British lock down

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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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Covid-19 “Another day another $300bn.”

The Chancellors announcement of a £300bn support package for business to address the impact of the Corona Virus epidemic should ring loud alarm bells. When this is presented as a starter for ten then you know we are in trouble. A Tory government, lately of austerity fame, has discovered the money tree, in fact has found a forest of them.

There are two things that make the current situation stand out. Firstly, daily briefings from the PM setting out the state of play with the spread of the virus and the actions the government is taking to address its health, social and economic consequences.

Secondly, the scale of resources being talked about which, outside of war time, are unprecedented.

Given all this it seems strange that the government seems loath to move from an exhortatory strategy of mitigation, please do not go to the pub, to a much more aggressive strategy of suppression by shutting the pubs. At the moment there seems to be a dissonance between on the one hand the rhetoric about the seriousness of the situation and  importance of social distancing actions and on the other hand the advisory nature of the steps to achieve the appropriate social distancing.

In the PM’s press conference yesterday the public were thanked for the way they were following the advice. Perhaps if your only experience is the drive from 10 Downing Street to Parliament you may be impressed by how quiet the Capital is. However, you do not have to go far to see reduced but brisk trade in bars, pubs and restaurants.

Maybe there is some legal impediment to his issuing closure notices to Britains hospitality industry. Maybe that will be corrected next week when the Corona Virus Bill is enacted. This contains a whole range of enabling powers to: allow the health work force to be expanded; the effective management of the disposal of bodies; and the power to regulate the access to premises.

Given the speed of the current virus, if there was ever a case for acting now and legislating later this is it. Or indeed, getting Parliament to sit over the weekend to put the legislation in place if that is what is needed.The legislation could have a 6 month sunset clause to enable Parliament to review, amend and improve in the light of experience. Days matter.

My concern on this is driven partly, but far from wholly, by the article I referenced in my last post on this by Tomas Pueyo entitled: “Coronavirus: why you must act now“. It made a strong argument for urgent action.  Mr Pueyo has written a follow up article, (Coronavirus The hammer and the Dance) on the importance of early adoption of an aggressive suppression strategy as opposed to a mitigation strategy.

Ordinarily CEO’s of $billion businesses are not my favourite source of information. However, the logic of Mr Pueyo’s argument seems reasonable and the numbers he quotes are consistent with information from other public sources. Further, his logic is certainly no weaker than that which says – it is vitally important that you don’t go to pubs, but we are not going to force them to close. The latter message undermines the former.

Whilst Mr Pueyo’s articles are at best sobering the latter one provides some hope about the period of social isolation we might face.

If these articles are wrong in their estimation of what strategy the government needs to be pursuing and when, they at least provide a framework of questions which seem to me to be very relevant. If you are interested in a very accessible introduction to the epidemiological issues around Corona Virus,  then these articles are the best I have seen so far.

But, to be clear, my concern about the current situation is not based on a single article however well illustrated with graphs. In the past we have heard about Ebola, SARS and MERS as things that happen over there, to other people, far away. This is here and now. We can see what it has done to those that have gone before us. Italy is a peacetime war zone with the health system all but overwhelmed. What all the experience to date points to is the urgency of action and the cost of delay.

We are told we are about three weeks behind Italy and that we have a finely graduated response which will minimise the impact on our social end economic lives. I am sure there are some very clever people looking at this with some very sophisticated models. However, if ever there was a time for the adoption of the precautionary principle this is it.

The advisory position at the moment is logically lockdown. Businesses are closing left, right and centre. Serious economic damage has been done. But lock down is not complete. People think if the pub is open why can’t I go?

If lock down would get us on top of this virus why would we not enforce it now. If, they manage to calibrate the perfect flight path we may save some economic and social dislocation and some lives. If they act too early it could cost us more social and economic dislocation. but save more lives. If they are just too late, the consequences are much worse. The economic and social loss will be greater than either of the two other options. But, more critically, we will face an overwhelmed NHS, thousands of deaths and scenes which will live with people for the rest of their lives. 

I think I am in the camp of those who feel the government needs to act now to aggressively suppress the virus with all that goes with that.

Be Safe.