From HMG’s perspective, now that the UK has left the EU, the Covid-19 pandemic provided an opportunity to show the UK’s true genius, unshackled from an allegedly moribund Europe. What better opportunity to showcase the true and exceptional greatness of Great Britain?
The UK is world-leading (almost). According to the Global Health Security Index (GHSI), the UK is the second best-placed country in the world to fight a pandemic. It’s one of the wealthiest countries in the World, ranked in 5th place in terms of GDP. Britain has the NHS, regarded by many as the world’s best health system. It has some of the best universities and scientists in the world; first-class scientific advice is on tap. The country, unlike for example Italy, was hit fairly late by the virus and had plenty of time in February and early March to prepare.
Britain is also a sovereign island, which as New Zealand has shown, can add very much to enhanced protection. Unlike the EU which is crisscrossed by land borders, there are none in Britain. Hermetic sealing of the border is possible and was used to great effect in NZ.
In the UK there is, of course, Northern Ireland which shares a border with Ireland. A country ranked 23rd in the GHSI, 32nd in terms of GDP and with a very complex health system, a mix of public and private, which might find it difficult to respond well in a crisis. The Irish Border is of course totally open and NI could be overwhelmed. This would be regrettable but largely outsides HMG’s control. Blame for this singular failure could easily be placed on Ireland, or on the polarised politics which causes deadlock in NI.
In addition to all these advantages, by coincidence, HMG had only recently been elected with a landslide majority. This landslide majority should also ensure that there is a depth and breadth of talent available for cabinet positions. In the honeymoon period, tough and decisive measures could be taken. With no GE for 5 years, short-termism could be ditched and strategic choices made.
The superiority of the First Past the Post electoral system would also be demonstrated. Ireland which also had a recent GE under the single transferrable vote PR system and has yet form a new Government, and Germany with a lame-duck German Chancellor fighting to keep a coalition together, would surely fare much worse.
Whatever one’s views of PM Johnson and his special advisor D. Cummings, in terms of communicating they had been excellent throughout the Brexit Referendum and GE 2019. One could expect more of the same.
It was obvious to HMG that with the exception of Northern Ireland, the UK went into the Covid pandemic in a commanding position, further underlined by having completed a pandemic simulation in 2016. Confidence was high in March that the UK would cope brilliantly. The superiority of the UK response to that of Germany in particular, ranked in 14th place in the GHSI, with a decentralised health system and sharing a border with 9 separate countries was surely predestined? It was particularly glorious that this “win” over the Germans should be evident by the 75th anniversary of VE day.
Strategists in No. 10 must have been over the moon as a major boost in popularity from the adoring Brexit voting fraction public seemed assured.
Given that health is a devolved competence in the UK, the superiority of the English response in particular should dampen calls for an independent Scotland, an increasingly fractious Wales and a United Ireland.
The only country ranked higher in the GHSI, is the US. If it panned out that the US coped better than Britain, that would be understandable and indeed strategically advantageous, given that the UK is moving away from the EU’s orbit and towards that of the US.
All seemed set fair back in early-March. How did things actually pan out?
The Current UK Position
The official UK pandemic figures for deaths for example (standing at 34,546 at the time of writing) are widely disbelieved and the suspicion is that actual deaths are around twice that number. Until recently the official figure reported only deaths in hospital of people who had tested positive for Covid-19. Since the UK overtook Italy with the highest number of headline deaths in Europe, this figure has included some Covid deaths outside hospital and was spun by HMG as “all deaths”.
Fortunately, the UK has the Office for National Statistics (ONS) which is truly independent and professional and produces data to the highest international standards. The total number of registered deaths is released once per week (here) at 9:30 on Tuesday mornings in the form of an Excel spreadsheet. Fig. 1 shows excess deaths above a 10 yr average (2010-19) to the 1st May (week 18) at 49,126. With a 5 year average (2014-19) the figure is slightly higher at c.50k.
Though the data is of gold-standard quality, it is about two weeks out of date. It includes all registered deaths to 10 days before the publication date, but registration typical takes a number of days. Registration should be within 5 days of the actual death, but this limit is often breached.
The spikes and troughs on the mean, maximum and minimum graphs are artefacts caused by bank holidays. Notable is the drop around the Christmas period and the spike in January when registry offices reopen.
It is then possible to project the model forwards using daily hospital deaths and adjusting this to include deaths in other settings and adding the figures from Scotland and Northern Ireland. This produces a number of around 60k deaths.
A similar methodology is also used by Jamie Jenkins @statsjamie (a former statistician at the @ONS) who has estimated the number of 60.5k to the 11th May, as illustrated in Fig. 2. He uses the average of deaths from 2015-19 as a baseline. The lack of artefacts indicates that this data has been corrected to the actual date of death. The winter/summer trend is evident with deaths being higher in winter.
Chris Giles of the FT has also used a variant of this methodology and comes up with an estimate of 59,700 deaths as of the 11th May.
It can be said with high confidence that the excess number of UK deaths as of the 11th May was c.60,000. Both Jamie Jenkins and Chris Giles keep a running total and their estimates are 62,430 and 61,200 deaths respectively as of the 16th May. To be clear, excess deaths are those higher than ordinarily expected and likely attributable directly or indirectly to the pandemic.
How Does the UK Position Compare to Peer countries?
There is no question that many of the Asian countries have done very well. South Korea, Japan, Taiwan and Vietnam, for example, reacted swiftly and appropriately, keeping well ahead of the curve. So too have Australia and New Zealand. It is fairer, however, to compare the UK to European countries.
