Fear is the mind-killer. Fear is the little death that brings total obliteration
Of all the stupid ideas which have emerged during the pandemic, and there are many, there is one which surpasses all others for its perniciousness. That is that idea that we should eliminate as many risks from our lives as possible.
On the face of it, what could be wrong with the idea of reducing risk? Surely risk is a bad thing. The superficial appeal of the idea is the source of its danger. Lots of well-meaning people subscribe to it (and support politicians who do).
But should we always reduce any risks that we can?
Let me re-frame the idea of reducing all risks: in practice, this is identical to the idea that we should give in to our wildest fears. That we should live – or rather, exist – in fear. To reduce a risk is to allow a fear to move you to change something about your life. To ignore (or conquer) a fear is to ignore a risk.
Now, lots of people might agree with the idea of reducing as many risks as possible, but few would agree with it when framed as letting fear rule our lives. Yet, it is the same thing.
Living carries risks. The act of being alive necessarily carries a risk of death. In fact, the good news is that if you’re at risk of death, it means you’re alive. It’s something to celebrate. So why, during the pandemic, have we decided to give in to fear? This fear seems to affect different people in different ways.
Some people are terrified of COVID, others are terrified of vaccines. Yet others are terrified of some global conspiracy to sterilize us all (with vaccines), or to subject us to a totalitarian global order of endless lockdowns.
The unifying trend in this is the mind-killer aspect. When afraid, people simply stop thinking.
Let’s talk about risk.
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Years ago, I read a great book called the Norm Chronicles by Michael Blastland and David Spiegelhalter, which was about risk. This book noted that typical adults in the UK have a one-in-a-million chance of dying each day from non-natural causes (accidents and violence). A one-in-a-million chance of dying is what is known as one “micromort” – micro being a millionth, and mort being, well, death. Micromorts are not cumulative. You wake up each day with a clean sheet.
If you consider death from all causes, our risk of dying increases exponentially with age. For a 50-year old man in the UK, it’s about 10 micromorts per day. That’s one in one hundred thousand.
Now, let’s deal with fear of the COVID vaccines.
A lot of people are afraid of vaccines and are ridiculed for that fear. I think that ridicule is not justified. First of all, there is something normal about a fear of something new, with “emergency approval”, which may have passed stage 3 trials but about which we (necessarily) had no long-term data. I think some trepidation is perfectly fair. Especially if you live in Russia, where you were the stage 3 trial.
Over time, of course, this changes. More than 9 billion COVID vaccines have now been administered. Now we know that the vaccines present a low risk. You can read about the UK data here.
I will summarise it quickly: The chance of dying from a blood clot the Astra Zeneca vaccine is about 2.7 in a million from the first dose, and if you survive that, 0.2 in a million from the second. The chance of dying from myocarditis from the Pfizer mRNA vaccines is about 1 in 10 million. From Moderna, there have been no deaths in the UK (possibly because 2.8m doses is not enough to uncover one of these hyper rare risks). Interestingly, Astra Zeneca also caused a few myocarditis deaths (2 deaths for 49m doses, or a 1 in 25m risk).
So, we are clearly in the micromort range of risk when it comes to vaccines – between 0.1 to 2 micromorts. For adults, this is below the average daily “background” risk of dying from any cause, and similar to the risk of dying in an accident or from violence on a given day. Something that most of us don’t give a second thought to.
So far, so rational. But we are not rational when it comes to risks and probability. The same people who sneer at those who are afraid of vaccines will, unashamedly, buy a lottery ticket. Or, they may be afraid of flying commercial aircraft. Or worried that a paedophile will kidnap and murder their child.
The chance of winning Powerball in Australia is 1 in 134 million per game, so for the minimum 6 game ticket, it’s about 1 in 20 million, and yet perhaps a quarter of Australians buy tickets in the large jackpots. Even for a rare $80m jackpot, the minimum number of games is a $7 investment for an expected $4 return. So, this is not rational (in the narrow sense), but what it shows is that people think there is a real possibility of being struck by lightning (incidentally, the risk of death from real lightning is about 0.5 micromorts per year).
