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Following the Science

On 3 March 2020 one of the Scientific Advisory Group on Emergencies’ (SAGE) sub-groups said the government should be advising the public to avoid shaking hands. On the very same day Boris Johnson told a press conference that he was still shaking everyones hand.

One might say, in the face of an epidemic, the like of which the world has not seen for 100 years, this was an initial failure to get to grips with the seriousness of the issue and the epidemiological science around how to respond.

To be fair the early advice from SAGE and others was not as definitive as sometimes supposed. A Special Report by Reuters in April 2020 provides a more nuanced picture of the evolving scientific consensus. It indicates even the scientists struggled to keep pace with the disease.

It was not until Italy had locked down, our TV screens were full of Italian hospitals being overwhelmed and an Imperial College report projected 500k deaths that the Prime Minister said we “must” stay at home and certain businesses “must” close, instituting the first lock down.

We then had nightly press conferences at which the government would always state they were “following the science” and therefore “doing the right thing at the right time”. It was so obviously a mantra with a covert message-management role attempting to push responsibility for actions limiting the freedom and economic activity of the nation, unprecedented outside of war time, onto scientists. Providing cover against the natural concerns of the public and also the concerns of their own back benchers.

It was disingenuous and over time the emptiness of the mantra became plain. The issue of face masks was one where the science seemed to follow availability logistics. Instead of saying there were not enough masks for everyone the message was that the masks were useless, in fact more likely to cause infection, and anyway we needed them all for the frontline staff. Ignoring the inherent contradictions in the messaging its duplicty became apparent as availability increased and masks became increasingly compulsory.

We will not have a real understanding of the culpabilities and mistakes made by government and others until long after the epidemic has run its course. However, there is one simple critique of the “following the science mantra” which can be made in principle. Government’s job is to lead not follow.

Government needs to take account of the science in relation to health, but it needs to combine and balance that with an assessment of the economic consequences of actions to limit the virus and also on the likely impact and response of the general population to calls for severe limits to their freedoms.

As the economic consequences of the lock down began to become clearer the mantra about following the science started to be challenged by back benchers and qualified by ministers. Growing concerns about the impact on the national economy led to arguments being made that the cure was worse than the disease.

The need to open up was argued in order to: save jobs; prevent young people from having their education permanently damaged; improve mental health; and enable hospitals to deal with those with life threatening diseases that had been pushed back in order to deal with Covid-19 patients. Clearly there is real strength in all of these points.

So we opened up, schools, universities, shops and hospitality. As predicted this led to an increase in infection rates. A more sophisticated response was designed to deal with the problem. A “world class” track and trace system combined with a geographic, locally tailored but nationally determined, tiered response was to enable us to simultaneously keep the economy going and control the virus.

It appears the scientific community have a much clearer appreciation of the nature of the threat the virus now poses. They have far fewer reservations about models which predict much worse outcomes. What is more they have experience that the modelling so far has tended to underestimate the virulence and impact of the virus.

From a lay persons perspective the constant increase in infection rates and hospitalisations always looked as if there could only be one outcome. A second lock down. It looks as though that is what is going to be announced imminently. It also looks as if the government are following the science once more but again they are behind the pace, and days matter.

There are strong voices now arguing government needs to give due weight to all the other considerations around the economy, education etc. However, what they do not seem to be taking account of is the synchronisation of the pandemic.

The first wave seemed to roll across Europe sequentially, this time the wave seems to be occurring in parallel across the continent. what is more the second wave is starting from a higher level of infection. If twenty people are infected and the numbers of infection double every 7 days it is one thing. If one hundred thousand people are infected doubling every 7 days it is another matter altogether.

If the disease gets away from us, and it looks like it might if we continue as we are, the hospitals will be overwhelmed. It will not matter whether you have Covid-19 or cancer you will not be able to get treatment.

According to the CIPD more than 30% of the UK workforce are over 50, many others will have underlying health issues. If hospitals are inundated will they be willing to go to work? Will they go out shopping for anything other than essentials.