International comparisons are difficult, as testing and reporting regimes vary from country to country. Other governments are not above putting a gloss on their data. Fortunately just as the UK has the ONS, all European countries have an independent statistics office and other bodies free of political spin.
The Danish Statens Serum Institut has a project to collate European data on excess mortality and the Euromomo Group have produced an interactive mapping and data tool. This is produced for participating countries and regions. In Germany, only Berlin and Hesse are taking part. Very usefully however for the UK, England, NI, Scotland and Wales are all treated separately.
Mortality rate follows a Poisson rather than a Gaussian (Normal) distribution. (One of the classic historic examples following a Poisson distribution is the number of cavalrymen kicked to death by horses in the Prussian army.) The z-score is effectively the number of standard deviations the measurement is away from the expected value.
Fig. 4 from the Euromomo tool shows the z-scores for participating countries, from the peak of the pandemic, for weeks 15 (top left), 16 (top right), 17 (bottom left) and 18 (bottom right) – click on images to expand. In week 15 Spain, France, Italy, Belgium, the Netherlands and England all had extremely high excess. By week 18 England was the only country with extremely high excess. Sweden is rated at high excess and Scotland, Belgium the Netherlands and Italy moderate excess.
Fig. 4 Excess Deaths in Europe (participating countries and regions) wks15-18 Euromomo.
Euromomo also produces time-series graphs (Fig. 5) – I recommending exploring the data on the tool itself. It seems in terms of z-scores that England is easily the worst-performing country in Europe. At the height of the pandemic, the top five in terms of peak z-score were England 42.75 (Wk 15), Spain 34.41 (Wk 14), Belgium 29.91 (Wk 15), Italy 22.16 (Wk 14) and France 21.17 (Wk 14).
England is also the worst-performing country on these islands. The peak z-score was 19.71 for Wales (less than half that of England), 8.90 for NI, 7.03 for Scotland and 3.95 for Ireland all in week 15.
What is more frightening, however, is that the English z-score is still around 20 in the latest data – easily the worst in Europe. All other countries are below five. The next highest is Sweden at 4.8.
Something must have gone very badly wrong. In a fast-moving crisis, mistakes will naturally be made by all governments, but HMG seems to have failed on nearly all fronts.
What went Wrong?
Far from being the best-performing country in Europe, the UK is the worst. England, in particular, has been a disaster. With all the UK’s advantages going into the pandemic clearly this has been a catastrophic failure. The response of the BMJ is worth reading.
A full-blown enquiry is needed however a few mistakes seem obvious.
- February and the first half of March was a golden opportunity for the UK to prepare, particularly in the building up of Personal Protective Equipment (PPE) and a fit for purpose Test Trace and Isolate (TTI) System. This time was largely squandered.
- Rather than keeping ahead of the exponential curve, the UK locked down very late in comparison to most European countries, who looked on in horror as major events such as the Cheltenham Festival were allowed to go ahead.
- Whereas it is true that the NHS has coped brilliantly, this has been at the expense of in particular the Care Home sector, where lack of testing before discharge from hospital, lack of PPE, training and resources has produced an unfolding tragedy, and has taken a terrible toll of lives of, in particular, BAME NHS staff.
- The Elective Dictatorship nature of the British constitution may work when competent Prime Ministers, Cabinet and advisors are in charge. This seems far from the case and both Germany and Ireland for example have handled the crisis far more competently.
- Far from having a cabinet of superstars, we seem to have one filled with sycophants and incompetents; probably the least talented cabinet in living memory.
- The”Scientific Advice” coming from SAGE seemed so far from international best practice that it was suspected, rightly, as having been politically constrained all along. So much so, in fact, that the former and highly respected Chief Scientific Advisor Sir David King felt it necessary to set up his own independent SAGE committee.
- The abandonment of TTI and the decision to go for “herd immunity” in mid-March is so totally at odds with WHO best practice it needs to be singled out as a catastrophic error.
- Communication has been a disaster. Industrial-scale dishonesty may be par for the course now but the sheer ineptitude of the “Stay Alert” messaging has been breathtaking. It was described as An Unholy Shambles by Ian Dunt.
England is relaxing lockdown at a time the z-score is the highest in Europe without a fit for purpose TTI system in place. The potential for things to go catastrophically wrong is high, and even more so in a potential 2nd wave as summer winds down and people spend more time indoors. If the z-score of 20 is correct, this is only marginally lower than France’s as the height of the pandemic.
Few countries have responded worse than the UK. The major exception has been the US, which under Trump’s leadership has been truly disastrous. As Fintan O’Toole has written, the US is to be pitied rather than envied. This sadly gives some limited cover to HMG. The superiority of the UK’s Covid-19 response to that of the US is evident. Doing less badly than the US may be perceived as a success by many Brexit fans.
In the background is the fact that the Brexit talks are likely to end in failure. I agree with Tom Hayes that a “No-Deal” outcome seems inevitable as argued powerfully on his BEERG blog. This has the potential of tipping the UK from a post-Corona recession to a full-blown depression.
On a more positive note Scotland, Wales and Northern Ireland seem to be doing a lot better. For Scotland, this comes as no surprise, but seeing the DUP having a more sensible position than the British Government is refreshingly unexpected. The NI approach is in fact not far off that of Ireland in some respects but it has been comparatively behind on testing (eg, from 5-11 May, ROI tested 44,027, NI: 7,642), and it seems that NI will suffer least in the UK from the pandemic.
It is positive also that it now seems the Northern Ireland Protocol may be adhered to. The realisation that any US trade deal would be blocked by Congress seems to have finally dawned, likewise a clear idea that the EU was likely to suspend talks without evidence of good faith in terms of preparations to put what was agreed into effect.