COVID – Florence Nightingale’s verdict
Thanks to the great nurse, we can see the full effects of the pandemic
The Nightingale diagram – named after its inventor, Florence Nightingale – is the best and easiest way of visualising the effect of the COVID-19 epidemic on overall mortality.
It is a circle divided into 52 equal segments, representing the weeks of the year, the radii with a numerical scale giving the number of deaths in any particular week. I wrote about the diagram in the March issue – here is an update, using the latest figures.
When the plots are joined up and given different colours for each of the last five or six years, it is easy to see whether the overall number of deaths in any given year has risen, remained the same or fallen. As you would expect, 2020 and 2021 showed months of grossly increased numbers of deaths.
The diagram has its limitations, of course. It does not tell you what people died of, or how many years of life lost the excess deaths represented. For the diagram, a death is a death, whether it takes place at six months or 95 years.
Some epidemiologists hypothesised, rather optimistically, that, since COVID killed the old and ill disproportionately, peaks of deaths would be followed by troughs – the most susceptible to death having already died.
So far, this has not happened, or has happened only to the most minimal extent, and only briefly. As I write, there is still an excess of deaths, though nothing (so far) like former peaks.
How many of the excess deaths were collateral damage from the virus, to adapt slightly military terminology?
Since it is necessary always to do double-entry bookkeeping, we shall have to consider the possibility that the response to COVID prevented some deaths, for example by traffic accidents.
But this will not be easy: such fatalities in Britain did decline in 2020, but only in the same proportion as they declined in 2019. Since counterfactual history is the playground of people with axes to grind, what would have happened without COVID must be a matter of conjecture.
One of the reasons there have been no troughs to speak of in the Nightingale diagram is that death rates from other diseases might have risen. For several months, medical screening, investigation and treatment were held more or less in abeyance. If all or any of those things save life, lives may have been lost.
A paper from Japan examined the effect of the various measures taken during the pandemic on the detection of gastrointestinal cancer in two hospitals.
The investigators found that not only were fewer cancer and bowel cancers diagnosed, but that those that were diagnosed were diagnosed at a later stage. They did not examine the subsequent death rates from these diseases – it was too soon to do so.
Supposing that earlier diagnosis results in greater survival rates and longevity, particularly with bowel cancer, it seems reasonable to suppose that these effects will sooner or later translate themselves into premature deaths.
Whether these effects will be large enough to affect the Nightingale diagram is again as yet unknowable. Moreover, the diagram is graphic but crude.
A study in the United States estimated that the decline in the rate of cancer detection caused by COVID in 2020 will lead to nearly 34,000 cancer deaths.
A single death is a terrible loss, of course, if it occurs in someone near and dear to you; 34,000 is equal to 1.2 per cent of annual deaths in the country. It is equal to about 0.5 per cent of all the deaths directly attributed to COVID.
I wish I had a clear doctrine to propound. If I did, I could be an economist, or perhaps a financial adviser.