Category Archives: Politics

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 – 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 – 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 – 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.

Coronavirus – better an admission of failure than a pathetic cover-up

It’s the cover-up that gets you, not the issue” said Nixon, about his resignation. Politicians seem very unwilling to learn the lesson half a century on, however.

The UK was in fact quite well prepared for a pandemic. It had run simulations; it had stockpiled PPE; it had prepared modelling; it had drafted emergency legislation. The problem was that it had prepared for an influenza pandemic; the UK Government’s risk register had an influenza pandemic very high, above nuclear fall-out; but any other sort of pandemic was felt almost impossible.

On the basis of the simulations and the stockpiles, the UK began modelling in January, drafted emergency legislation on 10 February; and was already preparing administratively from mid February. The Government asked the scientists what the value of was in this case, allowing for reasonable modifications in people’s behaviour; the response going into March was “2.3”.

This was an error. It was in fact 2.8.

This does not sound much different, but in early March it was the difference between hitting peak of infections around ten weeks later (i.e. about now) or hitting them five weeks later (i.e. at Easter). The Government thus prepared to introduce gradual lockdown measures.

This was also an error, and not just of timing. The modelling was all about protecting the NHS from an influenza pandemic which would affect the broad population and be spread primarily by children. But in fact this is a coronavirus pandemic which disproportionately affects older people and is primarily spread by people of working age.

Even though it was beginning to be obvious to amateurs just watching the graphs comparing the UK and Italy, it was not until 12 March that the Government received further modelling saying it was 2.8, not 2.3; meaning that from that stage, the UK was four weeks, not nine weeks, from peak of infections. To protect the NHS, which was always the main aim, lockdown would have to be introduced faster.

This article is not about the peculiarities of why the Government relied so much on one set of modelling rather than on what was going on around it. In Scotland in late February a Nike event had already proven a “super-spreader”; somehow, this was not revealed, even to neighbouring businesses, until May. In other words, there was evidence right before their eyes, even without a cursory look at the comparison graphs with Italy, that spread was much faster within parts of the UK than the modelling was suggesting. The reliance on modelling (which is not even forecasting and is only as good as the data you put into it – and the data from China was at best patchy) is a debate for another day, albeit an extremely important one.

There ensued a degree of panic as a Prime Minister, who knew little about the virus because he had taken much of February off on holiday and does not seem a big fan of hard work anyway (has anyone seen him recently?), returned on 2 March to tell everyone he was washing his hands but also still shaking them. Only 10 days later he was faced with the reality that to protect the NHS he would have to lockdown.

And there is that phrase again – “protect the NHS”. Still not having adjusted from an influenza pandemic, the focus was mainly on protecting the Health Service (likely, during an influenza pandemic like 1918, to become overburdened with people of working age) and also contemplating school closures (a standard response to an influenza outbreak).

It is worth emphasising here that almost every Western country struggled with this adjustment. The emphasis across Western Europe was on ensuring that there were enough ICU beds essentially for an influenza pandemic. Ireland and German state authorities even closed their schools, as a standard response to an influenza outbreak. Only the German Health authorities and some other smaller countries recognised quickly that this was not, in fact, an influenza pandemic but a coronavirus and therefore the rules were slightly different: national governments and public health authorities in countries such as Germany, Austria, Norway and Iceland therefore focused resources early on trying to understand the virus rather than assuming it was just like influenza. They have been a month ahead of everyone else in Western Europe and North America ever since, saving initially at least tens of thousands of lives as a result.

The result in March was an intentional policy of pushing people out of hospitals as quickly as possible (as well as building new ones), to create space for the victims of the pandemic. One of the places they pushed them into was residential care. In other words, as we approached peak infections from a virus to which older people were most vulnerable, the UK Government intentionally pushed people out of hospital and into care homes where many of those older people live.

This looks in retrospect like a truly shocking error of public policy. At the time, however, it was not totally unreasonable – it was based on all the plans prepared for an influenza outbreak. In such a case, it would have been the correct policy.

But it was not the correct policy. The fundamental error was the failure to grasp quickly enough the difference between the expected influenza pandemic and the actual coronavirus pandemic. (This failure also led to the UK throwing away its initial testing advantage in the belief it did not really need to understand the virus – summed up on 27 March by one of its senior advisers in a media briefing with the line “Testing is something of a sideshow“.)

