It struck me overnight that there us at the heart of this government's policy paradoxical and incoherent choice.
Let's assume there are just three big issues it has to address. They are Covid, Brexit and climate change. Their approach is different in each case, and always wrong.
In the case of Covid the assumption implicit in the so-called road map from Boris Johnson is that it is possible to maintain an equilibrium position with regard to a pandemic. In other words, the belief is that vaccines will let us live with a virus that neither goes away, but does not grow exponentially. It is presumed that R will be 1 and that as a result we will, somehow, settle into an equilibrium that lets us jog along with deaths of 400 or so people a day, which it is believed that the NHS will manage and people will accept.
But this is not how viruses work. They don't reach equilibrium positions. They either die out, because the opportunity for them to reproduce or mutate is denied to them, or they grow. They just don't stagnate. You either eliminate them, or accept the rather ghastly consequences.
The government is not trying to eliminate Covid. Instead it is pretending that we can live with it, aided by a vaccine that will always lag mutations. The result is foredoomed to failure in terms of the management of the disease, because the policy can only likely deliver an R of greater than 1.
And, in terms of the economy, the assumption that there will be a return to normal, implying equilibrium in economic terms has been restored, will see the rapid withdrawal of government support schemes. Economic collapse is likely as a result. Economic equilibrium is itself an absurd concept, but what it has to assume is a return after disruption to the optimal point from which we came. February 202O was not optimal. And almost no one is in the same position that they were then. The result is that equilibrium without support cannot be achieved. The assumptions underpinning next week's budget are almost bound to be wrong as a result.
Then there is Brexit. Officially we are now in a new equilibrium. We have left. The appointment of David Frost to manage post-Brexit relationships with Europe is a sure sign that there will be no change to what has been negotiated; he will not be revisiting his own homework. So we supposedly now know the new rules and must live with them.
But we also know those new rules do not work for a great many reasons. There is tolerance for the idea of confusion in transition. Equally, there is awareness that the impediments that Brexit has created will mean some industries closing, others moving to Europe and significant increased costs for others. The winners are very hard to spot. But in all this government policy is denial. On Brexit there isn't a roadmap to equilibrium. There is instead a pretence that the new state of bliss already exists, barring one or two easily resolved bumps.
But no one is fooled. The official claim is only supported by lies. Those are obvious, blatant and offensive. The government hope is that, like Covid deaths, the economic casualty rate from Brexit will come to be accepted as the new normal, to be tolerated as the status quo. And yet in this case it has still hardly begun. The impact is still sufficiently unknown for any acceptance of anything about Brexit as being normal to be possible. The denial that there is an issue to manage, implicit in government behaviour, that is only maintained by continuing deliberate misinformation, is not a sustainable policy, let alone a strategy at all. It is simply pretence.
That is the approach also taken in the third issue, which is climate change. Here the assumption is that the market will create an equilibrium. The presumption is that rational people who know that the world is in peril will change their behaviour in response to ensure that the catastrophe will be avoided. This, of course, is what standard right wing thinking suggests: the invisible hand will guide us to a solution. But we know this does not work, for two reasons. The first is that we would not be in this state if the market worked, but it does not because it does not price externalities. And second, if the market was going to react we would clearly be seeing signs of that when there is almost no evidence of that happening, at all. So the belief that a market based equilibrium will arise is false.
In all three cases the government is using a bankrupt economic phenomenon, of equilibrium, to drive policy. The approach is different in each case. On Covid there is a false attempt to impose equilibrium that is doomed to failure. On Brexit there is a false pretence that equilibrium already exists. And in the case of climate there appears to be a belief that it will all happen anyway when it is already apparent that it will not.
The net outcome? Poor theory, driving delusional thinking, is resulting in dire management. It's not a good mix.
Thanks for reading this post.
You can share this post on social media of your choice by clicking these icons:
You can subscribe to this blog's daily email here.
And if you would like to support this blog you can, here:
I think you’ve misunderstood what endemic equilibrium looks like with respect to infectious diseases for which there is a vaccine. Measles is a good example as explained by among others Devi Sridhar.
The aim is not living with measles
The aim is eradication
We have not succeeded, but that’s the goal, which his why cases are rare
That us not the aim with Covid, where the aim is to treat it like flu
And that is completely different, as experts point out frequently. I am not nine. But I read those who are.
Smallpox was eliminated globally, so no real reason why Covid should’t face the same fate.
@ Julian,
“Smallpox was eliminated globally, so no real reason why Covid shouldn’t face the same fate.”
