Understanding Risk

by Lynda Goetz

The late-lamented Prince Phillip, Duke of Edinburgh, whose very moving funeral service took place in St. George’s Chapel, Windsor, last Saturday, was, like many of his generation, very aware of the pitfalls of life, the constant presence of death and the risks associated with living life to the full. This does not always seem to be the case with the generations which have followed. Those of us born in the UK after World War II have, with few exceptions, not had to contend with the risks and dangers of war, nor, unless deliberately sought, with risk at any serious level. The founding of the NHS has meant that previously unaffordable hospitalisations, operations and treatments are now available to everyone and the advances in medicine have kept alive many who would, in the early part of the last century when Prince Phillip’s generation were born, have died. Have we as a result, as the Duke might well have said, ‘gone soft’?

Certainly, when one hears about university lecturers having to issue ‘trigger warnings’ before lectures and is constantly confronted with the apparent fragility of the younger generations, it is hard not to wonder about the extent to which we have removed, or tried to remove the elements of risk in life. The elements of risk, which for some like the Duke, are almost essential to life. In our rush for ‘safety’ are we perhaps reducing lives rather than enhancing them?

There has been much comment in the press about the lonely figure cut by the Queen sitting alone and apart from her family during her husband’s funeral service. Given the current Covid-19 regulations, she would almost certainly not have had it any other way. In this she was sharing the experiences of so many of her subjects over the last year. Unlike some, she had at least had the comfort and companionship for much of that time of her husband who was with her in the royal ‘bubble’. Many over the last year have died cut off from their family as part of a worldwide experiment in pandemic management. The cruelty of the authoritarian measures put in place by governments around the world to ensure the ‘safety’ of their citizens and to prevent the collapse of their health systems is unprecedented in countries describing themselves as liberal democracies.

The majority have, it seems, approved of the lock-downs and numerous restrictions. Have they however really assessed the situation and associated costs, risks and benefits for themselves or have they simply accepted that those governing us know best? This latter seems unlikely given the level of mistrust of politicians. Is it rather that most of us are out of the habit of assessing risk for ourselves?

It is interesting that when, a few weeks ago, the issue of risk relating to the Oxford Astra Zeneca vaccination arose there was something of a panic, both here and elsewhere. Some of that panic related to rather deliberate misinformation generated within the EU for reasons unconnected with the vaccine itself. This however, in conjunction with fears of blood clots believed to have a causal link with the vaccine in the under 55s, has led to several countries dropping use of this vaccine altogether. France’s largest vaccination centre, located in Nice, which was supposed to have been open all last weekend, closed on Saturday afternoon: only 58 people of the several thousand expected turned up. However, to put this risk into context, 30 cases of blood clotting out of 18,000,000 people given the Oxford AZ vaccine means that you have a 1 in 600,000 chance of getting blood clots should you receive the vaccine. The UK government, with, it should be said, a vested interest in this particular vaccine, has made sure that this risk has been put into context and widely publicised.

By contrast, when it came to Covid-19 itself, we, the public, were given very little context. This is partly because that context is difficult to give. However, considering the extensive use of mathematical modelling, based in many cases on worst-case scenarios, this could presumably equally well have been used to set out, early on, the possible long term costs to the country, both economic and health-wise of shutting down. This was never done. In spite of later calls for a cost-benefit analysis, the only statistics we were ever willingly given by the government (via BBC and ITV news mainly) were those relating to positive test outcomes, hospitalisations and deaths on a daily basis. Even these were not contextualised (e.g how many recovered; what the daily death toll would be in ‘normal’ times).

This emphasis on the downsides of what is clearly a thoroughly unpleasant virus should you be unfortunate enough to be one of the two out of three who are not asymptomatic, and the insistence on the importance of lengthy lock-downs as the preferred method of dealing with it, does not paint the full picture. Even if the full picture is almost impossible to give because of the lacunae in our knowledge of this disease, the presentation of what effectively amounts to a one-sided argument for a course of action is almost insulting. Should we not be given a much fuller assessment of the risks and allowed to exercise judgement on the level of risk we are personally prepared to accept? Ah, you may argue, but we owe it to others in a situation like this to consider not only our own risk, but the risk we may pose to others. This of course is true. Also true is the fact that governments do not always have time to have debates and referendums; they need to exercise rapid judgement on behalf of those they are governing.

