Sometimes an issue arises to which there is no obvious answer. The usual appraisal of risk cannot apply because those risks cannot be quantified. There is instead only uncertainty, which means a decision has to be taken on the basis of judgement alone.
As the FT reports this morning, one such question relates to when to end the lockdown. As they nite:
Boris Johnson is facing a split at the top of his cabinet over the speed with which Britain exits its coronavirus lockdown, while also confronting claims he was “missing in action” when the crisis first hit.
They add:
The prime minister, recovering from Covid-19 at Chequers, faces a big test when he returns to work in deciding whether the economy can start to reopen before the virus has been completely suppressed.
Michael Gove, cabinet office minister, and Rishi Sunak, chancellor, are among those arguing for a swifter reopening, while Matt Hancock, health secretary, wants to crush the virus before the lockdown is eased.
So what is the right choice? And what are the decision criteria?
The US right-wing think that each person has their own right to choose to lockdown.
Some governments have been considerably harsher than the UK.
But everywhere, sometime lockdown will end.
However, the question remains, what are the trade-offs?
How many deaths will we accept?
Would they happen whether we lockdown or not?
Is lockdown just about keeping death rates within manageable limits at a point of time rather than stopping them?
And what is the price of that?
What then should that happen given what we know, which includes the fact that we do not know when, or if, we will get a vaccine.
And we do not know if people can be reinfected with Covid -19 with any certainty.
And that we do not know what the current reinfection rate is, but know that unless it is less than 1 the best we can hope for is continuing infection at the current rate until herd immunity is finally created.
We do know that the elderly are especially vulnerable to this disease.
We do know that the economic cost of the economy being closed is very high.
We do know that lockdown conditions cannot be maintained forever: however willing people are now, that cannot survive for good.
So what are the conditions for easing lockdown? And what are the trigger points? The government has to face this decision and will, whatever happens, in this case get it wrong in part, for which they will not on this occasion be wholly to blame: we would all make errors in this situation. Any thoughts?
My view is that gradual easing will be necessary to maintain social order sometime soon and that the death rate is, anyway, going to be much higher than almost anyone now talks about, come what may in this and other countries: but that does not mean we can stop taking the issue seriously. Partial lockdowns are going to be here for a considerable time to come, I suspect, with recurring fuller episodes lasting weeks at a time, because the mayhem of massive death rates that might otherwise occur are at present unimaginable within our society.
But it's just one opinion. I am genuinely interested in those others here have.
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Conditions should be:
1) Maintain distancing protocol in public.
2) Issue PPE to all hospitals/care homes / shop workers /public sector workers (free face or low cost masks in particular to the public where possible).
3) A regime of national local testing, selecting those who need to isolate. Maybe focus on public sector workers first.
4) A selective re-introduction of some business but avoiding those where people congregate indoors for social reasons.
5) Increase the ways and means Government financial help can be delivered – it must be continuously appraised and improved as the lock down goes on.
6) No austerity when its over or else.
Regarding your point 2, facemasks have to be the most important. I am sure I have seen information suggesting they are at least as good, if not better, than social distancing. Surely, before any lockdown can be eased, the wearing of facemasks in public, has to be mandatory. This could be enforced in places of work, much like people who are ill are not allowed to return to work.
But who is making them?
Yes – good point – so we might consider then nationalising an existing provider or at least funding them to provide for whole country – that is if we have a manufacturer at all!
So, the domestic capacity to deliver some of these contingencies needs to considered than as my point No. 7 then.
A factor that should be of prime importance is at what point if at all, does the increased death rate from the lockdown itself and the conditions it causes outweigh the death rate from the virus. There are already extra deaths from people not getting to hospital to be treated for heart attacks and strokes. Add increases from suicide, substance abuse, neglect of the elderly and anything else you can think of. It needs to be taken into account.
Of course
That’s the only figure I am interested in…
The Covid 19 ones are random in the sense that doctors may or may not put it on the death certificate
There’s an interesting perspective at
https://www.spiked-online.com/2020/04/17/theres-no-direct-evidence-that-the-lockdowns-are-working/
WHO has already issued six conditions for lockdown exit;
http://www.europe-solidaire.org/spip.php?article52950
Two decisions that need to be taken soon are the opening of small retail (why are these closed when grocers are open?) and schools (education is essential for the future and mental health of the community). Obviously as HMG still has no mechanism to understand local conditions (AND STILL has no intention of doing so), a continuation of blanket bans is probably inevitable. So frustrating.
I think small retail is easy to imagine happening
But schools? Why, when that is likely to lead directly to granny being infected?
