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Dr Andrew Murrison is a former Foreign Office and DfID Minister, a doctor, and MP for South-West Wiltshire.

Breaking bad news, laying out unpalatable options, are among the most difficult conversations any doctor will have. With the government bringing the immediate COVID crisis to heel, difficult conversations are needed to test the boundaries of society’s appetite for surrendering liberty and livelihood in return for lives saved or years of life gained. That’s because, whether it’s a COVID variant or something else, it’s quite likely we will be here again, and again.

If coronavirus becomes seasonal, we can anticipate thousands of deaths annually even with a vaccine, just as we do with ‘flu. What then will be the trigger points for again shutting down society and the economy?

In 2014/15 over 28,000 people died from seasonal flu. It was a particularly bad year but it barely intruded into the public consciousness. Look it up – it hardly got a squeak in Parliament. COVID has shut Parliament down.

Here’s another hideous figure. The NHS tells us that each year 78,000 people die from smoking in the UK, many more are incapacitated and the burden on the NHS from smoking-related cancer, respiratory, heart and circulatory disease, including stroke and dementia, is severe. Despite its wholly avoidable toll, whose horrors I have witnessed at close quarters time and again, I’m not advocating a ban on smoking. I cite it to contextualise the raw trade-offs society makes between liberty sacrificed and human life saved. We have resisted banning a foul and disgusting poison long known to kill and horribly incapacitate tens of thousands year in year out, particularly among the less well off, a butcher’s bill of a similar order to COVID, on the grounds of freedom, agency, and an aversion to the nanny state.

Yet lockdown – which I voted for consistently – has curbed freedom and the quality of our existence in a far more profound way than a ban on smoking ever would.

Save Lives, Protect the NHS applies to smoking as it does to COVID. Otherwise we would be saying that a life lost to smoking is less significant than a life lost to COVID or that the NHS is less burdened by someone with lung cancer than a person with coronavirus.

Last month in the Commons I suggested that the public conversation needs an opening bid for deaths it is prepared to stomach before we again pull the shutters down on society. It could be the number of lives we have found the public is prepared to lose in a bad flu year. When we lost 28,000 to seasonal flu six years ago we did not come close to lockdown or emergency powers to protect public health or the NHS and we did not countenance the swingeing restrictions that have overshadowed life since the start of the current crisis.

In the autumn, when SAGE trots over to Downing Street with graphs and graphics anticipating winter deaths to respiratory viruses, we need to have had our difficult public conversation involving two figures already embedded in our wall of human misery – 28,000 and 78,000.