Questions, questions, questions….

What has been going on with Covid-19 in Leicester? I’m intrigued.

The high number of cases, identified in early June  – now thankfully coming down – has not been reflected in a significant increase in hospital admissions or even clinical presentations to GPs. Why should this be? Back in June, when it was clear that the average age of cases in Leicester was about 37, we dreaded how this might roll out over the next few weeks. We knew that the majority of cases were located in deprived areas of the city where residents tend to live in cramped conditions, often in multigenerational houses. Surely parents and grandparents would be the next to succumb to the virus, especially as the city was in lock-down, with almost everyone staying at home?

What stopped this happening? Could it be that the Asian families that predominate in the areas identified protect their elderly better than the rest of us do? Is it possible that the virus is getting less virulent? Or is the high number of cases identified partly explained by the extensive testing regime? Do we even know the percentage of false positives? An established, and much debated, medical phenomenon is the evidence that extensive screening for any pathological condition will uncover abnormalities in healthy people, some of whom will not become ill and some who will be made worse by future interventions. Is it possible that we are witnessing a version of this?  Certainly, if we conceptualise Leicester city as the patient, there are many who think the intervention – an extra five weeks of strict lockdown, now slightly eased – has caused more harm than good.

Raising these questions feels uncomfortable.  I find myself in distasteful company! Donald Trump, in denial back in May, tried to persuade the world that America didn’t have a Covid-19 problem, it just looked that way because it was doing more testing. Clearly rubbish, as the soaring number of deaths has proved. I feel a need to constantly reassure people that I’m not in any way dismissing how dangerous this virus can be, that I’m not wanting to say anything that might contribute to a more blasé attitude towards social distancing, that every life lost to this virus is a tragedy. Nevertheless, the questions remain, and it’s important that they are explored. “Once you’ve seen one pandemic, you’ve seen one pandemic,” is a common saying amongst epidemiologists. In other words, every virus is different and we are learning new things about Covid-19 all the time. We need to keep our minds open.

With a few exceptions, these questions are not being asked in the main media. In general, there seems to be an obsession with numbers of cases but very little unpicking of what these numbers actually mean. Comparison groups are not mentioned so we don’t know, for example, if the number of cases in Leicester is that much higher than in other cities with similar areas of deprivation. It is hard to find out from reading the newpapers what percentage of tests are coming back positive. The very real possibility of false positives and false negatives seem to have dropped out of our collective consciousness. The potential for ‘herd immunity’ – an insensitive term, but an important concept – has become linked in people’s minds to libertarians who would have allowed the virus to rampage through the community, so now seems to have become a taboo that can’t be thought about.  Even the link between numbers of people testing positive and actual clinical illness, let alone deaths, has got lost somewhere along the line.

It has been painful to observe the potential damage done to my home city and its citizens by extending lockdown. But as far as our knowledge of this pandemic goes, the situation in Leicester has confounded expectations and deserves further scientific scrutiny: especially if, as has happened in North West England, further ‘partial lockdowns’ are going to be part of the government’s response to the data they are gathering. We may even find good news hidden away, although it will be a risk to mention it in the current climate!