These are quite different diseases. The original SARS of 2002 – 2004 was successfully contained because it caused a far more serious illness than the later Sars-Cov-2. This meant that carriers and sufferers were far less likely to be unaware they were carrying the virus and could be easily identified and isolated.
Estimates vary of the number of people in the UK who have been exposed to the Sars-Cov-2 virus. I’ve seen figures of 10% or so which I suspect is very much an underestimate. Testing for antibodies is more difficult as time passes and it is reasonable to assume that if the disease was unnoticed the first time, even the presence of a tiny number of antibodies will make it even less likely to be noticed on a second infection.
So, unless we forcibly imprison everyone, including children, for a month or so, who we even suspect might be carrying the virus the chances of eradicating it are vanishingly small. There are no plans to vaccinate younger people. The virus will happily live inside them and move between them for the foreseeable future.
So,we need to change policy radically
Always the problem with centralised systems. When they get it wrong, both the speed of travel and direction of travel are adversely affected. When senior figures suffer from folie de grandeur, there is no hope for the little people.
I have a lot of regard for your views on many aspects of economics and politics but I think you are quite wrong in your assessment of how we might live with Covid. Many of the things you claim are simply not consistent with our experience. Firstly there are diseases that we live with controlled by vaccination. An example is measles which is endemic in many poorer parts of the world. We have it in the UK but mostly it is managed because there is very little of it around and it is contained by vaccination plus a few unfortunate people who actually catch it. We have influenza which is potentially dangerous. Each year the influenza vaccine is updated to match the most likely varients that we will have to deal with. It’s not perfect and between 5000 and 20,000 people per annum die from it. We are happy to live with that.
No Covid vaccine has proved totally ineffective against any of the varients yet discovered. Those that have reduced efficacy (which means capacity to stop you catching it at all) all appear to eliminate the risk of catching the disease and then putting you in hospital. The varients that looked to be more threatening will no doubt be included in an autumn top up jab that we will be offered along with the flu vaccine, and it may well be included in one shot.
No vaccine is perfect but if our present vaccination programme continues we should see the effects very rapidly. We do not need to be concerned about the second dose yet, and indeed there is very little evidence that the second dose is really essential. We do know that very few people get Covid twice which implies that immunity persists for a long time, probably a good part of the year at least. We can work out how long immunity lasts if we simply ask 10,000 volunteers who have had the jab and measure their antibody level at intervals so we can track whether or not it declines to a worrying degree.
Sadly, I do have to agree with you about the other parts of your post. It is very concerning that Lord Frost, the man who did such a good job of giving us a really rubbish Brexit deal is now in charge of sorting it out. He got it massively wrong first time round I can think it will get any better in the future.
This is pure lunacy
Sorry, it comes into the category called crass
Read independent sage
And realise that if we treated it like measles it would be great – because we seek to eliminate that
But we are treating it like flu, except its impact is vastly worse
And realise too that very few really die of flu; they die of poverty, which is why it is much worse in the U.K. than other countries
As for the second virus comment….
I am so angry at such stupidity that you are banned
Richard,
What you are saying here is dramatically and horribly wrong.
We don’t seek to eliminate measles. Not least because it is essentially impossible to do so. What we do seek to do is immunize people against it. Fortunately it is a Ribovirus, which doesn’t mutate quickly and few subtypes, and only one serotype. We seek to minimize it and control it to practical levels.
This contrast with the flu virus, which certainly can’t be eradicated thanks to how easily it survives outside the body and it’s rapid evolution. You are quite wrong that nobody dies of it though. The WHO estimate 650,000 die of it each year.
You imply that we should try and eliminate COVID. Which also implies that you would be in favour of not lifting lockdowns until there are no more cases, and possibly even want stricter lockdowns. This would have to be done globally to work, which would potentially take many years.
This seems to be foolish in the extreme when vaccines exist, have proven to be effective, and the mortality rates for the disease are still relatively low (around 1%), despite the headline numbers. It would also likely be totally ineffective as like all coronaviruses, it mutates rapidly.
Are you trying to say that until a given disease is totally eradicated, life should not be allowed to return to normal for most people because of the risk that some people catch this disease and for an even smaller number, it proves fatal? Even when this is practically impossible?
By extension, road deaths kill far more people globally (and more young people than anything else) than most diseases (1.35m people a year). Should we eliminate driving as well?
You can’t eradicate all disease and all risk.