Unfortunately, I believe that one of the main reasons for lifting the lockdown (in whole or part) will be optics.
Firstly, the optics of comparing to other states. If the EU or US start opening shops and schools then the clamour from the media will follow pretty quickly as we have already partly seen in respect of Denmark’s schools.
Secondly, the optics of not doing something. The Government has appeared to have been fairly reactive throughout the pandemic such as asking people to stay at home a week after many services firms were already working from home or saying clothing shops should close after many already had. But as more ‘essential’ shops and restaurants start to open up again (such as KFC, Decathlon and B&Q now opening some shops or the Hyundai car plant) then an argument will be that businesses can put fail safes in place to reduce the potential transmission of the virus.
Lastly, the optics of a fresh start. Summer starts on 20 June, 10 days before the end of the revised furlough period and roughly 3 months after initial lockdown. It would be easy to imagine this date being pencilled in as a day to lift the measures we have in place.
“The usual appraisal of risk cannot apply because those risks cannot be quantified.”
I don’t accept this. Risks can always be quantified. The Schedule Risk Analysis (SRA) may be using parameters so wide, for example a 10% chance that life can return to normal in a couple of months’ time, and a 90% chance it will take ten years, that the answer is very scary, but that is exactly the point. Government by arts graduates was always going to struggle with this. It is not just that they do not know the answer, I suspect they do not understand the process. All of the questions in the article have an answer, for example the range of acceptable deaths and the percentage chance of that number being accepted. I accept that there is no plan to get us out of this, we are still populating the risk register. Then we need to understand how that maps to the SRA, then we have a plan. All of this is ether being done in secret, or as I suspect, not being done at all. I thought Project Brexit was the ultimate in Project Management disasters, I didn’t take into consideration that Project Management incompetence could lead to thousands of unnecessary deaths. I am so angry about this.
I should have said uncertainties
You know there are such things?
A balance of probabilities cannot be applied?
Yes, you should have said “uncertainty”!!, but unless you are immersed in the world of risk management a Risk Event and the general level of Uncertainty are terms which get easily interchanged when they apply to quite different things.
We are not facing a Risk Event. It happened. What we have is a large number of uncertainties. Applying a “balance of probabilities” is precisely (sic) what it is about. No matter how wide a range of minimum and maximum probability values each uncertainty has.
We can, and should quantify the uncertainty. This can, and should be explained to everyone.
Uncertainty can’t be quantified
Only risk can be
That was the lesson of 2008, appreciated by Adair Turner in 2009 and forgotten again by 2010, now to be recalled
The metrics being tracked and reported in some countries that likely matter most:
Deaths
ICU admissions
Hospital admissions
New cases
Nr of tests
The verdict is out on serological tests, but perhaps this will change. We’ll see a split between those who can isolate and those who can’t. The effects will be with us for a long time, possibly for good. One change I can imagine is many of the better off downshifting to tiny homes in rural areas, growing their own food, renouncing foreign holidays, working from home using connectivity and solar power. (See the TinyHouse movement on YouTube). How sustainable that will be is another matter given all the external dependencies that entail sacrifices of others. In any case, a lot of people questioning their assumptions about how we all live (and could live) has to be a good thing.
“… the mayhem of massive death rates that might otherwise occur are at present unimaginable within our society.”
You may have unwittingly (?) hit upon a truth there…… it may come down to be a question of what death rates we can imagine and accept. We accept what ought to be unacceptable levels of slaughter on our roads in the interests of convenient travelling.
I for one cannot imagine that we can keep going for the predicted twelve to eighteen months waiting for a vaccine to appear with part of the workforce working and most of it not, and not able to do anything much. Frankly I’m surprised we’ve survived that for this long without major civil disturbances.
I would hope our government is watching very closely what happens elsewhere, as different strategies are trialled. We have the advantage of not being in the vanguard, but we have the disadvantage of a government which seems very resistant to recognising sensible advice. Performance to date has been shambolic and this means that the normal sympathy with which we would treat those making what genuinely IS a difficult decision, has to a large extent been lost. though a recent opinion poll (albeit only from YouGov so it hardly counts) suggests there is widespread approval of the government. If that is so it is a triumph of media manipulation.
I think we will end up with a situation where lock-down is eased and government will do its best to persuade us that the old people are being looked after as well as possible. Many will die because they either cannot continue to be socially isolated at home, or because it will prove impossible not to have the virus sweeping through elderly care centres. In short I think Dominic Cummings will get his (eugenic) cull of old, ill and economically inactive citizens and there will be little we are prepared to do, to prevent that.