Nevertheless, as we motor at a tortoise-like pace along Boris Johnson’s roadmap to freedom, many of us are still wondering at the breakneck, hare-like speed with which restrictions were not only imposed (albeit after a hesitating start) by governments, but embraced by the vast majority of the population. The journalist, Janet Daley who writes for the Sunday Telegraph asks this very question in her article ‘How did a free people become so relaxed about losing their liberty?’ a couple of weekends ago. She remains uncertain what the answer is and feels a full and rigorous examination of what happened is necessary.

It does not seem likely that this will happen any time soon. Possibly at some time in the future, the extraordinary events and behaviour of the last year will receive proper analysis. In the meantime, as governments around the world double down on their actions and draconian legislation it really feels as if those who question all this are not only in a minority, but a heretical minority. The supremely logical and rational voices of those who have questioned our anxiety-driven lockdowns are regarded as conspiracy theorists at best or selfish ‘Covidiots’ at worst.

The economic effect of shutting down society has largely been, if not ignored, at least played down in many quarters. Whilst it may well be true that all the government support which has been put in place could result in a fairly rapid recovery of the economy as a whole, this does not take away from the fact that many may never recover from the effects of having to shut down newly-set-up businesses and the loss of saved capital or the disappearance of jobs post-furlough. These risks and outcomes appear to be ones that both government and the majority of the population (presumably mainly those not affected or who think they will not be affected) are prepared to accept in return for their ‘safety’. Are their perceptions of risk actually based on the data or on the propaganda?

What in fact are the chances of any one of us dying of Covid-19? I am no statistician, but Heart Matters, the online magazine of the British Heart Foundation shows some interesting examples using risk tools like QCovid and OurRisk developed by bringing together large amounts of data to calculate potential individual risk. Unfortunately, such nuanced information has not been at the heart of governments’ approach to advising the public during the pandemic.

One of the successes of the UK government has been in persuading a fearful public to stay indoors for most of the past year. Indeed the extent of compliance has been far greater than was ever anticipated. According to one report, psychologists are now accusing the government, acting on the advice of behavioural experts, of emphasising the threat from Covid without putting the risks in sufficient context, leaving the country in “a state of heightened anxiety”. The actual current percentage of the entire population of the UK which has died of Covid is 0.19%. Even allowing for the various misconceptions pointed out by Full Fact, most people seemed to believe the percentage of the population killed was 1%. Small wonder they were fearful. Laura Dodsworth, author and photographer who has researched the subject for her latest book, A State of Fear: How the UK Government Weaponised Fear During the Covid-19 Pandemic, said “The problem with fear is it clouds rational thinking…….. We have forgotten how to analyse risk.”

This clearly applies to more than Covid. Have we indeed forgotten how to analyse risk? Perhaps this should be yet another thing taught in schools, since it no longer appears to be something with which the majority of the population are comfortable? This is to do with understanding simple percentages and thus percentage risks. The odds of dying in a car accident in this country are roughly 1 in 200; the likelihood of dying of Covid-19 depends on so many individual factors that the risk cannot really be calculated as a general one. Epidemiologist David Spiegelhalter discussed this in an article in the BMJ written last September. As one consultant oncologist opines in a response to that article however, “awareness of normal-risk is not normal”. He concludes that “educating the public about extra mortality risk over and above ‘normal-risk’ would be a tall order”, given that humans are “more attuned to anecdotes than data”.

If he is correct, and he almost certainly is, perhaps more awareness from an early age might be a good thing. For those for whom living is living with an element of risk, extreme sports rather than gambling, can continue to be their outlet. Those, like Prince Phillip, who need the adrenaline-rush of flying, sailing, carriage-driving or skiing and instinctively seek out and assess the risks can continue to do so, but those who are risk-averse and fearful need to be educated about probability theory and understanding risk. This would help to put into proportion and context the level of risk they face from their everyday lifestyle. It could lead to a better understanding of the risks they are running by smoking, drinking, being overweight or even sunbathing – none of which on the face of it appear to be very risky activities. Unfortunately, as the epidemiologists understand only too well, it is not only these activities individually which lead to risk, but the way in which they combine with age and with diseases like coronavirus that can lead to a greater chance of death than the apparently more dangerous activities enjoyed by those less concerned about ‘safety’.