Liam Fox is a former Secretary of State for International Trade, and is MP for North Somerset.
Over 71,000 more people died in 2020 than would have been expected in a normal year. Apart from a deluded and dangerous minority whose addiction to conspiracy theories leave them in denial about the impact (or even the existence) of Covid-19, most people recognise that these excess deaths are due directly or indirectly to the pandemic.
The UK has been recognised as one of the world leaders in the vaccination programme. Britain has made £548 million available to the Covid-19 Vaccines Global Access facility (COVAX), to support equitable and affordable access to new coronavirus vaccines and treatments around the world.
The rollout of the vaccine to the UK population has also been impressive, although there is growing concern about the decision to extend the period between doses of the Pfizer (but not the Oxford AstraZeneca) vaccine.
If we are to continue to lead globally on the issue – and this year’s G7 summit gives us an ideal opportunity to do so – we must be clear about the reality in which we find ourselves, and recognise that the data systems we currently have will be inadequate to deal with the challenges of global pandemic.
We need to understanding that, contrary to a great deal of assertion, this is unlikely to be a “once in a generation” event.
The first major, and deadly, coronavirus outbreak of the 21st century was SARS in 2002. The second was MERS in 2012. So we are now in the third major global coronavirus outbreak in 20 years.
While the first two had higher death rates than Covid-19, it is the transmissibility of the latest viral variant that has caused such damage. There is, however, no guarantee that we will not get both a more deadly and more transmissible outbreak in the future. It is likely that Coronavirus is here to stay, and that we will have to deal with potential new variants emerging from time to time around the world. To have any chance of dealing with this effectively, we need to develop international protocols, and this means having standardised recording of data.
In the UK, there is no single measure to calculate the mortality rate for Covid-19 accurately . We use inferences from total excess death rates, the number of people who have died within 28 days of a positive Covid-19 test, and those who have had Covid-19 mentioned as a contributory cause on their death certificate.
None of these on their own can give us a truly accurate picture about the cost in lives of the virus. There are three different types of patients who may fall within the excess mortality figures.
The first group is those who have died of Covid, i.e: where this was the main cause of death.
The Coronavirus Act 2020 made changes to death certification which may cloud the waters in this regard. While it is still intended that the doctor who attended the deceased during their last illness should, where possible, complete the death certificate, the Act also allows this to be completed if a patient was not seen by any medical practitioner during their last illness.
If that happens, a doctor would need to state to the best of their knowledge and belief the cause of death. Covid-19 is now an acceptable ‘direct’ or ‘underlying’ cause of death for the purposes of the certificate but, although it is a notifiable disease, this does not mean that deaths from it must be reported to the coroner.
This may well result in fewer post-mortems being conducted, and a valuable source of data missed. Some autopsy studies of patients who died of “influenza” during the 1918 Spanish flu pandemic showed that, while almost all patients had evidence of bacterial pneumonia, fewer than 50 per cent tested positive for influenza viral antigens or viral RNA. In other words, there was a significant overestimate of the numbers who had actually died of influenza itself.
The second group is those who died with Covid19, that is, those who had been diagnosed with a positive test ,but who may have died of other, unrelated causes.
It seems strange to many that someone who tested positive for the virus but was hit by a bus within a month is counted as a Covid-19 death.
The third group is those who have died as a consequence of Covid-19, including those who did not access medical care because of lockdown, or those who were unable to access the appropriate care because hospitals were overwhelmed with Covid-19 patients.
This will be of importance in determining how we run our healthcare services, especially if pandemic is likely to occur more frequently. It has long been the practice in the NHS to run at very high bed occupancy rates.
We have to ask, if pandemic is going to be potentially a more frequent event, whether this is tilting the balance between efficiency and resilience in the wrong direction. Given that we have spent billions of pounds trying to stop the capacity of our healthcare system being overwhelmed, would it not be more sensible (and potentially more financially prudent) in future to run the system with many more beds available than we expect to need at any one time?
Given the overall cost to our economy and the impact on the future of our public finances, perhaps we need to re-visit some of the assumptions that have underpinned policy under governments of all political colours. ,
Britain has a real opportunity to lead the global debate and the government can lead the way with the shakeup of Public Health England and the Resilience Unit within the Cabinet Office, both of which should have been better prepared for any pandemic.
I have supported the Government in all the lockdown measures they have taken in relation to Covid-19 but, in future, are we really going to close down the global economy every time a new virus emerges?
If not, what are the international protocols that we will need to develop as a global community and what are the metrics that we will require to make them work? Without proper information, how will we be able to determine the case fatality rate (the deaths from a disease compared to the total number of people diagnosed in a particular period) which will be one of the key measures that we will have to make in the event of a new outbreak?
We will also need enforceable global rules around transparency and notification. As we head for the G7, there can be no better example of “Global Britain” than for Britain to take a lead in pandemic preparedness and work towards global definitions that will enable us to avoid the uncoordinated global response that we have seen during Covid19.