By Dr Ami Banerjee
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09 Jun, 2020
I entered lockdown six days early, when the UK had 1950 cases and 81 deaths from coronavirus (COVID-19). Mine was driven partly by concerns that we were not following lessons from Wuhan, but mainly by a question that day in my clinic from a long-standing patient with heart failure. I often said he was fitter than me, so he was confused at being “high-risk” (now “ clinically vulnerable ”), as per the list of conditions announced on 16th March, recommending stricter “social isolation”. Every affected country reported increased deaths with old age and certain conditions like heart disease. I wanted to communicate his individual risk. I wanted to investigate whether risk of death differed between conditions on the government’s list, from chronic kidney disease to diabetes, to check we were isolating the right people. Finally, I suspected unchecked infection rates would create thousands of deaths. My lockdown was with my laptop. I did not see my family for four days. By 20th March, our four-strong research team (Laura Pasea, Spiros Denaxas, Harry Hemingway and I) had convinced twelve colleagues to join us in this research. Everybody contributed with skills from virology to statistics via phone calls, emails and Microsoft Teams, which I had only just discovered. On the same day that a further “ extremely vulnerable ” list of conditions was declared, we published our preprint on 22nd March, after sending to the Chief Medical Officer’s office. The new list included 1.5 million individuals who should stay at home for at least 12 weeks (“shielding”), including those on chemotherapy. The following evening, the Prime Minister announced lockdown, now easing. We showed that 10% infection rate (likely in March/April) would lead to 30,000 and 70,000 excess deaths over one year, only preventable by reducing infection rate. With refinements, we published in The Lancet on 12 May, showing 20% of UK adults are “high risk”. Twelve weeks after lockdown, there are at least 287,399 confirmed cases and 40 597 deaths, now including colleagues, friends and several patients. I am in a family of strong women. My wife, a dentist at home during lockdown, prepares to return to work as the curve flattens, PPE supplies improve and clear professional guidance emerges (dentistry is among the highest risk professions). She is home-teacher to our 6-year old daughter (the other strong madam in our house). There is another strong woman I am missing. My mother, in her sixties with diabetes, is in Yorkshire, socially isolating with my father. Since the Prime Minister’s announcement on 11 May, she wanted to know if and when she should return to teaching. She asked if my exercise, now unlimited, might lead me up North from Barnet (with her granddaughter of course). The first question was easier to answer and the actions of Mr Cummings introduce doubt at best. Whereas we have guidance for extremely vulnerable individuals, it is confusing for people like my mother, who represent a larger proportion of the population. 90% of excess deaths occur in this category. Moreover, care of underlying conditions is likely to have been reduced, probably due to patients not attending hospital and health system strain. To avoid further tragedy, we must focus our efforts here, protecting them from infection and ensuring treatment of their comorbidities. We urgently need to communicate risk, regardless of COVID-19, to patients, carers, researchers and policymakers. During intensive care shifts at the Nightingale Hospital, I saw how evidence could help conversations with relatives in difficult times. We started to address this gap with a free online calculator , allowing people to put in their age, sex and underlying conditions and see their individual risks. This is the beginning of the journey. We will revise and refine as more data become available. Our research group has grown. Like all academics globally, we are looking down the back of the sofa for data, people and funds to help our research which never needed to be done so quickly. Although we could access health records from 3.8 million individuals for research, that is still only 5% of the UK population. Perhaps we need to reflect on health data which should be accessible for urgent and sometimes immediate research in public health emergencies. Data has long been labelled the “new oil”. Much more than that, it could be the “new drug” or the “new vaccine”.