Coronavirus: Northern Ireland updates/advice

I am going to leave this page up with advice on how best to manage through the COVID-19 crisis, aimed particularly at those caring for over-70s or people with underlying conditions in Northern Ireland.

What I would ask, please, is that people leave comments on this page with any thoughts or information they feel may be helpful (I may not see Facebook responses and will definitely not see Twitter responses).

Please rest assured that the Northern Ireland Health Service was well prepared; it had been contingency planning for this for months, on the basis of strategies put in place ten years ago and revised regularly since.

Nevertheless, it has come under the greatest burden it has ever faced in the last few weeks and will now face serious challenges as it returns to “normality”.

Government advice on a range of issues and services appears on NI Direct.

The NI Assembly has links to sources of advice here.

Members of the public must play their part in restricting this burden by adhering to the advice: stay safe, keep your distance, and wash your hands.

In Northern Ireland, you may volunteer here.

Vulnerable groups

COVID-19 is a relatively mild infection for most people who contract it, but there is an increased risk for older people and people with underlying conditions; for safety, this should also be assumed to include pregnant women.

People with rare conditions, particularly those which affect the immune or respiratory system, should assume they are also in this group, unless specifically told otherwise by a qualified medical professional.

D3E94432-ED28-495E-BED8-8A16F6B2E5E4Essentially, people in those vulnerable groups must try to avoid getting the virus and, if they do show symptoms, should immediately dial 111 and seek medical advice and attention immediately. In emergency dial 999 or 112.

People who have underlying conditions which clearly elevate the risk will have received a letter from their GP to tell them to ‘shield’. As restrictions are raised, these people who have a particular vulnerability may be advised differently – a little like proceeding along different lanes on a motorway.

People who are not in those groups are tasked primarily with not spreading the virus; in other words, they should live their daily lives assuming they have it. They should self-isolate (as well as booking a test) in case of symptoms, but otherwise their task is to look after and look out for those in vulnerable groups.

Updated health information for everyone in Northern Ireland through the crisis appears here.

Anything wrong here? Anything which should be expanded? Please leave a comment.

Hygiene

The coronavirus causing COVID-19 is spread in sneeze or cough droplets transferred primarily from a close distance (also via things); it can also be transferred via surfaces (most commonly metal).

Note that symptoms, if they occur at all, follow the virus – you are already infectious before you have symptoms.

With regard both to avoiding getting the virus and not spreading it, certain hygiene rules are fundamental:

  • wash hands for 20 seconds in soap and water (or sanitiser) being careful to clean the whole area, including between fingers, finger/thumb tips and wrists;
  • cover the mouth or nose with a tissue or sleeve when coughing or sneezing (and then wash hands);
  • put used tissues in the bin immediately;
  • do not touch any part of the face with unwashed hands; and
  • look after your mental health and, particularly, avoid too much social media.

Anything wrong here? Anything which should be expanded? Please leave a comment.

Social distancing

Given that close contact is a common way of spreading the virus, “social distancing” is required to stop its spread.

CEDE431B-B3BA-4413-B41A-13CA840B135CThe implications of this are that we must spend less time with other people, less time in public spaces, and particularly less time in enclosed public spaces. If, for those in non-vulnerable groups, this is genuinely unavoidable, remember our task is not to spread the virus; so as soon as we detect symptoms in ourselves or anyone close to us, we must withdraw immediately into self-isolation.

Vulnerable people do not need to withdraw completely, but must take extra care (and those known in the UK as “shielding” or in Ireland as “cocooning” must take particular care). They must:

  • avoid any contact with anyone with symptoms (most obviously fever or persistent cough);
  • avoid unnecessary journeys and any travel at all in rush hour or on public transport;
  • work from home;
  • absolutely avoid hospital or health centres/GP surgeries – phone or contact online.

A contingency plan for carers appears here (source: Carers NI).

Anything wrong here? Anything which should be expanded? Please leave a comment.

Symptoms

Remember, if you are in a non-vulnerable group your priority is not to spread the virus and essentially, therefore, to behave at all times as if you have it (albeit allowing for essential work and shopping). The need for extreme care is heightened if you come into contact with anyone (most obviously a member of the same household) who displays symptoms.

For vulnerable groups, it is important not to get the virus and to act immediately if there are any signs of it. Therefore, if you recognise the symptoms dial 111 immediately (or 112 or 999 in an emergency). The most obvious symptoms are a persistent (typically dry) cough, fever (high temperature), or loss of taste/smell. Other less common symptoms include a (typically dry) sore throat or shortness of breath.

Anything wrong here? Anything which should be expanded? Please leave a comment.

Self-isolation

This is a contagious disease and there is no shame in having it; furthermore, most people will experience only mild symptoms. However, it is important to protect others, particularly those in vulnerable groups.