What I say here is not dramatically or horribly wrong but what you are saying evidences callous indifference
First I would draw your attention to the comment made by Andrew to George Gordon, earlier on this post. You ignore the risk of total NHS breakdown still, which is very real.
And maybe you are happy with the idea of the 30,000 deaths that are built into the opening up plan, but which probably horribly understate the true number to come this year
If so say so
But also do not accuse me of falsehoods. We do effectively try to eliminate measles, as we do Ebola. We have not succeeded, but we try.
We have not eliminated flu. But recent studies suggest flu is not as such that dangerous now. What kills people is the poverty that creates their inability to deal with flu. That’s very different.
And of course, I know all about risk. But I go back to the comment by Andrew: unless you want the NHS to collapse – and what you suggest guarantees it will, guaranteeing many more deaths way beyond the number created by Covid, your plan is dangerous. If you want that collapse then instead you are dangerous.
You are suggesting death run riot. I do not agree that is a price worth paying. Remember this disease is likely to have a mortality rate of at least 1%. That’s more than half a million more you are happy to let die – and miserable deaths in an NHS wholly unable to cope.
I despair that humans can be so indifferent.
What I am saying is not callous or indifferent, but pragmatic and realistic. You can’t prevent all infections and all deaths, no matter the cause.
Moreover, when you factor in the deaths likely to be caused by the lockdown itself, in terms of missed treatments for other diseases, the increase in mental health issues and the increase in poverty as people lose their jobs (which has been shown to have a direct link with mortality) I would argue that our analysis is superficial and hasn’t at all taken into account the costs of lockdown on health and wellbeing.
You talk as if all deaths are preventable when simply, they are not. You claim 30,000 deaths are built into the opening up plan, as if these would all be preventable by keeping the economy locked down. But you fail to calculate how many lives opening up the economy will save.
You are also totally wrong about measles and ebola. There is no plan to actively try and eradicate it. Cases are so low in vaccinated populations that it simply isn’t practical. Ebola, unfortunately, tends to eradicate itself thanks to it’s virology. But given outbreaks start when transmitted from wild animals, unless you have a plan to vaccinate them as well, controlling it is the best achievable.
You are also totally wrong about the flu. The mortality rate is not dramatically lower than COVID (normally quoted around 0.5%). It has a high annual global death toll. Even in the UK, with a vaccinated population, approximately 20,000 people die of it every year. That is not to mention SARS, H1N1 etc which still have outbreaks every year. Are you suggesting we lock down the economy again every time there is an outbreak of the flu?
You say that you know about risk, but then are arguing for perpetual lockdown globally until COVID is eradicated. Regardless of NHS capacity, which you have just brought into the argument. With COVID cases and hospitalizations falling dramatically, this isn’t a reason to keep the UK in lockdown. At the moment NHS bed occupancy rates are actually lower than normal for this time of year. The NHS is coping, and the situation is getting easier and better as vaccines are rolled out.
I am not suggesting death run riot, which I think is nothing more than rhetorical flourish from you. Nor do I know where you have plucked this figure of 500,000 extra deaths from COVID you are claiming. I’m guessing you don’t know how mortality statistics work and have just taken the population and multiplied by 1%. But you seem to think the only solution is to have an indefinite lockdown. Which in itself is likely to cost more lives, let alone the fact that eradicating a virus of this nature is practically impossible and would probably require decades.
So let me ask you a simple question: When should lockdown be ended because of COVID?
Independent Sage members have addressed all the points you have raised and show your arguments to be wrong
When do we reopen? When the NHS can manage us doing so
Can it now? No. So we can’t.
And when we do it will need to be very much slower than the government suggests
What is being planned is a nightmare
You are, quite simply wrong.
Please don’t waste my time again. I have no time for the Great Barrington crowd
Independent Sage recently produced a report about the path out of lockdown.
They suggest that the economy should only be re-opened fully when cases number less than 10 per 100k.
There is a good chance this will never be reached if you consider things like SARS and H1N1 (which were far more dangerous in terms of mortality statistics).
So is your solution simply never to re-open the economy again?
Unless of course the disease is eradicated. Do you know how many diseases we have eradicated over the course of human history?
One has been eradicated
Many are effectively contained
And we are nit trying to do that
And your wish is that many people die
Now, very politely, peddle your ghastly opinions elsewhere
You say death certificates rarely give flu as the cause of death. This in itself isn’t true, but you do realize that the opposite is true for COVID?
We are forced to give ICD-10 codes for all deaths, which include all potential underlying conditions. This includes COVID. One code is for identified cases. The other is for unidentified or suspected cases. The guidance also states that anyone having tested for COVID in the last 28 days has that put on the underlying symptoms list – and is therefore recorded as a COVID death in the statistics.
