Courageous leaders needed in Covid times

Covid-19 kills its victims in different ways. In one such way, our own immune system sometimes overreacts to Covid-19; and this overreaction ends up killing the patient. This overreaction is called a cytokine storm.

n a cytokine storm, the human body launches an all-out attack against the viral invader. Our killer cells are committed in vast numbers to the area of infection (in Covid-19’s case, the lungs) as the body attempts to kill as many of our cells carrying the virus as possible.

The immune system goes into overdrive; it overcommits to the task, and ends up causing so much collateral damage to healthy cells that the patient dies.

Scientists still do not fully understand why some people react in this deadly way to Covid-19, but there is a plausible theory that weaker immune systems find it harder to calibrate their response to a viral invader – and end up going haywire, thereby killing the patient outright.

National picture

It is impossible to avoid the parallels between this deadly overreaction to Covid-19 at a cellular level and the ongoing national overreaction to Covid-19 that has ripped the fabric of the country apart over the past six months.

We are living through our own shared cytokine storm of fear, uncertainty and suspicion. We are mortgaging our children’s future as we rack up enormous levels of debt to fill this self-created hole in our public finances. We are destroying livelihoods, not by the thousands or by the tens of thousands, but by the hundreds of thousands.

We are building up untold liabilities for chronic and terminal illness as we cancel health screenings and postpone important treatments for non-Covid conditions. We are placing enormous psychological burdens on vulnerable people as we tell them that it is ‘safer to be on their own’.

Worst of all, this national reaction to Covid – this daily drumbeat of ‘x cases with y hospitalisations and z deaths’ (where z is usually at or about zero) has turned some good people into criminals and other good people into informers. Twenty-somethings are on national television for having had a bit too much to drink in Killarney. Politicians have become pariahs for attending a golf do. The anger that many people feel when they see this behaviour is understandable, but any society that criminalises normal human activity will end up with many criminals.

I have had more than my fair share of difficult family moments over the past few months that have been made more difficult because of Covid-inspired rules.

However, like it or not, Phil Hogan didn’t make up the rule that you couldn’t attend your uncle’s funeral – the government did. The young man dancing on the telephone box in Killarney didn’t stop your daughter from accessing that experimental cancer treatment abroad – government restrictions did.

Maximum panic

And for what? Like a compromised immune system that cannot correctly calibrate its response, we are unable to ratchet back our anti-covid measures from ‘maximum panic’ mode.

Every day, more and more information comes in from other countries that indicates that Covid may not be as severe a threat as it first appeared in March. In the US, hospitalisations have declined by one third in the past month – even as social distancing restrictions were relaxed.

Sweden – where pubs never closed – now has a lower Covid rate than Ireland. In the city of Manaus in Brazil – as close to a ‘control’ sample for unrestricted Covid spread as exists in the free world – both cases and deaths have flat-lined after the initial surge.

We also now know that Covid poses no greater threat than a bad ‘flu for those under the age of 65 who are otherwise in good health. We have done precisely nothing with these insights – other than ask pensioners to cocoon. Instead, in cytokine storm Ireland, the panic is never allowed to diminish.

Leadership

The country cries out for courageous leadership that balances the health risks with the myriad other risks that we now run due to our Covid response. We need leaders who recognise national panic for the danger that it is, rather than as a means to ensure compliance with draconian regulations. Among other things, a courageous leader would provide for the following as a matter of urgency:

1. Cease all public NPHET briefings. The public NPHET briefing is intrinsically frightening and we need to avoid unnecessarily scaring people. If we had similar briefings about the ‘flu or any other disease, the population of the country would be similarly terrified of these diseases. It is counterproductive and it should stop.

2. Explain what metrics matter and why they matter. Infection numbers are less important than hospitalisations, and hospitalisations are less important than deaths. Lead with the important metrics. The important metrics happen to be encouraging for Ireland right now and people should be so told.

3. Where metrics are unhelpful or misleading on their own, break them down. Case rates should be broken down between asymptomatic and symptomatic cases, and hospitalisations should be broken down by age cohort. Deaths should be broken down by age and the presence of co-morbidities. There is anecdotal evidence that many deaths are deaths with Covid rather than deaths from Covid. Whether this is true or false, it is essential that the important numbers be clearly communicated.

4. Explain the risk factors to the population, and – just as importantly – explain to the majority of the population who are not at significant risk from Covid that they are, indeed, not at significant risk.

5. Perform an actuarial analysis of all anti-covid measures – before implementation – so that we can understand the trade-offs we are accepting. Across a population of 5 million people, practically any national policy measure will have an effect on either quality of life or life expectancy; in many cases, both. We should calculate such effects in terms of quality-adjusted life years before implementing measures that destroy either jobs or quality of life.

6. Clearly define the exit criteria for any anti-Covid measure – and then stick to them. For example, given that we began to wear masks when there was practically no Covid in the country, when can we ever be mask-less again? We need to avoid this rabbit hole by being clear about both the entry and exit criteria for anti-Covid measures.

There is no question that Covid-19 is a deadly disease. It has killed lots of people. However, our cytokine storm reaction to Covid-19 could well end up killing more in the long run. We need sensible, courageous leadership to bring us out of this crisis – and we need it now.

Independent.ie – News