Anyone displaying any of the three main symptoms above must practise self-isolation even within the home; those in vulnerable groups may find it prudent to do so even without symptoms. Everyone else in the household must stay home.

Self-isolation means that the individual displaying symptoms should distance themselves even from the rest of the household. If possible, they should sleep in a separate room and be in the only person in that room; they should use the bathroom last and clean thoroughly afterwards; if they must use the kitchen, it should be alone (and again with thorough cleaning afterwards).

Through self-isolation, it is important if possible to get outside (the garden or yard are safe as long as no one is there) and to stay in touch as widely as possible. Consider talking to family and friends about the best way to do this (Skype, Facetime, Google Hangouts, or whatever) to maximise the potential for keeping in touch safely.

Households can still take deliveries if someone is in self-isolation, but ideally deliveries should not be handed over in person; typically, deliverers now know to offer this option and will offer to deliver to a particular location and phone from a distance to say where the delivery has been left.

See also notes on mental well-being and social security below.

Anything wrong here? Anything which should be expanded? Any other ideas? Please leave a  comment.

Restrictions

The Northern Ireland Executive is now moving through its 5-step plan to move out of “lockdown”. As of evening of 8 June we are at Step 1 (with one exception) with some specific additions:

These are now the first stage of raising lockdown, which generally means:

  • no gatherings of more than six people outdoors (but currently meetings indoors away from the workplace must involve only members of the same family);
  • travel only for work, for shopping or exercise (which may include outdoor sport as above); or
  • care for a vulnerable person.

There is no distinction in law for those who are “shielding”; but they should only leave the home to meet people outdoors from one other household; otherwise, in anything other than the most exceptional circumstances, they should stay home and seek assistance even with essentials such as shopping.

Work and classes may continue remotely where possible.

Mental well-being

As above, it is essential you look after your mental health during the disruptive days and months ahead.

Some ideas:

  • get exercise (even if it is just a few stretches or a bit of yoga);
  • read a book (and avoid too much social media fake news and fear-mongering);
  • learn a new skill (a language off YouTube, a course on Coursera, or whatever);
  • think! (Stop panic-buying – no good decisions are made in fear or in a rush);
  • phone (don’t just text);
  • do go out and meet friends.

Be aware no one else has experienced this either. Just because everyone is doing it, doesn’t make it right!

Pets

Dogs and cats cannot contract nor transmit COVID-19.

Dogs may be walked; however, it is good practice for only one person to do the walking, and over a restricted route, maintaining two metres from everyone else at all times.

Additionally, dog walking must take place close to home; it is not recommended to drive somewhere first.

Finance

A useful overview of the “furloughing” options for self-employed and employed people across the UK is provided by Martin Lewis here.

A Community Fund is open here.

Updated advice for business here.

All non-essential retail stores (i.e. non-food, pharmacy, transport, dry cleaners) and hospitality must close.

The UK Government will cover 80% of salaries to try to limit lay-offs to August-October 2020.

No business rates are payable until June (NI Department of Finance).

Grants now available (up to £10k for small businesses, up to £25k for businesses in retail/hospitality) – apply here.

Business loan scheme with six months interest free.

VAT is cancelled for three months to end May.

For tax issues (restructuring, suspending debt collection etc), HMRC helpline is 08000 159 559.

Information for self-employed here.

Insurance depends on level of cover – contact your insurer.

Social Security

Full information on benefits/welfare here.

  • If laid off temporarily, apply for “new-style” Jobseeker’s Allowance on 0800 232 1271.
  • If self-employed and have to self-isolate, apply for Universal Credit here and note if on ESA support is available from day one (not day seven);
  • If employed and have to to self-isolate, apply for immediate sick pay here.

There will be no face-to-face appointments.

AdviceNI hotline: 0808 8020020.

NI Department for Communities Financial Crisis line: 0800 5872750.

207EB4A4-D07D-457C-A00B-C153A5A58F7D

There is a discretionary support fund available from NI Direct.

Practicalities

The best way to shop, and absolutely for vulnerable groups and those in self-isolation, is home delivery.

People “shielding” have priority delivery slots for Tesco, Sainsbury, Asda or Iceland which may be arranged here.

If you must go into a shop, consider shopping local and absolutely avoid busy periods. Consider also buying a little extra to support a local foodbank. Some shops will have specific hours for older people. Imminently, expect many to add restrictions to the number of people allowed in at any one time.

Prescriptions may be ordered online.

If hospital visits are essential, you will be checked for temperature; try if at all possible to arrange a lift with a (non-vulnerable, no-symptoms) family member, as taxis are currently understandably wary.

Non-essential hospital appointments may be cancelled, although are increasingly proceeding (often remotely) – you do not need to do anything.

Schools, youth clubs and Department-funded childcare are currently closed except for children of key workers (they will close and re-open together); however private childcare will remain open and provisions may be made for it to be specifically used to enable vital workers to work.

