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Is coronavirus a terrifying killer or a manageable risk? We still don't know

Government press conference
Until the picture becomes clearer, there’s little alternative but to prepare for the worst

Last week, Imperial College London released one of the most consequential academic papers in recent history. Unless the government took drastic action, it suggested, the coronavirus might take 250,000 lives.

This was enough of a jolt for Boris Johnson to impose the lockdown he had, until then, been resisting. But a few days ago, a group from Oxford University posited another theory: that the virus might already have hit most of us - so substantial “herd immunity” might have been acquired without us realising. These two studies point to two very different versions of Britain’s future.

The Imperial study sees coronavirus as something that would have taken more lives than any disease in living memory had pretty drastic measures not been taken. School closures, quarantines, social distancing of the entire population: all were on its list of remedies. And even then, it said, thousands would still die. I was persuaded by the Imperial study and remain so. If there is even a small chance of the death toll it envisaged, this lockdown will be a price worth paying.

The Oxford study paints a very different picture. It suggest the virus spread for more than a month here before the first recorded death, but is so mild as to be unnoticeable for the vast majority. Its authors don’t oppose the lockdown and their study is entirely theoretical, but their timetable suggests this nightmare being over in weeks rather than months.

The study has its (vociferous) critics but it’s seen as entirely plausible at the highest levels in the government. As one senior official in the Covid response team puts it, Oxford could well be right. As could Imperial. But which scenario should they prepare for? The answer, obviously, is the worse one.

Preparing they are. The transformation of the NHS is a wonder to behold. The Chinese paraded a 1,000-bed hospital in Wuhan a few weeks ago but the NHS is building capacity for 4,000 extra beds - including a makeshift ward at the ExCel Centre in London. Interestingly, it’s being done in phases - just in case these beds are not all needed.

Government ministers are unsure what to think. They agreed that the Prime Minister should follow expert advice, but what if experts disagree? There might be doubt about the deadliness of Covid, but there’s no doubt about the damage inflicted on the economy by the lockdown: the surging unemployment, the children denied their education, the apprenticeships abandoned, the businesses going bust. It might all be worth it. But how will we know?

Look around the world, and the Covid picture is still unclear, with the reported death rate varying massively. In Italy: about 9 per cent, which is terrifying. But in Germany, the Robert Koch Institute calculates it’s 0.5 per cent. Normal, seasonal flu is 0.1 per cent. The Deputy Chief Medical Officer said last weekend that Britain’s official rate was 4 per cent, but she thought it “should” be closer to 1 per cent. That might sound like an odd thing to say but her boss, Chris Whitty, has always stressed the uncertainty around such calculations. To work out the true death rate, you need to know how many cases there are. If most people with Covid don’t feel sick, they won’t get tested - so those tested will be the tip of an iceberg. To understand the virus, you need to measure the iceberg.

An attempt was made earlier this week by Eran Bendavid and Jay Bhattacharya, professors of medicine at Stanford University. Their model - and again, it is no more than that - concluded that about six million Americans could well have it. If they’re right, they say, this implies a death rate of 0.01 per cent, “one-tenth of the flu mortality rate of 0.1 per cent”. Covid would still be a problem, but one primarily facing the over-70s and already-sick. There’d be a case for focusing on protecting these vulnerable groups.

Of course, none of these hypotheses explain the scenes in Madrid, where an ice rink is being turned into a temporary morgue. Or the towns of Lombardy, where streets are abandoned to ambulances and hearses. Or in New York, where they’re desperately trying to turn hotels into hospitals.

Given all this, the Prime Minister had no real choice but to act as he did. And the lockdown helps buy time, he says, to let the NHS gear up for whatever lies ahead. And also buy time to try and understand more about what he calls the “invisible killer.”

Britain’s last encounter with a pandemic was Swine Flu. Then, as now, no one really knew how many it infected. The breakthrough came with an antibody blood test, which found the disease was ten times as widespread as had been believed. In the end, Swine Flu was found to be no more deadly than standard flu.

Might Covid go the same way? Might we come to see it a weird winter lurgy, albeit one that - like flu - can be fatal for certain vulnerable people? The Prime Minister himself has asked Sir Patrick Vallance, the Chief Scientific Adviser, if the Oxford study could be right. “We simply don’t know,” came the reply. No one can know, without more data. Until it arrives and the picture becomes clearer, there’s little alternative but to prepare for the worst.

This is why antibody testing is so crucial. A test has been developed and if it works - still, I’m told, a horribly big ‘if’ - then the data it provides could help solve the puzzle and determine how far the virus has spread. If lockdown has meant Covid has been contained, as the Imperial paper envisages, we’d risk spreading it again when lockdown ends. But if the viral horse bolted several weeks ago, as the Oxford model imagines, restrictions could be eased on a speedier timetable.

So this limbo, where even the NHS can only guess if it will need an extra 400 beds or an extra 4,000, might not last for long. The antibody test will be, at most, two or three weeks away - if the Americans don’t develop one first. Every day, new studies and more data comes flooding in from around the world. As they do, the picture will become clearer and the “invisible enemy” will come into view. Then, and only then, can we be sure how best to fight it.