The idea that we can beat the virus without severe economic pain is unrealistic. We either proactively accept the pain in another lockdown which will help save lives and control the spread, or we try sophisticated tiers of action which will lead to more deaths and ultimately the same economic pain.

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On Tyranny. “…it could never happen here?”

This is a book you can read in a morning and is well worth the time. First published in 2017 it is shot through with real concern and a sense of urgency following early experiences of the Trump campaign and presidency.

The book, written by Timothy Snyder, Housum Professor of History at Yale, looks at the tyrannies of the 20th Century, particularly Hitlers Fascism and Stalin’s soviet communism. It identifies a set of behaviours to be avoided or adopted to oppose tyrants. These are set in a theory of history which see it as being made as much through the voluntary actions of the many as what appear to be the irresistible impositions of a few. And a theory of democracy which sees it as something to be tended and nurtured regularly. A key part citizenship is a responsibility to actively engage in that process.

His concerns about the behaviours of Trump which parallel those of tyrants of the 20th and 21st century have only become clearer in the period since the book was written. The attacks on the judiciary and the media; the rejection of truth; the characterisation of political opponents as extremists or enemies of the people; the use of the state apparatus to persecute critics; the demands for personal loyalty over professional integrity. The parallels with nazi Germany, the Soviet union and more recent political strongmen are truly frightening.

The book is a demand we learn from history and as citizens identify ways in which individually and collectively, in our day to day behaviour and in organised actions, we can oppose the threat which Trump is seen as posing.

The strategies include things which stated alone seem blindingly obvious, like “believe in truth”; “defend institutions”; “remember professional ethics”. Five years ago, as advice to a mature democracy, they would have appeared as simplistic truisms. It is interesting how, with four years of a Trump presidency, they take on a much more powerful relevance.

A key message of the book is that, as Professor Snyder puts it, “Most of the power of authoritarianism is freely given.” He warns against “anticipatory obedience”. This is where an aspirant tyrant starts to fly policy kites and waits to see if people start to adopt behaviours ahead of any specific action. If this occurs the tyrant is emboldened to go further.

The book outlines how this type of behaviour sealed the fate of Austrian Jews. How Hitler only had to threaten annexation of Austria to secure violent discrimination against Jews by Austrian nazis. This experience of anticipatory obedience taught the nazi leadership a lesson which added confidence to their organising of Kristallnacht.

On Tyranny provides a challenging frame to assess the Trump presidency. The author’s passion is clearly driven by his deep understanding of the holocaust. Particularly the recognition that the acts of omission by the many contributed to the horror as well as the acts of commission by the minority. In addition to the passion and urgency a real sense of fear pervades the writing.

At the time it was written I think the fear was well founded. As we approach the 2020 election I now have more hope. Although the awfulness of Trump was apparent his incompetence was still being revealed. An incompetence which extends not just to the governance of the nation but to his own affairs and long term best interest.

Two years down the track and it is clear he does not just lie to others he lies to himself. What is more, the self deception only gets worse as the reality and his mental picture of reality diverge. Whilst there is still significant risk with voter suppression; calls to his solid base of armed supporters to go poll watching; attempts to discredit the result and refusal to confirm he will accept it; packing the Supreme and federal court system to facilitate future legal challenge, there is a growing sense that American democracy is going to fight back.

The polls show not just a Biden lead but the potential for a blue wave to crash across the capitol taking both houses of Congress. It is no less than the pliant Republican poodles deserve. They are up to their necks in the outrageous behaviour of their president, whatever distance they are now trying to put between themselves hand him.

One institution, more than any other provides comfort that a Trump coup is unlikely to succeed. If you want to lead a coup make sure the armed forces are on your side. Two hundred and fifty years of civilian government has embedded a culture of military compliance with civilian authority. Further, you do not gain the support of people that risk their lives for their country by denigrating their sacrifice.