Anything wrong here? Anything which should be expanded? Any other ideas? Any other information or updates? Please leave a comment.

Coronavirus – UK and Sweden’s standing diminished

Sweden’s Chief Epidemiologist Anders Tegnell admitted yesterday that the country had, essentially, got it wrong by not shutting down tighter. Northern Ireland’s Health Minister Robin Swann also said there were things he would change. Still, UK Prime Minister Boris Johnson, who has overseen what may well be the world’s worst death toll per head in England, denies any errors whatsoever.

At least Dr Tegnell admits now that there were errors – in fairness, he had always warned that nothing was certain. Mr Johnson continues to deny it all, claiming that the rest of the world stands in awe at how the NHS has survived and then talking vaguely about “world-beating” testing. Such delusion is getting genuinely scary now.

Both the UK and Sweden have done themselves significant damage beyond the unnecessarily high death tolls they have inflicted upon themselves by not learning from others and refusing to try to understand the virus properly. They had previously each commanded a degree of global respect for their public administration and public health expertise; that is now hugely diminished.

The UK in fact exports expertise in public administration, but it is hard to see too many buyers for this now. The mishandling of the Coronavirus, symbolised by the nonsensical sight of two thirds of MPs queuing up for half a mile to vote to stop the other third from voting, follows the farce of Brexit in which the UK has overtly opted to crash its own economy and opt out of global protocols for everything from medical regulation to fighting terror. Far from looking on in awe, the rest of the world can scarcely bring itself to look on at all, such is the scale of the cringe which inevitably accompanies doing so..

Sweden too was widely regarded as a country of unrivalled expertise, not least in public health where life expectancy has risen to among the highest in the world. For weeks if not months the rest of the Western World seriously looked at Sweden and wondered if Sweden could be right and the rest of the world wrong – for many this was a serious possibility, such was the respect in which Sweden was held. However, as hundreds of people continue to die every week in Sweden while almost no one dies in any of its neighbouring Nordic countries, the view has shifted dramatically; it is dawning on everyone, including Sweden’s public health leadership, that after all the rest of the world was essentially right and Sweden catastrophically wrong. Even the UK has worked out now that testing is important, but still Sweden stumbles along effectively pretending this is just a bad (or actually not even a bad) ‘flu. Respect has turned into bemusement, which will soon give way to outright ridicule. Sweden’s reputation for sound management and excellence in public health will be undeniably tarnished, both at home and abroad.

Both countries will struggle to deal with the consequent adjustment, as others take over as beacons of sound public administration and expertise in public health. The UK in particular will have to ask itself fundamental questions about where the ongoing centralisation of political and economic power, at least within England, has ended up – what has happened is that an ever declining number of people with an every declining amount of expertise have ended up taking all the decisions, often in complete ignorance. Brexit and Coronavirus are obvious and major shambles, but they are accompanied by all kinds of minor ones, from a collapsing higher education sector to the farce of the rising costs around the HS2 rail project. Sweden too will face the trauma of having to recognise that those they trusted to take them through this challenge failed abjectly – does its whole system of expertise ahead of politics really work?

Both countries, their standing diminished, will now face the challenge of reform. Will they be able to meet that challenge? Certainly in one case, it is very doubtful.

Coronavirus – could it be safer to re-open schools in NI?

It is essential to read all my posts on the subject of the coronavirus in the recognition that I am not a virologist, nor an immunologist, nor indeed a biologist of any sort. They are designed to pose questions on the basis of the information available.

Today’s piece is written to try to open some kind of informed debate about how we answer what is an increasingly pressing question: might it, in fact, be safer to send pupils back to school in Northern Ireland, than have youths (and even families) congregating in an unmanaged way across various beauty spots?

On all the issues around the coronavirus, I am absolutely certain about only two: firstly, we have to test a lot (and with a purpose) to understand the virus; and secondly, there is no point in (effectively) closing schools if you do not proceed immediately to lockdown (i.e. universal curfew). The second point is relevant here, because as we come out of the lockdown in Northern Ireland, we are opening things up but we still have schools (effectively) closed.

From the very first Imperial model, but also through pure common sense, as soon as you raise curfew but do not have pupils at school, you are creating for yourself in practice an unmanageable problem. Families with older children essentially have two options – either they stay off work and find ways to entertain the children, which on a sunny day probably means heading out to a beauty spot with lots of other people who have made the same decision; or they go to work and leave the children to do their own thing, which on a sunny day probably means heading out to a beauty spot with lots of other people who have made the same decision…

In terms of the virus itself, this is unlikely to be a significant problem, although it is not ideal. The key is to avoid the three ‘C’s – closed spaces, contact, and crowds – and gatherings at beauty spots are a worry only for the third of these (maybe in some cases the second). Nevertheless, the situation is unmanaged and, at least to some extent, practically unmanageable – once drink is added to the equation and inhibitions are reduced, as we have seen, outcomes include police officers being assaulted, drunken anti-social behaviour, and mass littering; alongside, it has to be said, the unlikely but certainly possible careless further transmission of the virus.