Same goes for plane crashes. Flying commercial aircraft is pretty safe – less than one micromort per flight. At yet, plenty of people are terrified of this tiny risk. Note, they are not terrified of the risk of getting a blood clot while flying (thrombosis), which is a thing, but terrified of the plane falling out of the sky (which is also a real thing, but a much rarer one).
A long haul flight exposes you to a roughly 1 in 4,500 chance of a blood clot (venous thrombosis) and perhaps 8% of these are fatal.
That’s a 1 in 8 x 4,500 chance of dying from a blood clot while flying, or a staggering 17 micromorts per flight. Meanwhile, the chance of dying in a plane crash on a commercial airline is closer to 0.3 micromorts.
Of course, some risks we just ignore. Most women are not terrified of the contraceptive pill (although many dislike its side effects), but the risk of death from blood clots is estimated at 10 per “million women years”, which if you are one woman means, 10 per million per year. 10 micromorts per year, or about one a month. Your first Astra Zeneca shot is as risky as 2 months on the pill.
I could go on. The point is not to show how bad we are at assessing risk. You already know this.
The point is that we do not lambast these people who are afraid of flying as “science deniers” or the “tin hat brigade”, even though they do deny (or at least are unmoved by) the evidence of how safe commercial aircraft really are. Instead, we are somewhat sympathetic to their irrational fear, perhaps because all of us have sometimes experienced something similar. We empathise.
And yet, for some reason, many people are decidedly unempathetic about vaccine fears. Instead, intoxicated by self-righteousness and convinced that their own vaccination is some sort of altruistic sacrifice (instead of the act of self-protection that it really is), they hold the vaccine hesitant in contempt.
This is one of the depressing things about the pandemic. The rapid development of safe and effective vaccines is something to be celebrated. But for many, it was also the opportunity for an oxytocin hit of self-righteousness and judgement.
Now, you might object that a fear of flying costs no-one anything, but not taking a vaccine imposes a risk to others. This is true, sort of. Let us turn to the risks of COVID.
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It turns out, no-one has a monopoly on science denial. The vaccine fearing brigade are the ones who cop a lot of the contempt, but there is just as much science denial from those who fear COVID, if not more.
At the beginning of the outbreak, when much was unknown, it is understandable that people got things wrong. It was initially thought that COVID was spread by fomites (i.e. on surfaces), as much by air. Stand 1.5m away from someone and you’ll be fine. That turned out to be wrong.
But one bit of data that has been there right from the start, which has remained true, was that the risk to children is very low. And yet, it is routine to deny this. Often as part of an attack on the unvaccinated, people claim that they are particularly at risk of COVID, not because they are old, have a comorbidity or are immunocompromised, but because they have young children who have not been vaccinated yet.
There are two fears here: one is the fear for our children. And the other is the fear of our children. Naturally, people like to dress the second one up as the first, just as they like to dress up vaccination as an altruistic sacrifice they’re making for others. But often, it is the second fear which is driving their behaviour.
Here are the stats:
In the UK, during the first year of the pandemic, an estimated 469,982 children got COVID out of a population of 12 million. None of these were vaccinated (this data is up until Feb 2021). 25 died of COVID, of whom, only 6 did not have an underlying health condition. 16 of the 25 children had 2 or more co-morbidities.
In the same period 3,080 children died in the UK from all other causes. 124 died from suicide, 268 from trauma. In 2019, 10 children in the UK died riding their bikes.
We can calculate the risk of COVID in micromorts per year. For all children, 25 divided by 12 million gives 2 micromorts per year (for the year to March 2021). Once a child actually catches COVID, the risk is 53 micromorts (25 / 469,982). If the child is otherwise healthy, the risk is 12 micromorts (6 / 469,982). The “background” risk for children is 3,080 / 12 million or 256 micromorts per year, or 0.7 per day.
So, what COVID did in the UK for children is increase the risk of dying in the year from 256 in a million to 258 in a million.
