Reading reports from China early last year describing an apparently novel viral pneumonia, I was initially sceptical. Terrifying threats have become the currency of public health and 24/7 news, and doctors have become used to the ensuing procession of patients unnecessarily worried about diseases such as Ebola or Zika virus. Then I encountered my first patients gasping for breath with Covid-19, amid accounts from colleagues of mounting deaths in nursing homes. It was soon evident that this new virus was a threat of a qualitatively different order from those of the recent past.
The Tyranny of Health
The experience of inflated health scares inevitably makes some of us sceptical. Such scares have come to play a role in ‘the medicalisation of life and the politicisation of medicine’, as I observed in 2000 when I wrote The Tyranny of Health. It was already apparent then that issues of health were steadily occupying a more prominent role in the politics of the post-Cold War world, as the established polarities of Left and Right, Labour and Capital were no longer offering any convincing visions of the future. A burgeoning interaction ‘between a state seeking authority and individuals seeking reassurance, provided enormous scope for government intervention in personal life and guaranteed the popularity of such intervention’. ‘Public health’ and an unremitting focus on lifestyle and personal well-being became the order of the day. Rather than a means to our desired ends ‘health’ was becoming the very goal of human endeavour, thus diminishing rather than enhancing the quality of our lives.
Playing its part in this process was the gross exaggeration in the late 1980s and 1990s of the threats posed to every one of us by diseases such as HIV/Aids and BSE/CJD, provoking widespread anxiety. The ‘worried well’ became a recognised disease category. New viruses in the new century — SARS in 2002–3, Avian Flu in 2005–6 and Swine Flu in 2009–10 — were accompanied by predictions of apocalyptic death rates that were rapidly revealed as disproportionate to the real threat. This was generating unwarranted fear, and also eroding trust in doctors and health authorities. In a paper in 2010 I endorsed the growing view that when a genuine threat arrived it would not be taken seriously.
So it came to pass. When Covid-19 appeared, many people, suspicious of a scare and hostile to lockdown measures, were too ready to dismiss or minimise the threat. The wish was father to the thought. Commentators such as Ross Clark and Ivor Cummins hastily claimed that Covid was no worse than seasonal flu or the flu pandemics in 1957 and 1968.  They cherry-picked congenial expert criticisms and dubious expert authorities, rather than objectively examining the available range. Later, when new cases fell to low levels over the summer of 2020, they disputed the abundant indications that this reflected the impact of lockdown policies.
These are not the only sceptics giving scepticism a bad name. Some reputable scientists such as epidemiologists Sunetra Gupta and Carl Henegan, suggested, on the basis of disputed interpretations of the data, that herd immunity had been reached and that a second wave of infections was now unlikely. Some even asserted that the pandemic was ‘past its peak’ and ‘over’. When these claims were patently falsified by the dramatically rising curve of infections and deaths from November onwards, few sceptics — commentators or scientists — were prepared to acknowledge their mistaken prognostications.
Quarantines and lockdowns inevitably entail adverse consequences for freedom, health and the economy, and must be subject to intense scrutiny and review. We need therefore to clarify, through public discussion, what measures are justified and what are not. We need sceptical questioning and debate. Critique, however, hardly includes the baseless imputation of malign and conspiratorial motives to the authorities. Overwrought sceptics on Spiked-online for example have accused the government of brainwashing the public, using psy-ops, waging war on our youth, using the pandemic to disrupt our lives, colluding with the Great Reset, conducting a dystopian experiment and generally advancing an authoritarian, even totalitarian, agenda. Repeatedly describing the UK as a ‘police state’ serves only to minimise the oppression of those who actually live in one.
Many lockdown sceptics have avoided a rigorous and enquiring engagement with the reality of Covid-19 and the societies which it is ravaging. Instead, they have simply used a familiar critique of the politicisation of health and the growth of a culture of fear as a script for explaining the reception of a new virus in new times. This is not a sceptical approach. Every medical crisis does not have to be understood as a health scare, nor the official response as an assault on a fearful populace. Rather than ourselves politicising a public health issue we need to grasp the specific features of this pandemic and the policies advanced to contain it. As CLR James once said ‘We have a method which is aware of the past, but open to the future’.