Assault, anti-social behaviour and littering are not excusable but, realistically, they are a predictable consequence of the restrictions as they stand. There is nowhere else to congregate but beauty spots (i.e. beaches, parks etc); and working parents and care givers are now faced with unenviable choices in terms of balancing their professional and family lives as work re-starts but schools remain effectively “closed”.

As I have written before on these pages, there is in fact no “safe” option here. The status quo is not safe – it leads to crowds, albeit of people not particularly vulnerable to the virus gathering outdoors; it also leads to general disturbance (not least for residents nearby who may be shielding or otherwise feel vulnerable who then face further stress).

So the question must arise: would “re-opening” schools, if only for three weeks and even if part-time, in fact be the safer option? It would mean that at least some young people would have somewhere to go; parents would have space to work (and indeed sort other things); and the danger of crowds would be less apparent.

In terms of the virus itself, we are finding increasingly that the task is to avoid “super-spreading”; if we can do this (and we are increasing our knowledge in this regard), we may find the virus has been eliminated in Northern Ireland by the end of this month.

In Hong Kong, for example, studies now show that half of those infected became infected at just six events. In fact, seven out of every ten people infected with the virus there did not infect anyone else at all. In Germany, a single church service accounted for nearly a quarter of all new infections in the entire country on 10 May. Now that we understand better where the real dangers are, we will soon understand better how to manage the virus.

It should be emphasised that, with just 14 new cases confirmed yesterday on the entire island of Ireland despite testing being available to anyone with symptoms, realistically any further “wave” will have to be imported.

Remember, this is not ‘flu – failing to realise this was the core error in the UK’s and Ireland’s response. With a coronavirus the odds are probably against a further wave, but it is of course wise to be prepared.

There are other options too, of course. For example, many German States have an effective night-time curfew (the exact times vary, but 11pm to 6am would seem reasonable), meaning that outright lockdown is in effect re-applied at night. As case numbers continue to decline, perhaps organised sport could be re-started faster than initially intended as a managed diversion. Certainly there is a case for re-opening caravan sites and holiday homes well before 20 July, with the benefit of broadening the spaces in which people may spend time safely.

As the virus moves out of circulation (across much of the island of Ireland at least), these are the sorts of questions which need to be raised. The answers are, of course, best left to the experts.

Coronavirus – podcast

Last Thursday evening I recorded a podcast with Mick Fealty from Slugger O’Toole, outlining some of the issues to consider in Northern Ireland.

The context in Northern Ireland is a peculiar one – a recently re-assembled Executive finds itself charged with managing the response to the pandemic, taking account of its position in the UK but also on the island of Ireland, and being scrutinised by MLAs who had not been working on legislation for three years. Northern Ireland also has the peculiarity of being governed for domestic matters not by a single “Government” but by legally separate “Departments”, making coherence something which has to be worked at. At the very time they get back to the work, a virus is spreading beyond China and within weeks is clearly set to become the most significant pandemic for over a century.

There is as ever the issue of myth-making. We are having a lot of information thrown at us, some of which is based on demonstrable expertise, some of which is educated guesswork, some of which strays into assumption, and some of which is politically motivated nonsense. We are now at the stage in the pandemic where a lot of people, from government to academia, are involved in defending their reputations rather than learning and adjusting. No one will get this right all along – so beware anyone who claims that!

Northern Ireland has made mistakes in common with other jurisdictions – it focused too much on “protecting the NHS” at the expense of the wider issues of protecting the most vulnerable (most obviously in care homes) and of understanding the virus, not least through tracing (which it gave up too early, effectively by its own admission). Nevertheless, we do not notice the things which go smoothly and, when you count them, up, there is a fair argument so far that Northern Ireland’s response has been the most effective in the UK. Decisions in Northern Ireland, for example on steps to raise lockdown and the specific implementation of them as the numbers show the virus may be deemed “under control”, are in fact close to exemplary in terms of evidence-based policy-making.

The major challenge now is to adjust to research which shows increasingly that the issue is not just who gets the virus but how. Danger is increased by age and by being someone with a particular underlying condition (most obviously diabetes or COPD); but also, it increasingly appears, by receiving the virus at close quarters indoors. This danger is not just of death, but also of the development of chronic rather than acute needs.

Coronavirus – UK Government’s plans look dangerously clueless

The fundamental point of the “Cummings Saga” is that the Prime Minister is outrageously hypocritical but, worse still, also dangerously clueless.

