A6 will be huge benefit to Derry

Finally, after almost 20 years, the project announced to improve the Derry-Belfast road was completed last week. It has been a long road, in every sense!

Scenes of disorder in the Creggan earlier this week were inexcusable of course, but they also served to re-emphasise the importance of connecting the city; its sense as a place apart can generate a strong sense of community spirit, but the fact is it cuts its people off from opportunities and leaves it markedly more marginalised and thus inevitably poorer and unhealthier than places farther east. The average person even in the neighbouring Mid Ulster council area can expect to live two years longer than the average person in Derry & Strabane. New connections, efficiently delivered, can only be good.

History

For a history of the route, the first port of call should always be Wesley Johnston’s blog; it is a classic case of where actuality does not really match political assumption, and therefore the truth of the matter gets brushed to one side.

As it happens, historically the main road from Belfast to Londonderry was what is now numbered the A2, which perhaps explains its prominence (it was indeed almost certainly the second postal route in Ireland, after Belfast-Dublin, which is the A1). This route was coastal, but exactly that meant it avoided the Antrim Hills and Glenshane, routes which were initially effectively impassable. It is worth noting that this remains the case for rail, which is why the rail route is still the old coastal one (and takes such a long time).

That remained the case until into the 1960s; vehicles were so unreliable that travelling over the narrow Glenshane Pass, even if more direct, was not a serious option. Of those who did attempt it (who numbered hundreds rather than thousands per day), breakdowns were frequent; experiencing a breakdown yourself was a serious risk and being caught behind someone who had broken down with little room for manoeuvre was probable. It is small wonder, therefore, that the coastal route was preferred.

The initial proposal from the early 1960s in the early motorway era was to link Belfast to Derry via Ballymoney and Limavady (via the M2 and a proposed M23) and, at the time, that made sense. (The M2, for reference, was initially proposed to go directly to Ballymena, which is why the M2 bypass was built early and why the A8(M), originally meant to be part of the M2, exists as it does.)

By this time, however, vehicle reliability had improved and therefore it was decided to build a multilane road (exactly what constituted a motorway and dual carriageway has varied over time) from Belfast to Antrim and then via a spur on to Magherafelt; in preparation for this, the Glenshane Pass (more specifically, the section of the Glenshane Road from Dungiven to Magherafelt) was widened to provide passing opportunities (most obviously by adding a “hard shoulder”, a rarity on single carriageway roads in Great Britain but common in the rest of Ireland) and to bypass all settlements. This would then be linked to a Dungiven bypass at one end and the end of the M22 at Magherafelt/Castledawson at the other.

Unfortunately, until 2019, the M22 never made it beyond Randalstown and Dungiven remained un-bypassed, despite a definite proposal for a bypass existing from 1986. In the early 1990s Castledawson itself was bypassed (which is why the roundabout takes its name, rather than that of the larger Magherafelt) but that was it – there remained a wicked, narrow stretch between the M22 and the Castledawson Roundabout known as the Moneynick Road, as well as no bypass of Toome nor of Dungiven.

Impatience

Understandably, people in the North West were always agitated by the perception that their main city was not properly connected; it was often declared the “city farthest from a motorway in the UK and Ireland”. (There was also the not insignificant issue of the impact on air quality for residents of Dungiven living in a settlement with so much traffic passing through.)

It was always evident to me that the west would not develop fully without adequate road links; this is not just a “private transport” argument, as buses also benefit from good infrastructure and, specifically, from multi-lane roads (i.e. roads at very least built with “hard shoulders” to ensure that tractors or broken down vehicles do not slow everything down).

One counter-argument is that this issue was not unique to Northern Ireland within the UK. The UK’s major motorway-building phase occurred in the 1960s and 1970s and ever since funding has been allocated mainly to maintaining existing motorways; in fact, not a single mile of non-tolled new motorway has been constructed in England, Wales or Northern Ireland in the last two decades (every added mile of motorway has been an upgrade of an existing dual carriageway or, in one case, a tolled route).

In fact, though comparison is difficult, Northern Ireland has not done badly by comparison this century if you count expressways as much the same as motorways (see also below). Even while the A6 was being argued about, the A1 Newry Bypass was constructed to motorway standard and then, since 2010, there had been an extension of the M1 via the A4 into south Tyrone; an A8 Newtownabbey-Larne expressway; and an extension of the M2 Ballymena bypass via the A26 northbound. This compares to the initial period of motorway building (and very favourably to the 1975-2005 period when very little construction of truly high-quality routes took place).

The main reason for impatience in Northern Ireland is probably more the speed of progress in the Republic; however, its motorway network compares to the very best in the world. Notably, like nearly all the most expansive networks globally, it is also largely tolled, something which is instinctively unpopular north of the border. There is an element that you get what you pay for.

Multi-modal

There is also an understandable wariness of investing too much in road-building when we are being told that public transport (and other transport modes, such as cycling) is the way to go to meet our environmental objectives. There is some truth to that.

However, the key is multi-model transport; the main role for public transport falls within large urban areas. For example, assessments of how many planets it would take to host people living as they live currently unsurprisingly show that if we all lived as Americans live, we would need five planet Earths; for some Middle Eastern city states this in fact rises to nine. However, even Germany, with its vastly more advanced high-speed rail and city public transport systems, comes in at three. We would expect the UK, as it often seems to, to fall between Germany in the United States on this measure given its inferior public transport and reliance on flight; it does not, however – the UK comes in at two and a half, still too high but clearly at the lower end in the Western World, and considerably lower than Germany.

Part of this has been the UK’s relative success in its energy mix (which, sadly, Northern Ireland has not contributed to anything like as fully as it might); part of it also demonstrates, however, that multi-modal transport is key.

Nor can we simply dismiss the freedom of the private vehicle (and indeed of the delivery vehicle). Remember, in 1989, when the Berlin Wall fell, the crowds shifted from the more equal jurisdiction to the less equal one – but also from the less free one to the more free one. Freedom is fundamental to human nature and thus to human society, and the private car is part of that. The key in discouraging private transport is to do so in the most effective ways which deliver the biggest practical impact – moderation, not absolutism.