This is over-zealous as it has meant Doctors are not able to use clinical judgement in the same manner we usually do. In my personal experience this has led to a significant number of patients already terminal when admitted catching the virus in hospital and adding to the statistic.
But back to my main point.
You keep changing your story whilst not answering the question. I thought you wanted COVID eradicated before the economy reopens. Now it’s just containment. What does that mean exactly?
What are your criteria for ending lockdown? Please tell us, because at the moment all it looks like you are doing is taking whatever the government suggest and opposing it, regardless of content or fact.
Most importantly, how many extra deaths are you going to cause by extending lockdown from other causes, whilst you remove people’s freedoms and liberties whilst chasing COVID cases down to impossibly low levels?
Are you in some fantasy world where COVID exists and can be treated in isolation?
You are wrong re flu on death certs, as the ONS says
And I am suggesting we follow Independent Sage
If you are a doctor then is it really that hard to work out what that means?
PHE and the ONS have statistics on annual flu deaths. Typically around 20,000 a year, in bad years it can be up to 40,000. Winter 2017/18 was particularly bad from memory.
You say we should follow independent Sage. Who are a self-appointed pressure group, with very distinct political leanings and ties to a particular party. Which gives me reason to question their motives.
But let’s leave that aside for a moment. independent Sage want the economy only to re-open when cases are under 10 per 100,000, amongst other things.
There is a good chance that this is in practical terms impossible. Most diseases as easily communicable as COVID has an underlying baseline case load which is near impossible to totally eliminate.
Are you saying that the economy should stay locked down for potentially years in an effort to reduce cases to an arbitrarily low number?
If so, have you calculated how many excess deaths will be caused by this extended lockdown and compared them to how many lives will be saved from COVID? Independent Sage are notably absent in this analysis.
For example, suicide rates have shot up during lockdown, from around 10 per 100,000 to nearly double that. Yet you seem to want to trade 10 guaranteed deaths via suicide for 10 cases (not deaths) of COVID. Not that you care at all.
It’s easy to pretend a plan is good if you ignore the costs and drawbacks of it – as you are doing.
It’s clear to me that you don’t actually have any knowledge or understanding of the situation and your main aim is to just take cheap shots at the government – who for once have done a good job with the vaccine rollout. Your only interest is in arguing for the opposite of what they do and spreading lies and hate. Your arguments are simplistic, stupid and full of factual inaccuracies, as bad as some of the anti-vaxxer and COVID deniers going around. We really don’t need more people like you and your falsehoods at the moment.
We really don’t need people like me?
That’s a bit strong. What are you recommending?
And if you don’t need people like me, then note I am simply agreeing with Sage and Indepdnent Sage and academic research on flu
You are doing the Great Death Wish of the Great Barrington Declaration
I would suggest I can disagree with you
I would not suggest like you do that I am not needed, which has very sinister overtones, as has all your last paragraph
I published it to reveal that
A policy of eradication does not necessarily lead to eradication. Apart from smallpox, we have not been that successful at completely eradicating infectious diseases, but there is no acceptable level of measles or polio, or any disease that is as infectious and deadly as this coronavirus. The mortality for coronavirus is an order of magnitude or more worse than influenza, and it is probably more infectious too.
I accept, we will relax restrictions eventually, but show me the evidence first, please. I am not willing to take the politicians’ word for it. I want data. Where is the convincing evidence that the vaccines are already working in practice? And what is the prediction for the increase in transmission and so infections, and so illness, long term health impacts, and deaths, if we do what the government proposes. How many thousands of deaths are we willing to bear to get back to pubs and coffee shops and theatres and cinemas?
I accept, in the long term, it is likely that this coronavirus will become a background infection, like the various different viruses that contribute to the common cold; like the coronavirus that is suspected of causing a million deaths in the 1889-91 “Russian flu” pandemic, for example. We are nowhere near that yet. We still have around 10,000 cases a day, and it is still deadly. We’ll know soon enough if that turns a hundred or so deaths in a few weeks.
It may sound like hair splitting, but very few people actually die from just influenza. Many times more die from pneumonia. Here are some numbers. https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/deathsfrominfluenzaandpneumonia20152020
Thanks
And thanks for the link re flu, which is true, per death certificates
Death certificates rarely give flu as a cause of death
The numbers are imputed, but not what medics see
Medics see death caused too often by poverty
I don’t want to get into a discussion of Brexit and I don’t know enough about economics to question you on that subject but Covid is a different matter.