We have seen this again this week. His evidence to Liaison and his media appearances have demonstrated his fundamental ignorance of the basic issues around how the virus behaves. He has even admitted that he does not read scientific papers (as noted before on these pages, he is also just plain lazy), and he is now blatantly ignoring warnings from scientific advisers that infection rates are still too high to raise lockdown in England.

In his desperation to “re-open”, he has asked SAGE to review the 2-metre rule while ignoring it on everything else. In itself, the question is not unreasonable – yet it is designed to enable the re-opening of hospitality with no functioning 24-hour tracing system in place, absolutely contrary to SAGE advice and when indoors is increasingly being demonstrated as much more dangerous than outdoors. Meanwhile thousands of people are still being infected every day in England (with deaths likely to number in the hundreds per week on an ongoing basis of rates are not slowed).

If you ask limited questions to suit your bias, you get limited answers to suit your bias – that has been the crux of the UK Government’s failings from the very start.

Looking at the figures in any part of Great Britain, with many multiples more infections and deaths each day than in comparably sized Italy, it is obvious there should not be the remotest consideration of re-opening indoor hospitality before the autumn. Testing, which takes 72 hours from referral to result typically, is too slow for a functioning tracing system to be put in place. We are seeing – in Korea, in Germany and (as revelations of an event in February have shown) even in Scotland – that crowded indoor events can all too easily lead to mass infection.

Hospitality may not like that, but that is the penalty for the UK Government giving up “test, test, test” and then focusing on pointless targets rather than useful outcomes in the first place.

Remarkably for a functioning cabinet in the UK we need to look to, er, Stormont. Here, of all places, the requirement for a tracing system was understood for longer and indeed tracing has already restarted on a scale capable of covering every positive test; the difference between indoor and outdoor is understood so that the next steps of restriction raising are also focused primarily on outdoor retail and sport; and indeed Northern Ireland is being cautious to ensure that its much lower comparative fatality and infection rates stay low. Bar an early further wave imported from elsewhere, Northern Ireland can as a result look forward to the resumption of something approaching normality from about August. It is hard to see how the numbers and the plan would justify any such optimism in England.

Ultimately this is why the Cummings debacle matters. The Prime Minister, a clueless charlatan who himself lies compulsively about everything from his eyesight to his children, relies on an elite hypocrite whose judgement is at a level where he thinks sixty-mile round trips to check for eye-sight are a sensible story. As a result, they are aiming to re-open things based on populism rather than science. This cannot but lead to further infections and deaths. It is remarkable and perhaps even alarming that the population is so relatively calm about this.

There are no easy choices here but it is now beyond obvious that these idiots’ ignorance (and their refusal to learn even the basics about this virus) is blatantly leading to lots of people dying.

Why do so few care? Why are they still in post?

Coronavirus – R-number has value, but it is limited

The news in Northern Ireland, as it does in many other jurisdictions, focused in on the R-number yesterday – but it did so in a way which is not entirely helpful, and indeed which Northern Ireland’s own Chief Scientific Adviser, Prof Ian Young, warned against last week.

R, as commonly presented currently, is essentially the average number that each person who is infected goes on to infect (this will typically take place over 4-5 days, but maybe up to a week). There are significant problems with it, however.

Firstly, we simply do not know what the number is. Despite wider testing, we are still probably missing (but by definition we do not know) over three quarters of those infected across the UK. We are having to run with the assumption, therefore, that testing is picking up the same proportion day after day – that assumption is not outrageous, but it is a stretch.

Secondly, even if we did know what it is, it is of limited value. For example, if Northern Ireland had a run of exactly 100 new infections for four days and followed that with a run of 95 new infections for a week, R would be calculated (all other things being equal) at 0.95. However, if Northern Ireland had a run of 2 new infections for four days followed by 2 for the next seven except for one, in which there were 3, all other things being equal R would be 1.07. Yet, obviously, the latter is much preferable to the former – and indeed that type of discrepancy is likelier the lower your total infections go.

Thirdly, and perhaps most importantly of all, R merely marks an average across an entire population, but in fact there is significant variance within the population. This is where focusing on it too much can become part of the problem, rather than a solution. This is not just to do with regional discrepancy or whether you count care homes; it is a much broader problem than that, to the extent that R may in fact be a significant barrier to finding out how the virus is behaving.

To use an example from German virologist Christian Drosten’s latest NDR podcast [in German], if you take ten infected people and nine infect one other person, you are looking set for R=1. But if the one remaining person infects 10 more people, that means that between them 19 people have been infected and suddenly R=1.9!

It would be ludicrous, where R=1 in all bar particular and probably identifiable instances, to close down an entire population when in fact only one person has caused the rise in infections – and this is what is known as a “super-spreader” [even in German!]

As discussed before on these pages, the fundamental key to enabling us to restore something like normality is to identify these “super-spreaders” – are there particular people or groups of people who are prone to “super-spread” (is there even some underlying medical reason); or, more likely, is it to do with particular locations where those people spend time?