In responding to the challenges of Covid-19 we have to begin from a recognition of the realities of this viral epidemic. The scientific method is essential to our understanding of this disease, and it is also essential to the task of social analysis in shaping our understanding of the pandemic and the official and popular response to it. Neither medical science nor social analysis is sacred, and neither can be scanted. But taking the measure of bureaucratic impositions like lockdowns requires something more too: it requires a moral compass. Government ministers abdicate responsibility for their policies by claiming they ‘follow’ the science (and sometimes they do, sometimes they don’t). It is up to the politicians to make judgements not only on the scientific advice and the wider analysis, but also on what is the right thing to do.
We too must make our own judgements. We should tread carefully — but that does not imply relinquishing the task to politicians and experts. Too many lockdown sceptics simply ignore or injudiciously select scientific findings in support of their established beliefs. These include convictions that lockdown is at best unnecessary and at worst a plan to control the minds of the people. Critics are right to point to administrative failures and also to the plight of groups particularly disadvantaged by lockdown such as children and the working class. But they fail to specify the consequences of policies that they promote, such as ‘we need an anti-lockdown movement for freedom and jobs’. This amounts to an evasion of the realities of Covid-19 and of the difficult choices that have to be made in responding to it.
There are a number of reasons why Covid-19 is a more serious threat than earlier viral epidemic diseases. As a novel virus that appears to have made a recent transition from animals, human populations have no natural immunity to it. A degree of cellular immunity arising from earlier exposure to other coronaviruses may diminish the severity of illness, but does not prevent it. Unless contained, it is transmitted relatively rapidly (each affected person infecting, on average, three others) and individuals, including children, can transmit the virus even if they have no symptoms. In Western countries, it kills between 0.5% and 1% of those infected, with a particularly high fatality rate among the elderly (10–15% in those over 80), especially those with underlying health conditions. The mean age of death is 80, and it causes on average a reduction in life expectancy of 10–15 years. It is around 10 times more lethal than seasonal flu. Though the most common cause of death from Covid-19 is viral pneumonia, it also causes a wide range of other pathological features, affecting every bodily system, causing long-term disability (‘Long Covid’) as well as acute illness.
Despite major research efforts over the first year of Covid-19, there is still no specific treatment and, before December 2020, no vaccine. The only measures available to mitigate the impact of the coronavirus are, in some combination, measures of personal hygiene and social distancing, testing, tracking and isolating infected individuals, quarantines and lockdown restrictions on travel, education, economic and social life. Such measures inevitably have damaging impacts on individuals and societies. Yet every country in the world has introduced some mix of them according to local epidemiological and political conditions, with widely varying degrees of success.
Sceptics repeatedly claim a lack of evidence that lockdowns are effective. Leaving aside the success of lockdown in ‘flattening the curve’ in the UK, we can readily point to another key outcome. Apart from the benighted cities of Bergamo, Guayaquil and Manaus, governments around the world have — so far — managed to prevent the exponential spread of infection in a way that would cause catastrophic loss of life and the collapse of health services. There is a sensible debate to be had about timing and implementation, tiers and lockdowns, and other restrictions. But, as Covid-19 continues its rampage, it is clear that some form of lockdown remains our best chance for containing the transmission of the virus.
New world order
It is important to note that this qualitatively different virus has made its impact on a radically different world. Covid-19 wreaks its destruction mostly upon the elderly with underlying health conditions, and it causes the greatest damage in societies with ageing populations and those other comorbidities of economic stagnation and political dysfunction. It has remorselessly exposed and exacerbated the divergence between a declining West and an ascendant East that had been accelerating over the previous two decades.
Financial and commercial centres in the USA and Europe closely linked to a globalised economy suffered from early exposure to viral transmission. Countries in East and South East Asia had lower rates of infection and the benefit of the experience of SARS. Governments in China and South Korea, Singapore and Vietnam also had the benefit of well organised health systems and a relatively high degree of public confidence in health authorities.
