Dr Matt Strauss

'Do no harm' are three words all doctors must follow in the course of their work. These words make me convinced that Covid-19 lockdowns are the wrong approach, and a growing number of doctors are on my side.  Medical students throughout the West are taught the principles of beneficence and non-maleficence as pillars of medical ethics. In simple terms, they dictate that the likely benefits of our treatments ought to substantially outweigh their potential risks. In my practice, I prescribe medications like atorvastatin to lower cholesterol, or warfarin to thin the blood, because international, randomised, double-blind control trials have proven that their benefits far outweigh their risks.

In the 1780s, medical authorities largely agreed: insufflation of the rectum with tobacco smoke was the best treatment for near-drowning. Therefore, the Royal Humane Society lined the banks of the river Thames with tobacco smoke enema kits and rewarded heroic members of the public who used them to ‘save’ drowning victims. It’s easy to laugh at their efforts. With our modern insistence on evidence-based medicine, we would never significantly invest in medical infrastructure that has not been proven beneficial by a randomised control trial. Except of course we have, and we continue to do so. No area of medicine is immune to these lapses. But it is my own specialty of life-support medicine where this has recently been thrown into the sharpest relief.

As Boris Johnson was being treated in intensive care, Dominic Raab expressed his confidence that the Prime Minister would defeat Covid-19 and return to work because 'he is a fighter.' The press howled in opposition to these hopeful words. Things culminated in BBC Newsnight’s Emily Maitlis, disdainfully telling viewers: 'You do not survive the illness through fortitude or strength of character, whatever the Prime Minister's colleagues will tell us'. The video clip achieved its intended virality, and was picked up by cable networks around the world. But we need to set the record straight.  She’s wrong. Medically wrong. Dangerously wrong.

I am a critical care physician and assistant professor of medicine in Canada, and have spent weeks obsessively consuming Covid-19 medical literature. Ultimately, I see only one way to navigate society through this pandemic with neither apocalyptic death rates nor economic devastation. To my surprise, the conclusion I have reached seems very similar to the ‘back to work’ plan the Trump administration floated on Tuesday.Extreme measures to suppress Covid-19 through enforced social distancing are likely to be successful, and seem to have already succeeded in Wuhan. However, as an Imperial College London paper published last week makes clear, these measures may only work as long as they remain in place (the shaded blue area of the below chart).