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7 July 2021

Is there an acceptable number of Covid-19 deaths?

If you don’t acknowledge that risk is an inevitable fact of life, it is much harder to have an honest conversation about mitigating it. 

By Rachel Cunliffe

Is there an acceptable number of Covid-19 deaths? It’s a morbid question, especially when the UK death count stands at more than 128,000 (for deaths within 28 days of a positive test). There has been so much tragedy over the past 16 months, so many personal losses and untimely funerals, that simply raising the prospect of more seems callous. 

That may be why even the new Health Secretary, Sajid Javid, who has argued that we must “learn to live with Covid”, is refusing to be drawn into a discussion about numbers. He dodged the question in the House of Commons on 5 July, then told Sky News on 6 July that “it’s not about some number of deaths being acceptable, of course not” when asked whether the government had a figure in mind as it moves to end all Covid restrictions on 19 July. 

As far as Javid’s opposite number, the shadow health secretary Jon Ashworth, is concerned, even contemplating this figure is unconscionable. Appearing on the Today programme on BBC Radio 4 yesterday (6 July), he was asked a similar question. “I don’t think any avoidable deaths are acceptable,” he replied. “That’s why I would always want to put in place mitigating precautions to try to save people’s lives.” 

The second part of Ashworth’s statement is hardly controversial. At a time when Covid cases are surging, it is sensible to look at precautionary measures, such as continuing to encourage mask-wearing and improving ventilation in public buildings. But the first part deserves scrutiny. 

Sad as it may be, we “accept” a large number of theoretically “avoidable” deaths. For example, in 2019 the UK had 1,752 road traffic fatalities. That means nearly 2,000 people – including 49 children – died because the UK does not ban driving. 

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A further 40 people died in 2018-19 in rail-related incidents (excluding suicide). There were also 7,565 deaths related to alcohol in the UK in 2019, while approximately 77,600 people die from smoking per year in England. Meanwhile, over the past half-decade, the winter flu season has claimed between 3,500 and 23,000 lives per year.  

All of these could be classed as “avoidable deaths”. If the UK banned not only driving but also trains, alcohol and tobacco, and imposed nationwide lockdowns and school closures between October and March every year, a significant proportion of these lives would have been saved, if only temporarily. We could save more lives still by banning cycling, skiing, rugby, rock-climbing and eating chicken; by keeping everyone over the age of 65 in a sterile bubble; or by imposing a blanket curfew on men to prevent male violence against women. 

That no sane politician even suggests we do any of the above tells us that there is a level of “avoidable” death we as a society are comfortable with, whether we like to think about it in those terms or not. 

This does not mean that we – by which I mean both government and individuals – make no effort to reduce deaths as much as possible. Cars come with seatbelts, airbags and speed limits; alcohol and tobacco are strictly regulated, while public health campaigns try to limit drinking and smoking; rock-climbers wear harnesses; and we are all taught to cook chicken thoroughly. Maybe after the horrors of the past 16 months, we will consider measures to ease the impact of flu season each year. 

But it is wrong for anyone – least of all the shadow health secretary – to suggest there is no such thing as an acceptable number of deaths, or that politicians should not be asking this question. There is a whole organisation – the National Institute for Health and Care Excellence (Nice) – dedicated to helping the NHS grapple with this challenge. It even has its own metric to determine which life-saving interventions are worth the cost and which, tragically, are not: quality-adjusted life years, which, according to the Nice website, “are calculated by estimating the years of life remaining for a patient following a particular treatment or intervention and weighting each year with a quality-of-life score”. Even the NHS does not attempt to save every life it hypothetically could. 

In the context of Covid, this might seem facetious. When I tweeted about Ashworth’s comment, I was bombarded with people telling me he obviously hadn’t meant what he said, and was arguing for further precautions, not trying to eliminate deaths altogether. But while I agree this probably is what the shadow health secretary meant, I think it’s important we challenge such “risk-illiterate” statements when we see them, especially when they come from people asking us to trust them with governing our lives. 

Because if you don’t acknowledge that risk is an inevitable fact of life, it is much harder to have an honest conversation about mitigating it. Minor interventions, such as mandatory mask-wearing, are easily justifiable at this time, but what about more severe ones? What if we could prevent ten people dying from Covid-19 if we kept all pupils off school for the next 12 months? Most people would consider this extreme and disproportionate, but if your baseline is that no avoidable death is acceptable, denying 6.7 million children a year of state education in England would seem a moral imperative.  

When politicians make inane statements such as this, they make it impossible to have a rational conversation about how much risk we as a society are prepared to take. We can’t even begin to weigh up the relative costs and benefits before the debate descends into a shouting match about who “values life” the most. They also undermine their own arguments for further precautions – how can you take the very reasonable case for masks and ventilation seriously if it’s coming from the mouth of someone who claims Covid risk must be reduced to absolute zero? 

None of this is about downplaying the potential severity of the third Covid wave or opposing measures to limit its impact. New daily cases now stand at 28,773, and even with 86 per cent of adults in the UK having received at least one vaccine dose, there is so much we still don’t know about how this virus spreads and mutates.  

But, of course, there is an acceptable number of Covid deaths – just as there is an acceptable level of death from many other causes. And we deserve politicians who are brave enough to admit that.