Firstly, a R of 1 does not necessarily mean we “jog along with deaths of 400 or so people a day”. R=1 is simply stating that the infection rate is constant. It can be constant at 1 per day or 100,000 per day or any number you might care to mention. Even zero in mathematical terms.
Secondly, I would also challenge the statement: “They (viruses) either die out, because the opportunity for them to reproduce or mutate is denied to them, or they grow. They just don’t stagnate” We live with lots of different viruses. There has been some recent suggestion that the so-called “Russian flu” of the 1890s was caused by the Coronavirus OC43. OC43 is still around. It hasn’t died out or mutated significantly as far as we know, neither has it grown. Admittedly we don’t know as much as we might like, because, until very recently, no-one paid Coronaviruses much attention. It was just another of those nuisance viruses which caused the common cold. We’ve never bothered to develop a vaccine – but when it first appeared it probably had at least a similar effect on the population as SARS-COV-2 has had recently.
Whatever the cause of the 19th century pandemic, the virus that caused it is still around, just as the strain of flu that caused the later pandemic of 1920 is still around. Examples of viruses, and other pathogens, that have been completely eradicated aren’t that easy to think of after we’ve suggested smallpox and polio. And that’s not even completely true for the latter. It’s still hanging on in a few places.
We aren’t going to eliminate the Covid (SARS-COV-2) virus. It will still be there in the years to come. Vaccines will enable the elderly to live with it in the short term. In the longer term children will be naturally exposed to SARS-COV-2 and build up some natural immunity just as we’ve all built up immunity to OC43 in our younger years. No-one is scared of that any longer.
The problem for countries like Taiwan who have dealt with the problem by sealing their borders will be unsealing them. They can only do that once they have immunised 80% or so of the population. It will probably require a measure of compulsion and even that may not be enough. There won’t have been any build up of natural immunity in the population and they will be totally reliant on the effectiveness of vaccines.
Wow
The Great Barrington crowd are out today
@ Richard,
That’s a rather snidey comment. As it happens I don’t agree with them at all . Prof Gupta, was of the group to which you are referring, made the rather silly suggestion in May last year that “Covid was on its way out” and called for an immediate relaxation in the lockdown rules. When I questioned this publicly I was told she was an Oxford professor and knew much better than me.
However, just because they are at one extreme of the argument, and obviously wrong, it doesn’t mean the correct argument can be found at the other extreme.
I am not at an extreme
I just either to read the evidence from independent Safe and Sage itself
None on independent Sage would agree with you
Few on Sage would
That’s not extreme. That’s rejecting the comments you made as being without evidence
Despite the serious and damaging incompetence and mendacity of this Tory Government – that has led to so many excess deaths, the extent and speed of the roll-out of the vaccination programme is truly remarkable and all involved deserve huge credit. The combination of effective government provisioning and direction, of a functioning national health service providing universal services free at the point of use and of colossal, widespread, well-trained and committed local volunteering has delivered a huge success.
Unfortunately, when it is contrasted with progress in other EU states it has provided a significant post hoc justification for Brexit in the public mind – which, of course, is being advanced and leverage furiously by the government. Tory politicians, being the canny operators most are, know that most voters will not want to relive in their heads the nightmare of the last year. What they will remember is how they got out of it and how quickly they got out of it compared to others. And the Tories will bank and then cash-in this political capital. Unionists in NI will also trumpet it as a life-saving benefit of the Union.
Voters in other countries viewing the contrasts between their experience and those of their counterparts in the UK will severely punish – and deservedly punish – their governing politicians.
In addition, for most Tory voters – and they’re the voters who’ll count for the next decade and longer – Covid has had a very limited impact on them. Most experienced just inconvenience and some constraints on their liberties. Even those affected have no other political home. The Lib Dems and Farage’s new party may snaffle a few disgruntled Tory voters — and some may decide to sit on their hands, but Labour won’t benefit. Covid deaths have impacted on roughly one household in 1,250 and these were disproportionately concentrated among non-Tory voting groups in society. Quite a few Tories view Covid as performing a “culling” that will greatly reduce future health, welfare and social care costs.
On climate change, the Tories can rely on a continuation of the current bipartisan approach. On the economy, there is a slow rebalancing of fiscal and monetary policies taking place in the western advanced economies, which, ironically was initiated in Germany and advanced under cover of the economic response to Covid. It will be reinforced by the Biden administration and the government here will row along with this. And there will be efforts to rein in the Tech Titans that are in line with moves being made by this government.