Some people may not appreciate some of these paragraphs, but all main parties in Northern Ireland implicitly endorse them. After all, all bar one support the construction of the A5 expressway – which involves spending £1.5 billion specifically to increase vehicular traffic on a particular corridor, something which will unquestionably do environmental damage. The benefits to the economy and, fundamentally, to freedom of people living along that corridor are perceived to trump environmental concerns – even by parties purportedly of the hard left, one of which even has a spokesperson dedicated specifically to delivering this objective. We can see that almost everyone accepts, in reality, that multi-modal transport provision is the key.

FAQs

As I noted on this blog recently, Twitter is a real misery-fest at times, so it is worth correcting a few issues which appeared on it:

• it is perfectly safe (and actually more efficient) to build a new expressway without a full “hard shoulder” – breakdowns are extraordinarily rare now and in fact on the new A6 there is over a full car width of space available on the left in an emergency;
• Northern Ireland’s infrastructure is not “abysmal” – and even less so when you consider we do not toll roads nor pay in any way for public infrastructure on a “user pays” basis and that we pay the lowest domestic taxes [again, also see below];
• rail is not a cost-effective option over Glenshane;
• there is no serious case for an expressway over Glenshane either – it would come at considerable cost and it is in fact the least trafficked portion of the route (and, as explained, the width of the existing road limits any prospect of serious delay);
• for similar reasons, it made absolute sense to do Drumahoe-Dungiven before the section between Dungiven and Magherafelt, as more vehicles travel from Dungiven to Derry than towards Magherafelt/Belfast, and also because the pre-existing single carriageway on that stretch was lower standard;
• infrastructure is phenomenally expensive to build and becoming more so, not least given the precarious geopolitical situation (a significant problem for the A5 upgrade); and
• it is true that even the road construction process itself is environmentally damaging, but the net benefit of improving the air quality of settlements previously passed through (in this case, most obviously, Dungiven) cannot be discounted.

It is worth noting that during the motorway construction period from 1961 to 1975 around 110km of motorway was built in Northern Ireland; since 2007, over 100km of expressway has been constructed. Effectively, therefore, the overall expressway network has close to doubled in size – yes, this is not close to the epic scale of construction south of the border, but over the past 15-20 years it is well ahead of any other part of the UK and most other parts of Western Europe.

Northern Ireland moves ahead

It is worth reinforcing the point that the road network has been hugely enhanced in Northern Ireland over the past couple of decades since the Newry Bypass was completed. This is the period during which “cheap and cheerful” upgrades to “dual carriageways” (typically achieved by building an extra carriageway alongside the existing one) were abandoned and replaced by expressways with grade-separated junctions often built offline (i.e. away from the original main road).

In 2004 the Toome Bypass opened on the A6 and, at that point, the Belfast-Derry route was probably comparable to the most obviously similar route in Great Britain, the A69 from Newcastle to Carlisle. Newcastle is roughly the same size as Belfast – in fact the City Council area is a little less populous, but the surrounding built-up area is if anything a little larger; Carlisle is roughly the same size as Derry, possessing in place of the Donegal hinterland the Lake District. The A69 itself is 54 miles, versus around 66 miles for Belfast-Derry (assuming a practical start point a little out of the largest city centre, as is the case for the A69 which starts at the Newcastle western bypass rather than in the city centre).

By the mid-2000s, Belfast-Derry consisted of around 22 miles of motorway, plus a short dual carriageway bypass of Toome, and still passed through Dungiven; Newcastle-Carlisle consisted of 22 miles of dual carriageway (a higher share of the overall route though it was standard dual with right turns and occasional roundabouts) and now bypassed everywhere until the approach to Carlisle, but the single carriageway section had no hard shoulders and few passing opportunities.

Since then, however, some small grade separation projects have occurred on the A69; however, nearly 25 miles of additional expressway have been constructed on the A6 meaning, as of last Thursday at least, that the Belfast-Derry route is significantly the better of the two – the A69 is dualled for about 40% of its length versus 70% for the Belfast-Derry road between the city boundaries, and even the remaining 30% of the latter is superior in quality to the 60% of the former.

Fun fact, the section of expressway opened last week on the A6 (16 miles) is almost exactly the same length as the mainline M2 motorway; alongside the improvements between Randalstown and Magherafelt, the majority of the overall expressway portion of the Belfast-Derry road has been opened just within the past four years.

In fact, Belfast is now linked by motorway/expressway westbound to Ballygawley, northwestbound to Drumahoe (bar two roundabouts and the wide Glenshane Road), northbound nearly to Ballymoney (bar the Antrim-Ballymena standard dual carriageway and its roundabouts at either end) and northeastbound to Larne (bar four roundabouts). The most obvious gap in the expressway network from Belfast is now the A1 southwestbound towards Dublin, which is proposed for conversion to expressway from Hillsborough to Banbridge (though not yet on to Newry and not yet around Sprucefield) but proceeding painfully slowly given the relative cost-effectiveness and safety benefits of the junction upgrades required.

Benefit to Derry/North West

The benefit of this A6 upgrade to the North West is considerable, and should not be downplayed.

Drumahoe, on the edge of Londonderry, is now under an hour at speed limit from Sandyknowes, on the edge of Belfast; given the passing opportunities now presented, this is easily achievable at almost any time of day, and most importantly of all the journey is easy and stress-free. It is worth noting again that even the section of it which remains single carriageway provides a hard shoulder and plenty of passing opportunities as well (via 2×1 sections). It is no surprise to see new housing under construction in Drumahoe at the roundabout at which the A6 expressway now terminates; in many countries, this would be regarded as commuting distance to Greater Belfast.

Derry also comes into play now as an option for a quick break, even for an evening, for many people in Greater Belfast with access to a vehicle (not least since it is so much cheaper). A stress-free round-trip of two hours is comparable to the North Coast or the Mournes, and rather shorter than the Lakelands. As a potential location for investment, study or leisure, the North West just seems a lot closer now to the bulk of the population. This cannot but create opportunities.

