The vital contexts of coronavirus

By David Shaw

The coronavirus pandemic has taken over all our lives, confining most people to their homes and killing tens of thousands around the world. Every day we are updated on the latest infection rates and mortality figures, and speculate about how long the lockdown will last. Yet what is missing from much of the media coverage and general discourse about coronavirus is a certain degree of contextualization.

First, the death rate is reported every day in a way that is largely devoid of context. The headline is frequently “biggest daily rise yet” despite the fact that everyone knows that it will continue to increase for some time. More importantly, in all the millions of words written about how many people have died in each country each day, no coverage appears to have given the baseline daily death rate before the outbreak began. Take Scotland: here, the death rate had averaged between 6 and 8 people per day before increasing to 16 on the 1st of April. But the typical death rate in Scotland is 160 people per day, with about a quarter of them dying of cancer. This means that the virus is currently increasing the daily rate by 10% (and before that around 5%) – a substantial increase, but not as massive as many members of the public are probably assuming, given the press coverage. Reporting the increasing number of deaths in isolation without this context is likely to increase people’s stress about the virus, because people are unaware of how many people normally die each day. Another key number that is missing from coverage is the number of people recovering from the virus every day, which is likely to be at least 20 times higher than the death rate, and possibly even 100 times higher. This is understandable inasmuch as deaths are much easier to count than recoveries, because many people will have had such mild symptoms that they will not even know they had the virus.Nonetheless, the fact that dozens of people are recovering for each one that dies is almost entirely absent from media coverage, painting a distorted picture.

Second, other facts about the virus are often reported as if they are surprising or shocking when consideration of the context would reveal that they are not. One Observer headline on the 29th of March reported “grim statistics”: 50% of virus patients who make it to the intensive care unit die there. The article also stated that this “high death rate raises questions about how effective critical care will be in saving the lives of people struck down by the disease”. But this coverage misrespresents the difficult context of intensive care; even during normal seasonal flu outbreaks, almost a quarter of patients admitted to ICU with pneumonia die; it is not surprising that the figure should be substantially higher for a novel virus that we do not yet understand. The BBC has also failed to keep figures in context, presenting a graph that gave the impression that close to 100% of virus patients over the age of 70 would die when in fact the figure is under 15%. By representing these figures as shocking and failing to provide context, such articles unnecessarily increase stress and fear among the public.

Third, it is easy to forget the wider medical context of the fight against the virus. While the speed with which beds have been freed up and created for Covid-19 patients has been very impressive, the drive to focus on potential future patients may have neglected the wider context of the costs imposed on patients not suffering from the virus. Patients have been decanted from hospitals into their homes without sufficient care provision; elective surgery has been cancelled; Scotland has suspended its breast bowel and cervical screening programmes; and organ transplantation has come to a virtual standstill. Patients may die as a result of all these changes. Worse, in many hospitals there are now dozens of empty beds waiting for patients, meaning that some of those deprived of care are being harmed unnecessarily (at least for a while). In the long term the additional morbidity and mortality implications of these changes will become apparent, and they will not be insignificant. Some of these deaths may be unavoidable given the need to respond to the virus; others may not be. Either way, these other patients should not be forgotten in the drive to focus on the virus.

Finally, many have suspected the UK government of an initial intention to put the economy first by pursuing a strategy of herd immunity, which would have cost perhaps half a million lives – a key contextual point that some in government appear to have missed. But another important contextual feature of the outbreak is that life expectancy and health outcomes are closely linked to the health of the economy; if the economy crashes, this will also have substantial effects on both public health and death rates. Therefore, entirely neglecting economic impacts would also be irresponsible in terms of the health of citizens. Equally, however, if every country had pursued herd immunity this would probably have caused so many deaths that a global crash would even bigger. Had this wider context been considered, herd immunity would probably never have seemed economically attractive, even if its ‘local’ death toll was wrongly deemed acceptable.

The contextual factors mentioned here are not intended to distract from the enormity of the coronavirus outbreak for us all and the tragedy of it for many; after all, it has entirely changed the context of our lives, and for many of us it has contextualised what is important in those lives. But reporting and discussion of the coronavirus should keep these and other contextual factors in mind, even if only to minimize unnecessary stress and improve the logic of our discussions about this extremely complex challenge.

 

Author: David Shaw

Affiliation: Institute for Biomedical Ethics, University of Basel, and Care and Public Health Research Institute, Maastricht University

Competing Interests: None

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