We have a moral imperative to look after our elderly and a material interest in not doing so. Ambrose Bierce tells how this usually plays. 🙁
https://www.infoplease.com/primary-sources/fables-fairytales/fantastic-fables/fantastic-fablesby-ambrose-bierce
I know I’m probably going to get snarled at here. The other side of that is civil society. This will destroy our already weak civil society. Things like large social gatherings matter for a sense of commonality. Large intergenerational family meetings for example. Or shared ceremonies (churches will be wiped out by this). Or personal contacts at conferences and the like. Or the work of charity. A sense of shared community, where social commonality comes from, matters. The internet is a poor substitute. If you want to see what the tone of an online civil society is like have a look at twitter.
We can (should) argue about the commercialized nature of civil society – but that civil society still matters.
Now – of course – we are still someway from this. But was well as the economy I don’t think it’s unreasonable to be thinking about civil society too.
You touch on an issue that worries me greatly
The value created in such communities is unrecorded, and enormous
Indeed, for many it is the basis of wellbeing
Thank you. Appreciated.
Civil society has to go on. Indeed at my own church I’ve been very surprised by how many vulnerable people have wanted even now to keep going to church.
Until now I hadn’t quite realised how even quite trivial things matter so much. My wife is in tears at the thought she’ll never meet our daughter at the school gate with her friends. The common experience matters.
My best-guess is that the development of a personal testing device would be very helpful from an economic and social standpoint. Have it like cleaning your teeth twice a day.
All these common social interactions, which people want have been missing from people who are poor and have no money for generations. If you do not have a job you have no status and no money. So your life is mostly alone, no phone calls, no invitations, no friends coming round. Totally alone, the homeless, the disabled, the poor and the elderly. So for them apart from the old, this lock down means nothing has changed. For me it certainly has not. i find it incredibly easy to cope with this lock down.
Until testing at the level of Germany is reached then there should be no major relaxation of lockdown.
A detailed analysis needs to be made for what are essential jobs for survival. For example health and social care, food production/supply, energy, water and sewage, transport, law and order/justice. Only then when these workers have adequate support and protection should the other “normal” commercial activities resume but only at a very limited return rate until medical science is sure about the containment of this deadly virus.
Bill gets my vote.
Germany and Merkel are on top of the situation in the EU and we should be party to that.
The simplest solution.
(That means stuff brexit too!)
PS, i also like the EU coontries plans for dealing with the self employed- a fixed amount no questions , paid immediately;
And no bailout grants for firms and individuals registered in off-shore tax havens;
And a windfall tax on the internet retailers and deliverers who are coining it in like they hit the lode seam!
I too have been thinking about this for some days now (as a distraction from what’s now becoming a bit too much gardening, amongst other things).
First, you’re absolutely correct in acknowledging that this would be a difficult decision for any government – as we’re indeed seeing with France, Spain, Italy, Singapore, etc – and mistakes will be made. That said, we do have to recognise that the government’s prior decisions – or lack of them – now shape and constrain the options open to it, and the risks and costs that come with the adoption of each option. We see this most starkly with reference to testing, where decisions not to test and/or restrict testing made some weeks ago, later combined with what appear to be a shortage of the means to test, lead to a situation where the options being pursued by the German government, for example, are not open to us.
Beyond that I agree entirely with your final paragraph. Lockdown will have to end, otherwise it will fall apart. Indeed, just on the evidence from my immediate neighbourhood it’s obvious that people/households are becoming increasingly ‘creative’ in working around the lockdown. And that applies in particular to younger people and trades people (the latter for perhaps obvious reasons) but also to people with children – again for obvious reasons.
Three other factors also come into play here. First, however much we would wish to deny it the suffering and death caused by Covid-19 is fast becoming the new ‘normal’ and so we gradually become hardened to and accepting of it (i.e. of the ‘costs’).
Second, the lockdown is not without it’s own costs, as you’ve highlighted on your blog for several weeks now. And as is be more and more widely reported, these are not simply economic but are far ranging in both their scale and intensity.
Third, as in the US, an anti-lockdown, libertarian movement on the right is becoming increasingly organised and vocal (see Peter May’s short blog on Progressive Pulse about Toby Young here: http://www.progressivepulse.org/philosophy/policy-based-evidence-making-in-action) and their statements and actions will gain more and more traction as frustration with, and acceptance of, the ‘costs’ of Covid-19 and of the lockdown grows.