With their complacency and flippancy, patriotic bombast and posturing, delay and indecision, Donald Trump and Boris Johnson personify the crisis of leadership of the Western world in response to the pandemic. A decade after the Western Financial Crisis, the leading economies of the West are still mired in debt, stagnant productivity and public sector austerity, having out-sourced much productive industry to the Far East. The election of Trump and the Brexit referendum in 2016 revealed elites on both sides of the Atlantic that have lost any sense of conviction or direction, and any real connection with an alienated public. Little wonder that the official conduct of the pandemic in the West has been so shambolic.
The failure to suggest realistic alternatives
Lockdown sceptics have usefully focused on the baleful side effects of lockdown, and the official incompetence too often on show. However, although they usually make a quick genuflection to the existence of a serious disease, they have signally failed to advance any remotely convincing alternative to the government’s lockdown policies.
Former Supreme Court Justice Lord Sumption declares that ‘I do not doubt the seriousness of the epidemic’, but then loftily insists that he is not concerned with ‘the wisdom of the policy’, only with its legal and constitutional implications. Sociologist Frank Furedi similarly insists that ‘of course we need to take sensible precautions to protect public life’, but does not indicate what these precautions should be. Philosopher Bernard-Henri Levy, in a book devoted to the pandemic, includes one sentence indicating that ‘measures of caution and precaution were necessary’, but does not elaborate. My patients, many in isolation for months on end and now queueing in the winter cold for their vaccines, would welcome some detail on these precautions from these thinkers.
Of course, sceptics are entitled to criticise without presenting their own policies, although in the current pressing circumstances that might be helpful. But any measures they do put forward or rely upon are not exempt from sceptical scrutiny. Sumption and Furedi have clutched at the straw popularised by the Great Barrington Declaration in October 2020. This proposed, in general terms, ‘focused protection’ for the elderly and vulnerable while freeing the rest of the population from any restrictions. If only. Numerous authorities objected that continuing transmission of the virus among the young while also infecting many older people would cause substantial illness and death — and involve strict controls on up to 30% of the population. The authors have never indicated what level of imminent mortality they consider acceptable with this policy; nor explained how many people they think need protection; nor details of implementation. As the second wave of infections spread around the world in late 2020, Great Barrington fell silent. The sceptical mantle of Socrates and David Hume requires discipline. As Hume said, the sceptic must be careful ‘to begin with clear and self-evident principles, to advance by timorous and sure steps, to review frequently our conclusions, and examine accurately all their consequences’.
Collateral damage and future loss
Sceptics are right to highlight the fact that the lockdown has resulted in increased deaths from heart disease, stroke and cancer. Scrutiny of ‘excess deaths’ during the first wave of Covid-19, however, suggests that undiagnosed Covid is a more important factor. It is necessary also to point out that many fierce critics of Covid death projections are strikingly credulous regarding speculations about future cancer deaths, which are likely to be a drop in the ocean by comparison.
That there will be hardship, poverty and even deaths as a direct or indirect result of the economic cost of the lockdown policies is undeniable. When the economy suffers, and inadequate health systems fail, people suffer. Again, what is the alternative? No country has ‘let Covid rip’; no civilised government could. The duty we owe to those who now face a clear and present danger of dying from this disease must outweigh consideration of those whose deaths in the years ahead may be traceable to lockdown. And we owe that duty just as much to the old as to children. That this has to be said is the pity of it. Doctors do not make treatment conditional upon their assessment of the quality or expected length of the patient’s life. Melanie Phillips put it well: ‘The value of a human life is not a utilitarian consideration. It doesn’t depend upon how people behave, or the state of their health, or how long they have to live. … The point is that the value, or worth, of human life is innate. It does not depend on anything else. It derives simply from the fact that a person is alive.’
Condescending to the public
Some sceptics have turned upon the mass of the population who have, in general, shown remarkable stoicism in their compliance with onerous restrictions on their lives. For this, the public has been disparaged as broken, and sunk in helplessness and passivity. In fact, there has been a great deal of social solidarity and collective initiative in responding to the pandemic. A pragmatic spirit of ‘keep calm and carry on’ has prevailed over the past year, despite scolding from sceptics virtue-signalling their love of freedom and disdain for safety.
