Covid must be handled with effective risk management, not erratic risk avoidance

COBRA met this week for the first time in about four months. What took so long? This isn’t just a question of ignored process. It may be a clear indication as to why the handling of Covid-19 has been so erratic: proper processes for resolving issues have been neglected and their execution has been disjointed. An effective committee can resolve conflicts of views and also progress change. The process can be brutal. Reputations and careers can be shredded in weeks, but it gets the job done – as I recall from COBRA meetings that I attended as a minister during the foot-and-mouth crisis.

But this is only part of the re-evaluation required. The dilemma that government, but also the opposition and indeed the nation, will have to focus on now is how we may have to learn to live with or, to be more accurate, to coexist with the virus for some time. The dilemmas we are facing are not unique. Nearly all decisions in public life are balanced. Including in health, where NICE (National Institute for Health and Care Excellence) assessments on the value of medical procedures are underpinned by cost-benefit analysis. I question whether government decisions during the crisis have been subject to any such rigorous analysis.

Mankind has been living with, and attempting to manage, endemic diseases for centuries, millennia even, and many of these scourges still afflict the world. Malaria still kills about 435,000 a year worldwide, Tuberculosis (TB) 1.5m, Hepatitis C 700,000, even Influenza kills 290-650,000 according to the WHO. Less-noticed fungal conditions affect billions of people and kill an estimated 1.5 million a year. These diseases have hit societies with varying degrees of severity, sometimes disastrously. But throughout history, mankind has had to manage, mitigate and attempt to reduce and even eliminate them, with varying degrees of success. Even today, many parts of the world are still having to adapt to some or several of these and some, such as TB, are morphing into more virulent and treatment-resistant forms. Many of these exacted a high toll at the time and took a long time to control and marginalise and in some cases almost eradicate.

Sadly, there are no easy answers. Every choice made will result in people suffering and dying – but some choices may mean those numbers are reduced. Cuts to diagnosis and surgery costs lives. A broken economy and high unemployment crushes hopes and blights the dreams of young people, as does disrupted education. Loneliness, especially of older people, shortens lives and increases mental illness and suicide. A wrecked economy cannot pay decent wages or support proper public services. An emaciated entertainment and hospitality sector erodes the joys of life, as well as the livelihoods of millions. That is why we have to replace Matt Hancock’s erratic, reactive risk avoidance with well-informed and prudent risk management.

Closing down societies permanently until an effective vaccine is found is not a realistic option. Hopefully, the huge international effort to develop and manufacture a vaccine will be successful – but that is by no means certain. Even so, it will not be 100% effective, as is the case with the flu vaccine. The prudent course of action, therefore, is effective risk management rather than risk avoidance. There must be a clear policy with public education and public engagement.

None of this is to underestimate the heroic work of our health and care workers, nor the individual or family tragedies caused by our current pandemic. But our real challenge may be to work out how to minimise but, realistically, not eliminate the toll of Covid-19 on our lives. We have to face up to reality by acknowledging that for some years – potentially decades – we may have to live with this enemy.