Labour doesn’t have a story to tell about the future of Britain that will resonate with a majority of voters. Keir Starmer seeking to package himself as Citizen Clem won’t cut it. The party’s over.
Germans don’t agree with you the EU have a bette vaccine programme than the U.K.
https://www.newsbreak.com/news/2169772204263/we-envy-britain-germanys-biggest-newspaper-bild-praises-uks-incredible-vaccine-success-and-contrasts-boris-johnsons-optimistic-lockdown-exit-plans-with-merkels-doom-and-gloom
I – like John Crace in the Guardian – saw Johnson’s Covid update the other day and I saw a PM who sounded a little more measured and cautious in what he was saying. It was quite noticeable. By Johnson’s standards he was nearly chastened. This still did not stop him however from telling us that summer will be better and coming up with some sort of forecast.
How he could do that with so many variables at play is beyond me frankly – beyond belief.
And I think that this is the problem that Richard is discussing. Equilibrium depends on a lack of variables (or outside forces) in order to achieve that state and just focusing on a limited number of known variables (in the sense of Covid – the amount of vaccinations for example). In doing so it does the usual Neo-liberal trick of not understating the extent risks (or variables) at play and presents a falsely optimistic view (the sort of techniques used to get fools to part with their money the financial sector).
Some of the variables are below:
When one bears in mind (1) his past record of porkies, (2) the Tory party itself and the way it is putting immense pressure on Johnson to prematurely end the lock down and (3) we are a country that is basically weakened throughout by austerity (poorer services and lots of undernourished people) and (4) also racked by fake news about Covid, we have the ingredients for a perfect storm of variables that will end in the same consequences as we did before.
(5) Could be the assumption that some will revert to normal or break lock down rules before they should. (6) Could be yet more mutations. (7) Could be Johnson’s ‘boosterism’. (8) Could be the irrational fear of debt in the Treasury/Sunak. I bet there’s more.
So my view is that Richard is right. I would put it down in my own words to the innate grasping of over-simplification by people/politicians who are simply either out of their depth and/or in denial about just how much damage they have wrought in our society as well as the decades of inequality that has been allowed to build up.
So if you don’t get that then why do you bother to come here? If the world be too complex for you to contemplate, just stay away. Hmmmm? Please?
We may be an odd community who can handle complexity…..
Well, speaking for myself I do my best!
But I see over-simplification here at work and it un-does you every time – every time. We are a society obsessed with short cuts and managing on assumptions and fingers crossed behind out backs.
Am with you Richard – astounding that so many of your correspondents sound off in airey disregard of the many published analyses, including by Sage and Independent Sage, to show how to suppress the virus toward elimination.
If they can’t be bothered to educate themselves, maybe a mention of
NZ, Australia, Taiwan, S Korea, China, Vietnam etc etc would help, with deaths in the 10’s, 100’s , or low 1000’s. compared to our 130,000+. Their suppression or ‘elimination’ strategies have all worked – and their economies are more or less open, – there are no examples anywhere – of a successful ‘steady state living with’ the virus.
A very cogent tie in with the fantasy market ‘equilibria’ on climate change, Brexit/economy .
Maybe the causality is the other way – delusional thinking driving the poor theory. ‘I’ll pick or invent a theory which fits what I want to be the case’.
🙂
This particular blog has prompted a surprising amount of combative response in relation to Covid-19, when the facts are pretty straightforward. It isn’t really about whether eradication of the virus would be desirable, which few would deny, but whether it is achievable.
Covid is a very difficult virus to eradicate, because a good proportion of cases are asymptomatic and never detected but still cause onward transmission (that wasn’t true for the original SARS, which could be effectively eradicated). New Zealand has had cases popping up out of nowhere with no known contact, presumably from multiple cycles of asymptomatic transmission. And even at their incredibly low levels they had to have another lockdown last week. (To put that in context, because of our high starting point it would take almost a year to get the UK down to New Zealand levels under our current lockdown measures — no schools, no non-food shops, no face-to-face meetings).
Vaccines have been a totally extraordinary technological success story — genuinely as impressive as putting the first man on the moon — but as far as we can tell at the moment, however good they are at stopping severe disease all of them allow infections to circulate somewhat, asymptomatically. Any contribution of vaccines to the decline in overall cases in the UK isn’t yet measurable. It isn’t realistic to plan for total eradication, mostly because right now there isn’t a practical route there. There is though a legitimate discussion about where the break-even point might be when the restrictions pose a greater risk (for example to young children’s development) than the infections they prevent.