In the United States, as of 9 September 2021, 460 child deaths had been attributed to COVID from a population of about 74 million. That’s about 4 micromorts per year, twice the UK figure, which perhaps reflects the higher rate of underlying health conditions in the USA.
There were 5,292,837 cases of COVID in American children, so if your child actually got COVID, their risk was 460 / 5.2m, or 86 micromorts (including children with underlying health issues). Meanwhile, the background rate of child risk of death from all causes is 233 micromorts per year for children aged 0-4, and 134 for children 5-14. For risk-seeking teens, it’s 515. The data is here.
For children aged 5-11 (the safest age group for children), 66 American kids died from COVID, the same number as committed suicide in 2019. In that year, 969 died from accidents, and 207 were murdered. 84 died from the flu and pneumonia. For this age group at least, COVID has proved less dangerous than flu & pneumonia.
As in the UK, 68% of child hospitalizations for COVID were associated with > 1 underlying health issue. The rate of children in the USA who died in hospital from COVID (0.6% of admissions) was the same as the rate who had died in hospital from flu in previous years (0.6%).
In Germany, the results are similar. Out of 13.7m children, one study estimated that 1.5m had been in contact with the virus, 5,332 were hospitalized, 253 were in intensive care and 14 died. The case fatality rate for children without comorbidities was estimated at 0.03 per 10,000, or 3 micromorts once you get COVID. Overall (including those children with co-morbidities), we can estimate it at 14/1.5m cases, or 10 micromorts (this is considerably lower than the UK and USA, but different methods were used to estimate the overall number of child cases of COVID). The overall risk of death in the year was about 1 micromort (14 deaths from nearly 14m children). By comparison, in 2017, 15 German kids were killed riding bikes, and 18 drowned.
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Hopefully it is clear by now that COVID has not really represented a threat to children – at least, not significant increase to the background risks that they face. If a child actually gets COVID, the risk (10 to 80 micromorts, depending on the country) is similar to a couple of months of “normal” health risks. If your child is healthy, the risk (UK = 6 micromorts, Germany = 3) is the same normal risk that you face as an adult every day.
And yet, despite the overwhelming evidence concerning children, the pandemic has seen a host of measures put in place targeting them as a particular risk. Schools have been closed for years. Very young children have been required to wear masks, with no evidence that this achieves anything.
Masks rapidly became hyper-politicised in the United States. Evidence of the politicisation is that when a large randomised control trial on the impact of masking in Bangladesh was published, which claimed that cloth masks had no effect but that surgical masks did have a (small) effect, both sides cited it as evidence to prove their position. For those interested, there’s an interesting discussion of the results here.
Playgrounds and swimming pools have been closed, again with no evidence of transmission but simply because of “risk”. In the Philippines, children were been banned from going out in public for nearly two years. And of course, children are being vaccinated.
There are two arguments given for this. One is the “risk zero” argument, which is that all reductions in risk (no matter how insignificant, or at what cost) are justified. The other is that all these measures imposed on children are to protect “the community (i.e. adults, old people, the sick etc).
The second argument is interesting. Usually, it is adults who make the sacrifices for children. Now, it is the children who make the sacrifices for the adults: their play time, their education, their social development, their vitamin D levels and physical health, their mental health.
Early on in the pandemic – the same story. The UK was criticized for keeping schools open because Ireland closed on day 10 of their outbreak, while the UK closed two weeks later. There was no discernible difference in their outbreak curves in the weeks that followed. The same thing happened when English schools reopened on the 8th of March 2021: an outcry about risk (from those who didn’t have kids at home), but no impact on COVID rates, which continued to plummet for months after the opening. These were just my observations – but of course there were plenty of studies done on the subject (Japan, UNICEF). In short, the isolated effect of school closures is difficult to assess because the closures coincided with other non-pharmaceutical measures. The effect of re-opening, on the other hand, seems to be clearer (no effect).