UK Government Ministers now have two options. They can either admit the error: “Yes, we were following detailed pandemic plans set out by scientists with world-leading credentials in this area, but although this was also the case in other countries we now realise that in some of the detail those plans led to errors, for which we apologise and from which we intend to learn“; or they can, well, lie: “No, but really we were protecting care homes, and we never pushed people into them, and really no one could have foreseen all of this and it was all just a bit of bad luck“.

If they were to go for the former, the public would probably be quite understanding. The policy was well intentioned and well researched – it just turns out the research was skewed to the wrong type of virus.

However, just lying about it is callous and destructive. It shows an inability to accept responsibility and to learn from fundamental errors. No one is expecting any government to manage a crisis of this scale without making mistakes; but people do expect them to be honest about them in order to learn from them. The Government needs to learn, fast, that this is not an unreasonable expectation.

Coronavirus – Guernsey leads the way

Another peculiarity of some of the reporting around the new coronavirus has been the seeming unwillingness to learn from elsewhere – even if “elsewhere” is nearby British sovereign territory!

Guernsey’s response to the new coronavirus seemed exemplary from the outset. As swiftly as possible, testing capacity was developed on the island itself; contact tracing was maintained at all times with the intention of eliminating if not eradicating the virus from the island; after the peak of infections a 14-day obligatory quarantine was introduced for people entering the bailiwick; and a clear six-step plan out of lockdown was published at around the same time as Ireland’s and long before any UK jurisdiction’s. Media briefings were provided by the Chief Medical Officer primarily, rather than leading politicians, but the political decisions were still ultimately left to the latter.

Guernsey, like Jersey and the Isle of Man, is a “crown dependency”. This means it is self-governing but enjoys free movement of people (though not workers) and shared defence with the UK, and the UK Parliament retains ultimate (but extremely rarely used) legislative authority. There is a degree of reliance for complex healthcare and higher education on the UK and areas such as broadcasting, post and currency also remain aligned (but, unlike in “devolved nations”, areas such as telecoms, welfare and taxation do not). People native to Guernsey with parents also native to Guernsey are UK citizens but their passport is “endorsed”, restricting freedom of movement to work in other European countries that UK citizens may (or soon may not) enjoy.

The island, which I last visited this time last year, is not always so well governed. It is in the midst of a chaotic process of trying to merge schools, it has had to delay its election which was due to take place with a crazy electoral system (requiring each islander to mark 38 but no more than 38 of over 100 candidates on a single ballot paper), and its equality laws are outrageously backward – indeed married women still technically have to seek their husband’s approval before filing their own tax returns…

However, its response to the new coronavirus has been marked by a calm and reassuring assessment of the facts and a commitment to doing simple things well; this is in contrast to neighbouring Jersey, which went all out for a Nightingale hospital and England-style mitigation rather than elimination.

As a result, Guernsey has had no new cases at all since early May and is now re-opening up quickly; Step 3 of the 6 is proceeding ahead of schedule – people may socialise, get take-outs, go to work and primary schools will re-open part-time from early June. It has not been easy – even post offices were closed and some food supplies were threatened – but few on the island would doubt now that it has been worth it.

An interesting side point is that, contrary to the ITV report linked below, Guernsey no longer formally has a “Chief Minister”. It is governed more like a local council, with a series of Committees whose “Presidents” combine the role of “Chair” and “Minister”. The President of Policy and Resources is regarded as “primus inter pares” among Presidents and is thus often referred to as “Chief Minister”, but the position does not technically exist.

I proposed on this blog some time ago that Northern Ireland could, equally, manage without a “First Minister” or “deputy First Minister”. Its Executive Committee could have a rotating Chair who would perform any relevant external functions, but otherwise government would be by consensus working with Committees.

A thought, anyway…

Clearly a small island with a population about the same as Bangor is not in the same position as England, with close to a thousand times the population, or even as Northern Ireland. However, there are surely things we could learn:

  • dedicated testing and tracing can marginalise and ultimately eradicate the virus from a territory;
  • self-government is about making decisions which suit your own jurisdiction, not just copying others;
  • keeping people within a defined geographical area enables the re-opening of that geographical area – but just allowing people in and out does not;
  • clarity in communication – both in terms of the steps you are taking to tackle the virus and the steps you are taking to emerge from lockdown – is essential; and
  • an informed population and a bit of community spirit can go a long way.

