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As many younger people die, why did the Government minimise the under-70s’ vulnerability to Covid-19?

27 April 2020
Martin Shaw

Article published in Martin Shaw's blog on April 4, 2020

A central feature of the Government’s public health advice has been the idea that the over-70s, along with people with serious health conditions, are the ‘vulnerable’, ‘at risk’ group in the epidemic. Most younger people therefore believed that they if they caught Covid-19, they would get only a ‘mild’ disease, ‘not even as bad as flu’, as was often heard only a couple of weeks ago.

Many have been shocked at the number of younger people who have died in the UK, and wonder why we weren’t prepared for this. Welsh consultant Dr David Hepburn tells Channel 4 News that ‘all our ICU patients are in their 50s or younger’. The Government is lining up its excuses, even anticipating a ‘reckoning’ with China over ‘misinformation’ in relation to the outbreak. Michael Gove claims that some of China’s reports on the virus were unclear about the ‘scale, nature and infectiousness’ of the disease. 

In an article examining the papers of the Government’s Scientific Advisory Group for Emergencies (SAGE), Professor Sir Lawrence Freedman suggests that the vulnerability of younger people, in particular, was unclear. ‘The overall picture of this extraordinary moment changes with new information about the virus itself’, he writes. ‘Policies based on the idea that by far the most vulnerable group are elderly people become increasingly suspect as the fit and young are regularly struck down.’ 

Evidence of under-70s’ vulnerability from China

The problem with this narrative is that the vulnerability of younger people is not new information. It was perfectly clear from China. Early reports from Wuhan already showed many people much younger than 70 suffering severe disease. This was widely highlighted when the whistleblower Dr Li Wenliang died aged 34 on 7th February. 

Indeed, among the SAGE papers, we find a 10th February report of an Imperial College team headed by Professor Neil Ferguson with a table, ‘Hubei early deaths 2020.07.02’, linked in the paper, analysing 39 cases. The age distribution was not tabulated but individuals’ ages were given, so we can summarise them: twelve were over 80, nine 70-79, twelve 60-69, four 50-59, one was in their 40s and one in their 30s. 

This was not a representative sample, but it is striking that figures were there, in the papers available to SAGE at this early stage, showing 48 per cent of cases under 70 and 15 per cent under 60. One would have thought that the scientists, if not the politicians, would have spotted this and looked further into it.

If they overlooked this, more representative Chinese data, based on 44,000 cases, were published on 17th February, showing the following death rates:

Age range Deaths as a percentage
of reported cases in the age group
Percentage
of
total deaths
80+ 14.8 20.3
70-79 8 30.5
60-69 3.6 30.2
50-59 1.3 12.7
40-49 0.4 3.7
30-39 0.2 1.8
20-29 0.2 0.7
10-19 0 0.1
0-9 0 0

The left-hand column was widely reproduced, and even in these figures it was quite obvious that there was a gradual increase in the death rate along with increasing age, rather than a sharp change at 70 or any other age. 

The right-hand column was not widely reported. Yet it showed that 49 per cent of those who died were under 70 and 19 per cent under 60. The number of deaths of people in their 60s who died was pracitcally identical to that of people in their 70s. There was significant death in all age groups except the under-20s. 

Another figure in the Chinese table should have rung alarm bells: almost a third of victims (32.8 per cent) had no ‘comorbid conditions’. Although later Italian data suggested that almost all victims had at least one condition, these widely used Chinese data, the major source for the World Health Organisation and UK responses, implied that the fit and healthy were also vulnerable. 

Failing to warn the middle-aged and young

Yet the British authorities drew the conclusion that the over-70s together with those with pre-existing conditions were the ‘vulnerable’ or ‘at risk’ group, and based their strategies on ‘cocooning’ them, as Dr David Halpern, head of the Government’s Behavioural Insights Team put it on 11th March, at the time when the Government was still pursuing the notorious goal of ‘herd immunity’. Even after the policy switched a week later, it was still the ‘over-70s’ who were told to isolate.

Yet the dangerous consequences of an over-overemphasising the elderly, at the expense of the middle-aged and younger groups, had become clear in Italy in early March, when doctors reported over-60s being denied intubation because of the large numbers of under-60s requiring it

But still the UK government failed to warn middle-aged and young people of the dangers they faced. While increasingly complaining that many in these age-groups were flouting social distancing advice, the Government failed to give them the key information which might have changed their behaviour: they were also at risk.

Half-digesting the available information, leading to culpable ignorance of the threat

I have combed the SAGE papers for scientific advice justifying the restriction of the at-risk group to the over-70s. I’ve found only one one paper which refers to the decision. This states that it was ‘to be discussed and agreed by SAGE on 10th March as a change from over 65’s’. It had been ‘modelled for 65+, 70+, 80+’, and although the modelling isn’t explained, it’s noted that ‘models using 65+, and 70+ deliver comparable results’. 

So why was the cut-off changed from 65 to 70? Even recommending protection for the over-65s would have alerted many more potential victims. Without a scientific reason, did political interference lead to this change?

In any case, it remains completely unclear why, if the Government had really taken on board the evidence from China, they would have so consistently referred to only the over-70s as ‘vulnerable’. It wasn’t that the Chinese were unclear (about this at least), still less that they had misinformed us. 

Rather ministers and, seemingly, also their scientific advisers were guilty of only half-digesting the available information. This seems to have made them culpably ignorant about the threat posed by the disease to the middle-aged and young. Indeed, having put the ‘over-70’ idea so consistently at the centre of their propaganda, they appear to have made the mistake of believing it themselves. 

As younger victims fill up ICUs, young nurses and doctors risk their lives, and older people risk being left to die in their homes and care homes while ICU beds and scarce ventilators go to the relatively young, we seem to be paying a high price for this carelessness.