This reinforces the need for good infrastructure, and for the recognition that multi-modal transport options remain the way forward. It has all taken far too long, of course – the road should have been there a decade ago. However, it is an undeniably positive story for the North West and, ultimately, for us all.

Long haul won’t be the same for some time

My most popular post in the last two years involved neither language nor coronavirus but aviation – an area of limited expertise based on past work doing PR for airports many years ago. Nevertheless, that was probably the most interesting area of my work pre-Pandemic given aviation is so poorly understood in general. (This can matter, for example, when you see some of the entirely false assumptions around connectivity from Belfast’s airports versus, say, Dublin).

Last week Qantas set a record with a repatriation flight from Buenos Aires to Darwin, which in fact crossed the Pacific and skimmed Antarctica. This is a highly unusual route; airlines generally choose not to cross the Pacific directly for a variety of reasons, mainly that it simply cannot be made financially viable. Why not, and why does this matter?

Ultimately, and even more importantly post-Pandemic, making a route viable depends on connecting it to other routes – in much the same way as link roads and trunk roads. For example, an airline flying from the UK to the Middle East to Australasia is likely to pick up far more linkage than an airline flying directly from the UK to Australasia. A route such as London-Dubai-Sydney picks up both London-Dubai and Dubai-Sydney as prospective passengers (and even either side then passengers arriving in London from say North America en route to the Dubai and those going on from Sydney to elsewhere in Australasia); London-Sydney really would cover only people going specifically from the UK to Australasia.

This is to leave aside that passengers simply may not fancy sitting in a plane for 19 hours; specifically, they are only going to do this from business class upwards. The actual London-Perth route (currently suspended due to the virus) has no economy seating – who would want that anyway?

The problem is that post-virus the rebound in aviation will come primarily from leisure travel. Businesses will increasingly take the view emerging from the Pandemic that Zoom or Teams can cover work that used to involve travel, not least given the ongoing risks of the virus in some parts of the world. No one is likely to want to pay for business class from London to Perth when they could fly much more cheaply from London (or Dublin or wherever) via Dubai (or Doha or wherever) to Sydney (or Auckland or wherever); indeed, it may actually be quicker to do the Middle East stopover in terms of accessing the actual destination.

This is good news more nearby for the likes of Ryanair or Easyjet, who will be able to bounce back using largely the same model they always did – no frills, predominantly leisure. Airlines orientated towards business travel (and more luxury, more expensive options) will face huge challenges – in terms of making routes viable and in terms even of routes they assumed could be made to work. Once some routes start getting knocked out, others will become less viable, and so on; increasingly, long-haul routes will become tricky to make profitable at all.

We may therefore almost be at the stage where we move back half a century, accessing further away places (with some exceptions) via a series of short flights rather than one or two long ones. Long haul could come to look quite different post-Pandemic.

Coronavirus: NI’s disconcerting economic unreality

Of all the madness which passes for politics in this part of the world, the notion that we should be pushing for city centre offices to open so that we could boost the economy through “civil servants buying sandwiches” is outright scary. The sheer scale of the unreality that passes for economic debate in Northern Ireland defies belief.

We should not even need to address such nonsense, but let us think about it: cafes sell sandwiches and drinks, use the profit to pay taxes and rates, which are used to pay civil servants to sit in offices on prime land, so that they can buy sandwiches and drinks in cafes, which use the profit… eh?!

The issue here is not just the obvious one that we are supposed to be using the current situation to encourage home working for the sake of family time and the environment (and that, if we do this, we could actually sell the city centre offices on prime land and return the money to the ratepayer either directly or in the form of transferring it to public services); nor even that we were already supposed to be moving offices out of the city centre precisely because that is the most expensive location you could put them and they are paid for by the tax/ratepayer who expects value for their taxes/rates.

The issue remains still that no one at any stage is actually creating any wealth. Shuffling public money around is not an economy. At some stage, someone has to innovate, export, and create wealth so that money comes into the jurisdiction – precisely so that we can pay for the health, education, transport and other services that civil servants are providing.

Underlying all of this, we even have the notion that somehow we can afford for absolutely everyone to work from home, or perhaps even not work at all, as was the case during lockdown. The scale of the unreality is that some people think that lockdown is a viable long-term policy option, to be used for as long as it takes until the virus goes away – perhaps even forever.

Even without a pandemic, city and even town centres need to be shifting towards an evening economy so that they become places in which people opt to spend time – ultimately, even, in which people opt to live. If they are dependent on bureaucrats coming in and out by car, they have failed as entities.

Meanwhile we need to grasp that cafes paying rates to pay for the offices in which civil servants work to buy their sandwiches is not a serious economic plan. We need to move on from such unreality, quickly, not least to grasp the opportunities presented by the current enforced re-think of how we do things.

Coronavirus – blog review

As I will no doubt be reducing my writing on the subject next month, I thought it worthwhile to summarise some of the points made on this blog so far with regard to the new Coronavirus; I also made some of them in a podcast in late May.

I re-emphasise that I have no expertise in biology and medicine, but I do have some in public policy (and I happen to speak German, thus enabling the comparison between the English-speaking world and the German-speaking world upon which I intend to build in the coming days and weeks). These are analysis pieces for information and interest; they do not constitute formal research, far less government policy.

If, like me, you are in Northern Ireland, remember the core government advice currently remains stay safe, save lives – wash your hands, keep your distance, do not engage in gatherings indoors of more than six or outdoors of more than ten.

Remember also to avoid the three ‘C’s – contact, crowds, and closed spaces!

In summary, the most important thing right now is that there must always be room for doubt. We still do not understand this virus, so we cannot say anything about public policy responses with absolute confidence (so those who do are making it up).

We must be aware that in our own response to this, it is as much about managing and perceiving risk as anything else. Also, the objectives are not quite as obvious as we might at first think. Even when we establish what they are and judge performance thus far, we must also be aware that our own intuition may be deceiving us fundamentally and always apply the plausibility and relevance test.

Therefore, never has the truth been more important. Almost anything said with absolute certainty does not merit attention – it is invariably said to appeal to prejudice rather than truth. We even need to consider that the reverse of what we view to be instinctive may end up being true, and that what we regard as “safer” may not be. There is also considerable risk in simple, apparently clear claims which are in fact profoundly misleading, even to the extent of missing key points in their favour. If we must make comparisons… well, we probably shouldn’t too often. We also should not overstate the significance of apparently simple numbers like R.