I don’t think SAGE is currently saying anything different. Not sure about “independent SAGE”, after all the raison d’etre of an alternative committee is to provide alternative views. I am certainly not defending a government which has failed us in so many respects recently, but agreeing to sign a large cheque for vaccines back in last July was Johnson’s one decision which has turned out right.
Slightly different topic, but I totally agree with your over-arching analysis that government working on the basis we are in an equilibrium situation is worryingly misguided (as also discussed in the comments to a previous blog).
Cases have reduced from nearly 70,000 a day in early January to 9000, and the vaccines help to suppress further – why just stop when we could get infection right down – as we did in July. ‘There is no route’ towards elimination is just your assertion. Your ‘lockdown for a year’ comes from no serious analysis I am aware of. Your assumption that infection can be stabilised at several thousand a day is not justified by any model of control through tracking and tracing plus, whereas several countries have kept control at near zero through track and trace , plus local very short, very local lockdowns of a few days. The whole point is to avoid your worry about ‘where the break-even point is’. You are doomed to be juggling infections, hospitalisations, restrictions – for ever. These countries have opened up – they are not juggling constantly with breakpoints. As of now we are just repeating the mistakes of March 2020, and September 2020 – and heading for tens of thousands more deaths (Sage and Independent Sage).
Sage members suggest cases are five times higher than reported still….and with asymptomatic cases that is likely
Yes, it has been quite punchy. I will tread carefully!
We must try to achieve some equilibrium – the problem is that they are all UNSTABLE equilibria (bar complete global elimination or “let it rip” herd immunity). Whatever strategy we pursue it will need continual tweaking – even NZ has to implement occasional local lockdowns in order to maintain its “almost zero” position.
So, I see two questions.
First, what (unstable) equilibrium are we trying to achieve? Second are the policies we pursue likely to achieve that aim.
The second question is an area of intense debate but is, ultimately, decided by the data. Vaccine effectiveness, classroom transmission etc. are imponderable but we will know soon enough from infection and hospitalization rates. What we want is a policy that helps people isolate if sick and can respond to data. The only “philosophical” issue here is whether there should be a presumption of caution. In my view, caution should prevail because “upside” is far more unstable than the “downside” (infection rates rise faster than they fall)……. but that is easy to say as I potter in my garden pruning apple trees – I don’t run a small hospitality business or have to home school my kids. I am hopeful that the vaccine plus some permanent changes in social interaction could see disease levels fall quite quickly but what I REALLY want is a policy that can change as the data change.
The first question is profoundly difficult. What is an acceptable level of casualties? Who gets to decide this level? How are those casualties distributed in society? What can the NHS cope with on a sustainable basis? It is a grim calculus and is all about values. My view is that anything other than a very low level is cruel, unfair and too unstable.
So, oddly enough, I am not too unhappy with Boris’s road map IF he reads it properly (that is a big IF because his track record is poor). I would have preferred a staggered return of schools and more emphasis on how flexible the next unlock dates need to be….. but the key issue is will he be able to face down the C(E)RG nutters if infections and hospitalization rates rise. At the moment he needs to get lucky with the vaccination programme….. and on that the jury is still out.
Yes, it is obvious that the government has done badly in its efforts to control the SARS-CoV-2 virus.
Is the analysis a bit black and white though? I know little, if not nothing!
“Normal” flu is caused by a virus, so is measles. We live with both. The annual flu vaccine often doesn’t quite hit the current mutations, and it does cause deaths in winter. Flu virus has not been eliminated.
Is the measles virus more stable? Perhaps it doesn’t mutate so much, because it does seem to be mainly controlled, at least with those people who accept the vaccine. Measles virus has not been eliminated.
Is our problem with SARS-CoV-2 virus really because it’s infectivity is high, it’s mortality is a little high, and perhaps it’s mutation rate is also high. From previous experience it will not be eliminated! Virus are not like parasites or bacteria.
I believe that elimination is probably impossible. If so it IS a question of learning to live with it – somehow.
Even if we have to live with it we can contain it vastly better than at present.
And opening up schools will send cases up again – for absolute certain
The reopening of schools will apply upwards pressure to the infection rates. On the other hand we are heading for warmer weather and that certainly had a beneficial effect last year. Also we should start to see the effects of the vaccine in the figures soon. I agree that its difficult to see much sign of that happening at the moment. If we don’t in the next month or so we really will be in trouble.
