‘WAR IS PEACE, FREEDOM IS SLAVERY, IGNORANCE IS STRENGTH.’
The slogan of the Ministry of Truth in Orwell’s, Nineteen Eighty-Four,1 is my favourite literary example of the use of words to influence the thoughts of the masses. The official language of Oceania, Newspeak was designed to diminish the range of thought of the poor inhabitants of the totalitarian state. Strictly speaking, Newspeak was the opposite of old speak but I wonder if a deliberate ambiguity was intended by Orwell by calling it Newspeak; a subtle reference, perhaps, to the power of the media in being able to alter the thoughts and ideas of the masses.
A new kind of vocabulary has started to take hold among my patients too. April was spent mainly discussing the daily death rates mentioned at the evening government briefings. The numbers appeared staggering; hundreds of daily deaths, striking fear to the degree that I had not witnessed before.
I had a patient refusing to attend eye casualty despite having gone blind in one eye a few days prior, and another refusing to attend the surgery for an assessment of her post-menopausal bleeding.
A NUMBERS GAME
The power of the numbers was immense; a nation paralysed despite being unable to put the numbers into any context. Telling patients that on average 10 000 people die every week in the UK2 (approximately 1500 every day) had little impact on them. The incessant 24-hour media coverage had everyone spooked by an invisible enemy, much like the Eurasian army that had spooked the inhabitants of London in Orwell’s novel.
As a degree of normality has begun to be restored, thanks to the persistently low prevalence levels of COVID-19, mundane chats with my patients often end up discussing the ‘second wave’. There seems to be a general preparedness among everyone for the ‘inevitable second wave’. Reading and hearing about the second wave often reminds me of Orwell’s masterful creation. There is a general agreement that there is no scientific consensus on what a second wave actually is; yet it is on the tongue of every doctor and patient I speak to. At what point does one declare that a second wave has begun?
The figure of 120 000 expected deaths in a winter peak makes the headlines,3 but the fact that the number could be as low as 1300 fails to get a mention in some news outlets.4 The Office for National Statistics reported a prevalence of 0.09% on 25 June 20205 (a non-significant rise from the 0.06% reported in the prior week due to overlapping confidence intervals).6 This was picked up by one media outlet as a cause for pessimism and a sign of a probable impending second wave.7 The prevalence dropped to 0.04% the following week.8 I noticed an amendment in the article a few days later, acknowledging this drop in terms of halving the number of cases.7 This received barely two lines hidden in the middle of the article, with no change to the pessimistic title of the article predicting the second wave. Data released on 17 July revealed a persistently low prevalence at 0.04%.9
THOUGHTCRIME
Well-respected epidemiologists predicted, from the outset, that the societal, economic, and psychological harm from the unprecedented lockdowns were likely to be far greater than the perceived risk of death. However, such views were lost in the narrative of fear that predominated the early discussions on the matter and treated like an Orwellian Thoughtcrime.
As GPs we should reassure our patients and encourage their active participation in bringing forward other health worries that they may have been ignoring over the last few months.
It is important that as the collateral damage of the steps taken in the last few months to curb the virus becomes clearer and the lower than initially expected fatality rate emerges, a sense of responsibility is demonstrated by those charged with informing the public.
- © British Journal of General Practice 2020