“Lockdown” always was a profoundly good idea, provided it was properly prepared for. However, it is a long way from the “safe” option it is sometimes presented as, and it cannot last forever. Even right now, you can legitimately argue for or against “raising lockdown”, but make sure you are asking the right question. When it is raised, however, other countries can be taken into account and it must not be done piecemeal, but rather via a phased or staged approach, and based on the Regulations which set out what we are trying to achieve.

For all the discussion about “lockdown, however (understandable because it is what most obviously affects most of us), the difference between good and bad outcomes is predominantly to do not with “lockdown” but with early diagnostics. This truth may be boring but that does not make it less true – indeed, we should always be seeking solutions, not headlines. It is also legitimate to attack the UK Governent for its early inaction, but such attacks must be specific to where it actually erred otherwise they serve no purpose.

It is also important to report what actually matters to us. Targets and personalities are meaningless; actions and delivery are what count. We should probably also define our terms. “Social distancing” does not mean “lockdown”, for example – saying the former must remain for months or years does not mean the latter must.

One of the difficulties in dramatic here-and-now news is it misses the broader analysis, such as the awkward truth that the difference in outcomes between the UK and Germany is not narrowly in the two countries’ response to the new coronavirus (regardless of the UK Government’s very evident failings in that regard), but in the fundamental basis of their health services. The UK is always fire-fighting whereas German-speaking Europe puts in the early preparation in a targeted way – this reveals itself further in the two countries’ testing strategies. Yet, for all that, things in Germany are (and were, when the linked piece was written) nothing like as smooth or simple as they are reported in the English-speaking world (and they are still not even post-lockdown); its lockdown was fundamentally less strict. The UK continues to miss the point on testing that the virus can often be asymptomatic; and also that it needs a better informed public of active citizens taking responsibility. Yet one UK territory has done rather well.

There are also differences within the UK just as there are within Germany – Northern Ireland is going its own route in some significant areas and has its own recovery plan, maintaining rightly or wrongly a later lockdown, which is not perfect but is an improvement on the UK Government’s. We have also not paid enough attention to the immense challenges of re-opening the Health Service. To some degree, this is what devolution is all about.

Also, if you get it wrong as the UK Government has done, it is better and safer to admit your errors (and likewise in Sweden) and stop defending the indefensible otherwise you end up looking (and being) dangerously clueless with your global standing diminished and daft policy decisions mocked for being made with no purpose.

There is a concern that politicians in Northern Ireland were too focused on the worst case while the authorities in Northern Ireland are not publishing the science, which makes the public feel they are being treated like idiots and actually causes more confusion, leaving also bewilderment over why there are no checks at ports of entry and why meat factories are still operating. It may also be useful, later in the pandemic, to think of lanes more often than bubbles.

There are some quirks, too, such as why planes are still in the air and why we need the return of sport. There is also always the chance that we are closer to the end of this than we think – but that really is not very likely. We are probably over-thinking apps, and there are also always just random questions.

We also need to consider our own personal well-being, not least how we think our way through living during the virus and after it and how we imagine the future while making sure not to write humans out of it.

Where does all of this end? Maybe somewhat differently from what we had initially understood. But we can learn from others, particularly around things like restaurant re-openings. There will surely be some good to come out of it; we just do not know when.

I have also included some Facebook posts, for example on how we ourselves can balance probabilities in terms of virus transmission; the meaning of “Step 1” in Northern Ireland; on the practicalities of shopping with the virus about; and on that ever present danger of comparisons.

More recently, I have considered how we apply our knowledge, what the statistics tell us (both at home and abroad), what we are learning (and how we continue to learn from global outbreaks), how to focus on the right issues, and how we deal with complex problems. There have also been testing queries, general confusion and outright nonsense…

I also reckon this external article from Unherd is essential reading for anyone genuinely wanting to understand the public policy and scientific challenges around all of this.

In the meantime, here is some outline practical guidance primarily for people in Northern Ireland.

Coronavirus – think “lanes” more than “bubbles”

The concept of “bubbles” was first discussed here six weeks ago, but with shops now open it is of limited value to the bulk of the population in Northern Ireland – now, you can meet anyone in any shop, meaning that as of last Friday your “bubble” is in practice anyone in Northern Ireland who is not shielding.

In my view, the Executive made its first mis-step last week on re-opening after lockdown, by failing to recognise the needs of young families. Home visits, even if limited, should have been considered and clear guidance given on why they are still not allowed; and access to “informal” childcare via close family should have been allowed – a “two-house bubble”, if you like. Much of this will simply have to happen anyway.

However, for people who are shielding, lockdown effectively remains in place with the one exception that they may meet outside at 2m distance in a group of up to 10.

Also, there is another group of people, those who are not shielding but are either themselves clinically vulnerable or are caring for someone who is, who also feel unable to make use of the new freedoms.

This is where I think it is helpful to talk of “lanes”. Most of us are in “Lane 1”, those who are clinically vulnerable or caring for some who is are in “Lane 2”, and those who have been instructed to shield are in “Lane 3”.

This again goes back to the difficulty with escaping lockdown – lockdown benefits from the fact it is straightforward – essentially no one leaves home; you work from home if you can; if you can’t, you are paid a share of your salary by the state. However, at this quasi-lockdown stage everything becomes very complicated.

Technically, and oddly, lockdown still exists in Northern Ireland but not in England. In Northern Ireland the Regulations still prohibit us from leaving home except in certain circumstances (it is just the circumstances have now broadened), whereas in England they have been thoroughly re-written so there is no such specific prohibition.

However, in practice, lockdown no longer applies in either jurisdiction, and indeed there are more freedoms in Northern Ireland than in England (and rightly so, given comparative rates of transmission).

We are quickly moving towards the stage that anyone in “Lane 1” should feel safe to go out and work and play as normal.