The “zero-risk”, non-evidence based approach has been embraced by US college campuses, despite being populated by young people who had very low COVID risk before the vaccines, and a vanishingly low risk after being vaccinated. This is perhaps unsurprising for the cotton-wool generation brought up to believe that college should be a “safe space”, and that no-one should ever experience risk of any sort.
All of these measures offer very little benefit (and considerable cost) to the young people subject to them, but do they protect everyone else?
What is the risk of COVID to the vaccinated adults? Well, it is not zero, but what is it? At the start of the pandemic, we were told that COVID is 10 times worse than flu, perhaps more (e.g. 6 to 16 times). But then we developed vaccines that reduces its lethality by something like 90% (i.e. 10 times). So, does that mean once you are vaccinated, it is as dangerous as flu?
We can take a look at the UK data, where the Omicron variant has resulted in a huge outbreak and most adults are vaccinated. COVID deaths typically lag cases by about 3 weeks. In the week ending December 10th, England reported 588 excess deaths for the week. Now, I can’t find the death statistics by vaccination status, but about 60% of people admitted to the ICU in December 2021 were unvaccinated, despite being only 10% of the adult population. If we assume an even survival rate once you get to the ICU, that means only 40% of the 588 deaths were vaccinated, or 235.
Three weeks before that the national infection surveys estimated that 862,000 people in England had COVID that week (1/65th of the population). I don’t know how many of these are vaccinated – it looks like this data is not collected during testing. However, we do know that being vaccinated reduces your chances of testing positive (i.e. of being infected). This is about 60% say (risk reduction of testing positive, not of symptoms, which was 75%).
Using that data, we can estimate the split of the 862,000 cases as follows:
- 69% were fully vaccinated (vs 82% of the adult population)
- 10% had one dose (vs 8% of the population)
- 21% were unvaccinated (vs 10% of the population)
So the case fatality rate, once you are fully vaccinated (or naturally immune, which amounts to a similar protection according to the UK data) is 235 / (0.69 x 862,000), which is 0.04%, or about 400 micromorts of risk.
For context, 400 micromorts is the risk babies experience on their first day of life, the cost of a base jump in Norway, or the cost of living a single day when you’re 90 years old. For a 50-year-old, it’s about 40 days of “normal” risk from all causes.
How does it compare to flu?
According to the CDC, in 2018-19, 29 million cases of influenza caused 13 million medical visits and about 28,000 deaths (i.e. risk = 965 micromorts).
This study from the UK estimated that 800,000 GP consultations for influenza A resulted in between 10,500 and 25,000 deaths. If the number of consultations is half the true number of cases (as in the USA), then this gives a staggering 6 to 15 thousand micromort risk for flu.
Interestingly, since the COVID pandemic and frequent comparisons drawn with flu (as a way of downplaying COVID risk), the authorities have sought to downplay the flu risk. This recent BMJ article claimed there were only 1,500 flu deaths a year in the UK. The rest were “pneumonia”.
How times change… the annual flu monitoring reports refer to 10,000 to 30,000 annual deaths “associated with influenza”. It’s as though suddenly it was important to emphasize just how safe the flu was, just in case people started normalizing COVID.
The United States CDC did a similar thing. One of their web pages refers to 28,000 flu deaths a year, while another refers to 5,902, (or 49,783 flu and pneumonia deaths ). The 5,902 figure is cited by the BMJ article which downplays the risk of flu.
This BMJ article also presents the COVID mortality figures over the whole pandemic (i.e. including the unvaccinated phases), so it doesn’t allow us to compare our risk now that we are vaccinated.
However, the numbers discussed above suggest that once vaccinated (or naturally immune), COVID is in the ballpark of flu, perhaps even less risky.
There is one important difference of course, which is the infectiousness. COVID’s latest variant is far more infectious than flu, which means it is capable of filling hospitals and – in effect – denying you treatment. This could increase its lethality. But that only matters if you are hospitalized, which itself is reasonably unlikely. In the 2020-21 winter season (when most people were unvaccinated), the UK peaked at about 60,000 cases of COVID per day, and 40,000 hospital beds were occupied. 4,000 people were being admitted every day, so 6% of cases. Now (December 2021), there are 200,000 cases per day and around 2,500 admissions per day (1.25%). Around 17,000 beds are occupied.