In every walk of life, there seems a peculiar determination to report on where things have gone wrong but only to report where they have gone right from afar. There is a successful outcome right on our door step. Maybe we should, you know, stay alert to how it controlled the virus…?!

Indeed, Guernsey may even be the location to complete the Premier League season

Coronavirus – blog review

I thought it worthwhile to summarise some of the points made on this blog so far with regard to the new Coronavirus.

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 home, save lives.

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. 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.

“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.

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.

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.

Where does all of this end? 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.

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 – 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

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: UK Government drifts from embarrassment to farce

The reason there are so many conspiracies around the Kennedy assassination is that people cannot get their heads around the idea that some random loner shot dead the President of the United States. The very notion makes us feel insecure and fearful. So we choose not to believe it – at least if there is a conspiracy, we can imagine someone was in control and we do not need to fear that such things can happen entirely at random. Yet the fact still remains that they do happen at random, and indeed that Kennedy was shot by a random loner.

Likewise, people cannot get their heads around the idea that at a time of huge crisis the UK Government consists of a bunch of complete incompetents. This also, even if we don’t like Tories very much, makes us feel insecure and fearful. So we invent things. It actually makes us feel more secure that they are evil geniuses intentionally trying to get rid of old people, than it does to confront the reality that they are just simply useless and do not know what they are doing. Yet the fact still remains that the UK Government consists almost entirely of useless incompetents, not least its Leader.

The simple fact is that Boris Johnson has not the first clue what he is dealing with. In a 13-minute “address to the nation” (which ended up being recorded in chunks over two days) he did nothing but bumble idiotically because he had no idea what he was talking about. He talks cluelessly in Parliament about the virus being in the “water supply” when it is actually airborne. He can deal only in slogans, not detail. He fundamentally has no idea what he is doing and the fact that he is a convalescent from the disease itself, and is clearly not fully recovered, only makes matters worse.

His colleagues are little better. The result is that the UK ends up with someone on television trying to explain why in England as of now your cleaner can visit your home but your significant other cannot, or with someone at a media briefing arguing that it is reasonable to visit a house and enter every room with a stranger to view it for potential purchase but not to enter just one room to see your own mother. If this seems idiotic it is because, simply, it is idiotic.

Just as one example of how dangerous it is, we have the additional idiocy that people in England can now travel anywhere when the one thing that is certain about managing the virus through lockdown is you do not want people moving around too much. The whole point, for example, of the Korean approach is that you are able to identify quickly if there is a problem in a particular neighbourhood. If people are moving around too much (and you have no apps because, you know, that doesn’t seem to have happened…), you are going to find that a lot more difficult. And yet somehow, while people still cannot meet neighbours for a barbecue, they are allowed to drive from Newcastle to Cornwall or from Norfolk to the Lake District and go to an enclosed garden centre when they get there.

It is demonstrable that the UK Government’s response was the worst of any large European country’s during this pandemic simply from looking at excess deaths by region. Whereas other countries may have suffered higher excess mortality because a particular region was hit so hard that its health system collapsed (but then managed to stop infections from spreading quickly elsewhere in the country), in England every single region bar one has seen excess mortality more than 50% above average. The country is particularly densely populated but faster action even simply to stop people travelling about widely would have seen spread contained largely to the London area and some other hotspots – yet the first step out of lockdown, incredibly, is to allow people to travel around again. It’s sheer lunacy.

It is essential, therefore, that we do not try to over-complicate what is going on here. There is no evil mastermind behind all of this. The UK (and particularly England, as it happens) is just being led currently by a bunch of political ideologues who, when it comes to the business of government, are utterly clueless. We are experiencing farce and embarrassment because they are farcical and embarrassing. The result is sheer idiocy because the government consists of idiots.

Even though this is quite scary, we must avoid conspiracy or complication about it – not least because, especially now we have a proper Opposition, we need to get the current incumbents out as soon as possible.