Again here, the debate among politicians and the commentariat about whether distancing should be 1 metre or 2 metres may be a little behind the game. There is also a serious problem that Northern Ireland’s data appear to be utterly inadequate.

Imminently, distancing will not be required at all. This is already the case on the Isle of Man, and will be as of the weekend in Guernsey.

As it happens, there is very little strong recent evidence specifically for 2 metres. Denmark has managed perfectly well with 1 metre right from the start, as has Germany with 1.5 metres, and parts of Italy have now re-opened with only 1 metre required.

However, that does not quite mean that anyone in “Lane 1” will feel safe (that depends on personality and circumstance), and there will be a number of people with caring responsibilities who will also quite legitimately feel safer in “Lane 2” alongside people who are clinically vulnerable (retired age, pregnant women, people with particular underlying conditions such as COPD or diabetes). There, it is important that allowances are made – that people who really cannot go into work are not forced to; people who really don’t want to partake in activities are not obliged to; and the people who want to ensure their home is still safe are enabled to. Ultimately, two things are required for this – patience and information. It all comes down to managing risk, but people need to be informed so they can do precisely that.

We must also find ways to ensure that those in “Lane 3” – who are there by instruction, remember – are not left marginalised. Increasingly, proactive ways will need to be found to involve them in things, to enable them to see loved ones, and to help them ensure services are available to them. In time, the “instruction” will be removed and they will in effect move into risk management with the rest of “Lane 2”.

This is not just a matter for the authorities, but for all of us – most of us will be in “Lane 1” but nearly all of us will know people in other lanes. Occasionally, our role will be carefully to reach across and ensure they are not left behind permanently.

There is some merit of talking of “bubbles” with regard to childcare (even in schooling) but otherwise we perhaps need to move from “bubbles” to “lanes”. They are, in any case, much easier to visualise…

How a pandemic fundamentally changed the English language

I have written many times before about how interesting it is that we, at 400 years’ distance, can easily read Shakespeare’s Early Modern English and could also largely understand him if we heard him speak (with a bit of adjustment); yet Shakespeare could not have read Chaucer’s Middle English, writing just 200 years before him, and would not have understood his speech at all.

One reason for this was the invention of the printing press. This drastically slowed the development (and actually the ongoing process of regularisation) of English grammar so that, although it changed unrecognisably between 800 and 1500 and even between 1300 and 1500, it has barely changed since 1500.

However, that does not explain why the development of the pronunciation was so much faster between 1300 and 1500 than it was in the entire period since 1500. What was the main reason for that?

Well, a pandemic.

The Great Vowel Shift is a term coined just over 100 years ago by Danish linguist Otto Jespersen, as a remarkable disruption to the pronunciation of vowels in English. Nearly all languages have undergone vowel shifts, but the shift in the period between Chaucer and Shakespeare, even though the former died only 160 years before the latter was born, is exceptional by the standards of major European languages.

English is, of course, written more or less as it was pronounced by Chaucer. Words such as drive, name, stone and so one were pronounced with more or less a one-to-one letter-to-sound correspondence. Steak rhymed with bleak; you shed tears that rhymed with bears but not with beers. The pronunciation of the word shire in county names such as Yorkshire or Buckinghamshire is not a lazy effort at the current pronunciation but in fact the original pronunciation minus the final -e.

At the time of Chaucer’s birth, England had become fairly densely populated compared to neighbouring lands but people, 90% of whom lived agrarian lives in rural locations, rarely had cause to travel more than about a dozen miles from home. As a result, the language across the country varied hugely; if they ever did travel more than about 50 miles for any reason, mutual intelligibility would become difficult. On top of that, English was the informal spoken language but not the formal written language – laws were promulgated and adjudged in Norman French and church services (to which it may be noted only a minority of people went) were in Medieval Latin.

An apparently unremarkable event in Weymouth in June 1348 would change all that, and one of its effects would be an astonishing change in how the language was used and thus how it was spoken. A sailor arriving from Gascony in south-west France brought with him a particularly virulent form of the bubonic plague. The “Great Pestilence” hit London, a city with a population six times larger than any other in England, by the autumn, and the whole country was affected within a year. Perhaps half the population died in what, many centuries later, became known as the “Black Death”.

As now, urban settlements were particularly dangerous because of the speed with which infection spread, but counter-intuitively after the plague passed it was the cities, not the countryside, which recovered their population fastest – perhaps within a century, where rural areas had to wait 200 years or more. In the city, there was more work needing done and fewer people comparatively to do it, so the wages commanded were high. There was a significant shift in population particularly towards London, and not just from within England – by the time of Chaucer’s death in 1400 it is believed that over 1% of London’s (and perhaps even all of England’s) population were immigrants from places such as France, Flanders (modern northern Belgium) or Scotland, compared to a situation only a century earlier when people hardly moved any distance from home at all.

The effects on language from that point were profound. Firstly, the pandemic did not distinguish between rich and poor so many of the French-speaking landed gentry were wiped out – but their land survived, so they were replaced by English speakers; the first ever King’s Speech to Parliament in English was made in 1362. Secondly, the move towards urban settlements brought changed speech patterns as people from different parts of the country mixed (an obvious modern example of this is “Scouse”, which simply did not exist as a markedly separate dialect from Lancastrian until within the last two centuries but then developed as a distinct urban dialect as Liverpool Port grew in importance and attraction). Thirdly, immigration effectively reintroduced influence from Romance languages.

The unusual combination of a rise in linguistic status generally, the mixing of dialects in urban settings, and reinforcement of foreign influence through immigration led to a dramatic shift in pronunciation.

Yet little of it would have happened without a pandemic…

Coronavirus – NI forward planning still too fixated on worst case

BBC NI ran a frankly bizarre investigation suggesting there was something odd about the NI Health Minister’s decision to publish only the “reasonable worst case scenario” on 1 April, rather than mentioning a best case scenario. Mr Swann, with the support of the entire Executive, clearly did the right thing, by ensuring there was no complacency and the public responded in the way intended. This had the desired effect of outcomes closer to the best case than the worst case – it was basic communications strategy based on behavioural science, and it was spot on.