The rationale of the lockdown originally was to “flatten the curve”. I have not heard anyone say that recently. This effectively meant we were engaged in a policy of mitigation rather than elimination. The slogan was “protect the NHS”. I would say that is probably the best we can do. There is insufficient popular support for the type of year plus long ultra strict lockdown, together with the complete sealing of the borders, that we would need to achieve eradication of the virus.
We’ll see a gradual loosening of restrictions which may or may not lead to a third wave. No matter what the politicians say now there will be another lockdown later in the year if the NHS looks to be in danger of being under too much pressure. The prospect of being blamed for a failure in the NHS does scare them.
Another factor here is the uneven incidence of the disease, vaccination, and health and economic outcomes. I’ll just leave this here. https://www.bbc.co.uk/news/health-56162075 (This is already a factor in influenza/pneumonia deaths, by the way.)
The suggestion that the ability to participate freely in society (to visit venues, get a job, etc.) might be dependent on having some sort of official certification or badge – a “pass law”, if you will – would as things stand lead to a sort of vaccine apartheid which disproportionately affects people in more deprived economic groups and/or non-white ethnicities within the UK. Or indeed people with disabilities: it noticeable how vaccination rates were trailing for eligible people with learning disabilities or mental illnesses. https://opensafely.org/covid19-vaccine-uptake-reports/2021/02/09/opensafely-covid19-vaccine-uptake-report/
Are we ok with that?
And that is without considering the effects of people moving to and from other countries, which may provide a reservoir of mutating virus after we are all vaccinated in the UK while they are not. People coming back from holidays, or visiting relatives? Business visitors (some of whom are currently exempt even now from the hotel quarantine)?
This is where Brexit and Covid coincide….
Why are people here and elsewhere so reluctant to learn the obvious and clear lessons from NZ, Aus, Taiwan, S Korea, Vietnam, China etc?
Clive Parry points to the answer – what ‘equilibrium level’ of cases are we aiming for – zero – (as achieved by the above countries) or the ‘living with’ option of 4-10,000 per day? He accepts that the high level equilibrium is more difficult to maintain – (it has been achieved nowhere), and then throws in the towel by going with Johnson’s – 30,000 minimum deaths option.
Andrew’s point about unequal incidence and vax take-up could also threaten the aim of getting infection right down nationally, but with infection more or less eliminated, the ‘passport’ issue will be largely irrelevent. The international restrictions can be implemented as in the successful countries .
Norman Willcox – just says elimination is impossible – when countries with a billion and a half population have already done it.
Independent Sage’s definition of zero is ‘sustainable suppression’. Yes it involves continued Test, Trace, Isolate – and the odd local short lockdown. But most of the time the society and economy is more or less fully open. There will be cases popping up in ones, twos, tens etc. – but many weeks will be the odd one or two – or with zero.
Richard is dead right on this . I find it almost frightening that people are so defeatist, or callous about unecessary deaths, and just not prepared to accept what has already worked.
Thanks
Andrew Broadbent, Those countries that you mention have not eliminated the virus, but they have indeed controlled it, just as UK could and should have done.
For the world to control this virus all countries must succeed in close to this level of control.
Elimination has not been achieved for many, if not any, virus. I suppose some can just die out like any other “living” things. I don’t understand why you think that this virus can be eliminated, when pretty well none other has been. Elimination means none left anywhere. What is needed is determined, energetic, scientific, absolute control – that is the way to go. That does not allow throwing all the UK schools open at the same time before the necessary level of control and trace & testing has been achieved.
Small Pox virus – eliminated.
Polio virus – 99% eliminated and further efforts should lead to 100% elimination very soon.
Most – if not all – of the (very small number of) outbreaks of covid cases in places like New Zealand and Australia (leading to very short, isolated lock downs) are actually from breaches in quarantine of cases imported from overseas. They are almost without exception NOT started from local community transmissions.
The lesson there is about strictness in adherence to quarantine procedures, not that it is impossible to eliminate or reach the covid equivalent of “full employment”.
The problem with the UK getting to the same levels as New Zealand etc is that the UK left it too late to lock things down.
You can thank the Tory unspoken approach of trying to taking covid infections and deaths “on the chin”, i.e. the unpublicised Demonic Scummings / Tory policy of trying to achieve herd immunity by letting covid sweep through the population unchecked.
The callousness of that is bewildering, as are some of the responses in this blog thread completely ignoring and / or misrepresenting the circumstances of the minuscule outbreaks in other countries who did the right thing from the start. Really bewildering.