The massive support for lockdown policies in current circumstances does not imply a contemptible rejection of freedom, nor does it merit the charge that ‘madness’ and ‘unreason’ prevail in the land. People have been much patronised. According to Sumption, ‘the British public has not even begun to understand the seriousness of what is happening to our country’ . From my perspective, working as a GP through the pandemic, the British public understands very well the seriousness of this disease and its members are willing to take what they believe to be necessary measures to protect themselves and their families.
Civil liberties and freedom of speech
The threat to civil liberties and the danger that the police may abuse their extensive powers should concern us all. The cursory parliamentary scrutiny of lockdown regulations is woeful; so too the abject failure of the official opposition to challenge the government. We should protest against the current outrageous attempts to censor or silence critics of pandemic policies or to criminalise anti-vax campaigners. It is a scandal that dissenting commentators such as Karol Sikora and Knut Wittkorski, and journalists such as Julia Hartley-Brewer and Peter Hitchens have been excluded from YouTube. It has even been suggested that spreading ‘misinformation’ or ‘disinformation’ about Covid or vaccinations on social media should be banned or made a criminal offence. Such measures represent egregious intrusions on free expression and are also likely to be counter-productive. However, robust criticism of sceptics is not censorship and it should be answered rather than evaded; it’s part of the debate.
The Covid-19 pandemic is the greatest global health crisis in the lifetime of anybody currently living, apart perhaps for a few survivors of the 1918–19 flu pandemic. In one year global deaths from Covid-19 have passed the two million mark. In the UK the toll has surpassed 100, 000, far exceeding civilian deaths in the six years of the Second World War. And it is not over yet. It is said that we need scepticism more than ever — I think it would be a very good idea.
My memories of 2020 will be of the wracking cough and debilitating breathlessness of elderly patients — and of the persisting fatigue and debility of younger survivors. I will also remember the altruism of individuals and communities, of families and carers looking after elderly parents and grandparents and younger members with physical and psychological disabilities. They all deserve better — both from political leaders and their critics.
25 January 2020
Michael Fitzpatrick is a GP currently working in the Hackney Covid-19 Hot Hub; acknowledgements are due to John Fitzpatrick and John Gillott.
 Michael Fitzpatrick, The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2001, pp.168, 89
 Michael Fitzpatrick, Pandemic Flu: Public Health and the Culture of Fear, NTS Working Paper Series No 2, RSIS, Singapore, November 2010
 See Ross Clark, ‘Summer flu is now more deadly than Covid’, Spectator, 11 August 2020; ‘Restrictions are an over-reaction when serious Covid-19 cases are ‘on the floor’ claims lockdown sceptic engineer’, Daily Telegraph, 1 October 2020
 See Sunetra Gupta ‘Covid-19 is on the way out’, Unherd, 21 May 2020; Nick Triggle, ‘Covid: Is it time we learned to live with this virus?’ BBC News online, 28 September 2020; ‘Carl Heneghan — no evidence for a second wave’ Sky News, 20 September 2020
 CLR James interview, ‘You never know when it’s going to explode’, Living Marxism 6, April 1989, p.40
 Jonathan Sumption, This is how freedom dies: the folly of Britain’s coercive Covid strategy, Spectator, 28 October 2020
 Frank Furedi, Towards a Fearless Future, Spiked-Online, 25 December 2020
 Bernard-Henri Levy, The Virus in the Age of Madness, Yale, 2020
 Ian Sample and Rajeev Syal, ‘Chris Whitty decries Great Barrington plan to let Covid run wild’, The Guardian, 3 November 2020; Nisreen A Alwan et al, ‘Scientific consensus on the COVID-19 pandemic: we need to act now’, The Lancet, 30 October 2020
 David Hume, An Enquiry Concerning Human Understanding (1748), OUP, Oxford, 2008, p.110
 Melanie Phillips, ‘Who is Lord Sumption to decide the worth of a life?’, The Times, 18 January 2020
 Jonathan Sumption, This is how freedom dies: the folly of Britain’s coercive Covid strategy, Spectator, 28 October 2020