It is worth adding that a “reasonable worst case scenario” is not in fact the same as a “worst case scenario”; it is a term used by academics running modelling programs to show a likely outcome, albeit at the worse end of the spectrum, if proposed interventions are ignored.

However, there is a legitimate concern that proposals for re-opening Health and Social Care are still too focused on what may be described as a reasonable worst-case scenario. They openly assume, for example, that there will be a further wave of COVID-19 some time in the autumn of 2020.

To be clear, it is absolutely not unreasonable to be prepared for the possibility of the virus returning in a similar fashion to February/March some time in the autumn, with the additional challenges of this occurring at a time of year usually characterised by ‘flu outbreaks (themselves unpredictable in their scope). It is entirely sensible to have plans in case for that eventuality.

However, as a result, there is perhaps not enough planning taking place for if there is no further wave. The assumption that there will be a further wave essentially derives from the fact that four of the last five major pandemics did consist of several waves, and that is fair warning; however, the one which consisted of only one wave was SARS, the one closest to the current virus.

The Framework, for example, assumes that COVID-19 Centres (taking up significant resources from primary care just at the moment transformation is supposed to be shifting them in that direction) will have to be in place until there is a vaccine. However, we do not know that there will ever be a vaccine; can we reasonably leave such Centres in place when infections are low just because there is no vaccine? It is reasonable to consider that such Centres may need to pop up and pop down for a significant period of time if there are further waves; however, it is also necessary to consider that they may not be necessary, not least because they are eating up resources urgently needed elsewhere.

Albeit more implicitly, it is also assumed that “social distancing” (there is a problem with the public understanding of that term, but here it appears to mean people keeping a 2m-distance from each other and wearing nose-and-mouth protection where this is impossible) will remain in place indefinitely, dramatically restricting the capacity in hospitals and health centres. However, such distancing is being abandoned in the German State of Thuringia this weekend; and in Guernsey, all being well, from the end of this month. Therefore, the restriction of capacity should be seen as a potentially necessary contingency, but not as a presumptive mainstream option.

There are two fundamental problems here. First of all, we are still making assumptions based on models from March which are already outdated, rather than responding to the evidence base about how the virus is behaving; this is why we still operate on the premise that a vaccine is essential to end the crisis or that 2m-distancing is essential to stop spread, when in fact the developing evidence and trends show we can now hope to eliminate the virus without a vaccine and to identify and isolate “super-spreaders” to enable the safe resumption of normalisation.

Secondly, there is something I always say about language learning which is relevant here – the most common mistake in language learning is trying to perfect everything at beginner’s level before going on to intermediate, meaning in practice people never really move on. Likewise, there seems to be a focus on making ending COVID-19 the absolute priority before re-opening health services to manage cancer screening, neurological pathways or even key preventative services such as physiotherapy.

Fundamentally, even beyond the Health Service, we cannot wait for COVID-19 to go away completely before we get on with our lives – meeting loved ones, getting healthcare, returning to work and so on. What we have to do is manage risk.

The risk is that we will end up facing much greater social, health and economic problems by not opening up. For children and people of working age the biggest threat from the pandemic, all other things being equal, is not from the virus itself but to their mental health. This is before we account for cancer screenings delayed, neurology diagnoses missed, or even basic physiotherapy postponed; and that is before we account for the damage to social relationships and economic livelihoods.

Our profound failing here is that, as ever, we focus too much on the target (“COVID-19”) rather than on the impact of the target (the huge social distress caused, alongside its direct impact in terms of high death rates and even subsequent chronic conditions even to some of those who recover). The impact of the target is what counts, and it is the risk of that impact we need to manage. To do this, we do need contingency plans – but we also need to consider that the opportunity costs of not re-opening when we can are vast.

Coronavirus – UK Government’s “border quarantine” just another stupid, pointless policy

As of yesterday anyone arriving in the UK (except, in fact, for a long list of exceptions) will be required to head straight to a particular address and remain there for 14 days, not even leaving to buy food unless it is an “exceptional circumstance”.

In the list of ridiculous, pointless, populist and frankly stupid policies thought up by the UK Government as it continues to provide literally the worst response to the coronavirus in the world, this is right up there. It is an outrageous breach of human rights which serves no purpose other than deflecting attention from failings elsewhere.

Firstly, there is the outright lie behind the Home Secretary’s claim that the policy is “in line with the science”. It is in fact completely out of line with the science. The “science” actually says that you introduce border quarantine when you have lower infection rates than your neighbours – obviously, because once you have control of the virus you do not wish to re-import it. Yet England alone (the area covered in practice by the UK Government’s policies, including the enforcement of this one) continues to suffer almost as many deaths a day as the entire EU and, unlike almost anywhere else in Europe, has regions where the infection rate is still growing. Other countries (and even jurisdictions, such as Northern Ireland) might want to quarantine arrivals from England, as indeed the Channel Islands and the Isle of Man (where the virus has been largely eliminated) understandably already do, but there is no reason scientifically for England to do from anywhere else. All this policy will do is waste police time and destroy the tourism industry.

Secondly, and worse than that, the policy is simply not good practice anyway. Any vaguely sane country would simply offer tests, even at a price, to those arriving in the country. This is what South Korea has been doing for months; and it is the option Austria went for a month ago. Why on Earth would you quarantine people for 14 days when you can simply test them? Indeed, if someone in quarantine decides they have symptoms, gets tested, and is in fact negative, unbelievably the law would still require them to quarantine – it would be a criminal offence for them even to go out to walk a dog, even though they have tested negative. Only an utter buffoon would come up with such a policy – which is no doubt why the Prime Minister and his blind driving chum came up with it.

At just the moment the UK Government is said to be considering abandoning Sunday trading hours in England to “boost the economy” (a policy which will not boost the economy as all it will do is shuffle money around it rather than boost actual productivity and create actual wealth), it then introduces a policy which will bust tourism and put off investment, thus stopping money coming into the country. It is not just contrary to the public health advice, but also economically crazy.