There is a natural inclination to focus in on the R-number because it gives us something apparently straightforward and understandable with which to judge progress. However, as with everything that looks straightforward and understandable with this virus, while not without its uses it is in fact extremely limited (and sometimes outright flawed) as a means of understanding behaviour of the virus and how to move forward with raising restrictions safely.

Perhaps as a guide, it is probably best to treat R a little like an opinion poll. It gives you an idea, particularly in terms of the trend, but it does not give you the whole picture – and, on occasions, it will be outright misleading…

Coronavirus – podcast

Was good to join Slugger O’Toole for a podcast on the Coronavirus, the Northern Ireland Executive’s response and some international comparisons on YouTube.

Coronavirus – what to learn from restaurants re-openings in Germany

Germany’s federal system offers an interesting parallel as the 16 states go slightly different routes with regard to easing lockdown, but they do give us some hints at how this may proceed in the UK.

From Monday, hotels, restaurants and cafes re-opened across Germany except in Saxony-Anhalt and Bavaria – in Bavaria outdoor opening is allowed (Biergaerten and so on may re-open, therefore). In all cases, a 1.5m distancing rule applies.

Hamburg, Hesse, Rhineland-Palatinate, the Saar, Saxony and Thuringia had already opened hotels and guesthouses before Monday; Bremen, North Rhine-Westphalia and Schleswig-Holstein joined the club on Monday; so does Lower Saxony, but with a strict requirement that hotels may only be half-capacity (the Saar intends to do something similar). In Mecklenburg-West Pomerania hotels and holiday homes have already re-opened but, curiously, there was still a prohibition on entering the state until Monday (and here too, hotels may only be at 60% capacity). Brandenburg has only opened holiday homes.

Some states require reservations with an address, but the largest state North Rhine-Westphalia does not. Even in pubs and cafes, prior reservations are generally recommended and, in Bremen, required. Hesse has a guideline that any location should only allow one person per five square metres.

In Rhineland-Palatinate and Brandenburg there must be hand sanitisers available and use is obligatory before entering; in the former, nose-and-mouth covering is compulsory other than when at the table and cutlery must be washed in a dishwasher at over 60 degrees. Saxony also requires menus to be disinfected; Mecklenburg-West Pomeria even salt cellars (in Hesse these, alongside pepper mills, are simply not allowed). Buffets are not strictly prohibited, but self-service is not recommended (most strongly in Hesse).

Even in its outdoor eateries and beer gardens, Bavaria requires a mask for anyone standing up.

Most states do not allow restaurants to open after 10pm; but again, North Rhine-Westphalia is a liberal outlier here.

Pubs, in a British or Irish sense, and bars must, however, remain closed across the country. It is reckoned that it is impossible to maintain distancing in them, and it is unclear when they will be allowed to re-open.

Germany is not immune from politics either. The First Minister (Ministerpraesident) of North Rhine-Westphalia Laschet and of Bavaria Soeder are reckoned to be candidates to replace Chanceller Merkel, but are taking markedly different positions. Certainly in Laschet’s case, this looks like a political choice.

What can we learn from this in the UK and Ireland? Firstly, it does not look good for pubs and clubs; the rule of the three ‘C’s (no close contact, no crowds, no closed spaces) applies and makes it difficult to see how they will be viable for the foreseeable future anywhere. Secondly, restaurants will have to prepare for lower capacities, with tables 2m apart (though expect the lobby to reduce this to 1m as per WHO guidance, or 1.5m as in Germany, to become more vocal); the question, of course, will be how to make that viable.

In terms of the potential for re-opening at all, this will vary from location to location. If trends in new infections and deaths are maintained, it is possible to imagine that restaurants in St Anne’s Square in Belfast may be able to open, viably, a month or so from now (as they literally have the space in the Square to move out into). In the Cathedral Quarter, however, this looks altogether more difficult – the structures of the buildings themselves and the limited space even outside them will unquestionably make things difficult, particularly given the reliance on crowded weekend trade.

As ever, there is no easy route forward, sadly.

Coronavirus – Sweden’s “special route” has failed

Sweden‘s approach has failed. We need to call it, so we can learn from it.

The principles behind the Swedish Public Health Agency’s approach to managing the coronavirus were probably sound. The intention was to set out a series of restrictions with which the population could live for some years if necessary.

However, the country’s authorities’ unwillingness to understand the virus at a national level, and to adapt the approach to new international understanding, has proven its undoing. It is a considerable error and will likely lead to a serious reconsideration of Sweden’s unique system of government whereby, constitutionally, issues like these are left to the experts with barely any interference from politicians.

Last weekend, there was one death from the coronavirus registered in Denmark and none at all in Finland, Norway or Iceland – yet there were 127 in Sweden. In fact, the previous week, Sweden had the highest death rate in the world.

