold interest groups in their own homes, or attend interest groups or attend monthly meetings until they have followed the NHS advice provided after calling 111... The monthly meeting should be cancelled for that month (and possibly longer) until the spread of the virus has been assessed. In general a U3A may consider other precautions such as using hand sanitiser gel in interest groups and monthly meetings and reducing physical contact such as shaking hands until further information becomes available." (26)

However, there was no suggestion that individual sessions should be cancelled. I contacted the local branch chair but she replied that U3A policy was to follow government advice. I therefore took matters into my own hands and on Wednesday 11th March, I cancelled all meetings. Since then, other leaders of sessions have followed this example, and decided not to wait for the U3A chief executive or the government, to make up their mind on the subject. The U3A should have the followed the example of sporting organisations and listened more to foreign governments more than their own government, and cancelled their own events. (27)

What the government is unwilling to acknowlege that ten years of underfunding of the NHS means that when we have more deaths than we should have. As Yascha Mounk has pointed out that in the case of Italy: "There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air." The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow as these already extraordinary circumstances worsen. The authors suggest, it may become necessary to follow "the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources." The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.” They then go on to say: "It may become necessary to establish an age limit for access to intensive care." (28)

Dr Jonathan Ives of the Centre for Ethics in Medicine at the University of Bristol has argued that most people prefer a "first come, first served" queuing system. That may well be the best strategy in normal times - but a pandemic is not normal. "Consider that the person first in the queue suffering from Covid-19 is an older - but not elderly – person, with an underlying lung condition that means they need critical care. Treatment would not be futile - it might save their life - but to choose to treat them would require an extended period of critical care and the outcome would be uncertain. The next two people in the queue are of similar age and have been hit hard by the virus, but they do not suffer with underlying lung problems. They are more likely to survive. They also need critical care to get them over the worst effects of the virus, but because they have no underlying health conditions they will pass out of the danger zone faster, meaning that both of them are likely to be saved in less time, and for less resource, than it would take to try to save the first patient. In this scenario, assuming that all three cannot be given critical care, it appears to make sense to treat the person who will take up fewer resources with a more certain outcome and free up the bed faster... It is a conclusion that, ultimately, says some people should be left to die." (29)

The wealthy will of course do what they can to avoid the possibility of death. The outbreak of the Second World War created mass panic amongst the upper-classes and over 5,000 people fled in the few days leading up to the war. This included three Conservative Party MPs. One of these was Captain Alex Cunningham-Reid, the MP for St. Marylebone, who took his family to Canada. (30)

When it became clear that Germany intended to invade Britain, Winston Churchill, the prime minister, made a series of speeches during the summer of 1940 calling for national unity and for Britons to "show the finest qualities of their race" and the only way we would survive "if all do their duty". (31) After the Blitz began in August, he ordered "every man and every woman" to do their "duty". (32)

Neville Chamberlain had been prime minister when Tory MPs fled the country. Churchill therefore asked the Home Office to prepare a Bill to allow the seats of those MPs who left the country without government permission for more than six months to be declared vacant. When this was discussed at the home policy committee, Ernest Bevin argued that the MPs should be stripped of their British citizenship. However, when the war cabinet discussed the issue later that day, they agreed that introducing such a Bill would create too much undesirable publicity and alert the public to the fact that MPs had been fleeing the country. (33)

Owen Jones is already suggesting that the wealthy members of society are also acting in the same way as in 1939: "The coronavirus pandemic is about to collide with this engine of inequality. The super-rich are fleeing on private jets to luxury boltholes in foreign climes, while the well-to-do may deploy their private health insurance to circumvent our already struggling and soon to be overrun National Health Service. Meanwhile, Britain’s army of precarious workers have nowhere to hide, including from employment that puts their health at risk. Uber drivers, Deliveroo riders, cleaners: all in low-paid jobs, often with families to feed. Many will feel they have no choice but to keep working. While many middle-class professionals can protect themselves by working from home, supermarket shelves cannot be stacked remotely, and the same applies from factory workers to cleaners. How many could truly afford to live on £94.25 a week, which is our country’s paltry statutory sick pay?" (34)