Of course, the policy is quite popular because as human beings we are instinctively drawn to “defending our turf” and keeping others out, even if residents of England itself are literally more likely than residents of any other jurisdiction on the planet except perhaps Belgium actually to have the virus. Bizarrely, Northern Ireland will now have to allow people from England to enter freely but will force those coming from Germany or Austria, where the virus is largely suppressed, to quarantine. If that sounds idiotic, that is because it is.

This is what happens when you have government by pure populists. They are now overtly ignoring the science, and just doing what they think is popular. That is no way to manage a pandemic of vast complexity which has already killed over 50,000 people in England alone; in fact it is just pointless, stupid and callous.

Coronavirus – the relevance of plausibility…

In the NDR podcast with Germany’s Chief Virologist Christian Drosten last week, presenter Korinna Hennig gave the example of a headline “Does eating strawberries help with the Coronavirus?” to which, when you read the article, the answer was clearly “no“. However, by the time you have read the article, the idea has already been planted that strawberries may help with the Coronavirus – and that is the inherent risk in the headline.

It is always useful to apply our plausibility and relevance test!

(And no, it is not “plausible” that strawberries help in any way at all – other than, perhaps, steering you away from chocolate in the interests of your general health…)

United Kingdom

A Daily Mirror headline ran yesterday that “19 million” people in the UK may already have been infected.

Technically, this is just about plausible; a death rate at the very lowest conceivable based on current research would just about allow that conclusion.

However, it is so close to the borderline of plausibility as to be irrelevant and therefore frankly irresponsible, as implicitly it suggests pre-vaccine “herd immunity” is a viable means out of the current crisis, when there is minimal evidence to suggest this is true (although, under London below, it is not to be ruled out completely).

In fact, later the same day, the UK Government released evidence that in a two week period from late April to early May fewer than 150,000 people in England were infected at any time. This would push the overall number since late February very low indeed.

The balance of the evidence is that around 3-4 million people across the UK have been infected. That is very plausible.

It is, of course, not much of a headline – but therein lies the problem with too much media reporting currently, particularly in the press.

Northern Ireland

A BBC headline ran yesterday “70% more Coronavirus deaths than official figures”.

How plausible is that? And how relevant is it?

Well, of course, it is plausible. Not only do official daily counts in Northern Ireland record only those dying having tested positive for (or, latterly, having been diagnosed with) COVID-19, but they are quite openly counts of registered deaths up until that point. A combination of deaths “assumed” to be COVID-19 (which only appears on the final death certificate or theoretically may even in the end be determined by a Coroner), excess deaths on which COVID-19 had some effect (even, say, a heart attack for which the patient did not seek immediate attention), and the simple lag in reporting deaths all mean that it is plausible that the total number as of this moment is around 70% higher than the official daily count figure.

There is an issue here, however, with the relevance of the way the headline is worded. Implicit to it is the suggestion that deaths are somehow being “hidden”, even that the record is being tampered with to make it look better than it is. On the absolute contrary, Northern Ireland is one of the quickest jurisdictions in the world to publish excess death figures and thus enable a full comparison of total excess deaths, with deaths assumed to be associated with COVID-19, and with the official daily count of those diagnosed with COVID-19 before death.

A very common error here, made even by one of the “experts” providing evidence to the Health Committee at Stormont on Thursday, is to compare the “excess death” figure in the UK (the publication of the overall figure for the UK is slightly slower than for Northern Ireland alone, but still relatively quick by global standards) with the “tested positive for COVID-19 figure” for Germany (which is the only one we have beyond early April, but is clearly a lower total – by definition, we do not know by how much). This is a totally flawed comparison, and anyone defining themselves as an “expert” needs to do better.

The headline was all the more curious because it ran with figures two weeks out of date.

The figures as they were published yesterday are interesting not because of the gap between daily count and excess deaths (which we have in fact known about for weeks), but because they provide a clear argument for lockdown, at least as an initially important policy intervention. That is the relevant point here.

The question raised by a blog post a few days ago was whether the excess deaths were being caused by COVID-19 (but just missed by medical professionals) or by lockdown itself. Either was plausible, but the figures provide evidence towards the former.

None of this is perfect, because we are trying to compare deaths by date of occurrence with deaths by date of registration, and in a relatively small jurisdiction even minor statistical biases or errors can cause significantly different apparent outcomes. Nevertheless, fundamentally, if lockdown itself were causing deaths (in the immediate short term), we would expect that number (not the share, the number) of excess deaths over those attributed to COVID-19 to remain relatively stable. The evidence had suggested that it was relatively stable over a three-week period to 1 May (though we cannot yet absolutely know for reasons aforementioned) but in the week to 8 May we see an apparently dramatic decline. In the five weeks from the last week in March (i.e. to 1 May) deaths attributed to COVID-19 accounted for only 71% of all excess deaths in Northern Ireland; but in the six weeks from that week (i.e. to 8 May) that figure rises to 76%.

It would not appear to be “good news” that more deaths are being and thus potentially can be attributed directly to COVID-19 than until now, but at least it means that lockdown itself has not had quite the effect we may initially have feared in terms of people not seeking treatment in emergencies. However, that does not mean it has had zero effect; and nor does it mean at all that the long-term effects of not screening for cancer or the psychiatric difficulties inevitably associated with lack of social contact will not be considerable.

Republic of Ireland

This can work the other way, too. On Wednesday, the Republic of Ireland initially announced just 33 new cases. This seemed just about plausible, given already by this stage those were the sorts of figures emerging from the whole of London (with a much higher population), although it seemed a little unlikely (we will come back to why below).

Yet the next day, it announced 426 new cases. Questioned about this, its Chief Medical Officer said that the 426 included an “accumulation” of cases from one hospital which were being announced at once. This seems relevant, but also stretches plausibility – why would you declare 33 one day when you are sitting on hundreds?

Few journalists thought to ask the obvious question but thankfully two did. One revealed that there had been a significant problem with testing (potentially relevant to when infections are actually being determined); another revealed that of the 426, 223 were “accumulated” at one hospital but this was a problem because it was unclear if there had been any contact tracing of those 223 (definitely relevant). There is also the obvious problem that this would still leave the daily count at 203, up from 33 initially announced (but as one commenter subsequently points out, also subsequently published as 159) the previous day, which is implausible.