So, our government – as with all government across the world – are going to have to make some extremely tough, difficult decisions. These are, by definition, conditioned and shaped by prior decisions about how to prepare for and fight Covid-19. Some of these prior decisions were extremely poor and it’s now obvious we will have to live the consequences for a considerable time in the form of a cycle of lock-downs and lifts and lockdowns and lifts of varying severity. Sadly, that’s our future for the forseeable future.
Thanks Ivan
David Blunkett was on the radio recently, discussing the police approach to social distancing and e.g. people sunbathing. He said that we should always start with ‘what are we trying to achieve, what are the principles?’ then the answers, for the most part, become easier.
In my view the approach has too much command and control about it, rather than harnessing local initiatives.
There has been much inflexibility. We have many labs that can do tests, we have contract manufacturing who can produce (some/more) PPE and then we have a one size fits all approach, so that only e.g. Burberry gets to make gowns. We had spare testing capacity for hospitals but odd rules that only 15% of tests are for staff, whereas a principle based rule/guideline could have eased the flow of testing e.g ‘aim for 15% staff and 85% patients, and increase staff testing where capacity allows’ may well have served us better.
In the military there is an overriding proposition – whoever is the most senior person at any given time, makes a decision. It goes right down to two soldiers sitting in a trench; one of them makes the decision and they follow through. Yes, it does lead to some very poor outcomes, but overall it works incredibly well.
We know that we want the lockdown to be unwound safely and so a much more inclusive approach is required; trusting people to make decisions. Small scale trials in a number of towns and activities would help.
I think we have to assume that a vaccine will not be available for the forseeable and that herd immunity will not happen. That leads to managing work and leisure with continued social distancing.
For shops and takeaways, they can, as far as possible, follow the supermarket model.
Schools will need regular (weekly?) testing of staff
Churches have gone online and that should continue
Care homes are already in dire straits and facilities, equipment and testing need to be massively increased – regardless of the lockdown. Then we need to look at opening up activities for the residents.
Having said all of that, I would give front line medical staff a very big say in the decision process and I would include care staff in that. I would ask for representatives from each of the streams to form a council to agree a process. If those in the firing line have a genuine say in how this is ended, we will have a much better and safer process to ease restrictions.
Hmm. I don’t seem to be able to “reply” to a “reply”
I completely disagree with your idea, Richard, that uncertainty can’t be quantified. We do it all the time. Perhaps I am not defining the terms or the process clearly.
A risk event, is something like a pandemic happening.
Uncertainty is something like how long will it take to drive to work today.
In the base text of your post you say, for example, “we do not know what the current reinfection rate is, but know that unless it is less than 1 the best we can hope for is continuing infection at the current rate until herd immunity is finally created.”
Exactly, so the model iterates a few thousand times with values between, say, .5 and 5.0 with a published distribution, perhaps beta normal, and that uncertainty is now quantified.
Anyway, stay safe. I think we can be certain that our leaders haven’t a clue about risk management.
I am not sure you are reading the context of my argument correctly
Clearly Not!
You start:
“Sometimes an issue arises to which there is no obvious answer. The usual appraisal of risk cannot apply because those risks cannot be quantified. There is instead only uncertainty, which means a decision has to be taken on the basis of judgement alone.”
“Sometimes an issue arises to which there is no obvious answer”
Of course, actually “Sometimes” is quite optimistic.
“The usual appraisal of risk cannot apply because those risks cannot be quantified. ”
I role a dice, I have a one in six chance of getting a specific number. I have quantified the risk precisely.
“There is instead only uncertainty, which means a decision has to be taken on the basis of judgement alone”
I am uncertain how many sides the dice has. I can either give up and guess, aka “judgement” or I can investigate the probability of the number of sides, create a range of probabilities to constrain the guess, and use Monte Carlo methods to come to a range of outcomes. Uncertainty is quantifable, not as a discrete number, but as a range of probabilities.
I accept that we are so short of discrete parameters that P10 and P90 for anything we want to investigate such as number of deaths, economy reopened, collapse of the NHS etc will be much further apart than makes decision making comfortable. But that is not an excuse for failing to measure as best we can. We cannot control what we cannot measure.