A decade of austerity, and a social order that deprives millions of citizens of a comfortable existence, will mean many more deaths in the coming weeks and months that could have been avoided. It will be interesting to see how Boris Johnson reacts to people like Richard Branson who has claimed that Britain's airline industry needs emergency government support worth up to £7.5bn to avert a catastrophe that would wipe out tens of thousands of jobs. "The bailout request will come ahead of what could prove to be the bloodiest week in British aviation history, with British Airways, Virgin Atlantic, easyJet and Ryanair all expected to announce mass groundings of aircraft and potentially huge redundancies as the COVID-19 crisis escalates." (35)

Is it a good idea to help Branson with his economic difficulties? Branson's business empire is owned by a complicated series of offshore trusts and companies. The Sunday Times stated that his wealth is calculated at £3 billion; if he were to retire to his Caribbean island and liquidate all of this, he would pay relatively little in tax. In 2013, Branson described himself as a "tax exile", having saved millions in tax by ending his mainland British residency and living in the British Virgin Islands. This has resulted in calls for his knighthood to be revoked. (36)

Even if, surprisingly, wealthy businessmen have been paying their taxes, should they receive bailouts? How would you decide which company you are going to help? It is not only airline industry that needs help. Given the belated advice given on 16th March, 2020, a whole range of different industries will be in serious difficulties. How will it be possible for any government to transfer money obtained from taxpapers to wealthy corporations? As the Scottish businessman, Duncan Bannatyne, has pointed out, the taxpayer needs to bailout "the poor, the starving, the ill and the disabled", not billionaire owners of corporations. (37)

Ad Sinistram has argued: "And it begins… the early signs of the taxpayer being asked to bail out the billionaires yet again… Privatising profits and socialising losses refers to the practice of treating company earnings as the rightful property of shareholders, while losses are treated as a responsibility that society must shoulder. In other words, the profitability of corporations are strictly for the benefit of their shareholders. But when the companies fail, the fallout - the losses and recovery - are the responsibility of the general public. Popular examples of this include taxpayer-funded subsidies or bailouts… The phrase privatising profits and socialising losses has a number of synonyms, including socialism for the rich, capitalism for the poor. Another likens it to lemon socialism." (38)

In reality we are facing the greatest crisis in capitalism since the 1929 Wall Street Crash. When that happened some countries such as Germany and Spain turned to fascism and the corporate state. However, other countries turned to the ideas of John Maynard Keynes, and this resulted in progressive governments being formed in the United States (Franklin D. Roosevelt) and Sweden (Per Albin Hansson). The UK was slow in getting the message and Keynes' proposals were only introduced by Clement Attlee following the 1945 General Election. These measures were reversed by Margaret Thatcher in the 1980s, but I am sure the British public would be more keen to nationalize these bankrupted companies than to bailout billionaires.

James Meadway has pointed out that the current crisis is very different from the Wall Street Crash and the 2008-09 Financial Crisis: "Covid-19 is different again because it does not just threaten a recession. It does not just threaten the stability of major institutions... . Rather, it threatens the most fundamental institution of all in capitalism: the labour market itself. Once people are too sick to work, or forced to self-isolate, the conventional operation of the labour market begins to break down. The division of labour – the secret to capitalism’s immense gains in productivity, as Adam Smith pointed out 250 years ago – itself is called into question: the present allocation of work between different parts of the economy is suddenly and, of necessity, forcibly altered... This crisis will require more than money to resolve; it will require the reshaping and restructuring of our economy. This will be done either to the benefit of people and the planet, or it will not be. So the demands we place now should be to: first, deal with the immense health crisis, which includes ensuring everyone can self-isolate; second, support existing economic activity; and third, start to show the path to the future." (39)

John Simkin (12th March updated 17th March, 2020)