The problem is, this whole thing led to a debate about whether figures were being tampered with ahead of the announcement on raising lockdown from Monday. This is probably not the case, but in some ways that is more worrying – the first rule of the plausibility and relevance test is that in the battle between conspiracy and cock-up, it is almost always the latter…

London

On Thursday, according to a Cambridge University study there were just 27 new cases in London (population over 8 million). Given that it had long been suggested that in London R<0.5, this is just about plausible (although the above does make you wonder).

However, is it really plausible? The assumption was that in London R<0.5 because there had been so many cases to begin with that even relatively high figures constituted a sufficient decline on earlier numbers to deem the R-number relatively low.

This is combined with the notion of “undercover spread”, widely discussed in German-speaking Europe but completely missed in the English-speaking world.

Essentially, even under lockdown, the virus will spread into areas it has not previously touched – be that regionally (say into previously less affected parts of England like the South West) or even socially (say, into care homes); therefore even if R=1 and the virus is not spreading exponentially overall, it will almost certainly be spreading exponentially in places not previously heavily hit – essentially because the same number of infections proportionately means previously less affected areas will see R>1 while previously more affected areas will see R<1.

This is one of many problems with relying purely on R!

However, only 27 new cases is an extraordinarily low number. Certainly relevant questions need to be asked:

• Is testing being properly carried out (there are serious questions around the quality of tests when testing is based around random targets rather than established outcomes)?
• How are confirmed cases actually being “confirmed”?
• Are there cases not being assigned to a particular region?

If it really is as low as that, it opens up two relevant policy options which are completely contrary to each other:

• Is it, in fact, plausible to go for outright eradication in London (and, by extension, the whole of the UK and Ireland) by extending lockdown?
• Or, almost completely conversely, is it plausible that this figure so low because some sort of “herd immunity” has already been built up in London, where the virus spread very quickly before lockdown (this is what Sweden has been banking on all along)?

This is where the quest for plausible figures becomes hugely relevant…

 

Coronavirus: Preparing the health system for the future

Full version of an article from earlier this week in the News Letter.

The fundamental objective of all governments in the West in tackling the coronavirus crisis is to ensure their health systems are not overwhelmed. However, this requires a balance between the understandable priority to maximise capacity for managing COVID-19 itself with the ongoing need to manage other diseases and conditions, which can themselves be life-limiting without the intervention and treatment of health professionals. The outcome in Northern Ireland and perhaps elsewhere will surely be faster transformation of Health and Social Care.

Studies in the UK reported by the BBC show the decision to suspend cancer screening for the duration of the coronavirus crisis may mean as many as 100 people in Northern Ireland each week are not being diagnosed for cancer; studies from Germany show that people are not reporting to hospital even with mild heart attacks, which are therefore going untreated. The evidence is that this alone will result in years of lost life, as treatment in either case begins later than it would otherwise.

There are also questions also about when and how the treatment of long-term conditions will be restored. Diabetes is itself a significant risk with COVID-19, but is no longer being dealt with through face-to-face contact. Some Parkinson’s specialists (both in nursing and movement disorder) have been formally redeployed, leaving some people living with Parkinson’s with only background support. From kidney disease to dementia, direct support has been postponed or temporarily removed, with consequences which are hard to calculate. Basic but vital interventions such as physiotherapy are only available remotely (making them practically unavailable for many). Most people are understanding of why this must be, but it does raise the question of how we restore these services and make up for lost time and treatment.

There is also what has been described by experts at the Institute for Healthcare Improvement as the potential for a “Mental Health Pandemic” – an appalling spiral where a combination of loneliness, uncertainty about the future and loss of livelihood combine to cause hugely elevated rates of anxiety and trauma. The immediate issue concerns domestic violence and child abuse, which is much harder to measure without health visitors and social workers being able to check a residence or look out for well-being at school. Calls to helplines have risen by half, and it is appropriate that Northern Ireland is currently urgently considering a Domestic Abuse and Family Proceedings Bill.

This broad social trauma – from the social isolation to the loss of livelihood – will stay with us for years and will have an impact on well-being for decades. Tackling that trauma will require a fundamental mainstreaming of mental well-being in public policy, to stop it leading not only to longer term mental disorders but also (as studies show it does even in relatively mild economic downturns) to a rise in chronic conditions arising from increased levels of obesity or smoking, with consequent reduction in life expectancy associated with these.

All of this – the need for early diagnosis, to treat long-term conditions, and to mainstream mental well-being – must also be combined with the likely ongoing need for tertiary care for COVID-19 itself, whose side effects we still do not fully understand. It is a complex and gloomy picture, so is there any room for optimism?

What all of this will do is reinforce the need for urgent reform of Health and Social Care. Where German-speaking Europe has led the way in the West on tackling the new coronavirus has been in its recognition that the virus needs to be understood and interventions made early to break the chains of infection – in other words, it has a health system build on preparedness (diagnostics and research), not just response (management and treatment). This is exactly what Professor Rafael Bengoa envisages in “Systems not Structures” – a health service built on systems designed to prepare (and intervene early), rather than on structures primarily designed to respond (and treat later).

So, what do we do now? In the immediate term, we face the challenge of charting our way out of lockdown safely. Lockdown was a necessary move to buy time and gain understanding, and there is a strong case for its maintenance while improved testing and tracing is developed. However, it is not even a medium-term policy option anywhere. Extended families cannot remain separated for much longer; friends cannot be kept from meeting all summer; schools cannot realistically remain closed beyond August; even leisure activities cannot be put on hold indefinitely.

Most immediately, however, our Health Service has to return to providing the universal care for which it was established and is renowned. The toll on our collective mental health alone is already difficult to contemplate; once you add in the missed cancer diagnoses, the lost treatment and the delayed care, and the case against long-term lockdown is beyond dispute on health grounds alone. That must now be the priority.

As we do re-open our health system, we should also remember there is always hope. That hope is that this crisis will speed up the much needed transformation of our Health and Social Care services so that they are better placed to intervene earlier and improve our overall health and well-being faster in the very near future. That would be a significant benefit to come out of perhaps the most challenging period of our lifetimes.