Professor Snyder’s worries about tyranny, may not come to fruition in the person of Donald Trump. Democracy may consign him to an ignoble chapter in the history of US presidents. However, no one should underestimate the stress US democracy has experienced over the past four years or its impact on the body politic.

Even if President Trump is voted out America has much to do to repair and strengthen its democratic systems and procedures but most important its democratic values. It remains to be seen whether Joe Biden is up to the job.

On Tyranny provides something of a yard stick to measure the damage that has been done. What it shows, across all parts of US governmental institutions, is that what was unthinkable 5 years ago has become commonplace. It would be a brave person, following the Trump presidency who could say “it could never happen here.” It is up to the American people to make sure it never does.

On Tyranny. Prof. Timothy Snyder.The Bodley Head. 2017

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A $52,112 Air Ambulance Ride: Coronavirus Patients Battle Surprise Bills – The New York Times

A $52,112 Air Ambulance Ride: Coronavirus Patients Battle Surprise BillsCongress was close to a solution before getting hit with millions of dollars of ads from private-equity firms. Then the pandemic struck.Air ambulance charges are often the most costly type of surprise medical bills.

An intubated coronavirus patient was declining rapidly when doctors decided to airlift her to a hospital with better critical care resources.“It’s life or death,” the family of the 60-year-old woman recalled being told when it happened in April. “We have to transfer her now.”The patient was flown by helicopter from one Philadelphia hospital to another 20 miles away. She spent six weeks at the new hospital and survived.

When she came home, a letter arrived: The air ambulance company said she owed $52,112 for the trip.Last year, Congress abandoned its attempt to prevent surprise bills like this one, and coronavirus patients are now paying the price. Bills submitted to The New York Times show that patients often face surprise charges from out-of-network doctors, ambulances and medical laboratories they did not pick or even realize were involved in their care.

 

Northern Comment  – This kind of “surprise” was going to be stopped by legislation in Congress. At the 11th hour the legislation, which would have capped fees for certain serviced like air ambulances, fell as private equity firms mounted a massive campaign to spike the legislation. They then invested millions in things like air ambulances given their was no cap on what they could charge a customer who was desperate or unconscious or both.

Excesses like this will only promote support for a single payer provider.People will see that some thing like the NHS is not the first step toward communism, but the first away from rentier capitalism.

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Rates of Change

In September Andrew Bailey, one of the Governors of the Bank of England, declared that, whilst negative interest rates were in the bank’s tool bag they were not about to push for negative rates in the near future. Yet today the BBC were reporting that the Bank of England has written to banks in the UK asking them their state of preparedness for zero or negative interest rates.

The central banks of other countries, noticeably Switzerland Denmark and Japan have experimented with this approach. Initially it is about the central bank not paying any interest on short term deposits they hold from retail banks. The aim being to encourage the banks to lend more.

At the extreme of course it could lead to a situation where borrowers are paid to borrow and savers are charged for the bank holding their money for them.

Following the 2007/08 financial crisis some very innovative financial engineering has been engaged in by central banks. Plucking the fruits of the money tree they have pumped enormous amounts into national economies through quantitative easing.

The economics profession, stung by criticisms of their failure to foresee or anticipate the credit crunch, have been looking at how they theorise the impact of finance in the economy. Indeed, some have been adopting a more root and branch review of the very foundations of their subject.

In the US and the UK an obsession with fiscal deficits have evaporated in the face of, on the one hand corporate tax hand outs by Trump, and on the liquidity support for locked down industries on the other. Despite huge amounts having pumped into the economies, inflation remains stubbornly low on both sides of the Atlantic and investment rates remain morribund.

It may be the case that ever more innovative financial engineering is required to get economies moving. With mass unemployment, high debt levels and growing uncertainty, aggregate demand may remain flat or indeed fall.

How long before radical options like massive investment programmes in infrastructure (as recently proposed by the IMF), huge new green deal programmes, and basic income guarantees get traction and investment?