The response of the Swedish authorities to this has now to be called out as either arrogant or ridiculous. They claimed that “per capita” figures did not matter; having previously claimed that their response was working well “except that more people died than expected”. This is because the whole public health response was based on blind assumptions – and we all know what assumptions are.

Fundamentally, the Swedish response relied on the death rate from the virus being just 0.1%, as with most cases of influenza; yet already, 0.25% of the population of New York City has died from this coronavirus (and, given city populations are in fact younger in profile than the general population, this means the actual death rate across an entire population becoming infected must be above that, possibly well above it). That is why “more people died than expected”. Yet why did they assume 0.1%? There is literally no reliable study anywhere which puts it much lower than 0.4%, and as high as 0.8% remains possible.

It also relied on peculiar claims that studies showing 11% of the population of Stockholm had antibodies meant that 30% (subsequently revised to 26%, but that made it no less baffling) had had the virus and were immune. These differentials were never explained; nor is anyone yet sure about the nature of immunity with this virus.

There was a third baffling assumption too – having initially ruled out any danger at all, the country then relied on experts who claimed that the virus had already been around for months and had infected lots of the population already. A survey in Northern Ireland (of all places!) has shown this is simply untrue – surveys of samples from early 2020 initially taken to test for ‘flu were re-analysed and not a single one matched this coronavirus; it arrived when we thought it arrived.

To compound the arrogance and ridiculousness is the argument that neighbouring countries are now “following the Swedish route”. Actually they can now follow the Swedish route with a tiny death toll for the very reason that they did not follow it to start with.

The certainty with which these figures and assumptions were presented to the Swedish public led to those making them becoming quite popular – in time of crisis, people crave the security of feeling they are being led by knowledgeable people who know what they are doing. When the Swedish public work out that actually it was all based on obviously flawed assumptions (and the current State Epidemiogist Anders Tegnell was as close to publicly savaged as you will get in Scandinavia by his precedessor, Annika Linde, on Sunday), it is anyone’s guess what the response will be.

This is of global relevance, because Sweden is the ultimate example of “government by expert”. Yet the experts have comprehensively failed.

This will immediately give a boost to the broadly pro-lockdown argument, but caution and precision are required here. As noted above, in each of the aforementioned neighbouring Scandinavian countries where deaths have been reduced to close to zero, restrictions have been raised now to about the same level as Sweden; indeed, Iceland never locked down as tightly even as Sweden. If there is a specific issue with lockdown to be learned for any future wave (or future pandemic), it is that specific aspects of it must be implemented in good time not just to apply through peak of infections but indeed to help reduce that peak – but also not maintained for too long (remember Denmark and Norway, with low infection rates and death tolls now running close to zero, opened primary schools six weeks ago).

That Denmark and Norway have re-opened schools and infections have continued to decline (to the extent that there are now scarcely any deaths at all) is an argument for re-opening schools in England, but again it requires precision. Denmark and Norway were never hit anything like as badly as England; schools re-opened there with infections at a lower rate comparatively than they are in England now (although they were about the same, in fact, than they are currently across the island of Ireland).

In fact, Sweden’s biggest flaw was its unwillingness to learn about the virus, exemplified by its remarkably low testing rate (in this sense, it is similar to the UK). With Denmark at close to 100,000 tests per person and Norway close to 50,000, Sweden languishes at barely above 20,000. However, even here, there is a note of caution. The real issue is not the quantity of testing but the quality; Finland, for example, has not tested much more than Sweden but used its testing to lock down specific localities where clusters became apparent (Norway also did this to some extent). Ultimately, either through mass testing or targeted testing with a purpose, all Scandinavian countries showed a willingness to understand the virus and how it was behaving – except Sweden, which just went with unfounded assumptions.

What can we learn from this? A few thoughts:

  • when you face a new virus, you need to adapt to understand it and its behaviour, and then target specific interventions accordingly;
  • if you go for something approaching lockdown, do it quickly and then lift it quickly – the first should enable the second;
  • with regard to testing, either do “mass” or “targeted” but do it with a specific purpose of identifying clusters and protecting/isolating them;
  • if you see something going wrong, admit it and change it; and
  • ultimately, for all their ills, decisions need to be made by elected politicians working off a range of expert advice and accountable directly to the people, while taking account of all the issues involved (not just those relating to public health).

It could yet be that in the end death rates all level up as we face wave after wave of the virus with no vaccine. Likelier, however, is that a combination of improved treatments and better understanding of what social restrictions matter will enable us to keep death rates low in future; so that those who acted quickly to keep them low to start with will benefit overall. It may well turn out that we all end up living with the same restrictions as the Swedes – but their neighbours will have suffered a much lower toll to get there.