Unfortunately, this conversion is academic, that is in the sense of the people-in-charge-don’t-know-what-we-are-talking-about
Non-independence of future events; distinguishing risk and uncertainty. More fundamentally, however, it is important to realize that the assumption that past distribution patterns carry robust inferences for the probability of future patterns is methodologically insecure. It involves applying to the world of social and economic relationships a technique drawn from the world of physics, in which a random sample of a definitively existing universe of possible events is used to determine the probability characteristics which govern future random samples. But it is unclear whether this analogy is valid when applied to economic and social relationships, or whether instead, we need to recognise that we are dealing not with mathematically modellable risk, but with inherent ‘Knightian’ uncertainty.21 This would further reinforce the need for a macro-prudential approach to regulation. But it would also suggest that no system of regulation could ever guard against all risks/uncertainties, and that there may be extreme circumstances in which the backup of risk socialization (e.g. of the sort of government intervention now being put in place) is the optimal and the only defence against system failure.
From http://www.actuaries.org/CTTEES_TFRISKCRISIS/Documents/turner_review.pdf page 45. See also the footnote
1) After massive reduction in cases confirmed over 4-6 weeks, restrictions will be cautiously modified.
2) 3 months of 0 confirmed new cases & almost 0 deaths will be an indication that virus has been eradicated
Life will then resume as ‘normal’
Indeed. With optimistically strongly crossed fingers we seem to have reached a plateau, and we might hope that the cases will decline over the next three weeks or so. At that point, initially limited and then gradually increasing reductions in social distancing might be in order, to try to get back somewhere closer to normal while managing R0 at some point below 1.
So, for example, permitting people to travel, to visit parks and other open-air public places without an excuse such as exercise, to return to work, and reopening of non-essential shops, all while wearing face masks for example. We will have examples such as Germany to show how that might work. And then, if cases stay low three weeks later, we might move to schools going back. We will want to avoid it, but if cases spike, we might close down again for a month or two…
Beats me why the government won’t treat us like adults and explain this.
I was once told the only two things we could be certain of is tax and deaths. Well, we can’t even get the death count right, so I personally am with Hancock on this one. The risk of opening the Economy to early is unknown as R0 has to below 0.2.
We cannot have another episode, because that as you have previously blogged will kill more companies than people. And as we know those who do not learn from history tend to repeat it, repeat it, repeat it…
Half facetiously I think the lockdown should remain until:
1. Our government tells us what the economy is for
2. And where money comes from
3. Why our current diet is allowed to be promoted by corporate food when it greatly assists NHS morbidity and probably mortality: https://www.europeanscientist.com/en/article-of-the-week/covid-19-and-the-elephant-in-the-room/
4. Doing what it takes is not the same as we cannot protect everyone – which is it?
On 23rd March lockdown started
Number of new cases in UK on 23rd March was 967…
Surely we would have to have very good reasons if we lifted the lockdown before the numbers drop well below that?
If the numbers were properly stated
But they aren’t….
New Zealand is on track to eradicate the virus. As their PM said today, this does not mean no cases. It means ongoing widespread surveillance testing (they have already started 1000 tests in a high risk tourist area of South Island produced no positives), and aggressive and fast isolation and contact tracing and isolation when a case is detected. Plus I imagine testing/quarantine for any arrivals once they are allowed. Too late for the U.K. to adopt this, but parts of Australia (Tasmania, South Australia and Western Australia) are attempting the same, and perhaps all of Australia might achieve it. Even Melbourne where I am. Norway might manage this too. The world is going to be divided into countries/regions that are free of it, and those that aren’t. Until a vaccine.
Lockdown should be lifted once I have got all the jobs in the house and garden completed.
More seriously, whatever the exit process there needs to be some consensus. The government has failed to be honest with us on many things related to this crisis…. and then had to back-pedal hard. It would be nice if there were an adult debate but there won’t be; discussion and doubt is seen as weakness by both government and media.
Wouldn’t it be fantastic if Matt Hancock left a reply on the blog? He won’t but until that mindset changes we will be burdened with poor decisions.
As in S Korea, New Zealand, China etc, deaths and infection rates have to be suppressed to a minimum – <10, <1000 per day to afford a realistic chance of keeping them down through testing, tracing and isolating .
But:
– that aim could be compromised – our 'lockdown' is not rigorous (infection spreading among non essential workers still working, overcrowded neighbourhoods, care homes etc).
– no sign that government is gearing up for this – no obvious drive to recruit contact traces etc.
Jonathan Portes(below) points out .. suppressing the virus completely is the best way of minimizing economic damage, rather than ducking and diving in an on-off locking down policy over a year or more.
https://drive.google.com/file/d/1HZwRzf6PcNwaHUtqxOep7UEV-RoqIT5U/view?usp=sharing
https://drive.google.com/file/d/1gaVwqDAHwhMzvq6GW45hahc6Ky7gIj8F/view?usp=sharing
He is right