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What risk do the unvaccinated pose to the rest of us? The short answer is, not much. Omicron’s infectiousness and the fact that even highly vaccinated populations (such as Australia’s) have very high rates of COVID means that no matter what, all of us are going to get exposed to the virus at some stage. Even if everyone were vaccinated. There is the idea that unvaccinated people offer more opportunities for virus replications, mutations and new variants, but the major source of this risk is probably the immunosuppressed population (see here also). Remember that once they’ve had COVID, the unvaccinated are, in effect, vaccinated. Their window for creating a new variant, relative to vaccinated people, is fairly limited.
There is one circumstance when the unvaccinated may impose a risk on others, which is if the health system comes under strain. In this situation, when unvaccinated people are filling wards, the COVID risk will go up considerably for everyone, as happened in Italy at the start of the pandemic. In this situation, when health care is rationed, all of us should to do everything we can to ensure there is a bed available for someone else, if required.
There are some counter-arguments to this, of course. Some people make “bad” vaccine choices, others make “bad” eating choices, or “bad” smoking choices, and all of them end up in the ICU with COVID. Who is more to blame?
You decide. But decide with a considered, evidence based view of the risks.
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The point of this article was to discuss the idea that we should reduce all risks. A blanket policy of doing anything that might, on the face of it, “reduce risks” is lazy and stupid. And yet, it has been widely adopted and advocated by lots of people. It is understandable at the outbreak of a pandemic, when the data is not available. But to see this approach being followed as we enter the third year is depressing.
Why?
All risk reduction measures have costs. Many of these costs are imposed on others. Many of them are absolute risk increases – displacements of risk, rather than reductions. After the London tube bombings, people took to riding bikes and there was a 15.4% increase in bicycle fatalities: 214 people died. When people stopped flying after September 11, to “reduce risk”, an estimated 1,500 people died on the roads . That’s not just the people making the wrong risk decision, it’s also the other people who were killed by the choices of those who took to the road instead of flying. Taking children out of school imposes huge costs on their future productivity and earning capacity. We did this in the beginning, sure. But then we continued to do it despite no demonstrable benefit.
We are trying eliminate all risks despite the considerable evidence that this dogma is harming children. Jonathan Haidt, a psychologist, has written an entire book about this in “The Coddling of the American mind”. My favourite example from that book is the peanut allergy policy. My kids’ schools to this day will not allow nuts on campus, and yet we know that this nut avoidance policy of “zero risk” has massively increased nut allergies in children.
During the pandemic we have taught children that their needs come after ours, that all risks are to be feared and avoided, costs ignored, and evidence ignored if it does not agree with an anti-risk dogma. We are teaching children that non-evidence based security theatre should be performed if everyone else is doing it, no matter how absurd. To wear cloth masks – which do nothing – outside, and then eat together inside, without masks. To walk through chlorine footbaths. To close outdoor, chlorinated, swimming pools, parks, beaches. To wear plastic face shields.
We spend millions promoting science technology engineering and maths (STEM) subjects, but children see that adults, teachers and governments just ignore or deny science when it comes to risk.
We are teaching them to defer to experts (i.e. authority) because the experts have decided that it’s too hard to explain nuance to us, and want to stick to a “simple message”, even if this makes little sense. We’re supposed to accept that nonsense is good for us, because we don’t have critical thinking capacity, or at least most people don’t. The underlying message is that we should hold our fellow citizens in contempt. We of course know the rules don’t make sense, but simplicity is essential for most people, who are stupid.
What sort of lesson is this for our kids? What sort of future are we building? How can our children have confidence in democracy when they’ve been taught that most people are stupid and have no faculty for critical thinking? What sort of society are we building when we teach kids that following rules that make no sense is a sign of righteousness?
In our pursuit of zero risk, we are creating a dangerous world.