Coronavirus – the Olympics and imagining the future

The Olympic Games due to be held in Tokyo in July and August have been postponed by one year. Clearly, the discussion has shifted to whether even that will be possible. The issues are complex, and relevant to us all because they affect not just an international sporting event, but fundamentally everything we do.

There remains a widespread view that the pandemic will exist, at different levels of intensity, until there is a vaccine. That is, however, rather simplistic. This view derives from the Imperial College London modelling which, for the sake of assumption as much as anything else, determined that eighteen months was the minimum time required for a vaccine to be developed and a vaccination programme implemented. This was in fact optimistic; that timescale would be remarkable, but also there is no guarantee of a safe, workable vaccine at all. It is not possible for a non-virologist to gauge the probability, but it may be best to operate on the assumption that a vaccine would be a significant bonus.

There is also a view that the only alternative is “herd immunity”. That need not be the case either; it could be that other treatments or medicines render it less dangerous, or that social distancing is successful in marginalising it so that it has less effect (after all, viruses do not travel on their own). It should also be emphasised that immunity is not necessarily dependent on antibodies showing up in a serological test (some media reporting here is outright wrong).

The Spanish ‘Flu outbreak is deemed to have ended in 1919 because of “herd immunity”, but in fact the virus hung around in isolated communities until it seemed to be knocked out of circulation by the virus which caused the Asian ‘Flu of 1957 (this was a less known but nevertheless serious pandemic – in fact, unfortunately, it killed my own grandmother). However, there was an odd epilogue to this: in 1977 there was another ‘flu outbreak in Russia; it turned out, however, that anyone older than 20 was immune to it – the virus which caused the Spanish ‘Flu was, in fact, still about…

The question probably will be whether testing and tracing has managed to keep the virus isolated; what the scale of immunity (and indeed general susceptibility among a population which has already had a full wave of the virus) actually is; and whether some social distancing measures are still applicable and viable a year from now.

The balance of probability is that, one way or another, a year from now the virus will be largely under control in the Western World – we will have learned to live with it, we will be much more able to balance the risk ourselves, and the availability of everything from technology and treatment will be much enhanced. An Olympic Games in principle, with widespread testing, will probably be able to take place.

The question we rarely ask is whether this will be the case across the whole world. We should not underestimate the ability of the developing world to manage epidemics – it does so more often, after all. However, there is a risk that in particular locations, either because of socio-political instability or political populism, the virus will still be endemic and uncontrolled.

Ultimately, as ever with this thing, even asking the right questions does not necessarily lead us to the right answers – but even getting to the right questions is difficult.

Coronavirus – Keep it simple on Cummings

One of the reasons Left Liberals lose a lot is that they don’t know how to keep things simple.

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It was made very clear, by the Prime Minister himself, that everyone had a civic responsibility not to break the rules or people would “suffer”.


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It was made clear from his Twitter account as he lay in intensive care that there were no exceptions.

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It was also clarified a few days later that the “rules” are not guidance, they are the law. And understandably, since everyone could “suffer” and they “include you”.

On 31 March prominent adviser to the UK Government Professor Neil Ferguson received a female guest at his home in London. The same day, prominent adviser to the UK Government Dominic Cummings drove from London to Durham.

These were the Regulations as they applied in England on that day.
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In Mr Cummings’ case, there is a further problem with his having left home, namely that both he and his wife (who was also in the car) had symptoms. The guidance for people with symptoms across the UK was, is, and for some time will be:

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It was clear that Professor Ferguson had to resign; the law does not permit people to “leave the place where they are living” to visit friends, but he had encouraged someone to do so to visit him.

It is obviously equally clear the Mr Cummings has to resign. The law does not permit people to “leave the place where they are living” to deposit their children with grandparents or indeed anyone else, whether 260 yards or 260 miles away. In his case, the Guidelines are also clear that neither he nor his wife were allowed to “leave home for any reason”.

Let us not complicate it, therefore. As the Prime Minister’s own account put it, if one person breaks the rules we all suffer; the rules apply to everyone including Mr Cummings; Mr Cummings and his wife broke the rules and therefore broke the law; and Mr Cummings and his wife acted clearly contrary to the Guidelines.

“Common sense”, for the record, would dictate that if there was any issue with childcare, someone else should have come to the house to deal with it. But many people with symptoms not requiring hospital care have managed childcare perfectly well.

(Note the Regulations allow only childcare carried out by a public service.)

That’s it. And any Cabinet Minister or MP claiming otherwise (or indeed any journalist reporting otherwise) is embarrassing themselves. Remember, the Government itself has explained why these rules and guidelines exist:
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So Mr Cummings, on the Government’s own terms, must go. It is probably time the Prime Minister went too. A crisis of this scale is no time for Downing Street to be occupied but a convalescent, far less one as obviously hypocritical and incompetent as the current occupant.